With COVID-19 and its mutations still present and cold and flu season in full swing, nurses across the country continue to be pushed to their limits.
In January, nurses from two private hospitals in New York went on strike. Personnel level was an important topic of the meeting.
At the end of the strike, Montefiore Medical Center released a statement saying the new contract includes wage increases and more than 170 new nursing positions. Mount Sinai Hospital has not released details, but New York State Nurses Association President Nancy Hagans says the deal includes “wall-to-wall secure staffing ratios,” according to news station NY1. No information was provided on the recruitment of new nurses.
The federal government projects that more than 203,000 new registered nurse (RN) positions will be created each year between 2021 and 2031, according to the American Association of Colleges and Universities (AACN). But a November 2022 article in U.S. News and World Report, “The State of the Nation’s Nursing Shortage,” states that “Factors like staff burnout, an aging population and a lack of training, states across the country are facing a familiar and common problem: the shortage nurses.”
Nursing schools strive not only to educate future nurses, but also to bring more diversity to the profession.
“There are structural, social and systemic determinants that prevent greater diversity in the nursing workforce,” says Dr. Shannon B. Smith, Associate Professor and Chair of the Department of Nursing, Claflin University. “These barriers lead to inadequate access to quality education for our minority and disadvantaged students.”
In 2022, Claflin, an HBCU institution in Orangeburg, South Carolina, was the winner of the AACN Diversity, Inclusion and Sustainability in Nursing Education Lectureship Award. Claflin does not have a traditional four-year Bachelor of Science in Nursing (BSN) degree. Rather, it is known for its RN–BSN program, in which RNs with associate degrees (ADNs) can earn a bachelor’s degree. Claflin also has a master’s program (online except for the clinical portion) and is the only HBCU in South Carolina with a BSN or MSN program.
“RN to BSN enrollment is declining across the country [since the onset of the pandemic]and Claflin experienced that, too,” says Smith. “Some of it is that these nurses are working so much overtime, they’re so stressed that school becomes a secondary thought.”
Smith says Claflin nursing faculty went above and beyond to offer psychosocial support to students. This includes making several phone calls to offer encouragement or simply to hear what these working nurses have experienced personally and professionally. She credits the faculty for creating an environment where students feel safe to discuss their issues while continuing their education with sustainable quality.
During the pandemic, faculty from Dominican University, a private Catholic institution near Chicago, and other AACN honorees held two virtual symposia on the lack of diversity in healthcare, as well as health disparities and inequities that existed before COVID-19 and how the pandemic has made them more apparent. Conversations are underway on campus about how to better meet the needs of students, faculty and staff using a holistic approach, says Dr. Tamara Bland, associate professor and interim dean of the Borra College of Health Sciences and the Elizabeth T. MacNeil School of Nursing.
“We’re giving students more resources to meet different needs,” Bland says. “During COVID, we had to be vulnerable about our own burnout as a faculty. This shows students our authentic selves, so they know it’s okay to be vulnerable.”
Diversifying the Nursing Workforce
“For every one we graduate, there’s another provider that can improve patient outcomes for different populations,” Smith says, adding that the MSN programs — one for family nurses and one for nursing leadership — are critical to increasing the diversity of the healthcare workforce in South Carolina.
Dominican University is a Hispanic-serving institution. Sponsored a cohort of faculty to participate in the ESCALA program to close the educational access and achievement gap for Latinx students. ESCALA works with HSI to close gaps in access and completion.
“We have a lot of opportunities here on campus to showcase and talk about diversity in private and public spaces,” says Bland. “It’s incredible that minority students have a safe space on campus to talk about issues that affect them — whether it’s political, cultural, or school issues.”
Bland also works with the admissions department on targeted recruitment in specific communities in the Chicago area to reach minority groups. Efforts are underway to diversify the faculty to reflect the student population the university seeks to enroll. Although Dominican does not have graduate programs, students who express an interest in becoming nurse educators are employed as lecturers after graduation and are encouraged to participate in other activities, setting them on the path. She also encourages the sisters of color she meets at various events and offers to mentor individuals considering entering academia.
Some kindergartens have implemented outreach programs for middle schools. Claflin begins its program in the summer of 2023. Smith says the program will allow these individuals to be better prepared for the rigors of nursing education. The Ohio State University College of Nursing has established a free program for high school students (grades 9-12), the Summer Institute for Future Nurses. Since the pandemic, it has evolved into a hybrid model that has allowed individuals from across the country to participate online.
“Students engage online, and there is also a day where they can come to campus and participate in tours of our simulation lab,” says Dr. Angela D. Alston, Assistant Professor, Head of the Faculty’s Specialized Nurse Practitioner Unit. diversity at The Ohio State University College of Nursing. “Students can’t be what they can’t see, so this program is designed to give them an opportunity to hear from individuals who are in nursing. He participates in didactic lectures. They listen to panel discussions by educators or current students and have the opportunity to ask them questions. Then they also have the opportunity to get some hands-on practical skills that they can practice to get a feel for what it’s like to be a nurse.”
Alston conducts implicit bias training for all nursing faculty and staff at the college. It provides strategies that individuals can use in their classrooms. The college is introducing virtual reality for students to create scenarios where they can feel closer to given situations in the learning environment.
National Nurses United (NNU), a national union of approximately 225,000 nurses, maintains that there is no shortage of nurses; rather, there is a staffing crisis with nurses unwilling to work in the conditions employers have created, says Michelle Mahon, NNU’s assistant director of nursing practice. He says employers need to create conditions that encourage recruitment and retention.
Mahon offers a different perspective on how to diversify the nursing profession and increase health equity: strengthen ADN programs. “Focusing on associate degree programs at community colleges and public universities really helps address medically underserved areas and populations,” Mahon says. “ADNs can be ready for entry-level nursing positions within two years.”
Towards the future
The Ohio State College of Nursing recently established a Doctorate in Nursing Education (DNE) program with the goal of creating more nursing faculty, particularly individuals from underrepresented populations. It is designed to prepare nurses who are interested in teaching in either a higher education or clinical setting.
“It is a unique online program that is specifically designed to prepare nursing leaders who want to be educators,” says Alston. This DNE program began this semester with 21 students enrolled in its inaugural cohort.
AACN also praised Ohio State, noting that the College of Nursing continues to demonstrate a commitment to recruiting, developing and retaining faculty, staff and students from underrepresented groups. The College of Health Sciences has started to publish demographic statistics on its website.
“This strategy does not in itself increase the number of underrepresented individuals, but it certainly highlights the progress our school has made and the commitment to continuing efforts that will help us better reflect the community in which we live and serve,” she says. Alston.
Smith says most RN-BSN students at Claflin return to school because they are eager to move into leadership positions. Those who want to continue to provide care at the bedside are looking to expand their roles and improve nursing processes in the hospital setting. Graduate students who study as nurses seek to be involved in population health, and those who complete a master’s degree in nursing leadership wish to move into administrative positions.
Dominican University has also developed programs designed to create more nursing faculty. Bland says there are faculty mentors within the Borra College of Health Sciences and School of Nursing who guide faculty who are entering campus for the first time. The university also has an extensive registration process.
Mahon says future nursing schools should educate students about what collective action means to the profession — that nurses should be informed about the industrial, for-profit nature of the health care industry before they leave nursing school and learn how to take collective action to advocate for their best interests hobbies.
“Our work environment and the conditions in which we practice nursing are just poorly connected to the industrial nature of health care in the United States,” says Mahon. “She has to stand up for herself and for the security of the registered nurse position.”