Achieving Diversity and Inclusion in Nursing Requires a Closer Look at the Profession’s Structure

October 23, 2020 by Rebecca Collins MS, RN, OCN®, CHPN, NE-BC, CENP

Does lack of inclusion in areas that are important to us affect how we see ourselves overall? Can someone amplify their voice without being represented in an authority position? Should leadership reflect the population that it’s leading? More and more medical organizations are publishing formal and informal position statements on diversity and inclusion (https://www.ons.org/ons-condemns-racism), which is a great start, but the next logical step is bringing those beliefs and concepts to our institutions and communities. Here are some of the issues and the ways that any nurse can take action.

Inclusion in the Nursing Workforce

America’s population is comprised of (https://www.census.gov/newsroom/press-releases/2015/cb15-tps16.html) roughly 38% minority citizens, but nurses from minority backgrounds represent (https://www.aacnnursing.org/news-information/fact-sheets/enhancing-diversity) only 19.2% of RNs, leaving 80.8% of the nursing workforce Caucasian. Other inconstancies include gender and identity: The United States’ population (https://www.statista.com/statistics/737923/us-population-by-gender/) is 51% male, but the nursing workforce (https://nurse.org/articles/Male-Nurses-And-The-Profession/#:~:text=According%20to%20the%20U.S.%20Bureau,gender%20equality%20in%20all%20professions.) is 12% male. About 4.5% of the adult population identifies as (https://news.gallup.com/poll/234863/estimate-lgbt-population-rises.aspx) lesbian, gay, bisexual, transgender, or queer (LGBTQ), but most of the education and resources regarding LGBTQ individuals focus on caring for the patient (https://voice.ons.org/news-and-views/lgbtq-patients-with-cancer) rather than increasing representation in the nursing workforce. Currently, the nursing profession doesn’t match the composition of America’s population. 

Action: A nursing workforce that aligns with patient populations allows for better progress into health equity and health access because diverse populations feel seen and understood by someone they can identify with. Nursing organizations and educators can help bridge gaps in diversity.

Grants, recruitment, and funding support institutions’ access to minority communities (https://nursejournal.org/articles/financial-aid-minority-students/). Educational leaders can reach out to underrepresented groups and promote careers in nursing. Minority Nurse is an online forum with more information on diverse nursing associations (https://minoritynurse.com/nursing-associations-in-the-us/) in the United States. Increasing diversity in the nursing profession is the first step to increasing diversity in board and leadership positions.

Inclusion in Hospital Settings

Nursing is the largest healthcare profession (https://www.aacnnursing.org/news-Information/fact-sheets/nursing-fact-sheet) in the United States. However, fewer than 10% (https://campaignforaction.org/resource/percentage-hospital-boards-rn-members/) of the nation’s hospital boards have nurses, and board representation has never matched the 58% of RNs (https://www.aacnnursing.org/news-Information/fact-sheets/nursing-fact-sheet) who work in hospital settings. Even more disturbing is that the percentage has been decreasing (https://campaignforaction.org/resource/percentage-hospital-boards-rn-members/) since 2011.

Action: Look at the demographics of board members and advocate for increased input for decision making in hospital settings, post-acute settings, community outreach programs, pharmacologic companies. RNs can diversify board rooms and bring expertise in quality and safety in patient care.

The Nurses on Boards Coalition (https://www.nursesonboardscoalition.org/resources/for-nurses/) (NOBC) links nurses to resources and opportunities across the United States. NOBC’s goal is to guide 10,000 nurses to fill board seats in 2020, which will amplify nurses’ voices to improve the health of communities throughout the nation.

Inclusion in Nursing Organizations

Among Amongprofessional nurses, 55% have a BSN, 17.1% have a master’s degree, 1.9% hold a doctoral degree, and 40% have certifications (https://www.oncc.org/certifications). Nursing organization board members strategize the future of nursing and make current policies for our profession. By including input from the populations they serve, boards will ensure that all perspectives are considered as they set strategies.

Action: A BSN is considered (https://www.aacnnursing.org/news-information/fact-sheets/impact-of-education) a degree that prepares nurses to provide education on leadership skills. Review the composition of the national boards for nursing societies and see how nurses with BSNs are represented compared to those with advanced degrees.

Institutionally, we need to look at how we promote leadership development at all levels. Leadership opportunities must be open to all nurses without limitations based on terminal degree. When certification is a requirement for board involvement, the institution must provide options for nurses to afford the cost of certification and study materials. Here’s what else nurses need to know (http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No2-May-2016/Articles-Previous-Topics/Serving-on-Organizational-Boards.html) about joining organizational boards.

Increasing diversity in nursing will ensure that all colleagues and patients, no matter their gender, identity, race, or socioeconomic status, are cared for and understood. This makes our profession so much stronger. If we don’t apply the concepts institutionally to improve diversity at all levels of health care, position statements are nothing more than words on paper. We need to advocate for change and put those words into action in our institutions and communities.  


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