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One Pathway to Health Equity: Increasing Racial and Ethnic Diversity in Nursing Education

Partnering with the Foundation of the National Student Nurses' Association to increase nursing scholarships for Black students and other traditionally underrepresented groups
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The Johnson & Johnson Our Race to Health Equity platform, a $100 million commitment over the next five years, aspires to take on the inequities rooted in systemic racism that threaten health in communities of color across the United States. A key component of the platform focuses on addressing the lack of diversity in healthcare professions such as nursing—to better connect clinical and medical care with social and cultural needs.

Over 38% of the U.S. population is made up of individuals from ethnic or racial minority groups, however, only 19% of registered nurses (RNs) come from those same groups. That's almost a two to one discrepancy in representation which is growing each year—on top of a shortage of nurses in the U.S. overall.

Since its founding in 1969, the Foundation of the National Student Nurses' Association (FNSNA) has been working to help support and fund the education of deserving student nurses. In 2020, the Johnson & Johnson Foundation partnered with the FNSNA to increase the number of nursing scholarships for students who are Black or from other communities of color.

I sat down with Dr. Diane Mancino, Executive Director of the FNSNA, and Kenya Williams, NSNA Deputy Executive Director and past president of the FNSNA, to discuss the urgency and importance of this effort.

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Q: Why is it important to increase diversity in student nursing programs?

Today the U.S. has over 350 languages that are spoken. This means that over 67 million people are speaking a language other than English in the home. The demographic shifts occurring in the U.S. can and should be viewed as an opportunity for improving the capabilities of all nurses to provide care. In many instances, individuals are unaware of how their culture influences their attitudes and behavior.

Increasing inclusivity and the need for cultural awareness in patient populations has had an impact on nursing. Nursing schools today are more likely to provide instruction in the delivery of culturally competent care. Additionally, standards for delivering culturally competent care have, to some degree, been established in healthcare organizations. For instance, the Joint Commission on the Accreditation of Healthcare Organizations has established standards that address culturally competent care for patients based on the realization that patients' cultural and language differences can compromise patient safety and the ability of healthcare organizations to deliver effective and efficient care.

It is no longer acceptable to simply talk about the concept of racial/ethnic diversity as an essential component of healthcare delivery. Success in implementing diversity in nursing practice requires leadership that facilitates inclusion as fundamental to providing high quality nursing care. One major step in achieving this reality is by continuously priming the pipeline with diverse nursing students.

Q. What changes have happened in nursing education over the years/decades?

Nursing is one of the few health professions with multiple ways to enter practice and sit for the state board licensure examination. Entry into the nursing profession may be with a hospital Diploma, an Associate Degree in Nursing (ADN), a Bachelor of Science in Nursing (BSN), or direct-entry Master of Science in Nursing (MSN).

The history of nursing education is rich and dynamic. In 1873 three nursing education programs were established in New York, Connecticut and Massachusetts hospitals. By the mid-1950s, ADN education was established in community colleges, replacing the hospital diploma as the predominate entry level for registered nurses.

Today, BSN graduates have outpaced ADN graduates and there is an expectation that diploma and ADN graduates will advance academically to achieve a bachelor’s or higher degree in nursing. In New York state, associate degree and diploma graduates are required to achieve a BSN within 10 years of graduation. The movement of academic advancement is based on evidence that higher quality is achieved with higher education.

Q. How is the Foundation of the National Student Nurses Association (FNSNA) and the NSNA helping diverse student nurses and how has their role evolved over the years/decades?

Increasing diversity in the profession has been a long-term goal of the National Student Nurses’ Association (NSNA) and the FNSNA. In 1965, NSNA established the Breakthrough to Nursing® (BTN) project to increase the number and diversity of students choosing nursing as a career.

The project aims to promote career opportunities in nursing, with a focus on substantially increasing the number of students from groups that traditionally have been underrepresented in American nursing; and to encourage the nursing education system to be more responsive to the needs of these students. Its effectiveness seems due, in part, to the peer relationship that can be established between nursing students and minority group elementary, middle, and high school students. BTN Scholarships were the first scholarships to be awarded by the FNSNA in 1974.

This long tradition of supporting scholarship funds to increase the number of underrepresented nurses in the profession can now make an even greater impact through the generous support of the Johnson & Johnson Our Race to Health Equity Diversity Nursing Scholarships. These scholarships will truly make a difference in the lives of Black and other students of color. A nursing education would not be possible for many qualified nursing students without this support.

The funding comes at a critical time when many students are overwhelmed by job loss, illness, family support, and debt from student loans. The COVID-19 pandemic has impacted nursing students, especially ethnic minority students, many of whom are struggling to manage resources to pay for tuition and books. More support helps these students stay in school, complete their nursing education, and enter the workforce with less student-loan debt. All of this promotes better nursing care for ethnic minority patients provided by those whom they are more likely to identify with and trust. Ultimately, the goal is to reduce health disparities through education, access to high quality care, and economic equity.

Q. How can people help if they want to get involved in supporting the Foundation's mission?

Although many things have changed in the past year, FNSNA scholarship funds remain strong and are available to qualified nursing students. We welcome the support of individuals, corporations, and foundations that find congruency with our mission, vision, and values. The hope and joy that funding brings to students is best described by a past FNSNA scholar:

“Receiving this scholarship has opened several doors for me. As I progress through nursing school the amount of financial aid decreases which means the amount of loans increases. This scholarship will help take the burden off my shoulders and especially my mother's. She a single mother and constantly worries about whether I can afford my school expenses. This scholarship has not only relieved my burden, but hers as well. I can now be at ease knowing that this scholarship will help pay my tuition.” - Natisha Simon, Promise of Nursing for New Jersey Scholar

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Nurses change the world, and your support can change the life of a nursing student. You can make donations to FNSNA by clicking here. To learn more, visit the FNSNA website.