NAHN Position Paper: Nursing Workforce Diversity


Issue: By the year 2030, Hispanics will comprise 20% of the population but only 5% of the healthcare workforce (Vespa & Medina, 2018).

Policy goal: Increase Hispanic nurses to the level of the national population from 5 to 20%.
Paralleling the Hispanic patient population with bicultural, bilingual providers can increase patient compliance and positive health outcomes such as prevention of chronic illness and less expenditure on emergency room visits.

Barriers: Socioeconomic factors lead to less Hispanic students and faculty through attrition and lack of retention. There is a lack of an efficient workforce pipeline while ready-to-work DACA students are not allowed to sit for the NCLEX license examination in some States. Furthermore, currently employed DACA healthcare workers remain in limbo.

         We believe the following recommendations can assist in achieving parity between the percent of Hispanics in the United States’ population and the nursing workforce.

NAHN Recommendations

1. Implement the DACA pathway to citizenship at the Federal level to stop the limbo. At the State level, NAHN supports the National Council of Boards of Nursing to allow licensing regardless of immigration status to benefit to the State’s economy. Currently, some States deny NCLEX license testing to DACA students even in the face of current and projected nursing workforce deficits, such as Georgia (U.S. Department of Health and Human Services [HHS], 2018).

2. Expand financial assistance through loan repayment forgiveness programs, low interest loans and stipends. Socioeconomic factors lead to attrition. Students leave school or do not start at all when they take care of family, such as in a single-parent household where they cannot afford daycare or caregivers for elder relatives. Students may have to work too many hours at multiple jobs and not do well in school when faced with the choice to pay their bills or do homework. Financial assistance can help students finish their program and move into the workforce (Feeg & Mancino, 2016).

a. We support HealthCare organizations to provide loan repayment as incentives to increase educational level.
b. We support Title VIII and expanded Federal aid through Congress to increase financial program funding such as HRSA grants and PELL grants.
c. We support the Veterans Administration to provide more information regarding Nursing Careers and resources through the GI Bill benefit.

3. Facilitate Curriculum Support

a. Federal funds should be provided to high schools with high-quality vocational healthcare courses. College-level, pre-requisite courses can be provided for academically qualified students to constructively begin the educational pipeline into the field of nursing and, thereby, reduce the burden of student college debt.
b. Community colleges should be supported to provide state-of-the-art, accredited ADN programs as a viable entry into nursing. Currently, 20 States offer free community college tuition. We support free or discounted tuition for accredited nursing programs from community colleges so that there will be less student loan debt default.
c. There is a national crisis regarding the large number of nursing faculty retiring compounded by less nurses going into education. We support increased Federal funding to help nurses transition into teaching. We support schools of nursing implementing graduate programs to educate the next generation of nurses.
d. It is necessary to have Federal oversight for predatory Online Educational programs that promise nursing degrees with non-accredited nursing programs and without validated clinical experiences.

4. Encourage Mentorship

a. Federal funds should be considered for professional nursing associations to supply free memberships and scholarships to students to provide mentoring opportunities.

5. Ensure a streamlined process for international nurses with nursing degrees from other countries to sit for NCLEX examinations.

 a. CGFNS, the credentials certifying organization for foreign graduates, does not uniformly recognize secondary programs of nursing in U.S. territories and other countries. Applicants may have English as a second language and are not versed in maneuvering through the system of red-tape and are thwarted. States have different rules and regulations which pose a block to nurses from U.S. territories and foreign countries to become licensed. We support uniformity of regulations among States and within the credentialing organization to streamline the process for experienced and qualified nurses to licensure.

References 
Feeg, V., & Mancino, D. (2014). Nursing Student Loan Debt: A Secondary Analysis of the National Student Nurses’ Association Annual Survey of New Graduates. Nursing Economics,32(5), 231-239. Retrieved January 30, 2019, from https://www.nursingeconomics.net/ce/2016/article3205231239.pdf. 

U.S. Department of Health and Human Services, Health Resources and Services Administration. (2018). The U.S. Health Workforce Chartbook. Rockville, MD: U.S. Department of Health and Human Services. Retrieved January 30, 2019, from https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/hrsa-us-health-workforce-chartbook-part-1-clinicians.pdf. 

Vespa, J., Armstrong, D., & Medina, L. (2018). Demographic Turning Points for the United States: Population Projections for 2020 to 2060. Washington, D.C.: U.S. Census Bureau. Retrieved January 30, 2019, from https://www.census.gov/content/dam/Census/library/publications/2018/demo/P25_1144.pdf