NurseWeek Coming to Our Census: Nurses join effort to make this year’s count more accurate

Although the orange background and black text of the Census 2000 questionnaire bring to mind Halloween, and the official census day coincides with April Fools’ Day, the decennial count of the nation’s population is anything but a joke.

The 2.7 percent undercount of the California population from the 1990 census cost the state $2.2 billion in federal funds over the decade—90 percent of which was related to healthcare programs. To make sure that doesn’t happen again, officials are trying to get more people, including nurses and other health professionals, involved in spreading the word about the importance of participating in the census.

The Constitution requires the U.S. Census Bureau to count every person in the country every 10 years. This will be the 22nd census in the nation’s history. Information gathered is used to determine appropriate allocation of funds and services, including those for health care, roads, and schools.

"This is our only hope: having trusted members of the community—respected people—telling people that it’s safe to participate and urging them to do so," said Linda Gage, chief of the demographic research unit for California and the governor’s liaison for Census 2000.

Crucial for health care

California was the most financially penalized state in the nation, with an estimated 837,557 residents missed in the 1990 head count. Unless the response rate improves, Gage estimates California could lose another $3 billion in federal revenue over the next decade. That loss could mean either increased state taxes or decreased services, she said.

Historically, nurses have not been involved in encouraging residents to participate in the census, said Susan Brank, assistant executive officer for the California Board of Registered Nursing. "But in this case, since it’s going to translate directly to increased healthcare funding, I think it’s a good idea," she said.

"It’s not a political issue; it’s not a radical issue. It’s not even controversial," she said. "It’s a factual situation that translates directly into whether California is going to get the money it is entitled to to provide health care."

Unless nurses sign up as official enumerators, they won’t be involved with the actual counting. Rather, their role would be to "help assure their clients of the safety and confidentiality of the census," Brank said. "Perhaps clinics would agree to have handouts related to the census."

Everyone needs to be counted, regardless of their living situation or immigration status, stressed Jay Greenwood, a consultant to Census 2000 in California. "As long as you’re breathing, you’re supposed to be counted."

But many people fear that answers given on the census will be divulged to other federal agencies, such as the IRS or the INS, Greenwood admitted. So part of the awareness campaign needs to focus on convincing people that their answers will remain confidential, he said.

If the issue comes up for nurses, they should let their clients know that "anyone who breaks any aspect of confidentiality could be imprisoned up to five years or fined up to $5,000," Brank said.

Public and community health nurses probably will be in the best position to spread the word about the importance of the census because they’re most likely to work with the traditionally undercounted—migrant workers, the homeless, minorities, and young people, Brank said.

Nurses’ contributions to increasing public awareness of the census are similar to the role they play in encouraging eligible patients and their families to sign up for children’s health insurance benefits, said Deborah Bayer, RN, a member of the board of directors for the California Nurses Association and a PICU nurse at Children’s Hospital Oakland. "It’s in the nurse’s interest and the patient’s interest to get the count right," she said.