Neighborhood Watch
Nurse recruiters and communities struck by the shortage find potential nurses in their own back yards

By Steve McLinden
December 3, 2003

As some nurse recruiters scour the world to fill chronically empty hospital jobs, others are looking to another place for help: their own city's urban neighborhoods.

American minorities, still largely underrepresented as caregivers in hospitals, may be the key to the industry's crippling labor shortage, say organizers of new programs that encourage inner-city nurse training.

One such group, the Valley Initiative for Development and Advancement, has even piqued the interest of the U.S. Department of Labor as a possible national model with its groundbreaking program in the heavily Hispanic Rio Grande Valley area of South Texas.

VIDA launched the Rio Grande Valley Allied Health Training Alliance early last year as a pilot program for 40 students.

"In a year and a half, we placed 180 [nurses] through it and it looks like we will place a total of about 400 by the end of 2004," said Dominique Halaby, VIDA's executive director. Most graduate as RNs and take positions in area hospitals, helping fill bilingual job requirements while offering culturally sensitive care.

Using seed money from the city of McAllen, the Weslaco-based organization teamed with the area's workforce board and several schools, hospitals and charitable organizations to form the alliance. Its main focus is to help college-age Hispanics overcome such daunting obstacles as tuition and book costs, but also some less tangible roadblocks such as child care and transportation needs.

In early September, the labor department flew Halaby to Washington for a briefing on the program and, two weeks later, department representatives traveled to the Valley, part of a poverty-stricken area of 1.1 million that includes McAllen, Edinburg, Mission, Browns-ville and Harlingen.

"We're here to see how this collaboration works and determine if it can be a model for similar opportunities in other parts of the country," said Joe Juarez, regional administrator for the labor department's Region 4, as he toured the area Sept. 15.

"It has the three key ingredients we feel this type of program needs to succeed: employer involvement, community involvement and the participation of educational institutions," he said. "How many times do we hear that the education community is too slow to react, and that there are too many barriers to certification? Well, they are working out those issues here."

Participating students who have completed at least one semester of college are interviewed by VIDA counselors for the program. When they are accepted, counselors will help students outline a path to a nursing degree at one of three area colleges: South Texas Community College, Texas State Technical College and the University of Texas at Brownsville.

As they begin their studies, students will be placed in a health-related job at one of the many hospitals participating in the program, making at least $7 per hour for a maximum 10 to 20 hours per week. Each participant has a case manager/facilitator to help students overcome behaviors or problems that might impede their progress, Halaby said.

All 14 Valley-area hospitals have opted to participate. Brownsville's Valley Regional Medical Center has sent recruiting teams as far away as England, South Africa and the Philippines in search of nurse recruits, according to Charles Sexton, chief executive officer for the hospital.

"We were spending a lot of money all over the world and the results weren't that great," Sexton said. "But as we looked around this area and saw the unemployment rate was high but education levels low, we realized that there are people in our own community who want to be productive individuals who can fill these jobs."

Minorities comprise about 30 percent of the total U.S. population, but represent just 12 percent of the nursing workforce, according to the American Nurses Association.

Sexton said there's no reason that collaborative efforts such as VIDA can't work nationwide to help bridge that gap, "as long as they have an elevated level of energy and focus."

McAllen city officials committed $350,000 to the VIDA program in a partnership with the Houston Endowment and Texas Workforce Commission. The Levi Strauss Foundation and other organizations also have stepped forward.

Other approaches

A few thousand miles away to the northeast in Cleveland, Hispanics comprise the city's fastest-growing population segment-a demographic that has helped spur a new nursing-education program for high school students and older adults called Creando Posibilidades, or Creating Possibilities.

Launched in July by social service provider El Barrio, Creando Posibilidades is based in part on a Phoenix program at Maryvale High School Student Nursing Academy.

The Cleveland program is designed to increase the number of bilingual health care workers locally and help Hispanic youth stay in school while ultimately preparing for high-demand nursing jobs. Its main offshoot, the nursing academy at Lincoln-West High School in inner-city Cleveland, is set to open in the fall of 2004.

There, students will take advanced courses in science, math, medical terminology, time management, communications and life skills, and attend a series of counseling workshops and lectures, plus have the opportunity to shadow local nurses. El Barrio and its partners also are working with elementary and middle schools to provide additional early exposure to health care education, said Jaren Wilson, project coordinator for Creando Posibilidades.

"At the end of their junior year in high school, they can start taking class work to be a [licensed practical nurse]," Wilson said. "It's an immensely upwardly mobile and innovative program that can help solve so many problems. By the time these students graduate, many will have earned their LPN and be making about $13 per hour."

For adults, Creando Posibilidades will offer the Patient Care Nursing Assistant training program to bilingual people older than 18 with a high school degree or equivalency. Its students will enroll in an intensive five-week training program and upon completion, be offered patient care nursing assistants' jobs at the Cleveland Clinic, receiving full health insurance and tuition reimbursement.

The projects are funded by a combined $1.3 million from the local Cleveland Clinic Foundation, area hospitals and the nation's largest health care philanthropic organization, the Robert Wood Johnson Foundation.

Hurdles to clear

Minorities face more barriers to nursing careers than a simple lack of resources, a study by the Center for the Health Professions at the University of California, San Francisco, found. These include poor high school career counseling and career path tracking, gaps between professional and culturally familiar worlds and lack of information about nursing and nursing education, according to the 2001 report, "Diversifying the Nursing Workforce: A California Imperative."

Those findings, plus the ever-growing nurse shortage, imply a need for major systemic changes in nursing curriculums, said Ed O'Neil, a professor of medicine and director of the Center for the Health Professions and principal report researcher. Needed are more programs that foster partnerships between education, employers and health care, more minority faculty role models and more recruitment funding, he said.

O'Neil said there is confusion about the multiple entry levels of nursing that will lead to an RN designation. A career pathway that accepts a broader set of practices building to an RN designation is essential to attract more minorities, he said. Hospitals, for example, could expand their volunteer programs to expose people to options in health care, and area colleges, in turn, could apply that credit to nurse training programs, O'Neil said.

Although making up more than 30 percent of California's population, Hispanics constitute only 4 percent of practicing nurses in the state, the study said. African Americans also are underrepresented, making up about 7 percent of the state's population yet only 4 percent of its nurses.

"We know we've got a yawning nurse shortage looking at us over the next 20 years, yet these two large groups in particular are underrepresented," O'Neil said. "We need to learn more about their values and goals, and structure education and employment systems to better meet those needs ... and at the same time, focus on culturally competent care. That requires us to do more things than just put out a space-available sign."

In many poorer neighborhoods, the family dynamic appears biased against advanced education in part because of the potential separation from the family. "But as we've seen, they can be trained to be certified nursing assistants in six months in their own communities," O'Neil said.

"So almost overnight, they have the ability to double the salaries of what they can make at a McDonald's. That's the real hook that gets them."

But minority nurse organizations need more funding to promote recruitment, O'Neil said.

The Pittsburgh-based Nursing Recruitment Coalition, which helped more than 150 African-American women and men, as well as other nontraditional students, become nurses in a 10-year span, ceased operation in early 2000 when its federal grant money dried up.

"That's the problem with solely grant-based programs," VIDA's Halaby said. "As soon as the grant money ends, so do the programs. Our program is structured to lay more of the groundwork in its early stages [with grants] and rely more on community and private financial support after that."

Rolanda Johnson, assistant professor of nursing at Vanderbilt University, said the college's nursing school is stepping up efforts to recruit more minorities. "Many times, minorities feel isolated and alienated because they don't see many people like themselves," she said. "These groups need to see a person in a role and say, 'I can do that.' "

Future harvest

Academia must act to promote health care careers more vigorously to youth, said school nurse/educator Randall Peterson, MSN, RN, founder of the Maryvale High School Student Nurse Academy in Phoenix.

Peterson's mentoring and instructional program, instituted at the school more than three years ago, provides high school students a means to become LPNs by graduation. Freshmen apply by writing an essay on nursing and submitting their eighth-grade report cards. Students with the best essays, grades and attendance are invited. Peterson helps graduates pursue scholarships and grants for college.

"The solution to the nurse shortage so far has been to import nurses from Canada and the Philippines," Peterson said. "But now, there is nobody else we can steal from. We have to look to our own resources."

Peterson took what he called a "massively underperforming" student body with more than 50 percent failure rates, and now has a "100 percent pass rate in our CNA program and 90 percent in LPN," using what he calls a no-child-left-behind approach.

The Arizona Hospital and Healthcare Association, in fact, wants to implement a similar program statewide, said Fran Roberts, Ph.D., RN, vice president of professional services at the association. The Maryvale academy proves that young people of multiple backgrounds "can be drawn to nursing and other health care professions despite the obstacles they face," she said.

Polly Bednash, executive director of the American Association of Colleges of Nursing, said reaching students in communities where they live may be the most effective way to both diversify and fortify the nurse population. "We do know that people want to have care from individuals who are like them," she said. "It's like a woman wanting a female gynecologist or obstetrician."

Several recruitment efforts are under way. To make inroads into American Indian communities, the Intercollegiate College of Nursing at Washington State University appointed a member of the Nez Perce tribe as a recruitment coordinator.

In June, the Department of Health and Human Services awarded a total of $3.5 million in grants to 16 universities to support nursing education for individuals from disadvantaged backgrounds.

More distance-education programs for American Indian nurses and other minority groups that strive to keep their families together geographically need to be developed by colleges, Bednash said.

"If you have a large Native American population or a large Latino or Cambodian community, or any other ethnic group in an area, then disciplined efforts should be made to bring them into the health care community in proportionate numbers," she said.

"There are cultural reasons, language and communications reasons, quality-of-care reasons and, of course, nurse shortage reasons. These more than justify that effort."

Contact Steve McLinden at smscribe@hotmail.com