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Nursing workforce diversity increases, but room for growth remains

Growth in nursing workforce diversity is welcome news for a healthcare industry focused on health equity.

The nursing field is getting closer to improving medical workforce diversity, with new figures from the Health Resources and Services Administration (HRSA) showing greater proportions of non-Hispanic Black and non-Hispanic Asian people working as licensed registered nurses.

The report, which used data from 2022, showed a net 3 and 4 percentage-point increase in the number of Black and Asian nurses in the United States, respectively. However, the number of Hispanic nurses decreased slightly between 2018 and 2022, from 10 percent of the nursing workforce to 9 percent.

These findings come as healthcare continues to stare down striking workforce problems. During and after the early aughts of the COVID-19 pandemic, the industry has seen serious issues with provider satisfaction, leaving healthcare professionals to exit medicine in droves.

In addition to shortages, healthcare organizations have been grappling with calls to improve workforce diversity amid calls to promote health equity.

According to the HRSA figures, the number of licensed RNs went from just under 4 million in 2018 to just over 4 million in 2022, showing that the industry might be rebounding from employment changes that happened during the pandemic.

But while overall employment numbers stayed somewhat stable in the past four years, the report showed that demographics seriously fluctuated. As noted above, HRSA clocked an increase in the number of Black and Asian nurses.

The nursing field is still predominantly White, with around two-thirds of RNs in the US identifying as White. Still, that is down from 73 percent of RNs identifying as White in 2018, suggesting that the racial composition of the nursing workforce may be shifting to reflect the total population.

There are also more nurses identifying as male in the healthcare workforce, with 12 percent of nurses identifying as such in 2022. In 2018, that figure was 10 percent.

But although representation related to race/ethnicity and sex is slightly increasing, the HRSA report showed that the diversity of languages spoken remains stagnant. Multi-lingual healthcare providers are important assets to the organization and industry at large as medicine continues its push toward health equity. Providing language access and congruence at the point of care can improve patient safety and the overall patient experience.

In 2018, 82 percent of nurses reported that they spoke no additional language other than English. In 2022, that figure remained pretty much the same, with 81 percent of nurses reporting that they spoke no additional languages other than English.

The number of nurses who said they spoke Spanish in 2022 was around 7 percent, while 4 percent said they speak Filipino, and 9 percent said they speak another language besides English, Spanish, or Filipino.

These figures underscore an opportunity for healthcare organizations to recruit for more language diversity. Hospitals and health systems may also consider continuing education opportunities to help nurses and other staff members learn other languages, although such initiatives will need to consider provider workload and burnout levels.

Still, the overall demographic numbers for RNs are trending in the right direction as healthcare continues to seek a more diverse healthcare workforce.

After all, workforce diversity and the potential for patient-provider racial concordance have significant benefits. For one thing, a more diverse workforce could provide comfort and instill trust in racial/ethnic minority patients who previously may have been reticent to access care at all.

The data shows that racial concordance can also be good for clinical quality. In 2023, a JAMA Network Open study showed that having more Black primary care physicians in a given area is linked with better survival-related outcomes for Black people who live there. Although the study focused on physicians, similar findings stand for other healthcare providers, including RNs.

Further bolstering patient-provider racial concordance is a long-term goal, as medical entities acknowledge they first need to diversify their applicant pools, medical schools, and undergraduate medical tracts. Improving cultural competence could help improve the patient experience in the meantime, while 2023 data from West Virginia University has indicated that expanding scope of practice laws for certain types of nurses could also move the needle.

In particular, the data indicated that granting full practice authority for nurse practitioners could increase workforce diversity.

The HRSA data backs that up. Between 2018 and 2022, the number of White NPs went down from 75 percent to 67 percent, despite the total number of NPs increasing from 253,181 to 355,044. This indicates that more providers of color are becoming NPs.

Indeed, the number of Black NPs increased from 8 percent to 13 percent of all NPs. For Hispanic NPs, those figures were 9 percent and 8 percent, respectively, and for Asian NPs, they were 5 percent and 8 percent.

As healthcare continues to work toward a more diverse medical workforce, it may be fruitful to consider the role nurses can play. By granting fuller practice authority to NPs, who disproportionately specialize in primary care, could be the key to helping racial/ethnic minority patients see themselves in their providers.

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