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Nurses of Color Are Underrepresented – with Serious Consequences

Funding to scale up Mini Nursing Academies, a program of the National Black Nurses Association, across the nation will increase racial and ethnic diversity in the nursing field.


Health Equity

Health workers staff a mobile Covid-19 testing site in historically black neighborhoods in Seminole County, Florida, in April, 2020, to help residents who were not only especially vulnerable to coronavirus, but who could not drive to a health clinic or unable to afford health insurance. Groups like the National Black Nurses Association represent nurses who are on the frontlines of providing that care. (Photo by Paul Hennessy/NurPhoto via Getty Images)

When Jennifer Coleman attended her first National Black Nurses Association Conference, she felt a newfound sense of belonging. There were nurses who looked just like her, in prominent professional roles, with long lists of professional accolades. 

“That left an impression on me,” Coleman said about the Black nurses she met at the conference. “I felt like ‘I can do that,’ and here I am, already a nurse,” she said, laughing.

That’s a feeling the National Black Nurses Association (NBNA), which has 114 chapters in over 30 states, wants to encourage nationwide. Of the millions of nurses in the United States, less than 9% are Black.

Coleman, a professor at Samford University and pediatric nurse, is one of several NBNA members working toward diversifying the nursing profession and enriching other nurses.

A recent pilot program, in which Coleman played an important role, taught elementary school students in Alabama what nurses are and what they do. Now, with seed funding from Direct Relief and local governments, NBNA is scaling up the service to create seven more Mini Nursing Academies across the country. 

The association hopes that the academies will encourage young students of color to begin thinking about nursing as a profession. The new programs will begin in the fall of 2022 in Florida, Louisiana, Missouri, Illinois, Connecticut, Oregon, and South Carolina. Students will conduct a research project the first semester, followed by hands-on activities the following semester with nurses in the field throughout their community. Each year a new cohort of students is expected to join the program. 

“You have to role model”

NBNA is focusing on school children from grades three to six so that students are aware of nursing opportunities early. The geographic areas the association chose had schools with a significant number of students who represented a racial or ethnic minority, a high percentage of students who qualified for state-funded lunch programs, and low graduation rates.  

“It’s when they are at an impressionable stage of life,” said Loretta Lee, who helped lead the Alabama pilot program. “We’re trying to give them a sense of worth so that they understand that they can become a nurse, and alert them to the impact of health disparities.” 

Students in Alabama’s pilot program led and participated in a research project to understand the effects of a sedentary lifestyle. They learned the research process by tracking classmates’ health through weight, height, blood sugars and heart rate before and after activities. The students also learned about chronic diseases that have significantly affected Black and Latinx populations, like diabetes, hypertension, and obesity. 

Like Coleman, Lee is an accomplished nurse who said there is great value in representation. An associate professor at the University of Alabama at Birmingham and a family nurse practitioner, Lee said she first recognized the importance of representation when meeting with fellow NBNA members. 

“Students in our communities probably don’t see people who look like them very often as nurses,” Lee said. “I believe you have to role model, meaning if a Black student or Brown student sees a registered nurse, has interactions with a registered nurse throughout their youth, then they are more apt to become a registered nurse if they can get information, if they can know what that profession is about. And they’re more apt to want to emulate what they see.” 

“A small proportion of the whole”

NBNA was organized in 1971 and incorporated as a nonprofit in 1972. The association serves as the “voice for Black nurses and diverse populations by ensuring equal access to professional development, promoting educational opportunities, and improving health,” according to its website.

Martha Dawson, who is serving in her second term as NBNA President, made a vow to her colleagues to increase diversity within the field, expand the workforce, and further the support and engagement of NBNA members. The acclaimed doctor of nursing practice said she is deliberate in her work to support Black nurses to reverse the disparities that have hindered their access to educational and professional opportunities. 

Dawson said that many of NBNA’s members are also members of the American Nurses Association, but the other organization doesn’t support all of their needs. 

“Why do we need a Black Nurses Association? Because society doesn’t see me as a person first, they see me as a Black person first,” Dawson said. “So, therefore, if I’m going to be seen as a Black person, then that means they also see me as a Black nurse. There’s still racism embedded within the nursing profession and there are still some patients out there who do not want Black nurses.” 

When Dawson ran for re-election, she told her colleagues that she would focus on diversity, equity, and inclusion. To her, that means supporting education and professional outlooks for nurses, but also building trusting relationships with patients. She said that moving past cultural congruence to cultural competency is a major part of the work. To achieve that nationally, racial and ethnic diversity is required within the nursing workforce. 

“It is my philosophy that I can never be competent in someone else’s culture,” Dawson said.  “I can provide good care to a Native American but would I ever be culturally competent? No…So it’s not just about increasing the number of Black nurses; we need to increase the number of Native American, Asian, Hispanic, because again when we look at the millions of nurses, minority nurses still only account for a small proportion of the whole.” 

“To help people survive”

That small proportion of nurses has been called on in a major way throughout the coronavirus pandemic. Members of the NBNA helped create the Black Coalition Against Covid in March of 2020. Other members used local radio stations to consistently update communities on the virus and talked about the importance of getting vaccinated once doses became available.  

The nurses held webinars and town halls to talk about coronavirus. They created a system to support elderly residents during the pandemic, and worked with health departments and the faith-based community to build trusting relationships with people. NBNA nurses have also advocated for policy issues like smoke-free environments, reducing food insecurity, and supporting environmental justice – all social issues that predominantly affect Black and Brown communities.  

“Every space that we felt we needed to be in to help people survive, those were the things we were doing,” Dawson said. 

“serving the people where they need to be served”

While serving their communities during a global pandemic, the nurses continued to look for ways to support each other.  

The Portland, Oregon chapter of the NBNA was formed in early 2020, just before the coronavirus pandemic shut down much of the country. In Oregon, just under six percent of the population is Black. 

Danaya Hall, who founded the Portland chapter, said 16 nurses decided to join the organization that February due to the “toxicity” they were experiencing at work. 

“Here in Oregon, it’s such a white community,” she said. “It was really created to be a white utopia. You know, we had laws excluding Black people well into the 60s, which wasn’t that long ago. So I think people were really reckoning with the racist history here in particular.”

Hall moved to Oregon from California and said the difference was startling. Many of her Black colleagues in the area experienced trying times at work during the pandemic. On top of working extreme hours and trying to protect themselves and their families, Black nurses witnessed the Black community die from coronavirus at a disproportionately high rate. 

They founded the Portland chapter to build trusting relationships with one another and to strategically address systemic racism in Oregon’s healthcare systems. 

“Most of the Black nurses, in whatever setting they work in, they’re the only one – and that is a very vulnerable place to be,” Hall said. “When we’re talking about managing health disparities, and all these organizations run by white folks are scratching their heads to understand why African Americans are sicker, they can’t really understand that. It’s because the institution is not serving the people where they need to be served.”

As the Oregon nurses began to discuss ways to improve equity within the sector, their work collided with NBNA’s effort to scale up the Mini Nurses’ Academy. With additional funding support, the Portland chapter plans to use a mobile unit to teach young people about the nursing profession, to support representation and racial inclusion in the nursing profession moving forward. 

Direct Relief’s Fund for Health Equity supported the National Black Nurses Association with a $248,000 grant for the Mini Nursing Academy. The organization also received $100,000 from Direct Relief’s Covid-19 Response Fund for Community Health for pandemic response efforts.

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