Presentation by Dr. Shanita D. Williams, PhD, MPH, APRN, Chief, Nursing Education and Practice Branch, Division of Nursing and Public Health, Bureau of Health Workforce, HRSA

1. Shanita D. Williams, PhD, MPH, APRN
Chief, Nursing Education and Practice Branch
Division of Nursing and Public Health
Bureau of Health Workforce
Health Resources and Services Administration
SWilliams3@hrsa.gov
Division of Nursing and Public Health:
Nursing Workforce Diversity Updates
and Anticipated Trends
AACN Spring 2016 Conference
Workshop: Building the Case for Diversity and Inclusive Learning
March 18, 2016 and March 23, 2016

2.  BHW Priorities
 Spotlight: Preparing a Diverse Workforce
 Programmatic Overview
 Legislative Authority: Nursing Workforce Diversity (NWD) Program
 Why Diversity? Why NWD?
 NWD vs U.S. Population Demographics
 Benefits/Strengths of Diverse and Culturally Aware Workforce
 Evidence-based Strategies to Increase Nursing Diversity in U.S. Population
 NWD Program Initiatives and Investments
 Spotlight: Urban Universities for HEALTH Study: Holistic Review and
Admissions in Nursing
 Discussion and Questions
Presentation Outline:
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3. Bureau of Health Workforce Mission
Improve the health of
underserved and
vulnerable populations
by strengthening the
health workforce and
connecting skilled
professionals to
communities in need.
Collaboration
Accountability
Innovation
HRSA Mission
Improving health and health equity through access to quality
services, a skilled health workforce and innovative programs.

4. BHW Programs Snapshot
In FY 2015, BHW awarded over $1
billion to more than 8,500
organizations and individuals through
more than 40 workforce programs.
Collectively, our programs increase the
nation’s access to quality health care by
developing, distributing, and retaining a
competent health workforce.

5. Workforce Supply
Priorities
Program
Design
Academic & Community Partnerships
Interprofessional Practice & Training
Rapid Cycle QI/Data Driven
Research and Resources
Bureau of Health Workforce
Preparing a
Diverse
Workforce
Improving
Workforce
Distribution
Transforming
Health Care
Delivery
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6. Legislative Authority: Title VIII, Section 821 of the Public Health Service Act (42
U.S.C. 296m), as amended by Section 5404 of the Patient Protection and
Affordable Care Act (P.L. 111-148). Annual Appropriations: $14.5 million/year
1st Year of Appropriations/Awards: 1987
Nursing Workforce Diversity (NWD) Program:
Goal: increasing nursing education opportunities for individuals from
disadvantaged backgrounds (including racial and ethnic minorities
underrepresented among registered nurses)
 Student scholarships, stipends, pre-entry preparation, advanced education
preparation, accelerated nursing degrees, and retention activities
FY 2015:
11 - new awards - $3,488,008; 31 - continuing awards - $10,442,526
1 - Interagency Agreement w/NIH National Institute on Minority Health and
Health Disparities (NIMHD) - $150,000
Title VIII—Nursing Workforce Diversity
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7. Frequent Question:
“Why do we need a dedicated funding stream for
Nursing Workforce Diversity? Hasn’t workforce
diversity been integrated into all funding
priorities?”

8. Why Nursing Workforce Diversity Matters…

9. Why Nursing Diversity Matters?
Nursing Diversity:
 Increases cultural competence
 Improves patient satisfaction
 Improves patient-provider communication
 Increases access to care
Vulnerable populations
Underrepresented minorities more likely to
practice in underserved areas
 Economic advantages
Good business practice

10. NWD Program vs. U.S. Population Data
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Participant Criteria NWD
Nursing Workforce Diversity (NWD) Program Disadvantaged Backgrounds
1. Educational or Economic disadvantage
2. Racial or ethnic minority
underrepresented among registered
nurses
Demographic Profile*^ NWD National~
White
Black
Asian
Hispanic/Latino
35.6% 83.2%
23.4% 5.4%
2.9% 5.8%
22.8% 3.6%
Female
Male
76.3% 91.0%
17.2% 9.0%
Disadvantaged Background
Rural
73.4% 16.8%
27.9% 16.0%
*Demographic Data from National Center for Health Workforce Analysis: NWD Program Annual Report CY
2013 -2014-unpublished
^National Council of State Boards of Nursing (NCSBN) and Forum of State Nursing Workforce Centers (2013)
~Registered Nurses

11. Constant Question:
“What racial/ethnic minority recruitment and
retention models implemented in undergraduate
nursing programs have been successful in
recruiting, retaining, and graduating students
form schools of nursing”?

12. Nursing Workforce Diversity: Evidence-
based Strategies That Work

13. Successful Strategies that Achieve
Health Professions Student Diversity
Successful models include various combinations of
evidence-based strategies:
 Academic support
 Professional and peer mentoring
 Student financial support
 Community partnerships
 Holistic Review and Admissions

14. What Works to Achieve Diversity:
Insights from HRSA Grantees
 Academic and peer support
 Before admission and during academic progression
 Professional and peer mentoring
 Establishing mentoring networks
 Language partnerships
 Visible minority faculty
 Financial support
 Uninterrupted
 Social support
 Active Community partnerships

15. Nursing Workforce Diversity: Current and
Future Directions

16. Social Determinants Framework
Social determinants are the conditions in which people
are born, grow, work, live, and age, and the wider set of
forces and systems shaping the conditions of daily life
World Health Organization
Five social ‘class’ determinants of student success and
achievement:
1. Challenged home intellectual environments
2. Single parenthood
3. Irregular parental work schedules
4. Inadequate health car access
5. Exposure to environmental lead
Economic Policy Institute (2015)

17. Social Determinants as a Nursing
Workforce Diversity Strategy
 Move beyond individual-level strategies rooted in
deficit-based models and assumptions
 Multi-level and systems approaches
systems (college, university, and community-level)
 Partnerships
public and private sectors (beyond nursing)
industry and other disciplines
 Collective activity vs. Individual nursing school effort

18. From Social Determinants to Holistic
Review and Admissions

19. Holistic Review and Admissions
 Admitting and graduating the best “nurses” vs the
best “students”
 Matching a student background/experiences to the
College/University mission, vision, and values
 Using diversity of admission criteria not exclusive of
quantitative metrics:
 GPA, GRE
 Requires institutional leadership involvement starting
at the top

20. HRSA’s Holistic Review and
Admissions Investments
2013: Urban Universities for HEALTH $265,000 HRSA Grant
Survey of Admissions in the Health Professions examined how universities are
admitting students into health professions programs, with a particular focus on
“holistic review” as a strategy to increase diversity and cultural competence in
the health professions, with the larger aim of improving access to care and
achieving health equity
2015: Urban Universities for HEALTH $150,000 HRSA Grant
Disseminating Evidence on Admissions project aim is to improve
the understanding and use of evidence-based university
admissions practices that lead to a more diverse and culturally
competent nursing workforce

21. Shanita D. Williams, PhD, MPH, APRN
Chief, Nursing Education and Practice Branch
Division of Nursing and Public Health
Bureau of Health Workforce
Health Resources and Services Administration
SWilliams3@hrsa.gov
Division of Nursing and Public Health:
Nursing Workforce Diversity Updates
and Anticipated Trends
AACN Spring 2016 Conference
Workshop: Building the Case for Diversity and Inclusive Learning
March 18, 2016 and March 23, 2016