“We recognize that there is a serious deficiency in the number of Latino registered nurses and we want to lead the way in increasing the numbers,” said Dean Linda Sarna at her presentation to the National Association of Hispanic Nurses in January. “We need nurses who will understand the community – its language and its culture. Latino nurse researchers are underrepresented and that needs to change too.”
In a 2004 article in Nurse Administration Quarterly, Antonia Villarruel, dean of the University of Pennsylvania School of Nursing and Nilda Peragallo, dean of the University of North Carolina at Chapel Hill School of Nursing, discussed the impact of the underrepresentation of racial and ethnic minority nurses and other health professionals which has led to the continued disparities in health outcomes for these populations. In the article, they point out that strategies to reduce health disparities, such as increasing the cultural competence of majority nurses, often depend on leaders of the same racial and ethnic groups to provide leadership in research, education, practice, and communities.
Villarruel and Peragallo embody the definition of Latina nurse leadership. The School was excited and proud to have both visit UCLA and speak to students and faculty during the past year.
Villarruel gave the motivational keynote at the 2017 graduation. During her talk, Villarruel pointed out that nurses are needed in leadership roles “in the board rooms at local and national policy tables to advocate for policies that support health and illness management.” Villarruel has followed her own advice: “I have been around many policy tables advocating for the advancement of Hispanic and other minority nurses. I have worked with consumer, local, state and national organizations in finding ways to support adolescents in making safer sex decisions to prevent HIV/AIDS and unplanned pregnancies. I have had incredible opportunities and champions to support me in my journey….but I know I’m not done.”
Peragallo, an internationally recognized expert and widely published researcher who has dedicated her career to improving individual and public health with a particular focus on minorities, spent two days at the school and on the UCLA campus meeting with students (in particular doctoral and post-doctoral), community nurse leaders as well as nurse researchers. She provided many ideas for how to advance research and enhance our academic programs. Her presentation at the distinguished lecture series,“Culturally Informed, Community Engaged Research with Latinos,” was inspiring and well-received.
The school is proud to have three strong Latina faculty role models that are making a difference – through advocacy, research and leadership. Not just in Latino health but in healthcare for all.
Rosamar Torres, PhD, MSN, RN, Assistant Professor at the School, is focused on perinatal health of Latinas. As a clinician in Pediatric and Neonatal Intensive Care units, she noticed that many Latina mothers received little to no prenatal care. While earning her PhD, she studied beliefs, barriers and practices of prenatal care utilization in late adolescent Latinas and found that a majority of these young women experienced numerous institutional, personal and biological barriers including depression. Her current research is focused on maternal-child health, specifically on cognition and depression.
The multidisciplinary research, teaching and service by Associate Adjunct Professor Dr. Maria Elena Ruiz interweaves familismo (a core Latino cultural value, which refers to the importance of strong family loyalty, respect, closeness, and getting along with and contributing to the well-being of the nuclear family, extended family and kinship network) aging and caregiving, homelessness, violence, farmworker health risks, and issues faced by Latinos. Most recently, she
was the lead author for an article published in the Journal of Transcultural Nursing: “Older Latinos: Applying the Ethnocultural Gerontological Nursing Model.” She is affiliated with the UCLA Chicano Studies Research Center (Associate Director, 2010-2012). Through her work, she is assisting nurses and other health providers in gaining a fuller assessment of the heterogeneity of Latino families, language and cultural needs, and ways to improve health and decrease health disparities.
Ruiz received an award from the American Public Health Association for her dissertation on Latino and Asian elders, plus several awards for her Spanish language/Latino culture programs, research on aging minorities, clinical work in high risk communities, international programs, as well as advocacy and mentoring of underrepresented students. She has held several positions with the National Association of Hispanic Nurses (NAHN), including past president of NAHN-Oregon Chapter.
Lecturer Mary Canobbio is an exemplar in advocacy. Her work with the American Heart Association has changed policy and health care delivery. In 2017, she made headlines when a committee she chaired at the AHA released recommendations for successful pregnancies for women born with congenital heart defects. Like Ruiz, Canobbio has received numerous awards for her leadership including Fellow, American Heart Association, Council on Cardiovascular Nursing and Fellow, American Academy of Nursing.
GETTING STARTED: ATTRACTING LATINOS TO NURSING
It is probably no surprise that studies prove that having Latino nurses in the workforce shows there is better communication with Latino patients and better outcomes.
Out of the more than 3 million registered nurses in the U.S., Latinos represent only 3.6 percent even though they make up 17 percent of the total U.S. population. In California, where 39 percent of the population (and growing) is Latino, just 8 percent of nurses are Latino.
A paper co-authored by UCLA School of Nursing PhD graduate Teodocia Maria Hayes-Bautista, published in the February 2016 American Journal of Nursing: “Latino Nurses in the United States, an Overview of Three Decades,” discusses the statistics. “Between 1980 and 2010, the number of RNs nearly doubled while the number of Latinos in the general population nearly tripled. If nursing education had kept pace with the increasing Latino population, we would expect the number of Latino nurses to have grown by a factor of at least two, which would have resulted in closing the gap between the number of non-Latino white and Latino RNs per 10,000. Instead, the number of Latino RNs grew by one third, only half of what we would expect.”
The paper concludes “Nursing education programs and institutions need to improve their efforts to increase the number of Latino nurses relative to the Latino population.”
So how do we get more Latinos to consider nursing and to be prepared for a nursing career?
Many Latino students and parents are not aware of the requirements and multiple opportunities that exist in nursing fields. The School believes that it is its responsibility to make nursing school an option and is continually looking for ways to inform Latinos of the requirements for a health career and to encourage them to apply. One way to do that is to offer scholarships that support more Latinos in obtaining undergraduate and advanced practice nursing degrees in order to provide specialized health care to underserved populations, create opportunities for advancement within the health care profession, and to forge a place at the table where policies are being made.
The School of Nursing found a very influential partner for that effort in AltaMed Health Services – Southern California’s leading nonprofit community health network delivering integrated primary care services, senior care programs, and health and human services for the entire family. Dr. Ruiz, who was instrumental in expanding the School of Nursing collaboration with AltaMed, worked with them to establish annual scholarships and to expand clinical opportunities for MECN and APRN students.
“The purpose of these scholarships is to work toward upgrading health care to underserved populations,” said Castulo de la Rocha, AltaMed President and CEO. “By providing support to students who are focusing on health care needs and issues specific to Latino communities, we are creating the health care providers that will meet the needs of our communities.”
Vanessa Torres, a MECN student was one of the first recipients of an AltaMed Scholarship. She saw nursing as an opportunity to be at the forefront of care, where she could also use her Spanish language and personal background to empower and aid patients in diverse and underserved communities.
Through a grant from the Health Resources Service Administration (HRSA), the school is also able to support minority and disadvantaged students pursuing advanced practice nursing degrees. More than 40 students each year have benefitted from this grant that encourages nurses to work in primary care with medically underserved communities.
COLLABORATIONS AND LEARNING OPPORTUNITIES
During their studies, students are provided with several opportunities to learn more about the Latino community and its unique health needs.
During their Public Health rotation, the MECN students worked with one of the AltaMed PACE (Program of All-Inclusive Care for the Elderly) senior care centers, giving the students exposure to gerontology care. Their projects have included a survey of residents on their knowledge of end-of-life and advanced directive issues and education programs for fall prevention.
In addition, AltaMed and the School received a grant from HRSA that pairs MECN students with nurses and a nurse case manager at one of AltaMed’s primary care clinics to achieve better health outcomes for patients with diabetes and heart failure. The students developed health education programs that the AltaMed nurses can deliver to patients. By moving this education program into the community, the hope is that patient health will improve and individuals can be kept out of the hospital.
This year, a group of energized students introduced the Latino(a) Nursing Student Alumni Association – LANSA. (In Spanish, lanza means to launch; i.e. careers, action, professionalism, empower.)
“LANSA was formed to give a voice to our Latino/a students and create change through inspiration, leadership and role models,” said Valeria Amezola, LANSA President and Founder. “In turn, I hope it can empower a generational change within the UCLA School of Nursing and our communities, empowering and motivating more minorities to join our profession. I truly believe that when we see people like us, we believe the nursing profession is for us. A diverse nursing community makes for better health care solutions and diversifying the nursing profession is our dream!”
Another student organization, Global Action in Nursing (GAIN) offers members the opportunity to visit places such as Panama (alongside Floating Doctors), where they can learn more about Latino culture.
Participants said the medical volunteer trip to Panama was very valuable as it provided an opportunity to the pre-licensure and licensed nursing students to see differences in health care among international communities who often belong to different social ladders and habitants of areas where health care is often not available.
“This broadened our lens to the reality that not everyone has the option to go to the doctor, which helps us understand why many of our communities often question or mistrust physicians and Western medicine,” shared Fatima Urquilla Soto, a 2nd year MECN and Alejandra Lopez, a 4th year BS student.
This trip provided a glimpse of how different a culture can be – from their language to their way of engaging, and their teachings. “As nurses, we are taught time and time again how we must be culturally sensitive, especially because we live in such a diverse city where we take care of patients from different backgrounds. We firmly believe that our volunteer trip to Panama provided all of us with a stronger desire to learn more about different cultures, their practices, and their beliefs so that we can apply this knowledge to our nursing practice,” concluded Soto and Lopez.
IT’S NOT ONE SIZE FITS ALL: THE NEED FOR CULTURALLY COMPETENT HEALTH CARE TO IMPROVE THE HEALTH
OF THE COMMUNITY
Your zip code may be more important that your genetic code. Patient preferences, environment, and behaviors
can also impact outcomes.
In the AJN paper, Hayes-Bautista pointed out the importance of also preparing non-Latino RNs to engage the Latino patient population for effective patient-centered care. “Training in communication skills is fundamental and should include minimal Spanish language skills and science-based information.”
Another way the school has prepared nurses to work in Latino communities has been through the Song Brown Community Partnership. Family nurse practitioner students work in community clinics throughout Los Angeles where many Latinos access care. Students have served more than 444,000 people since 1993. Currently, 40 first-year students see an average of 130 patients annually, and 40 second-year students see 980 — in communities throughout the region from Arroyo Vista to Watts. Upon graduation, over 50 percent of these nurses go to work in the community clinics.
Carol Vasquez, family nurse practitioner class of 2015, now works at a community clinic. She said “it (Song Brown) gave me a very special training that I am able to use on a daily basis with my patients.”
UCLA – LEADING THE WAY TO A BRIGHT FUTURE
“The future of the health of Los Angeles depends on encouraging Latinos not just to get a degree in nursing, but to pursue advanced degrees. We need Latino nurses to be academically prepared to be nurse leaders, community advocates and policy changers,” said Ruiz.
“I wanted to come to UCLA because of the diversity of Los Angeles and the School’s concentration on vulnerable populations,” said Torres.
“What I found was a school that is committed to diversity and they are taking the steps to promoting diversity – not just within the school, but within the profession and I wanted to be a part of that.”