Lesson 8: The Future of Care: Building a Diverse Nursing Workforce and the Role of Nurses in Policy & Activism
- Domain 6 - Interprofessional Partnerships
- Domain 7- Systems-based Practice
7.2f Identify the impact of differing system structures, leadership, and workforce needs on care outcomes. (Entry-level)
7.3d Recognize internal and external system processes and structures that perpetuate racism and other forms of discrimination within health care. (Entry-level)
- Domain 9- Professionalism
9.3m Advocate for policies/practices that promote social justice and health equity. (Advanced-level)
9.4a Advocate for policies that promote health and prevent harm. (Entry-level)
9.4d Advocate for policies that enable nurses to practice to the full extent of their education. (Advanced-level)
Associated Nursing History Framework
- Pedagogy - Provides space for discussion of racism/discrimination in healthcare
- Evidence - Bears witness and gives voice to experiences of Black providers and patients
- Explanation - Provides context for ongoing discussions in health care related to racism and discrimination (Matthias and Hundt, 2023)
Essential Questions (student and teacher guide)
- How have Black nurses influenced healthcare policy, and why is their role in leadership critical to reducing health disparities?
- How can nurses influence policy and activism to address the social determinants of health in marginalized populations?
- What role will Black nurses play in building a more diverse and inclusive nursing workforce in the future, and how can they help overcome current challenges in nursing education and practice?
- How can the legacy of advocacy organizations like the NBNA shape future workforce diversity initiatives?
Learning Objectives
- Examine the Role of Black Nurses and Organizations in Policy Advocacy and Healthcare Leadership: Students will assess the contributions of Black nurses, and the National Black Nurses Association, in shaping healthcare policy and promoting leadership in addressing health disparities (AACN 6.3a, 7.1a, 9.4a, 9.4d).
- Evaluate the Role of Black Nurses in Building a Diverse Nursing Workforce for the Future: Students will assess the current challenges faced by the nursing workforce, particularly the lack of diversity, and explore how Black nurses can help shape the future of nursing by promoting inclusivity and representation in healthcare (AACN 7.2f, 7.3d, 9.3g, 9.3m).
Introduction (Faculty)
The role of Black nurses and their organizations has been pivotal in shaping healthcare policy and advancing leadership in addressing health disparities in the United States. Despite facing systemic barriers throughout history, Black nurses have continuously worked to advocate for the health needs of underserved communities, pushing for policy reforms and promoting diversity within the nursing profession. Central to this effort has been the National Black Nurses Association (NBNA), established in 1971, which serves as a vital platform for Black nurses to unite, lead, and advocate for healthcare equity. As healthcare faces future challenges, including workforce shortages and growing disparities, the leadership of Black nurses in both policy advocacy and workforce diversity will play a key role in reshaping the landscape of healthcare.Historical/Conceptual Background (for Faculty) (adapted from Mapping Care website)
The formation of the National Black Nurses Association (NBNA) came at a time when Black nurses continued to face exclusion from leadership positions, even after the legal integration of nursing schools and professional organizations. In the decades following the dissolution of the National Association for Colored Graduate Nurses (NACGN) in 1951, Black nurses struggled to gain visibility and influence in mainstream healthcare leadership. The NBNA was established to advocate for the inclusion of Black nurses in leadership roles, policy development, and decision-making processes that directly affected the healthcare of Black and marginalized communities.
Throughout history, Black nurses have made significant contributions to public health, often addressing the unique needs of their communities. These efforts extended beyond clinical care, as Black nurses became key advocates for policy changes that addressed the social determinants of health, such as access to education, housing, and employment. Leaders like Mary Eliza Mahoney, the first professionally trained Black nurse in the U.S., paved the way for future generations of Black nurses to not only practice nursing but also lead efforts to improve the health outcomes of marginalized populations.
In addition to policy advocacy, the role of Black nurses in building a diverse and inclusive workforce is crucial for the future of healthcare. The U.S. nursing workforce has long struggled with a lack of diversity, which undermines the ability to provide culturally relevant care to an increasingly diverse patient population. Black nurses, with their deep ties to underserved communities and their commitment to equitable healthcare, are essential in shaping a more inclusive and representative nursing profession. The future of nursing will depend on the leadership of Black nurses and other nurses of color in promoting inclusivity, fostering mentorship programs, and advocating for systemic changes that support the recruitment and retention of minority nurses.
This lesson will guide students through the historical and contemporary roles that Black nurses and organizations like the NBNA have played in advocating for healthcare equity and fostering diversity within the profession.
For more resources on this subject, see:
The Future of Care
The Chicago Chapter of the National Black Nurses Association
Read/Watch/Listen (Resources from The History of Black Nurses in Chicago website)
- The Future of Care
- The Chicago Chapter of the National Black Nurses Association
- Research and Advocacy
- Black Migrant Nurses
- Black Nurse Activism
- Black Nurses Healthcare Equity
- Oral History Collection
Supplemental Resources
Websites
Books/publications
- Increasing Racial/Ethnic Diversity in Nursing to Reduce Health Disparities and Achieve Health Equity - PMC
- The Future of Nursing 2020-2030 - National Academy of Medicine
- AACN Fact Sheet: Enhancing Diversity in the Nursing Workforce
- Black Nurses Collaborative Approach to Addressing COVID-19 in Black Communities - PubMed
Activities Summary: The following is a brief summary of activities included in this lesson. Faculty are encouraged to pick and choose the activities that work best for their students and course. Faculty may also modify activities through adding readings or changing learning modalities, instructions, or evaluation criteria as they see fit.
- Examine the Role of Black Nurses and Organizations in Policy, Advocacy and Healthcare Leadership: Students will assess the contributions of Black nurses, and the National Black Nurses Association, in shaping healthcare policy and promoting leadership in addressing health disparities.
- Evaluate the Role of Black Nurses in Building a Diverse Nursing Workforce for the Future: Students will examine the challenges in the nursing profession, such as workforce shortages, burnout, and lack of diversity, as highlighted in "The Future of Care" content. They will work in groups to design a recruitment and retention strategy that could be implemented by nursing schools or healthcare institutions to increase diversity in the nursing workforce.
Activity Plan 1 Examine the Role of Black Nurses and Organizations in Policy Advocacy and Healthcare Leadership (Group, in-class or online, small group research, timeline development, and presentation)
Preparation
- Pre-class reading:
- From the Oral History Collection
- Pre-class Instructions:
- Encourage students to highlight key contributions, even if dates are not precise, and emphasize the broader themes and impacts of the NBNA's work.
- Provide students with resources to create effective timeline development
Main activity: Group Research/ Collaborative Timeline Development and Presentation
Step 1: Divide the Class into Large Groups (15–30 students per timeline):
- For small classes (fewer than 30 students): Work together as one large group to create a single comprehensive timeline.
- For medium to large classes (30–90 students): Divide students into 2–3 large groups. Each large group will create a separate timeline.
Step 2: Assign Small Groups Within Large Groups:
- Within each large group, divide students into small groups (3–5 members).
- Assign each small group to research and develop the timeline for a specific decade (e.g., 1970s, 1980s, 1990s, 2000s, 2010s).
- Each small group will:
- Research one oral history (e.g., Ethel Walton, Sandra Webb Booker, Barbara Norman) and highlight contributions of their assigned oral history subject.
- Identify milestones, themes, and policy contributions of the NBNA during their assigned decade.
- Contribute their findings to the shared timeline.
Step 3: Use Padlet or a Similar Platform for Collaboration:
- Collaborative Timeline Creation: Each large group will use Padlet (or a similar tool) to collaboratively build their timeline.
- The founding of the NBNA in 1971, and its historical context, including why Black nurses felt the need to form their own organization.
- Major policy initiatives the NBNA has supported over the years, such as legislation that expanded nursing roles, efforts to promote diversity in healthcare, and campaigns for healthcare equity.
- Contributions of individual nurse leaders.
- Any significant collaborations between the NBNA and other healthcare or civil rights organizations.
Step 4: Class Presentations:
- Each small group will present their contributions to the timeline focusing on the significance of each milestone, Insights from their assigned oral history subject they included.
- Encourage students to focus on the impact of the NBNA's policy initiatives and how these efforts have shaped healthcare leadership and advocacy for health equity.
Faculty Note: Depending on the time available and the number of groups, faculty can adapt the presentation format:
- Option 1: Each small group presents their assigned decade on the timeline.
- Option 2: For large classes, faculty can choose one timeline to be presented to the class or allocate additional time for all timelines to be shared.
Discussion and Feedback
- Facilitate a class-wide discussion following the presentations, asking questions such as:
- What have been the most significant policy achievements of the NBNA?
- How have Black nurse leaders influenced broader healthcare reforms?
- How do the contributions of Black nurse leaders and the NBNA relate to the ongoing challenges in nursing today?
- In what ways can future nurses build on the legacy of the NBNA to further advocate for healthcare equity and leadership roles?
Evaluation
- Rubric for the timeline development and presentation to evaluate clarity and organization of presentation, depth of research and understanding of the policy advocacy role of Black nurses, ability to connect historical examples to modern healthcare challenges, and participation in discussion by using Lesson 8 Rubric for Group Presentation, Timeline Development and Discussion
Activity Plan 2 Evaluate the Role of Black Nurses in Building a Diverse Nursing Workforce for the Future (Group, in-class or online, Group research, strategy development and presentation)
Preparation
- Contextual reading
- Black Public Health Nurses in History
- Black Nurses & Healthcare Equity
- Increasing Racial/Ethnic Diversity in Nursing to Reduce Health Disparities and Achieve Health Equity - PMC
- AACN Fact Sheet: Enhancing Diversity in the Nursing Workforce
- Black Nurses Collaborative Approach to Addressing COVID-19 in Black Communities - PubMed
- Supplemental resources: Students can also review successful diversity initiatives in other professions or institutions as case studies, as well as existing programs within nursing that promote diversity, mentorship, and accessibility.
Main activity: Group Discussion and Research
- Group Discussion
: Ask students to reflect on historical examples of how Black nurses have tackled diversity and workforce challenges in the past.
Emphasize how those examples can be connected to modern nursing workforce challenges, including burnout, shortages, and the underrepresentation of marginalized communities.
Guiding Questions for Discussion:
- What are the biggest challenges identified in terms of workforce shortages and lack of diversity?
- How have Black nurses historically contributed to increasing diversity in healthcare settings?
- What role do mentorship and education pathways play in building a more inclusive nursing workforce?
- Group Strategy Development and Presentation
- Groups should consider the following elements in their strategy:
- Recruitment strategies: How to attract students from marginalized backgrounds into nursing programs. This might include partnerships with high schools, community outreach programs, or financial support.
- Mentorship programs: Develop a plan for establishing mentorship opportunities between experienced nurses and students from underrepresented communities.
- Accessible pathways to education: Explore ideas for creating affordable and flexible pathways to nursing education, such as community college programs, online courses, or work-study models.
- Support services: Propose additional support systems for students facing challenges related to finances, work-life balance, or discrimination, such as counseling, peer support groups, or academic advising.
- Each group should create a 5-7 minute presentation that includes:
- The identified challenges related to diversity in the nursing workforce.
- The group's proposed recruitment and retention strategy.
- Justifications for how their strategy will help improve diversity, reduce burnout, and address workforce shortages.
Discussion and Feedback
After the presentations, facilitate a class-wide discussion where students compare strategies, ask questions, and explore the potential impact of these proposals on nursing schools and healthcare institutions.
During the discussion, prompt students with questions such as:
- How can mentorship programs and accessible education pathways for marginalized students be adapted to meet the needs of today’s nursing workforce?
- How can the recruitment strategies you designed help address these workforce shortages while increasing diversity?
- Why is it important for the nursing workforce to reflect the diverse populations they serve? How does diversity improve patient care and outcomes, especially in marginalized communities?
- How can nursing schools and healthcare institutions take proactive steps to ensure that their workforce recruitment and retention efforts are sustainable?
Evaluation
- Rubric for the group strategy development and presentation to innovation/feasibility, depth of understanding, clarity of presentation and Engagement in class discussion by using Lesson 8 Rubric for Group Strategy Development and Presentation.