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What the national nursing shortage means for Black patients

What the national nursing shortage means for Black patients

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The number of skilled nurses leaving the profession each year has been called a national healthcare crisis, but the exodus will have a disproportionate impact on Black communities.

Burned out after the COVID-19 pandemic and frustrated with systemic problems in healthcare, nurses in the U.S. are leaving the medical profession in droves, a quiet exodus that some are calling a national crisis. 

But—as usual—a crisis in America is a catastrophe for Black America. Experts say the situation will exacerbate the lack of access to care for communities of color, increase the time it will take to get routine as well as urgent or specialized medical attention and further widen the health gap between Black and white patients. 

The situation is considered so dire that the White House last August announced it had earmarked some $100 million through the Department of Health and Human Services to quickly grow the nation’s corps of nurses. At the same time, colleges, universities and teaching hospitals that specialize in nurse training are offering accelerated programs to get caregivers on the job as soon as possible.

“Nurses are an essential part of our nation’s health care system,” HHS Secretary Xavier Becerra said in a statement rolling out the Grow the Nursing Workforce grant program. “Now more than ever, we need to double down on our investments in nurses who care for communities across the country.” 

Deborah Trautman, president and CEO of the American Association of Colleges of Nursing, said that generating “strong interest in nursing careers, and training new nurses” are top priorities for stakeholders like her organization.

“Maintaining a healthy supply of practice-ready nurses is critical to ensuring access to essential patient care services and protecting the nation’s health,” she said in April. 

Experts say the overall nurse shortage stems from a combination of factors—chiefly, the COVID-19 pandemic, which called on nurses to work long hours in a highly-charged, uncertain environment. But others point to more mundane, long-term issues frustrating the workforce: poor working conditions, relatively low pay, high caseloads, and lack of support from hospital management. 

For Black nurses, the issues also include racial bias on the job. Black Nurses are almost twice as likely to report racism on the job—bigotry, slurs, a patient’s refusal of treatment—than white nurses. 

Why Black nurses matter

According to data from the U.S. Chamber of Commerce, there are only nine registered nurses on average for every 1,000 people. And only 6.7% of registered nurses are Black, even though Black people make up around 13% of the U.S. population.

Black nurses matter because multiple studies confirm Black patients are more likely to seek out care, follow instructions and have better overall health outcomes if their caregiver looks like them. 

Research shows that patients who are of the same race as their healthcare provider have better outcomes. These improvements range from significant declines in Black infant mortality and an approximately 19% drop in mortality rates for Black men.

Black patients and patients of color also were more likely to get preventative care when their clinician shares their racial background. And 83% of Black mental health providers believe racial concordance is important to patient outcomes, according to the Journal of Racial and Ethnic Health Disparities. 

But nurses are heading for the exits in droves.

A 2022 national workforce survey of almost 335,000 registered nurses, licensed practical nurses, and licensed vocational nurses found that more than 25% of them were planning to leave the profession by 2027, through retirements as well as resignations, according to the National Council of State Boards of Nursing. 

The Bureau of Labor Statistics (BLS) predicts that between 2022 and 2032, the country will see 193,100 openings for registered nurses each year. But the actual workforce, according to the BLS, will likely increase by 177,400 each year.

However, there was one bright spot amid all the data: Historically Black Colleges and Universities (HBCUs) are overperforming when it comes to nursing education. Only 2% of all colleges and universities are HBCUs but as of 2017 they had graduated almost 7% of nursing-school graduates. 

And a wealth of research shows the presence of Black nurses helps decrease health disparities. When patients and clinicians share the same racial or ethnic background Black infant mortality declines significantly and for Black men mortality can drop by as much as 19%. 

Black patients are also more likely to pursue preventative care when their healthcare provider is Black. And a whopping 83% of Black mental health providers say this racial concordance is important to care outcomes

Legacy of discrimination

Yet, more than 40% of nurses said they experienced racism or discrimination while in nursing school, with nearly 80% of nurses calling for more diversity, equity, and inclusion (DEI) training in nursing education, according to a 2023 Robert Wood Johnson survey and interviews of nearly 1,000 nurses. 

A combined 44% of respondents reported that racism or discrimination was part of their nursing school’s culture to some extent.  

There’s evidence that the profession is trying to address racism within its ranks. 

“If we are to truly provide just and equitable care to our patients, we as nurses must hold ourselves accountable for our own behavior and work to change the systems that perpetuate racism and other forms of discrimination, said Beth Toner, RH, the foundation’s director of program communications. 

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