Black History Month is an annual celebration of achievements of black Americans and a time for recognizing the central role of African-Americans in U.S. History. Duke University School of Nursing (DUSON) has its own history in confronting racial issues. During the Fall of 1967, School of Nursing students joined others from across Duke for a sit-in to demand that student groups stop using University funds to patronize segregated facilities in Durham. This was also during the time that DUSON enrolled its first black student Donna Allen, who would later join the DUSON family as a nurse researcher.

While nursing is an excellent career that offers a wide variety of opportunities for clinical practice, research and education, the racial and ethnic makeup of its workforce is largely homogenous with a disproportionate number of minority nurses, including men. According to a 2013 survey conducted by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers, nurses from minority backgrounds represent 19 percent of the registered nurse (RN) workforce. African-Americans and Asians comprise six percent of this population with Hispanics, American Indian/Alaskan Native, Native Hawaiian/Pacific Islander and Others comprising one percent.

In this article, three Duke University School of Nursing (DUSON) professors Brigit Carter, PhD, MSN, RN, CCRN, associate professor and director of the Accelerated Bachelor of Science in Nursing Program; Schenita Randolph, PhD, MPH, RN, CNE, assistant professor; and Michael Cary, PhD, RN, assistant professor, discuss their entry into the nursing field, barriers for minorities in the field of nursing and how to accelerate the progression forward.

Carter’s nursing experience of more than 18 years started in the clinical setting of the Duke Intensive Care Nursery. She finished her PhD in 2009 and moved into academia in 2010.

Randolph has more than 19 years of nursing experience, 12 of which are in nursing education. She started her career as a staff nurse at Wake Forest Baptist Health and then continued her nursing career in community/public health as a public health nurse, home health nurse and school health nurse.

Cary has more than 10 years of nursing experience that started in an entirely unexpected manner. After graduating with a degree in health services administration, he began working in the regional office of a large health insurance company as a quality consultant. He was responsible for overseeing a financial incentives program for primary care physicians. After two short years with the company, his position was eliminated due to company restructuring.

The Beginning

What inspired you to pursue the field of nursing?

Carter: There was not a loud clap and lightening that moved me into nursing. I was in the U. S. Navy, and my assignment was working with nurse recruiters. But as soon as I heard about the profession and the opportunities it provided, I never looked back! My then fiancé was happy to support my dreams and has done so through three degrees.

I will say that the scholarship and mentoring I received through Duke was so amazing. I worked on the surgical floor at Duke Hospital while going to school, and the nurses were so inclusive, teaching me every step of the way and encouraged me until I finished my degree.

Randolph: I was influenced to become a nurse by my great aunt who was a nurse for more than 30 years before she died in 2001. She would often share her experiences of working with her patients and families in New York. When it was time for me to go to college, I knew exactly which school I wanted to attend but was unsure of my major.

My aunt shared with me some of the joys of nursing, the promise of a job after graduation and that nurses made a pretty decent salary. Additionally, my close friend from high school was attending the same university, and we were actually going to be roommates and her major was nursing.  So, there you have it, everything seemed to fall into place – so I chose nursing.

Cary: After experiencing a significant life change so early in my career as a quality consultant, I had to come up with a Plan B. I began thinking about next steps, and my department chair, who was a former RN, suggested nursing school. He was a relatively young Pilipino man who mentored me through this time of crisis. I gladly held onto every nugget of advice as he frequently demonstrated an intimate knowledge of the health care system, which I admired.

A clear clinical training, coupled with my health services background, would be a particularly powerful and unique skill set. So I enrolled in an accelerated bachelor's of nursing program at the University of Virginia.

What has been your most memorable moment in your nursing career?

Carter: Oddly enough, I have that moment on video as the Learning Channel was doing a day in the life of a nurse. That day I was taking care of an extremely ill premature infant who we knew was going to die, but his mother was also in intensive care and unable to be there to hold this precious baby.

I held, rocked and sang to this little one as he passed away. It was the most special moment of my life, to be there for that mother when she could not be there herself. How we give back comes in many different forms, but my most precious memories are when I am able to make the difference in the family’s experience.

Randolph: Unfortunately, my most memorable moment in my career was not a good one.  I was fresh out of nursing school and landed a job at a local hospital. My first day on the floor the nurse manager walked me to the nurses’ station and introduced me to the nurse who was assigned to be my ‘mentor’ while in orientation: “This is Schenita. She will be working with you throughout her orientation.” The nurse looks at the manager, looks at me, pauses and says, “Oh, really, well if I must.” 

I stood there for a moment – a new nurse, new job and new experience – and I thought to myself, “What just happened?” Although a terrible first experience, it has always been a story that I often share with my students. I always encourage them to be the compassionate nurse that the art of nursing teaches you to be and to do it with patients, families and others on your team.

Barriers

Historically, there has been a lack of diversity in the nursing profession. How did you deal with this as you advanced in your career?

Carter: While there is a lack of diverse nursing faculty, this was not a barrier to my development. What we must realize is that those that are born to nurture and support do not have to look just like us. This may never be the case so seeking out mentors who are interested in your work, career and progression is the most important thing.

I was very fortunate to have a multitude of mentors, some African-American but most who were not, and each supported me in different capacities. What is significant about having diverse faculty is the ability for them to relate to the challenges we do face due to race, gender or other descriptors of diversity.

Randolph: I was intentional about collaborating with other nurses and disciplines within the university and outside of the university. Building relationships with others who are different but share the same goals was important for me in order to learn different views, perspectives and approaches that would impact my decisions and career advancement.   

Cary: I have been fortunate to find great mentors in the nursing profession – many who were racially and ethnically diverse and others who were not, but equally invested in my success. One such mentor introduced me to Robert Frost's poem, "The Road Not Taken.” Over the years, whenever I encounter moments of doubt, I often reflect on the last few lines: “Two roads diverged in a wood, and I –, I took the one less traveled by, and that has made all the difference.”

Call to Action

What recommendations do you have to improve diversity in the nursing field, including clinical practice, education, research and leadership?

Carter: These are the most important questions: What do we plan to do in the future? How can we make a difference?

I have been fortunate to be a part of two Nursing Workforce Diversity grants supported by Health Resources and Services Administration. These programs provide opportunities for students to enter into the profession and attend superior institutions such as Duke and then work within the health system.

We have to first begin by educating high school students about the profession of nursing and then mentor them as they exit high school and transition into college. We also have to address the barriers that minority students have in high-level education systems, including academic, financial, lack of emotional and social support, and lack of diverse mentors.  

Randolph: The need to recruit diverse students who will go into nursing is paralleled by the need to recruit more faculty from minority populations. Few nurses from racial or ethnic minority groups with advanced nursing degrees pursue faculty careers.

According to a 2012 American Association of Colleges of Nursing survey, only 12.3 percent of full-time nursing school faculty comes from minority backgrounds. I have made a personal commitment to provide mentorship for some of my previous students who have made decisions to go into nursing education. I want to mentor them in their development plans and professional growth as they prepare to have a career in higher education and academia. 

More funding, support and resources for historically black colleges and universities (HBCUs) that have undergraduate nursing programs is needed. HBCUs in our surrounding area produce the largest number of African-American/Black nurses in the state of North Carolina, yet some lack research infrastructure, and the ability to recruit and retain faculty. The appropriate resources would better prepare future nurses and faculty for research and leadership trajectories.

Cary: I believe equity and inclusiveness need to be considered as core values of all schools of nursing. Operationalizing such efforts might result in the increased recruitment and retention of underrepresented minorities among nursing students, faculty and staff and bolster financial and social support to increase their confidence and commitment.

In addition, develop curricula that include common threads (i.e., racism, social determinants of health, health access and health disparities) that run seamlessly through all levels of nursing school education and philosophy. Also, develop holistic admissions policies and procedures that consider metrics beyond grades and standardized test scores of prospective students, but also focus on increasingly cultural sensitivity and implicit biases of reviewers.

Looking Forward

What words of advice or encouragement would you give to the underrepresented populations in the nursing profession, including students?

Carter: Our Nursing Workforce Diversity grant mantra is: “To whom much is given, much is expected” (Robert Kennedy). Once you have achieved your goals, don’t forget to reach back and pull the next person through. You don’t even have to wait until you have achieved all your goals. There is always something that you can do or some wisdom you can impart to help support the next prospective nurse.

Be strong, be committed and you will persevere. NEVER GIVE UP YOUR DREAMS!

Randolph: Diversity means having people who are different races and cultures within an organization, and it means having many different forms, types and ideas. Therefore, be you. Be great.

Cary: Don’t be afraid to fail – it is a frequent occurrence along the road to excellence.