Vanderbilt Health nursing leaders address the need for greater diversity amid a shrinking nursing work force.

Many nurses are aging out of the profession. Others are simply leaving – or at least leaving the hospital setting, exhausted from the burden of understaffed floors.

Though long anticipated, the nation’s growing nursing shortfall grabbed the spotlight during the COVID-19 pandemic, which highlighted the ongoing critical need for educated, experienced and caring professionals in the hospital setting.

Compounding the problem, nearly 92,000 applications to nursing schools were rejected in 2021 due to a shortage of qualified faculty to teach them and limited access to supervised clinical-practice opportunities, according to Mamie Williams, Ph.D., A.P.R.N., senior director for nurse diversity and inclusion at Vanderbilt University Medical Center.

Despite these challenges, Williams is in charge of not just attracting more nurses to Vanderbilt Health, but building a diverse staff that better reflect the makeup of the patient population.

Nursing at the Center

In June, 2023, Williams and VUMC’s executive chief nursing officer Marilyn Dubree, M.S.N., co-authored an article that made its way onto several health care professional career sites in which they identified “nurse engagement” as the hub of Vanderbilt’s staffing strategy.

Radiating from the hub are spokes covering a wide swath of initiatives, including running a nurse leadership academy and residency program, working with high school academies on health care career options, and providing staff nurses more options for tuition assistance and loan forgiveness.

The need for greater diversity in health careers is a longstanding issue that has become more urgent with the recognition of racial and economic health disparities and medical care that grows more patient-centered and personalized.

“At Vanderbilt Health, education and advancement opportunities are open to people of all races and ethnicities. But my group’s particular effort is centered on encouraging, mentoring and providing assistance to members of underrepresented groups, including men, who may have considered nursing or advancement in nursing to be daunting, or who have run up against barriers to moving toward their goals,” Williams said.

Dual Forces

The country’s nursing shortage is projected to rise to a 510,000 registered nurse shortfall by 2030, analysts project. Baby-boomers are creating a bulge in the geriatric patient population, living longer than previous generations. Meanwhile, many aging, experienced nurses are ready for retirement.

Another factor – population growth, where the United States is leading the pack among developed nations – is exacerbating the nursing shortfall.

By 2030, the country’s population, now with about 335 million residents, is estimated to expand by 24 million people (7 percent), further straining the health care systems. These numbers are in addition to the country’s estimated 11 million undocumented immigrants who may utilize U.S. health care services.

Need for Diverse Providers

Demographics underscore the need for more diversity in the nursing work force. With growth in the white population sputtering and even shrinking in some parts of the U.S., nonwhite citizens are expected to outpace the historically majority population over the coming decades, according to the U.S. Census Bureau. Yet, about three-quarters of registered nurses are white, and about 87 percent of those with an R.N. or advanced degrees are female.

“By growing a nursing staff that better reflects our patient population, there is also a more balanced cultural environment with richer perspectives on policy issues.”

Unaddressed, this threatens to expand the current cultural gap in health care settings, where greater health care diversity is associated with improvements in patient care and the organization’s financial performance.

“By growing a nursing staff that better reflects our patient population, there is also a more balanced cultural environment with richer perspectives on policy issues that arise,” Williams said. “This is a win for patients and staff.”

Many Facets of Engagement

Williams has recruited her current staff to actively participate in the diversity mission, aiming at all rungs of the nursing ladder. During focus groups, she has probed barriers to retention, along with factors related to job satisfaction and advancement. To truly engage diverse staff, she encourages them to join hospital committees or other initiatives to affect policy decisions and prepare for leadership roles.

“We provide role models that some of our nurses have never had along the way in life.”

Vanderbilt instituted one of the first accredited nursing residency programs in the U.S, in which Williams’ role is to ensure equitable access toward a diverse applicant pool. Under Williams’ leadership, a new one-year leadership academy is inviting diverse employees new to management to team with a mentor in a leadership role.

“We provide role models that some of our nurses have never had along the way in life, to help them navigate advancement pathways,” Williams said.

Pipeline Development

Expanded tuition assistance and loan forgiveness programs are also available for employees wanting to advance. This effort, in part, is to encourage those in jobs like environmental services, patient transport and nutrition services to move into higher job grades.

“Anyone can enter the program, and we have had across-the-board diversity, but since 90 percent of these staff members are non-white, this program helps us meet our diversity goals on up the line,” she said.

To support an even earlier pipeline, Williams began a collaboration with Pearl Cohn Health Care Academy, one of five high schools in the Metro Nashville area devoted to medical career training.

“This last year, VUMC nurse mentors worked with 26 high school seniors enrolled in a first-of-its-kind mentorship program with the Pearl Cohn High School Health Care Academy,” Williams said.

“All 26 students were accepted to colleges, and more than half accepted summer jobs at VUMC as CNAs [certified nursing assistants] upon high school graduation.”

The program at Pearl Cohn will expand to 35 students next year, and Williams hopes eventually to extend it to Nashville’s other four health care academies.

Williams said she is the first nurse in her family, but a sister, niece and a cousin have since followed her into the profession.

“Sometimes it just takes an example,” she said. “For these young people and for our nurses who seek advancement, our mission is to guide them through the steps along the path.”

About the Expert

Mamie Williams, Ph.D.

Mamie Williams, Ph.D., M.P.H., A.P.R.N., serves as the senior director for nurse diversity and inclusion at Vanderbilt University Medical Center. She is a co-director and task force member of the Academy for Diverse Emerging Nurse Leaders at Vanderbilt School of Nursing, the executive sponsor of the VUMC Nurse Diversity Equity and Inclusion Committee and co-chair of the VUMC Racial Equity Task Force.