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Bridging The Health Care Gap For Many Latinos


SCSU Nursing students teach healthy eating habits at the Spanish Community of Wallingford.

Bill Sarno/
For many Hispanics living in Connecticut during the 1980s, the health care system care seemed alien and inaccessible, populated by nurses and other providers who did not talk like them, did not understand their culture and did not appreciate their financial barriers.
If a patient could only communicate effectively in Spanish, it might take a little effort but a translator usually could be found among the aides and physicians at a major medical center, such as Hartford Hospital. Or the housekeeping staff might help, recalled one longtime health care provider.
And if she was on duty that day, a young Hispanic nurse named Elizabeth Perez not only would bridge the language gap but could relate to the patient’s cultural background. But she was the exception.

Elizabeth Perez, RN remembers having to serve as interpreter anytime she was on duty in the 1980s.

In the 1980s, Connecticut’s Hispanic population was growing but was still only a quarter of what it is now, but had produced few nurses. Perez, a New Britain native, recalled, “There was one other graduate nurse who was Spanish-speaking on the floor.”
Thirty years later, many Latinos, especially those living in what the government has designated as under-served areas, encounter a health system where their now more Latino nurses and other providers, but hardly anywhere proportional to their population.
During Perez’s career, which now finds her at Aetna as a health consultant, Connecticut’s Hispanic/Latino sector has grown to more than 550,000, or about 15 percent of the state’s population. However, this group only accounts for about 3 percent of the state’s 62,924 licensed registered nurses and its 4,279 advanced practice registered nurses.
The figures are a little better nationally. Hispanics comprise more than 17 percent of the total population and Latino/Hispanic nurses is marginally better. They represent 4.8 percent of the nation’s 2.8 million nurses, according to the U.S. Department of Health and Human Services.
“The number of Hispanic nurses is growing, but not as fast as what is going to be needed,” said Maria Krol, the president of the Connecticut chapter of the National Association of Hispanic Nurses, whose membership is predominantly drawn from Fairfield and New Haven counties. In Connecticut, there is not only a nursing shortage but the nurse population and overall population are aging.
The road into nursing careers is not an easy one. There are educational hurdles as well as financial challenges. Krol, who is an assistant professor of nursing at the Southern Connecticut State University, is well aware of the cost factor through working with students who must juggle tuition costs and family obligations from her own experience.
The path into nursing that Krol, who was born in Peru, pursued included three years in the U.S. Army. This service enabled her to use the G.I. Bill to finance her nursing education. She now holds a master’s degree from Sacred Heart University and a doctorate of nursing practice, leadership and education from Oakland University. Over the last 26 years, she has worked as a nurse and later as an educator for more than a quarter century. 
Once Latinos make it to nursing school, keeping them there is another challenge. In some cases, financial concerns mean that students find it difficult to study full-time. “Many of our students receive financial aid, but also a lot work at jobs to help their families, and that can present problems,” Krol said.
The Hartford chapter, of which Perez is secretary, provides three scholarships which designed to help existing students. Recipients have to have already matriculated in a nursing program, said Perez, who started her nursing education at Mattatuck Community College and now holds a master’s degree in nursing with a public health focus from the University of Hartford.
Along with organizations such as NASN, an array of federal, state, academic and private sector entities are engaged in initiatives to increase the number of Hispanic and other minority nurses and upgrade their training and education beyond basic RN certification. They want to make care more effective and available culturally competent and more reflective of the nation’s ethnic and racial diversity.
The emphasis on greater inclusiveness in the nursing workforce is not an overnight revelation, according to Marcia Proto, executive director of the Connecticut League for Nursing. “This emphasis has always been out there nationally, but now is being framed differently,” she said.
The federal Office of Minority Health has gathered several studies that indicate satisfaction with care is greater and its proficiency improves when patients are treated by providers of the same race or ethnicity, or who know their native languages and culture. Moreover, nurses and health professionals from minority and socioeconomically disadvantaged groups are more likely to provide care in underserved communities.
Proto also cites the pro-active involvement of the Joint Commission, an independent, not-for-profit organization, which  provides accreditation and oversight to health care organizations, including hospitals, clinics, nursing homes and physician’s offices throughout the nation. For several years, the commission’s evaluation teams have made it a point to critically observe how well providers communicate culturally and linguistically with diverse patients.
In Connecticut, there is a growing need to replenish an aging and ready-to-retire, mostly white and female nursing workforce. One part of the solution, recognized by labor and health agencies and organizations such as the Connecticut Nursing Collaborative Action Coalition (CNC) and the Connecticut League for Agencies, might be Latinos who generally are younger than the general population.
“Latinos need to be a larger component in filling the pipeline, period,” said Lisa Sundeen, director of the Connecticut Nursing Collaborative Action Coalition (CNC). This organization has been working with the labor department to quantify and bring attention to the need for more new nurses in Connecticut.
Connecticut has as many as 1,700 nursing positions open, according to a 2015 state Department of Labor study. Moreover, CNC-AC  reports that 51 percent of nurses in Connecticut are age 55 or older. In 2013, the Connecticut League of Nursing projected that 28 percent of the nursing workforce, more than 17,000 nurses would retire by 2018.
In less than a decade, the state’s demographics is expected to resemble Florida’s in that about a fifth of the population will be at least 65 years old. As a result, there will be additional strain on healthcare resources and a heightened need for qualified nurses, according to a 2006 study on the impact of an aging workforce published by the Connecticut League for Nursing.

A group of SCSU students is talk to youngsters at Leap Kids Org., an after-school program in New Haven.

in an effort to recruit more Latinos into nursing, NASN members are going out into the community, addressing school groups and serving as role models, Among their selling points is the important roles nurses play in the health care system and that with the emergence of new technologies and special programs this is an exciting time to be a nurse. In addition, a nurse who is bilingual is a “shoe-in” for a good job, one nursing activist noted.
Potential nurses are learning that if they have the calling for this profession, the compensation and career opportunities are excellent. Salary figures vary depending on the timing and scope of the study, but nurses pay generally runs higher than the general average.
According to the American Association of Colleges of Nursing, the national average for nurses in 2014 exceeded $91,000. Another study by the Bureau of Labor Statistics in May 2013 found that the mean salary for nurses in Connecticut was $76,280.
 The numbers are even more impressive for nurse practitioners. An APRN who is qualified to prescribe medication, as well to diagnosis and treat diseases, in 2011 drew an average income of $96,916 in Connecticut, and over $100,000 in Stamford and New Haven, according to American Academy of Nurse Practitioners.
Perez said that while there are more Hispanic students who would like to go into nursing, a crucial factor is what guidance they receive regarding the profession’s educational requirements. Krol and Perez suggested that the quest to become a nurse might need to start as early as eighth grade.
A major concern is that many Latinos are not placed in a college preparatory curriculum and do not take enough science courses. Those who have had these classes in high school, will do better when they pursue a nursing degree,” Krol said.
“When the light bulb goes off in their senior year of high school,” Krol said, these potential nurses often are not qualified academically. Then what happens is that they get into the nursing curriculum, some may do poorly in their science classes, noted the Peruvian born nurse-educator, and this can impact retention in a college nursing program.
Once minority students have made it into nursing school, NAHN continues to play an active role, setting up mentoring and establishing student groups. “We want to help find ways to keep minority students enrolled,” said Krol, who has a doctorate in nursing and is an associate professor of nursing at Southern Connecticut State University in New Haven.
On the plus side, there is evidence that more Hispanics are entering this career’s pipeline. Last year, they comprised 11 percent of the nursing students in Connecticut in the state identify. This is an improvement from 2013 when the figure was 9.4 percent, Proto said.
There also is identifiable progress in the pursuit of higher degrees beyond RN certification, although Hispanic nurses now only represent less than 3 percent of those Connecticut nurses with at least a bachelor’s degree in this field.
“The message we are sending is that if you are entering nursing at the associate degree level is that we want you to progress to at least the baccalaureate level,” said Sundeen, who is a nurse but now focuses on education. “Health care has become a lot more complex and requires a greater skill set.” she said.
The American Association of Colleges of Nursing found that in 2015 Connecticut nursing schools enrolled 5,879 nursing students in baccalaureate and graduate school programs and generated 1,500 graduates. Minority students, which included Hispanics, African-Americans, Native Americans, Pacific Islanders and people with two or more races, represented 22 percent of the master’s degree students and 19 percent of the PH.D candidates.
Another challenge is how to create cultural climates at nursing schools that make Hispanic students more comfortable as well as more likely to succeed.
A recent University of Washington study found that faculty behaviors and the curriculum were responsible for an unconscious “climate of whiteness” that made non-white students feel like “others.”
Krol, who is the only Latino member of the SCSU nursing faculty, said there is a need for more minority faculty, people who can talk with students aware of their cultural background and the barriers they face.
The shortage of qualified nursing faculty is an issue the American Association of Colleges of Nursing has targeted. In 2015, AACN reported, in Connecticut there were 11 faculty vacancies and the average age of faculty members was 55. Pay is cited as one factor that keeps nurses from joining nursing school staffs. In 2014, the association said, the average salary nationally of an assistant professor of nursing was $75,600 or nearly $16,000 less than for a nurse.
Finding enough space for additional Latino students and others seeking to attend nursing school is another problem, but nationally and on some campuses. Krol would welcome an increase in faculty and clinical facilities at SCSU. She noted each year about 145 sophomores declare for the nursing program but only 80 can be accepted .
One way the limitation on nursing school facilities for students seeking BS degrees and higher, is through Connecticut’s community college program. Currently, six of these two-year schools offer an associate’s degree and preparation for RN status. These transfer students pose less of a strain on SCSU’s resources, Krol said, because they already have completed their clinical requirements.
The community college route also can lessen the financial burden, which is cited by several studies as particularly difficult for Latinos, who often come from lower-income families and have to take jobs while trying to attend college.
While federal and state aid programs provide valuable assistance, the dollar amounts fall far short of student need, according to the Robert Wood Johnson Foundation. The American Association of Colleges of Nursing’s 2013-14 survey of nursing graduates who received aid through the U.S. Health Resources and Services Administration  programs, the debt of nurses who had earned BSN, MSN, DNP, and PhD degrees averaged $33,300, $52,218, $67,905, and $64,457 respectively.
Among the reasons additional financial aid for nursing students is important, Sundeen said, is because these programs are a little more expensive than average. The extra costs include background checks, uniforms and lab fees which can add as much as $1,000 to the college cost.
In fiscal year 2015, federal nursing workforce development programs provided $2,880,389 in Title VIII funds for nursing education programs and individual students, according to AACN.
Entering the 2016-17 academic year, the University of Saint Joseph received $930,000 from a U.S. Health Resources and Services Administration (HRSA) to create scholarships dedicated to “under-represented students” studying full-time for a bachelor of science in nursing. The West Hartford school said it plans to use this money to provide $20,000 to $25,000 per year for four years to assist exceptional female students.
This fall, USJ has awarded seven of these scholarships, one to a Hispanic female. More scholarships will be offered in the future, with a total of 17 planned using the HRSA grant funding. In addition, 41 Latino undergraduate and graduate nursing students are currently enrolled at USJ, representing 11 percent of all nursing students at both undergraduate and graduate level.
University President Rhona Free expressed pride in the scholarship program. “Such an investment will benefit our campus and our community,” she said.

SCSU nursing students talk to students at Sound School in New Haven about nursing as a career.

At many nursing schools, students are not waiting until they get their RN certification to help their communities. At Southern Connecticut, a student nursing association was started and its members are actively volunteering at schools and local health programs, Krol said, adding that this includes going out to heavily minority communities and working with organizations such as the Spanish Community of Wallingford.

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