Whether you are already part of the industry or are considering starting your career in healthcare, you may wonder about the current state of diversity in nursing, especially if you, too, come from a community that has been historically underrepresented and underserved.
If you wish to better understand the current state of healthcare regarding diversity and equity and the methods by which industry leaders, workplace managers, and nursing personnel can tackle the ongoing challenges and barriers to a more inclusive nursing workforce, we have prepared a comprehensive presentation that will explore all the essential elements and facts of the matter.
What Is Diversity in Nursing?
Nursing diversity refers both to the degree of inclusivity encountered within the nursing field and an aspirational goal of reaching a more accurate level of representation and equity nursing by encouraging members of previously neglected groups and communities to join the workforce and incorporate their personal experiences into the professional protocols of care.
Thus, the current state of diversity in nursing helps to understand possible elements in the field that discourage aspiring nurses from pursuing the career, as well as identify areas of expertise and practices that may not accurately meet the needs of the communities they serve.
Why Is Diversity in Nursing Important?
With an increasingly more diverse US population, the healthcare industry and workforce are tasked with tackling novel medical scenarios and patient needs, many of which arise from or relate to the complex cultural backgrounds that patients and communities in need of healthcare services feature.
A significant part of the nursing practice involves bolstering positive relationships with patients, their relatives or caretakers, and with the serviced community at large. This process also entails following a treatment methodology and ethos that arises from a culturally sensitive standpoint, one that may be lacking or skewed when developed in and applied by a demographically unrepresentative nursing workforce.
While increasing and promoting equity and diversity in nursing can prove beneficial to the field as a whole, various organizations have pinpointed several concrete benefits to healthcare brought about by welcoming aspiring nurses from different backgrounds, walks of life, and especially from rural, minority, and other underrepresented and underserved communities.
The Impact of Diversity in the Nursing Workforce
Here are the main benefits and advantages of better diversity in nursing education and practice, as identified by the American Association of Colleges of Nursing (AACN), the National Advisory Council on Nurse Education and Practice (NACNEP) and supported by several studies in the past.
Addresses Health Disparities in Areas Where They Arise
Perhaps the most crucial impact of a more diverse nursing workforce is the ability to mitigate health disparities across the spectrum by bringing quality care to previously unaddressed or underserved populations.
One study identified an optimally utilized and growing nursing workforce as one factor for improving access to healthcare for racial and ethnic minorities. However, it also signaled specific barriers, including restrictive state regulations on the scope of practice, disparate reimbursement policies that reduce equity in nursing fields, poor organizational structures, and lack of workforce diversity.
Reducing the effects and occurrence of these hurdles can result in a more equitable and diverse nursing workforce that is ready to tackle disparities in healthcare provision among racial or ethnic minorities.
Improves Patient Outcomes by Meeting Patient Needs
Patient outcomes and the quality of care have been shown to correlate with the level of diversity in nursing practice. A less diverse workforce is one factor contributing to poorer health in the community and higher rates of mortality among minority and underrepresented groups.
Studies show that patients with minority backgrounds find it essential to have a healthcare provider who shares or understands their culture. Additionally, as one National Health Statistics Reports study shows, patients from a minority background are more likely to report never being able to see a culturally similar provider compared to non-Hispanic white adults, and the trend persists regardless of sex, age group, and urbanicity differentiators.
In other words, increasing diversity in nursing can address patient outcomes in ways not addressed by better staffing, more outreach in rural areas, or other modes of improving services and outreach.
If you want to discover other ways of impacting outcomes, read our guide to how nurses’ education can improve patient outcomes.
Helps Increase the Nursing Workforce and Reduces Shortages
The ongoing shortage in nursing personnel is a reality that endangers the continuity of the current healthcare industry. More so, as highlighted in our nursing shortage study, insufficient staffing hurts rural and underserved populations the most.
Increasing diversity in nursing education and practice by enabling aspiring learners from underrepresented and underserved communities to pursue careers in the field is one of the central methods of mitigating the current trends in personnel numbers and healthcare coverage. Not only does it access untapped populations of prospective nurses, but it can also provide sustainable means to equalize discrepancies between urban and rural services, as well as disparities in care for minority communities.
Enhances the Work Environment for All Members of the Workforce
As nurses from different walks of life join the workforce, the emerging working environment changes to incorporate new perspectives and accommodate members who have previously been excluded due to educational or service disparities.
The condition for an enhanced work environment is that nursing leaders, managers, and other stakeholders reinforce the precepts and practices necessary for an inclusive workplace that can invite representatives of various cultural backgrounds to contribute, foster innovation, and promote openness and understanding toward staff and patients.
Reducing unconscious bias and becoming aware of exclusive past practices can bolster a culture of learning about and from other nurses’ experiences and changing approaches for better results, both on personal and organizational levels.
Reduces the Rates of Burnout and Improves the Mental Health of Nurses
A more significant number of nurses in the workforce and a more equitable workplace can help address the ongoing mental health crisis among nurses and reduce the rates of nursing burnout.
According to a 2023 Urban Institute report, Black nurses are prone to experiencing higher burnout rates due to racism from patients and colleagues. Another survey from the National Commission to Address Racism in Nursing reported that approximately 63% of nurses have personally experienced racism in the workplace, with nearly 50% declaring that there is “a lot” of racism in nursing. ‘
Higher diversity in nursing not only tips the balance in personnel distribution, making racist encounters less frequent but also promotes a change in workplace policies and attitudes that discourage prejudiced behavior and facilitate increased inclusivity. Better equity in nursing regarding racial attitudes should be a priority in the field, as 56% of nurses say that racism in the workplace has negatively impacted their professional well-being.
Increases Community Engagement and Culturally Competent Care
While the first effect of increasing the diversity in nursing education and practice will be the promotion of quality healthcare in underserved communities, there are reasons to believe that the introduction of nurses hailing from a background different than the urban, majoritarian one can prepare all members in the field for better community engagement.
According to a national survey on the perceptions of sense of community and community engagement among rural nurses, nurses with the lowest scores on sense of community and community engagement were from larger communities and working in the North. In comparison, those with the highest scores on both indicators were more likely from smaller childhood communities and were in the late middle age group.
Better recruitment and retention practices for nurses can, therefore, be achieved by focusing on the critical traits of personnel in relation to community engagement. The study identifies the need for recruitment from smaller communities, which have been underserved and neglected over time, with other initiatives including matching community activities with the age and stage of the family and developing welcoming strategies for the workplace and community for new nurses.
Since older personnel prove central in bolstering community engagement, especially in small communities, you should consider pursuing the nursing profession, no matter the moment you decide to. Read more about how old you have to be to become a nurse, including whether there are any age restrictions and how the learning and practice experience changes for different age groups.
Current and Future State of Diversity in Nursing Education
Here are the most recent statistics regarding the current demographics of nursing personnel, as well as the emerging trends regarding equity and diversity in nursing.
Current Demographics of the Nursing Workforce
Here is what the current demographics of the nursing industry look like:
1. Gender Breakdown
Approximately 88% of nurses identify as female, with around 12% identifying as male, according to the AACN.
However, on average, women earn 99¢ for every $1 earned by men, according to Zippia. Thus, despite the disparity in representation, gender-based equity in nursing pay is an area worth addressing.
When considering sexual orientation, only around 5% of all healthcare providers are LGBT, which is lower than the 7.1% share of adult Americans who identified as LGBT.
2. Race Disparities
According to the National Sample Survey of Registered Nurses (NSSRN) published by the HRSA, the most common ethnicity among healthcare workers is White (67%), followed by Black or African American (11%) and Hispanic or Latino nurses (9%) and Asian nurses (9%). Pacific Islander nurses comprise 4% of the workforce, while American Indian and Alaska Native nurses make up less than 1% of the workforce.
According to Zippia, Hispanic and Latino nurses have the lowest average salary ($39,267 per year), while Asian nurses have the highest average salary ($43,565 per year).
3. Age Disparities
The average age of nurses is 47.9 years old, with the average age of women in the field being higher than for males across all demographics where there is data for both.
Nurses who are 35 to 44 years old make up the most significant percentage (25%) of the workforce, followed by those aged 45 to 54 years (22%) and nurses who are 34 years or younger (20%). Nurses who are 55 to 64 years old make up another 19%, with those who are 65 or older comprising 15% of the workforce.
The State of Nursing Diversity Based on Role
In order to have a better understanding of distributions and disparities in the nursing field, we have to adopt a more granular perspective. All population demographics vary considerably based on occupation and role.
Ethnic and Racial Underrepresentation in Nursing Roles
Here is the breakdown of racial and ethnic distributions in 2023, according to the Bureau of Labor Statistics (BLS):
| Demographic | Licensed practical nurse or licensed vocational nurse (LPN/LVN) | Registered nurse (RN) | Nurse practitioner (NP) |
| White | 59.20% | 72.60% | 77.80% |
| Black or African American | 31.80% | 15.60% | 13.50% |
| Asian | 5.80% | 8.90% | 7.30% |
| Hispanic or Latino | 12.60% | 8.90% | 5.50% |
It is worth observing that most non-White groups are overrepresented in frontline roles, with the percentage of Black or African American nurses working as LPNs being more than double the share of the population (12.6% as of 2021).
The same group is the only non-White demographic to be overrepresented in relation to the share of the national population. In contrast, the Hispanic and Latino demographic is the most starkly underrepresented in nursing relative to the 18.9% share of the national population it represents.
White and Asian nursing shares of the workforce coincide or surpass the share of the national population (59.3% and 5.9%, respectively). Additionally, for both groups, overrepresentation, both absolute and relative, increases with the level of education required by the role. The trend is inverted for other non-White groups.
Gender Distribution Based on Roles
Similarly, the gender distribution in the workplace differs from one occupation to another:
| Role | Females | Males |
| Registered nurse | 87.4% | 12.6% |
| Licensed practical nurse or licensed vocational nurse | 88.7% | 11.3% |
| Nurse practitioner | 89.8% | 10.2% |
As established before, women comprise most of the healthcare provider workforce, generally surpassing males over 7 to 1. This is true in most frontline care occupations, where the ratio of women to men in the workforce approaches 9 to 1.
While the number of male nurses has been steadily increasing since the 1970s, it reached a recent stall in 2022, when the share fell from 13.3% from the previous year to 12.1%. However, 5-year trends still indicate an overall upward trend, and we can expect to see more male nurses in the future.
Read more about why men should embrace a nursing career and the benefits of better gender-based equity in nursing for the industry and for its outcomes.
What Is the Future of Diversity in Nursing?
The US is expected to have a majority non-White population by as early as 2045, and the trends in the nursing workforce reflect the broader demographic changes.
Most non-White nurse populations are steadily growing from one year to another, with the Health Resources and Services Administration (HRSA) stating that the trends are consistent with the changes in America’s ethnic makeup.
There is one exception, however, as both the share of Hispanic nurses and of Spanish speakers in the field dropped by approximately 2% in recent years, according to Axios. Similarly, the percentage of White nurses fell by nearly 20% in 10 years.
So, while we can expect the diversity in nursing fields to reflect the changes in demographics nationally, we can also notice some ongoing disparities that may exacerbate specific crises in healthcare provision to underrepresented and currently underserved communities if they go unaddressed.
What Are the Barriers to Promoting Diversity in Nursing?
The challenges of promoting inclusivity and diversity in nursing fields are multifaceted and multilayered. They can start from the educational stage and may continue into the later stages of professional practice.
Challenges to Inclusivity at the Educational Level
One 2024 study identified and studied various barriers to creating an inclusive environment in nursing environments. The challenges to incorporating change include institutional racism, power differences, privilege, and implicit biases.
While the primary method to grapple with these ongoing issues in nursing education is highlighted to be the implementation of diversity, equity, and inclusion (DEI) initiatives within schools, the ways to approach the current academic landscape can differ.
For instance, one sure approach to encouraging students from underrepresented and underserved communities to pursue higher education and a career in nursing is by providing material support in the early stages and throughout their learning experience. That is what the Nightingale Foundation has endeavored to offer through its nursing scholarships, prioritizing traditionally underserved and underrepresented student populations. Additionally, the Foundation runs a Community Education Outreach program that reaches out to low-income and underserved school districts across various states to conduct educational outreach presentations and engage with prospective students early in their post-secondary education journey.
Find out more about the activities of the Nightingale Foundations and how you can support its efforts to promote better inclusivity.
Barriers to Diversity in Nursing Practice
Nurses from minority backgrounds face multiple challenges in continuing their practice as part of the workforce and in advancing to leadership roles.
One case study on Black and African-American nurses in the US has shown that seven recurring themes can indicate hurdles in the career advancement of minority personnel. These are the attempt to maintain white comfort, distrust, a lack of colleagues that are alike, efforts to pave the way, not finding oneself worthy of representation, considering that leadership roles are not expected of Black nurses or minority nurses, in general, and a discrepancy between the level of the degree held and the resulting opportunities. Another study that included a more diverse sample of minority nurses from across the US has similarly confirmed that participants desired opportunities for career advancement and leadership development but encountered entrenched systemic and organizational barriers and obstacles in fulfilling roles with an impact towards diversity and equity in nursing.
How to Promote Diversity in Nursing Education?
The first attempts at mitigating disparities in the workforce and enhancing healthcare provided to minority communities should start within the educational environment. Academic institutions and stakeholders should take steps toward promoting and offering quality education to prospective learners from traditionally underrepresented and underserved communities. As we have seen, promoting education and helping students from smaller and rural communities not only balances the current disparities but also has a noticeable impact on community health and lower levels of shortage in provided services.
Here are the main actions that educational institutions should perform or adopt to increase diversity in nursing education:
- Recruit from Underserved Communities: Institutions should focus on attracting nursing students from underrepresented, rural, and low-income areas to build a workforce that mirrors the diversity of the current US population. Additionally, stakeholders should partner with local schools, community centers, and outreach programs to inspire interest in nursing as a viable career path, emphasizing the need for diverse perspectives in healthcare.
- Implement DEI in Schools: Integrating diversity, equity, and inclusion (DEI) principles into nursing school curricula is a central step for change and can create an environment where all students feel valued and included. This approach can consist of developing cultural competence training, addressing implicit biases, and ensuring that the curriculum reflects diverse patient needs and healthcare scenarios.
- Support Early Education Initiatives: Institutions, authorities, and stakeholders should develop or promote early-stage outreach programs that provide educational resources, mentoring, and scholarships. These initiatives help students from underrepresented communities overcome financial and informational barriers to nursing education, making the learning path and the subsequent career more accessible for a broader range of learners.
The activities and resources of the Nightingale Foundation follow the same principles when it comes to providing material support and guidance to prospective nursing students coming from traditionally underserved and underrepresented communities. The nursing scholarships offered by the Foundation aim to promote excellence in the nursing field while also addressing the possible negative impacts of a lack of resources, poor access to education, or systemic bias.
Additionally, the Nightingale Foundation organizes a Community Education Outreach program that reaches out to schools from low-income and underserved districts across the country in order to offer educational outreach presentations and engage with potential students as early on as possible in their journey. The program provides education and materials and addresses learners’ financial needs and concerns regarding enrolling in a nursing program after graduation.
Learn more about the activities of the Nightingale Foundation and find out how to support efforts to enhance diversity and equity in nursing education.
How to Increase Diversity and Equity in Nursing: Strategies for Nurse Leaders
Nursing leaders are responsible for participating in governmental, institutional, and managerial efforts to increase diversity and equity in nursing workplaces. Here are the main elements that should be incorporated into the daily professional activities of any healthcare environment to promote more inclusivity and reduce potential barriers to integration:
- Create Inclusive Work Environments: Nurse leaders should promote a workplace culture that values diverse perspectives by implementing training on unconscious bias, racism, and cultural competence.
- Promote Leadership Development: Employers and institutions must offer career development programs and training explicitly aimed at minority nurses to overcome systemic barriers and satisfy the need to advance in leadership roles.
- Address Pay and Role Disparities: Leaders and employers should ensure and maintain pay equity and remove barriers that keep minority nurses in lower-level roles by providing opportunities for advancement.
- Increase Mentorship Opportunities: Institutions must develop mentorship programs where experienced minority nurses guide and support new nurses from similar backgrounds.
- Support Mental Health: Developing supportive policies that reduce nursing burnout is necessary, especially for minority nurses who may face additional stressors such as racism or isolation.
- Foster Culturally Competent Care: Nurses should be trained in cultural sensitivity to ensure they provide patient care that respects and aligns with the diverse requirements that arise from various backgrounds.
- Increase Community Involvement: Leaders must encourage nurses to engage with served communities, particularly in rural or minority areas, in order to build trust and improve healthcare delivery.
- Match Nurses with Culturally Similar Communities: Pairing minority nurses with communities of similar cultural backgrounds can enhance patient satisfaction and outcomes, as well as bolster a better community impact and cohesion.
- Advocate for Policy Reforms: Any stakeholder in the healthcare industry should push for healthcare policies that eliminate barriers to practice, such as restrictive state regulations and disparate reimbursement policies.
- Reduce Workplace Racism: The implementation of clear anti-racism policies and practices that address the root causes of discrimination within healthcare settings can reduce the discouraging factors for new nurses from underrepresented backgrounds, as well as diminish stressors associated with working in the field as a minority nurse.
- Monitor and Adjust DEI Initiatives: By continuously evaluating DEI programs to measure their effectiveness, stakeholders and industry leaders can make necessary adjustments to meet evolving workforce and community needs.
- Encourage Late-Career Transitions: Workplace managers should promote nursing as a viable career option for older adults, especially those from underrepresented communities, to aid in the tackling of workforce gaps and shortages.