Nobody has yet officially counted the number of minority nurses who hold upper management positions. But everybody knows what such a census would reveal: There aren’t that many of you at the top. Despite the rapidly increasing racial, ethnic and cultural diversity of the U.S. population, nurses of color are still finding it difficult to break into the executive suite at the nation’s health care facilities.
“I think for a lot of minority professionals, there’s not just a glass ceiling at the top—it’s more like a cement ceiling,” says Arneatha Martin, RN, MSN, ARNP, who is the CEO and co-president of the Center for Health and Wellness, a health care center serving the predominately African-American community in northeast Wichita, Kansas. “After you hit your head on that cement too much, it starts bleeding.”
In a 2002 research study, Minority Nurses in the New Century, led by pioneering African-American nursing scholar Hattie Bessent, RN, EdD, FAAN, 46% of African- American nurses surveyed felt they had been turned down for a job promotion that they were qualified to fill. Almost 60% of these nurses believed they lost the job because of their race. The study was funded by the W.K. Kellogg Foundation and sponsored by the American Nurses Foundation (ANF), an affiliate of the American Nurses Association (ANA).
“The African-American nurses often said that their supervisors had less education than they did, and they often had to teach their supervisors how to do their job,” says Bessent, who is director emeritus of the ANA’s Ethnic Minority Fellowship Program.
But despite the odds, a growing number of minority nurses are indeed rising to upper-level management and administrative positions across the United States. How did they manage to break through the barriers to get where they are today? According to the nurse managers who were interviewed for this article, it takes a healthy mix of hard work, tenacity and courage. As Ruth W. Brinkley, RN, CHE, president and CEO of Memorial Health Care System in Chattanooga, Tenn., puts it: “I’ve run into some glass ceilings, but I didn’t let them stop me.”
The first step to the executive suite is a solid education. “[Minority nurses] need to eliminate as many excuses as we can for people not promoting us to the next level,” says Martin. “If you have the right education, then you will have the ability to get a [promotion] when it becomes available. And if you don’t get the job, you’ll know it’s not because you don’t have a degree or the right kind of degree.”
While some nurse executives have earned MBAs, Martin strongly recommends pursuing the appropriate nursing degrees before seeking degrees in business or other fields. “If you’re a nurse, you should have a BS in nursing,” she advises. “Then, when you pursue a master’s, first get an MS in nursing. If you think you need to know accounting or business, then get a second master’s in those fields. But you’ll have better luck if your first degrees are in nursing, which is your field.”
Strong, versatile career experience also counts. Ampy de la Paz, RN, MS, assistant administrator/compliance officer at Doctors Hospital Tidwell in Houston, Texas, recommends acquiring as many varied work experiences as you can. “If you stay in one specialty, for instance, you will limit yourself,” she cautions. “But if you spend time in medical/surgical, orthopedics and other specialties, then you will have a lot of marketable skills that you can transfer to any setting.”
But sometimes having the appropriate education and experience may still not be enough. When Bessent’s survey asked minority nurses why they were turned down for promotions, the respondents often reported a Catch-22 scenario: Their supervisors said the nurses lacked appropriate leadership training and experience. But how can minority nurses get that experience if they are not taken under the wing of management?
“One of the barriers for minority nurses is the lack of mentoring and exposure that will help them cultivate the skills they need to be quality executives,” Bessent says. “There are many [nurses of color] working under Caucasian executives. But the Caucasians often don’t pull the minority nurses up the career ladder with them.”
G. Rumay Alexander, RN, MSN, EdD, cites the lack of mentorship in her career as a major disappointment. “I needed to be mentored by someone in upper management,” says Alexander, a former senior vice president for the Tennessee Hospital Association who is now director of the Office of Multicultural Affairs at the University of North Carolina School of Nursing in Chapel Hill. “But no one ever really reached out to do that. It meant cross-racial and often cross-gender mentoring, and I don’t think people were comfortable doing that. As a result, I had to do a lot of my learning by trial and error.”
Fortunately, many nursing schools and programs now offer leadership development courses that can help minority nurses acquire the management skills they need. The Minority Nurse Leadership Institute at Rutgers University in New Jersey is just one example. Bessent has also created Project Lead, an ambitious program designed to help minority nurses develop and enhance their leadership skills.
Currently in its third year, the project pays for minority nurses to come to Washington, D.C., on a regular basis for intensive weekend seminars on various management topics, such as conflict resolution, strategic planning, fundraising, hiring and firing. Project Lead is funded by the Kellogg Foundation and sponsored by ANF.
For most minority nurses who have risen to upper management positions, the road to the top was paved with hard work and long hours. “You have to seize opportunities,” says Rose Gonzalez, RN, MPS, director of Government Affairs for the American Nurses Association in Washington. “Sometimes you volunteer to do things and, during that process, other opportunities open up to you.”
Brinkley agrees. “You can’t be afraid to take risks,” she stresses. “You have to be on the lookout for people who need someone to take on a hard assignment. Then, you can’t be afraid to tackle that assignment.”
Sometimes a little persistence can pay off, adds Martin. “Don’t be afraid to ask for a position or demand it. Because if you think you’re the best-qualified person, then you should demand the job.”
Capturing that major assignment or position is just half the battle, of course. Then comes the problem of having to prove yourself. Many minority nurses feel like they have to work even harder than Caucasian nurses in the same position. “I think we are always aware that we are a minority, so we always want to do our best and exceed our peers,” says de la Paz. “But there’s a big sense of pride when you accomplish something despite the odds.”
Because health care management is still such a predominantly Caucasian environment, invisibility is another barrier many minority nurses face as they try to climb the career ladder. “Sometimes a person of color will make a statement in, for example, a leadership meeting and that statement is ignored,” Alexander explains. “But then someone from the majority group makes the same statement and all of sudden it’s profound.”
Sound familiar? It’s a tough obstacle to get around, says Alexander, but not impossible. “You have to continue to contribute,” she advises. “You must be willing to be part of task forces and take on chairmanships of committees to show that you are a strategist, have good ideas and can think on your own two feet.”
Minority nurses sometimes need to assert themselves to be recognized, de la Paz feels. “I think we need to learn how to blow our own horn from time to time. For instance, when you are writing a major report, include your name at the end so people know the report was prepared by you. Then, if the report goes to administration or the corporate headquarters, those leaders may say ‘Hmmm…this is good, and she or he did it.’”
Raised in the Philippines, de la Paz is committed to helping other Filipino nurses move up in their careers. She says that for some ethnic minority nurses, especially those who are recent immigrants to the U.S., language differences can be a major barrier to advancement.
“Ethnic minorities have a tendency to group together and speak their language,” de la Paz notes. “But you need to start communicating in English so it becomes second nature. You can talk your native language when you are by yourself or on break
. But in the patient care area, speak English. I know of a lot of [ethnic minority nurses] who are very smart people, but they have had difficulty going up the ladder because of their inability to express themselves.”
When minority nurses start breaking through the glass ceiling, they often find that they are one of very few people of color in their organization’s management ranks—perhaps even the only one. “This can get lonely,” says Alexander. “I’ve had moments of alienation and isolation.”
But Alexander also sees her position as an opportunity for positive change. In a way, she argues, minority nurses in management act as ambassadors for their race and culture, opening up doors for younger nurses to follow in their footsteps.
But change doesn’t happen with silence, Alexander continues. What is needed is “courageous dialogue” when you encounter stereotyping or distrust. “You have to take a chance and go to the individual,” she explains. “You have to be candid and say, ‘This is what I heard. Help me understand why this was said or why you have this perception.’ But you don’t want to embarrass people. If something occurs in a meeting that bothers you, you need to go to the person privately.”
These conversations are not easy, Alexander adds. “Most people think that they are further along on the race relations continuum than they are. Some of that is fueled by what I call ‘virtual integration,’ or the fact that you now see more people of color on TV so it feels like we’re integrated. But we’re not really having true human face-to-face experiences with people of other races.”
For true integration to occur, she believes, there needs to be more honest dialogue among people of different races and cultures. But Alexander also advises minority nurses to stay true to their own cultural identity rather than try too hard to assimilate into the majority culture.
“I think it is challenging to work in the majority culture and try to help bring attention to some of the issues that people in your own culture face,” agrees Gonzalez. “I try to be myself as much as possible at work. I try to talk a little bit about my culture, which is Puerto Rican. I share some of my perspectives and try to highlight the differences. A lot of nurses and nursing organizations talk about the need to tolerate [cultural] differences. But I don’t just want to be tolerated, I want to be respected.”
G. Rumay Alexander, RN, MSN, EdD
Director, Office of Multicultural Affairs
University of North Carolina at Chapel Hill, School of Nursing
Chapel Hill, N.C.
A typical day in her current position: Alexander’s responsibilities are 80% administrative and 20% teaching. Her charge is to create an environment at the school where everybody has the opportunity to be their best selves. She spends much of her time in meetings, discussing and developing strategies for student and faculty recruitment and retention.
Her first job as a nurse: Staff nurse on a pediatric unit at a hospital
Some milestones in her career:
Advice for future minority nurse managers: “Stay in character, stay authentic. Know in your heart that you can make a difference.”
Ruth W. Brinkley, RN, CHE
President and Chief Executive Officer
Memorial Health Care System
A typical day in her current position: As CEO, she is responsible for putting strategic plans and operating plans in place to achieve Memorial’s mission. Her days usually start about 7 a.m. and last till 8 or 9 p.m. She meets with many people on a day-to-day basis, including physicians and members of the community.
Her first job as a nurse: Clinical nurse at a hospital
Some milestones in her career:
Advice for future minority nurse managers: “Get a solid education and experience. Take management courses, business courses and leadership courses. Don’t be afraid to get out of your comfort zone.”
Ampy de la Paz, RN, MS
Assistant Administrator/Compliance Officer
Doctors Hospital Tidwell
A typical day in her current position: She oversees multiple departments, including compliance, quality management, risk management, medical staff credentialing, physical therapy and occupational therapy. There are no typical days. Because she’s in charge of RM and QM, she spends a lot of time investigating issues, and she is currently very involved with HIPAA compliance. She also runs all the medical staff meetings.
Her first job as a nurse: A charge nurse on a medical/surgical unit
Some milestones in her career:
Advice for future minority nurse managers: “I think how you present and market yourself is very important.”
Rose Gonzalez, RN, MPS
Director, Government Affairs
American Nurses Association
A typical day in her current position: She’s responsible for moving the ANA’s legislative agenda through the U.S. Congress and Capitol Hill, as well as the state legislatures. She meets with ANA lobbyists, helps organize letter-writing campaigns and other grassroots efforts, and works on fundraising and endorsement campaigns for candidates that ANA supports.
Her first job as a nurse: Staff nurse on a medical/surgical unit
Some milestones in her career:
Advice for future minority nurse managers: “You have to have an open mind. Use your skills and don’t be afraid to translate them into other arenas.”
Arneatha Martin, RN, MSN, ARNP
CEO and Co-President
Center for Health and Wellness, Inc.
A typical day in her current position: The Center for Health and Wellness is a state-of-the-art primary health care facility that focuses on prevention and wellness education. Its mission is to provide first-class, affordable health care to a predominately African- American community. As CEO, Martin spends much of her time on fundraising activities, such as grant writing. She also oversees all the day-to-day business of the clinic.
Her first job as a nurse: A psychiatric nurse counselor for the County Department of Mental Health
Some milestones in her career:
Advice for future minority nurse managers: “When you see other [people of color getting management jobs], you think you can do it, and you go ahead and try. The fact that I was able to see strong black women doing what to me was an awesome job made me think, ‘I could do that.’ I think minority nurses need to try for management positions. Put your application in, ask for the job, be prepared to answer all the questions and maybe you’ll get the position.”