Featured Stories- The Management Path

Link to MinorityNurse.com

The Management Path

Experts agree that the time is right for minority nurses to move into hospital leadership positions

By Cari Coleman

As the new millennium begins, ethnic minorities will make up 28.2% of the U.S. population, and this percentage will increase to 37.2 in 2025. But, according to figures reported by Hattie Bessent, R.N., Ed.D., FAAN, director emeritus of the Ethnic and Racial Minority Fellowship Program at the American Nurses Association, less than 10% of the 2 million nurses employed in this country are ethnic minorities. Bessent is conducting a study on the future of nurses of color, specifically those nurses in leadership positions.

“The most recent information [1996] from the Division of Nursing, Health and Human Services, shows that 203,753 R.N.s were African American, Hispanic, Asian or Native American,” says Bessent. “In this new millennium, we’re wondering what will happen to the nurses of color.

“And of those minority nurses, only 14,300 have doctoral degrees,” Bessent adds. “To study the reasons for the lack of nurses of color in leadership positions, we have to look at the biographic, educational, earning and employment characteristics of these nurses.”

Bessent points to advanced degrees, along with clinical experience, as marking the path to leadership roles for nurses in health care industries. She adds that this path, especially for minority nurses, is not easy. “A lot of educational programs are not geared to fit the person of color. It would be good for hospitals to work with this population.”

Overcoming Barriers

Bessent explains that financial constraints and family challenges are obstacles that prevent many nurses of color from achieving leadership positions. But consider the success story of Ruth Williams-Brinkley, senior vice president for performance management with Catholic Health Initiatives in Denver. No stranger to such difficulties, Williams-Brinkley was a single mother of two as she finished her master’s degree and began her clinical career. Raised on a farm in Georgia, she came to the University of Chicago on a scholarship, but did not realize her dream of nursing until attending the Michael Reese Hospital School of Nursing in Chicago.

After working as a nurse for two years, Williams-Brinkley decided to return to school for her bachelor’s and then master’s degrees from Chicago’s DePaul University. Determination fueled her as she became a staff nurse at Michael Reese, nurse manager at the University of Chicago Hospitals, and moved on to being a supervisor and then assistant executive director at St. Anne’s Hospital in Chicago. “To get ahead, I think you have to work hard and work smart,” she says.

As one of few African-American women in her position, keeping her focus was key. “In my position, I see mainly men. But I can’t get stymied by obstacles,” she says. “I’ve had my share of detractors, and I’ve also had my supporters, but you have to have confidence in yourself.”

When asked about the current climate of affairs in upper management roles in health care, Williams-Brinkley sees diversity as a challenge that must be faced, both by those who run hospitals and educational institutions, and by minorities.

Both Williams-Brinkley and Bessent point to the lack of encouragement directed at minorities to enter nursing and thus to continue on to management—beginning as early as the secondary school level. “High school counselors may not refer minorities to math and science courses, and instead recommend liberal arts,” says Bessent. Williams-Brinkley adds that there should be added encouragement for minorities because they have been historically underrepresented in these careers.

Health Management Scholarship Recipient

The Institute for Diversity in Health Management has awarded its Elliott C. Roberts Sr. scholarship to Kimberly O. Sledge, a second year graduate student at Tulane University Medical Center’s School of Public Health and Social Work in New Orleans. Sledge will receive $5,000 for the 1999-2000 academic year.

The scholarship was established as a fund for minority graduate students in health service administration. It is named in honor of Elliott C. Roberts Sr., one of the nation’s leading public hospital administrators.

“I encourage minorities in health systems or health care to pay attention to bulletins and announcements at their university because that’s always helped me,” says Sledge. “Had it not been for me reading, investigating and researching—be it going online or making a phone call—I don’t think I would have gotten the scholarships and fellowships that I’ve received.”

Sledge, a 1998 cum laude graduate from Xavier University in New Orleans, is pursuing dual master’s degrees in social work and public health management. She works as an intern at Tulane University Medical Center, where she is responsible for public health education and program development for the Pediatric Pulmonary Center. In addition, she has developed curricula for asthma and tobacco prevention education for patients with pulmonary diseases.

“I designed a smoking prevention program for the Family Life Center and presented the program at Louisiana’s Third Biannual Tobacco Control Conference as a model for other programs throughout the state,” says Sledge. “Ours ran as a pilot program last year, and now other schools and agencies are using my program as a model for developing their own.”

Sledge was recently approved by the National Center for Excellence in Women’s Health to develop and implement an institute designed to advance minority women in health system management. She has traveled extensively throughout the United States and Tokyo as an International Public Policy/Woodrow Wilson Fellow. This fellowship provides experiences in public policy and international affairs with the goal to increase the numbers of minority Americans who serve as ambassadors to foreign countries.

Founded in 1994, the Chicago-based institute is committed to expanding health care leadership opportunities for minorities and increasing the number of qualified minorities entering the field. For further information, call (312) 422-2680.

—Vicki Chung

Education—And Then Some

But educational training may not be enough, according to an article by Dr. Willa Doswell, Association of Ethnic Minority Nurse Fellows president, that first appeared in the ANA’s Ethnic and Minority Fellowship Program (ANA/EMFP) newsletter. “For members of ethnic and racial groups, getting a Ph.D. is not the key to open all doors of opportunity,” she wrote. “Sometimes it takes a firm resolve, persistence, superhuman effort and forward movement amidst many rebuffs and adversity.”

Doswell goes on to say that the need for specialized programs, grants and fellowships for minorities is “even more pronounced... in the wake of increased politicization of affirmative action programs.”

The ANA/EMFP, established in 1974, administers pre- and post-doctoral programs for registered nurses who are African American, Hispanic, Native American, Asian American or Pacific Islander. The program currently has 10 fellows, seven in a Clinical Training Program studying mental disorders affecting minorities, and three fellows in a Substance Abuse Training Program studying the factors that lead to addictive behaviors.

Dr. Cornelia Porter, director in the ANA/EMFP, believes fellowships like the ANA’s are a step toward better representation of minorities in upper-level management positions, but sees completion of a degree program without working as the best way for this group to advance. “I created my own plan for my education while in my diploma program, promising myself to work for two years between each degree, but I think the situations havechanged,” she says. “It’s now important to move through school, getting your degrees at an earlier age. When you work between degrees, it may get harder to go back.

“The question that faces nurses,” according to Porter, “is if there should be another way for us to earn doctoral degrees while also forming relationships with practitioners to gain clinical experience.” A balance of both practical experience and formal training is an important step to taking leadership roles, she suggests. As a tenured professor at the University of Michigan School of Nursing, Porter has spent most of her career in academia at institutions like Yale and McMaster University, but has also incorporated needed clinical roles in her work.

“Along with a solid background, one strategy for minorities is to be centered in your own identity and to get to know who has what information, who has what power and who is truly behind decisions,” Porter suggests. “When you know the system in which you’re working, and you know who you are, you can figure out the best approach to get ahead.”

Williams-Brinkley also recommends knowing your own goals. “You have to have confidence in yourself and know what to do with what you have,” she says. Nurses of color, especially, need a network of people who could advise, support and refer them to leadership positions, she emphasizes. “Each minority nurse should have a mentor, someone who is an advocate, someone who can give advice.

“Our future leaders in the health care industry also need a solid professional background, incorporating clinical and business skills,” Williams-Brinkley recommends. “If nurses understand the economic impact of health care, they’ll have greater opportunities for advancement.”

Room at the Top

There are still few minorities in upper-level health care positions. Porter sees the noticeable void, not only in upper levels, but also in all areas of nursing. “We are underrepresented as a whole and because of this, the pool for minorities in management positions is low,” she says.

She points to subtle barriers (like the implicit withholding of information) as a hindrance for minority nurses who want to advance in their careers—barriers that a good network of advisors could aid in overcoming.

“I grew up knowing that I had to work harder than anyone else,” says Williams-Brinkley. “I knew I had to do my job well and I knew that my patients deserved the best care that I could provide for them. I didn’t have an inheritance waiting for me. I still see a lack of diversity [in nursing], not just with African Americans, but Asians and Hispanics—and Native Americans are almost unheard of.

“And I don’t see a lot of change,” she continues. “But I see this as a great opportunity. Minorities can make a difference, and the timing is right. There are opportunities out there, because health care needs are increasing and we need nurses with that passion for taking care of people. And this can be used as a springboard to gain upper-level positions.”

Williams-Brinkley maintains optimism when it comes to minority nurses in future management levels. “There is funding for education and some support to move up,” she says. “Finding these opportunities may take a little work, but the opportunities are there.”

Cari Coleman is an editor with a medical association in Washington, D.C.