Ana Ramirez struggled for three years after arriving in the U.S. to resume the nursing career she left behind in her native Colombia.
Night schools did not offer the advanced English classes Ramirez needed to earn her U.S. nursing license. She could not afford college courses, and instead studied the language in libraries. Eventually, Ramirez volunteered at a community clinic. It was so frustrating, she says of the obstacles that repeatedly blocked her return to nursing.
Her break came in January 2006. Public health officials in Montgomery County, Md., tapped Ramirez and two dozen others with similar stories for English classes, training and mentoring as part of an effort to boost the countys pool of bilingual nurses. Fourteen months later, Ramirez earned her license. Ramirez, who starts her solo nurse career this week in intensive care at 417-bed Holy Cross Hospital in Silver Spring, Md., says she is anxious, but grateful for the support and encouragement that landed her a U.S. nursing license.
I love nursing, she says. I loved nursing as a child.
Efforts like those that aided Ramirez underscore the mounting pressure U.S. healthcare faces to meet challenges from two powerful forces that experts say will only intensify in coming years: the demand for skilled workers and the nations increasing diversity.
By 2050, roughly half the U.S. will belong to a racial or ethnic minority, Census Bureau estimates project. Hispanics will represent one-fourth of the population. To keep pace, healthcare has a long way to go. Diversity among doctors, nurses and industry executives already lags far behind the nations demographics. In 2000, 5% of U.S. doctors were Hispanic while 4.5% were black, compared with 12.6% and 12.1% of the U.S. population, respectively, according to Census Bureau statistics.
Many inside and outside the industry consider recruiting a more diverse workforce necessary to ease labor shortages and tackle chronic disparities in care quality and health status among the nations minorities.
At Holy Cross Hospital, President and Chief Executive Officer Kevin Sexton sees the areas burgeoning population and an influx of immigrants clearly reflected among patients and employees. Elderly patients admitted to Holy Cross are its least diverse, Sexton says. As ages drop, diversity rises, he says. We dont hire in labor and delivery unless theyre bilingual, Sexton adds. The hospital now provides translation for patients in 28 languages, primarily relying on employees. In the past three years, Holy Cross has added 150 bilingual employees to its payroll, he says.
Sexton called the hospitals workforce changes significant but necessary. Theres always a risk in departing from the status quo, but in my mind its the right thing to do, and in the long run its the smart thing to do, he says.
Ramirez is one of seven foreign-born nurses at Holy Cross enrolled in the Montgomery County Latino Health Initiatives bilingual workforce effort. To date, six have earned a U.S. nursing license; the seventh is awaiting scores from an English proficiency exam. To maximize training, Holy Cross assigned the returning nurses to critical care, where technology is highly sophisticated and the nurse-to-patient ratio is low. Sexton says he hopes to double or triple Holy Cross recruits from the county program.
Sexton is convinced the efforts improve care, though Holy Cross does not have data to show quality gains from its diversity initiative. My experience is that (healthcare) is a highly personal service, he says. Patients and families deal with extraordinary stress during an illness. Ready translators and a workforce that mirrors diversity in the community will improve communication and comfort patients, he says. I will believe forever that (diversity) makes a difference.