The workforce does not match the population yet. The share of Black or African American RNs rose from about 6% in 2015 to roughly 9% in 2024, according to NCSBN's National Nursing Workforce Survey (NCSBN), while about 14% of the U.S. population identifies as Black or African American (U.S. Census). Representation also extends beyond race, ethnicity, and gender to nurses who are LGBTQ+, live with disabilities, or practice different religions.
Why It Improves Care
The National League for Nursing defines diversity as affirming the uniqueness of and differences among persons, ideas, values, and ethnicities. Research ties representation among nurses and providers to better outcomes and smaller health disparities, including infant mortality, and to fewer cultural barriers between patients and their care teams.
The Oakland Men's Health Disparities Project showed how much this matters. African American men have the lowest life expectancy of any group studied. In a sample of just over 1,000 participants, the men were more likely to accept preventive care when it was recommended by Black doctors.
Karen Innocent, DNP, RN, points to unconscious bias and structural racism as drivers of these disparities. "Lack of representation between populations and the healthcare organizations serving the community can result in variability in patient care," she says. "There is overwhelming evidence that healthcare workers should be hired in proportion to the diversity of the communities that they serve. Increasing diversity among nurses and physicians is a means of reducing health disparities because patients have better outcomes with healthcare professionals of the same race."
Edna Aurelus, DNP, FNP-BC, adds that representation lets patients reach "someone who can be empathetic with one's situation as well as someone who can understand the person's viewpoint."
The American Association of Colleges of Nursing recognizes the shortage and treats active recruitment of men and of African American, Hispanic, Asian, American Indian, and Alaska Native students as fundamental to building a skilled, trusted workforce.
What Gets in the Way
Several barriers slow progress. The nursing shortage is one, driven partly by a faculty shortage: AACN reported that nursing schools turned away tens of thousands of qualified applicants in recent years, including roughly 65,800 in the 2023 cycle, citing limited faculty, clinical placements, and classroom space (AACN), and low faculty pay keeps nurses from teaching. Others include unequal access to education, financial and socioeconomic obstacles, and weak recruitment pipelines.
Implicit bias compounds all of it. "As a person of an underrepresented group serving in both clinical and higher education settings, I can frankly state that one of the challenges we routinely face is implicit bias," Aurelus says. Implicit bias is acting on a stereotype or prejudice you do not consciously hold.
What Is Changing
COVID-19 exposed health disparities among people of color and pushed organizations to act. Several efforts stand out:
- LaDonia Patterson, EdD, RN, and Gaea Daniel, PhD, RN, built the High School to Higher Education Pilot Pipeline Program, which mentors Black male high school and college students in metro Atlanta toward nursing careers.
- AACN appointed Vernell DeWitty, PhD, MBA, RN, as chief diversity officer and co-authored research on recruiting underrepresented nursing students. In 2018 it launched a Diversity, Equity, and Inclusion Group to guide schools toward their diversity goals.
- Hospitals and nursing schools have created chief diversity officer roles and standing inclusion committees.
- LGBTQ+ care has become a training priority, with classes and resources preparing students to care for the community.
- Faculty actively encourage underrepresented nurses to apply for higher-education positions and pursue graduate study.
The Bottom Line
Innocent is blunt about what works: "Achieving diversity is a process and cannot be improved unless healthcare leaders commit to addressing the root causes, including hiring practices and barriers to admission to schools of nursing."
The U.S. spent about $4.9 trillion on healthcare in 2023, roughly 17.6% of GDP (CMS), yet Americans carry a heavier chronic-disease burden than peer nations, and African Americans die from those diseases at higher rates. A workforce that mirrors its patients is one of the clearest paths to closing that gap. The work is far from done, and it takes everyone.
Frequently Asked Questions
Why does nurse representation matter for patient care? Research links diverse care teams to better patient outcomes, stronger communication, and smaller health disparities. Patients are also more likely to accept preventive care from providers who share their background, as the Oakland Men's Health Disparities Project found among Black men.
How diverse is the nursing workforce today? It's becoming more diverse but still trails the population. NCSBN's 2024 survey put Black or African American RNs at about 9%, up from roughly 6% in 2015, while about 14% of Americans identify as Black or African American.
What is implicit bias in healthcare? Implicit bias is acting on a stereotype or prejudice you don't consciously hold. It can shape clinical decisions and contribute to disparities, which is why many programs now train students to recognize and counter it.
What's slowing progress on diversity in nursing? A nursing and nurse-faculty shortage limits how many students schools can admit. AACN reports nursing programs turn away tens of thousands of qualified applicants each year, on top of unequal access to education, financial barriers, and weak recruitment pipelines.
What are schools and employers doing about it? Efforts include high-school-to-college pipeline programs, chief diversity officer roles, standing inclusion committees, expanded LGBTQ+ care training, and active recruitment of underrepresented students into graduate study and faculty positions.