Journal of Nursing Education

Guest Editorial Free

Leading Across Differences

Vernell P. DeWitty, PhD, RN

The year 2011 was a significant milestone for both nursing and diversity. Over the span of that year, for the first time in the history of the United States, more minority babies were born than White babies. Soon, most children will be racial minorities: Hispanic, Black, Asian, and other non-White races. According to Frey (2018), this milestone signals the beginning of a transformation from the mostly White Baby Boom culture that dominated the nation during the last half of the twentieth century to the more globalized, multiracial country that the United States is becoming.

The second milestone was the release of the influential 2010 Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health that placed renewed focus on diversity in nursing, calling for the development and use of new educational models that promote respect for race, ethnicity, geography, background, and personal experience.

It is widely accepted that the ethnic demographic transition of the U.S. population will likely have numerous consequences for the health care sector, including an increase in the demand for a more diverse health care workforce. Evidence indicates that diversity is associated with improved access to care for racial and ethnic minority patients, greater patient choice and satisfaction, and better educational experiences for health professions students, among many other benefits. Promoting diversity and inclusiveness across all levels of learning and practice environments, including administration, employees, faculty, and students, can be an important way to achieve a diverse and inclusive climate (Pacquiao, 2007). Addressing the needs of a more diverse population presents opportunities for both nurse educators and nurse administrators, as key stakeholders, to provide transformative leadership in leading across differences.

In his 2018 book, Diversity Explosion, Frey used data from the U.S. Census Bureau to examine the population projections through 2050. He stated that during the next 40 years, each minority group is expected to more than double. These new minorities contributed to more than three quarters of the nation's population growth in the past decade, and this trend will accelerate in the future. Frey (2018) postulated that if planned for properly, these demographic changes will allow the country to face the future with growth and vitality as America becomes the melting pot for a new era.

Despite the population shift, during the past 50 years there have been disparities in the participation of underrepresented students of color at multiple points across higher education, including pipeline, application, admission, enrollment, persistence, and completion. According to the American Association of Colleges of Nursing's 2017–2018 Enrollment and Graduations report (Fang, Li, Turinetti, & Trautman, 2018), which features data on the race/ethnicity of enrolled students from 2008–2017, nursing students from minority backgrounds represented 33.5% of students in entry-level baccalaureate programs, 34% of master's students, and 32.5% of students in research-focused doctoral programs originate from populations underrepresented in nursing.

The National Council of State Boards of Nursing and The National Forum of State Nursing Workforce Centers reported in June 2017 that the total number of active RN licenses was 3,844,410, with 81% of this population actively employed in nursing (Smiley et al., 2018). The average age of RNs was 50 years, which is consistent with previous study findings (Smiley et al., 2018). In 2015, 12.4% of the RN respondents were 65 years or older, compared with 14.6% in the 2017 findings, which is an increase of 2.2 percentage points, indicating a slow but steady growth of RNs that may be heading for retirement (Smiley et al., 2018). The 2017 findings revealed that only 19.3% of the RN respondents were minorities, which includes other and two or more races (Smiley et al., 2018). Based on these data, collaborative opportunities exist at the intersection of nursing education and nursing practice, where advancing diversity in the workforce becomes a reality. Academic practice partnerships are an important mechanism to strengthen nursing practice and help nurses to become well-positioned to lead change and advance health for all. Partnership opportunities to advance diversity in both the academic and practice setting can be accomplished by (American Association of Colleges of Nursing, n.d.):

  • Partnering to create a system for educational and career advancement to prepare leaders representative of all racial and ethnic groups.
  • Advancing cultural humility as a core competency for nursing students and practicing nurses.
  • Collaborating on the recruitment and retention of both nursing students and nurses of color.
  • Using a holistic admissions review process that focuses on both qualitative and quantitative data. Encourage use of admission criteria that focus on both qualitative and quantitative data and a holistic admissions review.

Learning to lead across differences is a lifelong commitment to diversity competence. Nurse leaders and educators must model the way. This can be accomplished through academic practice partnerships.

Vernell P. DeWitty, PhD, RN
Director for Diversity and Inclusion
American Association of
Colleges of Nursing


  • American Association of Colleges of Nursing. (n.d.). The academic-practice partnership community: Guiding principles to academic-practice partnerships. Retrieved from
  • Fang, D., Li, Y., Turinetti, M. & Trautman, D.E. (2018). 2017–2018 enrollment and graduations in baccalaureate and graduate programs in nursing. Washington, DC: American Association of Colleges of Nursing.
  • Frey, W.H. (2018). Diversity explosion: How new racial demographics are remaking America. Washington, DC: Brookings Institution Press.
  • Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.
  • Pacquiao, D. (2007). The relationship between cultural competence education and increasing diversity in nursing schools and practice settings. Journal of Transcultural Nursing, 18(Suppl. 1), S28–S48. doi:10.1177/1043659606295679 [CrossRef]
  • Smiley, R.A., Lauer, P., Bienemy, C., Berg, J.G., Shireman, E., Reneau, K.A. & Alexander, M. (2018). The 2017 National Nursing Workforce Survey. Journal of Nursing Regulation, 9(Suppl. 3), S1–S88. doi:10.1016/S2155-8256(18)30131-5 [CrossRef]

The author has disclosed no potential conflicts of interest, financial or otherwise.


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