How Do We Get More Latinas Interested in Nursing? Ideas & Inspiration from Authors of New Book

Mark (00:04)
The Latino community is the fastest growing ethnic group in the nation, but you would not know it by looking
at the nursing staff of most hospitals, clinics, and programs. In fact, when our guests tried to find a book about
Latinas in nursing, she could not find one. So she wrote the book herself.

Tina Loarte-Rodriguez (00:23)
Definitely, this opportunity has strengthened my community and definitely has rejuvenated and refilled my soul.
Anytime there's a, adversity or challenge or just of having a bad moment, I, I think about the book and the
contributing authors.

Margaret (00:41)
Our guest is Tina Loarte-Rodriguez, the author of “Latinas in Nursing: Stories of Determination, Inspiration,
and Trust”. Also, joining us is one of the contributors to the book, Zacnité Vargas-Avalos.

Zacnité Vargas-Avalos (00:56)
I highlight stories of my patients and other community members that have showed me what resiliency looks
like, and I, I try to honor them through that, through the book and, and what I write is their journey of resiliency
and how as a community we are, we are strong.

Margaret (01:13)
And this is Conversations on Healthcare.

Mark (01:25)
Well, welcome Tina and Zacnité, to Conversations on Healthcare.

Tina (01:29)
Thank you very much, mark. Pleasure to be here.

Zacnité (01:32)
Thank you for having us.

Mark (01:34)
Absolutely. Tina, let's start with you. We're so excited to see this book, and, you know, our part of the world, as
you were previously, were the Vice President of Nursing at Wheeler Health, which is a community health center
with five locations across Connecticut. How did you find the nurses to include in the book? And maybe you
could give our listeners a brief overview of their backgrounds.

Tina (01:57)
Sure, my pleasure. so at the time when I was, the Vice President of Nursing at Wheeler, I was looking for this
source of inspiration, to really help me, get rejuvenated and, fill my soul again. It was around December, 2020.
So, you know, we had been through COVID for a while, as well as some of the other kind of, racial injustices
that were happening that, and so thankfully in my search for this book, unfortunately, I didn't find a book, which
is why I decided to write one. I did find some other sources of inspiration and community, the National
Association of Hispanic Nurses, which I did not know about until December of 2020, was, something I did find
as well. And I immediately joined, both the national organization as well as the Harper Chapter. and so a lot of
the contributing authors are members of that association. and then also going to some of the conferences, I was
able to, connect more with some of the contributing authors. And actually, and I met in, DC this February at our
first, Latino, health Policy Summit. and then the others, I kind of went searching for Mark. I really wanted to
ensure that I had, diversity in our backgrounds, both from a nursing perspective, but also educationally as well
as our specialties. And so I was really intentional in trying to find where the other Latinas in nursing that were
excelling in certain areas, entrepreneurship, academia research, community health. and so I was really pleased to
curate this beautiful first and overall class. there will be more classes coming.

Margaret (03:52)
Well, Tina, I'd like to share your experience from the book, and you wrote, I want to quote, as the toll of the
pandemic continued, and with the racial murders of 2020, towards the end of 2020, I was done exhausted and
demoralized by the broken healthcare system. I was a member of the most trusted profession in the us. I felt
overlooked and isolated by my profession. Such a powerful passage, Tina, and I wonder if I can ask you now,
with a couple of years behind us, since you wrote this in 2020, how do you see things now?

Tina (04:26)
Definitely this opportunity has strengthened my community and definitely has rejuvenated and refilled my soul
anytime there's, adversity or challenge or just if I'm having a bad moment, I, I think about the book and the
contributing authors, and how much they have given me, as well as now the larger community. And, and I'm
just, again, rejuvenated and really happy. but there is still much work to be done. Our numbers do not reflect,
our, you know, our ratio within the population, particularly in positions of leadership and, and influence. So,
you know, there's very few of us that have the opportunities to be part of boards or the executive suites, as well
as in academia and nursing boards. There's still too few of us in those positions. So this has been, an exciting
journey to highlight those that I was able to in this first, in this first book. But there is still opportunity for so
many more, to be featured as well as for so many others to continue to rise to their fullest potential to continue
to have the greatest impact for nursing as well as healthcare.

Mark (05:49)
Tina, I wanna pull up on two parts of what you said. One, there's more work to be done, and then the numbers
really tell the, a story that requires all of us to be focused, because the Bureau of Labor Statistics says about 8%
of registered nurses are Latina, and nearly 7% of nurse practitioners are Latina. What has the reaction to the
book been so far, and how how's it raising awareness of the situation?

Tina (06:16)
It's just been overwhelmingly positive. I mean, we countless get countless feedback and stories and, and
reactions from Latinos, Latinas, and non-Latinos alike, thanking us for, you know, highlighting, our successes as
well as our struggles. Because the book does talk about, you know, both the ebbs and flows of our careers. and
there's definitely a call to action for there to be more, sponsorship and mentorship and more intentionality, and
how, again, those that have the power of influence, to really reflect back on how they can contribute to assisting
others, get the opportunities that they deserve.

Margaret (07:08)
Well, thank you, for that. And I wanna, turn to Zacnité with a question, if I can, tell us about your journey to
becoming a nurse and maybe share with us, what your, part of the book covers.

Zacnité (07:22)
Yeah, absolutely. Thank you so much for having us, today, and like I said, I live in Nashville, Tennessee, and so
the south has been, it's been hard trying to get into these leadership, positions, like Tina said. I had DACA
deferred action for childhood arrivals through my process of becoming a nurse. And there were some barriers
that my state, had within its legislation of who was able to obtain licensure. And so in 2016, I wanna say, I,
really advocated for legislation to, to change that. And it wasn't until last year that it got approved, and the state
of Tennessee now can give out licensure to those DACA recipients and TPS holders, but it was an uphill battle.
And like Tina mentioned, I wanted to find community. And through the National Association of Hispanic
Nurses, I found that community. Unfortunately, back then, when I was a nursing student, there wasn't a chapter
in Tennessee, and then COVID hit. And as a first generation oldest daughter of immigrant parents, I took on
responsibilities that a lot of kiddos didn't take at their age. And so I was the interpreter. I would always go to
different clinics with them, making sure that I was translating for them, and that my parents' voices were heard
at healthcare centers or wherever they would be. And so I reflected on that and, hit, it came around. I saw my
community really suffer, and I saw those disparities really come to life due to lack of language access services.
Folks didn't know where to go to get tested. And so with my education, and now as a nurse, I had to step up.
And so I founded the chapter here in Tennessee. and it's been a really, really great opportunity to dive into those
leadership experiences, mentoring other students, actually mentoring five nursing students at this point right
now. And the book really highlighted, the need that there is for community, especially those in Latinos and
Latinas who want to see representation. And in my book, I highlight that the, the barriers that can come with
being a non-US citizen in this country with other identities, living in the South. And I highlight stories of my
patients and other community members that have showed me what resiliency looks like. And I, I try to honor
them through that, through the book. And, and what I write is their journey of resiliency and how as a
community we are, we are strong.

Margaret (10:16)
Well, Zacnité, thank you for, sharing all that. And, in particular, the legislative barriers, related to, DACA and
becoming a, a registered nurse, to getting a license in your state was, I think, new information for most people
reading it. So thank you so much for sharing that.

Mark (10:35)
Yeah, that was such a powerful message. And, and thank you for, for, for writing it. And, you know, Zacnité, I
wanna stay with you. 'cause there's, in terms of your grassroots advocacy there, there's an initiative in California
that says the state needs Spanish speaking physicians more than other, linguistically underrepresented language
groups. the current supply is insufficient to address, the demand from Spanish speaking populations. I'm
wondering, does the healthcare sector put too much pressure on Latinas in nursing to also serve as translators?
What, what are your thoughts?

Zacnité (11:12)
Yeah, I think that, I'll speak for myself, for me, it's, it's a duty to make sure that I use all of my skills. Again, it
started as a child helping my parents, and that was my expectation. But we also have to recognize that speaking
another language is a skill, and we, we need to, and it's a need and a demand, and we need to be compensated
and we need to be recognized, for that level of skill of, of translation and interpretation. because it takes time.
You, you have to process and you have to make sure that you are medically correct, translating things to your
patients. And so there is pressure there, and I think that we need to recognize that, we are extremely skilled and
we need to make sure that we are compensated, when it comes to language, access. and I think the barrier that I
see here in, in Tennessee is that, nurses stay in the lower level of, of nursing, as medical assistants, which we
need them as well, but we need a pipeline. and highlighting that your language is very important, how do we get
you to A BSN degree or for myself, how do you get to an advanced degree? I'm in that process right now, and
it's been a struggle trying to find mentors, who can in, in the state, who can help me get to that. And so, how do
we keep pushing and highlighting that our skills are valuable and we need to have spaces in these leadership
circles?

Mark (12:51)
I really like the, the differentiation between just knowing the language and medical certification. It's a, it's an
added level of, responsibility.

Zacnité (13:02)
Yes, exactly. And you have to take a test and you have to pay money to make sure that you're certified and
knowledgeable in those exams or those courses can take, months nine a year I've seen. And so can our
institutions where we currently work, can they pay for those? Can we make sure that we are being supported in,
in that process of making sure that we are providing the correct information to our Spanish speaking patients as
well?

Margaret (13:28)
Tina, you, are, and have been making important leadership contributions. I want to note that you're now the
associate Director of Health Equity measures at the Yale Center for Outcomes Research, and evaluation. Tell us
more about, that work, your role, at the center and, how is this really, promoting cultural competency in our
nursing schools? are universities doing enough to encourage cultural competency?

Tina (13:56)
I appreciate that question. Thank you, Margaret. So I have the privilege and honor of working with so many
talented professionals, epidemiologists, statisticians, masters prepared, public health professionals. And it's
really been, a gift and a, and a pleasure to come into the measure development world. as, a nurse who worked in
quality for so many years, I was on the outside of it, right? I was the one having to wait for the final decisions
and then the guidance of how to operationalize it in the clinical setting and then, reporting data and also looking
back at the data. So now being at this, you know, uphill stream part of it is really, a highlight for me both
professionally and personally. I am very privileged because of my education and my profession, but not
everybody in my family or who I love and care for have that same privilege and, education of knowing how to
navigate the, the healthcare system. And so that is the lens and that is the voice that I bring into my work,
ensuring that yes, we are in, looking at the evidence-based practices and the clinical, trends and getting that
stakeholder appreciation, but always bringing it back to that patient, ensuring that it's, you know, people back in
my neighborhood, in the Bronx, New York, my family members, those who aren't, very fluent in health literacy,
as well as also in English, can have the tools that they need to be informed consumers of healthcare and to be
advocates for themselves. And so that's the work that I'm able to do with my team. And every day it's just a gift
to kind of be in rooms of influence and with conversations with key stakeholders about how to truly make this
work meaningful and really relevant.

Margaret (16:04)
And, and Tina, if I could just follow up on that, are you having an opportunity to dialogue with the leaders of
our, schools and colleges of nursing around what they're doing, both in curricula and experiences to encourage
competency in this area and the use of these measures that you're developing?

Tina (16:22)
Yeah, so, currently in my professional setting, that's not one of my responsibilities, but in my work, in my,
extracurricular activities in numerous organizations as well as through Latinas and nursing, that is one of our
goals to ensure that we are connecting with the entire pipeline of nursing, professional development education,
to ensure that, that, that cultural humility, ensuring that there's that constant, assessment and identification of
opportunities of how to, improve our methodologies, our pedagogy, our engagement and our outcomes.

Mark (17:00)
Well, certainly now in your role as a distinguished author, you get to speak, in many different circles, and we
look forward to it. And you're absolutely right. It's such a gift that you're giving, to all communities by the work
that you're doing. But I have a question for both of you. UCLA studied earlier this year found that Latinos still
represented a disproportionate share of COVID cases in the United States. The report also found that a higher
share of Latino groups were not fully vaccinated compared with the white and Asian population. And we've
talked a lot on our program about the reasons for these differences. Some of them relate to the fear about
immigration status. I'm wondering what advice you would have for the entire healthcare community about
improving the situation?

Zacnité (17:48)
Yeah, I can take a stab at it. I think that the most important thing that people forget is when you are going into a
community, you have to recognize that that community might not trust you. And we look back into history and
how, black and brown communities have been affected, by racism in healthcare settings. And so my approach,
even though I am Latina, speak the language, I don't assume that someone who might have the same background
as me is going to agree with what, with what I'm going to say. I provide the space. We can talk about vaccines.
that the biggest thing for me when COVID was happening was even just hearing their fears and going back and
making sure that we had a conversation where I was nonjudgmental and I would just listen. And slowly but
surely, I was able to educate them on what a vaccine was, why you would get side effects. That did not mean
that you were infected by the vaccine, but this was a natural process of your body's defense mechanism. And so
just taking my time and talking to, hesitant community members really made a difference. I did the same thing
with my parents, and I can't blame them for their fears as well as their immigration status, because they are
trying to survive, every day, with a status that puts them at risk from being separated from their families. And so
I approached my community with compassion and kindness and try to make sure that I was active listening all
the time. And that's part of what, you'll find in the book, is this common thread of compassion and care. and so
that's how I approach all communities that I work with as a community health nurse. And as someone who, who
works, in government now as well, is trying to make sure that I check my own assumptions and biases and that
there is a, an opportunity and a space to be a trusting individual to make a difference.

Tina (19:58)
I wholeheartedly support that on the micro level. And I think at the macro level, the system has to be examined
and held accountable because it's producing what it was set up to do. There's so many social and political
determinants of health that impact our communities that don't allow them to be able to make that decision of
going to get more information from a trusted healthcare provider, that speaks their language, that looks like
them, that understands their culture, nuances at times, and locations that work for their schedules, be it work,
family, school, plus all the other, you know, adversities that they have to overcome to, just survive sometimes.
And so I feel that as a system, there needs to be more opportunities and accountability to addressing those
political and social determinants of health to then be able to, truly evaluate, you know, the outcomes that we're
seeing now.

Margaret (20:57)
You know, Tina, you've, worked at community-based organizations you are at at Yale now, and, Nicole Gomez
wrote in the book that she never imagined that she would become a professor of nursing. And we, we could
change the name, we could change the role, but we're basically saying, how, how, or asking how do we
encourage people to be thinking big, far down the road, thinking about positions that influence, early on in their
career, how do we support people in doing that? And it's, it's not just nursing, Latinas and Latinos are
underrepresented in behavioral health specialties in medicine and the technologies that support healthcare across
the board. So tell me a little bit about what you're thinking about around that kind of support. You, you

mentioned there aren't a lot of people in the c-suite, in nursing who are Latina. You were the vice president, at a
very prestigious organization here in Connecticut. Tell us what you're thinking about how we create that kind of,
career, aspiration and, and hard, hard support and skills to help people move there.

Tina (22:01)
Absolutely. Yeah. So I have a couple of thoughts on that. first and foremost is representation, right? Like, others
need to know that there are people like us in these positions and, and highlighting that and, and recognizing that
and ensuring that, we, celebrate those of us who are in those positions. I think the other piece too is really being
intentional with, those, those pipelines. again, having, accountability to the fact that there should be diversity
within the leadership, of any organization to reflect its community and, its customers, so that, you know, there's
a commitment from the organization to ensure that their leadership is reflecting their community and then
actively working to that. And in that work as well, there needs to be sponsorship. So I, I once referred to being
overly mentored, but under sponsored. and, and very interesting. Yeah, there's a lot of, opportunities out there,
but they cost, right? They cost time, they cost money. And if, if I'm going to, if I'm working a full-time job, plus
I'm going back to school, sometimes carrying three or four classes, I don't have opportunity than to do any other
development that would then help me advance faster in my career. So if there was opportunities built into our
organizations, into our assistance and structures that allowed for that development to be, again, more concrete,
more intentional, I think that is also gonna assist in, ensuring that the representation is needed is there.

Margaret (23:41)
And Tina, I think it's safe to say when we say sponsored, we mean economically too, providing the kind of
stipends or support for people to maybe cut back a little bit while they're undertaking that kind of leadership,
development work. Great.

Mark (23:54)
Let me follow up on the, the sort of the, mentoring issue. Mentoring and medicine, is a non-profit that works
with under-served students beginning as early as third grade, to encourage them to become healthcare and
science professionals. And this program has had great outcomes of the National Association of Hispanic Nurses,
also advocates for mentoring efforts. I'm wondering what other programs do you see out there that are making a
difference?

Tina (24:24)
I've seen some immersion programs where, middle school students are bought into simulation labs to learn
about some of the, there's within the healthcare, specialties and times people able to hear about the doctor, the
nurse role. And so just really expanding, you know, the general population's understanding of other ways that
you can have a career in healthcare, maybe as, you know, a phlebotomist or a surgical technologist. and then
while you're doing that, using tuition reimbursement to continue on through your training if you wanted to be a
nurse or advanced practitioner or a physician. So, that's one of those successes I've seen. I think also, there's a
need to even go younger than third grade, right? Like I, I, I have a vision of creating the Latina nursing picture
book series so that as early as one years old, they can be exposed to the nursing profession and all its beauty and
all its rewards. and to see that progression of, you know, women and women of color and the stems is definitely
something that I think is another area of opportunity.

Zacnité (25:40)
I just wanted to add, my chapter in Tennessee has a partnership with an elementary school, a local elementary
school. And during Hispanic Heritage month, we go and we talk to the kids and we give 'em little scrub hats
and, our vice president made a little Play-Doh surgery, thing, and she performed surgery with Play-Doh and all
the kids were able to see. And so it's just doing the little things, what we think are a little, have a big impact, to
younger students.

Mark (26:13)
You know, I'm wondering if I could get one final question into both of you. And, and I know this show is going
out, in for, monolingual, but I'm wondering if you might answer this in Spanish, because we have many people
who, who are bilingual and understand it. And you've shared many details about the tough parts of being Latinas
in nursing. What are the best experiences or memories that might also motivate, young people who are listening
of any age?

Zacnité (26:43)
Yeah, I, I can answer in Spanish. I think that, (Speaking in Spanish) And hearing those words, how proud they
are of me, even though they have, we've never met, I am their nurse and I walk into the room, but they know

that they're safe, keeps me going. And, it's just a unexplainable feeling that you know, that, that that patient is
going to open up to you and you will be able to deliver the care that they need.

Tina (27:38)
(Speaking in Spanish) And it truly has been, you know, an honor to, walk into spaces and immediately, as
Zacnité said in Spanish, to see their faces shine and to see them relax and, and to feel recognized and to feel,
seen. And so I highly encourage, everyone to be, bilingual, and everybody can learn it. and to continue to
practice it and, and always be curious.

Margaret (28:33)
I think that is a wonderful note for us to end this conversation on. I hope it's the first of many more
conversations, and please let me thank you both for joining us to discuss this important topic. And thanks to our
audience, be sure to go online to chcradio.com, sign up for email updates, and also please share your thoughts
and your comments about this program. Thank you so much, both of you.

(29:01)
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