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Lack of Racially Diverse NPs in Neonatal ICUs Creates 'Glaring Health Disparities'

Analysis  |  By Carol Davis  
   January 31, 2023

Neonatal nurse practitioner (NNP) training programs don't include enough underrepresented groups, affecting care of the tiniest patients, study says.

Racially diverse nurse practitioners offer valuable perspective in caring for underrepresented patients, yet "glaring health disparities" exist in neonatal ICUs because neonatal nurse practitioner (NNP) training programs lack racial minorities, a recent survey says.

"There is a significant difference between the racial and ethnic backgrounds of neonatal ICU RNs and NNPs and the neonates they serve," concludes the study published in Advances in Neonatal Care, the official journal of the National Association of Neonatal Nurses.

Indeed, nurse practitioners (NPs) of color in general are underrepresented in the workforce, with less than 7% being Black, according to employment recruiter Zippia.

Nurse researchers Desi M. Newberry, DNP, NNP-BC, of Duke University School of Nursing, Durham, North Carolina, and Tracey Bell, DNP, NNP-BC, of Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, designed a survey to determine the racial/ethnic composition of NNP faculty and students in accredited NNP programs in the United States. The findings from 23 responding accredited education programs were then compared to available data on the racial/ethnic composition of newborns admitted to US NICUs.

There was no significant difference in the racial and ethnic composition between neonatal nurse practitioner faculty and students, as indicated in this data of 198 NNP faculty and 403 NNP students:


 83% White

 7.4% Black

 5.6% Asian

 2.8% Latin American

 0.9% "other" race/ethnicity



 79.4% White

 6.5% Black

 4.5% Asian

 5.7% Latin American

 1.7% "other"



However, there were discrepancies in the rates of underrepresented groups among NNP students compared to national data on newborns admitted to US NICUs.

All racial/ethnic groups showed significant difference, particularly:

  • 19.5% of NICU admissions were Latin American, compared to 5.7% of students
  • 18% of newborns admitted to NICUs were Black, compared to 6.5% of NNP students

"Underrepresented infants are born prematurely at higher rates and have increased rates of mortality and morbidity,” Newberry and Bell said in their study.

Despite recommendations to increase diversity among nurses and other healthcare providers, an "ethnic discordance" remains between NICU providers and patients, they wrote.

“The discordance between neonatal nurse practitioner students and neonates in the neonatal intensive care unit is important in addressing disparities,” the study says.

Diverse nurses offer a valuable perspective to nursing care by bringing shared life experiences with their patients and the ability to understand the culture and establish partnerships and communication with their minority patients, the authors wrote.

Most nursing schools are working to diversify their student population to address and rectify ethnic discordance. For example:

  • Chamberlain University, with the largest school of nursing in the country, has developed a research-based framework—the Social Determinants of Learning™—to advance nationwide efforts in creating a more diverse pipeline of students entering the nursing profession.
  • Frontier Nursing University in Versailles, Kentucky, has tripled its student of color population in the last decade by changing to a holistic admissions process and adding measures to ensure the inclusion or admission of students from a diverse backgrounds and rural and underserved areas.

Recognizing and addressing the barriers faced by underrepresented nursing students and faculty will "increase the diversity of NNP students and faculty and ultimately practicing NNPs," Newberry and Bell conclude. "The ability to diversify the NNP workforce will result in improved neonatal outcomes."

Related:  3 Nursing Schools That Have Put Diversity and Inclusion at the Forefront

Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.


There are significant differences in the rates of underrepresented groups among NNP students compared to data on newborns admitted to NICUs.

Ethnic discordance between NNP students and NICU patients is important in addressing healthcare disparities.

Most nursing schools are working to rectify ethnic discordance.

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