Journal of Nursing Education

Retention of English-as-a-Second-Language (ESL) Students: Approaches Used by California's 21 Generic Baccalaureate Nursing Programs

Mary Kelly Memmer, MNEd, RN; Charles C Worth, PhD

Abstract

ABSTRACT

A rapidly growing number of California's ethnic minority nursing students are individuals whose primary language in not English; these English-as-a-second-language (ESL) students often have high attrition rates. This research surveys the approaches used in all of California's 21 generic baccalaureate nursing programs to retain their ESL students until graduation. Comparisons between the five programs with the highest ESL student retention rates and the group as a whole show significant differences.

Abstract

ABSTRACT

A rapidly growing number of California's ethnic minority nursing students are individuals whose primary language in not English; these English-as-a-second-language (ESL) students often have high attrition rates. This research surveys the approaches used in all of California's 21 generic baccalaureate nursing programs to retain their ESL students until graduation. Comparisons between the five programs with the highest ESL student retention rates and the group as a whole show significant differences.

Introduction

Two thirds of the world's current immigration is to the United States (Haycock & Navarro, 1988). By 2020, 35% of the American population is expected to be ethnic minority (Tifft, 1989). Minority students, however, are not gaining admission to, nor graduating from, American universities and nursing programs in proportion to their representation in the nation's population (Tucker- Alien, 1989).

Half of these immigrants come to California, where 46% of the population is expected to be ethnic minority in just 10 years (Haycock & Navarro, 1988). English is not the primary language for most of these immigrants, and a large proportion are not literate in English. Unlike the national picture, enrollment of ethnic minorities in California's public universities has increased over the last 15 years, currently accounting for more than one third of the total enrollment in the 19 campuses of the California State University system (California State University: Statistical Report #3, 1989).

The enrollment of minority students in California's generic baccalaureate nursing programs mirrors the pattern of its universities. A significant and growing number of California's minority nursing students are not native English speakers. These English-as-a-secondlanguage (ESL) students encounter myriad problems that native English speakers, both minority and Caucasian, do not experience. An ESL student is defined as a student who attended grade school outside the United States using a language other than English, or who was raised in a non-English-speaking home, continues to use his or her native language in the home, and uses English only in environments where the native language is not used.

The pool of California's future nurses will be drawn from its expanding, diverse ethnic groups; it is neither likely nor desirable that a larger pool be drawn from the static population of California's Caucasians. California needs ethnically diverse nurses to care for its diverse population. The ways in which California's nursing programs learn to retain their ESL students over the next decade should provide direction for nursing programs across the country when they face similar challenges.

Problem

Nurses must be able to speak, write, read, and understand the English language. Among the most valid test predictors of successful completion of a generic nursing program are those that require effective use of English language skills (e.g., SAT, ACT) (Woodham & Taube, 1986). Another valid predictor, GPA (Boyle, 1986), reflects the degree to which a student has used English literacy skills effectively in courses.

California's nursing programs have admitted ESL students in far greater numbers in recent years, and it is likely that this trend will continue. In spite of intense motivation to succeed, these ESL students often have a higher attrition rate than their peers for whom English is the primary language (Memmer, 1990). Clearly, it is not enough to recruit ESL students into our nursing programs. When an ESL student leaves the program due to failure or discouragement, the student returns to his or her community, forcefully indicating to future ESL students in that community that a nursing career is not a possible option for them. The critical shortage of nurses demands that we make every effort to retain all nursing students, especially those who can work most effectively with our non-English-speaking citizens.

This research addresses ways to assist ESL students to succeed in nursing programs. The data provide us with a more systematic basis for making programmatic changes than the trial-and-error approaches that so many of us use now.

Literature Review

A computer literature search, undertaken to identify useful approaches to increase retention of ESL nursing students, produced one reference (Loustau, 1986), a onepage essay! Since this search produced so little, a broader search of related literature ensued. This included factors that influence retention and attrition of university students in general, of university ethnic minority and ESL students, of nursing students in general, of minority nursing students, and of minority and ESL university students in other disciplines. This search produced numerous references!

While there is no conclusive evidence about what causes university students to persist or withdraw (Moore & Carpenter, 1987), the literature suggests 30 different approaches that could be useful in the retention of ESL nursing students. These 30 approaches were used to derive the research tool used in this study. Specific references used for this purpose are listed in the bibliography.

Research Questions

* What approaches are being used in California's generic baccalaureate nursing programs to retain their ESL students?

* Are there differences between those programs that are most effective in retaining their ESL students and the total group?

Limitations

This research focuses only on retention of ESL nursing students enrolled in California's generic baccalaureate nursing programs.

ESL, ethnic minority, and "disadvantaged* student groups often overlap. In one recent study, half the minority students in one nursing program also were ESL students. Retention rates for the ESL students, however, were lower than those for non-ESL minority students or the student group as a whole (Memmer, 1990). Although not all ESL, minority, and disadvantaged students demonstrate poor academic performance, many members of these groups do experience academic and retention problems. While this research focuses on approaches useful in retaining ESL students, many of the approaches would benefit any nursing student.

Sample

There were 21 generic baccalaureate nursing programs in California during Spring 1990. Data for this study were collected from all 21 program directors or their designees.

Methodology

Data were collected by telephone interview using a structured questionnaire. Content for the 35-item questionnaire was derived from the literature review outlined previously. The first five items requested statistical data about ESL student enrollments; the remaining 30 items requested information about specific approaches used to retain their ESL students.

After pilot-testing the questionnaire, the director of each program was contacted by telephone and asked to participate or to select a knowledgeable faculty designee. When a designee was named, she was contacted in the same manner and was asked to participate. Eight interviewees were nursing program directors and 13 were designees. All were female; all but one was a nursing faculty member, and several identified themselves as ESL and/or minority.

At the initial contact with each interviewee, arrangements were made for a telephone interview to take place one to two weeks later. Then, a short form of the questionnaire and a cover letter reiterating the purpose of the study, how confidentiality would be maintained, and the date and time agreed upon for the interview were mailed to each interviewee. The 7- to 14-day delay allowed time for the interviewee to receive materials and to collect needed data.

The senior author, a Caucasian female, made the arrangements and conducted the interviews between April 16 and May 30, 1990. As the interview ensued, the interviewee used the short form of the questionnaire as a guide while verbally conveying her responses. The interviewer recorded the responses on a more detailed questionnaire. As the interview progressed, the interviewer maintained consistency by clarifying, requesting elaboration, and focusing on the questionnaire items.

Table

TABLE 1ESL Students Admitted to California's Generic Baccalaureate Nursing Programs During Three Academic Years: 1987-1988, 1988-1989, and 1989-1 990 (N= 17)

TABLE 1

ESL Students Admitted to California's Generic Baccalaureate Nursing Programs During Three Academic Years: 1987-1988, 1988-1989, and 1989-1 990 (N= 17)

Program Description

The 21 programs varied greatly in their number of overall admissions in the past three years; 14 programs admit fewer than 80 students per year, the rest admit from 100 to 200 students. ESL students comprise 6% to 15% of most programs' admissions (Table 1), and moat show an increase in their ESL admissions over the three-year period. Programs in populous urban areas tend to admit more ESL students. In one of these programs, Caucasian students have been the minority for the last seven to eight years; the ESL students in one recent class represented 19 different languages!

Five programs keep no data on their ESL students, citing reasons such as "discriminatory," or that they do not consider the students as ESL once they have successfully passed high standards for English proficiency to gain admission to the program.

The 16 nursing programs that provided data on ESL retention vary greatly in their retention capability, as shown in Table 2. Programs that have large numbers of total admissions are more likely to have better ESL student retention rates. No relationship was found between percentage of ESL admissions and a program's ability to retain ESL students. Fourteen programs indicated that they regularly monitor and evaluate their retention efforts.

Several programs noted that when students fail they are much more likely to do so during their first year in the nursing program, when they initially encounter nursing theory courses with emphasis on physiology concepts, a great deal of reading, or nursing care plans that require competence in English writing skills. Many programs noted poorer retention rates among both ethnic minority and ESL students than among the student group as a whole.

Approaches

The 30 retention approaches are described beiow. Five of the 21 programs had ESL student retention rates of 93% to 100%. These five programs used a significantly greater number of the 30 retention approaches. Numbers in parentheses indicate how many of these five high retention programs used each specific approach.

Table

TABLE 2Retention Rates in California's Generic Baccalaureate Nursing Programs During Three Academic Years: 1987-1988, 1988-1989 and 1989-1990 (N= 16)

TABLE 2

Retention Rates in California's Generic Baccalaureate Nursing Programs During Three Academic Years: 1987-1988, 1988-1989 and 1989-1990 (N= 16)

Placement tests. Eighteen 3 of the high retention programs) universities require a placement test in writing skills and in math for all undergraduate students. Seventeen (4) universities require a placement test in reading comprehension.

ESL students, in addition, are required to take the Test of English as a Foreign Language" (TOEFL) in 13 (4) programs. A passing score, usually 500, on the TOEFL is expected prior to entry into the nursing program. In three of the nursing programs, a score of at least 550 is required for entry. Two of these programs indicate that admission of ESL students with this higher score has significantly decreased problems with language proficiency and has been a major factor in student retention. Five universities require a test of English conversational skills of their ESL students.

This is the only approach intended solely for ESL students. The next few approaches are appropriate primarily for ESIVminority students; but most approaches would benefit any student.

Remedial courses. Many of these universities require students who do not score high enough on their placement tests to take a remedial course in basic writing skills, 13 (1), and/or math 12 (1). Some offer optional remedial courses for any student in reading comprehension, basic writing skills, English conversational skills, and/or math.

Some unique efforts at ESL student remediation were reported. One university offers special general education sections for ESL students, to assist them with English skills. In another, all students are required to successfully pass three English courses prior to the nursing program; if a student then has difficulty with English, the student is asked to withdraw for one year, immerse in the language and culture, then return to the nursing program. A third university encourages enrolled ESL students to participate in a "Conversation Lab" held each school day at noon, with a brown bag lunch, to practice English.

Medical I Nursing terminology course. No programs require their students to take a course in nursing/medical terminology prior to entry.

Nursing "Career Day." Twelve (3) nursing programs hold their own Career Day, usually once a year. Eight others participate only in a university-wide Career Day. All feel their Career Day efforts are helpful in encouraging students to persist.

Preadmission meeting. Seventeen (5) programs hold a preadmission meeting to assist students applying for admission. These sessions last one to two hours and occur once a month or once each semester. One program holds occasional meetings on weekends or evenings to facilitate attendance.

Several programs report innovative approaches for assisting their applicants. One holds a free prenursing luncheon annually for potential and recent applicants and their parents; these have been particularly successful in attracting minorities. In another, nursing students invite prospective applicants for pizza, a tour, and discussion of the application process. In a third, faculty telephone each prospective applicant to answer questions about admission.

Orientation program. Seven programs require an orientation session for incoming students and five offer an optional orientation session; these are separate from regular nursing courses. All five programs with the best retention of ESL students use such an orientation session.

Most of these one- to four-hour orientation sessions are held in the week prior to the start of classes. The content commonly includes program overview, requirements/ commitments of the program, registration assistance, and how to seek assistance. One program holds a four-hour orientation followed by a barbecue luncheon. Two hold orientation courses for credit: one (optional) for prenursing students, and one (required) for enrolled freshman nursing students. These programs believe the early courses help students identify with their nursing major, and increase their commitment to their prerequisite science courses and the nursing program.

Many programs are interested in starting an orientation program for new students or improving their orientation. They felt these efforts would improve student retention, especially among disadvantaged students, by clarifying program expectations, making campus assistance to students known, and helping students to plan for success in the program early.

Study skills workshop. Five (2) programs offer study skills workshops outside of their required nursing courses (and two additional programs plan to begin these). Of the five programs, two have a required workshop, either for students who test poorly on study skills at admission, or who rank in the bottom half of their entering class. Three other programs offer optional workshops. Two of these indicate that the workshops are heavily attended by ESL and minority students. Three of the programs offer the workshop prior to entry into the nursing program, two after entry. Most involve 4 to 16 hours of student time. All programs felt that improvement in study skills was very helpful in student retention. Almost all programs that offer these workshops do so as a result of grant funding.

Two universities require a general studies course in study skills of all entering freshman. Fifteen programs offer content on effective study skills as a part of their first nursing courses; several are very thorough.

Nursing writing workshop. Three (1) programs oner workshops on writing nursing care plans. One of these programs encourages students who anticipate problems in writing papers to take a one- to three-unit, lower division, special problems elective nursing course along with their first nursing course to assist them with this content.

Eighteen programs use class time and office hour time on a 1:1 basis to assist students in learning library skills and in writing nursing care plans, process recordings, and research papers. The time commitment for faculty, especially in the first nursing courses, is considerable.

Involvement of students' families at a nursing "Open House." Eight (5) programs hold an open house in which the students support system learns about the opportunities, responsibilities, and time commitment required of a student. Thirteen programs offer no open house although at least half participate in a similar university- wide event. All focus on family involvement and support. Most occur just before or just after the student's admission to the nursing program. One program features a very successful panel presentation on family survival skills by recent graduates, current students, and their spouses.

Financial aid coordinated by the nursing program. Thirteen (4 to 5) programs coordinate the scholarships and loans for their own students. The university-wide financial aid offices coordinate the scholarships and loans for the remaining programs. Nursing programs located in large urban areas are most likely to have non-debt scholarships, loans, and grants, which are frequently offered by agencies that employ many of the programs graduates.

Part-time job opportunities during the academic year and full-time summer jobs are coordinated by only three programs. Local health care agencies so actively recruit nursing students that it isn't necessary for programs to become involved.

One program requires a 16-hour/week work experience at one of seven local health care agencies, for which the student receives two units of course credit and payment by the agency. This course is scheduled for the end of the student's first year. A faculty member holds two hours of seminar each week with the students. Later in the program, students can repeat this experience as an elective. Several programs plan to initiate similar activities.

Eleven (5) programs coordinate work-study opportunities for their students within the nursing program and/or assist their students in obtaining these positions elsewhere on campus. Several programs indicate that they are especially interested in employing ESL/minority students in their program's skills labs, media labs, and for faculty grant projects.

Nurse-Coordinator. Five (2) programs have a nurse coordinator who monitors student progress and provides a "bridge" between the student and faculty/stan7resources; all but one are part-time. Programs that have a nurse coordinator are most likely to focus only on ESL, minority, and disadvantaged students in the first year of the nursing program. Almost all have funded the nurse coordinator position with grant money. In the remaining 16 nursing programs, the director of the program and/or faculty members share this responsibility without release time.

Mentor programs for nursing students. 1) ESL/minority nurse alumni or locally employed nurse mentor program. Five (3) programs have a formal mentor program for their ESL/minority students. Another plans to initiate such a program, and three others are writing grants for this purpose. The mentors generally assist a student of the same ethnicity. Mentors are usually recruited through the program's alumni group, local health care agencies, or local chapters of ethnic nurses' associations.

One program maintains a looseleaf notebook in which ESL/minority nurse alumni describe their jobs and provide their phone numbers and an invitation to assist a student as a mentor. The notebook, kept in the nursing office, is frayed from constant use. Apparently, students rarely contact the alumni but seem to sense their support from the notebook.

2) Big-little, sister-brother nurse mentor program. Thirteen (4) programs match a beginning student with a more advanced student. This is usually coordinated by the program's chapter of the California Nursing Student Association, and is usually a nonpurposeful match of ethnicities. The matching most often reflects geographical nearness of the two student's homes so that they can get together more often.

3) Nursing faculty (all ethnic groups) matched with groups of two or three ESL/ethnic minority students mentor program. Five (3) programs have a formal mentor program. Unlike an advising or counseling role, the faculty mentor assists the student in a manner similar to the alumni nurse mentor described earlier. Two programs provide some release time for a faculty member to mentor small groups of these students.

ESL/minority nursing faculty. Fifteen (5) programs have at least one full-time ESL/minority faculty member; 10 (4) programs have at least one part-time ESL/minority faculty member. Three programs have none. Most programs expressed concern about the difficulty in attracting and keeping qualified ESL/minority nursing faculty.

Flexible class load option. Fifteen (5) programs offer a faster or slower paced option for students who desire it. Several indicated that students rarely select this option, either because they want to remain in classes with the classmates with whom they entered the program, or because they cannot receive financial aid unless they maintain a 12-unit course load.

Flexible class time. Flexible scheduling that offers some evening and/or weekend class sections is intended to accommodate student job/family/child care needs. Three (2) programs offer some sections of evening classes and three more plan to offer this option. None offers weekend class sections. One program indicated that they had tried this option but, even with extensive advertising, no students registered for it.

Table

TABLE 3Ratio of Nursing Students to Teacher in Clinical (Patient Care) Labs

TABLE 3

Ratio of Nursing Students to Teacher in Clinical (Patient Care) Labs

Ratio of nursing students to teacher in clinical (patient care) labs. Table 3 shows the participant's student-faculty ratios. Two of the three programs that have high studentfaculty ratios (11:1 to 13:1) in the first year of the program have these students only in nonacute care settings. Three of the five high retention programs are among those with the lowest student-faculty ratios.

Clinical lab (patient care) ethnic student grouping. Six (3) programs produce a purposeful heterogeneous ethnic mix in their clinical labs. Some of these indicate that this approach is closer to a "real world" mix and less discriminating. Some said they also purposefully mix students according to their ability levels so that each clinical section has an approximately equal mix of strong and weak students.

The remaining 15 (2) programs produce a nonpurposeful ethnic mix in their clinical lab sections. In at least half of these, the students themselves choose, or a "lottery" assigns them to a specific section. Arrangements that help with a car pool or desire to be with a friend are primary reasons for student selection of a specific section.

Additional clinical (patient care) and skills learning assistance. Six (2) programs offer a required or an optional opportunity for additional direct patient care to students who are minimally satisfactory or who have been ill. These labs are usually offered as one- to six -unit elective nursing courses, occasionally during the summer, and are usually quite expensive for the student.

Sixteen (5) programs offer optional opportunities for students to obtain additional practice with nursing skills in simulation or skills laboratories. Faculty members in six of these programs occasionally write prescriptions that require a student to obtain additional practice in order to meet course objectives.

Peer tutorial assistance. Nine (3) programs offer peer tutorial assistance coordinated by the nursing program using various combinations of approaches to first-year students. Fewer offer tutorials to advanced students. The programs are most likely to offer tutorial assistance on a 1 :1 basis to first-year students only. Three additional programs have grants, or are writing them, to start or expand their peer tutorial programs. An analysis of student failures in one program showed that most failures occur in theory courses primarily because of insufficient study of the course content and, secondarily, because of lack of content understanding. They concluded that peer tutors would be helpful only for students with the secondary problem.

Academic advising. Nineteen (5) programs provide academic advising for their prenursing students; all provide academic advising for enrolled nursing students. Fourteen (5) require their students to see their advisor at least once every term.

Counseling. Fifteen (4) programs indicate that their faculty do not counsel students for family or personal problems, social or cultural conflicts, or conflicts between academic and family values; these programs refer their students to the campus counseling center. Many programs expressed strong opposition to their faculty becoming involved in personal counseling, either because they were not qualified as counselors or because of role conflict when faculty serve as counselors. Four programs, however, employ a qualified counselor, some of whom are also nursing faculty. Six (1) programs encourage their nursing faculty who wish to counsel students to do so.

Nursing ESL / minority group-based housing. Unlike some other disciplines which have found that clustering minority students in special sections of dorms improves students' confidence and peer support (Student Affairs Planning Document. CSU, Chico, 1988), none of the nursing programs have housing arrangements specifically for ESIVminority nursing students.

ESL /minority nursing student participation in campus organizations. 1) ESL/minority nursing student participation in ESL/minority nursing groups. Fifteen programs indicate that their ESL/minority nursing students do not participate in any ESIVminority nursing group, primarily because there are no groups available locally. In six (3) programs, ESL/minority students participate in such offand on-campus groups as local chapters of the AfroAmerican or Hispanic Nurses' Associations.

2) ESL/minority nursing student participation in groups with other nursing students of all ethnic backgrounds. In all programs, ESL/minority students participate with their peers in nursing student organizations.

3) ESL/minority nursing student participation in ESL/ minority groups on the campus at large. In 10 (3) programs, ESL/minority nursing students participate in ESL/minority organizations on their campus at large such as the Latino-Hispanic, Asian, and Afro- American student organizations. No ethnic organizations are available to students on some campuses.

4) ESL/minority nursing student participation in groups with other students of all ethnic backgrounds on the campus at large. Eighteen (4) programs indicate that their ESL/ minority nursing students participate in organizations of this type.

Visiting ESL/minority nursing leaders as guest speakers. Ten (3) programs have sponsored at least one ESL/minority nursing leader as a guest speaker in the last three academic years.

Instill student's sense of belonging. All programs attempt this in various ways: class bulletin boards, tutorial centers, study areas, lockers, and lounges. One provides individual mailboxes for students and several have student newsletters. One holds a well-attended, annual "Evening of Excellence" rewarding clinical practice and leadership.

Increase ESL / minority nursing student pride. Nineteen (5) programs reported addressing this content. Content includes: increasing content about cultural diversity - 19 (5); how to enhance communication among divergent ethnic groups - 18 (5); decreasing stereotypical attitudes - 17 (5); the need for all nurses to learn to work with divergent populations - 16 (5); and the need for ESL/ minority nurses - 16 (5).

Workshops to sensitize nursing faculty. Less than half have held workshops addressing the special needs and problems of ESL/minority students, and useful approaches for helping these students. Those who have include: special student needs - 9 (3); faculty attitudes and approaches toward ESL/minority students - 4 (3); classroom approaches to assist ESL/minority students - 4 (3); and faculty early identification of academic problems - 4 (3).

System for early faculty intervention. Twenty (5) programs have developed systems for early coordinated nursing faculty intervention when academic problems first arise for ESL/minority students. These include: a system to monitor academic progress - 19 (5); retention/ withdrawal assistance - 18 (5); early intervention - 18 (5); and faculty workshops to support intervention efforts - 16 (5). Two hold annual workshops to orient new faculty and to review the intervention system. Many indicate that the lead teacher in a teaching team is responsible for instituting early intervention.

Participation in groups to decrease racial and ethnic intolerance. Most participants could not answer questions relating to nursing faculty and student participation in campus and community groups in an effort to decrease racial and ethnic intolerance; the results are inconclusive.

Other approaches. Nursing faculty have found other approaches useful in their work with ESL/minority students. The vast majority of these responses evolved from the five programs with the highest ESL student retention

* improvement of student study skills;

* emphasis on test-taking strategies;

* improvement of English language skills (One program takes their ESL students on recruitment visits; this improves their English, public speaking, and confidence while helping to recruit future ESL students into the program);

* the need for faculty to work with these students as individuals rather than as representatives of an ethnic group;

* a strong total faculty commitment, rather than involvement of one or two faculty members;

* early "connection" of prenursing students to the program;

* campus support for program retention efforts;

* a strong peer tutorial program;

*a low student-faculty ratio in first-year clinical labs;

* recruitment and retention of more minority faculty;

* a minority nurse mentor program; and

* a retention coordinator, especially if a minority person.

Further Analysis

The five programs with the highest ESL student retention rates are compared with the total group of 21 programs on 47 viable approaches using the Sign Test. Ties were ignored. In 40 of 47 comparisons, the programs with the highest ESL student retention rates reported using the greater percentage of the approaches described (p<.01). This is particularly impressive because the data are confounded, with the five programs with the highest ESL student retention rates represented in both data sets. The five programs with high retention rates are more likely to be programs in publicly supported universities, to admit large numbers of nursing students each year, and are located in large, urban areas. They are using almost every approach described in this study. These programs may have more resources: more nursing faculty, more financial assistance, and more off-campus resources due to their overall size and geographic location.

Similarly, the four programs that have the lowest retention rates for their ESL students (50% to 58%) are using significantly fewer of the approaches described in this study.

The three programs that admit the highest percentage of ESL students (15% to 24% of their total admissions) look somewhat similar to the four programs that have the lowest retention rates for their ESL students in the approaches they use. Similarly, the four programs that admit the smallest percentage of ESL students (2% to 6% of their total admissions) look somewhat similar to the five programs that have the highest ESL retention rates in the approaches they use. Neither comparison, however, is statistically significant.

Finally, the five programs that do not keep data on their ESL students are compared with the total group of 21 programs. These programs used a much smaller percentage of the approaches described in this study (p<.05), than the total group of 21 programs. This comparison is impressive because these data are also confounded; the five programs that do not keep data on their ESL students are represented in both data sets. This suggests that programs that do not keep data on their ESL students' retention are much less likely to use many of the approaches described in this study.

Discussion

Although the sample size is small, it does comprise 100% of California's generic baccalaureate nursing programs. The data suggest that intensive retention effort should be expended several months before students enter the program through the end of their first year.

This study was not designed to identify the specific approaches that are most effective in retaining ESL nursing students. Nevertheless, the literature reviewed and this study suggest some approaches that may be more likely to be effective. These include:

* a strong orientation program,

* a study skills workshop,

* an "open house" that includes family involvement,

* a strong financial aid program coordinated by the nursing program,

* a retention coordinator, especially if a minority person,

* an ESL/minority mentor program,

* hiring and retaining ESL/minority nurse faculty members,

* a student-faculty ratio in clinical labs (patient care) of 7.5:1 to 9:1, especially during the first year,

* a purposeful heterogeneous ethnic student mix in clinical labs,

* additional opportunity for skills learning,

* a strong peer tutorial program,

* systematic academic advising,

* workshops to sensitize faculty to the needs and problems of ESL/minority students, and

* the development/use of a system for early intervention when student academic problems arise.

Conclusion

This study suggests that the first step toward improvement of ESL student retention is to systematically identify those ESL students admitted to the program. Collection of retention data on these students is necessary in order to evaluate the effectiveness of retention approaches implemented by the program.

Second, we should carefully scrutinize the approaches used by the five programs that are most effective in retaining their ESL students, so that we can learn from them. These programs have been innovative and committed in using their program, faculty, and community resources effectively. Many of their ideas could be useful to other programs.

Third, with rising costs and diminishing funds for nursing programs, the cost-effectiveness of approaches that are implemented must be considered carefully. While all of these approaches initially require faculty time to plan, some may not cost a lot to implement, either financially or in faculty time. Almost all innovative approaches reported by participants in this study were initially funded by grants.

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TABLE 1

ESL Students Admitted to California's Generic Baccalaureate Nursing Programs During Three Academic Years: 1987-1988, 1988-1989, and 1989-1 990 (N= 17)

TABLE 2

Retention Rates in California's Generic Baccalaureate Nursing Programs During Three Academic Years: 1987-1988, 1988-1989 and 1989-1990 (N= 16)

TABLE 3

Ratio of Nursing Students to Teacher in Clinical (Patient Care) Labs

10.3928/0148-4834-19911101-04

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