The attrition of ethnic-minority students from schools of nursing has unfortunate consequences for the students themselves, the ethnic communities they represent, the nursing profession, and the health care system. The students, most of whom come from a lower socioeconomic group, experience financial loss. Their failure to succeed may be a selffulfilling prophecy in that ethnic students often enroll in a nursing program at great risk to their personal egos and self-esteem (Tucker-Alien, 1989). Because ethnic nurses tend to work in underserved areas composed largely of populations from their own ethnic backgrounds, the attrition of these students ultimately deprives ethnic communities of nurses who have appropriate language skills and cultural competence.
The Health Education and Training Center (formerly a federally funded Area Health Education Center) at the San Jose Medical Center, in collaboration with Evergreen Valley Community College and San Jose State University, conducted a mentor program for ethnic-minority undergraduate nursing students from September 1989 through June 1991. The purpose of the project was to improve the retention of ethnic students enrolled in both nursing programs.
Underrepresentation of Ethnic Minorities
A great disparity exists in the number of ethnic-minority RNs relative to ethnic populations in the United States. The ethnicity of RNs in this country has been estimated to be 3.6% African American, 1.3% Hispanic, 2.0% Asian, and 0.2% American Indian. More than 91% of registered nurses are nonminority. In 1982, 111,279 students were admitted to U.S. nursing programs. Of these, only 9.5% of the students were African American, 3.0% Hispanic, and 2.2% Asian or American Indian, whereas the national ethnic population is 11.5% African American; 6.4% Hispanic; 1.5% Asian and Pacific Islander; and 0.5% American Indian, Eskimo, and Aleut (California Postsecondary Education Commission, 1986).
Compounding the problem of low enrollment has been the attrition of ethnic nursing students. One study shows a consistent pattern of increasing attrition as ethnic students progress through admission, enrollment, and toward graduation (TuckerAlien, 1989). Another study revealed that problems encountered by freshmen nursing students were evenly divided between personal and academic issues. The personal issues were associated with loneliness and health care needs. The academic problems were difficulties with course work, i.e., science and English, and other problems such as time-management skills (Cameron-Buccheri & Trygstand, 1989).
There are other problems that possibly affect the retention of ethnic nursing students. They do not use support systems effectively. There is a lack of ethnic role models in positions of power and authority. For the most part, nursing curricula do not address the health care issues and practices of ethnics. Ethnic nursing students perceive that instructors treat them differently from other students (M. Canton, personal communication, October 5, 1989). These ideas are supported by others who observe that previous educational handicaps and cultural differences experienced by ethnic students enrolled in white educational institutions influence their retention (Drice, Hunter, & Williams, 1987).
Mentoring as a Strategy
Mentoring is an effective strategy because personal as well as academic needs and concerns of undergraduate students can be addressed. Mentoring also provides a means for assisting students individually. The local ethnic nursing community can model a wealth of professional expertise, leadership skills, and community commitment for ethnic nursing students. The involvement of those nurses whose ethnic and cultural backgrounds are similar to those of ethnic nursing students can serve as a natural support system. The need for mentor training is minimized, and the psychosocial accessibility of the mentor to the mentored student is increased (Petrovich, 1990).
Several goals were established for participants in the mentoring program. For mentors, they were to: (1) provide emotional support to protégés, (2) assist protégés in working with faculty members, and (3) assist protégés in making the transition from student to RN. Goals set for protégés were to: (1) improve performance in their nursing programs and (2) recognize the value of their biculturalism in preparing them for a profession that assists the health care needs of a culturally diverse community.
Recruitment of students and mentors
Undergraduate ethnic students were recruited from Evergreen Valley Community College, which offers an Associate Degree in Nursing (ADN), and San Jose State University, which offers a Bachelor of Science degree (BSN). Program staff made presentations to nursing student groups and classes, distributed flyers, and enlisted the support of nursing faculty. Interested students contacted program staff and completed applications with information about their student status, educational goals, employment, and area of nursing interest. All 46 students choosing to participate were fluent in English, and the majority spoke a second language, so language proficiency was not an issue. None of the students had received any nursing education outside the United States.
Mentors were recruited from hospitals and clinics serving large ethnic populations, the county health department, and ethnic nursing organizations. Each institution or organization was asked to nominate ethnic nurses with at least two years' experience, who were considered leaders by their supervisors and peers, who were respected in the nursing community, and who demonstrated interest and skill in working with students. Program staff contacted nominees, explained the project, and invited their participation.
The nominees completed applications with information about age, ethnicity, place of employment, position, nursing specialty, educational background, language skills, and hobbies. The educational backgrounds of the mentors varied. More than half had BSN degrees; others were diploma graduates or held masters' degrees in nursing, business administration, or public health. Professional backgrounds varied as well and represented a wide variety of nursing specialties, such as trauma or administration. The average length of the mentors' professional experience was 15.5 and 19.5 years, respectively, for participants in the first and second years. Many of the mentors were staff nurses with charge positions. The majority of the mentors were members of at least one hospital committee and belonged to a professional ethnic nursing organization.
The training design for mentors was based on the authors' experiences in working with ethnic undergraduate nursing students and the literature reporting problems of undergraduate nursing students in general (Cameron- Buccheri & Trygstand, 1989). More than half the mentors were given time within their jobs to attend training.
Training was divided into two parts. The first four-hour workshop introduced the mentors to the concept and techniques of mentoring. These included the purpose of the mentor program, mentoring in nursing, the roles of mentor and protégé, contracting with a protégé, strategies for enhancing student survival skills, assisting student transition to professional nurse, and resources for mentors. Vignettes posing various student problems, both academic and cultural, were presented.
During the workshop, mentors readily identified with the situations in the vignettes and applied their problem-solving skills and experience to formulating solutions. The group displayed keen sensitivity to, and understanding of, the cultural issues. Basic skills, such as note-taking, preparing for an exam, and time management were reviewed. Written materials about these subjects were distributed along with lists of campus resources for both participating campuses.
The second four-hour training session was held four months later, after the mentors began working with their protégés. Mentors discussed successful experiences as well as frustrations in working with their protégés. They were able to offer and receive suggestions for helping each other solve problems encountered in the mentoring relationship. Program staff provided feedback from students. Feedback was positive, and mentors were encouraged and somewhat surprised at the amount of influence they were having on students.
In the first year of the program, orientation for students was informal and conducted individually. This did not seem to meet students' needs for information about mentoring and the program's structure. The second year, an orientation meeting was organized. Information was given about the history and purpose of the mentor program, roles of mentor and protégé, meeting and contracting with the mentor, and the mentor-protégé relationship. Copies of a mentor-protégé contract were distributed and discussed. Students were given the same written materials about campus resources, time management, and study skills as the mentors. They were informed about the mentors' selection process and the nature of their training. They were also advised that protégé and mentor had equal responsibility for the relationship.
Matching protégés and mentors
Protégés were matched with mentors following the first training workshop, using information from the application forms. Program staff had met all mentors and protégés at either the training or orientation sessions. This provided additional information that was important about the "chemistry" of the potential relationships.
In the first year of the mentor program, a total of 24 mentors and 24 proteges participated: six African-American, six Hispanic, three Asian, and six Filipino mentors were matched with an equal number of protégés of the same ethnicity. Because there were more Hispanic protégés than mentors, an additional three Hispanic students were matched with two AfricanAmerican and one American Indian mentor. This was done with the permission of those involved.
Each participants was notified by mail that a mentor or protégé had been selected, and a copy of the counterpart's application was enclosed. Each was encouraged to contact the other as soon as possible. Some participants admitted feeling awkward about the initial meeting, as if they were "going on a blind date." The awkwardness disappeared during the first meeting, which program staff and mentors termed a "getacquainted and assessment meeting." During this meeting, participants made introductions and identified and discussed what each one expected from the relationship. They agreed on a date and time for the next meeting or telephone call and established who would make the contact. A written contract outlining the responsibilities of each party in the relationship was completed and signed during either the first or second meeting, depending on the readiness of the participants.
Mentor- Protégé relationship
Mentors and protégés met once each month and made telephone contact every two weeks. Mentors and protégés attended meetings of professional organizations and ethnic nursing organizations, conferences, staff meetings, and informal gatherings. Protégés had an opportunity to accompany mentors to staff meetings and other nursing activities. Public health nurses invited protégés to accompany them on rounds, and some students volunteered at their mentors' place of work. Relationships developed into friendships of varying intensity. Many became close friends and confidantes, as issues of a very personal nature were shared and protégés grew to trust and respect their mentors.
Participants were encouraged to direct questions or concerns to program staff; and staff contacted participants periodically to assist with problems or provide encouragement. The majority of calls from mentors occurred when they were unable to contact their protégés. Protégés rarely contacted staff except to express regret about lack of time to call or meet with their mentors.
Program staff contacted protégés by mail if they did not respond to phone calls. Four students had to be dropped from the program during the first year. They were encouraged to reapply to the program when they felt ready to participate actively. Two of these reapplied the second year and subsequently had successful experiences.
During the second year the mentor program was expanded. Twenty-two additional mentors and protégés were added to the program. In the second year, seven AfricanAmerican, six Hispanic, one Korean, and four Filipino mentors were matched with protégés of the same ethnicity. Two Japanese mentors were matched with two Vietnamese protégés, and one Samoan mentor was matched with a Filipino protégé.
The evaluation of the program was designed to identify mentor and protégé behaviors during the relationship, to assess the effects of mentor behavior on the protege's academic and personal growth, and to provide suggestions for refining the program. A survey instrument was sent to all participants. Among the 46 mentors and 46 student protégés in the program, 70% of mentors and 60% of protégés responded.
Three categories of mentor roles and corresponding protégé behaviors were identified in the survey. They were behaviors associated with developing the relationship of communicator, serving as a support person and adviser, and discussing specific topics.
In developing the communicator relationship, mentors engaged in the following behaviors with their protégés:
* discussed protégé behavior concerns;
* encouraged assertive behavior;
* clarified roles and responsibilities;
* helped identify successful communication techniques; and
* provided problem-solving techniques.
As a result of their relationships with their mentors, proteges felt they increased their ability to:
* understand the mentoring process;
*set goals and objectives;
*seek help with problems and concerns;
* problem-solve effectively;
* practice assertive behavior; and communicate with instructors.
As a support person or advisor, mentors discussed the following with their protégés:
* time-management strategies;
* how to set priorities;
* stress-management techniques;
* family situations and issues;
* study habits and study aids;
* test-taking and learning strategies.
As a result of having a supporter/ advisor, proteges felt they were better able to:
* clarify and set priorities;
* practice better time-management strategies;
* develop better study habits and study aids;
* practice stress-management techniques;
* confront family and personal problems more assertively; and
* practice problem-solving approaches.
Using their own experiences as examples, mentors explored the following topics with their protégés:
* higher educational opportunities in nursing;
* current issues in the nursing profession;
* strategies for career development;
* learning strategies in the clinical setting;
* interpersonal skills in the clinical setting;
* ethnic issues in the nursing school; and
* the role of the student versus that of the professional nurse.
As a result of having a role model, protégés felt stimulated to:
* practice interpersonal skills in the clinical setting;
* explore a variety of nursing careers;
* practice new learning strategies in the clinical setting;
* consider higher education opportunities;
* develop strategies for career mobility;
* plan the transition from student to professional nurse;
* keep abreast of current nursing issues; and
* address ethnic identity issues at school.
Protégés and mentors gave feedback about the program and its effects on their personal and professional growth. Protégés reported that the program provided role models and a support system to help them with their problems, improved their leadership skills, helped them gain insight about the realities of nursing practice, facilitated communication with instructors that enhanced their experiences in the nursing education program, helped them to develop networking strategies, and raised their self-esteem.
Mentors reported that the program strengthened their leadership skills, provided insight into ethnic identity issues that students encounter at school and in the workplace, enhanced their self-worth by encouraging them to share their experiences, and motivated them to help other students that they encounter in the work setting to resolve ethnic identity issues. Mentors also indicated that, because of their involvement in the program, they plan to be more involved in their community and workplace, assist in developing new graduate programs, seek out nursing students or new graduates in clinical settings to assist them in their learning needs, and develop a nurse-mentor program in their workplaces.
Several recommendations were made by mentors and protégés to improve the program:
* Interview program applicants to clarify program requirements and assess level of interest.
* During mentor training, focus on needs common and specific to ethnic- minority undergraduate students.
* Point out time commitment to students.
* Match students and mentors by ethnicity to enhance relationships.
* To facilitate recruitment by ethnicity, recruit students first.
* Maintain communication between program staff and participants on a regular basis.
* Keep a log of all communication between program staff and participants.
* Enlist aid of nursing faculty in reaching unresponsive protégés.
* Send letter to unresponsive students that encourages program compliance but also provides "permission" to formally drop out of the program.
Of the 46 protégés, 25 graduated from their nursing programs, 19 passed the NCLEX, 18 continued in their nursing programs, and three students went on medical or personal leave.
Trends indicate that the number of minority and immigrant students entering our educational system is on the rise. These students often require greater remediation than middle-class students. The mentor program described here provides a structured approach to address the mentoring needs of undergraduate ethnicminority nursing students. Mentors can have an important role in the retention of these students.
- California Postsecondary Education Commission. ( 1986). Health sciences education in California. Fourth Biennial Report to Governor and Legislature, Sacramento, CA, 198586.
- Cameron-Buccheri, R., & Trygstand, L. (1989). Retaining freshman nursing students. Nursing & Health Care, 10, 389-393.
- Drice, A.D., Hunter, V, & Williams, B.S. (1987). The influence of academic support systems in retention of minority nursing students 1971-1974: A descriptive study. Journal of Nursing Education, 17(3), 22-35.
- Petrovich, J. < 1990). Mentors: Effective role models, advisers, 'gate openers.' A special report on mentoring. Washington, DC: The ASPIRA Association, Inc.
- Tucker-Alien, S. (1989). Losses incurred through minority student nurse attrition. Nursing & Health Care, 10, 395-397.