Journal of Nursing Education

Major Article Supplemental Data

Factors That Promote and Impede the Academic Success of African American Students in Prelicensure Nursing Education: An Integrative Review

Teri A. Murray, PhD, RN, APHN-BC, FAAN

Abstract

Background:

The aim of this review is to identify factors that impact the academic success of African American nursing students in prelicensure nursing education programs, given the need for RN health care workers to be more reflective of the general U.S. population.

Method:

A literature review was conducted to integrate the findings of the research related to African American nursing students in entry-level nursing programs to identify perceived barriers and supports to their retention and graduation.

Results:

The review revealed alienation, isolation, and being different as barriers to success. Academic support, mentoring, and integration and inclusivity were factors that helped promote success.

Conclusion:

Recommendations for the establishment of diversity and inclusivity plans, structured enrichment and academic support services, mentorship, and activities that fostered student engagement and integration were actions that could contribute to the academic success of African American nursing students. [J Nurs Educ. 2015;54(9, Suppl.):S74–S81.]

Dr. Murray is Dean and Associate Professor, School of Nursing, Saint Louis University, St. Louis, Missouri.

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

Address correspondence to Teri A. Murray, PhD, RN, APHN-BC, FAAN, Dean and Associate Professor, School of Nursing, Saint Louis University, 3525 Caroline Mall, St. Louis, MO 63104; e-mail: tmurray4@slu.edu.

Received: February 05, 2015
Accepted: May 14, 2015

Abstract

Background:

The aim of this review is to identify factors that impact the academic success of African American nursing students in prelicensure nursing education programs, given the need for RN health care workers to be more reflective of the general U.S. population.

Method:

A literature review was conducted to integrate the findings of the research related to African American nursing students in entry-level nursing programs to identify perceived barriers and supports to their retention and graduation.

Results:

The review revealed alienation, isolation, and being different as barriers to success. Academic support, mentoring, and integration and inclusivity were factors that helped promote success.

Conclusion:

Recommendations for the establishment of diversity and inclusivity plans, structured enrichment and academic support services, mentorship, and activities that fostered student engagement and integration were actions that could contribute to the academic success of African American nursing students. [J Nurs Educ. 2015;54(9, Suppl.):S74–S81.]

Dr. Murray is Dean and Associate Professor, School of Nursing, Saint Louis University, St. Louis, Missouri.

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

Address correspondence to Teri A. Murray, PhD, RN, APHN-BC, FAAN, Dean and Associate Professor, School of Nursing, Saint Louis University, 3525 Caroline Mall, St. Louis, MO 63104; e-mail: tmurray4@slu.edu.

Received: February 05, 2015
Accepted: May 14, 2015

The aim of this article is to identify factors that impact the academic success of African American nursing students in prelicensure nursing education programs. Of concern is the stagnant graduation rate of this specific ethnic group, the poor health outcomes often experienced by African Americans, and the need for RN health care workers to be more reflective of the U.S. population.

In 2012, there were 40.4 million non-Hispanic Blacks or African Americans in the United States, constituting more than 13% of the U.S. population (U.S. Census Bureau, 2013). Within this subset of the U.S. population, the health status of African Americans differed significantly than that of the majority White population (Centers for Disease Control and Prevention [CDC], 2014). The differences or disparities were manifested as higher rates of morbidity and mortality for heart disease and stroke, hypertension, obesity, diabetes, and other chronic conditions (CDC, 2014). For 2007 through 2012, African Americans had the highest mortality rates of all racial and ethnic groups from heart disease and stroke, and also colorectal cancer (CDC, 2014). Moreover, the incidence and prevalence rates for hypertension, obesity, diabetes, and HIV infection were much higher for African Americans than for their White counterparts (CDC, 2014). These health disparities have been attributed to factors such as limited access to health care, the affordability of health care, and past negative experiences with health care providers (CDC, 2014). In addition, the health care workforce lacks significant ethnic and racial diversity, and this lack of diversity has the potential to foster lingual and cultural barriers, biases, and clinical uncertainties, which can lead to further barriers in access to high-quality care for socially vulnerable populations (Braveman & Gottlieb, 2014).

The U.S. Department of Health and Human Services, Health Resources and Services Administration (HHS/HRSA) recognized that to improve the health of all U.S. citizens, there must be a reduction in the health disparities often experienced by minority populations (Braveman, 2014; Wakefield, 2014). Health care providers who are ethnically and racially diverse could improve communication and trust among minority populations through language and cultural concordance and increase provider services in underserved areas since they are more likely to work in resource-poor rural and urban communities where health professions shortages exist (Williams et al., 2014). In addition, such providers would more likely advocate for services and programs for minority populations since minorities are often keenly aware of the need for services in disadvantaged and underserved areas (Williams et al., 2014). Having a cadre of health care workers from diverse backgrounds would be a step toward achieving health equity, which is the optimal standard of health that should be attained by all U.S. citizens, regardless of racial or ethnic origin (Braveman, 2014; Institute of Medicine, 2010; Williams et al., 2014).

The approximately three million RNs living in the United States represent the largest group of health care providers employed in the United States (HHS/HRSA, 2010). Within the RN population, there are approximately 16.8% individuals who identified as belonging to a racial and ethnic minority (HHS/HRSA, 2010). The 16.8% represented a notable and laudable increase, compared with the 7.2% in 1980, but remained far removed from the 28% diversity of the general population (HHS/HRSA, 2010). The most recent U.S. census data revealed the U.S. population was 72% White, 13% African American, 5% Asian, 0.9% American Indian and Alaskan Native, and 0.2% Native Hawaiian and other Pacific Islander (U.S. Census Bureau, 2013). Thus, there is still a need to improve diversity within subsets of the RN population if the goal is for RNs to be reflective of the general population (Smedley, Butler, & Bristow, 2004).

A recent National Council of State Boards of Nursing Workforce Study (2013) revealed that 19% of the RNs responding to the survey were from minority populations. Of those 19%, only 6% identified as Black or African American. The HHS/HRSA Nursing Workforce Study revealed that African American nurses constituted 11.8% of the total working RN population (Carthon, Nguyen, Chittams, Park, & Guevara, 2014; HHS/HRSA, 2010). Both surveys revealed insufficient growth in the African American RN population. There has been no substantial growth in the number of African American RNs despite the fact that the African American population is currently the largest racial subgroup in the United States (HHS/HRSA, 2010; U.S. Census Bureau, 2013). This stagnant growth may be attributed to the recent findings in the enrollments and graduations of African American students from nursing education programs.

Recently, the American Association of Colleges of Nursing (Fang, Li, Arietti, & Bednash, 2014) reported an enrollment of 29% racial and ethnic minorities in generic (entry-level) baccalaureate nursing programs. The 29% represented an approximate increase of 10% since 2004 and validated that the number of diverse students enrolled in undergraduate nursing education programs improved within the past decade (Fang et al., 2014). However, on closer examination and when stratified by race, the enrollment of African American students in entry-level baccalaureate degree programs had not increased significantly since 2004. In 2004, the enrollment of African American students in generic baccalaureate programs constituted 9.3% (Fang et al., 2014). Ten years later, the enrollment remained relatively flat at 9.6%, reflecting virtually no growth (Fang et al., 2014). Moreover, the graduation rates of African American students have decreased from 10.2% in 2004 to 9.3% in 2013 (Table 1).

10-Year Trends of African American Students’ Enrollment and Graduation Rates

Table 1:

10-Year Trends of African American Students’ Enrollment and Graduation Rates

African Americans have not fared well in entry-level baccalaureate programs compared to their White counterparts. Yet, the African American population is at a disproportionate risk of being uninsured, often lacks access to care, and experiences worse health outcomes than their White counterparts (Jackson & Gracia, 2014). If the goal for the health care workforce is to mirror the population, then the need to produce more African American RNs is now even greater than ever (Sullivan Alliance, n.d.).

Dapremont (2011) reported that African Americans have the highest percentage of nongraduates among nursing students compared with other ethnic and racial groups. The high attrition rates among African Americans have been associated with financial difficulties, lack of social integration, and lack of faculty support (Payton, Howe, Timmons, & Richardson, 2013; Zuzelo, 2005). The lack of African American faculty role models may further invoke feelings of isolation (Payton et al., 2013; Zuzelo, 2005). Coleman (2008) proposed that nonsupportive academic environments, lack of faculty involvement and commitment, institutional barriers, and encounters with race were factors that could negatively impact the academic success of African American nursing students in predominantly White institutions. Love (2010) postulated that the limited success of African Americans in nursing education could be attributed to the lived experiences of African Americans as nursing students.

Patterned after studies conducted by Bond et al. (2008) and Loftin, Newman, Dumas, Gilden, and Bond (2012), an integrative review of the literature was conducted in an attempt to gain a better perspective of African American students’ experience in nursing education programs. The purpose of this review was to integrate the findings of the research studies related to African American nursing students in entry-level nursing programs to answer the following two questions:

  • What are the perceived barriers to the retention of African American students enrolled in prelicensure nursing education programs?
  • What are the perceived supports that facilitate the retention and graduation of African American students enrolled in prelicensure nursing education programs?

Method

Literature Search Stage

The method for this integrative review was structured using the five stages proposed by Whittemore and Knafl (2005): problem identification, literature search, evaluation of data, data analysis, and presentation of results. It is limited to a comprehensive review of the published research on the academic success (retention and graduation) of African Americans enrolled in entry-level associate degree in nursing (ADN) and baccalaureate nursing (BSN) programs between the years of 2005 and 2015.

For the purpose of this review, retention is used to reflect the student’s persistence through to degree completion. Inherent in one’s persistence is the academic success that encompasses progression and graduation and includes the mastery of learning outcomes (Renn & Reason, 2013).

The racial terms, African American (Black) and White were used as defined by the U.S. Census Bureau. The term White can be defined as a person having origins in any of the original peoples of Europe, the Middle East, or North Africa, and the terms Black and African American can be defined as a person having origins in any of the Black racial groups of Africa (U.S. Census Bureau, 2013). These definitions were selected based on the standard language used in the U.S. Census and to maintain consistency with the federal government guidelines for racial designations.

For inclusion in this review, the research articles must have been published in peer-reviewed U.S. journals and focused on the retention (i.e., progression through graduation) of African Americans in U.S. prelicensure collegiate RN education programs between the years of 2005 and 2015. These dates were selected to examine 10-year patterns and trends.

The selected databases included articles found in nursing journals, biomedical journals, and allied health journals. Theses and dissertations were excluded from this search. All publications that addressed underrepresented nursing students and were not specific to African American nursing students were excluded, as well as articles describing African American students enrolled in non-U.S. nursing education programs. Studies that addressed retention strategies for other underrepresented minority groups but did not focus specifically on African American nursing students also were excluded from this review.

An electronic database search was conducted using the following databases: National Library of Medicine, National Institutes of Health PubMed®, MEDLINE®, Scopus®, CINAHL®, Health Source®: Nursing Academic Education, and PsycINFO®. The Medical Subjects Heading (MeSH) terms used in the search included the following keywords, phrases, or permutations and combinations of the keywords and phrases: African American nursing students; Black nursing students; minority nursing students; underrepresented minorities, diversity; academic success; attrition; retention; persistence; graduation; and nursing education: generic nursing education and prelicensure RN education. After articles were found that fit the inclusion criteria, the reference lists of those articles were reviewed for additional articles addressing the subject matter that fit the inclusion criteria. For the articles found that met the inclusion criteria, an author search also was conducted using the electronic database author search tool.

The database search using the keywords, phrases, or permutations yielded a total of 48 articles related to the retention of underrepresented minorities in nursing education programs. Of those 48 articles, five articles focused specifically on the retention and graduation of African American nursing students in prelicensure nursing education programs (Figure). No additional citations were found by reviewing the references cited within the inclusion articles, using the find “related or similar articles” link provided by the PubMed search engine, or by conducting author searches for the five articles that fit the inclusion criteria. The majority of the 48 articles fell into one of the following categories: identification of factors that impact the retention of underrepresented students in nursing; strategies for the successful recruitment and retention of minority nursing students; descriptions of projects that favorably impact a school’s ability to recruit and retain underrepresented minorities in nursing; assessments of the cultural competency of the faculty; surveys to determine the extent to which concepts on cultural competency were embedded within curricula; and studies of strategies to increase the licensure examination success of underrepresented nursing students prior to graduation. Those articles were not included in the review, as they were not research based, and although they were focused on underrepresented minorities, the articles were not exclusive to African Americans.

Flow chart illustrating the number of articles that met the review criteria.

Figure.

Flow chart illustrating the number of articles that met the review criteria.

The focus of this review was to gain a better understanding of the lived experiences of African Americans in prelicensure nursing education programs, given that 10-year trend data revealed a reduction in the percentage of African Americans who graduated from prelicensure programs (Table 1). The lack of published research in the area underscored the need for further exploration of the declining graduation rates of this particular population if the workforce is expected to reflect the population. Therefore, this review was conducted to integrate what is known about the educational experience of African Americans, what is the quality of what is known about the educational experience of African Americans, and what should be known about the educational experience of African Americans.

Data Evaluation

All five studies that met the inclusion criteria used a small sample of African American students (N = 8 to 26). There were a total of 66 African American students enrolled in ADN or BSN prelicensure programs. One study focused specifically on African American students enrolled in a BSN program, and the participants in the study also held non-nursing bachelor degrees (Love, 2010). The other four studies focused on African Americans enrolled in ADN and BSN programs.

All of the studies used a qualitative method of inquiry. Qualitative research can provide a deep, rich insight into understanding the human experience (Denzin & Lincoln, 2011). For the five studies included in this review, the researchers collected the data through the use of face-to-face and tape-recorded interviews using semistructured interview guides and open-ended questions to guide the process (Coleman, 2008; Dapremont, 2011, 2014; Love, 2010; Payton et al., 2013). The quality of each research article was coded according to two criteria, high or low, based on the relevance of the data to contribute to the review questions and the methodological rigor. All of the articles included in this review were coded high in relevance and described the lived experience of the students. The rigor varied among the studies specific to methods used for thematic analysis and the validation of findings. Given the limited number of studies that met inclusion criteria and the relevance score of each, all five studies were incorporated into the analysis. None were excluded based on the data evaluation process.

The demographic data varied significantly among the five studies. Although all of the articles used the racial classification of African American or Black in the nursing title, one study included two students of Jamaican descent and one from Haiti (Love, 2010). This study remained in the review because it met the inclusion criteria and the definition for African Americans as outlined in the definition of terms. Study participants’ ages ranged from 18 to 50; the majority of the participants were women (N = 60), along with a total of six men. Only two of the five studies reported marital status (Dapremont, 2014; Payton et al., 2013). Forty-four participants were included in the two studies that identified marital status. Of those, 68% were single, 20% were married, 3% were divorced, and 1% were separated. Other demographic data such as employment status, income level, or parental income status were not described and therefore cannot be described in this review. The settings of the studies varied and included schools in the northern, midsouthern, midwestern, and southern United States, thus demonstrating variability within the geographic spread.

Two of the five studies focused on the perceptions or feelings that students experienced as African American nursing education students, and the other three studies focused on the strategies that were used to promote academic success. The five studies are summarized in Table A (available in the online version of this article). The themes, patterns, and strategies used to promote academic success are summarized in Table 2.

Study SummaryStudy SummaryStudy Summary

Table A.

Study Summary

Common Themes and Coping Strategies for Success of African American Nursing Students

Table 2:

Common Themes and Coping Strategies for Success of African American Nursing Students

Data Analysis

The goal of data analysis was to uncover themes and differences that existed across the five studies. A matrix was used to analyze the data based on the following categorical components: target population, publication date, quality score, use of a framework for thematic analysis, use of a co-researcher to validate themes, and the ability to answer the questions that guided this review. Each study was analyzed further based on the key contributions made to the literature as well as any noted deficiencies and omissions (Torraco, 2005).

The challenges encountered by African American students included feelings of discrimination, isolation, financial barriers, problems related to academic and social adjustments (which is inclusive of low academic achievement in high school), and lack of academic preparedness for college-level coursework; these are consistent with those generally found in underrepresented minority groups (Bellefleur, Bennett-Murray, Gulino, Liebert, & Mirabito, 2009; Childs, Jones, Nugent, & Cook, 2004; Igbo et al., 2011). These challenges can impede the student’s persistence to graduation. This review revealed consistent themes of discrimination, the need for academic support, mentoring, and integration and inclusivity as factors that could impede or promote success.

Discrimination

In the studies used for this review, the students believed that they could be successful and that belief served as a motivator for success (Coleman, 2008; Love, 2010). This notion of self-efficacy is consistent with Bandura’s (1986) social cognitive theory, which posits that belief in one’s self can lead to success. The individual’s confidence in his or her ability to perform a certain task or behavior can ultimately impact the expected outcome, or in the context of this study, the student’s persistence to graduation (Bandura, 1986). Students expressed that discrimination (blatant, subtle, or both) from faculty, staff, and peers served to undermine their belief in self, causing self-doubt, fear, and diminished self-esteem (Love, 2010).

Students felt unwelcomed when they perceived that faculty did not treat them similar to White students or when they perceived a sense of the faculty’s discomfort when working with them. These behaviors were manifested as failure to acknowledge the student’s presence and maintain eye contact with the student (Coleman, 2008; Dapremont, 2011; Love, 2010). Students who felt unwelcomed by individual faculty members tended to avoid those faculty members (Coleman, 2008; Dapremont, 2011; Love, 2010). Students who felt powerless and insignificant often made the decision to leave the program. Such experiences of racial discrimination, isolation, and seemingly institutional abandonment served as impediments to students’ academic success and caused the students to experience feelings of displacement and otherness (Coleman, 2008). Reassurance, encouragement, and motivation by faculty and family were considered essential ingredients for students’ academic success (Love, 2010). Alienation, isolation, and being different were consistent themes found across the five studies.

Academic Support

Dapremont (2012) found that timely feedback on examinations, quizzes, and clinical performance contributed to the academic success of students. The assessments could be accomplished through review sessions, pop quizzes, class discussions, case study applications, or the use of automated audience response systems (i.e., clickers) as a way to review the material. Tinto (2012) pointed out that frequent assessment to determine students’ mastery of content could facilitate the learning process. Faculty, academic advisors, mentors, and counselors should attempt to meet with students frequently to assess students’ progress before they get into difficulty. Early warning systems served to help students prior to them getting into academic difficulty. Overall, students felt a strong need to be part of an inclusive environment that had faculty role models, mentors, and peers who embraced rather than tolerated them (Coleman, 2008; Dapremont, 2011, 2014; Love, 2010). Findings from this review were consistent with Tinto’s identification of the need for strong administrative support and programs that ensured a culturally sensitive, inclusive, and accepting campus environment with the academic infrastructure to promote success (Coleman, 2008; Tinto, 2012).

Mentoring

Faculty members, as mentors, were identified as helpful to students’ academic success. The students expressed that having mentors who “looked like me” provided a degree of reassurance that “I can do it too” (Dapremont, 2011; Payton et al., 2013). Bannister, Bowen-Brady, and Winfrey (2014) found that the mentoring process can enable the mentee to learn the new role and the professional values, skills, and knowledge inherent within the role. In addition, the students expressed that mentors could teach them the “tricks of the trade” and help with tasks such as how to complete financial aid applications and apply for scholarships (Payton et al., 2013).

Academic Integration and Inclusivity

Activities that integrated the students into the community such as peer networks and study groups (inter- and intraracial) were viewed positively by the students (Dapremont, 2011, 2014; Love, 2010). Initially, students expressed a need to have faculty-organized study groups, but as the students progressed through the program, most felt they could self-organize into study groups, and the racial congruence became less significant. Academic development and enrichment opportunities such as study skills sessions, time management sessions, writing laboratories, peer interaction, and faculty concern have been associated with the academic success of minority nursing students (Evans, 2013; Igbo et al., 2011). Dapremont (2014) found that students perceived study groups as a way to help learn the course content, prepare for examinations, and ultimately pass the licensure examination. Study groups can provide an informal assessment of one’s knowledge compared to his or her peers.

Discussion and Implications

Tinto’s (2012) theoretical model was used as the framework to discuss the cross-cutting challenges identified from this review. The model has five components consisting of expectations, support, assessment and feedback, involvement, and administrative action; these components served as the basis for the key recommendations (Tinto, 2012).

Expectations

This review found that African American students and recent graduates expressed feelings of inadequacy and perceptions of discrimination. This finding was consistent across all five studies. According to Tinto (2012), expectations are the degree to which the faculty, staff and administrators expect the students to be successful, and this expectation can impact the academic success of students. These expectations may be expressed in the subtle ways that individuals, whether teachers or students, treat others who are of a different social class, gender, or ethnicity. However expressed, students quickly detect the differences between positive and negative expectations, and these differences can (or cannot) validate their presence on campus (Tinto, 2012).

  • Key recommendation: Create an institution-wide diversity and inclusivity plan. Institutions could take a proactive stance to ensure that faculty recruitment efforts include a diverse pool of candidates and that the campus atmosphere is welcoming and has a critical mass of diverse individuals (Coleman, 2008). Such an atmosphere would go a long way in decreasing the anxiety, fear, and loneliness expressed by the students in this review.

Support

Structured study and the development of ritualistic study habits were deemed as factors that contributed to the academic success of African American students across all of the studies in this review. Students from disadvantaged or minority backgrounds may enter college unprepared for the rigors of the program of study. As such, academic, social, and financial support may be needed. Many students had not developed strong study habits prior to entering nursing school, which caused the students to struggle academically early in the program. Oftentimes, minorities do not enter nursing education programs with the same academic preparation as their white counterparts; many may be first-generation college students. Thus, the program may be more difficult than students anticipated. Study skills, time management, test taking, and other enrichment sessions would be of benefit to African American students. These sessions would be instrumental in teaching students to develop and adhere to a daily routine for study (Dapremont, 2014).

  • Key recommendation: Provide enrichment services that increase student success. Academic support frequently has been demonstrated through the use of services such as tutoring, study groups, supplemental instruction, and summer bridge programs (Tinto, 2012).

Assessment and Feedback

Students reported that frequent assessments would enable them to better monitor their academic performance. Performance assessments with frequent feedback provide students the opportunity to adjust behaviors to better promote academic success.

  • Key recommendation: Create an early warning system to identify at-risk students and begin working with them before they get into academic difficulty. To be effective, assessments must be frequent, early, and formative as well as summative. Warning systems should be established as early as possible and close to the beginning of the semester so that the necessary adjustments can be made to ensure students learned the foundational material and can successfully complete the course (Tinto, 2012). Establish a comprehensive mentor program. Mentors could be extremely helpful in guiding students, specifically if the mentor was of the same ethnicity of the mentee (Payton et al., 2013). The mentors could be faculty, staff, or other professionals who could spend additional time working with the students (Dapremont, 2011). The lack of minority faculty to serve as mentors and role models has been identified as a challenge for students from underrepresented backgrounds (Loftin et al., 2012).

Involvement

The students in this review believed integration and inclusivity were factors that contributed to overall academic success. Faculty support was found helpful; students who did not feel supported by faculty tended to avoid those faculty members (Dapremont, 2011). The more involvement and guidance that were provided by the faculty, the more likely students were to be successful in the program (Dapremont, 2011; Gardner, 2005). Tinto (2012) found student engagement (both academically and socially) with the faculty, staff, and other student peers increased the likelihood that students would complete the program of study and graduate. Barnett (2011) concurred that greater engagement in meaningful learning activities leads to more effort put into studies, which in turn should heighten academic performance and retention. Students’ sense of belonging enabled them to see themselves as part of the community, and this sense of belonging occurred more frequently when there was a critical mass of students who looked like them on campus (Tinto, 2012). The critical mass can perhaps minimize students’ feelings of isolation and loneliness as was reported by students in this review.

  • Key recommendation: Provide opportunities for social interaction with the faculty and student peers to foster engagement, learning, and add to students’ confidence and sense of belonging in the academic milieu (Dapremont, 2011). Development opportunities should be provided for the faculty. Faculty could organize study groups, which could prove helpful for some students at the onset of the program.

Administrative Action

This review found that persistence encompassed more than an individual’s decision to depart; it also was based on factors related to the academic environment and other key social factors such as family and financial support. Love (2010) described how the various institutional structures, ideologies, and practices tended to perpetuate the status quo in beliefs regarding “professionalism” and could potentially undermine cultural practices related to language and dress, thus devaluing the need to better understand differences in race and socioeconomic status. Strong administrative support with intentional, structured, and proactive actions that were consistently applied for the long term and coupled with policies that supported and guided those actions for those responsible for implementing them could greatly contribute to minority students’ academic success (Tinto, 2012). Without administrative support and action, programs of this nature are not sustained over time (Tinto, 2012). Similarly, Valverde and Rodriguez (2002) found financial support, emotional and moral support, mentoring, professional socialization, academic advising, and technical supports as key components of institutional support that contributed to minority students’ success.

  • Key recommendation: Encourage families to help students meet their educational goals vis-à-vis emotional support, financial contributions, and encouragement. Administrative support of programs aimed to improve the academic success of students must be in place.

Limitations and Recommendations

This review identified numerous factors that were perceived to impact the academic success of African American nursing students according to students’ reports of the lived experience. The small number of studies found in the literature that specifically focused on African American nursing students was a major limitation of the review. In addition, two of the five studies appeared to use the same sample population (Dapremont, 2011, 2012). Perhaps the review could have been made more robust if it had been expanded to include graduate education and practicing nurses. Graduate education was not included due to the variability of graduate education, compared with undergraduate education. Part-time study is common in graduate nursing education as opposed to full-time study in undergraduate education, and many graduate nursing students are able to offset tuition costs through employee reimbursement or remission when working full-time as a practicing nurse. In addition, graduate classes frequently are small and focused on specialty interests. These factors, often not present in prelicensure education, could impact the academic success of students and differ significantly from the educational environment generally encountered in prelicensure education. The accurate recall and memory of the lived experience of prelicensure education also might influence practicing nurses’ recounting of the prelicensure education experience.

The sample in this review consisted of African American students who were currently enrolled in or recently had graduated from prelicensure education programs. The students who recently graduated relied on recent recall of the student experience. Even for the recent graduates, the accuracy of the recollected experiences may not be clear since some time had lapsed. Also, for students who recently completed the nursing education program, it is possible that information critical to the academic success of the students was missed or forgotten.

What was missing from these studies was an account from students who were not academically successful in nursing education programs, which could perhaps shed more light on additional variables that caused them to be unsuccessful in their academic pursuits. Thus, the students who were not able to persist through program completion could have dissimilar needs or other barriers that were not identified in this review and warrant additional study (Loftin et al., 2012).

None of the studies incorporated in this review addressed integration and inclusivity based on age or gender, which appeared to be a glaring omission. Perhaps integration and inclusivity needs were not stratified by age or gender due to the limited number of study participants. However, certain demographic variables, such as age, marital status, gender, and socioeconomic status, could influence perceptions of integration and inclusivity.

A next step could be to conduct a study with a much larger sample size of students who are near graduation to determine the factors that created or hampered their academic success and perhaps stratify those factors by the type of nursing education program (ADN or BSN) and other demographic characteristics. This would enable the researcher to develop program-specific interventions to aid in students’ academic success. Hopefully, this review will stimulate further dialogue and raise awareness of the significance of racial differences on academic success.

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10-Year Trends of African American Students’ Enrollment and Graduation Rates

YearEnrollment (Fall)Graduation (Spring)
20049.3%10.2%
200511.7%9.9%
200612.1%9.8%
200711.8%9.3%
200811.0%9.8%
200911.1%9.7%
201010.9%9.7%
201110.3%9.2%
201210.2%9.4%
20139.6%9.3%

Common Themes and Coping Strategies for Success of African American Nursing Students

Common FeelingsCoping Strategies Leading to Program Completion
DiscriminationIndividual study habit strategies
  Inferiority  Develop study rituals
  Less privileged  Reading assignments
  Insignificance  Use of note cards
  Inadequacy  Study with peers
IsolationAcademic support
  Anxiety  Mentor support
  Fear  Academic enrichment opportunities
  Loneliness  Faculty support
  Discomfort  Faculty-structured study and review sessions
Feelings of being misunderstood  Campus activities
  Having to go along to get along  Financial resources
  Lack of understandingFamily support
  Understanding of academic responsibilities
  Assistance with chores
  Financial support
  Emotional support

Study Summary

StudyYearStudy PurposeStudy DesignSampleFindingsProgram Type
Dapremont2014The aim of this study was to determine the strategies deemed successful by Black graduates of PWIs.A qualitative, descriptive study to explore the strategies that Black graduates found helpful for program completionEighteen Black graduates who successfully completed nursing education programs in PWIsThe graduates found that establishing daily routines or rituals for study, ongoing participation in peer study groups, reading class assignments, and making and using note cards for study purposes helped them to succeed and complete the program.ADN/BSN
Payton, Howe, Timmons, & Richardson2013The purpose of this pilot study was to describe African American nursing students’ perception of how mentoring could contribute to academic success.An interpretive, qualitative study design that used semi-structured interviews to capture themes and patterns within subjective perceptions of the use of mentors as relating to academic successTwenty-six African American students who were enrolled in clinical courses at a 4-year university or a 2-year collegeFour themes emerged regarding the use of mentors to promote academic success. The study participants felt that mentors could serve as role models, teach students tricks of the trade, foster a sense of belonging, and provide an opportunity to connect with someone who “looks” like them.ADN/BSN
Dapremont2011The purpose of this study was to determine the perceptions and experiences that contributed to the academic success of Black students enrolled in a PWI.A descriptive qualitative study to examine the lived experience of Black nursing students who attended a PWI, using guided interview questionsEighteen Black graduates who successfully completed nursing education programs in PWIsThematic analysis revealed the need for same-race peer support. As the students matriculated through the program, the race of the peers became less important. Use of study groups were helpful, including studying with White peers. Students felt White peers had access to information that was unavailable to Black students. Family support was critical; faculty support and encouragement and the lack of faculty support motivated some students to want to succeed all the more.ADN/BSN
Love2010The purpose of this study was to explore the socialization process of Black students in a PWI to achieve academic success.A phenomenological study to capture the experience of eight African American students in a PWIEight African Americans enrolled in a PWISix themes emerged from the eight African American students: Strength to Pursue, Overcoming Encounters With Discrimination, Pressure to Succeed, Isolation and Sticking Together, The Need to Fit in and Talk White, and To Learn With New Friends and Old Ones.BSN
Coleman2008The purpose of this study was to explore the academic and social experiences of African American nursing students enrolled in an ADN program at a PWI.This study used a qualitative design to understand what the experience of being enrolled in a PWI meant to the students and the impact of the experience on academic success.Fourteen African American students enrolled in a 2-year community college nursing education programOverall the students felt that race was a major factor in the sense of fit and compatibility with the nursing program. Their experiences included feelings of alienation, insignificance, being different, and unwelcomed. Students felt the “uneasiness or discomfort” White faculty displayed when working or dealing with them and viewed faculty as distant, uncaring, and unsupportive. The students’ indicated they coped by working harder, staying on top of their studies, and/or going along to more or less get along.ADN

10.3928/01484834-20150814-14

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