Diversity among nurses is essential to meet the cultural and health care needs of a growing and increasingly diverse population (American Association of Colleges of Nursing, 2015). Despite gains in recruiting and graduating nurses from diverse backgrounds, the current number of racial and ethnic minority nurses, and also male nurses does not reflect the ethnicity demographics of the United States. In part, this imbalance reflects high attrition rates and lower graduation rates that persist for minority (Gilchrist & Rector, 2007) and male (Meadus & Twomey, 2011) nursing students. Data from the National Council of State Boards of Nursing and the Forum of State Nursing Workforce Centers indicate that only 19% of RNs are members of racial and ethnic minority groups (Budden, Zhong, Moulton, & Cimiotti, 2013). However, according to recent census data, ethnic minorities comprise 37% of the U.S. population (U.S. Census Bureau, 2012). In 2011, only 9.6% of RNs in the United States were men (Landivar, 2013), which was an increase from 8.9% in 2006. The proportion of male RNs in the United States is still significantly lower than the proportion present in other developed countries, such as the United Kingdom (Nursing and Midwifery Council, 2015). Equally important to promoting diversity in the nursing workforce is the education of well-qualified nurses. Higher levels of nursing education allow workers to provide safe and high quality care in a variety of patient care settings (Institute of Medicine, 2010).
Nursing faculty and administrators have attempted to address the problem of underrepresentation of minority and male nurses by implementing recruitment and retention strategies that target a more diverse applicant pool. Generating posters and brochures that include underrepresented groups such as ethnic minorities and men assists in the recruitment process of these students for nursing institutions (Noone, 2008). Under-representation of male and ethnic minority nursing students still persists, although recent recruitment and retention efforts have increased enrollment of these groups in baccalaureate and graduate nursing programs. The American Association of Colleges of Nursing’s 2013–2014 Enrollment and Graduation in Baccalaureate and Graduate Programs in Nursing reported that minority enrollment in U.S. entry-level baccalaureate nursing programs represented only 28.9% of the total enrollment (Fang, Li, Arietti, & Bednash, 2014). Minorities also comprised 30% of total enrollment in master of science in nursing (MSN) programs, 26.9% in doctor of nursing practice (DNP) programs, and 28.4% of students enrolled in research-focused doctoral programs. The trend was even lower for men in nursing programs: 11.4% of baccalaureate, 10.3% of MSN, 11.3% of DNP, and 8.7% of research-focused doctoral program students in nursing are men (Fang et al., 2014). Minority and gender characteristics of students enrolled in entry-level accelerated MSN programs were included in the aggregate MSN program data and were not reported separately.
Barriers have been identified for both minorities and men entering and matriculating in nursing schools. Ethnic minority students report a lack of academic support and role models, as well as discrimination in the educational system. Both faculty and peer support contribute to the success and retention of ethnic minority students (Condon et al., 2013). African American nursing students have communicated the desire to identify with other African American students and receive peer support from students of other ethnicities (Dapremont, 2011). In addition, ethnic minority students have reported that a lack of financial support was a major barrier that often caused them to seek employment to pay for educational and living expenses (Loftin, Newman, Dumas, Gilden, & Bond, 2012). Both male (Stott, 2007) and ethnic minority students report feelings of loneliness, isolation, and differentness (Loftin et al., 2012; Stott, 2007). The lack of sufficient numbers of male nurses in clinical settings and among faculty was identified as a barrier for male nursing students (Stott, 2007). Men also reported that gender stereotypes in the nursing profession, such as the lack of gender-neutral language (Meadus & Twomey, 2011; Roth & Coleman, 2008) and discrimination in academic and clinical settings, were common barriers experienced during their nursing program (Keogh & O’Lynn, 2007; Stott, 2007).
One strategy to promote success and retention of ethnic minority and male nursing students is employment of successful mentorship programs for baccalaureate and graduate-level nursing programs. Wilson, Andrews, and Leners (2006) support the idea of nursing students acquiring a variety of mentors, such as a professional nurse mentor, a faculty mentor, and a peer mentor. Through positive mentoring relationships, students learn to think through situations independently, and they can better identify with what type of mentor they would be to another individual. Successful mentorship programs also increase student motivation, independence, and professional competence, while fostering socialization into the nursing profession (Escallier & Fullerton, 2009).
Financial assistance offers another opportunity to recruit and retain ethnic minority and male nursing students. The Robert Wood Johnson Foundation (RWJF) developed and implemented the New Careers in Nursing (NCIN) Scholarship Program to increase minority and male enrollment and retention. As of 2013, RWJF had awarded more than $30 million in scholarship money to 3,117 economically disadvantaged students in accelerated entry-level nursing programs. The program provides valuable financial resources to scholarship recipients and engages nursing students in a variety of programs designed to increase retention in nursing school. One tenet of the program is establishing mentoring relationships between the scholars and the faculty in a college of nursing (RWJF, 2013).
Although the success of ethnic minorities and men has been tracked at the traditional undergraduate and graduate levels, research focused on the progress of underrepresented groups in accelerated entry-level MSN programs has been limited. Few programs exist that identify methods of recruiting and retaining ethnic minority and male adult learners who are returning to nursing school after successful completion of baccalaureate degrees in other fields. Accelerated nursing programs provide efficient means to educate students who earned bachelor’s degrees in other fields and thus provide the nursing workforce with individuals who can apply information and skills from their previous profession in the nursing occupation. Rich knowledge and experience that these students bring to nursing has the potential to advance the nursing profession and improve patient care outcomes. Resourcefulness, initiative, effective communication skills, and patient advocacy are assets employers have identified in graduates of accelerated entry-level programs (Ziehm, Uibel, Fontaine, & Scherzer, 2011). Graduates of accelerated-degree nursing programs contribute new information to the profession and are excellent candidates for advanced practice (Payne & Mullen, 2014). This article examines strategies used at a college of nursing to facilitate program retention and graduation rates for ethnic minority and male students entering an accelerated, entry-level MSN program.
The NCIN Program, sponsored by RWJF, has a rich history of supporting students in accelerated nursing programs by providing scholarships, which assist in alleviating financial burden. With a commitment to meet nursing workforce diversity, the NCIN enables scholars’ rapid entry into the nursing profession. In 2009, the authors’ college of nursing implemented a unique accelerated entry-level MSN clinical nurse leader (CNL) program for students with degrees and experience in various non-nursing fields. To assist with recruitment and retention of ethnic minority and male nursing students, the Scholarships for Underrepresented Students in an Accelerated Initial Nursing (SUSTAIN) program was launched, funded through the RWJF’s NCIN. Scholars accepted into the SUSTAIN program were selected based on meeting one or both of the following criteria: member of an underrepresented group in nursing or from an economically disadvantaged background. After acceptance, scholars received financial support for the first year of their nursing program.
The strategies used in the SUSTAIN program were the same for male students and ethnically diverse students. Male and ethnically diverse students are a visible minority in nursing programs and report similar feelings of loneliness, isolation, and differentness (Loftin et al., 2012; Stott, 2007). A sense of inclusiveness and community among the students was fostered by having them participate together in the SUSTAIN program activities. Male and ethnically diverse students were selected for the SUSTAIN program; some of the ethnically diverse students were men. From 2009 to 2014, all of the scholars who participated in the SUSTAIN program graduated from the school’s accelerated MSN-CNL program.
During their respective nursing programs, SUSTAIN program participants engaged in leadership activities, service-learning activities, and social and academic support sessions. Faculty members, including those who were graduates of the RWJF Executive Nurse Fellows program, were invited to conduct a variety of leadership seminars for participants. These sessions introduced program scholars to content on topics such as leadership styles, effective communication skills, and management of conflict among their peers and colleagues. Scholars were able to identify their leadership and personality style, and explore effective methods to think critically and work collaboratively in a professional setting. Outside of the sessions, faculty members took an active role in inspiring SUSTAIN scholars to engage in collegiate and professional leadership roles.
Each month, scholars participated in service-learning activities within an assortment of community locations under the guidance of a faculty member. These service-learning activities were not embedded in existing courses, and no release time from courses was provided as compensation for the service-learning activities. Students committed to participate in the service-learning activities at the time of their application to the SUSTAIN program. These activities promoted scholars’ autonomy and socialized them into the professional nursing role. Activities for scholars included teaching parents and children of a local family shelter about proper nutrition. Scholars supplied information on nutrition, oral care, and hand hygiene in an after-school program in a disadvantaged area. Scholars also provided health-related screenings, such as blood pressure and blood sugar examinations, to homeless individuals within the community. In addition to performing health screenings, scholars also educated these individuals on healthy nutrition, dental hygiene, and appropriate foot care. Participation in health fairs was also a building block to foster independence and supplied the scholars with resources and a wider exposure to disadvantaged communities than was experienced by students who were not in the SUSTAIN program.
Academic support was another essential component of the program. Tutoring sessions that expanded on topics taught in the classroom and clinical setting were led by faculty members and doctoral students. During the sessions, interactive teaching approaches, such as structured games, were used to engage students in learning activities and assess their content knowledge. Team-based learning techniques also were used during academic support sessions to allow students to facilitate the meeting in an attempt to foster leadership skills. The key component of this technique allowed scholars to suggest topics that were significant to their studies. Tailored curriculum plans were established to best meet the academic needs of program scholars. Finally, scholars were afforded the opportunity to learn additional test-taking strategies such as integrating nursing concepts, eliminating distracters within the question, and practicing time management during a test.
Scholarship recipients also participated in social activities in which they gained insight into the nursing profession through a mentorship component of the program. Students were provided with the opportunity to form both formal and informal mentoring relationships with past RWJF scholars, faculty members, doctoral students, and community members. Mentorship activities with past scholars were informal and provided an opportunity for collegiality and development of professional and social relationships. Past scholars shared their successes in the program, as well as their postgraduation future professional plans. They also provided honest and positive feedback to questions posed by new scholars. Mentors included RWJF fellows, administrators, and faculty within the college of nursing. Scholars interacted with doctoral students routinely, thus gaining an understanding of the various doctoral programs offered and potential career opportunities.
Since the inception of the SUSTAIN program in 2009, a total of 51 scholars have entered and completed the program in the college. Seventy-five percent of the participants were from an ethnic minority, 35% were men, and 92% were economically disadvantaged. The program boasts a 100% retention rate of scholars from economically disadvantaged backgrounds. Ninety-eight percent of these students progressed on-time to graduation. SUSTAIN scholars have achieved a 92% first-time pass rate on the NCLEX-RN® examination.
SUSTAIN scholars served in various leadership roles within the college, university, and student professional nursing associations. They coauthored abstracts and served on advisory boards within the university. The success of the SUSTAIN program led to the implementation of a new pre-matriculation program within the college of nursing. Standardized testing is now used throughout the program to identify potential gaps in student knowledge. In addition, the college’s progression committee is involved in the ongoing monitoring of student success. The college also provides free small-group tutoring and is exploring strategies to develop small mentorship groups to promote a sense of community within the college.
The SUSTAIN program enhanced the success of male and ethnically diverse students enrolled in an accelerated, entry-level MSN program. Frequent contact, three to four times per month, particularly during the first term of the accelerated nursing program, fostered a sense of community within the student group. Although the group size did not affect retention, on-time progression in the program, or NCLEX-RN pass rates, larger group sizes resulted in the formation of subgroups and less personalized interactions between the students and faculty or doctoral student mentors. Subsequent groups were limited to 10 or 11 students. SUSTAIN sessions were planned around the students’ course schedules and included on their academic calendars. Incorporating the group sessions into the students’ schedules facilitated participation, despite students being enrolled in an accelerated program.
Students participated in service-learning activities as part of the SUSTAIN program. These service-learning activities increased the visibility of the male and ethnically diverse student population within the community and fostered positive relationships between the college and the organizations served. The majority of the service-learning activities were not included as part of the students’ clinical experience and required additional time from students and faculty. Incorporating service-learning activities into existing nursing courses could reduce the burden on the students and faculty, and facilitate sustainability of the service-learning component of the SUSTAIN program.
Scholarships and personnel were the primary costs associated with implementing the SUSTAIN program. Tuition was waived for doctoral students for service in the research or teaching programs of their faculty advisor. Incorporating doctoral students into the SUSTAIN program resulted in lower personnel costs and was mutually beneficial to the scholars and the doctoral students.
Implementation of a program to retain ethnic minority and male nursing students in an accelerated or entry-level MSN can be accomplished. Careful planning and monitoring is required to best meet the individual needs of the students. Mentorship relationships are especially important to consider. Mentors should have strong leadership skills and the ability, desire, and time to serve as mentors. Encouraging minority and male faculty members to serve as mentors also is recommended. According to Fischer (2007), having formal ties to a college professor increases academic success among minority students. These findings are consistent with the preliminary results of the SUSTAIN program.
Service-learning is a tool to build confidence, increase interpersonal communication skills, and provide leadership opportunities. Fischer (2007) further outlined the need for social connection and its positive correlation with academic success. Accelerated nursing programs often include adult learners with prior work experience and educational success. Service-learning is an opportunity to build confidence among minority and male students.
Additional academic support may be needed to help ethnic minority and male students attain success. Academic counseling and small group tutoring sessions were helpful for students who identified a need for additional support. Seminars on leadership, conflict management, and communication were important to adult learners who often come into the program with significant past work experience.
Financial support was a crucial factor in achieving student success. Students were able to work fewer hours or defer working when receiving scholarships as part of their financial aid. An institutional commitment to diversity should include scholarships designated for students from groups underrepresented in nursing.
Accelerated entry-level MSN programs should consider the development of programs to retain ethnic minority and male students, as these students identify more barriers to academic success. By focusing on the needs of these specific underrepresented student groups and improving retention and graduation rates, the demographics in the nursing profession will better reflect those of the general population.
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