Understanding a person's experiences, challenges, and thought processes is essential in expanding the dialogue on race and ethnicity in nursing education. Having firsthand experience of what it feels like to be a minority in the profession—starting as an undergraduate nursing student and moving through to positions of leadership—it was easy for me to detect environments where one was welcomed, tolerated, marginalized, or invisible. My journey encompassed many settings and spanned several institutions; some environments were welcoming, yet others not so much. Institutional work and learning climates matter.
My intent in writing this editorial is to accomplish, if nothing else, the recognition that no one, including nursing students, is inoculated from feelings of marginalization, especially if the individual or group perceives a difference in their treatment in comparison with others. Even the slightest perceptible difference can have a significant effect on one's ability to thrive in any given environment, including academic environments. Microaggressions, the subtle messages sent by body language, word choice, and behavior, can be readily detected by individuals in response to difference (Sue, 2017). People of color often have lived racial realities about bias, microaggressions, and discrimination that have been frequently disregarded and dismissed as the person being overly sensitive, paranoid, and misinterpreting the actions or words of another. This skepticism to microaggressions can dilute, dismiss, and negate one's lived experience; as the old adage goes, “the true tale of the lion hunt will never be told as long as the hunter tells the story” (Sue, 2017, p. 170). Ask your students about their perceptions of the environment and how they are perceived and treated by others—in the classroom, in their clinical experiences, in social situations. They will tell you.
Institutional climates, including those in nursing education, have been of growing concern since divisive rhetoric, focused on exclusion rather than inclusion, has emanated from within the highest levels of government. The divisive rhetoric has unfortunately surfaced at a time when the need to increase the diversity within the RN population is more urgent than ever before. Clearly, having a diverse RN workforce depends on the ability of nursing schools to successfully recruit, retain, and graduate a cadre of students from Underrepresented Minority groups. How else can we ensure an RN workforce that reflects the demographics of the U.S. population? To achieve an RN workforce reflective of the population, we should start by reviewing the challenges associated with admissions into nursing education programs.
First of all, students must be admitted into a nursing education program. Stringent admission requirements, especially those that rely on traditional metrics, have created challenges for some under-represented minority students who desire to enter into nursing. Many underrepresented minority applicants may, based on some aspect of disadvantage—whether educational, environmental, economic, or social—may not meet the prerequisite grade point average (GPA) or the required standardized test score needed for admission. Although it is understood that standardized test scores and GPAs are proxies for future academic success, they are based on past performance and do not present an accurate reflection of one's ability or potential, nor do they take into account the effort and diligence the student has had to employ to overcome disadvantages to achieve academic success. For these reasons, some nursing education programs are beginning to expand their admission criteria to look beyond the customary high school GPA and standardized test score.
Some universities are now using a holistic admissions process that evaluates the applicant based on institutional mission and the applicant's experience, personal attributes, previous academic performance, potential contributions, and other diverse attributes—all of which allow schools to build a diverse class that can enrich the learning environment for all (Urban Universities for Health, 2014). Holistic admission has been shown to increase the diversity of incoming students without resulting in measurable changes in the class's overall academic quality, student performance, or retention (Urban Universities for Health, 2014). Nurse educators should consider the holistic admissions process as an alternative to the current admission practices to create a more diverse student body.
After students have been admitted to a nursing program, the focus should be retention through program completion. Retention through program completion means having the necessary supports in place for students to achieve academic success. Many schools have had success in admitting a diverse applicant pool, but the percentage of the students who actually complete the program is dismal. Once a student is enrolled, sufficient support services should be provided by faculty and staff to help the student achieve success. Support services can include, but are not limited to, faculty support, academic advisors, academic counselors, retention coaches, writing center assistance, tutors, and financial support.
Surprisingly, there is much variability in the completion rates of underrepresented minority students among nursing programs, despite comparable standards for admission and similarities in the curricula. What factors contribute to the academic success of students in some environments more so than others? Acknowledging that external (e.g., work, family responsibilities) and pre-entry factors (e.g., GPA) have a significant influence on college success, Museus, Yi, and Saelua (2017) found that culturally relevant and responsive environments tended to allow underrepresented minority students to achieve higher levels of success. College campuses identified as culturally engaging were found to have a positive influence on the student's sense of belonging, academic self-efficacy, motivation, persistence, and performance, all of which increase the student's chance of success (Museus, Yi, & Saelua, 2017). Campus environmental elements predictive of academic success for underrepresented minorities included opportunities for students to:
- Interact with faculty, staff, and peers who could relate to their background and experiences.
- Exchange and share information related to their culture, race, and ethnicity.
- Engage in real-world, community-based research and service activities.
- Participate in conversation with peers regarding the sociopolitical challenges related to culture, race, and ethnicity.
- Understand that the institution values their culture and respects their identity.
- Embrace collaborative teamwork, rather than compete with other students.
- Experience meaningful relationships.
- Take advantages of resources and support services the institution has established to foster student success.
- Connect with at least one individual, faculty member, student service advisor, or university official who the student feels can support and guide them, regardless of the circumstance (Museus et al., 2017).
Given the opportunities listed above, what are the areas within your institution where the contextual or environmental factors could be improved? What are the social structures and barriers within your institution that should be altered to be more welcoming for students from underrepresented minority groups? What can you do as a faculty member or administrator to make the environment more welcoming for students from diverse backgrounds? What is your role in helping students achieve success?
Knowing that most institutions of higher learning are well intentioned and aim for all students to achieve academic success, the American Association of Colleges and Universities (AACU, 2017) developed core principles on diversity, inclusion, and equity to help colleges and universities engage in the often difficult but necessary conversations to transform their learning environments. These core principles of diversity, inclusion, equity, and equity-mindedness serve as guides for universities and colleges to move toward inclusive excellence: Diversity is the recognition of individual differences; inclusion is the intentional efforts to address diversity; equity is the creation of opportunities for historically underrepresented groups; and equity-mindedness is the awareness of and willingness to address equity issues (AACU, 2017). These principles, when used in nursing education, can be of great assistance with the recruitment, retention, and graduation of underrepresented minority students.
Embracing inclusive excellence is a start to achieving greater diversity within nursing education programs and, subsequently, the RN workforce. Has your institution adopted these or similar principles on diversity, inclusion, and equity? What strategies has your institution embarked on in the journey toward inclusive excellence? The hope is for a diverse RN workforce equipped to meet the health care needs of all populations. The challenge is for nurse educators to expand on ways to recruit, retain, and graduate a diverse pool of entrants into the RN work-force. It should be our shared desire to create academic environments where all students feel welcome and are able to be successful.
Teri A. Murray, PhD, APHN-BC, RN, FAAN