Journal of Nursing Education

Educational Innovations 

New Careers in Nursing: An Effective Model for Increasing Nursing Workforce Diversity

Melva Craft-Blacksheare, DNP, RN, CNM

Abstract

Background:

The Robert Wood Johnson Foundation and the American Association of Colleges of Nursing developed the New Careers in Nursing (NCIN) program to address the nursing shortage, increase workforce diversity, and raise the profession's educational level. The program provided scholarships to second-degree underrepresented or economically disadvantaged (UED) students attending an accelerated nursing program to earn a Bachelor of Science in Nursing degree.

Method:

A midwestern university received three academic-year cycles of NCIN funding. The program's model, resources, and functioning are described.

Results:

The NCIN provided exceptional financial and program support that received high marks from participants. During the three award cycles, 20 UED scholars graduated with a Bachelor of Science in Nursing degree. Nineteen of the 20 scholars passed the NCLEX-RN on the first attempt.

Conclusion:

While the NCIN program has ended, nursing school administrators and faculty wishing to promote UED student success should consider using the program's model and resources as the basis for their own program. [J Nurs Educ. 2018;57(3):178–183.]

Abstract

Background:

The Robert Wood Johnson Foundation and the American Association of Colleges of Nursing developed the New Careers in Nursing (NCIN) program to address the nursing shortage, increase workforce diversity, and raise the profession's educational level. The program provided scholarships to second-degree underrepresented or economically disadvantaged (UED) students attending an accelerated nursing program to earn a Bachelor of Science in Nursing degree.

Method:

A midwestern university received three academic-year cycles of NCIN funding. The program's model, resources, and functioning are described.

Results:

The NCIN provided exceptional financial and program support that received high marks from participants. During the three award cycles, 20 UED scholars graduated with a Bachelor of Science in Nursing degree. Nineteen of the 20 scholars passed the NCLEX-RN on the first attempt.

Conclusion:

While the NCIN program has ended, nursing school administrators and faculty wishing to promote UED student success should consider using the program's model and resources as the basis for their own program. [J Nurs Educ. 2018;57(3):178–183.]

For many reasons, increasing the diversity of the nursing workforce is important to the future of health care. Between 2012 and 2015, the University of Michigan–Flint's School of Nursing (SON) received funding from New Careers in Nursing (NCIN), a national scholarship program designed to address the nursing shortage and increase nursing profession diversity (Robert Wood Johnson Foundation [RWJF], 2016). The purpose of this article is to report on our experience with the NCIN program to encourage other nursing schools to use it as a template for retaining underrepresented or economically disadvantaged (UED) students who succeed in advanced education.

Background

Health disparities such as race, socioeconomic status, and geographic location can prevent people from UED backgrounds from seeking care or result in them receiving suboptimal care. These same barriers can prevent nursing students and others pursuing formal academic preparation in health professions disciplines from degree completion. The Sullivan Commission on Diversity in the Health Care Workforce concluded that increasing the racial and ethnic diversity of the U.S. health care workforce would have profound implications for the health care system, including increasing health care access and quality for minority patients and providing a sound system for all citizens (Sullivan, 2004). In addition, the Agency for Health Care Research and Quality (2013) posited that a diverse health care workforce positively affects outcomes, quality, safety, and patient satisfaction. In addition, Schoenthaler, Allegrante, Chaplin, and Ogedegbe (2012) found that race-concordant patient–provider relationships result in longer medical visits with higher ratings for positivity, effectiveness, shared decision making, and satisfaction.

After a 2-year assessment of the nursing profession, the RWJF and the Institute of Medicine (IOM) produced an action-oriented blueprint called The Future of Nursing Report for improving patient care. The report recommended fostering a more diverse nursing workforce, particularly in gender, race, and ethnicity (IOM, 2010). Furthermore, the report addressed the nursing shortage and highlighted the importance of raising the minimum educational level of RN to the baccalaureate degree (BS with a major in nursing or BSN degree). In addition, the RWJF and IOM joint committee's goal is to increase the percentage of RNs with BSN degrees to 80% by 2020 (IOM, 2010).

To address the nursing shortage, increase workforce diversity, and raise the profession's educational level, the RWJF and the American Association of Colleges of Nursing developed the NCIN. During the program's seven funding cycles (2008–2015), 130 schools of nursing in 41 states and the District of Columbia were selected as grantees, and 3,517 UED nursing students received $10,000 awards to complete their education (DeWitty, Huerta, & Downing, 2016).

Method

Between 2012 and 2015, SON received three cycles of NCIN funding. In the 2012–2013 academic year, $50,000 was received to give $10,000 scholarships to each of five UED accelerated second-degree (ASD) BSN students. Compared with traditional nursing students, second-degree ASD students typically are older and have nonacademic responsibilities (i.e., families and mortgages). NCIN also gave the university $6,500 to help with retention program and service development. In addition to mentoring and leadership activities, the retention programs included direct costs for scholar travel, meeting expenses, conference fees, and support for NCLEX review. For the 2013–2014 academic year, we received $100,000 to fund 10 UED students, and $6,500 for retention programs. This cycle also included $1,000 for the principle investigator and program director to attend conferences supporting pertinent skills and training. During the 2014–2015 academic year, we received $50,000 for five scholarships, $6,500 for retention programs, and $1,000 for the principle investigator to attend conferences. During each award cycle, the NCIN program hosted a 2-day summit for the principle investigator and program directors from all the recipient schools. The summit allowed participants to share program successes and challenges. Once notified of the NCIN award staff sent a letter to elected scholars to attend and discuss their achievements, ideas, and recommendations for NCIN program development, as well as their concerns.

Post-Award Activities

Once notified of the NCIN award, the university's staff sent a letter inviting all accepted incoming ASD students to apply. The letter explained the program's dates (16-month academic period), award amount, application deadline, award notification date, program commitments, and the eligibility criteria: Recipients must be underrepresented (in nursing), which included being African American/Black, American Indian or Alaska Native, Asian or Pacific Islander (excluding Chinese, Filipino, Japanese, Korean, Asian Indian, or Thai) and male, and they must be economically disadvantaged (expected family contribution ⩽ $1000). Students were given 10 days to return the application. The first cycle of NCIN scholars were chosen from an applicant pool of 20 to 40; the second cycle applicant pool, 15 to 40; and third cycle applicant pool, 20 to 40.

All applicants were interviewed by the principle investigator and program director, a nursing adviser, and a faculty member. Applicants also signed an agreement to sustain full-time enrollment (≥ 12 semester credits) in the fall and winter semesters; remain in good academic standing for program progression and completion; participate in the preentry immersion program (PIP), the mentoring program, and other leadership development activities; and become an active Student Nurses' Association (SNA) member.

Preentry Immersion Program

The NCIN program required all recipient schools to host a preentry immersion program (PIP) to help the scholarship recipients (scholars) develop the skills needed to complete an ASD program. Although the NCIN provided a PIP toolkit, grantees were encouraged to tailor their PIPs to their unique scholar population (Lee et al., 2016). A mandatory, 2-day PIP was hosted prior to each NCIN funding semester. The PIP objectives included providing preentry support that addressed scholars' self-identified needs; offering schools turnkey instructional options for mentoring and leadership development activities; presenting support and structured opportunities promoting scholar successes and retention as they move into the nursing profession; and encouraging grantees to use innovative strategies to develop productive partnerships that increase diversity in nursing leadership (Lee et al., 2016). In addition, nursing and interdisciplinary faculty and staff attended the PIP to help students prepare for the rigors of an ASD BSN program.

Prior to PIP participation, all scholars completed an online learning and study strategies inventory (LASSI). The LASSI is designed to assess students' learning and study practices and attitudes (Weinstein, Palmer, & Acee, 2017). Scholars were instructed to bring their LASSI results to the PIP so their strengths and weaknesses could be reviewed and support provided as needed. Nursing and other faculty from the university community gave presentations on a variety of topics including time management, critical thinking development, medical math, medical terminology, test-taking strategies, and study skills. In addition, scholars were given access to the online PIP supplement posted on an NCIN Blackboard® shell that included the following modules: Welcome to Nursing, Developing Survival Skills, Participating in Our Program, Introduction to Mathematics in Nursing, Introduction to Medical Terminology, and Leadership in Nursing. The online PIP supplement was available for scholars to view as desired during the entire academic period. Day two of the PIP for the second scholar cohort included a luncheon during which the senior scholars in their last program semester shared what they had learned during the program. In addition, the NCIN program developed the online scholar network to connect and support active scholars and alumni from across the country.

The PIP's success was documented by an evaluation tool (using a 5-point Likert scale) administered at the end of each program (Table 1). PIP evaluations from all three cycles were favorable. The success of the initial PIP prompted the development of a 1-day immersion program for all incoming ASD BSN students. The second day of the PIP was limited to NCIN scholars, to facilitate group bonding and allow them to focus on their individual needs. However, according to DeWitty et al. (2016), many of the NCIN grantee schools utilized the entire PIP for all ASD students. Given that the option to make all program materials available to the entire ASD cohort existed, the initial decision was to pilot the program with the selected scholars.

Preentry Immersion Program (PIP) Evaluation Tools

Table 1:

Preentry Immersion Program (PIP) Evaluation Tools

Mentoring Program

Loftin, Newman, Dumas, Gilden, and Bond (2012) reviewed 20 studies (quantitative and qualitative) related to minority nursing students' perceived barriers to success. The results indicated that mentoring programs and professional socialization opportunities facilitated minority students' achievement and success. After reviewing the nursing literature on mentoring, Peltz and Raymond (2016) described several mentoring models that vary in formality, structure, length, and personnel involved. The body of mentoring literature, including both qualitative and quantitative investigations, continues to grow without a clear agreement on what factors make mentoring successful (Loftin et al., 2013). In 2008, SON established a mentoring program in which UED students were paired with RNs working in the surrounding community. The RN mentors represented an abundance of professional accomplishments in a variety of clinical roles and positions, such as case managers, community health, medical, surgical, obstetrical nurses, and nurse educators. The student and RN pairs had face-to-face or telephone contact monthly. Twice during the academic year, the program would host mentor and mentee events that offered continuing education units for the RNs and topics of interest to the students. One program had a speaker on stress management who taught relaxation techniques to use during challenging times. In addition, a masseuse provided individual massages to mentees' as well as mentors. The mentor program was so successful that the SON began offering it to all nursing students.

Knowing the importance of mentoring for student retention, the NCIN required scholars to participate in a mentoring program. The university reconfigured its mentoring program to conform to the learner-centered mentoring model described in the NCIN mentoring toolkit (Choi, DeWitty, & Zachary, 2012). In the new program, scholars were matched with local RNs during their first year. However, during the second and subsequent years, they were paired with peer mentors (senior ASD students). Most mentees reported that the peer-mentoring program was beneficial. This program is still going strong and remains popular with incoming students. This popularity aligns the literature highlighting the fact that mentoring increases underrepresented students' feelings of being included and helps support their retention (Michigan Center for Nursing, 2014; Sutherland, Hamilton, & Goodman, 2007).

Leadership Program

An NCIN leadership development toolkit, with four distinct leadership development plans, was provided to all participating nursing schools (Choi, DeWitty, & Millet, 2012). The toolkit offered nursing faculty members guidance to help students progress into leadership positions by providing development activities over the course of the 16-month nursing program. The kit also provided support to help schools of nursing meet and sustain the NCIN's leadership and mentoring eligibility requirements. As part of the NCIN grant award, a thorough organizational leadership assessment was conducted to identify aspects of university's organizational culture, curriculum, student body, faculty dynamics, and community resources that could be used to develop and support a leadership program curriculum. The assessment results determined which leadership plan was appropriate.

The initial leadership exercise focused on the student's leadership style and educating them on the differences between leadership and management. Scholars took the true colors personality assessment and leadership matrix survey (Lowry & Clemens, 1990) and used the results to discuss their main leadership style. In subsequent meetings, scholars completed and discussed leadership and management practice exercises. In addition, nursing faculty shared and discussed real life nursing leadership and management vignettes.

To help scholars master a wide range of competencies allowing them to lead themselves and others, they worked through several ethical decision-making and interprofessional collaboration case studies. In addition, scholars completed effective working relationship exercises including some that helped them understand generational differences.

All scholars participated in the SNA. Each year, an NCIN grant allowed scholars to attend the state SNA conference and report their activities to their peers.

Many scholars were class officers and active in the SNA. During its last year of funding, the NCIN paid for one scholar from each university to attend the NCIN national summit in Washington, D.C. The attending scholar participated in workshops with other scholars from around the country. Scholars reported to their cohort about the importance of mentoring, leadership, and student support and retention for increasing nursing profession diversity.

Results

During the three NCIN grant award cycles, a diverse group (Table 2) of 20 UED scholars graduated from ASD program. Nineteen of the 20 scholars passed the NCLEX-RN on their first attempt. The NCIN program provided exceptional financial and program support. Even though the $10,000 grant did not cover all the scholars' expenses during the 16-month academic period, scholars repeatedly stated, “I don't know what I would have done without it.” Students often expressed their concern about the program's rigor and fast pace. However, mentoring and leadership sessions and monthly check-in luncheons with the principle investigator and program director allowed them to debrief, refresh, and refocus. In addition, concerns about the all-consuming nature of the program turned to excitement as graduation approached. As a small cohort, the scholars were able to help and support each other to ensure no one was left behind.

Diversity of University of Michigan-Flint New Careers in Nursing (NCIN) Scholars (N = 20) by Award Cycle

Table 2:

Diversity of University of Michigan-Flint New Careers in Nursing (NCIN) Scholars (N = 20) by Award Cycle

The support the scholars received from the NCIN program ignited a desire to give back. Despite the intense ASD program requirements, most scholars found time to volunteer in the community. All scholars appreciated the financial component of the scholarship. However, they also appreciated the supplemental programs. Following are a few comments made by the scholars and how the program affected their lives: “I attended two SNA conferences that intensely impacted my future goals. I know that I will further my education after being a nurse for several years.” Another scholar indicated, “The ASD was really fast and hard, sometimes I didn't think I could make it. The support I got from the faculty and my peer mentor really helped.”

Peer mentoring was established during the project period. Scholars wanted input and support not only from RNs but senior students in their program. Evaluations of peer mentoring and leadership programs were positive, with the majority of responses to program effectiveness questions from being agree to strongly agree (4 to 5 on a 5-point Likert scale).

The aforementioned programs have been expanded to all students. For ethnic minorities and underrepresented groups networking with nursing leaders from similar groups is crucial for retention and successful completion of a nursing program (Michigan Center for Nursing, 2015). To assist in this endeavor, SON chartered a chapter of the Professional Nursing Sorority Chi Eta Phi, Incorporated, and anticipate a student chapter in 2018. In addition, we encourage students to join the Greater Flint Black Nurses Association and the SNA. SNA members are involved in multiple community activities both health and nonhealth related. NCIN scholars indicated that participating in community activities and attending SNA conferences “intensely impacted their future goals.”

Innovation Strategies

In addition to materials and support from the RWJF, the university developed supplementary approaches to ensure sustainability of programs and retention for UED students. Incoming students are introduced to program opportunities at the white coat ceremony, where students are inducted as a cohort and receive their school of nursing clinical patch. The ceremony is attended by faculty, community leaders, friends, and family. Junior and senior officers of the SNA are responsible for leadership and planning of the event (supported by the school of nursing SNA adviser). The school of nursing faculty provides several SNA scholarships, which are raffled during the program. The school of nursing continues to support the professional and peer-mentoring program. Partnerships with local chapters of the Black Nurses Association, Sigma Theta Tau International, and Chi Eta Phi, Inc., assist UED nursing students in leadership development and career opportunities. Furthermore, to facilitate retention and NCLEX success, a nursing faculty success committee was implemented. This committee is led by the success coordinator who receives student referrals from faculty. Students' may also self-refer. The success coordinator, assesses the students' needs and formulates a success plan. The student is encouraged to seek tutoring (if applicable) and meet with the mentoring program director. The referring faculty and success coordinator work simultaneously to ascertain student success. To assist with scholar transition from nursing student to professional nurse the NCIN program funded a scholar alumni toolkit, which is available for download on the NCIN website (RWJF, 2015). The toolkit serves as a valuable resource for all nursing graduates. The SON will conduct a pilot study using the toolkit with upcoming graduating cohorts. The school of nursing continues to hire faculty and staff representing increased diversity to create an environment of inclusion for ethnical diverse students. On a university level, a faculty diversity committee was established that implements a collaborative yearly educational program on diversity for all students, faculty, and staff; diversity training is ongoing. Incoming student orientation has been expanded to include content related to cultural awareness and diversity. New programs implemented by academic advising and career center are aimed at the retention of high-risk students, including disadvantaged and minority students. In addition, the university implemented an interdisciplinary teaching circle: effective recruitment and retention of minority students. The development of a social justice center as a strategic initiative is in the strategic plan.

Teaching Strategies

Developing pedagogical strategies that facilitate learning among diverse student nurse populations is paramount to transform the nursing workforce. Results of a case study by Diefenbeck, Michalec, and Alexander (2016) found that when minority nursing students are exposed to diversity-based curricula, they demonstrate feelings of inclusiveness, even while attending a predominately White university.

A 3-semester credit-hour course in transcultural nursing is required for all nursing students. Faculty incorporates cultural competent and culturally congruent nursing and health care, diversity, health disparities, effective cross-cultural communication, and related concepts throughout the curriculum. Methods of problem-solving pedagogy include case studies and simulation. Case studies (used in the classroom) thread the gap between theory and practice, by stimulating critical thinking to develop a plan of care with expected outcomes. In maternity classes, for example, case studies are frequently used where students are placed into groups to discuss and develop plans of care. Case studies not only include information about a clinical disease, but also a client's ethnic, cultural, and social situation, which must be taken into consideration when developing a plan of care. Acknowledging a patient's cultural background and ethnicity supports the uniqueness of the individual and downplays a pedagogy that solely supports a dominant culture or perpetuates cultural stereotyping. In small groups (three to four participants), each student can speak, share ideas and reflections, and assist in plan development. Case studies are presented by each group to the class and discussion follows. The diversity of the class increases the richness of the discussion due to the unique experiences of participants. The identification of the culture-specific needs of the patient are viewed as a crucial component to health, healing, and well-being for the mother and infant, as well as the overall health of the family.

The simulation laboratory at the university contains high-fidelity human patient simulators that represent several ethnicities. This portrays a feeling of representation of everyone, not just the dominant culture. During simulation scenarios, patients' culturally based influences on their health care are assessed and integrated into the plan of care. Recognizing ethnicity and culture allows all students to have a feeling of inclusiveness in nursing education.

The flipped classroom pedagogical model was used in several nursing classes to foster and promote active student engagement. Students were required to complete assigned readings, and view recorded lectures and videos prior to class. Student groups were assigned and worked as a team on various assignments. Student groups researched and presented assigned maternity topics to the class, which also included a series of NCLEX-style questions requiring class participation. Two evidence-based articles were discussed with their presentation to support the information given.

The above pedagogical models received favorable grading on student evaluations. The flipped classroom pedagogy demonstrated a substantial improvement in maternity Health Education Systems Incorporated scores.

Conclusion

After working with the NCIN program for 3 years, the author offers three recommendations to other nursing schools: personalize and customize the NCIN program in ways that best match your school's mission philosophy, and program and course outcomes; take advantage of the excellent NCIN program resources; and use creativity, persistence, and innovative partnerships to help fund UED nursing students. The NCIN website still offers its toolkits for download (RWJF, 2016). With such quality resources available, there is no need for nursing school faculty and administration to reinvent the proverbial wheel. Instead, NCIN resources can be customized to create a program that supports UED students' success.

Although many schools of nursing are unable to offer every ASD student a $10,000 scholarship. Funding for such students can be generated in other ways, including seeking grants and scholarships from state, federal, corporate, or individual donors. Financial aid officers should regularly notify students about scholarships, grants, and loans for which they are eligible. Nursing school administrators and faculty can develop innovative programs, such as partnerships with local hospitals, which offer tuition in exchange for a specified period after graduation. For example, Relf (2016) described a program that served as a “workforce pipeline program for the clinical partner” (p. S46). In that program, students received a 50% tuition scholarship, completed their clinical work at the sponsoring hospital, and received a guarantee of employment upon successful program completion. This model is a win-win for the student and the hospital center because it increases students' financial assistance and helps decrease the hospital's nursing shortage.

Due to the importance of increasing the diversity in the nursing workforce, a follow-up study to evaluate the university scholars' feedback on their experience in the nursing program and its relationship to their professional career will be undertaken. The study will also include UED graduates who were not scholars. The intent is to gather information to further improve our approach supporting this population.

References

Preentry Immersion Program (PIP) Evaluation Tools

PIP Evaluation Tool—Day 1aRatingc
1. The preentry immersion program offered important information and was helpful.12345
2. Introduction to nursing exercises12345
3. Writing center skill development12345
4. Public safety12345
5. Time-management presentation12345
6. Library resources12345
7. Do you think time spent was worthwhile for your future success in the program?12345
8a. What should be added to improve the program?12345
8b. What do you think was least valuable and most helpful and why?12345
Please comment on anything else about the one-day program.
Thank you for your valuable input!
PIP Evaluation Tool—Day 2bRatingc
1. The preentry immersion program offered important information and was helpful.12345
2. Skill development12345
3. What to expect when you're expecting12345
4. Professional etiquette12345
5. Medical terminology12345
6. The adult learner and accelerated learning process12345
7. Do you think the time spent was worthwhile for your future success in the program?12345
8a. What should be added to improve the program?12345
8b. What do you think was least valuable and most helpful and why?12345
9. Please comment on anything else about the second day.
Thank you for your valuable input!

Diversity of University of Michigan-Flint New Careers in Nursing (NCIN) Scholars (N = 20) by Award Cycle

NCIN CycleNCIN Scholars
2012 to 20132 African American females
1 Latina female
1 White male
1 White female
2013 to 20141 African American female
1 Latino male
2 White females
6 White males
2014 to 20151 African American female
2 Latina females
2 White males
Authors

Dr. Craft-Blacksheare is Assistant Professor, University of Michigan-Flint, Flint, Michigan.

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

Address correspondence to Melva Craft-Blacksheare, DNP, RN, CNM, Assistant Professor, University of Michigan-Flint, 1300 Wellesley Drive, Detroit, MI 48203; e-mail: Melvagcb@umflint.edu.

Received: April 21, 2017
Accepted: October 25, 2017

10.3928/01484834-20180221-11

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