Recruiting and retaining ethnic minority students and ensuring their successful trajectory into the nursing profession is a critical challenge for prelicensure nursing programs to keep pace with the changing demographics of the population and the increased demand for nurses. Some progress has been made enrolling diverse students in baccalaureate nursing programs; for example in 2011, 26.8% were enrolled in entry-level baccalaureate nursing programs, and in 2014 the National League for Nursing (NLN) reported 28% minority student enrollment (NLN, 2014; Phillips & Malone, 2016). However, only 25% of the current nursing workforce identifies as being an ethnic minority (American Association of Colleges of Nursing, 2016; Robert Wood Johnson Foundation, 2016). Nursing programs must confront the reality that ethnicity can have an impact on being a nursing student and the negative inferences they may experience in the educational setting (Diefenbeck, Michalec, & Alexander, 2016; Gardner, 2005).
Steele's and Aronson's (1995) seminal research recognizes stereotype threat as a disruptive psychological state experienced when people feel at risk of confirming or being identified by a negative connotation associated with an aspect of their demographic. Effects of stereotype threat include self-doubt, hypervigilance, low motivation, impaired memory, and constrained intellectual abilities (Aronson, Burgess, Phelan, & Juarez, 2013; Steele, 2010). Stereotype threat reduces working memory due to increased awareness of confirming the perceived stereotype (Schmader, 2010). For example, stereotypes related to race can impair an ethnic minority student's ability to perform, even if he or she is academically strong (Schmader, 2010).
Steele (2010) identified a correlation between academic strength and underperformance when African American students who were academically strong and dedicated were affected by the risk of stereotype threat and underperformed to a greater extent than students who were disinterested in school. This finding has implications for nursing programs that are typically selective and have high admission standards. Ethnic minority students entering nursing programs should excel academically, in contrast to commonly held, albeit rarely discussed, views of inferior achievement associated with race. Steele's (2010) findings suggest that ethnic minority students entering nursing programs would be at higher risk of experiencing stereotype threat and could underperform as a result; thus, the purpose of this study is to identify and describe the experiences and implications of stereotype threat among a group of ethnic minority nursing students at a large urban university.
The phenomenon of stereotype threat plays a significant role in gaps in academic achievement, especially related to evaluative analysis of ability among the African American population (Aronson et al., 2013) resulting in two commonly held, yet unwarranted beliefs. First, faculty expect African American students to perform differently than their White peers; consequently, student performance is noted to be different. Second, African American students believe faculty expect them to have lower performance than their White peers, despite whether they could do better. Steele and Aronson (1995) noted that African American perform poorly on certain aptitude tests intended to diagnostically evaluate their abilities but score equal to White peers when testing was described as nondiagnostic. Steele's and Aronson's (1995) research expanded to include effects of stereotype threat with students from varying ethnic backgrounds and genders revealing all people experience some type of stereotype threat based on their demographics, including social identity and situational context (Steele, 2010).
Other studies explored stereotype threat and underlying psychological processes attributable to stereotype threat (Johns, Schmader, & Inzlicht, 2008; Schmader, 2010; Schmader, Forbes, & Johns, 2008). Schmader (2010) concluded that a person experiencing stereotype threat has some level of anxiety, which when regulated via suppression and not verbalizing feelings causes underperformance on tasks due to competing cognitive load. However, Schmader (2010) also found that stereotype threat can be mitigated with reappraisal of the situation and emotions.
Stereotype Threat in Nursing
Experiences of stereotype threat have been explicated in the extant nursing literature. Ackerman-Barger, Valderama-Wallace, Latimore, and Drake (2016) noted the pervasiveness of stereotype threat within minority health profession students, including nursing. Students acknowledged experiencing anxiety associated with stereotype threat, questioning academic abilities compared with White counterparts, and having the sense of not belonging. Similarly, Diefenbeck et al. (2016) and Love (2010) interviewed traditionally aged, underrepresented minority baccalaureate (BSN) nursing students in predominantly White universities. Participants described having to work harder than White peers, feeling unequal, encountering discrimination, feeling pressure to succeed, feeling isolated, and trying to fit in. These findings suggest stereotype threat may be pervasive within nursing programs. Nursing faculty and administrators need to be aware of this phenomenon and options for addressing it.
Based on a qualitative phenomenological approach as described by Jones (2001), this study incorporated semistructured in-depth interviews to explore the experiences of ethnic minority nursing students in an undergraduate nursing program. During and after each interview, the researcher wrote field notes and did reflective journaling, providing a written audit trail to enhance trustworthiness of the study. All interviews were audio recorded and then transcribed by a professional transcription service. Institutional review board approval was obtained prior to study onset, and protocols regarding confidentiality and informed consent were adhered to throughout.
The example comprised (N = 20) undergraduate nursing students who self-identified as ethnic minority. In this study, ethnic minority is used in reference to a segment of the U.S. non-White racial groups that include Black/African American, Hispanic/Latino, Asian/Pacific Islander, American Indian, and Alaskan Native (United States Census Bureau, 2014). Students were recruited using a purposive convenient sampling strategy involving posting on-campus flyers, sending e-mails, and visiting various undergraduate nursing lectures. Recruitment strategies targeted students who identify as ethnic minority, were between the ages of 18 and 26 years, and were enrolled in the nursing program. Data collection continued during data analysis until saturation was achieved. Participants ranged in age from 19- to 26-years old (M = 20.95, SD = 1.9). Of the 20 participants in this study, five identified themselves as African/African American/Black, five identified themselves as Asian/Asian American/Southeast Asian, nine identified themselves as Latino/Hispanic, one identified themselves as Arab. Among the example, 16 identified as female. All participants were full-time students representing different university levels: one freshman, nine sophomores, five juniors, five seniors. Twelve participants were first-generation college students, whereas others reported their parent(s) completed some college or were college graduates.
Interviews were recorded, transcribed, and then analyzed using thematic analysis. An open coding process with constant comparison occurred after each interview. Further coding was completed with use of NVivo® 11.0 software for Mac. To establish trustworthiness, the researcher engaged in multiple readings of the interview transcripts, utilized constant comparison techniques, and developed a matrix analysis. Credibility was established via member checking interviewees, which involved reviewing study findings with participants to ensure that their experiences were being interpreted correctly.
Three major themes emerged from this study that eliminated subtle yet often overlooked undertones of stereotype threat in the daily lives of ethnic minority nursing students. Themes involved (a) a Sense of Uncertainty About Abilities, (b) Avoidance, and (c) Vigilance for Signs of Failure. Findings reflect the cloud of stereotype threat the participants experienced, and the subsequent negative influence causing uncertainty about their academic abilities.
Uncertainty About Academic Abilities
Throughout the interviews, participants questioned their abilities in the nursing program, describing feelings of inferiority as though others were breezing through the program, while they struggled and asked themselves “What am I doing wrong?” Although the participants were admitted to their nursing program under the same admission standards as every other student, an air of uncertainty remained with concern about their ability to be successful similar to imposter syndrome, which Day-Calder (2017) described as debilitating emotions derived from doubting oneself and feeling like a fake inside. Many participants discussed struggling with a lack of self-confidence and self-doubt related to their academic abilities despite history to the contrary. Participants also discussed feeling judged based on their race, which led to feelings of inadequacy and uncertainty about their academic success. Participants stated they often remained quiet in class out of fear of being judged for not being smart enough. During examinations, participants would begin questioning themselves, noting that other students seemed to speed through the examination or know so much more while they struggled to get through it. Faye, an African American sophomore, explained her feelings by saying:
It's, a lot—stressful. It's just, I don't know, because you—I don't know, you're always like doubting yourself. Like you could talk to another—like another [African-American] nursing student and they'd tell you like—I don't know, I'm always like comparing myself to other people and that's a problem. Like the program is so competitive and so I'm always like, “Oh, dang, she [White student] got this. She got this on her examination? Why didn't I get that?” It's like, I don't know, I'm just, it's always—it just comparing myself to other people. That's what it is.
Like, it's not as easy for me because I am Black. There's no way around it. I can't help that, but I just know that I have to work a little harder than other people, which is kind of frustrating too. It's like, “How can they just breeze on by,” and I'm struggling, but—uh, I guess I've got to do what I've got to do. And for those that are struggling, it gets better in time. It always gets better. It does, so that's all I have to say.
Participants in this study referred to being an ethnic minority as if it were a distraction, which in some cases put undue pressure on them to perform in their academic work. They felt isolated due to their identity and as though they didn't belong because they were not White. Constant worry and anxiety caused participants to disengage and, in some cases, not attend classes or school events. Many of the participants lived off campus and described how they spend as little time as possible on campus due to feeling uncomfortable because they were not encountering others that look like me. Penny, another African American sophomore struggled to articulate her feelings, indicating that she had not been happy being a minority student within a predominantly White nursing program and the university as a whole. She was contemplating transferring to another university, with more diversity in the students and faculty, where she would not be a minority.
Yeah, and …in my—class, it's only like five of us, and three of us sit together, and so it's like—we just—it's not like—I've been in classes and I've been the only one, and you get the stares of—well, I'm not saying—you get stares. They'll just be looking at you. It's like, “I belong here too!”
Vigilance for Signs of Failure
Many participants alluded to a fear of failure due to perceived academic inadequacies because they were not White, resulting in heightened awareness of their perceived need to be perfect in the nursing program, as if any mistake was not tolerable. This caused the participants undue stress and anxiety. Pressure to be perfect and highly successful was further uncovered when they discussed the competitiveness within the nursing program. Many junior- and senior-level participants described high standards faculty placed on them because of who they were (non-White). Sophia, a Hispanic senior pinpoints the invisible standard ethnic minority student felt:
Like it's really nice to hear—like when nurses are—like you know when professors are like, “Yeah, I didn't do well in math…. I didn't do well in pharm…. I almost failed pharm,” and I'm like that's good to know. It's nice to know that it's like—at least for faculty, like here at—you know, like I feel like they should step away from expecting us to be perfect constantly because it causes problems with us, and it would cause—I feel like it causes huge mental health issues, and I know, I've had them myself because I'm constantly trying to live up to this invisible standard that I think that there is, and then it's like when you talk to the faculty, like the undergrad advisers, and like—you know, the level coordinators, and they're like, “It isn't really there,” it's like you make it seem that it's there, and so I feel like all of us are trying to uphold ourselves to this huge invisible standard and it's not really there.
Regarding being vigilant of failure, Faye, an African American sophomore shared her perception of not succumbing to negative stereotypes and not finishing school:
Well, it means a lot, because I know that everyone is looking at me, and looking at me to finish and to succeed and like— I don't know, being a young African American girl, you know [there is a stereotype], people—young girls, they get pregnant and like they can't finish school, or like they go through situations that won't allow them to finish school, but I know that I worked hard to get here, and I know I have to continue working hard to get where else I want to be.… I can't fail, if I fail this will all be worth nothing.
The lived experiences that participants shared reveal subtle, but critical reminders that stereotype threat has implications on the academic performance of ethnic minority nursing students. Transitioning into college and successful matriculation are affected by expectations related to ethnicity—aspects of stereotype threat; stereotype threat causes students to have an increased sense of failure, becoming distracted. Executive functioning (i.e., working memory) decreases when a person is more vigilant toward succumbing to negative stereotypes (Johns et al., 2008). Following the theory of stereotype threat, these students have a fear of appearing aloof or, worse, failing. Stereotype threat potentiates a self-fulfilling prophecy and the student performs poorly as initially feared.
Consistent with the literature, participants alluded to the problem of a lack of diversity within the discipline and scarcity of ethnic minority faculty and nurses in whom to find inspiration (Murray, 2015). According to Tatum (2000), all students should be able to see reflections of themselves in others on campus. Polly, an African American sophomore participant, bluntly acknowledged this occurring when she looked around campus and the college of nursing stating, there's not enough color here. Matthews, Lauremann, and Banerjee (2014) noted the importance of the relationship between identity and level of academic motivation. The isolation experienced by participants could manifest as a protective factor due to stereotype threat. Steele (2010) highlighted how African American college students tend to study alone versus in groups because they do not want to show any signs of academic weakness or negative judgement.
Reappraising internal and external situations can break the cycle of stereotype threat (Schmader, 2010). Faculty awareness and instruction specifically used to reappraise high-anxiety situations can aid ethnic minority nursing students to reexamine emotions and expectations associated with identity, undermining stereotype threat (Schmader, 2010).
Being mindful of the impact of stereotype threat on the academic performance of ethnic minority nursing students is important for faculty, particularly when there are not ethnically associated role models in the program or on campus. Faculty and administrators need to be sensitive to the impact of diversity in their students and the unique barriers they experience (Gardner, 2005). Implementing specialized, mandatory orientation programs could alleviate feeling unprepared and the pressures participants described transitioning to college. Faculty and staff could address positive coping strategies, give a venue for open dialog, and acknowledge the impact of stereotype threat to promote academic persistence. Positive and continuous interaction with administration and faculty is associated with academic persistence (Morrow & Ackermann, 2012). Including ethnic minority students already enrolled in the program as peers and mentors, students would have an intentional social network to gain strength from which (Mehta, Newbold, & O'Rourke, 2011). Having a sense of community increases a student's perception that they belong and matter to others, which increases intention to persist in college (Morrow & Ackermann, 2012). Extending supportive programming throughout the course of the undergraduate experience could further enhance retention strategies and undermine the threat of stereotypes for ethnic minority nursing students.
Strategies aimed at deconstructing stereotype threat and changing how threats are perceived (Schmader, 2010) can mitigate the unintended effects of stereotype threat and foster success for everyone, especially ethnic minority nursing students. Engaging students in study groups with students that are of like ethnicities could also facilitate positive feelings of belonging and affirmation of identity within the nursing program. Participants discussed wanting groups of similar people to study with being formed by the faculty, versus the assumptions that these groups occur. Mentoring from upper-classmen of the same ethnicity would further contribute to student success. Formation of these groups must be an intentional strategy of faculty and administration to address cultural and academic needs and enhance a sense of belonging within the nursing program for ethnic minority students to be successful.
- Ackerman-Barger, K., Valerama-Wallace, C., Latimore, D. & Drake, C. (2016). Stereotype threat susceptibility among minority health professions students. Journal of Best Practices in Health Professions Diversity, 9, 1232–1246.
- American Association of Colleges of Nursing. (2016). The changing landscape: Nursing student diversity on the rise. Washington, DC: Author.
- Aronson, J., Burgess, D., Phelan, S. & Juarez, S. (2013). Unhealthy interactions: The role of stereotype threat in health disparities. American Journal of Public Health, 103, 50–56. doi:10.2105/AJPH.2012.300828 [CrossRef]
- Bureau of Labor Statistics. (2015). Occupational outlook handbook: Registered nurses. Retrieved from https://www.bls.gov/ooh/healthcare/registered-nurses.htm
- Day-Calder, M. (2017). Imposter syndrome. Nursing Standard, 31, 35.
- Diefenbeck, C., Michalec, B. & Alexander, R. (2016). Lived experiences of racially and ethnically underrepresented minority BSN students: A case study specifically exploring issues related to recruitment and retention. Nursing Education Perspectives, 37, 41–44.
- Garnder, J. (2005). Barriers influencing the success of racial and ethnic minority students in nursing programs. Journal of Transcultural Nursing, 16, 155–162. doi:10.1177/1043659604273546 [CrossRef]
- Johns, M., Schmader, T. & Inzlicht, M. (2008). Stereotype threat and executive resource depletion: examining the influence of emotion regulation. Journal of Experimental Psychology: General, 137, 691–705. doi:10.1037/a0013834 [CrossRef]
- Jones, A. (2001). A condensed history of the phenomenology: The first and second phases from Franz Brentano to Hans-Georg Gadamer. Nurse Researcher, 8, 65–75. doi:10.7748/nr2001.07.8.4.65.c6167 [CrossRef]
- Love, K. (2010). The lived experience of socialization among African American nursing students in a predominantly white university. Journal of Transcultural Nursing, 21, 342–350. doi:10.1177/1043659609360711 [CrossRef]
- Matthews, J., Lauremann, F. & Banerjee, M. (2014). Academic identity formation and motivation among ethnic minority adolescents: The role of the “self” between internal and external perceptions of identity. Child Development, 85, 2355–2373.
- Mehta, S., Newbold, J. & O'Rourke, M. (2011). Why do first-generation students fail?College Student Journal, 45, 20–36.
- Morrow, J. & Ackermann, M. (2012). Intention to persist and retention of first-year students: the importance of motivation and sense of belonging. College Student Journal, 46, 483–491.
- Murray, T. (2015). Factors that promote and impede the academic success of African American students in prelicensure nursing education: An integrative review. The Journal of Nursing Education. 54. (9, Suppl.) S74–S81. doi:10.3928/01484834-20150814-14 [CrossRef]
- National League for Nursing. (2014). Percentage of minority students enrolled in basic RN programs: 1995, 2003 to 2005, 2009 to 2012, and 2014. NLN Biennial survey of schools. Retrieved from http://www.nln.org/newsroom/nursing-education-statistics/nursing-student-demographics
- Phillips, J. & Malone, B. (2016). Increasing racial/ethnic diversity in nursing to reduce health disparities and achieve health equity. Public Health Representative, 129 (2, Suppl.), 45–50.
- Robert Wood Johnson Foundation. (2016). Charting nursing's future. Reports that can inform policy and practice, 27, 1–8.
- Schmader, T. (2010). Stereotype threat deconstructed. Current Directions in Psychological Science, 19, 14–18. doi:10.1177/0963721409359292 [CrossRef]
- Schmader, T., Forbes, C. & Johns, M. (2008). An integrated process model of stereotype threat effects of performance. Psychological Review, 115, 336–356. doi:10.1037/0033-295X.115.2.336 [CrossRef]
- Steele, C. (2010). Whistling Vivaldi. How stereotypes affect us and what we can do. New York, NY: W.W. Norton & Company, Inc.
- Steele, C. & Aronsen, J. (1995). Stereotype threat and the intellectual test performance of African Americans. Journal of Personality and Social Psychology, 69, 797–811. doi:10.1037/0022-3518.104.22.1687 [CrossRef]
- Tatum, B. (2000). The ABC approach to creating climates of engagement on diverse campuses. Liberal Education, 86, 22–29.
- U.S. Census Bureau. (2014). 2014 Quickfacts [Data file]. Retrieved from https://www.census.gov/quickfacts/