Journal of Nursing Education

Major Article 

Forging Unique Paths: The Lived Experience of Hispanic/Latino Baccalaureate Nursing Students

Lisa K. Woodley, PhD, RN, CNE, CHPN; Lynne P. Lewallen, PhD, RN, CNE, ANEF

Abstract

Background:

The purpose of this study was to describe the lived experience of Hispanic/Latino nursing students, as shared by new graduates of baccalaureate nursing programs in the southeastern United States.

Method:

This research used descriptive phenomenology with in-depth, private, semistructured interviews. Data were analyzed using inductive analysis methods consistent with Braun and Clarke.

Results:

Data analysis resulted in four main themes: Being an Edge Runner, Connections Matter, Looking Within, and We Are Not All the Same.

Conclusion:

Analysis revealed that the lived experience of Hispanic/Latino baccalaureate nursing students is complex and multifaceted. Fostering these students' connections within nursing, understanding their unique paths, and recognizing the individuality that each brings to the learning environment are key factors in promoting their success. [J Nurs Educ. 2021;60(1):13–19.]

Abstract

Background:

The purpose of this study was to describe the lived experience of Hispanic/Latino nursing students, as shared by new graduates of baccalaureate nursing programs in the southeastern United States.

Method:

This research used descriptive phenomenology with in-depth, private, semistructured interviews. Data were analyzed using inductive analysis methods consistent with Braun and Clarke.

Results:

Data analysis resulted in four main themes: Being an Edge Runner, Connections Matter, Looking Within, and We Are Not All the Same.

Conclusion:

Analysis revealed that the lived experience of Hispanic/Latino baccalaureate nursing students is complex and multifaceted. Fostering these students' connections within nursing, understanding their unique paths, and recognizing the individuality that each brings to the learning environment are key factors in promoting their success. [J Nurs Educ. 2021;60(1):13–19.]

Health equity is predicated on having a health care workforce that mirrors the population (American Association of Colleges of Nursing [AACN], 2015; The Robert Wood Johnson Foundation and Institute of Medicine, 2016). For the Hispanic/Latino population, interacting with nurses who can combine their knowledge and understanding of Hispanic/Latino culture and health practices with nursing knowledge, skills, and attitudes is paramount (Woodley & Lewallen, 2020). However, currently only 5.3% of the U.S. nursing workforce identifies as Hispanic/Latino (National Council of State Boards of Nursing, 2019). In contrast, 18.3% of the current U.S. population identify as being Hispanic/Latino, and this number is expected to increase to 29% by 2060 (Colby & Ortman, 2015; U.S. Census Bureau, 2019).

Furthermore, a diverse student body in health care educational settings improves student learning and engagement (AACN, 2015). Despite this, Hispanic/Latino students are admitted to nursing programs in lower numbers and experience higher attrition rates than their White counterparts (AACN, 2017; Alicea-Planas, 2017). Research with Hispanic/Latino nursing students is scarce and almost nothing is known about their lived experience, making retention of this highly needed group in nursing challenging. The purpose of this article is to describe the lived experience of Hispanic/Latino nursing students as recounted by new graduates of three baccalaureate nursing programs in the southeastern United States. The use of the term Hispanic/Latino in this study represents individuals of “Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin regardless of race” (U.S. Census Bureau, 2018, para. 1), and does not imply homogeneity within the group.

Literature Review

An integrative review of literature focusing on Hispanic/Latino prelicensure nursing students revealed only 13 studies published within the United States since 2007 (Woodley & Lewallen, 2019). Many were single-site studies, and more than half were conducted in Texas, leaving a complete absence of research in other areas of the United States (Woodley & Lewallen, 2019). Almost all of the research focused on a particular aspect of these students' experiences, such as academic performance in specific courses, success rates compared with other groups, barriers and/or supports for program completion, academic and financial predictors of success, and the impact of academic advising (Bond et al., 2015; Bond et al., 2008; Díaz et al., 2012; Dolan et al., 2015; Evans, 2008; Moceri, 2010; Nadeau, 2014; Thompson et al., 2012; Torregosa et al., 2015). Several studies compared Hispanic/Latino students with other demographic groups in nursing (Bond et al., 2015; Evans, 2008; Loftin et al., 2012). Although important, these comparisons do not account for culture being transitional, variability within groups, and the impact of intersectionality (LaVeist & Isaac, 2013). Almost nothing is known about the lived experience of prelicensure Hispanic/Latino students within their nursing programs of study.

Method

Research Question, Design, and Data Collection

This study sought to answer the following research question: What is the lived experience of Hispanic/Latino nursing students, as described by new graduates of baccalaureate nursing programs? Inclusion criteria were self-identification as Hispanic or Latino and graduation from a baccalaureate nursing program in the southeastern United States within the past 6 months. New graduates were used because they could reflect on the entirety of their nursing school experience and their memories would be fresh. Working as a nurse was not requisite to being in the study, and experiences working within participants' first nursing position were not investigated.

Choi's (2008) theory of cultural marginality provided theoretical underpinning for the study and assisted in conceptualization of the study's purpose and research question. More details of the theoretical framework and its relationship to the study are reported by Woodley and Lewallen (2020). Descriptive phenomenology served as the study's methodological approach.

To ensure consistency of data collection, the principal investigator (PI) conducted all interviews. Face-to-face, in-depth, private, semistructured interviews allowed each participant to freely share without the influence of other participants (Braun & Clarke, 2013). Interviews took the form of informal dialogues. The PI checked regularly with participants during interviews to ensure accurate capture of their experiences and thick description of the study phenomenon.

The study was approved by the institutional review board governing the research, and the approved protocol was observed throughout the research process. Convenience sampling was used. Participants were recruited through the following steps: (a) information letters were emailed to academic administrators at three schools offering baccalaureate nursing programs within driving distance for the PI, (b) administrators shared study information with graduating student LISTSERVs®, and (c) graduating students were directed to contact the PI directly through email if interested in participating. Snowballing techniques were also used, whereby participants shared the study information with other Hispanic/Latino new graduates; these individuals then emailed the PI directly expressing their interest in participation.

Data collection occurred over a 5-month period from May to September 2018. Interviews took place in coffee shops or casual restaurants of each participant's choosing and were digitally recorded. The PI reviewed the study information sheet with participants prior to commencing interviews and obtained verbal informed consent. Interview questions were designed to capture participants' overall impressions of being a Hispanic/Latino nursing student and describe various aspects of their lived experience within their respective nursing programs. All questions were reviewed and approved by the PI, co-investigator, and a qualitative research expert in an advisory role to the study. Follow-up questions during interviews were iterative, and at the end of each interview, demographic questions were posed verbally. The interview guide, including demographic questions, is found in Table 1. Participants were free to omit any questions they chose, but all responded to every question. Interviews lasted between 75 and 153 minutes with an average time of 108 minutes, and participants were incentivized with a $30 gift card to an online retailer. Given the limited number of eligible participants and parallels in their descriptions, the researchers believed that data saturation was achieved.

Semistructured Interview Guide

Table 1:

Semistructured Interview Guide

Study trustworthiness was enhanced by member checking verbally during interviews, as well as the PI keeping detailed field notes, memos, and a written audit trail. Interviews were transcribed verbatim by the PI and double-checked for accuracy by both researchers. Participants were given the opportunity to review their deidentified interview transcripts to verify accuracy, and pseudonyms were assigned. Data collection and analysis occurred in tandem.

Sample

Eleven new graduates from three baccalaureate nursing programs within the southeastern United States participated in the study. Nine participants were female, two were male, and ages ranged from 22 to 30 years. Seven were first-generation college students. Three had immigrated to the United States as children or young adults, seven were the children of immigrants, and one was a fourth-generation U.S. citizen. All were highly fluent in English. Seven described their Spanish fluency as high, whereas the rest described themselves as moderately fluent in Spanish. Participants and families had immigrated to the United States from eight countries: Chile, Costa Rica, Dominican Republic, El Salvador, Guatemala, Mexico, Spain, and Venezuela.

Data Analysis

Interview transcriptions were coded and analyzed following Braun's and Clark's (2013) steps to inductive analysis. Line-by-line descriptive, process, and in vivo first-level coding was initially carried out by the PI after each interview, with second-level codes further distilling data. These codes condensed into categories that were thoroughly described and defined, and categories refined into themes. Codes, categories, and themes were checked and verified by the co-investigator and the qualitative research advisor to the study. The use of qualitative software (MAXQDA©) and matrices in Excel® facilitated organization of large volumes of data. Table A (available in the online version of this article) reflects an abbreviated audit trail. Analysis revealed four themes: Being an Edge Runner, Connections Matter, Looking Within, and We Are Not All the Same.

Audit TrailAudit TrailAudit TrailAudit TrailAudit Trail

Table A:

Audit Trail

Results

Theme 1: Being an Edge Runner

Being an edge runner reflected that all participants in this study were the first within their community to discover and pursue nursing. Members of their communities, including their own families, did not understand participants' desire for nursing as a career, and in some cases actively dissuaded them from applying. Melissa (all names are pseudonyms) explained, “I think they just don't know. It's been my role to educate them.” Instead of nursing, many participants were strongly encouraged by their families to pursue a more “prestigious” career, such as medicine, law, or banking. Jose conveyed how he convinced his family that nursing was a viable career option:

I had to do a whole intervention. I said, “Mom, Dad, I need to talk to you about something.” I had everyone sit down. I gave everyone a glass of water. I sat everybody down in the living room. I connected my laptop to the TV, and I put on a Prezi© presentation as to why I wanted to go into nursing.

All participants navigated the process of finding a nursing program, completing prerequisite courses, and applying to nursing school without the help of their families. As Marisol stated, “There was nothing I could look up to as far as my family, because I'm the first one who graduated, first one in the medical/nursing field. I was always the one asking…looking for nursing.” In most cases, they were completely alone throughout this process. No participant recalled having a high school counselor recommend nursing as a potential career.

As edge runners, many participants experienced pressure to do well in nursing school because they felt that academic performance would represent and reflect on their entire community. Angelina stated, “So few of us make it to college. I have to represent them and do really well. I want to make us look good.” Through their successes within nursing school, most believed that they were leading the way for younger siblings and other community members. Marisol stated, “My other two sisters, I've been a role model to them to pursue their dreams.” Therefore, as edge runners, participants were independently forging their own unique path into nursing and paving the way for others.

Theme 2: Connections Matter

Most participants described feeling lonely and lacking connections upon entering nursing school, which in turn affected their sense of belonging. Maya explained, “It was hard to fit in…. It looked like they [other students] already had cliques.” Some participants looked for other Hispanic/Latino students and faculty to connect with but found few. Others described a lack of connectedness associated with being a transfer student from community college. Mateo admitted, “[Being] a first-generation college student, Latino, minority, coming to college—you don't see much of yourself or of your people there. So, you have to just figure it out and get through it.”

Almost every study participant reported that their ability to make connections with others in nursing school would have been enhanced if they had engaged in extracurricular activities or social events. Several expressed regret at not doing so, but most acknowledged that engagement in outside activities was simply not an option. Reasons cited included a lack of time, needing to commute between campus and living at home, and maintaining heavy work schedules to support themselves and their families. “All I did was work and study, work and study,” said Eva. Furthermore, the fewer connections that participants felt, the less likely they were to reach out for help. Marisol stated, “Feeling isolated, you're not going to reach out. You're not going to say, ‘I need help with this.’” Several participants deemed themselves a “minority of the minorities in nursing,” further challenging their sense of having connections. Ana explained:

We're the minority of the minorities. When we're in the classroom, the majority are the White people. When we're in minority group activities, the majority are the Black people. There is no room really for me to speak up about myself.

Connections to classroom content also mattered to study participants. Most described the scarcity of diverse content and images within their classroom learning environments and yearned for more representation of health beliefs and challenges experienced by the Hispanic/Latino population. Eva said, “I would have definitely appreciated and related better if more of the classroom content reflected our people, our culture.” Others observed that given that most classroom content focused on health conditions experienced by the majority group, their classmates did not learn about important health issues impacting the Hispanic/Latino population, further perpetuating health care disparities. As a result, some participants' disconnect in the classroom was heightened and they chose to sit in the back of the classroom, where they felt more comfortable.

In the clinical setting, every participant described deep connections that they made with Hispanic/Latino patients. In some instances, connections with patients were made because of shared religious practices. Isabella stated, “A lot of times, I've had Hispanic families in Med Surg, and in ICU [medical–surgical and intensive care units], that I see have rosaries. And that's an easy way to connect to a patient. I have done that several times.” In other cases, connections with Hispanic/Latino patients and families were made because of shared language. Cristina reported:

I walked into a patient's room, actually not knowing they were Hispanic. I just went to unhook them from their pump because their nurse was busy. And they had family there. And they all start speaking in Spanish. So then, I was like in Spanish, “Oh, where are you guys from? I'm Hispanic too.” And you could just see it on their faces—relief. Trust. And I never had them, they were never my patients. But they stayed on our unit for a while. And anytime I'd see them, they would say “Hi! How are you?” I think they felt more comfortable too.

All participants believed that patients and families disclosed more information and bestowed more trust in them as nurses because of understanding their shared culture. Maya explained:

I definitely had an immediate connection with Hispanic/Latino patients, like I was able to give them better care and meet their needs. A lot of them are afraid to call out for help, because they don't know how to communicate their needs to the nurse, but many of them would open up to me…. They trust you and ask you questions and tell you their entire story…. I felt more comfortable providing care because they trusted me.

It was clear that connections felt with patients and families were impactful for all participants, enhancing their sense of purpose for being in and contributing to the nursing profession.

Theme 3: Looking Within

Looking within refers to participants' self-reflection in how they were able to express their own values and ideals through nursing. Each described their determination to make a difference in the health of the Hispanic/Latino community as a driving force behind their pursuit of nursing. Several told stories of being young children translating for family members in health care appointments, and their resultant passion for health equity. Marisol said:

The reason I wanted to be a nurse was to advocate—because of the experiences with my grandmother. She's always gotten less than quality health care. As a kid, I would see how certain things were not told to her when they should have been. And it grew this anger in me. I wanted to advocate for people who can't speak English, who should know their information and know everything that is happening to them, for them, and around them.

Because of the high value they placed on positively impacting Hispanic/Latino health and well-being, every participant shared their intent to work with this population. Some were already planning for graduate school for the same reason. As Angelina stated, “I've set this goal…. I want to go back to school, become a nurse practitioner, and work in a clinic for the Latino population.”

As part of looking within, many participants spontaneously self-reflected on their own personal biases and how these intersected with their values as a nurse. For example, Jose disclosed, “I don't particularly want to take care of Veterans. I cringe inside. And I recognize that I spend less times in those rooms. That's something I want to improve on. As a nurse, it's not appropriate.” When they experienced microaggressions from classmates, participants reported trying to assume the best in people, consciously taking a step back before reacting, and acknowledging that others had different points of view—all reflective of professional nursing values. For instance, Melissa noted, “I didn't want [the interaction with my classmate] to bring any tension…. Maybe the other student didn't intend it that way. I was trying really hard to think from a different perspective.”

Looking within also refers to the high value that participants placed on personal characteristics of tenacity, perseverance, and determination. Each viewed these characteristics as critical to their personal success in nursing. All described refusing to give up, regardless of “bumps in the road.” As Maya said, “I had to push through...not give up. Don't ever let anyone tell you that you can't.”

Theme 4: We Are Not All the Same

We Are Not All the Same refers to differences among the lived experiences of this study's participants. Most profound differences related to gender, external appearances, Spanish language fluency, and whether participants were first-generation college students.

Gender. Although there were only two male participants, both shared their experiences of being a “double minority” in nursing—a phenomenon not experienced by female participants. For example, Mateo was told by his family that “nursing is women's work” and was encouraged to seek other career options. He noted the paucity of male nursing images in classroom environments, the frequent use of the pronoun “she” to describe nurses, and the gender bias he experienced from nursing staff within his maternity clinical rotation. Jose shared his preceptor's remarks that males are “better suited” to specific clinical environments such as the emergency department and was discouraged by his preceptor from providing personal care for female patients:

When I was doing my capstone, [my preceptor] wouldn't let me perform any peri-care… She just didn't want someone my age to be cleaning a woman…. I felt a little undermined. I'm going to have to do it regardless eventually, and if I'm not going to learn from you, I'm going to have to learn from someone else. Although the occasions of gender bias for these two study participants were limited, they were impactful and had a compound effect because these participants were already part of an underrepresented minority group.

External Appearances. Some participants, self-described as having lighter skin or eyes, were told by others that they could “pass” as White. Ana explained, “I feel like I have had a different experience from other Hispanic/Latino nursing students because of how I look.” Others with darker complexions felt judged by others. Camile lived with a perceived stigma that “Because I'm Brown, I'm not as smart as you” and described her classmates' surprise when she achieved high grades. No participants wanted to “pass” as another ethnicity. On the contrary, all were intensely proud of their Hispanic/Latino culture and heritage.

Spanish Language Fluency. Variations among participant experiences were associated with Spanish language fluency. All participants self-described as moderately fluent in Spanish hesitated to reveal their Spanish fluency in the clinical setting. Ana explained, “I don't go around advertising that I speak Spanish because I don't want there to be that expectation and not meet it.” Those fluent in Spanish described being frequently called upon to translate in the clinical setting, which reduced opportunities to practice psychomotor and other nursing skills. Jose stated, “I love interpreting for families. It warms my heart. But if I wanted to be an interpreter, I would have gone to community college and become an interpreter. I'm a nurse. I want to be taken seriously as one.”

Being a First-Generation College Student. Participants whose parent(s) had completed postsecondary education felt less pressure to support themselves and less obligation to maintain family responsibilities throughout their nursing education. In contrast, all participants who self-identified as first-generation college students faced intense familial obligations, adding to the stress they experienced as nursing students. The following statement by Melissa demonstrates this experience:

My parents were just like “I support you and I want you to go to college and do everything you need to do,” but they still expected me to come home every weekend and help with the house. They don't even know what a GPA [grade point average] is. They didn't understand my workload in nursing school.

All participants in this study sent the clear message that they did not want to be considered as a homogenous group. Instead, each emphasized the unique attributes they brought to nursing. As Camile said, “I feel that we shouldn't be all grouped together, because we are very different.”

Discussion

Findings from this study add valuable insight into the lived experience of Hispanic/Latino baccalaureate nursing students. It was clear that participants in this study were forging their own unique path into nursing with little to no assistance from families, communities, or high school resources. Similarly, Dolan et al. (2015) reported that Hispanic/Latino nursing students found nursing school to be an environment untested by others in their family or community. Other researchers have noted that Hispanic/Latino students experienced resistance from their community about their decision to pursue nursing (Evans, 2008) and received nonspecific academic advising for nursing school (Bond, 2008). According to Stroup and Kuk (2015), Hispanic/Latino students were interested in a career in nursing but lacked direct contact with nurses, as well as an understanding of what the nursing role entails. This was presumably because they did not know others in their family and community who were nurses. More support, guidance, and education is needed to assist these prospective students in planning for a career in nursing and putting together a successful application package for nursing school.

This study adds to the growing body of knowledge that many Hispanic/Latino students, once in their nursing programs, lack connections and feel isolated. Alicea-Planas (2017) also reported that Hispanic/Latino nursing students lacked a sense of belonging. Evans (2008) found that being associated with a “token” status negatively influenced the academic performance of Hispanic/Latino nursing students. Similar to the current study, Moceri (2010) noted sheer determination displayed by Hispanic/Latino nursing students, perhaps as a result of having to rely on themselves for their success. Specific initiatives to better support these students are needed to enhance their sense of belonging and connectedness and foster their success.

The deep and meaningful connections made with Hispanic/Latino patients, families, and communities is an exciting finding unique to this study. Dolan et al. (2015) found that Hispanic/Latino nursing students connected with elderly Spanish-speaking patients, but these connections centered on language only. Morales (2014) described Hispanic/Latino new nursing graduates positively influencing Hispanic/Latino patients but was not specific about what this impact was. In this study, connections made with Hispanic/Latino patients and families transcended language and involved a shared understanding of the culture, patients bestowing more trust, and participants being better able to educate and support these patients. Moreover, each participant in this study was energized by the interactions they had with Hispanic/Latino patients and families and articulated clear plans to work with this population after graduation.

Finally, whereas other research has considered Hispanic/Latino nursing students as a homogenous group, this study revealed powerful and distinct differences among participant experiences related to gender, Spanish language fluency, external appearances, and being a first-generation college student. This important research finding has not been previously reported in the literature. Furthermore, the within-group variability captured in this study underscores the need for faculty to avoid assuming that all Hispanic/Latino nursing students are alike. Although there is value in considering them as a group and offering group support, it is also important to acknowledge them as unique individuals within that group.

Implications for Nursing Education

Having an understanding of the lived experience of being a Hispanic/Latino nursing student informs ways to foster inclusivity within nursing education. Nursing faculty and administrators should carefully examine the demographics of their incoming classes and consider the importance of diverse class membership. Outreach to high schools and other community venues is needed to increase the pipeline of Hispanic/Latino students applying to nursing school. In addition, workshops and information sessions designed to assist first-generation college students with nursing school applications might make the application process less daunting and give applicants the tools they need to assemble a successful application package.

This study demonstrates that the educational climate directly influences how connected many Hispanic/Latino students feel to classroom content, as well as the nursing school as a whole. To enhance these important connections and foster a sense of belonging, nursing faculty should ensure that a variety of perspectives and voices are shared in the classroom. Learning environments should include diverse examples of patients and nurses, as well as regular discussions about health disparities and health concerns for all sectors of the population.

Because many Hispanic/Latino students work and have intense outside obligations, educational initiatives during lunch hour breaks or other times when students are already on campus might be most impactful. This study revealed that some Hispanic/Latino students feel like a “minority within a minority” and that their voices are not heard. Thus, there may be added value in holding support activities specific to this group while acknowledging them as individuals. Potential examples might include resource sharing, academic support, peer-to-peer mentorship, and faculty mentorship.

Finally, results from this study underscore the importance of not considering Hispanic/Latino nursing students as a homogenous group. Recognizing how differences in Hispanic/Latino student experiences may be related to gender, language fluency, being a first-generation college student, and external appearances provides an important platform for individualized learner assessments and support.

Study Limitations and Recommendations for Further Research

Transferability of study findings is limited by program size, type, and location, given that all participants in this study attended large, public, urban universities within the southeastern United States. This study included only participants who had successfully completed baccalaureate nursing programs. It did not attempt to address the experiences of Hispanic/Latino students who had been unsuccessful, nor the experiences of those in associate degree or diploma programs.

This study sought to understand the lived experiences of Hispanic/Latino nursing students in nursing programs where they were vastly underrepresented. Comparison with Hispanic/Latino nursing students in other geographical areas of the United States where they represent larger numbers in their nursing programs could provide insight at a national level. In addition, how the lived experience of Hispanic/Latino nurses evolves over time remains unknown. A longitudinal study describing this phenomenon could provide an understanding of the best ways to foster Hispanic/Latino nurses' success and retention within the nursing workforce.

Conclusion

This study gave voice to the lived experience of Hispanic/Latino undergraduate nursing students, as described by new graduates of three baccalaureate nursing programs in the southeastern United States. Results demonstrate that these students possess invaluable qualities that they bring to the learning environment and the nursing profession itself. It is paramount that nurse educators use best educational practices that are inclusive, culturally responsive, and tailored to meet the needs of these unique students to promote their success.

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Semistructured Interview Guide

Interview Questions
Do you have any initial impressions or insights about your experiences as a Hispanic/Latino nursing student that you would like to start with?
Please tell me about your process of deciding to pursue nursing.
Family is very important to many people, and it may be the same for you. Can you tell me a little more about your family and your role within it? (The principal investigator explored whether participants were born in the United States, if they were first-generation college students, language[s] spoken at home, family expectations, and their role[s] within the family unit. This gave insight into participants' culture of origin).
What was the process of applying to nursing school like for you? Please tell me about your interactions with resource people inside or outside the school. (As appropriate, the principal investigator asked more specific probing questions about the role that high school counselors, role models in nursing, friends, family, and faculty advisors played).
Please share with me what it was like for you in the first week of classes. What were your thoughts and feelings as you sat in your first nursing classes? Did these thoughts and feelings change over time?
How did your experiences in the classroom setting in nursing school impact your journey in becoming a nurse?
What were clinical experiences like for you? Please tell me about your relationships with clinical faculty, peers, staff, patients and families, and other health care team members.
Let's talk about your out-of-class engagement, if you had any, such as use of campus and/or school of nursing resources, and involvement in student organizations. If you participated in these, what value did they bring for you?
What relationships and interactions were most valuable to you in your nursing school experiences?
Please tell me what it was like for you to walk across the stage at graduation.
What are your plans after graduation in terms of where you will practice nursing?

Demographic Questions

If you are comfortable, please share with me:
  Your gender
  Your age
  Your country of origin
  Your fluency in English
  Your fluency in Spanish
  Whether or not you are a first-generation college student
  Did you immigrate to the United States yourself, are you the child of immigrants, or other?

Audit Trail

Sample Participant QuotesCategoryThemeNumber of Participants Represented by Theme
In my family, both sides, the majority of the people, if not everybody does not have an actual profession. They have jobs. There's no career. There's like one job, keep it steady as long as you can, then the next job. That being said, I am the first on my father's side to go to college, so I'm the first one to get up and dive into a profession and not have to depend on if I'm going to find a job. I chose nursing because it's a profession not a job.Independently discovering nursing as a careerBeing an edge runner11
No counselors talked to me about nursing.
I did everything in telling my family about nursing. I was like “this is what nurses do; this is the experience I've had with nursing”. It's in the medical profession. I was trying to find what I wanted and what they wanted. I included statistics. This is how much a nurse makes. I will be able to survive, I promise.Educating family members about nursing
I'm one of the very few of my friends who actually went to college. I'm the only one who has graduated. It has just been hitting me how very few of us there are out there.Being the first in the community to pursue higher education
My other two sisters, I've been a role model to them. Because one of them, she's in her junior year, so that felt good, because I'm like, okay if I did it, I know, I guess it gives them motivation to finish.Being a role model
I guess that was my first exposure. I guess I knew that something was inherently wrong with having a child translate [in health care appointments]. I was in second grade. I held onto that and it made me want to become a nurse. To make a difference for Latino health.Desire to impact Hispanic/Latino healthLooking within11
You have to take a step back and try not to let whatever they say or what's going on affect you. It does affect you, but kind of not jump back at them. Just like in nursing.I think even just awareness to start is something that's big. Because everybody has their own biases, and if at least you can start to think about them and be aware of them, I think that's a huge step. Because then automatically, you start consciously thinking about it.Emulating nursing values
I just keep on going. If it takes me 10 years, it doesn't matter. I'll get through it eventually.I had to just push myself and just ignore the negativity to get through school.The value of perseverance
If they only knew the rest of my life. They're in a bubble.Lacking connections with majority group peersConnections matter11
I'm a first generation [college student], I'm an older student, I'm a non-traditional student coming from a community college.I've always struggled with my own personal self-esteem, and I don't think that helped. Being the only one. Maybe if I was surrounded by more of my people, I would have grown into a more confident person. That's how I feel.Lacking connections
I don't think I've seen any. We don't have any Latina faculty members.Scarcity of Hispanic / Latino faculty
So, I counted. I'm looking. I don't see any. But we were supposed to be the most diverse class. I guess they took into account males, females, everything else but I didn't see any Hispanics.Seeking out connections with other Hispanic / Latino nursing students
It would be a Caucasian or African American example. That was mostly it. Maybe there was one or two instances when they talked about Hispanic women being prone to gestational diabetes. But I don't remember much after that.I remember being in an assessment class the first semester and we were looking at capillary refill, look at cyanosis, and I was like “what if they're Black? Or really Brown, or something like that?” Neuro assessments. I remember during the neuro lecture, they didn't once say anything about getting an interpreter if they don't speak the language of your choice. And I thought about that, because I think that's important.I'm there and whatever the majority is, that is what it is. That is what I'm learning.... And I think that's a problem. I feel like I should speak up and say “Why isn't there any information on Latino patients?” But I've just kind of accepted it. And it affected my engagement. I never said anything in class.Lack of connection to classroom content
It's kind of like seeing someone of your own face. Knowing that ethnicity, being able to care for you, and it be genuine. There is an instant connection. A unique connection. I'm meant to be here in nursing to care for you.I definitely bonded with a lot of Hispanic patients. It comes back to working in clinics. Low income clinics…. It just makes my heart flutter. I love it. I really love it. I can help these people.Sometimes they give me their phone numbers, and be like “let's meet up afterwards, when I get out of the hospital”. And I'm like, I can't do that. But they were connecting with me. Very few people make the effort to see them as a person.Connecting with Hispanic / Latino patients
You can't put every Hispanic student in one bucket. Just from country to country, there are lots of differences. I feel like we shouldn't be all grouped together, because we are very different. We have a lot of differences in culture.I know Hispanic people from the Caribbean, from South America, even with those, country by country, there's lots of differences. I don't think that just grouping everyone together represents us.I met the Hispanic students, but I felt a disconnect. Because I was like-it's nice hearing Spanish, but you're saying all of these expressions and you guys are all so happy talking to each other about where you're from, where your heritage is from, what you had for Thanksgiving, but those aren't my recipes, it's not my way of speaking, it's not my country of origin. None of our words are the same in Spanish. I definitely don't think we're the same.Importance of not treating Hispanic / Latino nursing students as a single groupWe are not all the same11
My parents don't even know really what a [grade point average] is. They had no idea about the workload in nursing school.That's one of the first things they did when they moved here. They started a college fund for me and my sister. There was never a question of whether we were going to college or not.Influence of parents' education
I wasn't really practicing my clinical skills, the stuff I needed to learn because I was translating the whole time sometimes.Spanish language fluency
I don't look like your typical Hispanic. And maybe I don't share a lot of similar experiences that they had. And so, I think—I mean, I honestly don't know if I ever talked to any of the other Hispanic students in our class.Because I felt like they were all understanding each other, and I was not really on the same page as them.Maybe they are judging me that I don't know what I'm doing. Maybe they're judging my knowledge because of my skin color.External appearances
[describing nursing images shown in the classroom]: It was always a picture of a woman. They would always show pictures of these white women as nurses with perfect skin. And I'd be like “Oh, great, I'm going to become one of them” (sarcastically).In the United States, of course when I first said nursing, everybody was like “Oh, that's a woman's job…. Oh, meet the Fockers.”Influence of gender: males being a double minority in nursing
Authors

Dr. Woodley is Associate Professor, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, and Dr. Lewallen is Professor and Associate Dean for Academic Affairs, School of Nursing, University of North Carolina at Greensboro, Greensboro, North Carolina.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

The authors thank Susan Letvak, PhD, RN, FAAN, for her qualitative methodology expertise and consultation.

Address correspondence to Lisa K. Woodley, PhD, RN, CNE, CHPN, Associate Professor, School of Nursing, Office 529, Carrington Hall, University of North Carolina at Chapel Hill, CB 7460, Chapel Hill, NC 27599; email: lwoodley@email.unc.edu.

Received: July 28, 2020
Accepted: September 23, 2020

10.3928/01484834-20201217-04

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