Strategies to address structural and institutional barriers to success among students of color in nursing programs

Advancing health professions education: a review of holistic admissions and competency-based admissions practices

In this review, we gathered information about competency-based admissions and holistic admissions related to healthcare education to understand current practices better and offer recommendations within the healthcare education field. A literature search was conducted to gather peer-reviewed articles detailing information related to competency-based admissions and holistic admissions that have been implemented in healthcare education, including medical schools, nursing schools, dental schools, and other allied health fields. After screening and the addition of articles through ancestral search, 166 articles were included in this systematic review. The articles were coded for information related to definitions of competency-based admissions and holistic admissions, specific desired competencies, procedures to evaluate these competencies, outcomes of these practices, and the success of admitting well-prepared students using these practices. Results show there is wide variation in established definitions and desired competencies. Similarly, there was some variation in methods for evaluating these competencies with some common practices identified. Lastly, little evidence demonstrates the effectiveness of admitting students who are well-prepared for their programs when competency-based or holistic admissions are employed. There is a need for future research to establish a standard definition for both competency-based admissions and holistic admissions. Desired competencies should be established based on the program's mission and vision statements for what type of students they want to admit. Lastly, future research needs to focus on the long-term outcomes of implementing these practices.

Diversifying the Workforce Through Focused Support of Nursing Students With Socioeconomic Challenges

BACKGROUND

Diversifying the nursing workforce entails concerted efforts to recruit and retain students from under-represented racial and socioeconomic groups who are especially vulnerable to barriers hindering academic success. This article describes faculty strategies for retaining and supporting students toward program completion and first-time National Council Licensure Examination for Registered Nurses (NCLEXRN) passage at a mission-driven school in rural Appalachia where most of the students have socioeconomically disadvantaged backgrounds.

METHOD

Independent samples t tests were used to compare academic variables between students who passed the NCLEX-RN on their first attempt and students who did not. Qualitative data were elicited from interviews and surveys. Data analysis informed policy change and student support services.

RESULTS

An action plan supported under-represented students' success in first-time NCLEX-RN passage with an average rate of 96% for the past decade.

CONCLUSION

Focused multimodal support can promote the success of students with socioeconomic challenges who will enrich the nursing workforce with the diversity that the profession seeks. [J Nurs Educ. 2024;63(12):844-849.].

Coming and going: A narrative review exploring the push-pull factors during nurses' careers

BACKGROUND

Shortages of nurses are one of the biggest challenges healthcare systems face around the world. Given the wide range of contexts and individuals working in nursing, a 'one-size-fits-all' retention strategy is unlikely to be effective. Knowing what matters most to nurses at different career stages would help employers and policy-makers who want to enhance nurse retention to design tailored strategies.

OBJECTIVE

To review and synthesise findings from recently published literature on the push-pull factors influencing nurses' decisions at the micro level, to enter and stay (or leave) at key career stages (i.e. pre-career, training, early-, mid- and late-career, and return to practice).

METHODS

We undertook a set of structured searches of the literature and a narrative synthesis to explore factors that motivate individuals to enter the nursing profession and the push-pull factors influencing nurse retention at different career stages. Electronic databases CINAHL, Medline, Scopus and Embase were searched in December 2022 (and updated in November 2023) for English language publications. Additional health workforce sources, such as King's Fund and Nuffield Trust, were also searched.

RESULTS

227 articles met the criteria for inclusion in the narrative review. Some push-pull factors were common to nurses across all career stages, including workplace support, flexible schedule patterns, opportunities for career advancement, fair treatment and salaries. In contrast, some challenges and push-pull factors were unique to each career stage. Students experienced difficulty in adjusting and balancing education and life; early-career nurses experienced transition shocks; mid-career nurses were frustrated by the lack of career advancement; late-career nurses desired more recognition; nurses returning to practice were discouraged by their lack of confidence and the cost of return-to-practice courses.

CONCLUSION

Our findings reinforce the view that factors influencing nurses' choices about whether to enter, continue or leave nursing jobs are multi-factorial and multi-dimensional. Policy and employment practices should be informed by research that has a more nuanced insight into what matters most to whom and at what career stage.

TWEETABLE ABSTRACT

Nuanced insight into motivations is needed to attract and retain a mix of nurse throughout their careers @ZEjebu @julia_philippou @JaneEball.

Social Support Is Protective Against the Effects of Discrimination on Parental Mental Health Outcomes

BACKGROUND

Discrimination, or unfair treatment based on individual characteristics such as gender, race, skin color, and or sexual orientation, is a pervasive social stressor that perpetuates health disparities by limiting social and economic opportunity and is associated with poor mental and physical health outcomes.

AIMS

The purpose of the present study is to (1) examine the association between maternal experiences of discrimination and paternal experiences of discrimination; (2) explore how discrimination relates to parental (maternal and paternal) stress and depressive symptoms; and (3) examine whether social support exerts protective effects.

METHODS

The sample was 2,510 mothers and 1,249 fathers from the Child Community Health Network study. Linear regression models were conducted to explore associations between maternal and paternal discrimination. In addition, mediation analyses were conducted to explore if social support functioned as a mediator between discrimination on parental stress and depressive symptoms.

RESULTS

Most mothers (40.3%) and fathers (50.7%) identified race as the predominant reason for discrimination. Experiencing discrimination was significantly related to stress and depressive symptoms for both parents, and all forms of social support mediated these relationships. Our findings suggest that social support can act as a protective factor against the negative association between discrimination and both stress and depressive symptoms.

CONCLUSIONS

These findings highlight the need to integrate social support into existing interventions and include fathers in mental health screenings in primary-care settings. Finally, we briefly describe the role of nurses and other allied health professionals in addressing discrimination in health care and health policy implications.

Burnout, Exhaustion, Experiences of Discrimination, and Stress Among Underrepresented and First-Generation College Students in Graduate Health Profession Education

OBJECTIVES

Mental health disorders are increasing among health profession students. Compounding this, students from underrepresented backgrounds may face additional stressors and challenges. The aims of this study were to: (1) assess the extent to which burnout, exhaustion, experiences of discrimination, and stress exist among students in dentistry, nursing, occupational therapy, pharmacy, and physical therapist professional education programs; (2) determine if there are significant differences by key demographic characteristics (those who are first-generation college students [FGCSs], a member of an underrepresented minority [URM] group, or both); and (3) highlight strategies and solutions to alleviate these challenges identified by students.

METHODS

Cross-sectional survey using a mix of question types of a sample of graduate students from dentistry, nursing, occupational therapy, pharmacy, and physical therapy programs from February to June 2020. Utilizing the Maslach Burnout Inventory Student Survey and campus climate and stress survey, mean subscale scores were calculated for the following outcomes of interest: MBI-SS burnout, dimensions of stress, and observed racism. Logistic regressions examined student factors that may help explain these outcomes. Content analysis examined participants' responses to open-ended questions.

RESULTS

There were 611 individuals who completed all survey questions. FGCSs were significantly more likely than non-FGCSs to report exhaustion (adjusted odds ratio [aOR]: 1.50; 95% CI = 1.04-2.16), family stress (aOR: 3.11; 95% CI = 2.13-4.55), and financial stress (aOR: 1.74; 95% CI = 1.21-2.50). URM students reported not feeling supported in their program and mentioned needing additional support, particularly for well-being, from staff and faculty.

CONCLUSION

Findings from this study are consistent with literature that FGCSs experience additional stressors that may lead to burnout and exhaustion. URM students reported not feeling supported in their programs. This study's findings point to the need for leadership and faculty of health professional schools to implement or strengthen current policies, practices, and strategies that support URM students and FGCSs.

IMPACT

Research demonstrates that a diverse student body and faculty enhances the educational experience for health professional students, and that diversity strengthens the learning environment and improves learning outcomes, preparing students to care for an increasingly diverse population. However, this study finds that students from underrepresented backgrounds may still experience more burnout, exhaustion, discrimination, and stress than their peers. Programs and policies to support URM students and FGCSs throughout their academic careers can help improve graduation and retention rates, leading to improved workforce diversity.

The Syllabus: A Commitment to Diversity, Equity, and Inclusion in Nursing Education

BACKGROUND

Preparing a diverse nursing workforce skilled at caring for diverse populations is essential for achieving health equity in our society. Academic organizations, schools of nursing, and faculty are responsible for creating diverse, equitable, and inclusive (DEI) learning environments. The obligation for DEI initiatives in nursing education is guided by professional position statements and accreditation criteria.

METHOD

The course syllabus is an inclusive strategy for setting the classroom tone at the start of the semester. Faculty can leverage the syllabus to provide explicit rhetoric for a diversity-centered educational climate.

RESULTS

This article provides a sample DEI syllabus statement developed by the authors using existing organizational policy terminologies and which was reviewed by a DEI team including the nursing dean, DEI champions, and the university legal department.

CONCLUSION

A carefully crafted syllabus statement is a purposeful acknowledgement of DEI as a core value in nursing education and may positively affect students' impression of a course. [J Nurs Educ. 2024;63(9):634-637.].

Culturally Competent Care for Diverse Populations: A Review of Transcultural Nursing Education

Transcultural nursing is a discipline that emphasizes culturally competent care for diverse populations, recognizing the influence of culture on health beliefs, values, practices, and outcomes. It requires nurses to respect cultural differences and similarities, but faces challenges in curriculum design, faculty development, and student assessment. This paper explores transcultural nursing education's current state and future directions, addressing the American Association of Colleges of Nursing essentials for integrating cultural content into nursing curricula, reviewing Madeleine Leininger's transcultural nursing theory, diversity, equity, and inclusion concepts, and discussing the main challenges of transcultural nursing education, including lack of student diversity, training, and resources. Strategies to overcome these challenges include interprofessional collaboration, cultural immersion, and evidence-based practice. The paper concludes with how emergency department nurses should incorporate this into practice.

Increasing Diversity in the Advanced Practice Nursing Workforce Through Partnerships With Historically Black Colleges

BACKGROUND

Health inequities have enhanced efforts to diversify the nursing workforce. Despite recruitment strategies, the percentage of Black nurse practitioners (NPs) lags in comparison with the populous.

PROBLEM

Barriers to improving workforce diversity can be traced to academic nursing's lack of diversity in faculty, under-resourced education opportunities for students from underrepresented backgrounds, and historical hurdles.

APPROACH

One systems-level approach to increasing NP workforce diversity is developing pathway programs aimed at preparing, recruiting, and supporting Black students into advanced practice nursing education. Current undergraduate RN students from 2 historically Black colleges and universities (HBCUs) attended a 1-week summer immersion program at a graduate school of nursing at a predominately White institution.

CONCLUSION

Pathway programs for Black undergraduate RN students show promise for increasing awareness of graduate nursing, offering race and ethnicity concordant mentorship, and cultivating deep awareness for health equity.

A Mentoring Initiative for Students at Historically Black Colleges and Universities: One Strategy to Increase Nursing Workforce Diversity and Advance Health Equity

This article addresses low retention and graduation rates among historically marginalized students in nursing programs at Historically Black Colleges and Universities (HBCUs). Mentoring is a proven success strategy to support systems for historically marginalized students, helping them navigate challenges, improving academic outcomes, and increasing the diversity of the nursing workforce. The article highlights the mentoring initiative of AARP's Center for Health Equity through Nursing and the Future of Nursing: Campaign for Action, an initiative of AARP Foundation, AARP, and the Robert Wood Johnson Foundation, and the outcomes of this collaboration. The paper details the implementation of a mentoring initiative to enhance graduation rates and National Council Licensure Examination (NCLEX) success among historically marginalized students and emphasizes collaboration among institutions and organizations, as well as strategies for funding, mentor recruitment, and NCLEX preparation. Recommendations include promoting robust mentoring programs, preparing mentors, and conducting further research on the effects of mentoring on student outcomes in HBCUs.

Sustaining success for Black nursing students

Of the estimated 5.2 million nurses across the United States of America, only 6 % identify as Black or African American. Increasing the number of Black Registered Nurses (RNs) can benefit society by improving the well-documented healthcare disparities. Black students continue to report negative experiences in nursing school that contribute to difficulty in nursing education programs. Nursing programs struggle to adequately support Black students so that they are successful in their quest to become RNs. Often when students are unsuccessful, faculty focus attention on the student's failed strategies, as opposed to examining possible programmatic and faculty failures. The purposes of this article are to describe challenges Black students may face and to present practical strategies focused on the programmatic and faculty improvements that are needed to foster success. Strategies such as using root cause analyses, use of academic care coordinators, academic success teams, and intentional faculty development can be used to facilitate success for Black nursing students. Addressing programmatic and faculty issues may improve Black students' success in nursing programs.

Strategies to engage and retain African-American students in BSN programs based on oral history

BACKGROUND

The nursing profession continues to struggle with attracting African-American applicants into our nursing programs, supporting their retention and their success to graduation. This problem must be rectified if we are to generate adequate numbers of African-American nurses to meet the increasingly diverse and complex needs of our changing demographics.

METHOD

An oral history was conducted with the first four African-American nurses to graduate from a Predominantly White Institution between 1960 and 1969 to learn more about how they successfully navigated their educational environment and recommendations they could offer that could be used today to support our African-American students.

RESULTS

Participants told us that we need to value and pay attention to students as unique individuals, provide mentoring and skill building support, create group gathering opportunities for African-American students to bond, create and deepen their connection with each other and faculty in order to build trust and community. In addition, the cultural role of religion and spirituality cannot be minimized in this population as it serves to reinforce connection, hope, grounding and a familiar source of support.

CONCLUSION

To attract, retain and support academic success of Africa-American students in nursing programs, strategies must target the needs at the individual, group and faculty levels in addition to addressing organizational and structural practices that serve as additional impediments to the success of these nursing students.

Developing a mission statement to reflect the diversity, equity, and inclusion values and priorities of a College of Nursing

A mission statement represents an organization's values, expectations, and priorities and guides its strategic decision-making. This article describes an innovative and iterative process for developing mission statements to reflect and guide the diversity, equity, and inclusion values of schools and colleges of nursing. The process began with extensive input from the faculty during the fall 2021 faculty retreat using a World Café approach. Following the retreat, members of the Equity and Inclusion Committee reviewed the information from the faculty about the college's values, goals, and vision for our tripartite mission. In drafting the mission statement, the Equity, and Inclusion Committee, which includes faculty, staff, and student representation from the college's multiple regional campuses, units, and departments, met to craft an initial draft collaboratively. The initial draft of the mission statement was then circulated to the Faculty Leadership Team, the Faculty Executive Committee, and individual departments within the college for feedback. Committee members used the input and suggested revisions to refine and finalize a proposed new mission statement. A survey was distributed to faculty, staff, and students to provide quantitative and qualitative feedback about the proposed mission statement (N = 125). Mean scores suggested agreement that the new mission statement reflected the values and future direction of the college (M = 7.91), aligned with personal values and career goals (M = 8.25), and its achievement would advance the discipline of nursing (M = 8.30). The level of support for adopting the new mission statement was strong (M = 7.83). Most of the faculty voted to adopt the new mission statement at a faculty meeting (N = 98, 85 %). The strategies described have implications for guiding the development of mission statements to speak to the issues of diversity, equity, and inclusion as core values and priorities of schools and colleges of nursing.

The High School to Higher Education Pipeline Program: A focus on Black male representation in nursing

BACKGROUND

Increasing the number of Black men in nursing can enhance racial, ethnic, and gender diversity within the nursing workforce. However, there is a lack of nursing pipeline programs that specifically focus on Black men.

PURPOSE

The purposes of this article are to describe the High School to Higher Education (H2H) Pipeline Program as an approach to increasing representation of Black men in nursing and to describe H2H Program participants' perspectives of the program after the first year.

METHODS

A descriptive qualitative approach was used to explore Black males' perceptions of the H2H Program. Twelve of the 17 program participants completed questionnaires. Data collected were analyzed to identify themes.

FINDINGS

Four themes emerged during data analysis regarding the participants' perspectives of the H2H Program: 1) Coming to realize, 2) Managing stereotypes, stigma, and social norms, 3) Making connections, and 4) Expressing gratitude.

CONCLUSION

Results indicated that the H2H Program provided participants with a support network that fostered a sense of belonging. The H2H Program was beneficial for program participants in their development and engagement in nursing.

Support for Doctoral Nursing Students in PhD Programs in the United States

BACKGROUND

The number of PhD nursing programs in the U.S. has increased, but the number of nursing students entering and completing these programs remains stagnant. It is crucial to consider innovative approaches to recruit, nurture, and graduate more diverse nursing students.

PURPOSE

This article presents the perceptions of PhD nursing students regarding their programs, experiences, and strategies to support their academic success.

METHODS

This study used a cross-sectional, descriptive design. Data were obtained from an online 65-question student survey completed between December 2020 and April 2021.

RESULTS

A total of 568 students from 53 nursing schools completed the survey. Five themes emerged regarding the barriers students experienced during their programs: Faculty issues, time management and balance, insufficient preparation for dissertation research, financial barriers, and COVID-19 impact. Student recommendations for improving PhD nursing programs were also captured in five themes: Program improvement, coursework improvement, research opportunities, faculty, and dissertation. The low numbers of male, non-binary, Hispanic/Latino, minority, and international survey respondents indicate a need for innovative recruitment and retention strategies to increase diversity of PhD students.

CONCLUSION

PhD program leaders should complete a gap analysis based on the recommendations in the new AACN position statement and perceptions of PhD students reported from this survey. By doing so, PhD programs will be better positioned to implement a roadmap for improvement to better prepare the next generation of nurse scientists, leaders, and scholars.

Description of a student success program to increase support, coping, and self-efficacy among under-represented minority nursing students in the wake of the dual pandemics of COVID-19 and racial violence

BACKGROUND

Increasing the size and diversity of the nursing workforce is an important priority. Here, we describe a student success program to increase students' perceived support, coping, and self-efficacy for completing the nursing program among underrepresented racial/ethnic minority students in nursing education following the dual pandemics of COVID-19 and racial injustice.

METHODS

In collaboration with the Urban Health Program at the University of Illinois Chicago, we conducted a 15-week online student success pilot program with a volunteer sample of upper-level undergraduate nursing students. The curriculum for the program included topics centered on traditional student success topics and psychological, emotional, and contextual issues associated with student success. The sessions were conducted weekly throughout the Spring and Fall semesters of 2021, lasting 90-min. Quality improvement evaluations included weekly process variables and a post-test assessment.

RESULTS

Participants (N = 35) were primarily female and Hispanic. The program was acceptable, with participants very satisfied with the weekly sessions (83 %). Post-evaluations revealed self-reported improvements in peer support (69 %), confidence in reaching educational goals (94 %), handling microaggressions (77 %), coping with adversity (80 %), stress levels (63 %), and thoughts about leaving the program (86 %).

CONCLUSIONS

This student success program shows promise for improving general and minority-specific factors associated with student success. Additional development and evaluation are needed to determine the program's benefits for a larger group of nursing students.