In moments of doubt, there are few better comforts than being able to turn to a knowledgeable, experienced, supportive mentor. In nursing, that relationship truly makes a difference.
These are the results of Project DIVERSITY, an IRB-approved study that successfully increased the diversity pipeline of the nursing workforce. Staff development educators will find that the nurses’ involvement in academic outreach efforts and mentoring increased nursing satisfaction. Nurse mentoring was extremely effective in recruiting and retaining these underserved ethnic minority students, and may contribute to reducing health care inequality.
Foundational research
Previous nursing research has addressed the serious problem of racial and ethnic health care disparities through mentoring racial/ethnic minority students. The nursing profession does not represent the population at large. The nation’s minority population has reached 104.6 million, which represents one out of three who are minority residents (U.S. Census Bureau, 2009). A growing body of research demonstrates that racial and ethnic disparities in health constitute a national crisis and are a growing public health challenge (IOM 2002, 739; Buerhaus and Auerbach 1999).
There is a well-documented need for greater minority representation in nursing as the national population becomes more diverse. It is important to have a racially diverse nursing workforce because nurses who can speak the same language, understand the culture, values, and beliefs of their patients may provide better care (IOM 2002, 739). Increasing the route for underrepresented minorities to enter the nursing workforce will address the health care disparities that plague our healthcare systems. (Gordon and Copes 2010, 11-13).
Project DIVERSITY (Develop/Increase the Voice of Ethnic, Racial Students and Interns Through Youth) is a Partners Invested in Nursing (PIN) Project that used mentoring to help minority students complete high school and enter college with nursing as a major (Robert Wood Johnson Foundation 2010). Minority high school students were recruited into the program and participated in bi-monthly nurse mentor workshops, weekly tutoring, a six-week long summer program, job shadowing, and college preparation that resulted in 100% of the these minority high school students entering a college nursing program. Mentoring these students was one of the most effective interventions yet employed.
Increasing the number of minority nurses is one solution for eliminating health disparities and increasing the quality of care (IOM 2002, 739; Buerhaus, Auerbach, and Staiger 2009, 657). Research has discovered that when Hispanic nurses serve the Hispanic community, they correct cultural mistakes, and this decreases racism and discrimination in healthcare (Wros 2009, 151-157).
The problem in New Mexico
New Mexico has a great need for minority nurses, as a minority-majority state with a population that is 41.4% Hispanic, 11.2% Native American, 2.7% African American, and 1.7% Asian American. Yet, less than 10% of New Mexico nurses are Hispanic, and less than 1% of nurses are Native American (New Mexico Department of Health 2006). This cultural disparity creates language and cultural barriers for the Hispanic, Native American, and other minority populations when they try to access the health care system. These cultures tend to look toward their own communities to find medical help. Both subcultures depend on alternative medicines to solve their health problems. The end result is that an individual’s health status may have deteriorated by the time they finally seek professional health care. The Hispanic and Native American populations tend to live in more rural settings, and they often lack the ability to communicate effectively with health care professionals. They either cannot speak English or they do not feel comfortable speaking it; consequently, they feel the health care system does not consider their cultural bias.
Increasing the ethnic minorities within the nursing and health care professions will increase access to care, allowing providers to communicate more effectively, incorporate cultural differences, and provide higher quality care to these populations. The language barrier alone creates misunderstandings regarding the diagnosis, procedures, proper medication, and consistent follow up care for chronic illnesses. Minorities receive less quality disease care regarding their hypertension, diabetes, cancer, chronic infections, and drug and alcohol abuse. If the health care system reflected the general populations, then communication, cultural sensitivities, and health care could be delivered in a more acceptable manner. Mentors for Hispanic and Native American high school students can ensure that more of these students enter the nursing profession and provide more effective care for these populations (New Mexico Center for Nursing Excellence).
The PIN Project
The Robert Wood Johnson, Northwest Health, Con Alma, and two New Mexico Health Foundations (which worked out of high schools with a large number of disadvantaged minority students) funded the PIN Project. The program aimed to motivate minority students, who were interested in nursing, to successfully complete high school and enter college with nursing as a major (Robert Wood Johnson Foundation 2010). The PIN Project provided nurse mentoring, bi-monthly nursing workshops, tutoring, a six-week summer program, college preparation, and job shadowing opportunities. Because most of the students came from families who did not support them academically, students reported that the nurse mentoring and job shadowing helped them stay motivated in their studies, focus on a career, and finish school.
Fifty-four nurse mentors and 59 students participated in the Project DIVERSITY program. The targeted high school had over 90% ethnic minority students and a dropout rate of over 50%. With one counselor for over 600 students, they did not have adequate career counseling. Many of these students did not have family support, and education was sometimes not valued. When the students met with their DIVERSITY mentors every week, they discussed school, nursing, home, family, relationships, and any other challenges on their minds. In the end, the students connected with their mentors in a constructive and supportive way. Students often said the relationship with their mentors had enriched and changed their lives.
Supporting literature
Mentoring is an effective method to increase self-esteem, academic performance, and social skills in Latino students (U.S. Census Bureau 2009). Research has demonstrated that mentoring has also been effective in recruiting high school students into nursing (Timmons 2007, 747). Racial/ethnic minority students have lower college admission and retention rates than white non-Hispanic students. A review of strategies reveals that to recruit and retain racial/ethnic minority students, schools of nursing will have to use interventions that reach diverse student populations and make connections with middle and high schools (Balogun, Sloan, and Hardney 2005). Many minority students do not take, or are not encouraged to take, science and mathematics in high school. Assuredly, this leaves them at a serious disadvantage when confronted with college health sciences curricula.
Language and cultural norms are some of the causes of health disparities between ethnic and racial groups as they try to enter the health care delivery system (Harris 2010, 1-22). Other causes of health disparities include socioeconomic (poverty) and environmental characteristics (many live in rural areas where full medical care is not possible).
New Mexico ranks among the lowest in the United States (31st state in ranking) when it comes to educating its youth with one of the highest dropout rates in the country. However, graduating from high school is not an indicator as to whether students are prepared to go on to college or university (U.S. Census Bureau 2009).
Methodology
Study aims
Project DIVERSITY is a University of New Mexico Health Science Center IRB-approved research program aimed to recruit and prepare underserved ethnic minority students for a career in nursing. The study’s goals were to recruit and retain 60 underserved, ethnically diverse students into a path for nursing as a career; to academically prepare students for college and nursing as a career; to expose these students to nursing as a career choice; and to establish community partners for the support of success or students in the Nursing Career Pipeline.
Study design
This descriptive longitudinal cohort intervention study recruited underserved minority high school students and provided nurse mentoring, workshops after school, job shadowing, academic tutoring, and college preparation. Nurses mentored students by participating with students in nursing workshops, teaching them about health care issues, and providing job shadowing experiences.
Intervention
The Project DIVERSITY program used mentoring and job shadowing as a main factor in motivating ethnically underrepresented high school students to graduate from high school and consider nursing as a career choice. It is important to provide the motivation and academic resources to keep students in school, as more than 50% of Albuquerque high school students drop out. The mentoring program was conducted at the high schools in a safe, relaxed manner. A group of students and nurses established relationships and learned about each other, nursing, and health science topics. The mentors were encouraged to listen patiently, foster discussion, and nurture self-sufficiency. They provided an introduction to nursing careers and developed a working relationship with their students. By building trust they helped their mentees develop self-esteem. As the bond grew between the nurse mentors and students, the mentors were able to address and advise students on personal and academic problems.
Job shadowing was conducted after the students completed the University Hospital Volunteer Orientation Program. This orientation class outlined the essential elements required of all volunteers to enter the hospital. Items such as HIPPA regulations, security, safety, and communication were discussed. After the orientation, the students were given an identity badge and a shirt that identified them as a volunteer. The students shadowed their nurses for a minimum of eight times per month, arranged by the program coordinator. Outcomes included students journaling every day they worked with their nurse mentor and completing pre/post self-efficacy surveys. The mentoring experience truly introduced them to the hospital nursing environment.
Conclusion
The data was analyzed using both quantitative and qualitative methods depending on its nature. As a result of this research program, all of the eligible students entered into college with a plan to apply for nursing. The mentors spoke of what they had learned from their students as well. These personal relationships not only helped students envision what could be, but also helped nursing staff be more empathetic of their hardships. Hopefully, this will make them better nurses, better students, and more understanding human beings.
Fifty nurses served as mentors and 63 students participated in the program. Two-hour workshops were offered twice a month beginning in September 2007 and ran through December 2009. Pre/post tests were given for every workshop to measure the students’ grasp of the information. A curriculum was established and carried out at both high schools. The nurse mentors met with the students twice a month at their respective high schools and participated in health-related workshops.
Over 80 hours of nursing-related workshops with mentors and content experts covered a variety of areas, including dissections, nutrition, interview skills, chemistry experiments, laboratory values, and nursing workforce subjects. In addition to the program, many of the students volunteered for additional job shadowing during the school year to get hands-on nursing training. The nurse mentors were involved in their students’ lives in a very personal way, and many students and nurses became friends. They still maintain relationships with each other long after the program’s end. Having an adult who is not a parent can be very helpful to students who need direction in their lives and counsel from mentors they trust.
Discussion
The issue of minority representation in nursing care is critical because racial/ethnic concordance between patient and provider has consistently been associated with greater patient participation in care processes, higher patient satisfaction, and greater adherence to treatment. Language barriers are similarly important, because they can affect the delivery of adequate care through poor exchange of information, loss of important cultural information, misunderstanding of physician instructions, poorly shared decision-making, and even ethical compromise.
One of the major challenges for Project DIVERSITY was finding minority students at Highland High School who had a strong educational foundation. Too often, their coursework did not provide the necessary rigor to pursue a career in nursing. Currently, only 19% of all the school’s freshmen are proficient in math, 18% in reading, and 22% in science. These numbers do not change for 11th grade. This presented a major obstacle for successful outcomes and posed a challenge in recruiting students for Project DIVERSITY.
Mentoring had the greatest impact on Project DIVERSITY outcomes. The program allowed nursing mentors to act as authentic role models. Through their experiences, the students became well acquainted with the nursing staff and with nursing as a profession. The mentoring program gave the students the opportunity to learn about nursing and the academic preparation required.
Project DIVERSITY demonstrated that (1) underserved ethnic minority students are interested in nursing as a career and can progress academically with appropriate support, (2) nurses and other health professionals are committed to supporting these students and are willing to donate their time and expertise to support these students, (3) community foundations and institutions are willing to support programs that measure program outcomes that keep students in school and motivate them to enter the nursing profession, (4) these children are marginalized because some schools do not expect much of them and thus the children do not perform academically, (5) the program has demonstrated that these students can achieve high academic goals, and (6) although the students and families said college was not part of their family culture, with adequate professional support, they believe they can attend college. All students completing the program entered college, applied to college, or are researching college opportunities.
Project DIVERSITY targeted underserved students, not just to show them career pathways into nursing, but also to break the poverty cycle by providing the tools to pursue a career that will support them their whole lifetime. In the process, they would increase diversity within the nursing community. Families, schools, foundations, and the community must work together, in partnership, to reach these children.
The nurse mentors helped with academic tutoring to ensure that students achieved the grades they needed to get into nursing school. In addition, many of the students volunteered with their nurse mentors to get hands-on training in what nurses do day-to-day. Finally, mentoring directly influenced these students to broaden their horizons and reset their life goals higher than when they entered the program.
Nurses Ethnicity
Nurses Ethnicity*
# of Nursing Population
% of Registered Nurses (2,909,357)
% of General Population (33M)**
Hispanic
48,009
1.7
0.2
African American
122,495
4.2
0.4
Native American
9,453
0.3
0.03
Asian
89,976
3.0
0.3
** US Census Bureau 2000
References
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Harris, K. M. 2010. “An integrative approach to health.” Demography 47, no. 1:1-22
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U.S. Census Bureau. Census 2000 Foreign-Born Population Map Series by Selected Countries of Birth. in U.S. Census Bureau [database online]. 2009 Available from www.census.gov/newsroom/releases/archives/census_2000/2009-05-07_census_2000.html.
Wros, P. 2009. “Giving voice: incorporating the wisdom of Hispanic RNs into practice.” Journal of cultural diversity 16, no. 4:151-157.
Aneesah Coates, BSN, RN, is an experienced psychiatric mental health nurse with nearly ten years of experience in acute care, long-term care, and home health care. She is the owner of aneesahcoates.com and is passionate about helping nurses, current and aspiring, learn more about the profession.
Coates works at a mental health crisis center as a senior professional evaluation nurse, preceptor to new nurses, Nursing Journal Club facilitator, and nursing department trainer for new staff. She’ll graduate with her doctorate in nursing practice as a psychiatric mental health nurse practitioner in December 2023.
The series highlights healthcare leaders who are prominent figures in their organizations and are making transformational impacts in nursing.
Meet Aneesah Coates, BSN, RN, and senior professional evaluation nurse.
Talk about your role in nursing.
I wear several hats in my current nursing role. I am a senior professional evaluation nurse at a local mental health crisis center. We’re part of the University of Pittsburgh Medical Center, specifically under the Western Psychiatric Hospital umbrella, a national leader in diagnosing, managing, and treating mental health and addictive disorders. And we are located in an urban community setting, so we get consumers with various needs and diagnoses.
My duties include triaging consumers coming into the center, conducting intake assessments, making referrals to the appropriate level of care, and working with local pharmacies to ensure that our consumers can access the medications they need. I also serve as a resource for other nurses and clinicians in the facility, providing mentorship and guidance to new staff members and helping with problem-solving when necessary.
More formally, I am trained as a preceptor to new nurses, so I help lead nursing orientation and provide ongoing support during the onboarding process. As the trainer for the nursing department, I give presentations to new staff from all disciplines, providing them with an overview of the nurse’s role within the team. My goal is to ensure everyone who works here understands our role as nurses and how we fit into the team’s overall approach to helping our consumers.
Lastly, I serve as the Journal Club facilitator for the nursing department. I started this initiative by creating a presentation to refresh us on defining key research terms and levels of evidence. Every month, I select a journal article relevant to our work, conduct an article critique, and provide the group with a summary of the main findings. I also provide them with a blank copy of our research critique form and encourage them to reply to the initial email to share their thoughts to foster discussion. Each of my roles has this common thread of support for consumers and staff alike and empowering everyone in the process.
How long have you worked in the nursing field?
This year marks a decade as a nurse for me.
Why did you become a nurse?
Becoming a nurse was a natural progression for me. Seeing my dad in the hospital greatly impacted me as a child, and I was continually inspired by the nurses who cared for him. Despite being in and out of the hospital, my dad was involved in my education and invested a lot in my early education. He nurtured my curiosity and encouraged me to keep learning. My mother’s hard work ethic was also an influence on me.
Between their encouragement and my growing interest in healthcare, nursing seemed the perfect fit. I was drawn to all aspects of the profession and wanted to make a difference with my work. That desire has only grown since then, and I’m continually driven to learn more and improve my practice.
What are the most important attributes of today’s nursing leaders?
A great attribute for today’s nursing leaders is being able to role model the behaviors and attitudes they’d like to see in their staff. Nursing leaders should be able to demonstrate qualities such as professionalism, accountability, and integrity. It’s also important that nursing leaders are problem-solvers and innovators, ready to take on challenges and come up with creative solutions for their teams. Nursing leaders should strive to be lifelong learners and stay current on best practices and evidence-based research to improve care.
Many attributes that contribute to successful nursing leadership can be learned and developed over time. So if an aspiring leader still needs to possess the desired qualities, they can acquire them through professional development opportunities such as certifications and continuing education. Mentorship and networking can also be great resources for learning and developing these skills.
What does being a nursing leader mean to you, and what are you most proud of?
Being a nursing leader means taking an active role in helping shape healthcare’s future. It’s about understanding how my work can impact the lives of my patients, their families, and our community. It’s about being an advocate for all those I serve and working to ensure that everyone has equal access to healthcare. It’s also about empowering my colleagues, mentoring them, and encouraging them to reach their potential as healthcare professionals. And this can all be done no matter what level of nursing leadership you are in.
I take my leadership role very seriously. I am continuing my education to obtain my doctorate in nursing practice (DNP) to become a psychiatric mental health nurse practitioner (PMHNP). I plan to graduate this December and am excited about the opportunities this degree will bring. I am also excited about the work I have done to create aneesahcoates.com, a website devoted to helping students and new and seasoned nurses navigate the world of nursing by providing access to resources and insights on a variety of topics.
Tell us about your career path and how you ascended to that role.
My career path in healthcare began 20 years ago as a dietary aide in a hospital cafeteria. My nursing career started sometime after that when I decided to attend a local community college and obtain my associate’s degree in nursing science. From there, I went to the California University of Pennsylvania for my bachelor’s degree in nursing. And three years ago, I entered Robert Morris University’s BSN-DNP program to become a psychiatric mental health nurse practitioner. As a nurse, I have worked in an acute care setting caring for lung transplant patients. I have also worked in skilled nursing, home health care, long-term care, and psychiatric mental health care.
What is the most significant challenge facing nursing today?
The most significant challenge facing nursing today is the shortage of nurses (source). The nursing shortage results from multiple factors, including low enrollment in nursing programs, a lack of nursing school faculty, and a significant segment of the nursing workforce nearing retirement age. Not to mention how the pandemic has put an even more tremendous strain on the nursing profession. And the shortage is likely to have several downstream effects, including a strain on staffing ratios, leaving nurses overworked and stressed out, which can lead to nurse burnout. This can negatively impact patient outcomes and the quality of patient care. To address this, we need to focus on initiatives such as recruitment and retention programs and professional development opportunities that focus on building leadership skills. We should also continue to invest in incentives such as tuition reimbursement and scholarships to encourage more people to enter and stay in the profession.
These initiatives can create a pathway for nurses to move up the ladder, which not only increases retention but also helps to foster an environment of strong leadership among nurses. I don’t want to minimize the challenge the nursing shortage presents. It’s a complex issue that requires innovative solutions and collaboration between multiple stakeholders.
As a nursing leader, how are you working to overcome this challenge?
I am working to overcome this challenge by engaging in various initiatives and activities to help recruit, retain, and mentor nurses. I am doing this through my website, which provides essential nursing resources to students and new nurses looking to enter the profession. My current professional role allows me to precept students and new nurses, allowing me to share my passion and excitement for the profession. I make it a point to express how nursing is a dynamic profession that can be whatever we make it. In the future, I plan to use the knowledge I have gained through my DNP program to contribute to initiatives and programs that will empower nurses through education and advocacy.
I am interested in health economics and policy, so we’ll see what opportunities open up.
What nursing leader inspires you the most and why?
Nurse Alice Benjamin inspires me. She does so much that you can’t help but be inspired by her. Nurse Alice has achieved so much in her career and is passionate about helping others do the same. She is a leader who uses her platform to promote health and wellness while advocating for nurses and patients. Nurse Alice is a force of positivity, and her passion for nursing is contagious. She’s an author, TV medical contributor, ambassador for the American Heart Association, Chief Nursing Officer at Nurse.org, and the list goes on. Her work goes beyond the traditional boundaries of nursing leadership, and she is an excellent example of how nurses can impact healthcare through direct patient care and advocacy.
What inspirational message would you like to share with the next generation of nurses?
My inspirational message to the next generation of nurses is this: the sky is truly the limit. You can make a real difference in healthcare and positively impact the lives of those who need it most. Believe in your professional abilities, stay true to your values, and don’t be afraid to push the boundaries of being a great nurse.
Is there anything else you’d like to share with our readers?
I want to remind readers that we all have the power to make a difference in the healthcare field and that each of us has unique skills and talents that we can use to help others. No matter what role you play in healthcare or how much experience you have, your contribution matters. So stay motivated, focus on the task at hand, and always remember why you decided to pursue a career in healthcare in the first place.
Encapsulating 15 years of anything is difficult. How to summarize the life of Minority Nurse, a publication not only concerned with the profession of nursing and all its struggles and rewards, but also inextricably linked to the challenges and benefits of being a minority? Issues tied to the personal as well as the professional? For the past 15 years, we have tried to balance these facets of nursing.
Minority Nurse is more than a niche professional publication, more personal than your typical industry magazine. It has been, and always will be, a forum for minority populations, a place for advocacy, and a venue highlighting minorities’ unique insights.
When minorities living in the United States comprise well over one-third of the population, but the number of minority nurses hovers around 11%, we still have work to do. Yet, we’ll never limit the scope of the word “minority” to racial or ethnic boundaries. Wherever a nurse is statistically underrepresented—whether he is one of the approximately 6% of male nurses in a female-dominated profession; a nurse with disabilities; or a GLBT nurse—this is their forum too.
A number of the issues we cover are perennial favorites, like assessments of the nursing workforce and job market. Then again, many topics simply need to be addressed repeatedly, such as dealing with health disparities and prejudices in the workplace. But the repetition is necessary; talking about such issues keeps them at the forefront of people’s minds. As long as inequalities persist, we must keep the dialogue going.
We have been fortunate to see growth and progress in pay parity and health care initiatives over the life of the magazine. However, with the country in an economic gridlock, the number of those with health insurance has plummeted, particularly in minority communities, where economic inequalities are most apparent. Even more troubling is the subsequent decline in the quality of life in those areas.
We have chronicled the inequalities affecting not just minority nurses, but minority communities as well. The 1990s were a period of growth for many African American and Hispanic families, with median incomes rising an average 2.2% and 1.5%, respectively, each year, but the 2000s saw a steady decline (around 1%), according to the Center for American Progress. As many minority nurses practice in their communities or venture to communities in need, they encounter economic disparities firsthand.
Beyond the scope of the hospital, nurses play a unique role in their communities, so even if you work in a facility where “minority” nurses are actually the majority, you may still return to a neighborhood where widespread economic inequalities still exist. In an impoverished urban neighborhood, the school nurse may be the only health care resource available—not just for the school children, but for their parents and the surrounding community as well. These nurses serve as child advocates and impart crucial health care knowledge about everything from nutrition to hygiene.
The challenge is solving these problems, but you, our readers, have been phenomenal in sending us research papers and narratives detailing solutions. In every issue, we hope to provide such solutions, such as resources for nurses teaching ESL students, the effects of mentoring on minority nurse retention, and the benefits of online education for Hispanic nurse recruitment.
Our readership is indeed a remarkable group. You represent every specialty, from ICU third-shifters to flight nurses deployed overseas. You are every age, from recent graduates to established veterans looking for a career change. And you’re redefining the field, as you move from the bedside to boardrooms, business, and the halls of Congress.
You have proven yourselves consummate caregivers, passionate about your work as you improve the lives of others at home and abroad. In the aftermath of 9/11 and Hurricanes Katrina and Rita, you were there for your fellow Americans. After the tsunamis in Southeast Asia and the earthquake in Haiti, you traveled overseas to aid those in need. You’ve also gone into your neighborhoods to educate and advocate for your profession, speaking with children from grade school to high school, to inspire the nurses of tomorrow.
What’s on the horizon? As 2011 progresses and the economy continues its tumult, we will cover the impact on nurses and the communities they serve. We will explore the impending nursing shortage and focus on recruiting nurse educators to train the next generation of caregivers. Finally, we hope to explore the diversity of hospitals across the country through research and the input of readers like you.
To hope for a long future for Minority Nurse is not a wish for continued disparities, nor is it a wish for a workplace where we pretend everyone is the same. Diversity isn’t about ignoring our differences, but acknowledging and celebrating them. Likewise, the patient population will never be a homogeneous group with homogenous care needs. Even if “minority” issues fade, minority nurses impart cultural competency that leads to higher quality care for all patients. Those with life experience can share their knowledge with anyone willing to learn. And we will continue to be your forum.
In the 2000 hit comedy “Meet the Parents,” Ben Stiller plays a suitor who can do no right in the eyes of his future in-laws. The punch line for many of the jokes is his occupation: He’s a male nurse.
The movie may have left audiences laughing, but not Michael Desjardins, RN. As the first male president of the National Student Nurses’ Association (NSNA), he knows only too well that the fictional jokes are reality for men who have chosen nursing as a career. “After all of the chaos [Stiller’s character causes], the one thing the father can’t forgive is that he’s a male nurse,” he complains. “I don’t see that as funny.”
Desjardins confronts stereotypes about male nurses practically every day. People act surprised when they learn his occupation. Friends have told him to wear his wedding ring to work so people won’t assume he’s gay. Even though he’s only been an RN for a year, he’s already concerned about the effects his gender may have on his career path.
These long-standing perceptions that nursing is strictly a “women only” profession have for years deterred men from entering the field. While nursing has finally started to make moderate inroads in increasing its ethnic diversity, the RN workforce still remains 95% female, according to the most recent National Sample Survey of Registered Nurses. Based purely on the numbers, male nurses are a distinct minority in the profession, regardless of their race, ethnicity or sexual orientation.
But today’s critical nursing shortage might just be the catalyst to change that statistic. Recognizing that they can no longer afford to ignore 50% of the population, nursing schools, health care facilities, nursing associations and government agencies are all developing aggressive recruiting strategies to close this gender gap and persuade more males to consider nursing as a viable—and masculine—career.
“Nursing no longer has the luxury of accepting only females,” explains Gene Tranbarger, RN, EdD, CNAA, a professor of nursing at East Carolina University in Greenville, N.C., and president of the American Assembly for Men in Nursing (http://aamn.org), an advocacy group with 500 members. “We need to find and encourage people who have the ability and qualifications to become good nurses, regardless of whether they are male or female, straight or gay, white or people of color. Today, those differences are irrelevant.”
Making Nursing Schools More Co-Ed
According to the American Association of Colleges of Nursing (AACN), nursing schools are spearheading the national campaign to increase gender diversity in the profession. To cite just one example, the University of Texas Health Science Center at Houston convened a forum of male nurses to develop a plan for attracting more men to its nursing program. As the result, the number of male students at UT-Houston’s School of Nursing has increased to nearly 30% of the student population, thanks to the use of innovative strategies such as redesigning recruitment materials to make them less “feminine” and more appealing to men.
But many experts feel that simply getting more male bodies into classroom seats is not enough. Nursing programs, they argue, must also make significant changes in their curricula and teaching styles to create a more positive and nondiscriminatory learning environment for nursing students who happen to be men.
Tranbarger recalls receiving rejection letters from schools based solely on his gender when he first started his nursing journey in the 1950s. Today, he thinks the discrimination is still present, although it’s much more subtle. “All nursing schools now accept men,” he maintains, “but I’m not sure that all schools welcome them.”
Tranbarger points to professors who still habitually begin class lectures with “Good morning, ladies” and textbooks almost exclusively written by women for women as examples of ways nursing educators fail to acknowledge the needs of male students.
Jim Richmann, RN, BS, CEN, coordinator of patient care services for the emergency department at Underwood Memorial Hospital in Woodbridge, N.J., feels educational opportunities for men who want to become nurses have changed for the better over the past 30 years. But still, he says, societal attitudes about male nursing students have been slow to change.
“When I told my guidance counselor I was interested in nursing, he said, ‘What do you mean? Can’t you afford medical school?’” Richmann remembers. “If you were a male going into nursing, the stereotypes were either that you weren’t smart enough to get into med school or you were gay.”
AACN President Carolyn Williams, RN, PhD, FAAN, dean of the University of Kentucky’s College of Nursing in Lexington, says nursing schools are trying to make their programs more welcoming to male students, but the task isn’t always easy. Many schools are having trouble finding male faculty who can serve as role models and mentors, she reports. UK currently has two full-time male professors and hopes to persuade a third part-time professor to accept a full-time position.
Leo-Felix Jurado, RN, MA, CNA, APN, BC, associate professor and assistant chairperson of the Department of Nursing & Allied Health at the County College of Morris in New Jersey, says he’s often the first male nurse his students see. He feels the lack of strong male role models in all levels and fields of nursing is a barrier that is blocking men’s entry into the field.
“Men in nursing face the same situation as women have faced in getting into male-dominated professions,” Jurado comments. “Seeing a female CEO motivates other women to pursue business careers, and seeing a male nurse motivates more men to consider nursing. My [male] students are happy to have a male instructor because they see me as someone they will be comfortable talking with, someone who can understand how it feels to be a male nurse.”
Boys II Men II Nurses
The sooner a boy or young man realizes he can be a nurse, the greater the odds are that he will seriously consider nursing as a career choice. For young people in the Omaha area, the idea of a male nurse is no surprise, thanks to the efforts of Art Baux, a senior in the University of Nebraska Medical Center’s College of Nursing (www.unmc.edu/nursing).
Baux became the unofficial mascot for UNMC’s nursing program when he signed up to assist the college’s nursing recruiter, Dani Eveloff. His face has greeted visitors to the school’s Web site and he has spoken about careers in nursing to preschoolers and high school students. His message, Baux says, is that “it’s okay to be a man in nursing.”
UNMC is another example of a nursing school that has achieved encouraging results by implementing recruitment efforts targeted specifically to male students. Between 1999 and 2001, the number of male applicants to the program increased by 54% and the number of males actually admitted rose by an impressive 77%.
In addition to creating more male-friendly recruiting materials, UNMC has used strategies like holding an open house to subtly sell male youths on the idea of going to nursing school. “One of the most effective things we did was to make our open house a family event,” Eveloff says. “We wanted to get both husbands and wives to attend. We had an exploratorium with fun things for kids and then the parents could talk about careers in nursing.”
Since the school had a limited promotional budget, the recruiting staff focused on securing free ads in high-visibility places where people of all ages—not just high school and college students–would be likely to see them. The open house was advertised on a marquee at Omaha’s busiest intersection. Minority newspapers and cable stations ran free promos.
When the school did pay for a newspaper ad, Eveloff made sure it was placed in a gender-neutral part of the paper, rather than in the female-oriented lifestyle section. “People don’t always read the whole paper, but most people check the movie listings,” she points out. As luck would have it, the ad appeared directly above an ad for that weekend’s big action flick.
Opening Closed Doors
It’s a Guy Thing: Making Recruiting Materials More Male-Friendly The University of Nebraska Medical Center College of Nursing, the University of Iowa College of Nursing and the School of Nursing at the University of Texas Health Science Center at Houston are three schools that have been cited by the American Association of Colleges of Nursing for their outstanding results in attracting male students to their programs. For all three, a key part of the process was taking a critical look at their recruiting materials. What they found was that marketing approaches that had for years succeeded in bringing females to their campuses could actually deter males. “Our brochures had been done in pinks and teals,” recalls UNMC’s nursing recruiter, Dani Eveloff, RN, MSN. Those colors were pretty, but Eveloff doubted the hues did anything to welcome men to the profession. A complete overhaul was in order. “We went to primary colors with a lot of red and black,” she says. “It doesn’t have such a feminine feel now.” The old brochures also used fancy, script-style fonts, which tend to give a more feminine look. Eveloff and her team replaced them with bolder, simpler fonts, which are usually easier to read anyway. Next, they revamped the photography, replacing old photos with more gender-diverse ones. Whether it’s an action shot of a nurse working frantically in a surgical setting or a headshot of male faculty, men must see other men in marketing materials or else traditional stereotypes that nursing is only for women are reinforced, Eveloff advises. But just showing male faces is not enough, she continues. Photos should also depict male nurses performing activities that men can relate to. For example, traditional pictures of a nurse helping a child with a teddy bear are cute but aren’t likely to capture the imaginations of males the way emergency room action shots would. In addition, Eveloff included photos of “nontraditional” nursing students, a pool from which UNMC and other programs have found an abundance of qualified male students. People who are leaving the military, workers whose job skills have become obsolete and career changers longing for a more personally fulfilling job are often open to considering a career in nursing. The appearance of a recruiting brochure is just the first step, however. View the text as a chance not only to educate males about opportunities in nursing but also to dispel stereotypes and myths about the profession. The Men in Nursing Mentoring Task Force at the University of Iowa College of Nursing successfully used this approach to create its innovative “Men in Nursing” brochure, designed exclusively to recruit members of the underrepresented sex. Instead of ignoring or glossing over the stereotypes, the brochure addresses them directly, explains task force member Jo Eland, RN, PhD, FNAP, FAAN, director of Student Affairs. “The market we’re going after has those concerns. By addressing them up front, we hope our readers will continue to read the brochure.” Meanwhile, the UT-Houston School of Nursing has capitalized on still another successful marketing approach: giving nursing a “macho” image. Its recruiting materials emphasize action-oriented nursing specialties that have traditionally appealed to males, such as emergency care and trauma nursing. The school also carefully scrutinized its brochures to remove “flowery, feminine language” and has even placed recruiting ads in the sports pages of newspapers.
It’s one thing to attract men to the nursing profession but another thing to keep them there. When male nursing students begin to transition into the professional RN workforce, they often encounter enough discrimination to make them seriously reconsider their choice of careers. Here, too, experts says, traditional ways of thinking will need to change radically before gender diversity in nursing can truly become a reality.
Even while doors of opportunity for women have swung open throughout the medical profession, male nurses still find that many doors are closed to them in the clinical setting, especially when female patients are involved. “In some clinical education programs, hospitals have a difficult time finding a place for male nursing students in women’s health areas,” Jurado explains. “It’s common to hear things like, ‘He really doesn’t belong here. I’ll find an alternative assignment for him.’”
This prejudice isn’t just limited to labor and delivery rooms, he adds. Often, male nurses must be accompanied by female “chaperones” even when doing simple abdominal examinations–an exclusionary practice in light of the fact that no such restrictions are placed on female nurses who care for male patients.
Other men in nursing agree that male and female RNs are not treated equally in the workplace. For example, male nurses often find that their female colleagues automatically expect them to handle unruly or heavy patients. “If someone has to be lifted, the male nurse will be the one called,” Tranbarger says, adding that male nurses are often so busy doing the unit’s heavy work that they fall behind in their own patient care.
Tranbarger is currently studying the recruitment and retention of male nurses at hospitals near East Carolina University. His findings suggest that while many male RNs are feeling the effects of negative stereotyping in the workplace, their number one complaint is gender politics.
“I think at the staff level, most men would tell you they are generally welcomed by their [female] colleagues, but problems come in instances,” he says. “There’s an underlying tension between the overwhelming number of women in nursing and the much smaller number of men trying to find a place within that group. Gender-related management issues are a common problem. Some men have trouble accepting a female authority figure and some females have trouble managing men.”
Adds Desjardins, who works at the University of Utah Neuropsychiatric Institute in Salt Lake City, “Sometimes it does get lonely [when you’re a man in nursing]. You feel like you’re not part of the sisterhood.”
Give a Guy a Break
Desjardins’ election to lead the country’s largest student nursing association may have surprised many, but he says gender was not a factor. He won by a slim margin of 38 votes out of a total of 500 cast.
While Transbarger cites Desjardins’ presidency as a step forward, he feels that many nursing organizations still aren’t sure what to do with male members. He’s attended national conventions where he felt less than welcomed. “Sometimes one of the first orders of business is to declare all of the bathrooms in the building as female,” he says. “I’ve had to go to the next building to find a bathroom.”
Desjardins, too, is frustrated at the slow pace of change. “Everybody talks about bringing more men into nursing, but that doesn’t mean they’re doing anything about it,” he declares. “In many cases, it takes a backseat to recruiting other minorities.”
One strategy that has helped diversify the face of nursing is the establishment of scholarships and other financial assistance programs targeted to racial and ethnic minorities. While minority scholarships have created more opportunities for men of color to earn nursing degrees, their definition of “minorities” rarely includes Caucasian males.
Desjardins says he doesn’t think there is a need for scholarships that target white men, since this population is statistically not disadvantaged in society. He does feel, however, that financial support from health care employers could help more male nursing technicians and men in other health care specialties make the transition to nursing.
“Employers need to step up to bat,” he says. “Pay for school in exchange for a couple of years of service.” The investment will pay off, he adds, because employers and the patients they serve will ultimately reap the rewards of a more diversified nursing workforce.
Associate degree nursing students at the Alamo Colleges, a group of community colleges in San Antonio, Texas, benefit from flexible class scheduling, user-friendly study facilities, smaller class sizes, tutoring and supportive faculty.
As the economic downturn has wiped out thousands of jobs in other industries, many Americans are enrolling in nursing programs with the hopes of experiencing a recession-proof career. A large number of these career-changing students— including many minority and male students—are turning to community colleges for their nursing education, in part because these two-year schools offer lower tuition rates and more flexible class schedules than four-year colleges and universities.
Although very few community college nursing programs offer baccalaureate degrees, they provide the opportunity to earn an associate’s degree in nursing (ADN) and become licensed as an RN. Some minority nursing students in community colleges are able to continue on into BSN degree programs at four-year institutions; for others, attending a community college may be their only option for getting a nursing degree.
Unfortunately, many community colleges are losing large numbers of their nursing students, and this high attrition rate is exacerbating nursing shortages in some parts of the country. According to a 2007 article in The Sacramento Bee, one-fourth of community college nursing students in California fail to graduate—a problem that could lead to a shortfall of 12,000 full-time RNs by 2014 unless the schools can find ways to increase student recruitment and reduce dropout rates.
In North Carolina, the State Board of Community Colleges is undertaking a major study to identify ways for twoyear schools to respond to the state’s urgent nursing shortage—and specifically, to improve program retention and increase pass rates on licensing exams for students enrolled in ADN programs. According to the North Carolina Community College System, about 65% of North Carolina-educated RNs earned their credentials in one of the state’s 55 community college ADN programs. But the number of nurses coming out of that pipeline could be much higher, because more than 40% of the state’s community college nursing students drop out for academic, financial, personal or other reasons.
The high attrition rates for minority nursing students at community colleges are disappointing, but hardly surprising when you consider the cultural and financial obstacles many of these students face when it comes to completing their education, says Carmelle Bellefleur, PhD, RN, a professor at Nassau Community College in Garden City, N.Y. These hurdles include lack of financial resources, insufficient academic preparation, low expectations from instructors, family obligations and, in some cases, language barriers. “Many [minority students] don’t get the support they need to complete all of their classes,” Bellefleur believes.
Community colleges have limited resources for addressing these types of student retention issues. However, many community college nursing programs throughout the country are working to improve minority students’ chances of success by offering academic support, mentoring programs, financial assistance and culturally appropriate teaching.
“We’re finding that many of our minority students are married with families, and they have to work while they go to school,” says Lula Westrup Pelayo, PhD, RN, district director of nursing for the Alamo Colleges, a group of community colleges in San Antonio, Texas. To help accommodate these students’ needs, the nursing program offers flexible class scheduling.
“We have a full day and evening program. We also try to get students into an academic and clinical setting in a condensed form,” Pelayo explains.
When students go home to busy families, they may not have a quiet place to study. Alamo Colleges’ remedy for that problem is to provide spacious, user-friendly facilities to help students maximize their on-campus study time. “We want to help people get into groups and study while they’re here,” says Pelayo.
Prep Talk
On-campus study rooms can help, but students also have to be academically prepared for the coursework, says Bellefleur. She is the director of Preparation Retention Education for Professional Success (PREPS), a grant-funded program designed to retain minority and underserved students enrolled in Nassau Community College’s nursing program.
“We’re seeing that many students need to take developmental courses before they can successfully complete our program,” she says. “This often means instructors have to be available for face-to-face tutoring.”
According to Bellefleur, the need for this type of intensive tutoring was what prompted the creation of the PREPS project. “We go from unit to unit in the nursing textbooks and try to break down the material for the students. When many of them first came to us to ask for help, they brought their textbook and the entire book was highlighted!”
These difficulties in understanding the material don’t come from lack of intelligence, Bellefleur emphasizes. “These students are certainly not stupid. In reality, many of them are ESL (English as a second language) students. They think in their native tongue, then they have to translate their thoughts and respond in English. All this takes time,” she says. “As educators, we should have the patience to allow them to process their thoughts so they can be successful in the program. They come to our door every day asking for help. We’re a community college and we need to be able to [serve the community] by helping them.”
After identifying what the students’ needs were, Bellefleur helped develop PREPS as part of the college’s nursing curriculum. “We spend time with students after their classes, and we do critical thinking problems to try to find any gaps in their understanding.” The study groups have about 10 students in them, so if one person doesn’t understand something, a peer is probably able to explain it, she says.
Bellefleur has found that explaining a topic in several different ways can play a big part in boosting students’ comprehension. “When a student is in front of you while you’re explaining something to them, you may think they understand the topic. But if you ask them to apply it, you might find out that they really don’t understand,” she says. “Instead of just telling them something verbally, give them the information on paper. Write it down, then use a PowerPoint presentation or overhead projector to explain it, so they can see the material for themselves. Give them a way to take the information home and view it on their own time.”
Another way to increase retention, she continues, is to make sure students master their remedial classes before enrolling in nursing coursework. “We advise them that when they take their nursing classes, they should focus solely on those courses. We don’t want them thinking about sociology or math when they need to focus on nursing.”
There’s no shame in taking the basic classes first, says Bellefleur, who adds that she too was once an ESL student. “I was advised to take my reading classes first, and I did. But once I took those classes, I was able to go back to school for my bachelor’s degree, then I went back for my master’s, and back again for my PhD.”
She finds the same work ethic in many of her minority students. “We see them working in the lab from morning to night. They want to complete the program so badly. For many of them, this is their dream, their ticket to a better life.”
The dream of not just completing community college but continuing their nursing education to the next level is not an impossible one, but too many minority students don’t have a personal mentor to advise them along the way, says Leonard Leos, MSN, RN, director of the ADN program at St. Philip’s College, which is one of the Alamo Colleges.
“Many of our students are the first people in their family to go to college, and they don’t have role models to tell them they can continue their education. We’re constantly trying to help [our students increase their] self-esteem and resilience, and to convince [students in our college’s LVN program] to transition to an RN,” he says.
According to Leos, the solution is for minority nursing faculty who have already achieved their educational goals to help students envision their own possibilities. “One of the things we need to do [at the community college level] is have more minority leadership. We need role models who can tell students, ‘I went back to get my bachelor’s degree.’ Those of us who have made it through the ranks need to become mentors.”
Infusions of Funding
The dream of going to nursing school can’t be realized without money. But in these tough economic times, finding financial resources can be difficult— not just for community college students, but for their schools, too.
A high school student participating in Moberly Community College’s Summer Nursing Academy practices CPR skills on a patient simulator. The academy was part of the college’s HRSA-funded cultural diversity program.
“I had to apply [to the Department of Health and Human Services] for the [PREPS] grant three times before I got it,” says Bellefleur. “[Obtaining grant funding] is very competitive, and people from all 50 states and the District of Columbia are trying to be awarded grants.”
Fortunately, community college nursing programs may soon receive a funding boost. President Obama recently announced the American Graduation Initiative, a program that will invest $12 billion in community colleges over the next 10 years. The money will be used in part to help schools modernize facilities, raise graduation rates and create new online learning opportunities.
Community colleges are also turning to local hospitals and non-profits for help. Pelayo was able to acquire a grant from San Antonio-based Methodist Healthcare Ministries, a faith-based organization that provides health care in underserved communities, to implement a new teaching model designed to help retain more students. One of the model’s most innovative features is the use of bachelor’s- prepared nurses to teach in Alamo Colleges’ clinical simulation labs while they pursue their master’s degrees to prepare for careers as nursing educators.
“I call it the combination in-patient and clinical simulation experience,” Pelayo says. “We pair one master’sprepared faculty member with a bachelor’s- prepared instructor. Together they can admit 15 students. Ten students at any given time will rotate through the hospital with the MSN [instructor] and do their clinical experience there. The other five students will rotate through the simulation lab at the school.”
With this structure, students will get two-thirds of their clinical experience in the hospital and one-third in the simulation lab. “This helps student retention,” she explains, “because when the students are in the simulation lab with that bachelor’s-prepared clinical teaching assistant, they’re given more individual attention. It’s a one-to-five [teacher-to-student] ratio instead of the one-to-ten ratio that you have in the hospital.”
In addition to benefiting students, putting BSN-prepared nurses in this environment helps them gain teaching skills, Pelayo adds. “[It has a faculty development component], because these bachelor’s-prepared nurses have not necessarily taught before. We put them through a special program. They work [at our college] three days a week, and then we give them two days a week of relief time to get their master’s degree. In the days they work here, they do simulation lab twice a week, and the other day they do retention activities with students.”
It’s a win-win situation, because students have two people they can turn to for academic help instead of one, and the instructors are learning effective ways to educate diverse groups of students. “The bachelor’s-prepared faculty member is assigned to help with tutoring, grading and monitoring, so [that provides an additional resource for the students],” says Pelayo.
Meeting Cultural Needs
Another important strategy for retaining minority nursing students in community colleges is to provide education that is culturally appropriate. This often means revamping traditional one-style-fits-all teaching methods to meet the needs of today’s more multicultural student populations.
“Nursing has historically been a profession where we sometimes get stuck in how we teach things,” says Leos. “[Students] can walk into some established nursing programs in academia and if [they] don’t fit the guidelines, [they] get thrown out.” He believes nursing educators must find ways to rate, judge and evaluate a student’s performance in a manner that can help that person succeed.
Learning to teach in a more culturally inclusive way must start with educators becoming more knowledgeable about diverse students’ cultural backgrounds, Leos adds. For example, he notes that many Hispanics, like himself, learn best in large groups. “[In Hispanic culture], many family decisions are made only after consulting with several family members. The same principle applies to learning.” This could mean making sure new material is taught in a group format whenever possible.
As another example, Bellefleur has found that some students don’t make eye contact with their instructors because they come from a culture that believes making eye contact with an authority figure is disrespectful. As a result, the instructor may mistakenly conclude that there is “a problem” with that student. If the instructor only knew the student’s cultural background, says Bellefleur, he or she would know that the lack of eye contact is not an issue. In fact, understanding cultural differences not only benefits students but could make the instructor a more effective teacher.
Developing a more multicultural curriculum that focuses on the health care needs of people from a variety of racial, ethnic and religious backgrounds can also play a part in minority student retention.
“Care practices are different in different cultural groups,” says Ruth Jones, MSN, RN, director of nursing and allied health programs at Moberly Area Community College (MACC) in Moberly, Missouri. “We don’t have a lot of diversity in northeast Missouri, but we are seeing more of a migration of the Hispanic population into our rural areas, so we felt it was important to get the word out to our students about different care practices. We received a HRSA grant in 2007 to do just that.”
As part of that program, the college invited guest speakers to discuss issues of cultural diversity and cultural sensitivity, both for nurses and for patients, says Jones. The school also partnered with local high schools and hospitals to hold workshops and share information with practicing nurses at various clinical facilities.
Although MACC does not have a grant for the program this year, Jones says the college and its nursing students still benefit from its effects. “I’ve seen an increased awareness among the students to reach out to different sectors of society,” she says.
By reaching out to help minority students overcome academic, financial and cultural barriers that could prevent their success, community college nursing programs can help decrease these students’ chances of dropping out and increase their chances of graduating out.
“I have former [Nassau Community College] students [of color] who now have their BSN, master’s and PhD degrees,” says Bellefleur. “It’s all about empowering them to believe they can do it.”
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