Planting the health policy seed has become increasingly important to professional nursing organizations, nurse educators, and even nursing students who applaud the call for integrating health policy and advocacy content in today’s nursing curricula. As nursing students become acquainted with the policymaking process, they are also encouraged to familiarize themselves with the various professional and specialty nursing organizations who advocate on behalf of the nursing profession and the patients/consumers they serve.
Numerous nursing organizations including the American Nurses Association (ANA), National Council State Boards of Nursing (NCSBN), and National League for Nursing (NLN), to name a few, work to ensure that nursing’s voice is represented during policy discussions on issues that impact health care delivery, patient outcomes, nursing workforce development, and other issues of concern to the profession. These and other organizations advocate to ensure that students have financial support to attend nursing school, have access to loan repayment programs, and support to advance their nursing education and training. These organizations work diligently to help ensure that today’s nursing workforce is well prepared to meet the demands of providing high-quality health care services in an ever-changing complex and challenging health care environment.
In this article, we present information about the American Association of Colleges of Nursing (AACN) and share insights from AACN Chief Policy Officer Suzanne Miyamoto, PhD, FAAN, RN.
The American Association of Colleges of Nursing
Since 1969, AACN has been a leader in advancing nursing education, research, and faculty practice. Moreover, AACN serves as a national voice for baccalaureate and graduate nursing education. In addition to creating standards for designing and delivering quality nursing education programs, AACN represents over 810-member schools and colleges of nursing nationwide. The AACN has a Government Affairs Committee and a Health Policy Advisory Council that coordinate and spearhead several public policy initiatives and activities focused on advancing nursing education, research, and faculty practice. Currently, the association’s federal policy agenda focuses on four key areas: workforce, higher education, research, and models of care—all ongoing public policy imperatives.
Here, Miyamoto shares some insights about her organization and health policy advocacy.
Describe Your Role and the Role of the AACN in Preparing Today’s Nursing Students in Becoming Influential Advocates in the Health Policy Arena.
As Chief Policy Officer, I oversee AACN’s policy and advocacy work at the federal level working with all three branches of government. My role and that of our team can be described as strategist, lobbyist, and analyst. To ensure we meet the needs of our member organizations, the association has a Government Affairs Committee and Health Policy Advisory Council that provides guidance when we are reviewing legislative proposals or federal regulations. We want to ensure that what we support, oppose, or remain neutral on is in line with the experiences or challenges of our member institutions. AACN is in a unique position that we represent the schools of nursing, which includes the deans, faculty, and students. This requires our advocacy work to be nimble and abreast of the key issues Congress and the Administration are discussing. It is our role to not only develop the strategy but to educate and inform our membership on our position and why we take it. Information is the best offense and the best defense. That is why AACN fully supports all members of a nursing school to be engaged in our advocacy efforts. We have a grassroots network with other 11,000 students, faculty, and deans. This network has great potential to grow and offers real-time, advocacy opportunities.
What Are Some Top Priority Policy Issues Impacting the Profession and Health Care Today?
Some key issues impacting the profession today include
• Securing funding for Nursing Workforce Development Programs, Title VIII of the Public Health Service Act, National Institute of Nursing Research, National Health Service Corps, among others
• The Title VIII Nursing Workforce Reauthorization Act (H.R. 959, S. 1109)
• Health reform
• Deferred Action for Childhood Arrivals (DACA)
• Public Service Loan Forgiveness
• Opioid epidemic
What Can Students Do Within Their Area of Influence to Advocate for the Profession?
It is important that students stay informed of the issues. Students need to be active participants in their own learning. To understand what is happening at the federal level, a student must embrace the policy from multiple lens. It is not enough to read one source or one disciple. To truly garner the depth and breadth of the issue, the more voices, for and against, the better one’s understanding becomes. Securing a basic level of knowledge on an issue that may impact one’s education, research, or future practice is an excellent starting point.
Grassroots campaigns are central to any of our efforts. We can be more effective if we know how our national organizations are weighing in on issues. It’s also important to listen to all perspectives. Again, policy think tanks like the Center for American Progress or the Heritage Foundation may have different political viewpoints, but on some issues, they may see eye to eye. Their rationale for getting there may be different, but it is that difference that can help further an argument depending on the audience. Students can also join forces with faculty and others to reach out to legislators at the federal, state, and local level on issues important to nursing. Discussing issues with nursing faculty, who can serve as tremendous mentors for those interested in policy, can ignite a passion for this work in the future. That is how I came to seek a career in health policy and advocacy. It was the foresight of my faculty mentors who gave me the opportunities to succeed.
What Resources Are Available for Nursing Faculty Who Are Preparing the Next Generation of Health Policy Activists?
AACN established a Faculty Policy Think Tank that worked to prepare a set of recommendations for AACN’s Board of Directors on this exact question. The charge of the group was to inform and improve the state of health policy education in undergraduate and graduate education. The ultimate goal was to consider ways that will help create a generation of future nurses who understand the micro and macro drivers that impact policy—most importantly, how nurses in the future can continue to skillfully insert nursing expertise into policy discussions. The report was released in October 2017.
Turning to the continued need for policy advocacy at the student level, AACN also offers a three-day student policy summit open to undergraduate and graduate nursing students enrolled at AACN member institutions. The program helps to prepare students to engage in policy advocacy and the federal policymaking process. For more information, visit http://www.aacnnursing.org/Policy-Advocacy/Get-Involved/Student-Policy-Summit.
As mentioned earlier, AACN’s 2017–2018 Federal Policy Agenda is well suited to serve as a foundation for shaping policy discussions during online and classroom discussions as well as during virtual and/or actual lobby days. Students are encouraged to speak with their deans and faculty at their nursing programs to learn more about what’s happening within their institutions regarding public policy advocacy efforts that impact nursing education and nursing practice.
Seeking Federal Support for Nursing Workforce Development Programs: A Clarion Call for Continued Advocacy
Very central to this discussion is the need for ongoing advocacy to secure funding to support Title VIII programs. Title VIII programs are administered under the U.S. Department of Health and Human Services, Health Resources and Services Administration. The Nursing Workforce Development Program (Title VIII of the Public Health Service Act) continues to benefit countless numbers of nursing programs, practicing nurses, faculty, students, patients, and communities. In fact, numerous minority nurses continue to benefit from diversity grants because of Title VIII funding. During 2015–2016, the Nursing Workforce Diversity grants supported 7,337 students. Numerous other minority nurses, including minority nurse faculty, have received funding through this program to support their advanced nursing education or pay back student loans. To learn more about how Title VIII programs are making a difference for nursing students, practicing nurses, academic institutions, and communities at large, visit http://www.aacnnursing.org/Policy-Advocacy/Title-VIII-Community-Impact.
As a nursing student, speak with your faculty and professional organizations about how you can play a role in policy advocacy. Throughout nursing’s history, nurses have made a tremendous impact in advancing the profession and the delivery of health care by advocating for issues of importance to them. Developing your knowledge base about these and other issues impacting the profession is a great first step to becoming an influential advocate on behalf of the profession and the patients and communities you serve.
We all sat around in my living room, friends in the fight against those nursing school teachers who seemed hell-bent on making our lives miserable. There were about ten of us crammed into my small living room for this Saturday study group, and I was the de facto leader. I didn’t need to be there. I didn’t need much more than to glance through the notes to get good grades, but I wanted to help these on-the-bubble students pass. I taught what I knew. Everyone wanted to study with me because, well, test scores speak for themselves in nursing school.
Yes, I was one of those, and I always have been. Give me a book, and I can ace a test. It isn’t really genius. It’s just that I know how to take a test. Of course, I was immensely proud of my 4.0. I didn’t lord it over people, but I did feel rather smug I guess, rather superior. I felt this meant the nursing world was my oyster. I was cocky that I would breeze through orientation, but I certainly didn’t feel I knew it all. I also didn’t put my fellow students down. In fact, I enjoyed helping them, fighting the good fight to get them to pass.
One day, my teacher said something that made the bottom drop out of my stomach: “The best nurses are usually those in the middle of the pack. Those who score high tend to not do so well.”
Was she talking to me? She said it to the class, but was she talking to me?
Maybe I was paranoid, but it turns out that there was a kernel of truth in what she said.
When I interviewed out of nursing school, no one cared that I graduated at the top of my class, although I told them repeatedly. They were more interested in how I would handle a crisis and what sort of person I was and whether or not I would fit in with this culture. Despite my obvious hubris, I am actually someone who can work well with others, can care for patients, and can be a part of the team. The only thing is that my work in school didn’t matter a damn to them.
What really opened my eyes was orientation. I was lost. Everything I had learned was so much chaff. It came into play from time to time, but it really and truly did not matter.
I remember the first time I had four patients. It was a juggling act. The fact that I knew all the bones of the hand by heart was completely irrelevant. I needed to look at vital signs and know what they meant. I needed to know when to pass meds and when to chart. Most importantly, I needed to know when I didn’t know something, and I needed to ask for help.
Fortunately, questions have never been a problem for me, and I was able to become a safe nurse because of that. This 4.0 student spent more time with her preceptor or charge nurse than she did with her patients in the first year of nursing.
And still, all that book learning I had was merely peripheral. Sometimes, it came into play. I would know obscure things about electrolyte imbalances, for instance. I was also considered one of the go-to nurses with problems in my later years.
But my knowledge is not what makes me a good nurse.
I found that my personal sense of patient safety was the most important. My ability to handle more and more stress became the calling card of my practice. My life was about looking at a situation and making a decision. Do I call a doctor about this, or do I have the means to fix it myself? Do I delegate this responsibility, or do I do it myself? Should I ask for help, or do I know enough?
My mentors—my preceptor, my manager, the various charge nurses, and the more experienced nurses—made me into a nurse. It wasn’t that huge book I lugged around for so many years. It takes a village to raise a nurse. Not a textbook.
These are skills that are not measured by GPA. These are skills that I have but don’t come as easily to me as multiple-choice questions. The point is that if you are a 2.5 student, don’t worry. Your ability to pass tests and get good grades has nothing to do with real world nursing. Trust me. I’ve been there. I am a good nurse. I worked hard to become one, but it didn’t have anything to do with what I did in school. It was about a fabulous preceptor, a supportive group of experienced nurses, and hard work on my part.
Not graduating at the top of your class? You may just be the best nurse yet. If you are someone who can manage your time well, you will make a good nurse. If you are someone who can stare down a stressful situation and make decisions, you will be a good nurse.
Most importantly, if you can and will ask questions when you don’t know the answers—and accept that you know very few of the answers—you will be well on your way to becoming a fantastic nurse. If you just eked by in nursing school, don’t let it bother you. Take it from someone who has been there: It doesn’t matter at all.
One of the most commonly heard phrases right from day one of nursing school is “critical thinking.” The common consensus is that everyone has to develop sound critical thinking in order to be a safe and effective, registered nurse (RN). This necessity is magnified when it comes to critical care areas where one decision by the RN can change the patient’s outcome. Nursing has changed from a simple caregiving job to a complex and highly responsible profession. Hence, the role of nurses has changed from being task-oriented to a team-based, patient-centered approach with an emphasis on positive outcomes. Strong critical thinking skills will have the greatest impact on patient outcomes.
So, what is critical thinking and how do we develop this? A precise definition was proposed in a statement by Michael Scriven and Richard Paul at the Eighth Annual International Conference on Critical Thinking and Education Reform during the summer of 1987. “Critical thinking is the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action. In its exemplary form, it is based on universal intellectual values that transcend subject matter divisions: clarity, accuracy, precision, consistency, relevance, sound evidence, good reasons, depth, breadth, and fairness,” reads the document.
Simply put, critical thinking in nursing is a purposeful, logical process which results in powerful patient outcomes. “Critical thinking involves interpretation and analysis of the problem, reasoning to find a solution, applying, and finally evaluation of the outcomes,” according to a 2010 study published in the Journal of Nursing Education. This definition essentially covers the nursing process and reiterates that critical thinking builds upon a solid foundation of sound clinical knowledge. Critical thinking is the result of a combination of innate curiosity; a strong foundation of theoretical knowledge of human anatomy and physiology, disease processes, and normal and abnormal lab values; and an orientation for thinking on your feet. Combining this with a strong passion for patient care will produce positive patient outcomes. The critical thinking nurse has an open mind and draws heavily upon evidence-based research and past clinical experiences to solve patient problems.
How does one develop critical thinking skills? A good start is to develop an inquisitive mind, which leads to questioning, and a quest for knowledge and understanding of the complex nature of the human body and its functioning. A vital step in developing critical thinking for new nurses is to learn from those with a strong base of practical experience in the form of preceptors/colleagues. An open-minded nurse can learn valuable lessons from others’ critical thinking ability and will be able to practice for the good of their patients.
Critical thinking is self-guided and self-disciplined. Nursing interventions can be reasonably explained through evidence-based research studies and work experience. A strong sense of focus and discipline is also important for critical thinking to work. If thinking is unchecked, nurses can be easily misguided and deliver flawed patient care. A constant comparison of practice with best practices in the industry will help guide a nurse to think critically and improve care. This makes it easier to form habits which continue to have a positive impact on patients and colleagues. Every decision a critical thinking nurse makes affects not only the patient but also his or her families, coworkers, and self.
In summary, the take-home message for nurses is that critical thinking alone can’t ensure great patient care. A combination of open-mindedness, a solid foundational knowledge of disease processes, and continuous learning, coupled with a compassionate heart and great clinical preceptors, can ensure that every new nurse will be a critical thinker positively affecting outcomes at the bedside.
There have always been challenges facing nursing students. What are the biggest ones today, and how can students deal with and overcome them? Some experts weigh in.
Frederick Richardson, a BSN student and the Breakthrough to Nursing director for the National Student Nurses’ Association, had no doubt about how much of his time would be taken up when he began attending nursing school. Yet, he says, this seems to be one of the toughest aspects of attending nursing school that students struggle with.
“One of the biggest issues that nursing students face is time—making time for everything,” explains Richardson. “Nursing school is very demanding, and when you add in the coursework, reading for homework, and the clinical work, there usually isn’t time for anything else.”
Richardson says that he was fortunate enough to learn about this before choosing to attend nursing school. His older brother had attended nursing school, and Richardson saw firsthand how often he didn’t see his brother during that time. “He would be at the library studying, at class, or at clinicals,” recalls Richardson. “When I’d see him, it would be late at night. And he would be out of the door first thing in the morning. At the time, I recognized that when I would get to nursing school, I would probably have a similar schedule, and sure enough, it’s been exactly the same way.”
To overcome this, Richardson says that students need to have perspective and be realistic regarding what they can accomplish in their lives while attending such vigorous programs. “Our schedules can get really hectic. But I think that when you get into nursing school, you have to recognize that you’re going to devote the majority of your time to your nursing program. A lot of students don’t realize that,” he says.
Students need to set their priorities straight and decide how they are going to organize their time. Richardson, for example, says that he had to learn how to plan his time, organize his life and tasks on a calendar, and then follow that calendar every single day. From his perspective, quite a lot of students expect to attend nursing school and still have an active social life and do everything they did before, like watch all their favorite television shows.
“I think that the trouble students run into is they believe they can have everything—do well in nursing school, have an active social life, et cetera. If they go in with that kind of view, I don’t think they’re going to survive nursing school,” says Richardson. “They’re going to have to sacrifice a lot of that time, but once you get into it, it gets a bit easier.”
Martha A. Dawson, DNP, MSN, FACHE, assistant professor and coordinator of Nursing and Health Systems Administration at the University of Alabama at Birmingham School of Nursing, as well as the current historian for the National Black Nurses Association, agrees that having enough time can be an issue for nursing students. Traditional nursing students still face challenges that relate to study time, finances, and part-time work. In addition to the challenges of traditional students, however, second degree nursing students, such as those in a BSN to MSN bridge or other accelerated degree program, may also have immediate family obligations, explains Dawson. For instance, some may be primary caregivers for older parents. “Many students in these new and emerging programs are older, and these added life demands can lead to both high stress and exhaustion,” she adds.
Money, Money, Money
Richardson and Dawson agree that financial issues can also be a big challenge for nursing students. Dawson says that with the varying nursing programs and the older student population in them, these students may have greater financial obligations besides school, like a mortgage. “The current economic climate is making it more difficult for students to gain access to scholarships, trainee grants, and other forms of funding without going further into debt,” says Dawson.
In addition to taking out loans to attend nursing school, Richardson says that there are a number of scholarships available for students. Believe it or not, though, not a lot of students are applying for them. “There are a good number of scholarships available,” says Richardson. “After speaking with some people who have scholarships or who fund scholarships for students, I’ve discovered that they’re not getting a lot of applications. One reason is because of the time. A lot of students don’t know that the scholarships exist, and a lot who know they exist feel like they don’t have the time to fill out the applications because of the high demand of nursing school.”
The reality, Richardson says, is that studying takes up so much of the students’ days that many don’t think they could take the time to do what some scholarships may require in their applications—like get a letter of recommendation, write three essays, get transcripts, and the like.
Recently, Richardson had a heart-to-heart talk with a student who was frustrated because of going to school, clinicals, and a part-time job. “I said, ‘If you took about three hours applying for a scholarship, you would get more money to help you out with your school fees,’” says Richardson. He continued to explain to the student that he was working twice as hard and putting in twice as many hours at his part-time job to make the same amount of money that he could get if he applied for a scholarship—which would ultimately free up more of his time. “It would help the student more in the long run,” says Richardson.
Along with not getting enough financial support, some nursing students don’t have as much family support, says Rebecca Harris-Smith, EdD, MSN, BA, dean of Nursing and Allied Health at South Louisiana Community College. “Nursing classrooms across the nation are filled with an intergenerational, multicultural group of students that range from millennials to baby boomers,” explains Harris-Smith. “This nontraditional classroom of students has many that are parents who frequently do not have siblings, parents, or other relatives to assist them with child care. The expense of child care, transportation, and after-hours coverage often impacts the nursing student’s classroom, clinical, and study time.”
Richardson says that family support and encouragement is often needed, but not every student has it. “I noticed immediately that I needed a lot of support,” says Richardson.
“In my personal experience, soft skills as they relate to interpersonal people skills have become an issue for nursing students. The ability to communicate both verbally and in writing appears to be a challenge,” says Harris-Smith. She says that because Gen Xers and millennials have grown up with a lot of technology, they have spent a lot of their early years communicating that way.
“Basic socialization has changed in that the younger generations would prefer to text over having a verbal conversation. The lack of appropriate communication skills has an impact on the students’ ability to work collaboratively with physicians, fellow nurses, and other members of the health care team,” explains Harris-Smith.
“Effective communication is essential due to the intra- and interprofessional team collaboration essential in the health care arena,” Harris-Smith explains. “Additionally, nursing students must learn flexibility, professionalism, and a strong work ethic—which are essential to the development of the new nurse graduate. Being able to adapt to an ever-changing environment is important as health care facilities have staffing issues often requiring nurses to work beyond their shifts.”
Challenges for Minority Students
Although the challenges for nursing students are often the same for students of color and those who aren’t, “students from underrepresented groups in the nursing profession and in society . . . have them on a much larger scale,” says Dawson. “There are barriers and biases that these students experience such as academic skills, perceived perceptions about their abilities, lack of faculty role models, limited peer support, and major financial issues that ‘majority’ students do not have to deal with on a daily basis. Many minority students also struggle with the very basics of housing and food.”
An additional burden that minority students face, says Harris-Smith, is that of access and equity in education. “A selective admission process is used by schools of nursing across the nation, and this very process can serve as a barrier for students of color. Academic profiling of students ensures admission of the most academically prepared students that rank highest among their peers, but students from underrepresented populations are often the first-generation college students that struggle with the issues of being the first in the family to attend college. This situation places a heavy burden on the student because s/he may be dealing with the pressure of being the ‘savior’ for the family. These students are generally not savvy enough to apply for multiple college programs, have difficulty completing financial aid forms, and generally come to college with limited resources,” says Harris-Smith.
“Nursing programs tend to address diversity in their mission statements but fail to explain how this is accomplished. Merely placing the statement in the mission statement does not explain how the school of nursing addresses the issue. To ensure transparency, each school of nursing could better address this issue by providing information on the way in which this mission is accomplished,” says Harris-Smith. For example, she says, schools could use a statement that’s more explanatory: This school of nursing addresses diversity via academic profiling of students but is careful to admit a diverse student body that resembles the demographics of the community in which we live.
“There is a need for schools of nursing to restructure their admission process to address the lack of the underrepresented students in attendance at their colleges and universities,” Harris-Smith adds.
Richardson says that’s why he is a part of the Breakthrough to Nursing committee because its goal is to increase diversity in the nursing profession. Another challenge he’s seen is that some minority students don’t last in nursing school because they have different ways of learning. “Culturally, students from different backgrounds learn differently. I’m a kinesthetic learner. If you show me how to start an IV, I will know how to start an IV more efficiently than reading three chapters about how to start an IV,” Richardson explains. “A lot of nursing school is geared toward your textbook. But a lot of students are visual, auditory, and kinesthetic learners.”
He says that there are also students from various cultural backgrounds who don’t know how to study. “For students who come from the other side of the world to America to learn, their views are different from yours, and when you have a different perspective, you’re able to become more aware. You’re able to see a different view. It actually makes us stronger and allows us to become smarter to look at the way that other people do things,” suggests Richardson.
“With diversity, we need to recognize and communicate to understand what the other person’s thinking is and allow them to realize that though their culture is different, it’s not a bad thing,” says Richardson. “It’s just a different view and perspective for them.”
Recruiting more minority nursing students is one battle that must be won to increase nursing diversity. Another important battle: ensuring these students graduate and stick with nursing through their first few years when turnover tends to be high. Mentoring is proving to be a critical type of support to help novice nurses steer successfully through early career challenges.
Marisol Montoya, BSN, RN, had one semester left at the SUNY Downstate Medical Center’s College of Nursing when she recognized she needed help navigating the next phase of her career. “I knew I would be walking into a foreign land very soon,” Montoya says. “I would have to take my NCLEX, and then I was going to have to look for a job.”
Thanks to a mentoring program offered through the National Association of Hispanic Nurses (NAHN), Montoya has spent the last year under the tutelage of a fellow Hispanic American nurse, Miriam “Mimi” Gonzalez, BS, RN. Gonzalez was able to provide Montoya with targeted support right when she needed it, drawing on her experiences and connections as one of NAHN’s founding members and a 50-year career as a labor and delivery nurse.
“I believe mentorship relationships are incredibly valuable anytime anyone is going through a transitional period,” says Montoya, who recently started a job as a postpartum nurse at Mount Sinai Health System in New York City. “It is very helpful to have someone in your life who has already done what you’re doing and knows the territory better.”
Culturally sensitive mentorships are proving critical to keeping novice minority nurses in the pipeline, helping to ensure they graduate and stay on the job after earning a degree. Research suggests that minority nursing students tend to feel lonely, isolated, and alienated on top of having financial and academic difficulties—all of which can lead them to drop out.
Student retention programs that offer mentoring and other support tend to have lower attrition rates. For instance, the SCRUBS program at Georgia Southern University increased retention rates among minority nursing students to 95% (from 69%), and NCLEX pass rates to 100% (from 84%), according to a 2013 study in the Journal of Nursing Education and Practice.
Similarly, mentoring can help reduce on-the-job vacancy rates among newly graduated nurses. In the California Nurse Mentor Project, only 8% of new hospital nurses who were assigned a mentor left within a year of being hired, compared to 23% who did not have a mentor, according to a study published in 2008 in Nursing Economics.
The first step for novice nurses looking for support and advice is not to shy away from the experience of mentoring, says Vivian Torres-Suarez, RN, MBA, BSN, director of NAHN’s Mentorship Academy. “I sometimes think people perceive that needing a mentor is like needing a tutor. They see it as a remedial type of thing. And it’s not. It’s about collegiality; it’s about learning from those who have been through a process before us. All of us should be open to it.”
Understanding What Novice Nurses Need
Three years ago, the Washington Center for Nursing (WCN), based in Tukwila, Washington, surveyed local minority nursing students and new graduates to assess their needs. In addition to finding a lack of mentoring programs, the survey identified specific topics that novice nurses were interested in: “The students really needed somebody to help them with work-life balance issues,” says Sofia Aragon, JD, BSN, RN, the executive director of WCN.
Other highly ranked topics on the survey were developing a professional sense of identity, honing leadership and communication skills, and transitioning from education to practice. The diversity committee at WCN also identified lateral violence and bullying as issues that contribute to attrition among minority nurses.
Mentors interviewed for this article stressed that many novice nurses also need help developing practical skills, such as putting together a resume, applying for a scholarship, or sorting out what paid-time-off time is all about. Nilda (Nena) P. Peragallo Montano, DrPH, RN, FAAN, would put time management and critical thinking on the top of the list. “You want them [novice nurses] to learn to think critically and make choices that are best for them,” says Montano, dean and professor at the University of Miami School of Nursing and Health Studies. “The mentor doesn’t always have the solution for the person. The student has to learn how to resolve whatever situation they come across. That’s part of learning.”
The mentees interviewed for this article emphasized how much they appreciated the empathy and encouragement they received from their mentors. “It’s good to have another person constantly telling me, ‘You can do this. I’ve gotten through this. Other nurses have gotten through it,’” says Jasmine Carter, an undergraduate in the nursing program at Arizona State University.
A 2014 study published in the Journal of Professional Nursing found that minority nursing students perceived the following traits as the most important characteristics in a mentor:
- a willingness to listen
- enthusiasm for nursing and how the mentor sparks the mentee’s interest
- clarity regarding expectations for mentees
- pushing mentees to achieve high standards
Do mentors need to be of the same race or ethnicity as the mentee? Although research suggests that minority nurses can get effective support from nonminority mentors, many nurses point to the advantages of having a mentor with a similar background and culture. “It’s important because they’ll be more likely to have the same experiences as you than someone who is from another race,” says Carter.
Carter’s mentor, Angela Allen, PhD, CRRN, RN, who teaches culture and health in her classes at Arizona State, agrees: “It’s easier for us to be able to relate when we are from the same ethnic culture, whether African American, Caucasian, or whatever. We can immediately make a connection and say, ‘I know you’ve gone through something similar to what I’ve gone through.’ There’s already a foundation for a relationship.”
Finding a Mentor
Montoya and Gonzalez met at a NAHN speed-networking event for prospective mentors and mentees, or protégés per NAHN parlance. After attending an educational session on mentoring, Montoya spelled out her goals for the mentoring experience and identified a few questions to ask potential mentors. Then she had brief one-on-one meetings with experienced nurses who had volunteered and been selected to be mentors.
“They [the protégés] ask the same questions of each mentor,” says Torres-Suarez, assistant vice president of utilization management at Healthfirst. “Then they walk away with an impression of whether that mentor is somebody they’re going to be able to work with.”
One of Montoya’s questions for the mentors asks, “What do you desire to bring to this relationship, and what do you desire for your mentee in this relationship?” As Montoya recalls, Gonzalez said something like, “I believe one of the biggest things I can bring into your life where you are right now is to connect you to everyone I know.”
This response resonated with Montoya. “In that moment, that was important to me because I felt like everyone whom she [Gonzalez] connects me to will also be a mentor to me. I felt like she was going to provide a village to raise me.”
Formal programs. Formal mentoring programs like NAHN’s is one place for novice nurses to find mentors. So far, about 20 nurses have gone through the association’s year-long Mentoring Academy. Originally piloted at the national level, the program is now being deployed at the chapter level. So far, five NAHN chapters have launched their own programs, and Torres-Suarez hopes to see every chapter create a program.
Similarly, 30 chapters of the National Black Nurses Association (NBNA) have mentoring programs. That’s how Hailey Hannon, MSN, RN, met her mentor. In 2004, when Hannon was a nursing student at Indiana University-Purdue University Indianapolis, Denise Ferrell, DNP, RN, who introduced herself to Hannon one day on campus and told her about the mentoring program offered by the NBNA Indianapolis Chapter. Ferrell, who is now president of the NBNA Indianapolis Chapter, became Hannon’s mentor during college and continued to mentor her through her first nursing job.
“I was new to the nursing program, and Denise caught me at a good time when I needed that mentoring guidance,” says Hannon. “At the undergraduate level, I looked to her for encouragement and help balancing work and being a nursing student. She would say, ‘You can do it. Let’s just talk about it.’ Then once I became a new nurse, she introduced me to the professional development side of things, like, ‘How do you find people on the unit that can help benefit you?’ or ‘Are you on any committees on your unit?’”
The NBNA is getting ready to launch a national mentoring program this year that will connect novice nurses, as well as experienced nurses in career transitions, to volunteer mentors from among the NBNA national membership. “This won’t be taking away from the mentoring programs offered by our chapters,” says Allen, who helped developed the mentoring program. “What we want to do is enhance them.”
Many nursing schools also offer various types of mentoring for minority students. For instance, American Indian and Alaska Native nursing students at the Montana State University College of Nursing are paired with a peer mentor and communicate on a biweekly basis as part of the college’s Caring for Our Own Program (CO-OP). Additionally, perspective high school students interested in pursuing a career in nursing can be paired with a CO-OP mentor who will provide them with information on scholarships, educational preparation, and career options, among other things.
Informal engagements. Not all good mentor-mentee relationships spring from formal programs like NAHN’s and NBNA’s. For instance, Carter and Allen met informally at a NBNA chapter meeting. Carter won a scholarship from the chapter, and Allen recognized her potential and decided to take her under her wing. Now, the two regularly talk, text, and e-mail each other.
Torres-Suarez encourages novice nurses to seek out various types of mentors, including informal, short-term contacts. “We have to be constantly open to opportunities to network and connect to individuals,” she says. “You can have an in-depth formal mentorship like in our [NAHN] program. And you can have an informal, five-minute mentorship with someone you just met, somebody that could be a connector for you. You can have sort of an elevator speech prepared to say, ‘I’m a new nurse. I’m not sure where to get a job, and I’m looking for some advice.’”
Torres-Suarez also thinks nurses need to seek mentors from outside of nursing, as needed. “We have to be open to mentors coming from all directions and all walks of life. While nursing mentors are important, we could also get mentoring from people who are in business because, at the end of the day, health care is a business.”
Building a Beneficial Relationship
One of the key steps novice nurses should take before seeking a mentor is to “really understand what their specific needs are,” says Aragon, who has been working to match mentees at two nursing schools with volunteer mentors at the WCN. Developing mentorship goals can help nurses identify and communicate with potential mentors—and find the best mentors for their particular needs.
Aragon shares this example: “When I was getting to know one mentor, she was talking about her journey to be more vocal with other nurses and physicians and a better communicator. She struggled with that but eventually overcame it. Then a mentee said on her application, ‘I really want to find my voice, I’d like someone to help me do that.’ This really helped me match those two up because it seemed like the mentee’s need was exactly what the mentor could give somebody.”
Yet, even the best-matched mentors and mentees need to work at building a durable, beneficial relationship. What helps? The nurses interviewed for this article provide the following lessons learned:
Create a structure that works for you. The exact structure and rules of a mentoring relationship will depend on the program and people involved. One of the requirements of the NAHN Mentorship Academy, for example, is that mentors and mentees agree to communicate with each other at least once a month for a year. Because they both preferred to connect in person, Montoya and Gonzalez agreed to meet for an hour or so before the monthly NAHN New York Chapter meeting. Then, they supplemented their monthly meetings with e-mails and phones calls, as necessary.
During the first few monthly meetings, Montoya and Gonzalez focused on getting to know each other. “We talked about our histories, and I discovered her background in nursing and the history of her life in Puerto Rico and here in the United States,” says Montoya. “When it came closer to me taking the NCLEX, our meetings became more about preparing for the NCLEX. Then we turned to preparing me for my first job interviews. When I got hired, our meetings became about accepting an employment offer. We reviewed all of the paperwork page by page.”
Walk in with intentions rather than expectations. Montoya recommends being open to what can come of a mentoring relationship. “Operate with intentions rather than expectations,” she says. “Know what your intention is. I would say that should be the first conversation that you have [with your mentor], ‘What is your intention as a mentor? What is my intention as a mentee? What is our intention for this relationship?’ Allow that to be your guiding compass throughout the relationship.”
Get personal. It’s virtually impossible for mentors and mentees who have a long-term relationship to avoid talking about personal issues, from money and child care issues to layoffs and illness, says Torres-Suarez. “This is real life. All of those things happen and all those things get addressed as part of the conversation with the mentor.”
Remember, it’s a two-way street. “It has to be a respectful relationship,” says Montano. “It’s not a one-way street where the mentees sit there and expect everything to be given to them.” Montano gives the example of a mentee not showing up for scheduled meetings. “You can’t mentor someone who doesn’t want to be mentored.”
Make use of technology. NBNA’s national mentoring program is gearing up to take advantage of live-chat, texting, e-mail, and other mobile communication technologies, says Allen. This will allow mentors and mentees from different states to communicate. NAHN also uses Skype and other technologies when needed. But Torres-Suarez recognizes the benefit of in-person meetings between mentors and mentees. “Eye contact is an important piece when you’re trying to get to know each other.”
Influencing Generations of Nurses
One argument against mentoring is that it only helps one nurse at a time. But Aragon believes the long-term effects of helping one nurse can multiply exponentially. As an example, she tells the story of the first Filipino American nurse to work in a major hospital in Yakima County, Washington. “She was someone who thought nursing was not in her universe,” yet friends, family, and community members offered her encouragement and paid her nursing school tuition, says Aragon.
“In her lifetime, she’s helped two other nurses go to school and seen the numbers of Filipino American nurses go up over time,” Aragon notes. “So, for me, even though we may only reach a few people by mentoring, just one person could be a champion and really multiply the number of minority nurses a community has.”
Often it’s not nursing knowledge that makes the difference in passing nursing boards, but having strategies for answering questions so that it’s apparent that you really “get it.” There are ways to prepare for what is often a daunting test so you can take it with complete confidence that all the time, money, and hard work that went into nursing school won’t go to waste. We interviewed experts, educators, and other nurses who aced these exams—first time around or later—and share their most helpful hints with you here.
Jake Schubert, RN, BSN
Travel nurse and executive director of Nursity.com, an online NCLEX strategies and review course
1. Carefully consider your options.
“The average candidate takes one or two prep or review course, and spends an additional 40 to 50 hours on other independent study,” according to Schubert. He recommends that students talk to their peers about their experiences and read online testimonials. In addition, check to see if your school has partnered with a test-preparation program. “Some schools provide review courses as part of the capstone curricula—ATI, Kaplan, and HESI are the big corporations with relationships with many of the schools. Most students take an additional course as well,” he adds.
2. Understand the NCLEX format and how it works.
“When you intimately know the beast, it won’t be as intimidating,” says Schubert. Because this is a computer adaptive test that uses algorithms, it’s different from every other test students have taken in their entire academic career. You must also prepare for it differently. “If you did exceptionally well or performed extremely poorly, the exam will end at 75 questions,” he explains. But if you are somewhere in the middle, it can go up to 265 questions to assess how well you know the material and whether you’ll be able to perform as a nurse in a safe manner. (See Schubert’s YouTube video—“How to Pass the NCLEX with a 58%” for more details about this type of test.)
3. Strategize how you will approach questions in which you don’t know the answer.
Most students who graduate from nursing school have sufficient content knowledge, but because the test is computer adaptive it will find an area where you are weak, says Schubert. “The NCLEX will assess your judgment as much as anything else.” What will you do when you don’t know what to do? You need strategies for these types of questions. “How do you answer a question about content you never learned? Strategy. Ask yourself, ‘Why did they write this question? Is it a medication question? A judgment question?’ As a new graduate nurse, that’s all you do all day, is try to figure out what to do in situations you don’t necessarily fully understand. This is much of what the NCLEX is assessing—will you make a safe decision?” he adds.
4. Don’t wait to study or take the exam.
The longer you wait, the more you forget, and the worst you score. “Take the exam immediately after graduating from nursing school,” Schubert advises. “Begin studying for the NCLEX before you graduate, to keep the material fresh in your mind, which will improve your score. Pass rates go down the longer a candidate waits after graduation,” he says. To find out more about pass rates, we recommend you go directly to the source: the National Council of State Boards of Nursing website at www.ncsbn.org.
5. Figure out the best way for you to study, and then stick with your plan.
“Keeping to a study schedule and certain days and times is important,” says Schubert. “But don’t cram. Instead, spread it out over a longer period.” He also recommends reducing distractions, such as television, devices, and social media as well as calls or visits from family and friends. Make sure your study area and equipment are well set up so that you’re comfortable during each study session. Then take frequent breaks so that you don’t deplete your energy, and switch among various subjects every half hour or so to maintain focus.
Launette Woolforde, EdD, DNP, RN-BC
Vice president of system nursing education at Northwell Health in New Hyde Park, New York
1. Find a role model with a similar background.
“When you don’t have minority role models that reflect who you are, it can hamper your optimism and pursuit of certain goals,” says Woolforde. “For example, I remember reading that 12% of the U.S. population is African American, but only 2% of nurses in the workforce are African American.” The lack of role models may extend to educators, staff, and mentors who can help monitor and guide students. On the other hand, those missing pieces of the career puzzle “can serve to motivate students to start a new trend and make a clean break from what’s happened before,” she adds.
2. Be aware that factors such as language, cultural norms, and your environment can influence your standardized testing experience.
Being a first-generation nurse or college student, for example, means you have to figure out your own way around in academia and career preparation, says Woolforde. “Minority nurses might not fit the norm in their family or culture. But I’m happy to see so many nurses exceeding these norms. Soon, minorities will be the majority in the U.S.”
Minority test-takers may have to “think against” their own cultural norms, cautions Woolforde. “Maybe in your culture women do not make decisions. You have a question about a patient coming into the ER—a male with a wife—and the wife is upset and vocal about it. How would you answer the question? The correct response is ‘Reassure the wife,’ but what if in your culture, wives aren’t spoken to? A wife may be dismissed in that culture.”
3. Do two or three things to “pump yourself up” each day.
“Overthinking and overprocessing while studying is a problem,” says Woolforde. “Don’t try to master everything. Do a little bit every day. Take tests over and over. Spend more time doing practice tests than in reviewing your general knowledge.” Some review services provide assessments, so take a look at your pharmacology scores, for instance, and decide if you need to allocate more time to that section of the test. Nursing students know a lot, but when they look at the questions they may not understand what the question is really asking. “It’s not ‘What is this medication for?’ but more about ‘What would you do to prepare a patient?’ For example, if a patient is taking Lasix then he needs a diet that’s rich in potassium,” she says. “Review what you’ve learned over the years. Believe in yourself. You’ve come this far, so you can pass this exam. There’s great positivity that comes from that belief. There’s power there.”
4. Don’t let fear hold you back.
Fear of failure and fear of the unknown are two major hurdles for many minority nursing students, says Woolforde. “They ask, ‘Am I smart enough?’ They’re afraid that they’ll fail the test because they don’t know the right answers. They’re afraid there’s material that they didn’t get in school or that they didn’t study it enough. I usually tell them all that might be true—you might not know the answer outright. But you can usually rule out two answers and reduce your choices. Then reread the question, think about it, and let the right answer surface,” she advises.
5. Think beyond the NCLEX.
“Even during your orientation, you can be thinking about specialty certification,” says Woolforde. “If you work in oncology and pediatrics but like peds, then you may decide, ‘This is where I want to spend my career.’” Next, consider specialty board certification as a stamp of expertise in an area of practice. In order to maintain that certification, you have to maintain a minimum number of continuing education hours and must practice for a minimum number of hours there. “Certification shows that you’re current with best practices; you’re currently practicing and staying on top of trends and issues in that specialty,” she adds.
G. Rumay Alexander, EdD, RN, FAAN
Interim chief diversity officer and director of the Office of Inclusive Excellence in the School of Nursing at the University of North Carolina at Chapel Hill
1. Keep your mind in the game.
For highly vulnerable students, every test becomes a test of language proficiency, says Alexander. Multiple choice questions are especially problematic, she adds, so practice to understand how they’re structured and how to answer them. “Outside of the U.S., most countries don’t use multiple choice questions on tests, so international students may need more help to pass. Non-English speakers typically need to translate questions into their own language and then retranslate their answer in English. Older students are another minority group that is disadvantaged; they’re out of practice with test-taking.”
2. Understand that half the battle is staying level-headed.
“Try not to let your brain get hijacked by emotions,” advises Alexander. “Avoid being hungry, angry, lonely, or tired [“H.A.L.T.” is a good memory aid]. Make sure you’re well-nourished, well-rested, and really and truly try not to get panicked because you don’t know the answer immediately. Answer the questions you are certain you know and then revisit the questions you skipped.” It’s normal for people taking the NCLEX to think that they’re failing, so try not to be overwhelmed if you need to skip questions. Usually, you are doing fine, so just stay the course.
3. Tap the various staff members and other resources that your school provides.
“We have student advisors who meet with students and take them through different tests and practice exams,” says Alexander. Practice questions come from the end of textbooks, or students go online and get questions that best address their weak spots. “Students who have test anxiety can get help at a center that helps with managing anxiety and practice with testing, too,” she adds.
4. Find your happy place.
When highly vulnerable students were not passing gatekeeper exams at her school, Alexander asked the school’s “cultural coaches” to work with them. “We told the distressed group to forget about the exam and we asked them this question: ‘If you didn’t have that coming up, what would you do?’ Their response was ‘Let’s have a party!’ so we blasted music for 40 minutes and they taught each other new dances. There was laughter, joy, and smiles. Then they went on to study for the exam.” The nursing students were advised to do visualization exercises for stress reduction, like the school’s winning basketball team did before a game. “We told them, ‘When you’re stuck on a question during the exam, go back to this time. Remember the dance or anything that makes you feel peace, joy, or sense of accomplishment.’” The visualizations worked, and students later reported that their anxiety was greatly reduced when they applied the technique.
5. Understand that not everyone will pass the exam on the first try—and that’s OK.
“If you failed, well, you’re not the first person who has,” says Alexander. “Maybe you need to practice more or review a certain part again. Students repeat exams all the time. It’s not a denial of your dream; it’s a delay. Maybe you need to work more on test anxiety or preparation. Failing should inform you, not defeat you.”
Sometimes students face difficulties right before the exam that throw them off course, such as a suddenly ill child or a minor fender bender. Everybody has a bad day, Alexander explains, and the main thing is to resist the urge to ruminate. “Instead, focus on what’s next,” she suggests. “Ask yourself, ‘What do I want? What’s my next move?’ Remember, there is a skill to test-taking and it takes intentional preparation. Prepare, don’t despair!”
There are so many ways to prepare for the nursing boards now, what with new technology as well as in real-life social support. You can pick and choose the techniques that work best for you. Take an online review course, use an app, study with a group, or set up an at-home program. Success is absolutely within your reach!