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.”
When you’re a nursing student, thinking about your finances seems almost like a pointless task. With the immediacy of paying for school and the almost universal need for student loans that you pay back after graduation, thoughts of your future financial plans stay where they are – way in the future.
Believe it or not, this is actually a great time to think about your future and your finances, which includes retirement but also might include big-ticket things like a car, a house, travel, or additional educational costs. When you start working right after graduation, you’ll want to develop good financial habits right from the outset. If you can begin planning for your future early, you’ll be much better prepared.
You may not be able to set aside money when you’re still taking courses and during clinicals, but you can learn how to make good financial choices.
Set a Budget
As a nursing student, get comfortable with the funds you have, the funds you earn, and the amounts you owe. Don’t guess at how much your food costs are each month—add them up so you know. Use an online budget app like Mint (it’s free!) to calculate that in with your rent or mortgage, any insurance costs, student loan payments, transportation, and costs for entertainment, pets, or clothes.
Balance that with what you take home each month and you’ll get a good idea of your cash flow. If you get comfortable doing that early on, you’ll have an easier time making sure you make solid, financially stable decisions in the future.
Learn Where to Save
When you have a budget, you’ll know what you have and don’t have. You can figure out if you can cut back on one thing to make some extra money for something you want. Eliminating a take-out lunch once a week and you can easily save another $50 to $70 a month. Add that to an emergency fund until you have enough to cover three to six months of expenses. Then start putting it in a retirement fund. You’ll never notice the difference.
Pay Your Loans
This one is simple, but can be difficult. If you have student loans pay them on time every single time they are due. Defaulting on your student loans or being late on payments can wreak havoc with your credit score. And you’ll need good credit to secure a car loan, a loan for a home, or even future student loans if you return to school. Don’t let a mistake limit your life that much.
Plan Your Next Steps
Set some financial goals. Do you want to save $1,000 this year? Do you want to commit to saving 15 percent of your income? Figure out how much that breaks down to save each week and then do that. Either have it automatically withdrawn and placed in a different account or fund or do it yourself each payday. Setting concrete goals complete with amounts and the steps you have to take to reach your goal is half the battle.
Start implementing steps toward setting good financial behaviors now and you’ll be thankful years down the road.
When young children and young adults don’t hear about nursing as a viable career choice or learn about how to pursue a nursing career, the world loses an untold number of excellent potential nurses.
Mona Clayton, MSN, RN and CEO of Nurses 2 Roc Pub, knows all too well how some dreams need a little nudge. She is making sure that will happen with a goal to reach out to 100,000 people worldwide to tell them that a nursing career might just be the best career for them.
As a kid growing up in South Central Los Angeles, Clayton didn’t have the encouragement she needed to even think of nursing as a career. “You could say nursing chose me, I didn’t choose nursing,” says Clayton. “I didn’t think about nursing as a career at all. I didn’t like blood, and I didn’t like math. And I never had anyone tell me I could do this.”
She didn’t have professional role models telling her that her fascination with health care and the medical dramas she watched on television might mean she had a passion worth pursuing. They could have told her she could overcome her queasiness about blood and that improving her math just meant she had to practice.
Clayton aims to be the inspiration and mentor for those who might want to follow the same path. With seminars in person and online, casual discussions, a blog, and a pure determination to have good people become good nurse, Clayton spreads her message.
Clayton’s path changed when her cousin became a nurse and when Clayton herself worked in a trauma unit while attending college. After forays into journalism, pharmacy, computer science, and business, Clayton went back to school for her nursing degree in her mid 30s. As an older single mom who was also a minority and didn’t consider herself great in math, Clayton says the unknown was scary. “I think the main barrier for many people is the mindset that they think nursing is an impossible venture,” she says.
In fact, Clayton says when she is running a seminar, the young adults she is speaking with invariably ask her the nuts and bolts of how she achieved her goals. They want to know how she applied to a nursing school and how she even knew which one to apply to. They ask how she was able to pay for classes and did she work and go to school simultaneously. They want the details on how she managed while being a single mom and how hard her classes were. They are all hungry for information on how to make their dream become reality.
Clayton admits the road for her wasn’t always smooth. Her daughter was active in lots of school activities, and Clayton relied on extended family to help fill in the gaps as she continued to work and go to school while raising her daughter. When the going got tough, Clayton says she just looked at her daughter. “She kept me going,” she says. “I wanted her to see the importance of education. I wanted her to see how I did it and then they think, ‘If she did it, I can do it, too.’”
And while Clayton’s message connects her with people worldwide, you’ll also find her talking to people in Target or at the gym. She talks to kids who are curious about nursing and older people who are thinking about going back to school for nursing. And she recruits men and women believing a balance of genders is necessary in the workplace.
“I could go and work as a nurse and not do this,” says Clayton, “but this is a passion and drive I have. It feels great when I see someone succeed.”
Have you ever thought about changing career paths and teaching up-and-coming nurses? For those of you who have, we wanted to provide you with some information about what it’s like to teach, including the challenges and the benefits.
Michelle DeCoux Hampton, RN, PhD, MS, Professor and Doctor of Nursing Practice Program Director at Samuel Merritt University School of Nursing in Oakland, California, took time to talk with us about her experiences in teaching.
Following is an edited version of our Q&A:
What does your job entail? Do you specialize in specific topics that you teach? How many courses do you teach each semester?
I started in 2005 as a full-time faculty member teaching psychiatric mental-health nursing, health assessment, and synthesis for students throughout our accelerated bachelor’s program in nursing. Later, I began teaching an online course in research in the Master’s program and then the Doctor of Nursing Practice Program.
In 2013, I became the Director of the Doctor of Nursing Practice Program, and now I teach evidence-based research and several of the DNP Project courses that are geared toward providing mentorship to doctoral students as they complete their scholarly projects.
In my administrative role, 75% of my time is administrative work involving admissions, student advisement and progression, faculty support, as well as curriculum review and improvement, among other responsibilities. In my full-time teaching role, I taught about two courses per semester.
Why did you choose to teach?
My interest in teaching stemmed from my enjoyment of education from the student perspective and my many positive experiences with faculty and mentors.
I first tested myself as the Director of Staff Development in a skilled nursing facility to see how I would like being “on stage” before I ever applied for a teaching position at a university. I was able to learn a lot about adult education and enjoyed the opportunity to connect with the facility staff through our orientation and continuing education programs.
I advised many of our staff nurses about how to go about continuing their formal education and found it was one of the most enjoyable parts of my role in staff development.
What are the biggest challenges of your job?
Compared to being a staff nurse, one of the biggest challenges in teaching is that there is often no one to fill in for you—at least not at a moment’s notice. You often find that you work when you’re ill, on semester breaks to prepare for the next semester, and on your vacations. The flexibility is nice in a lot of ways, but the tradeoff is that you’re never really off the grid.
What are the greatest rewards?
One of my favorite parts of my job is to work with my doctoral students on their DNP Projects—usually an evidence-based practice implementation project. These students evaluate best practices through critical appraisal of the research literature, design practice change programs, implement changes that involve policy and procedure changes of the staff in a variety of health care settings, and evaluate the outcomes. Through each of their projects, they have provided improved health care to individual patients, communities, and within organizations. Seeing these projects develop from an idea to influencing real people’s lives is incredibly rewarding, and it never gets old.
What would you say to someone considering this type of work?
To me, the best teachers that I’ve known and worked with take a service-oriented approach to education—providing what the student needs to progress to the next level, to continue growth. This takes good observation skills, flexibility to change your approach based on where your student is and what his/her needs are, and a willingness to keep learning. The field of education, beyond what we need to know as nurses, continues to evolve and we have to evolve with it.
Is there anything else that is important for nurses to know?
In my early years of teaching, I felt like I needed to know everything—to answer all of my students’ questions on the spot. This expectation of myself produced a lot of anxiety and self-doubt for me.
Over time, I relaxed a bit more and accepted that even if students wanted me to have all the answers, that was not possible 100% of the time. Feeling confident in the knowledge that I had and my ability to research answers that I couldn’t answer right away effectively, enabled me to say that I didn’t know, but would find out or even enlist the support of other students to find the answer. It was a turning point for me. I don’t think I would have been able to sustain a career in education long term with my previous mindset.
Keondra Rustan, RN, MSN, PhD(c), visiting assistant professor at Linfield College in Portland, OR, has overcome many challenges in her decade-long career as a nurse and nurse educator. Raised in a single-parent home with limited resources, she discovered how she could channel her interest in science into a nursing career by reaching out to mentors along the way.
Today, she shares her story and offers advice to other minority nursing students and nurses who may face similar challenges in their education and careers.
How long have you been in the nursing field and what has been your career history until now?
I have been a nurse for nine and a half years. I started out working in cardiac health care in Virginia. I did cardiac stepdown, some cath lab work, and I floated to some cardiac ICUs. I then went to the ICU where I learned a great deal and developed some professionalism and leadership traits. I then went on to become an assistant manager of an ICU and IMCU. I finished my master’s degree and became a professor at a private college where I rediscovered simulation and developed a great love for it. I became the simulation lab coordinator and for a time was the interim director of the LPN program, and went on to become the assistant director of the LPN program so that I could make more time for my doctoral schooling.
I am currently working in the dissertation phase of my doctoral program and enjoying my work at Linfield College as a visiting assistant professor working in simulation as lead faculty.
What inspired you to enter the nursing profession?
At first I didn’t want to be a nurse. I went through all of my primary schooling without having the decision of wanting to be a nurse. I wanted to be a scientist at first like those scientists in Jurassic Park.
Later on in high school I decided that I wanted to be a scientist that could help cure diseases and study microbes. However, I lost my grandmother when I was in high school and some of the care that she received wasn’t the best and lacked empathy. I decided that I wanted to help people more directly and show them that they aren’t just a room number but a thriving person who was deserving of care. I wanted to be a person who made a difference in the lives of others.
As nurses we often aren’t remembered individually; but if a patient has less exacerbations and starts feeling better because of your care and the education that you provided, it is very rewarding.
What inspired you to become a nurse educator?
I discovered that I liked teaching by precepting new nurses and nursing students. I enjoyed seeing the potential in them. I loved teaching them how to do things based on evidence and why it was so important for it to be done that way. I wanted to show them how to provide holistic care to patients and help them grow into future leaders.
I also enjoyed telling them stories so they could directly apply the teachings to their practice. Most importantly, I wanted them to have things I did not have prior to becoming a nurse: resources and a mentor. I wanted to apply these principles on a broader and larger scale so I went into the field of nurse education.
I would say the first year or so I was not very good at it. Or at least I did not feel as though I was a good teacher. I did not have a mentor or anyone to show me the ropes so I just taught them the way I was thought, which did not work.
What challenges have you faced in your career and how have you overcome them?
In my career my biggest challenges have come from lack of resources and lack of mentors. I grew up in a low-income single parent home with no vehicle. We did not have the funding or access to resources to get informed about career programs while in high school or even most scholarships. I wasn’t aggressive enough in thinking of my future and did not have enough drive when I was younger to seek those resources.
Once I decided to become a nurse, I didn’t really know how to become one, what nurses actually did, and what type of nurse I wanted to be (even when I graduated I still did not know that part). I had a lot of ideas, but I did not know how to bring them into fruition.
I overcame the lack of resources and lack of mentoring by joining organizations (good old-fashion Google search) based on my interests. When I was obtaining my BSN I got accepted into Sigma Theta Tau (the nursing honor society). Going to those conferences really opened a lot of doors for me. I am so grateful for the aid of the nurses and educators that I have met throughout my nursing career. They were able to point me into a lot of great directions. I am still growing and have a great deal more that I want to accomplish.
What challenges do you see minority nursing students face and what is your advice for them?
I see lack of resources as a big one and lack of mentors. Minority students (and I include males in this) have a high risk of falling through the cracks in nursing school. There seems to be a reluctance to seek aid when dealing with difficulties. It is hard to get over, because typically it is culturally ingrained.
My advice is to seek help right away when you are having trouble. If your school does not assign faculty mentors, seek out an instructor that you feel you can connect with. Shadow a nurse if you are not experienced with the duties of a nurse, so you have an idea of if it is right for you. Don’t be afraid to ask for help; if you do not understand, seek help (think of the patient’s safety).
Most nursing schools have scholarships, open labs, writing labs, and tutors available for their students; make use of these resources and give yourself support. View any setback as a learning opportunity and grow from the experience. Never stop learning even after you are licensed and working on the floor. Google search some nursing organizations (you can even join some as a student for a cheaper price) and they can lead you down some interesting paths. Also, once you obtain your knowledge, pass it on. You never know who you will be helping with your expertise and experience.
Where do you see yourself in 5-10 years?
I see myself with at least 10 articles published and maybe a book, of course having obtained my PhD. I want to still be educating nursing students and maybe have obtained my NP. I want to continue to learn and grow each day to become the best educator that I can be. I want to do more in community and be a greater help to those in need.
Like many minority nurses, Jackie F. Webb, DNP, FNP-BC, RN, associate professor at Linfield College School of Nursing in Portland, Oregon, had to overcome many challenges on her career path to becoming a family nurse practitioner.
Webb is the daughter of immigrants to the United States and is a first-generation college graduate. Her parents worked hard to provide for their family and instilled the importance of going to college. It wasn’t until Webb got a job in a nursing home that she set her sights on becoming a nurse.
“I did not start out college knowing I wanted to be a nurse,” says Webb. “It was the experience of working in a nursing home and meeting an incredible nurse who exposed me to the challenges of nursing that convinced me to major in nursing. Looking back, I realize the time this nurse took to help me see the power and art of nursing, and her support is what gave me the belief I, too, could be a nurse.”
Webb initially thought she wanted to work as a critical care nurse, but soon realized she was most interested in preventing patients from ever needing a critical care unit.
“Working as a public health nurse opened my eyes to the challenges of seeing patients in their own homes, without fancy equipment but my stethoscope and a BP cuff, and my ability to really listen and take a thorough health history.”
This experience motivated Webb to go to graduate school and become a nurse practitioner where she learned how to manage chronic illnesses and how to incorporate cultural beliefs into the patient’s management plans. She has been a family nurse practitioner for more than 30 years.
Like many minority nurses, along the way Webb had several challenges to overcome.
“Not having role models, not having parents who knew how to navigate the world of college applications, finances, scholarships, etc. Additional challenges for me included not having good writing skills, not having a rich vocabulary, and not having experiences like so many of my friends. My parents didn’t take vacations, they didn’t belong to book clubs, they didn’t have dinner parties nor did they have their brothers and sisters or any family member close by. They both had to work long hours to afford a roof over our head. The isolation of being a first-generation immigrant was at times difficult.”
Webb believes that there are ways for colleges and universities to help immigrant and first-generation college students overcome the unique challenges they face.
“Colleges and universities who work with immigrant students and/or first-generation college students need to know that these students are for the most part willing to work harder than any other student population,” says Webb. “For some they see how hard their parents work to just keep food on the table, they don’t take anything for granted. These students are grateful for any type of assistance and will overcome amazing barriers to obtain their college degrees. Many of these students end up inspiring other students and take on challenges many students are fearful to take. Many students value their college community and will take on various leadership roles.”
So what advice would Webb offer to minority nursing students today? “I would tell them to value their personal stories,” says Webb. “Value your history and that of your family. Be proud of the hard work your family has gone through to get to where you are now. The passion, the self-reliance, and support students have will get them very far.
Webb also encourages minority students to reach out for support. “For many students of color they are the first to attend college. This is an incredible journey they are undertaking and they cannot do it alone,” says Webb. “It is so important that they find a mentor or advisor so they can feel comfortable asking how to navigate this new journey. Use every available resource so you are able to be successful. Don’t be afraid, embarrassed, or feel that asking for help is a sign of weakness. I believe it is absolutely the reverse: asking for help is a definite sign of strength as it shows you are ready to do the work.”