If there’s one question that I frequently get asked by nursing students, it is how to properly study to pass nursing tests and exams and make it out of nursing school alive. During nursing school I tried different ways to study and it took trial and error for me to finally find what worked best for me. Here are my top study habits to help you get those A’s and tackle nursing school exams.
Best Study Habits:
1. What type of learner are you?
First and foremost, determine what your learning style is. It’s imperative that you’re honest with yourself about the type of learner you are to get the best results from studying. Learning styles typically fall into 3 categories: visual, auditory or tactile/kinesthetic learning. Each learning style retains and processes information differently. So before signing up to be a part of that study group session find out if it works for you. Some students are able to study in only quiet places while others can concentrate around loud noise. Here are two educational websites that offer free learning assessments to help you determine which learning style fits you the best: https://www.how-to-study.com/learning-style-assessment/ and http://www.educationplanner.org/students/self-assessments/learning-styles-quiz.shtml
2. Be organized.
Before you begin studying collect all of your essential tools such as notecards, pens, highlighters, coffee, and wine (just kidding). There’s nothing worse than being in your groove when studying and you realize that you’ve forgotten your favorite pen or highlighter. Have a plan of what you want to study for each session and a realistic expectation of how long it will take to go over the material. Give yourself adequate time to review each subject and include break times for each study session. According to a study recently done by Microsoft the average adult has a concentration span of only 8 seconds. That is less than that of a goldfish! So studying straight for hours without any breaks will not help you retain the information more.
3. Set goals.
You had a goal to get into nursing school and you have a goal to graduate, so why not set goals when studying? If there is a particular topic that is a weak area for you take out your planner and set a goal for when you want to fully master that material. Create a study outline with exact dates, time and even the location for when you will study each material. This will help you avoid having to cram for exams. Your class syllabus should have dates for when exams and texts will take place so don’t wait until you’re two weeks into the class to begin setting your study goals.
4. Less is more.
One of the biggest mistakes you can make when studying in nursing school is using too many books or resources at once. Determine which resources are necessary for each exam and study that content. Professors typically outline which books or resources are appropriate to use for each course so use that as a guide on what to use when studying. If not you may run the risk of studying information that contradicts what you were taught in the classroom. Seek guidance from your professor when choosing to use other resources aside from what is required.
Nursing school is probably one of the most stressful and rewarding things you’ll ever go through in life. Help make things easier for yourself with the four study tactics I listed above to help you prepare for every test and ace those exams. Always remain positive and remember to relax before an exam. You’ve got this!
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The beginning of a new year is a common time to reflect on the previous year, and deciding what goals you would like to accomplish in the next 365 days. This is not a time to be shy about the things that you want in your life. Be bold, intentional, and brave when setting goals for yourself. The sky is not the limit; it is simply the view. Although we tend to start out highly motivated and dedicated to the goals that we have set, we have got be honest with ourselves and realize that often that ambition can fade, and nothing gets accomplished! I want to share with you five methods I utilize to keep myself grounded, motivated, and a realizer of my goals.
Find Yourself a GOAL MATE
What is a GOAL MATE? A goal mate is someone that you have a great connection with that supports, motivates, encourages, and enables you to manifest all of your wildest dreams. It does not matter how far-fetched they may seem, your GOAL MATE will not only hold you accountable but encourage you to jump in and get dirty neck first. Whether you succeed or fail at accomplishing a goal they are there to pick you up if you break your neck for real (just kidding), brush you off, and send you on your awesomely merry way to attempt your next goal. Keep in mind, that in order to be a good GOAL MATE, you need to reciprocate the same energy and tenacity that your partner(s) give to you. It’s important to keep each other focused, interested, and motivated.
Make Clear, Objective, and Achievable goals
Be clear and intentional about the goals you are setting. It is also important to be specific. Think about where you want to be with your finances, health, career, and love life. Self-love included. Be realistic with your timeline and remember that there are only 12 months in a year, but that is a valuable time that can be leveraged to generate a better you.
Make a Vision Board or Host a Vision Board Party
This is an annual tradition of mine. Each year I invite my GOAL MATES, friends, neighbors, co-workers over to craft vision boards. This is inexpensive and so much fun. All you need is magazines, scissors, glue, posters, your imaginations, and perhaps some wine!
Set Mall Quarterly Milestones
Hold yourself accountable. Think about where you want your progress to be after 3,6, and 9 months. I like to review my goals monthly. This keeps it relevant in my mind. You should review your goals quarterly at a minimum. Think about what is working for you, and what you can switch up.
Look at It
If you do not see your goals periodically, or place your vision board somewhere that you can see it every day. I have my goals on my vision board, iPhone, iPad, and posted in my locker at work. Don’t forget the plans you have made for yourself. Utilize these tools, go forth, and prosper!
Jazmin Nicole is a military officer, obstetrics nurse, advisory board member of Black Nurses Rock Inc., and the founder/CEO of Jazmin Nicole & Co.
For more posts/blogs like this follow me on twitter (@jazminweb), Instagram (@therealjazminnicole_, and Facebook (Jazmin Nicole and Co.)
It all started with a conversation that took place in 1999 between the deans of two highly respected schools of nursing–one of them an Ivy League school, the other a historically black university. These two academic leaders shared a common, passionate goal: to introduce undergraduate nursing students from underrepresented minority populations to careers in advanced practice nursing and research. Today, their germ of an idea has blossomed into a highly successful collaboration that has been praised by the National Institute of Nursing Research (NINR) for its leadership role in addressing racial and ethnic health disparities and has been recognized by the National Institutes of Health (NIH) as a national model for nursing school health disparities partnership programs around the country.
Catherine Gilliss, RN, DNSc, FAAN, dean of Yale University School of Nursing in New Haven, Conn., and Dorothy Powell, RN, EdD, FAAN, associate dean of Howard University’s Division of Nursing in Washington, D.C., wanted to change the face of nursing research by encouraging talented minority students at the baccalaureate level to develop an interest in research, go on to graduate school and pursue doctoral degrees. The most effective way to accomplish this, the deans agreed, would be to immerse the students in research to help them understand the process. Empowered by that understanding, they reasoned, the students would gain confidence in themselves and in their ability to make a difference by becoming nurse scientists.
So it was that the Yale-Howard Scholars Program was born. Each year, the program brings a small, select group of Howard BSN students to the Yale campus to receive mentorship, training and research opportunities. The project’s original design involved an intensive six-week summer internship in which each Howard scholar was matched with a mentor from Yale–a nursing faculty member conducting funded research–with whom they would work closely.
In the summer of 2000, the first group of nurse scholars traveled to Yale for their internship. Five students from Howard University were chosen to participate. During that inaugural year, Yale covered all of the students’ expenses.
“That first summer,” Powell recalls, “we had to convince the students that this was a good thing to do. We chose good students who were considering graduate school and had an interest in learning about research.”
The students stayed at Yale in campus housing facilities, attended seminars, performed some community service and worked on projects with their mentors. Within the context of the larger research project, the Howard scholars had to identify a research question that they could look at more closely, then use the data from the parent project and transform it into a research problem involving minority health disparities. The students were responsible for studying the data, analyzing it and presenting their results.
“An Incredible Experience”
Nicole Laing, RN, BSN, was one of the first Howard University scholars to attend the internship program at Yale. Her research project focused on type 2 diabetes in minority women.
“I originally wanted a clinical experience but was offered the opportunity to learn about research at Yale, so I went. I thought it would be a good experience and would prepare me for graduate school,” she says. “It was an incredible experience. I enjoyed my mentor’s approach. I was introduced to the research project and encouraged to just dive in. I appreciated being able to run with it.”
Laing graduated from the BSN program at Howard in spring 2001 and is now a graduate student at Yale, studying to become a Child and Adolescent Psychiatric Nurse Practitioner. “I love it!” she reports. “I’m having a good time and learning a lot. For minority nurses especially, the impact we can make on health care is so great. It’s worth the time and effort required to complete a graduate school education.
“Attending the Yale-Howard internship program definitely fueled my desire to go to graduate school and to attend Yale,” Laing adds. “The internship experience developed me both as a nurse and as a professional. It helped me prove to myself that I could do it, that I could attend an Ivy League school. Sure, it was challenging. But like anything else, I just had to make the commitment and do it.”
Making an Impression
At the end of their six-week internship, the inaugural group of Yale-Howard scholars presented their research at a symposium held at Yale. They had created PowerPoint presentations in which they demonstrated the application of statistics and their understanding of the research vocabulary to explain their findings. They fielded questions from doctorally prepared nurses in the audience. Everyone was very impressed at how well the scholars were able to articulate their research, says Powell. “Clearly, there was a transformation in these students,” she declares.
“Presenting my project was a challenge,” Laing remembers, “and it was wonderful! I actually understood the process and felt confident about what the numbers meant.”
But the research experience for the minority students didn’t stop when the six weeks were over and they returned to their own campus. To continue the process, the scholars were assigned Howard University mentors to work with them throughout their senior year. These faculty members attended Yale for three days to study the research being done by the Yale mentors so they could help the students continue their research during an independent study.
At the end of their senior year, the scholars presented their research findings to their own student body at the Howard University Carnegie Endowed Visiting Professorship and Research Day, an annual event where 350 people converge on campus to hear minority nurse scientists share their research. Here, too, the Yale-Howard scholars were very well received. “There was such pride and appreciation from their fellow students,” reports Powell. “The scholars did so well and it made a positive impact on their peers.”
One such peer was Angela McKnight, RN, BSN. “When I heard the scholars give their presentation, I felt encouraged. The following summer, I applied for the internship at Yale,” says McKnight, who participated in the Yale-Howard Scholars Program in summer 2001.
A Shining Example
From this early success, a ripple effect began. Students from Howard signed up for the next internship in droves. The program began to attract national attention. The Yale-Howard scholars became highly desired by some of the best graduate schools in the country; 75% of the students have gone on to pursue advanced degrees. The scholars were invited to present their research at the Howard University College of Medicine’s annual Biomedical Research Symposium. “The appreciation of the medical community on campus reflects the respect for the research culture developed in the nursing school,” Powell notes.
Deans Gilliss and Powell decided to bring their partnership program to the attention of the National Institutes of Health, in hopes of obtaining grant funding that would help them continue and expand the project. The agency was so impressed with the program that it agreed to provide funding for five years. In 2001, the NIH identified the Yale-Howard Scholars Program as a model partnership program for developing a pool of minority nurse scientists who can contribute to the elimination of health disparities. Since then, the program has provided a prototype for seven similar nursing school Partnership Center initiatives throughout the United States. (See page TK.)
The two deans agree that the benefits to both universities are great. “We have truly benefited from the relationship with faculty at Howard University, such as [learning from them] how to access [minority] participants for research studies and breach barriers in hard to reach populations,” Gilliss says. Adds Powell, “Yale’s influence helped us cultivate a research culture and a capacity for scientific education. We are experiencing an increase in applications to our undergraduate and graduate schools, attracting more students and faculty interested in research. And we are experiencing an increase in funding for research projects as well.”
Yale, which does not have an undergraduate nursing program, has also gained much from the fresh perspectives and cultural diversity that the BSN students from Howard bring to the campus. “Our faculty are more aware of how their scientific work can and should impact health disparities,” Gilliss explains. “It is exciting to have these extraordinary students on campus. There has been an increase in our graduate school admissions as well as an increase in faculty applications. Nationally, we are being recognized as an institution that values diversity in our faculty and student populations and that welcomes diversity of thought, culture and country of origin.”
Gilliss’ excitement is shared by the Howard scholars who have participated in the initiative, including the most recent group of four students who attended the summer 2002 program. The scholars are immersed in graduate- and doctoral-level culture. The seminars and networking events they attend pull them into the world of research and enable them to experience what happens at the higher levels of learning.
“I learned so much at Yale. It was an awesome experience,” recalls McKnight, who graduated from Howard University in 2002 and will be attending graduate school in the fall at George Mason University in Virginia. She wants to teach and, ultimately, become a nurse scientist conducting research in minority communities. “I am more critical of research studies now,” she says. “You can’t take the numbers at face value. You have to look at the sample used in the study.
“The partnership with Yale is opening doors for us,” McKnight continues. “We need more partnerships like this! This was a new experience for me as a person of color and as a student. I am excited to get involved so I can make sure that research is representative of and real for the minority population.”
McKnight says the hands-on research experience she acquired at Yale helped her truly understand what being a nurse scientist is all about. “The internship at Yale has opened my eyes to the possibilities,” she comments. “It has given me a greater understanding of how research works and how projects are determined worthy for funding. Research makes sense; without research, how will we know how new medicines, for example, impact our [minority] community if the members of our community are not involved in the research studies? Research is so important to our future and it is a critical part of nursing. We’re the ones who are on the front lines with the patient. Patients trust us. Our population needs us.”
Perhaps you are a newly graduated nurse. Maybe you’re an experienced nurse assuming a new position. Or perhaps you’re looking for a little guidance as you investigate new nursing roles. What all of these situations have in common is a need to learn the ropes of a new position. One effective avenue is mentoring.
Jill is a new RN who had been seeking a nurse position in her home state. With today’s wilting economy, she was unable to find a suitable position, so she ventured into a new territory and accepted a position in her chosen specialty, medical-surgical nursing. She felt fortunate to have found a position at a medical center about 200 miles from her family.
Jill is encountering many new things at once: a new home, new city, new hospital, and new job. Sounds overwhelming, doesn’t it?
One of the reasons Jill selected the medical-surgical unit at her new hospital is because her interview with the nurse manager and the unit staff went so well. She found them to be welcoming, caring, friendly, professional, and patient-centered. Also high on her list of positives about the job was the unit’s mentoring program. Jill had the opportunity to interview with a mentor and mentee in the program, and it was this interview that sealed the deal for her decision to accept the position.
So what exactly is mentoring?
Mentoring is a reciprocal and collaborative learning relationship between two individuals with mutual goals and shared accountability for the success of the relationship. The mentor is the guide, expert, and role model who helps develop a new or less experienced mentee.
In many instances, mentoring is a spontaneous relationship that develops between two people. However, mentoring can also be successful when the mentor and mentee are paired or matched intentionally. This is often the case in health care facilities when a mentee transitions into a new role. The mentee is paired with an experienced nurse to learn a new position and develop in the role.
Mentoring is more than orientation or preceptorship, which may last a few weeks or through a three-month probationary period. The duration isn’t cast in stone; it is an ongoing relationship that will last as long as the mentor and mentee find meaning and value in it.
A mentoring relationship can occur at any phase of an individual’s career, whether a new graduate, an experienced nurse assuming a nurse manager or clinical nurse specialist position, or an established clinician taking on a leadership position as the chairperson of a shared governance council. Some nurses may also become a mentor themselves one day, using their knowledge, wisdom, and experience to provide meaningful learning experiences for a mentee.
Mentoring is a partnership between the mentor as a teacher and the mentee as a learner. As adult learners, mentees are responsible for their own learning and behaviors. As teachers, mentors act as guides or facilitators of learning.
Each of us has numerous opportunities throughout our lives to be new at something, and it isn’t always a pleasant experience. There is fear of the unknown, uncertain confidence, fear of making a mistake, and just the uncomfortable feeling of not being in control. We’ve all been there and will be there again at some point. In the role of a mentor, it is very helpful to remember what it was like being new to a position or task. It helps to get in the frame of reference of the mentee.
Novice to expert continuum
Patricia Benner, Ph.D., R.N., in her book From Novice to Expert: Excellence and Power in Clinical Nursing Practice, says learning new skills requires a progression through stages or levels. These levels are novice, advanced beginner, competent, proficient, and expert.
When nurses take on new and unfamiliar roles, they often begin at the novice stage. Novices use rules and facts to guide their actions. They adhere to these rules without consideration for the context of the situation. It is difficult for a novice to put all of the parts together and see the whole picture. They are concerned with the tasks at hand and often cannot do more than one thing at a time.
Most novices want to feel and be seen as competent immediately upon taking on a new role. It is uncomfortable knowing one does not have a firm grasp of the position. Mentors and mentees must remember that learning new skills is a process that takes time. Both individuals must be patient during this formative time and realize what’s occurring is normal.
With time and experience, novice nurses continue to experience the real world and progress to the advanced beginner and higher levels of the continuum. Mentors can continue to play a significant role in the mentees’ progression.
Mentees will become successful in their roles more quickly when they listen actively to what is going on and are willing to soak up as much learning as possible. Mentors are a rich source of knowledge—they’ve been there, done that, and learned the critical pieces to perform successfully. Thus, mentees can gain a tremendous amount from an effective mentoring relationship.
Successful mentoring relationships are built upon trust, openness to self-disclosure, affirmation, and willingness and skill in giving and receiving feedback. Mentoring involves a significant expenditure of time and energy on the part of the mentor and especially the mentee. Living up to promises and commitments to each other is extremely important to the relationship.
Mentees learn to achieve a balance between their own independence and reliance on the mentor. Over time, the independence will most likely dominate and the relationship will change.
After experiencing an effective mentoring relationship, mentees often feel refueled and inspired to make a difference in their practice. Other benefits of mentoring for the mentee include:
- Increased self-confidence
- Enhanced leadership skills
- Accelerated acclimation to the culture of the unit/facility
- Advancement opportunities
- Enhanced communication skills, especially with the interdisciplinary team
- Reduced stress
- Improved networking ability
- Political savvy
- Legal and ethical insight
Time seems to be the most precious commodity these days. Potential mentors may feel they don’t have the time to spend on a mentoring relationship, especially when they have a full workload themselves. However, the time invested in mentoring a nurse transitioning to a new role is time well spent for the mentor and mentee, as well as the unit and facility. It is a huge contribution to advancing the future of nursing.
Mentors help mentees learn the ropes, their role, the political environment, and the culture of the unit or organization in a formal—yet unstructured—way. They create a warm and accepting environment that allows mentees to control the relationship, while at the same time allowing mentees to be themselves and voice relevant needs and concerns. Mentors are personable, approachable, reasonable, and competent individuals committed to helping mentees achieve the success of which they are capable.
Effective mentors are confident enough in their own knowledge, skills, and successes that they do not perceive mentees or their accomplishments as threatening. They are committed to seeking situations that will benefit the mentees’ development.
Mentors provide their mentees with insights that would otherwise have been gained only through trial and error. They ask a lot of questions—especially “Why?”—which encourages mentees to stop and reflect on situations and potential alternatives. Mentors are good at linking different bits and pieces of their mentees’ lives, such as work and home, thoughts and feelings, successes and failures. They try to look at the bigger picture and the future. Mentors help their mentees grow in their critical-thinking skills and progress along the novice to expert continuum.
Potential problems with mentoring
Not every relationship is successful. This can be true of a mentoring relationship as well. Sometimes the interpersonal dynamics or the match between mentor and mentee just doesn’t work. One partner might grow faster than the other or in a different direction, and a strain on the relationship may occur.
One common problem is the lack of follow-up and commitment to sustain the relationship. Mentors might overburden the mentee with work and responsibilities and vice versa. Mentees may become a clone of the mentor and lose their individuality. They may also become too dependent on their mentors. An unfavorable incident may occur in which the mentor or mentee feels let down or betrayed. Jealousy and personal or ethical disagreements can also strain the relationship.
There is also the case of toxic mentors who are detrimental to the success of their mentees. Toxic mentors may be unavailable or inaccessible to mentees or may throw the mentees to the wolves to either sink or swim. Toxic mentors may also block the mentees’ progress or criticize them in various non-constructive ways.
Both mentors and mentees can learn from the problems others have encountered in the mentoring relationship. If signs of these problems begin to develop, both individuals have a responsibility to confront the situation and actively plan a resolution or dissolution.
Prior to entering into a mentoring relationship, both parties should agree to a no-fault separation if one or both individuals realize the relationship is not working.
Mentoring facilitates professional growth
Mentoring has proven to be a successful way of facilitating the professional growth and development of recently graduated nurses and other nurses transitioning to a new role.
The Academy of Medical-Surgical Nurses (AMSN) has long recognized the value of mentoring for nurses in the acute care setting. AMSN has recently evolved its long-standing Nurses Nurturing Nurses (N3) mentoring program into a self-directed format that provides the tools for designing a successful mentoring program of your own, whether you are a mentor, mentee, or a mentoring program coordinator.
The AMSN Mentoring Program is provided on a complimentary basis on the AMSN website. The program contains a Mentor Guide, Mentee Guide, Site Coordinator Guide, and an Introduction to Mentoring” article. You may use and customize the information and tools provided in any manner you deem appropriate for your facility or yourself.
Need-to-Know Advice for Mentors and Mentees
Tips for Mentors
- Exhibit exemplary/role model behavior.
- Recognize and encourage potential.
- Monitor your mentee’s progress and provide helpful feedback.
- Introduce your mentee to coworkers, physicians, and other significant individuals.
- Offer guidance in the customs/culture of the unit/organization.
- Build a relationship of trust.
- Discuss the confidential basis of the relationship.
- Live up to promises and commitments.
- Publicly praise your mentee’s accomplishments and abilities.
- Provide support in times of personal crises or problems.
- Assist in making decisions through listening, support, and feedback. Ask “why?”
- Share appropriate life experiences to personalize and enrich the mentoring experience.
- Encourage your mentee to take risks and learn from mistakes.
- Agree to a no-fault termination of the relationship if it isn’t working or when the time is right.
Tips for Mentees
- Assume responsibility for your own learning and growth.
- Seek challenging assignments and responsibilities.
- Be receptive to and ask for feedback. Also, give constructive feedback to your mentor.
- Live up to promises and commitments.
- Articulate your professional and learning needs to your mentor.
- Ask questions. Share concerns.
- Be prepared for meetings with your mentor.
- Discuss your long-range career planning with your mentor.
- Ask for advice/feedback on handling difficult situations/behaviors.
- Discuss clinical decisions that are made.
- Progressively increase the independence in your role.
- Honor the confidentiality of the relationship.
- Agree to a no-fault termination of the relationship if it isn’t working or when the time is right.
© 2012 The Academy of Medical-Surgical Nurses. All rights reserved.
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.
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.
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).
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.
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.
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.
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.
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.
# of Nursing Population
% of Registered Nurses (2,909,357)
% of General Population (33M)**
** US Census Bureau 2000
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Diversity directors appear to be a small but dedicated niche among nursing schools that are making an effort to better include and serve people of varying racial, ethnic and cultural backgrounds. While campus-wide diversity and multicultural affairs offices are fairly common at major U.S. universities, it’s rarer for nursing schools—or other individual colleges and professional schools, for that matter—to have a diversity department of their own.
“There have been pockets, but it hasn’t been done consistently, and there hasn’t been a big vision ,” says Mary Lou de Leon Siantz, PhD, RN, FAAN, assistant dean for diversity and cultural affairs at the University of Pennsylvania School of Nursing in Philadelphia.
There’s at least one reason, however, why the idea of establishing an office dedicated to enhancing the recruitment, retention and teaching of a diverse population may soon catch on at more nursing schools. “Now more than ever, because of the changing demographics of the United States, [a greater focus on multiculturalism in nursing education and practice] is very badly needed,” notes Siantz, who is a past president of the National Association of Hispanic Nurses.
By having their own formalized diversity departments and appointing diversity directors, nursing schools are in a position not only to create a more inclusive profession but also to prepare future nurses to meet the health care needs of an increasingly multicultural patient population. But what exactly do diversity directors do? And is this an emerging career opportunity that more minority nurses should consider pursuing?
The Mission and the Vision
One of the first tasks that Lillian Stokes, PhD, RN, FAAN, took on when she took the helm of the Office of Diversity and Enrichment at Indiana University School of Nursing in Indianapolis was to help fashion a diversity mission statement. Today, she sees that message displayed on a bronze plaque each time she walks through the front entrance of the school.
“Our overall vision is to try to promote an environment that values respect and reflects a global view of diversity,” says Stokes, who is also an associate professor at Indiana and the national president of Chi Eta Phi, a sorority for minority nurses.
Clarifying the vision of a diversity department usually starts with determining what diversity means. “We define diversity here as ‘holding multiple perspectives without judgment,’” says G. Rumay Alexander, EdD, RN, director of the Office of Multicultural Affairs and associate clinical professor at the University of North Carolina-Chapel Hill School of Nursing.
Nursing school diversity directors say they want to expand the definition of diversity beyond the familiar parameters of race, ethnicity and gender. “One of the things I always talk to our first-year students about is the need to think about diversity in broader terms, not just [in terms of] ethnicity,” says Jana Lauderdale, PhD, RN, assistant dean for cultural diversity at Vanderbilt University School of Nursing in Nashville. “That’s something I kind of preach all the way through the program.”
The term can apply to any subculture or underrepresented group, she explains–for example, homeless persons, people with disabilities or people with chronic illnesses.
In Alexander’s view, achieving diversity means more than simply admitting more students from diverse backgrounds. These students need to find a supportive environment that will help them succeed.
“If you’re inviting people into an environment that for whatever reasons does not feel welcoming to them, or treats some [members] of its community in an inequitable way, then you may be bringing in many people through the door, and your numbers may be going up in terms of admissions,” she says. “But if these students are not successful in matriculating through the program and graduating, then it’s kind of like coming in the front door of a house and going out the back door.”
At Penn, Siantz says a key element of the school’s vision is that the commitment to diversity must be top-down. “That means that at the top there is recognition of the need to diversify the administration and the faculty, as well as the student body, to better promote the mission of the school,” she explains. “Diversity is the number one strategic goal of the School of Nursing. Globalization is the second.”
The Scope of the Job
A common thread in the job descriptions of nursing school diversity directors is a major focus on assisting students. Some are also involved in faculty programs and curriculum development.
At Indiana University School of Nursing, Stokes’ Office of Diversity and Enrichment is part of the Center for Academic Affairs. The enrichment part of her job title is broad in scope.
“This position calls for working with all students, not just minority students or underrepresented students,” she says. “Although the faculty and my office are committed to supporting underrepresented students as much as possible, I probably see just as many or more majority students.”
Diversity-related programs at Indiana’s nursing school include “empowerment sessions” to aid students with test taking, stress management, time management, organization and other skills; peer-led tutorial reviews of specific classroom subjects; a Diversity Forum series featuring presentations by faculty members and local and national leaders; and workshops for faculty on teaching students from diverse cultures.
Recruitment of minority and international students is another aspect of Stokes’ job, although she says it’s not her primary role. “We have a marketing and recruitment person [who is in charge of that],” she explains. “I work very closely with that office, and also with our graduate offices.”
Stokes and some of the senior nurse researchers on the faculty have established a program called Connections that targets students who might be good candidates for the PhD program in nursing. “We meet with students—it may be one student or ten—who express an interest or who I see have potential,” she says. “We take them through the admissions process [and] get them to start thinking about their research area, so we can think about a faculty member who might work with them.”
Two students–one African American and one Nigerian–who participated in Connections have since begun their doctoral studies in the School of Nursing. “They are doing very well,” Stokes reports.
She is also a founding member of the nursing school’s Minority Advisory Council, now called the Diversity and Enrichment Council. The group includes faculty, students, staff and community partners, such as practicing nurses, politicians and leaders of local organizations.
Lauderdale, who is president-elect of the Transcultural Nursing Society, says the range of her job at Vanderbilt “seems to be a moving target. Almost every day, there seems to be another layer added to it, which tells you something about the scope of the need for a position of this type.”
Lauderdale’s initial focus was on ensuring a “cultural diversity content thread” throughout the curriculum, “so that by the time students graduate, they feel comfortable working with patients from different cultures and are able to provide culturally competent care.”
Today, in its expanded role, the cultural diversity office at the School of Nursing offers an Academic Enrichment Program in which a group of students meet about once a month for brown bag lunch discussions on a wide range of topics–from critical thinking skills and time management to working with culturally diverse patients. Lauderdale also coordinates a Pre-Nursing Society for freshmen and sophomores who are considering nursing as a career.
For faculty, the nursing school’s summer institute on teaching strategies includes discussions of how to celebrate cultural diversity in the classroom. In addition, Lauderdale works closely with the faculty member who directs the cultural diversity program in the School of Medicine.
Diversity Is a Full-Time Job
When Alexander came aboard at UNC, she turned what had previously been a part-time role into a full-time focus. “Prior to my [being hired], the issues relating to diversity and inclusion were part of an assignment [given to] someone else on the faculty,” she explains. For her predecessors, this function took up a relatively small percentage of their responsibilities.
“I came into the interview with a clear understanding, because of [my] past work experience in diversity, that if it wasn’t getting the full attention of someone and it was kind of the job of ‘everybody,’ it was not going to get the traction that it needed to get,” Alexander says.
Specific diversity enhancement strategies at her school include a continuing education requirement for faculty and staff that is linked to their performance evaluations and compensation; the Kindred Spirits Award for Excellence in Multicultural Scholarship, given each year at commencement to a student who exemplifies respect for diversity; and an Ethnic Minority Visiting Scholars Program.
All of these elements, Alexander says, make her days on the job “unpredictable and lots of fun.”
At Penn, Siantz works closely with the nursing school’s Master’s Curriculum Committee and Diversity Committee. She also partners with other groups within the school and throughout the campus that are interested in promoting diversity.
For example, Siantz has partnered with the university’s medical school to develop a Leadership Education and Policy Development program to promote leadership skills among nurses and physicians of color. Supported by the university vice provost’s Office for Diversity, this program also teaches them how to use their research and clinical practice to help shape public health policies to eliminate disparities.
Another key strategy for Siantz has been to become a faculty member of minority nursing student organizations on campus, holding leadership retreats with the groups’ outgoing and incoming boards.
Challenges and Rewards
All of the nursing school diversity directors interviewed for this article admit that the work they do has its share of challenges. Yet they also find it extremely rewarding, especially when they see that their efforts to promote diversity and inclusiveness are producing measurable results and making a real difference at their institutions.
Siantz says one of the biggest challenges in diversifying the nursing profession is that nursing schools need to extend their outreach beyond the college campus.
“We need to partner with the [elementary and secondary] school systems, because despite the fact that the numbers [of people of color] are growing, they’re not going to college,” she emphasizes. “That’s something that the schools in individual communities need to wrestle with in terms of how they’re going to change that picture over time.”
Stokes sums up the main barrier multicultural students face in advancing their nursing studies with one word: “Money.” For example, she says, “I’ve been in communication [recently] with a young lady who graduated from another university here in [Indianapolis]. She has attended several of [our] Connections programs, but right now it’s [the lack of] money that’s keeping her away [from pursuing doctoral studies here].”
On the plus side, the school has been successful in obtaining a National Institutes of Health grant that provides some scholarships and stipends for qualified nursing students. About 36 nursing students at Indiana have participated in the university-wide Summer Research Opportunities Program, and several have gone on to pursue graduate studies. “I think we have had more students in the program than any other unit [of the university],” Stokes comments.
Another success story for Stokes has been seeing the nursing school’s learning environment change for the better when it comes to faculty interaction with students from diverse backgrounds. “They just have a better understanding of students who are different from them,” she says.
At UNC, one of Alexander’s proudest accomplishments has been to have the School of Nursing become a national role model for promoting and achieving diversity.
“We are called on frequently to consult with other schools about how to walk the talk of inclusion,” she says.
Is This a Career for You?
Because nursing school diversity directors represent a newly emerging specialty, there is little data available about their current employment statistics, salary levels or the career outlook for the field. However, the U.S. Bureau of Labor Statistics reports that the mean annual wage for all education administrators in colleges, universities and professional schools was $86,480 in 2006.
What kind of background and experience would be prerequisites for this career? The BLS notes that top student affairs positions usually require an EdD or PhD, along with good interpersonal, leadership and decision-making skills.
The directors interviewed for this article all have credentials that fit that profile. Alexander has an MSN from Vanderbilt University, training as a family nurse practitioner and an EdD in educational administration and supervision from Tennessee State University. She also has work experience in both hospital and corporate settings. Just prior to arriving at UNC, she was the head of her own diversity consulting business in Nashville.
Lauderdale has an MSN with a major in maternal-child health from Texas Women’s University and a PhD in transcultural nursing from the University of Utah.
Stokes has an MSN from Indiana University School of Nursing and a PhD in instructional psychology with a minor in gerontology from Indiana University-Bloomington. She says her instructional psychology background, with its focus on teaching behaviors, is an asset in her current job.
Siantz has a master’s in child psychiatric nursing and community mental health from UCLA and a PhD in human development from the University of Maryland. Before accepting her position at the University of Pennsylvania, she was an associate dean and director of the Center for Excellence in Hispanic Health at Georgetown University.
Siantz believes the successful nursing school diversity director will be someone who is a visionary leader with excellent communication skills and strong relationship-building skills. “The person who is recruited to this position must be a senior-level person who not only walks the talk but also understands, and has a vision for, how to pull it forward,” she says.