Like many other nursing specialties, nurse anesthesia education programs face the challenge of recruiting, retaining and graduating a sufficient number of qualified students to meet the demands of the health care workforce. A significant aspect of this challenge is the struggle to achieve a racially and culturally diverse student mix that represents the patient population.
The assertion that racial and ethnic minorities are underrepresented in the field of nurse anesthesia does not require sophisticated statistical analysis. One need only visit the meeting rooms and exhibit halls of a professional nurse anesthesia conference to arrive at this conclusion. A recent survey by Dr. Prudentia Worth, director of the Nurse Anesthesia Program at Wayne State University, reveals that only 16% of students in such programs are non-Caucasian.
The Nurse Anesthesia Program at Georgetown University has begun to address this challenge by developing a project designed to prepare more minority nursing students for nurse anesthetist careers. Funded by a grant from the Health Resources & Services Administration’s Bureau of Health Professions, Division of Nursing, the project’s approach is multifaceted, encompassing student recruitment, admissions and, above all, successful completion of the program.
The success of this diversity initiative serves to benefit not only students but also communities that are at the greatest risk of suffering from a shortage of nurse anesthetist professionals. In creating and implementing this project, our goal was to produce a diverse group of graduates with the competencies to deliver cost-effective, culturally appropriate, quality care to all patients.
The project was officially launched in July 2001. As the result of our initial efforts, the Nurse Anesthesia Program’s class of 2003 has more minority students enrolled than any previous class.
Beginning the Journey. . .
The academic journey toward a career as a practicing nurse anesthetist is not an easy one. After earning a bachelor’s degree and licensure as an RN, the nurse must acquire experience in an acute care setting. From there, the formal application and enrollment process into a nurse anesthesia program can begin.
The length of these programs ranges from two to three years, with 27-28 months being the average. The student faces a rigorous course of study, including classes in the basic sciences (e.g., anatomy, physiology, pathophysiology, pharmacology), professional aspects of nurse anesthesia and advanced principles of nurse anesthesia practice. Upon completion of the program and conferral of a master’s degree, the graduate may sit for the certification exam. It is only after all of these steps are successfully completed that a nurse becomes a Certified Registered Nurse Anesthetist (CRNA).
The Georgetown project’s first step in bringing a more diverse group of nurses into this journey was to initiate strategies for recruiting qualified minority RNs into the Nurse Anesthesia Program. This ongoing effort currently includes outreach to members of student associations, state and regional nursing associations, nurses practicing in local critical care units, and minority nurses’ professional organizations, such as the National Association of Hispanic Nurses.
Another key focus of this outreach effort is personal visits by faculty, alumni and admissions recruiters to hospitals that have a high percentage of nurses of color. Students in our program spend 15-16 months in clinical rotations in the operating room, providing anesthesia under the supervision of a licensed anesthetist. Because of a growing need for more nurse anesthetists in the D.C. area, enrollment in Georgetown’s program has risen 400% in the past five years.
This has required an increase in the number of hospital sites students can use to obtain their clinical experience. To dovetail this need with the goals of our diversity initiative, we have sought out new clinical sites that not only provide contact with minority nurses who could be potential applicants to the program but also give students exposure to a more diverse patient population.
Applicant selection is important to the success of a nurse anesthetist education program, in order to minimize the student attrition rate without compromising the professional expertise of the graduates. For this project, we developed a selection tool based on such criteria as previous nursing education, GPA (undergraduate and graduate), GRE scores, number of years of nursing and critical care experience, three references and a personal statement. The process also includes a personal interview with faculty.
The admissions committee then ranks candidates based on their overall presentation, including academic, clinical and personal accomplishments. In addition, the faculty identifies candidates who have potential but may not meet all requirements or have deficiencies in certain areas. For these applicants, the faculty recommends specific actions, such as additional course work or clinical experience, to increase the candidate’s chance of being accepted into the program and completing it successfully.
In 2001, Georgetown faculty and students conducted a pilot study that describes the benefits of providing associate degree nursing students with information about nurse anesthesia as a career path. As a result of this study, our diversity project also focuses on establishing partnerships with local associate degree programs. This provides minority graduates of these programs with information about the field of nurse anesthesia and the opportunity to pursue an advanced degree. Georgetown offers a number of bridge programs for associate degree students, including RN-to-MSN and a second-degree program.
. . .and Finishing It
The philosophy of Georgetown’s Nurse Anesthesia Program is that every effort must be made to ensure that the students who receive their degrees on graduation day are the same students who sat in orientation on the first day of the program. This level of commitment to student retention requires a labor-intensive strategy of evaluation and advisement throughout the course of study.
Program faculty conduct individual evaluations with students at least once each semester. Students who need to improve their performance receive assistance in the form of advising, tutoring and mentoring. In the program’s clinical phase, mentoring is provided by practicing CRNAs. A more formal peer mentoring program for incoming students is also under development. When indicated, faculty provide individualized remediation programs to help students address specific areas of weakness.
A concern of all students is the ability to fund their education, and this is even more critical if the students are economically disadvantaged. The project at Georgetown is addressing this issue by seeking means to increase financial assistance sources for minority students. These sources include future employers who are willing to provide tuition assistance, corporate funding, support within the nursing school and the university, government-sponsored minority scholarships, program traineeships and alumni-sponsored scholarships.
A major initiative to recruit more minority students also requires appropriate resources in terms of faculty and staffing. We have addressed this by increasing the number of full-time faculty, hiring a full-time administrative assistant and using adjunct faculty and teaching assistants to provide supplemental teaching and administrative support.
Another of the project’s goals is to provide role models for the students by increasing the number of minority faculty in the program. Our diversity recruitment efforts at the faculty level include both short- and long-term solutions: recruiting from areas where minority faculty work and encouraging new minority graduates and junior CRNAs to pursue teaching careers.
Although this project is still in its infancy, the initial results are encouraging. At open houses for the Nurse Anesthesia Program this year, 38% of the attendees were nurses of color. And while it is difficult to accurately measure changes in the racial and ethnic makeup of new applicants and enrollees, because 25% of these nurses chose to not specify their race or ethnicity, we have seen increased minority representation in both of these areas between 2001 and 2002.
Other quantitative and qualitative results we will evaluate on an ongoing basis to monitor the project’s success include student feedback, review of the selection tool and of admissions committee comments, enrollment of minority students whose initial nursing degrees were at the associate level and employer participation in tuition assistance programs.
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