Going the Distance

As nursing schools across the country continue to work aggressively to increase the diversity of their student populations, minority nurses remain less represented in doctoral degree programs than at the bachelor’s and master’s levels. But progress has been made over the last decade, and today universities are continuing to look at ways to not only recruit more nurses of color into doctoral programs but also ensure that they graduate.

According to data from the American Association of Colleges of Nursing (AACN), minority doctoral enrollments are up across the board among all ethnicities. Of the 3,362 nurses enrolled in research-focused PhD programs in 2006, for instance, 670–almost 20%–were nurses of color. That’s almost double the number from just five years earlier, when minority enrollment in those programs totaled 359 (about 14%). Ten years ago, minorities comprised just 11.6% of research-focused doctoral nursing students.

Graduation rates are up, too, AACN reports. Seventy-four minority nurses graduated from doctoral programs in 2006, comprising about 17% of all doctoral nursing graduates, compared with only 47 minority graduates (about 10% of the total) five years ago.

But many nurse educators believe universities need to do more to increase doctoral program enrollment and graduation rates among all students in general, and to continue to increase the representation of minorities.

“I think we still have a ways to go in getting more nurses interested in pursuing doctoral education,” says May Wykle, PhD, RN, FAAN, FGSA, dean of Case Western Reserve University’s Frances Payne Bolton School of Nursing in Cleveland, Ohio.

The need for more doctorally prepared nurses is critical for addressing the nursing faculty shortage. “It’s a big problem,” says Marjorie Isenberg, DNSc, RN, FAAN, professor and dean of the University of Arizona College of Nursing in Tucson. “The average age of a faculty professor is 55, so we have a large cohort of faculty who are preparing to retire.”

This has implications not just for nursing schools but for health care as a whole. If universities can’t recruit enough nursing faculty, they can’t expand their enrollments and programs to meet the nation’s need for more nurses. And nursing schools especially need more minority faculty members to foster a diverse student body.

More Options, Closer Access

Of course, doctoral degrees enable nurses to do more than just teach. More doctorally prepared minority nurses are also needed to conduct research and work in the field, especially in areas relating to the elimination of racial and ethnic health disparities. Wykle says nursing schools need to make sure that potential minority doctoral students know about other, newer options besides the traditional PhD degree, such as clinical doctoral programs for nurse practitioners (Doctor of Nursing Practice degrees).

The ability to work in the community with a doctorate is an important factor that is leading more American Indian and Alaska Native nurses to pursue terminal degrees. One reason Native nurses have been particularly underrepresented in doctoral programs is that many wanted to work in their communities and help their people in more tangible ways than they could through a faculty or research position at a university, says Sue Henly, PhD, RN, professor and project director of the American Indian/Alaska Native MS to PhD Nursing Science Bridge program at the University of Minnesota School of Nursing in Minneapolis.

“When pursuing a doctorate, Native students are doing something that’s less familiar to their families and communities,” she explains. “There’s less certainty about how it will pay off and fit in with their lives. What will come afterwards? They’re really trailblazers.”

Universities are also working on making young nursing students more aware of doctoral education opportunities. At the University of Arizona College of Nursing, faculty and diversity directors identify younger students who have an interest in research and teaching and then encourage them to move toward pursuing advanced degrees sooner rather than later. The university is one of a growing number of nursing schools that now offer BSN-to-doctoral programs, which are designed to put students on the path to the doctorate earlier in their careers than ever before.

“We have this tradition in nursing in which students earn a degree and go out and practice, and then they get another degree and practice again, and then they come back and get their doctoral degree,” Isenberg explains.

But by that time, nurses are in their 40s. They’re often married with children and they may be caring for aging parents. “Then life becomes very complicated,” Isenberg says. “We’re not talking about a 20-year-old who can lay all those things aside and concentrate on [getting a PhD].”

Schools that hope to recruit more minority doctoral students also need to look at making their programs more convenient for students to get to. Picking up and moving one’s family to another city or state to pursue a rigorous course of study is difficult at best. It’s particularly challenging for students from Hispanic, American Indian and other cultures, where the family context is so important, Isenberg says.

To address this issue, the University of Arizona College of Nursing launched a full-time online doctoral program four years ago. The distance-learning program has been well received by students, because they no longer have to leave their families behind to go to class.

“We noticed that some of our students were driving 200 or more miles to go to school,” Isenberg says.

Students and faculty meet face-to-face before the semester begins, and everyone has a camera on their computer to make communicating online more personal. The students get to know each other well: Each cohort has about 10 people, who move through the doctoral program together. “They become a very tight-knit group,” Isenberg adds.

Meeting Financial Needs

Because doctoral education is expensive, nursing schools also must make sure their programs are financially accessible to students of all backgrounds. Financial aid, including stipends as well as assistance with tuition, is critical for doctoral students, Wykle says. “If students don’t have enough scholarships, and they have to work [while trying to pursue their degree], that can be deadly.”

In recent years, the federal government has created more funding opportunities to assist nurses in obtaining advanced degrees. For instance, the Health Resources and Services Administration (HRSA)’s Nurse Faculty Loan Program (NFLP), created by Congress to address the nursing shortage, provides loans to nursing students enrolled full time in master’s or doctoral programs. If the student becomes a full-time nursing faculty member after graduating, the program forgives up to 85% of the loan.

The Graduate Assistance in Areas of National Need (GAANN) program, offered through the U.S. Department of Education, provides grants to academic institutions that enable the schools to offer fellowships for doctoral students in fields considered areas of national need, such as nursing. The Yale University School of Nursing in New Haven, Conn., is among the schools where GAANN fellowships are available. The school launched a new PhD program last fall to replace its Doctor of Nursing Science (DNSc) degree and received the three-year federal grant to support the recruitment and training of doctoral students to counter the nursing faculty shortage.

The school uses the grant funding to provide tuition and a stipend for four students based on financial need. In the first two years of the program, students work closely with faculty to gain graduate research experience. In the third or fourth years, they are mentored as they get experience teaching master’s-level classes. The students also receive support through the university’s Center for Graduate Teaching, which helps them with such practical issues as how to handle difficult students and how to write exams.

“When people graduate from here, they should be pretty set to go into an academic position,” says Marjorie Funk, PhD, RN, FAAN, FAHA, director of the PhD program.

Attention Helps Retention

Having a diverse and culturally sensitive faculty is also an important factor in the recruitment and retention of minority doctoral students. And faculty members must be trained in how to mentor students. “The faculty needs to be able to understand what you do to advise students,” Wykle says. “It goes beyond establishing office hours and returning phone calls.”

Individualized attention from faculty is a key to student retention in the doctoral program at Hampton University School of Nursing in Hampton, Va., the first historically black nursing school to establish a PhD program. Students have access to faculty members’ home phone numbers as well as work numbers and email, and the cohorts are kept fairly small–about 10 people–so everyone gets to know each other well. Classes are offered online and students are encouraged to post their own Web pages on the program’s network. Telephone conferences and computer cameras allow students and faculty to talk to and see one another. And an annual three-day to one-week residency brings faculty and students together for education and socialization.

Far more students apply than the PhD program can accommodate, says Pamela Hammond, PhD, RN, FAAN, professor and director of the program. Ten students so far have graduated, and five more are expected to graduate in the next year. The program receives numerous calls from employers interested in hiring its graduates for faculty and research positions, Hammond adds. “People are looking at our students because they know the program is rigorous and that our students do very well.”

Unfortunately, says Wykle, attitudes still prevail in some parts of the academic world that expanding minority enrollment in doctoral programs will mean letting standards slip. Not only is this completely untrue, she argues, but even students who are accepted on a provisional basis can succeed if they receive assessment of their study and writing skills, a welcoming attitude and enough support so that they have the tools and resources they need. “Schools have to go the extra mile to offer support services,” she emphasizes.

Bridging the Distance

Still another initiative that is not only boosting the number of minority nurses enrolled in doctoral programs but also ensuring that these students receive the cultural, academic and financial support they need to cross the finish line is Bridges to the Doctoral Degree, sponsored by the National Institutes of Health.

Bridges programs, such as the American Indian/Alaska Native MS to PhD Nursing Science Bridge program at the University of Minnesota, pair one or more universities that offer Master of Science as their highest degree with a university that has a doctoral program. The partner schools work together to help minority students successfully bridge the transition between the two programs. Other nursing schools whose doctoral programs are participating in Bridges to the Doctoral Degree include the University of Illinois at Chicago College of Nursing and Rutgers, The State University of New Jersey College of Nursing.

In the last six years, 17 Native nurses have been set on the path toward PhDs through the bridge program at the University of Minnesota, whose partner schools are the University of North Dakota and the University of Oklahoma. That’s a significant number considering that there were only a dozen American Indian/Alaska Native nurses in the country with a PhD when the program started. Of the 17, five have attained their master’s degrees, three have transitioned to the PhD program and one has advanced to candidacy.

While earning their master’s degrees, students in the bridge program receive financial support through paid research assistantships. This also helps them gain hands-on experience while serving as a valuable resource to faculty members. Students learn library research skills, data management and how to compile and critique research literature.

Once they enter the doctoral program at the University of Minnesota, the students receive financial assistance in the form of a research or teaching assistantship for the first year, which includes tuition. They are then encouraged and supported to apply for competitive fellowships through the university.

Recently, the University of North Dakota and the University of Oklahoma both decided to start their own doctoral programs, Henly reports. As a result, the bridge program at the University of Minnesota will end in July 2007. But the addition of the two new programs at the former partner schools will continue to increase Native nurses’ access to doctoral education. And with its history of providing culturally sensitive support, the American Indian/Alaska Native MS to PhD Nursing Science Bridge program leaves a legacy that serves as a successful model.

The program relied on American Indian academic consultants, who guided the faculty and served as role models for students. It also worked closely with Native elders, medicine people and spiritual guides to provide a welcoming environment. A highlight of the program was a project retreat every two years, in which faculty and students gathered with tribal elders and spiritual leaders to learn about and experience Indian culture.

“The program has been a bridge from good intentions to action in supporting Indian students in doctoral education,” Henly says.
 

Ever Upward: Minority Enrollment and Graduation Rates Continue to Rise
Enrollment in Nursing Doctoral Programs, 2006
Research-Focused Programs:
Ethnicity	No. of students	% of total
American Indian/Alaska Native	28	0.8
Asian/Native Hawaiian/Pacific Islander	172	5.1
Black/African American	357	10.6
Hispanic/Latino	113	3.4
Caucasian	2,692	80.1
Total minority:	670	19.9%
Doctor of Nursing Practice:
Ethnicity	No. of students	% of total
American Indian/Alaska Native	5	0.7
Asian/Native Hawaiian/Pacific Islander	17	2.2
Black/African American	56	7.3
Hispanic/Latino	21	2.8
Caucasian	664	87
Total minority:	99	13%
Graduations in Nursing Doctoral Programs, 2006
Research-Focused Programs:
Ethnicity	No. of students	% of total
American Indian/Alaska Native
Asian/Native Hawaiian/Pacific Islander	19	5.3
Black/African American	34	9.5
Hispanic/Latino	9	2.5
Caucasian	297	82.7
Total minority:	62	17.3%
Doctor of Nursing Practice:
Ethnicity	No. of students	% of total
American Indian/Alaska Native
Asian/Native Hawaiian/Pacific Islander	2	2.8
Black/African American	6	8.5
Hispanic/Latino	4	5.6
Caucasian	59	83.1
Total minority:	12	16.9%
Source: American Association of Colleges of Nursing