Growing Our Own
A growing number of nursing schools nationwide are taking an innovative approach to solving both the nursing shortage and the underrepresentation of minorities and men in the profession: They are partnering with local middle schools and high schools to introduce girls and boys from culturally diverse backgrounds to the benefits of nursing careers.
But these colleges and universities are doing much more than just planting seeds of interest and hoping the teenagers will consider enrolling in their nursing programs when they graduate. Instead, they are making sure this happens, by establishing programs that essentially pre-recruit these students into nursing school. In other words, they are reaching out into their communities to cultivate–and eventually harvest–a bumper crop of future nursing talent in their own backyards.
The Health Resources and Services Administration (HRSA), part of the U.S. Department of Health and Human Services, is funding a number of these projects through Nursing Workforce Diversity grants. The Catholic University of America (CUA) School of Nursing in Washington, D.C., is one of the latest schools to secure such funding. Its project, the Latino Nursing Career Opportunity Program, prepares primarily Hispanic middle and high school students to enter CUA’s nursing program and successfully complete a BSN degree.
“We submitted our proposal to HRSA because the D.C. metropolitan area, like the rest of the country, has a tremendous need for nurses, and also because the Latino population is growing every day,” explains Carmen C. Ramirez, PhD, RN, director of the Latino Nursing Career Opportunity Program. “Latinos are now the largest single ethnic group in the United States.”
The program has three objectives:
- Create a structured pre-entry nursing program primarily for Hispanic students in grades 7 to 12 attending selected schools in the District of Columbia and Montgomery County, Maryland.
- Help faculty at nursing schools in the Mid-Atlantic region build and update cultural competencies and skills in mentoring, advising and teaching multicultural students.
- Increase retention of Hispanic BSN students through a comprehensive program at CUA.
Through a pre-nursing summer camp and educational activities during the school year taught by teaching assistants who are graduate students at the CUA School of Nursing, the teenagers learn about nursing as a career, build academic and social supports and learn health promotion skills.
“I know for a fact that if we were not working with many of these students, they would not have considered nursing as a career,” Ramirez says. “Finding out about nursing as a career option and having a viable goal of pursuing a degree in nursing is not in their frame of reference. In order to survive the academic rigor of a professional nursing education, the students must begin to prepare in middle school and early high school.”
The Latino Nursing Career Opportunity Program is currently in 12 schools, with a minimum target goal of having at least five students from each school participate in the program–and those numbers have been exceeded. Workshops for middle or junior high school students introduce them to the nursing field, while the high school students get more one-on-one attention. Helping students pick out the appropriate preparatory classes for admission to a college program is just one of the many things the project’s teaching assistants do. The students also meet nurse mentors, visit hospitals and universities, prepare college applications, find scholarships and funding opportunities, attend workshops and conferences, and build their math, science, language and computer skills.
Many of these students are the first generation in their families to go to college in the U.S.–and in some cases, the first generation to have even gone to high school. “Their parents may have never experienced what it is like to apply to and attend a university,” Ramirez says. Many times, the teaching assistants simply point students to existing resources that they may not have been aware existed, such as tutoring services and classes that prepare students to take the PSAT and SAT.
Earlier this year, the pre-nursing summer camp–split into two sessions–drew a total of 40 students to CUA’s campus. The camp ran from 9 a.m. to 3:30 p.m. Monday through Friday. The students took leadership workshops, established career goals, learned study skills, worked on effective communication skills, learned some basic nursing skills and explored college and financial aid Web sites.
The program’s first faculty workshop was also a success, drawing almost 50 faculty members from five states and 25 different schools, Ramirez reports. A second workshop will be held on November 1 and two others are scheduled for 2005.
SOS: More Nurses Needed!
At historically black Howard University, also in Washington, D.C., a collaborative project between the school’s academic Division of Nursing and the Howard University Hospital Division of Nursing is likewise taking aim at developing the next generation of minority nurses through funds provided by a HRSA grant. The project–Socialization to Success in Nursing (SOS)–is a multifaceted recruitment and retention program aimed at minority and/or economically disadvantaged high school students. Its purpose is to generate interest in nursing as a career and facilitate the students’ successful navigation of the nursing school admission and matriculation processes.
The SOS program has four components: Future Nursing Clubs (FNC), Saturday Nursing Academy (SNA), the Summer Nursing Immersion Program (SNIP), and the Retention and Enhancement Program (REP), for SNIP graduates who are now attending Howard University.
SOS has established Future Nursing Clubs at four high schools in the greater D.C. metro area. Over the past two years, approximately 80 students have attended club meetings, which are held twice a month. The teens learn what it takes to become a nurse and explore the career opportunities, salary potential, mobility and flexibility the profession offers. Other FNC activities include a basic assessment class, guest lectures by nurses and a field trip, usually to Howard University Hospital, an acute care medical facility.
The Saturday Nursing Academy, which meets once a month, attracts about 20 participants drawn from the FNCs and other area high schools. Building from the FNC activities, the academy’s focus is on getting ready to take the SAT and preparing college applications. It also includes more in-depth nursing career exploration as well as field trips and sessions designed to build the students’ cultural awareness. For example, the teens are invited to attend the Division of Nursing’s annual Marie J. Bourgeois Lectureship in Cultural Diversity, held each fall semester.
The Summer Nursing Immersion Program is a five-week residential program at Howard University where the focus is on becoming socialized into academic life and experiencing firsthand the wide variety of career options that nursing offers. The most critical part of the program is its mentoring component. Each student shadows an RN mentor at Howard University Hospital three hours a day, two days a week. They rotate through various units of the hospital, including labor and delivery, pediatrics, OR, ER, psychiatric, the dialysis unit and the outpatient clinics. They also visit a long-term care facility and a sub-acute-care children’s hospital and participate in the District of Columbia Area Health Education Center Annual Teen Summit to explore other educational and career possibilities.
SNIP is structured to provide the high school students with academic enhancement and exposure to scientific concepts in nursing. “We want them to think about how they can apply the scientific process to nursing and to problem solving,” says SOS Project Director Carolyn J. Harris, RN, MSN, JD, FNP. “This is to stress the science of nursing, something we value greatly at Howard. [We want to] get them thinking about nursing research and how to look at conditions or patients more critically.”
Workshops on cultural awareness with follow-up focus groups are also key parts of the program. “It gives the students a heightened sense of who they are and who their potential [patients] may be and how [culture] factors into [a person’s response] to health and illness,” Harris explains.
SNIP is a very competitive program. Only 20 students–either high school seniors or recent graduates–are accepted annually. Those selected receive a $600 stipend during their residency at Howard. While SNIP gives preference to FNC students, it has accepted students from a number of states outside the District of Columbia.
The final component of SOS is the Retention and Enhancement Program, designed for SNIP graduates who elect to attend Howard University to study nursing. REP offers the students a variety of resources to assist them in successfully completing their BSN studies. These include tutoring, mentoring, academic and personal counseling, and cultural competence development, plus a $250 monthly stipend to help defray the expenses of being a student.
Although SOS is open to students of both sexes, all of the participants so far have been female. Harris hopes to change that and has offered a workshop called “We Save Lives: Men in Health Care.”
Harris is passionate about getting teens interested in nursing. “Starting with the Future Nurses Clubs, I think a lot of these students would not have pursued their interest in nursing [if it wasn’t for SOS],” she says. “They either don’t get the information or don’t get the reinforcement they need to pursue registered nursing as a career.”
Nancy T. Lee, MARS, MA, RNC, assistant director of the SOS program, sums it up best when she adds, “Minorities are grossly underrepresented in nursing. In order to make a difference [in changing this], we need to draw on support from the entire village, including the academic and hospital communities.”
Giving Students a Head Start
Valencia Community College in Orlando, Fla., which offers an associate’s degree program in nursing, is still another school that has a HRSA-funded project designed to give local minority high school students a head start in pursuing nursing careers. Valencia’s initiative–called Pathways Into Nursing (PIN)–has an added bonus for teens who successfully complete it: automatic entrance into the college’s nursing school.
The program primarily targets Hispanic and other minority students in grades 10 through 12. PIN works exclusively with three Central Florida high schools (two in Osceola County and one in Orange County).
The students must meet certain criteria to gain admission into PIN, which allows them to take college-level pre-nursing courses while still in high school. Currently, 111 teens are enrolled in the program. Over 53% are Hispanic, while the other students are African American, Asian and Caucasian. “They are very bright young people who want to become nurses to make a difference in people’s lives, while offering one possible solution to the nursing shortage,” says Linda Speranza, PhD, ARNP-C, director of the project.
Many of these young people are the first ones in their family to go to college, Speranza adds. “Their parents don’t necessarily know how to career-counsel them into nursing, so we work with the parents as well,” she says. “It’s a win-win situation.”
PIN partners closely with each high school’s health science teacher as well as its principal, guidance counselors and other administrators. In addition, the HRSA grant has enabled the project to hire three part-time educators who work with the students 20 hours a week. Two of these educators are nurses; the third is a physician from Venezuela who is going back to school to become an RN.
Diane Reed, MBA, RN, PhD(c), the project’s retention specialist, manages the daily high school PIN program as well as the educators and a staff assistant. Reed, who is African American, helps the educators custom design each student’s workload to make sure they are taking the appropriate high school classes to get into Valencia’s nursing program. Many of the students take dual enrollment classes, which counts toward both high school and college completion credit.
This approach allows the teens to take some of the prerequisite classes they need to work toward their associate of science or associate of arts degrees. “Then they can shorten the time it takes to get into nursing school,” Speranza says. “They have a 19-month window to finish those prerequisite courses and when they do, they get automatic entrance into Valencia’s nursing program.”
PIN also includes a month-long summer dual enrollment hospital externship enrichment program, which allows the students to see first-hand the career opportunities available to nurses.
When PIN participants graduate from high school and enroll at Valencia Community College, Reed meets with the students and, when necessary, helps them find the appropriate resources they need to succeed in their nursing studies. Some of these students are already working in the health care field, having become certified nursing assistants through the interest PIN has sparked.
In the first year of the grant, Valencia had 100% retention of the Hispanic students. This past year, however, a few students changed career plans to become doctors and a couple joined the armed forces.
Once PIN students bridge to Valencia, they get help in designing goals for future career plans. “We also encourage them to go on to get their baccalaureate degree after they finish their ASN or AA degrees,” Speranza says. The college has an articulation agreement with the University of Central Florida, which has RN-to-BSN and RN-to-MSN program options.
Speranza hopes that besides helping to reduce the nursing shortage, these future nurses will make a difference in providing culturally competent health care to minority populations. “Many of these students are bilingual and some are trilingual,” she notes. “This program provides a way for them to bring health care to individuals in their own communities.”
There is definitely a need for a more culturally diverse nursing workforce, agrees Reed. “From a clinical perspective, the best [care] can come from those nurses who can relate to [ethnically diverse] patients and can speak their language,” she says. “The innovative design of the Pathways Into Nursing program helps everyone, not just the patients but the nurses in the workplace as well.”
Meeting the Community’s Needs
At Texas A&M International University (TAMIU)’s Canseco School of Nursing in Laredo, Texas, the HRSA-funded high school pre-recruitment program is directed by Carmen Bruni, MSN, CS, CNA-C, RN. Since Laredo, which is close to the Mexican border, is approximately 99% Hispanic, the area has many Hispanic nurses but has been hard hit by the nursing shortage nonetheless. Part of the problem, says Bruni, is that many of the community’s nurses choose to move to larger cities like San Antonio and Austin.
The TAMIU project, which recruits students from high schools in surrounding Webb County, is a relatively new program. It began in late 2003 and is still growing. Eleven rural schools from seven other counties in a 100-miles radius of the university will be added in the future.
Bruni says part of the program’s purpose is to increase enrollment at the Canseco School of Nursing “so we can meet the need in the community.” Laredo has two acute care hospitals, she explains. “The demand for nurses is very great and the turnover is significant. We hope more nurses will stay in the community.”
Working through guidance counselors at the high schools, Bruni met with students and parents to give them an orientation to nursing. “We gave a presentation on how versatile the nursing profession is, the different [work settings], roles and functions,” she reports. “We talked to them specifically about our [nursing school] and tried to encourage the students to come to a baccalaureate program.”
This year the project included a weekend overnight summer camp for students in grades 9, 10 and 11. “We had seven students who came [to TAMIU] for a weekend of exposure to nursing,” she says. “They were certified in first aid and CPR by the American Heart Association. We augmented that program to do more bandaging and glucose monitoring and we showed them how to identify heat stroke vs. heat exhaustion.”
The teens also visited two hospitals and a city Department of Health. “We wanted to show them locations where nurses work,” Bruni comments. “They [were able to get] an overview of the various functions nurses perform. Some of the students were surprised at the things that nurses do.” Computer documentation is one example. “The students learned you can go into [specialties like nursing informatics], which would [involve] a concentration in the new technology of computers.”
Bruni plans to expand the program by using high school health, fitness and science teachers to reach out to students. “I am going to add other avenues to go into the classroom and have direct contact with the students,” she emphasizes. “We want to start at the lower [grade] levels and encourage students to stay in the science classes as well as reading, so that they will not have difficulty with entrance exams [into the university].”
The Canseco School of Nursing has a retention program that identifies at-risk students and offers them counseling. “We want to expand that to the high schools,” says Bruni, “and at the same time motivate the students to consider nursing in the preliminary year or year and a half that they take prerequisite courses at the university.”
High school seniors who have finished their requirements for graduation will be counseled to take at least one entrance class at the university, she adds. “That will get them into the mode of continuing their education.”