Historically Black Nursing Schools: Yesterday and Today

Today, 24 historically black colleges and universities (HBCUs) offer baccalaureate-level nursing programs. During the first half of the 20th century—and in some cases, even earlier—HBCU nursing schools provided a gateway into the profession for generations of African Americans nurses who had no other educational options. But when the Supreme Court struck down racial segregation in its Brown v. Board of Education decision in 1954, some people predicted that HBCUs would fade away.

After all, the nation’s 104 official HBCUs were founded because African Americans were not allowed entry into white-run colleges and universities. But when the doors to white institutions were thrown open and integration became the law of the land, some people asked: Why would black college students still want to attend historically black schools when they now have the freedom to enroll in majority schools? Are HBCUs even necessary anymore?

The answer, more than a half century later, is that HBCUs have endured, continuing their historic legacy of providing an educational backbone for African Americans. And they have also evolved. Today, HBCU nursing programs are expanding on that legacy by reaching out to new sources of prospective students, updating their teaching methods to meet the needs of a new generation of learners, establishing advanced degree programs and modernizing their campus facilities.

“There is a resurgence going on at historically black universities,” says Bertha Davis, PhD, RN, FAAN, a professor and former dean at Hampton University School of Nursing in Hampton, Va., which was founded in 1891. “Black students can come here to socialize and to learn.”

Building for the Future

Over the years, historically black nursing schools have weathered many challenges, from small endowments to wars, recessions and depressions, and even devastating hurricanes. In 2005, Hurricane Katrina caused more than $400 million in damages to the campus of Dillard University in New Orleans. For the next year, classes in the university’s Division of Nursing— which was founded in 1889, making it the nation’s oldest continuously operating black nursing school—had to be held in temporary off-campus locations, including a downtown hotel.

Betty N. Adams, PhD, RN, dean, Prairie View A&M University College of NursingBetty N. Adams, PhD, RN, dean, Prairie View A&M University College of Nursing

After two years of rebuilding, Dillard University moved back to campus and broke ground on a new Science and Professional Schools Building in November 2007. The new structure, which will open in 2010, will house a reinvigorated Division of Nursing that also boasts the country’s oldest historically black BSN program (established in 1940). When the new building opens, the number of nursing laboratories at Dillard will increase from one to six, including a high-tech simulation lab.

“The commitment of our faculty and staff produces graduates who distinguish themselves by generating the knowledge to advance the profession,” says the nursing school’s dean, Betty P. Dennis, DrPH, RN.

Other historically black nursing programs are also building new foundations. Prairie View A&M University College of Nursing in Houston, Texas, which was founded in 1918 and was the first nursing school west of the Mississippi to admit black students, opened a new 12-story, $20 million building in 2006, combining classrooms and skills labs with numerous nursing-related tenants.

“We’re doing our part to address the nation’s critical nursing shortage while offering state-of-the art facilities and curricula,” says dean Betty N. Adams, PhD, RN.

Tuskegee University nursing students practice hands-on patient care skills.Tuskegee University nursing students practice hands-on patient care skills.

Meanwhile, North Carolina Central University (NCCU) in Durham, N.C., has allocated $24.5 million in state funds for a new building for its Department of Nursing—a relatively new HBCU nursing program, considering that it was founded in 1948. Groundbreaking is planned for 2011, with an opening date scheduled for 2015.

“It’s going to be a wonderful building,” says Lorna Harris, PhD, RN, FAAN, chair of the department. “We will have enough room, which is an issue now [in the current building].” The university’s leadership has also authorized the nursing school to increase enrollment from 125 students to more than 250 when the building is completed, and the department has plans to introduce a graduate program.

The state of North Carolina is providing funds for expanding NCCU’s nursing program to help alleviate the current severe shortage of African American nurses, Harris explains. “Of the more than 2.6 million nurses in the United States, approximately 5% are African American,” she says. “But 85% of NCCU’s nursing students are minority candidates.” A 2004 study published in the North Carolina Medical Journal found that 65% of black RN graduates in North Carolina come from HBCUs, including NCCU.

Keeping Up with Changing Times

Historically black nursing schools aren’t just expanding their physical facilities. They’re also expanding and revamping their academic programs, introducing new teaching technology and opening pathways to advanced degrees.

Prairie View A&M’s nursing school upgraded its technology in 2003, introducing patient simulators (computerized mannequins that respond to students’ care). For example, students can learn to master the skill of starting IVs on the mannequin before doing so with real patients.

Howard University Division of Nursing in Washington, D.C., is rewriting its curriculum to bring it into the 21st century. “Today there is a different generation of students who need a different set of teaching strategies,” says associate dean and professor Mary H. Hill, DSN, RN. She is also pushing for more use of technology in nursing education. “We need to put some fun into learning,” Hill explains.

She adds that the nursing school is currently getting help from Drexel University in Philadelphia, a pioneer in educational technology, to introduce high-tech approaches like the use of handheld devices and patient simulators (such as SimBaby, a mannequin that helps students learn to provide emergency care to infants).

As nursing becomes increasingly complex and demanding, some HBCU nursing schools have expanded their traditional BSN focus by adding graduate degree programs designed to increase the supply of black nursing researchers, educators and advanced practice clinicians. Hampton was the first HBCU nursing school to introduce a master’s degree program (in 1976) and the first to start a PhD program (in 1999), according to The Path We Tread: Blacks in Nursing Worldwide, 1854-1994, Third Edition, by the late M. Elizabeth Carnegie, DPA, RN, FAAN. Today, about a dozen historically black nursing schools offer master’s programs and two offer PhDs.

Before Hampton’s school of nursing started its doctoral program, “we were graduating people from the master’s program and they all went off somewhere else to get their PhD,” recalls dean Pamela Hammond, PhD, RN, FAAN. African Americans are underrepresented among PhD-prepared nurses, she adds, “and we wanted to do something about it.”

Southern University A&M College, an HBCU in Baton Rouge, La., also has a PhD nursing program, and Prairie View A&M is planning to start one. To qualify for PhD status under the state university system, the school has to show that the program would meet a need and that the school has the finances and qualified faculty to teach it, Adams says.

Howard’s nursing school offers a master’s degree for family nurse practitioners and is now planning a master’s degree for nurse educators to help meet the great need for more African American nursing faculty, says Hill. Although the school does not have a PhD program, it champions research, an area where HBCU nursing schools have been at a disadvantage. Each year, the Division of Nursing hosts the annual M. Elizabeth Carnegie Research Conference in honor of the renowned nursing educator, researcher and historian, who passed away in 2008 at age 91.

The school has also recently completed a multiyear partnership with Yale University School of Nursing that gave Howard nursing students and faculty the opportunity to study with Yale’s intensely research-oriented faculty. Some Howard nursing students who participated in this program have gone on to pursue research careers, Hill reports.

Reaching Out to New Students

Continuing their long tradition of increasing the number of African American nurses entering the U.S. health care system, today’s HBCU nursing schools are working hard to cultivate the next generation of potential students. For example, they are reaching out to girls and boys in local elementary and high schools, providing them with information about nursing careers and helping prepare them to meet nursing school admissions requirements.

Tuskegee University nursing students practice hands-on patient care skills.Tuskegee University nursing students practice hands-on patient care skills.

NCCU is collaborating with Durham Public Schools on a university- wide project called the Early College High School Program. This innovative fast-track program identifies promising high school students, assists them in preparing for college and lets them complete their bachelor’s degree in just two years. Nursing student Shana Blount was part of the first cohort of the accelerated program, entering the university last fall as a junior.

“I would never have had these experiences if not for this program,” she says. “My mom didn’t know how we could afford four years of college, but I am two years ahead now.” After she completes her BSN program, Blount plans to get a master’s degree and become a pediatric nurse practitioner.

Tuskegee University School of Nursing in Tuskegee, Ala., one of the oldest HBCU nursing schools in continuous operation, is using a similar approach. The school’s Nursing Workforce Diversity Project has been working with high schools and junior colleges to identify potential BSN students. In 2008, the program received a $1.2 million federal grant to strengthen recruitment, retention, pre-entry and faculty development. The school will also conduct “Nursing as a Career” presentations at Stillman College and Alabama State University, two Alabama HBCUs that do not have nursing schools.

“This grant will help us identify students for the nursing program and graduate competent nurses,” says Doris S. Holeman, PhD, RN, associate dean and head of the nursing program at Tuskegee.

Howard University has been offering a six-week summer enrichment program for high school students who have a strong interest in the health professions. Participants receive instruction in science, math, research, writing and college-preparation skills.

“Too many students were coming into the university with deficits in math and science, which are critical [prerequisites] for nursing,” Hill explains.

This emphasis on preparing students to succeed is important, because many students in HBCU nursing schools come from low-income families that have no college graduates. In the Howard nursing program, for example, 80% of enrollees are firstgeneration college students.

According to a report by the Institute for Higher Education Policy, first-generation college students of any race are more likely to have some academic deficits and to drop out without completing their degrees. But many historically black nursing schools have found that offering tutoring, mentoring and other academic support services can help increase these students’ chances of beating the odds.

Many of these students end up excelling at nursing, says Hammond. “Promising students don’t necessarily have the best grades or SAT scores,” she points out. Or as Tuskegee’s Holeman puts it, these students are “diamonds in the rough.”

Meeting Financial Challenges

For many students at historically black nursing schools, financial assistance is even more urgently needed than academic assistance. And with the country now in the grip of a severe recession, both HBCU students and the schools themselves are feeling the pinch.

Doris S. Holeman, PhD, RN, associate dean, Tuskegee University School of NursingDoris S. Holeman, PhD, RN, associate dean, Tuskegee University School of Nursing

An Associated Press study conducted earlier this year found that six out of ten HBCU students have federal Pell grants, which are awarded mostly to students whose family incomes are less than $30,000, or $8,000 above the poverty line for a family of four. While these grants help defray the cost of tuition, many HBCU students still have difficulty covering their living expenses. As a result, they have to work one or more jobs, taking valuable time away from their studies.

HBCUs’ relatively small endowments and high proportion of disadvantaged students mean that it is harder for them to weather the recession than wealthier schools. Howard’s Division of Nursing is bracing for lower enrollments for the 2009-2010 academic year, Hill says. “We don’t have the final numbers yet, but it’s looking like we’ll see a drop in enrollment,” she reports.

Hammond says Hampton’s nursing school has managed to avoid cutting faculty, but “we won’t know the full [impact] of the recession until students arrive this fall.”

Holeman at Tuskegee notes that it is not yet clear how much funding HBCUs will receive from the Obama administration. The president’s education budget, released in May, didn’t include an extra $85 million that HBCUs have been receiving annually for the past two years. But Obama did raise other direct federal support to the schools from $238 million to $250 million and he increased the maximum Pell Grant by $200, to $5,550. Meanwhile, the federal stimulus plan includes more than $800 million for infrastructure projects on HBCU campuses and $500 million over two years for improvements in technology.

The Changing Face of HBCUs

Historically black colleges and universities, as defined by federal law, are institutions founded before 1964 whose principal mission is to educate African Americans. This status makes them eligible for direct federal aid that amounted to $323 million last year. But while most HBCUs today remain majority black, they are not shutting their doors to students of other races. In fact, in keeping with the country’s growing multiculturalism, they are embracing diversity and inclusion. At some HBCUs, the percentage of students who are not black is as high as 15%.

Pamela Hammond, PhD, RN, FAAN, dean, Hampton University School of NursingPamela Hammond, PhD, RN, FAAN, dean, Hampton University School of Nursing

Another factor behind the changing demographics is that most African American students attending college in this country are enrolled in predominantly white institutions, from community colleges to Ivy League universities. In his 2008 study Contemporary HBCUs: Considering Institutional Capacity and State Priorities, Dr. James T. Minor, a researcher at Michigan State University, reported that the proportion of black college students who choose to attend HBCUs has declined from 75% at the time of Brown v. Board of Education to 14% today (28% in Southern states). But a recent article in U.S. News and World Report found that HBCUs’ enrollment actually increased from the mid-1980s to today by 70,000 students, to a total of about 270,000. This is a solid 35% growth rate, even though most HBCUs have less than 3,000 students each.

This brings us back to the debate over the relevance of historically black colleges and universities in post-segregation America and why some black students still prefer to attend HBCUs even though they have the option of enrolling in majority institutions. In recent years, the 47 state-run HBCUs, many of which have nursing programs, have been facing pressure to assimilate. A 1992 Supreme Court ruling instructed state legislatures to find “educational justification” for these institutions, all of which are in the South, or merge them with their white counterparts. So far, states have ignored this directive and have even allocated new funds for expansion of some HBCUs.

Dr. Betty Adams, dean of Prairie View A&M University College of Nursing, pins a graduate. In recent years, student populations at historically black nursing schools have become increasingly diverse and multicultural.Dr. Betty Adams, dean of Prairie View A&M University College of Nursing, pins a graduate. In recent years, student populations at historically black nursing schools have become increasingly diverse and multicultural.

A number of African American legislators and civil rights organizations, such as the NAACP, have voiced opposition to the Supreme Court directive. How can the NAACP, which fought for integration during the civil rights era, support separate schools for black students? The answer is that HBCUs continue to be seen as a haven for young black students, sheltering them from the racial tensions of predominantly white institutions. Several research studies have shown that HBCUs give African American students a chance to find their identity and ground themselves before venturing out into the white-dominated professional world.

For example, a 1996 study by H. H. Wenglinsky, published in the journal Educational Evaluation and Policy Analysis, found that students in HBCUs were more academically motivated and more likely to achieve their professional aspirations than African American students at majority institutions. And a 2004 study by the consulting firm McKinsey & Company reported that the average graduation rate at many HBCUs is higher than the average graduation rate for African Americans at predominantly white schools.

Many HBCU alumni have strong feelings about the benefits of blackmajority education and tend to send their children to HBCUs, too. In an online discussion forum at BlackParentMovement.com, “Cassandra” recalled coming from a mostly white town to study at Tuskegee University in the 1980s. “I found that I was better able to develop as a person in the predominantly black environment,” she wrote. “There is a feeling of family and nurturing that my friends who attended white institutions do not have.”

Charlie Dickson, EdD, RN, FAAN, a 1968 alumna of Tuskegee’s nursing program, agrees. At predominantly white universities, she says, “there are a number of subtle [race-related challenges] for the black student in that environment.” Growing up in segregated Birmingham, Ala., Dickson attended all-black schools, but “we were taught to excel. My piano teacher was [former secretary of state] Condoleeza Rice’s mom.” After earning her master’s degree at a majority university, she became one of the first African Americans to join the nursing faculty at the University of Alabama and taught there for 18 years. Now retired, Dickson volunteers her time teaching nursing students as an adjunct professor at Tuskegee.

“There is a security [here] that students cannot find in a predominantly white institution,” Holeman says. “Faculty and students get to know one another on a very personal level.” Tuskegee’s student-to-faculty ratio is 15 to one, similar to that at other HBCUs, while the University of Alabama’s is 19 to one, which is typical for many other state universities.

While today’s HBCU nursing schools continue to provide unique educational benefits to a whole new generation of black students for whom the civil rights movement may seem like ancient history, students from a diverse range of races, ethnicities and nationalities are now enjoying those benefits as well. In fact, at Prairie View A&M University College of Nursing, black students are actually the minority. Total enrollment university-wide is still 90% black, but in the nursing school African Americans represent less than half of the student population, sharing classroom space with students from Vietnam, Cambodia, the Philippines and three or four African nations, dean Adams reports.

“The international experience enriches the lives of our African American students,” she adds. “It is beautiful to see how alike we all are.”