Minority Nurse Retention in Doctoral Programs: What Works and Why

The literature from professional nursing organizations is full of recommendations that nurses continue to advance their education by pursuing doctoral degrees, either in clinical practice or in research. In 2004 the American Association of Colleges of Nursing (AACN), after studying the issue for two years, published a position paper recommending the advisability of obtaining a terminal degree even if a nurse’s career focus is on nursing practice rather than research or teaching.

The doctorate is seen as a necessary credential for nurses who hope to move into leadership and change-agent positions, whether in the area of patient care, administration and management, nursing education, nursing science or health policy making. But who is responding to these recommendations? And even more importantly, who is finishing these doctoral degrees?

Minority nurses cannot afford to walk away from this one. In the nursing literature, article after article repeats the theme: A culturally diverse population needs culturally diverse nurses at every educational level.

In my 29 years of nursing, I have seen great changes in the nurse’s role in clinical practice, health care regulation and research. We nurses are becoming more autonomous. We have become decision makers–whether we like it or not–on both a small and large scale. New trends and best practices are constantly emerging from advances in research and technology. As a result, the knowledge base for many of us is no longer the same as when we first became RNs, and much of it is most likely obsolete. We need to keep abreast and constantly sharpen our expertise, which is at higher level now than even before.

Do minority nurses need doctorates? Yes, I strongly believe we do. Without them, how can we spearhead the movement for cultural responsiveness in patient care? How are our issues going to be included if we don’t have a seat at the policy-making table? How will we be able to educate the next generation of culturally diverse nurses as the current generation of nursing faculty moves into retirement? We must earn this level of academic preparedness in order to exercise leadership in all of these key areas–for our patients, for ourselves and for those who follow.

A bridge is needed for currently practicing minority nurses to access these terminal degrees, and we will have to join hands to form that bridge. Where will the physical, mental and emotional energy, as well as the money, come from to enable these nurses to not only pursue doctoral degrees but to actually complete them? The best way to answer these questions is to look at some examples of proven strategies for assuring retention of minority nurses in graduate programs.

What Works for Us

Thad Wilson, PhD, APRN, BC, associate dean of graduate nursing at the University of Missouri-Kansas City (UMKC), says the personal touch has contributed to his institution’s success in retaining minority graduate students. Feelings of exclusion, loneliness and alienation cannot be allowed. Outreach efforts such as counseling, student support services, mentoring, reorganization of faculty responsibilities and other institutional measures can open channels of communication that prevent minority doctoral students from drifting away.

Maithe Enriquez, PhD, ANP, RN, an assistant professor who earned her doctorate from UMKC School of Nursing in 2002 and now teaches in the PhD program herself, is a perfect example of a minority nurse who has benefited from the school’s nurturing approach. When asked to name the most important factors in retaining minority nurses in graduate programs, she readily answered, “For me, it was having two great mentors, family support and funding.”

Dr. Enriquez, who began her career as an operating room nurse, has become an outstanding leader in her profession. In addition to her faculty position at UMKC, she also works in the clinical setting as a nurse practitioner and is an award-winning researcher specializing in the management of chronic illness in vulnerable populations. From 2002-2004, she was a post-doctoral fellow at the University of North Carolina at Chapel Hill School of Nursing.

Examining the career paths of role models like Dr. Enriquez can help minority nurses understand the steps involved in the process of completing doctoral study. Her curriculum vitae includes over 21 published articles, 11 professional presentations, six research grants and seven program grants.

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Mentoring is no longer the exclusionary practice it often was in the past. “Fitting in” with the majority culture has been replaced with appreciating and valuing the perspectives of minority cultures and the ability to relate to diverse populations. For this reason, many graduate programs are actively recruiting more mentors to overcome the mentor shortage that once created obstacles to minority nurses’ retention rates. California State University at Chico, Prairie View A&M University, the University of Florida, the University of Mississippi, the University of Northern Colorado and the University of South Dakota are all mentioned in the literature as participating in new and successful mentoring paradigms.

Encouraging minority graduate students in nursing to be involved in community partnerships, collaborations, professional organizations and social networks is another effective retention strategy. Returning to our example, in 2005 Dr. Enriquez was the recipient of a Mentor Award from the National Coalition of Ethnic Minority Nurse Associations. She is a member of the National Association of Hispanic Nurses, the Association of Nurses in AIDS Care and the nursing honor society Sigma Theta Tau. She received UMKC’s Community Service Award in 2001 for service to the HIV/AIDS community. Dr. Enriquez has also received many other awards, has given numerous community health presentations and her CV lists 18 other community service activities.

Opportunities to participate in forums, leadership development programs, peer networking and role modeling can also help minority doctoral students stay the course and finish their degrees. Sharing stories of personal journeys helps increase confidence and promote realistic goal setting. Nurses tend to be highly idealistic and may be harsher critics of themselves than others. Mentoring and networking programs can help reestablish a perspective for measuring progress. The key is cultivating an active sense of involvement and acceptance from faculty and other students.

Support Systems: Family and Financial

In today’s fast-paced society where multitasking has become the norm, many minority nurses pursuing graduate degrees can easily become overextended in their commitments of time, energy and money. Juggling the demands of relationships, family, community, work and school may seem impossible.

Nurses who are highly self-reliant may find it hard to ask for help. Often the decision to pursue graduate work is made alone, but the goal cannot be achieved without support. Family members must agree to a plan to help the graduate nursing student.

To save time and money, some nurses have taken advantage of shared childcare expenses, academic research services, support groups and other forms of assistance to help them in completing their degree requirements.

If family support is scarce, especially from spouses, other support systems must be in place to assist these students, and the university should know about it. Providing access to childcare, financial assistance, housing, transportation, counseling and cohort support groups can help nursing schools retain doctoral students who do not already have a functional support network.

In recent years, federal, state and private entities have dedicated unprecedented funds to encourage minority nurses to complete graduate work and assume faculty positions. Many new programs, grants and scholarships are now available to provide financial and career support. Some of these programs fund career ladders or tuition and fees for graduate work beyond the normal financial aid packages.

For example, the California Endowment/AACN Nurse Faculty Scholarship provides $18,000 plus mentorship and leadership training to underrepresented minority graduate students in California who intend to pursue careers as nurse educators. On a national level, the federal Nurse Reinvestment Act, signed into law in 2002, established a faculty loan cancellation program to allow rapid completion of advanced degree studies by nurses who agree to take on faculty positions at schools of nursing.

We cannot say that the opportunities are not there. Monies have been allocated nationally to meet the need for minority nursing leadership.

What Else Is Working

There are a number of other effective strategies that schools of nursing can implement to improve retention of minority students in advanced degree programs. UMKC School of Nursing’s Strategic Plan for 2005 specified expanding the availability of distance learning options, which provide more flexible time frames for students to complete their coursework. This flexibility is especially important for minority nurses, who are more likely to be employed full time than majority nurses.

Another successful tactic universities can adopt is to sponsor activities that will increasefaculty members’ familiarity with the cultural needs of their students, such as cultural differences in learning styles and communication styles. Faculty with high student failure rates can learn to modify their instruction to increase students’ chances of success without sacrificing standards. An academic environment where ethnic and cultural differences are understood and accepted is empowering and encouraging to minority students.

University libraries should also make sure they subscribe to multicultural nursing journals, such as the Journal of the National Black Nurses Association, Journal of Transcultural Nursing, Journal of Cultural Diversity, The Journal of Multicultural Nursing and Health and Minority Nurse, to name just a few. 

In some cases, doctoral programs may need to reexamine some of their admissions policies. Minority nurses who overcome great odds to achieve their nursing education and practice are more severely challenged when additional layers of preparation are mandated. One possible strategy would be to allow nurses with high levels of clinical experience to be grandfathered into programs after establishing a way to translate their skills into equivalencies for the doctorate.

Providing pre-entry programs and orientation to graduate work are approaches that have worked well for some schools. Likewise, establishing more public and community partnerships would help promote access to doctoral programs for minority nurses. Opportunities for minority students to practice leadership must be available within the program, rather than being viewed solely as an end or goal of the program.

Networks of exchange can help expand access from linear to lateral connections. Leaders in the minority nursing community could advise nursing schools on policies that aid retention. Quality candidates could be given opportunities to shadow administrative and faculty participation in the doctoral program.

Investing in Our Future

Today, minority nurses are in a position to leverage our knowledge and expertise as never before. We cannot afford to pass up this opportunity to access institutional support for our future by pursuing doctoral degrees.

While we can and should make use of the financial, academic and community resources available to help us accomplish this goal, we must also be our own advocates. We are our own best mentors, support systems and cultural ambassadors within our institutions. Together we can raise funds to help a university library purchase a subscription to a multicultural journal. Together we can form support groups. Together we can hold forums to address our unique issues and challenges.

Whatever it takes to help minority nurses bridge the gap between enrolling in doctoral degree programs and successfully completing those degrees, it is our hands together that will form the bridge. By sharing the unique strengths of our community, we will cross over together, helping to keep each other afloat.

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