Hispanics are the largest and fastest-growing minority population in the United States, and their numbers are expected to triple by the year 2050 to constitute a quarter of the total U.S. population. Today, in fact, Hispanics account for 42% of the population in New Mexico, roughly one third of the population in California and Texas and one fourth of the population in Arizona. Yet only 2% of the nation’s registered nurses are Hispanic, and the percentage of Hispanic nurses educated at the baccalaureate level or higher is even smaller.
Fortunately, nursing schools all over the country are taking action to change that situation. Through innovative outreach and retention initiatives, they are working to recruit more Hispanic and other minority students into nursing programs, guide them through successful completion of their degrees and increase the supply of culturally and linguistically competent nurse leaders who can improve health outcomes in Hispanic communities.
Here’s a look at four successful model programs, all of them funded by federal grants from the Health Resources and Services Administration (HRSA).
Although the Hispanic population in Virginia is growing five times faster than the overall population, less than 1% of registered nurses in the state are Hispanic. Furthermore, Hispanic nurses are less likely to hold bachelor’s degrees in nursing than RNs of other races and ethnicities.
To address these two issues, Virginia Commonwealth University (VCU) School of Nursing in Richmond is recruiting Spanish-speaking RNs to a program that lets them earn their BSN on the weekends while working full time. The recruitment project, called “Public Health for Virginia’s Future, Part Two,” is also designed to increase the number of public health nurses who return to school to get their baccalaureate degrees.
VCU first started its RN-BS Weekend Program in 1989 to provide more convenience for working RNs seeking bachelor’s degrees in nursing. The program is offered at locations across the state and online. Students take classes one weekend a month and can earn their BSN degree in as little as 18 months.
In July 2005, the School of Nursing was awarded a $600,000 HRSA grant to fund a three-year project to recruit more Spanish-speaking nurses to the weekend program. The school hired a full-time Hispanic Coordinator, Milagritos (Millie) Larrauri Flinn, to market the program to the Hispanic community. It also started offering classes on “Spanish Language and Culture for Health Care Providers,” a cultural competence seminar series for students and faculty, and a mentoring program to help retain students.
In its first two years, the project exceeded its recruitment goals and the nursing school is optimistic about the initiative’s impact. “I feel we’re making a huge difference in spreading the word,” says Flinn.
Between the 2005-06 and 2006-07 academic years, the targeted recruitment effort increased Hispanic nurse enrollments in the RN-BS Weekend Program by 75%. The nursing school is now exploring the possibility of offering scholarships for Spanish-speaking students. In partnership with the Virginia Department of Health and the state’s community college nursing programs, VCU School of Nursing is conducting surveys to determine whether scholarships would enable more Spanish-speaking RNs to earn their BSN degrees.
Building community awareness of the program was challenging at first, because the Hispanic population in Virginia is relatively new. Many in the community are the first generation to live in the United States.
Flinn reached out to Hispanic community leaders and made presentations at community organizations, community colleges and hospitals. She also worked with the local English-language and Spanish-language media. Flinn serves as a friendly point of contact for students inquiring about the program and she provides personal attention and support to students, from enrollment through the completion of their studies. Alumni from the RN-BS Weekend Program serve as mentors for students.
The program’s overall goal is to strengthen Virginia’s health care system. Recent studies show a link between the shortage of nurses prepared at the baccalaureate level and patient outcomes. Surgical patients, for instance, had a “substantial survival advantage” if treated in hospitals with higher proportions of nurses holding bachelor’s degrees or higher, according to a study published in 2003 in the Journal of the American Medical Association. A 10% increase in the proportion of nurses with BSN degrees lowered the risk of patient death by 5%, the researchers found.
“Our work in this grant means [there will be] more nurses and better-trained nurses to care for patients most in need,” Flinn says. “Nurses are our first line of health care providers, so strengthening our nursing workforce benefits all Virginians.”
Reaching for STARS
To increase nursing education opportunities for ethnically and racially diverse individuals from disadvantaged backgrounds, including Hispanics, the University of Texas at Arlington (UTA) School of Nursing designed a program that takes a comprehensive approach. The multifaceted STARS for Nursing project ranges from educating high school students about health care careers to providing academic, financial and personal support to help recruit, retain and graduate minority nursing students.
About 4% of RNs in the Tarrant and Dallas counties UTA serves are Hispanic. In contrast, more than a third of the population in Dallas County and almost a quarter of the population in Tarrant County is Hispanic.
The three-year, $728,000 HRSA grant that funded the STARS project ended in July, but the initiative has been so successful that the school plans to continue it, says Mary Jane Ashe, MN, APRN, RN, assistant director of undergraduate student services.
STARS stands for:
- Stimulating interest in nursing
- Tutoring and mentoring students
- Assisting with career and financial resources
- Recruiting and retaining pre-nursing and upper-division nursing students
- Strengthening the health care community with BSN-prepared nurses from diverse backgrounds.
STARS for Nursing comprises three programs: Aspiring STARS for high school students, Emerging STARS for pre-nursing students and Shining STARS for junior and senior nursing students.
During the grant period, Aspiring STARS adopted six high schools where Hispanics and African Americans make up the majority of the student population. Representatives from UTA School of Nursing made presentations at career days and college nights and led classroom activities focusing on cultural diversity, career guidance, college admission and succeeding in college. The high school students also had the opportunity to tour the School of Nursing and attend a two-day nursing summer camp, where they took classes, met nursing students and faculty, practiced hands-on skills in the university’s “smart hospital” and visited area hospitals that partnered with the program.
The ultimate goal of Aspiring STARS was to recruit these students into the UTA nursing program. Part of the recruitment process included sponsoring events for families so parents would understand the demands and benefits of attending nursing school. For Hispanic students, families play a central role in their lives. “It’s not only the potential student you have to consider,” Ashe says.
The Emerging STARS program set up “freshman interest groups” for pre-nursing students, to create a sense of community and provide help with time management and study skills. Older nursing students served as peer mentors and counselors. Research shows that students are more likely to complete school when they are part of a learning community, Ashe says, particularly those who are the first generation in their family to attend college. In addition, the School of Nursing hired a fourth full-time advisor to provide support and monitor the students’ progress.
To help retain and graduate upper-division nursing students, Shining STARS provided a variety of support services, including RN and peer mentors and tutoring available in a learning center. A faculty member served as a student success coordinator and was available for any students who needed extra help with study skills, test-taking skills and preparation for the NCLEX-RN® exam. Local chapters of minority nursing organizations, such as the Dallas chapter of the National Association of Hispanic Nurses and the Lambda Eta Chapter of Chi Eta Phi sorority, partnered with the program to provide RN mentors from their memberships.
Going forward, the STARS for Nursing project plans to set up a mentor program for high school students and restructure an RN mentor program for college students, Ashe says.
Thanks to a program at the University of Texas at El Paso (UTEP), a Hispanic-Serving Institution located on the U.S.-Mexican border, nursing students who otherwise might not have pursued their bachelor’s degrees got the support they needed to graduate, and thousands of students from grade school to college learned about nursing career opportunities.
Funded by a three-year, $674,394 HRSA grant, the Recruitment & Retention of Hispanic Nursing Students Program was designed to increase Hispanic enrollment and graduation from the university’s School of Nursing and to help meet the growing need for culturally sensitive health care in the Border region. The grant ended in July, but the school plans to apply for an extension, says project director Velma McInnis-Edmonds, DNS, MSN, RN.
As part of the project’s recruitment component, School of Nursing staff visited elementary, middle and high schools to speak to children and teens about the nursing profession. UTEP also hosted a summer day camp on campus for high school students interested in nursing careers. Other outreach efforts included working with local community colleges to hold pre-nursing workshops to recruit students and help them make the transition into UTEP’s School of Nursing. The workshops provided information on topics like how apply to the university and how to access financial aid.
The retention side of the project focused on ensuring that the Hispanic students had the resources, support and skills needed to successfully complete the BSN program. The School of Nursing provided financial assistance through scholarships and stipends, as well as individual attention and support to retain students through graduation. The school also partnered with an economic development initiative called Project ARRIBA (Advanced Retraining & Redevelopment Initiative in Border Areas) to provide case management and social services to students.
The Recruitment & Retention of Hispanic Nursing Students Program also provided services such as tutoring and counseling. Educational outreach manager Hilario Monreal met weekly with students to help them stay on track to reach their goals and address any obstacles to their success. Once a year the students attended workshops on study skills, computer and library research skills and time management.
Meanwhile, the program also sponsored workshops for nursing faculty to help them understand and be sensitive to the Hispanic students’ cultural needs. Instructors were encouraged to make themselves available to students.
Program statistics for the third year of the grant are not yet available, but in its first two years the project exposed more than 2,000 potential students to nursing opportunities and recruited 43 Hispanic students into UTEP’s nursing school. Almost all of these students have completed their BSN degrees or will graduate within four years of enrolling in the School of Nursing. Many of the students were single mothers with English as a second language, and they started college with doubts about whether they could make it.
“Most [of the students] probably wouldn’t have gotten their bachelor’s degrees if it weren’t for [this] program,” Monreal says. “They all said the greatest thing the program did for them was provide support and encouragement. Because they were determined and passionate, they did well. I’m very proud of the students and glad we were able to help them fulfill their dreams.”
McInnis-Edmonds agrees. The program, she says, helped provide a caring and nurturing environment for students, giving them the confidence and support they needed to succeed.
A Ladder to Licensure
Internationally educated nurses are the focus of the Enfermeras en Escalera (Nurses on a Ladder) Program at Mesa Community College in Mesa, Arizona. The program, also known as E3, prepares immigrant nurses for licensure as RNs in the United States and helps them transition into jobs in the U.S. health care system. Ultimately, E3’s goal is to help address the nursing shortage in Arizona and increase the supply of bilingual, bicultural nurses in the state.
The program, which enrolls 15 students a year, is the only one of its kind in the United States that is based in an academic center. Initially targeting Spanish-speaking students, E3 has grown more diverse to include nurses from Africa, Eastern Europe and the Middle East as well as from Mexico, Puerto Rico and Central and South America.
Although living here legally, many of these students who were practicing nurses in their countries of origin haven’t been able to navigate the system to get licensed in the U.S. The Enfermeras en Escalera Program provides a “nurse refresher” curriculum, including a clinical rotation at local hospitals. It also helps students strengthen their English skills and cultural competence, prepare for the NCLEX-RN licensing exam and transition smoothly into nursing practice in the United States. The program provides tutoring and counseling, and local hospitals and health care systems provide scholarships for students.
So far, 56 nurses have enrolled in the program and 19 have passed the NCLEX-RN.
“We have [internationally educated] nurses out in the workforce [here in Arizona] who thought they’d never be able to practice their profession again,” says Bertha Sepulveda, BSN, RN, director of special projects for the Mesa Community College Department of Nursing.
A team from the college and the local Valle del Sol chapter of the National Association of Hispanic Nurses developed the program and wrote the grant proposal. The Arizona Community College Association provided $144,000 in funding and the Arizona Hospital and Healthcare Association provided $30,000 for the first year. The program was then awarded a three-year, $487,000 HRSA grant.
With the critical need for more bilingual nurses who can communicate effectively with the nation’s rapidly growing Hispanic population, internationally educated nurses living in the U.S. are a rich yet largely untapped resource. In addition to passing English and licensing exams, they must prepare for a work environment that is different from that of their native countries. Nurses in other countries often don’t have as much responsibility as those in the United States because doctors in those countries take care of the more complicated procedures, Sepulveda explains.
The E3 Program can be completed in three semesters and includes 31.5 credit hours. The nurse refresher curriculum helps students develop skills in critical thinking, pharmacology and medication, patient management, delegation and working as part of the health care team.
“The biggest challenge for these nurses hands down is language,” Sepulveda says. Although many of the nurses speak English fluently, some need formal language courses to prepare them for passing the reading and writing portions of the English proficiency examination.
Sepulveda and her team are working on a plan to sustain the program at Mesa Community College after the grant period ends. “It’s been so satisfying [to see] these nurses out in the workplace,” she says. “It’s certainly improved the quality of their lives, and overall it’s improving the quality of life in our community.”
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