In moments of doubt, there are few better comforts than being able to turn to a knowledgeable, experienced, supportive mentor. In nursing, that relationship truly makes a difference.
These are the results of Project DIVERSITY, an IRB-approved study that successfully increased the diversity pipeline of the nursing workforce. Staff development educators will find that the nurses’ involvement in academic outreach efforts and mentoring increased nursing satisfaction. Nurse mentoring was extremely effective in recruiting and retaining these underserved ethnic minority students, and may contribute to reducing health care inequality.
Previous nursing research has addressed the serious problem of racial and ethnic health care disparities through mentoring racial/ethnic minority students. The nursing profession does not represent the population at large. The nation’s minority population has reached 104.6 million, which represents one out of three who are minority residents (U.S. Census Bureau, 2009). A growing body of research demonstrates that racial and ethnic disparities in health constitute a national crisis and are a growing public health challenge (IOM 2002, 739; Buerhaus and Auerbach 1999).
There is a well-documented need for greater minority representation in nursing as the national population becomes more diverse. It is important to have a racially diverse nursing workforce because nurses who can speak the same language, understand the culture, values, and beliefs of their patients may provide better care (IOM 2002, 739). Increasing the route for underrepresented minorities to enter the nursing workforce will address the health care disparities that plague our healthcare systems. (Gordon and Copes 2010, 11-13).
Project DIVERSITY (Develop/Increase the Voice of Ethnic, Racial Students and Interns Through Youth) is a Partners Invested in Nursing (PIN) Project that used mentoring to help minority students complete high school and enter college with nursing as a major (Robert Wood Johnson Foundation 2010). Minority high school students were recruited into the program and participated in bi-monthly nurse mentor workshops, weekly tutoring, a six-week long summer program, job shadowing, and college preparation that resulted in 100% of the these minority high school students entering a college nursing program. Mentoring these students was one of the most effective interventions yet employed.
Increasing the number of minority nurses is one solution for eliminating health disparities and increasing the quality of care (IOM 2002, 739; Buerhaus, Auerbach, and Staiger 2009, 657). Research has discovered that when Hispanic nurses serve the Hispanic community, they correct cultural mistakes, and this decreases racism and discrimination in healthcare (Wros 2009, 151-157).
The problem in New Mexico
New Mexico has a great need for minority nurses, as a minority-majority state with a population that is 41.4% Hispanic, 11.2% Native American, 2.7% African American, and 1.7% Asian American. Yet, less than 10% of New Mexico nurses are Hispanic, and less than 1% of nurses are Native American (New Mexico Department of Health 2006). This cultural disparity creates language and cultural barriers for the Hispanic, Native American, and other minority populations when they try to access the health care system. These cultures tend to look toward their own communities to find medical help. Both subcultures depend on alternative medicines to solve their health problems. The end result is that an individual’s health status may have deteriorated by the time they finally seek professional health care. The Hispanic and Native American populations tend to live in more rural settings, and they often lack the ability to communicate effectively with health care professionals. They either cannot speak English or they do not feel comfortable speaking it; consequently, they feel the health care system does not consider their cultural bias.
Increasing the ethnic minorities within the nursing and health care professions will increase access to care, allowing providers to communicate more effectively, incorporate cultural differences, and provide higher quality care to these populations. The language barrier alone creates misunderstandings regarding the diagnosis, procedures, proper medication, and consistent follow up care for chronic illnesses. Minorities receive less quality disease care regarding their hypertension, diabetes, cancer, chronic infections, and drug and alcohol abuse. If the health care system reflected the general populations, then communication, cultural sensitivities, and health care could be delivered in a more acceptable manner. Mentors for Hispanic and Native American high school students can ensure that more of these students enter the nursing profession and provide more effective care for these populations (New Mexico Center for Nursing Excellence).
The PIN Project
The Robert Wood Johnson, Northwest Health, Con Alma, and two New Mexico Health Foundations (which worked out of high schools with a large number of disadvantaged minority students) funded the PIN Project. The program aimed to motivate minority students, who were interested in nursing, to successfully complete high school and enter college with nursing as a major (Robert Wood Johnson Foundation 2010). The PIN Project provided nurse mentoring, bi-monthly nursing workshops, tutoring, a six-week summer program, college preparation, and job shadowing opportunities. Because most of the students came from families who did not support them academically, students reported that the nurse mentoring and job shadowing helped them stay motivated in their studies, focus on a career, and finish school.
Fifty-four nurse mentors and 59 students participated in the Project DIVERSITY program. The targeted high school had over 90% ethnic minority students and a dropout rate of over 50%. With one counselor for over 600 students, they did not have adequate career counseling. Many of these students did not have family support, and education was sometimes not valued. When the students met with their DIVERSITY mentors every week, they discussed school, nursing, home, family, relationships, and any other challenges on their minds. In the end, the students connected with their mentors in a constructive and supportive way. Students often said the relationship with their mentors had enriched and changed their lives.
Mentoring is an effective method to increase self-esteem, academic performance, and social skills in Latino students (U.S. Census Bureau 2009). Research has demonstrated that mentoring has also been effective in recruiting high school students into nursing (Timmons 2007, 747). Racial/ethnic minority students have lower college admission and retention rates than white non-Hispanic students. A review of strategies reveals that to recruit and retain racial/ethnic minority students, schools of nursing will have to use interventions that reach diverse student populations and make connections with middle and high schools (Balogun, Sloan, and Hardney 2005). Many minority students do not take, or are not encouraged to take, science and mathematics in high school. Assuredly, this leaves them at a serious disadvantage when confronted with college health sciences curricula.
Language and cultural norms are some of the causes of health disparities between ethnic and racial groups as they try to enter the health care delivery system (Harris 2010, 1-22). Other causes of health disparities include socioeconomic (poverty) and environmental characteristics (many live in rural areas where full medical care is not possible).
New Mexico ranks among the lowest in the United States (31st state in ranking) when it comes to educating its youth with one of the highest dropout rates in the country. However, graduating from high school is not an indicator as to whether students are prepared to go on to college or university (U.S. Census Bureau 2009).
Project DIVERSITY is a University of New Mexico Health Science Center IRB-approved research program aimed to recruit and prepare underserved ethnic minority students for a career in nursing. The study’s goals were to recruit and retain 60 underserved, ethnically diverse students into a path for nursing as a career; to academically prepare students for college and nursing as a career; to expose these students to nursing as a career choice; and to establish community partners for the support of success or students in the Nursing Career Pipeline.
This descriptive longitudinal cohort intervention study recruited underserved minority high school students and provided nurse mentoring, workshops after school, job shadowing, academic tutoring, and college preparation. Nurses mentored students by participating with students in nursing workshops, teaching them about health care issues, and providing job shadowing experiences.
The Project DIVERSITY program used mentoring and job shadowing as a main factor in motivating ethnically underrepresented high school students to graduate from high school and consider nursing as a career choice. It is important to provide the motivation and academic resources to keep students in school, as more than 50% of Albuquerque high school students drop out. The mentoring program was conducted at the high schools in a safe, relaxed manner. A group of students and nurses established relationships and learned about each other, nursing, and health science topics. The mentors were encouraged to listen patiently, foster discussion, and nurture self-sufficiency. They provided an introduction to nursing careers and developed a working relationship with their students. By building trust they helped their mentees develop self-esteem. As the bond grew between the nurse mentors and students, the mentors were able to address and advise students on personal and academic problems.
Job shadowing was conducted after the students completed the University Hospital Volunteer Orientation Program. This orientation class outlined the essential elements required of all volunteers to enter the hospital. Items such as HIPPA regulations, security, safety, and communication were discussed. After the orientation, the students were given an identity badge and a shirt that identified them as a volunteer. The students shadowed their nurses for a minimum of eight times per month, arranged by the program coordinator. Outcomes included students journaling every day they worked with their nurse mentor and completing pre/post self-efficacy surveys. The mentoring experience truly introduced them to the hospital nursing environment.
The data was analyzed using both quantitative and qualitative methods depending on its nature. As a result of this research program, all of the eligible students entered into college with a plan to apply for nursing. The mentors spoke of what they had learned from their students as well. These personal relationships not only helped students envision what could be, but also helped nursing staff be more empathetic of their hardships. Hopefully, this will make them better nurses, better students, and more understanding human beings.
Fifty nurses served as mentors and 63 students participated in the program. Two-hour workshops were offered twice a month beginning in September 2007 and ran through December 2009. Pre/post tests were given for every workshop to measure the students’ grasp of the information. A curriculum was established and carried out at both high schools. The nurse mentors met with the students twice a month at their respective high schools and participated in health-related workshops.
Over 80 hours of nursing-related workshops with mentors and content experts covered a variety of areas, including dissections, nutrition, interview skills, chemistry experiments, laboratory values, and nursing workforce subjects. In addition to the program, many of the students volunteered for additional job shadowing during the school year to get hands-on nursing training. The nurse mentors were involved in their students’ lives in a very personal way, and many students and nurses became friends. They still maintain relationships with each other long after the program’s end. Having an adult who is not a parent can be very helpful to students who need direction in their lives and counsel from mentors they trust.
The issue of minority representation in nursing care is critical because racial/ethnic concordance between patient and provider has consistently been associated with greater patient participation in care processes, higher patient satisfaction, and greater adherence to treatment. Language barriers are similarly important, because they can affect the delivery of adequate care through poor exchange of information, loss of important cultural information, misunderstanding of physician instructions, poorly shared decision-making, and even ethical compromise.
One of the major challenges for Project DIVERSITY was finding minority students at Highland High School who had a strong educational foundation. Too often, their coursework did not provide the necessary rigor to pursue a career in nursing. Currently, only 19% of all the school’s freshmen are proficient in math, 18% in reading, and 22% in science. These numbers do not change for 11th grade. This presented a major obstacle for successful outcomes and posed a challenge in recruiting students for Project DIVERSITY.
Mentoring had the greatest impact on Project DIVERSITY outcomes. The program allowed nursing mentors to act as authentic role models. Through their experiences, the students became well acquainted with the nursing staff and with nursing as a profession. The mentoring program gave the students the opportunity to learn about nursing and the academic preparation required.
Project DIVERSITY demonstrated that (1) underserved ethnic minority students are interested in nursing as a career and can progress academically with appropriate support, (2) nurses and other health professionals are committed to supporting these students and are willing to donate their time and expertise to support these students, (3) community foundations and institutions are willing to support programs that measure program outcomes that keep students in school and motivate them to enter the nursing profession, (4) these children are marginalized because some schools do not expect much of them and thus the children do not perform academically, (5) the program has demonstrated that these students can achieve high academic goals, and (6) although the students and families said college was not part of their family culture, with adequate professional support, they believe they can attend college. All students completing the program entered college, applied to college, or are researching college opportunities.
Project DIVERSITY targeted underserved students, not just to show them career pathways into nursing, but also to break the poverty cycle by providing the tools to pursue a career that will support them their whole lifetime. In the process, they would increase diversity within the nursing community. Families, schools, foundations, and the community must work together, in partnership, to reach these children.
The nurse mentors helped with academic tutoring to ensure that students achieved the grades they needed to get into nursing school. In addition, many of the students volunteered with their nurse mentors to get hands-on training in what nurses do day-to-day. Finally, mentoring directly influenced these students to broaden their horizons and reset their life goals higher than when they entered the program.
# of Nursing Population
% of Registered Nurses (2,909,357)
% of General Population (33M)**
** US Census Bureau 2000
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