Misty Lynn Wilkie, RN, MSN, a member of the Turtle Mountain Band of Chippewa Indians in North Dakota, hopes to increase the number of Native Americans who are willing to be organ donors. There are currently about 1,400 Native Americans on the waiting list for a kidney, liver or other organ. But only about 12 donate an organ in a typical year.

Donna Ho-Shing, RN, MSN, CNOR, plans to unlock the reasons why African Americans and other racial and ethnic minorities tend to have higher mortality rates from cervical cancer and other diseases than Caucasians. Once she has the answers, Ho-Shing, who is African American, hopes to balance these statistics by encouraging people of color to get more involved in managing their own health.

Are Wilkie and Ho-Shing just chasing after windmills? Can a single nurse really help to decrease minority health disparities on a national level?

The answer is: No and yes. Nurses often come into the profession because they want to make a difference. Some nurses are satisfied with helping one patient at a time in a clinical setting. Others aspire to improve the health of large numbers of patients by affecting the way nursing care is provided across the nation.

Both Wilkie and Ho-Shing fall into this second category. Thanks to an innovative National Institutes of Health (NIH) initiative called Bridges to the Doctoral Degree, both of these minority doctoral students are on their way toward rewarding careers as nurse scientists. Eventually, they hope to teach and conduct research that will guide nursing practice and help ensure that minority populations get equal access to health knowledge and services.

“I am really concerned about the health disparities among minorities,” says Ho-Shing, who is currently a perioperative educator at Overlook Hospital in Summit, N.J. “What is it about minorities that causes them to have more mortality and morbidity than Caucasians? Is it a cultural thing? Is it a social thing? That’s what I really want to get at with my research.”

Paving the Way to a PhD

Bridges to the Doctoral Degree is one of several programs the NIH is sponsoring to encourage more talented people of color to work in the various medical sciences. The Bridges initiative provides financial support to universities that are helping minority students attain a master’s of science (MS) degree and, eventually, a PhD or other doctoral degree in science. Two of the NIH’s centers and institutes jointly fund and oversee the Bridges program: the National Institute of General Medical Sciences (NIGMS) and the National Center on Minority Health and Health Disparities (NCMHD).

Currently, there are three Bridges to the Doctorate programs that are specifically for nursing. The oldest, most established program aims to increase the number of American Indian/Alaska Native nurse scientists. It involves a partnership among three schools of nursing: the University of Minnesota (U of M), the University of Oklahoma (OU) and the University of North Dakota (UND).

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“As of now, there are only 15 American Indian nurses with doctoral degrees in the United States, which is not enough to do all the [research] work that is needed,” says Susan J. Henly, RN, PhD, associate professor and director of the American Indian MS to PhD Nursing Science Bridge program at the University of Minnesota School of Nursing in Minneapolis.

Henly and her associates plan to address the dearth of Native American nurse scientists by graduating 12 more Bridges students with doctorates in nursing by 2011. The program is well on its way toward achieving this goal. Currently, six Native nurses are working on their MS with a major in nursing at OU or UND. In addition, one student has completed the MS degree and gone on to work on a doctoral degree at the U of M; two more are expected to begin their doctoral study this fall.

A key requirement of all Bridges programs is a cooperative relationship between universities. Schools that offer doctoral degrees must link up with one or more colleges that award a master’s degree but not a doctorate. Nurses who are accepted into the Bridge program complete their MSN at one university and then apply to the doctoral program at the partner school.

Initially, U of M’s Bridge project only had a partnership with the University of North Dakota. However, UND recently began offering its own doctorate in nursing. To continue meeting the requirements of the NIH grant, U of M is now partnering with OU, which does not have a doctoral program. But a few students are still finishing up their master’s at UND.

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What type of nurses are the Bridges to the Doctorate programs looking for? Any minority nurse who has a talent for and an interest in research. “Nurses who aspire to become nurse scientists need to have a curiosity that will drive them to really understand the nature of a problem and what is causing it,” Henly explains. “They must also have the determination to perform the kind of scientific work that is needed to verify hunches and understand a problem.”

Ho-Shing says she has always hoped to get into research. But other nurses come to the discipline from a more circuitous route. Wilkie, who has just finished the first year of her doctoral studies at U of M, had originally applied to a family nurse practitioner program. But now she finds research very rewarding. “It wasn’t until I was working on my master’s thesis that I got involved in research,” she recalls. “I found that I really enjoyed research, which is something that I never thought would happen after reading all those research articles as an undergraduate.”

More Than Just Financial Support

Minority nurses in Bridges to the Doctorate programs receive financial support while working on their master’s degrees. The amount and type of assistance varies from Bridge program to Bridge program. Native American nurses in the Bridge program at the University of Oklahoma get a salary in exchange for working as graduate research assistants, as well as some payment of tuition.

A key benefit of receiving a salary–as opposed to a scholarship–is that nurses do not need to fulfill a service payback to the university. “A lot of scholarship opportunities require that students work for the [sponsoring] organization as a payback after graduation,” explains Henly. “We don’t have that requirement, because our students receive a salary. Once you get paid, you’re even and you’re free to proceed with your career however you want.”

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In addition to financial help, Bridges scholars receive a level of personal support and mentoring that would be hard to find elsewhere. The challenge of completing an MSN and PhD is onerous enough for any nurse. At the fastest possible clip, it takes five years of graduate classes, a master’s thesis and a dissertation. But the journey can be particularly difficult and lonely for minority nurses, who often encounter very few–or no–other nurses of color along the way

Take Rutgers, The State University of New Jersey, whose College of Nursing began a Bridges project about two years ago. “[At that time], our campus was rated the most ethnically diverse campus in the country by U.S. News and World Report,” says Charlotte Thomas-Hawkins, RN, PhD, CNN, assistant professor and project director of Rutgers’ Bridges to the Doctorate Program. “Yet, if you looked at the diversity of students in our doctoral program, it did not mirror the diversity of the students in our College of Nursing undergraduate program.”

These types of disparities can be daunting even for the most determined student. “I think when minority nurses get into school, they don’t see a lot of [other nurses of color] and they tend to get discouraged,” Ho-Shing comments. “There are not that many minority nurse faculty who [are available to] be role models and who would mentor them.”

As a Bridges scholar in Rutgers’ program, Ho-Shing has been able to avoid this problem of “being alone in a crowd.” She recently completed her MSN at William Paterson University, one of the five New Jersey colleges Rutgers partners with. In addition to receiving support from minority faculty at William Paterson, she was assigned to a research mentor at Rutgers–Thomas-Hawkins–who guided her throughout her master’s study. Both Ho-Shing and Thomas-Hawkins are African American and interested in similar research.

“I received a lot of support and encouragement from Dr. Thomas-Hawkins,” says Ho-Shing. “She always pushed me and said she believed in me. She has been a true mentor and a great role model.”

Completing a master’s degree at a Bridge university does not guarantee that a student will be accepted into the PhD program at the partner school. But it certainly helps. One reason why is that Bridges students get to know the faculty at the doctoral program while working on their master’s studies.

“The Bridges program provides people who will be on your side and look after you when it comes time for the admissions process to the doctoral program,” says Wilkie. “If you don’t have anyone to stand up for you and say, ‘I really think this person would be a good match for our [PhD] program,’ then why would they want to admit you?”

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The collaborative relationship between Bridges partners allows faculty from both the master’s and doctoral schools to become actively involved in the students’ careers early on, by serving as research mentors, sitting on thesis committees and in other creative ways. For instance, Bridges students who are working on their master’s studies at the University of Alabama will be spending four weeks this summer at their partner doctoral school, the University of Illinois at Chicago (UIC). During their stay, the Bridges scholars will live in a UIC residency hall and work side by side with a faculty mentor on a research project.

“We want to recruit minority students early on so that we can help them and mentor them,” explains Mi Ja Kim, RN, PhD, FAAN, professor, dean emerita and director of the Academy of International Leadership Development at UIC’s College of Nursing. “[That way], when they come to UIC for the PhD program they will be somewhat accustomed to the environment and the requirements and can complete the doctoral program successfully.”

UIC also provides peer support to Bridges students. Karine Richardson, RN, a graduate assistant at UIC, has assumed the job of peer mentor. “I call Bridge students on the phone and ask how everything is going so that they don’t feel like they’re tackling this huge graduate school [challenge] by themselves,” she says.

Real Research Experience

Bridges to the Doctorate scholars have another major advantage over other MSN students applying to PhD programs: hands-on research experience. For example, a major component of Rutgers’ Bridges program is a research assistantship during the students’ MSN studies.

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“Our Bridges scholars participate on a research team in whatever aspect of research the faculty member is actively engaged in,” says Thomas-Hawkins. “It could be proposal development, data collection, data analysis or dissemination of research findings. We’ve had one of our students be a co-author on one of our faculty members’ papers. The goal for our students is that they serve as active members on a research team so that they get a beginning idea of what being a nurse scientist means. This is an invaluable experience that most doctoral students do not have [when they enter their PhD program].”

During her research assistantship, Ho-Shing helped Thomas-Hawkins with qualitative data analysis for a study involving elderly renal failure patients on hemodialysis. “It was a lot of fun for me,” she reports. “I helped collect and analyze data and figure out what the data were saying. The experience really made me realize that qualitative research is what I want to do, but it also made me realize that it takes a lot of work. It’s not just going out there and asking some questions and plugging in the figures. You really have to come up with [an understanding of] what the patient is saying and that can lead to doing even more research.”

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Bridges faculty members encourage students to get involved in research and activities that help find solutions to racial and ethnic health disparities. In support of this goal, Native American elders, medicine people and spiritual leaders serve as advisors for the Bridges program at the University of Minnesota and its partner schools. “One of our goals is to integrate our work with the local Indian communities to help our students stay connected with their families and communities,” says Henly. “For instance, for the last three years in Minnesota, we’ve had a project retreat on the White Earth reservation. A medicine man and woman from a nearby tribe work with the project and help us with the retreat.”

The Not-So-Impossible Dream

One barrier that prevents many minority nurses from becoming nurse scientists is unrelated to skin color or ethnicity. “Most nurses are adult learners [when they’re] at the phase of their careers where they’d consider a doctorate,” Kim explains. “They often have a job, a family and other commitments that they have to weigh and balance.”

Thomas-Hawkins feels that waiting to target nurses during their MSN studies may be too late. “Students enrolled in nursing master’s programs tend to be middle-aged and have a lot of responsibilities,” she says. “The decision to get a PhD is a big commitment–and it’s not just an individual commitment, it’s a family commitment. I think we need to start discovering talented nurses in undergraduate programs who express an interest in discovery and research. Then we need to mentor these nurses on for their master’s and then on for their doctorate.”

The NIH has also realized the need to recruit nurses and other health sciences students into research early in their academic careers. In addition to Bridges to the Doctoral Degree, NIH sponsors a Bridges to the Baccalaureate Degree initiative that helps minority students transition from an associate degree program to a bachelor of science program.

But Wilkie believes that any talented and determined minority nurse can earn a PhD–no matter where he or she is in his/her career. “I think if you set your mind to something and you want it badly enough, you just do it,” she says. “I never really thought that I was an exceptionally bright student who would go on for a doctoral degree. I was just an average student in high school. But that just shows that you can do anything you want if you set your mind to it.”

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