An Effective Teaching Method: Double Testing

An Effective Teaching Method: Double Testing

Current literature reminds us that active learning helps promote critical thinking and problem-solving abilities. Active learning requires that students be engaged through more than listening, reading, writing, and discussion. 

Research has significantly proven the opposition amid adult and child learning styles. Established on the research that adults do not learn in the same style as children, it is practical to accept that one cannot teach adults employing methods developed and planned to facilitate the learning experience of children. Malcolm Knowles, a pioneer in the field of adult learning, hypothesized some assumptions to assist teachers with teaching children and adults. These assumptions include:

The Need to Know. Adult learners need to know why they need to learn something before undertaking to learn it.

Learner Self-Concept. Adults need to be responsible for their own decisions and to be treated as capable of self-direction.

The Role of Learners’ Experience. Adult learners have a variety of life experiences that represent the richest resource for learning. These experiences are, however, imbued with bias and presupposition.

Readiness to Learn. Adults are ready to learn those things they need to know in order to cope effectively with life situations.

Orientation to Learning. Adults are motivated to learn to the extent that they perceive that it will help them perform tasks they confront in their life situations.

The reason most adults enter any learning experience is to create change. This could encompass a change in their skills, behavior, knowledge level, or even their attitudes about things. In a 2006 article published in the journal Urologic Nursing, Sally Russell suggested that, compared to school-age children, the major variances in adult learners are in the degree of enthusiasm, the extent of earlier experience, the level of engagement, and how the learning is applied. Double testing allows the adult student to be engaged in the learning process.

Students need support and validation from their peers. In any classroom, evaluation is necessary. In 2012, the National League for Nursing suggested in its fair testing guidelines that tests and other evaluative measures should be used “not only to evaluate students’ achievements, but, as importantly, to support student learning, improve teaching, and guide program improvements.” Double testing is one such teaching method in which evaluation, peer support, and validation can be instituted to support student learning.

Instructors who teach in higher education can no longer rely on lecturing as their main teaching method. In Teaching in Nursing: A Guide for Faculty, scholars Diane Billings and Judith Halstead emphasize that dependence on the use of the lecture is no longer an accepted teaching technique. Instead, faculty must integrate the use of technology so that students will be more actively involved and engaged in the learning process. Also, faculty must focus more on teaching in a learner-centered fashion, as opposed to the teacher-center approach.

Double testing has been proven to be an effective teaching method.  A 2013 study published in Nursing Education Perspectives found that learning, communication, and collaboration were prevalent themes in students’ perceptions and opinions of double testing. According to the researchers, the study found that “a majority of students preferred double testing and indicated that this testing method had more advantages than disadvantages.”

Throughout nursing programs, instructors are responsible for assessing students’ abilities and assuring they are competent to practice nursing. Since one of the nursing instructor’s goals is to prepare students to be safe and competent nurses, I believe that collaborative learning, such as double testing, is an excellent strategy to assist students in being able to successfully care for patients. I have used this teaching method for more than two years with senior two-year nursing students and have found that double testing promotes group interaction, interpersonal skills, and interdependence among the nursing students—qualities needed to work with members of any health care team.

In using the double-testing method, I have also found that students are more engaged and more cooperative; they also exhibit improved critical thinking skills. For example, when double-testing scores were compared over a six-month period, students’ overall grades increased from 69% to 82%. Indeed, a systematic review conducted by The Campbell Collaboration confirms that the benefits of collaborative testing “include—but are not limited to—better critical thinking skills, better collaboration and team work among peers, reduced test anxiety, and improved test taking performance.”

In a 2011 study published in Science, Deslauriers, Schelew, and Wieman  compared the amount of learning students experienced when taught—in three hours over one week—by traditional lecture and by using interactive activities based on research in cognitive psychology and physics education. The researchers found that students in the interactive class were more involved and absorbed more than twice the learning than their colleagues in the traditional class.

Twenty-first century students should be allowed some control over their learning. For many years, teacher-centered instruction has been dominant in higher education. In a traditional classroom, students become passive learners or just receivers of teachers’ information; whereas, with double testing, the students make the decision whether or not to participate. This way, students take charge of their own learning and are openly involved in the learning process.

In “Helping Students Get to Where Ideas Can Find Them,” an article published in 2009 in The New Educator, Eleanor Duckworth asserts that teacher-centered learning actually hinders students’ learning. In contrast, double testing is a learner-centered teaching method, which focuses on how students learn instead of how teachers teach.

I believe that double testing is a worthy teaching method that instructors can use in the classroom to enhance student-student and student-teacher interactions. Most educators understand that learners have different preferences and styles of learning and believe that it is essential to use teaching methods and approaches that will satisfy the variety of learning styles in the learning event.

Annie M. Clavon, ARNP, PhD, MS, CCRC, is an associate nursing professor at Keiser University in Ft. Lauderdale, Florida.


Parental support for first-generation college students

For incoming freshmen, attending college can feel like entering a maze. But for first-generation students, that maze can have added twists and turns, as they may not have a role model or rule book to follow when starting out as a first-year student.

In turn, while parents are proud of their college-bound daughter or son, they too are unfamiliar with the road they are about to travel. Yet, parents can still offer ample support for students just by showing up at family orientation events, asking questions from the program staff, and seeking out other parents to share information, guidance, and direction.

In the Rutgers College of Nursing Educational Opportunity Fund (EOF) Program, parents are strongly encouraged to be a support base to their students. The EOF program has a Family Orientation Day where not only parents, but the entire family is invited to attend. Family Orientation Day provides an overview of what students are expected to do in the intensive six-week Summer Readiness Program. The College of Nursing has the only EOF program exclusively for nursing students in the state of New Jersey.

In 2011, parents were given a firsthand account from a parent whose daughter completed the summer program the previous year. She and her daughter spoke to the audience and answered questions. Additionally, the mother stayed through the entire day to privately speak to parents, many of whom indicated this was especially appreciated. Having a parent whose child went through the program offered them a sense of relief and comfort, making it easier to leave their daughter or son on campus.

At the end of the Summer Readiness Program, the students “graduate” to become members of the College of Nursing (Class of 2015). The students participate in a celebration entitled “Culture Kitchen,” where students and/or parents prepare a dish from their culture. It is truly a feast! Students represent many countries, and sampling the cultural cuisine is a cherished memory of the Summer Readiness Program. This past year’s program was especially gratifying because one parent insisted on being a part of the team in setting up the buffet table and working with the students and staff! It was important for her to become actively involved and not sit on the sidelines.

Perhaps the most moving part of the Culture Kitchen program is watching the students reflecting on their summer experience and seeing the proud faces of their parents. Students benefit from their parents’ support and involvement, and parents are encouraged to be a part of the students’ college experience. The EOF Program wants parents to feel welcomed; we understand the daunting process of wanting their child to be educated along with the difficulty of “letting go” so their daughter or son can progress into adulthood and become a distinguished nurse.

Teaching Neonatal Resuscitation in Afghanistan

What’s an African American neonatal intensive care nurse doing in the middle of Kandahar City, Afghanistan? Teaching neonatal resuscitation protocols (NRP), what else!

During my deployment to Afghanistan in 2005 in support of Operation Enduring Freedom VI, I had the opportunity to teach NRP to local nurse-midwives in Kandahar. I had been assigned to the 249th General Hospital Alpha Detachment as an adult intensive care nurse. After months of caring for a variety of sick patients, I jumped at the chance to teach a class. I was excited about getting the opportunity to meet Afghan nurses and learn about their practice.

I had been invited to teach the class by Dr. Holland, a pediatrician assigned to the 173rd Army Battalion out of Italy. He had taught a previous NRP course in Kandahar and felt that having a female nurse assist with the teaching would be beneficial to the students.

The class I taught was coordinated by a Canadian physician who worked with both the coalition forces and local nationals. The goal of the course was to familiarize Afghan nurses and doctors with basic NRP in an effort to address the high rate of infant mortality in the region. There was also hope that after Dr. Holland and I taught the course to local nurse-midwives and pediatricians, they in turn would be able to teach NRP basics in their hospital and at the local midwifery school.

Dr. Holland and I donned our protective military equipment and traveled about 30 minutes from our base in Kandahar Airfield to an enclosed Canadian military base in the heart of Kandahar City. The base was surrounded by an eight-foot-high concrete fence topped with threatening barbed wire. Soldiers with weapons guarded the gates and kept watch from towers high above the ground.

While we felt safe inside the base, our students did not. The class was some two hours late getting started because of an early morning suicide bombing in the city. Because of the nurses’ security concerns, we were forced to condense two days of eight-hour-long classes into two blocks of instruction two hours each in length.

The Afghan nurses were concerned about being seen working with coalition forces. They felt unsafe traveling to the Canadian facility because the route was dangerously laden with improvised explosive devices. Due to an increase in suicide bombings and Taliban activities around the country, many husbands had restricted the movement of their wives and children. The nurses’ frustrations were compounded by several other factors, such as the refusal of a local male pediatrician to attend the course. He had been scheduled to take the class but refused to attend because he did not want to be seen traveling with a group of women.

But in spite of their fears and concerns, the eight nurses and one female pediatrician were full of energy. They arrived huddled together dressed in sky blue burkas that concealed their faces and bodies. Once the women were inside the classroom, the burkas came off and the course began like any other NRP class. We used an interpreter to translate each slide and followed up the instruction with lots of hands-on practice. The students were excited and eager to learn. They were desperate to improve their clinical knowledge and skills.

Most Afghan midwives are trained by experienced nurses. They have very little classroom education. They also continue to do a fair number of deliveries in patients’ homes rather than in mater-nity wards. This is because their local hospitals lack many vital newborn supplies, such as bulb suctions and ambu bags. The typical Women and Pediatrics Ward has minimal oxygen and a small foot-pump suction machine. The local city hospital had two donated newborn warmers but they were kept in storage because no one knew how to use them and the hospital lacked the proper power supply.

Cultural Exchange

Teaching this class in a country where medical technology was primitive, women lacked freedom and potential danger was everywhere made me feel as though I was teaching NRP to black nurse-midwives in rural America at the turn of the 20th century. I found myself wondering about the lives and working conditions of these African American nurse-midwives from an earlier era. Like the Afghan nurses, did they worry about their safety as they traveled around the countryside? Did they cluck their tongues at the dangers of 14-year-old girls giving birth in dusty village houses? Did they shake their heads at doctors who refused to be seen in the company of a nurse-midwife?

Perhaps they too trained younger nurses in back kitchens with little equipment in the hope that some young woman wouldn’t have to travel miles on unsafe roads just to give birth. I also wondered if black midwives from the past century were as vocal as the Afghan nurses of today about the lack of basic prenatal care available to women.

The students in our NRP course were excited to have a female nurse teaching the class. They were fascinated by my skin color and hair texture. “Is she from Africa?” they whispered amongst each other.

They were shocked that I would leave my children at home in America in the care of my husband to go work in a foreign country—something that would be unthinkable in their culture. “Why would any mother do this?” they wondered. They were disappointed that I had traveled to their country without my husband or brother but they were pleased that I was a married woman, a nurse with children who was educated and able to earn her own money.

At the end of the course, each nurse-midwife was provided with a copy of the NRP book, in English. They hoped that perhaps a doctor or local interpreters would translate the important pages we earmarked for them. As the women donned their burkas, they voiced excitement at the thought of practicing and sharing their new clinical skills. (And yes, they now know that there are black female nurses in America!)

I learned a great deal about bravery from the Afghan nurses. Today, as I travel back and forth across the world to do my job, I am grateful that I don’t have to be overly concerned about my personal safety. Above all, I am gratified that the classes Dr. Holland and I taught added a small amount of useful knowledge to midwifery clinical practice in Kandahar, Afghanistan. I believe this knowledge will help make a difference in improving the lives of women and children in this war-torn city.

CAPT Colleen Reid, BSN, RN, is a military nurse who currently works at the Landstuhl Army Regional Medical Center in Germany.

Navigating the Faculty Track

Navigating the Faculty Track

Harvey “Skip” Davis, RN, PhD, switched from full-time student to full-time nursing educator this year after completing his doctorate last summer. Then, he says, his education began in earnest.

“The transition has been daunting at times,” the San Francisco State University assistant professor admits. “The amount of actual work required between teaching, serving on committees and my research has been the biggest surprise. Teaching a class is actually the easiest thing I do.”

In addition, Davis is the only person of color on the nursing faculty and one of only two men.

That situation is all too common at many of the nation’s nursing schools, but it’s slowly beginning to change. Today, more and more academic institutions are aggressively seeking out racial, ethnic and gender minority nursing faculty, just as they’re trying equally hard to diversify their student populations.

For minority nurses who are just starting out as faculty members, getting on the right career path in academia requires navigational skills that Magellan would have envied. Should you choose a tenure- or non-tenure-track position? Would you be happier at a historically minority-serving institution? Will your college support your research efforts?

Completing a graduate degree is, of course, the first step toward getting on the faculty career track. After that, many different doors are open to you. Entering the right one is critical, not only for your professional advancement but also for your personal fulfillment. Just be sure to keep your expectations realistic.

Alone in a Crowd

Because nurses of color and male nurses are still extremely underrepresented in the ranks of nursing school faculty, many minority junior faculty starting out their careers at majority schools are likely to find themselves in a position similar to Davis’. While you would think that the enlightened, intellectual halls of academe would be free from prejudice and discrimination, the unfortunate reality is that this isn’t always the case. Davis knew this and he set out to find a university that would welcome him not only as a nurse educator but also as an African-American man. His first priority, however, was to become part of a high-quality educational institution, and SFSU’s reputation among area health care providers for graduating well-prepared nurses was the initial attraction. He looked at several schools, though, to make sure his gender wouldn’t hamper his career progress.

“Male faculty members need to ask questions to make sure you avoid [schools that aren’t welcoming to men],” he explains. “I’m pretty straight to the point. I ask if there’s a feminist philosophy. Do that and listen to the various responses you receive from members of a search committee. You’ll be able to figure out quickly if men are welcome.”

While it’s advice heard often, nursing education leaders recommend that minority faculty members who are victims of bias speak up and work within the institutional framework to address the issue. Begin with your supervisor or, if that’s not feasible, with the equal opportunity officer of the division or the college.

Minority professors looking for a completely prejudice-free campus, though, are unlikely to find it. “Sometimes you may feel that no matter how much you do, it’s never going to be enough to achieve the status of your non-minority colleagues. Just do the best you can do, give it 100% and then let it go,” advises Barbara Broome, RN, PhD, CNS, assistant dean and chair of community/mental health nursing at the University of South Alabama College of Nursing in Mobile. She is also president of the Association of Black Nursing Faculty.

The faculty lounge is not the only place on campus where minority professors may encounter insensitivity based on race or gender. Roxanne Struthers, RN, PhD, has the luxury of being one of three American Indian nursing faculty members at the University of Minnesota at Minneapolis. Still, she often faces an entirely Caucasian classroom.

“The student body is often very monocultural and that’s hard sometimes for faculty,” she says. “It’s important to know how to teach about [other cultures] and how to be proactive to help students understand. They’re not going to get it from their classmates.”

Struthers, an assistant professor in nursing and an adjunct professor in the university’s American Indian Studies department, encourages other minority faculty to take advantage of their captive audience and view it as an opportunity to educate majority students about minority cultures. One way to do that, she adds, is simply by making yourself available and listening to questions with a nonjudgmental attitude. “Encourage questions even though they may not be politically correct or may even seem uncomfortable or out of the ordinary.”

Struthers also refuses to let student attitudes influence her own. “One of the things I notice about students,” she says, “is that because I am a member of a minority group and they are not, they have a tendency to act as if I’m invisible. They go on and on talking about everything under the sun as though I’m not even there. It’s as though they think I’m not on their level. I just delve into class when that happens. I don’t say anything and I don’t let myself get frustrated.”

Historically Minority Schools: A Haven for Minority Faculty?

Teaching in a Historically Black College or University (HBCU), a Hispanic-Serving Institution (HSI) or a Tribal College or University (TCU) may seem like the perfect alternative for professors of color who want to avoid the potential for prejudice they might find at a majority school. But while choosing this option may increase your comfort level on campus, it doesn’t completely banish the specter of discrimination. Majority nurses are often unaware of the rich academic and social traditions of historically minority institutions and may incorrectly perceive those schools–and their faculty–as second-rate.

“There’s a misconception that because a school is historically black, there’s always an open admission policy or that students come here because they can’t make it in a majority institution,” says Alma Dixon, RN, EdD, MPH, dean of nursing at Bethune-Cookman College, a historically black college in Daytona Beach, Florida. “That’s simply not true.”

Most students, she argues, are drawn to HBCUs because of their academic excellence, the nurturing environment and the strong traditions. In fact, many students choose to attend them because of the positive experiences their parents had as students at historically black colleges.

“Certain sororities and fraternities are well-recognized within the black community and are only present on black campuses,” Dixon emphasizes. “People come here to share in that experience and tradition. That’s why I want my son to go to a historically black college.”

Teaching at a traditionally minority nursing school offers many rewards, but also presents its own unique challenges. Because these institutions are typically smaller schools, one of the biggest challenges, says Dixon, is staying financially sound. While no one becomes a nursing professor to get rich, faculty members and administrators at financially strapped universities often must stretch to make sure the budget can cover the entire semester.

“At a historically black college, you’re always mindful of money, “ Dixon explains. “You are always aware of what things cost. My colleagues at several state institutions are facing this now for the first time. You have to carefully weigh which conferences you’re going to attend. Traveling needs to be very cost effective, so that may mean two faculty members sharing a room or driving instead of flying.”

An indirect benefit of tight budget constraints is a constant focus on student retention. Dixon says that’s common to all private institutions, not just historically minority schools.

“In private institutions, you are always aware of how tuition translates into revenue,” she adds. “There’s a greater focus on retaining students and that creates a challenge in and of itself: keeping students while still maintaining your commitment to academic excellence.”

Getting the Right Fit

Teaching at a university that’s not a good fit for your interests and your style can be far more uncomfortable than wearing shoes that are a size too small. Dixon believes the most important thing to do when shopping around for a teaching position is to first do a thorough self-analysis.

“You have to know what you’re looking for and what your interests are,” she says. “Then, if you’re comparing different faculty positions, you need to know what the mission of the school is and how that plays out. Research may be stressed at one college, service at another.”

Most schools value a combination of teaching, research and service, but not necessarily in that order. You need to look at how your working hours will be allotted to determine which of those three will be most important.

“At our school, teaching is more important than service and research,” Dixon continues. “Here, you’re expected to have so many teaching hours and so many office hours. If you have a research project that’s going to take up three days every week, it would never work at this school because of the teaching and nurturing demands.”

Antonia Villarruel, RN, PhD, FAAN, associate professor and director of the Center for Health Promotion at the University of Michigan School of Nursing in Ann Arbor, says it’s important to make sure you know all the details about the school’s faculty evaluation system before walking into the classroom.
“I am fortunate to be at a place where being a director is not just an added responsibility. It’s considered part of my workload,” she comments. “That’s an indication of the school’s commitment to my research.”

Indeed, one of the reasons why Villarruel, a past president of the National Association of Hispanic Nurses, accepted the position at the University of Michigan is because the school allows her to grow in her specialty areas, which are preventing HIV infection in Latino youth and health promotion. “If a university tells you they value research and then gives you a very heavy teaching load, it’s going to be tough for you if you want to do research,” she says.
Dixon also advises beginning faculty to watch out for red flags that may signal hidden problems at the school. One example would be a low passing rate on the NCLEX-RNâ exam.

“This is a hard thing for us to talk about,” she says, “but you need to find out what the student success rate is. If the school is struggling with constant program reports to the board of nursing, that’s going to be an intense cloud hanging over the institution. I would want to know about problems like that before I signed on. At least going in I would know where the focus is. I would expect a lot of my energy to be consumed in making sure students pass that exam.”

Tenure: The Brass Ring?

Davis has just completed his first year in a track that will eventually lead him to tenure, that magical milestone sought and treasured by most faculty members.
“It’s a big rite of passage,” says Villarruel. “Every faculty member has a ‘tenure story’ to tell. The destination is the same but the journey is different. Everyone has encountered different roadblocks and figured out different paths.” She encourages minority faculty to share their stories as a way of learning from each other.

Most tenure tracks are seven years long. To reach tenure, professors are usually required to show excellence in the areas of teaching, scholarship and service to the university.

Teaching excellence can be measured in several different ways, the most common being the dreaded student evaluations. Some schools also evaluate faculty on the basis of student performance on standardized tests and use peer evaluations.

Scholarship means a track record in research and it is usually measured in two ways. First, faculty members are encouraged to bring grant money for research projects into the university. Second, they’re expected to publish their research results.

“Some people say that the research project isn’t finished until the articles are published,” says Villarruel. “You can have a wonderful project but if the world doesn’t know about it, it’s a moot exercise.”

Service can be measured in many ways and can mean different things at different institutions. “At some schools, it can be service to a professional organization,” Villarruel explains. “At others, it has to be service at the university. So it’s very important to know how you will be evaluated.”

While tenure is still highly valued, it has lost some of its glitter in recent years. Today, tenured professors no longer have reason to relax and stop worrying about having to prove themselves.

“In the past, tenure did bring a certain sense of job security and a certain amount of prestige,” says Villarruel. “Now, universities do post-tenure reviews and evaluations. You still have to do research and publish and continuing performing at the expected level.”

If the pressures associated with becoming tenured seem too stressful for you, or if you’d rather skip the research and service aspects of faculty positions, Broome suggests you consider a non-tenure track.

“Be aware of all the different roles and options that are available to you in academia,” she counsels. “Going into a non-tenured track allows you to focus only on teaching and clinicals.”

Broome does, however, caution new instructors to realize what they are giving up by not pursuing a tenure track. Non-tenure teaching tracks offer very limited, if any, research or publishing opportunities. Teaching loads will be very heavy, reducing time available to participate in other aspects of university life. Non-tenured faculty may also be paid less and be the last to be considered for professional development opportunities.

Aiming Higher

While many nurse educators thrive on daily classroom interaction with students, for others the classroom is just the beginning. A career in academia can offer minority nursing faculty many opportunities to advance into administrative and leadership roles, including department chair, dean, curriculum developer and education policy-maker.

“I love teaching, but I wanted to do more,” says Broome. While she has only been an assistant dean for a little over a year, she’s very pleased to have moved up to a position that allows her to have some influence on the future of nursing education.

“It’s good to be involved in helping to make changes that will benefit students,” she continues. “I also have the opportunity to be supportive of faculty and I am in a position to be an advocate for them.”

Broome advises junior faculty hoping to climb the academic career ladder to do so in small steps. One the most important breaks in her career came when she relocated to the University of South Alabama to assume a chair position.

Both Broome and Dixon credit previous clinical managerial positions with helping them develop the leadership skills needed to succeed in academia’s higher levels.

“Having a leadership position in a hospital gave me a clear view of the practicing environment of nursing, and I’ve never lost sight of it,” Dixon explains. “You do need a strong clinical experience [even in an academic setting].”

She also advises nursing faculty members to leave the security of the nursing department and venture out into other areas of the campus. For example, she says, get involved with university-wide faculty senates, seek out committee assignments that match your interests, and network with non-nursing faculty.
However, just as administrative experience and leadership skills can help you rise to a new role, making a few critical mistakes will block your path. One of the biggest “don’ts,” says Broome, is burning your bridges behind you.

“Nursing is a very small world,” she cautions, “especially when that world is narrowed down to minority faculty members. There are still so few of us that you will practically get to meet most of them during your career. Never forget where you came from. It’s been said that you meet the same people on the way down that you passed on the way up, and I think that’s true.”

Getting Along

In the business world, the process of fitting in with your employer’s company philosophy, goals and style is known as “navigating the corporate culture.” Similarly, every academic institution has its own personality and it’s the wise faculty member that learns its rules early. Perhaps even more important is learning how you function inside those rules, which are often unwritten.

Playing politics, though, can derail your career and your enjoyment of training future nurses.

“Don’t get caught up in things that may not pertain to you or in things you cannot control,” says Villarruel. “As a faculty member, you have enough on your mind.”

Broome advises junior faculty members to find other instructors with whom they can build networks of support. Alliances, after all, aren’t just limited to reality TV shows.

“Faculty circles do have cliques,” she says. “There are certain people you will be able to work well with regardless of color and you should seek those people out and form alliances to further your work.”

Still, if you are a racial or gender minority faculty member teaching at a majority school, it’s empowering to be able to network with colleagues who look like you. But since this is not always possible, all of the educators interviewed for this article stress the importance of becoming involved in minority nursing associations.

Davis encourages young faculty members not to overlook the opportunity to learn from nurses who are different from you. He says he’s grown and benefited from the support of many female nurses. “The reality is that this is a woman-dominated field,” he adds. “You will find many willing mentors who are women and have different things to offer. Just listen and take what you think will work for you.”

Photo by Phil Roeder

Passing With Flying Colors

Fact #1: Registered nurses comprise the largest portion of the health care work force in the United States.1 Fact #2: Of the nearly 2.7 million licensed RNs in this country, only 13% come from racial or ethnic minority backgrounds.2 Fact #3: Twenty-five percent of the total U.S. population—i.e., one out of four Americans—is non-Caucasian.3 Fact #4: Within the next 25 years, the ethnic and racial minority population of the U.S. is projected to increase at a faster rate than the nation’s Caucasian population.1,4

These statistics dramatically illustrate America’s urgent need to develop a more diverse nursing work force that is able to provide culturally and linguistically competent care to our increasingly multicultural population. This means not only increasing the number of minority nurses but also ensuring that nurses of all races and ethnicities are thoroughly prepared to care for patients from widely diverse backgrounds and cultures.

One place to start is by making sure that our nursing schools’ curricula truly reflect the cultural differences of our country’s wide spectrum of racial and ethnic populations. Although curricula may contain accurate cultural terminology, they often lack the qualities that enable students to understand different cultures and their health care needs. When revising curricula to incorporate a multicultural perspective, it is crucial to include in-depth information on cultural factors,6, 7 such as:

• environmental control (e.g., the practice of folk medicine or use of traditional healers) 8
• biological (physical and genetic) differences among cultural groups, which can include not only body build, skin color and hair texture, but also healing responses, susceptibility to disease and nutritional variations8
• social organizations, such as families, that shape an individual’s cultural development, beliefs and responses to major life events
• space and time orientation (e.g., some cultures are future-oriented and concerned with long-range planning while others focus on the present).

In addition, communication is an integral part of nursing practice. To communicate effectively with patients from diverse cultures, nurses must have knowledge of different languages, verbal and nonverbal behaviors, use of silence and attitudes about eye contact. They must understand not only what is communicated but also how it is communicated.

Evening Up the Score

While much has been written about incorporating cultural competency into nursing school curricula, one area that has received little attention is faculty-generated classroom testing. Because test scores play a significant role in student evaluations, it is important to utilize test questions that are as culturally unbiased as possible.

Educators must keep in mind that nursing students come from a diverse range of cultural backgrounds and may lack the necessary experience to perform well on tests if these cultural differences are not taken into account. In fact, a faculty’s failure to recognize the potential for bias in classroom testing can adversely affect minority students’ ability to succeed in the nursing program.

This inability to do well on tests is not due to lack of intelligence, but instead may result from a lack of necessary learned behaviors, or from differences in thinking patterns between cultures.9 For example, the Native American student has learned by stories, legends and role modeling.9 This nonlinear way of learning allows for more than one right answer,9 as opposed to the multiple-choice testing format customarily used in nursing schools. As a result, Indian students may have difficulty not only in learning but also in expressing their knowledge and understanding test questions.

Fortunately, most students are capable of learning test-taking skills if they are given the opportunity. It is the faculty’s responsibility to provide this opportunity—for example, by making tutoring available, within or outside of the nursing department, to help students identify and strengthen areas that need further development, such as writing, studying and time management. Providing these options for minority students does not mean lowering standards; rather, it means that mechanisms should be in place to enable faculty to refer students for additional help if it is needed.

A Culturally Sensitive Approach to Testing

What can nursing schools do to ensure that faculty-generated tests are not inadvertently biased against minority students? One solution is to use culturally sensitive standardized test questions. While these may be hard to find, one helpful resource is the National League for Nursing (, which is striving to make standardized tests culturally sensitive by reviewing them for potential bias. Another recommendation is to have culturally diverse groups of students and faculty evaluate potential test questions.

Within the larger context of providing a culturally sensitive learning experience for all nursing students, it is important to use clinically focused scenarios and class exercises that relate to multicultural issues, and to select textbooks, journal articles and reference materials that reflect cultural diversity. The following texts are recommended for their culturally diverse content:

• Spector, R.E. (1996). Cultural Diversity in Health and Illness (4th edition). Stamford, Conn.: Appleton & Lange.
• Kelly, M.L. & Fitzsimons, V.M. (2000). Understanding Cultural Diversity: Culture, Curriculum, and Community in Nursing. Sudbury, Mass.: Jones & Bartlett.
• Bennett, C.I. (1999). Multicultural Education: Theory and Practice (4th edition). Boston: Allyn & Bacon.

Finally, inviting culturally diverse guest speakers to discuss culture-specific behaviors and customs can be excellent way to help both students and faculty broaden their understanding of cultural differences.


1. Moses, E.B. (1992, March). Nursing Facts: From the American Nurses Association.

2. U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, Division of Nursing (2000, March). Preliminary Findings, National Sample Survey of Registered Nurses.

3. U.S. Census Bureau (2001, March). Census 2000 Brief: Overview of Race and Hispanic Origin.

4. U.S. Census Bureau (1995, August). Selected Social and Economic Characteristics for the 25 Largest American Indian Tribes: 1990.

5. U.S. Census Bureau (1997, October 31). Facts for Native American Month (November 1-30).

6. McCarthy, M. (1996). “Travelers From Many Lands: The Impact of Culture.” In Carson, V.B. & Arnold, E.N. (Eds.), Mental Health Nursing: The Nurse-Patient Journey (1st edition). Philadelphia: W.B. Saunders.

7. Strasser, J., Maurer, F.A., & Kavanagh, K.H. (1995). “The Relevance of Culture and Values for Community Health Nursing” (ibid.)

8. Spector, R.E. (1996). Cultural Diversity in Health and Illness (4th edition). Stamford, CT: Appleton & Lang.

9. Crow, K. (1993). “Multiculturalism and Pluralistic Thought in Nursing Education: Native American Worldview and the Nursing Academic Worldviews.” Journal of Nursing Education.

Minority Nurse Educators in Cyberspace: A Progress Report

Minority Nurse Educators in Cyberspace: A Progress Report

While many nursing schools around the country have successfully increased their enrollments as well as the racial and ethnic diversity of their student populations, there continues to be a severe shortage of nursing faculty–and especially minority faculty. According to the American Association of Colleges of Nursing (2005), fewer than 10% of the nation’s nursing educators are people of color.

To address this urgent need for more culturally diverse nursing faculty, the School of Nursing at Thomas Edison State College, an online college based in Trenton, N.J., received a $600,000 grant from the Health Resources and Services Administration (HRSA) to establish the Minority Nurse Educator program. Now entering its third year, the program provides experienced minority nursing faculty with the opportunity to enhance their skills and expand their expertise by preparing them for online teaching. With minority nursing educators in such short supply, training them to teach in distance learning programs will help make this scarce resource available to greater numbers of students than ever before.

Participants complete a 32-week Certificate in Distance Education Program (CDEP), then teach a 12-week online nursing course at Thomas Edison State College, under the guidance of an experienced mentor from the School of Nursing. Upon completion of the program, the minority faculty are ready to use their new distance teaching skills to introduce and expand online education programs at their own local institutions and across the nation.

Establishing the Need

In 2001-2002, Thomas Edison State College implemented its online RN-to-BSN program. Demographic data from the student population indicated that 25% of the students were racial and ethnic minorities. At that time, the program was open only to New Jersey residents. (It has been offered nationally since 2004.) The percentage of minority nurses in New Jersey at this time was 23%, which indicated that minority students were well represented at the School of Nursing.

Because of the high percentage of students of color in the program, we wanted to attract a similar percentage of minority faculty who could serve as mentors and role models. Our outreach efforts consisted of professional calls to minority nurses known to the dean, calls to several historically black nursing programs and requests for referrals from personal contacts. In the early days of the program, when the number of students enrolled was fewer than 250, these recruitment methods were sufficient. However, as enrollment grew, we found it increasingly difficult to maintain a similar minority mentor-to-student ratio using only these three methods.

Thomas Edison State College was already training nurse educators in online pedagogy, so it occurred to the dean that the same training could be offered to minority nursing faculty recruited as mentors for the online RN-to-BSN program. The idea for the grant was born. Once they became certified in distance education, the minority educators could be utilized not only by Thomas Edison State College but by any nursing program in the nation with online capability, regardless of geographical location. In addition, we felt that this could be a potential way to address the faculty retirement brain drain by enabling minority nurse educators to extend their tenure in the profession past the traditional retirement age.

To invite experienced minority nurse educators to participate in the CDEP, the School of Nursing used several recruiting strategies, including announcements in the nursing media, one-on-one recruitment at major national minority nursing association conferences, and advertisements in national and local newspapers and Web sites. In the first year, 19 educators were accepted into the program, with a 75% completion rate. For this first group of participants, the mentored online teaching experience is now in progress and will continue throughout this year.

A Growing Diversity

Summer 2007.Summer 2007

Of the 15 first-year participants who completed the CDEP, 67% are African American, 13% are Asian, 13% are Hispanic and 7% are American Indian (see Figure 1). Seventy-five percent of these nurse educators hold a master’s degree in nursing and 25% hold doctoral degrees (see Figure 2). The doctorally prepared candidates are from the African American and American Indian ethnic groups.

Geographically, our first-year grant participants come from many different parts of the country, including Georgia, Florida, New Jersey, New York, Missouri, Oregon, Pennsylvania, South Carolina, Tennessee and Virginia. The majority are from the East Coast (see Figure 3).

As the program became more widely known, we received many additional inquiries and applications. The second-year cohort of grant participants consists of 42% master’s-prepared nurse educators and 58% who are doctorally prepared. The geographic range has expanded as well, with new participants from Alabama, California, Indiana, North Carolina, North Dakota, Oklahoma and Texas.

We are currently constructing a database of grant participants who have completed the CDEP through the Minority Nurse Educator program. Information from this database will be shared upon request with schools of nursing across the United States who are interested in utilizing experienced minority online educators to increase their faculty diversity.

To promote collaboration and yearly networking, the HRSA grant has also enabled Thomas Edison State College to establish an annual Distinguished Lectureship on Cultural Diversity, which is hosted by the School of Nursing every fall. The first annual event, held last October 11, included speakers such as Kem Louie, PhD, RN, FAAN, past president of the Asian American/Pacific Islander Nurses Association, and Hilda Richards, EdD, RN, FAAN, past president of the National Black Nurses Association. Information about the 2007 lectureship will be available in local and national nursing publications and on our Web site at

In summary, the Minority Nurse Educator program has proven to be successful. Nursing educators from across the country have demonstrated support for the concept of sharing minority nursing faculty in cyberspace to increase diversity in the nursing profession. The program has drawn highly talented minority nursing educators from a wide range of ethnic backgrounds and geographical locations, and the number of educators who have expressed interest in participating has increased. As of this writing, some of our grant participants are already applying what they have learned in the CDEP course, and the feedback from the grant participants in general has been very positive (see sidebar).

Experienced Educators Invited

The third-year cohort of grant participants in the Minority Nurse Educator program will begin their CDEP courses this summer and fall. If you are an experienced nurse educator of color who is interested in expanding your skills into online teaching and course development, Thomas Edison State College School of Nursing would like to hear from you.

We are looking for candidates with at least two years experience teaching in a baccalaureate nursing program or equivalent. A minimum of a master’s degree in nursing is required; a doctorate in an appropriate field is preferred. Please send a CV to [email protected].


Funding for the Minority Nurse Educator program and annual Distinguished Lectureship was made possible (in part) by grant award # DIIHP05199 from the Health Resources and Services Administration. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the U.S. Department of Health and Human Services or the Health Resources and Services Administration, nor does mention of trade names, commercial practices or organizations imply endorsement by the U.S. government.