Jan Pflugfelder, RN, MS, knows what it takes for Native American students to succeed in nursing school: sheer determination plus culturally sensitive support from faculty and administrators who serve as mentors, cheerleaders, sympathetic ears—and sometimes even baby-sitters.
Pflugfelder, a doctoral student at Loyola University School of Nursing in Chicago, supplies all these things and more as director of the American Indian Students United for Nursing (ASUN) program at Arizona State University in Tempe. ASUN is a federally funded program designed to recruit and retain Native American students into the university’s nursing school by providing them with financial assistance and mentoring. It receives some of its funds from the Indian Health Service (IHS).
A number of other colleges and universities throughout the United States offer similar support programs for Indian students, under a variety of different names (see “A Master Plan for Mentoring”). Although many of these programs are new, they are already starting to make an impact in increasing the number of Native American nurses in this country—a population that has been drastically underrepresented in the profession.
One study conducted in 2000 showed that only 0.3% of all registered nurses in the U.S. were Indian, a percentage that hasn’t changed in 10 years. Similarly, the federal government’s most recent National Sample Survey of Registered Nurses (March 2000) indicates that only 0.5% of the RN population is American Indian/Alaskan Native, a figure that remains unchanged since the previous survey in 1996.
So critical is the need for Native American nurses who can provide culturally competent patient care in Indian communities that the National Indian Nursing Education Conference devoted its 10th annual gathering to this issue. Held in March 2000, the conference was co-sponsored by the Nursing Division of the IHS and the University of South Florida (USF) College of Nursing’s Recruitment and Retention of Native Americans in Nursing program, which is part of the Center for Native American Nursing Studies at the USF’s Tampa campus. “Our job is monumental,” says Joan Gregory, PhD, a member of the Lower Muskogee Creek tribe and director of the 21/2-year-old center.
As a group, Indians tend to be isolated from the rest of society, whether they’re living on a reservation or in an urban area. Many exist at or below poverty level and often they are undereducated. Therefore, directors of nursing schools say, many Native American young people find it hard to imagine themselves having successful careers.
Those who do succeed in nursing are often drawn into their careers by dedicated mentors. Many of these mentors are themselves Native Americans who have returned to their communities to help where the need is greatest. Indeed, nursing schools around the country—from large universities to small tribal colleges—are discovering that Indian nurses mentoring other Indian nurses is crucial to both attracting and retaining Native American students.
Whatever It Takes
Once Indian students enroll in a nursing school program that’s especially geared to their needs, they begin to see what value they can have as trained professionals, Pflugfelder emphasizes. That’s why she and her counterparts at other schools immerse themselves in their mentoring roles, doing whatever it takes to guide Indian students through their educational training and into successful nursing careers.
At Oglala Lakota College, a tribal college in Pine Ridge, S.D., this means arranging for Indian nursing students to be mentored by faculty in the Native American Scientist Program at South Dakota State University (SDSU)’s College of Nursing in Brookings.
“Our students collect data on chosen populations, which teaches them how to do research,” explains Margaret Hart, RN, director of Oglala Lakota’s nursing program. “They receive college credit and a stipend, which is very helpful because these students don’t have much money,” adds Hart, who is a doctoral student in nursing at Barry University in Miami.
The Oglala Lakota nursing students get an additional perk, according to Roberta K. Olson, RN, PhD, dean of the SDSU College of Nursing. “After being in the scientist program and graduating from Oglala Lakota,” she says, “they’re in a good position to enroll in an upward mobility program in nursing at our university.”
But to get students to that point often means “being willing to do things that a typical academic administrator wouldn’t do,” says Pflugfelder. For example, she maintains an open-door policy that permits her 45 students, most of whom are Navajo, to contact her by phone any time of the day or night—and they often do. Many of them are parents and may suddenly find themselves in need of someone to take care of their children while they take an exam.
“We tell them to bring the baby in [to our office] or we go to their home,” notes Pflugfelder, who collaborates with a social worker. “We get to know the students’ families. We’re like family to them, like a respected aunt or grandmother.
“I’ve learned that first-year students particularly need someone who’s sensitive to their needs,” she continues. “It can be really overwhelming for them to adjust to city life, not knowing anyone and taking challenging classes.”
Pflugfelder and her team do a lot of what she terms intrusive monitoring. “We have students sign an agreement stipulating that we can contact any faculty member to help a student in need, whether it’s a problem with paying the rent or receiving a low test score. We don’t wait until they’re put on academic probation. We do early intervention—aggressive advisement—which allows us to jump right in there at the first sign that a student is having difficulty.”
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In what may seem a time-consuming procedure, Pflugfelder keeps track of every phone call and visit from each Indian nursing student to make sure the students are staying in regular contact with her and her staff.
“If they don’t come in to see us enough, that’s a red flag,” she comments. “So we go to their home and ask, ‘What’s going on? Is there a problem?’” Fortunately, Pflugfelder doesn’t have to travel far. Most of the ASUN students, who on average are older than other students and have at least two children, live on campus. Their kids all go to the same school, so they can network for child care. They get to know each other through regular meetings and in the classroom, where Pflugfelder makes sure that there are at least two Indian students in every class.
To encourage camaraderie among the ASUN students, Pflugfelder helps organize an annual traditional Indian potluck meal, attended by faculty, staff, students and friends. When the students receive their nursing degrees at the end of the school year, Pflugfelder hires a drum group or singer to perform a special honor song.
These grads have accomplished no small feat, Pflugfelder points out. “Nobody gets into this program unless he or she meets the requirements. And our expectations are high.”
Traditional Beliefs, Modern Technology
Beverly Patchell, RN, CNS, project director of the American Indian Nursing Student Success Program at the University of Oklahoma in Oklahoma City, turns to traditional Indian rituals to help her students through the school’s challenging nursing curriculum.
“I might try to set up a ceremony as they come in [to the program] that will spiritually empower them to do the things necessary to succeed in nursing school,” says Patchell, who is of Cherokee and Creek origin. In her private practice, she helps Native American students reduce stress in a way they’re familiar with—by using flower and gem essences to improve energy fields in the body.
“While Western medicine takes a mechanistic view of the body—i.e., that everything’s going to break down over time—Indians take a synergistic approach,” she explains. “We include animals, plants and stars, all the energies of the universe. We look at the unseen, such as the spirit, to create healing.”
Patchell also offers a class called “Tribal Pathways to Health and Healing,” which focuses on the customs and cultures of the eight or so tribes represented at the nursing school. It is designed to help the students learn about each other’s traditions so they feel more connected.
Several nursing schools that offer mentoring programs for Indian students use a student retention model invented by Jan Pflugfelder. Appropriately, her model is represented by the medicine wheel, which Native Americans use to symbolize the circle of life. Each of the wheel’s four directions—north, south, east and west—correlates with the four elements of life: spiritual, emotional, mental and physical. Superimposed on the wheel is a dream catcher, an Indian symbol representing the complexities of life. “Everything is circular, non-linear, in the Indian tradition,” Pflugfelder says.
“All our activities revolve around the medicine wheel,” agrees Jacque Dolberry, RN, MS, director of the nursing department at Salish Kootenai College, a tribal school serving the Flathead Reservation in Pablo, Montana. The college’s nursing students receive assistance from a federally funded program called Pathways to Indian Nursing Education (PINE).
“Whatever we do [in the PINE program] becomes cultural,” states Dolberry. “Our events open with prayers, and our whole curriculum looks at the differences between modern culture and traditional American Indian beliefs.”
In the first quarter of the academic year, Dolberry takes students to a culture center to learn about hide tanning and stick games such as shinny, which is like soccer. PINE students come from 23 tribes in 12 states, “so we try to introduce them to the practices of different tribes,” she says.
Much of the learning at Salish Kootenai’s school of nursing is interactive, because “Indians like to learn through hands-on activities,” Dolberry adds. “We like to know the big picture, rather than just details presented in a classroom setting.” Because it is a custom in many tribes to avoid looking someone directly in the eye as a show of respect, hands-on learning also makes it easier to adapt to Indian students’ style of communication. Dolberry credits this interactive approach with boosting the nursing program’s student retention rate to about 75%.
In the PINE program, even the mentoring process reflects the circle-of-life concept. Dolberry trains Indian nursing students who have completed their first year to be peer mentors to incoming students. These student mentors also visit local middle schools, she says, to “help plant the seed [of nursing as a career choice] and show young people how to develop a healthy lifestyle.”
At the University of South Florida, which draws Native American nursing students from rural areas, Gregory offers courses through the Internet and on video to make it easier for students to stay in the program. She also formed a support group for Native American students called E-ma-ni-cep, which means “caring” in Creek.
Remarkable Results
High visibility in the Indian community is crucial to maintaining a steady stream of Indian students in a nursing program, according to Barbara Dahlen, RN, MS, FNP. A member of the Turtle Mountain Chippewa tribe, Dahlen is assistant coordinator of the Recruitment/Retention of American Indians in Nursing (RAIN) program at the University of North Dakota (UND) College of Nursing in Grand Forks, where she obtained her degrees.
Dahlen and her staff spend much of their time visiting and advising at tribal colleges, so that graduates of these schools can make an easier transition to nursing programs at universities like UND. “Community colleges play a key role in our success,” she says.
Dahlen, who attended a mission school as a child, feels that coming from the same background as the students she’s trying to recruit is a plus, both for her and for potential students: “[Seeing what I’ve achieved] makes them feel that they can be successful, too.”
After applying for and receiving federal funding to start RAIN, she held out for an Indian support staff and worked hard to enlist the whole-hearted support of the university’s administrators. “Everyone has to buy into the program to make it a success,” she maintains.
As of May 2001, UND’s nursing program has graduated 113 Native Americans—96 in the bachelor’s program and 17 in the master’s program.
“That’s significant,” Dahlen emphasizes, “because prior to 1994, there were no Indians with master’s degrees in nursing. We also have a 93% student retention rate; generally, 60% to 70% is considered good. Our board rate is also high: 90% of our RAIN students pass the licensing exam on their first try. That’s extremely significant. You don’t see results like that at a lot of other programs that target minority students.”
The most lasting proof of these mentoring programs’ success is that their graduates snare good nursing jobs, often in the Native American communities from which they came. And they continue to stay in touch with the nurses who mentored them through their nursing education.
“They never leave us,” one director of nursing explains. In this case, that’s a very good sign.
A Master Plan for Mentoring
By Pam Chwedyk
All of the mentoring programs for American Indian nursing students mentioned in this article are part of a larger umbrella program called Native American Nursing: Caring for Our Own. This project is sponsored by the Midwest Alliance In Nursing Initiative (MAIN), an organization formed in 1980 by a group of nurses from academic and service settings to collaborate on mutual nursing interests.
Funded by a grant from the federal Health Resources and Services Administration (HRSA)’s Division of Nursing, Caring for Our Own is designed specifically to prepare Native American nurses to care for Native American people. Its goal is to help Indian students complete degrees in nursing by assisting them academically and (to a limited extent) financially, with a strong emphasis on mentoring.
The project currently consists of nine nursing school “support programs,” each of which is funded by the Indian Health Service and custom-tailored to the needs of the particular school’s students. The participating schools are:
* Arizona State University, College of Nursing (Tempe, Ariz.)—American Indian Students United for Nursing project (ASUN) * Oglala Lakota College, Nursing Department (Pine Ridge, S.D.) * Salish Kootenai College, Nursing Department (Pablo, Mont.)—PINE program (Pathways to Indian Nursing Education) * Sisseton Wahpeton Community College, Nursing Department (Sisseton, S.D.) * State University of New York at Buffalo—Family Nurse Practitioner Program * University of North Dakota, College of Nursing (Grand Forks, N.D.)—RAIN program (Recruitment/ Retention of American Indians Into Nursing) * University of Oklahoma, College of Nursing (Oklahoma City, Okla.)—American Indian Nursing Student Success Program * University of South Florida, College of Nursing (Tampa)—Recruitment and Retention of Native Americans in Nursing program * University of Wisconsin at Eau Claire, College of Nursing.
On a national level, the National Alaska Native/American Indian Nurses Association (NAN/AINA) is very actively involved with the Caring for Our Own project. In addition, NAN/AINA is in the process of forming a student chapter within the association, which will be headed by Mechem Slim, a nursing student at Georgetown University in Washington, D.C. One of Slim’s goals for the new student membership section is to produce a national newsletter, written by and for Native American nursing students.
For more information about Native American Nursing: Caring for Our Own, contact: Roberta K. Olson, RN, PhD, Project Director, South Dakota State University College of Nursing, Box 2275, Brookings, SD 57007-0098, (888) 216-9806, [email protected]. Or contact the National Alaska Native/American Indian Nurses Association at (888) 566-8773.
Most colleges and universities have strategic plans that articulate goals to strengthen faculty search procedures to increase the diversity of their staff. While such goals are important, they have come under attack in the past, even needing legal support. For example, Justice Sandra Day O’Conner in her Supreme Court majority opinion clearly communicated that the skills needed in today’s global market can only be developed by exposing students to “widely diverse people, cultures, ideas, and viewpoints.”1 The Association of American Universities has long communicated that diversity experiences not only enhance the education quality and outcomes of students from underrepresented populations, but of all students.2
The Sullivan Commission on Diversity in the Healthcare Workforce articulated that the health professions of the United States have not kept pace with changing demographics and may be more directly related to disparities in health access, status, and outcomes than the overall lack of health insurance. With minority populations projected to become the majority by 2050, health disparities may continue to worsen if health care professionals do not become more reflective of the populations they serve.3 The diversity challenge is even greater in the academic settings that educate undergraduate and graduate nurses. The American Association of Colleges of Nursing reported that less than 10% of faculty in baccalaureate and graduate nursing programs are from underrepresented groups, with 5.6% African Americans, 1.5% Hispanics, 1.9% Asian, and less than 1% American Indian/Alaskan Native documented.4
The lack of minority nurse educators communicates to students and communities of color that the profession does not value diversity. Lacking mentors and role models to support and enhance their education, students from underrepresented populations may not recognize the professional opportunities that exist for faculty in higher education, and the academic leadership that is needed from a diverse nursing workforce to eliminate health disparities in the 21st century.
The growing multicultural world that all student nurses enter requires exposure to a diverse faculty who bring varying research perspectives, pedagogy, and life experiences to the classroom, the laboratory, health systems, and the surrounding community. A critical need exists to create, implement, and evaluate blueprints for action that will attract, retain, support, and promote the leadership and success of faculty from underrepresented populations in schools of nursing. Action steps to be considered in blueprints should strive to:
Increase the applicant/pipeline pool of diverse faculty candidates from underrepresented populations
Promote a climate of diversity
Market for diversity
Prepare search committees to review diverse candidates
Retain diverse faculty
Increase the applicant pool
U.S. colleges and universities are educating a larger and more diverse group of students than ever before. According to the Educational Testing Service, student diversity will increasingly evolve over the next decade, with 80% of the anticipated 2.6 million new college students from underrepresented populations, including African Americans, Hispanics, Asian/Pacific Islanders, or American Indians. Undergraduate minority students enrolled in colleges and universities will increase from 29.4%–37.2%.5,6 Most recently, the report on the future of nursing acknowledged the need to respond to the under-representation of racial and ethnic minority groups, including men, in the nursing workforce.7
While a steady increase in the minority university student population has occurred, similar diversification among university faculty has not happened.8 Faculty diversification not only attracts diverse students, thus increasing the applicant pool and supporting academic program growth, but it also contributes directly to the quality of student education. Diverse faculty expose students to a wider range of scholarly perspectives and ideas that build on a variety of life experiences, create intellectual stimulation with new research questions, and foster fresh perspectives in the academic enterprise. Diversification is also the right action, not only from a social justice perspective, but based on business.9 The corporate world has long accepted a mandate that they must expand markets to serve diverse communities to survive in a competitive environment.
Action steps
A number of changes are needed to increase the applicant pool, such as developing partnerships with minority-serving institutions and establishing alumni directories of doctorally prepared minority graduates for consideration in post-doctoral or visiting scholar appointments. This action will promote scholarship and research of mutual interest to the scholar, the school, and the community.
Metrics should include memorandums of understanding with individual colleges or universities with results measured by the number of candidates identified from partnering institutions for recommendation to search committees. To assure the success of these partnerships with minority-serving institutions, ambassador programs could be developed by assigning faculty members to communicate and represent their respective schools of nursing at designated partner institutions.
Faculty who teach at these institutions could be invited to do a presentation and talk about promising students for post-doctoral consideration through a faculty exchange initiative. Schools of nursing must set aside resources to support minority scholars in residence as well. Finally, an academic faculty network should be considered so introductions can be made through the network to administrators from underrepresented populations at member institutions.
Promote a climate of diversity
While organizational climate has a range of definitions, Baird suggests common descriptors include friendliness, hostility, or acceptance.10 Organizational climate includes the current attitudes, behaviors, and standards/practices that concern the access to, inclusion of, and level of respect for individual and group needs, abilities, and potential. This definition includes all groups, not just those who have been traditionally excluded or underserved by colleges and universities.5
If a school of nursing is to succeed in terms of the retention and recruitment of faculty of color, it must embrace diversity. Turner and Myers report that faculty of color leave for many reasons, including hostile environments—a major factor discouraging potential applicants.6 In contrast, a school of nursing that provides an environment that supports the success of diverse faculty is attractive and facilitates recruitment and retention. Research has shown that endorsement from leaders provides credibility for such programs.11 It’s important that administrative support is reflected by publicly rewarding departments, divisions, and units who demonstrate measurable improvement. Support from the top and rewards for increasing diversity have been shown to be the two key factors that determine the success of diversity programs.12
Action Steps
Fostering assessment and accountability must begin with a faculty diversity climate survey and should include an exit survey for those that leave. Faculty surveys should include both quantitative and qualitative data that measures the diversity climate within the school of nursing. Results should be reported through school departments and discussed in faculty meetings with recommendations to the faculty at large, as well as search committees, specifically.
Activities that promote a supportive climate should be identified through departments and the faculty panel discussion. The PBS film Shattering the Silences: Minority Professors Break Into the Ivory Tower could be shown at department meetings, followed by faculty discussions led by a diversity expert. A panel discussion focused on faculty diversity should be a yearly faculty event. It is also recommended that faculty who have led and created activities that support a climate of diversity receive merit recognition from those administrators held accountable for achieving faculty diversity in their departments.
Resources should be established to conduct climate surveys and maintain an office of diversity to assure that planning, implementation, and evaluation occur. Ideally, a faculty leader who is also a member of the dean’s leadership team would coordinate these activities. This nurse faculty leader should provide a vision and structure for faculty initiatives that will not only support the inclusive climate needed for recruitment, retention, and promotion of diverse underrepresented faculty but that will involve the entire school in a program that sets achievable and measurable goals with a business plan.
As research is needed to investigate diversity, equity, and climate beyond race and ethnicity to include differentials in power and privilege, external research support through federal, foundational, and private grant mechanism should be explored. The diversity office should address the need to continue to support and develop academic programs that focus on issues of diversity, underserved populations, and societal disparities, which will attract diverse faculty and scholars. Pilot research on faculty climate could also be supported through these mechanisms; then a larger study could be launched with funds sought through the National Institute of General Medical Science, an NIH program.
Marketing for diversity
Communicating a school’s commitment to diversity, whether through conferences, national meetings, publications, posters, brochures, and/or official websites, ensures the transparency of the school’s diversity recruitment goals. Business research shows diversity marketing reduces turnover costs and inspires a desire to be part of a dynamic and responsive team. It also helps institutions win the competition for talent by attracting, retaining, and promoting faculty and leadership from underrepresented populations. Organizations cited as the best places for employment by diverse underrepresented groups also experience an increase in applications.13 Furthermore, research has shown endorsement from the organization’s leadership brings credibility to diversity programs and influences attitude change.11
Sullivan (2007) underlined the critical role academic leaders play in successful diversity programs. These leaders must create a culture within their academic units that supports the implementation of a strategic plan—one that establishes goals, defines success, and fosters accountability, best practices, and financial resources.14
Action steps
Schools of nursing can maintain a diversity website that links to the school’s departmental sites. This site must communicate that diversity in the organization is critical to the recruitment of faculty from underrepresented groups. It should also showcase the successes of faculty from underrepresented populations in research, teaching a diverse student body, collaborating with university faculty and diverse communities, and scholarly achievements.
An interactive school of nursing Facebook page reflecting the diversity of the school’s leadership team, faculty, and students is also needed for effective marketing. It should be updated on a regular basis and evaluated by the number of hits and links made by browsers. A member of the school’s leadership team should be designated to work with appropriate media resources to maintain and update an interactive website that showcases the school’s successful recruitment, retention, and promotion of diversity.
Strengthen the search committee’s success
Nationally, hundreds of campuses are engaged in competitive efforts to diversify their faculties in response to external and internal pressures. Yet, according to Caroline Sotello Viernes Turner, in her book Diversifying the Faculty: A Guidebook for Search Committees, five prevalent myths have hindered the hiring process of ethnically, racially, and gender underrepresented diverse faculty.15
Good minority faculty only go to the best universities.
To hire minorities, standards must be lowered.
Minorities prefer the private sector.
Espousing equal opportunity doctrine is sufficient.
Minorities will not go to predominantly white institutions.
Research published in the Journal of Higher Education in 2004 showed that among institutions with predominantly white populations, the hiring of faculty from underrepresented groups occurs when at least one of the following three conditions are met. First, the job description explicitly engages diversity at the department level. Second, an institutional “special hire” strategy is used, such as waiver of a search, target of opportunity hire, or spousal hire. Third, the search is conducted by an ethnically/racially diverse search committee.16 Search committees often approach their charge in a passive, routine way (i.e., advertise the position in publications, evaluate résumés, invite three to five candidates for campus interviews, and then make an offer).
To address the need to recruit faculty from underrepresented racial/ethnic or gender diverse populations in a school of nursing, the search committee must take a more proactive approach to finding candidates from such populations. All steps taken during the search process can contribute to a solid foundation for the successful retention of diverse faculty hired as well as ongoing successful recruitment into the future.
Viernes Turner writes that schools of nursing should focus on eight action steps to form successful hiring committees:15
Diversify the search committee itself.
Educate the search committee on personnel issues and prepare the members through an annual retreat.
Debunk the myths listed above.
Create tailored position descriptions.
Attract diverse candidate pools.
Examine hiring biases.
Host campus visits
Make the offer.
The campus visit is also a critical moment of opportunity that allows the candidate to make a well-informed decision on whether the position and the school of nursing is a right fit. Evaluation forms should be provided to all campus parties involved in the visit and discussed by the committee. Asking the candidate to comment on the process will also provide the school’s search committee with information to improve the process for subsequent campus visits. It is important to not only evaluate the candidate, but also the search committee process, in order to improve the chances of reaching the desired outcome.
Action Steps
First, assuring that the composition of the search committee has different points of view is critical to its success. Members who represent diverse populations must be appointed.
Next, preparing the committee through a yearly retreat that addresses unconscious hiring bias and debunking of myths must be used in conjunction with current university guidelines to prepare new members and refresh returning members for the year’s goals. An annual search committee evaluation plan should be implemented to review the effectiveness of the diversity recruitment process. Metrics should include a percentage increase of the diversity applications and a percentage increase in hires.
Departments then need to conduct their own hiring patterns audit, examining the tenure track and associated clinical and research faculty patterns. At the annual evaluation discussion of department recruitment needs, a diversity recruitment plan must be developed and sent to the search committee prior at the beginning of the academic year.
Finally, a departmental diversity awards program will need to be established to acknowledge excellence in diversity recruitment and support of a climate of diversity that recruits and retains racially/ethnically and gender diverse faculty.
Retain a diverse faculty
The most successful universities have both a strong commitment and action plans that support faculty diversity.17 An important and overlooked strategy to retain professors from underrepresented populations is to create a critical mass to prevent feelings of isolation and alienation that result in leaving.15
Action steps
Mentorship programs should be established that help guide diverse faculty through promotions and tenure tracks. These programs should be advertised on school of nursing websites and shared with potential candidates. Diverse faculty should also be mentored in their achievement of awards that recognize excellence in research and teaching. Finally, ongoing mentorship will be needed to develop the leadership potential of diverse faculty, with recognition given for such leadership.
Resources must be designated to support family policies as needed by candidates; these should be marketed through the search committee process and the website. Funds will be needed for startup packages that will support pilot work and presentations of scientific findings at national or international meetings. Support may be needed for the development of untenured new faculty hires as well. Finally, exit interviews should be considered for tenured and untenured diverse faculty at departure to explore reasons for leaving the university.
Using a blueprint to transform an institution to reflect a pluralistic society requires the collective evaluation of attitudes, the behaviors they generate, and the unconscious bias that shape faculty actions.18 Critical to this process is a vigilant and widespread diversity campaign that promotes individual ownership of the blueprint for change and is advocated and supported by both the faculty and school leadership.
A need exists for schools of nursing to showcase a vision and strategy for recruitment, retention, and promotion of a faculty that reflects the diversity of the United States and the world whose health they plan to promote. And as Benjamin Franklin once said, “By failing to prepare, you are preparing to fail.”
References
Barbara Grutter v. Lee Bollinger, et al. 124 U.S. 35 (2003).
Association of American Universities (1997, April 24). “On the Importance of Diversity in University Admissions.” The New York Times, p. 27.
Sullivan, Louis W. (2004). Missing Persons: Minorities in the Health Professions, A Report of the Sullivan Commission on Diversity in the Health Care Workforce. Sullivan Commission, p. 66
Berlin, L., E., Stennett, J., and Bednash, G.D. (2004). 2003–2004 Salaries of Instructional and Administrative Nursing Faculty in Baccalaureate and Graduate Programs in Nursing. American Association of Colleges of Nursing.
Rankin, S. & Reason, R. (2008). “Transformational Tapestry Model: A comprehensive approach to transforming campus climate,” Journal of Diversity in Higher Education, 1:4, 262–274.
Turner, C., S.V. & Myers, S.L. (2000). Faculty of Color in Academe: Bittersweet Success.
Institute of Medicine (2010). The Future of Nursing: Leading Change, Advancing Health.
Sullivan, C.W., & Bristow, L.R. (2007). “Summary Proceedings of the National Leadership Symposium on Increasing Diversity in the Health Professions.” Sullivan Alliance, 1–12.
Correll, S. J. & Benard, S. (2006). “Biased Estimators? Comparing Status and Statistical Theories of Gender Discrimination.” Social Psychology of the Workplace (Advances in Group Processes, Shane R. Thye and Edward J. Lawler eds.) Vol. 23, 89–116.
Baird, L. L. (2005) College Environments and Climates: Assessments and Their Theoretical Assumptions. In J.C. Smart (ed.), Higher Education: Handbook of Theory and Research, Vol. 20, 507–538.
Fiske, S. & Taylor, S.E. (1999). Social Cognition, 2nd edition.
Rynes, S. & Rosen, B. (1995). “A Field Survey of Factors Affecting Adopting and Perceived Success of Diversity Training.” Personnel Psychology, Vol. 48, 247–270.
Robinson, G., & Dechant, K. (2007). “Building a Business Case for Diversity.” Academy of ManagementPerspectives, 11:3, 21–31.
Siantz, de Leon, M.L (May – June 2008). “Leading Change in Diversity and Cultural Competence.” Journal of Professional Nursing, 24:3, 167–171.
Viernes Turner, C.S. (2002). Diversifying the Faculty: A Guidebook for Search Committees, Association of American Colleges and Universities.
Smith , D.G., Turner, C.S., Osei-Kofi, N., Richards, S. (2004). “Interrupting the Usual: Successful Strategies for Hiring Diverse Faculty.“ The Journal of Higher Education, 75:2, 133–160.
Piercy, F.; Giddings, V.; Allen, K.; Dixon, B.; Meszaros, P.; & Joest, K. (2005). “Improving Campus Climate to Support Faculty Diversity and Retention: A Pilot Program for New Faculty.” Innovative Higher Education, 30:1, 53–66.
Handelsman, et al. (2005). “More Women in Science.” Science, 309:5738, 1190–1191.
Talk about a momentous birthday—the oldest baby boomers started celebrating their 65th birthdays in 2011, ushering in what appears to be a huge change in health care demands in the United States. As the population ages in unprecedented numbers and is living longer than at any other time in history, the field of gerontological nursing is facing big changes with staffing needs and day-to-day practices.
Experts in gerontological nursing are reporting a greater demand for nurses now and in the future. As the number of patients increases, a sufficient number of nurses will be needed to care for them and to relieve the workload. The solution is complex and depends on the collaborative actions of government agencies, health care providers, colleges and universities, and nurses themselves.
According to a 2005 report by the National Institute on Aging and the U.S. Census Bureau, projections indicate that by 2030 the older population will total 72 million residents, doubling the number from the year 2000. By that time, one in five citizens will be 65 or older. And, according to the report, seniors are living longer lives, but 80% of them have at least one chronic health condition (such as heart disease, diabetes, or respiratory problems) and half of them have at least two. So even as the population enjoys living longer, the health care needs of older adults are more complicated.
“There is a strong assessment that the current workforce today is not prepared to care for the population,” says Amy Cotton, M.S.N., G.N.P.-B.C., F.N.P.-B.C., F.N.G.N.A., and president of the National Gerontological Nursing Association. “Another issue of great concern for colleges is when graduates are not prepared to care for the population they have to care for, it creates a lot of job stress and can lead to a lot of turnover.”
Typically, health needs become more complex as people live longer lives. There is a pressing need for competencies surrounding normal aging, cultural norms, and the very fine line of effective communication with the patient. And as the age gap between the younger workforce and the increasingly older patient gets wider, awareness of those variations is essential to provide good care.
“Those generational differences can create a schism,” says Valerie Kaplan, Ph.D., A.R.N.P., F.N.P.-B.C., F.A.A.N.P. and a senior policy fellow with the American Nurses Association. For instance, older generations grew up following a doctor’s orders with no questions asked. Younger generations—who often search for second opinions and cutting-edge treatments—might find that a puzzling way to approach personal health.
In addition to the age differences, census predictions indicate that the population will be composed of more ethnically diverse elders by 2030, with 72% being non-Hispanic white, 11% Hispanic, 10% African American, and 5% Asian. “There is a diversity explosion in growth for various ethnic groups in this country,” Cotton says.
As those populations age, there arises a pressing need for more diversity among nurses. Cultural awareness of family expectations, patient lifestyle, and cultural norms often gives the nursing staff an indication of how to proceed with care plans. The more a nurse knows about a patient, the more likely the care plan will be successful from the beginning.
Natalie Nieves, a case manager for VNA Health Care of Hartford in Connecticut, sees firsthand the need for nurses of all backgrounds. “Minorities can be majorities in the inner cities,” she says. “Being bilingual is a plus in my field. [Patients] trust you a lot more, and they confide in you a lot more.”
When a Spanish-speaking patient can speak with a nurse also fluent in that language, they glean more from the conversation, since the details do not get lost in translation. “There is no barrier,” Nieves says. “It is clear, concise, and direct. It is amazing the difference it makes.” As valuable as an interpreter is, having a relationship where both parties speak the same language just makes it easier. “When a nurse goes out with an interpreter,” says Nieves, “the patient feels like they are talking to two people at once.”
The elderly patient benefits are both emotional and physical when they are receiving health care from a bilingual nurse. “There has to be an understanding of how cultural norms impact decisions,” says Tara Cortes, Ph.D., R.N., F.A.A.N., Executive Director of The Hartford Institute for Geriatric Nursing and professor at New York University’s College of Nursing. For instance, Nieves, who is of Hispanic descent and fluent in Spanish, has noticed this in her own practice when she visits patients who might not relate how a diet full of foods traditional to his or her upbringing might impact something like blood sugar levels.
“We need to encourage minorities to nursing,” says Nieves. “We need them out there.”
For most nurses working with an older population, good communication is of primary importance. “If you can’t, at a basic level, communicate with an older adult, you will miss the boat when caring for that adult,” Cotton says. “That communication is a critical piece and a basic piece that is easily missed. We have such a hurry-up system.”
Sabina Ellentuck, who is launching a second career as a nurse, says she tries to take a breath and focus on the patients before she approaches them. In a way, quieting her own thoughts helps her slow down, greet her patient, find out how they are doing, and speak with them for a while before moving on to the health care procedures. “You have to be able to connect with them or they will not listen or do what you ask,” she says.
That bit of personal interaction also gives a valuable perspective. “It is feeling good and communicating and having fun with them,” says Ellentuck. “On top of which there is this big need.”
Most nurses, whether or not they work primarily with a geriatric population, will care for elderly patients at some point in their careers; knowing the normal signs of aging is an essential skill. “You have to think of what aging does to vision and hearing,” says Cotton. There can be changes in balance, memory, or mobility. Personal interactions and communication also allow nurses to glean an understanding of what is a normal result of aging and what might be a red flag for something more serious.
But nurses feel the time crunch. “There is pressure to do things quick, but it is extremely important to connect with the patient and be a good detective and pick up signs when something is wrong,” Ellentuck says. “It is hard to do that when you are rushed. The balance really is the challenge of integrating good health care while doing all these things.”
While the need for nurses continues to grow, pay disparity is often a roadblock, says Cotton. When nurses can earn more money in an acute care setting than in a long-term facility setting, they are generally drawn to the higher pay scale. Cotton says payment reform has to occur to attract more nurses to the field. After all, many nursing students graduate shouldering large debts, and paying them off is of primary importance. “It is hard to support yourself with what a geriatric nurse makes today,” says Cortes.
Many experts say the foundation for successful gerontology nursing practices begins in school and continues as nurses enter the workforce.
“The first exposures to gerontological nursing practices are critical,” says Cotton at the National Gerontological Nursing Association. Students need exposure to healthy, vibrant elders, as well as those who are sick or frail. And age does not always indicate health. Students need to be able to refute the myth that aging goes hand-in-hand with illness. “Changing that perception requires interaction with healthy and well elders,” says Cotton.
Valerie Cotter, D.N.P., A.N.P./G.N.P.-B.C., F.A.A.N.P., and advanced senior lecturer and Director of the Adult Health Nurse Practitioner Program at the University of Pennsylvania School of Nursing, says schools are trying to make it interesting for students to come into the field of geriatric nursing. One of the best ways for that to happen is for students to see the passion that so many professionals have for working with an older population. Describing that job satisfaction to students is essential, Cotter says, especially if the students have not had an opportunity to experience in their own lives.
“I was fortunate to have a good relationship with my grandparents,” says Cotter. “As a nurse, I gravitated to older adults. I love the life story and the narratives. Older adults have many more experiences, and you look at health within the context of those life experiences.” Through education as well as their personal experiences, nurses are able to sharpen their skills to the complex needs of the elderly and recognize red flags quickly. “You have to know the baseline status to recognize change,” says Cotter.
In 2002, according to an article in Health Affairs, 58% of baccalaureate nursing programs had no full-time faculty with specializations in geriatrics.1 “We still don’t have enough geriatric content built into the undergraduate curriculum,” says Cortes. “We need nurse practitioners for geriatric care. We do not have enough physicians to care for this population. Nurses can do a tremendous job of keeping the older population safe and at home and functioning at their highest level.”
Even a nurse who works in ICU needs to know if the patient has had a flu shot to provide comprehensive care. A nurse might encounter a healthy and active 90 year old or 67 year old with high blood pressure, complications from diabetes, or other serious health issues. “The reality is we are still providing care for adults across the continuum,” says Kaplan. “As they age, their health care needs are not driven by where they end up in the health care facility, but by the health care problems. [Nurses] need to identify the care needs of patients not based on where they work.”
While an important foundation of geriatrics is educational, Kaplan says, nurses need a general understanding of what it is to care for someone who has lived through different times. “The brain changes are sometimes more challenging than the physical changes,” Kaplan says. They are also more difficult for some family members to come to terms with. The nurse’s job, says Kaplan, is to be present for the patient. “If they are in 1945, then you are in 1945,” she says. “It is important that nurses as caregivers recognize that and not challenge that.”
Nieves says there is so much going on with an elderly patient that nurses are forced to use all their nursing skills on the job. “You use every single thing you have got,” she says. “I really truly enjoy my job.”
The industry is constantly developing models for consistent, coordinated, and collaborative care for older adults, says Cortes, but it is the nursing staff that carries it out. Nurses care for the whole person, she says. Caring for an elderly population is much more complex than treating only health issues. With elderly patients, you must consider their lifestyle. Are they eating enough? If not, is that because they forget or because they do not have enough access to food or transportation to get food? Do they have a small appetite? Is their medication impacted in any way by their foods? Are they taking their medication exactly as prescribed? How involved is the family, and how will family beliefs and attitudes change the course of the care?
To encourage nurses to specialize in geriatrics, it’s important to get nurses into the field and show them how rewarding it can be. “I’d love to see the number of nurses certified in geriatric nursing and practicing as NPs, and caring for elder adults increase,” says Cortes. “Nurses will be much more involved in developing those practices. It is very positive.”
Ellentuck finds the changes galvanizing. “It is a very exciting time now in how we think of helping older adults—many assumptions no longer exist,” she says. “A prime focus now is on function and getting people moving, moving out of those wheelchairs (if possible), doing activities that connect to the person’s interest or background. . . . To me, this is very exciting, and I look forward to being involved and doing these new practices that are truly patient-centered care.”
Reference
Christine Tassone Kovner, Mathy Mezey, and Charlene Harrington, “Who Cares for Older Adults? Workforce Implications of an Aging Society,” Health Affairs 21 (2002): doi: 10.1377/hlthaff.21.5.78.
So Bette Keltner, PhD, RN, newly appointed dean of the Georgetown University School of Nursing in Washington, D.C., describes the minority recruitment challenge faced by nursing schools throughout the country. In an effort to more closely reflect the diversity of the general population and secure a voice for all communities, nursing schools are trying both old and new methods to attract more students of color to their campuses.
Keltner, immediate past president of the National Alaska Native American Indian Nurses Association, plans to attack Georgetown’s need for more minority nursing students from all fronts, beginning with careful planning. “There is no easy formula,” she says. “[Minority recruiting] is a complex set of circumstances and requires a systematic plan, similar to a business plan.”
The Georgetown dean encourages college and university nursing programs of all sizes to approach their diversity needs with a similar strategy. By drafting a written plan and highlighting short-term and long-term goals, schools will begin to formulate incremental steps to increase minority enrollment, Keltner advises.
Why are so many schools of nursing so eager to increase the diversity of their student populations? While each college or university may have its own motivation, many of these efforts seem to be driven more by a desire to better reflect the community than by a push from administration to up the minority percentages, or boost enrollments in general.
“One of nursing’s major selling points is that if you come into this profession, you will be able to serve your community,” explains Melissa Avery, MSN, RN, [TITLE TK] at the University of Minnesota’s School of Nursing in Minneapolis. The university’s Center of American Indian & Minority Health, established in 1987, recently received a major grant to further increase diversity at the school. The center provides academic, social and financial support to minority undergraduate and graduate students.
The goal of increasing diversity at the University of Minnesota is not limited to the nursing program, but exists throughout the UM system, Avery adds. In fact, receiving the grant to improve nursing diversity was a direct result of the Duluth campus’ success in attracting Native Americans into its medical school.
Entering the Mansion
Keltner believes recruiting more minorities into the nursing profession presents a threefold challenge for nurse educators.
“First, it isn’t just a nursing problem,” she asserts. “Increasing diversity has become a challenge for all professions. Historically, when minorities have been barred from participation, there is no pipeline established to lead students into the field.
“Recruiting minorities is very different [from recruiting non-minorities]. The approach must be more personal and family-oriented.” —Bette Keltner, PhD, RN, Georgetown University
“Second, the nursing profession has not adequately responded to changes in professional demographics. We still primarily recruit women. If you look at medical schools around the country, even the most traditional ones, enrollment is now approximately 50% men and 50% women. It’s hard to recruit minorities when you’re ignoring 50% of the minority population.”
Keltner’s third concern is the large number of minority nurses who stop their professional education at the vocational school certificate or associate’s degree level. “While vocational schools and junior colleges are doing a good job of attracting minorities into the field of nursing, those degrees do not lead to leadership positions,” she says. “This keeps minority nurses who do not go on to baccalaureate or advanced degree programs at the low end of the career ladder.
“It’s like opening the door to a mansion, but you can only stand on the front steps. You can’t go in where it’s warm, where the chairs are comfortable and where you can participate in the conversation.”
While Keltner expresses tremendous respect for minority nurses who hold nursing diplomas or two-year degrees, she also stresses the urgent need for more nurse leaders. “Minority nurses need to have a voice on administrative boards, in teaching and in the policy arena. It’s unfortunate that there are so many nurses of color who are not getting the advanced education that would prepare them to be those voices.”
Bridging the Gaps
Fortunately, college and university nursing schools are beginning to respond to this challenge. A growing number of baccalaureate programs are reaching out to students in two-year programs, helping to ease the transition for minorities who need encouragement and help in pursuing higher education.
“Sometimes, we do encourage students to attend a junior college first,” says Deb Wilson, program coordinator for the Recruitment/Retention of American Indians Into Nursing (RAIN) program at the University of North Dakota in Grand Forks. “Because a four-year institution can sometimes be overwhelming, our program helps junior college students receive one-on-one assistance. We help them succeed in the two-year program so that they will ultimately be able to succeed in a four-year program.” RAIN offers junior college students such assistance as help in course selection and a quarterly newsletter.
Another innovative way nursing schools are attracting more minority students is by making their classes more accessible to students who are trying to juggle the demands of career, college and family. Online learning programs are becoming increasingly popular. Schools are also finding that offering classes off-campus in locations convenient to minority communities is an effective tool.
With its newly received grant money, the University of Minnesota will fund a distance-learning program for graduate students. “This will make things more convenient for our minority students,” Avery explains. “They will be required to be on campus some of the time, but not nearly as much as they would in a traditional nursing program.”
Reaching Out—With Cultural Competence
To let prospective minority students know about the benefits their programs offer, many nursing schools are taking a more targeted approach to their advertising and publicity efforts. According to Avery, the University of Minnesota’s School of Nursing budget includes money to advertise in magazines and professional journals aimed at minority nurses. She is also working with historically black colleges to attract nursing students from those four-year programs into UM’s graduate school.
Other institutions have had good results by recruiting at career fairs in minority neighborhoods, manning booths at professional nursing conferences and even enlisting the help of alumni to speak to prospective nursing students.
But to be truly successful in recruiting minority nursing students, schools must be sensitive to students’ cultural needs, Keltner emphasizes. “Recruiting minorities is very different [than recruiting non-minorities]. The approach must be more personal and family-oriented. That doesn’t mean you can’t recruit minority students with promotional CDs and Web sites, but those efforts should be followed up with a face-to-face visit or a telephone call.”
Most minority parents are eager for their children to go to college, she adds. But it’s often difficult for them to send their children away to school because of cultural traditions, fear for the child’s safety and fear of the family’s growing apart. In Keltner’s culture, for example, a child’s umbillical cord is buried near the house so that the child will never move far from home. Without that knowledge, a non-Indian recruiter would automatically assume that the parents are eager for their child to attend a good school, regardless of its location.
The Price of Success
Delaware State University” src=”/sites/default/files/articles/02-14-01d-pc3.jpg” />“Three years ago, we hired a nurse recruiter to go out and recruit students. She was bringing them in, but we weren’t keeping them.” —Mary Watkins, PhD, RN, Delaware State University
In addition to providing specialized academic and cultural support systems, nursing schools that hope to attract more students of color must not overlook the financial pressures many minority students face. Most schools have found that a successful minority recruitment program must address this need with more than the usual financial aid package.
Keltner readily admits that tuition is expensive—a bachelor’s degree from Georgetown carries a $150,000 price tag. But she also points out that students have many other expenses that can be draining to their pocketbooks. “Trips home during breaks are important and can be very expensive, depending on how far away the student is from home. Even phone calls home need to be supported,” she asserts.
Delaware State University, a historically black college in Dover, Del., offers stipends to its neediest students, many of whom are single parents, says Dr. Mary Watkins, chair of the Nursing Department. When granting stipends, the school expects students to cut down on the hours worked at outside jobs to give them more time to study.
Wilson, who has been recruiting minority students to the University of North Dakota for 20 years, believes that students’ inability to pay for their education is becoming more common and harder to address, because of changing financial aid rules and the rising cost of tuition.
One funding source that has helped many RAIN students is the Indian Health Service. The agency provides scholarships and post-graduate placement services. Wilson maintains close contact with officials there.
Teaching Diversity With Diversity
To make their nursing programs more attractive to students from a diverse range of backgrounds, many schools are examining their faculty as well. An all-white, all-female teaching and advising staff isn’t likely to boost minority recruitment. Students want teachers they can relate to—they need positive role models who share their ethnic backgrounds. An academic staff with a lack of ethnic and racial diversity can be detrimental to minority student recruitment efforts.
“Student and faculty diversity often go hand in hand,” explains Avery. “We’re trying to recruit faculty of color as well as students of color. Currently, we have three American Indian faculty members. We hope to continue that and further increase our faculty diversity.”
But because minorities are still severely underrepresented in the ranks of academe, recruiting minority faculty can be difficult. “There are so few nursing educators of color, and they are being recruited so heavily right now. It’s hard to get them,” Avery explains.
Delaware State’s Watkins takes the importance of a diverse faculty one step further. She feels the faculty must also be able to relate to the perils and pains experienced by many of today’s minority youth.
“About half of our faculty are minorities, and we want them to understand our students’ struggles,” she says. “Some of our students have had family members murdered and other serious problems. We want our faculty to be caring and understanding of those issues.”
Holding On to What You’ve Got
While nursing schools may be working hard to recruit more minority students, they may soon be facing a more serious challenge: retaining those students.
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“Three years ago, we hired a nurse recruiter to go out and recruit students. She was bringing them in, but we weren’t keeping them,” Watkins explains.
This inspired Watkins to develop the Nursing Retention and Academic Success Project (N-RASP) at Delaware State. She hired a retention expert who helps students with everything from classroom problems to parenting advice. The school also revamped its programs to give borderline students the support and encouragement they need to succeed.
“Many of our minority students have a lower level of confidence and self esteem; they have to be really determined to make it,” Watkins states.
To help give minority students a better chance to succeed, some schools have implemented pre-nursing programs. “Many of our students have been poorly prepared in high school,” says Watkins. “If students have a C average, we will admit them into our pre-nursing program. They must maintain a 2.5 grade point average, complete all nursing subjects with a C or better and score 60% on our nursing entrance exam. We currently have 65 students in the pre-nursing program and we expect 20 of them to eventually become full-fledged nursing students.”
The N-RASP program offers students such assistance as motivational seminars and special courses that teach critical thinking and writing skills. N-RASP is also a prime example of how a successful mentoring program can keep students from dropping out. Each faculty member mentors one or two students for the duration of their nursing college experience. In addition, female undergraduates are assigned a more experienced student to be a “Big Sister,” while “Big Brothers” assist freshman and sophomore males. “Sometimes younger students are more open to their peers’ advice than their professors,’” Watkins comments.
Ultimately, one key ingredient seems to be common to all successful minority student recruitment programs: a committed staff that believes not only in the need for more potential minority nurses, but also in the college’s ability to attract them.
“We work 24 hours a day, seven days a week,” says Wilson. “When a student needs us, we have to be there. It takes that kind of commitment to make it work.”
When health care workers such as paramedics, emergency medical technicians (EMTs) or LPNs weigh the prospects of earning a nursing degree, the challenges can seem insurmountable. The stress and heavy workload of their current positions, as well as family and personal obligations, can make even the most ambitious student re-evaluate such a decision.
That’s where Excelsior College (EC) comes in. The school’s innovative online nursing program is designed to help health care professionals earn an associate’s, bachelor’s, or even a master’s degree while still working at their jobs and taking care of their families.
Thousands of nurses have taken advantage of this program since the college was established back in 1971. Called Regents College until early 2001, Excelsior College, based in Albany, N.Y., was renamed to focus on its “ever upward” philosophy and to mark its independent charter, granted by the New York State Board of Regents.
Founded to provide distance education and give nursing students a way to receive college credit for their prior health care experience and knowledge, Excelsior College lets students integrate what they already know into degree programs such as: Associate of Science, Nursing; Associate of Applied Science, Nursing; Bachelor of Science, Nursing; RN-to-MSN; and Master of Science, Nursing, with a major in Clinical Systems Management. An RN-to-BS(n) program was added in Fall 2001. The associate and baccalaureate degrees are accredited by the National League of Nursing (NLN) Accrediting Commission.
This novel distance education program is helping to address the nation’s urgent nursing shortage by providing nurses and other types of health care professionals with the ability to earn advanced credentials–or to refocus their careers into nursing—without having to take time off from their jobs.
“A Good Place for Minorities”
“From my perspective as an African American, it’s a good place for minorities,” says Sharri Pickney of Neptune, N.J., who graduated from Excelsior with an associate degree in nursing earlier this year. “Overall, it was a positive experience. The exams are fair, the instructors are there for you, you get to learn in your own style and my tuition dollars went further than at a traditional college. Whatever I asked, they answered.”
An agency LPN, Pickney shaped her degree program to fit her work schedule while reserving some time for herself. “As an LPN, I already had very good training as a nurse,” she explains, “so I thought it would be redundant to go back to the beginning at a traditional college. I could have finished [the EC program] in one year, but I took my time and spread it over two.
“People ask me, ‘Is it hard?’ I tell them it is challenging but if you study and know your critical elements, you’ll do fine.” The EC School of Nursing actively recruits both minorities and men (see “Excelsior by the Numbers”). According to Associate Dean Marianne Lettus, “We have a higher percentage of male students than traditional programs. Many of
Independent Scholars
Both Lettus and EC Nursing School Dean Mary Beth Hanner are alert to the special needs of adult learners with prior nursing or health care experience. “Flexibility is the critical thing for most of our students,” Hanner says. “Their average age is around 40 and many of them have families.
For More InformationHere’s where to find out more about the Excelsior College School of Nursing program: Web site: www.excelsior.edu Phone: (888) 647-2388 toll-free International students: (518) 464-8500 TDD: (518) 464-8501 Email: [email protected]
“We are a distance-learning program and our students work at their own pace,” she adds. “They don’t have to focus on areas in which they already have extensive experience and expertise. For example, an OB nurse does not have to spend a lot of time in that area but might have to focus more on diseases of older adults.”
EC’s programs are not for everyone, Hanner concedes. “Students must already have a clinical background, such as LPN, EMT, military service corpsman (certain classifications), paramedic, etc. And potential students need to know that we do not provide instruction; we are an independent study program.”
However, this doesn’t mean that students are entirely on their own. The range of support services is extensive, and includes teleconferences, study guides, a bookstore, videotapes and workbooks, and more. In addition, an electronic peer network connects students with each other, helping to create a feeling of community.
Most Excelsior students come to the program with credits from a traditional college or university. When they enroll in the online college, they are assigned an advisor who does an official credit evaluation from the student’s previous transcripts and informs the student about how much of this prior work can be applied as credit toward their EC degree.
“They receive a letter explaining what they need to do and how to get started,” Lettus explains. “It’s up to the student what they do next. They may take general education courses at a regionally accredited college in their area or choose to take a CLEP exam or enroll in a distance-learning course. The majority of our associate degree students choose a combination of course work and examinations.” For their nursing component, students in the associate degree program complete seven exams in nursing content. “There is a study guide for each,” says Lettus. “If students have concerns about taking the exams, they can call and make an appointment to talk with a faculty member by telephone.”
How much does all of this cost? At the associate degree level, costs include a $765 enrollment fee, which covers one calendar year of advising and evaluation services. For each year after that, the advising and activity fee amounts to roughly half the enrollment fee.
In keeping with the program’s emphasis on flexibility, many of the program costs can be handled on a pay-as-you-go basis. “Most associate degree students graduate in 18 months,” says Lettus. “They pay for each written exam as they take it. Nursing written exams are $145 and earn four semester hours of credit. The clinical exam is $1,200, the most expensive component. Books, tuition, etc. come to about $5,000 to $6,000 for the whole program.” The college also offers a variety of financial aid options.
The ASN and AASN programs have a 50-52% student retention rate that Lettus notes is about average for associate degree programs. The retention rate at the bachelor’s level is lower, in the 30-percentile range. “We have concerns about this,” she admits. “I think it is caused primarily by the fact that our students have full-time jobs and are required to do so much mandatory overtime.”
Best-Kept Secret
“I think Excelsior College is the best-kept secret in nursing education,” says Barbara Nichols, RN, DHL, MS, FAAN, an EC faculty member based in Philadelphia. “It’s an excellent school with a well-prepared faculty who are committed to excellence and to helping students achieve their goals. That makes for a phenomenal learning environment.”
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Nichols, who recently received a Lifetime Achievement Award from the National Black Nurses Association, is also CEO of the Commission on Graduates of Foreign Nursing Schools. When prospective students ask her about EC, she often encounters misconceptions. “Sometimes they think it is not a bona fide degree,” she explains. “Then they learn it is accredited just like [the schools of nursing at] Emory University or Vanderbilt.”
William Cody, RN, PhD, agrees. “The testing is rigorous,” he says. “That’s why it is such a reputable degree.” An associate professor and chair of the Family and Community Nursing Department at the University of North Carolina in Charlotte, Cody earned a 1982 associate’s degree and 1986 BSN degree from EC when it was called Regents College.
At the time he first enrolled, he was an LPN working in an ICU. “I didn’t want to have to start over from the beginning, learning how to take blood pressure,” Cody recalls. “It was exciting to me to be able to move forward [with my education] and still support myself. Excelsior College’s programs are for self-starters.
“I’d never have become an RN without the college,” he continues. “I’ve heard a lot of [other EC graduates] say the same thing. It’s hard to be an LPN near the bottom of the pecking order and go to school. But Excelsior treats you with respect and wants to help you succeed.” Now a member of the EC Nursing Family Committee, Cody is excited about remaining part of the college. “For me it was a journey from LPN to bachelor’s to master’s to doctorate to faculty member. They started the ball rolling; I would not be where I am without them.” Cody believes the college is “very egalitarian about minorities and men in nursing. As a faculty member, I know that all of EC’s written course material is sensitive about gender, race and ethnicity. When I was at the 2001 graduation ceremony in June, the diversity was obvious–different accents, people of color, men and women. It was a celebration of diversity.”
Take Your College to Work
Elizabeth Critchlow Benfield was a home health nurse when she entered the bachelor’s degree program at Excelsior. She had a diploma in nursing from a non-U.S. school and was eager to earn her BSN. Still, making the transition took effort.
Excelsior by the NumbersAssociate Degree Program–Class of 2001Total graduating class 1,451
Male 275 (19.0%) Female 1,176 (81.0%)
African American 158 (10.9%) Asian/Pacific Islander 124 (8.5%) White 1,040 (71.7%) Latino 56 (3.9%) Native American 14 (1.0%) Multiracial 19 (1.3%) Other/Unknown 40 (2.7%)
Bachelor’s Degree Program–Class of 2001
Total graduating class 89
Male 9 (10.1%) Female 80 (89.9%)
African American 4 (4.5%) Asian/Pacific Islander 5 (5.7%) White 77 (86.5%) Latino 1 (1.1%) Native American 0 (0.0%) Multiracial 1 (1.1%) Other/Unknown 1 (1.1%)
Currently Enrolled Nursing Students (All students in all degree programs as of April 2001)
Total 11,699 Male 2,201 (18.8%) Female 9,490 (81.1%) Gender not reported 8 (0.1%)
African American 1,501 (12.8%) Asian/Pacific Islander 725 (6.2%) White 8,269 (70.7%) Latino 488 (4.2%) Native American 102 (0.9%) Multiracial 161 (1.4%) Race/ethnicity not reported 453 (3.8%)
Mean age of all students 40.5 years
“It was difficult to work full time and complete the degree,” remembers Benfield, who is African American. “It took me a year to get my mind disciplined. I had to create a study space in one of my bedrooms and make myself sit there an hour a day.
“I tell people, ‘This is not an easy program,’” she continues. “It can be stressful, especially when you have to travel for clinical exams. I live in Brooklyn but because of the time frame I was working with, I had to go to California to take my clinicals. But in the long run it worked out well. It was a wonderful experience and the support was there for me. I was able to call the counselors and get advice as often as I needed.”
A June 2001 graduate of Excelsior’s BSN program, Benfield plans to forge ahead with both her career and her nursing education. “Occupationally, I can now become a supervisor in my department; educationally, I can earn my master’s degree,” she says.
Recognizing the difficult balancing act that working students face, some health care facilities are helping to ease the process for their employees by making arrangements with Excelsior College to conduct a Project LEARN (Learning, Experience, Assessment, Resources and Networking) program on site. Tina Raggio is director of Project LEARN at the Albany Medical Center in Albany, N.Y.
“The advantage of having a program on the premises is that it fits into our employees’ schedules,” she explains. Most Albany Medical Center student/employees can take their clinicals right at the hospital, reducing the cost and stress of having to travel to take them. In addition, a skills lab, library and on-site access to counselors are available at the facility.
Albany Medical Center has a contract with Excelsior College to administer the program for employees interested in pursuing a degree in nursing at the associate and bachelor’s level, as well as in the RN-to-MSN program.
Raggio, herself a 1987 EC graduate, says the on-site program is welcomed by both supervisors and students. “Over 300 students here are taking advantage of it,” she says. “There is a tremendous demand in nursing , and there are more Project LEARNs in the works for Excelsior.”
Learning for Success
Ask Katrina Brown, RN, currently a student in the BSN program at EC while working as a nurse at Ohio State University Hospitals East in Columbus, if she would do it again and she answers with an immediate “Yes!”
“The experience has benefited me greatly,” she says enthusiastically. “As of July, I am now associate director of Perioperative Services at the hospital. Attending Excelsior contributed to that advancement. It taught me leadership ability and organizational skills.”
Brown, who is African American, found the college a good fit. “It is particularly friendly to minority students,” she emphasizes. “Because it’s an online college, I don’t think they even know your race. I’m a single mother who works full time. I’ve been a nurse since 1985 and a perioperative nurse in the OR since 1992, so testing out of the basic nursing courses was not hard for me to do.”
Brown is a good example of an independent learner who knows how to take advantage of the college’s flexible options to meet her particular needs. “At one point I felt I needed an instructor, rather than preparing for my clinicals alone,” she relates, “so I took a class at the local community college to assist me in learning the proper techniques for doing a physical assessment. The Excelsior programs are meant for mature adults who know when they need a class to help them.”
On June 30 of this year, Brown traveled to Albany to be inducted into the Honor Society at Excelsior College. “It was one of the best experiences I ever had,” she says. “They welcomed me with open arms.”
![“Recruiting minorities is very different [from recruiting non-minorities]. The approach must be more personal and family-oriented.” —Bette Keltner, PhD, RN, Georgetown University](/sites/default/files/articles/02-14-01d-pc2.jpg)
