Duke University creates the next generation of minority nurses

This past summer, 10 college seniors took part in Making a Difference in Nursing II Scholars (MADIN II), spending six weeks at Duke University School of Nursing. MADIN II is a federally funded nursing work force diversity program that strives to increase the number of underrepresented minorities in nursing. The program attracts minority students from less fortunate backgrounds that could potentially enroll in Duke’s School of Nursing program. The participating undergraduates are pursuing degrees in a variety of fields, but MADIN II allows the students to work with faculty to explore the many specialties in nursing and the skills needed to pursue them. Additionally, the students participate in academic and professional development activities that stress teamwork and leadership skills.

Although there are many similar federally funded programs out there, Duke believes theirs is unique, from recruiting high-achieving students to basing their teaching on an exemplary model that prepares students for Ph.D. programs.

If you would like more information on Making a Difference in Nursing II, contact Julie Cusatis at 919-681-9051 or [email protected].

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.

Nursing School Enrollments Continue to Decline—But at a Slower Rate

A recent four-part study on the changes in the RN work force by Douglas O. Staiger, PhD, David I. Auerbach, PhD(c) and Peter I. Buerhaus, PhD, RN, FAAN, points to troubling implications for the already-dwindling RN profession.

The study found no evidence of any re-emergence of interest in nursing by first-year college students, based on a survey of freshmen over the last five years. Researchers believe this stems from a permanent shift in the labor market.

According to the third article in the series, “Expanding Career Opportunities for Women and the Declining Interest in Nursing as a Career,” published in Nursing Economic$, fewer women are currently entering the field of nursing because of expanded work opportunities for women over the last three decades in what were once male-dominated professions, such as medicine, law and business.

The authors state that while interest may regenerate in nursing, there will probably never be the same amount of women entering the field as there were in the 1970s, when women’s job opportunities were less varied.

The most recent study of nursing school enrollments by the American Association of Colleges of Nursing (AACN) also reflects this trend. According to the AACN, the year 2000 marks the sixth annual drop in baccalaureate nursing program enrollments and the third consecutive decline in master’s enrollments in as many years.

This downward spiral comes at a particularly bad time, as the demand for baccalaureate- and graduate-prepared nurses of all races and ethnicities continues to grow across the country. Hospitals, primary care facilities, home care agencies, outpatient surgical centers and other health facilities in many regions report an increasing shortage of registered nurses, threatening the nation’s ability to meet the health care demands of the future. The need for minority RNs is particularly imperative: As the United States’ racial and ethnic minority population continues to grow, so does the need for minority RNs who are able to provide culturally and linguistically competent care.

According to the AACN survey, nursing student enrollment in entry-level bachelor’s degree programs declined by 2.1% between fall 1999 and fall 2000, and master’s degree enrollments declined by 0.9%.

One year prior, however, enrollments fell even more drastically: Entry-level bachelor’s degree nursing programs had a 4.6% decrease in enrollments in 1999 and master’s degree enrollments fell by 1.9%.

AACN President Carolyn A. Williams, PhD, RN, FAAN, says of the slowing decline, “Hopefully we are witnessing the early effects of the last two years of widespread media coverage on the emerging nursing shortage.”

One statistic that would seem to support Williams’ view is the doctoral program enrollment statistic. This enrollment figure had remained stable for the last five years, but in 2000, it rose by 2.5%.

Opening Doors

“I always wanted a BSN,” says Pilar De La Cruz. “But being married and having two small children, I felt that I could not manage work, family life and four years of school at the same time.”

Faced with a difficult choice, De La Cruz opted for a diploma in nursing, so that she could start working as an RN as soon as possible. But looking back, she feels that in the long run she paid a big price for that decision. “I was fortunate enough to be promoted to supervisory positions,” she explains, “but I always felt inferior to non-minority nurses who had their [BSN] degree.

“I worked for a vice president of nursing who had a master’s,” De La Cruz continues, “and because I did not have a degree, she felt I was not worth much as a manager. As a Latina, I felt I had to work even harder to be recognized for my efforts because I lacked a bachelor’s degree.”

She found her solution by returning to school at California State University, Dominguez Hills in 1989, taking classes part time and traveling to different CSU campuses to accommodate her work schedule. In 1996, she received her baccalaureate and cried throughout the ceremony. “Finally, I could feel that I was equal to other nurses who were in management positions and were not minority,” she recalls.

De La Cruz went on to earn her MSN in 2001. As a result, she has attained the executive-level position of vice president of Education Development, Volunteers and Community University at Community Medical Centers in Fresno. “I like to mentor other Latinas [to go back to school],” she says. “I tell them, ‘if I could do it, so can you.”

She’s not alone. Many minority nursing leaders and educators feel there is an urgent need to encourage more nurses of color to think of their diplomas or associate’s degrees as a stepping-stone, not a stopping point. According to the 2000 National Sample Survey of Registered Nurses, published by HRSA’s Division of Nursing, nearly 60% of the total RN population, regardless of race/ethnicity, reports their highest level of educational preparation as either a diploma or associate’s degree. The one notable exception is Asian, Native Hawaiian and Pacific Islander RNs, who have the highest percentage of baccalaureate degrees than any other racial group.

Experts agree that while a terminal two- or three-year degree may be adequate for some nurses, the four-year BSN is the degree that truly opens the doors of opportunity for minority nurses. Those doors can lead not only to advanced degrees but also advanced careers–as managers, educators, researchers, nurse practitioners, clinical nurse specialists and more.

Recognizing the need to create more opportunities for minority nurses to earn degrees that will help them move up the ladder, America’s nursing schools, health care employers, government agencies and nursing associations are rising to the occasion. By developing innovative solutions–such as more flexible BSN and MSN programs, bridge programs, scholarships and an expanded loan repayment program–they are teaming up to make those doors easier to open than ever before.

Bridging the Gaps

“Going beyond the two-year degree is necessary for minority nurses’ careers and futures,” says Dr. May Wykle, RN, FAAN, dean of the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland. “When the nursing shortage eases, employers will want to hire nurses who have BSN degrees. We have to raise the image of nursing and create more awareness that it is collaborative work with doctors–and that this level of professionalism requires a baccalaureate.”

One reason why many minority nurses choose to attend associate’s or diploma programs is because of the lower costs, Wykle explains. Then, when they graduate, the demands of their jobs and family responsibilities make it difficult to continue their education.

“It’s hard to work and finish a degree at the same time,” she points out. “Many nurses do it, but sometimes they can’t study as much as they wish. I often recommend they begin by taking one course. Working full time and trying to study full time lessens their chances of completing their degree.”

The Bolton School is one of many nursing schools that are taking steps to make baccalaureate education more accessible to RNs who are graduates of diploma or associate’s degree programs. Wykle is considering a number of strategies, including the work-study option. “In some professions, such as engineering, students work a semester and go to school a semester,” she says. “This is a new idea to nursing but it makes sense.”

In addition, many schools are establishing bridge programs that make it easier for students in associate’s degree and diploma programs to transition into BSN programs, says Dr. Sheldon Fields, assistant professor at the University of Rochester Medical Center School of Nursing in Rochester, N.Y. “Some schools have formed partnerships and articulation models with junior colleges. At the University of Rochester, we are looking into making it seamless for a student at Monroe Community College to come into our program.”

Fields also believes that increasing the number of minority faculty would help encourage more RNs of color to earn bachelor’s and graduate degrees. “It is not unusual for large nursing schools to have a dearth of minority faculty–the numbers are not there,” he explains. “You cannot bring [minority] students in and not give them mentors. Those of us in faculty positions are a minority within a minority. For me–an African American and a Latin and a man–that has worked both to my advantage and against me.”

However, Wykle, who is also the current president of Sigma Theta Tau International (STTI), the Honor Society of Nursing, emphasizes that nursing schools will not be able to do the entire job alone. “We need to have both associations and schools promote BSN degree-earning,” she says. “And we need the support of health care organizations and the government, in the form of tuition assistance, loan forgiveness and making loan repayment easier.

“At STTI, we are collaborating with a coalition of other nursing organizations to raise the image of nursing through a program called Nurses for a Healthier Tomorrow. At the same time, as a nursing school dean, I’m very involved in trying to get sources of scholarship funding, and partnering with health care agencies. It’s slow going but we have to do it.”

C. Alicia Georges, RN, EdD, FAAN, a lecturer in nursing at Lehman College in Bronx, N.Y., and president of the National Black Nurses Foundation, says she is encouraged by Department of Health and Human Services Secretary Tommy G. Thompson’s January 2002 announcement that “the President’s [2003] budget will include a total of $15 million, a 50% increase above last year’s funding, to expand the Nursing Education Loan Repayment program.” But still, she believes, “The federal government’s role in nursing education needs to be amplified.”

Minority nursing associations, meanwhile, are also focusing increased attention on promoting the benefits of baccalaureate education to current and potential members. For example, the National Association of Hispanic Nurses (NAHN) is concentrating on strategies such as offering scholarships, says Viola Benavente, RN, MSN, CNS, an instructor in the Department of Acute Nursing Care at the University of Texas Health Science Center in San Antonio and chairperson of NAHN’s Public Relations Committee.

“We are not telling people to go for the bachelor’s as opposed to the associate’s degree,” she stresses. “The BSN may not fit the needs of all nurses. We do say, though, that it is the baccalaureate-level nurse who is in high demand.”


Partnering With Employers

Nursing schools aren’t the only ones who are recognizing that RNs need more flexible educational options that mesh with their work/life needs. Health care employers, too, are reaching out to help their nurses earn the bachelor’s degrees that will enhance their job performance and career potential.

For LaShawn Williams, RN, the cooperative effort between Detroit’s Wayne State University (WSU) and Henry Ford Health Systems was an exciting option. “I knew from the beginning that I’d come back to school,” she says. “It’s important for my long-term goals to have an advanced degree. There’s not much room for growth in the profession without it.”


After earning her associate’s degree, Williams took a job in the critical care unit at Henry Ford Hospital. There she learned the hospital partnered with WSU to offer a bachelor’s degree completion program. “It’s convenient, because classes and labs are held here at the hospital,” she explains. “Still, working and going to school is tough. I had to cut my hours to make it work.” Williams balances her job, studying and taking care of elderly grandparents by working the midnight shift so she can get tasks done during the day.

“The cohort program with Henry Ford Health Systems started in January 2002,” says Dr. Barbara K. Redman, dean of Wayne State’s School of Nursing. “Most of the classes are taught at the hospital by our faculty, but some of it is online.”

In addition to convenience, centering learning at the worksite provides “a support system,” according to Redman. “There is a major move for nurses to go back to school,” she notes. “We are reaching them at work because the employers have an interest in a more highly educated nursing workforce. The hospital provides access for us to counsel nurses, evaluate their diploma credits and talk to them about our program.” Students with all the prerequisites generally finish the BSN program in about two years.


Our Place or Yours

Online colleges–such as National University in San Diego and Excelsior College in Albany, N.Y.–and distance learning programs offered by traditional nursing schools are still another non-traditional solution that is making it easier than ever before for minority nurses to earn bachelor’s degrees even if they are working full time.

Through the magic of the Internet, these ultra-flexible programs let students take classes at the place and time that’s most convenient for them, complete the program at their own pace and even receive credit for the nursing knowledge they already have.

“Our bachelor’s degree program is all independent study with some online support services,” says Dr. Marianne Lettus, associate dean of the Excelsior College School of Nursing. “Students complete the degree by successfully completing exams.”

Excelsior offers both BSN and RN-to-MSN programs. “The bachelor’s degree tends to attract more minority nurses,” Lettus adds. “The RN-to-MSN program is relatively new and takes longer to complete.”

For Fernando C. Pimentel, an Infection Control Practitioner and ICU nurse at Guam Memorial Hospital in Oka, Guam, distance learning was the ideal option for making his dream of earning a BSN degree a reality.

“In my [Filipino] culture, education is valued very highly,” says Pimentel, who is working toward a BSN through Excelsior College. “I currently hold a bachelor’s degree in Business Administration and am concurrently pursuing a master’s in health sciences at the California College of Health Sciences. I look at education as a journey rather than a destination.”

Support Systems

Encouraging diploma- and associate’s-prepared minority nurses to enter BSN programs is one thing; making sure they successfully complete their degree is another. Both students and faculty agree that even with today’s advantages of extra flexibility and convenience, the challenge of juggling college, work and family can often be overwhelming. That’s why many nursing schools are going the extra mile to provide increased support services to help these students not only go back to school but also go the distance.

The key to preventing students from giving up and dropping out “is to have our faculty keep in close contact with them so we can sense if they seem to pull away,” says Dr. Donna Demarest, dean of the School of Nursing at the College of New Rochelle (N.Y.). Like many retention programs for returning students, she adds, the emphasis is on both tutorial and personal support.

“Most of our RNs who come back to school are women and minorities,” Demarest comments. “They tend to work in inner city hospitals where the stress is heavy.
So our program has a learning and caring center for nursing, as well as a holistic nursing track. When you tell adult female students they need stress reduction, they say they don’t have time. So we built it into the degree curriculum. They learn therapeutic touch, relaxation, yoga and other approaches.”

Georges believes scheduling is also critical. “Time management is the biggest challenge for nurses coming back to school,” she explains. “Most of them work and have families. If they haven’t been in school for a while, they have trouble scheduling their time. Peer support helps, including sharing ideas about what works best. Working in study groups adds structure.

“I think the key is setting up the kind of program that fits the schedules of real people. We have clinicals on weekends and classes in the morning or evening. We’re looking at how we can be more flexible to meet the needs of the working RN.”

Jump-Starting Research Careers

Are you a nursing student who is interested in the “why” and “how” of health care issues? Do you frequently wonder if there is a better, faster, more productive way to accomplish nursing tasks? Would you like to play a direct role in helping to eliminate minority health disparities? If so, a career as a nurse researcher may be just what you are looking for.

A research career provides exciting opportunities to develop new knowledge and influence future nursing practice. If you are interested in pursuing a teaching career in academia, research is an important expectation of the faculty role. But whatever your long-term goals may be, gaining hands-on experience in the research process while you are still in nursing school can help you lay the foundation for a successful future as a research professional.

To encourage more minority individuals to pursue careers in health care research, the National Institutes of Health (NIH) offers an exciting program, Research Supplements for Underrepresented Minorities. Although it was launched in 1989, many potential student researchers may be unaware of this program, which provides monetary support for minority students to work with researchers whose studies are currently funded by NIH. The student becomes part of the research team and receives research training and mentoring. High school, undergraduate and graduate students are eligible. The program is also available to support post-doctoral training.

Making the Match

If the Research Supplements for Underrepresented Minorities program sounds interesting to you, your first step should be to visit NIH’s web site at http://grants.nih.gov/grants/guide/pa-files/PA-01-079.html. There you’ll find everything you need to know about the program’s eligibility requirements, application procedures and funding levels.

Next, you need to find an NIH-funded researcher to hook up with. Be sure to do this early in your schooling, because participation in the program generally lasts for at least two years. To locate nurse researchers with active NIH grants, access the Web page of the National Institute of Nursing Research (one of the NIH institutes) at www.nih.gov/ninr/. Once you have found a researcher whose work interests you, talk with him or her to see if there is a good fit between the two of you and to determine whether you will be able to work well together.

Once the student and nurse researcher are matched up, the researcher should consult the NINR staff prior to completing the application process in order to receive suggestions for successfully applying to the program. The phone number to call is (301) 496-0207.

The application includes portions to be completed by both the researcher and the student. A step-by-step guide to application procedures can be found on the NIH Web site (http://grants.nih.gov/grants/guide/pa-files/PA-01-079.html). The structure and goals of the research training need to be clearly presented, along with evidence that the student will develop research skills as a result of participating in the project. Accepted and rejected applicants are notified in approximately eight weeks.

Danica’s Story

When I was growing up, I always thought nursing was limited to the clinical setting. My first exposure to nursing in an academic setting exploded that myth. In the spring of my senior year, my high school placed me as an intern at the University of Texas at Austin School of Nursing. Originally I was dismayed; as an aspiring pediatrician, I did not think a school of nursing was the place for me. But I accepted the internship and the following summer I participated in a research apprentice position with the Minority High School Nursing Research Experience, a program funded by the NIH.


This initial exposure to research opened my eyes to an aspect of nursing that I never knew existed. During my research apprenticeship, I worked with Dr. Gayle Timmerman, who had received an NINR-funded grant for a study on “Dieting, Deprivation, and Nonpurge Binge Eating in Women.” This experience inspired me to pursue a career in nursing rather than medicine. I chose the University of Texas at Austin School of Nursing to earn my nursing degree, not only because it is one of the top nursing programs in the country but also because I had established good working relationships with some of the faculty and staff.

During my sophomore year of nursing school, Dr. Timmerman asked if I would be interested in applying for another NIH-funded program designed to promote minority involvement in research–the Research Supplements for Underrepresented Minorities program. As part of the program, I would be an integral part of her research team while receiving research training. It sounded like a wonderful opportunity for me to gain further research experience, while receiving a salary to help with my school expenses. 

Since receiving the supplement, I have learned about the research process from the inside out. Through intensive training based on role playing and case study scenarios, I learned how to conduct telephone interviews to screen potential study participants and collect data during initial and exit meetings. My experiences in the community collecting data taught me how to interact with unfamiliar people in unfamiliar surroundings. This has helped me hone my interpersonal communication skills, an essential asset for a successful research career.

I have also learned how to work as a member of a research team. I attended team meetings where we problem-solved and brainstormed. This helped me learn that each team member’s input is important because each of us has something unique to contribute to the study. Knowing how to be a team player is another invaluable skill that I will carry throughout my life.

Participating in the Research Supplements for Underrepresented Minorities program also helped me develop and hone my technology skills. I received training in several computer programs used to conduct the study. For example, I use Food Processor almost daily to calculate participants’ daily caloric and fat intake by entering data from daily food diaries. I have created Excel databases to make computations easier. For example, I created a spreadsheet that computes the average caloric and fat intake for the 14 days that the participants keep the food diaries. I also use SPSS, a statistical analysis software program, to enter and analyze data.

In addition, I learned to formulate and answer my own research questions based on the data from the study, which helped sharpen my analytical skills. I presented my preliminary findings at a poster session at an undergraduate research symposium. This gave me the opportunity to see the entire research process from beginning to end while learning how to explain the data and answer questions about the study. This was valuable practice for future presentations and for building my networking skills.

Attending research conferences was still another important aspect of my research training. I traveled to Nashville to attend the Society of Behavioral Medicine’s annual meeting, where I heard presentations by researchers from numerous disciplines that focused on health and behavior. I was even able to have an expert consultation with Norman B. Anderson, PhD, former director of the Office of Behavioral and Social Sciences Research at NIH, who offered suggestions about various NIH programs geared towards nursing. He applauded me for getting an early start in my research career and encouraged me to continue in the path I had chosen.      

I also participated in a summer research institute sponsored by the NINR-funded Center for Health Promotion Research at my nursing school. This conference focused on how to prepare grant proposals, grant-writing tips and other key issues about seeking funding and conducting research. Here, too, I gained information that will help me throughout the rest of my career.

All of these intensive training experiences have increased my comfort level with research and provided me with essential research skills. Most important of all, I have been able to see first-hand the enormous importance of nursing research, especially in the area of minority health issues and the need to have more minorities conducting research.

Because of my participation in the Research Supplements for Underrepresented Minorities program, I plan to become a nurse researcher and faculty member. The solid experience in research I have gained will give me the edge I need to transition smoothly from undergraduate to graduate school, as well as the confidence of knowing that I am well-prepared to be a successful nurse researcher with a long and thriving career.

Authors’ note: Experiences in the Research Supplements for Underrepresented Minorities program described in this article were supported by the National Institute of Nursing Research grant R15NR04481-01A1S1.