In this time of increasing focus on efforts around diversity, equity, and inclusion, creating a more diverse nursing and healthcare workforce is a goal that many would agree is worth pursuing.
A more diverse workforce positively manifests for all parties involved, whether doctors, nurse practitioners, nurses, or other healthcare professionals. However, barriers to inclusion and diversity within the doctorally prepared nursing workforce are a challenge that some are beginning to address.
Advancing Equity in Nursing Education
Dr. Danielle McCamey, DNP, ACNP-BC, FCCP, is an expert critical care advanced practice clinician and the Assistant Dean for Strategic Partnerships at the Johns Hopkins School of Nursing. She is also the founder and CEO of DNPs of Color, an advocacy organization with a mission of inspiring more people of color to pursue advanced nursing education, particularly the Doctorate of Nursing Practice. In this regard, networking, advocacy, and mentorship are pillars of Dr. McCamey’s efforts to diversify the nursing workforce.
In terms of the representation of people of color in nursing, Dr. McCamey states, “We are not well-represented, as the literature shows, but we are much needed in order to close inequity gaps and advance health equity.”
And in the realm of the recruitment of people of color into the nursing profession, Dr. McCamey sees a path forward.
“We have to restructure our efforts so that we begin exposing the nursing profession early and consistently [to young people]. We must also remove financial and other barriers to access to nursing education, whether in the form of standardized tests or ensuring that we keep all pathways into nursing available, including CNA, LPN, ADN, and beyond.”
Expanding on the issue of nursing education, Dr. McCamey shares, “Honestly, nursing education needs to be free, and schools like Historically Black Colleges and Universities (HBCUs) and Hispanic-Serving Institutions (HSIs) need to be given more funding resources and other administrative support to be able to accommodate more students of color.”
Filling the pipeline of the nursing educational system is key to keeping the nursing workforce robust and well-populated. Yet, we also must be certain that diverse cohorts of talented and dedicated individuals can visualize an avenue to fulfill their educational and career goals, including at the doctoral level.
Patients and Quality of Care
A diverse nursing workforce benefits both patients and healthcare workers alike. When it comes to quality improvement in patient care delivery and the experience of healthcare professionals, an article in the New England Journal of Medicine states, “Lack of workforce diversity has detrimental effects on patient outcomes, access to care, and patient trust, as well as on workplace experiences and employee retention.”
No matter how we break this issue down, increasing diversity has qualitatively and quantitatively positive benefits that are well worth the effort of undertaking such initiatives.
Studies of a concept referred to as “race concordance” or “race congruence” have shown that patients like to be cared for by providers and staff who look like them. As noted in an analysis published on the National Library of Medicine website, “Research suggests that race concordance between patients and providers is associated with positive outcomes such as higher levels of perceived patient satisfaction of care, quality of healthcare, and more trust in their provider.”
Improved outcomes are certainly something everyone working in healthcare can get behind, and when we have a highly trained and diverse workforce, reaching patients where they are with providers who look like them and understand their lives is astronomically beneficial.
A Vision for the Doctoral Nursing Degree Path
When discussing people of color pursuing advanced nursing degrees, including the PhD and DNP paths, Dr. McCamey states, “Exclusionary practices and gatekeeping within nursing along with lack of mentorship have often stood in the way.”
Dr. McCamey mentors many up-and-coming nurses entering the doctoral field, and she understands the power of those relationships based on her lived experience.
She continues, “From my personal experience, mentorship was key to understanding some of the rules of the game and navigating certain spaces, as well as advocating for resources to contribute to my success and advancement in the profession. Having an affinity with those who’ve gone before is crucial.”
In terms of doctoral education, Dr. McCamey states, “Historically, PhD-level nurses are those that generate new nursing knowledge and science, while DNPs generally translate that science into clinical practice. However, we also see more DNPs pursuing nursing science and research.”
For nurses who wish to pursue a doctoral-level education but are uncertain about the choice between a PhD and a DNP, Dr. McCamey shares her clear opinion:
“I am biased towards the DNP because it has made doctoral studies more accessible, specifically for nurses of color. Unlike a PhD track, the more flexible DNP curricula allow students to engage in other life obligations while also going to school.” She continues, “For many of us, this flexibility is vital since we support our families and communities, whether financially or in caregiver roles.”
Dr. McCamey states to attract more nurses of color into doctoral studies, “I would like to see more consistent branding and marketing of the valuable contributions DNP-prepared nurses bring to nursing practice. I also want to see more nurses who reflect the diverse communities that we serve.”
Incivility in nursing education has become an increasingly bothersome problem; however, it has especially become a nuisance in online education. Suplee, Lachman, Siebert, and Anselmi (2008) indicated that a faculty witnesses daily encounters in classes and clinical settings. Incivility is defined as behavior that is unprofessional, rude, and disrespectful. It can result in burnout and psychological and physiological distress for the parties on the receiving end, especially if left unaddressed (Butler & Strouse, 2022).
Another term that has especially been seen in the online realm is bullying, which can occur student-to-faculty and faculty-to-student. Unfortunately, it can also occur in faculty-to-faculty (Butler & Strouse, 2022). There has been an increase seen in student-to-faculty students’ displeasure with their achieved grades.
We must evaluate the reasons that the behavior is happening.
Stress from many walks of life can be the culprit, including working too many hours, mismanagement of work-life balance, stressful work assignments, financial strains, relationship strains, biases, and so on. Butler and Strouse (2022) also indicated that burnout and demanding workloads contribute to the greatest stressors. Personally, I have observed these behaviors displayed when providing constructive criticism. How can we, the faculty, help to ease the burden and create the traditional professional environment that many of us were able to participate in our educational journey?
As a part of a nursing faculty for ten years, I feel it is my calling. I enjoy helping deploy educated and competent novice nurses and advanced practice nurses into the workforce. However, the stress and incivility sometimes make one feel burned out. Many of us ponder going back into the clinical setting, feeling unappreciated and undeserved.
Caputi (2015) reported that the faculty can assist students in engaging in constructive evaluation of themselves and others. One factor is professional maturity, which can allow the students to analyze their own performance. As a faculty, providing feedback that is useful in the workplace and not hurtful can be helpful for growth and development. Self-reflection and guided introspection can be useful (Caputi, 2015). Discussing values, morals, attitudes, and the AACN essentials, pertaining to professionalism and leadership can be useful in developing students with incivility and assisting students in understanding (Caputi, 2015). However, the most important element is support from the administration and the appropriate follow-up and disciplinary actions.
For decades, online nursing education options offered nurses a different path to a nursing degree, but the choices were limited. Today’s nurses enjoy nursing degree program choices that provide variations in everything from how and when they take a course to the length of a program.
For many nurses, particularly those seeking advanced degrees, this expansion in online programs allows flexibility to balance work, school, and personal obligations. Despite the proliferation of programs, online coursework isn’t for everyone; some nurses work better in a more traditional classroom-based curriculum. The key is
assessing each program you’re interested in, your learning style, and finding a match that sets you up for success.
For nurses considering this path, taking the time to find out essential details is time well invested. “There’s a growing number of online programs, so you have to know what you’re looking for,” says Patricia Bruckenthal, PhD, APRN-BC, FAAN, dean and professor at Stony Brook University School of Nursing, Stony Brook, New York. “You’re making one of the more important decisions in your life, and you have to place a high level of importance on how you’re going to fit that into your life and schedule.”
Assess the Program
Finding a program won’t be difficult, and they should be assessed carefully as any other program. “Students considering an online program should use the same criteria for selecting a program that they would use for assessing a traditional program, including choosing an accredited program, locating programs that will help you reach your professional goals, and finding schools that specialize in your primary area of interest,” says the American Association of Colleges of Nursing (AACN) president and chief executive officer Deborah Trautman, PhD, RN, FAAN.
In addition to considering the school’s reputation and accreditation, students are encouraged to use all the available information about the school and faculty members, says Bruckenthal. “Look at the level of experience the school has with online learning,” she says. “Are there any faculty who are published in online learning? Faculty who are that engaged will know students have different learning styles.”
Evaluate Your Lifestyle
Undoubtedly, online programs give a level of flexibility that makes a degree possible for nurses to juggle many obligations. “Due to the work and family responsibilities, working RNs often benefit from being able to attend class and complete coursework during non-traditional times,” says Mashawna Hamilton, DNP, RN, associate professor and associate director, RN to BSN Nursing at Ohio University, Athens, Ohio.
If students believe online learning offers flexibility, they still have to plan how to fit the class time and all the required work into their day. “It’s important to know what you’re looking for,” says Bruckenthal.
Online learning takes as much discipline as in-class courses. Look at your habits, motivations, and realities to decide if an online program will provide you with more opportunities for success or with unanticipated roadblocks.
Students working remotely must be highly motivated to complete the work when they have other obligations. There are other potential obstacles to be aware of, says Bruckenthal. Do you have quiet and sufficient study space? Do you have childcare if you need it? Is your family willing to take on additional duties such as cleaning or grocery shopping so you can carve out time for school?
Be Ready for a Challenge
Flexibility also doesn’t mean anything is simplified. “The biggest mistake a student can make is assuming that online courses are less rigorous than traditional programs,” says Trautman. “These programs take discipline, strong writing skills, and keen organizational abilities. Students in online courses are expected to answer all questions, provide regular feedback through discussion forums, and complete just as many assignments.”
If you’re looking for a program that fits your criteria, digging a little deeper into the school, the program, admission, and curriculum requirements will give the complete picture you need to make an accurate decision.
Here are some options to consider:
What is the program cost, and how will you pay for it?
What is the average program completion time?
Are online students ever required to be on campus?
What is the curriculum delivery (is it asynchronous or synchronous)?
What do postgraduate career outcomes look like?
What are the technology requirements?
What happens if you need more time to complete the program?
Knowing what happens for students postgraduation—from employment to alum networking—is critical to the whole program. “Students should consider the reputation of the online programs,” says Hamilton. “In doing so, consider comments from employers of previous graduates. What is the graduate employment rate? What accolades has the program received from national agencies?”
When you find a program that fits your learning expectations, schedule, and budget, some final details need clarification before committing to a program.
Trautman recommends contacting each school to assess how the learning format, clinical experience, and academic and professional development supports offered will help you. “School advisors will know what options and assistance is available to offset costs, including scholarships and loan repayment programs,” she says. “The only way to fully know what institution-specific programs are available is to contact the nursing school.”
And when planning when you’ll have that degree in hand, remember the course schedule of each school can vary. An average program completion time can indicate the pace of courses and flexibility, but sometimes required courses are offered only once or twice a year. If you aren’t aware of the schedule, it can derail your expected graduation date. “Students should also inquire about the frequency courses are delivered, the expected time dedication for courses, and requirements for part-time and or full-time enrollment,” says Hamilton.
Evaluating Supports
During your research, find out what assistance is offered to online students. Because a program is online, it may seem more difficult to access help when you can’t just go to a physical office. “The strength of student support programs can significantly impact the student’s success during their academic journey,” says Hamilton.
Good online nursing programs will have support, including online office hours for faculty members, remote technology support, online study, social groups, and even one-on-one student support from the college. Students may want to ask about online libraries, learning labs, online writing help, skill-building webinars, wellness services, and opportunities for online student engagement as well, says Trautman.
And students also have options that are outside the campus to help them succeed in an online program, including professional nursing organizations. For example, master’s and doctoral program students can access a free membership to AACN’s Graduate Nursing Student Academy, which provides focused support opportunities for students in online and traditional programs.
For many nurses, remote degree programs open possibilities and help bring more nurses into the workforce. “Since these programs are generally directed toward individuals who are already licensed registered nurses, most students are working and trying to juggle life’s many demands,” says Trautman. “Online programs make that possible.”
In today’s climate, nursing is everywhere. It’s in the news and social media, but the coverage is rarely positive. Nursing has been America’s most trusted profession for years, but COVID-19 changed the perception of nursing.
No longer are nurses viewed as the safe harbor for patients who were battered by the winds and wrath of an industrial health care complex. Instead, nurses are publicly placed on trial for system errors and named in lawsuits for medical malpractice. What does the future of nursing look like in America? No one knows for certain, but I do know
who can reframe the perception of nursing, and that is the nurse educator.
Soul of Nursing
The nurse educator is truly the master of the soul of nursing. Still, they are rarely esteemed for the critical work accomplished. The nurse educator takes the raw material of an eager student and pours endless knowledge and skills to form the building blocks of a nurse. There is not a single nurse in existence who has not passed through the skilled hands of a nurse educator. The educator can genuinely alter the perception of a new nurse before the nurse even realizes they have been altered. The nurse educator can transfer tolerance and understanding through their formative teachings, prejudice, and judgment. The responsibility to develop the future of the entire profession rests on a select few, rarely acknowledged, who guard our profession with love and passion.
Passion
It is passion that drives the nurse educator. It surely is not the ability to earn a high income. According to the Bureau of Labor Statistics, the average nurse educator earns an annual income of $78,000. For a job that requires an advanced degree, any nurse educator could be better served with more lucrative uses of their degree, such as a nurse practitioner or joining an organization’s nursing leadership. It’s not the hours that drive the nurse educator. Is getting Christmas off a perk? Absolutely! Is waking up to 13 texts from a student who could not upload an assignment a benefit! Absolutely not. As a nurse educator, the breaks from classes are spent reworking material, developing new experiences, and continuing to grow professionally. It is truly a passion and a calling that drives the nurse educator.
Need for Nursing Faculty
Why should every nurse be aware of the need for nursing faculty? According to the American Association of Colleges of Nursing, a faculty vacancy rate of 8.8% nationwide has remained. This has resulted in a horrendous outcome of over 91,000 qualified applicants being turned away from nursing programs. Turning away applicants continues to exacerbate the nursing shortage. With the current projection from NCSBN of close to one-fifth of the nursing workforce looking to exit in the next five years, every applicant to a nursing school is a building block to the solution.
Know Your Influence
So why consider nursing education? The nurse educator is an artist. They take a piece of unformed clay and place pressure to mold and change the clay into a beautiful vase. With every student, educators leave a tiny part of themselves to transform a corner of the world. As a bedside nurse, I touch a few lives every shift. But if, as an educator, I have taught the floor of nurses, my reach is far greater than I will ever know. Knowing that your influence can affect the health care of a region, state, or nation is a pride and privilege few know. Nursing education is a beautiful profession that is far too often overlooked but should be dutifully considered.
My nursing education journey began when I received my BSN in Nursing at Rutgers College of Nursing in 2011. During my time there, I met some strong, professional women professors. They took such a personal interest in me that, over a decade later, I think of them with much gratitude. Their strength helped me to see myself as a strong but caring nurse.
A Strong Caring Nurse
My education gave me the confidence to care for my patients competently. I had a tough clinical practice specialist on the Med/Surg/Tele unit I first worked on. When she asked me questions on the spot, I almost always knew the answer. I credit Rutgers and fellow student nurses who supported each other through nursing school.
Prisca Benson, MSN, RN is a a nurse navigator for the neuroscience department at The Valley Hospital
While there was a lot to learn on the job, the education I received provided a foundation I used to excel clinically. It was not long before I started picking up per diem job opportunities to explore and broaden my horizons as a nurse. I worked in home care as an intake nurse, home care nurse, and infusion nurse for different companies.
In 2014, I got a job as a neurology nurse at my dream hospital, NYP-Columbia University Hospital. While per diem there, I joined committees I was interested in and disseminated the information to the staff in my unit to improve our practice.
I also noticed that some patients lacked a basic understanding of their medical history and medication. So I used the principles I learned in school to educate them effectively so they could be more knowledgeable about their health and care.
A Life’s Passion Realized
I soon realized that my passion was teaching.
I began searching for nursing opportunities to give me more time to teach patients. I applied for a position as Neuroscience Nurse Navigator at The Valley Hospital, which allowed me to create and develop the role to support the patients during their admission and help them maintain outpatient follow-up.
This was a dream come true! I finally had the time to sit at a patient’s bedside, teach them about their new diagnosis and answer all their questions.
While working this job, I received my MSN in Nurse Education at Chamberlain University. The modalities taught have allowed me to be a better peer and patient educator. It encouraged me to start with the other person’s understanding as a foundation for effectively educating someone. I participated in my organization’s student nurse externship by teaching skills, theory, and even creating an educational game to increase knowledge retention.
Love and Desire to Educate
My love and desire to educate led me to start a personal finance and health blog, Our Green Life, during the pandemic. The fear and misinformation were very unsettling, so I wanted to provide a reliable but approachable space for information. I use what I have learned through my education and experience to make the information easy to grasp and to demonstrate how it could be applied.
My nursing education helped shape my career, goals, and values, and I will be forever grateful for it.
