Minority Student Success in Nursing Education

All minority populations are underrepresented in nursing when compared to the general population. Minority and nontraditional nursing students have lower retention and persistence rates as, well as lower NCLEX-RN® pass rates than white non-Hispanic nursing students. A variety of methods have been used to predict nursing student success and numerous interventions to improve student success have been reported. A review of these strategies reveals the necessity of thoughtful curricular and program approaches to increase the rate of success among nursing students. The Caring Imperative is proposed as a theoretical basis for these approaches. Minority Student Success 3 Minority Student Success in Nursing Education Issue and Significance A well-documented, global nursing shortage exists and is predicted to persist into the foreseeable future. The New Mexico Center for Nursing Excellence quotes the Health Resources and Services Administration (HRSA) as predicting that by the year 2020, 57% of the nursing requirements in New Mexico will not be filled (New Mexico Center for Nursing Excellence, 2006). One facet of this complex issue is the disproportionately small number of minority nurses. HRSA reports that even though the number of minority nurses increased from 7% in 1980 to 12% in 2000, those figures remain well below that of the general population where more than 30% are minorities in 2000 (HRSA, 2004). In September 2004 the Sullivan Commission released its report on diversity in the healthcare workforce entitled Missing Persons: Minorities in the Health Professions that revealed specific data about minorities in nursing. The Sullivan Commission sees increased healthcare workforce diversity as a priority to increase the overall health in the United States by increasing the cultural competence of its members as well as to improve health outcomes for members of minorities (The Sullivan Commission, 2004). The report notes that nursing has increased the numbers of underrepresented minorities at a slightly greater rate than medicine and dentistry, the other professions studied. However, they also note that an increase of 20,000 minority nurses would be required to raise the proportion of minorities by 1%. Minority nurses also pursue graduate education at rates higher than do white, non-Hispanic nurses. Less encouraging is the fact that numbers of Native Americans entering nursing have not changed appreciably in the ten years prior to the report. In addition, faculty and academic leaders in Minority Student Success 4 nursing have less diversity than the nursing population in general (The Sullivan Commission, 2004). As schools of nursing have sought and enrolled minority students at higher rates, another facet of the overall issue emerges. In California, where there is open enrollment in community colleges, minority-nursing students are less likely to graduate than are non-Hispanic white students (The Sullivan Commission, 2004). A report on the Transcultural Leadership Continuum project compiled by the National League for Nursing notes that in some areas, 60% of students entering at the associate level are enrolled in remedial programs. Attrition rates are up to 50% at the remedial level and up to 50% as well in the early science and nursing courses (Fitzsimmons & Kelley, 1996). Defining student success in nursing education must include retention and persistence. The National League for Nursing Accrediting Commission[NLNAC], considers the graduation rate to be the number of students who complete the program in 150% of the stated program length (NLNAC, 2005). In addition to completing a nursing program, graduates must pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN®) to be successful. Shortfalls in any of these areas constitute lack of success for individual students and nursing education programs. This paper will review assessment of and interventions to increase student success in nursing programs. Professional nursing education ranging from practical nursing to graduate education will be examined. Literature as far back as 1993 will be reviewed to ensure a broad view with special emphasis on the issue of student success as it relates to minority and nontraditional students where that information is available. Minority Student Success 5 Theoretical Foundation For the purposes of this paper, the theoretical foundation is based on papers presented in 1989 at the 11 National/International Caring Conference in Denver, Colorado. These presentations focus on caring behaviors that are culturally appropriate across the broad spectrum of education. Madeleine Leininger and Jean Watson (1990) edited a book based on those presentations. Both of these theorists have presented volumes related to the importance of culturally appropriate caring behaviors as these behaviors apply to providing nursing care. The Caring Imperative concentrates on applying this theoretical foundation to education. Education and caring share foci on growth and self-actualization (Appleton, 1990) making the connection a logical one. The Caring Imperative examines culturally appropriate care as it exists within the organizational culture of education as well as how it is modeled and taught within nursing education. Review of Literature General Education Literature Low completion rates in higher education are not restricted to minority students in nursing or health careers. Tinto (1993) reports that white students are almost twice as likely to graduate as are African American or Hispanic students (Tinto). Statistics in this work look at sixyear persistence rates. Six years after beginning an undergraduate program, students are divided into three groups. Completers have received a degree, persisters are still enrolled or are enrolled again after a break and departers have dropped out prior to completing a course of study leading to a degree. Of course, it is possible that some of the departers will return to become persisters. Tinto makes some interesting observations about higher education in general in the United States. For example, in most countries, the more selective the level of education, the higher the Minority Student Success 6 rate of completion. The opposite is true in the United States. Approximately 25% of all students do not graduate from secondary school, 35 to 40% of entering college students fails to obtain an undergraduate degree and it is estimated that up to 50% of those entering doctoral programs do not successfully complete the program (Tinto, 1993). Tinto concludes that student retention is a complex issue and that one key is integration of students into the institution. Whatever specific program is utilized, commitment to student success is the top priority. That would include a commitment to education for all students (Tinto, 1993). Tinto’s integration includes connections made with any portion of the university organization, including students and faculty. These connections fit well within The Caring Imperative. Nursing authors and researchers (Gardner, 2005; Shelton, 2003) do use the work of Tinto as a framework to examine nursing student retention. References to other mainstream educational theorists are often found in nursing literature, particularly when discussing subgroups like adult learners or nontraditional students. Literature Related to Predicting Nursing Student Success A portion of the literature is concerned solely with predicting student success. Research to determine causes of nontraditional undergraduate attrition establishes at least one significant difference from traditional students. Bean and Metzner (1985) define nontraditional students as older, part-time or commuter students. They note that these students are affected less by social variables on campus than are traditional students. Another conclusion is that the most important variables differ for various subgroups of nontraditional students; such as older, part-time, minorities or academically under prepared students at different types of undergraduate institutions. Minority Student Success 7 Jeffreys (1998) looked at predicting retention and academic achievement of nontraditional nursing students. Using the Bean and Metzner model, this study examined three groups of variables. These were background and defining variables, academic variables and environmental variables. In addition, self-efficacy, the belief that one is able to perform or learn, was measured. In this descriptive study of nontraditional, first semester nursing students, the students were asked to rate their personal perceptions of academic and environmental variables. They proved particularly inaccurate in perceptions related to academic factors, causing the researcher to postulate that the students in the sample did not have accurate perceptions about the academic skills necessary for success in professional nursing education. The students in this study perceived environmental factors were more influential for academic achievement than were academic factors. Students at greatest risk for attrition were those with very high self-efficacy who overestimated academic support and underestimated their need for academic preparation. Although the focus is on early identification of the students who are at-risk, Jeffreys suggests that faculty expand their role to include mentoring and that any support strategies used are planned to include the specific needs of nontraditional students. These interventions are easily related to The Caring Imperative. A relationship built on mutual trust in the caring environment (Halldorsdottir 1990), as described in The Caring Imperative, is at least part of the mentoring role. One study compared two entrance examinations to see which was most predictive of success in the first nursing course and on the NCLEX-RN®. Students entering the program took both the Entrance Examination for Schools of Nursing (RNEE) and the Nurse Entrance Test (N