With the rich diversity of the US population, there is a critical need to increase diversity among health care professionals, particularly baccalaureate-prepared RNs. A 2004 Institute of Medicine report on diversity of the health care workforce emphasized that health care equity and a reduction of health disparities cannot be realized unless there is an increase in the proportion of underrepresented minorities among health care professionals. The current US nursing workforce of more than 3 million nurses does not reflect the rich diversity of our nation's population (American Association of Colleges of Nursing, 2017), and innovative programs are needed to increase the number of baccalaureate-prepared RNs from diverse backgrounds.
ADELANTE
Adelante (Moving Forward) was creatively designed and implemented to increase nursing workforce diversity. A grant awarded from the US Health Resources & Services Administration provided funding from June 2015 to December 2017. Twelve students were accepted per year of the grant. Recruitment included information sessions to disseminate details about the program and provide application requirements and interviews conducted by the program project director and team.
The Johnson and Bozeman (2012) asset bundles model was used to underpin this innovative program. Johnson and Bozeman define asset bundles as specific skill sets and resources that persons develop and use that are helpful for moving forward and success in academic, professional, and personal endeavors. Three major strategies utilized in the program were: 1) retention activities and developmental relationships specifically designed to increase the number of underrepresented racial/ethnic groups in the nursing workforce; 2) provision of stipends to nursing students from diverse backgrounds who participated in leadership, research, and mentoring activities; and 3) partnership with a local four-year university to recruit prenursing students and help them earn prerequisites for nursing school.
Through the promotion of retention activities and mentoring relationships at both the individual and group levels, Adelante was designed to address social determinants of health and education that impact efforts to succeed in nursing school. Social determinants that can impact persons' health and education are factors and conditions in which they are born, grow, live, work, and age (World Health Organization, 2017). Adelante focused on aiding nursing students with individual social determinants of health and education that were influential in students' ultimate success. For example, participants were provided with stipends each semester to help them meet the financial responsibilities of nursing school. One student commented: "The stipend helped me pay for school. As a self-supporting student, I could not be more grateful for this opportunity."
Student-driven environments and programs facilitate students' persistence, socialization, and academic success (Del Prato, Bankert, Grust, & Joseph, 2011). Such programs emphasize that students themselves are key stakeholders in their education, and it is therefore important to verify and meet their needs (Hamid, Faroukh, & Mohammedhosein, 2013). The hallmark of the Adelante program was that it included peer-to-peer, student-driven activities and assignments, which led to a win-win environment for the student participants at the heart of the program.
Adelante provided nursing students with opportunities not only to mentor each other but also to serve as mentors to prenursing students. Mentoring has been shown to be a key strategy in promoting collegiality among nursing students, providing them with the development of rich, purposeful relationships strengthened by individual experiences and reflection (Gilmour, Kopeikin, & Douche, 2007). Adelante offered supportive, developmental relationships that helped students enhance the skill sets needed to advance the health and health care of diverse communities. These developmental relationships are important as the nursing profession works to promote a goal of Healthy People 2020 to reduce health disparities among racial/ethnic minorities and improve the health and health care of all groups (Office of Disease Prevention and Health Promotion, 2017).
Nursing students participated in three main activities: 1) mentoring prenursing students by attending and presenting at university prenursing society meetings, 2) assisting in the simulation lab with tutoring of clinical skills, and 3) working with a research professor as research scholars. One student wrote: "Under the encouragement of the Adelante faculty, I applied for what I thought was an unattainable research scholar position. I knew nothing about research. Needless to say, I was intimidated. After some time, I became more comfortable[horizontal ellipsis]. I learned to analyze data, investigate scholarly articles, write literature reviews, plan experiments, recruit volunteers, set up and conduct experiments, and submit abstracts to institutional review boards."
Literature has shown that supportive relationships among students from diverse backgrounds may better prepare them to face challenges encountered in academia or practice and widen their lens regarding race and ethnicity, cultural issues, and differences, which may also benefit their overall learning experiences and outcomes (Fine & Handelsman, 2010). Through student developmental relationships and sharing of experiences, mutual growth and benefits have been shown among participants. Caring, supportive relationships to assist and guide nursing students with any challenges or stressors of nursing school are critical to success. Adelante used developmental relationships and mentoring strategies to successfully advance the education of nursing students. The nursing students were the primary drivers of the program. Their leadership efforts were highlighted in quarterly newsletters.
MEETINGS, FAMILY ORIENTATION, NEWSLETTERS
The Adelante staff and baccalaureate nursing students met on a monthly basis to disseminate program information, support each other, and share ideas about their success in academic progression. Including nursing students in different semesters helped foster peer-to-peer mentoring, with upper-level students mentoring lower-level students. The emphasis during monthly meetings was to provide students with an intimate venue in which students from diverse backgrounds could engage in conversation and share their perspectives about different aspects of nursing school, learning experiences, and information about support and resources available. In this way, students were informed about what to expect and were encouraged to find assistance early on.
Family orientations for prenursing students were hosted at the school of nursing. A main focus was to introduce students and their support system(s) regarding the academic and financial responsibilities of nursing school while also providing an overview of services available, for example, supplemental instruction and tutoring. A panel of Adelante nursing students discussed various aspects of their educational experience such as courses, books, the application of prerequisite course knowledge in nursing, expenses, support and financial services, nursing student organizations, and the importance of seeking assistance early on as needed. Attendees were provided with a wealth of information about a variety of topics that might not be included in school pamphlets or websites. The discussion was followed by a question-and-answer session. Prenursing students and their family/significant others expressed their appreciation for the informative family orientation.
A quarterly newsletter was printed in English and Spanish to highlight the students' progress and accomplishments. Students wrote about personal experiences in nursing school and through Adelante. Student comments included "an amazing program because it aimed to help students reach their goals and excel," "promoted student-to-student interactions to ease anxiety of school and life," and "excellent experience as a student researcher."
Writing about their individual perspectives empowered nursing students and also enhanced their writing skills. The Adelante students offered advice and tips for beginning nursing students. One student wrote: "It will be hard, you will question your decision to become a nurse, and you may want to quit, but just keep going. There will be moments that will remind you exactly why you wanted to do it in the first place; like hearing a baby cry for the first time, holding a patient's hand during some difficult times, or just sharing the experience with your peers."
CONCLUSION
The Adelante program's foundational strategies are presently being used and expanded by our school of nursing student success center, which assigns a mentor to each nursing student and provides academic coaching, supplemental instruction, and tutoring services to address the needs of our diverse nursing student population. Nursing educators and academic institutions offering baccalaureate nursing programs are in a prime position to promote an increase in nursing workforce diversity. Sustaining innovative strategies and programs to increase nursing workforce diversity is crucial in moving forward to promote the health and health care of our nation's diverse population and thus reduce health disparities.
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