The disproportionate representation of African Americans (AAs) in the nursing profession is alarming. According to a 2017 survey conducted by the National Council of State Boards of Nursing and the Forum of State Nursing Workforce Centers, whites accounted for 80.8 percent of the RN workforce while AAs accounted for only 6.2 percent (American Association of Colleges of Nursing, 2019). AAs represented only about 11.8 percent of students enrolled in basic nursing programs (National League for Nursing, 2018) at a time when the percentage of AAs graduating from high school was increasing, reaching a peak of about 77.8 percent (EDC Facts Data Group, 2018). Despite these higher graduation rates, fewer than half of AA students were expected to enroll in a four-year college or university (McFarland et al., 2019), due in part to the college-going process.
Navigating the college-going process is often a difficult and intimidating task for any high school student, but even more so for those who want to pursue a degree in nursing education. Nursing is one of the few professions with multiple pathways for entrance, including prelicensure programs, diploma programs, associate degree programs, and baccalaureate degree programs. To make matters more complicated, there are accelerated programs and RN to BSN programs by which students can also earn a bachelor's degree in nursing. For AA students and their parents, navigating this process can be confusing. AA students are more likely to be first in their families to attend college and are less likely than others to encounter RNs who look like them. Having a family member who attended college may significantly help in navigating the college-going process. Exposure or contact with an RN from the same racial and/or cultural background provides a student with a role model and hope.
Students often look to the high school college guidance counselor for assistance. The Executive Office of the President (2014) found that by adding one additional high school counselor per 113 seniors, four-year college enrollment increased by 10 percentage points. Without the support of counselors in the college-going process, poor quality applications are often produced, leading to college rejections and the inability to obtain funding. Students are also more likely to delay college entry and less likely to pursue a bachelor's degree after high school graduation. An additional concern is that many guidance counselors are ill prepared to assist students interested in nursing education. Matutina (2008) found that more than one third of guidance counselors surveyed (n = 189) reported that they were not well informed about the nursing profession. In the same study, AA male and female counselors rated nursing lowest as a profession, reinforcing outdated and inaccurate perceptions.
With multiple obstacles, including lack of clinical placements (45 percent) and the shortage of qualified faculty (25 percent), limiting the number of acceptances (National League for Nursing, 2018), the admission process for those interested in nursing education is highly competitive, putting AA students at a great disadvantage. One way to remedy this situation is to provide resources that will help AA students be successful in the college-going process toward a degree in nursing education.
The Diversity in Nursing Awareness Project (DINA Project) was a mentoring program in southeastern Pennsylvania during the period September 2015 to January 2016. Its purpose was to assist first-generation AA students interested in nursing education during the college-going process. The DINA Project was part of a larger research study that sought to describe mentoring and parental involvement during the college-going process as experienced by first-generation AA students considering nursing education. This article reports on its development and outcomes.
PROGRAM DEVELOPMENT
The DINA Project paired high school students with RNs who contributed to their careers and psychosocial development. The end goal was admission into and enrollment in a BSN program. The project was conceptualized using Peplau's theory of interpersonal relations and modeled after an established formal mentoring program whose primary aim was to assist low-income, first-generation students during the college-going process. Modeling a successful, well-established program helped ensure that best practices for effective mentoring were followed, with monitoring, ongoing training and structuring of activities for mentors and mentees, clarification of expectations (Garringer et al., 2015), and parent involvement (King, 2012).
Nurse mentors were recruited from a local health care system and professional nursing organization via word of mouth and flyers. Inclusion criteria were as follows: must be an RN with a minimum of a BSN degree; must have active Pennsylvania RN license, child abuse history clearance, and criminal background clearance; and must be either AA or Caucasian. A recruitment flyer was emailed to school guidance counselors, principals, and teachers and then distributed among students. Student mentees were required to be AA high school seniors enrolled in a public, charter, or parochial school within Philadelphia, with a minimal cumulative grade point average of 2.8 on a 4.0 scale. Mentees were required to be first-generation students interested in applying to a BSN program.
Nurse mentors and student mentees were paired using the Mentoring Match Demographic Questionnaire. The Questionnaire matched mentees to mentors based on commitment and availability, nursing areas of interest, hobbies, and personality type. Prior to the match, mentors and mentees attended two separate orientation sessions for an overview of the program and expectations. The DINA Project followed a schedule for structured activities, including workshops and field trips. The Philadelphia Futures Outreach Program, the Tax Time Financial Group, and the Center for Financial and Economic Empowerment conducted the workshops, providing written materials for participants about the college-going process. Field trips included local college fairs, visits to local colleges, and the Overnight HBCU College Tour. Mentees and mentors were encouraged to develop the relationship outside the prescribed structured activities and events. A ceremony marked the end of the program with family members and supporters in attendance.
PROGRAM OUTCOMES
Ultimately, students participating in the DINA Project with the help of nurse mentors were able to successfully navigate the college-going process in nursing education, which aided them in their psychosocial and career development. Anxiety and knowledge deficits often experienced during this time were minimized. Parental involvement was also positive. Although most of the students reported limited "hands-on" and financial support from their parents, all felt emotionally supported by their parents while participating in the program, and parents expressed gratitude for help in the process. Of the six mentoring dyads, five students were accepted into BSN programs. Of these, four enrolled with nursing education as their major. The remaining student was accepted into a community college; the researcher was unable to determine her major or enrollment status.
IMPLICATIONS FOR THE FUTURE OF NURSING
The lack of diversity in the nursing workforce remains an ongoing issue. Nursing as a whole must do more to recruit AAs as well as other minorities into the profession so that the nursing workforce can be more reflective of and meet the needs of our multicultural society. Research has indicated, and professional nursing organizations agree, that having a nursing workforce that mirrors the population will have a positive effect by reducing health care disparities and inequalities. Recruitment efforts must begin as early as middle school. Mentoring programs in high school that assist AA students and their parents to navigate the college-going process of nursing education are needed.
The unequal representation of AAs enrolled in four-year BSN programs is also concerning. Having multiple entry points makes nursing education more accessible to students who may not otherwise qualify or choose not to enroll for financial reasons, but the multiple pathways to nursing currently in place may lead to inequity with regard to employment and salaries. Many employers, such as Magnet hospitals, will only hire baccalaureate-prepared RNs. The future of nursing should not only include mentoring programs that aid in the college-going process but also a redesign and/or restructuring of baccalaureate degree nursing programs that will make the degree more attainable for AA students and other minorities.
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