Achieving a diverse health care workforce is critical to reducing health disparities and achieving health equity in the United States (American Association of Colleges of Nursing [AACN], 2019; National League for Nursing [NLN], 2016). Providers who are members of groups that are underrepresented in nursing are more likely to practice in underserved communities, and their presence may increase access to care and improve patient-to-provider racial concordance. A more diverse nursing workforce would also support a culture of health, one in which more Americans have better access to care and improved culturally and linguistically appropriate care. However, retention and graduation rates of nursing students from underrepresented minorities continue to be a major concern for the nursing profession (AACN, 2017; NLN, 2016).

This article describes the application of the Collective Impact Model as an innovative conceptual framework for developing a pedagogical and collaborative process for advancing academic success for nursing students from underrepresented populations. It is our assertion that, by bringing together experts and thought leaders in nursing education, we can leverage collective knowledge and create strategies to ensure academic success of underrepresented nursing students. The outcomes of our workshops indicate that coalition building related to this topic is possible and can produce innovative approaches to academic success.

The collective impact model was first described by Kania and Kramer (2011) as a process model and an intentional way of working together and sharing information to solve a complex problem. The model has five conditions that together produce goal alignment and lead to successful outcomes: a common agenda, shared measurements, mutually reinforcing activities, continuous communication, and a background support organization. We describe how the Future of Nursing: Campaign for Action, an initiative of American Association of Retired Persons (AARP) Foundation, AARP, and Robert Wood Johnson Foundation (RWJF), applied this framework to create community in and among nursing schools at historically black colleges and universities (HBCUs) using mentoring as the core strategy. The Campaign, which is administered by the Center to Champion Nursing in America, also an initiative of AARP Foundation, AARP, and RWJF, was launched in 2010 to implement recommendations of the Institute of Medicine (2011)Future of Nursing report and build a healthier America through nursing.

THE FIVE CONDITIONS OF THE MODEL

Common Agenda

A common agenda requires a shared vision for change that includes a common understanding of the problem and a joint approach to solving it through agreed-upon actions (Kania & Kramer, 2011). Our common agenda has been to use mentoring as a strategy to increase the academic success of nursing students from underrepresented populations. To increase the number of BSN-prepared black nurses, the Campaign joined with the US Department of Health and Human Services' Office of Minority Health and multiple HBCUs that had BSN nursing programs. This was a coalition-building process involving HBCUs, the Campaign's state-based Action Coalitions, Office of Minority Health, and strategic stakeholders. The goal was to see what could be accomplished by bringing together groups with extraordinary expertise in nursing and workforce diversity. The focus was on mentoring, a successful strategy for students to achieve positive academic outcomes (Crisp & Cruz, 2009). For students from minority populations, it is particularly important to have mentors who have similar cultural and educational backgrounds and can serve as role models (Griffin, 2013).

Supporting large-scale efforts to build institutional capacity for mentor-training programs is aligned with the Campaign's mission. The Campaign has provided resources to nursing schools and its Action Coalitions for this purpose and, in 2018, convened its first pilot workshop, Diversifying the Nursing Workforce: Mentoring for Student Retention and NCLEX Success at Historically Black Colleges and Universities. Eight HBCUs in the mid-Atlantic region took part in the pilot, along with state Action Coalitions, federal stakeholders, and AARP. This resulted in an invitation to the Campaign from the White House Initiative on HBCUs to host a second workshop, during the 2019 National HBCU Week Conference; 23 of the 29 HBCUs participated.

Shared Measurement

Shared measurement involves collecting data and measuring results consistently on a short list of indicators (Kania & Kramer, 2011). The selected shared measurement systems were retention rates in HBCU nursing programs, which would be tracked by attrition rates, and National Council Licensure Examination for Registered Nurses^(R) pass rates. First-time pass rates of 25 HBCU baccalaureate-level nursing schools were analyzed prior to the workshops. Of the 25 schools, 15 reached the first-time pass rate accreditation standard benchmark of 80 percent; schools that consistently fall below this benchmark risk loss of accreditation and closure. As efforts to diversify the nursing workforce are jeopardized with the loss of even one HBCU nursing school, we will monitor these intertwined indicators of how nursing students are succeeding in school.

Mutually Reinforcing Activities

Mutually reinforcing activities encourage participants to undertake a specific set of shared activities in ways that support and are coordinated with the actions of others (Kania & Kramer, 2011). The mechanism for meeting the condition of mutually reinforcing activities for increasing academic success and nursing workforce diversity was the mentoring workshop, whose curriculum was based on the Mentoring Program Toolkit (DeWitty et al., 2017). The workshop incorporated active learning exercises, expert panels with audience participation, small and large group discussion, and structured action planning. During the workshop, representatives of the HBCUs were encouraged to collaborate and forge bonds with each other, the Action Coalitions, and stakeholders.

Continuous Communication

With continuous communication, trust develops among all participants and stakeholders and is needed to recognize and appreciate the common motivation behind their efforts (Kania & Kramer, 2011). Three platforms were implemented to facilitate continuous communication: 1) a monthly learning collaborative to foster peer-to-peer engagement and community building; 2) the Campaign's Engagement Planning Committee, which was developed to assist HBCUs in recruiting mentors and identifying funding opportunities; and 3) a series of webinars addressing such topics as health disparities, microaggressions, fundraising, and mentoring. These methods are intended to pave the way for partners to build trust over months and years.

Backbone Support Organization

A backbone organization is a distinct organization and staff have the necessary skills to serve as the backbone for the entire initiative (Kania & Kramer, 2011). The Campaign met this condition by providing backbone support, including organizational planning and ongoing communication via conference calls. Furthermore, the Campaign managed and supported various committees, learning collaboratives, webinars, and dedicated webpages on its website.

OUTCOMES AND FUTURE CONSIDERATIONS

Evaluation data from participants in the two workshops held so far are promising. Data from the 2018 workshop indicated that it met or exceeded expectations. Ninety-eight percent of participants rated the 2019 workshop above average or excellent in terms of usefulness; 92 percent agreed or strongly agreed that their understanding of how to build mentoring programs was increased. Participants from both cohorts stated that the most beneficial aspects were the opportunity to collaborate with other academic organizations, peers, and stakeholders and the tools provided to implement mentoring at individual universities.

An example of a promising outcome is a collaboration that developed among the three HBCU nursing programs in Maryland (Morgan State University, Bowie State University, and Coppin State University). Leaders from the three programs and the Campaign's Maryland Action Coalition discussed strengths and challenges, shared promising strategies, and identified areas for collaboration. As a result, the Maryland team is developing a mentoring workshop for all nursing programs in the state. The ongoing collaborative meetings and webinars involving HBCUs from both workshops are another positive outcome. We will monitor long-term outcomes using the agreed upon shared measurements. The Campaign is now working with nursing leaders on curricula for a mentoring workshop for Hispanic-serving institutions and Native American communities.

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