Researchers and national organizations clearly identify the need for a diverse nursing workforce to reduce health disparities. As summarized in the 2016 National League for Nursing living document “Achieving Diversity and Meaningful Inclusion in Nursing Education,” lack of racial and ethnic diversity in nursing education faculty, along with unwelcoming environments; insufficient academic supports; and lack of institutional efforts to recruit and retain students from different backgrounds impede diversity in nursing. The Agency for Healthcare Research and Quality and the Institutes of Medicine Future of Nursing 2011 report (National League for Nursing [NLN], 2016) also recommend a diverse nurse workforce for improvements in the quality of health care for diverse populations.
When nurses possess shared cultural experience with patients, there is greater communication and trust, which lead to high-quality nursing care (NLN, 2016). The national calls for a diverse nursing workforce encourage schools of nursing to enact innovative programs to promote educational diversity. One high-impact program that promotes diverse student success and is adaptable to nursing programs is the Center for Educational Partnerships’s (n.d.) Puente Project, which strategically targets outreach, learning, and career goal attainment of disadvantaged students through counseling and academic support. Academic preparation in high school that continues into prelicensure education is necessary to support success in nursing programs (Torregosa, Ynalvez, Schiffman, & Morin, 2015).
HealthStart, an innovative pilot model, utilizes Puente Project outreach methods in which bicultural advisors recruit and counsel at-risk prelicensure students. The program also makes use of lessons from the educational literature on contextualized learning and creates learning communities to provide at-risk, racially and ethnically diverse students the skills necessary to succeed in a nursing program. Contextualized teaching and learning integrate theoretical and occupational skills in a real-world context, providing experiences students may use immediately (Ambrose, Davis, & Ziegler, 2013). For example, for students with low scores in reading, writing, and critical thinking skills, class discussions and essays on ethical medical dilemmas promote active learning and engagement, leading to positive perceptions, student empowerment, and retention.
Specialized outreach methods of the Puente Project and learning communities also promote the academic success of at-risk students. In the Puente Project, at-risk Hispanic students take two consecutive introductory writing classes: English 50 and English 100. Students work with counselors, develop an academic educational plan, and improve their writing skills utilizing a Mexican American/Latino curriculum. Specific outreach methods include identification and recruitment of at-risk students by a bilingual and bicultural program coordinator during the last year of high school. Students demonstrate project commitment by completing an application and summer orientation.
Learning communities support students’ integration into college life and build a strong academic cohort in a mutual area of interest by incorporating contextualized curricula. The model utilizes cohort faculty/peer collaboration and integrates a range of college support services such as tutoring, counseling, and career planning to build a community and promote retention (Lorch, 2014). This article describes an innovative pilot model for promoting diversity in prelicensure nursing education utilizing: 1) scaffolding contextualized learning, 2) the Puente Project outreach methods, and 3) learning community strategies to ultimately promote diversity in nursing programs.
A DESCRIPTION OF THE PROGRAM
The setting is a large community college in Southern California with a diverse student population. The nursing and allied health department graduates approximately 200 students each year. Less than half of the students in this department are Caucasian (44 percent), whereas the other ethnicities include Hispanic (22 percent), Asian/Pacific Islander (13 percent), multiethnic (12 percent), African American (5 percent), and other (4 percent). Approximately 25 percent to 30 percent of the racially and ethnically diverse nursing students struggle with the English language (reading comprehension and grammar), basic math skills to include medication calculations, and science (data interpretation and retention) as identified on the Test of Essential Academic Skills entrance examination.
To meet these academic challenges, the nursing department, supported by college administration, participated in a California Linked Learning Pathways to the Baccalaureate (LLPB) two-year grant to first address deficient English skills. The LLPB grant set forth a purposeful mission for a global allied health pathway: to increase access and academic success specifically in reading, writing, and critical thinking skills for at-risk students in their transition from high school to community college to a transfer institution. After the funding was exhausted, a Basic Skills Initiative grant provided additional funds to continue HealthStart.
HealthStart currently encompasses two consecutive introductory composition courses, English 50 and English 100, which bolster reading, writing, and critical thinking skills for at-risk students interested in a baccalaureate health degree. HealthStart also incorporates student support services with career advisors, tutoring, and counseling. A Latina bilingual membership coordinator conducts high school recruitment efforts as previously described in the “The Puente Project” (Center for Educational Partnerships, n.d.). The outreach provides students vital opportunities to connect with educational (course planning) and career counselors, the English instructor, program coordinator, and the students’ cohort.
For the first grant year, 100 percent success in outreach, recruitment, and enrollment was experienced: 26 students who declared as allied health majors were recruited, oriented, and enrolled in HealthStart ENGL 50 for fall 2015. The English instructor developed a contextualized curriculum that maximized student engagement, relevance, and critical thinking. Students were prepared for nursing reading/writing challenges incorporating American Psychiatric Association formatting and readings from nursing journal articles, textbooks, and memoirs.
Thirty students in total completed the English 50 and English 100 courses. Of these, 57 percent were Hispanic, 20 percent were Caucasian, 10 percent were African American, and 7 percent were Asian; 7 percent reported two or more races. The sample was predominately female (n = 25, 83 percent), was of lower socioeconomic status (73 percent), and earned a cumulative Grade Point Average of 80.6 percent (2.56 of a 4.0 scale). Retention rates in the English 50 course increased from 72 percent collegewide to 93 percent in the HealthStart section. For the English 100 course, retention rates increased from 66 percent to 96 percent. These results represent a 21 percent to 24 percent increase in retention in a predominately lower socioeconomic, racially and ethnically diverse population with deficient academic skills.
The counseling support maximized students’ transitions to college and their fulfillment of personal, academic, and career goals. All students met with the counselor during their first semester and completed individualized, comprehensive education plans. Students utilized their career counseling resources and completed research assignments and action plans. The cohort model maximized peer connection, support, and the formation of college identities. Students participated in weekly study groups and experienced the best of academic/personal support.
Students composed a range of essays, which were assessed by a rubric created by both English and nursing instructors. Because of the solid college composition skills established in English 50, the English 100 instructor was able to increase rigor for this course. Students constructed organized expository texts; researched and evaluated academic databases; meaningfully integrated and documented sources using American Psychiatric Association format; and correctly applied grammatical conventions. Reflective survey feedback revealed that students actively utilized college support services and social networks in other classes. All but one student passed the classes.
Although the LLPB grant is completed, many of the start-up costs (website development and recruitment, orientation, application, referral, and promotional materials) are no longer needed. Currently, the total annual budget of $15,000 funds a coordinator, counselor, materials, and two summer orientations. HealthStart is currently sustained through Basic Skills grants and funding from the nursing and counseling departments.
HealthStart is the first step toward initiating systematic pathways for diverse, academically at-risk students to be prepared for rigorous nursing programs. Limitations to HealthStart include financial resources, sample size, and cross-sectional data. Additional outcome measures on college retention rates and baccalaureate degree completion will not be known for another four years as the students complete their degrees. However, dramatic increases in retention rates and fulfillment of program outcomes outweigh these limitations.
Funding for HealthStart is sustainable as it aligns with other Basic Skill and Achieving the Dream (or nationally recognized High-Impact practices for two- and four-year institution) initiatives. Most importantly, diverse, at-risk students, well supported in a strong peer and academic community and provided language comprehension, grammar, and critical thinking skills, are better prepared in meeting the challenges of nursing school. Currently, HealthStart is being evaluated to incorporate other prelicensure math and science courses. Recommendations for future research include longitudinal studies on nursing program retention and academic success.