Innovative Nursing Education Pathways and Racial/Ethnic Diversity

Friday, 28 July 2017

Kupiri Ackerman-Barger, PhD, MSN
Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA, USA
Patricia Farmer, DNP
Nursing, Center to Champion Nursing in America; The George Washington University, Fortuna, CA, USA
Bryan M. Hoffman, MA
American Organization of Nurse Executives, American Hospital Association, Washington, DC, DC, USA


The purpose of this study is to determine whether innovative nursing education pathways reflect the racial/ethnic diversity of traditional pathways. In 2008 the Robert Wood Johnson Foundation partnered with the Institute of Medicine to produce an action-oriented report that would serve as a blueprint for the future of nursing. The report (The Future of Nursing; Leading Change, Advancing Health) sought to address issues like the nursing shortage, developing technologies in healthcare, and meeting current and future healthcare demands (IOM, 2011). The results of the report were four key messages. This study focuses on Key Message #2 which states, “Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression” (IOM, 2011). They concluded that an improved educational system was necessary to deliver safe, quality care across care settings.

According to the Future of Nursing report a complicating issue in nursing education is there are 2 key ways that students enter into the nursing profession; a bachelor’s degree in nursing (BSN) (typically a 4 year university based program), or an associate degree in nursing (ADN) (typically a 2 - 3 year community college based program). In the last few decades the most common education pathway was through an associate degree in nursing. Two salient, but competing issues with these pathways are 1) having multiple options for entry into nursing provides more options for access, which is needed during frequent nursing shortages; and 2) although the evidence is not conclusive, several studies have indicated a significant correlation between levels of nursing education and patient outcomes including mortality rates. Rather, than recommending that nursing discontinue the ADN pathway, the Future of Nursing report suggested a goal of increasing the percentage of nurses with a bachelor’s degree to 80% by 2020. This entails two components. One is that more students are recruited into BSN programs. The second is that registered nurses with associate degrees have options for obtaining a BSN.

To this end, the Robert Wood Johnson Foundation (RWJF) funded grant initiatives to explore and support enhanced academic progression pathways in nursing. The Academic Progression in Nursing (APIN) program was coordinated through the Tri-Council for Nursing, with oversight provided by the American Organization of Nurse Executives. This project funded nine states in developing and evaluating innovative models of streamlining nursing education pathways. The State Implementation Program (SIP) was based at the Center to Champion Nursing in America, a joint initiative of RWJF and AARP. SIP grants allowed states to select any area of the IOM Future of Nursing report for development, and more than 20 states focused on nursing education. In addition to APIN and relevant SIP projects, a number of programs nationally have also designed creative options and piloted innovative pathways that would lead to seamless opportunities for nurses to obtain higher levels of education. The most promising of these models is to link community colleges with university partners to allow students to concurrently enroll in a community college for pre-licensure nursing courses and a four year university to complete the requirements of a BSN.

As APIN and SIP states have rolled out pilot projects supporting academic progression an area identified by RWJF for grant funding was attention to the recruitment and retention of underrepresented and underserved students in schools of nursing. Anecdotal reports from leaders of programs have indicated a variety of perspectives on this including a possible loss of racial / ethnic diversity in cohorts of students entering new educational pathways. The need to diversify the nursing workforce has been acknowledged across organizations (AACN, 2014; HRSA, 2015; HRSA, 2006; IOM, 2003; IOM, 2011; NLN, 2009).


An initial written survey tool (questionnaire) was developed and will be distributed to all consenting programs. Only one questionnaire will be completed for each program/consortium. Questionnaire completion would require detailed understanding of program structure and access to student demographics including race / ethnicity of students. The questionnaire will be designed for completion in less than 15-30 minutes if data is at hand.

We hope to recruit at least 7-10 programs or consortia. Programs that have received APIN or SIP grant funds for education, and who have been identified through other mechanisms as having innovative educational pathways and who meet criteria will be invited to participate in this study. In addition, informational flyers, personalized emails, will be sent to program or consortia leaders. There is also a conference occurring Nov.14-16th in Miami Beach, Florida where many representatives of the APIN and SIP efforts as well as other national nursing education leaders will be in attendance. Potential participants would be approached, given flyers, and questions answered.

Data from questionnaires will be analyzed using basic data analysis features on Survey Monkey to allow compare or find correlations between enrollments and graduations within traditional and non-traditional educational pathways, including evaluation of race / ethnicity of participants. Following analysis of the survey data, individual interviews with respondents may be conducted to clarify data. The latter will be an important step because the design of each consortium is somewhat different such that terms like ‘traditional” programs may be interpreted differently. Data from this study enrollments and graduations f may be compared to state and national averages.

Results:  Pending


The degree to which innovative and/or accelerated programs impact diversity rates, whether positively, negatively or not at all, is important to understand as nursing education simultaneously seeks to offer a variety of options for attaining higher levels of nursing education and diversify the nursing workforce. By understanding what impact, if any, innovative nursing programs are having on the compositional diversity of the student body we can identify consortia who have addressed this issue well and disseminate best practices; and/or identify a potential problems and determine strategies for mitigating them.