It is well documented that the face of the nursing workforce remains primarily female and white. Despite national efforts to attract underrepresented individuals into nursing, the profession does not yet reflect the population it serves. The population is served by only 5% Hispanic/Latino nurses, and the percentage of Black nursing graduates remained relatively unchanged over the last 10 years. For an individual with a bachelor’s degree in another field, the transition to a career in nursing through an accelerated nursing program is challenging and is often more challenging for underrepresented minority students. Although overall growth in nursing program graduates has increased by 141% in ten years, the nursing workforce remains predominantly White (75%) and female (93%). In one accelerated program, data analysis demonstrated that 10% of minority students were not progressing successfully to graduation.
Recruitment efforts are futile if educational support programs are not available to follow students through to successful program completion and more importantly, to be successful in passing the National Council Licensure Examination for Registered Nurses (NCLEX-RN) examination. Retaining nursing students from the beginning of their program to the second semester is vital to the student’s overall success. First semester students often underestimate the rigorous demands of a nursing program and often overestimate their supports, leading first semester students at risk for attrition and poor academic outcomes. Evidence suggests that minority nursing students may have higher attrition rates when compared to White nursing students.
Methods:
New Careers in Nursing (NCIN) Data
NCIN, in association with Robert Wood Johnson Foundation, implemented a Pre Immersion Program (PIP) Toolkit for those schools who received NCIN scholarships to help prepare students for the rigors of an accelerated program. The goals of NCIN were two-fold: help alleviate the nursing shortage and increase diversity among nursing professionals. The NCIN program provided 3,506 scholarships to underrepresented minority or economically disadvantaged nursing students attending 130 Accelerated Baccalaureate Science (ABS) in Nursing programs in the U.S. from 2008 to 2015.
Analysis of the national data resulting from these PIP programs revealed that both the graduation rate for all PIP participants and Non-white PIP participants was higher compared to non-PIP scholars. Withdrawal rates were also lower for PIP participants; 6.6% compared to 11.03% (p=0.0092). Overall retention was reported at 93.3%. PIP participants were more likely to graduate, and Non-white participants rated all components of the PIP course significantly more helpful compared to White participants.
The results of the NCIN data and data from other studies in relation to PIP programs suggest that PIP programs may be an important part of academic support for students enrolled in accelerated nursing programs. This study suggests that NCIN PIP program was associated with higher graduation rates for all students and also for Non-white students. These early interventions may be important to student success and confidence. Interventions that support student retention are vital to not only minority students but all nursing students. Schools working toward improving retention must consider the importance of PIP programs to help prevent attrition of minority students and support the success of all students.
Bridge to Success Program
Based on the NCIN results, the Bridge to Nursing Success Program was developed and implemented in Spring and repeated in Fall 2018. The project was approved by the IRB. The Bridge Program includes a total of 64 hours of content offered over a period of 3 weeks, beginning six weeks prior to, and ending two weeks prior to the start of the first semester. The program topics/ components include: medication mathematics; anatomy and physiology review with a focus on pathophysiology for nursing; cultural competence in nursing; test taking skills with a focus on NCLEX-type questions; nursing school policies and procedures; introduction to simulation; mindfulness; learning style inventory; note-taking skills; scholarly writing; clinical writing; upper level student panel discussion; program evaluation and general school orientation.
The Bridge program is offered to all ABS students accepting admission; the program is voluntary and provided free to students who attend. The faculty who teach portions of the program are not reimbursed. The Program coordinator is provided a partial course release.
The program was evaluated against the following variable: successful progression from semester one to the fourth and final semester. Student and faculty qualitative program evaluations were also analyzed.
Results:
A total of 35 (51.5%) out of 68 admitted ABS students participated in the Spring 2018 Bridge to Nursing Success Program held in Fall 2017 prior to Spring 2018 admission cohort. 30% of the participating Bridge students were minority students. Only one (1.4%) non-minority student of the Spring 2018 cohort did not progress to the second semester; the other 67 students- both those students who participated in the Bridge as well as those who did not- progressed successfully to the second semester. However, 14 (20.6%) of the remaining cohort of 67 did not progress from the second to the third semester. Of the 14 students not progressing to semester three, four of the 67 (5.9%) students participated in the Bridge Program compared to 10 of the 67 (14.9%) who did not participate in the Bridge. All four of the non-progression Bridge group were minority students; seven of the 10 non-progression, non-Bridge group were minority students.
A second group of scholars were invited to participate in the Summer 2018 Bridge Program provided for the Fall 2018 cohort. A total of 29 (55.8%) out of 52 admitted students attended this Summer Bridge program, prior to the start of the Fall semester. The Fall 2018 cohort at midterm of the first semester are all performing at a satisfactory level.
Students’ qualitative evaluations for the Bridge program were highly satisfactory. Student comments included: “It was so helpful to review what we should know before class actually starts.” “Helped me to learn Med Math and get an idea of what is expected with anatomy.” “I like that we got a chance to go over all the basics that would be useful in nursing school. We got to meet some of our professors and they were extremely supportive but at the same time gave us the realistic version of the program.” Faculty evaluations indicated that Bridge program students exhibited less difficulty in accomplishing assignments and that their attitudes were more positive. Semester three faculty noted many Bridge students taking leadership roles compared to non-Bridge students.
Conclusion:
New Careers in Nursing (NCIN) data analysis provided the impetus for developing and implementing a Pre Immersion Program geared toward increasing the success of underrepresented accelerated nursing students. The Bridge to Nursing Success program may assist students in feeling more confident and comfortable with the nursing program. None of the students, independent of Bridge participation, had difficulty moving from semester one to semester two.. This analysis revealed student difficulty in progressing from semester two to semester three. More data is needed before firm conclusions regarding the value of PIP programs in assisting students toward successful program completion More support for student learning is needed. Plans are under way to implement an Academic Ambassador Program to provide Peer Tutoring Support, as well as implementation of the ATI TEAS test for all admitted students, in order to identify weaknesses early and provide appropriate intervention. Faculty mentoring is also planned so that each student will have a consistent faculty member to advise them and provide guidance on a routine basis.