North America is a region that reflects dynamic migration of people from across the globe. The United States (U.S.) alone is home to nearly 44 million immigrants- more than any other country in the world, and the country’s immigrant population represents almost 14% of its total population (Migration Policy Institute, 2018). The largest group of immigrants within the U.S. comes from Hispanic countries, with Spanish being the primary spoken and written language of these immigrants (Migration Policy Institute). As a result of this global migration, nurses in the U.S. are now working with increasing numbers of Hispanic / Latinx patients and families in virtually every health care setting.
It is well established that when minority groups receive health care from those who are of the majority group, unequal care results, and this is particularly apparent in Hispanic / Latinx immigrant population within the U.S. (Healthy People 2020, 2017a). While nurses are potentially in an excellent position to reduce health inequities, language barriers and a lack of understanding of specific cultural practices contribute to challenges faced by nurses in providing culturally responsive care (Ubri & Artiga, 2016; American Association of Colleges of Nursing [AACN], 2015). The small numbers of Hispanic / Latinx nurses within the U.S. nursing workforce worsens the problem. According to the National Council of State Boards of Nursing (NCSBN), only 3% of practicing nurses within the U.S. identify as Hispanic / Latinx (NCSBN, 2018).
For health disparities to lessen, nursing must become a more diverse profession. Hispanic / Latino nursing students hold the key to mitigating these challenges, because they understand the culture, language, and health practices of the Hispanic / Latinx population and provide the pipeline for the nursing workforce. It is extremely important, therefore, that these students are supported throughout their nursing programs and that they gain the necessary knowledge, skills and attitudes to become successful nurses. Not only will this allow them the opportunity to provide culturally responsive nursing care when they care for the Hispanic / Latinx population, but to act as role models for other nurses to do the same.
National initiatives aimed at increasing the diversity of the nursing workforce within the U.S. are being put in place, including efforts to recruit and retain more students from underrepresented groups (AACN, 2015). Unfortunately, Hispanic / Latino nursing students are admitted in smaller numbers to pre- licensure nursing programs, and experience higher attrition rates than the majority group (AACN, 2017; DeBrew, Lewallen, & Chun, 2014). Many of these students describe their nursing education as fraught with challenges that contribute to attrition, perpetuating the shortage of this group that is highly needed in the nursing workforce (Alicea-Planas, 2008; Alicea-Planas, 2017).
To promote student success, and to be student-centered, one must first understand the experiences of students, but a serious deficit exists in the literature concerning Hispanic / Latinx nursing students’ experiences within their pre-licensure nursing programs. Most of the research with this population been done using single-site studies, with much of it focused on barriers to success, success strategies, or academic performance (Dolan, Young, Cesario & Symes, 2015; Evans, 2008; Moceri, 2010; Morales, 2014; Torregosa, Ynalvez, Schiffman, & Morin, 2015). No published research to date has attempted to discern the impact of the family immigration experience on Hispanic / Latinx nursing students, nor how current political climates may influence their experience within their undergraduate nursing programs. Furthermore, current research with Hispanic / Latinx nursing students has considered this population to be one group only. In doing so, the research overlooks the variability and diversity among and between Hispanic cultural groups, and does not account for the fact that culture is transitional, and that individuals can belong to multiple cultures at the same time (Kirkhart, 1995; LaVeist & Isaac, 2013).
The parent study informing the smaller secondary data analysis presented here was conducted by this author and attempted to capture the transition and intersectionality that Hispanic / Latinx nursing students experience as they acculturate into the profession of nursing. A phenomenological approach was used, with participants describing in detail their lived experiences as nursing students who had first discovered nursing, went through the process of applying to and being accepted into their nursing program, their journey through their nursing education including classroom and clinical experiences, completing their nursing program and graduating, studying for and passing the NCLEX, and looking for and obtaining their first position as a new nurse. Participants included eleven Hispanic / Latinx new graduates from three undergraduate nursing programs within the Southeastern U.S. Participants had either immigrated to the U.S. themselves, or were the children of immigrant families from eight countries of origin, including Mexico, Chile, Spain, Guatemala, Chile, Venezuela, Dominican Republic, and Costa Rica. Two males and nine females, ranging in age from 22 to 30 years participated in the study. In-depth, private, confidential interviews were conducted over a five-month time span from May to September, 2018, with interviews lasting between 75 to 153 minutes. Primary data analysis of the parent study used Choi’s Theory of Cultural Marginality to understand the process of acculturation into nursing for these participants.
This secondary data analysis focuses on a subset of de-identified data from the parent study and involves a more in-depth analysis of the following themes: 1) how political determinants shape Hispanic / Latinx nursing students’ perceptions of belonging within their nursing programs, and 2) the influence of being an immigrant themselves to the U.S. or being the child of immigrant parents on participants’ educational experience in nursing.
Methods:
Secondary analysis of the data subset is underway and is consistent with the methodology proposed by Braun and Clarke (2006). Coding is being used to focus, simplify and abstract the data and inductive thematic analysis will explore more deeply the experiences, meaning and reality of study participants as related to their family’s immigration experience and the influence of political determinants on their experiences. Emphasis will be placed on identifying semantic meaning of the data.
The qualitative data gathered during the parent study was shaped by the same social, cultural, and political realities that remain in place during the current secondary data analysis, and consent was obtained from participants for conduction of both parent study and secondary data analysis. Member checking, memoing, and maintenance of an audit trail is currently underway, with clean, uncoded transcripts from the parent study being used for the secondary data analysis with the intent to increase rigor.
Results:
Preliminary results reveal the following findings: nursing students who have immigrated or who are children of immigrant parents experience increased pressure to succeed and become financially independent; differences in experiences exist depending on students’ country of origin and political climate there; the political climate within the U.S. has a profound impact on their experience within their undergraduate nursing program; nursing faculty are often unaware of the impact of immigration experiences and political climates on Hispanic / Latinx students’ ability to thrive in their nursing education; social media reflective of political determinants appears a major factor in shaping their experiences; and political climates affect Hispanic / Latinx nursing student interactions with patients in clinical settings.
Conclusion:
Limitations of this secondary data analysis will primarily center on the small sample size and the geographical area of the study centering in the Southeastern U.S. Despite these limitations, this secondary data analysis has global implications, because as global migration continues, migrant populations will be increasingly reliant on nurses who can provide culturally responsive nursing care. Understanding how political determinants as well as how being an immigrant or the child of an immigrant family impacts their educational experience is expected to provide valuable insight and offer direction towards fostering an inclusive learning environment designed to promote minority nursing student success.