Background: The nursing profession has attempted to become a more diversified workforce over the last forty years. A diverse workforce is needed to serve the needs of an increasingly diverse client population (IOM, 2004, 2010, 2015). Greater racial diversity in the healthcare professions improves communication with clients, access to healthcare for minority populations, and client outcomes (IOM, 2003, 2004, 2010; National Center for Cultural Competence, 2004). Further, healthcare workforce diversity improves client trust, reduces discrimination, and promotes more positive experiences (Anderson et al., 2003; J. Cohen, Gabriel & Terrell, 2002; LaVeist, Nickerson & Bowie, 2000). While 12.4% of the U.S. population is African American[1] (Humes, Jones, & Ramirez, 2011), only 5.5% of RNs are African American (Budden, Harper, Brunell & Smiley, 2016). Therefore, the nursing profession is dependent on pre-licensure nursing programs to increase the enrollment and graduation of minority students to increase workforce diversity.
Graduation gaps: The Education Trust (2017) describes that though enrollment for African American students in colleges and universities is an accurate reflection of the African American population, six-year graduation is disparately lower for African American students; 70.2% compared to 80.5% for European American[2] students at non-Historically Black Colleges and Universities (HBCUs). However, African American enrollment in nursing programs does not reflect the African American population (AACN, 2014). Attrition is widely believed to be a significant problem for African American nursing students, though there are no national attrition data published by the AACN or the NLN documenting the problem. The AACN reports that African Americans have a lower graduation rate than all other racial and ethnic minorities (AACN, 2013).
Study: The purposes of this study were to describe the experiences, and the meaning those experiences had, for African American students who attended predominately European American schools of nursing. Qualitative descriptive design was used to answer the research questions. 14 study participants who self-identified as African American registered nurses and who reported that they attended predominately European American nursing programs were interviewed to reflect back on their nursing school experiences. The percentage of African American students in the nursing programs participants attended ranged from 1% to 18%. The participants came from 6 different states in the US including three regions: the east, mid-west, and south-central. Semi-structured interviews were used for this study using open-ended broad questions in order for the participants to choose what experiences were important for them to share with the investigator.
Findings: Thematic analysis of the interview transcripts resulted in theme of trust/mistrust with some European Americans encountered during nursing school including faculty, classmates, advisors, and administrators. Participants reported mistrust as behaviors by European Americans of looking down or judging them, not keeping information private, having a double standard between African American and European American students, and different life experiences compared to the African American students. Trust was described by study participants as people who cared, worked for diversity, and showed their genuine support through actions. Trust usually developed over time, sometimes taking longer than one semester to develop.
Trust in education: Trust between instructors and students is integral for learning (Willie, 2000) and contributes to enrollment and graaduation from colleges and universities (Ghosh, Whipple & Bryan, 2001). Faculty members who exhibit caring, respect, and active listening, and who engender trust and build and create a respectful classroom environment, are viewed by underrepresented minority students as most effective (Case, 2013). Feeling sterotyped or stigmatized by European American faculty members and classmates creates distrust in African American students that in turn hinders motivation and academic achievement (Cohen & Steele, 2002).
Implications: These findings are important in order to shed new light on a persistent problem in nursing in so that faculty members and program administrators can develop new strategies for recruiting and retaining African American nursing students. For example, nursing programs need to intentionally create fair and respectful learning environments that value and embrace racial and ethnic diversity in the nursing programs. Faculty, advisors, and administrators need to learn about, and work to minimize, micro-aggressions (Sue, 2010) and implicit bias (Banaji & Greenwald, 2016). For example, faculty who grade should be shielded from the student names whenever possible (Banaji & Greenwald, 2016). Focus groups and student surveys can provide important information about the nursing program’s environment. Trustworthiness is demonstrated by adhering to policies fairly for all students, participation in campus diversity programs and events by non-minority students, faculty and administrators, listening without judging, and acting on student feedback. Student trust is gained with convenient and welcoming office hours and timely response to emails. Faculty may need to continue to invite students into their offices after they have left the course since for some students trust is only gained over an extended period of time.
[1] The term African American is used in this paper to most accurately depict Americans who are of African descent, it is the term the study participants used to describe themselves.
[2] The term European American is used to most accurately depict Americans who are from a variety of European descents. It is a parallel designation to the term African American that the participants used to describe themselves, and therefore complies with APA formatting section 3.14. In common language this is White Americans.