Becky Fields, MSN, RN
Nancy B. Moody, DSN, RN
Less than 134,000 of the over 2.5 million practicing registered nurses are African American. The average age of RNs is 45 years and their average age at retirement is 49. The average age of African American nurses is older than any other group of nurses and the majority is prepared at the associate degree level.
Contributing to the current shortage is the decline in overall enrollment into nursing programs and a precipitous drop in enrollment by African American students from 31% in 1977 to 14% in 1996. While an overall general nursing shortage is worrisome, a shortage in African American nurses is even more troublesome. Minority groups in the U.S. currently constitute 25% of the population, with approximately 12% African American, 9% Hispanic and 3% Asian. By the year 2015, one third of the nation will consist of culturally and ethnically diverse individuals.
The fact that practicing nurses are aging and preparing for retirement is reflective of the general population. The largest number of elders ever in American history will emerge as the last cohort of “baby boomers” turn 65 and older between 2010 and 2030. African American elderly, the largest group of minority elders in the country, number 2.49 million and comprise 8.3% of the total African American population 65 years and older. By the year 2050, this group of seniors is projected to quadruple.
Thus, in the midst of a decline in enrollment and shortage of African American nurses, there has been a phenomenal increase in minorities in general and African American elders specifically. African American elders have higher morbidity and mortality than all other Americans and, therefore, are especially in need of culturally sensitive and competent health care. The idea that racial and ethnic pairings between patients and health care providers is conducive to the provider-patient relationship is supported by statistical data on African American physicians. Eighty percent of patients of African American physicians are African American. Sixty to 80% of racially and ethnically diverse physicians voluntarily practice in or close to areas with large minority populations. As a result, treatment effectiveness is enhanced, and patients are more likely to receive culturally congruent care.
The lack of diversity among nurses and nursing students has been recognized for decades. A review of the literature identifying strategies to increase the recruitment, retention and credentialing of African American nursing students will be presented followed by short-term and long-term strategies for increasing the number of African American nurses.
Recruitment
Recruitment and retention are linked together in the nursing literature. Interestingly, however, little if any discussion relates to recruitment. Strategies include media announcements, school presentations and newsletter articles concerning nursing, along with printed nursing literature, and summer enrichment programs, such as Upward Bound. These recruitment strategies are broad and general in nature without regard to specific populations. Recruitment programs that are “culturally specific” often rely on remediation and financial assistance as their main program strategies. No strategies are discussed that highlight nursing as a career equivalent to careers in business, education, engineering, law and medicine, careers frequently selected by African American college students.
Retention
In contrast to recruitment, much has been written about retention of African American nursing students. Strategies most often discussed are academic advising, faculty commitment and development, financial assistance, orientation, personal counseling, and remediation. Less common strategies include, intensive monitoring, availability of minority counselors and faculty, and workshops that instruct in study skill development. Little is mentioned about psychosocial strategies such as workshops on stress management, time management, development of black history month presentations, or community affiliations such as church or black organizations. Curricular and institutional structure issues are minimally discussed, with little attention to cultural diversity in the curriculum, mentoring within the faculty-student relationship, accommodation of different learning styles, and part-time study options.
Short-term Strategies
Associate degree nurses
In this 21st century, African American students have the opportunity to explore a number of career choices. Many individuals, either because of family obligations or lack of monetary resources, choose associate degree registered nurse (ADN) programs, licensed practical or vocational nurse (LPN, LVN) programs, or certified nurse assistant programs.
Individuals in these roles obviously already possess an interest in nursing and recognize the value of nursing as a career opportunity. The African American associate degree prepared RNs have passed the NCLEX-RN and have been deemed, by licensure, to be safe practitioners. Emphasis, in their educational preparation, is on technical ability. However, they are not considered to be professional nurses. Therefore, a baccalaureate nursing program with coursework on professional issues, ethics, community health nursing, and individualized clinical experience in a nursing specialty selected by the student is recommended. Credit for traditional clinical courses should be granted to all licensed RNs. Courses should be scheduled to enable completion on a fast track over one academic year. Alliances between baccalaureate nursing programs and agencies employing these nurses should be developed. To accommodate the needs of working nurses, classes should be offered at their places of employment and offered at a variety of hours. If available, African American faculty should teach these courses or at least be advisors and mentors to the students. This strategy would prepare, in a relatively short period of time, an already interested, licensed group to fill the overall need for BSNs and for African American BSNs in particular.
Long-term Strategies
LPNs and LVNs
A strategy for transitioning LPNs and LVNs into baccalaureate programs would involve designing their programs of study to include lower division courses and traditional clinical content that would transfer into an associate or baccalaureate curriculum. Emphasis should be on didactic information with an opportunity for students to demonstrate technical competence. If technical competence is not demonstrated, then a specially designed clinical component should be implemented for the LPN/LVN student. To demonstrate the value of their knowledge and experience, African American LPN/LVN and associate degree nurses should be grouped together for peer support throughout the program. This strategy is noteworthy in that it prepares an already interested group of individuals and targets groups containing the largest percentage of African Americans.
Certified Nursing Assistants
Transition of African American certified nursing assistants to the BSN level should involve mentorship, academic and personal counseling, financial assistance, part-time study options, formation of study groups and intensive monitoring by a culturally sensitive and competent faculty team. This web of support is needed to ensure that the student is successful in the BSN program. Many certified nurses assistants are single heads of households with the sole responsibility of support to their family. Thus, part-time study options are extremely important. This option would allow the student to work, if necessary, without causing a financial or academic burden. Adequate financial assistance would allow the student the option of part-time employment.
High School Students
A change in philosophical belief regarding recruitment is needed for recruiting African American high school students. The most effective recruiters of African American high school students are athletic coaches.
Head coaches, as well as their staff, are alert to outstanding prospective student athletes. The coaching staff scouts the prospective student by observation of athlete performance. The student athlete is informed of when the “scout” will be present so that the student athlete can perform at their best. If the athlete is seen as fitting into the team, an offer is made for scholarship. The coaches make a home visit and meet with not only the student athlete, but also the athletes’ family. The coach assures the student athlete and family that the student will obtain an excellent education as well as an opportunity to excel in their designated sport. The coach is able to make this assurance because of the well-orchestrated system of support, academic and personal, which the athletic department has at its disposal. The athletic department’s links with academic, cultural, and social institutions internal and external to the university assure a smooth transition of the student athlete into the university system.
Nursing faculty and staff could adopt this same philosophy. Faculty and staff could be alert to outstanding African American students in high school by establishing, cultivating, and maintaining close relationships with guidance counselors, science, health, and math teachers. Faculty recruiters could attend class presentations and academic competitions to “scout” prospective nursing students. Arrangements for personal meetings with students and their families could be made to acquaint students and families about the many educational and career opportunities in nursing. Community, social, and academic supports should be discussed and the nursing program’s commitment to the student should be highlighted. Scholarship opportunities, both internal and external, should be offered. These personal contacts should be made early in the students’ junior year so that periodic follow-up and opportunity for summer enrichment and orientation can be offered. Students, along with their families, should be invited to attend campus sponsored nursing and cultural events prior to enrollment. While on campus, students and families should have a faculty host who is African American and/or culturally sensitive and competent. If available, African American nursing students and/or alumni should be allowed to meet informally with the prospective students and accompany them to social events in the community.
Graduate Students
Strategies similar to recruitment of high school students could be used with prospective graduate students. A number of nursing programs exist that have a masters entry program for individuals who have a baccalaureate degree outside of nursing. Outstanding African American graduate students can be “scouted” by means of forming close contacts within historically black universities that do not offer a nursing program. Socialization to the community and to nursing should be in the forefront of these recruitment efforts. These outstanding graduates have already demonstrated academic success so less attention to academic support is necessary. Career opportunity in nursing practice, nursing education, and nursing and health administration should be emphasized to these students. The idea that nursing is a valuable career option should be highlighted.
Summary
These strategies emphasize nursing as a viable career option comparable to other careers often selected by African American students. Psychosocial issues as well as academic issues related to recruitment and retention were addressed by concentrating efforts on individuals interested in nursing, and academically prepared for the rigors of a university program. These strategies offer short-term and long-term remedies to the problem of shortage of African American professional nurses. A new paradigm for increasing the number of African American nurses is needed. To be effective, it is time for colleges of nursing to view recruitment and retention of African American individuals into the profession of nursing through a different lens.
Becky Fields is a doctoral nursing student at the University of Tennessee College of Nursing. Nancy Moody is Associate Professor, College of Nursing, and Executive Director of the Tennessee HealthCare Consortium for Nursing.
References are available upon request. Correspondence should be addressed to Becky Fields at the College of Nursing, 1200 Volunteer Boulevard, Knoxville, TN 37996.
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