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THESIS

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3 12930

 

LIBRARY
Michigan State
University

 

 

 

This is to certify that the

dissertation entitled

A Local Theory for Retention of Minority Students in
Michigan's Public Baccalaureate Nursing Programs

presented by

Sandra L. Nelson

has been accepted towards fulfillment
of the requirements for

Ph.D. degree“! Educational Administration

 

 

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‘10 pfOQ

Date July 1997

 

MS U is an Affirmative Action/Equal Opportunity Institution 0-12771

 

 

 

PLACE IN RETURN BOX to remove this checkout from your record.
TO AVOID FINES return on or before date due.
MAY BE RECALLED with earlier due date if requested.

 

DATE DUE DATE DUE DATE DUE

:W

ma? {é Q8238?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ma mus-p.14

 

A LOCAL THEORY FOR RETENTION OF MINORITY STUDENTS IN

MICHIGAN’S PUBLIC BACCALAUREATE NURSING PROGRAMS
By

Sandra L. Nelson

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR or PHILOSOPHY

Department of Educational Administration

1997

ABSTRACT
A LOCAL THEORY FOR RETENTION OF MINORITY STUDENTS IN
MICHIGAN’S PUBLIC BACCALAUREATE NURSING PROGRAMS
By

Sandra L. Nelson

Two purposes guided this study: (a) to generate a rich description of the
strategies used to retain minority students in nine National League for Nursing
(NLN)-accredited baccalaureate nursing programs in Michigan and (b) to develop
a local theory that reflects the patterns and actions needed to retain minority
students in baccalaureate nursing programs.

The naturalistic inquiry paradigm (Lincoln & Guba, 1985) and local theory
methodology (Eldon, 1981) were used to document the multiple realities of academic
retention as experienced by 17 nursing faculty and 15 first-year minority nursing
students. Data were collected using semi-structured, audiotaped in-person or
telephone interviews. Through constant comparative analysis, the image of nursing,
academic underpreparedness, and race emerged as focal categories and collision
as the central category. Inelastic collision, a dimension of collision, provided an
understanding of the interrelationships among the categories that emerged as a

result of category refinement.

Sandra L. Nelson

Although faculty were aware of retention problems among minority students
in their programs and had used a variety of teaching strategies, they had failed to
design and sustain comprehensive approaches to retention. One program out of
nine had a comprehensive retention program designed to meet the academic needs
of students or enhance their graduation rates. Faculty believed that one-to-one
contact of students with course faculty was the most effective retention strategy.
Most faculty believed that minority student support groups for the purpose of Ieaming
survival skills, tutoring, and socialization were the least effective retention strategy.
Students identified needs to understand the realities of nursing, the rigors of
education, and expectations of professional practice.

The conclusions were that faculty possess the resources needed to design
and sustain comprehensive retention programs but lack the will to do so. Faculty
have an obligation to (a) provide the academic support and curriculum needed to
prepare prenursing and nursing students to complete their professional goals, (b)
meet societal demands to significantly increase the number of federally designated
racial minority nurses, and (c) prepare nurses capable of providing culturally
competent care. A local theory for retention of minOrity nursing students was

developed as an outcome of the conclusions.

This dissertation is dedicated to my family and friends, the ”forever people.”

without whose enduring love and support I could not have completed it.

ACKNOWLEDGMENTS

No one completes a program of study and a dissertation alone. My thanks
and appreciation are extended to Dr. Marvin Grandstaff for his willingness to serve
as chairman of my doctoral program. Thanks also to Dr. Kay White and Dr. Wanda
Lipscomb, whose support began long ago and continued through their service as
guidance committee members.

I am privileged to know two very special nurse educators and to have had
them as members of my dissertation committee. They are Dr. Gladys Courtney,
whose leadership and singular tolerance have lasted throughout my journey at
Michigan State University, and Dr. Cornelia Porter, who never hesitated to offer her
time and supervision. I can never express enough accolades for their guidance and
patience while teaching and enabling me to reach this goal.

You were the wind beneath my wings!

Finally, my appreciation is extended to Jennifer Hutsko, who masterfully

produced the figures and theoretical design, and Sue Cooley Miller, whose renown

for editing and finalizing dissertations required that I seek her expert touch.

TABLE OF CONTENTS

LIST OF TABLES ................................................ x
LIST OF FIGURES ............................................... xi
Chapter
I. INTRODUCTION ...................................... 1
Background .......................................... 1
Baccalaureate Nursing Education and the Minority Student . . . 1
National Population and Health Trends ................... 3
Minorities In Professional Nursing Practice and Education . . .4
Who Are the Minority Nursing Students? ................. 15
Statement of the Problem .............................. 17
Purpose of the Study .................................. 17
Research Questions ................. _ ................. 18
Importance of the Study ............................... 18
Conceptual Orientation ................................ 19
Limitations of the Study ................................ 20
Definition of Terms ................................... 21
Il. REVIEW OF RELATED LITERATURE .................... 23
Introduction ......................................... 23
Retention in Higher Education Institutions ................. 24
Retention of Nursing Students .......................... 29
Retention of Minority Nursing Students .................... 33
Early Retention Studies and Models .................... 33
Current Retention Studies and Models .................. 39
Students” Responsibilities for Retention .................. 46
Summary ........................................... 47
III. METHODOLOGY .................................... 51
Introduction ......................................... 51
Design of the Study .....................................
Focus of the Inquiry ................................. 52
Fit of the Paradigm to the Focus of the Inquiry ............ 53

vi

IV.

Data-Collection Sources ............................. 53

Phases One and Two of the Inquiry ..................... 57
Data-Analysis Procedures ............................ 63
Ethical Considerations .............................. 68
Summary ........................................... 70
INTERVIEW RESULTS AND ANALYSIS .................. 72
Introduction ......................................... 72
Overview of Faculty and Student Perspectives of Organiza-
tional Structures .................................... 73
Faculty Perspectives of Minority Student Retention .......... 74
“Who Are the Minority Students in Your Program?" ......... 74
“Our Faculty. . . Are Reflective of Our Community“ ......... 76
"Most Are in the RN/BSN Completion Program” ........... 76
”The Real Difference Is Based on Black and White” ........ 77
'Geez, the Curriculum Is Being Bombarded WIth It” ........ 78
”It’s Kind of a Lonely Number Being One” ................ 80
Unheralded Race-Based Connections ................... 81
”Switching” to the Vernacular .......................... 82
'A Retention Plan Is on the ’Near—Back Burner" ........... 83
Retention Plans/Strategies ............................ 85
“The Problem Is Academic Underpreparedness” ........... 90
“Minority Students Can’t Compete" ..................... 91
Help-Seeking Behaviors .............................. 92
The “Unwritten Rules of the Game” ..................... 93

Faculty Perspectives on Minority Students’ Image of Nursing . 94
'It Has to Be a Lot More and Different. Society Will Demand

It" .............................................. 95
”Progress on a Step-By-Step Basis" .................... 97
Minority Nursing Students' Perspectives of Retention ........ 98
”It’d Be Nice If We Could Have More Than One" ........... 98
”There’s Sort of a Camaraderie Among Us” ............... 98
”There Are Some Things That Don’t Apply to Everyone“ ..... 99
'I Didn’t Know I Had to Take All of That Stuff" ............ 100
"If You Just Passed, Pulled C's, You’d Wash Out Real
Quick“ ......................................... 101
”I’m Not Going to Do THAT to Him!” ................... 104
'l Felt, I Don’t Know, Just a Sense of Total Accomp-
lishment“ ....................................... 104
”Be Prepared to Study at Least Three to Four Hours a Day
Without Fail ..................................... 107
Summary .......................................... 107

vii

THE REPORT OF THE STUDY ........................ 109
Introduction ........................................ 109
Statement of the Problem ............................. 109
Purposes of the Study and Research Questions ........... 110
Description of the Settings and Participants ............... 110
Discussion of the Categories That Emerged ............... 111
ThelmageofNursing........................ ....... 111
Academic Underpreparedness ........................ 112
Race ............................................ 1 13
Interrelationships of the Categories .................... 115

Implications of the Findings Based on the Research Questions 116
Suggestions for Future Research on Minority Nursing Student

Retention ........................................ 123
VI. THE LOCAL THEORY ................................ 126
Local Theory for Retention of Minority Nursing Students ..... 126
Minority Nursing Student ............................ 128
Organizational Structure ............................ 128
Precollege/Prenursing Student Socialization Opportunities . . 131
PrenursinglNursing Student Leadership Opportunities ..... 131
Culturally Relevant Curriculum Design .................. 132
Specific Retention Strategies ......................... 132
Conclusion ........................................ 133
APPENDICES
A. An Overview of Nursing Education Programs .............. 135
B. About Gender Statistics in Nursing Programs .............. 137
C. University Human Subjects Approval .................... 138
D. Final Guidesheet for Students .......................... 139
E. Final Guidesheet for Faculty ........................... 141
F. Letter to Program Dean ............................... 143
G. Letter to Study Participants ............................ 144
H. Process Consent Form ............................... 145

viii

I. Letter to Participants With Verbatim Transcription .......... 146

J. Trustworthiness ..................................... 147

K. Strategies Used in the Comprehensive Retention Program
Found in the Study .................................. 149
L. The FIND and SEND Programs in Nursing Diversity ........ 151
BIBLIOGRAPHY ............................................... 152

LIST OF TABLES

Registered Nurse Population by Racial Background ................ 8
Percentage Enrollment and Graduation of Minority Students

(1990-1996) ............................................... 9
Axioms of Naturalistic Inquiry ................................. 54
Characteristics of Faculty Participants .......................... 60
Characteristics of Minority Student Participants .................. 62

LIST OF FIGURES

Distribution of the RN Population and the US. Resident Population

by Racial/Ethnic Group ..................................... 10
Distribution of RNs in Each Racial/Ethnic Group by Basic Nursing
Education Preparation, March 1992 ........................... 11
Estimated Percentages of Basic Nursing Education Program

Graduates With Minority Backgrounds ......................... 12
Selected Strategies From Data Leading to Central Category ........ 66
Common Retention Functions Found in All Programs .............. 85

Local Theory of Inelastic Collision for the Retention of Minority
Nursing Students ......................................... 129

xi

Si

8f

on

CHAPTER I

INTRODUCTION

Background

Retention of racial-minority students, hereafter referred to as minority
students, in baccalaureate nursing (BSN) programs has been debated within the
nursing profession for decades without arriving at a functional solution (American
Nurses Association [ANA], 1960; Carnegie, 1974, 1991; Claerbaut, 1978; Group,
1980; Harvey, 1970; Memmer 8 Worth, 1991; Pennington, 1984; Story, 1978).
According to Rosella, Regan-Kubinski, and Albrecht (1994), a comprehensive
approach to designing strategies to increase the numbers of minority nursing
students is urgently needed. A comprehensive approach must include facilitating
and enhancing minority students’ competitiveness for admission and ensuring that,
once enrolled, these students have every opportunity to complete their education.

. .
WW" II' 1 SI l I

Historically, baccalaureate nursing programs have had more applicants for
admission than they could admit in an academic year. The traditional applicants
have been non-Hispanic white females who were recent high school graduates. The

student populations have included few minorities (Allen, Higgs, 8 Holloway, 1988;

1

2

Carnegie, 1991). A national decline in applicants occurred in the mid-1970s and
continued into the 19803. Factors cited as contributing to. the decline were reduced
numbers of college-age individuals, increased career options for women, increased
educational costs, and decreased financial aid (American Association of Colleges
of Nursing, 1980).

According to Allen et al. (1988), ”these factors were not likely to be
ameliorated in the near future. Schools of nursing were forced to choose between
adjusting their programs to decreasing enrollments or selecting applicants who may
be at risk for amdemic difficulty“ (p. 113). Nursing faculty launched vigorous
campaigns to attract and admit academically able. highly motivated, nontraditional,
and previously untapped sources of students (e.g., academically able and highly
motivated students who were older, racial minorities, and from disadvantaged
backgrounds). Rowland (1978) stated that 44% of all students admitted to
baccalaureate nursing programs as a result of these campaigns failed to complete
their programs.

In an effort to determine whether students left these programs for reasons
amenable to preventive action, nurse educators critically reviewed and adapted
educational programs based on the findings from retention research. The findings
indicated several common elements pertaining to retention of racial minorities. The
common elements included a need for directed recruitment efforts, academic and
personal counseling, academic remediation, and cultural enrichment. Other

Influential elements found in the research that would contribute to student retention

3

were an increased number of minority faculty to serve as potential role models for
students, positive perceptions among the primarily white nursing faculty about
minority student academic preparedness, and more financial assistance (Greer,
1995; Story, 1978; Tucker-Allen, 1989).

Baldwin (1995) contended that, despite slowly increasing enrollments in
generic and RNIBSN-completion programs, minority underrepresentation in
baccalaureate schools of nursing and in the nursing profession continues to be an
issue because efforts to retain minority nursing students have not produced
sustained success. Farrell (1988) declared that if nursing is to remain a viable
profession, serious inquiry must be made into the retention of minority students. The
importance of minority retention to racial diversity among nurses and minority health

care cannot be minimized.

Ill' IE II' III IIII I

National trends indicate that minority populations and minority health care
needs are increasing. In 1991, racial minorities constituted 19.8% of the total
population. If national immigration and birth trends persist, by the year 2020,
minorities will constitute 31% of the total population. By 2080, the percentage of
minorities is expected to double (Henry, 1990; US. Bureau of Census, 1990). In
Michigan, an estimated 1.8 million citizens, about one in five, are considered
minorities (Michigan Department of Public Health, 1995).

Nationally, most whites have enjoyed a better health status than minorities,

whereas a combination of factors (i.e., social, economic, political, and cultural) have

 

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led to poor health outcomes for many nonwhites. The lower socioeconomic status
of many minority group members and a variety of culture-related beliefs have
resulted in less access to, or use of, health care services. Thus, myriad complex or
chronic Illnesses, as well as higher costs for treatment, have resulted (Fleming,
1995; US. Department of Health and Human Services, 1993). In Michigan, minority
morbidity and mortality rates for diseases are disproportionately higher (48%) than
those for nonminorities (Michigan Department of Public Health, 1988).

Also, until the 1990s, ”blacks, Hispanics, and Asians. . . had limited access
to the political arena relative to health care policy and decision-making” (Greer,
1995, p. 45). The above-mentioned population and health trends have affected the
nursing profession and its minority nurses.

W l' | E l l'

. The representation of minorities in nursing has attained a prominent place in
the nation’s plans for health care reform, and it has significant political,
socioeconomic, and educational implications. Current restructuring of health
delivery systems has led to expansion of community-based health care and
concerted efforts to improve access to and use of such systems in underserved
areas.

The expansion of health care has raised a demand from health system
reformers for nursing to return to the profession’s historic roots, the provision of

community-based care. This demand includes provision of two critical nursing

5

functions: Nurses must be prepared to practice independently, and they must
provide culturally relevant care to clients in their communities (PEW Commission,
1995). .

Although the nursing profession encourages the increased emphasis on
independent community practice, serious discussions have ensued within the
profession as to who will provide culturally relevant care in underserved areas.
Alvarez and Abriam-Yago (1993) argued that, fundamentally, American communities
are racially and culturally defined. They insisted that minority nurses tend to work
in underserved areas composed largely of populations of similar racial backgrounds.
AlSo, Holtz and Wilson (1992) asserted that ”nurses who are members of culturally
diverse groups are better able to address the needs of their communities" (p. 28).
As system restructuring occurs, health care analysts have come to expect minority
nurses to return to their communities (Fleming, 1995; Sayles-Cross, 1994). That
expectation has brought to light the diminishing number of minorities in nursing.

Various nursing organizations have insisted that although a return of all racial-
minority nurses to their communities may not be a realistic expectation, provision of
health care by competent nurse practitioners from diverse racial and cultural
backgrounds is not only realistic, it is essential. Such recognition has profound
implications for nursing education programs as the suppliers of nurses who are
prepared to provide the expected care.

In July 1993, several health agencies held a national invitational congress

entitled "Caring for the Emerging Majority: Empowering Nurses Through Partner-

6
ships and Coalitions“ (US. Department of Health 8 Human Services, 1993a). At
that congress, several issues related to nursing education were identified:

1. Health care reforms have provided opportunities for nurses to
demonstrate leadership as well as have greater impact in primary health care
prevention and promotion. However, there is a paucity of persons who are
adequately and culturally prepared-to address this need in an era of reform. .

2. Nursing students are not being educated to work effectively in a
changing health care environment. Students tend to study in an isolated
environment and many times are not aware of what is occurring in communities.
NUrsing students are not adequately oriented to our nation’s changing population
mix and the needs of the various population subgroups and subcultures. Nursing
curricUlums and textbooks need to be reviewed and revised to reflect these changes.

Also in 1993, the American Association of Colleges of Nursing (AACN) stated
that

preparation for the entry level professional nurse now requires a greater

orientation to community-based primary health care and an emphasis on

health promotion, maintenance, and cost effective coordinated care that
responds to the needs of increasing culturally diverse groups and

underserved populations in all settings. (p. 1)

In 1995, the National League for Nursing at its annual convention adopted a
resolution that supported the Nursing Education Act (Title VIII). Excerpts from the
resolution are as follows:

There is an urgent need for the preparation of culturally competent health

care providers. . . . The Nursing Education Act provides support for culturally
competent nursing education at all levels with an emphasis on advanced

 

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7

practice and innovations in community-based care, including community
nursing centers. (Resolution 8)

The issues found In the national health priorities are clear. The nexus of
issues (i.e., population and community-care trends, culturally competent practice,
and educational requirements for practice) has magnified the demand for racial
diversity in nursing. Addressing these issues will require significant, even painful,
changes In conventional methods of nursing education if it is to fulfill the nursing
functions identified by the reformers.

Nursing educators can no longer conduct “business as usual.“ The results
of a 1992 NationaLSamnlefiunLQLQLBegislfledflum (see Table 1) and AACN
data (see Table 2) not only underscore the need for a greater racial diversity among
registered nurses (RNs) but also illuminate the continuing failure of nursing
programs to retain and graduate minority students.

. Sayles-Cross (1994) said that the enrollment trends for the decade 1982 to
1992 were both promising and deceptive. ”While the percent of. change in the
number of minorities is impressive on first glance, the overall number of degrees
awarded is insignificant compared to the total minority population. The nursing
statistics speak for themselves“ (p. 158).

. The survey data indicate several important points. First, of the estimated
2,239,816 RNs in 1993, approximately 207,000 (> 9.3%) were minorities. Second,
although the number of minority RNs has increased and kept pace with the increase
in total numbers of RNs, there has been no significant increase in the proportion of

minority RNs to the total RN population (see Figure 1). Third, of the racial groups

8

graduated from all nursing programs, African Americans (46%) and Hispanics (42%)
were primarily graduates of associate degree (ADN) programs. Fourth, most
Asian/Pacific Islander nurses were foreign graduates or evenly distributed across all
programs. F ifth, there were too few Native American nurses for them to contribute

useful data (see Figures 2 and 3).

Table 1: Registered nurse population by racial background (N = 2,239,816).

 

 

 

 

 

 

 

 

 

Race/Ethnicity Total Number Total Estimated RNs‘
"1 Sample Number Percent
White (non-Hispanic) 29,598 2,018,456 90.1
Black (non-Hispanic) 1,074 . 90,61 1 4.0
Asian/Pacific Islander 884 75,785 3.4
Hispanic 381 30,441 1 .4
mgzg'kmgm 177 9,998 0.4
Unknown 190 14,526 0.6

 

 

 

 

 

Note, Estimated number and percentage may not add to total due to rounding.
From “Update on demographics of minority nurse populations' In the United States,
by E. B. Moses, 1993, W p 16
Copyright 1993 by the Division of Nursing, Bureau of Health Professions, Health
Resources and Human Services Administration. Adapted with permission.

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The AACN annual minority enrollment and graduation data from 1990 to 1996
indicated slight increases in enrollment percentages (see Table 2), but African
American student graduations declined. Although the exact graduation year could
not be determined from the data, graduation rates for the expected year of
departure are shown in the table. These rates support Tucker-Allen’s (1991)
statement that “however grim the enrollment figures, the graduation figures always
prove to be even more dismaying" (p. 59).

Attrition of minority nursing students results in a loss of time, money, and
effort for both students and institutions (Pennington, 1984; Sherrod, Harrison,
Lowery, 8 Wood, 1992; Tucker-Allen, 1989, 1991). However, attrition ultimately
deprives communities of nurses who have the desire and cultural competence to
improve community health standards. National expectations of improved minority
health outcomes as a result of increased community-based care, provided primarily
by minority RNs, have prompted national directives that have profound implications
for nursing practice and education (Mundinger, 1996).

Several dilemmas arise from these national expectations and directives for
minority nurse practice in communities. First, most minority nursing students are
enrolled in community colleges, not universities (Baldwin, 1994; Carnegie, 1990;
July, 1994). Second, the minimal professional requirement for community nursing
practice is a Bachelor of Science in Nursing (BSN) degree or higher. Third, since
1965, nurse professionals have argued that there are too many avenues of entry into

practice (Appendix A) and have sought to require the BSN degree as the minimum

. 14
for professional practice (ANA, 1965, 1995; Greer, 1995; Louden, 1997; PEW
Commission, 1995). The entry-into-practice issue has yet to be resolved.

Forces external to nursing may force a resolution of this issue. Two directives
in a PEW Commission (1995) report may hasten requirement of the BSN or higher
nursing degree as the minimum for entry into professional practice. These directives
included (a) reducing the number of diploma and associate degree programs and (b)
dramatically increasing the numbers of advanced-practice nurses by doubling
current numbers of nurses with a master's degree as quickly as possible. The
directives do not bode well for an increase in minority nurses because only a
bachelOr’s degree and nursing Iicensure will allow entry to graduate nursing
education and advanced practice. Deloughery (1995) added an ominous prediction:
'In the future, the Doctor of Nursing degree . . . may become the minimum
background for entry into the profession” (p. 487).

Louden (1997), citing the NLN Annual Survey of Nursing Education Programs
(1995 and 1996), affirmed that nursing programs have begun to reduce the number
of generic student admissions. He cautioned nurse educators to reexamine nursing
curricula and modify them, if necessary, to better fit the changing health care
environment. Louden continued:

If nurses are to continue their work as effective health care providers, they

must be able to function within a changing health care system which has

altered the traditional hospital-based role, and has included managed and

community-based care. (p. 4)

Minority student retention must be improved if (a) nurses are to provide

culturally competent community-based nursing care, advanced-practice clinical

15

Minority student retention must be improved if (a) nurses are to provide
culturally competent community-based nursing care, advanced-practice clinical
expertise, and leadership; (b) representation among registered nurses is to parallel
the projected racial diversity in America; and (c) the nation’s health reform agenda
is to be addressed. These are imperatives. Thus, nurse educators must develop
philosophies, programs, and strategies germane to the retention of minority

students.

Richardson and Skinner (1992) argued that many prescriptions for improving
minority retention are based on excessively simplistic perceptions of minority
students. The varying descriptions of the racial-minority nursing student have
included such characteristics as cultural and ethnic backgrounds, as well as social,
educational, and socioeconomic factors.

The term ”disadvantaged” was the socially accepted descriptor for many
students in the 1960s and 1970s and currently is used by many faculty (T ucker-
Allen, 1991). In a landmark study about disadvantaged students, Carnegie (1974)
explained that people who differ from each other are handicapped not only by
depressed social and economic status, but also

predominantly Black, Puerto Rican, Mexican, American Indian, southern rural,

or mountain white possess cultural attitudes alien to those in the broader

community, and their children are educationally disadvantaged because their

culture has failed to provide them with the experience ”normal” to the kinds
of children the schools are used to teaching. (p. 11)

 

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16
found that minority students did not relate to the label “disadvantaged student” as
a descriptive phrase.

Crawford and Olinger (1988) defined the culturally diverse student as “one
who demonstrates characteristics that have distinctive differences in integrated
patterns of human behavior that include thought, speech, and customary beliefs that
exist between ethnic groups” (p. 379). Identification of minorities may include
individuals with a number of diverse characteristics that have been incorporated into
simplistic perceptions (e.g., gender, age, physical ability, sexual orientation, and
locus of power, control, or authority). Other influences on culturally diverse students
have been identified as folkways (cultural practices), time orientation, religion,
language, the political system, customs, family ties, and educational preparation.

In this study, the term ”minority” is used to refer to the federally designated
underrepresented racial-minority groups. Those groups are African Americans,
nonwhite Hispanic Americans, American Indians/Alaska Natives, and Asian/Pacific
Islanders. Although the state of Michigan has designated Arab Americans as
underrepresented minorities, they are not represented as such in this study. In the
nursing profession, Asian/Pacific Islanders and Arab Americans are not considered
minorities. Similarly, the term ”culturally diverse group" is used interchangeably with
the term "minority" to referto members of the federally designated underrepresented

racial-minority groups.

17
StatememmbiELobls-zm
Baccalaureate nursing programs have failed to develop the retention
strategies or comprehensive retention models needed by minority prenursing and
nursing students. As a result, BSN-prepared minorities are more underrepresented
in practice today than they were 15 years ago (Fleming, 1995). Baccalaureate
nursing programs must increase minority retention and graduation rates in order to
enhance professional practice and meet the health care needs of diverse individuals.
The number of minority baccalaureate—prepared nurses will directly influence
the number who are eligible to enroll in graduate nursing education programs and
the number available to provide culturally competent care to clients in underserved
communities. Similarly, the number of racial minorities with doctorates will directly
influence the number of minority faculty who are available to teach in nursing

education programs.

Eumosgpjjbefitudy

I had two purposes in conducting this study. They were (a) to generate a rich
description of the strategies used to retain minority students in baccalaureate
nursing programs at public universities in Michigan and (b) to develop a local theory
that explains current retention patterns and the actions needed to retain minority

students in baccalaureate programs.

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18
Beseambfiuestions

The overriding research question that was formulated to accomplish the study
purposes was as follows:

What is needed to improve retention rates among racial-minority

baccalaureate nursing students at public universities in Michigan?
To answer this research question, two subsidiary questions were posed to guide the
collection of data for the study:

1. What strategies are being used by nurse educators to retain minority
students in Michigan’s baccalaureate nursing programs?

2. What retention difficulties do minority students experience in

Michigan's baccalaureate nursing programs?

lmpcdarmflbefitudy

The failure to resolve issues related to the retention of minority nursing
students in baccalaureate programs, as well as the limited availability of minority
nursesin the future, demonstrates the need for this study. Given the prevailing
situations and arguments (Baldwin, 1994; Farrell,1988; Richardson 8 Skinner, 1992;
Rosella et al., 1994), a rich description of nursing faculty and student perceptions of
minority student retention is imperative. Further, research that proposes an
inductively derived local theory about the. retention of minority nursing students is

vital to nursing education, nursing practice, and higher education.

19
QQDQQDIUaLQfiamaIIQn

The conceptual orientation undergirding this study was based on naturalistic
inquiry methodology (LinCoIn 8 Guba, 1985) and the following personal assump-
fions:

1. Future nursing programs largely will be housed in institutions granting
a four-year degree (BSN).

2. Increasing numbers of minority, nontraditional, and academically
underprepared students will be entering higher education and seeking careers in
nursing. Therefore, only those strategies that have proven to be helpful in
enhancing academic success were explored in this study.

3. Most public universities have retention programs. Some baccalaureate
nursing programs offer retention programs within the academic units; those that do
are not comprehensive.

4. All public university nursing programs in Michigan have poor
representation of minority student nurses.

5. Many nursing students’ retention requires resources that nursing
schools are not able to provide.

6. Increasing numbers of minority students who are admitted to nursing
programs are academically underprepared.

7. Not all minority students should be retained in baccalaureate nursing

programs.

 

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20

8. Not all minority professional nurses will practice in minority
communities upon graduation.

Naturalistic inquiry, or the athoretical, “discovery-oriented” approach, was
selected as the best method to achieve the purposes of this study. Qualitative and
naturalistic approaches allow.one to understand inductively and holistically the
human experiences related to minority nursing student retention. Two axioms about
the naturalistic domain have particular relevance for the study: (a) phenomena
consist of multiple, often conflicting, context-dependent realities; and (b) all realities
have meaning(s) that can only be discovered from individuals in context-specific

sfluafions.

I' 'I I' [ll SI l

The responses of nursing faculty and administrators, hereafter referred to
collectively as faculty, and nursing students at public programs in Michigan may be
unlike those of persons from other nursing programs. Only academic retention was
explored in this research; the myriad other factors that influence retention (e.g.,
economic or social factors) were excluded from the study.

This study was further restricted as follows: (a) only those strategies currently
used or planned for the academic retention of American-born or naturalized
(excluding students with green cards or work permits) minority students enrolled or
planning to enroll in public baccalaureate nursing programs in Michigan were
explored; and (b) male nursing students were excluded from the study (see

Appendix B).

21
W

The following terms are defined in the context in which they are used in this
dissertation:

culturaLCornoetenoe: Recognizing and understanding the values and beliefs
of another culture. Included is the ability to assess, plan, implement, evaluate, and
provide care within the purview of that culture. Cultural competence does not
require personal belief or participation in another’s beliefs or behaviors.

QuituraLreleiranoe: The significance one attaches to relationships of
patterned behavioral responses and expressions that have been shaped by the
values, beliefs, norms, and practices that are shared by members of the same racial
or ethnic group. The connection is the result of acquired mechanisms primarily
affected by internal and external environmental stimuli. These acquired patterns
guide one’s thinking, doing, feeling, and being in the world. They are the expression
of who the individual is (Giger & Davidhizar, 1995, p. 3).

Minorities: The federally designated racial groups: African Americans;
Hispanics-Mexican Americans, Mainland and Commonwealth Puerto Ricans, and
Latinos; American Indians/Alaskan Natives; and Asian/Pacific Islanders.

WM): Persons who have graduated from a state-
approved program of nursing and are licensed to practice in the United States.

Retention: Successful preservation of a student in a baccalaureate nursing
program until graduation. The term ”persistence” is used synonymously with

retention in this dissertation.

22

Belenfinnsitaiegies: Approaches/programs developed and implemented by

an institution and discipline-specific academic units to help enrolled students reach
their stated or implied educational goal(s) and to facilitate their graduation.
Suggess: Graduation from a baccalaureate nursing program within six years
of beginning university study. This definition does not presume the nursing student’s
passing the National Licensure Examination (NCLEX-RN), although that is the
desired outcome of the educational experience.
underrepresenteominoritiesitiBMs): Federally designated racial groups that
are disproportionately found in the health professions, based on the nation’s
population base. Asians are no longer considered a nationally designated
underrepresented minority group in the health care industry. African Americans,
Mexican Americans, mainland Puerto Ricans, and American Indian/Alaskan Natives

are the nationally recognized URMs in health care.

 

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CHAPTER II
REVIEW OF RELATED LITERATURE

lntmduntinn

Higher education institutions are organized around specific programs that
have clearly defined requisites for admission, progression through the major, and
graduation. Student retention is the active attempt by faculty and, in many
instances, fellow classmates to sustain a student’s enrollment through completion
of the desired program of study. Anything less than degree completion may be
viewed as a student’s failure to reach the stated or implied goal (Feldman, 1993).

Distinctive efforts by an institution and discipline-specific program to help
enrolled students reach their stated or implied educational goal(s) are known as
retention strategies. According to Patton (1990), ”a strategy is a framework for
action that provides basic direction, permits seemingly isolated tasks and activities
to fit together, and moves separate efforts toward a common, integrated purpose"
(p. 35).

Numerous researchers have found that minority students leave educational
institutions or programs without achieving their educational goals at much higher
rates than do their white counterparts. Empirical and theoretical findings also have

suggested a number of recurring problems and feasible retention strategies for

23

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24

minority students in nursing programs (Allen, 1988; Burris, 1987; Green, 1989; Holtz
& Wilson, 1992; Pennington, 1984; Story, 1978; Sutton 8 Claytor, 1992).

To reflect the repetitious findings and the failure to sustain retention efforts,
the literature review is structured chronologically in three sections. The first section
is a review of research on retention in higher education institutions. Research on
retention of baccalaureate nursing students is discussed in the second section. The
third section contains a review of research on retention of minority baccalaureate

nursing students.

Bl l' 'll'l El l' ll'll'

From the 1940s through the mid-19603, the majority of higher education
studies concerned rates of attrition, predictive factors associated with student
attrition, and the 'fit” between student and institution. In the late 19603, research
shifted to the development of student-dropout typologies and identification of
students’ experiences while attending higher education institutions (Spady, 1970).
From the mid-19703 through the 19803, researchers turned their attention to
processes within institutions that might discourage degree completion (Astin, 1975,
1987; Beat & Noel, 1980; Noel & Levitz, 1994; Tinto, 1975, 1987).

A substantial body of literature on attrition and retention exists, particularly
concerning the freshman year (American Council of Higher Education, 1985;
Christoffel, 1986; Dowaliby, Garrison, 8. Dagel, 1993; Noel, Levitz, & Saluri, 1983;
Pascarella & Terenzini, 1982; Richardson & de los Santos, 1988). The

preponderance of literature has been concerned with white students’ collegiate

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25

experiences. Few researchers have examined the experiences of minority students
(Pascarella 8 Terenzini, 1991; Terrell & Wright, 1988).

Perhaps the most widely known, tested, or adapted model related to
institutions and students resulted from studies conducted byTinto (1975). His model
posited that student attrition or its opposite, retention, involved certain preentry
attributes interrelated with institutional academic and social integration processes.
Tinto argued that a student’s integration into the academic and social systems was
directly related "to that student’s remaining in college. In general, the greater a
student’s integration into the amdemic and social systems, the higher the degree of
goal commitment (i.e., the extent of the student's desire to obtain a given degree)
and institutional commitment (the student’s desire to receive a degree from that
particular institution).

' Tinto’s model has been highly predictive of white students’ persistence at
predominantly white, baccalaureate, residential institutions (Fox, 1986; Pascarella
& Terenzini, 1979, 1983; Stinson & Walker, 1992). However, increasing attention
has been given to the model’s ability to predict the success of minority or
nontraditional students, those in discipline-specific programs (e.g., nursing), and
those who do not enjoy full-time patterns of college attendance but enter with
coexisting responsibilities-and roles (e.g., commuter, female, older, employed, head
of a household, responsible for a family). Use of Tinto’s model in research about

minority nursing students is discussed later in this chapter.

26

Recent researchers have suggested that Tinto’s model fails to address many
of the preentry characteristics of minority students (e.g., commuter, employed,
feelings of being unwelcome on campus). In a study conducted at the University of
Michigan-Dearbom, an urban commuter university, Rose (1980) found that student
preentry characteristics did not significantly differentiate between persisters and
nonpersisters. He also found that goal attainment had little to do with institutional
commitment.

Sowell (1986) found student-institution mismatches to be relevant in minority
student retention. One important mismatch occurred because of minority students’
needs for financial resources, which often led them to enroll in large research
institutions that placed less emphasis on undergraduate development than did
smaller institutions. Other investigators have found that minority graduates tend to
advise future minority students to have a strong goal and not worry about whether
they like the experience or encounter discrimination (Astin, 1975, 1982; Munro,
1981; Shade & Edwards, 1985).

Richardson, Simmons, and de los Santos (1987) studied ten universities
identified as successful in retaining minority students. Observations made duringthe
first year of the two-and-one-half-year study resulted in a number of findings about
successful institutional retention strategies, whether designed for minority,
disadvantaged, underprepared, or nontraditional students. The successful strategies
included viewing minority achievement as a preparation problem rather than a racial

one, enlarging the numbers of minority faculty, demonstrating visible evidence of

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27

administrative commitment, instituting comprehensive and systematic rather than
fragmented and ‘sporadic strategies for promoting minority student success,
formulating favorable state policies, and recognizing the campus environment as a
critical factor in students’ involvement and success. With regard to the last strategy,
the authors also found that having a 20% minority student population produced a
'comfortability factor” among minority students. Not all of the universities studied
exhibited these strategies, and the degree to which they were used varied. There
was-a positive correlation between the number of strategies used and the degree of
success an institution experienced.

In studies conducted with African American, Hispanic, and Asian American
student groups, collectively and separately, at predominantly white institutions, it has
been found that the factors affecting student adjustment, development, and
academic retention are most closely associated with social and cultural isolation
(American Council of Higher Education, 1985; McKnight, 1996). When applied to
Native American students and their cultural beliefs, these factors take on
exceedingly complex dimensions.

Native American beliefs center on family, home, and community as the core
of their existence. Not only do Native beliefs place students at odds with most
academic settings, they have severely affected Native students’ adjustment,
development, and academic retention. Thus, these beliefs may be a reason for the
low number of Native American students entering higher education (Marin, 1991;

Tijerina 8 Biemer, 1988; Upvall, 1996).

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28

Richardson and Skinner (1992) suggested that a rich diversity of student
profiles should be described in terms of three dimensions: opportunity orientation,
preparation, and the mode of college going. Opportunity orientation refers to the
beliefs students develop about valued adult roles and the part education plays in
structuring access to those roles. These beliefs are reflected in motivation and goal
setting. Preparation involves both development of expectations about higher
education and participation in experiences that approximate going to college. Mode
of college going distinguishes between students who follow full-time patterns of
college attendance and those who enter with adult roles and responsibilities and
follow part-time patterns of attendance. Richardson “and Skinner further suggested
that

differences in opportunity orientation, preparation, and mode of attendance

influence the degree attainment and transfer rates for all students but have

a particularly strong effect on African Americans, Hispanics, and Native

Americans because they are more likely to be first-generation college-goers.

(p- 30)

Baldwin (1994) asserted that each racial group that is studied needs to be
clearly identified and the special needs of each group targeted in the retention
process. ”It is clear that each minority group has different cognitive styles and
intellectual talents that cannot necessarily be‘generalized to other cultural groups“
(p. 533).

After decades of research findings, universities have ' established more

conducive environments for minority students and offer a variety of services directed

toward retention. Yet the myriad problems hindering minority student retention

29

remain the same. The problems, broadly summarized, include poor adjustment to
college life; lack of financial resources; feelings of isolation and loneliness; poor
academic performance; and feeling entitled, yet not deserving, to be in college.
These problems are compounded by situations of racial and cultural insensitivity or
hostility and harassment from the racial-majority faculty and students.
Armstrong-West and de la Teja (1988) asserted that predominantly white
educational institutions still isolate more than they educate. Reliance on studies and
models that continue to relate traditional relationships between social and academic
integration in an institution to student retention but omit or diminish the most salient
aspects of minority student culture is fundamentally untenable when planning

retention strategies for the minority student of the twenty-first century.

Wm

Researchers have conducted numerous national studies to identify variables
that would predict nursing student achievement. High school grade point average
(GPA), high school ranking, American College Test (ACT) or Scholastic Aptitude
Test (SAT) scores, prenursing GPA, and NLN prenursing examination scores have
been found to be the best predictors Of success in nursing. Self-concept also has
been reported as a significant variable in relation to student retention. Many of the
variables also have been found to predict academic achievement in general
(Hudepohl 8 Reed, 1984; Munday 8 Hoyt, 1975; Rosenfeld, 1988; Schwirian, 1978;

Taylor et al., 1966). Similarly, studies of the relationships between noncognitive and

 

 

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30
biographical characteristics and academic success did not yield consistent findings
(Aiken, 1982; Campbell 8 Dickson, 1996).

Researchers hoped that the variables identified as predictors of success in
nursing school could be generalized to other programs, as well as to students who
would be at-risk for academic difficulty (Alichnie 8 Bellucci, 1981; Higgs, 1984;
Taylor et al., 1966). But minimal overlap of predictor variables was found among
schools of nursing. The best predictor variables were found within each local
program (Rosenfeld, 1987).

In a review of 26 studies focusing on variables associated with retention and
intervention strategies, Heydman (1990) found that most approaches represented
single efforts, “one-shot intervention programs rather than longitudinal studies” (p.
25); used a variety of statistical methods in analyses; and lacked consistency from
one program to another, thus decreasing generalization. Heydman concluded that
the current nursing literature provided limited direction for nurse educators to
improve student retention.

In support of Heydman, Campbell and Dickson (1996), following an
integrative review and meta-analysis of nursing education research from 1981 to
1990, stated, ”Although the literature is replete with achievement predictor variables,
no consistently stable predictor variables have been identified" (p. 48). A sample of
47 studies was used for integrative review. Four of the studies were deemed
appropriate for meta-analysis to describe and evaluate predictors of retention,

graduation, and National Council Licensure Examination (N-CLEX) success for

31

baccalaureate students. Significant'findings from the integrative review and meta-
analysis about nursing student retention were as follows:

1. Theory grades and GPA are the best predictors of academic success.

2. The SAT scores were most often studied, but the ACT scores most
often predicted success on the N-CLEX.

3. The least predictive of the variables studied were college cumulative

GPAs, liberal arts GPAs, scores on the SAT, and scores on examinations in nursing

courses.
'4. Science course grades consistently predicted student success.
5. ‘ Noncognitive factors were weak predictors of academic success. Only

test anxiety and self-concept/esteem were significant.

6. The use of support groups was found to be significant. Merely
participating in the support group may have reinforced the students’ beliefs in
success“ (p. 57).

Based on their findings, the strongest recommendation Campbell and Dickson
made about retention was that interventions should begin at the prenursing level.
Given the consistent ability of science grades to predict success, “nursing faculty or
prenursing counselors should, at the very least, dialogue with students regarding the
need for content mastery and future use of this information (p. 56).

Allen et al. (1988) provided comprehensive recommendations for admission
and progression for at-risk students that warrant presentation. The

recommendations included encouraging nursing faculty to (a) identify factors in their

32

individual programs that may put students at risk, (b) develop a potential at-risk
student profile, (c) consider lower facu lty-student ratios and the availability of tutorial
or other supportive programs when admitting at-risk students, and (d) institute an
”early warning" system that will give students every opportunity to succeed.

The early warning system Allen et al. recommended would “provide guidance
prior to crucial transitions or points in the curriculum where complexity of content or
emphasis on synthesis increases and weaker students are known to have difficulty”
(p. 118). The system should include the following steps: (a) an initial assessment
by academic advisor and student of potential academic problems, (b) anticipatory
guidance and referral to appropriate resources for assistance, and (c) development
of a method of tracking student progress through the upper-division major. These
steps, according to Allen et al., would help students succeed, enable programs to
reduce costs, increase the benefits of accepting at.risk students, and benefit the
community by promoting student retention.

Allen et al. insisted that students whose background data indicate potential
high-risk status (e.g., readmission 'D” or a combination of "D" and "F" letter grades
and withdrawals, poor findings on assessments of verbal fluency and thought
organization, and low self-regard scores) but who also possess characteristics
predictive of success (e.g., prerequisite and cumulative GPAs that would predict
good nursing GPAs, a previous earned degree) deserve an opportunity to succeed.
However, the authors stipulated that special caution should be taken with students

who accumulate college credits without progressing toward a degree. They may be

33

considered for admission, but upon admission a 'red flag“ should be waved as an
early warning sign for close academic tracking. Although admitting at-risk students
might require lower student-to-faculty ratios, tutorials, or other supportive programs,
to overlook the factors that may impede the students’ ultimate achievement of their
academic goals would be irresponsible, not only to the potential students but also

to the nursing profession and society as a whole.

WW

From the mid-1960s through the 1980s, as a result of national and
institutional affirmative action measures, minority student enrollments rose. In 1963,
the National Student Nurse Association began its Breakthrough to Nursing Project,
whose goals were to increase the numbers of minority nurses and leaders in
nursing. According to Carnegie (1991), ”students involved in Breakthrough realize
that recruitment alone is insufficient, and that efforts must also be directed toward
helping students complete the program so that they will become licensed
practitioners” (p. 57).

In 1965, the Rockefeller Foundation sponsored the Sealantic Project for the
Disadvantaged in Nursing. The purposes of the project were to (a) help selected
schools of nursing reach out to black and other disadvantaged youths and engage
in social and educational actions needed to prepare the youths for entering and
completing nursing programs; and (b) experiment with different ways of increasing

the numbers of black and disadvantaged youths who enter nursing. It was expected

34

that many other schools, with or without financial assistance, would be stimulated
to focus attention on this significant source of nursing power and on the expansion
of educational opportunities for these youths.

Six criteria were formulated for project participation. All programs had to (a)
be an NLN-accredited baccalaureate program; (b) admit freshmen directly from high
school, or admit students as sophomores or juniors; (0) offer intensive counseling
and special instruction, if needed, to students in the first one or two years of study
in other colleges on the same campus; (d) be desegregated and not admit a
predominant number of blacks; (e) be lomted in a community where a considerable
number of black or other minority candidates were available; and (f) have a dean
and other instructional staff who were known to have an interest in the purpose of
the program.

Ten nursing programs from throughout the United States were approved for
funding by the project. Although all of the programs had common goals (i.e.,
recruitment, academic remediation, counseling, cultural enrichment, and financial
assistance), each identified different strategies for achieving those goals. Of the ten
original programs, only the Opening Doors Wider in Nursing (ODWlN) project begun
by the Boston University School of Nursing’s Alumni Association became
independently incorporated (Carnegie, 1991). The goal of the project was to
acquaint area blacks with opportunities in nursing.

In 1974, faculty at The Ohio State University designed the "I AM” retention

model. The acronym ”i AM” reflected the model’s central objectives:

35
(a) identification of members of minority groups interested in a nursing career, as
well as intensified training and counseling for academic preparation and personal
social adjustment; (b) Awareness and exploration of nursing careers and
opportunities; and (c) Maintenance of the minority groups, by support services and
intervention processes, through to successful completion of requirements for
graduation.

The goal of the I AM retention model was to enhance minority students’
success through preventive rather than remedial measures, which included
academic enrichment, academic tutorials, and personal social counseling services.
The specific operational phases were (a) training of project staff, (b) identification
and orientation of students, (c) assessment of cognitive and behavioral skills, (d)
intensified preparation for prevention, and (e) resolution and termination. The lAM
retention model proved to be the most comprehensive model of that decade (Story,
1978)

Despite all of the early retention efforts, many of the students involved did not
graduate. Of the 27 programs Feldbaum and Levitt (1981) studied, only six were
able to recruit more than 15% minorities and to retain 80% of those enrolled (Alvarez
8Abriam-Yago, 1993; NLN, 1984; Soucier, 1994; Tucker-Allen, 1989).

Claerbaut (1978) observed that

Incoming minority students tend to have rather idealistic and sometimes

unrealistic attitudes toward nursing and nursing education. This optimism, if

not tempered by realism, may cause them to underestimate the rigorous

nature of the educational preparation ahead of them and can set them up for
disillusionment later as the path becomes difficult. (p. 44)

36

in 1980, the State University of New York at Buffalo initiated Striving for
Professional Achievement in Nursing (SPAN), a nursing career program. The
program goals were to establish and maintain contact with minority prenursing
students and to maintain contact with enrolled students. Highlights of this program
were the presence of a community advisory council comprising representatives of
the mOst prominent community organizations and the presence of one black, one
Hispanic, and one Native American nurse on the project staff who functioned as role
models. They were graduates of the nursing program. Other program features were
a future nurses club for high school students; summer preparatory programs for
students recruited from the future nurses club; and supportive, amdemic, and
financial assistance to enrolled nursing students. Many of these features were
integrated into the existing administrative and organizational structures of the school
of nursing (Watts, 1984).

Beckes (1980) identified four basic phiIOSOphical elements that must be
present for a college to provide underprepared students with a successful academic
experience. These elements are:

1. The administration and the faculty must believe that every student is
important as a person to himself or herself, to his or her family, and to society, and
that the student can make a valuable contribution to the general welfare.

2. The administration and the faculty must believe that most students can

Ieam, given adequate time and instructional support.

37

3. Faculty must be convinced that it is unfair to permit a student to
attempt a course for which he or she is not prepared; therefore, the means must be
provided to help the student prepare.

4. Both students and faculty must be convinced that finishing a particular
program in the traditional four or eight semesters is not important. The important
thing is that the student masters the information and attains the educational goal(s).
Of course, reasonable limits must be placed on the time involved and the
instructional effort consumed.

Pennington (1984) described the successful Retention Activities in Nursing
(RAIN) project conducted at the City College of New York. RAIN was designed as
a comprehensive program of support activities designed to help students
successfully complete the nursing program. The program increased retention rates
of nursing students from 35% to 63% over a four-year period; it currently operates
with even greater success.

Sword (1984) cited both faculty and student responses to the question, ”What
are some of the reasons for the difficulties experienced by minorities in schools of
nursing that make them educationally disadvantaged?“ The problems identified by
one faculty academic advisor were (a) unrealistic course schedules, sometimes
including two or three science classes; (b) financial problems, often due to lack of
understanding of potential sources of support, thus causing an inability to fully use
available financial assistance systems of the federal and state governments; (0)

personal needs and unrealistic expectations of both students and parents in regard

38

to academic achievement and social and family roles; and (d) difficulties with basic
academic skills such as time management, test taking, reading, writing, and
computation.

ln responding to Sword’s question, students placed greater blame on social
and cultural factors for the difficulties they experienced. The factors students cited
were (a) a perception of negative self-images of minority groups in professional
schools and the need for minority role models; (b) inadequate preparation and
counseling in high schools and deficiencies in science, mathematics, and basic
academic skills; (0) personal and financial hardships and inadequate knowledge of
available resources; and (d) cultural shock upon entering the school of nursing.

While dean at the Chicago State University College of Nursing, an inner-city
institution, Burris (1987) instituted an aggressive retention program following dismal
results in retaining students and their poor performance on the NCLEX-RN. One
strategy used in the program was to identify and train three interested nursing faculty
to teach reading and use the Nelson-Denny Reading Test to identify student-grade-
level equivalents in vocabulary and comprehension. Other strategies included
implementing the 804R (i.e., survey chapter headings, generate questions using the
headings, read the material, recite answers to the questions, repeat the previous
steps, and review all material) system of study; providing study guides, using review
and preexamination questions; employing group and individual study sessions; and
helping students construct nursing-care plans and organize term papers. As a result

of this intensive program, students’ reading abilities increased three grade levels;

their :
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39

their study skills improved; over a three-year period, attrition rates declined from
45% to 13%; and NCLEX pass rates increased in one year from a low of 33% to
96%, and the following year's pass rate was 100%. The pass rates at the college
have remained in the 90% range.

Specific strategies advocated by other investigators include readmission
assessment of college-level academic skills, computer-assisted instruction,
assessment of preferred Ieaming styles so as to meet the Ieaming needs of
culturally and linguistically diverse students, and the advisement of all students by
nursing faculty (Jones, 1992; July, 1994; Quarry, 1990; Rami, 1992; Sayles-Cross,
1995; Tucker-Allen, 1991).

Hansen (1988) stressed the need to examine the nursing program’s true
philosophy toward its students. Hansen believed that the philosophy is transmitted
to each student, and it becomes the most important factor in student retention. A
few years later, Rogers (1990) stated that minority student enrollment in
baccalaureate nursing programs presents a unique challenge for the faculty of
predominantly white colleges. The challenge, according to Rogers, is for faculty to
overcome their perceptions of minority students as victims of long-standing
educational disadvantages who more than likely are underprepared for the rigors of

college and nursing studies.

0 IE! I' Sll' lllll
Orrneaux and Redding (1990) described the Getting Assistance in Nursing

(GAIN) project sponsored and conducted by faculty at the University of

40

Southwestern Louisiana. GAIN is a recruitment and retention program for students
from disadvantaged backgrounds. Program features include (a) doing systematic
screening to identify those students at risk for academic difficulty before problems
occur, (b) teaching students strategies to increase their chances for success. (c)
scheduling peer tutoring, and (d) providing students with stipends. Most of the
assessment and intervention approaches used in the GAIN project begin in the
student's freshman year and are similar to those described earlier (Burris, 1987;
Pennington, 1984; Story, 1978).

In a study of 21 generic nursing students for whom English was their second
language, Memmer and Worth (1991) found that attrition rates for culturally diverse
students were significantly high, especially in the first year of the nursing program,
when students encountered nursing theory courses. In addition to the strategies
identified earlier, Memmer and Worth suggested purposefully promoting a
heterogeneous mix of students in clinical laboratories and family involvement in
student activities.

Using student demographic data, a Ieaming style inventory, and a Ieaming
and study strategies inventory, Keane (1993) examined the relationship between
Ieaming styles and selected learning/study strategies of culturally diverse nursing
students. The results indicated that students who expressed themselves effectively
and with understanding, both orally and in writing, were able to master concepts and

apply conceptual thinking to problem solving. Keane also found that the students

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41
whose primary language was English understood difficult content more readily and
took better lecture notes than did linguistically diverse students.

Holtz and Wilson (1992) created a model entitled Facilitation for
Empowerment of Culturally Diverse Nursing Students. The model represented a
“holistic conceptualization ofthe process of providing assistance to culturally diverse
students to Improve overall amdemic success in nursing programs" (p. 30). The
culturally diverse student was described as 'a member of a racial or ethnic minority
who may be from a lower socioeconomic group with an educational background that
is not adequate for academic success” (p. 30).

A pilot study based on the Holtz and Wilson model was developed and
conducted by four racially mixed faculty members with the support of the college
administration at Keenesaw State College in Marietta, Georgia, in Fall 1987. The
study participants were prenursing students (40 to 70 per year), those who declared
nursing as their intended major, and currently enrolled nursing students (10 to 25 per
year). As a result of a series of one-hour group meetings that included topics such
as students’ identified actual or potential academic needs or problems associated
with basic academic skills (note taking, test taking, studying), time management,
culture shock, and adjustment to the amdemic institution. In three years, the
program increased minority graduations from 0 to 2 per yearto between 4 and 5 per
yean

Holtz and Wilson stated that special efforts are needed to retain culturally

diverse students in nursing programs until graduation. The authors outlined the

42

following stepwise progression to program planning for racially and culturally diverse
students:

1. Assessment of the level of administrator and faculty commitment to a
philosophy geared to a special program for racially and culturally diverse students.

2. Program planning that involves identification of culturally diverse
students.

3. I Group support meetings and peer support.

4. Tutorial services to correct academic deficiencies.

5. Advisement and counseling to identify students who are experiencing

academic or social-adjustment difficulties.

6. Early identification of these problems, with appropriate intervention.
7. Role modeling and mentoring by racial-minority faculty.
8. Summer preparatory programs.

9. Study groups.

10. New-student orientation programs.

11. Prenursing courses.

12. Instructional development for faculty related to these programs.

13. Computer-assisted instruction to alleviate academic deficiencies (and
expected learning achievement; future professional preparation).

14. Assistance in dealing with the cultural system of the college/university.

15. A system of assessment and amdemic monitoring (the academic

success track) in place, with the appropriate services offered to meet students’

43

needs. This should include analysis of the predictors of academic success (i.e.,
GPA, scores on standardized achievement tests).

16. Remedial intervention, as necessary.

According to Holtz and \Mlson, “The program must culminate with a high
degree of potential for success on the NCLEX” (p. 29) and obtaining a job, either in
the original community orthe majority culture. The program must be funded forthee
specific purposes; otherwise, it is seen as a failure within the model. Students’
willingness to use the services offered is the final factor in successful retention
programming or strategizing.

Sutton and Claytor (1992) described a five-year retention plan designed and
used solely at the Indiana University-Purdue University at Indianapolis (IUPUI). This
plan has served as a point of reference in ongoing discussions about minority
retention among nurse educators. The IUPUI model incorporated the predominant
approaches found in the literature to enhance minority student retention at
predominantly white, public, commuter schools of nursing. The vital link for

achieving increased retention wasthe total commitment ofthe university and nursing

faculty to providing:

1. Alumni support groups with volunteers who were successful in the
programs.

2. Tutorial and peer counseling services.

3. Remedial programs.

4. More minority faculty and counselors.

44

5. Investigation into the needs of minority students.

6. Opportunities for minority students to participate in various programs.

7. Increased direct contact with professors.

8. Student affairs or amdemic support services within colleges!
departments.

Although the full effects of the five-year plan were not known at the time of
publication, preliminary results were very positive, and it seemed reasonable to
expect continued positive results. Unfortunately, the reported retention data
combined numbers of students from both the associate degree and baccalaureate
degree programs in nursing. Thus, the effects of the plan on baccalaureate student
retention alone were not evident. Data from the 1990-91 academic year indicated
that change had occurred. The minority enrollment had increased from 128 (8%)
students in 1985 to 251 (9.9%); undergraduate student graduations had increased
from 2.7% in 1985 to 8.9%; and NCLEX-RN results improved significantly. In
addition, Sutton and Claytor suggested that nurse educators must realize that many
students will take longer than the expected four years to graduate.

Nurse educators have used Tinto’s model to identify approaches to student
retention that are relevant to the identification of strategies for minority students.
Findings from Benda’s (1991) study led to the following strategic recommendations:
(a) students whose backgrounds include academic-risk factors should have a five-

year plan of study that requires fewer concurrent natural science and nursing

45

courses; and (b) high school students need more information concerning the realistic
requirements and components of being a nursing student.

Using Tinto’s model, Courage and Godbey (1992) described the comprehen-
sive academic services and policies of a prototypic retention program developed to
provide support to nursing students. Their findings supported earlier findings that
the integration of students into the life of the institution, the educational program, and
the reciprocal commitments of faculty to student and student to program were
essential. Further strategicrecommendations included achievement awards, stress-
management skills, and policies that included opportunities for readmission and
course repetition. Finally, the authors stressed that 'a student in crisis cannot wait
the 2 or 3 weeks often required for entry into external counseling systems” (p. 32).
Having an immediate individualized crisis-intervention service within a nursing
program is highly recommended. In a case study, Nelson (1994) described the
application of crisis—intervention methodology to the retention of minority students.

Jones (1992) suggested using only the broad factors (i.e., psychological,
environmental, economic, organizational, and interactional) of Tinto’s model. She
further suggested that nurse educators, who generally are not steeped in higher
education pedagogy but rather are consumed with issues of nursing practice, have
yet to explore retention models in much depth, particularly in relation to minority
students. Further studies are needed to determine the applicability of Tinto’s model

to minority student populations. At this point, the model leaves many questions

 

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unanswered regarding future minority nursing and nonnursing students’ retention
needs.

Greer (1995) summarized the components of a comprehensive retention
program for minority nursing students. The program should include the following:
(a) an extensive orientation program upon entering nursing school; (b) a course to
strengthen students’ writing skills; (c) a comprehensive introduction to the use of the
university’s library; (d) a computer-literacy course; and (e) a guide to support
services, including financial assistance, housing, counseling, insurance, and
employment opportunities. Nursing educators have a responsibility to offer
encouragement to students through mentoring and personal commitment, being
catalysts for change, projecting a positive self-image, providing a listening ear, and
serving as role models to minority students. Nurse educators must build students’

self-esteem and challenge students intellectually to achieve their personal best.

SI I I’B 'l'l'l' EB! l'
A number of researchers have addressed students’ responsibilities for
retention. Brown (1983) cited the lack of emphasis on involvement of minority
students in helping themselves. She believed that students should have a definite
role and define themselves as active participants in their own success. Students
should focus on three broad areas of self-help involvement:
1 . ' Personal: There is a need to assume responsibility for one’s behavior,

to develop a personable style of self-preservation, and to cultivate a positive self-

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47
concept by becoming knowledgeable of the contributions made by minorities to
health care and society, in general.

2. Family/social: It Is important to remember that nursing is an
interracial experience, to identify support elements for one’s efforts, and to plan time
for. social events, family, and friends.

3. Academic: Success in a nursing program is related to the
development of academic skills, seeking out those who are interested in providing
assistance, identifying and using campus and community resources, and, above all,
believing that one can and will succeed.

Tucker-Allen (1989, 1991) and Greer (1995) recommended that students
remain focused on their goals and objectives, think positively, embrace discipline,
take advantage of leadership opportunities by getting involved in institution and
program activities, make use of academic support services, request assistance with

problems before the “midnight hour,” and organize support groups.

Summary

A review of Tinto’s model was included in this chapter, with a focus on its
applicability to minority student retention. Although the model still has predictive
validity for traditional, white students on primarily white campuses, it does not have
predictive value for minority or nontraditional students. The culturally relevant
aspects necessary for minority nursing student retention do not seem to be an

integral part of the model. Only the broad structural components of the model (i.e.,

48

psychological, economic, environmental, organizational, and interactional) appear
to be useful.

Other institutional and discipline-specific models are more inclusive of a
variety of student characteristics, such as race, age, gender, cultural background,
and academic preparedness (Courage 8 Godbey, 1992; Greer, 1995; Holtz 8
Wilson, 1992; Sutton 8 Claytor, 1994). These models provide a wealth of strategies
for retention of minority students.

The host of problems confronting minority students on predominantly white
campuses in the past have been described repeatedly and remain essentially the
same today. The dominant reasons cited for the underrepresentation of minority
nursing students are:

1. Minority students, especially African Americans and Hispanics, are
more likely to come from poor socioeconomic backgrounds and enter universities
with inadequate educational preparation for college study.

2. The lack of a comprehensive program to increase minority participation
in nursing programs reflects the piecemeal approach used to attract and maintain
minority students (Baldwin, 1994).

3. An environment that is conducive to minority students” success has not
been created on most university campuses (Baldwin, 1994).

4. Minority students are not being admitted to schools of nursing in

proportion to their representation in the general population (T ucker-Allen, 1989).

49

5. A substantial number of minority nursing-intent students who are
admitted to universities fail to enroll in nursing programs (NLN, 1994; PEW
Commission Report, 1995).

6. Nursing faculty are overwhelmingly reluctant to support the increasing
demand for diversity in nursing programs (Fleming, 1995; Hansen, 1988; Rogers,
1990).

7. Minority students have unrealistic perceptions about the rigors of
nursing education (Claerbaut, 1978; Greer, 1991).

8. Nurse educators are largely unicultural and lack knowledge of diverse
student cultures (Campbell 8 Sigsby, 1994).

Despite the many comprehensive strategies that have been successful in
promoting nursing student retention, researchers have been unable to identify
variables predictive of success that can be generalized across nursing programs.
They have concluded that the best predictor variables can only be found within
individual nursing programs. Findings from several studies also have suggested that
the nursing literature provides limited direction for nurse educators to improve
minority student retention (Baldwin, 1994; Campbell 8 Dickson, 1996; Greer, 1995;
Heydman, 1990; Schwirian, 1978; Taylor et al., 1996).

However, five strategic links to retention continually were cited throughout the

literature:

50

1. There must be sustained commitments by faculty and institution to
providing the academic services and environment needed to facilitate students’
progression through the nursing major.

2. The nursing program’s academic services and environment must

include the prenursing year(s).

3. A comprehensive retention program must be designed, implemented,
and sustained.

4. Racial diversity must be integral to and fully operative in the nursing
program.

5. Culturally relevant curricula must be implemented, and clinical

laboratories must be heterogeneous by plan.

Given the vast number of specific retention strategies found in the literature,
what is needed to improve retention rates among racial-minority baccalaureate
nursing students seems clear. An understanding of why retention is still a problem
must be sought. The present research was undertaken in an attempt to dojust that.

Chapter III contains the methodology used to conduct this study.

CHAPTER III

METHODOLOGY

Introduction

In response to the minority student retention research of the 1960s and
1970s, Baldwin (1994) asserted that

the exclusive use of quantitative methods to explore phenomena related to

minority students may not have produced the most reliable and valid data. . . .

The use of qualitative methods . . . to examine minority students’ success

needs to be explored. . . . Illuminating the lived experiences . . . can uncover

their views of meaningful learning experiences related to academic success

[and] help faculty understand human experience from the individual’s

perspective. (p. 534)

Based on Baldwin’s assertions, my goal in this study was to understand and
document the multiple realities associated with the retention strategies used without
manipulating or eliminating any situational occurrences. I had two purposes: (a) to
generate a rich description of the strategies used to retain minority students in
baccalaureate nursing programs at public universities in Michigan and (b) to develop
a local theory that explains current retention patterns and the actions needed to
retain minority students in baccalaureate nursing programs.

The methodology of the study is described in this chapter. The seven

elements comprising the study design are discussed in detail.

51

52
DesigtmttbeStudx
Based on naturalistic inquiry methodology (Lincoln 8 Guba, 1985), a design
for conducting the study was developed, which comprised seven elements: (a)
focus of the inquiry, (b) fit of the paradigm to the focus of the inquiry, (c) data-
collection sources, (d) phases one (orientation and overview) and two (focused
exploration) ofthe inquiry; (d) data-analysis procedures, (f) phase three (the member
check) ofthe inquiry, and (g) ethical considerations. These methodological elements
also met the criteria of the University Committee on Research Involving Human

Subjects (UCRIHS) for conducting the research (Appendix C).

Eomuflbetnouirv

The focus of the inquiry was to gain sufficient knowledge to understand the
retention strategies used in baccalaureate nursing programs at public universities
in Michigan in order to answer the research question: What is needed to improve
retention rates among racial-minority baccalaureate nursing students at public
universities in Michigan? Also, I sought to acquire an understanding of the needs
within nursing programs, as expressed by the participants, so as to develop a local
theory about minority nursing student retention.

Literature reviews and elite interviews were conducted to gain and clarify
knowledge about national concerns and common strategies used to retain minority
nursing students. The boundaries used to focus the study were specified by the

naturalistic inquiry and local theory methodologies.

53

El [II E I' III E
Qflhilnquint

Five axioms underscore the fit of the naturalistic inquiry paradigm to the focus
of this inquiry (see Table 3). Within these axioms are the researcher’s commitments
to (a) investigate minority nursing student retention as it occurs naturally and (b)

inductively derive the research outcomes.

W

The natural settings, the study participants, and the researcher as bricoleur
represented the data-collection sources. The settings and the units of analysis
flowed naturally from the focus of the inquiry.

Ineneturaisettings. Nine of the ten accredited baccalaureate schools of
nursing at public universities in Michigan cited in the NLN’s W
orNorsingzaua 995) were selected for study. The tenth program, the investigator's
employer, was excluded from the study because ”unless you are conducting a form
of action research, it is not advisable to conduct your study in your own backyard--
within your own institution or agency, or among friends or colleagues. , Backyard
research can create ethical and political dilemmas” (Glasne 8 Peshkin, 1992, p. 21).

In addition to having obtained NLN accreditation, the nine selected programs
met the following criteria: the nursing programs had (a) national and local
recognition, (b) identified enrolled minority students in the NLN reports, (c) general
program differences, and (d) minority students who were readily available for

interview. Five programs were located in proximity to communities with relatively

54

Table 3: Axioms of naturalistic inquiry.

 

 

_
“

Axioms About Naturalistic Inquiry

 

The nature of reality (Ontology) Realities are multiple, constructed, and
studied only holistically. Inquiry Into these
multiple realities will inevitably diverge
(each inquiry raises more questions than it
answers) so that prediction and control
are unlikely outcomes although some
level of understanding (verstehen) can be

 

 

achieved.
The relationship of knower and Knower and known are interactive,
known (Epistemology) inseparable. The inquirer and the ”object”
of inquiry interact to influence one
, another.
The possibility of hypotheses The possibility of generalization, the aim
and generalizations of the inquiry, is to develop an ideographic

body of knowledge in the form of ”working
hypotheses“ that describe the individual
case. Only time- and context-bound
working (ideographic) statements are
possible.

 

The possibility of linkages All entities are in a state of mutual
simultaneous shaping so causal that it is
impossible to distinguish causes from
effects.

 

The role of values Inquiry is value-bound. Inquiries are
influenced by inquirer values as
expressed in the choices made of the
problem, the paradigm that guides the
investigation, the substantive theory
utilized to guide the collection and
analysis of data, and in the interpretation
of findings. Inquiry is influenced by the
values that are inherent in the context.

 

 

 

 

Note, From Natutaflsthlngulnr. by Y. S. Lincoln 8 E. G. Guba, 1985, Beverly Hills,
CA: Sage.

55

large minority populations. Two geographically remote programs had large Native
American populations. Four of the programs were selected for on-site visits because
of ease of entry, travel, season of the year, school calendars, and work schedules.

WW. One or two faculty members from each of the nine
nursing programs volunteered to participate in the study, for a total of 17 faculty
participants. Fifteen minority students who were completing the first year in three
ofthe programs also volunteered to participate in the study. Student interviews were
not originally included in the study design. However, while I was waiting to interview
a participant, an informal conversation (with a minority student resulted in a two-hour
interview with five minority students. Subsequently, student interviews were
arranged at two more sites where faculty interviews had been scheduled.

Ineresearonerasorjooleur. In a naturalistic study, the researcher's role is
integral to the research design and must be made evident. The researcher’s role is
described in the axiom, the relationship of knower and known.

Denzin and Lincoln (1994) further described the researcher as ”bricoleur,"
one who “understands that research is . . '. shaped by his or her personal history,
biography, gender, social class, race, . . . and those of the people in the setting” (p.
3). The researcher, using first-person accounts, connects these personal attributes
to “specific sites, persons, groups, [and] institutions” (p. 14).

Icame to the field with an experiential background as (a) a student engaged
in lifelong learning; (b) an academic counselor in nursing programs; and (c) a

nursing faculty member with more than ten years of combined experience in

56

diploma, associate degree, and baccalaureate degree programs. During 15 years
of professional employment at predominantly white public universities, l' have had
many experiences that have shaped my realities about minority student retention.
These experiences influenced the focus of the inquiry.

A crucial responsibility for any researcher is to recognize personal bias.
According to Denzin and Lincoln (1994), “the age of value-free inquiry forthe human
disciplines is over" (p. 12). ”There is no value-free or bias-free design. By
identifying one’s biases, one can easily see where the questions that guide the study
are crafted” (p. 212). A bias was identified late in the study.

Too often, when l have inquired about minority student representation in
nursing programs, the number of racial minority students has been augmented to
include, without clear delineation, international students (those whose declared
nationality is other than American) as well as all males. The inclusion. of these
students as minorities in program reports shrouds the fact that very few American-
bom or naturalized racial minorities, female or male, are represented in
baccalaureate nursing programs.

This approach to reporting has always annoyed me and was recognized as
a bias when one faculty member identified Canadian students as minorities in that
program. Such an identification gave credence to Richardson and Skinner’s (1992)
statement that people do not recognize who are minority students. I thought limiting
the population to federally designated underrepresented racial minorities would

exclUde anyone but American-born or naturalized citizens. Although I had no bias

57

against international students as individuals deserving of study in American nursing
programs, I had a decided bias against using international students to inflate what
should be accurate numerical representations of designated national minority

students In nursing programs.

Ebasesflneandlwooflbelmuinc

The inquiry was conducted in three phases (Lincoln 8 Guba, 1985). These
were the orientation and overview, focused exploration, and member check phases,
which are discussed in detail in the following pages.

finese_one;_Qrientation_ano_oirenriew. I entered the field of study for the
purpose of conducting elite interviews.

An elite interview is a specialized treatment of interviewing that focuses on a

particular type of respondent. Elites are considered to be . . . the well-

informed people . . . and are selected for interviews on the basis of their

expertise in areas relevant to the research. (Marshall 8 Rossman, 1989,.

p. 94)

Informal audiotaped interviews were conducted with four racial-minority nurse
educators (two African Americans, one Native American, and one Hispanic). These
educators were from four diverse geographic areas: Florida, Illinois, Maryland, and
Texas. The interviews focused on current national trends (i.e., population, political,
economic, social, educational, and health care), the effect(s) of the trends on the
future of nursing, and the influence of the trends on minority nursing student

retention. Several recurring trends were noted during the interviews with nurse

educators:

58

1. The continued lack of student awareness about the rigors of nursing
education because of nursing program failures to ”create a mosaic of outreach
programs.‘

2. Increasing numbers of academically underprepared minority
prenursing students, generally the result of substandard secondary education.

3. A lack of program support systems (e.g., representative numbers of
minority nursing faculty or discipline-specific academic resources) for minority
students.

4. A general hesitancy among primarily white faculty to change
organizational climate, even minimally, from intolerance of diversity to tolerance, If
not acceptance.

5. A hesitancy among faculty to change to a curriculum that recognizes
cultural differences. Curricular change was equated with changing course content
and teaching to acknowledge the diverse educational backgrounds of students and
the realities of client health care, not lowering academic standards. .

These trends had strategic-planning implications for nursing education
programs and helped focus the development and use of the interview guidesheets.
According to Patton (1990),

The general interview guide approach involves outlining a set of issues that

are to be explored with each respondent before interviewing begins. . . . The

guidesheet presumes that there is common information that should be
obtained from each person interviewed, but no set of standardized questions

are written in advance. The interviewer is thus required to adapt both the

wording and the sequence of questions to specific respondents in the context
of the actual interview. (p. 280)

59

Based on the results of the review of literature on minority student and
specifically minority nursing student retention, as well as the elite interviews, general
Interview guidesheets consisting of 11 program descriptors and 15 interview items
were constructed (Appendices D and E). The wording and sequencing of questions
were framed to obtain certain common information and were adapted to accommo-
date the context of each interview.

EnaseMo;_Inetoo.lsed_exploration. I gained entry to the setting by informal
and formal means. Knowing faculty at several of the institutions and 'snowballing"
(Patton, 1990, p. 176) simplified gaining access to participants. Using purposive
sampling techniques, I sent a letter of introduction, a synopsis of the study, and a
Process Consent Form (Munhall, 1988; Ramos, 1989) to each program dean. In the
letter I outlined the purposes of the study and requested the names of two persons
(one administrator and one or two faculty) to contact for participation in this study.
Each program administrator readily identified prospective participants. Following
receipt of the names, I sent the individuals letters requesting their participation. The
prospective participants were asked to sign and return the consent form indicating
their voluntary participation (Appendices F, G, and H). Characteristics of the 17
individuals constituting the faculty group are shown in Table 4.

Minority student interviews were not originally planned for inclusion in the
study but were added after an unexpected meeting with some of them. Opportunis-
tic sampling allows ‘on-the-spot decisions about the participants to take advantage

of unforeseen opportunities after fieldwork has begun” (Patton, 1990, p. 179).

60

Table 4: Characteristics of faculty participants (N = 17).

 

Characteristic Number Tenured T

E 'I' I'll
Dean
Director, Student Affairs
Associate Director
Department Head/Chairperson
Coordinator (Learning Center)
Faculty

Gender
Female 16
Male 1

Race
White
African American

I! i I II I'
1-5
6—10
11-25
Unknown

1-5

6-10
11-25
Unknown

2! [I l' E .
1-5
6-10
11-25
No teaching experience
HighestfiegreeEamed
Ph.D.” 10
MSN 7

 

 

(D-‘N-‘OO-i
4.5.5.;

 

 

coco

 

comm-I:

 

QUINO

 

NQODU'I

 

 

 

 

 

 

'All but the student affairs directors were registered nurses. bTwo minority faculty
also had a master's degree in Guidance and Counseling.

61

Following an informal meeting with the first student group, I telephoned the
deans of two programs and asked them to identify a group of minority students for
inclusion in the study. Following receipt of the student names, I followed the same
process as described for the faculty participants. The final student participants were
those who were available in each program and who fit the study criteria. Follow-up
telephone calls were made within one week of receipt of the Process Consent Forms
to establish Interview dates and times.

Nineteen students originally were interviewed. The first interview was
conducted with five students (all females), the second with seven students (two
males and five females), and the third with seven students (two males and five
females). At the time I requested an opportunity to interview minority students, I was
not aware that many of the programs included males, regardless of race, as
minorities. Three nonminority males were included in two of the groups. Due to the
racial mix, responses from all male students were excluded from the study report.
The final student group comprised 15 currently enrolled minority females who were
completing their first year in a nursing program. Characteristics of these students
are shown in Table 5.

Methods of data generation: The research was conducted during winter,
spring, and summer 1996. Multiple data-generation methods were used, but only
a human being has the capacity to process the multiple realities in which
phenomena exist (Lincoln 8 Guba, 1985). I performed multiple roles, such as

interviewer (research instrument), participant-observer, and learner. These roles

62

Table 5: Characteristics of minority student participants (N = 15 females).

 

 

 

 

Characteristic . Number
Race

African American 9
Hispanic 3
Asian American 2
Native American 1
Lower Peninsula 14
Upper Peninsula 1
African American (3) 6
Asian American (2)

Hispanic (1) . .

African American (6)
Hispanic (2) 9
Native American (1)

MamaLStatus (Number of children)

 

 

 

 

 

Married (4) 3
Divorced (1) 2
Engaged (1) 1
Single (1) 2
22-29 years 12
30—39 years 2
40+ years 1
Bachelor of Social Work degree 1
Master of Engineering degreeb 1
Bachelor of Fine Arts degree0 1
Nursing 9
Nonnursing 6
At respective university 8
At local community college 7

 

 

 

 

'All students were attending nursing programs in southeastern Michigan. bDegree
was earned in another country. °The student had not completed this degree but
planned to do so.

63

allowed me to discover the patterns that would be merged to construct a local theory
for the retention of minority nursing students.

The participants chose the interview time and location; privacy and comfort
were important considerations. Semi-structured in-person or telephone interviews
and field notes permitted mutual interactions with the participants’ "lived
experiences” in their natural settings and facilitated beginning trust. Each participant
had a copy of the interview guidesheet before the actual interview began so that
reliable program statistics and admission criteria would be readily available. The
interviews lasted from one to three hours, and the focus changed as new thoughts
or ideas were shared. Ongoing literature reviews provided data that clarified or
expanded my understanding.

Modes of recording the data: All interviews were audiotaped and
transcribed verbatim. I made field notes in a notebook during and after each
interview. Ethnograph 3.0 (Qualis Research Associates, 1988) computer software
was used for data transcription, preliminary content analysis, rudimentary coding,
data reduction, and data storage. However, this program proved to be difficult to use
and was discontinued after the first three interviews had been transcribed. The
remaining interviews were transcribed using a word processor and manual coding

and data reduction. Data were stored on microdisks.

Data:Anal¥sls_ELchdures
The constant comparative method (Glaser 8 Strauss, 1967) was used for

data analysis. According to Lincoln and Guba (1985), data should have two

64

characteristics. They should be '(a) heuristic, that is, aimed at some understanding
or some action that the inquirer needs to have or to take; and (b) the smallest piece
of information about something that can stand by itself" (p. 345).

Data were simultaneously collected, analyzed, and assigned to units by
general pattems for category development. The data were assigned to a category
on a "feels right” or ”looks right” basis (Lincoln 8 Guba, 1985). Data analyses
involved only those responses that were relevant to understanding minority student
retention in Michigan’s public baccalaureate nursing programs. Data were assigned
to categories as follows:

LeicLLccding began with the first interview and continued through
subsequent interviews. Constant comparative analysis revealed 56 unduplicated,
or open, units from faculty (34 units) and student (22 units) responses. Patterns
were derived from key words in participants’ responses, concepts perceived and
constructed by discovery during interviews or observations, and memoing (a means
of preserving patterns that emerge during analysis).

LeireLlioooinQ was done by constantly sorting and comparing the open units
and memos with new data gathered from the ongoing interviews and literature
reviews. Six additional units were identified in the student data, which now totaled
28 units.

A combined total of 62 units was then refined based on unit "fit” into eight
broad categories ranging from faculty and student perceptions about (a) precollege,

(b) prenursing, or (c) nursing program needs; to (d) remediation, (e) curriculum

65
design, (f) specific retention strategies, and (9) student leadership opportunities; to
(h) organizational policies. Through further clustering, the categories were reduced
to five: (a) specific retention strategies-used and needed, (b) diversity—the
unheralded race-based connections, (c) illusions of knowing and passing, (d) health
care trends, and (e) future student/future nurse.

Leyeiillooding involved further category clustering by commonality of themes
or obvious fit into the following substantive categories: (a) the insidiousness of
academic unpreparedness, (b) the image of nursing, and (c) race (see Figure 4).

The multiple realities about minority student retention were further outlined
according to three sets of opposing issues:

1. Faculty reports of

A. wanting more minority students but not being able to admit
them because of GPAs, or admitting the students and having
difficulty graduating them; and

B. wanting to use retention strategies but failing to implement
them in a comprehensive, permanent manner.

2. The conflicting realities found as a result of elite interviews and
literature reviews about minority nursing student retention needs when compared to
the participants’ responses.

3. Health care reformers’ demands for culturally competent nurses to
meet minority health care needs in the face of continued underrepresentation of

minority nursing students.

Specific Retention Strategies

OpposingiFactors

Level I Codes (62)

Front door needs
Learning community
Critical thinking

Basic skills

Science preparation
Crisis Intervention
Remedial vs. retention
Illusion of passing
Mentoring
Communication skills
Preresearch opportunities
Computer-assisted Ieaming
UnivaacuIty commitments
Student organizations
Leadership opportunities
Career days

Academic advisement
Summer camps
Collaboration model
Learning prescriptions
Find 8 seek models

Role models
Motivation/pride/passion
Student orientations

Illusion of knowing

Public perception of nursing
Prior knowledge

Trends In nursing

Image of nursing

Rigor: of education

Faculty as all things

Minority nurses
Faculty apathy/fear

Cultural health services

Nursing ls homogeneous

National vs. international

Unheralded race-based
connection

66

Level II Codes (10)

Illusion of passing
Precollege
Prenursing
Nursing

Nursing’s public image

Prior knowledge

Future studentlfuture nurse

Health care trends

Who are the minorities
Race-based connection
Racial/cultural diversity
Native Ameriwn student

Level III
Codes (3)

Academic

underpre-
paredness

Image of
nursing

Figure 4. Selected strategies from data leading to central category.

Central
Category

COLLISION

67

As I attempted to recognize a relational pattern among these issues in light
of the research question(s), the word "quagmire” came to mind. Quagmire was
dispelled as an unacceptable resolution to the research question. Then the word
”trajectory,” the path of the factors, emerged. The question became, What is the
path of the opposing factors?

The opposing factors and the failure of most programs to sustain useful or
specific retention strategies, as identified by participants, were going to collide with
each other. Collision, the one word that both illuminated and linked the multiple
realities among all categories and the opposing issue‘s, loomed as the central
category (Figure 4). Collision was then defined as objects (the opposing factors and
minority student retention needs)unavoidably comingtogetherfimpacting (colliding).

Lincoln and Guba (1985) cited three criteria for ending data generation and
analysis: (a) the data sources are exhausted and no new data are emerging, (b) the
researcher feels a sense of data integration, and (0) new data are far removed from
current data and are not contributing to an understanding of the study focus.

After all data sources had been exhausted and the new data did not further
an understanding of retention, l perceived a sense of data integration, but there was
no sense of resolution. Although the word ”collision” could stand alone as an
interpretive descriptor of the trajectory of minority student retention in Michigan’s
baccalaureate nursing programs, the term did not resolve the study question: What
is needed to imorotre retention rates among racial-minority baccalaureate nursing

students at public universities in Michigan?

68

I then looked for a way to set the trajectory of the collision toward a positive
outcome, as well as to answer the research question. Further category refinement
led to inelastic collision, a dimension of collision, as a desired outcome of the
analysis. The category was supported by participants during the member-check
phase, which is described next.

EheseJnree;__Ine_membeLoneok. In this phase, “the task is to obtain
confirmation [from the study participants] that the report has captured the data as
constructed by each informant, or to correct, amend, or extend it” (Lincoln 8 Guba,
1985, p. 236). A printed copy of the audiotaped transcription was sent to each
participant for verification and editing of the data (Appendix I). The participants were
to return the transcriptions to me only if they made changes in representation. Three
participants sent me sample documents concerning retention strategies or admission
criteria.

Confirmation of the data was an ongoing process. I cycled back and forth
between phases in order to follow up on data from the confirmations or those
uncovered in the analysis process. I reentered phase two following interviews at one
institution, where conflicting information necessitated an additional interviewto clarify

and confirm certain information.

E. II o I Q a l I.
Integral to any research are the ethical considerations related to the

researcher’s role in conducting the study. The ethical considerations in this study

69

included participant confidentiality and Informed consent. These ethical
considerations were rigorously maintained throughout all phases of the study.

Participants’ confidentiality was protected by following both federal and
university regulations. Human subjects approvals were obtained from my
dissertation committee and the University Committee on Research Involving Human
Subjects (UCRIHS) before beginning this study (Appendix C). Participants’
confidentiality was further protected through the careful use and handling of code
books. Two code books were created, one of which contained the code categories.
All related materials were stored in a locked cabinet in a secure location accessible
only to me.

Each participant voluntarily gave process consent (Appendix H), generally
known as informed consent. I chose the former term because it reflects the nature
of the naturalistic paradigm. The participants accepted the difference in phrases
without hesitation. Such acceptance might have indicated one measure of trust,
which was an integral part of the research process.

The ethical considerations were managed very carefully, ”particularly when
exploring sensitive and taboo areas" (Marshall 8 Rossman, 19879, p. 69).
Discussions of retention of minority students often proved to be very sensitive for
some faculty and students. I was acutely aware of the emotional states of several
minority faculty and students who remarked that the discussions ”brought back
painful memories of bitter discussions" about program practices in relation to

minorities. I also was aware of the shared concerns among minority and majority

70

participants who were incensed that many institutions dealt with minority admissions
and retention as if"big brother/sister is watching," because federal and state funding
required attention to the racial mix of students, or because the nation and profession
expected diversity.

Although not all potential risk situations could be anticipated, I offered the
participants as much flexibility and control over the interview situation as was
feasible. Many times the interviews went well past the requested time. One
participant, while in the ”heat" of graphic African American patois, canceled a dinner
arrangement in order to complete the interview. Several times I asked the
participant ifwe should continue the interview at a later date. The responses were
consistently, 'No.”

Finally, rigor, according to Streubert and Carpenter (1995), is demonstrated
through attention to and confirmation of the data that have been discovered.
Stringent adherence to the accurate representation of the experiences of the study
participants is the measure of a research study’s trustworthiness. Lincoln and Guba
(1985) suggested that a description of the steps for ensuring trustworthiness be

appended to the case study for interested readers (see Appendix J).

Summary

The conduct of the study, using naturalistic inquiry methodology. was
explained in this chapter. Descriptions were given ofthe data-collection process and
the constant comparative method of data analysis employed to (a) understand the

retention approaches used in Michigan’s baccalaureate nursing programs; (b)

71
discover the central category in the data, collision; and (c) refine the central category
to discover inelastic collision, a dimension of collision.
Chapter IV contains the results of the interviews and data analysis. The
report of the study may be found in Chapter V, and the local theory for retention of

minority students is presented in Chapter VI.

CHAPTER IV

INTERVIEW RESULTS AND ANALYSIS

IntLQductiQn

One purpose of this study was to generate a rich description of the strategies
used to retain minority students in baccalaureate nursing programs at public
universities in Michigan. Two subsidiary research questions were posed to achieve
this purpose: (a) What strategies are being used by nurse educators to retain
minority students in Michigan’s baccalaureate nursing programs? and (b) What
retention difficulties do minority students experience in Michigan’s baccalaureate
nursing programs?

In this chapter, the interview results and analysis are presented in three
sections. An overview of the combined faculty (N = 17) and student (N = 15)
perspectives of the program organizational structures (N = 9) is presented in the first
section. Faculty perspectives of minority student retention are presented in the
second section. Minority nursing students’ perspectives of retention are presented
in the third section.

To ensure anonymity, only aggregate responses about the retention
strategies used at the study sites are given in this report. On occasion, reference

is made to a participant’s race or specific position title (i.e., an administrator) when

72

73

a response is included that I considered critical to understanding minority nursing
student retention.
. .
WW [1 . l' l S! I

Each nursing program had its own unique perspective of student retention.
Two assumptions made in this study were that (a) there would be unequal levels of
retention programming or planning based on program priorities and traditions, but
(b) each program would have some mechanism for providing retention services
based on student need, either through the program itself or through the university.

All programs had committees or offices to deal with students’ academic affairs
in some systematic manner. The smaller programs had committees such as a
Minority Advisory Committee or a Student Affairs Committee. The larger programs
had Offices of Multicultural Affairs, Student Affairs, Academic Affairs, or Academic
Advising. Similarly, all nine programs used their university academic support
services either completely or in part for tutoring and improving mathematics or
writing skills.

Student input was encouraged and valued across all programs. "We use
student input to consider changes in our course content and curricula. It helps to
determine program policy, not often but sometimes.” There were varying
mechanisms for input (i.e., as members of committees: student affairs, curriculum,
undergraduate or graduate programming). “Once a year the graduating class does

an overall program evaluation.” One faculty member discussed the use of a national

74

survey to gain student input: “The university uses the Noel-Levitz Student
Satisfaction Inventory to do bi-annual surveys [and] then give feedback to the
departments. We even had Vincent Tinto here one year to help sensitize us.”
The National Student Nurses’ Association (NSNA) existed in all programs.
Faculty thought that NSNA was the best source for student input about the program.
Yet none of the minority students interviewed was a member of NSNA or of
departmental or university committees. None of the students knew of another

minority nursing student who belonged to NSNA or served on any of the committees.

E IIE I' [II' 'I SII IE! I'
.1” II "I III' 7..

The first two faculty interviews began with a broad request: ”Would you tell
me about your nursing program?” After analyzing the responses from the first
Interview, I became aware that the person had difficulty discussing racial-minority
students as identified in the study. ”We have a fairly large contingent of Canadians
among our students. About one-fourth are Canadians, and one or two are French
Canadians.” There were no federally or state—designated racial-minority students
in that program.

Another faculty member discussed males as minorities. During subsequent
interviews, without structuring or limiting the direction of our conversations, I asked,
as early as possible, for clarification of who were designated minority students in the
program. A total of four programs included males in their official minority student

reports while admitting that men are not considered a minority by regulatory

75

agencies or the profession. None of the respondents was able to provide accurate
data about enrolled racial-minority males. Six faculty stated, 'I think there are at
least one or two here.”

Two more terms, ”retention“ and "success," were clarified as early as possible
in the interviews. The typical questions asked, in no particular order, were "Would
you tell me your understanding of the term ’minority’ [or “success” or 'retention'] and
how you use the term in your dealings with students or other faculty?”

These terms provoked the most hesitancy, clarification, and restatement of
all of the questions posed to faculty. Five faculty had considerable difficulty
discussing issues relating only to racial-minority students. They preferred to discuss
retention needs related to disadvantaged students: ”That’s applicable to any student
and not restricted to minorities.” To these faculty, an educationally disadvantaged
student was one who came to the program with academic deficiencies and would
need support services. Most of the academic services were expected to be supplied
by the university, not the program.

Two faculty from another program identified Arab Americans among the state-
designated racial-minority groups. They thought that ”there may be two or three
Arab American students in the program.” No other faculty mentioned Arab
Americans as being a designated minority or identified those students as being in
their programs. However, another faculty member stated, "Our university considers
minority a little different than I do. It includes international students as minorities; I

do not.”

76

There was little racial mix among faculty in all programs. "Our faculty is not
ethnically diverse, but we probably are reflective of our community.” Of course, this
statement would not be true when applied to faculty in urban communities. Yet it
was, nonetheless, applicable to all of the nursing programs.

Geographic location was a factor accounting for the numbers of minorities
among faculty and students in programs or communities. One participant In a
geographically remote area stated, ”We have one adjunct faculty who’s a Canadian
citizen and was born in Poland, so we get diversity through people like that."
Another faculty member who was located in a geographically remote area stated,
"African Americans were in the region because of the prisons in our area. There are
a few families here now.” And from another participant in a remote area:

We had an Air Force base, and that helped with our minority population.

Some families moved here, so we had a little more diversity in our group than

we have now. Its closing clobbered our minority base. The Native Americans

were not affected, but the Asians, African Americans, [and] probably

Hispanics were affected. Now we’re back to our nice homogeneous group.
We use simulated learning experiences to introduce the concept of diversity.

Minority student mix was similar to minority faculty mix across all programs.
Although geographic location was relevant, it could not account for the paucity in
statewide admissions or graduations of minority students in public baccalaureate

nursing programs. The numbers of minorities in each admitted class ranged from

77
zero to a high of eight. Respondents gave very vague percentages ranging from 5%
to 20% to indicate student mix across programs.

A common response to the question of how many minority students were
graduating in the current class was “none.“ Rarely did participants report more than
an average of two to three minority students in a given class; most often there was
one. “But the numbers are getting better,“ replied one faculty member.

Two responses were pertinent to this study. First, “There are 58 minorities
out of a total of 660 students in our program; that includes both undergraduates and
graduates. Most are in the RNIBSN completion program.“ Second, “Our incoming
class will be about 20% minority, but we did some real active recruiting. That
brought our overall number to 16% minority.“ Based on a report from the latter
respondent, of the 80 students enrolled that year, seven were African Americans,

five Hispanics, and four Asian/Pacific Islanders; none was a Native American.

'II 1m '| I III III"

If the term “minority“ was difficult for many faculty to accept, the term
“diversity“ was even more troubling for them. “It seems that you have to be
absolutely specific about what is meant by the term. Otherwise you get all of the
’confounding variables,’ shall we say.“ The need to represent diverse issues (e.g.,
race, ethnicity, gender, sexual orientation, physical disability) was having an effect
on nursing programs. “As a college we’re uncomfortable dealing with sexual
orientation, let alone racial or ethnic diversity. It's not being ignored, it's just not

being dealt with.“ Yet another faculty member added,

78
I think many people-it's not just our college, it’s our country—sort of feel that
we’ll just ride out this diversity wave and it will go away. They see it as just
a cliche, an in-vogue kind of thing. You can couch it however you want, the
impact is just the same whether you call it diversity, quality, mutual respect,
community, whatever. Very clearly there are some things that occur because
of race and differences that affect our students’ performance.
One frustrated faculty member stated,

I see broad definitions as a “cop out,“ quite honestly. Right now, and it has
always been, the real difference is based on black and white. The issue is
needing to address things from black and white racial categories, from a
social definition of race. How that impacts how we act with each other first,
then we can expand to issues of the Italians versus the Irish, or something
like that.
Another participant stated,

Faculty are not comfortable with black and white. It’s much easier to talk
about being intolerant of academic degrees, “She’s an Ed.D., not a Ph.D.,“

than to deal with the discomfort that you have with something as innate as a
person’s color.

For years, nursing’s professional and accrediting agencies have encouraged
nursing education programs to develop culturally relevant curricula and expect
cultural competence as a fundamental feature of clinical practice. Although
respondents from all programs spoke of a need to develop cultural competence
among their graduates, the following two statements represent the overriding
sentiments of a number of faculty: “Geez, the curriculum is being bombarded with
it,“ and “Trying to give students a broad-based experience with people of many

cultures is a challenge when your community is very homogeneous.“

79

Facultyfrom six programs identified curricular requirements intended to foster
cultural competence. One participant stated, “I teach a course called Multicultural
Health Approaches, and it’s going to be required in our curriculum starting next year.
All students will have to take this course In cultural diversity. It’s wonderful! They’re
realistically exposed to a number of different cultures.“ Another offered, “Acquiring
cultural competence is a process that starts out small, sortof like a snowball, that’s
how small it is. It picks up these other categories or classes of interaction as it goes.
Right now we’re still in the early stages.“

Faculty from programs in the lower peninsula were better able‘ to define a
population of racially mixed American minority clients than were those from
programs located in the upper peninsula. The most fascinating, detailed, and
surprising comments came from a participant who remarked: “We’re an international
program.“ This participant provided a glowing description of the program’s
dependence for clinical-practice opportunities on a nearby, but foreign, country and
the benefits or problems that presented:

We have just about all clinical courses represented in their hospitals and

communities over there. Our students actually get quite schizophrenic by the

time they get finished; actually, we call them [students] “versatile.“ The

American health care system is quite different from the Canadian system. It’s

just like two worlds, and yet they [students] get to learn the best of both of

them. We’re pretty unique, aren’t we? The students are exposed to a rich

mix of cultures because there’s a significant mix of Italians, French

Canadians of course, Polish, Finnish cultures—if you don’t even count the

Canadians, which is similar to ours in many ways. They have a significant

Asian culture there too, so it’s not uncommon to go in and care for patients

that speak no English at all. We’ve had this neat arrangement with them for
about 25 years, and it seems to go well.

80
The obvious omissions from these clinical experiences are opportunities to care for
Hispanic Americans, African Americans, Arab Americans, and Native Americans-in
essence, those citizens of the United States and Michigan who have been identified

as minorities and/or underserved racial minorities.

There were many levels of disagreement between faculty and administrators
regarding admission of minority students. Several participants stated that faculty
would “talk about increasing the number of minorities in our program,“ but there was
an underlying “fear among some that minority students are not prepared to enter
nursing programs; to do so would require lowering the standards.“

The minority faculty understood that fear and would agree, “if all things were
equal.“ A statement respondents often made was,

Our program feels very strongly about increasing minority enrollment, at least

they’ve talked about it a lot. But, in order to do it, sometimes you have to take

a real active position and say, “I’m going to take “x“ number of students that

meet the requirements.“ Not lower the requirements but meet the

requirements, even if they are not competitive.

One majority participant referred to a division of effort that existed between
faculty and administrator:

I would say there are some faculty who believe that the dean pushes too hard

for retention. They think that these students don’t deserve to pass. That’s

just some. There are others who agree with the dean—if the students are
admitted they should be successful. They [students] don’t always have the
tools to help assure success. We need to provide them.

Probably the most poignant statement was reflected in the following flow of

questions and answers:

Question:

Answer:

Question:

Answer.

81
How many minority students do you usually admit each term or year?
Over the past three years we had one student the first year. The
second year we might have added two, and the third year we might
have had . . . all total, the largest number we’ve had in four years has
been four, I believe.
How many were admitted for the coming fall term?

One. It’s kind of a lonely number being one. . . . That In itself can be
a barrier.

WWW

African American females were the largest minority group cited by minority

faculty at six program sites; the remaining three programs had no minority faculty.

A prominent theme among the African American faculty was what one participant

referred to as “the unheralded race-based connection.“ The following five

statements reflect the sentiments of several minority faculty:

1.

There are only two black nursing faculty here, and we probably see all
black prenursing students. It is-not unusual for staff in the student
advising or amdemic skills areas to tell them to see me or the other
black faculty. So, one of the, I don’t want to say burdens, but
additional unheralded responsibilities that minority faculty take on in
a majority, white institution is this informal mentoring and advising.

There’s a small group of African American prenursing students who
come to me for cheerleading purposes and cussin’ out purposes and
monitoring purposes, [and] to get some advice about how to best
position themselves for admission. For example, we give preference
for admission to students who took the majority of their courses here.
Not everybody knows that. Not everybody is aware that if you take [so
many] classes someplace else, you just put yourself in a much more
difficult mode to become admitted. On the other hand, I have advised
students that if you are having problems with chemistry here, go take
it at a community college, it may be easier for you. As long as the
majority of your classes are taken here, it’s not going to disadvantage
you. That kind of inside-track information gets passed on from me.

Question:

Answer.

82

But then what happens with the Hispanic student or the Native
American student?

I have no idea. Hey, somebody did it for me. Somebody took the
time, and they didn’t ask me what my major was. They said, “Come
on in and sit down. How can 'I help you?“ I think that as an African
American one of the qualities of our community, that we want to
promote and get back to, is each one help one. It doesn’t say that I
only would do it for an African American student. It’s just that on a
campus where people of color are not in very high supply, these
students have a feeling that they’ll get established easier with a
person of the same race. That is not at all exclusive. I've known white
faculty who have also established these relationships. So, it’s got a
lot to do with caring, but there’s little doubt that if it is a black
prenursing student, most often they are counseled to come and see
me, and they very often do.

I can remember arguing with the dean because she wanted me to
start some kind of tutoring program, and I said, “Why don’t you go and
get some of these white students who are in Sigma Theta Tau to do
some tutoring? Why are you coming to me?“

I try to be available, but sometimes I’m just too busy. Sometimes it’s
too much of a burden to try to take on.

I guess we do it out of love and interest or altruism more than just
having any kind of relationship to our jobs. We seem to recognize a
need for it, if there are going to be minority students, notjust black, but
primarily black andHispanic students in the programs and in nursing.
It all boils down to, “If we don’t do it, nobody else will.“

In listening to several African American faculty, I noted a difference in voice

inflection and language-pattem usage. The following discussion reflects what Iwas

heafing:

Question:

You’ve switched into a different tone of voice and speech. I wonder
is there a certain type of voice or approach that you use when talking
to some black students?

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Answer: There is no doubt about it. I wouldn’t even deny it. I have closed my
door and said to a black student, “Have you lost your mind? What is
your problem? Sit your ass down. What do you mean?“ Yeah, I've
said, “Do you think that because I got a Ph.D. that I ain’t from the ghet-
toe? Dahlin’, I grew up on the East side, High School territory.

Don’t you get caught up in the credentials. You come into clinical late.
Your nursing care plans are sloppy.“

Question: Is that a culturally based strategy to get their attention?
Answer: I think that you need to use whatever works; with some students it’s
needed, particularly when you’re dealing with those who are the first

peOpIe In their family to go to college. They don’t have anybody to talk
to about these things. Sometimes you have to confront the “nitty-

gritty.“

Question: So you do intrusive advising whenever necessary?

Answer Sometimes I’ve had to call them. In my younger years, I was much
more energetic; I’ve done even more. I’ve gone across the bridge to
the dorm and gotten some sister out of bed.

Following this interchange, I asked informal questions about language-pattem
usage, particularly of African American study participants, to validate the frequency
of and occasion for “switching to the vernacular.“ All of the African American faculty
said that they had used some form of “streetspeak“ in attempts to help students

relax and to let them know that they were from similar backgrounds. But two added,

“I don’t do it very often, only if I think a point needs to be made.“

Respondents from all programs considered retention as maintaining a student
in the program until he or she had completed all requirements and graduated. One

participant added.

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7mg

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34

I think retention has a broader social context. I'd like minorities to be sure
they can visualize where they fit and that they are important to the nursing
profession at the same time so that they don’t see it only as a Caucasian,
female profession.

At least 13 faculty stated that their programs had not identified retention as
more than an issue to be dealt with at a later time. “We do not have a retention plan,
but It is on the ’near-back burner.’ It’ll be in a curriculum review.“ Or, as one
administrator offered, “Sure, we have a plan. I don’t know how we’re implementing
it, we didn’t define it in any kind of measurable terms.“

Of particular interest were statements of two participants. The first was made
by a majority faculty member:

Retention has really been identified as an issue in the program. We know we

lose more students than we should, or feel we should, and we’re not really

sure why-if they’re academically sound, or if there’re financial problems, or
just what’s really going on. It’s one of the things we want to look at, but other
things have taken priority and we just haven’t done the analysis, but we do
know it’s an issue.
When asked about plans for and approaches to looking at the retention problem, the
response was, “Actually, that’s where it becomes a problem. We’re a small school;
there aren’t real good computer records, and a lot of our information is either on
handwritten records or faculty happen to remember what happened to students.“

The second statement was made by a minority faculty member:

Faculty aren’t comfortable with the idea of “making special arrangements.“

Part of it, in my mind, is the need to educate faculty, to help them understand

remedial work and our commitment to it without them defining that as making

exceptions to the rule. Right now, remediation, to them, means making

exceptions.

Remediation was differentiated from retention, in that

W

85

Remediation is a part of retention, a tool for retention, that won’t be needed
by every student but on a case-by-case basis. It should be readily available
and fairly applied when needed. It is, sort of, after the fact. In the ideal world,
there would not be a need for remediation because you would have “front-
loaded“ by process of assessment to figure out who was at risk, established
the programs to support them, thus facilitating success during progression
through the major. I don ’t think supporting them through the program is equal
to remediation. Even so, there is a significant void in efforts.

8 l I' El [SI I .
Overall, participants from seven of the nine programs stated that they had no formal

retention plan. Six common functions were found in all programs (see Figure 5).

Faculty advising
Peer mentoring programs
Nursing organizations
National Student Nurse Association
Sigma Theta Tau
Alumni Association

Faculty encouragement of students
to participate in activities

Periodic review by faculty of the range
of services available to all students

Occasional faculty-development workshops related to
understanding culturally derived Ieaming styles

Figure 5. Common retention functions found in all programs.

Three programs used an Introduction to Nursing course for prenursing

students as an “opportunity to socialize students to our conceptual framework or

86

organizing framework.“ Three programs had academic advising offices In the
college, and one program used admission and ongoing assessment methods.
Oddly, most of the participants did not view these as retention strategies or the basis
for a retention plan. They were seen as “satisficing measures“ because the
expectation of the program and faculty was that ifa student was admitted, he or she
should be able to complete the course work.

The strategy that was unanimously supported by faculty and evaluated as
most effective in retention was to foster and maintain one-to-one faculty-student
contacts. “The better therelationship between faculty and student, the better the
retention rate.“ The second desired strategy was having faculty buy Into minority
retention needs. “Faculty are the front-line people; they have the day-to-day
contacts with students and can go the extra mile if they need to for students that
come from minority backgrounds. It’s better than sending them to an outsider.“ In
all programs, with or without directed in-house services, the first person(s) identified
to assist in overcoming academic difficulties was the classroom or clinical instructor.

When asked about minorities being in clinicals together, the common
responses were, “We haven’t thought about that“ or “We don’t really plan it.“ In
many cases, retained students had to repeat a course but did go on to eventually
graduate.

The least effective retention strategy that was unanimously identified by
faculty was support groups. Some statements in this regard were as follows: “For

the amount of energy pUt into it, we didn’t get much return.“ “The students who

87

really didn’t need to come took advantage of it. The students who did need to come,
didn’t come.“ “You have to consider the personality set.“ “Sometimes when
students are struggling they don’t seem to understand that they have problems, or
their priorities aren’t going to school or something. I think they’re more focused on
getting the car payment than the grades.“ “They [minority students] don’t want to
meet casually with the program’s student nursing organization. They would be
willing if there Is some structured activity that would help them in improving their
course work.“

Despite varying levels of agreement about effectiveness, four programs
offered such directed in-house strategies to minority students as (a) linking students
to a minority faculty and/or a minority practicing in the community, (b) linking
students to a minority nurses association if there was a local group, (c) establishing
a minority student nurse organization in the college, (d) establishing minority support
group information sessions, or (e) offering social sessions. Again, none of the
strategies seemed to be, or were reportedas being, more than satisficing measures.

Only one program had a clearly identified retention plan (Appendix K). The
plan was quite elaborate and was directed toward all students. That program, unlike
most of the others in the study, had a student affairs office and an academic affairs
office that worked “in close collaboration to provide coordinated student services
within the college 0 nursing.“ The plan included a two-day orientation for all newly

admitted students, one in June and one in September at the beginning of the term.

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In June, the Nelson-Denny Reading'Test is administered to all students.
Based on the results, “students are either congratulated and sent forward or referred
to the University Summer Development Program, where their reading, study, test-
taking, and time-management skills are enhanced.“ Socialization is nurtured during
the one-day experience; students are assigned to clinical groups, and “we send
them out to lunch together.“ The fall session is spent orienting students to the
college and its expectations.

The plan includes early notification of academic difficulty, a faculty-generated
prescription referral method for remedial-skills laboratory opportun'rties, and
individualized tutoring and assessment by college personnel. Finally, the nurse
resource person assists students by sitting down with them afterthey have taken the
NLN diagnostic examinations throughout the program, “to develop a Ieaming
prescription ifdeficiencies are reported on the scores. Before they take their Boards,
each student has a prescription of [what] they need to work on, and some students
are more independent about identifying their needs.“

Three innovative efforts were integral to the program’s retention plan:

1. The college’s Progression Academic Support Success (PASS)
program. This program is usually a university service offering. “Actually, it started
with some government funding, and once that ended we just continued it. It was a
commitment of the college.“

2. The piloting of a concept referred to as the Learning Community:

“We’re a commuter school, so instead of randomly assigning new students to faculty

89

advisors in the first year, we’re going to put them into small clinical groups based on
the students’ geographic locations. We want to see if that will have an impact on
retention.“

3. A concerted effort to enhance the success of prenursing and graduate
education. “We’re going to look at the prenursing student to see how we can better
prepare those students so they’d be ready and competitive to get into our program.
I think there are a lot of students that we need to assist. We’re also looking at
minorities in graduate education as a primary focus.“

Three faculty sent exemplars as part ofthe member-check process. Among
the exemplars was a copy of a master'sthesis that was based on the extant
literature and outlined a comprehensive retention plan (Appendix L). Cultural
competency and diversity were integral parts of the plan, which was designed as a
foundational and preparatory mechanism to increase minority students’ comfort and
familiarity with the college of nursing.

Facilitating Interest in Nursing Diversity (FIND) and Supporting Excellence in
Nursing Diversity (SEND) constituted a format of intervention focused on retaining
culturally diverse prenursing and nursing students. The structure had two parallel
systems or tiers. The first tier focused on prenursing students, and the second
focused on nursing students. Each tier had three parallel programmatic strands: (a)
foundational, (b) instructional/academic, and (c) developmental/psychosocial. The
plan focused on three target populations: (a) minority prenursing students, (b)

minority nursing students, and (c) ancillary supporters. Ancillary supporters were

90

defined as those people who were able to give support and help to students,
including faculty, key university resources, and students’ family or identified support

persons.

Nursing curricula generally are designed to be completed in four years, which
includes one year of prereqUisite course work. One of the many problems identified
was the extended length of time needed by increasing numbers of all students to
enter nursing programs. Although all participants stated that their students tend to
graduate in the expected length of time, they also hastened to add, “Nationally, the
length to completion for all students is now 4-1/2 years in all programs.“ Several
participants said that part of the reason for the extra half year was that students do
not make up their minds until late in their college life. "They take the freshman year
and decide in their second year what they want to do, or they mess up, and then
they're behind. It’s now taking many prenursing students two years to complete the
prerequisites.“ Few programs provided published plansto students who would need
more than four years.

Seven programs did not monitor prenursing students' academic progress.
However, there was an awareness of some issues facing prenursing minority
students. The overriding problem cited for failure to gain admission was academic
underpreparedness stemming from poor high school preparation. One participant

stated.

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Math is a prerequisite to the chemistry course. If they cannot do the math,
they do not take chemistry. Chemistry is a prerequisite for admission to the
program. Or they’re taking much longer to satisfy the math and science
components, which delays application to the nursing program. About 20%
of the students fall into that group.

Another faculty member added,

One of the problems with reversing this trend is that one has to go Into the
sixth, seventh, and eighth grades to do it. You and I know that every
university has general education requirements that include some natural
science. Many high schools don’t offer labs with their science classes, or you
can’t even get advanced placement with chemistry or anatomy and

physiology.

A problem continually cited by faculty was that minority students do not

understand that admission Is competitive. Many students will identify the minimum

admission overall GPA as the admission grade requirement; they fail to grasp the

rest of the statement that says “admission is competitive.“ As one administrator

stated,

made:

Usually the pool we admit is more around 3.75. A minority student tends to
cluster around 2.75 to' 3.0. So they get very upset because they’re not
admitted. The catalog says “minimal requirement“ . . . but we only start at
that point. We start at the top GPA and come down. That’s one reason we
don’t have minority students. Then there’s the performance on standardized
exams, the NLN or ACT. Usually minority students are lower. However, we
would not necessarily use that score to keep a student out. If we get a
student that looks pretty good, they’re a 3.0 and competitive, but their ACTs
or NLNs are pretty low, they might get admitted. But all things considered,
admission would go to the student with the higher standardized test score,
too.

During another discussion about this issue, the following statements were

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Something I think is important and say to minority students when they come
to see me as prenursing students is that you’re always competing against
other students who are applying for admission. If this is a very, very smart
group and their GPAs are very high, the GPA you need to get in may be
much higher this year than last year or next year. It’s definitely not the
published minimum. It never has been. So even though we say a 3.0 Is
required, I can’t remember the last time anybody ever got in with a 3.0. Out
of 18 years, I can remember one year where we had to reach down below
3.0. We almost always have far more students applying that we have

positions.

Question: Do your minority students really grasp that?

Answer. No, they really don’t. And let me tell how I know that they don’t. I’ll
see them because they come to my office, or I’ll see them in the
Center on campus, and I’ll say, “How are you doing?“ They’ll say, “I’m
doing pretty good.“ I’ve learned to say to them, “What’s pretty good?
Define that for me.“ “Oh, well, I got a 2.8 on my last. . . .“ Then I’ll
invariably say, “Are you crazy? A 2.8! I’ll never see you in nursing
with that. If you’re not getting a 3.3 or 3.4, you’re not doing pretty
good.“

Question: And they just do not get it.

Answer They really don’t.

Wallets

In recounting minority students’ help-seeking behaviors, the overwhelming

responses were “not often,“ “not usually,“ or “not at all,“ even where a program's

early warning mechanism for students experiencing academic problems was in

place. Most responses included statements about the need for students to be

“proactive“ rather than waiting until the last two weeks of the semester to try to see

whether the tutor could help. One respondent commented, “I still have students that

will say, ’Well, this happened or that happened, so I know what I have to do to pass.

I’ll take care of it. I don’t need to go to the tutor.“ Despite attempts to get students

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“in the mind set that you don’t go to tutorials when you have troubles,“ tutoring was
not seen as a preventive tool by students. “I’d constantly tell them that you should
go because you need to ISM this material, not just memorize it.“

A minority faculty member who recently had earned a doctorate in nursing
and had been a student nurse during the 19603 offered:

Iwas [in a program] many years ago, and one thing I did was get tutored from
day one. We relished the idea. They [the program] would ask, “Well, did you
get good grades?“ I’d say, “No.“ It wasn’t that I got bad grades, but I
believed that there was nothing wrong with having support throughout the
whole process. Anything they gave us we could use, but it’s a different mind
set now. Maybe that’s because we were post-60s baby boomers; they had
resources and we just ate them up. Sometimes, today, you can’t give away
resources. When we have resources to help, they won’t come. But when
they’re failing, then they come and it’s almost too late.

Another faculty member said that many students do not want to believe that
they may have different needs, “and it's clearly ’leave me alone.’ In other words,
they’re saying, ’l’m in the program. I don’t need anything special.’ I think students
have a right to be left alone if they’re truly not interested.“ But, in most instances

faculty reported, “I think they use all the options there are and then come to me.“

When comparing minority to majority student behaviors, all faculty spoke of
a tendency among minority students to isolate themselves:

Minority students tend to isolate themselves a little bit more than white

students. It seems that I have to do more active soliciting. I have to call them

and say, “Have you fallen off the face of the earth? Where are you? What’s

up?“ versus some of the white students that just sort of regularly stop in.

One black faculty member stated:

94

In my years as a faculty member, I think there are some things that are true
about black students. Now it could be true about any number of students, but
I have observed this In black students and It’s fairly typical: Sometimes we
go around comers to get where we’re going. I’ve got two master's [degrees].
I think it [unnecessary steps] contributes to why they don’t take advantage of
some things like establishing a relationship with a faculty member so that the
faculty members know them, or using the tutors. For example, black students
are not likely to come see the professor when they’re having problems.
They’re not going to come. You got to call them. How many faculty members
feel responsible for doing that? I’m not even sure that I could say that faculty
are responsible. I feel responsible for doing it. I understand the dynamics of
what they’re going through.

Yet another faculty member spoke about black students’ not knowing the
“unwritten rules of the game“:

What I recognize with most of these students is that they are not involved in
the everyday life of their department. They don’t go to the picnics, they don’t
go to the holiday parties. They don't go to those things that help to socialize
them into their academic discipline. So they’re viewed as strangers and
outcasts. They are probably the only black person in their class, so you don’t
want to be bothered. Students can’t be successful doing that. I say to them,
“Get in your car, go buy some potato chips and Coca Cola, and get out to that
park or wherever. While you’re sitting at home talking about you don’t want
to be bothered, they’re discussing things around the campfire. You’re
missing out on it.“ It’s the “unwritten rules of the game“ or the politics of
academic success. I tell them that if you want to stay, you have to also be
smart about the politics of your institution.

WWII I’l [ll'

Nearly all participants believed that students choose nursing without fully
understanding the rigors of the program and the reality of professional practice, the
health care climate, or the changes that are occurring. As one faculty member

stated,

When they’re talking it goes like, “When I was a nurse aide l was doing da da
da. . . .“ In their minds, all we’re doing is validating what they’ve already

95

done. I think I’ve seen that more in the minority students than in general. We
tend to get the lower paying job and tend to have a lot of experience being
aides or what have you. Taking care of somebody in a home, that kind of
thing. So they think this is what nursing is about. Most of the students do
well clinically. Most of them do well with the task, but it’s the theoretical piece
where students are really having the challenge. They say, “What do you
mean I’m not doing well? I’m doing excellent in clinical. I’ve been doing this
nursing for all these years.“ They really have a hard time.

A second participant stated,

We have people coming into nursing that have never done anything in health
care. They were in construction or they’re out of ajob and this will keep them
employed. They’re not looking for a career, just a job. Hopefully, they will be
able to recognize that this is the wrong place and say, “Gee, this is really not
what I want to be.“

A third offered,

They still have the TV image of the profession; they haven’t conceptualized.
You know, I had a student say to me, “All this therapeutic communication is
really bugging me out.“ He just couldn’t conceive that now we communicate
with people is an essential part of nursing. They still have the notion of the
nurse as a technician.

Yet a fourth participant stated,

I will have minority students who will say to me, “I just hate these sciences;
once I get to clinicals I'll be fine.“ I do know that students of color tend to
perform better in the cliniml context, where they are applying the concepts
as opposed to the theory, or basic sciences, where they are focusing on
different concepts. I always have to tell them that nursing is a science. If you
don’t like sciences, then that has ramifications for whether or not you like
nursrng.

'III II II ll'lfll
Several statements exemplified faculty concerns about and hopes for future

students and nurses:

96

I would hope that students come to us prepared with better thinking and
reasoning skills than they currently have. This is based on what I see in
terms of what is going on in grade schools and high schools.

The student going into nursing must have a broad knowledge base in a
variety of areas: essential communication skills; an ability to see themselves
as equals; to know that this Is my practice, my knowledge base, and these
are my judgments. Somehow or other, we’ll have to do something to get
them there. It has to be a lot more and different. I know we’re doing a lot
with putting them in the community and giving them a lot more nontraditional
cliniml experiences where they’re collaborating a lot more. We’re going to
do a lot more of that. Society will demand it.

I think that whatever students we have in the future, wehave to be real active
in letting people at the K-12 levels know what we need so we can see that the
outcome matches the expectations of a college. There’s a big gap there. We
expect a certain kind of person coming into college, certainly when coming
into a nursing program, but we’re not necessarily getting that. Maybe we
haven’t stated in measurable terms exactly what we’re expecting. I think
there’s a lot more we need to work on.

The most commanding statement about the minority student of the future was

made by a dean:

The minority student of the future will be one that already does quite well in
their high school. They are academically talented students because Iforesee
nursing to be a challenging area. Someone who has more of a social
conscience, more of a sensitivity, like the students we had in the 60s. They
were rabble-rousers, but they cared. They wanted to make changes.

. The future minority student will have a community focus that,
particularly, some of our Native students come with . . . because they and
their families are more community focused and valuing of the earth, the
environmental focus. They would come with that and would help the majority
students value that more, although a lot of us give it. . .well, a lot of us . . .
I don’t know. The minority students of the future will bring the strengths they
come with from their culture.

They will also have to buy into the majority culture’s competitiveness.
I believe they’ll have to be more competitive to feel that competition is good.
Academic time on task, spend their time studying. There are two others, as
far as women in their cultures. I’m a feminist from way back. The women
have to believe in equality along with the men. I do have the impression that
it’s somewhat more difficult in the Native culture. Although I have people tell
me that the women in Native cultures are revered, that’s not my observation.

97

Program and student success was defined as the student’s completing the
nursing major in a reasonable and timely manner. Many faculty included the results
of the NCLEX as an aspect of success: “It’s the last milestone to employability as
an RN.“ When asked about NCLEX results as a factor in success, one participant
stated, “Isn’t that interesting! I guess we don’t worry about the Boards because we
have such a high pass rate. Except for one year, we get the job done. When they
pass the program, they pass the Boards. Those who don’t pass the Boards have
nothing to do with minority status.“ There were virtually no minority students or
faculty in that program or university. Another faculty member added,

Usually once they get in, the reasons you aren’t successful shouldn’t have to
do with academics. It’s more the rigor of the nursing program. If people are
not successful, then we worry about our admission criteria, what we’re doing
during that process. If they fail the first nursing course, well we think,
“Hmmm, maybe we really didn’t assess this person that well.“ But ifthey get
up to the junior or senior level and then begin to fail, then we really look to
see what’s going on here.

The most encompassing definition of success was expressed in the following

statement:

I think that success is graduation from the program and passing the NCLEX;
that students who want to find jobs are able to do so; that students continue
lifelong learning activities, whether formal or informal; and students
participate in professional organizations that benefit nursing, which means
they could be in a nonnursing organization as long as it’s beneficial to
nursing. Even though I’ve not really seen this, I think it’s appropriate to say
that we define success in our ability to continue the student’s interest in the
school’s nursing activities. In other words, we want people to participate after
graduation.

98
Other faculty members defined success as “progress“ on a step—by-step
basis. “That might even mean they’re able to come back, identify some strategies,
have some adjustments made to their schedules, and repeat a course. I think most
faculty feel that if we can support the progress, even if it’s a lot slower, that’s
success.“ Oddly, these faculty did not endorse the “progress steps“ as a retention

strategy.

“.1“. Sit I’E l' [BI I'

When asked who were designated as minorities in the program, the students
identified only federally designated minority groups. All were surprised that Arab
Americans were a state—designated group but recognized the rationale for their
inclusion. One Native American student stated, “I don’t know for sure how many
Native Americans are in BSN programs statewide, maybe five or so.“

All students stated that they would like to see more minority faculty, “not
because they might teach any better or help us more, but . . . well, I guess I’d just
feel better about the program and things. . . .“ Another added, while laughing, “It’d
be nice if we could have more than one. Yeah, maybe one of each at least. That

wouldn’t be too much, would it?“

One aspect of their discussions was unanimously supported in one form or

another across all three student groups: “One thing we all thought about—it’s like

99

being back in high school. All of a sudden there are 60-some-odd people in a group,
we have a class president, we are a class. . . .“ Another continued, “and we’re
acting like we were in high school. It’s kind of bizarre. I’m thinking—W-W-Wow! I’m
in college, I’m supposed to be mature.“

As in any college class, many students had expected to have some classes
and activities together, but they were not prepared for the level of togetherness that
occurred. “In the other programs we’re not thrown together as much as you are in
the nursing program. We see the other 75 or 80 of us a lot more than I did after
three years in the Med Tech program. There’s sort of a camaraderie among us.“

A question about the usual cliques was posed. “I think that even though the
cliques are there, any one of us would stick up for the other, regardless of the clique
they are in, because we know what they’re going through.“ “As nursing students we
know it’s not easy, so we try to work together, but it’s not easy sometimes.“ “They
expect some of us to be . . . sort of troublemakers. We aren’t usually assigned to
clinicals together very often. It’s okay. I guess, but I would like to see another ’face’

from time to time, especially in clinicals.“

Most students got a “head set“ for a course or instructor by word of mouth.
One student said, “There’s one more thing that we’ve talked about. I think it would
be useful when this conversation is typed up to give some of the comments to
sophomores entering the program because you enter having no idea what is

expected of you or where you’re going.“ “Yeah,“ offered another, “you feel lost and

100

at odds, especially ’us,’ you know.“ Then from another student, “To know even at
the end of the first year that you’ll jell as a group and that you will all know each
other would be some sort of reassurance. I was really insecure when l was thrown
in with all these people.“

Some of the students had decided that there was a message or a contribution
that they wanted to provide to future students, a record of their Iearnings and insights
that could be passed on to future nursing students. I asked whether the message
was for all students, given the manner in which statements were made. Most
replied, “It can be for anyone, but I think we need it. There are some things that

don’t apply to everyone.“ “Isn’t that what one class does for another?“

When asked about why they had chosen nursing or their awareness of the
job they would have to do as a registered professional nurse, most students stated
that they had had no idea of the scope of nursing practice or professional
expectations when they entered the program. They were just seeking a college
degree and a job that offered good employment possibilities. Twelve students
stated, “I chose nursing because it offers great job security.“ Three said that they
knew a nurse or, as one student put it, “I met some peOple who were graduated, like
from other weird majors, and they didn’t have jobs.“ Another said, “I thought itwas
going to be hands-on care, helping patients get better, not knowledge of medicine,“
or “I didn’t know nurses wrote patient goals and care plans. . . . There’s a lot of

papenNork“ Some students had come to nursing after having tried medical

101
technology, occupational therapy, or business majors; “I never considered nursing
a profession,“ one commented. “It was just a job.“

Seven students had transferred after completing most, if not all, of the
prerequisites at their local community colleges. By student report, the GPAs ranged
from 2.88 to 3.10. Several students had had to repeat courses in the sciences,
particularly chemistry, and either sociology or psychology in order to bring their
GPAs up to competitive admission standards. All but six had had to delay their
intended admission up to one year in order to become eligible for admission.

Three students stated, “I didn’t take chemistry in high school, and I had
forgotten most of my math.“ Still another stated, “I didn’t know I had to take all of
that stuff. I thought I would be okay since I had already earned a degree in health
care, but instead I had to take courses like nutrition and repeat chemistry because
I got a C- in one, and the chemistry I took didn’t have a lab.“ Still another said, “My
mother told me I’d need these courses, but I didn’t really believe her.“

In assessing their perceptions of program entry requirements, the greatest
surprise for the student interviewees was the competition for admission.
Understanding the pressures students place on themselves to excel has always
been interesting to me. These students were consumed, if not overwhelmed, by the

need to earn and maintain good grades.

102

“In high school I didn’t think you had to go through so much to get in, but once
I got here I realized how serious and competitive it was.“ Another continued, “Yeah,
I didn’t know the competition was going to be anywhere as strict as it was to get in.
I thought everybody who got good grades in high school could become a nursing
student.“ Yet another student added, “I think that was difficult to deal with, that I’ve
always got to be among that top 5%.“ While the students were making these
comments, they expressed feelings of pride as well as amazement in themselves—
that they had actually been admitted and succeeded thus far.

All agreed that a student needed more than C’s to be admitted. “If you just
passed. pulled C’s, you’d wash out real quick.“ This was particularly important to
one student who had had difficulty getting admitted because of her previous
academic work: “I barely got into the program because of an old GPA. lthought,
God, anything you did 20 years ago shouldn’t still influence decisions today; it did
very much influence the decision.“ All students believed that any applicant should
have a minimum GPA of 3.0 to be successful in the nursing program.

Several disagreements ensued while students were exploring their
perceptions of the general education and prerequisite courses. Entry requirements
place emphasis on preparation in the applied and social sciences. For the most
part, students saw little real value in taking literature—especially poetry—history, and
sociology when considering nursing practice. “When you take the general education
courses, you take 101 and 102 and those are—read his notes, study his notes, and

you’ll get an A.“ One student allowed that “reading books is helpful for your mind,

103

no matter what.“ That statement was countered by, “You’re going to read anyway.
We’re readers by nature, or else we wouldn’t be here.“

The students tended to think that there was no need for “intellectual
roundness.“ When they had applied for admission, none had even considered the
possibility of nursing’s being either an art or a science. Six students had taken either
an Introduction to Nursing or an Introduction to Health Careers. but still did not
believe or had not explored the notion of nursing’s being other than a functional
service to doctors or patients. Nursing has failed to portray its image as a learned
science and art to potential students and the public at large. There is a clear need
for the nursing profession to expend more energy in public-image building and for
nursing faculty to be assured that future students understand what is involved in
gaining a nursing education and in nursing practice.

The most heated discussion occurred when one particularly'adamant student
declared that she saw absolutely no need to take statistics in order to be a nurse;
“The only reason to take statistics is if you’re going to be a research nurse.“ Another
student whose parent was a master's-prepared nurse offered, “See, I think we’re
going to get into positions where statistics are going to come into play, and I think
we’re going to have to be able to read and understand the research.“ The former
student persisted, “Statistics has nothing to do with research. You wouldn’t be doing
all those things, not with patients! If statistical information was necessary, they’re
going to have a staff analyst figure it out, not just the nurse on duty.“ All students did

agree that statistics would be necessary ifthey decided to go on to graduate study.

104

I asked the students about the changes in their perceptions of nursing after
classroom experiences and their first experiences in the hospitals—actually working,
as professional student nurses. Several students already had stated that they saw
nursing as “just a job, just working,“ more than as a profession.

The particular nursing functions that helped students begin to understand this
difference were the creation and implementation of nursing care plans. They were
forced to think critically, often spontaneously, and face the realities and
responsibilities of actual professional practice. “I thought they [faculty] were trying
to scare the wits out of us.“ Others replied, “Oh well, I’m not going to argue with
her,“ or “Everybody was having a hard time believing it at the time. Of course, after
reading other articles and stuff, . . .“ or “It is different than we thought.“ Another
student stated, “I loved the first clinical experience; it was more than I thought
nursing was about.“

W
nttotal accomplishment ..

Toward the end of our conversations, I asked students to come forward in
time to the present, the end of the first year,with the questions “Are you feeling
better now? Are you more confident?“ All students had fun reviewing the year.

One student humorously recounted her cliniml experiences: “Last semester,
just walking into a patient’s room and introducing myself was a chore. The instructor

had to take me by the hand and lead me into the room.“ “Listening to bowel sounds

r.

105

was unbelievable; telling a patient, ’Okay, I’m going to listen to your bowel sounds
now. You don’t want me to? Well, too bad, now here we 90.“ Another student
added, “Yeah, I never would have thought about doing that. . . .“ Another said, the
pitch of her voice“ and rate of speech increasing, “I almost told my clinical instructor,
'That’s too embarrassing. I’m not going to do THAT to him!’ Now it’s ’If that’s what
my job is, I’m going to do it.’“ On the whole, the responses were: “[I feel] pretty
good,“ “not confident but pretty good about things.“

Another student said, “I was stressed out before we went to clinicals, but then,
once we went, I realized that it wasn’t as big a deal as I thought. She explained that
she had been so stressed before the first clinical because “I guess lthought we were
going to get thrown into all this stuff and lwouldn’t know how to do it and I might
screw it up—l might have doctors coming at me.” The student was more terrified of
the doctor than the nursing staff, or faculty who could have gotten her removed not
only from the unit but also from the program.

Another student responded, “I don’t feel more confident. In fact, I feel less
confident.“ To that statement a classmate replied, “Really, I was the total. opposite.
I felt, I don’t know, just a sense of total accomplishment. . . . I had made it through,
I was doing it.“ She attributed these feelings to the grades she had earned; “It was
because of my grades. I thought, well, if I can do this, then I should be able to
handle, hopefully, what’s coming up. I guess I won’t have a nervous breakdown.“

Another laughingly offered, “I’m still waiting for that. Any day now, guys.“

106

One student said, “I was angry. I was feeling . . . could I do this for three and
onchalf more years? It’s very intense. You take full-time credit, workpart time, and
have a family. I’m like, can I physically do this for three and one-half more years?“
Another said, “I’ve become more serious about things, my studies, the things I had
to do to be a protessional nurse. I’ll do it.“

Oddly, several students were noticeably quiet or remote when the topic of the
next term was discussed. As it turned out, a total of four students from different
programs finally reported academic-progression problems. Four would have to
repeat pharmacology, and two thought that they would have to repeat pathophysi-
ology the next term or as soon as it was offered again. One of the four students
would have to wait a year to repeat a course she had failed. All four would not
progress with their respective classes.

When asked what they would do to improve their chances forsuccess when
they repeated the courses, most responded, “I’ll just have to study harder.“ I
followed by asking, “What does that mean, to study harder? How will you do that?“
Three students replied that they would spend more time studying. When asked
whether they would seek help, the response from all four was, “Yes. I’ll talk to my
instructor.“

Six students thought that their programs had a retention plan, although they
had sought help only from their Instructors. Four students said they did not know

whether their program had a plan. Five students knew that their program had a

107
retention plan and knew how to seek help from those faculty who administered the
plan. “Our instructors referred us to the skills lab,“ some commented.
WW
II I I 'II I IE 'I ,,

In concluding, I asked students to offer their advice to the profession or future
students about the first year—getting in and getting through.

I’d say complete your education before you start your family; it’s easier, folks.

Although, I think it gives me a distinct advantage for next year. I hays

children. So I’ve been through OB and Peds; at least I have that angle to

sustain me when we get to those rotations.

Others suggested completing the general education courses “so all your
energy and time can be put into the program.“ “Be prepared to study at least three
to four hours a day without fail.“ Also, “Getting settled into the program may be
difficult-learning the routines and what is really expected of you.“ Over all, the
students were very positive about their choice and their futures: “Now that I see

nursing as a profession, I’m looking into the different areas that I can get into and

trying to decide what I ultimately want to do as a nurse.“

Summary

There were many striking similarities between the faculty and student
perceptions of minority nursing student retention. Both groups recognized (a) the
problem of academic underpreparedness, (b) nursing’s failure to adequately portray
its image to potential students and the public, (c) the small numbers of minority

faculty and students in nursing programs, (d) minority students’ lack of

108

understanding about admission criteria and being competitive in the admissions-
selection process, (e) the inadequacy of students’ study and survival skills, and (f)
the failure to develop comprehensive retention programs.

The report of the study is presented in Chapter V. Chapter VI contains the
local theory about the retention strategies and programming used and needed in

public baccalaureate nursing programs.

CHAPTER V
THE REPORT OF THE STUDY

Introduction
Axioms ofthe naturalistic inquiry paradigm (Lincoln 8 Guba, 1985) formed the
structure for this qualitative study. Thus, the report includes a review of the research
problem; purposes of the study and research questions; a description of the settings
and participants; a discussion of the categories that emerged, their importance and
interrelationships; and the implications of the findings based on the research
questions. The chapter concludes with suggestions for further research about the

retention of minority nursing students.

Statementcttbeflroblem
Baccalaureate nursing programs have failed to implement the comprehensive
retention strategies or programming needed to sustain minority students’ success.
As a result, a great disparity exists nationally between the number of minority
students enrolling in and the number of minority students graduating from
baccalaureate nursing programs (see Tables 1 and 2). Minority student retention
and graduation rates must increase in order to increase the number of racially

diverse professionals and meet the health care needs of racially diverse individuals.

109

110
Emmescttbefludyarmaesearcbfiuesticns

My purposes in this study were to (a) generate a rich description of the
strategies used to retain minority students in baccalaureate nursing programs at
public universities in Michigan and (b) to develop a local theory that would ground
the retention strategies and answer the research question: What is needed to
improve retention rates among racial-minority baccalaureate nursing students in
Michigan? Two subsidiary questions facilitated exploration of the primary research
question:

1. What strategies are being used by nurse educators to retain minority
students in Michigan’s baccalaureate nursing programs?

2. What retention difficulties do minority students experience in

Michigan’s baccalaureate nursing programs?

[I 'I' [II SII' IE!" I

Nine representative public baccalaureate nursing programs in Michigan were
selected for study. The programs offered such features as a mix of programs,
reported enrolled minority students, and ease of access to entry and travel for in-
person or telephone interviews.

Purposive and opportunistic sampling techniques were used to identify 17
minority and majority nursing faculty, as well as 15 minority first-year nursing
students. Participation inthe studywas voluntary. Faculty participants included nine
whites and eight African Americans; participants informed me that there were no

other racial minorities on the faculty of these programs. Student participants

111
Included nine African Americans, three Hispanics, two Asian Americans, and one
Native American enrolled in three programs. Four “elite“ minority nurse educators
from different geographic locations were interviewed to help focus the Inquiry and

clarify retention Issues.

[1' '[llCl 'IIIE |

Semi-structured, audiotaped interviews were conducted to gain an
understanding of the retention strategies used in the various settings. Through the
use of constant comparative analyses, 62 data units emerged, reflecting the multiple
realities of the participants about retention. These units provided the data that were
used in answering the two subsidiary questions, which are discussed later in this
chapter. Further data reduction led to the emergence of the image of nursing,
academic underpreparedness, and race as three focal categories. Collision
emerged as the central category and link to the interrelationships among all
categories. Inelastic collision emerged as the dimension that was used to address

the research question.

IbeJmageQLNursinu

The image of nursing and the illusion of knowing (the accuracy of one’s prior
knowledge) about professional practice were frequently mentioned influences on
student retention. Faculty referred to the idealistic or unrealistic attitudes held by

many students about nursing education and practice. Inaccurate student

112
perceptions tended to shroud realistic decision making by students about nursing as
a viable career choice.

Those students who failed to perceive nursing as an art and a science tended
to underestimate the demands of the educational preparation ahead of them. The
students repeatedly stated that although they viewed nurses as caring and
educated, they had not considered the depth of scientific knowledge required or the
autonomous roles as expectations of professional practice.

Although students had received factual information about program entry
requirements, faculty took little responsibility for ensuring that all students,
prenursing and nursing alike, understood the realities of the demands for
progression through the nursing major. The attitudes held by students, when not
tempered by a priori realism, often “set them up“ for potential academic failure as the
path to graduation became more complex. Several students chose nursing because
“anyone can be a nurse“ or because “I’m a good nurses’ aide,“ or “I like working with

people.“

Academichndemrenarednm
Faculty identified students’ academic underpreparedness and their illusion of
passing as the antecedents and justifications for failed admissions or unsuccessful
progression to graduation. However, not all minority students experienced academic
difficulties or were designated by faculty as being at risk for academic difficulty.
The students, having earned competitive admission, believed that they would

pass the required courses. The belief was celebrated with considerable pride in

113

themselves. Six of the 15 students experienced academic difficulty. Five of the six
students failed to acknowledge their problems or seek help, despite evidence to the
contrary. The sixth student had sought help but was unable to improve her grade
before the end of the course. All of the students held, for some period of time, the
illusion that “I am passing; therefore, I am okay,“ or “I know what I have to do to

passf

Race

Among thethree focal categories, race wasthe precipitant or underlying entity
that hindered student, faculty, and program strides toward inclusion, diversity, and
cultural competence. Race emerged as an area of contention among faculty
members: “Faculty are not comfortable with black and white. It’s much easier to talk
about being intolerant of academic degrees.“

Race was an issue minority faculty had with the referral practices of some
academic advisors at the university. Prenursing students received most of their
academic advisement from nonnursing academic advisors. These students had little
contact with nursing faculty unless an advisor referred them to a specific nurse
faculty member. Some minority faculty perceived referrals as being the result of a
“unheralded race-based connection.“

In some instances, race was a problem between faculty and students. Of the
nine public programs, six had at least one African American family member and
three had no racial minorities on the faculty: “We’re a homogeneous group,“

meaning all white and female. Native Americans, Hispanics, and Asian/Pacific

114

Islanders were not reported to be among the faculty of any of these programs.
Students expressed a desire to have more minority faculty in the programs, “not
because they are better teachers, but just to have them included among faculty.“

The accurate accounting of the number of racial-minority students was an
issue across all programs. Most programs included all males as minorities. One
respondent raised another issue: “Our university considers minority a little different
than I do. It includes international students as minorities, I do not.“ Then, too, one
program counted Canadians as minority students and French Canadians as
minorities within another category.

Programs located in regions to which Native Americans were indigenous had
no enrolled Native students. Programs located in urban areas had the greatest mix
of racial-minority students. The reported mixes of students based on enrollment
were African American, Asian/Pacific Islander, Hispanic, and Native American. Arab
Americans are among the state—designated racial minorities but are not a federally
designated minority group. The numbers of minority enrollments ranged from zero
to eight. The largest numbers of minorities were among the newly enrolled classes
of each program.

Although faculty acknowledged a need for racial diversity, or diversity in
general, there was great reluctance to make a commitment to achieve it. Several
statements reflected the failure to confront issues of race and diversity: “It seems
you have to be absolutely specific about what is meant by the term [diversity].

Otherwise, you get all of the confounding variables, shall we say.“ “We’re trying, but

115

as a college we’re uncomfortable with sexual orientation, let alone racial or ethnic
diversity. It’s not being ignored, it’sjust not being dealt with.“ “Geez, the curriculum
is being bombarded with it.“ Such failure to confront issues of race and diversity
affects demands to revise curricula and the preparation of culturally competent

practitioners.

A holistic analysis of the multiple constructed realities and relationships
among focal categories resulted in an understanding that each focal category had
a detrimental effect on minority student retention. Because the categories were
inextricably linked to one another, altering all three categories would be necessary
to improve the outcome.

When the focal categories were considered from educational, social , political,
and professional perspectives, a different understanding emerged. The minority
student retention efforts made in Michigan’s baccalaureate nursing programs
conflicted with (a) the demands of health reform and expected numbers of minority
registered nurses, (b) the prospect of future minority students, and (c) the retention
needs of minority nursing students. Based on the values inherent in the categories,
a context-bound (ideographic) statement and central category in the data emerged.
Michigan’s baccalaureate nursing programs and the conflicting (opposing) factors
are on acollision course.

Collision was the descriptive term that accounted for most of the variations

in the data and linked the patterns found in the opposing factors. Category

116
refinement and integration led to dimensions of the central category, elastic collision,
and inelastic collision. At this point, a theoretical formation emerged with which to
ground the retention strategies and develop a local theory.
Il'l' [IIE'I' B |
meBesearcbfiuesticns

An analysis ofthe participants’ multiple realities resulted in the conclusion that
baccalaureate nursing programs in Michigan have either lost momentum or failed in
their efforts to ensure minority student representation and retention in their
programs. The implications of the findings with regard to the research questions are
as follows:

Question 1. What strategies are being used by nurse educators to
retain minority students in Michigan’s baccalaureate programs?

A number of specific and general approaches were used by nurse educators
to retain minority students. However, faculty did not clearly label the approaches as
retention strategies (see Figure 4). Yet the approaches did serve as mechanisms
for retention.

The approach or strategy used overwhelmingly by faculty was one-to-one
personal contact with students. All faculty stated that they made themselves
available to any student who wanted to contact them with problems or concerns
because “faculty are the front-line people and will go the extra mile.“ The contact
could be for any number of reasons deemed appropriate by individual faculty
members (i.e., assistance with course content, academic counseling, socialization,

or other general supportive measures). Because of the reliance on personal

117
contacts, many faculty identified their efforts on behalf of a student as “nurturing
opportunities“ rather than retention strategies.

Minority faculty believed they had an obligation to “see“ minority students,
especially the prenursing students referred to them. Several faculty members
stated, “On a campus where people of color are not in very high supply, these
students have a feeling that they’ll get established easier with a person of the same
race.“

All programs referred students with basic tutoring and skill-development
needs (i.e., mathematics, writing, test-taking) to the appropriate university support
unit. Some faculty stated that they felt uneasy making “special arrangements“ for
students. Eight of the nine programs provided either sporadic or fragmented in-
house support to nursing students. One had submitted a well-designed
comprehensive retention program proposal for funding, but it was not funded
(Appendix L).

The ninth program had a clearly defined and fully functional comprehensive
retention plan in place (Appendix K). An interesting strategy used in that program
was the issuance of a “Ieaming prescription.“ Students who needed course or
clinical-skill assistance were given a prescription form outlining the learning problem
and recommended forms of assistance, which they took to the skills laboratory or a
tutor. An approach to socialization and retention that was used only with an
Incoming class of students was the concept of a learning community. These

students would be purposefully divided into cliniml groups, based on the geographic

 

118

location of their homes. The idea was to facilitate travel to clinical sites and contacts
for group-study purposes.

All programs used faculty members as academic advisors for enrolled nursing
students. Individual faculty members assumed responsibility for meeting students’
Ieaming needs related to their specific course or clinical area. Faculty also assumed
responsibility for informing students’ advisors of academic or personal supportive
needs. Advisors attempted to see students at least once a term or semester. All
schools held at least one new-student information and orientation session for
enrolled students.

Prenursing students generally received academic and personal advisement
from the university advising center. Respondents from three programs referred to
at least one type of contact (i.e., career days, summer camps) with prenursing
students or said they offered an Introduction to Nursing-type course for students
intending to pursue a nursing major. Only one program administered assessment
tests to their prenursing students and made recommendations or referrals for
academic help, based on the assessment results. That program also had an
extensive plan to socialize students to their program.

All programs had active student organizations. Two programs also had
minority nursing student organizations; however, respondents reported that these
organizations functioned inadequately. Four programs attempted to link a minority
student to a minority role model in the program, the community, or a minority nursing

organization.

’ _

119

Faculty from all programs reported that they had periodic reviews ofthe range
of services available to all students. There were also occasional faculty-
development workshops related to understanding culturally derived Ieaming styles.

Question 2. What retention difficulties do minority students experience
in Michigan’s baccalaureate nursing programs?

Both faculty and students raised three issues. First was the aCcuracy of
students’ prior knowledge about nursing practice and nursing education. Students
had limited awareness of the “real“ impact of science courses, GPAs, and
competition In the admissions process. “I didn’t know I had to do all that stuff.“
Second, incoming students need to be made aware of the pace and expectations
of nursing courses. Third, the programs need more minority faculty, “not because
they might teach any better or help us any more; it’s nice to have more than one.“
Students thought that faculty had treated them fairly, and they expressed no
immediate problems with faculty.

The most serious retention difficulties among minority nursing students
occurred because of (a) academic underpreparedness as a result of poor secondary
school preparation; (b) not grasping the importance of grades or GPAs in the
competitive admissions process; (0) needing to take a minimum of two years, not the
expected one year, to apply to the programs; (d) poor study skills and help-seeking
behaviors; and (e) being able to manage the psychomotor skills in clinicals but not
being successful at applying theory to practice.

Six of the 15 students were experiencing academic difficulties, but only one

had sought help. Each of the six students believed she would be successful and

120

needed to “study harder“ the next time. The costs of seeking help cannot be
minimized. Seeking help implies inadequacy; thus, doing so is difficult for individuals
with high self-esteem. A student’s perception of vulnerability is likely to influence
help seeking for long-term achievement and in contexts where the cost of not
seeking help is high. Therefore, help seeking Is contingent on students’ perceptions
of inadequacy and/or vulnerability.

Although most of the students did not express specific feelings of isolation or
exclusion from the routine activities of the program, they did express reluctance to
seek membership in the nursing student organization. Thirteen of the 15 minority
students were not aware ofopportunities to serve on departmental or college
standing committees. Similarly, none of the students had been placed in a clinical
group with a student from a similar racial background. Several students thought it
would be nice to have a student of the same race in a clinical rotation but “didn’t
really expect it to happen. There are not enough to do it most of the time.“

Paralleling the students’ desire to increase racial diversity were six compelling
issues that seemed to overwhelm many faculty. First, respondents from all
programs professed a strong commitment to minority enrollment, but a common
response to the question of how many minority students were graduating in the
current class was “none.“ All but one faculty member thought that minority retention
was a problem In their programs. That person’s program had no minority students
enrolled. Second, the racial-majority faculty preferred the term “disadvantaged“ as

being inclusive of any at-risk or undereducated students. They believed that student

121
services should be available to all students, not just minorities. Writers have
suggested that minority students have soundly rejected use of the term
“disadvantaged“ in relation to any oftheir needs (T ucker-Allen, 1989, 1991 ). Faculty
did not appear to be aware of students’ preferences regarding or perceived
connotation of the term “disadvantaged.“

Third, minority faculty believed that prenursing minority student referrals for
advisement were made with a bias or an “unheralded race-based connection“ (e.g.,
African American prenursing students were referred to African American nursing
faculty). All faculty believed that they had an obligation to see the students but
expressed varying levels of acceptance. “It is a burden at times,“ one commented.
The race-based connection, if generalized across the programs, implied that
Hispanic, Native American, or Asian prenursing students would be referred to faculty
members from their respective racial groups. However, members of these racial
groups generally were not represented on the faculty. Fourth, the pressures to
increase diversity in other ways among students (i.e., related to gender, sexual
orientation, and physical status) in the programs often overshadowed the emphasis
on racial diversity.

Fifth, the programs were also at various beginning stages of incorporating
cultural aspects of care into their curricula. As one faculty member stated,
“Acquiring cultural competence is a process that starts out small . . . and picks up
these other categories or classes of interaction as it goes.“ Faculty identified

“simulated learning experiences to introduce concepts of diversity“ or a course called

122

Multicultural Health Approaches that would become a required course in cultural
diversity. Most of the programs offered “realistic exposure to diversity“ as a result
of “the purposeful selection of clinical sites.“

The richest description of cu ltu rally relevant clinical learning opportunities was
given by faculty from a program that had no minority students and used International
placements. Not only did the students gain an understanding of the differences
between two divergent national health care systems, but also they were exposed to
an ethnically mixed client population. None of the clients, however, was from an
underserved racial population found in the United States.

Finally, eight of the nine institutions had RNIBSN-completion programs with
30 to 60 students enrolled per year. None of the programs had more than five
minority students during any given year. Given the enrollment and retention issues
revealed in this study, it can be seen that future minority nurses will flow from
associate degree programs into baccalaureate programs.

The two subsidiary questions provided an understanding of strategies that
were being used to retain minority students and the difficulties confronting those
students. These questions also provided data needed to address the research
quesfion:

What is needed to improve retention rates among racial-minority
baccalaureate nursing students at public universities in Michigan?

The nation’s health care system is changing. As the system and its
expectations of nursing care change, so must nursing education. The answer to the

research question is that nursing education must be reformed. The necessary

123
reforms will require attitudinal and behavioral changes by both faculty and students.
A succinct answer to the research question was provided by a faculty member who
stated, “It’s got a lot to do with caring.“

Fundamentally, faculty must change their perceptions of minority students as
being underprepared for the rigors of college and nursing studies. Achievement is
not based on aptitude. With the appropriate assistance, students are able to excel.
Campbell and Davis (1990) argued, “Nurse educators must stop bemoaning the fact
that the ’best and brightest’ of young females are less attracted to nursing and
instead make a commitment to understanding and responding to the needs of other
diverse learners who are choosing nursing“ (p. 33).

Nurse educators must repair the image of nursing, but students also must
accept greater responsibility for gaining accurate information about the preparation
needed for entry to nursing and the expectations of professional practice. Also,
students must accept responsibility fortheir own learning. The realities of successful
program completion and professional development often prove hurtful or frustrating
to many students. Educators must continue to challenge all students to achieve their

personal best.

WWI . SIIIBI I'

The data obtained in this study support previous empirical documentation
about the piecemeal use of retention strategies by faculty in nursing programs.

Emphasizing a need for change in research methodology, Campbell and Dickson

 

124
(1996) stressed that predicting student success in an educational program remains
an inexact science.

The failure of quantitative methods to identify predictive criteria for academic
success or viable retention strategies indicates a need for more qualitative research
and collaboration among institutions. Collaborative institutional research would
provide opportunities to achieve consistency in design and methodology.

Enrollment figures for minority baccalaureate nursing students are not
encouraging. The greatest rate of enrollment growth and graduations among
minorities has been concentrated at the associate-degree level. At a time when
nursing programs are downsizing or closing and health care is being focused in
communities. an associate degree in nursing will not be adequate for professional
nursing practice. Consequently, the inadequate representation of minority nurses
in practice is directly related to minority student retention in baccalaureate programs.

Two potential questions for further research are:

1. What effect will the Clinton administration’s thrusts for community
college education have on baccalaureate nursing education and the entry of
minorities into nursing practice?

2. What preparations have been made to enhance or establish RNIBSN-
completion programs in anticipation of an increased need on the part of minority
students to earn a baccalaureate degree in nursing?

The challenge for baccalaureate nurse educators continues to be how to

ensure the successful retention and graduation of minorities. “Inelastic collision“

125

became the basis of a local theory and coherent framework to undergird the
research question: What is needed to improve retention rates among racial-minority
baccalaureate nursing students at public universities in Michigan? The local theory

is presented In Chapter VI.

CHAPTER VI

THE LOCAL THEORY

I III IBII' [II"III'SIII

The outcome of this naturalistic inquiry was a theoretical formulation, a local
theory for retention of minority students in Michigan’s public baccalaureate nursing
programs. A strategic framework for comprehensive retention programming was
developed from the local theory (Figure 6). This final step was taken to satisfy the
second purpose of the study and to expand the research question.

Lincoln and Guba (1985) stressed that the constant comparative method in
naturalistic inquiry is used simply to process data, not to generate a theory that will
predict and explain behavior. Although the outcome of the data analysis is to be a
report ofthe study, in the naturalistic domain, theoretical constructions (formulations)
are Invented or created and related to “tangible realities“-events, persons, and
objects. If these tangible realities are not solely creations of the mind, they must be
ontically “real.“ Thus, the outcome of the report could be an inductively derived
theoretical formulation, a local theory based on “constructed realities“ (Lincoln 8
Guba, 1985, pp. 83-87). A local theory is unique to the data of a study and shows

only how the data relate to the circumstances or lived experiences of the individuals

126

127

in that particular study. It can also offer an exciting new approach to an old problem
(Denzin 8 Lincoln, 1994; Elden, 1981).

According to Patton (1990), “a strategy is a framework for action“ (p. 36) in
which “all kinds of variations, combinations, and adaptations are available for
creative and practical situational responsiveness“ (p. 39). Within the proposed
framework, Inelastic collision, the desired dimension, will occur if nurse educators
make a commitment to implement realistic, culturally relevant, comprehensive
retention strategies. If educators do not implement the desired strategies, elastic
collision will occur and programs will do “business as usual,“ which will perpetuate
the quagmire of retention problems. Inelastic collision is presented as an integrating
concept that illuminates a local theory and permits development of a strategic
framework to describe possible comprehensive retention programming.

The theory of inelastic collision postulates sets of dynamic forces (faculty and
student, student and student, nursing program and student) whose coming together
(colliding) over a limited period of time (the nursing school years, which include the
prenursing period) leads to the permanent exchange of energy (the process of
nursing education) and information (knowledge). These sets of forces are
inextricably linked forever (permanently changed by virtue of the encounter, the
education process, program identification, and a lifelong career).

To substantiate the local theory, I continually listened to and looked for
negative responses to a direction taken In theory development during the interviews

and analyses. A negative response would offer a different context and cause me to

128
alter what was being developed. Each time I heard or found a negative response,
I revised the local theory to reflect the context of the response until the final realities
of concern to retention were categorized.

The following are the constructed realities of concern to this study: (a)
minority nursing student, (b) organizational structure, (c) precollege and prenursing
student socialization opportunities, (d) prenursing and nursing student leadership
opportunities, (e) culturally relevant curriculum design, and (f) specific retention
strategies. The six constructed realities are inextricably linked to each other and to
the retention of minority nursing students within the framework of inelastic collision

(Figure 6).

II' 'III . Sill

Minority students in this study were defined as federally designated American-
born or naturalized citizens who are underrepresented in nursing education and
practice. In one program, Arab Americans were identified as a state-designated

minority group that may be included in the minority student construct.

Q . I. I SI I

The organizational structure is not the sole guarantor of academic success;
however, the structure is endogenous to the nursing program and maintenance of
a comprehensive retention plan. Structure, as defined in this theory, pertains to
everyone and everything external to the student that will come into contact (collide)

with the student: the administrators, faculty, program mission and philosophy,

129

 

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130

and any services provided. Organizational structure is the staircase to retention and
should be rigorously evaluated annually.

The findings indicated that faculty need to focus on five major categories
when developing a comprehensive retention plan: (a) being committed to providing
broad-based retention-support mechanisms at the prenursing and enrolled-student
levels; (b) designing a culturally relevant curriculum to prepare culturally competent
practitioners; (c) providing inclusive leadership and socialization opportunities
directed toward improving the image of nursing, especially at the precollege level;
(d) maintaining an academic progression and early warning system; and (e)
preparing for graduate nursing education.

Sutton and Claytor (1992) offered a plan for identifying the broad struCtural
design for an organization. Story’s (1978) I AM retention model proved to be the
most comprehensive model of that decade and should serve as the prototype for
today’s retention programs. Combinations of Pennington’s (1984) RAIN model, as
well as Holtz and Wilson’s (1992) Model for Empowerment of the Culturally Diverse
Student, offer additional aspects of successful comprehensive retention
programming. Allen’s recommendation for an academic early waming tracking
system Is, not only fundamental, it is essential to student retention In nursing

programs.

131

ErecolleceLErenursingfludcnt
S'I'l' 0 I'I'

Nursing programs are slowly making strides to dispel the illusions that many
students have about knowing and passing. But the Introduction to Nursing course,
occasional faculty advising sessions held on an individual referral basis, or faculty
attendance at a career-day activity is not enough to provide more than a superficial
understanding of nursing education or practice. As a faculty participant stated,
“There has to be more ’front-loading’ so students are aware of what they will have
to do when they come into the program.“

. .
E[mJ.lmnglI!I!l1LmflgnsmgmmlII'EJI'I'

Whenever I have asked facility what leadership opportunities are available
to minority students, the responses have been, “the same as for any student“ or
“they don’t take advantage of the opportunities.“ I would argue two points here.
First, minority students do not volunteer for leadership opportunities for many
reasons (e.g., they do not feel qualified, they do not have the time or interest, they
do not feel welcome, or they do not know they should volunteer). Second, faculty
do not expect or encourage minority students to participate in leadership
opportunities.

The theory places a different “unheralded race-based connection“ within the
faculty purview. Faculty must be more proactive in providing opportunities for
prenursing students to offer input about issues of concern to them as future nursing

students and gain an understanding of “the unwritten rules.“

132
:IIIIEI IS'ID'

Campbell and Sigsby (1994) characterized nursing as largely unicultural,
reflecting the current majority population and lacking knowledge of diverse cultures.
Nursing programs must consider cultural issues as integral to a comprehensive
retention plan. Nurse educators have begun to respond to the special needs of
culturally diverse students with regard to linguistics, learning style, and help-seeking
behaviors (Abdur-Rahman, Femea, 8 Gaines, 1994; Crawford 8 Olinger, 1988;
Memmer 8 Worth, 1991). Indeed, the results of a recent study conducted at one of
the study sites suggested that “the sample of graduating baccalaureate students did
not feel confident about caring for Michigan’s five major ethnic groups“ (Kulwicki 8
Bolonik, 1996, p. 40). Faculty must remember that nursing, therefore nursing
education, has a contract with society that guaranteesthat nurses will provide “what
professional skills and knowledge they [society] most need and desire“ (American

Nurses Association, 1980, p. 19).

5 'fi 8 l I' SI I .

The specific strategies used by the study sites for student retention are
presented in Figure 5. The strategies, in and of themselves, should be adequate for
establishing and maintaining a comprehensive retention program for minority nursing
students. The inadequacies are that the strategies are used in piecemeal or
unimaginative ways and do not guarantee a faculty commitment to providing a

systematic process for retention of students.

133

The identified strategies, if fully implemented, monitored, and enforced,
should not only sustain academic success but also satisfy the concerns that
undergird the fowl and central categories in the study. These strategies should also
prepare students for the rigors of graduate education, as well as allow them to leave

the program by choice rather than through academic failure.

QQDQlusiQn

Not all minority students will enter college academically underprepared or
uninformed about the image of nursing orthe rigors of nursing education. However,
with the increasing need for well-prepared nurses in a multicultural environment,
more attention must be given to retaining minority students.

The obvious academic problems of minority students are often mitigated
when confronting the academic and critical-thinking needs of all students or the
reality that even those students, including minorities, “who earn A’s and B’s
frequently lack communication and computation skills“ (McGiven, 1989, p. 2.
Programs should embrace an obligation to ensure that all students have accurate
understandings about their needs and abilities to meet the rigors of education and
practice before making nursing a career choice.

Nurse educators can no longer simply acknowledge the different cultures in
our society; they must make a commitment to accept and include racially diverse
learners as the only way to do “business as usual.“ Faculty must concede that only
by intentional design can a program have meaning to a diverse citizenry or

potentially guarantee societal expectations of culturally competent care.

134

The incisive changes at hand may provide “the best of times“ amid “the worst
of times.“ Perhaps the reconfiguration of health care systems will signal
development of retention strategies and comprehensive frameworks that confront

the educational needs of minority students as we enter the twenty-first century.

 

APPENDICES

 

APPENDIX A

AN OVERVIEW OF NURSING EDUCATION PROGRAMS

 

135

An Overview of Nursing Education Programs

In the United States there are several types of education programs that allow

entry to practice as a registered nurse.

I [ll . E I l' E

1. W: The oldest of nursing programs. These
programs do not grant college credits; most are hospital based. Fewer than 60 such
programs remain.

2. WW: Two-year programs,
usually offered by a community college. Graduates do not receive senior college
credit for nursing courses but may receive credit for liberal arts or nonnursing
courses.

3. W: A program offered by
a senior college or university. There are currently two ways an individual can
receive a BSN:

a. W: A non-RN student enters a program and
completes the required four-year program of study. Many students
take five years to complete this program of study.

b. Wm: Aregistered nurse enters a program as
a graduate of a diploma or ADN program and completes the required
baccalaureate-level theoretical and clinical courses. This program

may take two years or more to complete.

136
Three other types of programs provide entry to nursing. For example, Yale
University and Massachusetts General Hospital offer a master's degree in nursing
(MSN) as the first professional degree, and Case Western Reserve University offers

a nursing doctorate (ND) as a first professional degree.

W

A nursing program in a given state must be approved by that state’s Board
of Nursing or Education for program graduates to sit for the licensing examination,
the National Council Licensure Examination for Registered Nurses (NCLEX-RN).
Upon passing the NCLEX-RN, examinees are issued a license to practice as a
registered nurse by each state Board of Nursing. Therefore, a registered nurse is
a graduate of a state-approved nursing education program who has passed the
NCLEX-RN and is licensed to practice nursing in a given state within the United
States.

Currently, the National League for Nursing (NLN) is charged with accrediting
nursing degree programs throughout the United States, no matter what type of
institution houses the nursing program. There are 582 baccalaureate nursing
programs accredited by the NLN and 137 approved baccalaureate programs
designed exclusively for RNs throughout the United States. In Michigan, there are
50 NON-accredited programs: 3 diploma programs (2 are in the process of closing),
33 ADN programs (31 public, 2 private), and 14 BSN programs (10 public, 4 private).
Two BSN programs are designed exclusively for RNs; both are at public universities
(NLN, 1995). Attaining NLN accreditation influences funding of nursing programs,

admission to graduate nursing education programs, and some job opportunities.

APPENDIX B

ABOUT GENDER STATISTICS IN NURSING PROGRAMS

137

About Gender Statistics in Nursing Programs

The growing number of males entering nursing education programs is a fairly
recent trend and reflects a pattern that will likely continue well into the future.
National League for Nursing (NLN, 1991) data from 1978 to 1989 indicate that the
number of males admitted to all generic RN programs rose from 6,359 to 7,558, a
12% increase. Recent data show an increase to 17.7% of American and foreign-
born males in all nursing programs, particularly BSN programs (Morgan, 1994; NLN,
1994). A number of articles about the increase in and career-choice factors of male
nursing students, as well as male RNs, have been published (Bough, 1994; Kelly,
Shoemaker, 8 Steele, 1996; Kilborn, 1992; Villafuerte, 1996).

Despite the data, gender statistics lose their relevance when one is looking
for indicators of racial groupings among males in nursing programs; most programs
have failed to keep this count. Of note to this study is that males often are counted
as minorities in reports by nursing programs. Campbell and Dickson (1996)
asserted that “the failure to report gender, race, or ethnicity . . . deters identification
of specific characteristics or strategies that may be more germane or, beneficial to
a specific group“ (p. 57).

To avoid duplication of male data by both gender and race, males were not
included in this study. However, informal reporting by gender indicates an increase
in the total number of male enrollments and a small increase in enrolled males

representing thefederally designated racial minorities, especially African Americans.

APPENDIX C

UNIVERSITY HUMAN SUBJECTS APPROVAL

138

MICHIGAN STATE

 

UNIV

ERSITY

December 14, 1995

To: Sandra L. Nelson

3858

S arrow Wood

Ann Ar or, MI 48108

RE: IRB#:

95-653

TITLE: STRATEGIES FOR RETENTION OF UNDERREPRESENTEE

MINORITY STUDENTS AT PUBLIC BACCALAUREATE
NURSING PROGRAMS IN MICHIGAN

REVISION REQUESTED: N/A
CATEGORY: 1-A,E
APPROVAL DATE: 12/12/95

The University Committee on Research Involving Human Subjects'(UCRIHS
reView of this prOject is complete. I am pleased to adVise that the

rights and

welfare or the human subjects appear to be adequatelv

rotected and methods to obtain informed consent are appropriate.

herefore,
above.

RENEWAL:

REVISIONS:

 

RESEARCH CHANGES:

AND
GRADUATE
STUDIES

University Commit!" on

the UCRIHS approved this project and any reViSions listed

UCRIHS approval is valid for one calendar year, beginning with
the approval date shown above. Investigators planning to
continue a project beyond one year must use the green renewal
form (enclosed with t e original agproval letter or when a
prOject is renewed) to seek u date certification. There is a
maXimum of four_such expedite renewals possible. Investigators
wishing to continue a project beyond that time need to submit it
again or complete reView.

UCRIHS must review any changes in procedures involving human
subjects, rior to initiation of t e change. If this is done at
the time o renewal, please use the green renewal form. To
reVise an approved protocol at ané other time during the year,
send your written request to the CRIHS Chair, requesting revised
approval and referencing the project's IRB # and title. Include
in your request a description of the change and any revised
instruments, consent forms or advertisements that are applicable.

Should either of the followin arise during the course of the

work, investigators must noti UCRIHS promptly: (1) roblems
(unexpected Side effects, comp aints, etc.) involVing uman
subjects or (2‘ changes in the research environment or new

information indicating greater risk to the human sub ects than
eXisted when the protoc0i was preViously reViewed an approved.

Researchlnvolvrng If we can be of any future help, please do not hesitate to contact us

HumanSuhiects at 1517) 355
(UCRIHS)

Micmoan State University 5 lncerely ,
232 AOmmlSIIBIlOD Budd:
Eas: Lansmg Micniqan
48824-1046

517/355-2180
FAX 517/432-1171

CRIHS Chai
DEW:bed

  
 
 
  

/
Vld E. Wright, Ph.D.

-2180 or FAX (517)432-1171.

.. ‘3.

   
  

r

cc: Marvin Grandstaff

APPENDIX D

FINAL GUIDESHEET FOR STUDENTS

139

Final Guidesheet for Student Interviews

Introductory Statement: “You are aware that our conversation is being tape
recorded?“ After participant gives an affirmative response, “You have agreed to
participate in this dissertation study titled ’Retention Strategies for Minority Students
at Baccalaureate Nursing Programs in Michigan' and you have a copy ofthe General
Interview Guidesheet?“ After participant's affirmation is given, “I have received your
signed Process Consent Form. 1 would like to explore your feelings about nursing
education and retention of racial minority students in your program. Would you tell
me. . . .“

1. People have various reasons for choosing a profession or course of study.
What led you to choose nursing?
3. Was nursing your first choice?
b. What did you know about the profession before you chose it?

2. What did you know about the nursing program before you entered?
a. What is your understanding now?
b. Did you meet any nursing faculty before you declared a major?

3. Now that you have completed the prenursing course requirements, how do
you feel about them?
a. Did you complete the prerequisites on this campus?
b. Were you able to complete the course work in one year?

4. Some students say they had to apply more than once before being admitted
to the program.
a. Would you tell me about your experiences?
b. How did program admission and academic support efforts address
your learning needs?

5. Now that you’ve had some program experiences, how do you feel about
nursing now?

6. I’m interested in academic retention strategies. Nowthat you have completed
this first year, what do you think of the class and clinical course work Is it
what you expected?

a. If you needed academic help, how would you go about getting it?
b. If you needed academic help, when would you seek it?
c. Would you tell me what you think about the academic support system

in your nursing program?

 

 

10.

11.

140
Most faculty encourage students to get involved in program governance.
Would you tell me about your membership or participation in standing
departmental/college or university committees?

Most programs have student organizations. What do you think about minority
student participation in the organizations?

What are your plans for graduate education?

There are many different views about minority students. Which groups of
students in your program do you consider racial minorities?

a. How many minority students are in the program?
b. How many minority students are in your class?
c. Do you have opportunities to meet outside of class?

As you go through the program, what will represent “success“ to you?

APPENDIX E

FINAL GUIDESHEET FOR FACULTY

141

Final Guidesheet for Faculty Interviews

Introductory Statement: “You are aware that our conversation is being tape
recorded?“ After participant gives an affirmative response, “You have agreed to
participate in this dissertation study titled ’Retention Strategies for Minority Students
at Baccalaureate Nursing Programs in Michigan’ and you have a copy of the General
Interview Guidesheet?“ After participant’s affirmation is given, “I have received your
signed Process Consent Form. Iwould like to explore your feelings about retention
of racial minority students and the retention strategies used in your program. Would
you tell me about your nursing program?“

Program Descriptors:

1.

2.

10.

11.

In what type of institution are you employed?

How would you describe the community your program serves (urban,
suburban, rural)?

In what region of the state is your institution located?
What is your title and primary faculty/administrative area(s)?

What is the highest degree offered at your institution? Your nursing
program?

How many students are admitted to your program each year?
Of the students admitted, how many enroll in your nursing program
How many minority students are admitted each year?

At what undergraduate level are students admitted to the nursing program
(freshman, sophomore, etc)?

What is your opinion of the prerequisites for admission?

What is the racial mix of students currently in your nursing program, by class
level?

142

Interview Items:

1.

2.

10.

How do you define the term “minority“?
How do you feel about retention of racial-minority students?
What represents “success“ for a student in your program?

Would you discuss your opinion of the universitywide retention services
available to minority prenursing and nursing students?

Would you discuss your opinion of the discipline-specific retention services
or strategies offered to minority students?

Which are the most effective strategies? Least effective?
How do faculty feel about the need for minority retention?

What do you think will be needed in the future for retention of minority
students?

How is student input about educational needs obtained/sought?

What should nurse educators do to impact minority student needs in the
future?

APPENDIX F

LETTER TO PROGRAM DEAN

143

Dear

I am a doctoral candidate in higher education administration at Michigan State
University seeking your participation and one Other faculty, or two designees, in a
study that will explore current and future planning strategies for retention of
underrepresented minority students among baccalaureate nursing programs at
Michigan’s public institutions of higher education.

A great disparity exists in the number of ethnic-minority RNs relative to the nation’s
ethnic-minority populations. Despite increasing enrollments, minority nursing
students are more underrepresented in health care practice today than 15 years
ago. Population-mix and educational-preparedness projectionsfor potential minority
applicants in the twenty-first century make identification and implementation of
retention" strategies an imperative for nursing programs.

Qualitative research methods will be used to generate a framework for retention that
will meet academic and entry-into-practice needs in the twenty-first century. Open-
ended, semi-structured audiotaped interviews of approximately one hour will be
done by either in-person or telephone contacts. Interviews will be transcribed and
submitted to respondents for validation of interpretation before inclusion in the study.
Enclosed are Process Consent Forms for signature and study questions for review
and preparation. Study results will be presented in aggregate form and should be
of value in future program planning.

I will telephone you in the next two weeks to validate your participation and arrange
an interview appointment. You may contact me at the address or telephone
numbers listed above. My dissertation director, Professor Gladys Courtney, Ph.D.,
RN, may-be contacted at Michigan State University, College of Nursing (517) 353-
8679, if further clarification is necessary. Thank you for allowing time to help me
with this project.

Sincerely,

Sandra L. Nelson, RN, MSN

APPENDIX G.

LETTER TO STUDY PARTICIPANTS

144

Dear

I am a doctoral candidate in higher education administration at Michigan State
University seeking your participation in a study that will explore current and future
planning strategies among baccalaureate nursing programs at Michigan’s public
institutions of higher education for retention of underrepresented minority students.

A great disparity exists in the number of ethnic-minority Rns relative to the nation’s
ethnic-minority populations. Despite increasing enrollments, minority nursing
students are more underrepresented in health care practice today than 15 years
ago. Population-mix and educational-preparedness projections for potential minority
applicants in the twenty-first century make identification and implementation of
retention strategies an imperative for nursing programs.

Qualitative research methods will be used to generate a framework for retention that
will meet academic and entry-into-practice needs in the twenty-first century. Open-
ended, semi-structured audiotaped interviews of approximately one hour will be
done by either in-person or telephone contacts. Interviews will be transcribed and
submitted to respondents for validation of interpretation before inclusion in the study.
Enclosed are Process Consent Forms for signature and study questions for review
and preparation. Study results will be presented in aggregate form and should be
of value in future program planning.

Iwill telephone you next week to validate your participation and arrange an interview
appointment. You may contact me at the address or telephone numbers listed
above. My dissertation director, Professor Gladys Courtney, Ph.D., RN, may be
contacted at Michigan State University, College of Nursing (517) 353-8679, iffurther
clarification is necessary. Thank you for allowing time to help me with this project.

Sincerely,

Sandra L. Nelson, RN, MSN

APPENDIX H

PROCESS CONSENT FORM

145
PROCESS CONSENT FORM

Retention Strategies for Minority Students at Public
Baccalaureate Nursing Programs in Michigan:
A Grounded Theory Approach

The purpose of the interview has been explained to me. My participation indicates
consent to use my comments in an exploration of my beliefs about retention of
minority students. I understand that there will be an audiotaped interview lasting a
minimum of one hour and that I will receive a typed copy of my responses to critique
and affirm before my responses are used.

I further understand that:

1. My participation is voluntary and may be withdrawn or renegotiated at any
time.

2. Any questions I have about the study and the final product will be answered

by the investigator.

Control and disposition of audiotapeslnotes:

3. My identity will be kept confidential. My name will be placed in .a codebook,
and I will be assigned a code name. My code name will be used in
subsequent written reports.

4. The investigator will maintain the codebook in a locked file in a secure
location, and will destroy all tape(s) and notes.

 

 

 

 

5. My code name will be placed on the face of all audiotapes made during the
interview(s). The investigator will transcribe my comments using my code
name.

6. I will receive a copy of this signed Process Consent Form.

Participant’s signature Date

Investigator’s signature Date

I Investigators copy Participant’s copy

APPENDIX I

LETTER TO PARTICIPANTS WITH VERBATIM TRANSCRIPTION

146

Dear

Thank you for participating in my investigation of retention strategies for minority
students at public baccalaureate nursing programs in Michigan. Your candid
discussion of the research questions and their applicability to your nursing program
has created a data base from which to proceed with my study, and you have
contributed significantly to its outcome. 1 hope you will also share any forms used
specifically for the retention of nursing students that could be used as exemplars in
the study.

A copy of the interview transcript and a stamped return envelope are enclosed for
your convenience. Please make any revisions in the transcript that you care to,
including deletions of remarks or additional comments. You have already retumed
the Process Consent Form.

I again assure you that your comments or materials will be treated as confidential
and with sensitivity. In its final form, the study will accurately reflect the intent of your
responses in aggregate form. I look fonrvard to receiving yourcomments and to the
completion of my study. Please contact me, if necessary. Thank you for everything.

I am very sorry about the delay in preparing and mailing the transcript to you.
Please take some time to review it and, again, many thanks to you.

Sincerely,

Sandra Nelson

Enclosures: Interview transcripts
Return envelope

APPENDIX J

TRUSTWORTHINESS

 

 

147

Trustworthiness

According to Lincoln and Guba (1985), an inquiry is trustworthy if the
researcher can convince the consumer that the results are “worthpaying attention
to or worth taking account of“ (p. 290). Four operational techniques that would
support the trustworthiness of one’s work need to be addressed: (a) truth value or
credibility, (b) applicability ortransferability, (c) consistency or dependability, and (d)
neutrality or confirmability.

Credibiljiy is the likelihood that credible findings and interpretations Will be
produced. Three techniques were used to ensure credibility: (a) prolonged
engagement, (b) triangulation, and (c) member checking. Prolonged engagement
is “the investment of sufficient time to achieve certain purposes: learning the culture,
testing for misinformation introduced by either self or the respondents, and building
trust“ (Lincoln 8 Guba, 1985, p. 301).

This process began well before I entered the field. I had worked with nursing
students in educational institutions for more than 15 years, which included faculty
positions at two of the programs included in the study. I had prior knowledge of and
experiences with four of the participants referred by the program deans, including
one faculty member I had not seen for several decades. Trust is not easily earned,
but it was an outcome as the interviews lasted well over the expected time frame
and participants openly discussed their perceptions of a number of issues.

Multiple sites, multiple informants, snowballing, elite interviewing, and

analysis of submitted exemplars were used to verify information. Constant review

148

of the relevant literature and explication of research bias also buttressed the
trustworthiness of the data (Denzin, 1978; Marshall 8 Rossman, 1989; Patton,
1990). Member checks were further accomplished by returning verbatim
transcriptions to each study participant, which gave them an opportunity review, vet,
or edit their comments throughout all phases of data collection. The process of
developing a local theory also required frequent checks with the participants.

Iiansieiabiiiiy refers to whether the findings are applicable in “some other
context, or even in the same context at some other time“ (Lincoln 8 Guba, 1985,
p. 316). The task is to provide a rich description of the data, thus enabling others to
reach a conclusion about whether the findings are useful in other contexts.
Purposeful and opportunistic sampling methods provided a wide range of information
for inclusion in a rich description.

Dependability connotes whether the findings would be repeated ifthe study
was replicated under similar conditions. Interactions between researcher and
participants are unique to that interaction. Yet, although there may be differences
in the scope of data generated, the content would be dependable. An “audit trail“
should make replication of the study possible (Lincoln 8 Guba, 1985, p. 319).

Cpnfltmability is concerned with neutrality. Personal biases were constantly
identified and double-checked through member checks, elite interviews, and
literature reviews. Auditing techniques also provided opportunities to validate

neutrality.

APPENDIX K

STRATEGIES USED IN THE COMPREHENSIVE RETENTION

PROGRAM FOUND IN THE STUDY

149

Strategies Used in the Comprehension Retention
Program Found in the Study

One of the nine public baccalaureate nursing programs in Michigan reported

having a discipline-specific comprehenSive retention program. The strategies

identified were as follows:

1.

A student affairs office and an academic affairs office that worked “in close
collaboration to provide coordinated student services within the college of
nursing.“

A two-day orientation for all newly admitted students:

A.

In June (one day)
(1) Administer the Nelson-Denny Reading Test to all students.
(2) Based on the results, students are either
a. congratulated and sent fonivard or
b. referred to the University Summer Development
Program, “where reading, study, testtaking and time
management skills are enhanced.“
(3) Socialization is nurtured during the experience.

' (4) Assignments to clinical groups are made.

(5) “We send them out to lunch together.“

In September (one day, at the beginning of the term)

(1) Orientation of nursing students to the college and its
expectations.

(2) Early notification of academic difficulty.

Throughout the academic year,

A.

A faculty-generated prescription referral method for remedial skills
laboratory opportunities as well as individualized tutoring and
assessment by college personnel.

NLN achievement and comprehensive examinations per specialty
course throughout the program.

A nurse resource person assists students by sitting down with them
after taking the NLNs “to develop a learning prescription if deficiencies
are reported on the scores.“

150

D. “Before they take Boards [NCLEX-RN], each student has a
prescription of where they need to work, and some students are more
independent about setting up their needs.“

Three innovative efforts were integral to their retention plan:

1.

The college’s Progression Academic Support Success (PASS) program. This
program is usually a university service offering. “Actually it started with some
government funding, and once that ended we just continued it. It was a
commitment of the college.“

The piloting of a concept referred to as the Learning Community: “We’re a
commuter school, so instead of randomly assigning new students to faculty
advisors in the first year, we’re going to put them into small cliniml groups
based on the students’ geographic locations. We want to see if that will have
an impact on retention.“

A concerted effort to effect prenursing and graduate education success:
“We’re going to look at the prenursing student to see how we can better
prepare those students so they’d be ready and competitive to get into our
program. I think there are a lot of students that we need to assist. We’re also
looking at minorities in graduate education as a primary focus.“

A respondent from another program reported that the proposal for a

comprehensive plan, which included cultural diversity and cultural competency as

its centerpieces, had been completed and was awaiting notification of funding

(Appendix L).

APPENDIX L

THE FIND AND SEND PROGRAMS IN NURSING DIVERSITY

151

Facilitating Interest in Nursing Diversity (FIND) and Supporting

Excellence in Nursing Diversity (SEND) Project Summary Chart

 

 

 

 

 

 

 

TIER
FIND SEND
. Letters of Welcome 1. Faculty Development
. . . 2. "Welcome to the College of
Foundational . Pre-onentauon Nursing"
° Parental Component 3. Minority RN Reception
. Supplemental Instruction 1. Tutorials
Sessrons
. Introduction to Research 2' Research Opportunities
g Workshop 3. Study Groups
Academic] . Academic Workshops . .
. 4. Revrew Sessrons
g Instructional . . . .
m . Intrusxve Academic Advrsmg & 5. Student Clustering
Cumculum Planning
. Early Warning System 6. Academic Advrsmg
. College of Nursing Open House 7' Early W g System
1. Brown Bag Discussions
. Personal Counseling 2. Minority Support Groups
. Career Planning 3. Outreach Activities
Developmental] . Mentoring Involvement 4. Inter-student Networking
Psychosocial
. Minority Student Nurses 5. Career Development
Organization
6. Minority Student Nurses
. Student Newsletter Organization
7. Student Newsletter

 

N911 From . l‘0 0
Wu, by R. B. Canady, 1993, Unpublished master's

.000 ._

'I . H .II 0-I

thesis, Western Michigan University. Reprinted with permission.

 

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