Cabezonas Con Suenos: Success Strategies for Nursing Students of Color

Successfully entering and completing a nursing program can be a daunting task for any student. But students of color often face additional challenges and barriers that white students do not—for example, lack of financial aid, inflexible admissions policies, a greater burden of family responsibilities and feelings of isolation.

While the obstacles experienced by students of color are well documented in the nursing literature, there is much less information available about the “survival skills” and strategies these students have used to successfully overcome those obstacles. Although the literature includes some older studies focusing on success strategies that American Indian and Latina nursing students found to be useful, there is very little currently being written about what today’s students of color can do to be successful as they plot a course through the process of obtaining their nursing education.

Why is so important for underrepresented students of color to not just get accepted into nursing programs but to succeed in them? The demographics of the United States are changing dramatically and rapidly. By the year 2050, 20% of the U.S. population will be foreign born, and Caucasians will no longer be the majority. As the country’s racial, ethnic and cultural demographics change, nursing has a responsibility to change with them so that the profession fully reflects the patient population it serves. Furthermore, if nursing is to retain its reputation as a profession that advocates for the underserved, then it must also advocate for the fair representation of people of color in the nursing workforce.

Latinos are the fastest-growing minority group in the U.S., yet they are severely underrepresented in the current RN population. What are the most significant institutional, personal and cultural obstacles Latino/a students face in nursing school? What assets and strategies can help them surmount these obstacles and complete their nursing programs? What can nursing school faculty and administrators do to create a more equitable educational experience for students of color and help ensure their success as they pursue their dreams of becoming registered nurses?

As a nurse researcher with a strong interest in exploring these questions, I conducted a study that used critical ethnography to examine how Latina students who were in their last year of an RN program or had recently graduated as RNs managed to successfully complete an associate degree or bachelor’s degree nursing program. Six nursing students and seven RN graduates from various schools participated in the study, which was conducted using open-ended interviews and focus groups. The participants were asked to describe their experiences in nursing school, focusing on obstacles, assets, coping strategies and how power was used in the nursing program they attended.

Encountering Racism

It is not surprising that the study participants cited many obstacles encountered while pursuing their nursing degrees. These included lack of multicultural understanding at the institutional level, hostility and lack of cultural awareness in nursing faculty, pressure to give up their Latino culture, inflexibility within the nursing program, unwritten “rules” of nursing education and a climate of competitiveness that was encouraged by the faculty.

The participants also talked about how family responsibilities created a dilemma for them. They had to push against the current of cultural expectations of women and deal with the day-to-day issues of childcare and other family obligations. This group of Latina students and RN graduates were not willing to abandon their families to get an education. Instead, they chose to find ways to maintain both family and school responsibilities, which was a difficult task to accomplish.

One of the most frequently mentioned obstacles was racism. This is noteworthy because racism in nursing school is rarely discussed or studied. It is widely perceived as a problem that existed in the past but has been eliminated today. Yet, racism—on the part of both classmates and faculty--was cited often in the interviews. For example, Latina students who spoke with accents commented that they felt they were being treated as less intelligent than other students. Many participants described being told by instructors that they were less capable than white students. As a system of advantage and disadvantage based on skin color and ethnicity, the effects of racism were felt by every participant in the study.

Perhaps even more insidious was the systemic racism they faced, which was evident in the number of blockades they experienced at the institutional level. Some of the Latina students reported being given different admissions information than that given to white students, and they were frequently encouraged by high school or college counselors to become nursing assistants rather than RNs.

While the participants had been able to develop strategies for overcoming a number of obstacles, they had difficulty naming specific strategies to deal with racism. They often described feeling that they should have responded more strongly to racist incidents or policies. Yet they feared that if they spoke out about racism they would be punished.

Cultural Assets

Sadly, when asked about assets that helped them overcome obstacles, the study participants were unable to cite many examples of institutional support from the nursing programs they attended. A few spoke of the “one” instructor who was supportive, but this was the exception rather than the norm for these students and RNs.

Therefore, they found support through other channels. Their own goals and dreams served as a compass that kept them on course as they headed toward their goal of becoming RNs. Interviewees also cited a desire to give back to their communities, and to help the Latino community to move ahead, as incentives that helped them persevere. Support from peers and being unified as a group were major assets the participants credited for their success.

Latino culture played a particularly important role in the coping strategies of these students and RNs. Every participant commented that they had to be a “cabezona”--meaning stubborn or determined--to make it through. They described this characteristic as a cultural asset that was a part of their Latino history and identity. They were proud to be Latina, proud of their heritage and they wanted to make their families and communities proud of them.

This cultural pride served as a powerful force that helped them swim against the tide of obstacles and racism they so often encountered. Perhaps because of their individual personalities, but most likely because of their culture, this group described how they actively resisted as a means of being successful. They resisted cultural norms that could hold them back. And by holding onto family ties and finding ways to integrate their Latino culture into their education, they resisted pressure to desert their cultural heritage.

Strategies for Students

Although all of the participants in this research study were Latinas, the findings revealed many strategies for success in nursing school that are applicable to all students of color. For example:

• When you are applying to or entering a nursing program, identify students of color who are ahead of you in the program. Ask for their advice about what to watch for and how they navigated the program. These students can serve as cultural brokers and explain the expectations that nursing instructors may have.
   
• Learn the unwritten “rules” of majority-dominated academia. This does not necessarily mean that you have to follow all of them, but awareness of these rules will help you decide when to resist and when to conform.
   
• Form support groups. Study together, share information and stand up together against injustices.
• Enlist additional support from family members. Maybe they are willing to baby-sit, cook some meals or help out in other ways so you can devote more time to your studies.
   
• Tap into your cultural heritage. If stubbornness and determination are the norm in your culture, then don’t give up!
   
• Acknowledge that racism exists, and that sometimes people who participate in it may not even realize they are doing so. This does not diminish the injustice, but as opportunities arise, educate your peers. Above all, do not let instances of racism define who you are. You have a great deal to offer the nursing profession!

How Faculty Can Help

Nursing educators who want to create a more equitable educational system for students of color must abandon the notion that treating all students the same or being “colorblind” is a solution to the problems of racism or student failure. As is true in the health care workplace, when failure occurs it is often the result of a system failure, not an individual one.

Based on the insights gained from the study participants, here are some additional recommendations for how faculty members can increase their understanding of the issues nursing students of color face and how they can partner with these students to help remove barriers to their success:

• Examine the curriculum to determine whether it is inclusive and relevant to all students or if it is centered on the care of white patients while excluding the needs of patients of color. It is imperative to bring racial, ethnic and cultural diversity into the nursing curriculum, such as teaching students about differences in skin, hair, dietary preferences, etc.

• Rather than having a “culture day,” thread the concepts of cultural diversity and its importance in health care throughout the curriculum.
   
• Encourage students of color to hold on to their cultures, both as assets for their own success and as assets that will enrich the nursing profession. Acknowledge, respect and build on these students’ cultural knowledge, beliefs and experiences.
   
• Recognize that while curriculum content that includes information about cultural differences, health disparities and culturally sensitive health care is essential, students remain underserved if the curriculum delivery is not culturally sensitive as well.
   
• Learn the personal stories of your students. Are there very young students? Older students? Students of color? Male students? Ask yourself: “What unique assets does this student bring to nursing?”
   
• Be aware that students have different learning styles, based on factors such as age, culture and personality. Offer to help students. Often, students of color are reluctant to ask for help because they are uncertain about how others will perceive them, but they appreciate help when it is offered respectfully.
   
• Flexibility is a must, both in the admissions process and in the classroom. Is your nursing program’s admissions policy based solely on GPA? Consider revising it to give more weight to students’ personal assets and experiences. Do your class times and days reflect a student-centered or a faculty-centered approach? Faculty and administrators must ask themselves who benefits from the policies and norms that are currently in place. Do they promote or inhibit student success?
   
• Nursing programs are notorious for having a competitive atmosphere. But keep in mind that some students may come from cultures where working together for the benefit of the group—rather than striving for individual success—is the norm. These students will not thrive in a highly competitive environment. Furthermore, fostering an atmosphere of cooperation and collaboration in the classroom more closely reflects what will be required of RN graduates when they enter the workforce.
   
• Mentor students and help them understand the unique culture that is nursing.
   
• Learn to recognize how racism is manifested institutionally as well as individually. There are many anti-racism curricula that can be incorporated into nursing education. Be a role model by teaching white students to be anti-racism advocates and by speaking out against racism yourself. Never, ever tolerate negative comments about an individual’s race, ethnicity, gender, religion, sexual orientation, disability or any other characteristic that is not the majority. Learn to talk openly about discrimination and bias and how they affect health equity. Encourage all students to consider other viewpoints than their own.
   
• Understand that many students may have strong family ties and responsibilities that they must balance with their academic responsibilities. Educators often argue that privacy laws make it impossible to engage with a student’s culture of family. Still, it is possible to find ways to include family in the nursing school experience. Invite family members to student presentations; include family in end-of-term celebrations. This sends a clear message that you value your students and acknowledge that they have their own lives outside the walls of the classroom, and that retaining these aspects of their lives is important.

In conclusion, there are many ways that students of color and faculty members, both individually and together, can employ strategies and engage resources to ensure that all students have an equal opportunity to successfully earn a nursing degree. Just imagine what could happen if every student of color was able to achieve his or her dream of becoming an RN. In today’s increasingly multicultural America, imagine what a difference this will make for the nursing profession, for health care and for improving the health of the medically underserved.