Associate degree nursing students at the Alamo Colleges, a group of community colleges in San Antonio, Texas, benefit from flexible class scheduling, user-friendly study facilities, smaller class sizes, tutoring and supportive faculty.
As the economic downturn has wiped out thousands of jobs in other industries, many Americans are enrolling in nursing programs with the hopes of experiencing a recession-proof career. A large number of these career-changing students— including many minority and male students—are turning to community colleges for their nursing education, in part because these two-year schools offer lower tuition rates and more flexible class schedules than four-year colleges and universities.
Although very few community college nursing programs offer baccalaureate degrees, they provide the opportunity to earn an associate's degree in nursing (ADN) and become licensed as an RN. Some minority nursing students in community colleges are able to continue on into BSN degree programs at four-year institutions; for others, attending a community college may be their only option for getting a nursing degree.
Unfortunately, many community colleges are losing large numbers of their nursing students, and this high attrition rate is exacerbating nursing shortages in some parts of the country. According to a 2007 article in The Sacramento Bee, one-fourth of community college nursing students in California fail to graduate—a problem that could lead to a shortfall of 12,000 full-time RNs by 2014 unless the schools can find ways to increase student recruitment and reduce dropout rates.
In North Carolina, the State Board of Community Colleges is undertaking a major study to identify ways for twoyear schools to respond to the state's urgent nursing shortage—and specifically, to improve program retention and increase pass rates on licensing exams for students enrolled in ADN programs. According to the North Carolina Community College System, about 65% of North Carolina-educated RNs earned their credentials in one of the state's 55 community college ADN programs. But the number of nurses coming out of that pipeline could be much higher, because more than 40% of the state's community college nursing students drop out for academic, financial, personal or other reasons.
The high attrition rates for minority nursing students at community colleges are disappointing, but hardly surprising when you consider the cultural and financial obstacles many of these students face when it comes to completing their education, says Carmelle Bellefleur, PhD, RN, a professor at Nassau Community College in Garden City, N.Y. These hurdles include lack of financial resources, insufficient academic preparation, low expectations from instructors, family obligations and, in some cases, language barriers. "Many [minority students] don't get the support they need to complete all of their classes," Bellefleur believes.
Community colleges have limited resources for addressing these types of student retention issues. However, many community college nursing programs throughout the country are working to improve minority students' chances of success by offering academic support, mentoring programs, financial assistance and culturally appropriate teaching.
"We're finding that many of our minority students are married with families, and they have to work while they go to school," says Lula Westrup Pelayo, PhD, RN, district director of nursing for the Alamo Colleges, a group of community colleges in San Antonio, Texas. To help accommodate these students' needs, the nursing program offers flexible class scheduling.
"We have a full day and evening program. We also try to get students into an academic and clinical setting in a condensed form," Pelayo explains.
When students go home to busy families, they may not have a quiet place to study. Alamo Colleges' remedy for that problem is to provide spacious, user-friendly facilities to help students maximize their on-campus study time. "We want to help people get into groups and study while they're here," says Pelayo.
On-campus study rooms can help, but students also have to be academically prepared for the coursework, says Bellefleur. She is the director of Preparation Retention Education for Professional Success (PREPS), a grant-funded program designed to retain minority and underserved students enrolled in Nassau Community College's nursing program.
"We're seeing that many students need to take developmental courses before they can successfully complete our program," she says. "This often means instructors have to be available for face-to-face tutoring."
According to Bellefleur, the need for this type of intensive tutoring was what prompted the creation of the PREPS project. "We go from unit to unit in the nursing textbooks and try to break down the material for the students. When many of them first came to us to ask for help, they brought their textbook and the entire book was highlighted!"
These difficulties in understanding the material don't come from lack of intelligence, Bellefleur emphasizes. "These students are certainly not stupid. In reality, many of them are ESL (English as a second language) students. They think in their native tongue, then they have to translate their thoughts and respond in English. All this takes time," she says. "As educators, we should have the patience to allow them to process their thoughts so they can be successful in the program. They come to our door every day asking for help. We're a community college and we need to be able to [serve the community] by helping them."
After identifying what the students' needs were, Bellefleur helped develop PREPS as part of the college's nursing curriculum. "We spend time with students after their classes, and we do critical thinking problems to try to find any gaps in their understanding." The study groups have about 10 students in them, so if one person doesn't understand something, a peer is probably able to explain it, she says.
Bellefleur has found that explaining a topic in several different ways can play a big part in boosting students' comprehension. "When a student is in front of you while you're explaining something to them, you may think they understand the topic. But if you ask them to apply it, you might find out that they really don't understand," she says. "Instead of just telling them something verbally, give them the information on paper. Write it down, then use a PowerPoint presentation or overhead projector to explain it, so they can see the material for themselves. Give them a way to take the information home and view it on their own time."
Another way to increase retention, she continues, is to make sure students master their remedial classes before enrolling in nursing coursework. "We advise them that when they take their nursing classes, they should focus solely on those courses. We don't want them thinking about sociology or math when they need to focus on nursing."
There's no shame in taking the basic classes first, says Bellefleur, who adds that she too was once an ESL student. "I was advised to take my reading classes first, and I did. But once I took those classes, I was able to go back to school for my bachelor's degree, then I went back for my master's, and back again for my PhD."
She finds the same work ethic in many of her minority students. "We see them working in the lab from morning to night. They want to complete the program so badly. For many of them, this is their dream, their ticket to a better life."
The dream of not just completing community college but continuing their nursing education to the next level is not an impossible one, but too many minority students don't have a personal mentor to advise them along the way, says Leonard Leos, MSN, RN, director of the ADN program at St. Philip's College, which is one of the Alamo Colleges.
"Many of our students are the first people in their family to go to college, and they don't have role models to tell them they can continue their education. We're constantly trying to help [our students increase their] self-esteem and resilience, and to convince [students in our college's LVN program] to transition to an RN," he says.
According to Leos, the solution is for minority nursing faculty who have already achieved their educational goals to help students envision their own possibilities. "One of the things we need to do [at the community college level] is have more minority leadership. We need role models who can tell students, 'I went back to get my bachelor's degree.' Those of us who have made it through the ranks need to become mentors."
The dream of going to nursing school can't be realized without money. But in these tough economic times, finding financial resources can be difficult— not just for community college students, but for their schools, too.
"I had to apply [to the Department of Health and Human Services] for the [PREPS] grant three times before I got it," says Bellefleur. "[Obtaining grant funding] is very competitive, and people from all 50 states and the District of Columbia are trying to be awarded grants."
Fortunately, community college nursing programs may soon receive a funding boost. President Obama recently announced the American Graduation Initiative, a program that will invest $12 billion in community colleges over the next 10 years. The money will be used in part to help schools modernize facilities, raise graduation rates and create new online learning opportunities.
Community colleges are also turning to local hospitals and non-profits for help. Pelayo was able to acquire a grant from San Antonio-based Methodist Healthcare Ministries, a faith-based organization that provides health care in underserved communities, to implement a new teaching model designed to help retain more students. One of the model's most innovative features is the use of bachelor's- prepared nurses to teach in Alamo Colleges' clinical simulation labs while they pursue their master's degrees to prepare for careers as nursing educators.
"I call it the combination in-patient and clinical simulation experience," Pelayo says. "We pair one master'sprepared faculty member with a bachelor's- prepared instructor. Together they can admit 15 students. Ten students at any given time will rotate through the hospital with the MSN [instructor] and do their clinical experience there. The other five students will rotate through the simulation lab at the school."
With this structure, students will get two-thirds of their clinical experience in the hospital and one-third in the simulation lab. "This helps student retention," she explains, "because when the students are in the simulation lab with that bachelor's-prepared clinical teaching assistant, they're given more individual attention. It's a one-to-five [teacher-to-student] ratio instead of the one-to-ten ratio that you have in the hospital."
In addition to benefiting students, putting BSN-prepared nurses in this environment helps them gain teaching skills, Pelayo adds. "[It has a faculty development component], because these bachelor's-prepared nurses have not necessarily taught before. We put them through a special program. They work [at our college] three days a week, and then we give them two days a week of relief time to get their master's degree. In the days they work here, they do simulation lab twice a week, and the other day they do retention activities with students."
It's a win-win situation, because students have two people they can turn to for academic help instead of one, and the instructors are learning effective ways to educate diverse groups of students. "The bachelor's-prepared faculty member is assigned to help with tutoring, grading and monitoring, so [that provides an additional resource for the students]," says Pelayo.
Another important strategy for retaining minority nursing students in community colleges is to provide education that is culturally appropriate. This often means revamping traditional one-style-fits-all teaching methods to meet the needs of today's more multicultural student populations.
"Nursing has historically been a profession where we sometimes get stuck in how we teach things," says Leos. "[Students] can walk into some established nursing programs in academia and if [they] don't fit the guidelines, [they] get thrown out." He believes nursing educators must find ways to rate, judge and evaluate a student's performance in a manner that can help that person succeed.
Learning to teach in a more culturally inclusive way must start with educators becoming more knowledgeable about diverse students' cultural backgrounds, Leos adds. For example, he notes that many Hispanics, like himself, learn best in large groups. "[In Hispanic culture], many family decisions are made only after consulting with several family members. The same principle applies to learning." This could mean making sure new material is taught in a group format whenever possible.
As another example, Bellefleur has found that some students don't make eye contact with their instructors because they come from a culture that believes making eye contact with an authority figure is disrespectful. As a result, the instructor may mistakenly conclude that there is "a problem" with that student. If the instructor only knew the student's cultural background, says Bellefleur, he or she would know that the lack of eye contact is not an issue. In fact, understanding cultural differences not only benefits students but could make the instructor a more effective teacher.
Developing a more multicultural curriculum that focuses on the health care needs of people from a variety of racial, ethnic and religious backgrounds can also play a part in minority student retention.
"Care practices are different in different cultural groups," says Ruth Jones, MSN, RN, director of nursing and allied health programs at Moberly Area Community College (MACC) in Moberly, Missouri. "We don't have a lot of diversity in northeast Missouri, but we are seeing more of a migration of the Hispanic population into our rural areas, so we felt it was important to get the word out to our students about different care practices. We received a HRSA grant in 2007 to do just that."
As part of that program, the college invited guest speakers to discuss issues of cultural diversity and cultural sensitivity, both for nurses and for patients, says Jones. The school also partnered with local high schools and hospitals to hold workshops and share information with practicing nurses at various clinical facilities.
Although MACC does not have a grant for the program this year, Jones says the college and its nursing students still benefit from its effects. "I've seen an increased awareness among the students to reach out to different sectors of society," she says.
By reaching out to help minority students overcome academic, financial and cultural barriers that could prevent their success, community college nursing programs can help decrease these students' chances of dropping out and increase their chances of graduating out.
"I have former [Nassau Community College] students [of color] who now have their BSN, master's and PhD degrees," says Bellefleur. "It's all about empowering them to believe they can do it."