“I always wanted a BSN,” says Pilar De La Cruz. “But being married and having two small children, I felt that I could not manage work, family life and four years of school at the same time.”
Faced with a difficult choice, De La Cruz opted for a diploma in nursing, so that she could start working as an RN as soon as possible. But looking back, she feels that in the long run she paid a big price for that decision. “I was fortunate enough to be promoted to supervisory positions,” she explains, “but I always felt inferior to non-minority nurses who had their [BSN] degree.
“I worked for a vice president of nursing who had a master’s,” De La Cruz continues, “and because I did not have a degree, she felt I was not worth much as a manager. As a Latina, I felt I had to work even harder to be recognized for my efforts because I lacked a bachelor’s degree.”
She found her solution by returning to school at California State University, Dominguez Hills in 1989, taking classes part time and traveling to different CSU campuses to accommodate her work schedule. In 1996, she received her baccalaureate and cried throughout the ceremony. “Finally, I could feel that I was equal to other nurses who were in management positions and were not minority,” she recalls.
De La Cruz went on to earn her MSN in 2001. As a result, she has attained the executive-level position of vice president of Education Development, Volunteers and Community University at Community Medical Centers in Fresno. “I like to mentor other Latinas [to go back to school],” she says. “I tell them, ‘if I could do it, so can you.”
She’s not alone. Many minority nursing leaders and educators feel there is an urgent need to encourage more nurses of color to think of their diplomas or associate’s degrees as a stepping-stone, not a stopping point. According to the 2000 National Sample Survey of Registered Nurses, published by HRSA’s Division of Nursing, nearly 60% of the total RN population, regardless of race/ethnicity, reports their highest level of educational preparation as either a diploma or associate’s degree. The one notable exception is Asian, Native Hawaiian and Pacific Islander RNs, who have the highest percentage of baccalaureate degrees than any other racial group.
Experts agree that while a terminal two- or three-year degree may be adequate for some nurses, the four-year BSN is the degree that truly opens the doors of opportunity for minority nurses. Those doors can lead not only to advanced degrees but also advanced careers--as managers, educators, researchers, nurse practitioners, clinical nurse specialists and more.
Recognizing the need to create more opportunities for minority nurses to earn degrees that will help them move up the ladder, America’s nursing schools, health care employers, government agencies and nursing associations are rising to the occasion. By developing innovative solutions--such as more flexible BSN and MSN programs, bridge programs, scholarships and an expanded loan repayment program--they are teaming up to make those doors easier to open than ever before.
“Going beyond the two-year degree is necessary for minority nurses’ careers and futures,” says Dr. May Wykle, RN, FAAN, dean of the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland. “When the nursing shortage eases, employers will want to hire nurses who have BSN degrees. We have to raise the image of nursing and create more awareness that it is collaborative work with doctors--and that this level of professionalism requires a baccalaureate.”
One reason why many minority nurses choose to attend associate’s or diploma programs is because of the lower costs, Wykle explains. Then, when they graduate, the demands of their jobs and family responsibilities make it difficult to continue their education.
“It’s hard to work and finish a degree at the same time,” she points out. “Many nurses do it, but sometimes they can’t study as much as they wish. I often recommend they begin by taking one course. Working full time and trying to study full time lessens their chances of completing their degree.”
The Bolton School is one of many nursing schools that are taking steps to make baccalaureate education more accessible to RNs who are graduates of diploma or associate’s degree programs. Wykle is considering a number of strategies, including the work-study option. “In some professions, such as engineering, students work a semester and go to school a semester,” she says. “This is a new idea to nursing but it makes sense.”
In addition, many schools are establishing bridge programs that make it easier for students in associate’s degree and diploma programs to transition into BSN programs, says Dr. Sheldon Fields, assistant professor at the University of Rochester Medical Center School of Nursing in Rochester, N.Y. “Some schools have formed partnerships and articulation models with junior colleges. At the University of Rochester, we are looking into making it seamless for a student at Monroe Community College to come into our program.”
Fields also believes that increasing the number of minority faculty would help encourage more RNs of color to earn bachelor’s and graduate degrees. “It is not unusual for large nursing schools to have a dearth of minority faculty--the numbers are not there,” he explains. “You cannot bring [minority] students in and not give them mentors. Those of us in faculty positions are a minority within a minority. For me--an African American and a Latin and a man--that has worked both to my advantage and against me.”
However, Wykle, who is also the current president of Sigma Theta Tau International (STTI), the Honor Society of Nursing, emphasizes that nursing schools will not be able to do the entire job alone. “We need to have both associations and schools promote BSN degree-earning,” she says. “And we need the support of health care organizations and the government, in the form of tuition assistance, loan forgiveness and making loan repayment easier.
“At STTI, we are collaborating with a coalition of other nursing organizations to raise the image of nursing through a program called Nurses for a Healthier Tomorrow. At the same time, as a nursing school dean, I’m very involved in trying to get sources of scholarship funding, and partnering with health care agencies. It’s slow going but we have to do it.”
C. Alicia Georges, RN, EdD, FAAN, a lecturer in nursing at Lehman College in Bronx, N.Y., and president of the National Black Nurses Foundation, says she is encouraged by Department of Health and Human Services Secretary Tommy G. Thompson’s January 2002 announcement that “the President’s  budget will include a total of $15 million, a 50% increase above last year’s funding, to expand the Nursing Education Loan Repayment program.” But still, she believes, “The federal government’s role in nursing education needs to be amplified.”
Minority nursing associations, meanwhile, are also focusing increased attention on promoting the benefits of baccalaureate education to current and potential members. For example, the National Association of Hispanic Nurses (NAHN) is concentrating on strategies such as offering scholarships, says Viola Benavente, RN, MSN, CNS, an instructor in the Department of Acute Nursing Care at the University of Texas Health Science Center in San Antonio and chairperson of NAHN’s Public Relations Committee.
“We are not telling people to go for the bachelor’s as opposed to the associate’s degree,” she stresses. “The BSN may not fit the needs of all nurses. We do say, though, that it is the baccalaureate-level nurse who is in high demand.”
Nursing schools aren’t the only ones who are recognizing that RNs need more flexible educational options that mesh with their work/life needs. Health care employers, too, are reaching out to help their nurses earn the bachelor’s degrees that will enhance their job performance and career potential.
For LaShawn Williams, RN, the cooperative effort between Detroit’s Wayne State University (WSU) and Henry Ford Health Systems was an exciting option. “I knew from the beginning that I’d come back to school,” she says. “It’s important for my long-term goals to have an advanced degree. There’s not much room for growth in the profession without it.”
After earning her associate’s degree, Williams took a job in the critical care unit at Henry Ford Hospital. There she learned the hospital partnered with WSU to offer a bachelor’s degree completion program. “It’s convenient, because classes and labs are held here at the hospital,” she explains. “Still, working and going to school is tough. I had to cut my hours to make it work.” Williams balances her job, studying and taking care of elderly grandparents by working the midnight shift so she can get tasks done during the day.
“The cohort program with Henry Ford Health Systems started in January 2002,” says Dr. Barbara K. Redman, dean of Wayne State’s School of Nursing. “Most of the classes are taught at the hospital by our faculty, but some of it is online.”
In addition to convenience, centering learning at the worksite provides “a support system,” according to Redman. “There is a major move for nurses to go back to school,” she notes. “We are reaching them at work because the employers have an interest in a more highly educated nursing workforce. The hospital provides access for us to counsel nurses, evaluate their diploma credits and talk to them about our program.” Students with all the prerequisites generally finish the BSN program in about two years.
Online colleges--such as National University in San Diego and Excelsior College in Albany, N.Y.--and distance learning programs offered by traditional nursing schools are still another non-traditional solution that is making it easier than ever before for minority nurses to earn bachelor’s degrees even if they are working full time.
Through the magic of the Internet, these ultra-flexible programs let students take classes at the place and time that’s most convenient for them, complete the program at their own pace and even receive credit for the nursing knowledge they already have.
“Our bachelor’s degree program is all independent study with some online support services,” says Dr. Marianne Lettus, associate dean of the Excelsior College School of Nursing. “Students complete the degree by successfully completing exams.”
Excelsior offers both BSN and RN-to-MSN programs. “The bachelor’s degree tends to attract more minority nurses,” Lettus adds. “The RN-to-MSN program is relatively new and takes longer to complete.”
For Fernando C. Pimentel, an Infection Control Practitioner and ICU nurse at Guam Memorial Hospital in Oka, Guam, distance learning was the ideal option for making his dream of earning a BSN degree a reality.
“In my [Filipino] culture, education is valued very highly,” says Pimentel, who is working toward a BSN through Excelsior College. “I currently hold a bachelor’s degree in Business Administration and am concurrently pursuing a master’s in health sciences at the California College of Health Sciences. I look at education as a journey rather than a destination.”
Encouraging diploma- and associate’s-prepared minority nurses to enter BSN programs is one thing; making sure they successfully complete their degree is another. Both students and faculty agree that even with today’s advantages of extra flexibility and convenience, the challenge of juggling college, work and family can often be overwhelming. That’s why many nursing schools are going the extra mile to provide increased support services to help these students not only go back to school but also go the distance.
The key to preventing students from giving up and dropping out “is to have our faculty keep in close contact with them so we can sense if they seem to pull away,” says Dr. Donna Demarest, dean of the School of Nursing at the College of New Rochelle (N.Y.). Like many retention programs for returning students, she adds, the emphasis is on both tutorial and personal support.
“Most of our RNs who come back to school are women and minorities,” Demarest comments. “They tend to work in inner city hospitals where the stress is heavy.
So our program has a learning and caring center for nursing, as well as a holistic nursing track. When you tell adult female students they need stress reduction, they say they don’t have time. So we built it into the degree curriculum. They learn therapeutic touch, relaxation, yoga and other approaches.”
Georges believes scheduling is also critical. “Time management is the biggest challenge for nurses coming back to school,” she explains. “Most of them work and have families. If they haven’t been in school for a while, they have trouble scheduling their time. Peer support helps, including sharing ideas about what works best. Working in study groups adds structure.
“I think the key is setting up the kind of program that fits the schedules of real people. We have clinicals on weekends and classes in the morning or evening. We’re looking at how we can be more flexible to meet the needs of the working RN.”