The objective of this paper was to identify barriers to successful program completion faced by underrepresented minority nursing students. This paper reveals that minority nursing student’s face multiple barriers to success including lack of financial support, inadequate emotional and moral support, as well as insufficient academic advising, program mentoring, technical support, and professional socialization. An additional theme—a resolve to succeed in spite of the identified barriers—was identified. This body of literature focuses solely on successful minority students’ experiences, revealing a significant gap in the research. The findings of this paper highlight the need to create and maintain nursing programs capable of aggressively supporting minority student needs. Recommendations for future research are included.
The increasing diversity of the United States is evidenced by a recent census report predicting that by midcentury, racial and ethnic minorities will make up over half of the United States’ population [
Registered nurses represent the largest number of professional healthcare workers in the United States. However, the racial and ethnic background of the nursing workforce is not reflective of the general population as a whole. Like other healthcare professions, minority representation in nursing is lagging [
Perhaps the most compelling reason for increasing the numbers of underrepresented minority nurses is the lack of equity in regard to healthcare access and quality. The groundbreaking Institute of Medicine (IOM) report
Efforts to increase diversity in nursing programs have resulted in increased admission of minority students. According to the AACN [
The Health Resources and Services Administration (HRSA) Nursing Workforce Diversity program has awarded millions in funding for projects to increase nursing education opportunities for students from racial and ethnic minorities underrepresented among registered nurses [
There has been continued demand for increased diversity in nursing thus a review of current literature regarding the barriers to successful program completion is warranted. Improved awareness about the barriers will enable educators to direct future efforts toward interventions that effectively impact and facilitate successful program completion for underrepresented minority nursing students. The purpose of this paper is to integrate the findings from recent studies identifying perceived barriers to nursing program completion for URM nursing students.
This integrative review follows the five stages of review as proposed by Whittemore and Knafl [
A comprehensive search of the literature was performed to locate such articles published between 1996 and 2011. This search was completed in early spring of 2011. The following online databases were utilized in this search: Cumulative Index of Nursing and Allied Health Literature (CINAHL), Educational Resources Information Center (ERIC), EBSCO, and Pub Med. The following search terms were used alone and in combination:
Titles and abstracts were reviewed in depth to determine studies’ relevance for inclusion in this paper based on the following criteria. Exclusion criteria included studies published prior to 1996, studies conducted outside the U.S., or articles that were not published in English. Studies that were limited to minority student experiences in graduate nursing programs were not included. Commentaries, expert opinion pieces, and review articles were also excluded. Seventeen publications met the selection criteria and were included in this review. Once identified, results of the studies were carefully reviewed and analyzed. Analysis was aided by presentation in a table format under the headings of author/date, study purpose, study design, sample, and findings.
The Adapted Model of Institutional Support conceptually informed this review. The Model of Institutional Support [
Valverde and Rodriguez introduced the significance of academic advising in their initial mentorship construct. Bond et al. adapted the model by extracting academic advising into a fifth construct [
A majority of the reviewed studies (16 of 17) utilized a qualitative methodology employing, open-ended interview, focus groups, or questionnaires that included open-ended items to explore and describe the students’ experiences in a prelicensure nursing program. Both associate degree and baccalaureate degree student perspectives were included in the reviewed studies. Similarity was noted in the studies’ stated purpose which often sought to identify personal and/or educational barriers encountered by the students as well as explication of their experiences in predominately White schools of nursing. The reviewed studies are summarized in Table
Presentation of reviewed studies.
Author and date | Study purpose | Study design | Sample | Findings |
---|---|---|---|---|
Jordan (1996) [ | Examine lived experiences of AA students in mostly White BSN program | Hermeneutics study—interviews | 4 AA nursing students | Three patterns emerged— |
Villarruel et al. (2001) [ | Identify barriers and bridges to educational mobility | Qualitative methodology utilizing focus groups | 37 Hispanic nurses participated in focus groups | Financial considerations required participants to work while pursuing education and reason many choose ADN program. Institutional barriers included unsupportive faculty, perceived discrimination by faculty and peers, lack of advisement, and lack of scheduling flexibility. Cultural/family barriers included family care giver or wage earner responsibilities |
Weaver (2001) [ | To describe supports and struggles endured as student | Survey | 40 Native American nurses and nursing students | Barriers identified included culture shock or differences, endured stereotypes and racist attitudes, isolation, and assumption about cultural identity |
Sanner et al. (2002) [ | Explore the experiences of international students in BSN program. | Guided interview approach | 8 Nigerian nursing students | All students reported becoming socially isolated and being prewarned of the social and academic challenges of the nursing program. Further identified the need to work to pay academic and living expenses |
Perez (2003) [ | To build understanding of the nursing education choices made by participants | Quant./qual. utilizing questionnaire and interviews | Qualitative—20 Mexican Americans—all female Quantitative—485 responses years | Numerous barriers were identified including financial difficulties and need to be employment, nursing education considered more difficult than expected, stress on family priorities and commitments |
France et al. (2004) [ | Explore the lived experiences of AA students in a mostly White rural university | Phenomenological approach—interviews | 4 AA nursing students | Three themes emerged including— |
Gardner (2005a) [ | Identify the factors influencing success of foreign-born nursing students | Case study | East Indian nursing student | Identified barriers included family demands and obligations, feeling of exclusion and isolation with regard to peers, and cultural differences including a reluctance to speak up in class or make eye contact with faculty |
Gardner (2005b) [ | To document minority nursing students’ perspectives of their experiences in a mostly White program | Phenomenological framework utilizing semistructured interviews | 15 racially and ethnically diverse students | Emerging themes included— |
Mills-Wisneski (2005) [ | To examine AA BSN students’ perception of impact of absence of minority faculty | Descriptive design-questionnaire utilizing Likert-type scale and open-ended questioning | 71 AA students from 9 programs | Students expressed concerns about lack of minority role models and difficulty establishing relationship with majority faculty as well as perception of being treated differently by White faculty |
Amaro et al. (2006) [ | To determine diverse nursing students perceptions of educational barriers | Grounded theory methodology utilizing in-depth interviews | 17 ethnically diverse recent graduate RN’s | Student needs and barriers included: lack of time due to family responsibilities, lack of adequate finances, major academic difficulties—some related to academic background and language, and prejudice and discrimination |
Taxis (2006) [ | To explore the experiences, perceptions, and factors that influence retention and graduation from a mostly White BSN program | Qualitative methodology utilizing questionnaire and face to face interviews, and focus group | Nine Mexican-American students in a predominately White BSN program or recent graduates | Identified barriers included financial situations that required working which resulted in inadequate time for rest, exercise, and study, not fitting in with Anglo peers, and difficulty functioning in two separate cultures including their predominately White university and their Mexican American peers and family |
Goetz (2007) [ | Identify the barriers faced by students completing studies and to identify strategies used to manage or overcome barriers | Qualitative methodology utilizing interview—grounded theory approach | 12 Hispanic nurses and nursing students | Numerous barriers identified including: being ill-prepared for the difficulty and intensity of the nursing program, time management problems balancing home, school and work responsibilities, financial issues, family beliefs and cultural influences, inadequate academic preparation, and prejudices |
Rivera-Goba and Nieto (2007) [ | To explore meaning and significance of mentoring during prelicensure program for Latinos in nursing | Phenomenological framework utilizing semistructured interviews | 17 Latina students or recent graduates | Marginalization was identified as a major challenge; feeling isolated or as if they lacked knowledge. Financial burdens were identified as a barrier. Faculty suggested students decrease amount of work although students needed to pay educational expenses as well as family expenses |
Bond et al. (2008) [ | To identify perceived barriers and support for retention in nursing program | Qualitative—focus group studies with theory guided data analysis | 14 Mexican-American students All Hispanic | Findings included revealed barriers congruent with model components of financial issues, emotional and moral support issues, professional socialization issues, mentoring, technical support, and academic advising issues |
Coleman (2008) [ | To explore academic and social experiences of AA students enrolled in a mostly White institution | Qualitative methodology utilizing semistructured interviews | 14 African-American students from a two-year community college | Four primary themes emerged including difference, coping, and survival, support systems, and institutional context as having significant influence on the experiences of the students |
Evans (2008) [ | Compare and contrast perceptions concerning barriers between minority students and a comparison group of Anglo students | Descriptive qualitative utilizing semistructured interviews | 14 Hispanic and American Indian students | Barriers to success included: financial hardships and work-related issues, heavy family obligations, early difficulty relating to nonminority students and faculty, fear of academic failure, and lack of faculty contact |
Loftus and Duty (2010) [ | To determine facilitators and barriers to successful completion of a BSN program | Naturalistic utilizing survey | 314 student participants: | Five barrier factors were identified including English language and computer skills, workload and pace of program, financial and family concerns, technology access (owning a computer or having internet access), and technology competence |
Table
One of the major barriers identified by students was financial with many reporting that it was necessary to work in order to make ends meet [
Two common reasons minority students gave for working included the need to cover education expenses as well as to provide for the living expenses of themselves and their families [
Student’s financial challenges were further complicated by the fact that they had been provided with little or no financial aid information regarding scholarships and grants [
A lack of emotional and moral support was perceived to be a key barrier by minority students in most of the studies. This lack of support manifested itself in multiple ways including feelings of social isolation and loneliness, racism and discrimination, and, finally, through family support issues.
Insufficient numbers of African American students in nursing programs decreased the opportunities for students to connect and develop relationships with other African American students leading to feelings of social isolation and loneliness [
Hispanic, Native American, African American, Asian, Nigerian, and Eastern Indian students described feeling isolated and lonely both inside and outside the classroom [
Multiple studies provided accounts of students being subjected to discrimination and racism by faculty, preceptors, peers, hospital staff, and patients [
The perception that nursing faculty members have a negative bias toward minority students was expressed in many of the studies. One student reported, “I was actually confronted by one of my instructors…she took me to her office with no one listening [she told me] that she did not like my face, and she was going to make it extremely difficult for me at school. And she did” [
African American students described their environment as “adversarial and nonsupportive” explaining that they were required to “excel 10 times more and be more presentable [dress] even on my worst days” [
Students described a “weeding out” process in which faculty members targeted minority students for failure [
Issues regarding family support were identified as both facilitators and barriers [
Female students also struggled with conflicting expectations and the responsibilities of caring for their families and extended families and their studies [
Minority students perceived the nursing program to be “much more difficult” than they had expected in sharp contrast to the Anglo students in one study [
Students in the Amaro et al. [
A lack of knowledge regarding the requirements for admission to nursing programs was identified as an added barrier [
Lack of minority faculty to serve as mentors and role models was identified as challenging for diverse students. Students reported believing that a mentor would help them to be more successful in their nursing program [
Ethnic minority student associations were reported to be very helpful to student members by providing motivational support and information about classes and strategies to improve academic performance [
Computer access and technology competence were reported in only a single study as significant barriers to successful academic performance [
Eight of the reviewed studies described an additional theme—a resolve to succeed in spite of the barriers. While not a concept of the Adapted Model of Institutional Support, Bond and colleagues discussed integrating such a concept in their 2008 study [
Resolve to succeed theme.
Author | Theme | Description |
---|---|---|
Jordan (1996) [ | Resoluteness | Resilience in the face of challenge; remaining steadfast to educational goal despite overwhelming trials |
Sanner et al. (2002) [ | Persistence despite perceived obstacles | Placed the burden on selves to make the necessary adjustments as they attempted to assimilate |
Frances et al. (2004) [ | “…you just got to maintain” | The participants persevered in spite of feeling isolated and discounted by others |
Mills-Wisneski (2005) [ | Persistence and self-motivation | Absence of minority faculty served as a catalyst and motivating factor to succeed in nursing program |
Gardner (2005b) [ | Determination overcome obstacles | Success is necessary to build a better future; Desire to overcome despite many obstacles |
Amaro et al. (2006) [ | Self-motivation and determination | Participants determined to complete their courses; strength was demonstrating self-motivation and determination |
Rivera-Goba and Nieto (2007) [ | Perseverance | In spite of many roadblocks, perseverance was the driving force to succeed; had an overall desire to succeed |
Bond et al. (2008) [ | Personal determination | Showed a personal determination to succeed and a desire to give back to other Hispanic students still “in the pipeline” |
Table
Minority students in several of the reviewed studies discussed their White peers’ lack of cultural knowledge and competence as a barrier for them [
While most of these reviewed studies were small, together they begin to paint a picture of the barriers to success many minority nursing students experience during their undergraduate nursing education. These are in addition to the typical challenges majority nursing students encounter. This integrative review provides an overview of the nursing research aimed at identification of those perceived barriers. Results of the review indicate that the successful completion of a nursing education is complicated and there are numerous barriers to overcome for minority students.
Financial struggles were common to the student participants in the reviewed studies. Unfortunately, for nursing students who consider financial concerns to be among their most difficult barriers, there is not likely to be a great deal of new aid available. As a result of the recent economic downturn and significant deficiencies in most state budgets, state support for higher education has been decreasing. Identification and dissemination of information on available state and federal financial aid through the nursing program will benefit all students.
Mentoring programs and opportunities for professional socialization can become facilitators of success and achievement for diverse students. The transition from student to nursing professional requires planning and active participation both inside and outside the classroom. Minority students in this review expressed a hesitancy to approach nonminority faculty, suggesting that they could more easily approach minority faculty, but often there are too few minority faculty members to serve as mentor and advisor. The development of formal mentoring and professional socialization programs will provide safe avenues that students can utilize to reach out to all available faculty mentors and advisors.
Support for technical and computing competence concerns was mentioned in only two of the studies. Computer and technical competence are fundamental skills for nursing students and essential for successful program completion. In a study assessing nursing students’ computer skills, Elder and Koehn [
The findings from this review have implications for nursing faculty and program administrators. Commitment to the retention and program success of diverse nursing students from faculty and administrators can significantly reduce some of the barriers they face. Data from the reviewed studies suggests that nursing faculty can have a negative effect on minority students’ educational experience through prejudicial and discriminatory practices. Therefore, faculty’s appreciation of the influential role they have in educating diverse nursing students is essential.
A substantial gap, noted in this reviewed body of literature, is that no study included participants who had been unsuccessful or left their nursing program prior to graduation. The literature focused solely on barriers faced by successful students. In fact, several of the studies included nurses who had already graduated and successfully completed the NCLEX-RN exam. Minority and ethnic nursing students who are not able to persist through to program completion may have dissimilar needs or additional barriers to success that were not identified by those students successfully completing nursing programs. Locating these students for participation in future studies will likely be difficult, but every effort should be made to include the perspective of this population.
Further study of the
The number of published articles discussing the need to increase diversity in the nursing workforce provides evidence that this topic is not being ignored. Unfortunately, the undertaking has met with minimal success as yet and in some aspects nursing education has not been responsive to the dilemma of URM nursing students as evidenced by the slow growth in numbers of URM nurses. Minority nursing students face daunting barriers and there is much to be done to improve the educational process for them. The findings of this paper highlight the need to create and maintain nursing programs capable of actively and aggressively supporting minority student needs as well as facilitating a climate that is welcoming and caring.