Black Nursing Students: Strategies for Academic Success

Abstract

AIM The purpose of this qualitative research study was to determine the strategies Black graduates of predominantly White education programs used to successfully complete their degrees.

BACKGROUND As the United States becomes more culturally and racially diverse, nursing is being called upon to diversify its workforce. Efforts are being made to increase ethnic and racial minority students' access to and rate of success in nursing education. This article focuses on strategies that helped Black nursing students excel and graduate.

METHOD Eighteen Black nursing graduates were interviewed in depth using an 18-item semistructured questionnaire.

RESULTS Participants in this study established a daily plan of study, joined racially and ethnically diverse study groups, read the course content, and developed note cards to help them succeed in the nursing program.

CONCLUSION These findings have specific implications for Black students' learning, retention, and progression in nursing education.

KEY WORDS

Academic Success - Black Nursing Students - Diversity - Nursing Education

As the United States becomes increasingly diverse culturally and racially, nursing education programs are challenged to recruit, retain, and graduate more students of ethnic and racial minorities. Doing so will improve health care access and quality among minorities (Beacham, Askew, & Williams, 2009; Cramer & Davidhizar, 2008; Sutherland, Hamilton, & Goodman, 2007; Wong, Seago, Keane, & Grumbach, 2008) as people frequently seek health care from providers of their own race or ethnicity (Dapremont, 2011; Martinez & Martinez, n.d.; US Department of Health and Human Services [USDHHS], Office of Minority Health, 2009). Medically underserved communities need health care providers who are culturally similar or sensitive to the residents (Beacham et al.; Martinez & Martinez).

A disparity currently exists between the size of the Black population in the United States and the Black nursing population. According to the 2008 National Sample Survey of Registered Nurses (USDHHS, Health Resources and Services Administration, 2010), Blacks make up approximately 13 percent of the population, but only 5.4 percent of the RN workforce. Racial- and ethnic- minority nursing students must be not only recruited, but also supported academically until graduation (Cramer & Davidhizar, 2008; Gardner, 2005a; Jeffreys, 2007).

The purpose of this qualitative research study was to determine the strategies used by Black graduates in the successful completion of their nursing education at predominantly White nursing education programs. For this study, the definitions for Black and White conform with the standards set by the US Census Bureau (2010), which are Black Alone and White Alone with no other race affiliation. Participants self-identified as Black.

BACKGROUND

The nursing literature is sparse regarding ethnically diverse students' perceptions of educational strategies that promote success. In recent years, the Institute of Medicine (2011), the National League for Nursing (NLN) (2005, 2009), and the American Association of Colleges of Nursing (2014) have called for an increasingly diverse nursing workforce and for learning environments that engage and support students.

Tinto (1993) found that students who interact and participate with peers in the academic setting are more likely to persist and complete their educations than those who do not. Furthermore, Tinto (1975) suggests that student perceptions within certain environments (e.g., faculty support) may positively affect student integration and academic success. Researchers have found that peer and faculty support emerge as themes contributing to ethnically and racially diverse students' success and retention in nursing academic settings (Higgins, 2005; Loke & Chow, 2007; Robinson & Niemer, 2010). Peer supportive behaviors include interactions with other students that increase feelings of inclusion and help in the understanding of nursing content (Dapremont, 2011; Higgins; Loke & Chow). Faculty supportive behaviors include being approachable, understanding, and encouraging (Dapremont; Shelton, 2003).

Also highlighted in the literature are barriers that interfere with the success and retention of ethnically diverse students in nursing education. According to a study by Amaro, Abriam-Yago, and Yoder (2006), academic needs that created barriers for minority students were study workload, tutoring, and study groups, with study workload the major concern. Ethnic- and racial-minority students stated that the amount of homework and studying required was overwhelming. Beacham et al. (2009) and Dapremont (2011) noted that early recognition and intervention with students can improve retention and success. Therefore, how students are supported and directed during their nursing education may determine whether they persist and graduate (Edwards et al., 2009).

Shelton (2003), along with the NLN in a position statement (2005), noted that faculty mentoring improved retention and graduation rates for Black students by identifying and directing them to resources and supportive services. Thus, provisions for forming supportive learning communities should focus on peer support, mentoring by faculty, and resource-driven interventions. These are essential to retain and graduate more Blacks from nursing educational programs.

METHOD

Design

A qualitative, descriptive study was designed to explore Black graduates' perceptions of their educational experiences and the strategies they used to succeed during their programs of study. The study design allowed the researcher to deeply probe participants' perceptions (Patton, 2002), to collect rich data, and to develop themes and categories representative of participants' perceived experiences.

Participants

Using purposive sampling along with snowball sampling, 18 Black nurses between 21 and 50 years of age who had graduated from four nursing programs in the years 2000 to 2006 were selected to participate in this study. The nursing programs, which granted both associate degree and baccalaureate degree nurses, were in the mid-South region of the United States and had predominately White student bodies. Initial approval to conduct the study was obtained from each university's institutional review board.The sample consisted of 16 females and 2 males; 7 were married, 7 were single, 3 were divorced, and 1 was separated. Participants' annual income ranged from under $10,000 to more than $50,000. Every eligible candidate was sent a letter requesting participation. Participants were informed about the study's purpose, the methodological approach, and the potential for results to be published and presented at conferences. All participants completed a consent form that included a confidentiality statement.

Data Collection

The researcher conducted 18 individual in-depth interviews to address the study goals. Most interviews were conducted face to face, but some were conducted via telephone, and lasted from 60 to 90 minutes. The 18-question semistructured questionnaire guide (Dapremont, 2011) was reviewed and revised by a panel of five experts that included doctorally prepared researchers experienced in qualitative methods. The questions were designed to elicit participants' memories about their nursing school experiences, particularly the strategies they used and experiences they had that helped them succeed. The interviewer reworded a question when a participant seemed uncertain about how to respond. Interviewing ceased when data saturation was achieved.

Re-interview questions were devised based on initial theme development to enhance understanding of participants' responses or to add new information. In addition, a data form was developed to collect demographic information on gender, age, income, and marital status. Data collection took two months.

Data Analysis

Audiotapes of all interviews were transcribed verbatim by two staffmembers experienced in transcription. Data management was done through development of suitable classification or coding schemes. A thematic analysis and deductive a priori template of codes were used to make sense of the data (Crabtree & Miller, 1999; Fereday & Muir-Cochrane, 2006; Patton, 2002). The initial describing phase began with analyzing the initial interviews; themes were validated and elaborated upon in five re-interviews.

Strategies that emerged were: having a daily routine, meeting with a diverse peer study group, reading the course content, and using note cards. Overarching themes that best answered the research questions and captured the experiences of study participants were created (Dapremont, 2011). A second qualitative expert used phrases and words to analyze a selective sample of the data. Associations were completed through reflection and engagement with the code and categorized reports of interview transcript data and notes. Pseudonyms are assigned to interviewees to preserve anonymity.

RESULTS

The results fill an important gap in the literature by categorizing strategies Black graduates identified as necessary for graduation from nursing educational programs. Most of the strategies identified in this study are not new to nursing education. However, participants did not use these strategies immediately upon entry into their nursing education programs. With the results of this study, nursing schools can design early intervention approaches to assist more Black nursing students in remaining enrolled in and succeeding in nursing education. The strategies are presented and illustrated with representative statements provided by study participants.

Daily Routine

When participants were asked "What things helped you adjust to your first year in nursing education?" most said they had a daily study ritual or routine (e.g., reading for one hour per day, studying for two hours per day). However, participants often struggled to develop this habit and did not recognize it as such. According to participants, they simply engaged in repetitive behaviors because they achieved positive results. They had not been convinced initially that this daily routine would lead to success.

Participants were then asked to describe their weekly study plan, including times and dates designated for studying and reading the course content. Anna said, smiling, "My routine was crazy. . . . I studied . . . every day about an hour." Several participants said they didn't follow their routines daily, but did so at least three or four times each week. For example, Tameka said, "Every [Tuesday and Thursday] I tried to do at least two hours [of studying]. Then [on] the weekends, I got to study a little bit more."

Participants also said that adhering to the routine improved their success, especially when an unexpected event such as a family emergency, occurred. Participants repeatedly stated that they wished they had known at the time how to improve their study skills and achieve greater consistency. They felt they had lacked organization and confidence about studying the right information and would have liked to have had more guidance and support to ensure that they would achieve successful outcomes.

Peer Study Groups

More than half the participants stated that they utilized study groups as a means of comprehending and understanding course content. Study groups could vary in structure and purpose, they said, but all groups had similar purposes: helping participants understand the course content, pass exams, graduate from nursing school, and pass the NCLEX-RN®. Some participants contended that faculty should have assisted with the formation of study groups and provided guidance about organization and process. Others stated that the study groups helped build better White and Black peer relationships. Several participants chose to study with only Black students, stating that they were most comfortable with Black peers.

Some participants said that while White students regularly engaged in study groups, Black students rarely did, partly due to obligations the latter group had outside of school. When Black students wished to join White study groups, they sometimes found it difficult to access them, and some Black participants who joined White study groups stated they endured racially insensitive comments. However, according to participants, no matter the racial makeup, the study group helped them understand nursing content and progress in their education while also building positive interactions with peers.

Some of the students' impressions about study groups included Carla's: "My study group was . . . all White people. It wasn't intentional. . . . It [just happened that way]. . . . What [things] I didn't understand, they [the White students] would give me another insight [on], and what they didn't understand, . . . I would help them with another insight. They studied differently than I did and so they kind of opened me up to other avenues of learning material, and I opened [them] up to other avenues of learning material." Lolita, a young student getting her first degree, said that "a lot of times another person may pick up [on] something [you didn't]. You're listening to the same information, but what you pick up and what I pick up are two different things or we can come to two different perspectives."

Gerald said: "Some students don't want to help you [a Black student], so you find a few person[s] to help you. And teacher[s], most of the time they are not there - they work, they teach, so their schedules [are busy], so you have to cram your way!" Gerald also pointed to "some [racial] jokes, you know, some [offensive] comments. People [White students] say a comment and you hear some people laughing louder, sometimes you see some people laugh loud and some people are, like, quiet, because they're uncomfortable [with racial jokes]."

Reading Course Content

Participants said reading was critical to their success. Fifty percent of the participants commented specifically that reading was necessary to understand the course content. Several participants stated that at the time, they did not read the textbook and instead just studied PowerPoint slides and notes given by the teacher; however, they realized after graduation that that was a mistake. One participant admitted that reading had been difficult for her prior to going to nursing school, and that today she still struggles with reading. Participants also described feeling tired while reading, which limited their ability to concentrate. Some stated that they did not read the textbook assignments before class, but did at some point before the course examination.

Reading was considered important to success regardless of whether it was done before or after lectures. Anna, a student getting her second degree, said: "The program was very challenging for me. But the positive side of it was, it forced me to want it [graduation] and to . . . read, and if I needed to read it a thousand times, then that is what I needed to do to get the information and understand [the course content]."

Note Cards

Some participants believed that another method helpful for retaining information was using note cards. Tameka said that as a visual learner, she knew she benefited from seeing words or pictures, and therefore she made note cards. Another, Carmeka, a mature student with children, said: "I had my cards with me . . . wherever I went. . . . That was my study plan: . . . reading the note cards combined [with the] reading and studying of content. It also was a repetitive process of seeing the information over and over again."

DISCU SSIO N AND IMPLICATIO NS

The participants in the study used various strategies to be successful in their nursing education programs: having a daily routine for study, meeting with a diverse peer study group, reading the course content, and using note cards.

Participants consistently stated that achieving success required them to concentrate their energy, work hard, and stay focused on schoolwork. They needed to set aside a consistent time for study and have a routine because the workload was sometimes overwhelming. Amaro et al. (2006) also found that ethnically diverse students reported needing strategies to successfully complete the large amount of work. A clear implication is that students need instruction on time-management skills and how to effectively plan study, in addition to referrals to campus resources.

Participation in diverse study groups facilitated informal learning and interactions among Black and White students. Participants stated that when they stepped outside the comfort of their ethnic or racial group, they heard different perspectives from other students, increased their understanding of the content, and developed a stronger sense of community. Prior research also supports study groups and peer tutoring as helpful for ethnically and racially diverse nursing students (Amaro et al., 2006; Beacham et al., 2009; Dapremont, 2011; Nnedu, 2009; Wong et al., 2008). However, students in this study reported needing help with forming diverse study groups; faculty should assist with this and set guidelines for participation.

Gerald said some study groups were not helpful to him because they were poorly organized and he did not feel welcome. When he told the faculty that he needed help studying, he was told to join a study group but there was no group readily available and he lacked the knowledge of how to form one. Several other participants also wished they'd had assistance with and support in forming and organizing study groups. When this assistance was not offered, students simply studied the way they were accustomed to, usually alone.

The implication for nurse educators is that active involvement in organizing study groups benefits Black nursing students. Ethnically and racially diverse students will more readily participate in study groups if faculty set criteria for participation (such as assignments that need to be completed and the minimal number of times to meet), ask for volunteers, assign students to study groups based on learning needs, diversify the study groups, and serve as resources for students. Research confirms that when faculty become involved and provide guidance and encouragement, students are more likely to achieve academic success (Dapremont, 2011; Etowa, Foster, Vukic, Wittstock, & Youden, 2005; Gardner, 2005b; Higgins, 2005; Wong et al., 2008).

Several Black students stated that reading was not a regular practice for them during their nursing education, and for some it was nonexistent. They learned that not reading the course content jeopardized their success and later resulted in pressure to learn the course material as the class progressed. Once participants realized how important reading was to understanding the content, they began reading and reported having greater success in their courses. Reading was cited in a previous study as a factor in minority and disadvantaged students' retention in nursing (Nnedu, 2009). Nurse educators should encourage reading and develop early intervention programs. A study hall monitor program could help students read and assimilate the course content, which could enable them to meet academic deadlines as well as to come to class better prepared to master the information.

Finally, participants believed that using note cards helped them visually picture the concepts and learn course material and pass exams. This strategy became an effective way for participants to study no matter where they were. Faculty can reinforce that studying can occur whenever students have free time, wherever they are. The use of note cards helped participants retain information through repetitious review, and thus led to student success.

LIMITATIO NS AND RESEARCH NEEDS

A limitation of this study was that only a subsample of the study data was verified by another qualitative researcher, and one person did the primary coding. Also, the length of time each participant had been out of school at the time of their interview may have affected the accuracy of their recollections.

This study should be repeated in Hispanic, Asian, and male populations, which also have dismal representation in the nursing profession (USDHHS, Health Resources and Services Administration, 2010; NLN, 2010). Perhaps additional studies of current nursing school practices regarding diverse study groups would clarify some of the issues raised in this study. For example, the practices of schools that are highly successful at using diverse study groups could be examined to discover the structural and contextual factors that contribute to their success.

Additional research on nursing schools that produce exemplary graduates, regardless of race or gender, is also needed to explore the methods they use in the promotion of excellence. Schools known for harmony as well as excellence might offer other rich opportunities for research. This study could also be replicated in all-Black colleges to determine if these findings vary according to racial environment.

CONCLUSION

This study found that at the beginning of their nursing education, Black participants did not use strategies necessary for success, and some did not know how to develop them. This early lack of awareness resulted in struggling and a costly loss of time. Faculty can aid in Black nursing students' retention and success by developing prenursing programs that reinforce the evidence-based strategies identified in this study. In addition, ongoing support and follow-up from faculty could ensure that Black nursing students consistently utilize these strategies.

Nurse educators are called upon to develop early intervention programs that emphasize the value of having a daily study routine, participating in diverse study groups, reading the course content, and using note cards for reviewing information. Early, active involvement of faculty is needed. The key to Black nursing student success is early intervention that directs and guides students in the use of the evidence-based strategies identified by this study.

doi: 10.5480/11-563.1

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ABOUT TH E AUTHOR

Jill A. Dapremont, EdD, RN, is associate professor, University of Memphis/Loewenberg School of Nursing, Memphis, Tennessee. The author acknowledges two colleagues from the Loewenberg School of Nursing for their support while writing this manuscript: Joan Thomas, PhD, RN, associate professor, and Lin Zhan, PhD, RN, FAAN, dean and professor. For more information, write to Dr. Dapremont at [email protected].