Many nursing school officials are interested in increasing the diversity of their student bodies, but do the “pipeline programs” that aim to do that actually work?
The answer is ‘Yes...but,’ according to a new study by J. Margo Brooks Carthon, PhD, APRN, an assistant professor of nursing at the University of Pennsylvania School of Nursing. Brooks Carthon is an alumnus of the Robert Wood Johnson Foundation (RWJF) New Connections program (2011) and an RWJF Nurse Faculty Scholar (2013-2016). The study was primarily funded by the RWJF New Connections program.
Significantly more Latino and Asian students enrolled in nursing schools with pipeline programs than in schools without pipeline programs between 2008 and 2012, the study found. And significantly more Latino students graduated from schools with pipeline programs than from schools without such programs during that period. The enrollment of Black students at schools without pipeline programs significantly decreased, while enrollment of Black students at schools with pipeline programs remained stable during the same time period.
“Diversity programs are meeting their primary goal, which is to increase underrepresented minorities in nursing,” Brooks Carthon said.
There is a major caveat, though. Enrollment among Native American and Alaskan Indian students decreased at schools with pipeline programs during those years. And graduation rates among Black students actually dropped at a higher rate at schools with pipeline programs than at schools without pipeline programs.
The reasons for this are unclear, Brooks Carthon said. Some minorities encounter barriers to graduation due to academic under-preparation in the areas of math and science, and some experience unwelcoming institutional climates. Pipeline programs aim to help minorities overcome these and other barriers with a wide range of services including academic and psychosocial support, mentoring, and financial aid.
Effects of Economic Downturn
But the recent recession may have overwhelmed some students, particularly those who are members of underrepresented minority communities, Brooks Carthon said, noting that economic downturns have a disproportionate effect on the Black community. Black students were also hit by funding cuts to historically black colleges and universities (HBCUs), reduced funding for federal student loan programs, and increased college tuition rates, she said.
The findings speak to the need for more targeted support for Black and other minority students, such as Native Hawaiian and Pacific Island students, who also saw downward graduation trends, Brooks Carthon said. “As nursing educators, we must be mindful of external contextual factors that compete with minority students’ ability to do what they need to do to graduate.”
For the study, Brooks Carthon surveyed 164 nursing schools with and without pipeline diversity programs. Published online in April in Nursing Outlook, it is the first study to evaluate nursing school-based diversity initiatives on a nationwide scale.
Minorities comprise about one-quarter of the nursing workforce but one-third of the nation’s population, a share that is projected to grow quickly in the coming decades, according to the U.S. Census Bureau. A more diverse nursing workforce can narrow cultural and linguistic gaps between patients and providers, improve patient satisfaction, and increase access to and utilization of health care services, Brooks Carthon said. A more diverse nursing workforce is urgently needed now, as more minorities enter the health care system under health care reform.
“We have a mandate to provide culturally competent care,” Brooks Carthon said. “This is not to say that minority groups must be treated by minority providers. But when students learn in diverse classrooms, they learn from one another, and patients benefit.”
The study revealed no single attribute of pipeline programs that effectively boosts diversity in all nursing schools. “One size does not fit all,” Brooks Carthon said. The most effective diversity programs, she said, customized their services to meet the unique needs of their individual student bodies.
View an infographic on Brooks Carthon's research.
Read the study.