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The ORIGINAL Diversity ARTICLES Imperative: Blackwell Malden, Nursing NUF XXX 1744-6198 0029-6473 Forum USA Publishing

Inc Strategies to Address a Diverse Nursing Workforce

The Diversity Imperative: Strategies to Address a Diverse Nursing Workforce

Joanne Noone, PhD, RN, FNP


TOPIC.

There has been a call to action for the need

to create a more diverse nursing workforce.


PURPOSE.

Joanne Noone, PhD, RN, FNP, is Assistant Professor of Nursing, Oregon Health and Science University, Ashland, OR. Introduction Nursing leaders at all levels are calling for a nursing workforce able to provide culturally competent care. Our commitment to social justice and the practical demands of the workplace call for nursing educators to take strong, sustained, and measurable actions to produce a workforce that more closely parallels the population it serves. Minority nurses are underrepresented in todays nursing workforce as compared to U.S. ethnicity demographics. The focus of this article is to provide an understanding of the efforts and successes that are occurring within schools of nursing in addressing the issue of increasing the diversity of the nursing workforce. Strategies that schools of nursing education can use to increase the recruitment, retention, and success of a diverse nursing student body will be reviewed.

The purpose of this article is to outline

and review strategies that schools of nursing education can use to increase the recruitment, retention, and success of a diverse nursing student body.
SOURCES OF INFORMATION.

A review of the

nursing literature was performed using CINAHL and hand-searching references. Abstracts were reviewed and articles included if the topic of the article referred to strategies to increase the diversity of nursing students.
CONCLUSIONS.

Minority nurses are underrepresented in todays nursing workforce as compared to U.S. ethnicity demographics.

A variety of strategies are being

used to address this issue. A multifaceted approach is recommended.


Search terms: Cultural diversity, nursing

education, nursing students

The 2000 National Sample Survey of Registered Nurse reports both a picture of encouragement and one that is cause for alarm when addressing ethnic demographics of the current nursing workforce (Spratly, Johnson, & Sochalski, 2000). Although the number of minority nurses has tripled from 1980 to 2000, increasing from 7% to 12% of the nursing population and is growing at a faster rate than the number of nonminority nurses, the percentage of minority nurses in the workforce lags far behind comparable
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(2008), The Author Journal Compilation (2008), Wiley Periodicals, Inc.

The Diversity Imperative: Strategies to Address a Diverse Nursing Workforce

U.S. ethnicity statistics. Minorities represent 30.9% of the U.S. population but only 12.3% of the nursing workforce. Preliminary findings from the 2004 National Sample Survey of Registered Nurses show a worsening picture, with ethnic representation in the nursing workforce dropping to 10.6% while the total U.S. ethnic population rose to 32% (U.S. Department of Health and Human Services, 2004). The report by the Sullivan Commission on Diversity in the Healthcare Workforce, sponsored by the W. K. Kellogg Foundation, also highlights a need for action and also addresses potential solutions (The Sullivan Commission, 2004). Although nursing is faring better than medicine and dentistry in its ethnic representation, the underrepresentation of ethnic groups in our profession is a call to action. The Sullivan Report collated reports of ethnicity from the three professions, focusing on African Americans, Hispanic Americans, and American Indians, which make up more than 25% of the U.S. population but only 9% of nurses, 6% of physicians, and 5% of dentists, respectively. Part of the problem may be related to the face of nursing education, where minorities make up less than 10% of baccalaureate nurse educators compared with 8.6% of dental school faculties, and only 4.2% of medical school faculties. There is also a concern that as the pool of qualified applicants to nursing programs rise and nursing schools contend with an ever-increasing applicant pool to screen, GPAs and SAT scores will be emphasized more as representing the most qualified applicants (Bellack, 2005). While many ethnically diverse students have excellent GPAs and SAT scores, ethnically diverse students are more likely to experience educational and economical challenges than their White counterparts, which may place them at a disadvantage if these scores are used exclusively or as a screening mechanism for applicants. Many nursing schools, however, are attempting to address the issue of diversity. In a survey of undergraduate schools of nursing in California, 48% of respondents were actively recruiting nursing students from diverse ethnic backgrounds (Martin-Holland, Bello-Jones,
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Shuman, Rutledge, & Sechrist, 2003). However, recruitment alone is not the answer. In a study of on-time completion, attrition, and NCLEX-RN first-time pass rates in California community college nursing programs (Seago & Spetz, 2005), both attrition and NCLEX-RN first-time pass rates were significantly impacted by ethnic diversity of the student body. Programs with a higher percentage of African American and Asian-non-Filipino students had higher attrition rates than the state average, while programs with a higher percentage of African American and Filipino students had lower first-time licensure pass rates compared with the state average.

Minorities represent 30.9% of the U.S. population but only 12.3% of the nursing workforce. Preliminary findings from the 2004 National Sample Survey of Registered Nurses show a worsening picture, with ethnic representation in the nursing workforce dropping to 10.6% while the total U.S. ethnic population rose to 32% (U.S. Department of Health and Human Services, 2004).

In order to identify strategies that nursing schools are using to address diversity in nursing education, a review of the nursing literature was performed using the database CINAHL, using a combined search of
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the terms Culture or Cultural Diversity with Nursing Education or Nursing Students, limited to the years 20002007. References of relevant articles were hand-searched. Abstracts were reviewed and articles included if the topic of the article referred to strategies to increase the diversity of nursing students. Strategies were grouped into categories representing the aim or focus of the strategy. Identifying Barriers Identifying perceived barriers and how they can be addressed is important to understanding issues related to retention of ethnically diverse students. Barriers identified from several studies of interviews with ethnically diverse students can be related to financial needs, academic needs, feeling isolated, and experiences with discrimination from faculty, peers, and patients (Amaro, Abriam-Yago, & Yoder, 2006; Evans, 2004; Gardner, 2005a; Taxis, 2006).

ethnically diverse students may have additional financial requirements and barriers. International students on student visas may have work restrictions, which may limit their income. International students may also be working to support themselves while attending school and also supporting extended family locally or back home (Gardner, 2005a). Compounding these needs is the concern that recent trends in financial aid awards tend to compensate merit over financial need applicants, which has a greater negative impact on ethnically diverse students (Bellack, 2005). Recommendations to assist with these concerns include maximal financial aid counseling and assistance. Attention should be paid to identifying scholarships that are targeted for ethnically diverse students. Isolation and Discrimination Ethnically diverse nursing students report feeling different and isolated from their White peers. In one study of Mexican American baccalaureate students (Taxis, 2006), the campus student nursing association was identified as an organization that was not welcoming to them and fostered isolation. Cultural differences may exacerbate a sense of isolation; for example, different modes of communication such as lack of assertiveness and difficulty with language and different customs such as alcohol use during social events. Being separated from family may also increase a sense of isolation. Although many nursing students may be separated from their family while at nursing school, this separation may be more isolating for ethnically diverse students because they are now surrounded by people who are very different from them (Evans, 2004). Discrimination may also be perceived by ethnically diverse students, from student peers, faculty and patients as well, which may worsen the sense of isolation (Amaro et al., 2006). Students reported overcoming these barriers through connecting with other ethnically diverse students either informally or via ethnic student associations.
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Barriers identified from several studies of interviews with ethnically diverse students can be related to financial needs, academic needs, feeling isolated, and experiences with discrimination from faculty, peers, and patients.

Financial Needs It is recognized that most nursing students have financial needs but it is important to realize that
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The Diversity Imperative: Strategies to Address a Diverse Nursing Workforce

Additional recommendations include mentoring of students by nursing faculty, particularly those of a similar ethnic background. However, since there is a lack of ethnically diverse nursing faculty as well, mentorship should be encouraged for all faculty. Ethnically diverse students identified helpful traits of faculty as being patient, approachable, available, and encouraging (Amaro et al., 2006; Gardner, 2005a).

In a survey of basic nursing textbooks, Spector (2000) identified that 93% of illustrations depicted Whites, 6% of illustrations depicted African Americans, and 1.4% portrayed Asian Americans, with

Since there is a lack of ethnically diverse nursing faculty as well, mentorship should be encouraged for all faculty.

no other ethnicities represented.

Academic Barriers Ethnically diverse students may be presented with additional academic barriers, particularly if English is not their first language. Although students may have conversational fluency in English, they may lack the academic language competency necessary to succeed as a nursing student (Newman & Williams, 2003). Students may require additional time to write papers, read texts, and take tests (Gardner, 2005a). A lecture may proceed too quickly to allow time for translation. Students may have difficulty with communication, including feeling comfortable expressing oneself in front of a group and using communication techniques that are not part of their culture. One example of this is assertive communication skills, which may be frowned upon as disrespectful in certain cultures: . . . in some cultures, it is considered rude to be assertive, ask questions of your teachers, or speak up for yourself (Amaro et al., 2006, p. 251), behaviors which are common expectations that nursing faculty in the United States have of nursing students. Ethnically diverse students may be more comfortable in learning environments where collaboration is emphasized over competition. Some strategies identified to counteract academic barriers include tutoring, particularly with English
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While nursing educators may be familiar with financial or isolation issues with minority students, there has been less focus on the more subtle aspects of discrimination and racial bias. Even within our nursing textbooks there is a distorted presentation of demographics, reinforcing the ethnic hegemony in nursing. In a survey of basic nursing textbooks, Spector (2000) identified that 93% of illustrations depicted Whites, 6% of illustrations depicted African Americans, and 1.4% portrayed Asian Americans, with no other ethnicities represented. In a thematic analysis of nursing fundamental textbooks addressing the presence of racial bias against African Americans (Byrne, 2001), evidence of racial bias was found in history, culture, and physical assessment sections. For example, White physical assessment findings were normalized, such as pink skin and silky hair. Nursing faculty need to be proactive about attending to such issues of discrimination. Gardner (2005b) provides an example of attending to subtle discrimination in the revision of a clinical dress code from requiring beige-colored pantyhose to flesh-colored ones.
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and assistance with writing papers. However, students may not even be aware that such services exist. Academic tutors of the same cultural background may be helpful. Study groups may also be of assistance to some students. Another recommendation is to foster group work during class time, which may help to facilitate learning for students who are more comfortable in a noncompetitive environment (Evans, 2004).

Ethnically diverse students may be more comfortable in learning environments where collaboration is emphasized over competition.

workforce issues in Oregon. One of its strategic goals is to increase minority representation in the nursing workforce (Oregon Center for Nursing, n.d.). Nationally, the Nursings Agenda for the Future is a strategic plan initiated by the American Nurses Association in 2002 and endorsed by more than 60 nursing organizations, including the National Black Nurses Association, the Philippine Nurses Association of America, and the Association of Black Nursing Faculty in Higher Education (Vital Signs, 2002). The plan outlines a vision for nursing in 2010. Diversity is one of the ten domains addressed, with recommendations made to increase the diversity of nursing students, nursing faculty, and members of various nursing organizations. Other objectives stress the need to develop programs and partnerships to address diversity issues and leadership development for culturally diverse nurses (American Nurses Association, 2002).

Strategic Planning It is important to identify if diversity or social justice issues are part of a schools strategic plan. In many instances, inclusion of this issue in the strategic plan may initiate action to develop programs to address the issue of diversity (Newman & Williams, 2003; Noone, Carmichael, Carmichael, & Chiba, 2007; Rosseter, 2002) for nursing students. Concerned nursing faculty may be sparked to action to address diversity issues by assessing community needs (Daumer & Britson, 2004) while others may initiate action if their school of nursing exists in an ethnically diverse environment (Bagnardi & Perkel, 2005; Labun, 2002). Action is also occurring on a state and national level. The California Strategic Planning Committee for Nursing (Martin-Holland et al., 2003) was formed to address state nursing workforce issues and formed a cultural diversity work group to focus attention on diversity issues. Formed in 2001, the Oregon Center for Nursing was established to address nursing
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. . . to reassess the schools strategic plan to identify if cultural diversity and social justice issues need to be incorporated into the plan and then transformed into action statements.

Recommendations for addressing this issue at the strategic planning level is to reassess the schools strategic plan to identify if cultural diversity and social justice issues need to be incorporated into the plan and then transformed into action statements. Consideration of social justice issues should not only be focused on the population nurses serve but threaded throughout the framework of the school of nursing, including nursing students and faculty. Identification of ways to
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The Diversity Imperative: Strategies to Address a Diverse Nursing Workforce

partner on a community or state level to address nursing workforce needs is also recommended, with maintaining a focus on addressing diversity as part of the spectrum of nursing workforce issues. Partnerships Forming partnerships with other agencies within the community may assist with strategies to recruit, prepare, and retain students. Potential partners will be identified in this section while discussion of specific initiatives aimed at recruitment, preparation, and retention strategies will be discussed in the respective sections below. Potential partners can include ethnic community associations, the public school system, employers, banks, foundations, and employment or workforce development programs. Local ethnic churches and community and nursing associations can be helpful partners in framing and understanding local issues impacting minority students, and their contribution may be essential in developing a successful initiative. They may also be a source of role models and mentors for students (Evans, 2004). Both local ethnic community associations and the public school systems can aid in recruitment strategies. The public school system may be an important link in developing strategies aimed at preparation of students for careers in science (Heller & Nichols, 2001). Local community or health foundations, local employers, banks, and employment or workforce programs may be sources of financial support for the program (Yates et al., 2003) or for establishing minority scholarships (Amos, Green, & McMurry, 2003). Local Area Health Education Centers (AHECs) and Health Education Training Centers (HETCs) may also be potential partners. Both AHECs and HETCs are federally funded programs designed to improve the health of underserved, underrepresented populations with focused initiatives on addressing healthcare workforce and diversity issues (National AHEC Organization, n.d.). A Medical Academy of Science and Health Camp offered to elementary through high school
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students to introduce students to health careers is one example of an initiative developed by AHECs. Other potential partners to consider are academic ones within or across colleges and universities. Partnerships between community colleges and universities can assist in complementing services such as remedial preparation or certified nurse assistant training. Resources within the university services may exist for assistance with evaluation and tutoring services for writing and testing, English as a Second Language assistance, and counseling services. Offices or programs that focus on international or minority students may help to provide perspectives, experiences, and resources for program development.

A Medical Academy of Science and Health Camp offered to elementary through high school students to introduce students to health careers is one example of an initiative developed by AHECs.

Recruitment Numerous strategies appear in the literature documenting efforts to recruit ethnically diverse students. Many recommendations focus on revising or creating brochures or posters to target the underrepresented groups. In 2001, the University of Maryland credited a 37% increase in applicants after a coordinated campaign, which included the use of a brochure that portrayed a diverse audience. In 2004, the Oregon Center for Nurses created a poster called Caring Knows No Boundaries portraying ethnically diverse nurses as a recruitment effort to attract
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Figure 1. Example of a Recruitment Poster Targeting Minorities

Examples of types of programs range from summer internships in which participants may attend clinical settings (Rosseter, 2002) to living on campus and attending camps which prepare students for college life as well as information on nursing (Stewart & Cleveland, 2003). An attractive strategy is to offer college credit while attending the camp (Daumer & Britson, 2004). Another summer program focused on college preparation and included certified nurse assistant training, with work-study assistance (Yates et al., 2003). Programs can alternately be held on the middle school or high school site. Cohorts of students can be identified and followed over time, such as the Pre-Nursing Academy created by the University of Maryland School of Nursing for high schools students interested in nursing (Heller & Nichols, 2001). Students participate in this academy throughout their high school years in preparation for college entry.

Reprinted with permission from Oregon Center for Nursing.

minorities into nursing (see Figure 1). Other resources for brochures and posters to help with recruitment may be found in Table 1. Reaching out to identified communities is another strategy to assist with recruitment of underrepresented students. In an effort to reach out to attract Native American students, one nursing school hired a Native American recruitment coordinator from a tribe within the local community (Rosseter, 2002). Places within the community to target recruitment efforts include Native American reservations, ethnic churches, ethnic employment centers or projects, and elementary through high schools with a high representation of diverse students (Labun, 2002; Rosseter). Personal visits to potential students by nursing faculty, admissions counselors, and current nursing students can assist in these recruitment efforts (Martin-Holland et al., 2003). Another strategy for recruitment is creating healthrelated programs or camps for middle or high school students to educate them about health-related careers (American Association of Colleges of Nursing, 2001).
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Another strategy for recruitment is creating health-related programs or camps for middle or high school students to educate students about health-related careers (American Association of Colleges of Nursing, 2001).

Preparation Many of the recruitment strategies discussed, such as health-related programs or camps, have the additional advantage of better preparing students for the rigors of nursing school and can occur before graduation from high school. Other strategies found in the literature
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The Diversity Imperative: Strategies to Address a Diverse Nursing Workforce

Table 1. Minority Recruitment Resources


Resource American Association of Colleges of Nursing Web site www.aacn.nche.edu/index.htm Information available Data on ethnicity of nursing school applicants Information on strategies on recruiting diverse students National strategic plan for nursing workforce 2010 Full report

American Nurses Association Nursings Agenda for the Future Institute of MedicineIn the Nations Compelling Interest: Ensuring Diversity in the Healthcare Workforce Johnson and Johnsons Campaign for Nursings Future Minority Nurse.com

www.nursingworld.org/naf/ www.iom.edu/CMS/3740/ 4888/18287.aspx

www.discovernursing.com/ www.minoritynurse.com

Diversity recruitment materials in English and Spanish Career and educational resources for minority nurses and students Information on strategies on recruiting diverse students Quarterly newsletter Full report

Missing Persons: Minorities in the Health Professions: A Report of the Sullivan Commission on Diversity in the Healthcare Workforce National Sample Survey of Registered Nurses

www.aacn.nche.edu/Media/ pdf/SullivanReport.pdf.

bhpr.hrsa.gov/healthworkforce/ reports/rnsurvey/default.htm bhpr.hrsa.gov/healthworkforce/ reports/rnpopulation/preliminary findings.htm www.nursesource.org www.oregoncenterfornursing.org

Survey data from 2000 with ethnicity breakdown Preliminary findings from 2004 survey

Nurses for a Healthier Tomorrow Oregon Center for Nursing

Diversity recruitment advertisements Diversity recruitment posters

include preadmission programs at the college level that can range from a summer bridge program to a 2-year pre-entry curriculum. Strategies were designed either for students who met and did not meet typical entry requirements. Common threads in preparation programs include a focus on professional and student success readiness. The Learning Achievement Program, a preparation and retention project, created by faculty from Barry University in Miami Shores, Florida (Bagnardi & Perkel, 2005), had a developmental
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summer bridge program for accepted students before they entered the nursing program. This 4-week bridge provided a comprehensive student assessment of motivation, social support, and abilities in mathematics, reading, and writing. Learning sessions were developed for these areas as well as for development of successful college and study skills in individual and group sessions. The bridge program culminated in an individual study plan for the student as he or she enters the nursing program.
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The faculty at Loma Linda University in California developed a recruitment, preparation, and retention program called Success in Learning: Individualized Pathway Program (Condon, 2007). One pre-entry quarter was part of this project, which included six nursing courses on the topics of successful study and test-taking skills; math, reading, and writing abilities; and an introduction to nursing and medical terminology. A nursing access program was developed by the nursing faculty at Red River College in Manitoba, Canada, for students of Native Canadian and other ethnic backgrounds (Labun, 2002). An additional 1-year program was developed prior to entry into the nursing program. This 1-year program consisted of general education nursing requirements as well as courses in successful professional and college readiness. Students who were successful in the first year were admitted into the nursing program and took successive professional and college readiness classes throughout the curriculum.

residents who were interested in nursing but underqualified, particularly in mathematics (Noone et al., 2007). This was a 2-year pre-entry program that included developmental courses, prerequisite courses, and general education requirements for the nursing program. Emphasis in the developmental courses was placed on communication, critical thinking, technology, research, and successful professional and student skills. Students were accepted into the nursing program if they completed the Academy for Future Nursing curriculum with a GPA of 2.75 or better. Retention Once students enter the nursing program, many strategies are apparent in the literature to enhance their success in the program. Some retention strategies are similar to preparation strategies discussed earlier, such as reviewing study and test-taking skills, particularly focusing more on NCLEX-style questions (Bagnardi & Perkel, 2005). Tutoring in English and nursing are common support mechanisms, with support staff available within the college or university to assist with writing and use of optional or required study groups as other strategies mentioned in the literature (Bagnardi & Perkel; Condon, 2007). The Learning Achievement Program had a learning coach, a registered nurse who provided review sessions for students three times a week (Bagnardi & Perkel). Many nursing programs use dedicated full- or part-time staff who may fulfill roles in recruitment and retention of diverse students as well as program coordination and advisor to faculty. Mentoring is another common thread in most programs with assignment of a counselor, nurse in the community, or faculty academic advisor to fill a role as mentor in supporting the student through the educational process (American Association of Colleges of Nursing, 2001; Gardner, 2005b). Mentors can be from the same ethnic background as the student (Condon). The use of peer mentors and support groups is another method that can provide student support (Martin-Holland et al., 2003; Valencia-Go, 2005).
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The Academy for Future Nurses was developed by the nursing faculty of Kauai Community College to address nursing workforce needs of community residents who were interested in nursing but underqualified, particularly in mathematics (Noone et al., 2007).

The Academy for Future Nurses was developed by the nursing faculty of Kauai Community College to address nursing workforce needs of community
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Figure 2. Bessents Model for Exemplary Strategies to Recruit, Retain, and Graduate Minority Students in Nursing

can occur for faculty (Labun, 2002) or for the larger nursing community, including students and faculty (Gardner, 2005b). A Comprehensive Approach A variety of resources are increasingly available to assist nursing faculty who are interested in developing programs to address diversity in nursing student enrollment (see Table 1). As is apparent in the literature, most programs to address diversity have developed a comprehensive approach. Bessent (1997) has developed a model for thinking comprehensively about strategies for recruiting, retaining, and graduating minority students to consider as faculty develops programs (see Figure 2). In this model, interested community members, students, faculty, and staff are integral to all aspects of recruitment, retention, and graduation. Nursing faculty interested in addressing nursing diversity workforce issues should consider such a comprehensive approach when developing such programs. Acknowledgment. The author would like to acknowledge Sharon Comden, DrPH, and Carol Craig, RN, FNP, PhD, for their helpful review of this article, and Heather Young RN, GNP, PhD, FAAN, and the other members of the Oregon Health Science University Rural Health Research Writing Group for their mentorship and motivation.
Author contact: noonej@ohsu.edu, with a copy to the Editor: nursingforum@gmail.com

Faculty development is another common strategy in the literature to assist them in working with students of diversity. Faculty seminars and workshops can focus on developing teaching strategies to address different learning styles (Valencia-Go, 2005) or can address issues such as racism and the development of cultural competency and sensitivity (Martin-Holland et al., 2003; Newman & Williams, 2003). Presentations by community representatives of ethnically diverse groups
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References
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Amos, E., Green, A., & McMurry, M. (2003). Using partnerships in developing a diverse RN workforce on the south plains of Texas. Texas Journal of Rural Health, 21(3), 27 38. Bagnardi, M., & Perkel, L. K. (2005). The learning achievement program: Fostering student cultural diversity. Nurse Educator, 30(1), 1720. Bellack, J. P. (2005). Threatening our diversity. Journal of Nursing Education, 44(5), 199 200. Bessent, H. (1997). Closing the gap: Generating opportunities for minority nurses in American health care. In Strategies for recruitment, retention and graduation of minority nurses in colleges of nursing (pp. 317). Washington, DC: American Nurses Publishing. Byrne, M. M. (2001). Uncovering racial bias in nursing fundamentals textbooks. Nursing and Health Care Perspectives, 22(6), 299 303. Condon, V. M. (2007). Success for disadvantaged and minority students: Retention, graduation and NCLEX-RN. Communicating Nursing Research, 40, 281. Daumer, R. D., & Britson, V. (2004). Wired for success: Stimulating excitement in nursing through a summer camp. Journal of Nursing Education, 43(3), 130 133. Evans, B. C. (2004). Application of the caring curriculum to education of Hispanic/Latino and American Indian nursing students. Journal of Nursing Education, 43(5), 219 228. Gardner, J. (2005a). Barriers influencing the success of racial and ethnic minority students in nursing programs. Journal of Transcultural Nursing, 16(2), 155162. Gardner, J. D. (2005b). A successful minority retention project. Journal of Nursing Education, 44(12), 566 568. Heller, B. R., & Nichols, M. A. (2001). Workforce development in nursing: Priming the pipeline. Nursing and Health Care Perspectives, 22(2), 7074. Labun, E. (2002). The Red River College model: Enhancing success of Native Canadian and other nursing students from disenfranchised groups. Journal of Transcultural Nursing, 13(4), 311317. Martin-Holland, J., Bello-Jones, T., Shuman, A., Rutledge, D. N., & Sechrist, K. R. (2003). Ensuring cultural diversity among California nurses. Journal of Nursing Education, 42(6), 245 248. National AHEC Organization. (n.d.). National area health education center organization homepage. Retrieved April 17, 2007, from http:/ / www.nationalahec.org/home/index.asp Newman, M., & Williams, J. (2003). Educating nurses in Rhode Island: A lot of diversity in a little place. Journal of Cultural Diversity, 10(3), 9195.

Noone, J., Carmichael, J., Carmichael, R. W., & Chiba, S. N. (2007). An organized pre-entry pathway to prepare a diverse nursing workforce. Journal of Nursing Education, 46(6), 287291. Oregon Center for Nursing. (n.d.). Oregon center for nursingAbout us. Retrieved February 24, 2007, from http:/ /www.oregoncenterfornursing.org/about.php Rosseter, R. (2002). Reshaping recruiting. Strategies for increasing diversity in academic nursing programs. AWHONN Lifelines, 6(3), 196197. Seago, J. A., & Spetz, J. (2005). Californias minority majority and the white face of nursing. Journal of Nursing Education, 44(12), 555 562. Spector, R. E. (2000). Presidents message: Nursing profession does not reflect the demographics of this nation. Journal of Transcultural Nursing, 11(3), 221222. Spratly, E., Johnson, A., & Sochalski, J. (2000). The registered nurse population: Findings from the national sample survey of registered nurses. Rockville, MD: U.S. Department of Health and Human Services. Retrieved January 15, 2007, from bhpr.hrsa.gov/healthworkforce/reports/rnsurvey/default.htm Stewart, S., & Cleveland, R. (2003). A pre-college program for culturally diverse high school students. Nurse Educator, 28(3), 107 110. The Sullivan Commission. (2004). Missing persons: Minorities in the health professions. Retrieved January 17, 2007, from www.aacn.nche.edu/ Media/pdf/SullivanReport.pdf Taxis, J. C. (2006). Fostering academic success of Mexican Americans in a BSN program: An educational imperative. International Journal of Nursing Education Scholarship, 3(1), 114. U.S. Department of Health and Human Services. (2004). The registered nurse population: National sample survey of registered nurses March 2004 preliminary findings. Retrieved July 2, 2008, from ftp:// ftp.hrsa.gov/bhpr/nursing/rnpopulation/theregisterednursepopulation.pdf Valencia-Go, G. (2005). Growth and access increase for nursing students: A retention and progression project. Journal of Cultural Diversity, 12(1), 1825. Vital Signs. (2002). Strategic plan for nursings future includes diversity on its agenda. Minority Nurse. Retrieved July 5, 2007, from http:/ /www.minoritynurse.com/vitalsigns/jan03-2.html Yates, S. H., Bline, K., Bird, C., Bresnahan, E., Couper-Noles, R., Cutler, S., et al. (2003). Start out: Building healthcare careers for minority teenagers. Journal of Continuing Education in Nursing, 34(3), 116121.

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