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American history celebrates Mary Eliza Mahoney as the first Black woman to become a licensed nurse in the US. Mahoney, the daughter of former slaves, was initially prohibited from attaining a formal nursing education. She worked in the New England Hospital for Women and Children for 15 years as a cook, janitor, washerwoman and eventually a nurse’s aide before receiving admission to the hospital’s nursing program.
She was the only Black student out of 42 entrants (according to hospital policy, the program could only admit one Black and Jewish student per cohort) and one of the only four to complete the 16-month program in 1869. For the next 50 years, Mahoney advocated for equitable nursing education and fought against discriminatory policies.
While institutional policies are less exclusionary, Black nursing students still face racial barriers to degree completion, only comprising 7% of registered nurses in the U.S. They have less access to education and job opportunities, creating rippling disparities in the quality of health care provided to Black and Brown communities.
The American Association of Colleges of Nursing (AACN) believes it’s time to reconcile the field’s sordid history of racism and prejudice. Using the Leading Across Multidimensional Perspectives (LAMP®) Culture and Climate Survey, the organization aims to improve diversity, inclusion and equity in college classrooms around the country.
“Nursing has an exclusionary past, and the climate survey will encourage administrators to look at their nursing program and examine what they’re doing to make students feel welcomed,” said Allyssa L. Harris, RN, PhD, WHNP-BC, Prairie View A&M University’s dean of the College of Nursing.
Identifying National Best Practices and Success Strategies
As the “national voice for academic nursing,” the AACN is partnering with Johnson & Johnson to fund the Building a Culture of Belonging in Academic Nursing initiative. The 18-month project will provide insight into the experiences of diverse student groups and improve how college faculty and staff approach “teaching, learning and professional engagement.”
When Dr. Harris received the call for the LAMP Survey, she knew PVAMU had to be a part of it. “There are many nursing colleges but very few HBCU nursing programs. This is an opportunity to step forward and say, ‘we’re here because what you’re doing, in diversity and equity, is important for everybody.’”
The LAMP Survey will measure fair treatment and observations of discrimination, belongingness, the value of diversity and inclusion, campus services and clinical training.
Participating colleges will receive an aggregated institutional-level report to help better understand how their classroom climate influences student achievement. The AACN will also use the data to define national benchmarks for change and growth strategies that improve student outcomes.
Of the 250 applicants, 50 schools from 28 states participated in the pilot. PVAMU will be the first HBCU included in the second administration of the LAMP survey.
“We will use the data to improve student engagement and success because we want students to feel like PVAMU is their home,” said Harris. “It is about expanding our nursing knowledge, science, research and involving faculty in national nursing health care priorities.”
Dismantling Racial Bias in Nursing Education
Black nurses have historically been the pinnacle of health care for African Americans. During slavery, they were “medicine women,” but before that, they were “healers” and “priestesses.” Without access to doctors, modern medicine and hospitals, these women birthed babies, healed the sick and provided herbal remedies that were even sought after by white families. Women like Harriet Tubman and Sojourner Truth are noted as abolitionists and Black revolutionary voices, but they were nurses too; Truth was a plantation aide, and Tubman was a Civil War nurse for Union soldiers.
Despite Black nurses’ contribution to the profession, they frequently encounter glass ceilings that prevent career acceleration and higher degree attainment. Many factors influence this outcome, including feeling overwhelmed during recruitment and receiving inadequate financial aid counseling, as 65% of African Americans are independent students, balancing their studies with work and family obligations. Yet, the lack of community and mentorship has the most impact on student progress.
For instance, students in a 2012 study expressed apprehension about approaching non-minority faculty, creating an isolated experience. “It’s hard enough as a young person to find your way and navigate the complexities of life. If you don’t fit in, it makes it even more challenging,” said Harris.
According to Vincent Tinto’s highly referenced student integration theory, social integration is necessary to increase student retention. When engaging their peers in course discussions and exchanging ideas, students feel valued in the classroom and a part of a larger team, making it easier to persevere and earn a degree.
“Nursing is a very challenging profession. It’s about giving and helping people, but it requires teamwork and engagement with stakeholders, patients and providers. When you feel like you don’t belong to the group, it’s hard to be comfortable and do your best job,” said Harris.
She believes peer bonding creates a learning environment that develops quality professionals. “Taking care of patients when they are sick and at their most vulnerable, you see things that you may never see anywhere else, and it bonds you together,” she said.
Negative Ramifications on the Quality of Black Patient Care
The hope is that the AACN’s initiative will help correct historical bias and shift the landscape for current and future nurses and, subsequently, their patients. The nursing profession’s exclusionary culture and practices start in the classroom but have an astronomical impact on the quality of Black patient care.
Black patients have the highest mortality and morbidity rates than other racial groups, but the level of care they receive from providers is the most influential to their health. A 2003 National Academy of Medicine report discovered that Black patients do not receive the same quality of care as their white counterparts even when insurance status, income, age and conditions’ severity are comparable. The report concluded that Black people were more likely to die from a chronic illness because of their race or lack of health care.
The reality is that nurses are exposed to the same negative narratives about Black people and may not be aware of their racial bias. In Dayna Bowen Matthew’s book, “Just Medicine: A Cure for Racial Inequality in American Health Care,” physicians completed the Implicit Association Test for racial bias. Most participants associated positive words with white faces and negative words with Black faces.
Dr. Harris believes that patients do much better when the people caring for them look like and advocate for them. “When you can trust your health care provider and that they understand you and the context of your life, then you’re more likely to give good information resulting in high quality, safe patient care,” she said.
Without equitable representation, Black patients are less likely to receive the most up-to-date evidence-based treatment modalities. They are less likely to receive appropriate cardiac care, kidney dialysis or transplants, or the best treatments for stroke, cancer and AIDS than their white counterparts. The outcome is higher infant mortality of Black babies, undiagnosed illness and poor pain management.
“And some of this is about access, lack of knowledge and the cost of health care,” said Harris. “If our ultimate goal is to reduce health disparities and improve health equity, then we need to educate diverse nurses. We will never accomplish that goal if there aren’t people who look like the population engaged in the profession. Some things are important for African Americans, but these things are important to all populations, and we’re advocating for all of those,” said Harris.
PVAMU’s College of Nursing is Raising the Bar and Providing a Sense of Belonging
Of the 105 HBCUs, PVAMU’s College of Nursing is only one of 36.
Fueled by the need for healthcare professionals, the sixth principal of PVAMU, J.G. Osborne, opened a hospital on campus, which led to the establishment of the first BSN program in 1918. It was the first nursing program west of the Mississippi to accept Black students. The initial class graduated five students in 1922, and from 1923-24 the hospital served more than 7,000 patients. Still, the early years were a challenge. The school didn’t have the latest technology, and faculty stood in the gap, providing hands-on instruction that continues to be the program’s hallmark.
The campus baccalaureate program debuted in 1952. Under the leadership and direction of the third President, Alvin I. Thomas, the nursing college evolved and joined the Texas of Medical Center in 1983. The program eventually added a Master of Science in 1999 and an MSN program in 2005. It was the first to introduce simulated instruction in 2003, allowing students to practice skills on mannequins and build confidence before they enter the field. The program finally expanded to include a Doctor of Nursing Practice (DNP) degree in 2014.
Today, students have 24-hour access to online libraries and resources, smart classrooms, laboratories and study and research facilities. They can also apply what they learned in internships and as a volunteer at local hospitals and clinics.
Dr. Harris says students may come to campus for the name and prestige but stay for the family and community. The program is more diverse than in previous years, with more than half of the student population from Vietnam, Cambodia, the Philippines and various African nations. But with 90% of the student enrollment identifying as African American, students have an opportunity to gain a new understanding of their Blackness and the breadth of the diaspora.
“When you are in a classroom with other students who look like you, you feel like you are more part of the group. We have a shared history and understanding. But it can be challenging for students when you’re the only one in the room,” Harris said.
The sense of belonging extends beyond the campus. It’s common to see PVAMU’s College of Nursing graduates working in hospitals and clinics throughout Texas. The extensive network creates an informal mentor-mentee relationship between seasoned nursing alums and recent graduates. For nurses new to the profession, having a trusted point person for questions and additional support is career-changing.
Alumna Denise Smith graduated in 1978 but still holds PVAMU close to her heart. She describes the program’s culture as one that encourages, equips and empowers students for a lifetime career in nursing.
Once a Student, Forever a Nurse
In its 100 years of service, the PVAMU College of Nursing has cultivated students in the spirit of helping others. Among the 42 schools in the Texas Medical Center, PVAMU has a reputation for developing prepared and courageous students.
Dr. Harris is a little over a year into her tenure, and she plans to make sure everyone in and outside of the state of Texas is familiar with PVAMU’s College of Nursing program’s prominence. “People know about Prairie View but don’t know our story, history and the excellent work that the faculty and students are doing here. I want people to understand we’re not just producing productive people, but the next generation of diverse nurse leaders,” she said.
Harris is looking forward to using the data from the LAMP survey to assess how PVAMU’s College of Nursing measures up against other institutions across the country and identify strategies for getting faculty and students more engaged at the national level.
“We want our students to step out, lean in and lead the nursing profession. We want them to advocate for change and to support and educate patients,” said Harris.
Source: Prairie View A&M University Newsdesk