Mentoring Nursing Career Pathways: The Maryvale High School Student Nurse Academy

INTRODUCTION

The issues surrounding the current nursing shortage have been widely documented. Buerhaus, Staiger, and Auerbach (2000) reported that the shortage will grow even more acute in the coming years, and the outlook is poor for recruitment of youth entering nursing. Joseph and Melick (2001) reported that the health care staffing shortage is the most significant problem affecting the industry today. Risk takers and progressive thinkers need to address this issue within a context that challenges the traditional educational paradigm and encourages innovation.

Joseph and Melick (2001) reported that 80–85% of the nation’s hospitals report a nurse shortage with an average vacancy rate of 10–12%. The prevailing thought is the shortage is not cyclical and therefore represents a long-term problem. If the nursing profession and the health care industry do not produce the future registered nurses (RNs) and other health care workers, they will forever be dealing with cyclical shortages and compromised quality of care.

A critical challenge is to attract new people to nursing and to attract the diversity necessary to meet the client needs. The following pilot study describes an after-school mentoring program that targets at-risk, minority inner-city high school youth for mentoring toward a career pathway of nursing. The concept is an example of a new paradigm that, over time, may help alleviate the chronic problem of shortages in health care professions. The nursing shortage did not occur over night and will require long-range planning, implementation of new strategies, and evaluation. The concept reported here has the potential to infuse the desperately needed cultural diversity in nursing by recruiting and mentoring minority students from Maryvale High School.

The 4-year Maryvale High School program is a collaborative partnership between the public school system, the community college system, public and private universities, and the hospital industry, with guidance from professional organizations such as the Arizona Nurse’s Association and Sigma Theta Tau. This descriptive study reports an initial evaluation of the program’s first year. The many goals of this program address the critical needs of individuals, communities, and the nursing profession; the goals are interrelated and have no rank in priority. Because of their intimate relationship, success in all strategic areas is necessary for optimal program success. Outcomes will be measured throughout the program to evaluate process and progress toward end objectives.

The mentoring project is to be dynamic and demonstratively meet the needs of the individual, school, community, and the associated health care organizations. It embodies the essence of attraction as described by McNamara and Roberts’ Model of Career Progression (q2000, the Arizona Hospital and Health-care Association). A matrix (Table 1) delineating the potential areas of study and defining the parameters for successful outcomes was created.

MENTORING

Bulstrode and Hunt (2000) identified various definitions of the term mentoring. The traditional term refers to the practice of senior management identifying young recruits that show promise and then grooming them for promotion. Nursing has traditionally used mentoring or preceptors to help the student nurse in the transition from the classroom and college environment to the realities of nursing practice. Mentoring is patronage and career guidance as provided by a tutor, role model, supporter, and friend.

Hurley and Lustbadder (1997) maintained that the comprehensive high school is an inhumane institution that does little to promote learning, trust, or caring. The impersonal nature of high school is difficult to overcome. However, creating a sense of belonging through a mentoring program can make a difference in the success or failure of a student. Templin, Engemann, and Doran (1999) found that mentors play a crucial role in affecting the learning and affect of the student. Buchanan (1999) identified a need for a structured mentoring program in nursing schools to address the challenges of the African American student. Pellman and Meyer (2000) report success with a mentoring program that focuses on educating 5th graders on nursing as a career. Nurses have successfully used mentoring across age groups to meet a variety of needs. Mentoring with a working professional can provide the appropriate intellectual stimulation, challenge, and academic rigor to create meaningful learning opportunities. Attraction to the nursing profession has a foundation in intellectual excitement.

Recruiting students who demonstrate the cognitive abilities to successfully accomplish secondary educational goals and enter an exciting profession can be difficult in an at-risk environment. Templin et al. (1999) found that mentoring programs have proven successful in assisting targeted populations in overcoming difficulties. Their mentoring program for high-achieving gifted students was successful in overcoming the challenges faced by this special population.

Hurley and Lustbadder (1997) reported that a triad of support from the family, school, and the community is necessary to engage students in the educational process. After discussing successful programs that targeted inner-city youth, a school-based mentoring program for middle school students was presented. They identified socioeconomic difficulties, safety issues, and the influence of neglect as challenges mentoring can address. The development of a strong positive relationship with a caring adult in the school correlates with the students’ perception of the school experience, their attitude toward school, and their achievement. Targeting at-risk minority youth in a socially and economically deprived environment will provide the support necessary to allow the student to avoid the pitfalls of teenage pregnancy, gang involvement, and dropping out. Mentoring intervention may mitigate the risk factors that when confronted daily can hinder academic achievement, healthy living, and self worth.

To varying degrees, people derive part of their identity and sense of self from the organizations or workgroups to which they belong. Indeed, for many people their professional and/or organizational identity maybe more pervasive and important than ascribed identities based on gender, age, ethnicity, race, or nationality. (Hogg, 2000, p. 1)

Hodgman (1999) reported success in a mentoring program that served Boston high schools and attracted minority students to nursing. The program was hospital based and recruited students from Boston area high schools. Assistance was provided in achieving school goals and included exposing the students to nursing through volunteer experiences. The program recruited the students as sophomores and began in the junior year. Of the 61 students who graduated from the program, 40 enrolled in a university with 36 choosing a nursing major. The recommendations from the program included establishing an ongoing presence in high schools and beginning the mentoring process with students as soon as possible.

Students can be easily derailed from a chosen career path or interest for any number of reasons. We found that students respond to the idea and structure of working toward a specific goal over time with others who are doing the same and with advisors who know the field and who support them when they falter. (Hodgman, 1999, p. 104)

Changing and challenging the students’ loyalties, expectations, and identities require a force of attraction that provides a clear goal for the future along with a tangible method of obtaining it. Comprehensive mentoring programs can accomplish the shift in loyalties that are essential to attract a student away from the pitfalls of the culture of poverty.

PROGRAM PURPOSE

The purpose of the mentoring program is to develop a self-perpetuating volunteer program that recruits at-risk, minority students into a career ladder of nursing. This program is a partnership involving Maryvale High School, Metro-Tech, Maricopa Community College District, Arizona Hospital and Health Care Association members, Grand Canyon University, Arizona State University, Hispanic Nurse’s Association, Black Nurse’s Association, Arizona Nurse’s Association, and local chapters of Sigma Theta Tau. The partnership focused around mentoring and formation of a year-round program to attract students to the nursing profession.

Learning opportunities emphasize hands-on activities, fieldtrips, after-school activities, volunteer time, continuing education programs, internships, and potential employment. Employment and college credits are the ultimate positive rewards of the mentoring program. After-school and summer programs are imperative.

The mentoring of students toward a career pathway in nursing is an ambitious long-range proposal that will have two effects. The first is to provide a pathway for nursing school recruitment. Current RNs in the field with various levels of knowledge, expertise, and practice act as mentors. The mentorship starts at the high school level, transitions to the college level, and terminates upon students’ employment as an RN. Mentorship will continue with Sigma Theta Tau and the Arizona Nurses Association after attainment of RN licensure.

The second goal is to stem the high school dropout rate by offering at-risk students the option of picking a career field in nursing and entering a mentoring program that will encourage them to achieve that goal. The program is targeted to begin in the 9th grade so that the students may develop a goal and relationship with a mentor at the start of the high school experience.

PROGRAM STRUCTURE

At the beginning of the academic school year, the freshman student population is shown a National Association of Student Nurses video titled Nursing: The Ultimate Adventure (Mancino & Sharrod, 2002). This film, extolling the virtues and rewards of the nursing profession, is presented during the freshman orientation as the first step in creating a sense of excitement and attraction for the nursing profession. At the end of the film, a panel consisting of RNs from diverse settings describes the varied practices and rewards, both tangible and emotional, of nursing. The students are then offered an application and invited to join the Maryvale High School Student Nurse Academy.

Interested students complete an application process, including an essay, transcript review, and personal interview. Acceptance into the program entails a contract for attendance in both the program and school. To remain in the program, the student must maintain a B average and have no more than five absences in the program per semester. Should the student be involved with criminal activity, such as violence or drug use, they are removed from the program.

During the school year, the program meets on Mondays and Thursdays. On Mondays, the program meets from 3 p.m. to 6 p.m. The first hour is devoted to tutoring so the students can get extra help in their academic classes. The remaining 2 hours is reserved for a guest speaker (Table 2). The speakers represent the community coalition and present a wide variety of nursing expertise, teaching essential skills for success. Education in confidentiality, infection control, conflict management, and social skills are also included. Conflict management includes crisis intervention training, anger management, assertive training, and negotiation skills. The mastery of these skills provides a foundation for the development of leadership skills. On Thursdays, the students volunteer at a local hospital from 3 p.m. to 8 p.m.

Maryvale is in the Phoenix Union High School District (PUHSD). PUHSD has 10 comprehensive high schools. Metro-Tech is a sister school. In addition to being a comprehensive high school, it houses a large vocational program for juniors and seniors that includes a health careers department. The curriculum in the health careers department includes health careers exploration and a certified nursing assistant (CNA) and licensed practical nurse (LPN) program.

As a junior, students are enrolled in the Metro-Tech CNA program. Completion of certified nursing assistant (CNA) course and becoming eligible for credentialing by the Arizona State Board of Nursing is the first concrete measurable milestone the program will demonstrate in adding to the workforce. Successful completion of the CNA credentialing process will allow the student to work in the profession in an entry-level position and determines eligibility to enter the LPN program. Successful completion of the LPN program in the senior year, combined with high school graduation and subsequent licensure, comprises the second milestone of measurement. This outcome demonstrates the program’s effectiveness in adding to the workforce.

Summer activities are essential to maintain student motivation to complete the program and maintain academic excellence. The summer component includes a summer camp at a local university nursing school and encouragement for volunteer hours. Summer volunteer time, scholastic achievement, and need will be considered when competing for scholarships. The maximum amount a student can earn toward the scholarship is $4,000, provided by the Arizona Hospital and Health Care Association. When students reach age 16, they enter an internship program and begin a work relationship with the hospitals.

To receive the scholarship, students must remain in the program, graduate on schedule, obtain CNA certification, pass the National Council Licensing Examination for Practical Nurses exam, and complete all the milestones as identified in the matrix (Table 1). In addition, students must adhere to all program rules and requirements, and the volunteer time must be authenticated. Remaining in the program will demonstrate the discipline and consistency necessary to be a professional nurse.

Summer camp addresses continuation of learning activities during the summer months for the students. This camp was sponsored by Grand Canyon University Samaritan College of Nursing and continues to provide students with exposure to nursing in a positive nurturing environment. The students slept in the dorms and were involved in nursing laboratory simulations, fieldtrips to local hospitals, and recreational activities. The students earned their cardiopulmonary resuscitation (CPR) card. Anecdotally, the students involved expressed a great deal of enthusiasm and excitement about the experience. “It was great” and “I really had fun” were comments frequently made to the staff.

The mentoring relationship continues throughout the educational period. Returning students are to be encouraged to mentor new students. The LPN senior students will assist in mentoring the freshman, thus creating a system that will continually create mentors from within.

PARTICIPANT PROFILE

Maryvale is an urban, primarily Hispanic, low-income neighborhood in the Phoenix metropolitan area. The school system uses data from the U.S. Department of Agriculture (USDA) to determine poverty in the school. The USDA provides funding to indigent families through the free and reduced school lunch and breakfast program. The income level set for funding is one of the benchmarks the school uses in determining services and programs for the community. In the PUHSD’s Annual Statistical Report (2000), an average of 43% of the Maryvale student body received free or reduced lunch. The dropout rate was 11%, and the 4-year graduation rate was 48.5%.

Over the past few years, Maryvale High School’s dropout rates have been declining; however, the graduation rate remains 48.5% (PUHSD, 2000). Many of the students are significantly below grade level as demonstrated by poor Stanford 9 test results (PUHSD). The current ethnic profile at MHS is Hispanic 71.2%, Anglo 14.8%, African American 10.7%, Native American 2%, and Asian 1.4%.

The drama of life in an inner-city high school unfolds each day; dropouts, pregnant 14-year-olds, minor illness, and injury are common issues for a school nurse. The primary health problems are assault and trauma; gunshot wounds, stabbings, and beatings are common. Much of this behavior results from despair and the posturing that accompanies denial of that despair. Maryvale High School sits in the middle of Maryvale police precinct. In the state of Arizona, Maryvale is among the busiest precincts, with a rate of violent and property crime second only to the Central City Precinct (Phoenix, 2000).

Many of Maryvale students come from a background not only of impoverishment but of neglect as well. The working poor are often too busy making ends meet to guide and parent their children through life effectively. The ills associated with poverty, such as alcoholism, drug abuse, and generational gang affiliation, is endemic to this area. Many of these students have been to multiple funerals for friends lost to gang activity, drug use, homicide, or suicide. These children, whether Caucasian, African American, Hispanic, Native American, or Asian, frequently relate a lack of hope for the future; many are planning to die before the age of 30. This is not an issue of color; these feelings are regularly expressed by all races and are manifested by the apathetic attitudes, poor school performance, nonattendance, and violence. For young men, the macho image is the only hope for status and self-esteem. They smoke and drink with their friends and “score” with the women. Motherhood becomes the means to status and self-esteem for women, so they have babies—early and often. They are all trapped by the poverty culture and have little hope of breaking free (Benson, 2000, p. 29).

Helping break the cycle of poverty will have a positive impact on all stakeholders and the community. As Benson (2000) stated, “The key to healthy communities is housing, jobs and education.” Chard and colleagues (2000) noted that the general educational level of students has a greater effect on family health than any other single factor. The nursing profession will profit by the diversity, cultural acuity, and bilingual ability of these students, whether they are men or women. Likewise, society will profit by having another avenue in which students may escape the culture of poverty.

FIRST YEAR RESULTS

Out of a group of 760 students, 100 young men and women showed an initial interest by requesting applications for the program. Six applications were completed, with one coming from a student who had not attended the assembly but was referred by a friend. The applications and the essay had commonalities. Each student stated that he or she wanted to take care of people and make a difference in people’s lives. Each wanted to be a registered nurse.

The program began with six freshman girls; all were Hispanic and bilingual. A tutor was obtained from the National Honor Society on campus to assist with the academic needs of the students. She was also Hispanic and bilingual and was in the Metro-Tech CNA course. The tutor was a senior in high school, so the program had the first on-site mentor. After Christmas, two girls asked to become part of the program so insistently that they were allowed to join. At the end of the year, the Maryvale Student Nurse Academy had nine participants.

All the participants in the program were Hispanic young women and were bilingual, with Spanish being the language spoken at home. All came from large families, with a mean number of family members at 6.55 (SD = 1.16). Among the participants, 67% had no computer at home, 56% had no health insurance, and 66% were participants in the USDA free and reduced lunch program.

The second measure of student interest and satisfaction was evaluated by four parameters: school grades, program guideline adherence, volunteer hours, and student ratings. The school results were significant; cumulative grade point average in the fall was 2.87 (SD = 0.53), and it was 3.21 (SD = 0.44) in the spring semester. Attendance in the program was documented. The students missed an average of 2 days (M = 2.22, SD = 1.61). The absence rate for the group was 3.5% (SD = 2.63). This compares with an absence rate of 11.1% for the school as a whole. Credit earned toward graduation was 6 (SD = 0.4), whereas the average number of credits earned for Maryvale students in their freshman year is 4.57. The dropout rate for freshman students is 6.7%; Student Nurse Academy students had no dropouts. The students volunteered at a hospital 4 hours per week (total for the year: M = 60.69, SD = 12.35). Program attendance and the volunteer hours were considered to be indicators of satisfaction with the program and attraction to the profession of nursing.

At the end of the academic year, the students were given a survey designed to measure their satisfaction with the program and their feelings about their volunteer experiences. The questions were answered on a 6-point Likert scale ranging from 0 to 5, with 0 being the negative end of the scale. The data indicated a high degree of satisfaction with the volunteer experience and indicated a strong desire among the students to become a registered nurse (Table 3).

Based on the first year outcome measures, the program has accomplished the identified goals and objectives. The students had a positive experience, and all indicated that they would return the next school year. Anecdotally, the Senior National Honor Society student who had served as the first mentor wrote a thank you note: “I just wanted to thank you for all the things you have done for me. The Nursing Academy was the best thing I did in all my high school years. Thank you for doing this not just from me but from all the girls.”

CONCLUSION

A comprehensive program was created that attracted students to nursing using a model designed to maximize chances for success. The nursing community was able to create a quality partnership that included the high school, Good Samaritan Medical Center, Phoenix College, Grand Canyon University, Arizona State University, Sigma Theta Tau, and committed volunteers. Each generously gave their time and money to the program. The collective efforts demonstrated success for the students of Maryvale High School Student Nurse Academy academically, socially, and emotionally.

As the program progresses into the second year, no substantial elements will change. The program will focus on attraction, creating enthusiasm, excitement, and a sense of hope. The objective of the students’ dreams to become an RN can be realized while shepherding them through high school. Because the students were bilingual, they were frequently asked to translate for Spanish-speaking patients in the hospital. A medical translation program element will be adopted. Learning to translate appropriately will increase the value of the program to participating hospitals and give the students another immediately marketable skill. The program will begin the recruitment process during in the registration when the high school counselors go to the various schools that feed 8th-grade students into the high school. The program will also continue to make inroads into the line staff at the hospital by attending staff meetings and educating staff RNs about the program and advising them with guidelines to increase the value of the student volunteer experiences.

A limitation of the study is its small sample size, making generalizations difficult. Also, ascertaining the element of attraction as an external force rather than an internal desire was not clearly differentiated. Clear motivating factors common to all participants derived from the data was the desire to be a nurse.

The program will continue to monitor the group and successive cohorts for milestone completion as delineated by the matrix. Additional efforts will be focused on the identification of common factors that motivate and influence this group to pursue the nursing profession and at what developmental point those characteristics manifest themselves. This information will be valuable in identifying key intervention points.

The program was successful from the perspective of students, school administration, and the nursing industry participants. Speakers uniformly reported satisfaction with their experience and committed to future volunteer time. The principal of Maryvale has expressed satisfaction with the program, allowing time for assemblies and donating space and transportation assistance to the program. Arizona Hospital and Health Care Association has supported the program by assisting in raising funds for scholarships and in helping to fund elements of the program.

Engaging the youth of our society in a mentoring program will allow the culture of the nursing profession to change. This proactive style of intervention will have many unforeseen consequences and, if done correctly, may undo some of the negativity currently found in the profession. The creation of a mentoring program is a good investment of time and money. It is imperative that hospitals and health care organizations begin to invest in workforce development. Without proactive workforce development, the future of nursing profession and the health care system is in doubt.