Helping Nursing Students Succeed Through C.A.R.E.
Hispanics comprise approximately 17 percent of the total U.S. population (Stepler & Brown, 2016), but make up only 5 percent of registered nurses (U.S. Department of Health and Human Services, 2017). The Sullivan Commission (2004) studied the number of ethnic minority students in health care education programs and concluded, “To increase diversity in the health professions, the culture of health professions schools must change” (p. 3). The Commission went on to propose that
Colleges, universities, and health professions schools should support socio-economically disadvantaged college students who express an interest in the health professions, and provide these students with an array of support services, including mentoring, test-taking skills, counseling on application procedures, and interviewing skills. (p. 7)
Morton College, a Chicago-area Hispanic Serving Institution, has historically struggled with retention in its nursing program. Retention rates for the entire two-year program typically average close to 50 percent. Such high attrition has been attributed to several factors, including a high percentage of first-generation college students; students having difficulty balancing work, home life, and school; and a sink-or-swim mentality in the nursing program. In order to address these factors, the Morton College Nursing Program has developed the Compassionate All-Inclusive Retention Effort (C.A.R.E.) program. C.A.R.E. endeavors to increase nursing student retention as well as student academic success and board pass rates by integrating the same philosophies of caring from nursing practice into nursing education. By improving student retention in the nursing program, the college hopes to increase diversity in the profession by supporting Hispanic and other minority students in their aspirations to become nurses.
The C.A.R.E. Program
Nursing programs are tasked with teaching students how to help others during their greatest time of need. In the same regard, C.A.R.E. strives to create a culture of caring, a caring learning environment, and resources so that students feel supported as they progress through a rigorous nursing program. The four main tenets of the C.A.R.E. program are: (1) showing students that nursing program faculty and staff sincerely care about their success; (2) being patient and empathetic with students while still being firm on standards and expectations; (3) supporting students with interventions and resources inside and outside the classroom and clinical sites; and (4) believing that all students can succeed with the right effort and support.
Caring pedagogy is considered an evolutionary, transpersonal process that occurs in nursing education when instructors use teaching moments as caring occasions (Bevis & Watson, 1989). This philosophy is manifested through the incorporation of additional support programming, policy changes, and resources into the nursing program. Nursing students are initiated into C.A.R.E. the summer before the nursing program formally begins. At the beginning of August, incoming freshmen must attend a multi-day Boot Camp during which they meet the faculty and staff, get to know classmates, and review important information that will help them be successful during their first semester. Camp topics include APA-style paper writing, what to expect at clinical sessions, and time management. Students also have opportunities to work on their nursing math skills and health care vocabulary through workshops and online content. All students are required to meet with the nursing program Retention Specialist before the end of the summer to develop a relationship with this college contact and discuss any personal concerns.
Another key component of the C.A.R.E. program is that freshman nursing students are required to attend Freshman Seminars, at which students meet with the Retention Specialist in small groups on a weekly basis for the first six weeks of the first semester. During these seminars, the Retention Specialist teaches study skills and metacognitive strategies which are contextualized in the nursing content the students are learning. Freshman Seminars are modeled as Supplemental Instruction (SI). As McGuire (2006) states, “SI is an important mechanism for introducing students to the learning process, engaging them in collaborative learning activities, and providing a collegial environment that increases motivation to engage in learning” (p. 4). Following the Freshman Seminars, students may participate in optional SI opportunities as well as group test reviews and individual tutoring with the Nursing Tutor.
C.A.R.E. also includes intrusive interventions for struggling students. Students must abide by the Academic Success Policy, which stipulates that all students failing a test are required to meet with their instructor, the Retention Specialist, or the Nursing Tutor. Students demonstrating a pattern of low academic performance or the need for additional support are candidates for one-on-one coaching using the Assessment, Diagnosis, Planning, Implementation, and Evaluation (ADPIE) coaching model, which is based on the same process used by nurses to care for patients. The major principle behind this requirement is that academic coaching in a student’s educational career can lead to engagement, learning, retention, and increased probability of degree completion (Bettinger & Baker, 2011). Students are coached by the faculty member teaching the course or the Retention Specialist on a weekly basis on a theme of the student’s choosing. Students take the Learning and Study Strategies Inventory (LASSI) at the beginning of the coaching process to identify areas of strength and areas for growth. Students are also given a Nursing Student Learning Plan, which was created by a nursing faculty member specifically for Morton College students. The learning plan includes the coaching model, LASSI score form, test and study strategies, time management strategies, and self-care strategies. The student and coach work collaboratively to create a plan and, using accountability structures, the student reflects on its effectiveness. The learning plan is reviewed and revised according to the student’s weekly needs. In addition, students demonstrating low test performance are required to attend group reviews and summer programming.
In addition to the aforementioned programming and policies, all students have access to the Serenity Room, designated exclusively for promoting self-care. The room contains a zero gravity chair, weighted blanket, yoga cards, fountain, aromatherapy, and iPad with pre-programmed meditations. Students are welcome to use the space to focus before a test or to experiment with the items in the room to determine which tools work best for them. Additional student resources include open lab time, Director Talks with the Dean of Health Sciences, and the Nursing Student Resources website, which contains study tools and useful information for nursing students at all levels.
The first elements of the C.A.R.E. program were incorporated into the nursing program in January 2018. Since then, the program has continued to expand and evolve each semester.
The data indicate that the C.A.R.E. program has had a significant impact on nursing student retention, academic performance, and program culture. The cumulative first-semester retention rate for the four years prior to the implementation of C.A.R.E. was 80 percent. In fall 2019, the first-semester retention rate was 99 percent. These students had the benefit of Boot Camp, Freshman Seminars, and an intrusive Academic Success Policy. Second-semester retention rates—including repeating students—jumped from 77 percent in 2017 to 87 percent in 2018 and 98 percent in 2019, when the C.A.R.E. program was more fully developed.
The graduating class of 2019 included 69 percent of the students who began the program two years ago, resulting in the largest class of nursing graduates to date. This class did not receive the full benefit of the C.A.R.E. program’s implementation, since it was being created, developed, and tested during their time in the nursing program. Even so, a 69 percent retention rate is significantly better than the 50 percent average program retention rate of previous years. The two-year retention rate of next year’s graduating class, which has been a beneficiary of C.A.R.E. throughout the entire length of the nursing program, is projected to be at least 90 percent.
The data also show that the C.A.R.E. program had a positive effect on students’ academic performance. For example, over the four years preceding the implementation of C.A.R.E., 57 percent of students received an A or B in the eight-week Foundations of Nursing I course, the first course in the nursing program. Following the advent of C.A.R.E., 88 percent of students received an A or B in the same course. These students also performed higher than previous years on a standardized, norm-referenced test on fundamental nursing concepts given at the conclusion of the first semester.
Evidence suggests that the C.A.R.E program has contributed to a more positive nursing program culture. In a survey administered in May and June of 2019, 97 percent of the 106 freshman and sophomore students who responded indicated that they either agreed or strongly agreed that resources in the nursing program were available to meet their needs. In the same survey, 84 percent of students felt that the nursing program faculty and staff sincerely cared about their success in the program either “a great deal” or “a lot.” These percentages demonstrate that the students recognize the caring intention of the C.A.R.E. program and the accessibility of resources provided through this initiative.
Initially, there was some skepticism regarding how receptive students would be to the C.A.R.E. program. Some felt that students might formally complain about or even protest mandatory interventions and elect not to participate in optional ones. However, students have been overwhelmingly appreciative of the resources, a feeling they have expressed through their cooperation and participation. For example, initially, 39 of the 80 students (49 percent) registered for optional SI sessions for the spring 2019 semester, but by the end of this semester, 68 students (85 percent) had elected to attend at least one of these sessions. Participations in this optional initiative totaled 685. Such a high number indicates that students not only took advantage of, but also highly valued this resource.
This summer, a new program called Camp C.A.R.E. will be piloted. Camp C.A.R.E. is an optional three-day workshop for incoming freshman students which is intended to give them experience performing basic nursing skills and mastering health care vocabulary prior to the start of the program. In the coming academic year, C.A.R.E will be integrated into the Physical Therapist Assistant program at Morton College. In future years, the Health Sciences department hopes to incorporate C.A.R.E. program initiatives into prerequisite classes and to create C.A.R.E.-style transition initiatives for high school and adult education students interested in entering the health care field.
The initial success of C.A.R.E. suggests that the program’s philosophy and interventions are effective in increasing the number of Hispanic and other traditionally underserved student populations completing nursing education programs. The C.A.R.E. program continues to evolve as new opportunities arise, new faculty and staff join the department, and the data and feedback from the existing programming are evaluated.
Bettinger, E., & Baker, R. (2011). The effects of student coaching in college: An evaluation of randomized experiment in student mentoring. Manuscript submitted for publication. Retrieved from ed.stanford.edu/sites/default/files/bettinger_baker_030711.pdf
Bevis, E., & Watson, J. (1989). Toward a caring curriculum: A caring pedagogy for nursing. New York, NY: National League for Nursing.
McGuire, S. Y. (2006). The impact of supplemental instruction in teaching students how to learn. New Directions for Teaching and Learning, 2006(106), 3-10.
Stepler, R., & Brown, A. (2016). Statistical portrait of Hispanics in the United States. Retrieved from www.pewhispanic.org/2016/04/19/statistical-portrait-of-hispanics-in-the-united-states
Sullivan Commission, The. (2004). Missing persons: Minorities in the health professions, A report of the Sullivan Commission on Diversity in the Healthcare Workforce. Retrieved from www.aacnnursing.org/Portals/42/News/Sullivan-Report.pdf?ver=2017-07-11-143723-787
U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Workforce. (2017). Supply and demand projections for the nursing workforce 2014-2030. Retrieved from bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/NCHWA_HRSA_Nursing_Report.pdf
Lydia Falbo is Dean of Nursing and Health Sciences, Toula Kelikian is Nursing faculty, and Carolyn Markel is an Educational/Retention Specialist at Morton College in Cicero, Illinois.
Opinions expressed in Learning Abstracts are those of the author(s) and do not necessarily reflect those of the League for Innovation in the Community College.