Diversity, Frontline Nurses, Nursing Education, Health System Partnership, Nontraditional Students



  1. Atkins, Robert L.
  2. Estrada, Erik Juan Jose
  3. Hagerman, Diane
  4. Ellis, Milton R.
  5. Wilson, Randall
  6. Maguire, Patricia


Abstract: In July 2014, New Jersey Health Initiatives, a statewide grant-making program of the Robert Wood Johnson Foundation, funded five higher education-health care system partnerships to develop and implement innovative models supporting frontline health care workers aspiring to become baccalaureate-prepared nurses. Discussed in this brief are achievements from the first year of the initiative. The innovative supports include mentoring, tutoring, and policy changes designed to address the academic, financial, and psychosocial challenges faced by adult learners. The potential impact of this initiative on the nursing shortage and increasing cultural diversity are discussed.


Article Content

The US Bureau of Labor Statistics estimates that more than one million new registered nurses will be needed by 2022 (2013). The landmark Institute of Medicine Future of Nursing report calls for 80 percent of all nurses in the United States to have at least a baccalaureate degree (BSN) by 2020. The report also supports greater student diversity to create a workforce prepared to meet the demands of diverse populations across the lifespan.


As the statewide grant-making program of the Robert Wood Johnson Foundation, the New Jersey Health Initiatives (NJHI) has advanced the foundation's mission by promoting the dissemination of health innovations and the strengthening of institutions and organizations dedicated to improving health in New Jersey communities. Through the New Paths to Professional Nursing initiative, NJHI is addressing the future nursing shortage by supporting the development and implementation of programs to prepare frontline health care workers from underrepresented communities to matriculate into BSN programs within the state.


Another goal is to increase the diversity and cultural competency of the nursing workforce and elevate entry-level educational preparation as called for by the IOM (2011) report. Evidence suggests that frontline health care workers, who tend to be adult learners from disadvantaged communities, are likely to face significant challenges that can hinder their success in the college environment (Dill, Morgan, & Kalleberg, 2012; McDonnell & Soricone, 2014). These challenges include inadequate academic preparation related to experience in low-performing secondary educational systems; limited access to help in preparing for, applying to, and being successful in college environments; family and work obligations; and limited financial resources.



In July 2014, five higher education-health care system partnerships, led by Caldwell University, Camden County College, Rutgers University School of Nursing-Camden, Robert Wood Johnson University Hospital, and Union County College, were awarded two-year, $250,000 grants totaling $1.25 million in funding from NJHI. These partnerships provide the financial, academic, and psychosocial supports that assist frontline health care workers to complete the course work required for admission to BSN programs.


The New Paths grantees also received support from Jobs for the Future (JFF), a nonprofit workforce consultant group that provides technical assistance to maximize the success of education and workforce development projects targeting adults from vulnerable communities. JFF tracks the progress of grantees through monthly conference calls and biannual site visits. Following is a summary of the successes achieved after the first year of this two-year initiative.


Program Participants

Although each of the grantees developed its own process for recruiting and selecting students to be eligible for inclusion in the program, potential participants had to be an employee in good standing at one of the participating health care systems. Across each project, participants were selected based on their supervisor's recommendation, the strength of their interview, and previous academic background.


The level of interest in this program exceeded expectations. Nearly 200 aspiring students were interviewed, and 48 students were enrolled in the programs. Most were unlicensed assistive personnel (nursing assistants, unit secretaries, and patient transporters); one of the grantees targeted licensed practical nurses. The majority of students were women between the ages of 25 and 40 from diverse racial and ethnic backgrounds, with some college credits completed. Most students balanced family obligations with going to school and working full-time and had stressors around paying bills. Several faced additional personal pressures that included cases of domestic abuse, substance abuse by family members, and the threat of home foreclosure.



The innovations designed to improve the success of students benefited from the conversations among project partners as they developed their proposals and engaged with each other during organized peer-learning events.



Student retention and success greatly depend on keeping motivation and confidence high. All partnerships implemented some form of mentoring, advising, tutoring, and coaching supports specifically designed to conform to both the academic and personal needs of students. Robert Wood Johnson University Hospital grantees sought to improve retention efforts by utilizing experienced nurses to serve as mentors to model the nursing role and encourage nursing students. One partnership employed a Nursing Education Navigator to function as a holistic case manager; all partnerships have staff providing this type of support to students. Many also employ a cohort model and deliver group workshops to foster peer support.



Academic supports and modifications support student success. For examples, tutors meet with students at the workplace before and after the students' shifts. Classes and meetings at Rutgers University are scheduled on the same day of the week. Intensive tutoring by faculty in selected subtopics helps students avoid having to enroll in remedial courses, speeding their progress into nursing candidacy.


Caldwell University attributed participant retention to assessment and focused tutoring in place of non-credit-earning developmental courses. Another partnership includes a foundational year that allows students to develop the math, writing, and technical skills they will need in nursing school.


Innovative policy changes at a systems level allow for more flexibility in transferring prior college credits, which saves students time and money. Another acceleration strategy is curriculum design to eliminate some requirements between an associate degree program and a BSN program.



One of the ways the partners support students under this initiative has been to alter their tuition assistance policies to better meet the needs of their student employees. Many students are not able to take advantage of tuition reimbursement benefits because tuition must be paid upfront, and frontline employees typically do not have enough money saved to be able to pay this out-of-pocket cost. Two partners are revising policies to allow employees to receive their tuition support.


The health care system partners found other ways to reduce financial barriers. For example, to save students the expense of buying textbooks, a librarian purchased required textbooks with library funds and allowed students to borrow the books as needed.



The aspiring nursing students served by this initiative have an array of challenges. It is therefore noteworthy that 44 of the original 48 students completed the first year. We believe the innovations developed and implemented in the first year of this initiative contributed to their success and retention. We look forward to the innovative supports implemented in the second year to support the needs of these future nursing professionals.


Over the long term, the New Paths to Professional Nursing initiative has the potential to stimulate collaboration between health care systems, community colleges, and universities as they develop and test new, more realistic models of delivering education to adult learners and working students. The design of this initiative includes a peer-learning component that allows grantees to share their challenges and learning with each other, as well as the larger community.


Cultural Diversity

All of the grantees and their partners have acknowledged that educating and employing a health care workforce with the attitudes, knowledge, and skills necessary to provide quality care to diverse populations is critically important to reducing health disparities. Although a growing number of policymakers and educators have sought to improve cultural competency by revising curricula for health professional students and those in the health care workforce, there is a growing awareness that greater efforts are needed to promote diversity. A strong association has been established between a culturally diverse nursing workforce and the ability to provide quality, culturally competent patient care (IOM, 2002).


BSN-Prepared Nurses

While 50 percent of the nursing workforce is prepared at the BSN level, research has shown that patients who receive care in hospitals that have more BSN-prepared nurses have less morbidity/mortality, experience fewer medical errors, and have better care outcomes (American Association of Colleges of Nursing, 2012; National League for Nursing, 2016). The New Paths to Professional Nursing initiative has the potential to improve the health and well-being of individuals from disadvantaged backgrounds as they take advantage of the new educational and career paths that become available to them as health care professionals in nursing.


The initiative also opens up a traditionally untapped recruiting source, frontline health care workers from disadvantaged communities who are proving that they can be successful in higher education programs and an asset to enriching classroom discussion and learning. Our hope is that these new pathways increase access to BSN programs for bright, committed, and compassionate individuals from communities where secondary educational systems are chronically underperforming and college attendance is rare.




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Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press. [Context Link]


McDonnell R. P., & Soricone L. (2014). Promoting persistence through comprehensive student supports. Boston, MA: Jobs for the Future. [Context Link]


National League for Nursing. (2016). Achieving diversity and meaningful inclusion in nursing education [NLN Vison Series]. Retrieved from[Context Link]


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