| Kara De La Fosse, Ed.D, MSN, BSN, PHN, RN, BS.Ed | Assistant Professor of Nursing at Minnesota State University, Mankato |
I have no known conflict of interest to disclose.
The global COVID-19 pandemic attributed to a mass exodus of nurse aides in the field leaving skilled nursing facilities crippled and desperately begging for qualified individuals to care for residents. This study examines the impact of a program designed to meet a shortage of nurse aids in Minnesota. The Next Generation Nursing Assistant (NGNA) initiative addressed barriers that had been preventing historically marginalized students from entering a nurse aide program. These barriers were related to program admission criteria, finances, and academic success. Utilizing strategies to address equity and empowerment, this program was successful in training a diverse group of students to enter the workforce to solve a real-world problem.
Key words: nurse aide, equity, inclusion, diversity, empowerment, success, higher education
The abrupt onset of the global pandemic influenced a mass exodus of nurse aides from the profession. Reasons for this included fear of the contagion, physical and mental exhaustion, insufficient personal protective equipment (PPE), inadequate staffing, and ethical dilemmas attributed to the growing phenomenon (Zhang et. al., 2019).
Two major factors prohibit historically marginalized and diverse students from getting into level allied health programs in higher education such as the nurse aide course. The first factor is financial considerations. This includes the cost of tuition, supplies, accessible transportation, and childcare as well as time away from work. The second factor is academic constraints.
To meet the growing demand for healthcare workers in Minnesota, the Next Generation Nursing Assistant (NGNA) initiative from the governor’s Federal American Recovery Plan was implemented. The hope was to remove financial and academic barriers for aspiring healthcare professionals. Historically, students enrolling in the nurse aide courses paid $1,300.00 for tuition plus books. To qualify for admission into the course, students were required to demonstrate competency on reading and comprehension exams. Students not meeting the benchmarks were not permitted to enroll in the course. The NGNA enabled all students to enter the course without pre-screening providing opportunities previously denied to many. To embrace equity, the course was offered free of charge. Students could enroll without worrying about how to pay tuition and just focus on learning the material. Offering equitable and inclusive learning.
The purpose of this qualitative phenomenological study was to explore the lived experiences of participants enrolled in a state-wide implementation of the Next Generation Nursing Assistant in Minnesota.
What are students’ perspectives on the next-generation nurse aide program design?
Nurse aides are responsible for over 80% of direct patient care in long-term care facilities; however, shortages have magnified since the onset of the pandemic observed globally (Castle et al., 2020). Disruption of adequate staffing in the healthcare profession has challenged long-term care facilities to remain nimble and innovative in order to persevere operationally and care for residents.
Innovation was necessary to mitigate the disruption of safe patient care at nursing establishments. Thus, a state-wide initiative funded by the Federal American Recovery Plan was implemented by Governor Tim Walz. The goal was to train 1,000 nurse aides within three months in order to mitigate attrition and replenish essential workers.
A phenomenological approach to inquiry positions the researcher to focus on individual experiences and interpretation of the phenomena. The purpose of this qualitative study was to examine the perspectives of faculty and students in a nurse aide program. The focus here was on faculty and students at a university offering next-generation nurse aide courses. Participants shared their perspectives, analysis, and involvement from their own lived experiences (Shafiei, et. al., 2019).
Data were collected using Qualtrics surveys that included open-ended and Likert-style questions. The open-ended questions enabled participants to freely share their experiences and thoughts without the constraints of pre-determined scales (Creswell & Creswell, 2018). Semi-structured interviews also provided feedback that enabled a deeper understanding of the experiences encountered. These data enabled me to observe the phenomenon through the participant’s view. The triangulation of these multiple data helped me determine emergent themes in the analysis phase of the study as well as lending credibility to my conclusions (Patton, 2016).
This study was conducted during the summer semester with students earning certification for the nurse aide registry. The University is part of the Minnesota State University and College system encompassing 26 state colleges and 7 universities. The University serves more than 14,000 students. The student population includes 1,300 international students from over 90 countries. Nearly 1,600 faculty and staff lead the educational arena, and over 90% hold a terminal degree. The city of the university was founded in 1852 and has a population of over 59,000 people near a national park and a major medical facility. It is approximately 80 miles from the state’s capitol making it a prime location for the recruitment of students and faculty and operates two satellite campuses. The university offers 27 certificates, 59 bachelor’s degrees, 69 master’s degrees, and 4 doctoral degrees.
Purposeful sampling was utilized to obtain student perceptions of their experience enrolled in the Next-Generation Nurse Aide program. The total number of students trained during this initiative was 300. Not all students participated and responded to the survey. There were 200 willing to participate, and share lived experiences. Students enrolled in the program were diverse in race, ethnicity, gender, marital status, having children, working full-time, part-time, and being unemployed. Students enrolled also resided in multiple states, Minnesota, Iowa, North Dakota, and South Dakota. Participants were predominately female, single and had no children. The majority worked full-time and were in their 20’2-30’s. Most impressive was the diversity of race and ethnicity, almost equivalent with Caucasian and African American. Most impressive was the unity among peers and genuine concern for the cohort to succeed collectively without consideration to differences.
Disruption in education amidst the global pandemic demanded a reevaluation of course delivery to mitigate impediments and promote course/program completion post-pandemic. Online learning modules enabled faculty and students to advance at their own pace while demonstrating competency and mastering learning outcomes. Students are also able to participate from any geographical location and customize the completion of modules within deadline demands (Castro & Tumibay, 2019).
Online and face-to-face learning are comparable in terms of student satisfaction, optimal learning outcomes, and effectiveness of problem-based learning. However, online learning must be carefully designed to avoid feelings of isolation and encompass adequate support for users who may be experiencing difficulty navigating the platform. Establishing a sense of community to extend support to participants is important as well as prompt feedback, clear expectations, and structured course design with flexible deadlines (Castro & Tumibay, 2019).
Some students have found that online learning promoted increased accountability for their education and thus, provided motivation for completion (Sit et al., 2005). Supporting students’ online learning experiences can enable students to develop the confidence necessary to contend with academic barriers (Ali, 2020). Additional benefits of distance learning include enhanced performance, mitigating decreased obstacles with attending class in person, convenience for enrollment, and heightened self-esteem (Yan et. al., 2021).
Allied health programs demand a certain level of skills proficiency before students advance into the clinical setting caring for real patients. Toward this end, online learning opportunities such as virtual simulation and learning modules are used to prepare students for complex nursing scenarios when extending care to patients (Coyne et. al., 2021). Students are also able to advance through content areas in which they may demonstrate weakness. This prepares them for mastery of content and increases confidence levels. Robust debriefing after students have completed online learning experiences expands learning and establishes a sense of community in the cohort (Esposito, 2020).
This study is underpinned by the empowerment theory aimed to provide personal and interpersonal power to enhance livelihoods and mitigate opposing forces (Zimmerman, 2000). Viewing the next-generation nurse aide training through the lens of Zimmerman’s empowerment theory allowed for identifying barriers to equity and inclusion for optimal outcomes for all participants. Academic and financial barriers were notably the most prominent for students that were eliminated during this initiative.
The most prominent factors were based on financial and academic constraints. The cost of tuition, supplies, accessible transportation, childcare, time away from work, and lack of student support were most often expressed as reasons why individuals were not able to enroll in the program. Academic benchmarks identified for student success regarding reading and comprehension ability were not obtainable predominately by English second language (ESL) students. Ultimately, labeling them as unlikely for excelling in this profession based on the need for stellar verbal and written communication skills. The next-generation initiative removed reading and comprehension screening before granting permission to enroll in the course. Eliminating discriminatory screening permits students, the opportunity to enroll in the program with equal opportunity to reach their desired educational goals. Offering the course and national certification examination at no cost facilitates equity and inclusion for students contending with financial limitations. Providing monetary student support offsets travel expenses and is a resource to pay for the internet service necessary to complete the program. Finally, equipping students with medical scrubs attire promotes a seamless transition from the classroom to industry.
Empowerment is crucial for marginalized individuals to possess adeptness over problems of apprehension for them, as evidenced by racial and ethnic minority students enrolled in this program (Keys, 2019). Higher education aims to lessen equity gaps and disparities promoting equal opportunity for academic success. Honoring the empowerment theory in academe produces stellar scholars and members of society able to thrive and continually reach higher aspirations and lifelong goals.
The findings in this study emphasize the constructs of the empowerment theory. The next-generation initiative allowed students to participate in a college-level program historically denied to them. Removing the criterion that pre-determined students would be unsuccessful in the course was paramount. Students defied the odds of failure in the program exemplifying equitable opportunity must be extended moving forward. Additionally, the successful completion of the nurse aide program augmented self-esteem and confidence levels. Students began to share aspirations of more advanced medical degrees previously viewed as unobtainable. Empowerment from unwavering support proved monumental in taking the next steps to increase skill set, knowledge, and more advanced career goals. Extending equitable opportunities inspired students to remain devoted to the learning process and mastering the content. Empowering students to be successful demands extending grace, flexibility, and compassion.
Responses from the Likert and open-ended questions yielded two emergent themes from participant feedback.
Flexibility emerged as a recurrent theme in survey responses. Students articulated the overwhelming desire to have lenient due dates to complete coursework around their work and family obligations. One hundred percent of the respondents stated that flexibility enabled course completion. Further supporting this emergent theme, students identified past barriers contributing to attrition when flexibility was not an option. Figure 1 contains the survey questions associated with the flexibility theme.
Flexibility with learning mitigates attrition and promotes competency. Survey responses illustrating this include the following:
“The predominately online format afforded me the ability to complete the program living three hours away from the training site.”
“The online modality enabled me to complete studies around family and job commitments\ldots and to learn at my own pace.”
“I would not have been able to complete the course if it were solely in-person.”
“Having small children and working full-time, I was able to complete assignments and coursework around the time that worked for me. This permitted me to finally complete a nurse aide course.”
Survey responses regarding empowerment exemplify the significance of supporting students in entry-level courses to build self-esteem and belief in themselves to matriculate into advanced programs. Respondents exemplified that the course afforded motivation to continue learning and return to the classroom as non-traditional students. Within the open-ended survey portion, numerous respondents shared that although initially seeking just certification on the nurse aide registry upon course completion their goals were higher. Successful completion of this course provided motivation and persistence initially lacking. Figure 2 contains the questions associated with this theme.
Empowerment from entry-level courses contributed to the pursuit of advanced degrees. Survey responses illustrating this include the following:
“This program motivated me to enter nursing school.”
“I did not think I was smart enough\ldots my passion grew from this class and now I am applying for medical school.”
“It has been 20 years since I was in college. Completing this course showed me I am not too old to return to be a nurse I have always dreamed about.”
“Now that I passed this course, I am enrolling in the medication aide course to obtain more credentials.”
The findings here support the need to extend equitable opportunities for all students to pursue desired academic paths. Pre-determining student success is an unacceptable barrier that needs to be mitigated. This means we must continually evaluate and re-evaluation of program admittance criteria in order to achieve equitable outcomes. Students who were typically turned away from traditional nurse aide programs were welcomed in the Next Generation cohorts. While they were not strong candidates initially, they demonstrated the ability to succeed. The overarching message is to remain innovative when removing barriers and building bridges to address the diversity of students and provide equality.
Based on the findings of this phenomenological study, the following recommendations are suggested:
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This work is licensed under CC BY-NC-SA 4.0
ISSN: 2995-648X
DOI: https://doi.org/10.62889/2023/KDLF1203
eLocator: e1203
De La Fosse, Kara. (2023). Equity and Inclusion for Nurse Aide Students: Removing Barriers to Empower Academic Excellence. Journal of Equity and Social Justice in Higher Education, 2. https://doi.org/10.62889/2023/kdlf1203