Retention strategies for ESL nursing students: Review of literature 1900-99 and strategies and outcomes in a small private School of Nursing with limited funding

Journal of Multicultural Nursing & Health, Summer 2000 by Klisch, Mary Lou

As our nation rapidly diversifies, the need to increase the numbers of culturally diverse nurses is paramount. However, attrition of nursing students from underrepresented groups, especially those who speak English as a second language (ESL), remains problematically high. Numerous schools have implemented a wide variety of retention strategies for ESL students, nevertheless these have tended to be large state schools with access to state and federal funding. Retention strategies are time and labor-intensive. How can small, private schools with no or limited access to financial funding for such endeavors implement retention measures? This article provides a literature review of all 1990-1999 nursing articles on the topic of retention strategies for ESL nursing students, and describes ESL retention strategies that were implemented at a small private school that had limited funding. Outcome measures reported include graduation and NCLEX pass rates and a Student Satisfaction Survey.

KEY WORDS: English as a Second Language, Nursing Students, ESL, Outcome Measures, Retention Strategies.

The rapid and growing diversification of our nation and the need for diversification in the nursing profession have received increased attention in professional nursing literature in recent years. Today it is nearly impossible to pick up a nursing journal that does not have at least one article focusing on some aspect of diversity in health care. Numerous journals have devoted entire issues to the topic, such as the recent May 1999 Journal of Nursing Education and additionally several nursing and healthrelated journals have focused solely on this topic. These include the Journal of Transcultural Nursing, the Journal of Multicultural Nursing and Health and the Journal of Cultural Diversity.

Many schools of nursing have responded to the need for nurses to provide competent care to our diverse nation in two main ways. First, efforts have been made to diversify the curriculum by including cultural content as a core concept, and more faculty have become prepared to teach transcultural content by becoming grounded in transcultural nursing theory through advanced study. Substantive courses have been developed to prepare nursing students with the cultural awareness, cultural knowledge, cultural skills, and cultural desire (motivation) needed to develop cultural competence. In addition to theory courses, diverse clinical experiences have been developed to provide opportunities for students to work with culturally diverse clients, both locally as well as through study abroad courses (Smith, Colling, Elander, & Latham, 1993; Campinha-Bacote, 1999; St. Clair, & McKenry, 1999).

Secondly, the need for increasing the diversity among the ranks of the nursing profession has been addressed. It is widely acknowledged that a multicultural nursing work force is needed to meet the needs of our multicultural population. Efforts have been made to recruit and retain students from underrepresented groups, including U.S.born ethnically diverse students as well as immigrant English as Second Language (ESL) students. However because of numerous cultural and language challenges, attrition rates of ESL nursing students have been higher than those of students who speak English as a first language (EFL). A variety of retention strategies for ESL nursing students have been implemented by numerous large schools of nursing, with access to grant funding. To date, no information has appeared about how small, private schools without benefit of funding, can also provide ESL nursing students with the support they need to successfully complete the nursing program and enter the profession.

The purposes of this article are to (1) provide a review of nursing articles published between 1990 - 1999 on the topic of ESL retention strategies, and (2) to describe ESL retention strategies which were implemented in a small private school of nursing that had very limited funding. Outcome data are reported which include retention and graduation rates, NCLEX pass rate, and a student satisfaction survey.

Review of Literature 1990-1999

As we enter into the new decade and century, it is appropriate to reflect upon the growing body of literature regarding retention strategies for ESL nursing students. A review of literature revealed no articles prior to the 1990 specifically on this topic; however, during the 1980's several articles were published which laid the groundwork. These focused on retention of diverse nursing students in general, and black nursing students in particular.

Between 1990-1999, over twenty nursing articles were published which addressed the issue of retention strategies for culturally diverse students in general, and/or ESL students in particular. It is the intention here to summarize briefly this body of literature in chronological order and to draw conclusions about the direction of the development of this important topic.

An early article focused on the need for aggressive advising methods, counseling, academic strategies, and academic support to address academic considerations as well as psychosocial factors that hinder the success of this subgroup of students. (Rodgers, 1990). Use of computer assisted instruction programs (CAI) for this population was recommended by Goodman et al (1990). Phillips and Hartley (1990), published the first article specifically about retention strategies for ESL nursing students. Drawing on the general educational literature on ESL students, they recommended strategies for improving linguistic and communicative competence in the areas of reading, listening, speaking, writing, and learning styles.