In 2004, the Sullivan Commission, funded by the Kellogg

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1 Affirming At-Risk Minorities for Success (ARMS): Retention, Graduation, and Success on the NCLEX-RN Judith A. Sutherland, PhD, RN, CNS, LCDC; Mary Jane Hamilton, PhD, RNC; and Nancy Goodman, MSN, RNC ABSTRACT Increasing ethnic and racial diversity in the U.S. population combined with inadequate minority representation in the nursing profession requires innovative strategies to recruit, retain, and graduate nurses from diverse ethnic and racial populations. Affirming At-Risk Minorities for Success (ARMS) was funded by a U.S. Department of Health and Human Services Basic Nurse Education and Practice Program grant. Participants (N = 64) were enrolled in a baccalaureate degree nursing program that has been predominantly White/ Anglo and is located in the south-central region of the United States. Research objectives were to increase program retention, graduation rates, and success on the National Council Licensure Examination for Registered Nurses (NCLEX- RN ) for minority or educationally disadvantaged students through programmatic interventions, including mentoring and advising, tutoring, and educational seminars. The comparison group was non-arms students derived from a comprehensive database (N = 265). Results indicated that interventions positively affected graduation rates (measure of retention = 98%), significantly affected grades in the Leadership-Management capstone course, and eliminated the effects of ethnicity on NCLEX-RN success. Received: July 11, 2005 Accepted: December 6, 2005 Dr. Sutherland is Professor, Dr. Hamilton is Dean and Professor, and Ms. Goodman is Visiting Assistant Professor, Texas A&M University-Corpus Christi, College of Nursing and Health Sciences, Corpus Christi, Texas. The authors acknowledge the Department of Health and Human Services-Basic Nurse Education and Practice Program Grant #5 D11 HP , as well as Thomas A. Teasdale, DrPH, of the University of Oklahoma and the Oklahoma City VAMC for performing the statistical analyses associated with this work. Address correspondence to Judith A. Sutherland, PhD, RN, CNS, LCDC, Professor, Texas A&M University-Corpus Christi, College of Nursing and Health Sciences, Center for Instruction 370, 3rd Floor, Corpus Christi, TX 78412; judith.sutherland@tamucc.edu. In 2004, the Sullivan Commission, funded by the Kellogg Foundation, compiled its report on the need for greater ethnic diversity in the health care professions and proclaimed, If the trends continue, the health workforce of the future will resemble the population even less than it does today (p. 2). This is cause for concern because increasing the diversity of health care professionals is associated with health care access and quality for minority patients (Sullivan Commission, 2004). The Sullivan Commission (2004) further clarified that improving health care quality and eliminating health disparities for minority populations requires diversity and cultural competence among clinicians at every level of the health care delivery system. Throughout the 21st century, the number of individuals from racial and ethnic minority groups is expected to steadily increase, and by the middle of the century, minority populations will constitute a burgeoning U.S. majority. According to the U.S. Census Bureau (2004), by 2050, the Hispanic population will nearly triple from approximately 36 million currently to 103 million. Asian American populations will triple from 11 million to more than 33 million, and the African American population is expected to almost double from 36 million to 61 million. As minorities constitute a larger percentage of the total population, meeting the health care needs for this emerging majority will become increasingly important. However, given the current growth rate of minorities in the health care workforce, tomorrow s health care professionals will not be representative of minority populations. According to the National Sample Survey of Registered Nurses (Spratley, Johnson, Sochalski, Fritz, & Spencer, 2000), the number of nurses identifying their background as belonging to one or more racial minority groups or as Hispanic/Latino numbered 333,368 in This is nearly triple the number of nurses estimated to be from minority groups in Minority RNs grew at a greater rate than did nonminority RNs for all of the years from , except for the period from 1984 to The difference in the growth rates is especially notable from 1996 to 2000 (Spratley et al., 2000). Although these increases seem substantial, August 2007, Vol. 46, No

2 AFFIRMING AT-RISK MINORITIES FOR SUCCESS the current population of nonminority nurses is seven times larger than the population of minority nurses. The representation of minority nurses among the total nurse population increased from 7% in 1980 to 12% in 2000 (Spratley et al., 2000). Despite these increases, the diversity of the RN population remains far less than that of the general population, where minority representation was more than 30% in 2000 (Spratley et al., 2000). In 2000, the national supply of full-time RNs was estimated at 1.89 million, whereas the demand was calculated at 2 million, a shortage of 110,000 or 6% (National Center for Health Workforce Analysis, 2002). Given the trends in the supply of RNs and their anticipated demand, the shortage is expected to grow relatively slowly until 2010, reaching 12% (National Center for Health Workforce Analysis, 2002). At that point, demand will begin to exceed supply, and by 2015, the shortage, which was 6% in 2000, will have almost quadrupled to 20% (National Center for Health Workforce Analysis, 2002). If not addressed, the shortage is projected to increase to 29% by 2020 (National Center for Health Workforce Analysis, 2002). Increasing diversity in the U.S. population, inadequate minority representation in the nursing profession, and the predictions of a spiraling RN shortage requires innovative strategies to recruit, retain, and graduate RNs from diverse ethnic and racial populations. This research, Affirming At-Risk Minorities for Success (ARMS), was funded by the U.S. Department of Health and Human Services Basic Nurse Education and Practice Program grant #5 D11 HP for 3 years ( ). The study participants were enrolled in a baccalaureate degree nursing program that has been predominantly White/Anglo and is located in the south-central region of the United States. The University is located in an urban area populated by a growing Hispanic community surrounded by rural counties with high poverty levels, which are also medically underserved. The purposes of the study were to: Identify at-risk minority students prior to entry into the program. Increase the number of minority and disadvantaged students in the program. Expand existing partnerships with area primary and secondary schools to increase minority recruitment potential. Develop a structured recruitment plan. Increase the number of minority and educationally disadvantaged students retained in the program. Increase program graduation rates and success on the national licensing examination. Develop a comprehensive retention plan on the basis of identified risks. The three research areas discussed in this article are increasing the retention rate, program graduation rates, and pass rates on the National Council Licensure Examination for Registered Nurses (NCLEX-RN ) for minority and disadvantaged students. Future publications will address the remaining program objectives. LITERATURE REVIEW Since the 1960s, the nursing profession has been challenged to focus on retention and graduation rates for minority students in higher education with the passage of the Higher Education Act of 1965 (U.S. Department of Education, n.d.). In 1966, the Allied Health Professions Personnel Training Act authorized a program of nursing education opportunity grants for financially needy students to foster recruitment of individuals in this category (U.S. Department of Education, n.d.). Despite these and other federal programs, the nursing profession does not reflect the diversity of the population it serves. Childs, Jones, Nugent, and Cook (2004) indicated that retention of minority students in nursing programs is critical because recruitment is seriously undermined when retention rates are low. Barbee and Gibson (2001) clarified that retention is successful when there is integrated institutional support for programs that support non-white students who demonstrate educational deficiencies. These authors cite one such program that combines recruitment with mentoring, personal group support, and tutoring (Barbee & Gibson, 2001). Several authors have discussed the importance of retention strategies focused on supporting student progression, graduation, and successful licensure to practice (Dowell, 1996; Lockie & Burke, 1999; Nugent, Childs, Jones, & Cook, 2004; Stokes, 2003). Dowell (1996) pointed out that high attrition rates have been associated with a lack of affiliation with the educational institution, which is defined by the absence of social support groups, student or peer study groups, and faculty support and advisement. In addition, lack of frequent faculty contact and commitment to student success significantly contributes to the perceived lack of support (Childs et al., 2004; Dowell, 1996). Some minority students are educationally and socially disadvantaged, which creates unique challenges for them in an academic environment that is not focused on diagnostics related to specific learning needs and structured support mechanisms (Dowell, 1996). Bridges to retention are viewed as deliberate actions taken by the nursing program to support and maintain the progression of minority and educationally disadvantaged students. Lockie and Burke (1999) delineated the Partnership in Learning for Utmost Success (PLUS) program that focuses on retention by instituting comprehensive student assessments, courses provided concurrently with the standard nursing courses to facilitate concept and skill development, and development of personal partnerships with nursing faculty. Faculty development was a critical component of the PLUS program and involved increasing the faculty s sensitivity to the diverse needs of multicultural students (Lockie & Burke, 1999). Stokes (2003) described a retention strategy called Gatherings. The purpose of the program was to facilitate academic success by maintaining contact and direct communication with minority and international students and by providing an opportunity for informal interactions between faculty and students. Supportive actions were providing material support (e.g., money), behavioral assistance (e.g., help with 348 Journal of Nursing Education

3 SUTHERLAND, HAMILTON, & GOODMAN solving problems), intimate interactions (e.g., nondirective counseling, guidance, instruction), and mutual sharing of successes among the students. A similar program described by Nugent et al. (2004) focused on mentoring and included elements such as academic support, financial support, self-development, and professional leadership development. Academic support was defined as remedial and tutorial support; self-development incorporated support for social and academic adjustment to the predominantly White institution; professional leadership development focused on the concept of professionalism and the importance of achieving career goals. These elements were rated very highly by the students involved, and the program achieved 100% retention rate in 2003 (Nugent et al., 2004). Finally, Fletcher et al. (2003) described the development of the Minority Recruitment and Retention Initiative (MMRI) at a predominantly White university. The focus of the initiative was to create an environment that supported the mentoring and socialization of individuals from ethnic minorities by establishing collaborative partnerships with other health care professional groups and increasing the knowledge levels within the community regarding the academic requirements for a professional course of study in nursing (Fletcher et al., 2003). With a reported 21% minority population at the University across all programs, the initiative was designed to increase enrollment and retention (Fletcher et al., 2003). METHOD Variable The ARMS study was designed to evaluate minority and educationally disadvantaged nursing student outcomes on the basis of programmatic interventions to increase retention, graduation, and success on the NCLEX-RN. Students from an ethnic or minority background (e.g., Hispanic, Asian Pacific, African American), first-generation college students, students from a rural community, and students currently achieving a grade of C in a nursing course or currently failing a nursing course were invited to participate in the ARMS program during the 3-year period (N = 64). The comparison group was non-arms students derived from a comprehensive database (N = 265) maintained by the College of Nursing. Participant consent and approval by the University s TABLE 1 ARMS Mentoring: Seniors 2003 (n = 19) Mean (SD) I am benefiting from the faculty mentoring I am receiving. 4.1 (1.2) I have implemented suggestions provided during mentoring. 3.8 (1.4) I feel better about my nursing school experience because of the mentoring. 3.8 (1.4) The mentoring has made a difference in my connection with the College of Nursing faculty. Variable TABLE 2 ARMS Tutoring: Seniors 2003 (n = 25) 3.8 (1.2) Mean (SD) I am benefiting from the tutoring that I am taking. 4.5 (0.9) The tutoring has made a difference in my grades. 4.4 (1.0) There have been adequate tutoring sessions available. 4.3 (0.8) I have seen improvement in my study habits as a result of participating in the tutoring. 4.2 (1.2) I have implemented suggestions provided during tutoring. 4.0 (1.0) The laptop computer has been very beneficial this semester. 2.0 (1.7) institutional review board were obtained prior to the study. The ARMS program interventions included faculty-student advisement and mentoring, focused expert tutoring, Seminars in Success, and provision of a personal laptop computer with educationally supportive software. Student advisement and mentoring was a structured process of monitoring and evaluating student progress through the nursing curricula from inception to graduation to determine individual educational and social support needs; ARMS students were assigned to one of eight faculty mentors who were committed to student success. Focused expert tutoring was provided in group and individual sessions through contracts with White and Hispanic practicing nurse experts from the local health care community; specific areas of focus were maternal-child, pediatrics, medical-surgical, and psychiatric nursing. Seminars in Success were provided by expert Hispanic and White educational consultants from the community and focused on techniques to reduce test anxiety, test-taking and study skills, memory enhancement strategies, and management of electronic resources, such as the Internet and Web-based programs. In addition, ARMS students were provided with their own laptop computers for use while in the nursing program. The laptops had Internet access, NCLEX Review 3000 (Springhouse, 2000) software, and other educationally supportive programs. Instruments Four Likert scale instruments, with ratings ranging from 1 = strongly disagree to 5 = strongly agree, were de- August 2007, Vol. 46, No

4 AFFIRMING AT-RISK MINORITIES FOR SUCCESS Variable TABLE 3 ARMS Seminars in Success (n = 12) I learned new ideas from the presentation on imagery, retention, and test-taking skills. Mean (SD) 4.9 (0.3) I enjoyed the presentation given on imagery, retention, and test-taking skills. 4.8 (0.5) I would be interested in attending additional seminars on other topics. 4.8 (0.5) I would be interested in attending other similar seminars. 4.8 (0.4) I have had success in using the methods since taking the class. 4.6 (0.7) I have used the relaxation methods that were explained to me during the presentation. 4.5 (0.5) I am using the techniques taught about imagery, retention, and test-taking skills. 4.4 (0.5) I plan to use the methods regularly. 4.4 (0.5) I have not used the methods taught at the seminar since that day. 2.8 (1.5) Program Element Overall program TABLE 4 ARMS Final Program Evaluation (n = 13) Mean (SD) The program offered practical information and advice. 4.4 (0.7) The program motivated me to overcome barriers to studying toward my bachelor s degree. 4.2 (0.7) The program enhanced my self-confidence. 4.1 (0.9) The program objectives met my needs. 4.0 (1.0) The program offered new information. 3.8 (0.6) Mentoring My mentor made himself/herself available to me when I needed assistance. 4.4 (1.4) I had adequate opportunity to interact with my mentor. 4.1 (0.6) My mentor encouraged me to draw on my own cultural support strategies. 3.8 (1.3) My mentor provided adequate support. 3.8 (1.2) Tutoring My tutor provided adequate support for my learning experience (e.g., learning laboratory, NCLEX-RN) with helpful feedback and critique. 4.1 (1.4) My tutor suggested effective studying strategies. 3.9 (1.2) My tutor suggested test-taking strategies. 3.8 (1.4) My tutor listened and suggested practical solutions to my concerns and needs. 3.8 (1.2) My tutor maintained realistic expectations for my progress. 3.8 (0.5) My tutor allowed me to evaluate, assess, and manage my own study problems without making me feel less than. 3.7 (1.3) My tutor challenged my thinking in problematic content areas. 3.6 (1.4) veloped to measure student responses to the mentoring, tutoring, and Seminars in Success, as well as a summative program evaluation. The scales for mentoring and Seminars in Success each contained 9 items; the scale for tutoring contained 11 items; and the scale for final program evaluation contained 16 items (Tables 1-4). Scale items not relevant to this discussion have been deleted from the tables due to space considerations. Data Analysis Descriptive statistics were used to delineate the demographic makeup of the ARMS participants, graduation rate, responses to program interventions, and final program evaluation (Tables 1-4). Analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 10 to explore the effect of ARMS participation on student success with nursing course grades and NCLEX-RN pass rate. Final nursing course grades for ARMS and non-arms groups were analyzed individually using unpaired t tests to reveal benefit to specific courses (Table 5). Grades were further examined for the effect of ethnicity on mean scores, again using multiple unpaired t-test analyses (Table 6). Because these approaches required multiple t tests, the critical value for reaching statistical significance was recalculated to (0.05/number of tests). Finally, a Mantel-Haenszel statistic was calculated to determine the effect of the ARMS versus non-arms status on NCLEX-RN pass rate, conditional on ethnicity (Table 7). The resulting chi-square p value provides an indication of the probability of the (four) cell frequencies being distributed as they are under the null hypothesis of no association. 350 Journal of Nursing Education

5 SUTHERLAND, HAMILTON, & GOODMAN RESULTS Demographic data of the ARMS participants were: 84% women and 16% men. 42% White, 42% Hispanic, 8% Asian Pacific, and 8% African American. 77% were single, widowed, or divorced; 13% were married with children; 2% were married; 3% were single, widowed, or divorced with children younger than age 12; and 5% were single, widowed, or divorced with children older than age 12. Graduation rate = 98%; 1 student dropped out due to pregnancy. Quantitative responses to the program interventions are displayed in Tables 1 through 4. Means on the mentoring scale ranged from 3.8 to 4.1, and means on the tutoring scale were slightly higher, 4.0 to 4.5, except for the item about the laptop computers (2.0). Seminars in Success demonstrated very positive ratings with means ranging from 4.4 to 4.9. The return rate for the final program evaluation was only 13 of 63 (21%). Means ranged from 3.6 to 4.4, with overall program evaluation ratings at 3.9 to 4.4. Final course grades for the ARMS and non-arms groups are presented in Table 5. Participation in ARMS did not significantly positively affect nursing course grades, with the exception of the Leadership-Management course, which is considered a capstone course for the nursing program. Final course grades for ARMS students were further analyzed by ethnicity (Table 6). This analysis demonstrated that ethnicity was a significant influence on final grades in almost half of the nursing courses. In all courses for which statistical significance was reached (Fundamentals, Maternal-Child, Medical Surgical II, and Psychiatric-Mental Health), White/Anglo ARMS students scored higher than those in the All Other group (Hispanic, Asian Pacific, and African American). A layered Mantel-Haenszel chi-square test was then performed to determine the potential covariance of ARMS participation with ethnicity on NCLEX-RN pass rate. Table 7 shows that among all individuals not participating in the ARMS program (usual state), White/Anglo students outperformed All Other students. However, among ARMS participants, this discrepancy disappears. That is, students in the All Other group performed in similar fashion to White/Anglo TABLE 5 Nursing Course Grades by ARMS Status Course ARMS Status n Mean (SD) p Value Leadership-Management Yes (3.2) No (5.8) Community Health Yes (7.9) No (7.0) Psychiatric-Mental Health Yes (3.8) No (4.0) Pharmacology Yes (11.3) No (11.5) Medical-Surgical II Yes (4.5) No (6.0) Pediatrics Yes (6.5) No (9.1) Medical-Surgical I Yes (7.5) No (9.7) Maternal-Child Yes (10.6) No (6.9) Fundamentals Yes (10.8) No (10.9) students. This analysis demonstrated that the ARMS program equalized the significant negative effect of ethnicity and race on the NCLEX-RN pass rate. The odds ratio demonstrates that White/Anglo students have a 2.9 times better chance of passing the NCLEX-RN than do students in the All Other group in the absence of ARMS. With ARMS participation, the odds drop to almost 1 (even odds) for the two groups. Test-specific p values echo this finding. It should be noted that White/Anglo pass rates dropped for those students in the ARMS program, indicating that the ARMS program was a greater benefit to students in the All Other group and less beneficial to students in the White/Anglo group. Available sample sizes were too small to determine whether the observed drop in White/Anglo pass rate was statistically significant or a reflection of normal variability (0.79 versus 0.27, p = 0.25, power = 0.3). DISCUSSION < * * Comparison meeting statistical significance criteria adjusted for multiple tests indicates course with significant final grade difference by ARMS status. The data from the mentoring and tutoring scales indicate that students were fairly positive about these interventions. Faculty mentors met with students initially at the students request and discovered there was a previously unverbalized August 2007, Vol. 46, No

6 AFFIRMING AT-RISK MINORITIES FOR SUCCESS TABLE 6 Nursing Course Grades by Ethnicity Course Ethnicity n Mean (SD) p Value Psychiatric-Mental Health White/Anglo (4.0) All Other (3.7) Community Health White/Anglo (7.0) All Other (7.4) Leadership-Management White/Anglo (5.6) All Other (5.8) Medical-Surgical II White/Anglo (5.4) All Other (6.2) Pharmacology White/Anglo (9.1) All Other (12.5) Maternal-Child White/Anglo (4.1) All Other (11.1) Pediatrics White/Anglo (7.8) All Other (9.7) Medical-Surgical I White/Anglo (9.9) All Other (7.7) Fundamentals White/Anglo (7.9) All Other (10.6) expectation among the students that faculty should initiate the sessions; this was instituted with a minimum of two sessions per semester. In addition, faculty mentors indicated that they had to structure the sessions with questions to elicit active student interaction. Faculty asked questions such as, How are your classes going?, What are your course averages up to this point?, How are other things going in * * < * * * Comparisons meeting statistical significance criteria adjusted for multiple tests indicate courses with significant final grade differences by ethnicity. TABLE 7 Value of ARMS Related to NCLEX-RN Pass Rate Pass NCLEX-RN ARMS Participant Ethnicity Yes No n No White/Anglo 79% 21% 176 Odds Ratio Chi-Square p Value All Other 56% 44% > Total 71% 29% 265 Yes White/Anglo 67% 33% 27 All Other 65% 35% Total 66% 34% 64 your life?, and Are there any problems I can help you with? Many students held jobs to support their education, so faculty asked about their work schedules and how work was affecting study time. Students were encouraged to use and assisted in accessing University resources, such as the student learning center, financial aid, and counseling services. After analyzing the final program evaluation data on mentoring, it appears that improvement is needed in the area of encouraging students to draw on their own culturally based resources for support. All of the faculty mentors were White/Anglo men and women, although the College of Nursing has since added two Hispanic nursing faculty and continues to actively recruit faculty from minority populations. Tutoring was provided in individual and group settings on the basis of student-expressed preferences. Because the tutors were paid for their time, they offered flexible hours for the students, such as evenings and weekends. The tutors asked students to initially identify learning needs and problems and to evaluate the tutoring process on a regular basis with narrative commentary. Tutors advised on specific studying strategies, such as note taking in class and during the tutoring sessions and reading the text with a focus on the charts, tables, clinical examples, and practice questions. Frequent review of the study materials was encouraged. A concept synthesis was performed to categorize student narrative comments on the tutoring scale during the early part of the sessions. The categories synthesized from student comments added a qualitative dimension to the students perceptions of the tutoring. The most notable 352 Journal of Nursing Education

7 SUTHERLAND, HAMILTON, & GOODMAN categories were appreciative, urgency, self-evaluation, and success. In the appreciative category, students were effusive in their appreciation for the tutoring sessions and the positive outcomes they were achieving. Comments included, Thanks so much for helping me and Without you, I would not have passed. Student statements in the urgency category indicated their motivation to succeed and desire for continued tutoring assistance. They said, I will meet on your schedule, I will meet whenever it is convenient, and I am desperate to make it through [the] Maternal-Child [course]. Students evaluated their own difficulties in the self-evaluation category by stating, I am having trouble finding a way that works, I am having trouble focusing, and I am failing. When students were successful on tests, their comments indicated the effectiveness of the tutoring, such as, The study session really helped, I did well, I want to continue tutoring, and I got an A on the test. Comparing the final program evaluation data with the tutoring results indicates that the tutoring process could be improved by fostering student self-analysis of studying and test-taking problems with the support of the tutor. The Seminars in Success strategies were highly valued by the students and provided a supportive framework for the tutoring. These seminars were provided by a Hispanic consultant who is a licensed professional counselor and is employed by a local community college to help students with test-taking skills, anxiety reduction techniques, and retention strategies. During the two seminars, the consultant guided the students through physical relaxation and visual imagery exercises for anxiety reduction. Imagery exercises included positive scenarios of success, a trigger word connected with the relaxation state, and positive imagery to reduce tension. Imagery was combined with self-talk in the form of affirmations. Retention methods incorporated rightbrain thinking using images, metaphors, colors, and humor to remember complex material. The final program evaluation responses revealed that the objectives that focused on supporting and encouraging students to be successful were achieved. Students indicated that the ARMS program motivated them to overcome barriers to studying, offered practical information and advice, and enhanced their self-confidence. The mentoring, tutoring, and Seminars in Success responses were compared with the final program evaluation results, but it should be noted that the low response rate (21%) on the final evaluation scale is not representative of the larger group. CONCLUSION Although ARMS students did not perform better than non-arms students, as determined by their final course grades, they did pass all of the nursing courses and performed significantly better in their last nursing course (Leadership-Management), which integrates all of the prior theoretical and clinical aspects of the nursing program. Nursing courses that demonstrated significant differences in final course grades for students of racial and ethnic minority groups indicate areas where additional student support through tutoring and mentoring will be needed. Finally, the ARMS program improved the NCLEX-RN pass rate of ethnic minority students in the program, resulting in almost even odds that students of White/Anglo or other ethnic and racial origins would pass the examination. This is of great importance for the program because the intention of the interventions was to increase graduation rates and success on the NCLEX-RN. It is unknown why White/ Anglo ARMS students demonstrated decreased successful performance on the NCLEX-RN when compared with non- ARMS students in the same category because the sample was too small to discriminate variability. The objectives of retaining ARMS students in the program combined with graduation and success on the NCLEX-RN were achieved. Further research will focus on improving the mentoring and tutoring process, determining why specific courses are more difficult than others for at-risk students, and developing additional strategies to support student learning and success. REFERENCES Barbee, E., & Gibson, S. (2001). Our dismal progress: The recruitment of non-whites into nursing. Journal of Nursing Education, 40, Childs, G., Jones, R., Nugent, K., & Cook, P. (2004). Retention of African-American students in baccalaureate nursing programs: Are we doing enough? Journal of Professional Nursing, 20, Dowell, M. (1996). Issues of recruitment and retention of minority nursing students. Journal of Nursing Education, 35, Fletcher, A., Williams, R., Beacham, T., Elliott, R., Northington, L., Calvin, R., et al. (2003). Recruitment, retention and matriculation of ethnic minority nursing students: A University of Mississippi School of Nursing approach. Journal of Cultural Diversity, 10, Lockie, M., & Burke, L. (1999). Partnership in Learning for Utmost Success (PLUS): Evaluation of a retention program for at-risk nursing students. Journal of Nursing Education, 38, National Center for Health Workforce Analysis. (2002). Projected supply, demand, and shortages of registered nurses: Retrieved May 29, 2007, from the American Health Care Association Web site: Nugent, K., Childs, G., Jones, R., & Cook, P. (2004). A mentorship model for the retention of minority students. Nursing Outlook, 52, Spratley, E., Johnson, A., Sochalski, J., Fritz, M., & Spencer, W. (2000). The registered nurse population, March 2000: Findings from the National Sample Survey of Registered Nurses. Retrieved May 31, 2005, from rnsurvey/rnss1.htm Springhouse. (2000). NCLEX review 3000 [software]. Baltimore: Lippincott Williams & Wilkins. Stokes, L.G. (2003). Gatherings as a retention strategy. The ABNF Journal, 14, Sullivan Commission. (2004). Missing persons: Minorities in the health professions. A report of the Sullivan Commission on Diversity in the Healthcare Workforce. Retrieved May 29, 2007, from the American Association of Colleges of Nursing Web site: U.S. Census Bureau. (2004). U.S. interim projections by age, sex, race, and Hispanic origins. Retrieved May 29, 2007, from U.S. Department of Education. (n.d.). Reauthorization of the Higher Education Act of Retrieved June 27, 2007, from ed.gov/policy/highered/leg/reauthorization_pg3.html August 2007, Vol. 46, No

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