Promoting Retention of Native American Nursing Students: Insights From a Qualitative Study

In this episode of Nursing EDge Unscripted, Dr. Steven Palazzo interviews Dr. Cody Bruce about his qualitative study on strategies to promote the retention of Native American nursing students. Dr. Bruce discusses how the Self-Determination Theory, which focuses on intrinsic motivation, shaped his research and the effective retention strategies for this unique student population. He highlights the importance of cultural safety, community engagement, and role models in helping Native American students succeed in nursing programs. Dr. Bruce also shares recommendations for fostering stronger connections between students and their communities to support long-term success.

Bruce, Cody. Promoting Retention of Native American Nursing Students: Insights From a Qualitative Study. Nursing Education Perspectives 45(6):p 348-353, 11/12 2024. | DOI: 10.1097/01.NEP.0000000000001263

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Transcript

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[Music] Hello welcome to this episode of NLN podcast Nursing EDge Unscripted. I'm your host,  Dr. Steven Palazzo, a member of the editorial board for Nursing Education Perspectives. In  this episode, we will discuss effective retention strategies for Native American nursing students. My  guest today is Dr. Cody Bruce. Dr. Bruce is an associate professor at the University of North  Texas Health and Sciences Center College of Nursing in Fort Worth, Texas. We will discuss  the article, "Promoting Retention of Native American Nursing Students - Insights From a  Qualitative Study." This article can be found in a November-December issue of Nursing Education  Perspectives. Welcome Dr. Bruce. Hi, thank you so much for having me on the program.  Yeah, we're looking forward to your conversation. You know, let's start off with just how about  a description of how the self-determination theory that you used in your study influenced  the aims of your study. So really as I began looking at Native American nursing students  and what kept them in the nursing programs and made them be successful and what led to them  not being successful or leaving the program, I really wanted to answer a question of what were  those effective retention strategies? And so I really want to know what drove those students  to complete that degree. And part of that was reviewing a number of theorists, educational  theorists, that really looked at motivation. And as you well know, and our listeners know,  motivation in education is something we've looked at for a long time. And mainly we look  at grades and financial rewards and that did not really seem to fit this population. Native  Americans have a a deep spiritual connection to the earth, to nature, to their being, and especially  to their communities. And I knew that many of them wanted to go back and serve their community after  they graduated with this degree. This was something that they saw that really wasn't just for them but  was a way to give back. And so it really led me to the self-determination theory because of these  kind of intrinsic factors that were leading those students to completion, which was a bit different  than the grades and financial rewards that you know had been seen in some other publications before. Well for our listeners, can you describe briefly the self-determination theory and how  you found that very useful to look at the aims of your study? So the self-determination  theory really helped describe what the Native American student was experiencing as far as  internal motivation factors. Whenever I had conversations with the participants they  were identifying things outside of financial support and outside of grants and just travel and  access to be able to persist. And what they were really centering in on was a sense of belonging,  kind of peer networks or social networks that were very unique. Some of the nursing programs actually  even had a special Native American nursing entry program and part of that program was that all of  the faculty were trained with cultural safety courses, which helped them develope cultural  competency and cultural humility toward Native Americans and it also connected them with the  community that they were serving. So those nursing professors were out in the community and they met  the elders of the tribe, or tribes in the area, and they knew that they were kind of also really  cheering on those students to be able to go back and serve in those communities. Some of the  other things that really kind of aligned well with the self-determination theory was this idea  of giving back, where a student would return back to the reservation and one student even pointed out that  they wanted to break this cycle that was happening in their reservation, which was when people would  leave and would be possibly successful at getting an education they would never  return. Their very best of their tribe would become educated and because of lack of  resources and job opportunities there they would not come back except for social or family events  so they weren't in the community and in supporting the community any longer. So several of the nursing  students really talked about they wanted to work within their reservation system at the Indian  Health Service clinics or hospitals that were run there to treat their own families and their  own community and that they realized that that was a significant decision because it determined,  you know, financial implications, because a lot of those small clinics did not pay as well in those  areas as it would in a larger city. However, the students wanted to be close to their families and  they knew that that was of great importance to not only themselves but also if they had children. So  that was a a really huge motivating factor because the students that had children that I interviewed,  their extended family were caring for them while they were in nursing caring for their children  while they were in nursing school. So they knew that that family model was just very important and  central. Great. So from the work of your study, what would you recommend if you just had one strategy  to recommend and I know it's multifactorial and there's more than one strategy and it's much more  complicated than that, but for our listeners, if you had one strategy to promote retention for Native  American nursing students what would that be? Well, I think it's really important to get to know the  students. You have to know the community you serve and as nurses, I think we all know that to some  degree that your population at one hospital will be very different than if you're a community nurse  in another setting. And I would say if you were a nursing Ppofessor or or a nurse that's working  in a hospital that's precepting students, I would say get to know the community that you're serving,  whether they're Hispanic or if they are Native American, and so I would say that first strategy  would be get to know the community. As you know the community, you're also going to unknowingly  be invested in that community and if you have, you know, one big strategy that you could take forward  with students is allowing them to see someone that is like them in the role. Yeah. That was the number  one takeaway from my study was that the students really valued seeing another Native American in  the role of professor, in the role of a preceptor, or just a registered nurse that the faculty  brought in from the community to help talk about heart failure in this clinic that they worked  in or that they were a diabetic nurse or just different issues that they were seeing within that  population. One really great program that one of my students described was, I think this was in South  Dakota State University, the student said that they have a program where the nursing students that  were Native American they let's say they probably had about 10 nursing students that were Native  American, they partnered with the community health nursing faculty and they actually went to the  tribe. The whole class went to the tribe and would do assessments with the elders and that community  so in order to prepare the non-Native American students to be able to know those cultural norms  out in the Native American community those 10 Native American students became the leaders  of that course. They actually taught the other students, you know, what to expect, how to show  respect to the elders, what to do if you're offered something, things like maintaining eye  contact, all those very important things are so nuanced in various communities. And so that was  their really contribution to that community assessment project and they were seen as leaders  not only in that one course but to their entire cohort because they were addressing and  and even giving back to their own community. That's great and I and you know you bring up  a great point about students wanting to see others like them in faculty roles. And as we  know nursing in general and more specifically nursing education is very heterogeneous as far as  faculty are concerned. And it's important also that I think we have conversations with students  about coming back to nursing education to be one of those people that represent an other  somebody who looks different or is, you know, is ... I don't want to say is different, but you know,  is representing a broader perspective than our traditional nursing faculty. And it really  does make a difference I know in universities I've been at when we have faculty of color,  we have faculty of that are men, LGBTQI faculty, it makes a difference to students to see those  role models and the work you're doing is very important in better understanding how students can  rise up and be leaders and also represent their their culture, their ethnicity, their perspective.  One thing I may also mention to our listeners is not all Native Americans are the same and  each tribe is so individualized and the historic trauma that each each tribe has experienced is  similar. It's a thread that is shared across all of Native America, but I think it's important to  know that just because you're looking at someone that may have pale or white, lighter colored skin  isn't to assume that they are not Native American. Right. Also, if you have someone with really, really  darker skin it you know not assuming that they're African American because they could very well be  Native American and be part of a a tribe. And so I think it's important to ask our our clients,  our patients, our students, you know what do you identify as, because I myself am Native American  from the Choctaw-Apache tribe in Louisiana and I'm very fair skinned. And so it is often  you know assumed that I'm I'm not Native American but I have been a member of the tribe, you know,  since birth. And so one of the things, this is one this is one of the messages that I think  people are trying to get out there as well, is to ask people how they identify as well  as their respected...if they're LGBTQ. And certainly one other aspect that is unique to being  a Native American is a new newer term to many listeners maybe indigiqueer or two spirit. And that  is those two terms identify Native Americans that are from the LGBTQIA community and so those may be  a couple of terms that you hear in some of your interactions with students so I just wanted to  share that. I think that's great and I think you bring up a wonderful point, right, a great life  lesson is never make assumptions. And you know, every day we make assumptions about  lots of things but it's important not to make those assumptions and clarify those assumptions.  Dr. Bruce, I want thank you for joining us for this important conversation. Your expertise  has helped broaden our understanding of some of this work and gives us some insight in how we can  introduce this at our own institutions. And to our listeners, if you've not had the opportunity please  look for Dr. Bruce's work, "Promoting Retention of Native American Nursing Students - Insights From a  Qualitative Study," in the November-December issue of Nursing Education Perspectives. And I want to  thank you again Dr. Bruce for joining us sharing your information with us. Thank you very much.[Music]