Bill Klaprorth (Host): This podcast is brought to you by Nightingale Education Group. Nightingale Education Group includes Nightingale College, which is a private for profit nursing college headquartered in Salt Lake City, Utah. The college offers six nursing programs along with the nursing continuum. To learn more, visit nightingale.edu. And this is a special episode of Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership, recorded live at the AONL 2024 conference. I'm Bill Klaproth. As we talk about higher education's role in diversifying the nursing workforce.

With me is Juliet Kolde and Jimmy Reyes, both from the Nightingale Education Group. Juliet, welcome.

Juliet Kolde, PhD, RN, CDE: Thanks. It's great to be here. Thanks for having me.

Host: Yeah, great to have you here. Jimmy, welcome.

Jimmy Reyes, PhD, DNP, RN: Welcome, Bill. Good to have you.

Host: Yeah, thank you so much for your time. I appreciate it. Juliette, let me start with you. When it comes to higher education's role in diversifying the nursing workforce, can you talk about that and how Nightingale helps contribute to this?

Juliet Kolde, PhD, RN, CDE: Absolutely. Nightingale Education Group, we contribute to closing the health equity gaps, which is another way of saying, diversification through elevating education and elevating employment systems. We're committed to creating a relevantly skilled and readily available nursing workforce which represents the communities they serve.

And that last part is pretty important because there's data out there that suggests that health treatment is improved and more adhered to when received by like individuals. So as a nursing workforce, we are called to diversify the profession so that we can create more opportunities to help our patients be the healthiest versions of themselves.

Host: Yeah, that's very well said. Like you said, closing the health equity gap. It's very important. So can you talk about NCLEX and the first time pass rate? Fill us in on that.

Juliet Kolde, PhD, RN, CDE: Yeah, I'd love to. So, the National Council for Licensure Examination, or as we affectionately call it, the NCLEX in higher education, it's a national examination for the licensing of nurses, in the United States. So, most of the states establish standards for nursing education and practice. You know, while practice standards are somewhat uniform, there's no guarantee, right?

And sometimes there's significant variances that exist from state to state and that impacts nursing regulations. So many of the regulations lack imperial evidence. Historical over reliance on NCLEX first time pass rates as the measure of nursing equity has forced nursing education to develop some bad habits, I guess, if you will, right?

We've created, rigorous admission standards, or maybe washout programs, where, you know, three quarters of the way in, you have to take an exam, and if you don't pass it, then you're washed out of the program. At Nightingale Education Group, we're trying to change that to give more people opportunities to be successful in the nursing program.

So through our innovative educational policies and practice, and this is afforded to us because we domicile in Utah, right? We don't have to be reliant on NCLEX first time pass rates. We can provide the nursing workforce development opportunities that maybe wouldn't otherwise be possible. So Nightingale College is actually actualizing the diversification that the National Academy of Medicine calls for right? They call for us to diversify the profession. And we do that through having a unique curriculum, wraparound student services, admission standards and policies that support learners. We even have foundational courses that get them up to par, so that they can be successful in the rest of their nursing programs.

So in doing that, we're helping to give opportunities to maybe people in socioeconomic classes that haven't always had those opportunities to get into nursing.

Host: So you're providing an easier pathway to becoming a nurse.

Juliet Kolde, PhD, RN, CDE: I wouldn't say easier in terms of the rigor is still there. I would say easier in terms of getting into a nursing school, not being wait listed. Because we have a national program, we can educate across the country. So the rigor, you know, I'm pretty proud of our curriculum. The rigor is definitely there. We have amazing staff that educate so that we can graduate competent practitioners who practice safety for nursing and who can go out and work in areas that may be underserved. Rural areas, rural communities, um, things of that nature.

Host: Yeah.

Jimmy Reyes, PhD, DNP, RN: And I would also like to echo Juliet. I totally agree with what you're saying. And also, looking at my own experience coming to the United States from a different country, not knowing the language very well. I wish that I would have had, a similar experience where the school, supported me in those efforts.

I didn't have additional opportunities, and it didn't happen until after when I learned the language much better, and when I had a better understanding of the healthcare system, of all the other opportunities that other individuals that may look like me, that may have a similar background, could also experience.

So I think what Nightingale is doing is that it's affording those opportunities to those communities, that they want to become nurses, they want to become nurse practitioners, nurse educators, but they just don't know how to do it. And so Nightingale is giving them a different pathway, again, agreeing that the competency level is high, it's a very rigorous program, it's difficult, nursing is challenging, but it's also very important for them to gain those competencies and feel comfortable that, yes, you can be a bilingual nurse, you can also advocate for your patients differently in that aspect, and then you can empower your communities and give back to them.

Juliet Kolde, PhD, RN, CDE: Well said, Jimmy.

Host: Is it fair to say that Nightingale provides extra support as well as you're making this journey?

Juliet Kolde, PhD, RN, CDE: We do. We have something we call our wraparound service. What's unique about that is we will follow our learners all the way through NCLEX passing. Not just graduation. Some schools will get them graduated and then they're on their own to pass the NCLEX. We have NCLEX coaches that will work with them until they pass the NCLEX, no matter how many times it takes.

Host: Well, that's really important. And that's wonderful that you said that. And Jimmy, can you tell us how else Nightingale is contributing to the diversification of the nursing workforce?

Jimmy Reyes, PhD, DNP, RN: Yes, Bill. So we have other graduate programs as well. We have a Master's in Nursing Education Program, a Family Nurse Practitioner Program, and now in the fall of 2024, a Master's of Psychiatric Mental Health Nurse Practitioner. We do know that there's a shortage of providers, of nurse educators teaching back to their students, giving back to our communities.

And it is so important for us to just make sure that they are competent, able, and have the different skill sets to ensure that they can advocate for the different communities, especially because our country is becoming more diversified. We are having many refugees, immigrant communities that do not understand the healthcare system.

And they also want to be taken care of by people that also look like them and that maybe understand a little bit better about their own belief systems, their worldviews. And also what's the nice thing about us is that we can also provide different perspectives in the healthcare system. For example, a student can have an idea on a quality improvement project for a family nurse practitioner program and that can actually enhance the entire healthcare system in thinking more creatively and being more diversified in that aspect.

So there are many opportunities that we can give our students and also for them to give back to their own communities as well.

Host: So it sounds like your faculty looks like the students you're trying to encourage to come to Nightingale. Would that be fair to say? Yeah?

Jimmy Reyes, PhD, DNP, RN: Yes, we have a very diverse group of faculty from different cultural, ethnic, racial backgrounds, religious backgrounds, from different areas of the country. And so that also enriches the experience of the student because they can talk about a rural location, an urban location, and they can also talk about different generational differences. And also how to work with them and patients because everybody will experience working with patients from different backgrounds.

Host: Yeah. I love that. And you said you offer master's programs as well, so you can start at the very beginning and work your way all the way through a master's too.

Jimmy Reyes, PhD, DNP, RN: That is correct. Yep. You can start on the beginning in a pre-licensure program, and then you can enroll into the Master's program right away. You can, we encourage the students to actually work for a year, at least before applying to the program so they can become a little more exposed to the rigor in the challenges of clinical practice.

Once they have that experience, they can then apply to the master's program and then go into the nurse educator track or the advanced practice track, which again, they will have another exam. And then also they will become certified and licensed.

Host: Yeah. Okay.

Juliet Kolde, PhD, RN, CDE: I want to go back. We offer an LPN diploma. We have an LPN to ASN degree. We have a BSN degree. So our undergraduate programs are stepped so someone can literally start from the beginning of their nursing journey, get all the way up to their masters.

Host: Yeah.

Juliet Kolde, PhD, RN, CDE: I also want to circle back around to the first time NCLEX pass rates because what I failed to mention is that at Nightingale we've analyzed thousands of data points around our students and alumni from like 2011 to 2023.

And what we have found is a significant NCLEX first time pass rate performance gap among different socioeconomic groups. And that the licensure gap closes upon subsequent exams. So, we want to, for us it's about getting them to licensure, and getting them to licensure quicker, no matter how many times they have to take the exam.

The NCLEX will allow you to retake the exam up to 45 days. You have to wait 45 days. Historically, schools have used the first time NCLEX pass rate as a measure of quality of students. So if you can get your students to pass the first time you're better. You're,

you're, More

worthy. Yeah, exactly. And what that does is that leads back to what I was talking about. The, admission standards are sometimes very rigorous. There's wait lists, there's washout programs. So imagine getting three quarters of the way through nursing school and being told you're not going to pass this test, so you have to drop out.

Host: Yeah. So this helps from instead of somebody going into the washout program. Hey, let's, support you. Let's work with you. Let's get you to pass it. Because everybody learns at a different speed, at different levels. Some people are visual learners, some people are audio learners. I mean, people learn at a different rate.

Juliet Kolde, PhD, RN, CDE: And it's about creating a curriculum that tests the competency, not the ability to regurgitate exam answers.

Host: Yeah, that's very well said.

Juliet Kolde, PhD, RN, CDE: We want to, we want them to be proficient in clinical judgment and clinical reasoning, which is ultimately what's going to make them be a successful nurse.

Host: Yeah, so Juliette, how does someone get involved with the Nightingale Education Group?

Juliet Kolde, PhD, RN, CDE: Oh yeah, so we have a booth here if anybody's listening. We're at 401, but you can go to nightingale.edu. That's N I G H T I N G A L E.E D U. Learn all about us. We have ways to contact our admissions team, and we can get you in touch with the rest of our collaborators if you have a need to want to work with us or partner with us. We've got many different avenues for to happen.

Host: That's great. Well, I want to thank you both for your time today. This has really been interesting learning about the Nightingale Education Group. Before we end I'd love to get final thoughts from each of you. Juliet, let's start with you. Anything else you want to add?

Juliet Kolde, PhD, RN, CDE: I just want to add that we're very proud of the work that we do at Nightingale. We're one of the first schools to tackle this issue and to do it in a way that supports the learners to still be safe and competent nurse and practitioners of care.

Host: Yeah, very well said. And Jimmy, how about you? Tell us any additional thoughts that you want to add.

Jimmy Reyes, PhD, DNP, RN: Yes, Bill. The other thought is also a call for all of the different healthcare facilities because they are the ones that are accepting, they're hiring all of our graduates, and also for them to have a commitment to diversity. A commitment to enhancing the workforce in that aspect. And also welcoming our learners because they are ready to practice.

They're practice ready. They're willing to help their communities. So, also again, a call for the healthcare facilities to be more welcoming, to continue to support them with nurse residency programs, and again, to partner with Nightingale College because we, again, are really willing to work with all of them to ensure that we can graduate proficient and competent providers.

Host: Absolutely. Great thought. Well, Juliet and Jimmy, thank you so much for your time today. I appreciate it.

Juliet Kolde: Thanks for having us.

Jimmy Reyes, PhD, DNP, RN: Thank you so much.

Host: You bet. Once again, that is Juliet Kolde and Jimmy Reyes. And once again, thanks to Nightingale Education Group for sponsoring this podcast. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you, just like this one at aonl.org.

 And I want to thank you again for listening. And once again, this is Today in Nursing Leadership. Thanks for listening.