Dismantling Barriers to Create Sustainable Change

Ann Gakumo, PhD, RN, has received more than $1 million in grants to diversify the nursing workforce and combat systemic racism in the profession.

According to a 2022 report published by the National Council of State Boards of Nursing (NCSBN), 80% of the registered nurses in the United States are white or Caucasian, while 88% are women. These numbers are a result of several factors, from the profession’s long-standing failure to include and represent the views and needs of nurses of color to recent data demonstrating systemic racism within the profession. The lack of academic, financial, peer and social support to diverse students, along with low representation of role-modeling faculty of color, have also contributed to the insufficient diversity in nursing.

With funding from two grants, Gakumo, who serves as UC College of Nursing’s associate dean for inclusion and community impact, and collaborators will drive forward efforts that recruit and support racially and ethnically diverse undergraduate nursing students at UC and build a learning collaborative that promotes anti-racist academic environments at sites across the country.

Recruiting, retaining and supporting a diverse student body Gakumo’s Systems in Holistic Innovation and Inclusion for Transformation (SHIIFT) program was awarded $750,000 by Genentech’s Health Equity and Diversity in STEM Innovation Fund, which supports projects that contribute to increasing representation of communities of color in clinical research, eliminating inequities in care delivery and dismantling barriers to a diverse, inclusive and anti-racist scientific and health care workforce.

With support from UC Nursing Assistant Professor Rosalind Moore, DNP, RN, Gakumo aims to establish a successful model for the recruitment, retention and academic success of racially and ethnically diverse undergraduate nursing students by:

• Examining undergraduate admission processes to determine structural barriers to equity;

• Admitting a diverse cohort of eight Bachelor of Science in Nursing (BSN) students in the 2023 freshman class based on factors other than standardized test scores;

• Creating collaborative academic-community partnerships to build capacity for community engagement; and

• Developing inclusive learning environments that integrate diversity, social determinants of health and equity throughout the curriculum and in evaluation.

“The College of Nursing is the only college in the university that still requires standardized test scores for undergraduate admission. Although this year’s incoming BSN class is the most diverse in recent years, more needs to be done to increase the racial and ethnic diversity of our undergraduate students. Granting access through a testoptional pathway will allow our admissions processes to be even more holistic,” Gakumo says.

Research from the University of Chicago shows that grade point averages (GPAs) are five times more accurate in predicting college success than standardized tests. GPAs measure a very wide variety of skills and behaviors needed for success in college, where students will encounter widely varying content and expectations. In contrast, standardized tests measure only a small set of the skills that students need to succeed in college, and students can prepare for these tests in narrow ways that may not translate into better preparation to succeed in college.

“Making standardized testing scores mandatory for undergraduate admissions also creates a bias toward applicants with the financial resources to pay for examination preparatory courses and those who would have attended private high schools. For those applicants with lesser financial resources, standardized testing becomes a barrier to applying to our direct-entry BSN program,” says Gordon Gillespie, PhD, DNP, RN, FAAN, interim dean for the College of Nursing. “We previously recognized evidence that standardized testing is not predictive of student success in graduate programs. As a result, our graduate programs no longer require standardized testing.”

Addressing structural racism in nursing academia

The Macy Foundation, the only national foundation solely dedicated to improving the education of health professionals, awarded Gakumo, in partnership with Greer Glazer, PhD, RN, FAAN, dean emeritus of the College of Nursing, $300,000 to support a national multisite project titled “Eliminating Structural Racism in Nursing Academia: A Systems Change Approach to Anti-Racist Nursing Education.”

The project builds upon the American Association of Colleges of Nurses’ (AACN) Leading Across Multidimensional Perspectives (LAMPSM) Culture and Climate Survey, deployed to 50 nursing schools — including UC — to better understand the culture of inclusion and belonging, particularly among students and faculty of color. Data collected by the survey provided institution-level assessments to help participating schools understand their campus climate and its impact on student experiences and achievements.

Through this grant, Gakumo and Glazer will build a learning collaborative composed of eight to 10 schools that were part of AACN’s original 50-school cohort to develop projects addressing structural racism and promoting antiracist nursing education in their respective institutions. Schools will develop and implement projects based on areas for growth and improvement identified by the LAMPSM survey and meet regularly to report on the status of their projects and processes, learn from one another, and gain key feedback and advice. A plan for sustainability and growth at individual schools, as well as a plan for replicability and adoption at nursing schools nationally, is part of the project’s goals.

“Nursing academia is at a critical time for change in adopting to new educational frameworks and standards,” Glazer says. “At a time of transformation, there is a rich opportunity for innovation in developing and implementing new practices, processes and curricula focused on dismantling structural racism. I’m thankful UC is taking an active role in this process.”

Gakumo adds: “Many of the efforts we’ve tried over the years focused on putting mechanisms in place so that people from minoritized backgrounds can overcome barriers in the system rather than focusing on the system itself. If we want any real sustainable change, it has to happen on a systems level.”

With funding from two grants, Gakumo, who serves as UC College of Nursing’s associate dean for inclusion and community impact, and collaborators will drive forward efforts that recruit and support racially and ethnically diverse undergraduate nursing students at UC and build a learning collaborative that promotes anti-racist academic environments at sites across the country.

If we want any real sustainable change, it has to happen on a systems level.”
— Ann Gakumo, PhD, RN

By: Evelyn Fleider

Bill Bangert contributed to this story.