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The Lived Experience of Hispanic new Graduate Nurses in the United States PDF

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Marquete University THE LIVED EXPERIENCE OF HISPANIC NEW GRADUATE NURSES IN THE UNITED STATES by Esther Grace Morales, MSN, RN A Dissertation submitted to the Faculty of the Graduate School, Marquette University, in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Milwaukee, Wisconsin December 2010 ABSTRACT THE LIVED EXPERIENCE OF HISPANIC NEW GRADUATE NURSES IN THE UNITED STATES Esther Grace Morales, MSN, RN Marquette University, 2010 There has been a significant increase in the Hispanic population in the United States that is not mirrored by representation of Hispanic registered nurses in the United States. Hispanic new graduate nurses enter nursing practice with few Hispanic role models and their story is not found in nursing literature. A qualitative study with a phenomenological philosophy and methodology was conducted to investigate the lived experience of seven Mexican American new graduate nurses, a subgroup of Hispanic nurses. Findings of this study were the seven themes: (a) being an employee; (b) an orientation with or without preceptors; (c) a transition; (d) shadows of doubt; (e) being Hispanic; (f) being bilingual and being pulled; and (g) blessed. The lived experience was described in more positive terms than negative terms and as a multifaceted experience. Hispanic new graduate nurses seemed to have an experience of transition typical of new graduate nurses, but with the added dimensions of cultural understandings, racism, and language proficiency with Spanish. i ACKNOWLEDGEMENTS Esther Grace Morales, MSN, RN Along my life’s journey there have been numerous individuals who have inspired and encouraged me to continue learning and seek education. My first-grade teacher accepted my shyness when I was the only student who did not walk across a balance beam while saying the ABC’s. Years later when I graduated with my Bachelor of Science in Nursing degree, a nursing professor gave me a hug and whispered in my ear, “You’re one in a million.” My family has endured when I have probably “taken on too much.” They are dear persons who literally believe and taught me that “you have to make hay while the sun is shining.” I accept and believe that being diligent in opportunities, often in the disguise of hard work, is embedded in my Judeo- Christian heritage. My advisor and committee chair, Marilyn Frenn, PhD, RN, has been most gracious and patient throughout my doctoral studies and the dissertation process. Marilyn Meyer Bratt, PhD, RN, and Walter J. Stohrer, S.J., PhD, have challenged, curbed, and guided big ideas and reality. Juanita (Terrie) Garcia, MEd., RN, has been a gentle friend; her leadership and advice is much appreciated. The participants in this study generously shared their time and stories. Without these nurses, my dissertation would have been impossible. The completion of this dissertation is a reflection of the support received from many and the hope that what I have learned may be beneficial and shared with others. ii TABLE OF CONTENTS ACKNOWLEDGEMENTS .......................................................................................... i LIST OF TABLES ........................................................................................................ vi CHAPTERS I. INTRODUCTION ............................................................................................ 1 Background ................................................................................................. 1 Significance to Nursing............................................................................... 2 II. REVIEW OF THE LITERATURE .................................................................. 8 Paradigm of Phenomenology ...................................................................... 8 Philosophies of Listening and Voice .......................................................... 11 Phenomenology and Nursing ...................................................................... 12 Theories Regarding the New Graduate Nurse ............................................ 14 Theories Supporting Cultural Diversity ...................................................... 18 Outline of the Literature Review ................................................................ 20 Education and Licensure of Hispanic Registered Nurses in the United States ............................................................................................... 21 New Graduate Nurse Experience in the United States ............................... 23 Underrepresentation of Hispanic RNs in the United States Nursing Workforce ..................................................................................... 36 Relation of Hispanic RNs and the Elimination of Health Disparities ........ 41 Summary of Literature Review ................................................................... 42 Assumptions of the Study ........................................................................... 43 Gap in the Literature ................................................................................... 44 Morales Dissertation iii III. RESEARCH DESIGN AND METHODS ........................................................ 46 Qualitative Research Design ....................................................................... 46 Method ........................................................................................................ 46 Selection of Sample Participants ................................................................ 47 Data Collection ........................................................................................... 51 Interviewing and Interview Questions ........................................................ 53 Data Analysis .............................................................................................. 54 Coding ......................................................................................................... 57 Protection of Human Subjects .................................................................... 58 Reliability & Validity ................................................................................. 61 Efforts to Control for Error and Bias .......................................................... 63 Limitations .................................................................................................. 65 IV. RESULTS ......................................................................................................... 67 Introduction ................................................................................................. 67 Presentation of Descriptive Data ................................................................ 67 Presentation of Identified Themes .............................................................. 70 Being an Employee ..................................................................................... 71 Prior Work Experience ............................................................................... 73 Politics and Policy....................................................................................... 73 Other Staff ................................................................................................... 75 Age .............................................................................................................. 75 Certified Nursing Assistants (CNAs) and Medical Assistants ................... 76 Ethnicity ...................................................................................................... 77 Morales Dissertation iv Gender ......................................................................................................... 77 Proficiency With Language Other Than English ........................................ 78 An Orientation With or Without Preceptors ............................................... 78 A Transition ................................................................................................ 81 Nursing School is Only the Beginning ....................................................... 82 Find Your Way and Place ........................................................................... 82 There ........................................................................................................... 83 Shadows of Doubt ....................................................................................... 84 Being Hispanic ............................................................................................ 85 Being a Minority ......................................................................................... 87 Alone ........................................................................................................... 88 Intertwined .................................................................................................. 88 Similar Life Experiences............................................................................. 89 Being Bilingual and Being Pulled............................................................... 90 Blessed ........................................................................................................ 91 Summary ..................................................................................................... 92 V. DISCUSSION ................................................................................................... 93 Significance of Findings ............................................................................. 93 Being an Employee ..................................................................................... 94 An Orientation With or Without Preceptors ............................................... 97 A Transition ................................................................................................ 99 Shadows of Doubt ....................................................................................... 100 Being Hispanic ............................................................................................ 102 Morales Dissertation v Being Bilingual and Being Pulled............................................................... 105 Blessed ........................................................................................................ 106 Implications of Research for Nursing Practice, Administration, Education, and Research ............................................................................. 110 Study Strengths and Additional Limitations ............................................... 116 Suggestions for Future Research ................................................................ 118 Summary ..................................................................................................... 121 BIBLIOGRAPHY ......................................................................................................... 123 APPENDICES Appendix A: Snapshot of Literature Review for Hispanic New Graduate Nurses ............................................................................................................... 142 Appendix B: Consent for Research Participants ............................................... 146 Appendix C: Demographic Questionnaire ........................................................ 148 vi LIST OF TABLES Participant Demographics ............................................................................................ 68 General Themes and Subthemes From Interviews........................................................ 71 Morales Dissertation 1 Chapter I Introduction Efforts and emphasis have been extended to recruit and retain diverse racial and ethnic minorities in the nursing profession with hopes to reduce and eliminate health disparities. The purpose of this study was to explore and describe the experience of Hispanic new graduate nurses who passed the National Council Licensure Examination for Registered Nurses (NCLEX- RN) and gained employment as registered nurses in the United States. The aim of this study was to understand the meaning of these nurses’ experience. The research question was, “What is the meaning of the experience of Hispanic new graduate nurses in the United States?” Background Hispanic refers to individuals living in the United States “who were born in or trace the background of their families to one of the Spanish-speaking Latin American nations or to Spain” (Marín & Marín, 1991, p. 1). Hispanic is recognized as a term of ethnicity as Hispanic persons belong to all of the human races and many are racially mixed. The 1980s were proclaimed as the “Decade of the Hispanic” when there were significant impacts on the demography of the United States evidenced by the number of Hispanic residents with a growth of 265% between 1950 and 1980. The 1990s saw prominent Hispanics in the sciences, business, industry, entertainment, and politics in the United States. As of July 1, 2006, there were 44.3 million Hispanics in the United States which accounted for 14.8% of the total population of 299 million (U.S. Census Bureau, 2008). The projected Hispanic population is expected to increase to 47.8 million in 2010 and

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