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

159 Pages·2016·0.52 MB·English

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