How Frontier Nursing University Has Pioneered a More Diverse Healthcare System

The Kentucky nursing school has tripled its student of color population in the last decade to provide racially concordant care.

While hospitals and other healthcare organizations work to rectify the health disparities and inequities revealed by COVID-19, one Kentucky nursing school has steadily contributed toward a more diverse, culturally competent healthcare system for more than a decade.

Frontier Nursing University (FNU), in Versailles, Kentucky, has strengthened its nationally recognized Diversity Impact Program to triple its student of color population from 9% to 28% in the last decade to better provide racially concordant care, or having a shared racial identity between a healthcare provider and patient.

Studies on racially concordant healthcare are a mixed bag. Associating positive health outcomes for minorities with race concordance is inconclusive, some studies say. However, other research indicates that disparities in patient-healthcare provider communication may create challenges in care delivery.

Conversely, Black men in Oakland, California, were more likely to get a preventive health screening when offered by a Black doctor, according to a 2019 study.

FNU's Diversity Impact Program, which recruits and retains underrepresented students and employees, contributes to the university's mission to provide accessible nurse practitioner and nurse-midwifery education to serve all individuals, but with an emphasis on women and families in diverse, rural, and underserved populations.

That program recently was bolstered with a $2.2 million Nursing Workforce Diversity grant from the Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services, which is the primary federal agency for improving healthcare to people in rural areas or who are economically or medically vulnerable. In 2017, Frontier received that grant for just under $2 million.

HealthLeaders talked with FNU's chief diversity and inclusion officer, Geraldine Young, DNP, APRN, FNP-BC, CDCES, FAANP, about how the 2,500-student nursing school is doing its part to contribute toward a more diverse healthcare system.

This transcript has been lightly edited for length and clarity.

HealthLeaders: Frontier Nursing University started working on disparities more than a decade ago. What was the impetus back then to create a program to begin addressing it?

Geraldine Young: Frontier knew that race concordant care would help improve disparities, so they wanted to put out more nurse practitioners and nurse midwives into the communities in which they live and serve to combat these issues, particularly in rural and underserved areas. We were able to increase numbers because we received a HRSA grant in 2017. That HRSA Nursing Workforce Diversity grant was instrumental in helping create different, innovative ways of recruiting and retaining students of color, as well.

HL: Frontier’s student of color population has tripled in the last decade and is now at nearly 28%. What are some of the strategies the nursing university has used to create that growth? 

Young: When you have programs that focus in on diversity, equity, and inclusion, then you create an atmosphere of belonging, and you're doing things for diversity that are intentional. Also, Frontier changed to a holistic admissions process and added in measures to ensure the inclusion or admission of students from a diverse backgrounds and rural and underserved areas.  

One way we do it is through intentional recruitment of diverse populations. We go to different, diverse conferences like the National Black Nurses Association or The National Association of Hispanic Nurses to recruit nurses to become advance practice nurses such as nurse practitioners or nurse midwives. The holistic admissions process is a big piece of it, too,  to have those inclusive metrics to ensure that you are admitting students of color.

Then there's the issue of making sure you retain them once they get into the program, so there's some things that we've done through the Diversity Impact Program and through the grants, such as mentoring programs for students of color, and we've offered scholarships through the Nursing Workforce Diversity Grant for students of color. We've also offered academic support, such as tutoring and peer mentoring to make sure we can retain the students of color. Not only do we look at bringing them in, but how we can assist them in making sure they sustain throughout the process to be able to successfully graduate.

HL: What is the retention rate on your students of color?

Young: Retention of students of color is at 84%, and our goal was 80%, so we're exceeding our goal.

HL: What are Frontier's percentage goals as far as the students go and what is the timeline for getting there?

Young: The goal we're shooting for is 30% for students of color, but at the same time, we do recognize that our nation is changing. By 2045 or 2050 the people we consider minorities in the United States will become the majority, so this is something that we will continue to look at and probably eventually try to match that population. Because in order to address health disparities and inequities and improve health outcomes, we have to have culturally competent healthcare being delivered by people who we know and trust or that understand us.

HL: You all are working on faculty diversity as well, correct?

Young: Yes, with this new HRSA grant, one of our main focuses is to increase recruitment of faculty of color and to retain faculty of color. The last percentage that we have for faculty is at 14% and we're looking to increase it to around 20%. Eventually we want to make sure it matches our student population. Right now, the students of color are at 28% so we are trying to eventually get to that number. We want our leadership, our faculty, to be representative of our student population.

HL: For health systems or hospitals that want to address health disparities, what are some of the first things they need to do?

Young: They need to make sure they educate themselves first. They can see what is going on around this nation with health disparities and health inequities, but I think education is the first step. Next step, I would say for an organization, diversity, equity, inclusion, and anti-racism work has to be at the core of what you're doing, so it has to be a part of the mission. It has to be a part of the vision. It has to be a part of the strategic planning and the goals. It has to be at the core of what you're doing, and it has to be threaded throughout everything that you're doing, if we're going to make everything right.