A Healthy Balance
A program aimed at remedying racial disparities is changing the face of nursing—and changing lives in the process.
Photograph: Sasha DuBois ’08, right, a mentor to Saby Jean-Pierre ’12, photographed at Brigham and Women’s Hospital.
In 2003, in her first year as a nursing student at Simmons, Sasha DuBois ’08 almost transferred out. “I felt so disconnected,” says DuBois, now a nurse-administrator at Boston’s prestigious Brigham and Women’s Hospital. “I realized I really need to be ingrained in a place to have a great experience there.”
She sought out advisors who could help her feel more at home, and she pushed through. But she also realized that pursuing a nursing degree as a woman of color carried a unique set of challenges. Concerned that other minority students might be experiencing similar difficulties, she spoke with Dean Judy Beal of the School of Nursing and Health Sciences—and learned that her instinct had been exactly right: Other students of color in the nursing program had indeed been struggling to feel comfortable at Simmons. Their unease was being reflected in lower-than-expected retention rates and academic achievement, and Simmons was already looking for ways to improve their experiences and outcomes. Beal was leading the charge.
“We had seen that students of color were not performing as well on the NCLEX [licensing exam] as their white counterparts,” Beal says, “and so we knew we had to do something to support them.”
That something turned out to be the Dotson Bridge and Mentoring Program, a framework of academic and personal support designed to help students of color achieve their potential.
“When we started,” says LaDonna Christian ’12HSC, ’16HSD, P ’12, “we had eight students, and five of them were [under academic review]. We sat down with the academic review board and said ‘please don’t exclude them. Give them to us—we’ll work with them.’ They’ve all since graduated and become RNs.”
Christian, who was the first Dotson faculty member and now directs the program, says that figuring out that bright students were simply feeling lonely and disconnected has been a powerful insight—and one that has led to rapid growth. Since its inaugural 2009-2010 rollout, the program has grown each year. Current Dotson scholars number over 90, and there is a waiting list.
“Because we have the Dotson Program, about 32 percent of the students who come here now are students of color, multicultural students,” Christian says. “When I first started it was around 15 percent.”
“Having a mentor allows you to see college with a different set of eyes. Students feel like there’s someone that’s looking out for them.” —Sasha DuBois ’08
The faculty and administrators who built the program also knew that the issue of minority participation in medical training wasn’t unique to Simmons. Blacks, Latinos, and other minority groups in the United States have long been underrepresented in nursing and other health-care fields. In 2003, Duke University’s Sullivan Commission on Diversity in the Healthcare Workforce issued a landmark report called Missing Persons: Minorities in the Health Professions, detailing the lack of minority health professionals and the subsequent racial and ethnic disparities in outcomes and care. According to a 2013 study by the National Council of State Boards of Nursing, African-Americans constituted 13.2 percent of the general population that year, but only 6 percent of registered nurses. For Hispanics, the gap was even wider: In the same year, they accounted for 17.1 percent of the general population and only 3 percent of nurses.
Beal and other professors had seen that Simmons was by no means immune to these inequities, and they wanted to address the problem.
In 2008, a perfectly timed gift of $2 million from Phyllis Nickerson Dotson ’62, a graduate of Simmons’ nursing program, and her husband, George S. Dotson, meant Beal could devote substantial time and resources to developing the Dotson Bridge and Mentoring Program—an integrated system of support designed to enhance the educational experience and success of African-American, Latina, Asian, and Native-American (ALANA) students pursuing nursing at Simmons. Under the leadership of Beal and Gloria Cater—the program’s first director—as well as inaugural faculty lead LaDonna Christian, the program would grow rapidly—and Sasha DuBois would soon be serving as one of the program’s first mentors.
Her role as a mentor “was my way to make a difference as an alumna” says DuBois, who has been mentoring Dotson students ever since—for 10 years this year. “I didn’t want students to have some of the negative experiences that my friends had, and that I had.”
Although it was carefully tailored to support students of color, the Dotson Program also addressed—and continues to address—a broader national issue. As health-care professionals have long acknowledged, racial and ethnic underrepresentation in nursing produces cultural and linguistic barriers that can introduce troubling complications to communications between patients and caregivers. Such breakdowns can be frustrating at best. In the worst cases, they can cause misunderstandings and delays that can prove critical or even fatal.
DuBois has seen such breakdowns, and she has also seen the progress that can be made when nurses and patients share a cultural vocabulary. She talks about the subtle cues that can be easy to miss without such connections, and the more direct ways that physiological differences like variations in skin tone can affect medical assessments and outcomes.
“By the time it is recognized that a person of color has issues with their oxygen—we call it hypoxia—they’re more likely to have a worse outcome,” DuBois says. “Next thing you know, they’re having an emergency, where they’re having a hard time breathing. You often have to use social and cultural cues to pick up subtle changes in a person’s status.”
Such factors can come into play in less-acute situations as well. When she worked as a clinical nurse, DuBois recalls hearing a doctor tell a Dominican woman with diabetes to “eat less rice and talk with a dietitian.”
From DuBois’ perspective, that simply wasn’t going to work.
“After we left the room,” she says, “I told [the physician], ‘She’s not going to be successful this way. She’s going to need different ways so that she can understand, [so] she can still have some of her cultural foods that are important to her, but just make them a little healthier. If you just tell her stop eating rice and walk out of the door, she’s not going to be successful.”
Figuring out that bright students were simply feeling lonely and disconnected has been a powerful insight—and one that has led to rapid growth.
DuBois says all the doctors she has worked with have welcomed such observations. “I’ve never been shy to speak up in rounds,” she says. “Providers may not understand what goes on in people’s houses, especially if it’s a patient who doesn’t necessarily share the same background they do. A lot of these little instances help with the outcomes and patient progression.”
Christian says students often share stories of patients or patients’ families who don’t speak English. Facing illness in a hospital or clinic can be difficult, she says, when “there’s no one there that understands.”
A similar dynamic can come into play for aspiring nurses. Saby Jean-Pierre ’12 transferred into the nursing program at Simmons a few years after DuBois graduated. At first, her academic work suffered as she struggled to balance her studies with a full-time job as well as her duties as a resident-life assistant on campus.
Then she took a course with Christian. Christian noticed the toll Jean-Pierre’s work and course-load was taking, and one day after class, Christian stopped her and said, “Are you OK? You look tired.” They talked, and Christian encouraged Jean-Pierre to apply to the Dotson Program. When Jean-Pierre followed her advice, Christian matched her with DuBois as a mentor, a pairing that would result in a lasting friendship.
From then on, in lunches and study sessions, DuBois supported Jean-Pierre’s education at Simmons, helping her chart a path through the rigorous curriculum. Having DuBois to talk to also meant that Jean-Pierre could process some of what she had experienced as a minority student. And the two shared family roots in Haiti, another bond that brought them closer.
“Sasha was great,” Jean-Pierre says. “She was there for me with anything that had to do with school, my personal life. Just to have the Dotson Program and to have that space, the Dotson Room, and the science building, it was somewhere to go, somewhere to speak to people about the kind of things that you were going through—family issues, academic affairs, anything. Having that supportive space really helped.”
DuBois also felt rewarded by the relationship.
“I always felt like Saby was kind of like a little sister to me,” she says. “There were certain things where I could do a lot of anticipatory guidance, so she could see things coming. She could bounce anything off of me. Now that she’s graduated, and she’s a clinical nurse, and she’s in a master’s program, and she’s heading a hospital committee, I couldn’t be more proud of her!”
For DuBois, mentoring—and service—run in the family. One of her aunts is a nurse, and several other relatives work in law enforcement. In the early 1900s, her great-great-grandfather on her mother’s side traveled from Bermuda to Lowell, MA, where he established a machine shop and a social club, welcoming other Bermudans and helping them get situated in their new home. His daughter, DuBois’ great-grandmother Cynthia Wood, ran a Girl Scouts camp in Townsend, MA, where she grew a big garden, adopted a vegetarian diet, and encouraged her family, including DuBois, who often visited her there in the summers as a child, to develop healthful habits and to value wellness.
“There was always a conversation about being healthy in my family, and especially in my large, extended family,” DuBois says. “Whether you took that advice or not, or had the resources to do that, it was always just a point of knowing. That was introduced to my life early.”
For Jean-Pierre, having DuBois in her corner has continued to be a game changer. It has informed her current role as a nurse in Brigham and Women’s intensive care unit—and her own work as a mentor in turn. After her experience with DuBois and the Dotson Program, Jean-Pierre says, “I wanted to give back and have the same impact myself.”
Now Jean-Pierre mentors Kara Walsh ’20, a rising junior. As it did for Jean-Pierre, the Dotson Program has given Walsh a sense that she is not alone.
“People may say, ‘oh, color doesn’t matter, I don’t see color,’” Walsh says, “but that’s a problematic statement, because you do see color, and people do have subconscious thoughts about color. Having someone to talk to about it is important. It helps you build a sense of community.” Through the Dotson Program, Walsh says, “you have mentors and other staff that are also persons of color, which makes you feel more comfortable in the program, and gives you a little bit more confidence that you’re not the only one facing these struggles.”
According to Gloria Cater, the program’s first director, the kind of experience Walsh has had is precisely what the program seeks to achieve. Through a combination of workshops, self-assessments, study groups, volunteering opportunities, mentorships, and leadership trainings, the Dotson Program coaches participants toward success and a sense that not only is there room for them in the medical professions, their presence is essential.
“There is a definite cultural component that we are able to embrace in our students,” Cater says. “It is needed in the health-care community. Don’t put it under a bushel. Let it shine.”
Christian, the current Dotson Program director, notes that some parts of the program are open to all. As the program has grown, she says, it has expanded to serve an ever more diverse population including Russian students for whom English is a second language, and male students, who are still vastly underrepresented in nursing programs. “Basically anyone who has cultural differences.”
For students like Walsh, and alumnae like Jean-Pierre and DuBois, the Dotson Program has been truly life-changing. “The cultural capital of knowing what nursing school is like is totally understated,” DuBois says. “Having a mentor allows you to see college with a different set of eyes. Students feel like there’s someone that’s looking out for them, someone that’s been there before, someone that understands the culture, understands the system, understands nursing, and really knows what they need to do to get there. You have to get people over that bridge.”