In 2012 my professional and personal lives intersected in a way I could not have imagined. Personally, I realized just how important—and neglected—parental education level is as a social determinant of health. I was raised in a working-class family in rural Ohio. I directly saw the impact that issues such as poverty, teenage pregnancy, alcoholism, suicide, and incarceration had on my family. In my case, with a combination of luck and good fortune; hard work and perseverance; generous scholarships and financial aid; and a healthy dose of great mentoring from someone willing to take a chance on me, I didn’t just attend nursing school—I climbed to the top and obtained a PhD in nursing.
Professionally, I started a new position at the UC San Francisco School of Nursing as an Assistant Professor. The University of California system had just started first-generation college student initiatives at each of its campuses and had begun collecting data on the highest level of education attained by applicants’ parents.
So here I was, a trailblazer in my family, a first-generation college nurse, working at an institution that was beginning to pay attention to the issues. Over time, word got around that I could relate to nursing students who struggled in a myriad of ways that first-generation college students struggle with, including self-care, finances, and family life. Students started showing up at my office door for help. To make students more comfortable sharing their challenges, I would sometimes meet them off campus.
My family upbringing is not a deficit; rather it makes me better able to care for my patients. When I walk into a patient’s room, or a first-generation student walks into my office, I know I can connect with them in ways my more privileged colleagues cannot. Our commonality as first-generation college nurses brings us together regardless of what language we speak, the color of our skin, or what neighborhood we grew up in. There are race, language, and social concordance benefits, and the research shows that better concordance between patients and their provider leads to better quality of care for marginalized populations. If you are a first-generation college nurse, what are the ways that your own experiences and this identity benefit your patients or students?
Students needed to understand this also, and I realized there was a need for a strength-based first-generation program specifically for nurses. So, to help cultivate the careers of other first-generation college nurses, with intramural funding I launched the First Generation to College Registered Nursing (FirstGenRN) Program at UCSF in 2017. Because of this unmet need, I applied for foundation and federal funding to continue and expand the program to other Bay Area schools to continue supporting nursing students who are the first in their families to attend and graduate from college. Support comes in many forms, and in order to enroll, accepted students often need financial support. I worked with a donor alumna of our nurse practitioner program to endow a need-based scholarship for first-generation college nursing students. The FirstGenRN Program helps students who have already been accepted to nursing school, but I’d like for everyone to consider what can we do to better support aspiring nursing student applicants at the beginning of the pipeline so they can be accepted and be successful?
An important part of being a professional nurse is belonging to membership organizations. Prior to writing this article for Sigma, I emailed the current 199 UCSF first-generation college nursing students to see if they would be interested in joining Sigma (if they were not already a member.) One student responded saying she wanted to join Sigma but couldn’t afford the membership fees. Luckily, Sigma has the Edith Anderson Membership Subsidy, but it is limited in how many applicants can benefit. That made me wonder, is there something we could do at the chapter level to offset the membership fees for first-generation college nurses who want to join? If your chapter already has something in place, I’d love to hear about it!
In 2019, UCSF became an inaugural First Forward Institution and remains a national leader on supporting first-generation students in health professions education. This is, in part, because our campus has a unique and rare partnership between faculty and first-generation support services staff. I invite you to join me this November 2022, where we will host a first-of-its-kind (and free!) virtual conference on how higher education leaders can better support first-generation college students in the health professions. If you are an academic, what is your nursing school doing to better cultivate the experiences of first-generation college nursing students? If you aren’t sure how to answer that question, this virtual conference would be a great place to hear more about how to make that happen.
We have an opportunity for this invisible identity as first-generation college nursing students to be a visible solution to some of healthcare’s greatest challenges. The first-generation to college nursing students I work with overwhelmingly say they want to go back and serve their communities. It is time for our profession, academia, and nurse leaders to step up and support the careers of first-generation college nursing students, from the mentoring and application process, throughout their schooling, to job negotiation strategies, and on-the-job mentoring. I live with this invisible identity every day as a nurse, including feelings of imposter syndrome. The future of our profession and providing first-generation college nursing students with opportunities to implement our public health strategies depends on all of us as we expand our diverse healthcare workforce.
Laura M. Wagner, PhD, RN, GNP, FAAN, is a professor at the UC San Francisco School of Nursing. She is a member of Sigma’s Alpha Mu Chapter.
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