Date of Award


Degree Type


Degree Name

Doctor of Philosophy in Nursing



First Advisor

Mary Sullivan


In the United States, increasing racial and ethnic diversity coupled with widening health care disparities have prompted growing concern about the lack of racial and ethnic diversity in the health professions. As the largest sector of the health care workforce who practice at all levels and settings of health care, the nursing profession has the potential to widely effect changes to reduce disparities. Yet only 19% of the registered nurse workforce reflects diversity, prompting a look at pre-collegiate pathways to a nursing career. Guided by Social Cognitive Career Theory, this study examined the pre-college factors that influenced student choice in a nursing career at three points of the pipeline, high school (HS) academic achievement, college admission with a declared health care major, and entry into the nursing/health workforce. A national representative sample of 4009 youth and parents from the Longitudinal Study of American Youth (LSAY) participated over 12 data collection waves from ages 13-37. Multiple predictors of gender, race/ethnicity, peer, parent and teacher academic and college push, student self-efficacy and college expectations contributed to HS achievement [F(13, 2096) = 85.64, p < .05, R2 = .35]. Later in the pipeline, a healthcare college major was predicted by gender, parent science push, self-efficacy, and student expectations to attend college (p < .05; R2 = .15). For students who became nurses, gender, SES, and student self-efficacy beliefs were significant (p < .05, Nagelkerke R2 = .15), but for healthcare providers, gender, parent math push, HS teacher college push, and self-efficacy were significant (p < .05, Nagelkerke R2 = .11). Clearly, math and science teachers are needed for success in nursing/health careers along with parents and teachers, but not peers. Self-efficacy was consistently important. Implications include nursing and education policy.



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