Lincoln University closes its nursing program, leaving a hole in the pipeline of Black nurses

Just three days before Olamide Afolabi’s graduation ceremony from Lincoln University’s nursing program last month, she got a startling email from the university’s president:

The program was closing. The Class of May 2023 would be the last.

Lincoln, located in Chester County, Pa., was the only historically Black college and university (HBCU) in the state to offer a bachelor’s of science in nursing. The university’s program served as a pipeline for Black nurses in a medical workforce in which 7% of registered nurses are Black.

Though a relatively small program, with about 15 graduates on average each year, its closure is a blow to national efforts to fix long-existing racial disparities in health-care staffing and improve care for Black patients.

In her May 4 email to students, Lincoln University President Brenda A. Allen explained that the Commission on Collegiate Nursing Education (CCNE) had withdrawn the program’s accreditation, primarily because not enough Lincoln graduates passed the national exam to become a licensed nurse. And the program’s accredited status would lapse on May 8 — the day after graduation.

“I was very shocked and also upset,” Afolabi said. “It just seemed so sudden.”

Years of warnings, leadership changes, and initiatives designed to turn the program around ultimately proved insufficient to prevent its closure. Lincoln’s baccalaureate program was one of only four out of about 840 nationwide that lost its CCNE accreditation so far this year, said Benjamin Murray, CCNE’s deputy executive director.

With the accreditation lost, Lincoln officials earlier this month went before the Pennsylvania Board of Nursing and announced they would not appeal CCNE’s disciplinary action and instead shut down the program.

“We still care deeply about health-care disparities. We understand that we play a significant role in that,” said Lincoln’s Dean of Faculty Patricia Joseph at the June 5 nursing board meeting.

“It’s just a sad day,” one state nursing board member said.

Before Lincoln ended its program, 32 HBCUs nationally awarded bachelor’s degrees in nursing. The graduates from these schools represented fewer than 1 in 10 of all bachelor’s degree nursing grads, but half of them were Black. Experts call HBCUs integral to advancing diversity in nursing.

From spring 2015 through May of this year, 133 students graduated from Lincoln’s nursing program. Joseph said Lincoln still plans to fulfill its mission of fostering a diverse health-care workforce through partnerships with area medical schools.

Eve J. Higginbotham, an eye doctor and vice dean of Penn Medicine Office of Inclusion, Diversity and Equity, said the loss of Lincoln’s program is “really catastrophic to our efforts to achieve health equity.”

“When you have ancestral or ethnic concordance between provider and patient, you have higher levels of adherence to medicines and higher levels of patient satisfaction,” Higginbotham said. “There’s a shared lived experience that is priceless.”

Then-student Bukola Adebayo arrived at Lincoln from Nigeria on a scholarship. She graduated from the nursing program in spring 2021. She passed the licensure exam, or National Council Licensure Examination (NCLEX), and took a job as a registered nurse at an Ohio hospital. During her first year of work, Adebayo said she was the only full-time Black nurse on the hospital’s staff. She felt “isolated” at times, she said.

Black patients, however, lit up when she walked into their room, Adebayo said.

“They were happy and excited to see someone who looks like them at a hospital,” she said. “They were more comfortable expressing how they feel to somebody of the same color.”

Lincoln administrators hailed the formation of its nursing program in 2013, saying the endeavor “will continue to propel us to new levels of excellence as we seek to be a resource to our region, state and nation,” according to the university’s 2013 annual report.

Shelley Johnson, the university’s director of nursing and health sciences at the time, got approval not only from Pennsylvania’s nursing board, but also from boards in Delaware and Maryland, because she needed to make sure there were enough spaces for Lincoln students to complete hands-on clinical training at medical institutions within 50 miles of the campus.

Johnson said she set up a “simulation center,” a lab that mirrors a hospital setting, recruited faculty, and secured full accreditation from the Commission on Collegiate Nursing Education (CCNE) prior to leaving to take another job in 2015.

While not required by Pennsylvania to operate a nursing program, many employers won’t hire nurses who didn’t graduate from an accredited program. Also, graduate and certification programs often require it.

The inaugural class of students — only four in all — graduated in spring 2015, according to Joseph.

But the program grappled with leadership turnover, faculty retention, and lack of competitive staff salaries.

The state soon flagged cause for concern in students’ relatively low test scores. Lincoln’s NCLEX passing rate was consistently below the 80% state mandate, according to the state board of nursing. Under state regulations, 80% or more of a program’s graduates must pass the NCLEX on first try.

When a program falls below the 80% pass rate, the state Board of Nursing grants provisional approval — a status that allows the board to demand reports, make campus visits, and impose restrictions such as limits on enrollment.

From December 2017 through its closure announcement this June, the board met with or discussed the program at Lincoln more than 20 times.

Board minutes show, Lincoln program administrators laid out their efforts to improve: bringing in a national expert to review the curriculum; hiring personnel to develop faculty and coordinate tutoring; acquiring new training simulators; and working with standardized testing prep companies. There were even discussions of pausing admission to implement improvements.

It’s not rare for a nursing school to periodically fall below the 80% pass rate. Among the 44 state-approved nursing programs that offered baccalaureate degrees in Pennsylvania, Lincoln was one of eight with provisional approval from the state as of April, according to the Department of State. Others locally included Temple University and Jefferson College of Nursing.

But Lincoln was the only nursing program in the state with low passing rates for the past five years.

Lincoln also is one of four “state-related” universities, meaning it receives tax dollars to subsidize tuition for in-state students. The others are University of Pittsburgh, Penn State, and Temple University. Lincoln receives about $15 million a year from the state for its operating budget. The rest of its budget — over $80 million total — comes mostly from student tuition and fees.

Running a nursing program is expensive and labor-intensive, noted Monica J. Harmon, president of the Southeastern Pennsylvania Area Black Nurses Association, who worked extensively with Lincoln’s administrators. She said they didn’t fully appreciate the resources that would be required. As a relatively new and small program, Lincoln also lacked alumni to tap for monetary support. Many HBCUs are underfunded, she noted.

“You think about HBCUs — most of the students don’t come from big means financially,” Harmon said. “Often, they are the first person in their family to go to college.”

Harmon said she believed Lincoln’s decision to close the program was “premature.” She had high hopes that under its new program director, Vilma Davis, a longtime pediatric nurse-practitioner “that program would have excelled.”

The university said Davis was unavailable for an interview.

Afolabi, 20, was one of 15 students who graduated on May 7. Like her classmates, she is now in the process of tackling the NCLEX and sat for her exam on Wednesday. She has a job lined up as a cardiac nurse on an ICU floor of a hospital in Ohio.

It feels unreal to be among the last graduating class, she said.

“Even now, I’m still hoping it’s not true, and that my class will do so well on the test that they will have no other option but to continue the program,” Afolabi said Thursday, as she awaited her exam result.

The school is assisting current students through the transition. Lincoln helped five rising seniors transfer to nearby accredited nursing programs, said Joseph, the university’s dean of faculty.

Lincoln had admitted 20 juniors into its program before its closure, but they had not yet taken nursing courses. The university offered them information on other majors and alternative pathways into nursing. Students don’t need a bachelor’s degree to get certified as a nurse.

Abigail Peter, a 25-year-old hospital ICU nurse who graduated from Lincoln in 2021, said the program’s small cohort size afforded her individualized attention from her professors. She was so inspired by the faculty that she had hoped to get her master’s degree and teach there.

Peter and three other 2021 graduates told The Inquirer that rumors of the impending closure loomed during each of their four years at Lincoln. It created an additional level of stress that if they didn’t pass the NCLEX, they would cause the program’s demise. They said the pressure was heightened because each class was so small.

But with each grace period from the state and CCNE, the threat seemed to wane, Peter said.

Peter questioned, “Why is this happening now? What has changed?”

Johnson, the former director who helped launch the program and is now dean of the nursing school at Florida Agricultural and Mechanical University, put it simply. “Times change,” she said.