Recruitment of Students

For several years, enrollment in schools of nursing has been decreasing. According to the American Association of Colleges of Nursing's website (www.aacn.nche.edu/), enrollments in bachelor's degree programs have declined for five years. The most recent data, for fall 1999, showed a 4.6% decline in enrollment and occurred in every region. Enrollment also declined by 1.9% in master's degree programs but not uniformly across the regions.

Many reasons explain the continual decrease in enrollment in basic nursing programs. First and foremost is the fact that women have many choices today when selecting a post high school education and career. Work conditions such as evening, night, and weekend shifts, or the exposure to contagious elements are cited as reasons that young people do not perceive nursing as a positive career choice.

The current nursing shortage has its roots in events of the 1990's. In the early 1990's, health care futurists were predicting a reduction in the number of hospital beds due to managed care penetration. Health care executives in all states watched the market changes in California in anticipation that capitation would be seen throughout the country. The nursing profession began to brace for an era of downsizing as hospitals were attempting to drive costs down by decreasing a patient's length of stay and adjusting their staffing models. A plan promoted by health care consultants was to reduce budgets by deploying assistive personnel where nurses once practiced. This resulted in layoffs of nurses in some parts of the country. The skill mix changes and movement of patients from acute care to homecare or ambulatory settings forced many nurses to evaluate their personal decisions. Feeling devalued and disenfranchised, nurses left the profession of nursing. Thus, schools of nursing and prospective nursing student candidates were left with an impression that fewer nurses would be needed in the future.

A compounding factor in many nursing schools is the availability of nursing faculty. They, like nurses in healthcare delivery, are aging. Thus, for some schools, even if they could recruit more students, they may not have faculty to teach them. Similar issues contribute to the shortage of faculty: compensation, cost of advanced preparation, and work conditions. Solution: Are there ways in which the aging practicing nurse who can no longer manage the physical demands of the job can be used to educate new nurses? One concern about practicing nurses is that they do not have curriculum development and performance measurement skills. If this is a barrier for recruiting needed faculty, solutions should possible. New models of education are needed as acutely as new models of patient care delivery. Practice and education have a long history of not being aligned. Perhaps the conditions now exist to unite practice and education, to have each earnestly listen to the other, and to enable them to design solutions together.

Strategies to recruit students are needed for the long term since the predictions are for a worsening shortage over the next decade, but there are immediate interventions possible. Many efforts are underway to recruit high school students. Solution: In San Diego, six hospital systems have committed $1.3 million to support a program called, "Nurses Now", which will add faculty and additional student slots to San Diego University (Kucher, 2000 ). The American Hospital Association News reports that in Laredo, Texas, a hospital CEO worked with Texas A&M University to develop a four-year bachelor's program and is providing $425,000 in scholarships to local students over the next five years (Runy, 2000). In Morris County, New Jersey, the Board of Freeholders offered scholarships to students who agreed to work in a long term care facility (Cichowski, 2000). The Dallas-Fort Worth Hospital Council raised $600,000 to expand student enrollment at local schools (Yednak, 2000). These are examples of various successful collaborative efforts among healthcare organizations, government, nursing associations and nursing schools. Many more are happening at the local level.

Within the general student recruitment initiates are efforts to reach minority students and young men. Solutions: Hodgman (1999 ) was project director of Choose Nursing!© , a state, privately, and federally funded project designed to recruit Boston public high school sophomores into a comprehensive 2 year hospital program to foster and maintain their interest in nursing and prepare them to apply to collegiate nursing programs. Departments of nursing or specialty organizations could implement variations of this program. For instance, a local chapter of a national specialty organization could "adopt" a middle or high school and establish an outreach program with students.

To ensure a continuous robust pool of nursing students, children must be reached earlier than high school. In fact, educators say that students often have their minds made up by fifth grade about desirable and undesirable careers. Thus, an early positive image of nursing for students is important.

To ensure a continuous robust pool of nursing students, children must be reached earlier than high school. In fact, educators say that students often have their minds made up by fifth grade about desirable and undesirable careers.

Solution: One long term strategy suggested by Ruth Kleinpell in Nursing Spectrum Metro Edition , is that a new series of Cherry Ames stories reflecting society today might be inspirational to a new generation of girls and boys. Although this suggestion may be met with skepticism, think about the influence stories have on children, the influence the original Cherry Ames books had on so many. She notes that Harriet Forman, who has the copyright to some of the books and is an executive with Nursing Spectrum, is working on new stories (Kleinpell, 2000). For older readers, there are books of stories about nursing and nursing leaders. By working with middle and high school teachers, guidance counselors and librarians, it is possible to introduce these books as resources. Nurses from a healthcare organization or a local chapter of a professional society could give these books as a gift. Solution: Current nursing students can be effective recruiters. Allentown's Cedar Crest College offers a four credit course that requires students to make presentations in local schools, participate in elementary school clinics, update public libraries on nursing books, and create displays about nursing as a career (Wlazelek, 2000).