AACN Issue Bulletin

December 2001

As the U.S. struggles to find solutions to the current nursing shortage, one strategy to address the emerging crisis continues to surface: Nursing schools need to strengthen their efforts to attract more men and minority students. Though nursing schools enroll more diverse students than medical (10.5%) or dental colleges (11%), the overwhelming majority of students in today's baccalaureate nursing programs are female (91%) from non-minority backgrounds (73.5%). Considering the fact that females comprise about 51% of the population and minority group representation is rapidly approaching 33%, today's nursing students do not mirror the nation's population.

Naturally, a lack of diversity in the educational pipeline leads to a lack of diversity in the registered nurse (RN) workforce. According to the latest National Sample Survey of Registered Nurses (2000) prepared by the federal Division of Nursing within the Bureau of Health Professions (HRSA), only 5.4% of all RNs are men; only 12.3% of RNs represent racial or ethnic minority groups. Though the current percentages are low in comparison to national norms, these figures do represent a slight increase over the previous sample survey which identified 264,000 minority nurses in 1996 compared to over 331,000 minority nurses today.

Studies point to many reasons why men and minority group members do not pursue nursing: role stereotypes, economic barriers, few mentors, gender biases, lack of direction from early authority figures, misunderstanding about the practice of nursing, and increased opportunities in other fields. Compounding the lack of student diversity, and further impacting minority recruitment efforts, is the fact that nursing school deans and faculty also comprise a gender-skewed, racially homogenous group. Men are represented by only 3.5% of faculty and 2.4% of deans; minorities represent only 8.7% of faculty and 6.8% of deans.

Why is it important to attract underrepresented groups into nursing? According to an April 2000 report prepared by the National Advisory Council on Nurse Education and Practice, a culturally diverse nursing workforce is essential to meeting the health care needs of the nation's population. Despite their small numbers, minority nurses are significant contributors to the provision of health care services in this country and leaders in the development of models of care that address the unique needs of minority populations. Given the projections for a deepening nursing shortage, the need to attract nontraditional students into nursing and expand the capacity of baccalaureate programs is also gaining in importance.

So what are nursing schools doing to recruit men and minority students into their degree programs? Using a combination of traditional marketing methods, targeted outreach campaigns, and strategic planning, schools are rising to meet the challenge of expanding student diversity and eliminating barriers. This issue bulletin examines some of the techniques that are working and can be duplicated across the country.

Presenting an Inclusive Image

Central to any outreach campaign is a marketing message with visual cues that speak to a target audience. Schools around the country have updated brochures, retooled promotional messages, and used images of diverse groups of nurses to appeal directly to underrepresented groups.

The University of Texas Health Science Center at Houston set their sights on increasing the number of men in their nursing programs and convened a forum of male nurses to find out what drew them to the profession. "They told us to play up the macho aspects of nursing - that is, emergency care and trauma - to advertise in the sports pages for students, to play up the longhorn symbol of UT," said Patricia Starck, DSN, RN, FAAN, dean of the School of Nursing. "And they told us to go back and proof our recruitment brochures and take out any flowery, feminine language." Having adopted many of these recommendations, the percentage of male nurses at UT-Houston has jumped to an impressive 29% of the student population.

Last year, the University of Maryland received a $1.2 million contribution of cash, services and in-kind gifts from Gilden Integrated, a Baltimore-based public relations firm. As part of that gift, Gilden developed a comprehensive marketing campaign focused on the many career opportunities in nursing. Included in the marketing mix were advertisements featuring an ethnically diverse mix of men and women actively engaged in nursing. The campaign was credited, in part, for a 37% increase in applications last fall. "Increasing diversity is the cornerstone of our strategic plan," said Barbara R. Heller, EdD, RN, FAAN, dean of the School of Nursing. "We are proud of our record in attracting minorities and other underrepresented populations."

Reaching Out to Diverse Student Populations

Reaching students in the communities where they live is effective in diversifying the nursing student population. In an effort to make inroads into the Native American community, the Intercollegiate College of Nursing/Washington State University appointed a member from the Nez Perce tribe as a recruitment coordinator for the nursing school and launched a statewide recruitment drive with a consortium of area universities. Consortium efforts are directed at both increasing the numbers of Native American nurses and increasing the cultural competence of faculty and graduates who provide care to Native American people.

Washington State University recently received funding to launch the Aid Latino Community to Attain Nursing Career Employment project, a community-based initiative that reaches over 100 students each year at key points along the progression to a BSN degree. Targeted to the recruitment of Hispanic and Native American nursing students, this program provides incentives for bilingual students (Spanish-speaking) to purse a nursing education and provide care within their own community. Mentors play a large role in this program by supplying advisement and encouragement while serving as successful minority role models.

Making Connections at the Middle/High School Level

Answers to the question, "What do I want to be when I grow up?" usually start to gel during the middle and high school years. Savvy college recruiters looking to develop a pool of future nursing students from diverse backgrounds have taken steps to reach this key demographic.

Indiana University entered into a collaborative agreement with the local public school system to link the school's faculty, graduates, and students with high school students interested in a nursing career. Funding from internal university sources was obtained to facilitate the entry of six students from economically deprived areas into the School of Nursing over a two-year period. Participating students were invited to attend special information sessions, tour the university, and attend undergraduate classes.

Through a Basic Nurse Education and Practice grant funded by the U.S. Department of Health and Human Services' Health Resources and Services Administration (HRSA), the University of Missouri-Kansas City School of Nursing launched a three-year project to increase enrollment in the bachelor's degree program, specifically targeting minority groups. Launched last fall, the school's first pre-licensure BSN class was composed of 36% minority students, 15% men. "This project will help us change the face of nursing by adding more men and minorities to the nursing workforce at a time when we're faced with a serious shortage," said Nancy Mills, PhD, RN, dean of the School of Nursing.

As part of the recruitment efforts, the university is collaborating with a nonprofit organization that disseminates health careers information and partners with health employers, elementary and secondary schools, and all area schools of nursing. This initiative encompasses school counselor education efforts; Web site enhancements; a Nurse Scholars Camp for high school students; and a mentoring program.

The University of California - San Francisco launched a Pre-College Nursing Internship Summer Program to provide direct contact with nursing care environments (hospitals and community clinics) to educate and attract high school students from minority backgrounds to the profession. This intensive week-long program offers informational, experiential, financial, and social opportunities to enhance students' access to and interest in undergraduate programs in nursing.

Supporting Students Through the Application Process

In the interest of diversity, the University of North Florida added an interview component to the nursing school's admission process, rather than just using a GPA cut-off to screen students. Interviews are now conducted in teams made up of two faculty members and one nurse leader from the community. Since implementing this new strategy, the attrition rate among students deciding that "nursing just isn't for me" has dropped considerably. This practice helped raise minority representation in classes from 2% to 20%.

The University of Washington is committed to providing as much support as possible to minority students during the application process. The school's recruitment staff stays in close contact with prospective students via telephone and personal meetings. In graduate programs, recruiters are most successful when prospective students have direct contact with local area faculty or doctoral students, usually by phone. Last fall the school added eight more men to its BSN program boosting its male student population to an all-time high. Jai Elliot, chair of the university's Cross-Campus Diversity Outreach Program, calls the school of nursing "a leader in the university's efforts to reach out, recruit in, and serve communities of color."

Montana State University-Bozeman received funding from the federal Division of Nursing to develop support structures to encourage more Native American nurses. A key element of this project is the development of a community network to guide Native American students along the path to graduation. Current enrollment of Native American students is up 100% over Fall 2000.

Mentoring as the Key to Retention

Mentoring is a key element in attracting new student populations into nursing. Mount Carmel College of Nursing in Ohio provides one-to-one attention, consultation, and mentoring to assist men and minority students throughout their entire college experience. Known as the Learning Trails program, this mentoring activity has helped the school achieve retention and graduation rates that exceed national averages.

The University of Florida (UF) and Bethune-Cookman College have developed a consortium to increase minority student enrollment in graduate nursing programs at UF. A central element of this partnership, the Gator-Cats Mentoring Program, provides mentoring, career counseling and financial planning advice for undergraduate students and alumni who want to pursue graduate studies. Students attend workshops on topics ranging from GRE preparation and application processes to the fundamentals of research methodologies, time management and other skills needed to successfully complete a graduate degree. Faculty workshops also are conducted to heighten sensitivity to issues that may affect the minority student's ability to succeed. "This consortium is a wonderful opportunity to promote graduate study among students who might otherwise not have considered it. The consortium has helped all of the faculty members and students involved to develop more cultural sensitivity," said UF Dean Kathleen A. Long, PhD, RN, FAAN.

Facilitating Student Success

"At the University of Alaska Anchorage, the real issue is facilitating the success of the non-traditional students we do recruit," explains Tina DeLapp, EdD, RN, dean of the School of Nursing. "Our efforts have been placed on facilitating success, maintaining and building confidence, and developing skills needed by students to transition into nursing school and succeed academically." In 2000-2001, Alaska's graduating class was 11% Alaska Native/Native American, a sharp increase from 1% only two years ago.

Student achievement at Loma Linda University in Southern California is assisted through the Success in
Learning: Individualized Pathways Program (SLIPP). Funded by a HRSA grant, SLIPP has recruited 45 disadvantaged students to the BSN program over the past two years. Eighty-two percent of these students are from minority backgrounds; half come from poverty-level households.

SLIPP requires a pre-clinical quarter during which students work to develop knowledge and skills needed to succeed in nursing courses. Courses include Study Skills, Intro to Critical Thinking, Intro to Nursing, Intro to Nursing Math, Medical Terminology, Intro to Computers, Reading Comprehension, and Intro to Writing in Nursing. Students are tested to determine their learning strengths, weaknesses, and needs. An individualized program is developed jointly with each student and an academic advisor (a faculty member with the same or a similar ethnic background as the student). This program has been very successful, not only in recruiting underrepresented groups into nursing, but in retaining 94% of the students to date.

Launching a Coordinated Campaign

Adopting the right mix of recruitment strategies is essential to the success of any outreach campaign. Though this Issue Bulletin outlines many effective techniques that work, individual schools must determine which strategies will be most effective given their resources, goals, and target populations.

The College of Nursing at the University of Nebraska Medical Center effectively uses a combination of recruitment techniques, with a few innovative twists, to reach out to men and minority students. The results are impressive: In 2000-2001, the school realized an 84% increase in minority applications with a 43% increase in minority admissions. In that same period, applications and admissions of male students were up 54% and 77% respectively. Among the strategies employed, the school:

• Hired a recruiter who was an experienced nurse able to talk about programs ranging from the BSN to the PhD, incorporating her real life experiences as a nurse;
• Updated all marketing materials, incorporating diverse images of men and minorities using colors that were "male" friendly;
• Developed an outreach letter in Spanish promoting all nursing programs;
• Created a "letter to parents" discussing the shortage of Native American, Hispanic, and African American nurses;
• Distributed marketing materials at high school/college fairs including stops at all-male high schools;
• Encouraged guidance counselors to steer bright students towards nursing;
• Approached the media about writing stories on the need for a more diverse nursing workforce;
• Attended community job fairs and college job fairs to canvass new recruits; attended state, regional and national student nurse conventions and minority nurse conventions as well;
• Encouraged current nursing students to volunteer at recruitment events and in local schools;
• Visited Native American reservations and attended minority community events including public school events, job fairs, open houses, and health fairs;
• Reached out to preschool and elementary school children by developing flash cards and a coloring sheet showing diversity in gender and ethnicity, and developing a multicultural children's Web site;
• Placed ads in minority newspapers and encouraged families to attend an open house with an "exploratorium for kids" staffed with current nursing students to teach children about nursing;
• Developed a system to track prospective students with personal follow-up for minority prospects; and
• Encouraged job shadowing for both traditional and non-traditional students.

"This may sound expensive and time-consuming, but all of this was accomplished within 20 months with a part-time recruiter," said Dani Eveloff, MSN, RN, recruitment coordinator for the university's College of Nursing. "We achieved our goals by coordinating students, faculty, alumni, and student services for recruiting efforts with financial support coming from grants to increase diversity within the college."

Attracting men and minority group members into nursing is essential to maintaining the integrity of the nursing profession. Schools of nursing must take the lead in launching new and aggressive recruitment campaigns aimed at diversifying the nursing workforce.

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