Look around at your coworkers and you’re likely to find a gray hair or two. It’s no secret that the nation’s registered nurse population is not only aging, but also shrinking. Nursing Economics recently reported that over 60% of the current RN work force is over 40. While “40-something” isn’t old, it does mean that over half of our current nurses will hit retirement age by 2025—or even earlier.

At the same time, nursing school enrollments have steadily declined during the last 10 years and the percentage of registered nurses under the age of 30 has dropped by 40% since 1980. When the baby boomer generation of nurses starts retiring en masse, who will take their place?

In an effort to reverse this alarming trend, a growing number of national, state and local initiatives are aggressively working to cultivate the next generation of nurses. Many of these programs are particularly targeting minority young people, both male and female—and for good reason.

The Bureau of Public Health, part of the U.S. Department of Health & Human Services, estimates that while racial and ethnic minorities make up 25% of the country’s population, they comprise only 10% of the nation’s health care work force. And while the number of men in nursing has increased significantly since 1980, they still represent only about 5% of the current RN population. Clearly, these numbers indicate a huge untapped human resources potential that the health care profession cannot afford to ignore if it is to meet the nursing needs of the 21st century.

To address this challenge, career education programs such as Health Careers Exploring, Colleagues in Caring and others are reaching out to girls and boys while they are still in high school—or even grade school—to sell them on the idea of nursing as an exciting career option. These innovative initiatives aim to hit early and often in an effort to tear down real and perceived barriers that block minorities and men from entering the nursing field.

Exploring Nursing

One of the most popular and successful of these efforts operates under the umbrella of Learning for Life, a national program with over 300 local offices coast-to-coast. Designed to support the federal School-to-Work employment preparedness initiative, and serving elementary, middle school and senior high school students, Learning for Life is actually two programs in one.

The first component, Learning for Life, is a classroom-based program that provides teachers with action-learning lesson plans for grades K-12. The Exploring component is a worksite-based program with a scouting-like format that lets students visit “Explorer posts,” such as community organizations, to learn about the dynamics of various careers, such as business, engineering and science.

Within the Exploring framework, the National Health Careers Committee sponsors Health Careers Exploring. While this program covers a wide range of different health professions, such as medicine, dentistry and pharmacy, it has a strong nursing component, helping introduce kids to career options such as LPN, nurse-midwife, nurse anesthetist, nurse practitioner and more. As Health Explorers, students not only learn by shadowing health care providers but also through hands-on activities, classroom discussions and volunteer opportunities.

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Barbara Broome, RN, PhD, chair of the community/mental health nursing department at the University of South Alabama in Mobile, is just one example of a minority nurse who is helping to reach out to the next generation of nurses by being actively involved in a local Health Careers Exploring program. The university sponsors an Explorer post that strongly targets inner city neighborhoods and currently has 58% minority participation, including many black and Vietnamese youths.

Broome, who is African American, visits area high schools to talk about nursing to young people aged 14-18, an audience she says isn’t as hard to play to as some would imagine. In fact, the students are usually attentive and interested.

“I typically tell them who I am, what my education is and why I decided to be a nurse.” But Broome doesn’t stand at the head of the class and lecture. Instead, she sits in a circle, at the same level with the students.

“I make it conversational and try to pull each of them into the discussion,” Broome explains. “I also expose students to some of the things a nurse actually does—simple hands-on activities like taking a blood pressure or listening to a heartbeat.” While such demonstrations are usually a hit with students, she adds, it’s best not to overdo it: The kids can easily become more interested in taking blood pressures than learning about nursing career opportunities.

Broome encourages other nurses of color who are involved in outreach programs like Health Careers Exploring to make a one-on-one mentoring connection with a student, even if just for a brief period of time—for example, by just talking with the student for a few minutes after class or giving him/her your card in case they have questions. “It doesn’t mean that you spend all of your time talking about careers,” she says. “Just being a friend and helping a student pick the right classes can help that young person succeed.”

Each year, Broome recruits her University of South Alabama students to help with the Exploring program’s efforts. Grace Tolbert, a senior nursing student who is a native of the Philippines, enjoys meeting with the high school students and feels it’s something she owes to her heritage. Even though Southern Alabama has a significant Asian-American population, Tolbert is currently the only Filipino nursing student at the university. She therefore becomes an instant role model to young Asian Health Explorers who may have never seen a nurse with their same skin color.

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“Because I work at a community clinic that serves a large Asian population, I feel that it’s important to go to the high schools and talk about nursing,” Tolbert maintains. “I tell the students that this is a field where more Filipinos and Asians are needed.”

Caring About the Future

One national career outreach program that focuses exclusively on nursing is Colleagues in Caring, funded by the Robert Wood Johnson Foundation and sponsored by the American Association of Colleges of Nursing (AACN). The program is based on the mandate that “health care professionals—in particular, nurses and the institutions they staff—must take proactive measures to build a work force with the capacity to adapt to the changes in the nation’s health care system.”

To accomplish this mission, Colleagues in Caring has a strong state and regional focus. Currently the program boasts 26 regional sites, including Alaska, Hawaii, California, New Mexico, Arizona, South Dakota, Texas, Minnesota, Iowa, Mississippi, Maryland, New Jersey, Massachusetts and the District of Columbia.

Colleagues in Caring helps regions build strong networks and alliances that in turn provide support to areas that are having a hard time attracting students to health care careers. Each regional program brings together government agencies, employers and schools along with community leaders, professional associations and health care consumers to determine what nursing work force development strategies will work best in their localities.

South Carolina’s Colleagues in Caring project, housed at the University of South Carolina School of Nursing in Columbia, is of particular interest because it is reaching out to future nurses through the medium of choice for today’s youngsters: the computer. The program’s Web site features a special “South Carolina Future Nurses Kids Club” section (www.sc.edu/nursing/cic/KidsClub/KidsClubIndex.html.)

To encourage area kids to join the online club, “we went into five or six elementary schools to present activities and information about nursing,” explains project director Renatta Loquist, RN, MSN, FAAN. “We gave the students coloring sheets and a postcard for their parents to send in, giving permission for their children to join the club.” From those initial visits during its pilot year, the program received 60 postcards from new members. In return, the children received a certificate of membership.

In addition to answering the question “What is nursing?” the Future Nurses Kids Club Web site includes information on nursing jobs and nursing education. Young people can also find answers to frequently asked questions like “Is nursing only for girls?” and “Do I have to work in a hospital?” The site has links to organizations such as the National Student Nurses’ Association, and the program’s staff is constantly working to add new features and maintain students’ interest in the club.

Launched in May 2000, the South Carolina Colleagues in Caring program’s primary targets are minorities and boys. Loquist estimates that less than 5% of the state’s nursing population is male and only 11% are minorities. She adds that the project isn’t content just to plant the seeds of interest in nursing careers in young people’s minds—it plans to follow these students as they grow older, continuing to provide them with information about nursing as they get closer to making actual career decisions.

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“Through the club, we’re developing a database so we can keep in touch with these children,” Loquist notes. “Students receive something in the mail from us four times a year, such as a Valentine’s Day card, to keep reminding them that we’re out there.”

If Loquist succeeds in meeting her objectives, the database will be much larger after the program’s second year as it seeks to reach every fourth and fifth grade classroom in the state. Because her limited staff resources won’t permit Loquist to personally visit every class in South Carolina, she has enlisted the help of nursing organizations, nursing schools and nurse employers to visit schools in their local areas. Again, students will be told about the Web site and given the opportunity to join the Future Nurses Kids Club.

The South Carolina program also has strong ties to community interests, including local Chambers of Commerce and the state’s School-to-Work initiative. The resulting networking contacts have proved invaluable, says Loquist. For instance, when the cost of copyrighted coloring sheets for the Kids Club became too expensive, the program turned to School-to-Work officials for help in designing its own sheets that could be mass reproduced for much less money.

KIHC-ing Off Nursing Careers

In late April 2001, the federal Bureau of Health Professions (BHPr), with support from the Health Resources & Services Administration (HRSA), will launch an exciting new career outreach initiative it describes as “an approach for the 21st century.” Kids Into Health Careers (KIHC) is a multi-tiered program designed to introduce nursing and other health care professions not only to students in grades K-12 but also to teachers, guidance counselors, school administrators and parents. Most importantly, students served by KIHC must be from an underrepresented minority population or from economically or educationally disadvantaged backgrounds.

HRSA’s fact sheet for the program notes that “the current market fails to train and distribute health care workers where they are needed most, in underserved areas. It also fails to ensure adequate, quality care to underserved and disadvantaged minorities…Under these circumstances, it makes sense for HRSA and BHPr to become the focal point for an initiative to expose underrepresented minority youth to health career opportunities.”

While KIHC is not a funded grant program, it will be used in conjunction with BHPr grants to augment the efforts of existing regional and local programs designed to develop a more diverse health care work force. Nurses and other health professionals who apply for and receive Bureau grants are required to visit schools and community organizations in disadvantaged or minority communities and make KIHC presentations to the program’s student and adult target audiences.

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The Kids Into Health Careers program provides grantees with a presentation kit, including visual aids, talking points and reporting materials. All you have to do is plug in your own knowledge, experience and enthusiasm about being a nurse.

By tapping into programs like these, or creating youth outreach initiatives of their own, minority nurses can play an important role in helping to increase both the numbers and the cultural diversity of future talent entering the nursing careers pipeline. As the BHPr says, “Young people must be given the opportunity to see who health professionals are, what they do and how their efforts affect the health and well-being of the nation.” And that means letting the next generation see that nurses are male, female, black, white, Hispanic, Asian, American Indian, Filipino, multiracial and more—just like them.

How to Sell Nursing to a Sixth Grader

“It is hoped that by reaching children at an early age, they will choose a health career and will prepare accordingly,” says Sam S. Shekar, MD, MPH, associate administrator for the federal Bureau of Health Professions. Unfortunately, when nurses visit elementary and high school classrooms to encourage students to consider nursing careers, they often find that kids have already formed less-than-positive opinions about the profession—also at an early age.

To help overcome objections that students may have about nursing careers, Barbara Broome, RN, PhD, chair of the community/mental health nursing department at the University of South Alabama and an active participant in a local Health Careers Exploring program, offers these suggestions for responding to some common misconceptions about the profession. She also feels that school guidance counselors need to have good information about nursing, so that they can advise students interested in entering the field.

 

  • Students view nursing as a service industry job. Female students especially tend to see nursing as a service job with little responsibility or challenge. To counter this impression, Broome brings a variety of nurses with her when she speaks to classroom groups. A nurse dressed in a lab coat with a stethoscope walks in, followed by a nurse with a laptop, a nurse in a business suit with a briefcase, and so on. Students are asked to pick out the nurse. “Without fail, they all point to the traditional lab coat and stethoscope,” Broome says. Brief skits are then used to show how each of these nurses represents a different nursing career option and to explain the different responsibilities involved in each.
  • Even though it’s the 21st century, many minorities have never met a nurse of their own color and thus feel it’s not an occupation for them. The success of many of these outreach programs will depend on their ability to provide role models for minority youths. Broome says she’s honest with students who ask about any negative experiences she’s had as a minority nurse, but she’s also quick to share the excitement of dispelling those prejudices and of helping your own people.
  • Boys think nursing isn’t a masculine occupation. Bringing in male nurses is often critical to involving the entire classroom in the discussion, Broome has found. If only female nurses are present, the boys aren’t even going to listen.
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  • Students don’t think they have the grades. Many youngsters believe they have to be straight A or B students to pursue a nursing career. While nurses should encourage students to do their best and should let them know that science and math courses are not optional, students should also be assured that it’s OK to get some Cs—or even fail a class. Broome always mentions that she failed algebra the first time she took it. That usually perks up a few students who had showed no interest just a few minutes before. “It’s like a light bulb goes on and they think, ‘Hey, I can do this!’” she says.
  • Students have heard bad things from a nurse. “When a student’s cousin tells them not to be a nurse and has a whole list of reasons, that’s a hard act for us to follow,” Broome admits. Presentations by groups of enthusiastic, successful nurses who love their careers can help students see the other side of the story.
  • Students don’t know about the possibilities for advancement. “Many students have not had enough exposure to nursing to know the difference between an LPN and a BSN, or even that many nurses have a master’s or doctoral degree,” Broome points out. “I try to explain the different career levels and let them know that they can enter the profession and then move up.”
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For More Information

Learning for Life/Health Careers Exploring
1325 West Walnut Hill Lane
P.O. Box 152079
Irving, TX 75015-2079
(972) 580-2000
www.learning-for-life.org

Colleagues in Caring
American Association of Colleges of Nursing
One Dupont Circle NW, Suite 530
Washington, DC 20036
(202) 496-1095

Kids Into Health Careers (KIHC)
Bureau of Health Professions
5600 Fishers Lane, Room 8-67
Rockville, MD 20857
Contact: Anthony Hollins, Jr.
(301) 443-0734

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