Although nurse recruitment programs have now been in effect for several years, the need for more nurses still constitutes a major problem. It is conceivable that if the profession takes a more active role in recruitment greater numbers of young persons will consider nursing as a career. For example, we should consider reaching more students in high school through wellinformed guidance personnel who will present a positive attitude about nursing and accurate information concerning the types of nurse preparatory programs. Through an investigation of high school guidance services, we may obtain answers to some of the problems related to recruitment.
In my own investigation in 1960 of the guidance services that potential nurse candidates have available to them in senior high schools, I explored these services from two focal points: ( 1 ) How do freshmen nursing students perceive the guidance services they received in high school? and (2) What guidance services are available to potential nurse candidates during their high school careers? In addition, I explored the factors associated with the lack of perseverance among the firstyear nursing students.
The answers to these questions were obtained by means of the questionnaire-interview technique. The information obtained from the responses to the items listed on the questionnaire-interview forms provided not only the answers to these questions but also additional information about the student subjects, the high schools from which these students were graduated, and the particular type of program in which the students were enrolled. The freshmen nursing students who were the subjects of the study were graduates of both public and private high schools.
Limitations of the Investigation
Any investigation inevitably involves certain limitations. A basic limitation of the study I made was the restriction of the sampling of the schools to the five boroughs of New York City and to Nassau and Suffolk counties in Long Island. This restricted area was selected because I wanted to visit personally the nursing schools and the high schools involved in order to give an added dimension to the study- observation of the services provided. The nursing students chosen for interview were the most recent high school graduates. This was done to sample the students with most recent memories of the kinds of guidance services they received in their secondary schools.
The Subjects, Materials, and Procedures
Data for this study were secured separately from three groups: freshmen nursing students, their guidance personnel in the senior high schools from which they were graduated the previous June, and the faculties in the schools of nursing they were attending at the time of the study. I conducted group interviews, using a questionnaire-interview form during the orientation period of freshmen nursing students in fourteen schools of nursing. Two schools offered associate degree programs, three had basic degree programs, seven offered diploma programs, and two had state hospital diploma programs. In these group interviews each student had an opportunity to ask for additional information about the questionnaire items and to elaborate on their responses. These students recalled details of previous guidance services offered in their senior high schools. I did not have a means of verifying the accuracy of the responses of the students, but the respondents interest and willingness to provide data for the study seemed to me an indication that they were making a serious effort to give accurate and reliable information.
The areas of investigation included in the questionnaire-interview form encompassed the guidance services in senior high schools, as seen by the new nursing students and by the high school guidance personnel, and the relationship of these services to the nursing student attrition rate. A total of 517 freshmen nursing students were interviewed. These high school graduates represented 160 public and private high schools. Of the 517 students, 271 were graduated from public high schools and 246 from private high schools. Guidance personnel in 156 of the selected high schools were then interviewed. The counselors in the remaining four schools requested that the questionnaire be mailed and a personal interview be excluded. Information was obtained from all 160 schools involved in the study. Of the 160 high schools, 103 were public high schools and 57 were private high schools. Lastly, the faculties of the fourteen schools of nursing furnished data for the study. An interview form was used to record the data pertaining to the attrition rate.
The information was collected by means of three questionnaire-interview forms used during individual and group interviews. The form used during the group interviews of the freshmen nursing students was constructed to elicit the amount and kind of guidance nursing students received and used during their high school years, pertinent to their choice of nursing as a career and to their selection of a school of nursing. The combination questionnaire-interview technique provided the opportunity to meet and confer with recent high school graduates. Through the use of the same technique with the guidance personnel in the high school, I was able to obtain the guidance personnel point of view on what actual guidance services are available for the potential nurse candidates and what the needs of these guidance personnel are for additional nursing information. The same technique was used with the school of nursing personnel to discover the number of dropouts from the group previously interviewed, their length of stay in the program, their reasons for leaving, and the counseling given to them by the nursing faculty.
The study was organized in seven steps:
1. Nurse-educators concerned with nurse recruitment were asked to express their opinions about the need, interest, and feasibility of the project.
2. Related literature was surveyed to determine the need for evaluation of guidance services and the placement or inclusion of occupational guidance as one of its functions. The literature included research reports, texts, periodicals, pamphlets, and other related publications.
3. Guidance personnel in the high schools and members of the Bureau of Educational Research of the Board of Education of the City of New York were contacted for suggestions related to the study and to the construction of the research instruments. Then the questionnaire-interview forms were completed.
4. Schools of nursing were visited, and interviews were conducted with freshmen students during their orientation period to the nursing school.
5. Senior high schools from which the freshmen nursing students had been graduated were visited, and interviews were conducted with the twelfth-grade guidance personnel.
6. Schools of nursing were revisited after a period of nine months, and interviews were conducted with faculty members.
7. Finally, the data and the conclusions were evaluated and the recommendations were enumerated.
The findings of this study seem to warrant the following general conclusions:
1. The sources of nursing information which are most available and are most helpful to potential nurse candidates are nursing career books, nursing school bulletins, and hospital tours.
2. The sources of nursing information which are least available to potential nurse candidates in high school include courses in occupations, Future Nurses Clubs, National League for Nursing Career materials and speakers who represent the two-year associate degree and the four-year basic degree programs.
3. Friends of the potential nurse candidates serve as a more helpful source of nursing information than do sources available in their high schools.
4. In the majority of high schools, guidance personnel are available. The number of students assigned to each person, however, limits the actual guidance services received by the students.
5. The high school counselor is more helpful to the average potential nurse candidate after the student has decided on nursing as a career.
6. The availability and helpfulness of guidance personnel in secondary schools are related to the selection of a particular nursing program by potential nurse candidates.
7. Potential nurse candidates and their high school guidance personnel are more familiar with the three-year hospital program than with the other two types of basic nursing programs.
8. Most potential nurse candidates are influenced in their selection of a particular school of nursing by the cost of the program and its location, i.e., nearness to home.
9. Freshmen nursing students find occupational information readily available in the high schools.
10. High school guidance personnel frequently use individual conferences, nursing school bulletins, occupational files, vocational book shelves, and group conferences as techniques for disseminating nursing information.
11. High school guidance personnel lack sufficient work relationships with nurse educators and professional nursing organizations. They also lack sufficient understanding of the educational programs available in nursing.
12. The largest number of freshmen nursing students who withdraw from their nursing programs do so because of academic failure and a discovered dislike for nursing.
13. There is a relationship between availability and helpfulness of high school guidance personnel on the one hand and the adjustment and perseverance of nurse candidates on the other in selected nursing programs. The less the counselor load in a senior high school, the fewer the number of graduates who tend to drop out.
Since this study was limited to the sampling of two nursing districts in a single state within the United States, any recommendations drawn from the findings and conclusions are limited to the population of which this sample may be considered representative. The following recommendations seem to be justified from the findings and conclusions:
Overall, nursing recruitment media needs improvement. Nursing recruitment literature needs to be current, realistic, factual, and attractive, and it should offer a more positive picture of nursing and be readily available to the counselor. The literature should interpret accurately the work of the nurse and should be made available to parents and adult groups. Since the freshmen nursing students reported that many lay persons influenced their career decisions, speakers, films, and literature about nursing should be made available to church groups, clubs, and community youth groups and services.
Professional nursing organizations and nurse educators should arrange for high school students to have greater contact with student and graduate nurses. This could be done through increased use of professional nurse speakers in high school career conferences and in discussion groups with high school students, their parents, and guidance personnel.
Since a large number of the freshmen nursing students considered hospital tours, visual aids, speakers bureaus, and Future Nurses Clubs as sources of information which were not helpful or not used, nursing career committees should study and properly evaluate existing recruitment activities used with high school students.
From the responses obtained from the guidance personnel, the following recommendations seem to be in order: Nurse educators need to develop closer work relationships between themselves and guidance personnel in the high schools; better communications are needed between the guidance personnel and professional nursing organizations, and greater personal contact is needed between guidance personnel and nurse educators to clarify the objectives and contributions of each type of basic nursing program. From the responses obtained from the freshmen nursing students and the guidance personnel pertaining to the number of students who applied to and are enrolled in the three-year hospital diploma programs, it is evident that the counselors and students need more information about nursing programs other than the three-year hospital diploma programs.
More guidance personnel are needed in the high schools, particularly in the private high schools. These additional personnel are needed not only to guide suitable students into, nursing, but also to guide some students into more appropriate kinds of nursing programs and other students away from nursing. The goals of the services of such personnel would be fewer dropouts from schools of nursing.
Since the freshmen nursing students became interested in nursing before entering high school, recruitment efforts by the nursing profession and vocational guidance from high school personnel should be expanded on the junior high level.
Although the male population in this study is small, their reasons for selecting nursing as a career suggest that guidance personnel ought to explore the possibility of guiding into nursing qualified high school boys genuinely interested in the medical field.
In conclusion, the following additional studies that are related to the recruitment problem, but which were not a part of this investigation, should be made:
1. A study to explore the problems related to the guidance and recruitment of male nurses.
2. A study to determine what information is available to counselors and to students about scholarships for basic nurse preparation.
3. A nationwide study to evaluate the quality of high school guidance services, particularly as they affect prospective nurse candidates.
4. An additional study to investigate the quantity and quality of guidance services and of guidance personnel in schools of nursing.
5. Additional studies about the nature of motivation in terms of recruitment, attrition, success, and satisfaction in the nursing profession.
6. A study to determine what guidance services are available in senior high schools to the potential practical nurse candidates, and the significance of the relationships uncovered in the study.
The possible contributions of this writer's study extend beyond the task of exploring available high school guidance services. This study makes clear the necessity of enlarging the avenues of communication with guidance personnel. The results imply the need for more counselors to help students make more realistic choices at an earlier school age. Although the counselor's task is not recruitment but guidance, his effectiveness in this role depends upon the information he receives from the nursing profession.