The generalist nature of nursing practice in rural environments has been identified as a barrier to recruitment and retention of nurses in a rural setting. Simultaneously, the issue of adequate health care in rural settings remains a great concern. Twenty-four percent of the population resides in rural counties, yet only 18% of all employed registered nurses reside in rural areas (Moses, 1984).
However, recruiting registered nurses with advanced/graduate education has successfully increased the availability and accessibility of health care in rural areas. These nurses provide primary care, maternal-child health care, and public and occupational health services, often in areas unable to attract or retain an adequate number of other primary care providers (Secretary's Commission on Nursing, 1988). The need for rural health nursing specialists will continue to grow. Schools located in rural areas are the logical sites to prepare graduate nursing students for rural nursing practice. However, recruitment of students to such schools takes extra effort due to the small pool of local nurses.
Implementation of marketing and recruitment strategies has been a major component of the University of Wyoming's graduate program expansion project for its Master's of Nursing in Rural Health. Central to evaluating recruitment strategies was a brochure about the graduate program, which was redesigned and revised early in the project. A self-addressed, return postcard requesting more information was added to the brochure, which identified the full-time option and highlighted the rural health focus of the program. To track responses, each postcard was coded to indicate the type of recruitment strategy from which the postcard came. Over 2,000 brochures have been distributed since the beginning of the project.
Several recruitment strategies were implemented during the first year of the project. These include: designing a recruitment display; graduate program recruitment meetings at local and regional hospitals; exhibiting the recruitment display at national and regional conferences, particularly those with a rural focus; exhibiting the display at regional state nurses' conventions; placing an ad in a special section of a national nursing journal; sending a mass mailing to 1,450 BSN-level nurses, by use of a purchased state board mailing list of BSN graduates; and contacting by telephone over 100 people who had either inquired about the program or who were in the application process. The recruitment display, designed by the graphic arts department, was eye-catching and included photographs of the area, as well as pertinent information.
During the second year of the project the following recruitment strategies were continued: local and regional graduate program recruitment meetings; national and regional advertising; a second mass mailing to BSN-level nurses; and continuation of phone contacts to inquiries. Less successful strategies, which included recruitment display at conferences and conventions, were continued on a limited, more selective basis.
New strategies were instituted during the second year: the use of MS graduates from the program at the various graduate program recruitment meetings and as community contacts; advertising in specialty nursing journals, as well as in a guide on graduate programs in health professions; and development of a videotape by the media department. The videotape has been used at meetings and has been loaned to a sample of nurses who inquired about the program.
Since the beginning of the recruitment project in July 1987, inquiries into the program have increased steadily. The average inquiry rate for the period July 1, 1989 to June 30, 1990 was 36 inquiries per month. During the initial 6 months the rate was nine inquiries per month. Thus, inquiries have increased approximately 400% since the project began. The costs of the recruitment strategies detailed below do not include staff time. They reflect costs of postage, travel, fees, etc., as needed for each strategy.
Regional and local hospital meetings
The graduate recruitment meetings in local and regional hospitals have been the most cost-effective in generating inquiry responses. During the first year of the project, 11 meetings were held in local and regional hospitals at an approximate total cost of $480. These meetings resulted in 22 inquiries, with a cost per inquiry rate of $22. During the second year of the project, 18 meetings were held at a cost of $1,300. These meetings resulted in 69 inquiries, making the cost per inquiry $19. Inquiries from meetings have resulted in four enrollees into the program. This makes the average cost of each of these enrollees $445 to date. Delayed enrollment from this group may yet occur.
National advertising has also been an effective strategy. During the first year of the project, a Va-page ad was carried in a national nursing journal in April, June, and October 1988. This ad reached approximately 55,000 subscribers, with 59<7r of these being at least BSN -prepared. Total cost for the recruitment ad for the three issues was approximately $3,854. Eighty-two inquiries resulted from the ads, making the cost per inquiry $47. To date, 11, 14, and 16 months later, one actual enrollment has resulted. During the end of the second year of the project, two specialty journals were chosen to carry a V4-page ad in May 1989. Cost for these two ads was $2,383. These ads, through August 1989, generated 63 inquiries, making the cost per inquiry $38.
A mass mailing was carried out mid-year during the first year of the project. A mailing list was purchased from a state board of nursing, in the only western state capable of providing a list of only BSN graduates. A one-page cover letter with the program brochure was sent to a sample of 450 nurses; only the letter was sent to another sample of 1,000 nurses. These nurses were located within the state from which the mailing came, as well as other Western Interstate Commission for Higher Education (WICHE) and selected rural areas of non-WICHE states. Of those 450 receiving a letter plus a brochure, only three inquiries resulted, for a cost of $140 per inquiry. However, one enrollment did result from a nurse who resided in a neighboring state. Of those nurses receiving the letter alone, 18 inquired about the program, making the cost for the letter only $23 per inquiry. No enrollments have yet resulted.
A second mailing was sent to a third sample from the same list during the second year of the project. Letters alone were sent to approximately 200 nurses from other states in close proximity. No inquiries resulted from this second mailing. Additionally, approximately 25% were returned due to address changes, indicating that mailing lists to BSNs may have a relatively short useful life span.
The recruitment display was taken to four nearby state nurses' conventions during the first year. The cost for recruiting at these conventions was $ 1,200, not including staff time. The number of inquiry responses from these state conventions was three, making the cost per inquiry $400. None of the inquiries from state nursing conventions has led to an enrollment. During the second year of the project, the display was taken to only one convention, the Wyoming Nurses Association Convention.
The recruitment display was taken to four research or rural health nursing conferences during the first year of the project, resulting in no inquiries. Cost of the four conferences was approximately $2,000. Two rural health conferences were attended with the recruitment display during the second year of the project. Additionally, faculty have been encouraged to distribute brochures about the program when they attend conferences.
Follow-up telephone calls to inquiries appears to have considerable potential. Of the 100 + inquiries who received a phone contact, 25% have actually enrolled in the program. Of those inquiries who did not receive a phone call, less than 1% have enrolled in the program. However, there has been no effort to randomly assign who receives phone calls. Such assignment will be the next step in the study.
Overall, enrollment has steadily increased since the project began. The largest enrollment since the graduate program's inception came in the 1989 fall semester at the end of 2 years of this recruitment program.
Meetings at hospitals and national advertising seem to be the two most costeffective strategies in recruiting potential students into the program. Follow-up phone calls to inquiries are also important. It has been noted over the course of this project that it takes many nurses approximately 2 years from initial interest to the decision to enroll in graduate school. Displaying at national conferences has not contributed to an immediate increase in inquiry rates, but the exposure of the program at national conferences may have long-term benefits, especially for a new and relatively unknown program.
Recruitment strategies discussed here may have general applicability to other graduate nursing programs. With the limited budget usually allowed for recruitment purposes, individualizing the strategy to most effectively meet the need of the graduate program is essential.
- Moses, E. (1984X The registered nurse population - 1984: Findings from the national sample survey of registered nurses. U.S. Department of Health and Human Services, Division of Nursing. Washington, DC: U.S. Government Printing Office.
- U.S. Department of Health and Human Services. (1988). The shortage of RNs in rural areas. Secretary's Commission on Nursing, Final Report (pp. 1-14). Washington, DC: U.S. Government Printing Office.