Recently, while supervising senior nursing students, I had a conversation with a nurse manager and her director, both of whom hold master's degrees in nursing. As we talked about the nursing shortage, I stepped away for a moment to talk to a student. When I returned, the manager began describing how she had talked her daughter and her daughters' friends out of considering nursing as a career. She had told them that nursing was an "awful job," and no one their age should consider it. The director responded that he had talked to his children about choosing something other than nursing too. I was stunned!
During a moment's lull in their discussion, I shared that I was thrilled that my 22-year-old married daughter had recently decided to follow me into a career in nursing. I said I was excited that I had been a positive influence on her career decision, as had been my many nurse friends who had served as "honorary aunts" in my daughter's life. I explained how she had grown up with a developmentally disabled older brother and a diabetic father and had learned many lessons about coping with family stresses, compassion, and chronic illness. Then they looked at me as if they wanted to laugh but were too polite to do so.
Earlier in that same conversation, they had praised the limited turnover and high job satisfaction among nurses on their units. These nursing colleagues discussed their problem with uncontrollable turnover caused by factors such as staff relocation or retirement. Finding new staff was difficult: new graduates seemed to find their mental health nursing units far less exciting than other services such as critical care that were also recruiting them. They seemed not to notice the contradictions between discouraging the young people they knew best from entering nursing and their problem recruiting staff.
Ironically, while waiting in the lobby later in the day, I joined my students who were talking to a well-dressed visitor who carried a very up-scale briefcase. She asked them if nurses really needed a college degree to pass pills and bedpans. Seeing that none of the students were going to address the comment, I smiled and said, "Nurses not only need undergraduate degrees, but master's degrees and doctoral degrees too. As nurses, we don't just pass pills. We assess the patient's need for medication and responses to medication. We teach patients and their families how to manage their health problems and maintain wellness. Some nurses, like me, teach in universities but I also was a nursing administrator in area hospitals. As a department director, I essentially ran a business where 100 nurses and support personnel reported to me, and I managed multimillion dollar budgets."
The visitor smiled, asked a few questions, and said perhaps she should listen to what her sister, a registered nurse (RN),had to say about nursing. Now, she said, she would stop discouraging her niece from entering nursing. Although I had not been able to help my nurse colleagues from discouraging young people from entering nursing, I had influenced one person and showed my student that nurses need to speak up when the profession is demeaned.
Recruitment in Nursing: Drop the Negativity
The nurse manager and the director offer a paradox that is not uncommon in nursing today. Nurses in all types of roles complain that not enough people are entering nursing and bemoan the impact of the nursing shortage, yet they discourage others from entering the profession. Some discourage others actively, telling those who aspire to nursing not to enter the profession. Some discourage indirectly by their complaints about nursing that they share with anyone within hearing range. Others discourage indirectly when they fail to encourage others to consider a career in nursing.
Leaders in all nursing environments are critical to successful recruitment of new nurses into the profession. Nurse leaders, in the varied settings where they work, are in contact, sometimes unknowingly, with potential nursing candidates daily. Visitors, patients, non-RN personnel, students from other disciplines, and vendors are just some of the potential nursing candidates that a nurse leader may encounter in a day. Neighbors, friends, the friends of our children, our own children, and other family members are other potential nursing candidates whose lives we touch daily.
A study of 495 ADN, diploma, and bachelor of science in nursing students in North Carolina1 noted that the 4 most important factors influencing their decision to choose a career in nursing, in rank order, were:
1. prior experience when they or a loved one was hospitalized,
2. prior experience working in healthcare,
3. the presence of a family member or friend who is a nurse, and
4. a nurse role model.
Only 21.6% of the students identified television or other media as an influence.
These data, although based on a small study, have significance for nurse leaders. The possibility of having a positive influence on a potential nursing candidate is one more reason for nurse leaders to ensure that the work environments they shape result in high-quality care and high levels of job satisfaction for nurses and other personnel. Nurse leaders must encourage interested non-RN personnel to consider careers in nursing. We have to encourage nursing colleagues to focus on a positive view of nursing and educate them about the harm that negativity can create. We must also encourage potential nurses in our families and circle of friends to consider nursing as a career through our examples as role models. Negative talk has to stop!
Creating a Positive Environment for Nurses and Patients
The Magnet Recognition Program and the research focused on magnet hospitals demonstrate the importance of the nursing work environment on nurse recruitment, retention, and satisfaction and for quality patient outcomes. The study of career choice influences by Larsen et al1 points out the importance of the healthcare experiences for patients and family members who might consider a career in nursing (71.7% of the respondents). Shaping a work environment that is magnet like, even in the absence of Magnet recognition, can support recruitment into nursing. Actions that can create this nurse-friendly, patient-centered environment include, but are not limited to, actions that reflect the forces of magnetism2:
* Encouraging nurses to advance their education through tuition support and recognition,
* Engaging nurses in programs and activities that shape the nursing practice and patient care,
* Measuring nurse satisfaction with the work environment on a regular basis and using these data to create change,
* Supporting professional development through career ladders and other recognition programs,
* Developing mentoring programs that support new nurses or nurses in new roles as they make their transitions,
* Educating nurses to be effective teachers to support patient education.
Supporting Non-RN Personnel Considering a Career in Nursing
Students in the previously cited study1 identified past work experiences in healthcare (65.6%) as another factor in their choice of nursing as a career. Nurse leaders can identify non-RN employees who express an interest in a nursing career and support them in their efforts with mentorship, encouragement, and information about tuition support and other human resource information about education benefits. Employees interested in nursing can be assigned a nurse mentor, an enthusiastic nurse who can answer questions, debunk myths, and support the employee as he or she seeks nursing education. Local accredited schools of nursing can present exhibits to provide information on their programs. Not only can the schools encourage RNs to further their education, but the schools also can encourage other employees to explore nursing as a career. In addition to ongoing activities and programs, Nurses' Week provides the opportunity to showcase employees who are enrolled in nursing education programs.
Being a Nursing Role Model
Students indicated that their career choices were influenced by a family member or friend who was a nurse (65.3%) or another nurse role model (53.3%).1 Nurse leaders can demonstrate their enthusiasm for nursing in conversations with family, friends, colleagues, patients, visitors, and even strangers in the lobby! Positions of leadership, whether formal or informal, carry the obligation to be an effective role model. The manager and director who discouraged their own children and their children's friends from seeking careers in nursing failed to live up to their roles as nurse leaders and serve as role models.
Nurse leaders can model their passion for nursing in how they relate to nursing and nonnursing staff. They can speak in positive terms about their own jobs, their careers, and their achievements in nursing. Although our jobs in nursing can often be demanding, annoying, overwhelming, and frustrating, we have the privilege, as a member of the profession of nursing, of caring for people in their moments of greatest need, supporting those who provide direct care, and teaching those who seek to nurse. We have to share our passion for nursing as role models for our colleagues and our future colleagues in nursing. Sometimes, being a role model includes gently confronting those who speak negatively about nursing, especially our nursing colleagues. Some nurses seem oblivious to the ripple effect that their negative attitudes and talk have on those around them.
Tell the Good News
No one should need to write an editorial to tell nurse leaders that talking positively about nursing will support recruitment of new members into the profession. It is simply the right thing to do and should be what nurse leaders do without thinking. I doubt that what I heard from the nurse manager and director was a one-of-a-kind event. We can all imagine, and perhaps have been part of, similar conversations that occur almost daily around the coffee pot, at the nurses' station, in the nursing administration offices, and in faculty offices. There is no reason to discourage nursing candidates from following our footsteps. We are responsible for ensuring the future of our profession. We must tell the good news about nursing and encourage our successors. There is so much good news to share about nursing. Negative talk is not allowed!
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