The Healthcare Group of JWT Specialized Communications has completed their initial research into the perceptions of Nursing as a professional career among students in the United States. This information will act as a basis for the creative to be developed for the Nurses for A Healthier Tomorrow campaign under the direction of Sigma Theta Tau International.

Face-to-face interviews were conducted with approximately 1,800 school children in 10 U.S. cities. The children were broken into three distinct groups for the interviews. These groups consisted of:

1. Students entering grades 2-6.
2. Students entering grades 7-8.
3. Students entering grades 9-10.

Cities in which these interviews were conducted included:

1. Albuquerque, NM
2. Atlanta, GA
3. Dallas, TX
4. Lincoln, NE
5. Los Angeles/Irvine, CA
6. Louisville, KY
7. Miami, FL
8. New York, NY
9. Philadelphia, PA
10. Seattle, WA

The children were interviewed in groups, and they were generally part of a sports team or camp setting. Groups ranged from two to 23 students. While the interviewers were allowed to run open with the conversation, and conversations were tailored to the ages of the groups being interviewed, the following questions were used as a basis for the interviews:

1. How many of you know a nurse?
2. Do you think they are nice?
3. What would you like to be when you grow up?
4. Have you ever thought of being a nurse?
5. What does it take to become a nurse?
6. What does a nurse do when she works?
7. What parts of nursing would you enjoy while doing your job?
8. Of the nurses you know, what do you like about them? Dislike about them?
9. Do you think nursing would be a good job?
10. Has anyone ever talked to you about becoming a nurse?
11. Are you going to college? What kind of college?
12. How will you pay for college?

A number of trends emerged from the interviews.  We believe these trends should be used as a basis for the development of the Nurses for A Healthier Tomorrow campaign. The following is a summary of the interviews with school-aged children; Please note that to mentioned in this report, each “trend” must have been repeated, in some form, in at least four interview groups.

1. The students had no compelling reason to become a nurse. Most knew at least one nurse and most often their experience had been from regular check-ups and sporadic emergency room visits for themselves or a sibling. In almost all groups we would find at least one child that had an extraordinary experience within the healthcare delivery system. Most common were things such as a father had a heart attack, a grandmother died in a hospital as well as personal health problems such as cancer, automobile/farm accident or serious emergency room visits. Those children had much stronger knowledge and desires to enter the healthcare profession, but the nurses generally did not stand out in their experience or their ensuing desires. School nurses stood alone in collective experiences but they were virtually undistinguished from administrators, cafeteria workers or other non-teaching positions.
2. They had been drilled on what was good about becoming a medical doctor as opposed to virtually no positive talk about becoming a nurse. Of the students who had extraordinary experiences within the healthcare delivery system, most wanted to become a doctor. They cited reasons that would be applicable to either a RN or MD, but it was much more accepted to become a physician. These reasons included:
   • wanting to help others as they had been helped
   • wanting to become a researcher to help solve the problem (cure cancer, stop diabetes)
   • wanting to “do good” in an otherwise uncertain world
   • wanting to solve other people’s problems
   • wanting to return the good they had felt in their extraordinary experience.
3. The older students (9-10^th grades) were more defined in their impressions on becoming a nurses and these included the fact:
   • They thought of nursing as being technical as opposed to professional. “Well, I go to a private school and I think they expect more from us. I think nursing is more like shop.”
   • Could not see any career advancement. For example, when they talked about nursing they envisioned someone going to work and doing the same job for 40 years.
   • They were not sure what it took to become a RN. More thought you could become a RN in two years while others who knew there were four-year programs could not distinguish the difference. “I think the 4-year programs are for getting the English classes and stuff and you get a more total college experience.”
   • They thought the job was “scary”. That it took two years of training, but that you were going to be expected to make “life and death decisions”. They did not think two years of training would be adequate and they would enter the job unprepared.
   • Some thought a four-year program prepared “Nursing Administrators” but they were not sure what someone in that position would be expected to do. “Paper work stuff” was a fairly common response.
   • Most were unsure of job security. Parents and guidance counselors generally suggested other “sure bet” occupations such as computers, physical therapy and teaching. When given figures about the industry’s projected needs most/all were surprised.
   • Most older students thought healthcare, in general, is a business in “turmoil”.  They were unsure about entering a healthcare profession because “they might cut off Medicare and then I wouldn’t have a job.” Other comments included things such as “I know they are going to close a lot of the hospitals.” “Who is going to pay for all this healthcare? Will there be jobs or will there be lay-offs?” “Do you remember how they reacted to Hillary Clinton’s plan? Only the rich will be able to afford healthcare.” “I want to make sure I get paid. My mother does medical transcription and the hospital she worked for (Charter) went bankrupt and she isn’t getting paid.”
4. Students of all ages were quick to point out that nursing “is a girl’s job”. While the older students were more creative in their message delivery, the answer was the same at all age groups and with all ethnic groups. Male students had to be asked directly about their thoughts since many automatically responded as if the discussion no longer involved them.
5. Surprisingly, in almost all groups, the idea of “wearing a uniform” was unappealing.
6. No group could provide any career advancement possibilities. A nurse was a nurse, was a nurse regardless of education or experience. When told some CEOs started out as a nurse most dismissed the notion and one older male student commented, “then they wouldn’t be a nurse would they.”
7. Students generally could not visualize where nurses worked. They knew they worked in hospitals, but past the front door was hard for them to visualize. Their impressions centered around interacting with a mobile patient, taking vital signs and working in an Emergency Room.
8. The strongest visualization came from the television series ER. Students however, commented more on Carol Hathaway’s romantic involvements than her profession. Other television and movie experience was less defined and almost always centered around “helping the doctor.”
9. Generally nursing was not separate from the MD’s role and it was almost always viewed as a supportive position.
10. Of children, who had strong interaction with nurses on a personal, and many times intense, the role of nursing was important, but not vital. “The nurse was nice.” “She held my hand and she told me I wouldn’t get sick.” “ She told me the truth about it hurting.” “She was mean.” “We would try to sneak around her.”
11. Nursing was viewed by the mid and older students as having unfavorable hours, tasks and that you had to work on weekends and holidays. They also cited that the job was emotional. “I couldn’t watch people being sick all the time.” “How horrible working with cancer patients and watching them die.” “I think I’d be stressed all the time.”

After we established that students were not being provided with positive information about nursing as a profession, we wanted to know what they were going to do about continuing education. In other words, if we could begin to offer positive information about nursing, and that information was turned into a desire to consider nursing,  could we make it more attractive by making secondary education more accessible? Generally, what we heard from older students was:

1. Paying for college was all over the board. Most students recognized need for financial support beyond having their parents’ checks. Grants, loans and scholarships were the most often mentioned. Most also mentioned the need to work and save for schooling.
2. In those schools where most students were in need of a full financial package (students could not expect any parental help), many mentioned the U.S. Army as a possibility. But the image of the military was negative. About 1/3 of the students in the lower income communities said they did not think they would be able to go to college immediately. Many said they had to work and save money. Others mentioned tuition reimbursement programs through their current employers (Chili’s and other national chain restaurants, BP and other gasoline stations, Marriott and UPS.)
3. None knew of scholarships specifically for nursing (with the exception of two female students in Los Angeles). A couple mentioned programs where “you could get the government to pay for your medical degree if you come back and work off the loan. Poor towns and Indian Reservations…things like that, but I don’t think they have that for nurses.”
4. College selection was either a major family experience or it was narrowed to local opportunities. “Mom and Dad are already planning my junior year college visits.” “I will go to (specific college) because it is close and I can live at home.” “Specific College is just 90 minutes away and so I think that is where I will be going.” “My parents told me I could only go to Specific College.”

Based on this information JWT Specialized Communications will work with the creative team to develop a specific message aimed at the following goals:

1. Improve the image of Nursing as a profession by:
   • Showing successful RNs who do “jobs” other than floor nursing. Demonstrate visually career paths that begin with the RN profession.
   • Show floor nursing in ways to help children better visualize the type of work and the environment. Push professionalism, teamwork, and RNs as leaders. Also push teamwork and successful outcomes.
   • Show RNs in a variety of environments and in a variety of clothes—Teaching, Administrative, and Research capacities.
   • Develop a message that shows how well prepared RNs are when they enter the job market. Be specific. Talk about continuing education, teamwork and how RNs are supported from the time they start until the time they retire.
   • Show more males and minorities. Sell the message that nursing is for everyone. Say something such as “We don’t hire female nurses. We don’t hire African American nurses. We don’t hire nurses with handicaps. We don’t hire male nurses. We don’t hire Mexican nurses. We just hire nurses.”
   • Develop a definitive message that distinguishes, explains and highlights: 2-year vs. 4-year programs--why they are different and why a 4-year program is good; How candidates can start with a feasible 2-year nursing program and advance professionally; Highlight the flexibility of a career in nursing.
   • Show some overachieving students who select nursing as a profession working against the technical image.
2. Develop a fact-based campaign to create more knowledge-based perceptions for the profession. This can support the items cited in number one and also include:
   • How nursing is just about the safest bet for secure employment. Projected needs, aging population, more business-based financial decisions ensuring the financial stability for most healthcare delivery providers.
   • How you can work and go to school too with tuition reimbursement and flexibility in scheduling.
   • How nursing can allow for a home life and professional life.
   • Provide compelling reasons for becoming a nurse and do not limit this to a “do-gooder” role. Making a difference personally and professionally is more believable and able to embrace. This message would be proffered in the NFHT campaign.
3. Make becoming a nurse an attractive alternative by supplying nursing scholarships. We believe there should be developed:
   • Nursing scholarships across the country. These scholarships should be established through individual hospitals and be selected by an established clearing house, possibly STTI or the National Association for Healthcare Recruitment. The sponsoring facility can place requirements on the scholarship such as a work commitment or the sponsoring facility can aware the scholarship without strings.
   • These scholarships will be based on a standard application. Information about the scholarships would be sent out to students asking for an application and information, guidance counselors, local nursing schools and speakers bureaus.
   • The scholarship information would be part of the NFHT advertising campaign.
   • The scholarships should become part of the Speakers Bureau for NFHT.
4. Develop and direct a part of the campaign towards existing nurses as to improve nurses’ own image of their profession.

How these messages will be delivered will be non-traditional because of the audience we are attempting to reach. We believe the audience consists of:

1. Parents, teachers, coaches, school administrators and guidance counselors.
2. The students themselves.
3. The current RN universe.
4. The public.

While it is easiest to focus on broad based delivery systems such as television, radio, magazines and newspapers, we do not think these are necessarily appropriate for a very limited budget, a focused message, and a relatively young market with broad-based influences. It is important to note that the final decision to become a nurse lies with the students of today. All other markets are simply influences. Based on those facts we are suggesting the following:

1. Development of a visual campaign with hard-hitting simple headlines that deliver a strong message. This message will be used in all mediums employed by the campaign.
2. Place these messages in areas most frequented by the students themselves such as mall signage, theatre screens, the Internet and music stores.
3. Employ additional means of delivering a message including ads in football, swimming and basketball programs in targeted schools, community health events such as fun runs, health fairs in the malls and YMCA programs.
4. Develop a direct mail campaign for students in the 10^th and 11^th grades, which push the nursing scholarships. The call to action will be for additional information about the scholarships but will also include the hard-facts about nursing. A tri-fold based on the fact-based visual nursing campaign will serve as the basis for the information to be sent to students requesting information.
5. Develop posters for career development offices, which provide an 800 number for nursing scholarships and a web site for information.
6. Develop note pads for Guidance Counselors, School Administrators, Coaches and Teachers, which deliver the facts about nursing as a profession on each sheet. Develop a minimum of 10 facts including toll-free numbers, a web site and scholarship information. These will be mailed free with the posters as well as handed out at career days.
7. Develop a Speakers Bureau where schools are encouraged to include a nursing professional as part of Career Day. Brochures note pads and other fact based messages will be supplied.
8. Develop Public Service ads for student focused publications such as Sports Illustrated for Kids, Time for Kids, Boy Scout Life, Teen People, American Girl, Ranger Rick, Hop Scotch as well as magazines aimed at older students such as Time, Cosmopolitan, Wired and Sports Illustrated.
9. Develop public service ads for the Kids’ Section of the local newspaper, the Friday Magazine and next to Ann Landers.
10. Develop posters for the existing nursing workforce, which can be hung in the healthcare facilities.

These mediums are not our final suggestions, rather the Research/Media Department will pull a comprehensive communications plan. This outline is for initial discussion only. Media placement will depend on what we can get as a public service announcement and what we can finance. Initial deliverables from JWTSC creative will be the following:

1. Ads that can be used in mall signage, newspapers, magazines, sporting programs and trade publications.
2. Direct mail for students.
3. Collateral supporting the nursing scholarships.
4. Posters for Guidance Counselors and for RN universe.
5. Note pads to be used as give-aways.
6. Nursing scholarship application.
7. Internet banners.

This is only a first step. Nothing has been decided and everything can be discussed. Our time frame, without significant changes to the plan, would be for products to be finished in January 2001. Please do not hesitate to call with questions and comments.

Thank you.

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