Solving the Crisis of Nursing Diversity:
Can We Learn From the Army?
Shannon Fenner

It’s no secret that the United States is facing a severe nursing shortage that is likely to intensify in the next two decades. Not only are there too few nurses for an aging population, but ethnically, culturally, and linguistically, nurses are not reflective of an increasingly diverse population. There is substantial evidence that culturally appropriate nursing and the establishment of an interpersonal connection between nurses and clients improves health care outcomes.

Unfortunately, nursing is too seldom considered by high school students as a legitimate career option. The brightest students often ignore nursing, one reason being that you can become a nurse by attending a two-year technical program (thereby diminishing the accomplishment in their eyes). “Underrepresented populations,” lacking mentors of a similar race/socio-cultural background, perhaps never consider nursing to be a relevant option.

To address this crisis, we don’t need to start from square one — a prototypical recruitment solution already exists. Odd as it may seem, the perfect parallel for the nursing profession is the United States Army. In the mid-1990s, faced with declining recruitment, the Army realized that it needed marketing expertise to understand how to appeal to its target audience. Subsequent market research revealed perceptions of military service among 18 to 24 year olds — only 15% had any interest in joining the Army, and those 15% often had very outdated ideas about the military.¹

A leading advertising agency was selected to develop a multi-media campaign to address those misconceptions and improve the perception of the armed forces. The “Army of One” campaign resulted. It focused on individuality and introduced the target audience to a small cast of characters who shared their personal stories about joining the army. The ads referred to “212 ways to join the Army, a reflection of the various specialties one could pursue in the Army.²

Immediately after initiation of the campaign, hits on the U.S. Army website jumped from 8,000 per day to 30,000 per day, and recruitment levels jumped.¹ It was a monumental nationwide effort in response to a perceived crisis that took years of planning and implementation (not to mention finances!).

The nursing shortage and diversity crisis warrants a similar investment. Using the Army’s strategy as a template will yield a strong and diverse cadre for the next few generations of nurses.

The U.S. Army, of course, has advantages over the nursing profession — mainly money and the presence of a national recruiting network. The nursing profession does, however, have certain professional associations that could potentially take on new roles and function in a capacity similar to the army recruiters.

In order for underrepresented populations to choose nursing as a career, they first need to consider nursing as a career option; to do this, they must have an accurate perception of the profession. My proposal addresses those considerations with two segments: a national advertising campaign (television, Internet, and direct mail) and a nationwide high school internship program.

The advertising campaign would be entitled “The Face of Nursing.” Like the “Army of One” campaign, these will be intimate glimpses of one person, designed to strike a chord with the targeted audience. They will highlight three points: the range of nursing-related fields, the emotional satisfaction gained from nursing, and the diversity of cultural backgrounds that can be compatible with nursing.

At least five or six televised versions would each feature one nurse in a poignant work situation. The commercials would include the person talking about the particular field of nursing they chose and why they chose it. Background details of these characters could be selected to be compatible with particular regional recruitment needs. For example, a Northern Wisconsin version might tell about “Loua,” a Hmong refugee who works as an ICU nurse. A central Arizona version might tell a story of “Lee,” a Navajo who studied traditional medicine before going into nursing and now works in a pediatric ward.

The commercial would end by giving a website and a toll-free phone number. The website would be coordinated at a national level with links to the regional internship programs, and the toll-free number would connect directly to those regional programs.

The regional internship/recruitment programs could be coordinated through the National League of Nursing, the National Student Nurses’ Association, and one or two nursing schools per state. A single staff person per state would be hired to administer the program. It could be a fairly loosely organized system, recruiting mentors through nursing journal advertisements and specific recruitment at targeted hospitals.

The internships would be offered to seniors in high school who submitted a successful application and compelling references. Students would spend a semester shadowing nurses in their choice of specialties and complete documentation for academic credit. Students would establish a mentorship to encourage them in the field of nursing, and would be able to use evidence of their successful internships as qualifications for entering an accredited nursing program.

Though this campaign would target underrepresented populations in particular, it could also be used to effect a much broader impact. Exclusive targeting of racial minorities or certain genders is fraught with legal and ethical dilemmas, whatever the purpose. With that in mind, the “Faces of Nursing” strategy could also be used as a generalized recruitment tool, using a wide variety of individuals as featured nurses. Given the impending nursing staffing shortage, the nursing profession as a whole could use this recruitment tool to increase interest in nursing across the racial and cultural spectrum.

Advertising campaigns aside, the hands-on experience of an internship is ultimately what will empower and inspire our next generation of nurses. Nursing is primarily an emotive and compassionate field. The truth is that regardless of background or culture, if that certain inspiration is present, any nurse can be successful in meeting the needs of a diverse clientele.

Shannon Fenner

References

1. Bulik B. Operation Army advertsing. American Way website. Available at: www.americanwaymag.com/ business/feature.asp?archive_date=9/1/2003.  Accessed April 19, 2005.

2. Army announces new adversting campaign. United States Department of Defense website. Available at: www.defense link.mil/transcripts/2001/t01102001_t110army.html.  Accessed April 19. 2005.