making healthy connections: introducing nursing as a career choice to middle school students

Making Healthy Connections: IntroducingNursing as a Career Choice to MiddleSchool Studentsnuf_221 146..151

Margaret Knight, PhD, PMHCNS-BC, Lisa Abdallah, PhD, RN, CNE, Mary Findeisen, PhD, RN,Karen Devereaux Melillo, PhD, GNP, APN-BC, FAANP, FGSA, and Jacqueline Dowling, PhD, RN, CNE

Margaret Knight, PhD, PMHCNS-BC, is Assistant Professor, Department of Nursing, University of Massachusetts, Lowell,Lisa Abdallah PhD, RN, CNE, is Associate Professor & Associate Chair, Department of Nursing, School of Health &Environment, University of Massachusetts Lowell MA; Mary Findelsen, PhD, RN, is Director of the Masters in ScienceNursing Program, at Endicott College, Beverly, MA; Karen Devereaux Melillo, PhD, GNP, APN-BC, FAANP, FGSA, isProfessor & Chair, Department of Nursing School of Health & Environment, at University of Massachusetts, Lowell, MA;and Jacqueline Dowling, PhD, RN, CNE, is Associate Professor & Director, Baccalaureate Nursing Program Departmentof Nursing School of Health & Environment, at University of Massachusetts, Lowell, MA.

KeywordsDiversity, nursing as a career,nursing workforce development,after-school programs

CorrespondenceMargaret Knight, University ofMassachusetts Lowell, 3 SolomontWay, Lowell, MA 01854-5126.E-mail: [email protected]

The current economic climate has resulted in many experienced nursesreturning to the workforce. Despite this, the nursing shortage is loomingin our future and the recruitment of a diverse nursing workforce reflec-tive of the population remains a high priority. The Merrimack Valley innortheastern Massachusetts has two large cities, Lawrence and Lowell, inwhich the Hispanic and the Southeast Asian populations are dispropor-tionately higher than state and national levels. Through the Universityof Massachusetts Lowell’s Bring Diversity to Nursing Project, partner-ships with both city school systems were developed and after-schoolprograms aimed at highlighting nursing as a career choice were initiated.Mr. Thompson’s Heart is the focus of a middle school, pre-entry programdeveloped by faculty. Introducing career choices in middle school givesstudents fundamental information about careers and how to begin inves-tigating them. Mr. Thompson’s Heart introduces nursing as a career choicecombining career information with a focus on developing healthy lif-estyle habits. Multiple hands on activities create excitement and interestin the nursing profession.

The nursing shortage remains a significant problem forthe future healthcare workforce. Predictions continueto call for 500,000 new nurses by 2025 (Buerhaus,Staiger, & Auerbach, 2008) and up to 868,000 addi-tional nurses by 2030 (IOM, 2008). In 2007 and 2008,the hospital registered nurse workforce in the UnitedStates increased by 243,000 full time equivalents(FTEs), and more than half of those positions werefilled by nurses over age 50 (Buerhaus, Auerbach, &Staiger, 2009). In 2010, the average age of the nursingworkforce is projected to be 45.4 (Cohen, 2006). Thecurrent economic climate has influenced the return of

many nurses to the workforce. However, as nursesretire, not only will positions need to be filled but thehealthcare needs of the largest sector of society, the“baby boomers,” will also need to be addressed. Morenurses must be educated at the baccalaureate level asthe care for “baby boomers” with health problemsbecomes more complex. Federal policy advisors to Con-gress and the U.S. Secretary of Health and HumanServices have urged that 66% of the nation’s nursingworkforce hold baccalaureate degrees by 2010 (Massa-chusetts Association of Colleges of Nursing, 2005).According to the United States Department of Health

AN INDEPENDENT VOICE FOR NURSING

146© 2011 Wiley Periodicals, Inc.Nursing Forum Volume 46, No. 3, July-September 2011

and Human Services Health Resources and ServicesAdministration Bureau of Health Professions (2010),only 47.2% of nurses were prepared at the baccalaure-ate level or higher.

In addition, the diversity of the nursing workforcedoes not reflect that of the population of the UnitedStates. The United States Department of Health andHuman Services Health Resources and ServicesAdministration Bureau of Health Professions (2010)reported less than 20% of the workforce representedminority backgrounds (Hispanic or Latino, Black orAfrican American, Asian), while nearly 35% of the U.S.population is from minority groups. Therefore, in addi-tion to increasing the numbers of registered nurses whowill be prepared to care for the complex health prob-lems of an aging population, we must recognize theneed to provide culturally competent care to a growingminority population. Strategies must be developed torecruit minority individuals into the profession.

The University of Massachusetts Lowell (UML),Department of Nursing, established the Bring Diver-sity to Nursing (BDN) program in 2007 when fundingfrom the Massachusetts Department of Public Health(MDPH), Reducing Racial and Ethnic Health Dispari-ties: Workforce Development Grant (2007–2010) wasreceived. In 2008, additional funding was receivedfrom the Health Resources Services Administration(HRSA), the Bureau of Health Professions NursingWorkforce Diversity Grant. The BDN program is a verycomprehensive approach to increasing the diversity ofthe workforce.

One goal of the BDN program is to bring the pro-fession of nursing into middle school classrooms andintroduce students to the exciting roles nurses play inhealth care and in the community. “Awareness ofNursing as a Career Choice” is a 4-week workshopthat was developed for middle school students to putnursing on students’ radar screens as they begin toformulate ideas about the future. Recruitment intoany profession must begin at an early age. Often bythe time students reach high school, they have alreadymade career choices, although many are not aware ofeither the opportunities available in nursing or thechoice of courses necessary to meet admission require-ments at the college or university level.

Literature Review

The National Student Nurses Association (NSNA)was one of the first organizations to respond to thenursing shortage through media that would appeal to

young students. Aware that the demand wouldoutpace entry into the profession, the NSNA (2000)produced the video Nursing: The Ultimate Adventureintroducing students to the excitement of a nursingcareer. The video is widely available and emphasizesthe difference nurses make in people’s lives as itdepicts a fast paced but thoughtful portrayal of acareer in nursing. In addition to NSNA’s campaign,one of the largest campaigns to increase recruitmentinto the profession of nursing was The Campaign forNursing’s Future (2002). Johnson & Johnson’s (n.d.)campaign reaches out to potential students and adults.Large-scale initiatives are critical if nursing is to attractstudents prior to entering high school. Parents andguidance counselors need to be appraised of the scopeof the profession and the opportunities it provides.

Students often begin investigating career choicesand discussing their future plans in middle school(Matutina, 2008). Hoke (2006) noted that 33% ofthose who ultimately choose nursing do so at an earlyage, and their choice is often based on stereotypinginstead of awareness of the opportunities. Parents playa major role in guiding children toward careers; theirlack of knowledge regarding the profession can hinderrecruitment. Parents may perceive careers such asmedicine, law, and engineering as more prestigious.Middle school students and their parents may not beaware of the many specialty areas in nursing, theability to practice at the advanced level, and theknowledge base needed to make critical decisionsabout patient care. Cohen, Van Palumbo, Rambur, andMongeon (2004) surveyed middle school students toevaluate their perceptions of an ideal career versus acareer in nursing and found that students rankednursing lowest on making decisions, leadership,making money, and being powerful. If adults and stu-dents have access to inaccurate information, nursingas a career choice may be overlooked.

Despite these challenges, a variety of programs existto introduce nursing at the middle school level. Hoke(2006) used a video to promote nursing as a careerchoice and found that seventh and eighth grade stu-dents’ perceptions were influenced positively througha simple classroom presentation. Balogun, Sloan, andHardney (2005) used lectures and videos to promotehealth professions career awareness to 133 AfricanAmerican middle school students. Following theprogram, 55% indicated interest in pursuing a careerin a health profession, yet only 11% selected nursing.Career fairs are another strategy to increase awarenessof nursing in middle school students. The Northern

M. Knight et al. Making Healthy Connections


Illinois University School of Nursing Rural AdultNurse Practitioner Project initiated the Kids Into HealthCareers project by teaming with school nurses (Cohenet al., 2006). Activities included participating in schoolhealth fairs, interacting with students, and playinggames that highlighted the characteristics of a nurse,settings where they work, and education needed tobecome a nurse.

While all information-based programs are useful increating interest in nursing as a career, programs thatstand out use activity-based, hands-on approaches.Teen summer camps are one method that offers oppor-tunity for several contacts over a short period of time(Randall, 2002; Redding, Riech, & Prater, 2004). TheNursing Exploration Summer Camp at Inova HealthSystem invited middle school students for week-longexperiences introducing them to the world of nursing.Activities included tours of the operating room, emer-gency department, hands-on activities in the com-puter lab, and practicing skills that health professionsuse every day (Randall, 2002). Redding et al. set upcamp at the Illinois State College Campus where stu-dents had an opportunity to not only learn aboutnursing but also live on a college campus. Participantsspent 2 days at a medical center shadowing a nurse,visiting units, and observing surgical procedures(Redding et al., 2004). The Nurse Anesthesia Programat the University of Pittsburg embarked on a majorinitiative in 2001 titled Your School Goes to the OperatingRoom (Sell & Palmer, 2004). This project targeted kin-dergarten through middle school, using operatingroom scenarios. Students observed a mock surgeryand practiced skills at stations set up around theclassroom.

Creative introductions about nursing as a careerare clearly needed if we are to impact the projectedshortage. Working with middle school students is apriority. Interest must be piqued prior to enteringhigh school where important course selections aremade. Accurate information is essential, yet activitiesmust be engaging, active, and hands-on. Working withthis age group requires commitment over many yearsto increase entry by “seeding the pipeline” into nursingprograms. While a variety of program models exist,none have described outcomes beyond interest innursing as a potential career.

The UML developed an after-school program aimedat increasing awareness of nursing as a career. Mr.Thompson’s Heart introduces healthy living throughdidactic and hands-on activities. The program wasdeveloped with funding from HRSA and the MDPH

Health Disparities: Workforce Development Grant aspreviously described.

Promoting Health Through Awareness ofNursing as a Career

Program Beginnings

Prior to receiving funding, interested nursingfaculty worked in collaboration with the UML Gradu-ate School of Education that provided summer enrich-ment activities for middle school youth. A pilot projectwas implemented in collaboration with the summerenrichment program in 2007. Fifty-five middle schoolstudents participated in a 1-day, 3-hr program. Activi-ties included hands-on skills: measuring vital signs,calculating and preparing simulated medications,working with simulation mannequins, and listeningto heart and lung sounds using a stethoscope. Allparticipants took a pre- and post-survey about theirawareness of nursing as a career and were awarded acertificate of completion.

Valuable lessons were learned from the pilot project.The youth need to be stimulated frequently withhands-on learning activities to enhance engagement.Lecturing should be kept to a minimum to maintaininterest and enthusiasm. Psychomotor learning activi-ties work best and enhance learning.

Funding was received late in 2007 from MDPH.Faculty involved in the pre-entry recruitment met tobrainstorm and design the best way to deliver after-school workshops that would engage and excite themiddle school students about nursing as a career.Inclusion of information about the heart and the pro-motion of heart health was a creative avenue toemphasize important healthy lifestyle tips while pro-moting nursing as a career.

Mr. Thompson’s Heart

The content of the program focuses on individualhealth and the role nurses play in health promotion.Mr. Thompson’s Heart is an exciting story created by thefaculty to illustrate the relationship between nursingand health, and to demonstrate how exciting a careerin nursing can be for those who study hard and obtaingood grades. Four sequential modules incorporatehealthy habits and their effects on long-term health.Each module contains a brief overview of the topicfollowed by a variety of hands-on and problem-solving activities.

Making Healthy Connections M. Knight et al.


The first module, Nursing as a Career, introduces thestudents to Mr. Thompson. He has many unhealthylifestyle habits; he works too much, smokes cigarettes,makes poor food choices, and leaves no time in his dayfor exercise. Mr. Thompson suffers a heart attack whiledriving to work. The story chronicles Mr. Thompson’spath beginning in the emergency room, through hisMedflight, the intensive care unit, the operating andrecovery rooms, home health care, and rehabilitativecare. A PowerPoint story presents real-life nurses withinformation about the different areas of nursing, thebenefits and rewards of healthy choices, and the edu-cational degree they have achieved. The nurses repre-sent diverse cultures, backgrounds, and races. Themiddle school students talk about nurses they know,family members who are nurses, and ask questionsabout health, illness, and nursing care. The studentsare exposed immediately to the many roles andpractice areas where nurses work. Mr. Thompson isfast paced and develops expectations for subsequentmodules: Nurses and Illness, Nurses and Health, andNurses and Safety.

Nurses and Illness

Nurses and Illness focuses on basic cardiac anatomy.Activities include listening to simulated heart soundsand viewing a video on the heart’s role in oxygen andcarbon dioxide exchange. Students color a diagram ofthe heart, learn to palpate pulses and count heart-beats, and learn the importance of exercise by count-ing their heartbeats before and after jumping rope.Each student is given a stethoscope to listen to heartsounds. Students are gifted these stethoscopes to takehome. All activities are directed back to Mr. Thompsonand his unhealthy lifestyle. Students identify activitiesadults and children can do to keep their heartshealthy.

Nurses and Health

Nurses and Health focuses on diet choice. Studentsstart out by identifying their favorite fast food andevaluating the nutrition content. Through the use of acomputer classroom, students work alone or in pairs toobtain information on their favorite fast food. Nutri-tional content including calories, fat, carbohydrates,and protein can be found at most fast-food Web sites.Emphasis is placed on identifying healthier choicesfrom a fast-food menu while limiting the frequency offast-food consumption. Students then are asked to

identify their favorite healthy food choice and look upthe nutritional information online. Comparing variousmenus and food choices helps students begin to under-stand the importance of good nutrition. Poor foodchoices and lack of exercise are then related back to Mr.Thompson and his unhealthy heart. The food pyramidgame “Blast Off” (http://www.mypyramid.gov/kids/index.html) is used as a final activity. This interactiveWeb site enables students to select appropriate kindsand amounts of foods within the food groups to loadtheir spaceship. If correct selections are made, studentssuccessfully launch into space; if not, their mission isended, only to try again.

Nurses and Safety

The final module, Nurses and Safety, introducesmedication safety. Students simulate the role of thenurse in medication administration. Activities includereading physician’s orders, calculating medicationdosages using simple math, identifying the number ofpills needed, and safely administering the medicationusing the six rights of medication administration (i.e.,right medication, dose, route, time, patient, and docu-mentation). This fun activity drives home the pointthat to provide safe patient health care, successfulnurses need to study hard, think smart, and reallyfocus on academics.

Discussion

Creativity is essential in developing a program thatwill stimulate student interest in nursing as a careerchoice. The importance of having hands-on activitiesthat would engage the student, introduce accurateand interesting information about areas of nursingemployment, and the multifaceted role of the nursewas emphasized during the development of theprogram. Realizing that interactions with studentswould be time limited, reflections on what nurses doprovided the framework to develop the four modules.A graduate research assistant was used in the devel-opment of a PowerPoint presentation to introduceNursing as a Career. Many of the nurses depicted werecolleagues who volunteered their “story” to the pre-sentation. Release forms were obtained from all of theactors so that future presentations could be sharedto a wider audience via the BDN Web site. The useof PowerPoint allows time for actual discussionand interjection of information when each frame isdelivered.



The second module of Nurses and Illness and itshands-on activities created much enthusiasm amongthe students. The cost of the stethoscope given to eachstudent was minimal when compared with the excite-ment realized from listening to their own and theirpartner’s heart and lung sounds. On subsequent work-shops, students often brought their stethoscopes andasked if they would be using it that day.

In developing the third workshop, the BDN facultyfelt that the role of the nurse in health, and not justillness or disease, was an important learning concept.The focus on nutrition and the relationship to diseasewas emphasized. The use of Web sites from the UnitedStates Department of Agriculture for the food pyramidand the Blast Off game allow for fun activities thatstudents can perform individually, in pairs, or as agroup. A variety of fun and educational resources areavailable through the Internet and provide studentsthe ability to access the information at another time toreinforce the content.

Although the final workshop focuses on Nurses andSafety and medication administration, the importanceof math, decision making, and reading critically asessential in providing safe nursing care is emphasized.A small graduation ceremony culminated the work-shop where students received a BDN pencil, a BDNfuture nurse pin, and a certificate of completion. Stu-dents were encouraged to continue to study hard andconcentrate on math and science to be successful inbecoming a nurse. Students were advised to look fornursing workshops with new and different activities atthe high school level and through summer programsoffered at the university.

Each student was asked to complete a seven-itemevaluation at the end of the workshops. Overall, stu-dents had an increased interest in nursing as a careerchoice following the workshops. Most of the studentsidentified that they learned new information aboutwhat nurses do, they would recommend nursing as acareer to others, and they would be interested in par-ticipating in other after-school programs that gavethem more information about nursing as a career.Students also stated that because of the program, theywould think about becoming a nurse. Another advan-tage of offering the after-school program was access toguidance counselors, teachers, and school administra-tors. Putting nursing on their “radar screen” is equallyimportant.

Middle school provides an excellent opportunity tointroduce students to nursing as a career choiceas it is the time when many students begin to explore

possible career options. At this young age, studentsmay not be aware of the multifaceted role of the nurseand may only identify with the limited number ofnurses that they see at their school or healthcare pro-vider’s office. An after-school workshop such as theone developed by the BDN program that integratedfun activities with accurate information, may serve asa pathway for students at a young age to consider thenursing profession. BDN’s continued involvementwith students through the high school level via after-school workshops and summer programs, withemphasis of academic achievement, will assist in pro-moting a sustained interest in nursing as a respectedprofession and career choice.

Acknowledgments. This project is supported in partby funds from the Division of Nursing (DN), Bureauof Health Professions (BHPr), HRSA, Department ofHealth and Human Services (DHHS) under GrantNumber D19HP09221-01-02 and title Nursing Work-force Diversity for $894,085, 2008–2011. The infor-mation or content and conclusions are those of theauthor and should not be construed as the officialposition or policy of, nor should any endorsements beinferred by the DN, BHPr, DHHS, or the U.S. Govern-ment. Funding was also received from the MDPH,“Reducing Racial and Ethnic Health Disparities: Work-force Development Grant,” 2007–2010, for the pre-entry recruitment activities and faculty culturalcompetency workshops.

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