How We Know It Works: A Case Study Examination of the Role of Advertising in Pre-Nursing Students’ Career and College Choice

A dissertation submitted by

Anne Sajo Grant

to

Benedictine Universityin partial fulfillment

of the requirements for the degree of

Doctor of Education

in

Higher Education and Organizational Change

Doctor of Education in Higher Education and Organizational Change

___________________________________ Julie M Bjorkman, PhD _____________

Dissertation Committee Director & Chair Date

___________________________________ Elizabeth Ritt, EdD ___________Dissertation Committee Reader Date

___________________________________ Amanda Turner, MSW, Ph.D ___________Dissertation Committee Reader Date

___________________________________ Andrea Lehmacher, EdD ___________Dissertation Committee Technical Advisor Date

__________________________________ Sunil Chand, Ph.D. __________Program Director, Faculty Date

__________________________________ Eileen Kolich, Ph.D. __________ Faculty Date

__________________________________ Ethel Ragland, Ed.D., M.N.,R.N. __________ Dean, College of Education and Health Services Date

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ACKNOWLEDGEMENTS

This dissertation is dedicated to my Alabamian parents, Phyllis Moore Grant and James

Grant, Jr. Without the both of you, I wouldn’t be on this journey. Thank you for instilling in me

the value of getting an education and pursuing my dreams. Thank you for giving a gift that I can

share with the entire world.

First and foremost, I would like to thank God. Without faith and perseverance, my dream

of completing this dissertation and obtaining my doctorate degree would not have been possible.

I would like to thank Dr. Julie Bjorkman, Dr. Elizabeth Ritt, Dr. Andrea Lehmacher and

Dr. Amanda Turner for their guidance and support as members of my committee. Thank for you

jumping in and committing your time and expertise to my research.

I would like to recognize my dissertation chair, Dr. Julie Bjorkman, for serving as my

coach, mentor and advocate from the beginning. Thank you for believing in me and sharing your

knowledge and appreciation for qualitative research.

I had the opportunity to share this memorable journey with wonderful co-hort members.

It was an honor to be a part of the first online co-hort class.

Last but not least, I would like to thank the university that willingly allowed access to

participants for this study and for being the voice behind my case study.

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ABSTRACT

This exploratory case study contributes to the area of advertising in higher education to

recruit nursing students in the state of Michigan – a topic that has been scarcely researched and is

necessary in order to help enrollment officials shape and refine their recruitment strategies to

meet the needs of both the institution and pre-nursing students. This study employs various

qualitative methods to uncover the phenomenon related to advertising strategies as well as career

and college choice among pre-nursing students. The theoretical framework for this study is

developed by the interpretive use of advertising for college and career choice, reactions and

interpretations of advertisements and the image of nursing. The primary focus of this study uses

the nursing field as a way to uncover issues that might occur with enrollment officials and

marketers to uncover perceptions of what students perceive advertising to be and how it

influences enrollment choice among pre-nursing students in Michigan. The insights of this case

study can better prepare institutions of higher education on which advertising methods are both

value-added and cost effective.

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TABLE OF CONTENTS

ACKNOWLEDGEMENTS..............................................................................................................i

ABSTRACT....................................................................................................................................ii

TABLE OF CONTENTS...............................................................................................................iii

LIST OF TABLES........................................................................................................................vii

LIST OF FIGURES......................................................................................................................viii

CHAPTER ONE: INTRODUCTION..............................................................................................9

Introduction..................................................................................................................................9

Evolution of Advertising........................................................................................................10

Advertising in Higher Education............................................................................................12

Healthcare Demands...............................................................................................................13

Statement of the Problem...........................................................................................................14

Purpose of the Study..................................................................................................................16

Theoretical Positioning of the Study..........................................................................................17

Significance of this Study..........................................................................................................17

The Researcher’s Experience.....................................................................................................18

Definition of Terms....................................................................................................................19

Organization of the Study..........................................................................................................20

CHAPTER TWO: LITERATURE REVIEW................................................................................22

Overview....................................................................................................................................22

The Power to Persuade...............................................................................................................23

The Role of Marketing and Advertising in Higher Education...................................................27

Marketing...............................................................................................................................27

Advertising.............................................................................................................................29

Higher Education....................................................................................................................30

Enrollment Management and Admissions.................................................................................33

Nursing School Enrollment....................................................................................................35

Diverse Enrollment.................................................................................................................37

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Financial Aid..........................................................................................................................43

College Choice...........................................................................................................................45

Disconnect between K-12 and Higher Education..................................................................49

Media and the Image of Nursing................................................................................................52

Nursing School Recruitment......................................................................................................56

Science and Medical Programs..............................................................................................57

Recruiting Pre-Nursing Students............................................................................................58

Middle School Recruitment....................................................................................................64

CHAPTER THREE: METHODOLOGY......................................................................................66

Overview....................................................................................................................................66

Research Questions....................................................................................................................68

Theoretical Positioning of the Study..........................................................................................68

Research Design.........................................................................................................................69

Case Study..................................................................................................................................71

Pre-Nursing Student Participants...........................................................................................72

Data Collection Strategies..........................................................................................................73

Pre-Screen Telephone Survey................................................................................................74

Interviews...............................................................................................................................74

Focus Group Discussions.......................................................................................................75

Data Analysis Techniques and Procedures................................................................................76

Researcher’s Self and Evaluation Criteria.................................................................................78

Researcher’s Role at the University...........................................................................................80

Delimitations..............................................................................................................................80

Limitations.................................................................................................................................81

Summary....................................................................................................................................81

CHAPTER 4: RESULTS...............................................................................................................83

Overview....................................................................................................................................83

Host University..........................................................................................................................83

Focus Group Participants...........................................................................................................84

Themes.......................................................................................................................................85

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“I want to help people.”..........................................................................................................85

“Advertising needs to portray real-life experiences.”............................................................88

“Word-of-Mouth Advertising”...............................................................................................91

“Social Media Works”............................................................................................................93

Nursing School TV Advertisements..........................................................................................95

Nurse Campaign.....................................................................................................................98

Career Institute #1................................................................................................................100

Career Institute #2................................................................................................................102

Community College.............................................................................................................104

Focus Group Summary............................................................................................................106

Employer Interview Results.....................................................................................................107

Dean of the Nursing School.................................................................................................107

Vice President for Planning and Enrollment Services.........................................................109

Director of Marketing...........................................................................................................110

Registered Nurse Faculty Member.......................................................................................112

Summary..................................................................................................................................114

CHAPTER 5: DISCUSSION......................................................................................................115

Overview..................................................................................................................................115

Theoretical Implications..........................................................................................................116

Recommendations....................................................................................................................125

Opportunities for Future Research...........................................................................................129

Conclusions..............................................................................................................................130

REFERENCES............................................................................................................................131

APPENDIX A..............................................................................................................................148

Informed Consent.....................................................................................................................148

APPENDIX B..............................................................................................................................151

Pre-Screen Telephone Survey Script (Available)....................................................................151

APPENDIX C..............................................................................................................................152

Pre-Screen Telephone Survey..................................................................................................152

APPENDIX D-Part I....................................................................................................................153

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Focus Group Guide..................................................................................................................153

APPENDIX D-Part II..................................................................................................................154

Focus Group Guide..................................................................................................................154

PMCI Nursing Commercial.........................................................................................................154

Hondros College..........................................................................................................................154

APPENDIX D-Part III.................................................................................................................155

Focus Group Guide..................................................................................................................155

APPENDIX D – Part IV..............................................................................................................158

Focus Interview Guide-Part IV................................................................................................158

APPENDIX E..............................................................................................................................160

Dean of Nursing School and Vice President of Admissions and Enrollment Interview Guide..................................................................................................................................................160

APPENDIX F..............................................................................................................................161

Marketing and Advertising Individual Guide..........................................................................161

APPENDIX G..............................................................................................................................162

Registered Nurse (RN) Faculty Interview Guide.....................................................................162

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LIST OF TABLES

Table 1. Private College................................................................................................................96

Table 2. Nurse Campaign..............................................................................................................98

Table 3. Career Institute #1.........................................................................................................100

Table 4. Career Institute #2.........................................................................................................102

Table 5. Community College.......................................................................................................105

Table 6. Summary of Findings....................................................................................................127

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LIST OF FIGURES

Figure 1. Private College Advertisement.......................................................................................97

Figure 2. Nurse Campaign Advertisement....................................................................................99

Figure 3. Career Institute #1........................................................................................................101

Figure 4. Career Institute #2........................................................................................................103

Figure 5. Community College.....................................................................................................105

Figure 6. Enrollment Model........................................................................................................125

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CHAPTER ONE: INTRODUCTION

Introduction

As changes in admissions and recruitment occur in higher education, colleges and

universities are researching methods to attract and recruit students (Tucciarone, 2007). This

study attempts to understand the advertising strategies that are focused on a nursing field that is

growing nationally. This study will also determine if the advertising strategies from nursing

schools are working effectively by recruiting the right students into the field. This could help

decrease the national nursing shortage to determine what type of student is a proper fit for the

field. Furthermore, the purpose of this study is to explore the role of advertising strategies in the

higher education recruitment process, specifically in regards to students applying to one or more

pre-nursing programs in the state of Michigan.

Most students seem to have a tendency to start their college choice as early as their junior

year in high school (Espinoza, Bradshaw, & Hausman, 2002). Contemporary American higher

education offers multitudes of choices for prospective students. With more higher education

options for students, colleges and universities are refining their advertising and marketing

strategies to attract students. Investigating the nature and messages of advertising that target

prospective college and university students is worthwhile since (Tucciarone, 2007) shows that

the issues of advertising are scarcely explored in the contemporary field of higher education.

When Henry Ewald, co-founder of the Campbell-Ewald Advertising Agency in Detroit,

was asked to explain his advertising philosophy, he stated, “I am not interested in advertising

that merely gets itself seen and talked about. It is the product that must be made to command

attention – not the advertising” (cited in Hampton, 1991, p. 26).

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An advertisement is a deeply complex piece of communication that distributes market

information, helps create and sustain an abundant society, helps manage choice in an abundant

society, and exerts social control without social responsibility (Bendinger, 2004). While this

statement is explicitly argumentative, advertising allows us to think and take action on something

that catches our attention.

Advertising is a part of a marketing strategy that promotes a product or service. While

advertising is part and parcel of the market economy, the question of its nature and role in U.S.

higher education still seems to be an issue that requires a complex scrutiny. On the one hand, the

essence and strategies of advertising in higher education should comply with the general

economic laws and strategies of advertising. According to Fueroghne (2000), “the Federal Trade

Commission (FTC) has the greatest control over advertising and the way it is used” (p.21).

Furthermore, the “FTC’s goal is to protect the consumer from false claims, deception,

misrepresentation and unfair acts and practices” (Fueroghne, 2000, p. 27). Yet, when taking a

critical view of advertising, one can question its very essence when it comes to politics and

policies of advertising in higher education. Given the complexity and controversial nature of

advertising, this study intends to problematize that notion in relation to the higher educational

context.

Evolution of Advertising

Advertising in the United States (U.S.) dates back to 1789 (Goodrum & Dalrymple,

1990). By the time advertising hit the shores of the U.S., it had already been thriving in England.

The world came to England during this time. Ships sailed the ocean to bring spices from India,

carpets from Persia, tobacco and tomatoes from the New World, porcelain from China, and

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coffee from Arabia (O’Barr, 2005). Every import had to be introduced and seen by the public

and advertising was the way of doing so.

The selling of land, capture of runaways (slaves and indentured servants), and

transportation made up eighty percent of advertisements by the end of the revolution (Goodrum

& Dalrymple, 1990). In the early and mid-nineteenth century, newspapers were definite in style

and size of advertisements. Advertisements were never wider than a single column.

Advertisements that appeared in Benjamin Franklin’s newspaper, the Philadelphia

Gazette, were all on a single page. In Colonial America, Benjamin Franklin changed the style of

advertising by adding illustration. Following American independence, newspapers were across

the new county with an estimate of 35 newspapers in 1775 (O’Barr, 2005). In the 1800s,

advertising of goods emerged causing profound changes in the way of business was conducted in

America. Large department stores such as Wanamaker’s in Philadelphia and New York, Macy’s

in New York, and Marshall Field’s in Chicago also pioneered new advertising styles and for

rural markets, while Sears Roebuck and Montgomery Ward mail-order catalogues offered a

variety of merchandise (O’Barr, 2005). As America recovered from the Civil War, commerce

and newspapers once again took their place in society (O’Barr, 2005).

The term “advertising agent” came to be during the time of Benjamin Franklin. Ad men

provided a service that was most convenient to businesses. Ad men would take ads and deliver

them to newspaper publishers. Agencies like N.W. Yer in Philadelphia and J. Walker Thompson

in New York, collected circulation figures and commissions on readership.

The 20th century saw the movement of ethics in advertising. Readers wrote letters to

editors and demanded change in marketing practices. Radio stations were up and running by the

1920s. Ads began appearing on radio with jingles and spoken word. During the Great 11

Depression, advertising budgets declined and agencies saw less business. Advertising did not

appear during the depression because consumers could not afford to buy. Advertising made a

comeback during and after the World War II. Advertising took a role in promoting patriotism

and support of the war and troops. After World War II, cities like New York and Los Angeles

had television stations. All of the major television networks were operating by the 1950s.

Television advertising had become a new sought after medium. The Internet and globalization

became an essential part of American society in the 1990s. Advertising has been an innovator in

the past and present American history. As technology evolves, so will advertising and the

messages it speaks to consumers.

Advertising in Higher Education

The historical background of commercial advertising affects the practicing of advertising

today. The use of advertising takes many forms with applying it to different sectors. What does

the role of advertising mean in higher education today? The role of advertising in higher

education is scarcely researched unlike marketing. Tucciarone (2007) explains that “little

empirical research has analyzed advertising and its effect during the college search process. In

addition, most advertising research focuses on the effects of direct marketing (Hossler, Schmit,

& Vesper, 1999; Utley, 1994) and does not analyze other advertising strategies” (p.29). The

practice of advertising in higher education creates many debates on its role and what strategies

are considered appropriate and acceptable. Tucciarone (2007) believes “more analysis is needed

to understand one of the most examined influences to affect search and college choice:

advertising” (p.29). Furthermore, in recent years, a handful of colleges and universities have

begun to place greater emphasis on researching their students as part of their marketing and

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advertising initiatives” (Tucciarone, 2007, p. 30). College and universities have developed new

advertising campaigns to recruit and boost student enrollment (Tucciarone, 2007).

Healthcare Demands

Colleges and universities are beginning to increase the awareness of the demands

required to work in the medical field. Today’s U.S. health care system represents nurses,

physicians, physical therapists, and countless other professionals who carry on the principles of

care established by the forerunners of this noble enterprise.

The society’s overall demand for healthcare can be grouped into “four broad areas:

changes in health; size and composition of the population; social cultural factors; economic

factors and organization of the health system” (Buerhaus, Staiger, & Auberback, 2009, p. 58).

Under these demanding conditions, the role of a nursing profession deserves special attention.

There is a documented need for nurses across the nation. Apparently, despite its popularity,

nursing is an underrepresented field. According to the American Association of Colleges of

Nursing (2012), the U.S. projects to experience a shortage of registered nurses. Dr. Peter Berhaus

(2009) states in Health Affairs that the U.S. shortage is projected to grow to 260,000 registered

nurses by 2025. The United States Department of Labor (2008) projects that there will be one

million total job openings for RNs due to growth and net replacements during the 2006-2016

time frames. Employment of registered nurses is expected to grow 26 percent by 2020 (United

States Department of Labor, Bureau of Labor, 2013). In the State of Michigan, there will be

6,660 openings for registered nurses making it the most sought after career in the State (The

Michigan Bureau of Labor Market Information & Strategic Initiatives, 2008).

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Statement of the Problem

With an overwhelming demand for nursing, getting qualified nurses into the field is an

on-going problem (Berhaus, 2009). New preliminary data collected in January 2014 from the

American Association of Colleges of Nursing revealed a slow enrollment growth at nursing

schools across the United States. This study contributes to understanding the nature and purposes

of advertising targeted toward pre-nursing students, and helping enrollment officials shape and

refine their recruitment strategies among this population. The purpose of this study is to explore

the role of media and social media advertising strategies in the higher education recruitment

process of in-coming students at a private not-for-profit university who applied to one or more

pre-nursing Bachelor of Science (BSN) programs in the state of Michigan. Research data from

the 2013-2014 American Association of Colleges of Nursing annual survey report indicates that

7,506 seats were left vacant.

The National Center for Educational Statistics (NCES, 2005) projected that between 2003

and 2013, total enrollment at colleges and universities would increase by 19 percent. Colleges

and universities have to compete with institutions of different types. For-profit institutions now

account for approximately eight percent of college students enrolled in the United States

(Morran, 2011).

For-profit institutions thrive on customer satisfaction and meeting the needs of particular

students. Anctil (2008) in the article Marketing and Advertising Higher Education, quotes Kinser

(2006) who believes “ the for-profit sector enrolls relatively higher proportions of low income

and minority students and more women, which has an impact on overall student diversity and

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changes the way in which degree-granting institutions might alter their advertising and marketing

efforts” (p. 22).

Gordon and Copes (2010) state “leaders in nursing education and practice are cognizant

of the urgent need to identify and implement effective strategies and interventions to address the

current nursing shortage” (p. 11). According to Bontrager (2004), “institutions waste countless

dollars each year on commitment strategies that do not test the target audience…only to waste

money on promotional activities and materials that have limited effectiveness” (p. 11).

The 2010 Institute of Medicine report brief on the “Future of Nursing: Focus on

Education” states a need for nurses with baccalaureate and master degrees. Morgan (2012)

believes for-profit institutions will try to extend their market share and invest in nursing

education. Typically, for-profit colleges contribute to educating students to become medical

assistants (NCES, 2010) and for-profits play a lesser role in creating Bachelor of Science (BSN)

programs (Morgan, 2012). Curriculum and program development at for-profit institutions engage

in LPN-BSN or RN-BSN (Morgan, 2012). Additionally, for-profit colleges have an interest in

students with a “foundation at the associate-degree or LPN level” (Morgan, 2012, p.6). There is

an argument on why nurse regulators are approving such programs that may result in poor

quality education (Morgan, 2012). For-profits can help meet the increase in demand for all

nurses to a baccalaureate education by 2020.

Paying close attention to the quality of for-profit programs is critical. Farrell (2004)

explains that the reason for-profit institutions have been able to create and develop nursing

programs is that community colleges and four-year institutions could not increase the size of

their programs fast enough to keep pace with student interest and market demand. Granting

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school accreditation and state approval is a process. Farrell (2004) purports that a school must

get initial approval from one of the two national boards: National League for Nursing

Accreditation Commission renamed as the Accreditation Commission for Educating in Nursing

or the Commission on Collegiate Nursing Education. Approval from the state’s board of nursing

is also a requirement.

Purpose of the Study

The purpose of this study is to explore the role of advertising strategies in the higher

education recruitment process of in-coming students at a private not-for-profit university who

applied to one or more pre-licensure Bachelor of Science (BSN) degree programs in nursing in

the state of Michigan. This study will focus on the inquiries that came from sources of nursing

program advertising and the impact advertising can have on such inquiries. Research can inform

what strategies are useful when attracting prospective students and understanding college choice

as it relates to the specific advertising strategies and advertising methods. Furthermore, this

study will identify the facets of advertising that are most conducive to their students’ choice of

career and college choice.

Research Questions

The following research questions create the framework for this study:

1. What are the key messages used in advertising at a private not-for-profit college

targeted at pre-nursing students?

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2. How have prospective nursing students responded to key advertising messages? How

did these messages impact their college choice?

3. What are effective advertising strategies employed at this university from the

perspectives of nursing students?

4. What are effective advertising strategies employed at this university from the

perspectives of those responsible for the development and implementation of these

strategies?

Theoretical Positioning of the Study

This study positions the interpretive and critical paradigms of research. First, this study is

interpretive, or qualitative (interchangeably) in nature, which renders social reality as a multi-

dimensional and multi-faceted construct and individuals as having freedom to construct their

own realities and identities based on diverse experiences throughout lifetime (Hesse-Biber &

Leavy, 2011). Secondly, this study is also critical in that it provides a post-structuralist critique

of the language of advertising in higher education, the critique that deals with “the social

meanings within language and discursive practices” (Hesse-Biber & Leavy, 2011, p. 238). The

interpretivist perspective guides the study that enables the researcher to untangle the meanings

and interpretations of advertising in higher education (Tucciarone, 2007).

Significance of this Study

There is limited scholarship that examines the unique contribution advertising brings to

career and college choice especially for the field of nursing. The majority of college choice

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research, not just limited to nursing, does not examine or use advertising or marketing as a factor

to determine career and college choice.

The significant contribution of this study to the field of nursing in Michigan and across

the country will give insight to determine if or which advertising channels play an important role

in career and college choice among pre-nursing students, especially within the social media

context. Information gathered from this case study will allow enrollment professionals to make

wise and cost effective decisions as to what is best for their program. If institutions identify a key

target market, then advertising could possibly have a greater effect on career and college choice.

In terms of psychological responses, affect and cognition are important for understanding

consumer behavior. What is consumer behavior? Consumer behavior is the “dynamic interaction

of affect and cognition, behavior and the environment by which human beings conduct the

exchange aspects of their lives” (Peter & Olson, 2005, p.5). The information gathered from this

study can ultimately assist educational institutions in improving their efforts to address and

promote their academic programs.

The Researcher’s Experience

The author’s experience as it relates to this case study comes from working in advertising

across different industries, including higher education, and at a medical institute recruiting pre-

nursing students. The researcher has previous experience working with Alzheimer's and

Dementia patients and doing marketing research for hospitals and healthcare organizations.

Knowing firsthand how advertising can play a role in career and college choice among high

school students and adult learners, the researcher has experienced failed advertising strategies.

The 21st century provides us with new channels from which to advertise, new ways to reach our 18

target audiences, and innovations around opening dialogue with potential students. Addressing

the use of advertising strategies to consider nursing as a career and to find Bachelor of Science in

Nursing programs schools of the participants can be understood through qualitative search and

will be the focus of the data collection process.

Definition of Terms

Advertising: “A paid persuasive communication that uses non personal mass media-as

well as other forms of interactive communication to reach broad audiences to connect an

identified sponsor with a target audience” (Wells, Moriarty, & Burnett, 2006, p. 5).

Affect: A feeling of emotion (s) a consumer experiences (Peter & Olson, 2005).

Cognitive: The process of mental thinking that a consumer uses to make decisions (Peter

& Olson, 2005).

Cognition: “The higher mental process of understanding, evaluating, planning, deciding

and thinking” (Peter & Olson, 2005, p. 45).

Career Choice: A profession of occupation chosen for work.

College Choice: The decision to attend a college or university. 

Consumer behavior: The dynamic interaction of affect and cognition, behavior and the

environment by which human beings conduct the exchange aspects of their lives (Peter & Olson,

2005, p.5).

Freshman: A recent high school graduate that applies to a pre-nursing program.

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Marketing: The activity, set of institutions, and processes for creating, communicating,

delivering, and exchanging offerings that have value for customers, clients, partners, and society

at large (American Marketing Association, 2012).

Pre-licensure BSN Program, Generic: “A program of instruction to prepare registered

nurses that admits students with no previous nursing education, the completion of which results

in a baccalaureate degree (e.g., BA, BS, BSN.) with a major in nursing and eligibility to apply

for licensure as a registered nurse (RN). The program requires at least four years but not more

than five years of fulltime equivalent college academic work within a four-year college or

university” (Michigan Center of Nursing, 2010, p.17).

Recruitment: The process of finding and admitting the best qualified students for

admissions to a college or university. 

Social Media: Forms of electronic communication through which users create on-line

communicates to share information, ideas, personal messages and other content (Merriam-

Webster Dictionary, 2015).

Organization of the Study

This study will be organized within five chapters. Chapter 1 provides an overview of the

study, highlighting the background, statement of the problem, purpose, research questions,

significance of the study, and definitions of relevant terms. A review of relevant literature will be

discussed in Chapter 2. Chapter 3 will outline the methodology by which the data will be

collected, analyzed, and reported. The presentation of the findings of the study will be presented

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in Chapter 4. Chapter 5 will provide the conclusion and discuss implications of the findings for

policy, practice and future research.

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CHAPTER TWO: LITERATURE REVIEW

Overview

The purpose of this study is to explore the role of advertising strategies in the higher

education recruitment process of in-coming students at a private, not-for-profit college who

applied to one or more pre-licensure Bachelor of Science degree programs in nursing (BSN), in

the state of Michigan. United States higher education institutions serve a diverse student

population. The degree to which those institutions are successful in recruiting and graduating

students depends on multiple variables. The research reviewed in this chapter focuses on five

important themes that form the context of the study pertaining to advertising and college choice.

The main six themes of this chapter are: 1) the power to persuade; 2) the role of marketing and

advertising in higher education; 3) enrollment management and admissions; 4) college choice

and; 5) media and image of nursing; 6) nursing school recruitment

Students learn about choices of college from multiple forms of advertising channels from

both traditional and new social media outlets such as television and radio commercials,

newspapers, magazines, billboards, internet, course catalogs, e-mail advertisements, and

brochures. For-profit colleges and universities are investing large amounts of resources in

advertising campaigns (Noaman, 2011). For- profit colleges and universities are considering

characteristics of the current student population prior to investing millions of dollars in

advertising and marketing efforts. Although this study does not focus on branding, institutions

of higher education can benefit from understanding their brand and how it can attract diverse

populations of students (Black, 2009). Gaining insight into specific preferences of prospective

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college students can enable colleges and universities to communicate their message to student

audiences more effectively (Tucciarone, 2007).

The Power to Persuade

Advertising often begins with persuasion, which has been considered to be misleading.

Fueroghne (2000) ascertains “advertising draws more than its share of criticism, despite an ever

increasing awareness and emphasis on social responsibility” (p.vi). Resources have defined

persuasion as a “process aimed at changing a person’s (or a group’s) attitude or behavior toward

some event, idea, object or other person (s), by using written or spoken words to convey

information, feelings or reasoning or a combination of them” (Business Dictionary, 2012, para

1). Encyclopedia Britannia (2013) defines persuasion as the “process by which a person’s

attitude or behavior are, without duress, influenced by communications from other people” (para

1). According to the Advertising Educational Foundation (2005), “advertising is about selling”

(para 1). Furthermore, “pleading its case through the strongest, most persuasive means,

advertising informs, entertains and sells” (para 1).

Advertising has challenges and consumers must wade through products and sort through

marketing messages and promotions to make a buying decision. “Commercial messages appear

just about everywhere -- television, magazines, newspapers, billboards, radio, buses, sports

arenas and the Internet” (Advertising Educational Foundation, 2005, para 4). Jones (2000)

believes that companies should be disappointed by the results of their investments since only

about a third of all ad campaigns have significant immediate impacts on sales.

Today, advertising is pushed downward and a proposal speaks for itself instead of top-

management chiming in and developing that personal touch. The key to creating advertising that

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“engenders persuasion is to have a sound and property focused advertising strategy” (Advertising

Educational Foundation, 2005, para 6). According to the Advertising Educational Foundation

(2005), “an advertising strategy identifies who the prospective target is and defines his/her needs,

wants and desires” (para 7).

Persuasion involves an attitude or behavior that influences feelings or reasoning. From

1930 to 1932, a social psychologist named Richard LaPiere traveled throughout the United States

accompanied by a Chinese student and his wife. The purpose of the journey was to determine if

there was a relationship between attitudes and behavior. They visited numerous establishments

such as restaurants, cafes, hotels and motels. While traveling, they were only refused service

once. Six months later, LaPiere sent a questionnaire to all the establishments they had visited.

One of the survey questions asked, “Will you accept members of the Chinese race as guests in

your establishment?” This item received a ninety-two percent acceptance to not accept Chinese

customers proving that LaPiere’s (1934) study shows no relationship between attitudes and

behavior. Firmin (2010) notes that LaPiere’s (1934) research is still used in current research and

literature reviews for this reason. Furthermore, LaPiere’s (1934) research created a chain of

events that debate how attitudes are expressed with how people act in real life situations.

McLeod (2009) quotes Hogg & Vaughan (2005) by revealing that an attitude is a

“relatively enduring organization of beliefs” (p. 50). Attitudes can be described by three

components: affective, behavioral and cognitive (McLeod, 2009). McLeod (2009) creates and

describes this as the ABC Model of Attitudes. McLeod (2009) explains that the affective

component involves a person’s feelings and emotions about an attitude; the behavioral

component is the way attitude influences how we act or behave; finally, the cognitive component

involves a person’s belief and knowledge about an attitude. The different types of affective

24

responses are emotions, feelings, moods and evaluations. The production of affective response is

found in the affective system (Peter& Olson, 2005). The affective system does not operate by

itself. Usually, environment plays a critical role in how the affective system response

immediately and automatically. In other words, the affective system is a learning process and is

largely reactive. The affective system responds to any stimulus.

When applying these three components of attitude to consumer behavior it is a complex

phenomenon and an eclectic field (Peter & Olson, 2005). Consumer behavior involves thoughts,

feelings, experiences, and actions as well as interactions and exchanges (Peter & Olson, 2005).

Consumers and their environments are constantly changing (Peter & Olson, 2005). Peter and

Olson (2005) explain that the environment refers to “all the physical and social characteristics of

a consumer’s external world, including physical objects (products and stores), spatial

relationships (locations of stores and products in stores), and the social behavior of other people

(who is around and what they are doing)” (p.264). Constant change highlights the importance of

on-going research to keep abreast of important trends. Strategies that worked at one time or

another may not work in the present day (Peter & Olson, 2005). Furthermore, “marketers need to

understand what products and brands mean to consumers, what consumers must do to purchase

and use them, and what influences shopping, purchase and consumption” (Peter & Olson, 2005,

p.8).

Peter and Olson (2005) explain three approaches to studying consumer behavior:

interpretive, traditional, and marketing science. The interpretive approach is new to the field

(Peter & Olson, 2005). Its meaning is taken from the cultural anthropology approach (Peter &

Olson, 2005) and seeks to gain a deeper insight to the meaning of consumer behavior. Research

involves long interviews and focus groups to understand what services and products mean to

25

consumers. The traditional approach is based on theories and methods from psychology and

sociology. This approach seeks to develop theories and methods about consumer decision

making and behavior. Studies involve experiments and surveys to test theories. The marketing

science approach is based on economics and statistics and tests mathematical models to predict

the impact of marketing strategies.

“Cognition is the higher mental process of understanding, evaluating, planning, deciding

and thinking” (Peter & Olson, 2005, p. 45). Peter and Olson (1995) review four important

aspects of the cognitive system that influence how consumers interpret information:

(1) Interpretation involves interactions between knowledge in memory and information

from the environment;

(2) The activated knowledge influences which information consumers attend to and how

they comprehend its meaning;

(3) Consumer can consciously attend to and comprehend only small amounts of

information at a time; and

(4) Much attention and comprehension processing occurs quickly and automatically with

little or no conscious awareness.

Interpreting information plays a vital role in why consumers’ purchase products and

services. Environment, time, and detailed attention help a consumer interpret information. Once

consumers are exposed to marketing information, the interpretation process of attention and

comprehension begins (Peter& Olson, 2005). Attending to certain information involves

selecting it from other sources and ignoring other stimuli. To attend to stimuli means to be

conscious of it. Consumers need to be alert and aroused. Their level of alertness influences how

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they process information. The more marketers know about these interactions, the better they can

satisfy consumers.

“Satisfaction has elements of both affect and cognition” (Peter & Olson, 2005, p. 47). An

advertisement portraying free money for college would trigger a student to get excited (affective)

and form a belief that he or she can get free money (cognitive) and have them make the decision

to call or make an inquiry. Students may be satisfied with a television ad, campus tour,

admissions representative or information heard from a family member or friend. “Consumers

use the information to make decisions” (Peter & Olson, 2005, p.57).

Peter and Olson (1995) believe “marketers need to understand the cognitive and affective

aspects of these consumer-product relationships” (p.95). Furthermore, if marketers can

understand the consumer-product relationship, they can segment the market. Once the market is

segmented, persuasion can lead to buying if advertising sells the product or service correctly.

According to Tucciarone (2007), “advertising is pervasive and the ability to tap into peoples’

innermost motivations” (p.34). Tucciarone (2007) quotes Tellis (2004) and adds, “it invades their

conscious and subconscious thoughts and may change, modify or reinforce their attitudes,

feelings and decisions (p.34).

The Role of Marketing and Advertising in Higher Education

Marketing

The American Marketing Association (2013) defines marketing as “ the activity, set of

institutions, and processes for creating, communicating, delivering, and exchanging offerings

that have value for customers, clients, partners, and society at large” (para 1). Marketing consists

of many moving components. One of the components that are heard most often, especially when

27

writing a marketing plan, are the 4Ps of Marketing. McCarthy (1964) offered the “marketing

mix”, often referred to as the “4Ps”, as a means of translating marketing planning into practice”

(Bennett, 1997, p.2).

Goi (2009) explains that the “marketing mix is not a scientific theory, but merely a

conceptual framework that identifies three principles of decision making managers make in

configuring their offerings to suit consumers’ needs” (p.2). Goi (2009) further explains that the

marketing mix can be compared to mixing a cake: “A baker will alter the proportions of

ingredients in a cake depending on the type of cake we wishes to bake” (p.2). Goi (2009)

references “the proportions in the marketing mix can be altered in the same way and differ from

the product to product (Hodder Education, n.d). The marketing mix is a power concept and

important tool because it gives a description of the marketing manager’s job and reveals the

dimensions of the marketing manager’s job (Goi, 2009).

In his 2006 study, Möller presents the current standing in the debate around the mix as a

marketing paradigm and predominant marketing management tool by reviewing academic views

from five marketing management sub-disciplines (consumer marketing, relationship marketing,

services marketing, retail marketing and industrial marketing) and an emerging marketing (E-

Commerce) (Table 1-6). Most researchers reviewed in these domains express serious doubts as

to the role of the mix as a marketing management tool in its original form, proposing alternative

approaches, which is adding new parameters to the original mix or replacing it with alternative

frameworks altogether (Moller, 2006).

In contrast, Fetherstonhaugh (2009) believes that marketers need to stop thinking about

the product itself, but the full experience from product to experience. From place to every place,

marketers need to intercept people when they are most receptive to engaging with things. From

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price to exchange means to be aware of the value of things and how to grab a consumer’s

attention. From promotion to evangelism means to create a branding experience so consumers

can share with others.

Advertising

One method to implement a marketing strategy is through advertising. Advertising is a

global business and a business cannot survive without it. “Each year billions of dollars are spent

to influence decisions to persuade us to spend more” (Advertising the Art of Persuasion, para 1).

The Federal Trade Commission (FTC) has the greatest control over advertising to protect

consumers from false claims, deception, misrepresentation and unfair acts (Fueroghne, 2000).

Furthermore, the FTC “examines the advertisement to interpret all information contained in it to

determine if the ad is deceptive or under current interpretation. The FTC also reviews the net

impression of an advertisement” (Fueroghne, 2000, p. 27). To advertise something means to

“give notice, to inform, to notify or to make know” (Nicosia, as cited in Sheehan, 2004, p. 2).

Professional marketing groups such as the American Marketing Association (2012) define

advertising on their website as the “placement of announcements and persuasive messages in

time or space purchased in any of the mass media” ( para 1).

Fueroghne (2000) explains that “most textbooks teach that modern advertising began in

the early 1990s. Greats like William Benton, George Batton, Albert Lasker, Chester Bowles,

Bruce Banson, Ernest Elmo Calkins, Leo Burnett, David Ogilvy, and others whose names you

may recognize, did not create the process of advertising” (p. v-vi).

When advertising is reviewed in its purest form, one can think it has been around for

millions of years. William Bernbach, one of the giants of American advertising in the 1960s and

29

1970s, described advertising as “fundamentally persuasion and persuasion happens to be not a

science, but an art” (Ignatius, 2013, para 1).

Higher Education

College and universities should be aware of the students they would want to attract.

Anctil (2008) discusses the challenges of positioning higher education while remaining truthful

to the mission and remaining financially stable in the marketplace. Anctil (2008) asks an

essential question: “Is higher education a product, service, provider, or vendor?” (p. 2). He

further provokes our thinking of a consumer market analogy as applied to colleges and

universities presumably selling a product (degree) to consumers (students), whereby the product

involves services such as teaching, learning, and a social life consumed for a certain amount of

cost for four or five years.

Students start this journey by applying, attending classes and graduating. If students

commit, the product or services are theirs with the hopes of getting that investment (degree) in

four or five years. Anctil (2008) agrees with Edmondon (1987) in claiming that, from the

economic standpoint, students can be viewed as customers, and that colleges and universities use

advertising to inform students of their services. Just by definition, there is a difference between a

student and customer. A student is a person who attends a school, college or university

(Merriam-Webster, 2013) and a customer is someone who buys goods or service from a business

(Merriam-Webster, 2013). Driscoll and Wicks (1998) conclude that treating a degree like a

product is inherently dangerous to the university. Both definitions create a picture of two

different individuals; one seeking to gain knowledge and the other to buy something that attracts

them.

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Harrison-Walker (2010) suggests “ one critical application of marketing all too often

neglected, misunderstood and mismanaged higher education is targeting customers for

profitability” (p.191). Marketing vocabulary can hardly be avoided when addressing pressing

needs of higher education economic survival and prosperity. Every institution in higher

education in this country has a marketing plan to recruit and retain students. College and

universities need to survive with that of a business plan. Yet applying marketing-orientated

concepts to higher education often leads to great debates (Harrison-Walker, 2010). Great

debates often unveil using the term “customer” to define a student even though both do not have

the same meaning. The use of the word “customer” often elicits “very strong negative reactions

in academic circles” (Redding, as cited in Harrison-Walker, 2010, p. 193).

For-profit institutions account for eight percent of students eligible for financial aid

(Anctil, 2008). In addition, the National Conference of State Legislatures (2013) states that,

“during the past two decades, enrollment at for-profit institutions increased 225 percent” (para

1.). For-profits can compete by filling a void some public and private institutions cannot meet

such as career-driven programs, shorter length of programs, hands-on practical experience,

flexible scheduling, and instructors that work in the field.

The University of Phoenix introduced the on-line experience in higher education. The

institution still remains the largest private college in the nation by student population. For-profit

institutions have a niche market by taking what is not visible in the marketplace and

transforming that as an opportunity to satisfy student demands. Apollo Group, parent company

of the University of Phoenix, spent $142 million on Internet advertising in one year (Anctil,

2008). The same figure is the yearly budget of some traditional college and universities. For-

31

profits invest in advertising to attract students and have the means to do so because their focus

seems to be based on the power of advertising.

College administrators are now beginning to see the importance of social networking and

its use in communicating with current and prospective students. Facebook dominates 85 percent

of the college scene market share (Wandel, 2008). Wandel’s (2008) survey suggests that 9.9

percent of college administrators use social networking to recruit new students. Furthermore, a

new common application has made it easier for students to submit college applications via

Smartphone (Hopkins, 2011). Administrators in higher education see the benefits of social

media. Today’s student is a savvier user of different types of media to interact with others in

their life. Colleges and universities need to speak the language of current college students to

attract and fulfill their needs.

Silber (1980) speaks of ethical observation as it relates to marketing higher education and

selling higher education. Palfreyman (2011) proposes an alternative to traditional market

economy views on advertising and marketing in higher education. An alternative to traditional

market does not seem revenue driven but more student-centered to prepare students to enter the

workforce. He suggests that higher education should have a different marketing perspective than

any ordinary product or service. Marketing efforts in higher education should promote education

that can make a contribution to society (Palfreyman, 2011). Marketing of higher education

should be viewed as a preparation for enabling students to grow personally and professionally.

Education goes beyond the need to struggle for economic survival and compete for prestigious

jobs. Education is priceless in its power to transform the human mind with knowledge and

society.

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Businesses use principles of marketing and advertising. However, when it comes to a

particular product and service, the strategies should be employed to fit the need of the customer.

In particular, many people working in higher education would not consider students customers or

consumers when they are attending an institution to obtain a degree that fits their personal and

professional goals.

Regardless of institutions of higher education, students should have similar experiences.

For-profits tend to spend more in advertising and marketing to illustrate a particular need or a

certain type of student that may be better off in a controlled environment where the focus is on

creating this buyer atmosphere to fit their needs. Even though this case study is not about a for-

profit college or university, it should be noted that for-profit colleges and universities are now

offering Bachelor of Science nursing degrees. As of June 2014, The Chamberlin College of

Nursing is expanding to Detroit and started recruiting for staff and faculty. For-profits tend to

portray an image of helping students reach their career goals by taking career focused and hands-

on classes that will prepare them for real work. Advertising can create the idea that all

departments will insure the success of every student. Advertising and marketing can be

instrumental to establishing relationships from enrollment management to academics to career

services.

Enrollment Management and Admissions

The research on enrollment management as it relates to pre-nursing students seems to be

highly scarce in contemporary higher education studies. Enrollment management can be defined

as a “process or an activity that influences the size, the shape and the characteristics of a student

body by directing institutional efforts in marketing, recruitment and admissions as well as pricing

33

and financial aid” (Hossler, 1984, p. 6). Hossler’s (1984) definition comes from the efforts of

marketing, admissions, and financial aid to attract and maintain students. Kurz and Scannell

(2005) believe “in today’s climate, colleges and universities can’t effectively compete without

the Admissions and Financial Aid offices functioning as a team” (p. 310).

Adams (2009) proposes a three-part model of the enrollment management process: (a)

plan, b) communicate, and c) select. According to this model, during the plan phase, institutions

establish goals that correspond with the institutional missions. Policies, procedures, and

strategies aid in the achievement of reaching enrollment goals. The communication stage is a

process for institutions to identify, inform, and recruit target students. Adams (2009) states that

in the enrollment management process we typically speak of either marketing or recruitment

activities or institutions use concepts and identify market segments and strategies to

communicate with students. Admissions officials screen applications and admit during the select

stage. After students are admitted, communication activities are set in place to achieve

matriculation.

The three basic requirements for admission to U.S. colleges and universities are (1) a

sufficient command of the English language, (2) adequate financial resources, and (3) a strong

academic record (Abel & Sementelli, 2002, p. 53). Most institutions require this as acceptance.

Every college or university has its own requirements and standards. Kaylin and Lee (2009)

explain that “postsecondary institutions have traditionally been accorded wide discretion in

formulating admission standards (p, 317).

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Nursing School Enrollment

According to the American Association of College of Nursing (2014), 2013 to 2014

survey data (August 1, 2012-July 31, 2013) showed that enrollment in entry-level

baccalaureate nursing programs increased by 2.6 percent from 2012 to 2013, which marks

the lowest enrollment increase in professional registered nurse (RN) programs over the past

five years. The response rate was 90.0 percent with 776 of the 882 schools of nursing in the

U.S. responding with baccalaureate and/or graduate programs. Students’ interest in nursing

careers remains strong but cannot be accommodated in nursing programs despite meeting

all program entry requirements.

Kenner and Pressler (2012) focus on highlighting enrolling few students in to nursing

school in the face of increased needs and pose new challenges for resolving the enrollment crisis.

Kenner and Pressler (2012) research shows deans are enrolling fewer student because of

insufficient clinical teaching sites, lack of faculty, and limited clinical space. Kenner and Pressler

(2012) indicated that there were 1, 088 faculty vacancies in 603 nursing schools with

baccalaureate and/or graduation nursing programs. The majority of positions require a doctoral

degree, a top two reason for not filling the vacancy and a lack of preparation for pool of faculty.

Not only are there lacks of teaching sites but hospitals are turning away students allowed in the

facilities because of their own staff shortages (Kenner and Pressler, 2012).

The lack of benefits and salary increases also influences the commitment of faculty and

staff members to stay in higher education. In conclusion, Kenner and Presser (2012) suggest that

deans develop policies to prevent enrollment decreases, ensure top candidates get into nursing

school, increase financial aid awards, and create opportunities for co-op and international

35

education and small classes. Furthermore, use stimulation to replace current clinical expenses

and development respectable faculty recruitment and hire packages.

According to Menninger and Tschettter (2013), there is not any literature available

regarding first-year nursing seminars. Mennenga & Tschettter (2013) conducted a survey to get

seminar feedback from 263 nursing students who enrolled in a nursing seminar. A total of 222

decided to continue with nursing, 38 decided to change their major and three were unsure.

One of the major benefits to offering a nursing specific first year seminar is to allow

students to become aware of high expectations for the program and requirements to be

successful. Brown et al (2003) agree that “nursing students should be encouraged to achieve a

level of confidence in their professional role” (p.163). A qualitative research approach was used

to explore the influence and meanings of confidence by nursing students. Three categories

emerged: “(1) the meaning of professional confidence; (2) influences prior to nursing

programme; (3) influences within nursing programme” (Brown et al, 2003, p.163). The findings

suggest that professional confidence evolves over the four-year period within the nursing

program. Findings also suggest encourage from faculty to boost self-confidence nursing student

and developing strategies to implement encouragement from faculty. Students recognized that

confidence was a part of their childhood and upbringing. How students perceived and

experienced confidence was a part of who they were (Brown et al, 2003, p.63). Students also

acknowledged the “specific culture of the nursing program, including small group learning,

permission to take risks, use of standardized patients, interactions with tutors, opportunities for

clinical experiences, receiving feedback and emphasis on self-evaluation affected the

development of professional confidence” (Brown et al, 2003, p.71).

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A single case study was developed to understand why nursing students voluntarily leave

pre-nursing programs. The study consisted of 15 students who had previous withdrawn from a

pre-registration program. O’Donnell (2011) used semi-structured interviews to collect data. Key

components of the conceptual model of higher education (HE) student attrition from Tinto (1975,

1987, 1982, and 1993) were used. O’Donnell (2011) referenced research that perceives the role

of nursing to involve minimal academic study and being mainly concerned with nurturing and

compassion skills.

Diverse Enrollment

In response to attracting diversity in nursing schools, marketing strategies are being

updated to attract more students. Colleges and universities are updating brochures, promotional

messages and images to fill this gap. According to the American Association of Colleges of

Nursing (2001), there is a lack of diversity among men and minorities entering the field of

nursing. Nursing has historically been dominated by the white female (Green, 1998). The

American Association of Colleges of Nursing (2001) further explain factors contributing to the

lack of diversity: role stereotypes, economic barriers, few mentors, gender biases, lack of

direction, misunderstanding about the practice of nursing and opportunities in other fields. The

National Advisory Council on Nurse Education and Practice (2001) believes a “diverse nursing

workforce is essential to meeting the health care needs of the nation’s population” (p.13).

The admissions process has been under the microscope for affirmative action. The first

affirmative action case in higher education was brought before the Supreme Court in 1978

(Blake, 2012). Regents of the University of California v. Bakke (1978) evaluated the

constitutionality of affirmative action programs in medical school admissions for higher

37

education. Bakke, a Caucasian, felt he had the grades and met the standards of the program but

was denied admissions and overlooked. Bakke was denied twice but had the MCAT scores, GPA

and benchmark scores significantly higher than those minority student admitted (McBride,

2006). The University of California-Davis had reserved 16 seats for Blacks, Chicanos, Asians,

and American Indians (McBride, 2006). Bakke sued the University of California in a state court

alleging that the “medical school's admission policy violated Title VI of the Civil Rights Act of

1964 and the Fourteenth Amendment's Equal Protection Clause” (McBride, 2006, para 2).

Furthermore, “the California Supreme Court agreed, finding that the quota system explicitly

discriminated against racial groups and holding that "no applicant may be rejected because of his

race, in favor of another who is less qualified, as measured by standards applied without regard

to race” (McBride, 2006, para 2).

Other affirmative action cases that have challenged admissions policies included

Hopwood v. Texas (1996) claiming the University of Texas Law School violated the Equal

Protection Clause of the Fourteenth Amendment and Title VI of the Civil Rights Act of 1964.

The plaintiffs alleged the law school had different admissions policies for White and minority

students resulting in more minority students being accepted into the school (Law& Higher

Education, 2012).

In Smith v. University of Washington Law School (2000), white students were denied

admissions alleged school officials practiced discriminatory admissions policies. The court ruled

that diversity was a constitutionally permissible goal (Lawhighereducation.org, 2012). In 2001,

Johnson v. Board of Regents, white females denied admissions to the University of Georgia,

claimed minority students were given extra points during the admission process

(Lawhighereducation.org, 2012). The court ruled in favor of the plaintiffs agreeing that the

38

university’s affirmative action program awarded bonus points to non-white students. Gratz v.

Bollinger involved undergraduate admissions at the University of Michigan

(Lawhighereducation.org, 2012).

Grutter v. Bollinger involved law school admissions at the University of Michigan. In

2011, the Obama Administration “aligned itself strongly with the right of colleges to consider

race and ethnicity in admissions decisions” (Jaschik, 2011, para 1).

Guidance issued jointly by the Departments of Education and Justice states that “diversity

is an important education goal and that colleges should be able to use a variety of methods”

(Jaschick, 2011, para 12). In September 2013, the U.S. Department of Education said, “colleges

on affirmation action still remains valid even after the Supreme Court in June set a high

constitutional bar for such policies” (Stratford, 2013, para 1). Furthermore, colleges can use race

to achieve diversity as long as race neutral alternatives do not overshadow the goal diversity.

Margaret Hadinger’s (2013) poster presentation at the 2013 Association of American

Medical College Annual Meeting followed a grounded theory approach to explore the medical

school admissions experience with minority medical students. Preliminary findings illuminated

elements of college access and choice models that may be applicable to medical school

admissions (Hadinger, 2013). Hadinger (2013) advises administrators to strengthen

communication and information, academic and test-testing support, recruitment/access

improvements. Furthermore, Hadinger (2013) advised applicants to have an early and thorough

experience, commitment to medicine, seek mentorship and networking opportunities, strong

application and academic preparation and ability to overcome barriers. In addition, the role of

the ACT and SAT tests, the call of higher high school graduation standards, selective

admissions, early decision and early action on admissions programs, and the impact that

39

institutional admissions selectivity have upon ranking have been contributing factors to scrutiny

in admissions (Hostler & Kalsbeek, 2009). All of these reasons hinder enrollment management

and admissions and its role in creating a positive student learning environment.

Barbee and Gibson (2001) identified three problems identified by non-white students:

“(a) lack of targeted recruitment toward non-whites; (b) subtle and not-so-subtle institutional

racism in nursing education; and (c) a belief that non-whites are not bright enough for nursing

school” (p.107). Furthermore, the study suggested there was more effort in targeting non-white

students. The American Association of College of Nursing believes nursing schools must strive

for diversity to mirror patients in society (Stewart & Cleveland, 2010).

In the fall of 2000, The University of Wisconsin Plan for Diversity included a pilot

program called the Wisconsin Youth Nursing Program (WYN). The program targeted minority

students in middle school and high school who were interested in exploring nursing as a potential

career. The program consisted of general education classes and special interest nursing classes

(Stewart & Cleveland, 2010). Priority was given to students with high grade point averages

(GPA) although some students with a lower GPA were accepted into the program. The program

consisted of ten female and three male students. Ten were from urban areas and three were from

small towns. There were three Asian, eight African-Americans, and two Native Americans.

Prior to the start of the program, students were asked to provide their expectations of the

program. The majority of the students were interested in technical nursing skills. However, the

middle school students were “intrigued with dead bodies” (Stewart & Cleveland, 2010, p. 108).

The high school student wanted to know more about what a nurse does.

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There are many opportunities in the field of nursing. The field has evolved over the past

decade but there is gap in the literature of knowing where to find and keep prospective students.

The assumption propagated is that the field of nursing has one distinct path whereas; nursing has

many avenues that need to be explored and discussed with prospective students. Advertising will

bridge this gap of knowing and perceiving what nursing is. Advertising can connect the dots by

illustrating the variety of jobs and careers nursing can offer. More advertising highlighting and

explaining career paths can be beneficial to anyone seeking to get into this field.

Dapremont (2013) attempted to understand what helps minority students succeed in a

nursing program. Dapremont (2013) research shows that certain data indicate that minority

students who are admitted to nursing programs are dropping out before graduation. Dapremont

(2013) examined seven models from various authors and noticed an underrepresentation of

minorities in nursing and nursing education programs. According to the 2014 American

Association of College of Nursing survey, 28.9 percent of nursing students in a baccalaureate

generic entry-level program are minorities, compared to 71.1 percent of Caucasian students.

This data can create debates of who is a nurse and who should be entering the field. Once again,

advertising has the power to persuade and encourage students of all ethnic backgrounds to

consider the field of nursing. A close relationship between nursing schools and high school

counselors can close the gap for diversity in nursing. A strong push from middle schools and

high schools can play a critical role in closing this gap. Future research can measure whether or

not promoting and advertising nursing at the middle school and high level increases enrollment

at nursing schools. It can also measure this theory at highly populated minority schools.

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Edwards (2009) identified several strategies to help move forward matriculation in

minority nursing students. Minority and educationally disadvantage students were immediately

identified as one strategy to focus. An intensive orientation was conducted prior to class that

included test strategies, new teaching approaches and software. Academic support, learning style

assessments and adding culturally competent content into the curriculum were other strategies

used. The Recruitment Enhancement Cultural Affirmation Project (RECAP) was implemented in

Oklahoma when census revealed a trend in minority growth. Data collected from minorities in

the community indicate they want care from someone of their own ethnic background. During

the project years, minority graduation rates increased. In addition, 96 percent of minority

students involved in the project passed National Council Licensure Examination-RN (NCLEX)

on the second setting” (Edwards, 2009, p. 116).

The Copin Academy for Pre-Nursing Success program was a year-long program in

Baltimore, Maryland that targeted minority and disadvantaged students, eight through twelfth

grade, interested in nursing as a career. The program partnered with historically black colleges

and universities (HBCU) and the Baltimore public school system. Students who graduated from

the Copin Academy for Pre-Nursing Success program “exceeded the retention rate of the

students at the university (Dapremont, 2013, p. 117). Additionally, the first co-hort passed the

NCLEX-RN on the first attempt. The Sutherland, Hamilton and Goodman (2007) program,

ARMS (Affirming At-Risk Minorities for Success) targeted ethnic students (Hispanic, Asian

Pacific and Blacks). Students were first generation college students, students from rural

communities and students with a C in or failing a nursing course (Sutherland, Hamilton &

Goodman, 2007). The program’s purpose was to 1) identify at-risk minorities; 2) increase the

42

number of minority recruitment; 3) develop and expand partnerships with secondary schools to

increase minority recruitment; 4) develop a recruitment plan; and 5) increase graduation and

NCLEX pass rats for minority students and develop a comprehensive plan (Sutherland, Hamilton

& Goodman, 2007).

Etowa, Foster, Vukic, Wittsock and Youden (2005) conducted a needs assessment in a

Canadian community and revealed that Blacks were not choosing nursing as a career. Efforts

from making nursing more visible in the Black community and at the university contributed to a

significant increase in admissions from the black community (Etowa et al. Foster, 2005).

Focusing on diversity recruitment could be one of the answers to help the nursing

shortage. Advertising could promote diversity in nursing. Literature in this section calls for a

need of diversity in nursing schools. In order to get more minorities in the field, strategies would

need to be developed to help minorities that come from disadvantage backgrounds enter into the

field.

Financial Aid

According to Esptein (2010), “between 2000 and 2009, the amount of Title IV federal

aid Pell grants, Stafford loans and all other aid administered to for-profit institutions grew $4.6

billion to $26.5 billion. Enrollment nearly tripled from 673,000 in 2000 to 1.8 billion in 2008”

(para 7). In an interview with student Chelsi Miller, Mary Beth Marklein (2010) paints a

frustrating picture of a former Everest College student. Miller applied to the University of Utah

Pre-Med program to found out that she was accepted but her credits from Everest College, a

43

national for-profit institute would not be applied to her Bachelor’s degree. She was left with

$30,000 in loan debt.

A new package of regulations regarding for-profit colleges from the U.S. Department of

Education ruled for-profit colleges responsible for student debt levels and repayment rates after

graduation. Thirty-five percent of students enrolled in for-profit programs had to be in

repayment status or loan debt could not supersede overall income (Nelson, 2013). For-profit

colleges challenged the new regulations in court. In March 2013, a federal judge thought the

action of the U.S. Department of Education was too arbitrary and that federal law prohibits a

national database to track graduates.

Childress (2013) states, “service members spend more than $30 billion on higher

education in the past five years and much of it on for-profit schools” (para 3). The Post 9/11 GI

Bill dramatically increased the amount of federal money given to veterans to further their

education. The new GI Bill does not include the 90/10 law which states colleges and universities

cannot take more than 90 percent from federal student aid. Childress (2013) quotes Holly

Petreaus, assistant director of the office of service member affairs at the Consumer Financial

Protection Bureau, “that’s made them attractive candidates for school recruiters some of who see

service members as nothing more than dollar signs in union” (para 6).

Fain (2013) states that the Federal Trade Commission is getting tougher with for-profit

colleges when stricter guidelines on deceptive marketing were released. The commission’s

guidelines only apply to vocational programs at for-profits that do not offer degrees. The

commission said “it is deceptive for a college to use any promotional materials that misrepresent

the availability of employment after graduation from a school or program of institution” (Fain,

2013, para 19).

44

Enrollment management is a campus-wide effort and not just an admissions department

duty and responsibility. Promoting academic success begins during the recruitment process

(Bontrager, 2004). Recruitment determines whether or not the student would be the ideal

institutional fit. Fit describes the student’s academic background, preparation and career

aspirations. The mission of the institution is the core message that should be communicated

effectively in all advertising and marketing practices to establish effective recruitment.

College Choice

Within this increasingly intense competition for students, many colleges have persisted 

in the belief that they can affect students' choice of college merely by modifying their

institutional descriptions or the targeting of their recruiting (Chapman, 1981). U.S. performance

has fallen further behind other industrialized nations on every measure (Darling-Hammond,

2009). It is in the best interest of the United States, and critical, that high school students seek,

select a college or university to attend, and enroll.

President Obama believes that regardless of educational plans after high school, all

Americans should be prepared to enroll in at least one year of higher education or job training

(Darling-Hammond, 2009). The National Center for Education Statistics reports that 42 percent

of entering student at two-year post-secondary institutions enroll in remedial courses (Lloyd,

2009). Researchers and policymakers express that too many American high school students lack

the skills and knowledge needed to succeed in college (Lloyd, 2009). As a result, students and

teachers may receive conflicting signals about the path to success. While campaigning for the

2008 presidency, then Senator Obama repeatedly pointed the acute need for dramatic education

reform and investment. In the Obama Plan for Higher Education, the President lobbied to reform 45

America’s public schools to deliver a 21st century education that will prepare all children for

success in the new global workforce (Darling-Hammond, 2009). President Obama wanted to

promote world-class academic standards and a curriculum that fosters critical thinking, problem-

solving and the innovation use of knowledge to prepare students for college and a career. Since

teachers are the single most important source in the way children learn, President Obama wanted

to ensure that teachers were supported as professionals in the classroom while holding them

accountable to student outcomes. The President also believed that education must be

accompanied by reform and innovation.

In response to financial, academic and economic pressures, higher education institutions

are now trying to understand the college choice factors among high school students. There is an

overwhelming amount of research involving college choice that exists (Hodges & Barbuto,

2002). Most of the current research focuses on several factors that model the Hosseler-Gallagher

(1987) three-stage model: (1) predisposition; (2) search; and (3) choice.

Spinoza, Bradshaw, & Hausman (2002) explained there should be “more targeted

advertising and promotions materials, telemarketing initiatives, and increased visits to local high

school” (p.19). Research conducted by Spinoza, Bradshaw, and Hausman (2002) suggest that

high school counselors may have an influence on prospective students’ choice of college.

Spinoza, Bradshaw, and Hausman (2002) focus on the search stage of the model to examine

what high school counselors consider important factors when selecting a college. Their study

focuses on the attitudes of high school counselors toward one Flagship University in a western

state. The same study concludes that counselors rated undergraduate research opportunities,

athletic programs, and diversity of students, extra-curricular activities, social life, and prestige of

46

the degree least important in college selection to what college students were looking for.

Counselors that rated the institution low on helpfulness and accessibility appeared to be highly

familiar with the campus. Eighty-six percent worked a short-distance from campus and had

visited the campus for professional reasons. The findings of the same study from Spinoza,

Bradshaw, and Hausman (2012) also suggest that the counselors could have influence on high

school students, positive or negative.

Hossler and Gallagher (1987) created the College Choice three-stage model to describe

the decision making process of college choice. The first phase of the model is predisposition:

students develop a plan for education or work after high school. The second phase of the model

is search: students search, explore and gather information about various colleges and

universities. The third phase of the model is choice: a choice is made and the student enrolls.

During the predisposition stage, students figure out if they will continue to post-

secondary education. In the search stage, students began to look at different options for

continuing their education. The choice stage consists of students submitting their applications.

Adams (2009) forms a model to create the Enrollment Choice Model that combines Hossler’s

and Gallagher’s college choice model. Adams’ (2009) model focuses primarily on the top half of

the model and not the actual enrollment, matriculation, persistence, or graduation. During the

predisposition stage, students decide whether or not to attend college. On the other hand,

institutions are making plans for their incoming freshman. Adams (2009) points out that “during

the predisposition/planning stage, students and institutions have little or direct or intentional

contact with each other” (p. 44). Institutions and students may not have direct communication

during this stage but to some degree this is where the relationship starts. Adams (2009) claims

that students are likely to select a college where an effective communication is in place.

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Institutions start to develop relationships in middle school until twelfth grade. Parents could

value this information in helping their children with a college selection. Students make changes

between middle school and high school. Contact is therefore vital in maintaining that approach,

and it is paramount to start the communication process early.

Advertising is a form of communication and students often make their college choice

based on what they see and hear. During the choice/select phase, students make a choice of

applying to various institutions. Institutions review applications, admit students and prepare for

them to enroll.

Hodges and Barbuto (2002) examine factors influencing the post-secondary institution

choice made by rural and urban high school students. Their study is based on a population

sample of eighty-one college freshman who applied and attended the host university. Hodges

and Barbuto (2002) concluded that respondents from rural backgrounds indicated that financial

aid, preparation, faculty, programs, and facilities were strong influential factors in their choice of

college. Urban students rated financial aid, career preparation, faculty, academics, and contacts

as highly influential. There seemed to be some similarities as to what rural and urban define as

an influence. Hodges and Barbuto (2002) suggest this as an “untapped opportunity for targeted

recruited strategies” (p. 21). The results of their study imply that rural students used the website

as a way to gain more information about various institutions.

Pope and Ferma (2002) conducted a similar study but their main focus was on identifying

the most relevant factors in students’ choice to attend college. The participants of Pope and

Ferma’s (2002) study included students from different racial and ethnic backgrounds. It is

interesting to note that African-American students responded higher than Caucasian students on

contact with admission officials to play an influential role in the decision to attend college.

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Advertisement has a high rank high among African-Americans and Hispanics. Confer &

Mamiseishvilli (2012) conducted a study that examined the factors that affected minority

students’ choice to enroll at four-year faith-based institutions. Of the choice factors, only high

school GPA, campus interaction and promotional materials remained significant. According to

their study, David W. Chapman was among the first to develop the college choice model. Later,

Hossler & Gallagher (1987) continued to develop theory on college choice. According to Confer

and Mamiseishvilli(2012), electronic communications and websites ranked very high among

students’ perception of institutional marketing strategies versus.). This study highlights what

minority students consider factors in helping them make college choice decisions. Overall, the

marketing strategies such as computer interaction, electronic communication, website,

promotional materials and college sponsored visits ranked higher than institutional

characteristics.

The gap of literature of this section has to deal with the fact that the majority of college

choice factor research is quantitative and does not provide a deeper understanding of “why”.

Quantitative data gives an overview of student responses and data collected but does not tackle

the opinion of each individual student to get a deeper understanding behind their reasoning.

Scarce research can bring aspects to students' choice for college. Several scholars have

attempted to explain what influences college choice but fail to explore in-depth consideration of

advertising and the college search process (Hossler, Schmit, & Vesper, 1999; Utley, 1994).

Disconnect between K-12 and Higher Education

The lack of compatibility between the kindergarten through twelfth grade (K-12) and

higher education policies and practices is one of the greatest failings of American Education.

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The disconnection between K-12 and higher education undercuts the high aspiration of young

people who want to go to college (Lloyd, 2009). Over the past decade, researchers and

policymakers have sought to identify the skills and knowledge students need for college.

Achieve, a Washington based group, defined college readiness by identifying the courses and

number of credits high school students should complete before graduation. Research indicates

that high school students who take high-level courses are more likely to earn a bachelor’s degree.

One such research effort is Clifford Adelman’s “Answers in the Toolbox: Academic Intensity,

Attendance Patterns, and Bachelor’s Degree Attainment”, a 1999 U.S. Department of Education

analysis of high school transcript data. The study found that the intensity of a student’s course

taking is strongly related to eventual attainment of a bachelor’s degree particularly for African-

American and Latino students (Lloyd, 2009).

International studies have found that the U.S. curricula provide superficial coverage of

too many topics without in-depth study, research, and writing needed to secure deep

understanding (Darling-Hammond, 2009). In an interview conducted by Phi Delta Kappa,

Secretary of Education Arne Duncan stated that he worries a lot about narrowing the curriculum

under the No Child Left Behind directives.

Educational Tools, the leader developer of supplemental digital educational, announced a

newly-formed partnership with School Town, a developer of interactive educational platforms.

The partnership will facilitate the delivery of Educational Tools CORE Curriculum via the

School Town framework, a symbiotic digital learning environment hyper-focused on optimizing

the learning experience (Information Technology Newsweekly, 2009). The joint venture will

amplify by:

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Streamlining many of the processes that diminish teachers’ time with students;

Increasing educator’s ability to assess student process;

Availing students to a wealth of collaborative forums;

Improving student performance; and

Keeping parents informed will bulletins, podcasts, assignment details and grade

books (Information Technology Newsweekly, 2009).

Student transition from high school to college needs to begin early in the former setting.

High school students need diverse support to gain many skills and knowledge necessary to

succeed in college. According to Mattern, Woo, Hossler and Wyatt (2010), “in the last two

decades there have been growing concerns about student persistence and graduation rates” (p.

18). The Higher Education Act of 2008 requires institutions to report graduation rates. At four-

year institutions, twenty-five percent of freshmen do not return to their sophomore year (Mattern,

et al, 2010).

Many colleges help students make this leap by offering summer transition camps and

remedial courses. No Child Left Behind requires that all teachers be highly-qualified however,

strategies for producing and equitably distributing a strong supply of well-prepared and effective

teachers have been lacking since the 1970s (Darling-Hammond, 2009). Shortages of teachers in

high-need urban and rural schools have grown worse as inequality in school funding and salaries

have grown. Concerns about the quality of preparation are widespread, and demands made on

teachers for sophisticated knowledge and skills to meet the needs of diverse learning, but little

has been done to improve most teacher preparation programs (Darling-Hammond, 2009).

51

High achieving nations prepare teachers to very high levels at state expense, pay them

competitively and support their learning throughout their career. Student teaching often occurs

either without models of expert practice or in a classroom that does not service high-need

students. Practice teaching under the wing of a veteran teacher is often reduced or omitted

(Darling-Hammond, 2009). This leaves many teachers trying to imagine good practice and

failing to help students achieve success.

Media and the Image of Nursing

Traditionally, American advertising “portrays nurses as trusted advisors and capable

professionals” (Johnson, 2012, p. 46). Johnson (2012) studied advertising in the post WWII era.

Her sample included 266 magazine issues from five mass market magazines. Women that

appeared in these magazines were defined as skilled workers. They appeared as symbols of

“medical care, hospital cleanliness and of scientific progress” (Johnson, 2012, p. 49). The nurses

who were featured in these magazines at this time were typically young white women. African-

American nurses were isolated to Ebony magazine, and older nurses were featured in magazines

that targeted older women. Nurses in post-war advertising were associated with the care of

babies and children. Advertising campaigns featured nurses to promote baby products. Some

campaigns such as Johnson & Johnson did not focus on the consumer but rather on the

promotion of the product (Johnson, 2012). The role of nursing is changing to meet the needs of

patients as they get older and have greater health needs. Male students are recruited to enter this

profession and people are now making nursing their second career. Accordingly, the historical

view of nursing has changed over the decades. Nursing is no longer seen as a white-dress and hat

profession (Johnson, 2012).52

Carol Rewers (2007) conducted a literature review in her dissertation on the images of

nursing. She cites various authors and their perceptions of nursing: According to Kalisch,

Kalisch, & Clinton (1982), prime time television represents an important “socializing force" for

molding ideas; further suggesting, the pervasive impact of the unfavorable portrayal of the

nursing profession on television not only makes recruitment of future nurses difficult, but also

adversely influences the decision-making process of policy makers who decide what scarce

resources the nursing profession will or will not have to carry forth its mission to the public.

(p.363).

Hereford (2005) explored how baccalaureate-nursing students’ career perceptions were

influenced based on stereotypic images of nurses they observed in the media. Hereford’s

research findings suggest, “Fictional images of nursing are harmful to those individuals who may

consider nursing as a career” (p. 187). The researcher’s conclusion was reached, through in-

depth interviews and focus groups with nursing students in the study which demonstrated the

most persistent stereotypic image conveyed by the media was the sexy or naughty nurse

(Hereford, 2005). The students also reported two newly emerging negative stereotypic images of

nurses that include: dimwitted, lazy nurses and homosexual nurses (Hereford, 2005).

According to Hereford (2005), the emotional responses of students to the media’s

negative portrayal of nurses varied by gender. For example, male student nurses reported the

following emotions: anger, embarrassment, disappointment, anxiety, humor, and excitement. In

contrast, female student nurses reported the following emotional responses: anxiety, humor,

pride, and excitement (Hereford, 2005, p.119). Hereford (2005) observed, that several nursing

students reported the media influenced their perceptions regarding career choice and jobs within

nursing. Study subjects also made the salient observation that the newly emerging depiction by

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the media of male nurses as homosexual could further deter men, who already perceive nursing

as a female profession, from pursuing a career in nursing. The researcher suggested, that more

“accurate and gender neutral” marketing strategies are needed. According to Hereford, media

images must be based on “real life examples” that show “what the profession of nursing really

does” (p.189).

Rewers (2007) literature review continues with the Sigma Theta Tau International,

nursing’s honor society, report entitled The Woodhull Study on Nursing and the Media: Health

care’s invisible partner: The Woodhull Study examined 20,000 articles which were contained in

16 different newspapers, magazines, and trade publications during a one month timeframe;

September 1997. Three key research findings emerged from the Woodhull Study’s analysis of

the publications: 1) nurses were only cited four percent of the time in the 2000 health-related

articles that were identified in the various publications; 2) the few references to nurses or nursing

that did occur were mostly just in passing; and 3) in many of the stories, nurses and nursing

would have been more germane to the story subject matter than the references selected (p. 9).

Auker (2004) conducted research involving the image of nursing in printed media and

observed, “there (still) remains an abyss between the reality and what the discourse in the media

is showcasing regarding the (nursing) profession” (p.93). The researcher utilized two different

approaches to examine two types of print media; nursing journals and U.S. newspapers. Initially,

Auker (2004) utilized content analysis to evaluate 30 advertisements contained within three

different nursing journals: The American Journal of Nursing, The Orthopedic Nurse, and

Nursing 2003. The main reason Auker analyzed nursing journals was to determine whether

hospital advertisements that were designed to recruit nurses, mentioned any of the criteria most

commonly associated with “Magnet Hospitals.” Auker, quoting Greene (2003), noted “The

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Magnet Hospital Program which recognizes organizations that are preferred places for nurses to

work is quickly moving from an obscure nursing journal subject to the latest hospital marketing

tool” (p. 54).

Auker (2004) utilized the following Magnet Hospital characteristics as the basis for the

study’s comparison criteria: strong leaders, participation in management, autonomy in practicing

nursing, flexibility in scheduling, low nurse/patient ratios, and career advancement opportunities

(p.54). Auker’s research revealed, “Overall the recruitment advertisements in the study sample

did not effectively communicate the Magnet message. In fact, eight of the 30 advertisements did

not mention any of the Magnet qualities at all” (p. 57). The vast majority of hospital

advertisements promoted “vacation-like qualities.” The researcher observed that these ads are

somewhat offensive…as they seem to give nurses little credit for the critical thinking skills of

which they are masters…promoting the vacation-like qualities of the location suggests that

nurses can be duped into any practice situation, as long as they can get a good tan after hours.

A sound approach to attracting nurses, encouraging prospective students to choose

nursing as a career, and to retain nurses, is for nurses and hospital administrators to work toward

improving nursing situations so that Magnet qualities are reflected more broadly across the

spectrum of the discipline. In addition, these qualities should be showcased in the media, in

literature used to inform prospective students about nursing, and in recruitment ads for specific

facilities (Auker, 2004, p. 58-59)

Auker (2004) also studied newspapers and observed, “Newspapers, read by 60 percent of

Americans, are powerful mechanisms to convey the essence of nursing to the public” (p.70).

Through the process of discourse analysis, which Auker described as “focusing on the analysis

of actual written and spoken texts in an effort to reveal how both the content and form, or the

55

way that language is expressed, promotes a preferred reading or understanding of that discourse”

(p. 71); the author discovered, that newspapers or “the press, is not only describing the plight of

nurses, it is contributing to the problem” (p. 83).

According to Auker (2004), nursing is portrayed by the press as a job that no one wants.

Descriptors of the work evoke images of drudgery and exploitation. The stories are replete with

accounts of long hours, lack of respect, too much responsibility, and limited support. Pictures are

painted of nurses who, after long shifts of taxing work, are not permitted to go home. Employers

are seen as doing battle for nurses to boost their supply and then watching them carefully as they

threaten to escape the harsh conditions. The question glares at the public: who would ever want

to be a nurse (p.84)?

Nursing School Recruitment

Among the 50 states, Alaska, Arizona, Arkansas, California, Florida, Nevada, New

Mexico, Texas, Georgia, and Hawaii are in high demand for skilled nurses (Education Career

Articles, 2013a). Furthermore, Education Career Articles (2013b) suggested that exceptional

communication skills, compassion, critical thinking, organizational skills and patience are

critical to have in the nursing field. There has been an immediate need for further training for

doctors and nurses. Inadequate training can result in: (1) Inadequate access to care, particularly

in rural and inner-city locations (2) Lack of emergency preparedness and (3) Decreased ability to

accomplish planned expansions of healthcare services, resulting in negative effects on local and

national economies (Council on Physician and Nursing Supply, 2013). The demand for high

quality knowledge and skills in the health care profession rises increasingly along with the

advancements in science and technology.

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Science and Medical Programs

Not only is there is shortage of nurses but there is also a shortage of doctors. According

to the Association of American Medical Colleges (2013), “the United States faces a shortage of

more than 91,500 physicians by 2020” (para. 1). The Association is asking medical schools to

increase enrollment by thirty percent. There are national school programs in place to attract

students in the science and medical fields. A well-known program that addresses concerns with

the lack of knowledge in these areas is STEM. STEM stands for Science, Technology,

Engineering and Mathematics. “The STEM Education Coalition works aggressively to raise

awareness in Congress, the Administration, and other organizations about the critical role that

STEM education plays in enabling the U.S. to remain the economic and technological leader of

the global marketplace of the 21st century” (STEM Education Coalition, 2013, para 1).

Furthermore, “members of the STEM Coalition believe that our nation must improve the

way our students learn science, mathematics, technology and engineering and that the business,

education, and STEM communities must work together to achieve this goal” (STEM Education

Coalition, 2013, para 1). Project Lead away is the “leading provider of rigorous and innovative

science, technology, engineering and mathematics (STEM) education curricular programs used

in middle and high schools across the U.S.” (Project, Lead Way, 2013, para 1). According to the

program initiatives, students “create, design, build, discover, collaborate and solve problems

while applying what they learn in math and science” (Project Lead Way, 2013, para 3).

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Students are also exposed to a variety of STEM careers from professionals who currently

work in the industry. In the high school biomedical program, students “explore the concepts of

human medicine and are introduced to bioinformatics including mapping and analyzing DNA”

(Project Lead Way, Programs Biomedical Sciences, 2013, para 1). The Title III, Part B of No

Child Left Behind authorizes mathematics and science partnerships (MSP) program to “increase

academic achievement of students and enhance the teaching knowledge of classroom teachers”

(Michigan Department of Education, 2013, para 1). “Approximately, $3,000,000 is available for

the 2013-2014 school year” (Michigan Department of Education, 2013, para 2). U.S. Weekly

released a 2013 Best High School list for STEM rankings. According to the article, “training in

science technology, engineering and math can place students in the pipeline for in-demand career

fields such as software development, biomedicine, aerospace engineering”(U.S. Weekly, 2013,

para 2). Okemos High School in Michigan is ranked at no.8 and East Lansing High School is

ranked in the top 100. The high schools are five miles apart and located near Michigan State

University.

Okemos and East Lansing High Schools were the only schools in Michigan on the list.

According to the rankings, California, New York and New Jersey have the best high schools for

STEM in the country” (Sheehy, 2013, para 13).

Recruiting Pre-Nursing Students

According to the 2013-2014 American Association of Colleges of Nursing survey, there

were 70,405 seats available in the baccalaureate of science in nursing generic program. There

were an additional 62 schools that did not have seat limitations. There were 271, 179 completed

applications received;170, 559 applications meeting admission criteria;112, 615 qualified

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applications admitted; 57,944 qualified students not admitted; 64,434 students enrolled and

registered with seat limitations; 11, 734 students enrolled and registered without seat limitations.

There were approximately 7,506 vacant seats from the number of seats of available minus the

number enrolled and registered with seat limitations.

Watson (2006) considers the arguments for and against the higher education of nurses

and what it achieves. Nursing has always been seen as “vocational”. Watson (2006) asks the

questions, “why would nursing not be considered a profession”? (p.624). Watson (2006) answers

that some suggest nurses are trained and not educated. Watson (2006) believes nursing is a

profession based on the accountability and interaction with patients and clients. Watson (2006)

quotes Suzanne Gordon (2005), …”what many people believe; nurses are people mainly women,

who don’t have the patience, stamina, ambition, curiosity or intelligence to make it through

medical school and who work in a field wholly owned and operated by doctors” (p.624). Nursing

schools are struggling to expand to meet the demand for healthcare reform.

According to Byrd, Garza and Nieswiadomy (1999) “the primary mission of

baccalaureate nursing programs is to prepare undergraduate students for entry-level” (para 1).

Admissions to baccalaureate nursing programs have been based on GPA. Byrd, Garza and

Nieswiadomy (1999) conducted a study that explored criteria that was predictive of failure in a

completion of a baccalaureate nursing program. Records and transcripts of students admitted

over a three year period to the baccalaureate program were examined. The same consisted of 285

students. After data analyses and interpretation, it was concluded that a higher cumulative

science GPA was a predictor of graduation for students before enrolling in upper-division

courses.

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According to Johnson & Johnson Campaign for Nursing’s Future (2013), registered

nurses account for 2.6 million jobs in the United States. In addition, nursing is the fastest

growing occupation in the United States. By 2020, the United States will face a shortage of

800,000 nurses (Johnson & Johnson, 2013). Furthermore, four out of ten registered nurses are

over the age of fifty. The American Association of Colleges of Nursing (2010) reports that

contributing factors impacting the nursing shortage are nursing school environment, shortage of

faculty, age, changing demographics, insufficient staffing and turnover.

Looking at marketing strategies related to nursing, Rewers (2007) examines a study by

Curry (1994) who surveyed 649 nursing students to determine what societal and marketing

factors influenced their decision to pursue a baccalaureate nursing program. Respondents

identified the following societal factors as influencing their decision to pursue a career in nursing

and enrolling in a baccalaureate nursing program: greater opportunity for career and educational

mobility (81 percent), personal desire for college degree (80.7 percent), desire to pursue

advanced graduate study (49.8 percent), status of having baccalaureate degree in nursing (49.1

percent), expectation of a higher salary (36.2 percent), convenient location of baccalaureate

nursing program (31.1 percent), some limitations for employment without a degree (27.4

percent), opportunity to work in non-hospital settings (26.3 percent), desire for comprehensive

liberal arts/scientific background to complement nursing knowledge (26.1 percent), and parents’

expectation that you acquire a college degree (17.3 percent) (Curry, p.59).

In response to marketing factors that influenced the students’ decision to enroll in a

baccalaureate nursing program, survey respondents indicated the following, in descending order

of importance, as factors influencing their career decision:

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Campus meeting with nursing dean/representative (18.6 percent), nursing program

brochure (16.1 percent);

Personal contact by student(s) in the program (13.7 percent);;

College bulletin/catalogue (10.9 percent);

Open house hosted by nursing program (10 percent);

Personal contact by admissions personnel (9.5 percent);

Personal contact by nursing alumni (9.5 percent);

Telephone call from nursing faculty/program representative (9.4 percent);

College view book (6.7 percent); and

Letter from nursing dean (4.6 percent)

In 2013, the Michigan Center for Nursing conducted a survey of nurses licensed in the

State of Michigan. Reports were analyzed from the following regions: southeast, southwest,

west central, mid-Michigan, east central, north central and Upper Peninsula. The sample consists

of responses from 18, 657 registered nurses (RNs) The total number of nurses licensed by the

State of Michigan as of January 1, 2013 is 166, 473 (139, 077 RNs). According to data reported

by the Michigan Center for Nursing (2013), 70 percent of active registered nurses are employed

in either a hospital inpatient or outpatient setting. Data on racial/ethnic and gender

characteristics of the nursing population in Michigan show that Caucasians make up the majority

of nurses:

Caucasian 88%

African-American 6%

Asian 3%

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American Indian/Alaska Native 1%

Middle Eastern/Pacific Islander <1%

The data on the racial/ethnic make-up of nurses continues to show the need to diversify

recruitment efforts for nursing students across ethnic boundaries.

All nurses responding to this same survey were asked to indicate their level of education

and almost forty-two percent of active RNs had an associate’s degree, seventeen percent had a

diploma in nursing, forty-four percent had a bachelor’s degree in nursing, nine percent had a

master’s degree and less than one percent had a doctorate degree in nursing. Between January

2014 – March 2014, 16,370 Bachelorette of Science in Nursing candidates in the United States

took the NCLEX exam, with 87.96 percent passing.

Penprase, Oakley, Ternes and Driscoll (2012) conducted a study to explore the empathy

characteristics of students who are attracted to nursing. Characteristics from the study could help

nurse educators determine retention factors. Penprase, Oakley, Ternes and Driscoll (2012)

reference Taylor, Lillis and Lynn (2008) by quoting “empathy is the capacity to recognize and

identify with feelings, experienced by another” (p. 192). Penprase, Oakley, Ternes and Driscoll

(2012) use the empathizing quotient (EQ) questionnaire and systemizing quotient (SQ)

questionnaire developed by Baron-Cohen and Wheelwright (2004) for their definition of

empathizing “as the drive to identify and respond to another individuals thoughts, emotions, and

feelings whereas systemizing is understood to be the drive to analyze, explore and construct

systems (p.192). Baron-Cohen and Wheelwright (2004) found that women tend to score higher

on empathizing and men on systemizing.

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A descriptive correlation design was used for this study. Undergraduate students enrolled

in a variety of majors at large Midwest U.S. research universities, including nursing students

participated. Faculty members were asked to recruit students and offer extra credit if they

completed the survey. A total of 1, 482 non-nursing students and 390 nursing students

participated in this research. Students declared majors in integrated studies, humanities, business

administration, science and math, engineering/computer sciences, education, human services and

social science. The majority were Caucasian. There were 13.8 percent male nursing students

who participated in the study. Only a small percentage (4.6 percent) of the overall nursing

population was represented because of declaring nursing their sophomore year. The results of

the study showed that students admitted to the baccalaureate nursing program at a large,

Midwestern university demonstrated higher levels of empathy than other majors. Combined

male and female nursing students scored higher with those of their gender in the non-nursing

student population. The findings support the conclusion that empathy plays a significant role in

attracting students including men into a nursing career. Other findings conclude that nursing

programs should consider assessing empathy skills set during the admission process (Penprase,

Oakley, Ternes and Driscoll, 2012). Significant findings indicate that “nursing student and

patient interactions reflect a patient-centered and care approach that emphasizing an empathetic

relationship as foundational” (p.196).

On August 1, 2002, President George W. Bush signed the Nurse Reinvestment Act into

law. The American Nurses Association fought for passage of this act to address recruitment and

retention initiatives. The Nurse Investment Act authorizes the following provision: (1) loan

repayment programs about scholarships for nursing students, (2) public service announcement to

encourage more people to enter the nursing professions, (3) programs to advance within the

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profession, (4) Long-term care training grants and (5) repayment program for nursing student

who agree to teach at a nursing school.

Middle School Recruitment

Middle school has been identified as the primary age to recruit students for nursing as a

career (Matutina, Newman, and Jenkins, 2010). The purpose of the authors’ research was to

identify middle school perceptions of nursing as a career and to evaluate the current instruments

used to measure middle and high school students’ perceptions of nursing as a career choice.

Effective recruitment strategies of potential nursing students may be a solution to the nationwide

nursing shortage (Matutina, Newman, and Jenkins, 2010). Some students view nursing as a trade

and not a career (Matutina, Newman, and Jenkins, 2010). However, prior research has

demonstrated practices in advancing nursing and realities of nursing cam have a positive

influence (Matutina, Newman, and Jenkins, 2010).

Theoretical issues of the instruments used to measure perceptions were missing nursing

theories (Matutina, Newman, Jenkins, 2010). Middle school students were influenced by

friends, guidance counselors, and friends Cohen, Palumbo, Rambur and Mongeon (2004). The

importance of school environment promoting nursing as a career through pamphlets, posters and

career days plays an important role.

Participants in a survey conducted by Lerner and Cohen (2003) indicated less

participation from faculty to recruit elementary and middle school students. Matutina (2008)

believes there are obstacles that prevent middle school students from considering nursing as a

career. One obstacle is that “both middle school students and their guidance counselors are not

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well informed about the roles of the professional nurse” (Matutina, 2008, p.112). In addition,

“male and female African-American counselors rated nursing lowest as a profession (Matutina,

2008). Educating middle school students about many specialists in nursing can boarded their

views as a profession (Matutina, 2008). Matutina (2008) key question was “will earlier

recruitment of middle school students promote a multifaceted, professional, image of nursing,

possibly increasing future professional nursing school enrollment”? (p.2). From the 301 middle

school students that were surveyed from Lerner and Cohen (2004) nursing research, nursing was

not the ideal career. Hoke (2006) study surveyed 171 middle school students with a video and

handouts. After the invention, 41 percent had an interest in nursing. Matutina (2008) believes

recruiting middle school students with efforts from guidance counselors, nurses and nursing

school administration could close the gap of the nursing shortage crisis.

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CHAPTER THREE: METHODOLOGY

Overview

This study investigated how advertising influenced pre-nursing students to enroll into a

pre-nursing program and the influence of social media to help them make that decision. Using

qualitative methods to collect data from multiple data sources, surveys, questionnaires and focus

groups were used to evaluate the effectiveness of advertising.

This study explored the career and college choice experiences of first-time Bachelor of

Science (BSN) nursing students and how advertising influenced their decision to enroll. The

purpose was to determine how advertising played a role in their decision to attend nursing school

and have a career in nursing. There are numerous ways to investigate the phenomenon of

advertising in educational research. Qualitative research allows for an in-depth inquiry into the

participants’ experience with college choice.

This is a qualitative case study of a single site’s nursing program. This study is grounded

in interpretive and critical analysis of the language and strategies of advertising in higher

education and the hermeneutics of pre-nursing college students. This study is unique in the

sense to the relevance of advertising in the nursing students’ career and college choice,

particularly at a private not-for-profit university in Michigan. There is a need to conduct more

research on aligning these factors with advertising to identify other contributing factors to

career and college choice.

Qualitative studies can provide reasoning for questions that go unanswered. Qualitative

studies can contribute to “search for meaning and understanding” (Merriam & Associates,

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2002, p.179). The history of qualitative research in education in the United States began from

early theories in American sociology and anthropology (Bogdan & Biklen, 2007). Qualitative

research includes “interview transcripts, field notes, photographs, videotapes, personal

documents, memos and other official records “(Bogan & Biklen, 2007, p. 5) .

According to Denzin & Lincoln (2000), “The word qualitative implies an emphasis on

the qualities and on processes and meanings that are not experimentally examined or

measured” (p.8). Furthermore, “qualitative research is an interdisciplinary and sometimes

counter disciplinary field” (Denzin & Lincoln, 2000, p.7). Researchers involved with

qualitative research are called journalists or soft scientists and their work is only exploratory or

subjective (Denzin & Lincoln, 2000).

According to Bogdan & Biklen (2007), qualitative research is enacted in naturalistic

settings; draws on multiple methods that respect the humanity of the participants in the study;

focuses on context; is emergent and evolving; and is fundamentally interpretive.

“Qualitative implies an emphasis on process and meanings” (Denzin and Lincoln,

1998, p. 8). Researchers need to capture perception of the data collected. The qualitative

researcher views the world as it occurs in action and therefore attempts to confront the

constraints found within everyday life (Denzin and Lincoln, 1998). Integrity is critical to the

knowledge of the researcher along with value issues, ethical guidelines and ethical theories

(Kvalve & Brinkmann, 2006). Furthermore, “the integrity of the researcher – his or her

knowledge, experience, honesty, and fairness – is the decisive factor” (Kvalve & Brinkmann,

2006, p.74). Research bias can influence the results of a study in order to obtain certain

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outcomes. Bias can occur at any phase of the research. Pre-trial bias can occur in study design

and recruitment of participants.

The purpose of this study was to explore the role of advertising strategies in the higher

education recruitment process of in-coming students at a private not-for-profit university who

applied to one or more pre-licensure Bachelor of Science (BSN) degree programs in nursing in

the state of Michigan. This study focused on the inquiries that came from sources of nursing

program advertising and the impact advertising has on such inquiries.

Research Questions

The following research questions guided the study:

1. What are the key messages used in advertising in a private not-for-profit college

targeted at pre-nursing students?

2. How have prospective nursing students responded to key advertising messages? How

did these messages impact their college choice?

3. What are effective advertising strategies employed in this college from the

perspectives of nursing students?

4. What are effective advertising strategies employed in this college from the

perspectives of those responsible for the development and implementation of these

strategies?

Theoretical Positioning of the Study

This study positions the interpretive and critical paradigms of research. First, this study is

interpretive, or qualitative in nature, which renders social reality as a multi-dimensional and 68

multi-faceted construct and individuals as having freedom to construct their own realities and

identities based on diverse experiences throughout lifetime (Hesse-Biber & Leavy, 2011).

Secondly, this study is also critical in that it provides a post-structuralist critique of the language

of advertising in higher education, the critique that deals with “the social meanings within

language and discursive practices” (Hesse-Biber & Leavy, 2011, p. 238). The interpretivist

perspective guides the study that enables the researcher to untangle the meanings and

interpretations of advertising in higher education (Tucciarone, 2007).

The primary focus of this study used the nursing field as a way to uncover issues that

might occur with enrollment officials and marketers to uncover perceptions of what students

perceive advertising to be and how it influences enrollment choice among pre-nursing students in

Michigan. The contribution of this study to the field of nursing in Michigan can provide insight

to college choice factors and why pre-nursing students choose to inquire and enroll in certain

colleges and universities. The theoretical framework was developed by interpreting use of

advertising for college and career choice, reactions and interpretations of advertisements and the

image of nursing.

Research Design

This exploratory case study took a deeper look into the advertising strategies of career

and college choice among pre-nursing students. A case study gives the researcher the choice of

what is to be studied and may be simple or complex in nature.

Creswell (2013) references Yin (2009) with regard to case study research that “involves

the study of a case within a real life contemporary context or setting” (p. 97). Denzin and

Lincoln (2000) describe a case study as “both a process of inquiry about the case and the product

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of that inquiry” (p. 436). According to McMillan (2008) a case study is an “in-depth analysis of

one or more events, settings, programs, social groups, communities, individuals, or other

‘bounded systems’ in their natural context” (p. 288).

An exploratory case study was the preferred method of this study because it updates and

expands the existing body of knowledge pertaining to factors that influence students’ interest in

nursing as a career and the decisions to attend and enroll in a pre-nursing program. Exploratory

research is “research conducted to explore the problem or situation, that is, to gain ideas and

insights into the problems” (Malhotra & Peterson, 2006, p. 72).

In particular, this research sought to identify what type of recent advertising efforts, if

any, were perceived by students to be effective strategies at improving the recruitment of future

nurses. This study sought to understand, rather than explain, ways in which advertising has

influenced career and college choice.

Denzin and Lincoln (2000) relate qualitative research design to choreography. Denzin

and Lincoln (2000) explain that “good choreography captures the complexity of the dance/story

by using rigorous and tested procedures and in fact refuses to be limited to one approach to

choreography” (p. 379). Furthermore, “the qualitative researcher is remarkably like a

choreographer at various stages in the design process in terms of situating and recontextualizing

the research the project within the shared experience of the researcher and the participants in the

study” (Denzin & Lincoln, 2000, p. 380). Choreographers and qualitative researchers make a

statement by deciding “what” to begin their dance/story. Choreographers and qualitative

researchers think the same in terms of bringing a story to life.

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Case Study

Denzin and Lincoln (2000) believe that “case studies have become one of the most

common ways to do qualitative research” (p. 435). Additionally, “in many professionals and

practical fields, cases are studied and recorded” (Denzin & Lincoln, 2000, p. 435). Case studies

can be identified as intrinsic, instrumental or collective (Denzil & Lincoln, 2000). A case study is

not a method or methodology but rather “an expansive field within qualitative paradigm”

(Hesse-Biber & Leavy, 2011, p. 256). A case study allows researchers to provide an in-depth

exploration of the problem, issue, or phenomenon.

Case studies begin with the identification of a case within certain parameters, such as a

specific place or time. A review of the literature indicates the shortage of nurses in the United

States. The intent of a case study has to be unique or unusual (Creswell, 2013). As an effort to

understand the nursing shortage as it relates to slow enrollments at nursing schools, an in-depth

look into the role of advertising will be examined to understand students’ perception of nursing

and determining the right college, specifically, as it relates to media, and social media. Choosing

nursing as a career has to be the right fit for a student. The approach to data analysis will be

reported from a private, not- for-profit university in Michigan.

This case study took place at a private, not for-profit college with an enrollment of 4,000

in Michigan with a setting that focuses on advertising strategies for recruiting students for the

Bachelor of Science in nursing program. This case study represents a ‘bounded system’ that

connects the study of advertising at a particular higher education institution with the students

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who decided to attend this institution, and the role that advertising might have played in their

decision to pursue nursing.

A holistic understanding of the problem, issue or phenomenon within its’ social context

provided the researcher with in depth understanding of why the problem, issue or phenomenon is

occurring (Hesse-Biber & Leavy, 2011). The language of advertising and marketing strategies

can be interpreted differently depending on the context in which it is used. This case study

intended to develop an in-depth understanding of overturned and hidden messages of advertising

and their relevance to the students’ career and choice of college.

Flyvbjerg (2006) rejects five misunderstandings about case study research:

That general, context-independent knowledge is more important than

concrete, context-dependent knowledge;

That one cannot generalize on the basis of an individual case;

That case studies are only useful for generating hypotheses;

That case studies contain a bias toward verification; and

That it is difficult to develop general theories on the basis of specific case

studies.

Pre-Nursing Student Participants

Research participants were first-time students taking pre-nursing courses at a private not

for-profit university. The selection of the participant in qualitative studies is purposeful because

of a characteristic and “researchers intentionally select individuals and sites to learn or

understand the central phenomenon” (Creswell, 2008, p.214). In purposive sampling, the

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researcher has the choice of whom, where and how to do their research. Since the number of

students enrolled in the pre-nursing courses differ from term to term, it is impossible to predict

how many of them can be potential participants of this study. The focus of this study was

estimated to be approximately 10 to 15 pre-nursing students as participants. The Maximum

Variation Sampling technique was used in this case study. Maximum Variation Sampling is

searching for cases or individuals spectrum of positions and perceptions of the phenomenon that

is being studied (Given, 2008).

Pre-nursing students that selected at least five channels of advertising with three being

from social media were invited to participate in the focus group. Pre-nursing students that

heavily engaged in media and social media were selected. Participants also included the dean of

the Nursing Program, a registered nurse (RN) faculty member, vice president of enrollment and a

representative from the marketing and advertising department.

Purposeful selection of participants provided in-depth information about the topic. For

the purposes of this study, the data was collected from first-time pre-nursing students and their

perception of advertising factors in college choice. Therefore, the selection of the participants

was critical to the case study design and goals of this research study. The research plan was to

contact the nursing coordinator and obtain contact for all pre-nursing students.

Data Collection Strategies

The data for this study will come from several sources: a pre-screen telephone survey,

focus group with the students that will consist of a questionnaire, review and survey of nursing

television ads, review and survey of nursing school social media accounts, nursing

documentaries, and a group discussion about their university as it pertains to college choice. 73

Individual interviews were conducted with the dean of the nursing school, a registered nurse

(RN) faculty member, vice president of enrollment management and a marketing and advertising

representative. The data collected from the pre-screen telephone survey, focus group and

individual interviews served as the major data for coding and identifying repetitive patterns for

the major themes for analysis and interpretation. All participants signed a consent form.

Pre-Screen Telephone Survey

In the beginning of the study a pre-screen telephone survey was administered by

telephone. The purpose of the pre-screen telephone survey was to recruit students for the on-

campus focus group. There was access to the nursing department’s enrollment database. Every

fourth person on the list was contacted. Currently, there are up to 200 pre-nursing students.

Students are that listed as “pre-nursing” on all enrollment and registration documents were

contacted for the pre-screen telephone survey. The intention of the survey was to gather

background information about the students, such as, what types of advertising they used to find

information about pre-nursing programs. The pre-screen telephone survey was not audio-taped.

A survey invitation for the focus group was extended to students who select as least five types of

advertising with three being from social media.

Interviews

Structural interviewing was conducted with the dean of the nursing school, registered

nurse (RN) faculty member, vice president of enrollment management and a marketing and

advertising representative to obtain additional data on the role of advertising and marketing in

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recruiting students to create a more expanded and holistic description of the central phenomena

of this study.

During the structural interviews, the researcher asked a series of pre-established

questions whereas group interviews involved direct inquiry and interaction with the respondents

and were semi-structured (Denzin & Lincoln, 2000). Kvalve and Brinkmann (2006) believe that

“interviewing is the new practice of the last few centuries” (p.18). Interviewing is also very

interactive (Kvalve & Brinkmann, 2006). Denzin and Lincoln (2000) explain that the most

common form of interviewing involves “individual, face-to-face verbal interchange” (p.645).

According to Kvalve & Brinkmann (2006), “the research interview is an interpersonal

situation, a conversation between two partners about a theme of mutual interest (p.123). The

researcher is his or her own tool (Kvalve & Brinkmann, 2006). The types of interview questions

that should be asked are- introductory, follow-up, probing, specifying, direct, indirect,

structuring, silence and interpreting (Kvalve & Brinkmann, 2006).

Furthermore, “both qualitative and quantitative researchers tend to reply on the interview

as the basic method of data gathering” (Denzin and Lincoln, 2000, p. 646). The individual

interviews were audio recorded.

Focus Group Discussions

A focus group usually consists of six to ten subjects led by a moderator (Chrzanowska,

2002). Focus groups encourage a variety of viewpoints and opinions. Topics are introduced to

create an atmosphere for expression and conflicting viewpoints (Kvalve & Brinkmann, 2006).

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Focus groups are not intended for solutions but to bring forth different opinions. According to

Kvalve & Brinkmann (2006), “focus groups are well suited for exploratory studies”. (p.150)

Based on the background information provided by the students in the initially pre-screen

telephone survey, an invitation to participate in the on campus focus group was extended to

students. Interview Guide (Appendix D) consisting of several structured questions served as a

general orientation for the interviewees. The purpose of the audio recorded two-hour focus

group discussion in this study was to obtain a greater understanding of the students’ responses to

the language of media and social advertising and their potential relevance to these students’

career and choice of college through televisions ads, documentaries and social media accounts.

During the focus group, participants completed a survey about nursing, watched and reviewed

nursing school and career television advertisements that they had not seen before, watched and

reviewed Johnson & Johnson documentaries, reviewed nursing school social media accounts,

answered questions about advertising and social media, nursing as a career and why they

enrolled in the pre-nursing program at the university. Afterwards, the group discussed their

opinions. All interviews—individual and focus group—were recorded electronically, the

participants’ consent transcribed, and analyzed following the general qualitative research

techniques and procedures.

Data Analysis Techniques and Procedures

An interpretive paradigm is the assumption that reality is socially constructed (McMillan,

2008). The major emphasis is the language that reflects the participant perspectives. Coding was

used to organize and unveil meanings (Kvalve & Brinkmann, 2006). Coding has been used in

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early analysis of texts in social sciences (Kvalve & Brinkmann, 2006). According to Kvalve and

Brinkmann (2006), “coding involves attaching one or more keywords to a text segment in order

to permit later identification of a statement (Kvalve & Brinkmann, 2006, p. 201). Kvalve &

Brinkmann (2006) reference how coding an important role played in ground theory. The

grounded theory approach was first introduced by Glaser and Strauss in 1960 (Kvalve &

Brinkmann, 2006). Coding was described as “the process of breaking down, examining,

comparing, conceptualizing and categorizing data “(Kvalve & Brinkmann, 2006, p. 202).

Kvalve & Brinkmann (2006) further explain that “Glaser and Strauss were significant in

enabling qualitative researchers to provide legitimation for their methods of inquiry by

presenting explicit strategies in the form of codified research process” Kvalve & Brinkmann,

2006, p. 202). The analysis of the data obtained from the interviews typically begins with open

coding (Creswell, 2013). Coding consists of “creating a label of title for a chuck of text that

captures its meaning” (Hesse-Biber & Leavy, 2011, p. 270). The coding process in this

exploratory case study began with identifying words and phrases pertaining to the research

questions and labeling them accordingly. Further, these initially identified codes were analyzed

and put into the clusters or categories reflecting the research purposes at a deeper level. The

analysis resulted in the identification of the themes that will allow for uncovering the meaning of

advertising and marketing and their role in the students’ choice of college and career choice.

Analyzing and interpreting data enabled the researched to frame the key ideas of the study

(Bodgan & Biklen, 2007).

The paradigm renders social reality as a multi-dimensional and multi-faceted construct

and individuals as having the freedom to construct their own realities and identities based on

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diverse experiences throughout lifetime. The objective of this kind of deep analysis is

important between researchers and the people they study.

Angen (2000) offers some criteria for evaluating research from an interpretive

perspective: (1) careful consideration and articulation of the research question, (2) carrying

out inquiry in a respectful manner, (3) awareness and articulation of the choices and

interpretations the researcher makes during the inquiry process and evidence of taking

responsibility for those choices (4) a written account that develops persuasive arguments and

(5) evaluation of how widely results are disseminated. Researchers really need to ask is the

information helpful to the target. Finally, there needs to be evidence and assessment of the

biases over the lifespan of the research project.

Qualitative data analysis “involves working with data, organizing, breaking into

meaningful units, coding, synthesizing and researching for patterns” (Bodgan & Biklen, 2007, p.

159). Data analysis finds meaning of the data by interpretation (Hesse-Biber & Leavy, 2011).

Data analysis and interpretation refer to developing ideas about the research findings and

“relating them to the literature and to broader concerns and concepts” (Bodgan & Biklen, 2007,

p. 159). Data analysis consists of “making a detailed description of the case and its context”

(Merriam & Associates, 2002, p. 209).

Researcher’s Self and Evaluation Criteria

In qualitative research, the researcher is the primary data instrument. The researcher

creates a natural setting with multiple types of data. The design or procedures of the study

emerges as the validation of findings occurs. According to Creswell (2008), qualitative validity

means “that the researcher checks for the accuracy of the findings by employing certain

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procedures” (p.190). Interviewer reliability is often questioned in interview research (Kvalve &

Brinkmann, 2006). Validity is one of the strengths of qualitative research and defining what is

accurate. Ascertaining the validity of interview research is more assuring than reliability (Kvalve

& Brinkmann, 2006). According to Denzin & Lincoln (2000), “one of the issues around validity

is the conflation between method and interpretation” (p. 178). The cornerstone of quality

research is people, place and events (Denzin & Lincoln, 2000). Validity in qualitative research

has to do with description and explanation. There cannot just be one way of interpretation

something and labeling that as credible.

Kvalve & Brinkmann (2006) discuss principal issues of validation and attempt to draw

conclusions on the concepts of objectivity and validity. Reliability pertains to the “consistency

and trustworthiness of research findings” (Kvalve & Brinkmann, 2006, p.245). Related to the

issue of whether a finding is reproducible, this refers to the interviewee changing their answers

during an interview or with another interviewer. Validity refers to the “ordinary language to the

truth, the correctness and strength of a statement” (Kvalve & Brinkmann, 2006, p.246). Research

is often invalid if it does not measure what is trying to be measured. Validity pertains to the

degree that a method investigates what is intended to investigate. The issue of what is valid

knowledge involves the question of what is truth. Within philosophy, three classical criteria’s

are discerned: correspondence, coherence and pragmatic (Kvalve & Brinkmann, 2006).

Correspondence criteria of truth concerns whether a knowledge statement corresponds to the

objective world. Coherence criteria refer to the consistency and internal logic of a statement.

Pragmatic criteria relates to the truth of a knowledge statement to its practical consequences.

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Researcher’s Role at the University

The researcher is not employed or in any way a volunteer with the university from which

this case study was identified but is an alumnus. The researcher’s current place of employment

does not have a Bachelor of Science (BSN) program. At the initial time of the proposal

development, the researcher was employed at a medical institute that only had a state approved

pre-nursing certification program not leading toward a degree in nursing.

The benefit of this project to society in general is:

(1) investigate a heretofore unresearched area; enrollment management in nursing

schools and advertising, career and college choice among nursing students.

(2) cure a deficiency in the literature; enrollment management in nursing schools and

advertising, career and college choice among nursing students. Advertising and

college choice in general.

(3) shape preliminary understanding; Advertising and its’ role in a career and college

choice among nursing students.

(4) provide a framework for future research

Delimitations

The most notable delimitation of the study regards bias on behalf of the participants. The

telephone survey was designed to only include first-time students enrolled in the pre-nursing

program and data collected reflects their personal experiences in their career and college choice

search. There may be bias involved with responses, since they are unsure if they will get

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admitted into the nursing program. Interviewing actual students in the focus group, who can

objectively reflect on their search experiences, will mitigate this delimitation. Another potential

delimitation is the small response of students who participate in the pre-screen telephone survey

and who have used media and social media as a main source during their career and college

search. An additional limitation to this study is site selection because it is a private institution

and doesn’t reflect the higher education spectrum.

Limitations

Interpretation of qualitative data requires sense making on behalf of the researcher, at

which time personal views and reflections may be used to assess findings (Creswell, 2008, p.

265). Therefore, due to the researcher’s experience with nursing school enrollment, bias may be

introduced into the interpretive part of the study. Finally, the reader may come to his or her own

conclusions about the need of media or social media to recruit nursing students when there is

already a demand. These limitations will be remediated through the triangulation of interview,

focus group and archival data from which to draw conclusions. Triangulation addresses the issue

of internal validity by using more than one method of data collection to answer a research

question.

Summary

This study focused on the exploration of advertising strategies and its role in students’

career and choice of college for a pre-nursing program. It sought to uncover the language of

advertising and how it played a role in helping students decide about what institution to choose

despite competitive enrollment at nursing schools. What messages behind advertising place hope 81

and determination into the mind of every pre-nursing that in four years they will walk away as a

nurse? This study can be beneficial for enrollment managers, deans, and the staff and faculty of

nursing programs. Qualitative research will give an insightful view of what students’ beliefs are

about advertising and how it influences their decision to act upon what they see and hear.

Colleges and universities are creating or expanding their nursing programs and need to

understand what attracts students to this particular field, and what factors students are looking for

when they apply to college but also an academic program. The definition and theory of

advertising as it relates to higher education, particularly, career and college choice will be

extended and reflected upon.

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CHAPTER 4: RESULTS

Overview

The following chapter provides the results of this study – first the findings from research

conducted with pre-nursing students followed by those results from the employee interviews.

The findings represent how the influence of advertising was employed differently for college and

career choice. In order to adequately represent the distinction between the results, questions

related to nursing as a career choice, analysis of nursing television commercials, and the use of

advertising to inquiry and enroll into a pre-nursing program are represented separately. The

analysis of the employee interviews will be discussed separately.

Themes and manuscripts were validated by the verbatim transcript of each participant. I

viewed all data has having equal value and meaning. The findings within both chapters will be

presented within the following themes: (1) “I want to help people”, (2) “Advertising needs to

portray real-life experiences”, (3) “Word of Mouth advertising” and (4)“Social Media works”.

Each of the four major themes was labeled by a phrase actually used and expressed by student

participants’ and employees.

Host University

The host university is located in a western suburb of Detroit, Michigan with an

enrollment of 4,400 students. As a Catholic and Franciscan institution of higher learning, the

mission of the university is to instill in its students Christian humanistic values, intellectual

inquiry, a respect for diversity, and a commitment to serving others through a liberal arts

education, integrated with career preparation and based on the truths and principles recognized

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within a Catholic tradition. In 1937, the university was established by Mother Mary DeSales

Tocka and her council in the Felician Central Convent and became a university in 1991. A leader

in nursing education at the state, regional and national levels, the university launched its’ first

doctoral program, the Doctor of Nursing Practice in 2009. The university celebrated years of

nursing education in 2013.

Focus Group Participants

Participants in the present study were seven pre-nursing students enrolled in prerequisite

courses for entrance into the Bachelor of Science in Nursing (BSN) degree program. Of the

seven pre-nursing students, all were women and enrolled in prerequisite courses as of the winter

2015 semester. The pre-nursing students were purposefully selected to attend the focus group

because, during their pre-screen telephone survey, they used a variety of advertising sources

during their college search.

Fifty-five students were called from a registration/enrollment list for an initial pre-screen

telephone survey out of ninety-eight. Random sampling was used to identify participants for the

initial telephone survey. Every third and fourth student was not called. Out of the 55 students

called, 18 participated in the telephone survey. Twelve were selected for the focus group and

seven were actually able to participate. The focus group participants agreed to a set date, time

and location on campus. The focus group was audio recorded. Significant meanings were

identified carefully, analyzed and formatted into pattern of themes.

Before the focus group started, participants were asked to answer a questionnaire about

choosing nursing as a career. Afterwards, participants analyzed nursing school TV 84

advertisements and discussed the use of advertising to inquiry and enroll into a pre-nursing

program. In addition, students viewed nursing testimonials from Johnson & Johnson. Nursing

school advertisements were from a private college, nursing campaign, career institutes and a

community college.

The coding process helped to identify words and phrases pertaining to the research

questions and attached key themes or labels. Further, these initially identified codes were

analyzed and put into the clusters or categories reflecting the research purposes at a deeper level.

The analysis resulted in the identification of the themes that allowed for uncovering the meaning

of advertising and marketing and their role in the students’ choice of college and career choice.

Themes

“I want to help people.”

The word “help” is often associated with people who want to make a different in

someone’s life. Throughout this focus group, the “help” was used by all focus group participants

and it was used repeatedly to clarify why participants wanted to become a nurse.

In making sense of their career choice, all of the participants started by indicating on the

questionnaire the need to help people. Within the narratives of the themes, the desire to help

people was the forefront in the participants’ answers from the questionnaire of how they chose

nursing as a career. The word “help” and the description of the word “help” was used repeatedly.

Furthermore, their responses were framed by their understanding of nursing as a calling and for a

special person. As the participants shared:

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“Nursing is a fit for me because ever since I was young I wanted to be a nurse. I work at a

hospital and I love taking care of people. I feel like I can make difference in someone’s

life every day. And when it comes down to someone’s health, which is a priority to me.

Health is a concern for everybody and I know I could be and would be a great nurse when

it comes down to helping someone change their lives to the better. I feel like I can make a

difference in someone’s life every day. Nursing is my passion. I wouldn’t consider

nursing a job because it’s what I love to do.”

“Help others achieve better health.”

“I love helping others in need and I want to give back to others the same way me and my

family was helped through past family medical experiences.”

“I want to make a difference in people’s lives. Whether it is long or small. And have an

influence on the improvement of patient care.”

“I love working with others and helping. I always have my brother in and out of hospital

growing up so I got a first-hand chance to see what they do and I want to able to help

people with their lives.”

“I want to become a nurse because I am very helpful and caring. I want to feel as if I’m

making a difference in someone’s life.”

The responses initially were on a helping orientation that employed nursing as a caring,

compassionate helping profession. As participants shared their connection to people, the desire

was central to their choice of nursing as a career:

“I have a heart that naturally wants to help others in need. I also have the determination

and drive within myself to help others understand their body and what they can do to help

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improve their overall health. I also love to communicate with people to understand them

and their point of view better of their personal needs.”

“I’m a very compassionate and empathetic person. I love helping those in need also. I am

also a great leader and work every well in team situations that require many people

working together to achieve a common goal. I am a people person and I love getting to

know and work with others diverse selves. I am also the type of person who gives 100%

to everything I do and I try my very best… How every day is a different story, working

and helping people in need, and performing skills I learned from school to practice.”

“I believe that I have the people skills necessary to perform excellent patient care, and the

patience to help aid the sick and dying. I do not view it as a job, but a caring lifestyle in

and outside the hospital.”

“I believe nursing would be a great fit because of my personality and my tendency to

always work hard and to put others in front of me.”

“Nursing would be a great fit for me because of my personality, hard work, and

dedication I put into everything I do.”

One of the participants desire to make a difference and help others was derived in part from her

experiences as serving in the military: “It’s a part of my purpose. I am a natural born giver. I

genuinely care and God doesn’t make mistakes. I’m “his” choice… “His” healer.” She also

added that nursing is about “Enhancing life and instilling hope.”

The responses positioned nursing as a career that has a meaningful contribution to

society, medicine and the healthcare field:

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“I always wanted to a nurse I love helping people and trying to make people happy. I

always loved the medical field.”

“The fact that nurses save lives is what interests me. I would do anything to try to

help/save someone.”

“Constant growth of medicine.”

“I feel as if it a field that is constantly changing. It is exciting to be a part of a field in

which new ways are being found to improve quality of life for all people.”

“Nursing interests me because I love learning how the body works and being able to help

others. Just the classes I already took here was amazing.”

What interests me about the field of nursing is helping others. More especially I would

like to work with babies.”

The act of choosing a career was employed as finding a fit for their need to help peoples, having

passion and the drive to make a difference. The participants’ description of their personality and

being influenced by family and friends served as a justification for their choice of nursing.

“Advertising needs to portray real-life experiences.”

Advertising plays a major role in marketing and, as such, has a role in persuading

consumers to buy and to become aware of a product or service. Advertising should portray the

truth about what marketers are trying to convey. Many times, “false advertising” is used when a

product and service is advertised in a wrong way that cause misinterpretation.

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In setting the stage for their choice of nursing, the participants identified the sources that

need to make advertising more realistic and the attributes they believe define a nurse. The

participants drew inspiration from personal experiences:

“The website is what worked for me.”

“Advertising made me inquire. What is everyone talking about with nursing?”

“Whether you research top nursing school around Michigan, the university comes up.”

“I’ve seen a billboard but the university in general.”

The participants watched documentaries about nursing created and produced by Johnson &

Johnson. It was apparent that real-life perception was taken at face value and most of the

participants spoke of the video as being a truthful insight into the role of nursing:

“I like the emotion form the Johnson & Johnson videos. You almost want to cry. The

patients really appreciate and care for the nurses. That is what makes you want to become

a nurse.”

“The Johnson and Johnson videos were inspirational. “The videos expressed how

important nurses are.”

“The Johnson and Johnson videos show the importance of a nurse and what nursing is all

about. People get it mixed up.”

“There are no people of color in the videos.”

“The university should have testimonials like the Johnson & Johnson videos. They

should be from actual students in the program.”

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The participants spoke about the reality of what the perceived nursing to be. The exposure to the

Johnson and Johnson documentaries informed participants on how there is an emotional attribute

to nursing and that it is a career that is exciting but challenging and rewarding:

“Nurses are compassionate, honest and caring. There are two types of nurses-the job and

the other one, compassionate. There needs to be more nurses who want to make a

difference in lives.”

“There is an emotional factor with nursing.”

“You can’t do without nurses. Nurses save lives every day.”

“Sometimes the nurse comes into contact with anybody.”

“It’s takes special person. It’s natural.”

“I liked how they interacted with the patients and families in the video. Nurses explain

what the doctors doing.”

“Nurses should love what they do. I love working in the medical field. You need the

love.”

One of the participants’ described nursing as a career that should not be reward through

monetary because it’s a passion that involves helping people:

“You need something that you would do for free.”

One of the participant was quick to dismiss about advertising paints an unrealistic picture of

nursing:

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“Current nursing advertising is the G version.” You need that emotional grabber when

advertising nursing. Using models in scrubs seeming happy doesn’t do it for me. I want

to see students in labs and working patients at clinical.

The participants recognized that inspiration from the Johnson & Johnson videos and felt nursing

should be portrayed in the sense that emotional is a part of nursing. The role of advertising to

shape the face of nursing was described as unrealistic and being safe.

“Word-of-Mouth Advertising”

Word-of-Mouth advertising doesn’t necessarily take an official place within the

marketing realm and instead is often used when consumers share experiences about a product or

service. Consumers tell about their experiences whether good or bad. Businesses may not pay

consumers to spread the word of their product or service, but the exchange can be considered a

referral.

In addition to advertising playing a role in college choice, it was apparent that word-of-

mouth plays a tremendous factor in selecting and enrolling into this university. Family and

community also had an influence:

“I’m from the area and the university is well known to me. I knew I wanted to go to

nursing school.”

“My advertisement was through meeting people and recruiters would come to my

community college.”

“I want to an affiliated school and they were constantly talking about the university.”

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“Girls I went to high school with could take classes at the university. Small class sizes

and the relationships with the professors did it for me.”

“This university was always the school I wanted to go to. I have a saying that the

university is me. It’s intimate. The university is an elite school.”

“My family graduate from here. They told me it was good. I love it here.”

“I hear all the time it’s a good school.”

“I am aware because my mom went here. And I love the class sizes. Word of mouth is

big.”

Central to a participant’s experience, the size of the university played a role in her decision to

enroll:

“What drawn me in how the small the university was. We not as big at the University of

Michigan or Michigan State.”

One of the participants’ contributed her college choice as knowing the reputation of the nursing

school:

“The university has a prestigious nursing school. The nurses that come from this nursing

school are in demand. I feel like half the people that go here are for the nursing program.”

Some participants described a situation that justifies that reputation of the nursing school from

others that are not from the area:

“I play on the softball team here and we have recruits coming here all the time. The first

question they ask is everyone in the nursing program.”

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The participants made sense of their college choice by indicating “word of mouth” as a

tremendous factor in helping them select a college and nursing school. The participants used

advertising during the initial college search but were strongly influenced by the reputation of the

nursing school told by others.

“Social Media Works”

Social media defines itself as being social over the media. Social media has emerged

tremendously over the past few years. With the launch of the World Wide Web to the birth of

Myspace and Facebook, social media has become the new concept of researching people

worldwide.

Recognizing that advertising did play a role in the initial college choice but was not the

guiding factor in the final college choice decision shifts advertising to a less factor in college

choice among this group of participants. “Word-of-Mouth” was a strong factor indicating that

people and the stories they share can influence college choice. The interpretation of social media

as a tool to advertise a nursing school for enrollment was not apparent. The depth of social

media exploration is important as to the “branding” of the school and keeping current students up

to date about the nursing school. Social media can be used as an alternative tool if traditional

advertising is not working:

“You get constant information on twitter. Social media is the way to go. I think the

reason that we don’t have a Twitter or Facebook is because the nuns are traditional.

Everything is so old school.”

“Everybody is into social media. It’s an excellent way to spread the word.”

“Social media can help students who are undeclared for a major.”

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“It would draw more people in who are not from the area. It’s a nice environment and it

would grow even more.”

Participants drew from their own perception that social media is important in their personal lives:

“I go on social media constantly.”

“I’m constantly on social media. I go on social media every second I get. I go on

Facebook and Twitter. I go on twitter the most because I’m more connected to it.”

“Facebook is my favorite.”

“I’m constantly on social media.”

“I go on social medial every second I get.”

“Social media is like a soap opera. People go on social media for the latest whatever.”

One of the participants expressed that “the nursing program stands by itself. It’s its own

reputation.” Despite an initial default that advertising or social media doesn’t influence the

outcome of the nursing school, participants expressed the desire for the nursing school to start

their own social media awareness:

“Social media is the way to stay connected.”

“You have to get it started. People need to be educated and connected to what’s going on.

We need a presence. We need to stay connected. “The University of Michigan goes a

great job with posting pictures and constant updates. “Nursing is changing every day. If

posting about nursing was there, it would keep everyone connected. “Change needs to

take place.”

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“Everyone is so local. Social media would get the word out that the university has a great

nursing program. If nursing would post pictures, it would get me more excited about the

program.”

“I follow nursing accounts on twitter. Social media grows awareness. It doesn’t have to

be advertising but just posting pictures of nursing students.”

Social media was characterized as having an influence on staying connected to the nursing

school with constant updates. Participants expressed the need of staying connected to the school

while taking pre-nursing courses. Despite that reputation of the nursing school, social media can

draw more students who are not from the area.

Nursing School TV Advertisements

Nursing school advertisement from the private college features two students – male and

female. The commercial talked about change, flexibility, career change and working married

people.

Table 1 identifies both the positive and negative impact identified by participants who

thought the majority of the private college advertisement was active, attention-getting, boring,

genuine/sincere, honest, informative, natural, pleasant, and satisfying.

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Table 1. Private College

Positive Impact Negative Impact Graduate testimonials Short Timing of program Catered to married

individuals Used men

Targeting one specific kind of person

Seemed limited Monotone No attention grabber Longer, more active

Multiple people Expressing their opinions Career choice Right to the point Different options

Shown more nurses Female clothing Script Felt thrown into it Plain, no emotion Boring Not enough information

Based on the nursing features advertised, Figure 1 shows that this advertisement was

rated by participants with 71 percent strongly agreeing it was understandable and 43 percent

strongly agreeing it was relevant, but less so in being believable with just 29 percent strongly

agreeing the message was believable.

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Figure 1. Private College Advertisement

71%

29%

The ad message is understandable

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

29%

57%

14%

The ad message was believable

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

43%

29%

14%

14%

The ad's message was relevant to me

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

43%

29%

14%

14%

The benefits described in the ad are believable

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

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14%

14%

29%

29%

14%

After viewing this ad, I would consider applying to this school

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

14%

14%

43%

29%

This ad is much better than other nursing school ads

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

Nurse Campaign

The commercial focused on the shortage of nurses. Statistics showed that 400,000 nurses

are needed by 2020. The main message behind the commercial was, “What would we do without

nurses?” Table 2 identifies the impact of the nurse campaign. Participants thought the majority of

the advertisement was active, attention-getting, boring, cheerful, emotional, genuine/sincere,

honest, informative, memorable, natural, pleasant, satisfying, strong, unique and warm-hearted.

Table 2. Nurse Campaign

Positive Impact Negative Impact Give statistics Asked questions that made

you think Seemed like they were

talking to you Patients Information Inspiring words

Music Weird clothing Depressing tone Dreary, dark Disheartening

Images Realistic Emotional Makes you want to become

a nurse

Nothing Grey Slow music Just said nurses are needed

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Talked about the importance of nursing

Patients doing things on their own

Based on the nursing features advertised, this advertisement was rated with 72 percent

strongly agreeing it was understandable, 43 percent strongly agreeing it was believable and had a

greater impact on relevance and inspiring a participant to apply.

Figure 2. Nurse Campaign Advertisement

71%

14%

14%

The ad message is understandable

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

43%

57%

The ad message was believable

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

71%

29%

The ad's message was relevant to me

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

43%

43%

14%

The benefits described in the ad are believable

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

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43%

14%

14%

29%

After viewing this ad, I would consider applying to this school

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

43%

14%

14%

29%

This ad is much better than other nursing school ads

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

Career Institute #1

The career institute advertisement was a short commercial that talked about the demand

of nurses and that the medical field is growing. Flexible hours are available with a 12-month

accelerated program. “Reserving your spot” was an attention getter. Table 3 identifies the

impact of this advertisement. The participants thought the majority of the advertisement was

active, attention-getting, boring, cheerful, creative, energetic, genuine/sincere, honest,

informative, memorable, natural, pleasant, satisfying, strong, unique, and warm-hearted.

Table 3. Career Institute #1

Positive Impact Negative Impact Happy Grabbed your attention Become nurse quickly Estimated time Minorities Men

Didn't draw me in Voice over talked too fast More active/exciting Just college name/picture

short Wait too long for info

Useful information Informative Good promoting nursing

school

Unappealing graphics Not natural Just pics with narrator

100

Gave facts Accelerated program

Fast Have more words on screen

Based on the nursing features advertised, this advertisement was evaluated with 86

percent of participants strongly agreeing it was understandable while only 43 percent strongly

agreed it was believable, as shown in Figure 3. This advertisement received mixed results on its

relevance and benefits to consumers.

Figure 3. Career Institute #1

86%

14%

The ad message is understandable

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

43%

14%

14%

29%

The ad message was believable

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

43%

29%

14%

14%

The ad's message was relevant to me

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

29%

43%

14%

14%

The benefits described in the ad are believable

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

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29%

14%

29%

29%

After viewing this ad, I would consider applying to this school

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

14%

29%

14%

14%

29%

This ad is much better than other nursing school ads

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

Career Institute #2

The second Career Institute commercial used statistics with salary and passing rates to

appeal to consumers. Other programs were advertised in the commercial like the CNA (Certified

Nursing Assistant), LPN program and LPN to RN three-year bridge program. Table 4 identifies

the impact of this advertisement. The participants thought the majority of the advertisement was

active, attention-getting, boring, cheerful, creative, energetic, genuine/sincere, honest,

informative, memorable, natural, pleasant, satisfying, strong, unique, and warm-hearted.

Table 4. Career Institute #2

Positive Impact Negative Impact Students practicing skills Informing Natural Showed what nurses do Action Explained the field of

nursing

Said 100 percent passing rate Reputation of school seems

questionable Shows how long to become a

RN

Involvement No minorities

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Roles of nurses Very informative Talked about journey

Nothing Music Slow Cheesy Written facts

Based on the second career institute advertisement, this message was rated with 86

percent strongly agreeing it was understandable and believable. This advertisement had a more

positive impact with 75 percent strongly agreeing in its relevance and 86 percent strongly

agreeing that the benefits are believable to consumers. Figure 4 depicts the overall results.

Figure 4. Career Institute #2

86%

14%

The ad message is understandable

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

86%

14%

The ad message was believable

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

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75%

13%

13%

The ad's message was relevant to me

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

86%

14%

The benefits described in the ad are believable

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

86%

14%

After viewing this ad, I would consider applying to this school

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

71%

14%

14%

This ad is much better than other nursing school ads

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

Community College

The community college commercial was catchy in the beginning, but quite confusing

because it didn’t seem like a nursing school commercial at all. A young girl saved her brother

who fell off his bike and she decides to become a nurse. The message did not connect for many

of the students. Table 5 identifies the impact of this advertisement. The participants thought the

majority of the advertisement was active, attention-getting, cheerful, creative, energetic,

genuine/sincere, honest, humorous, informative, memorable, natural, pleasant, satisfying, unique,

and warm-hearted.

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Table 5. Community College

Positive Impact Negative Impact Bright colors Voice over Creative Funny Showed how nurses save

lives Cheery

Acting Made no sense Beginning was confusing More believable No flow No connection to viewer

Very humorous Energetic Active, not boring Scene with brother and

sister

Not informative Irrelevant Didn't seem like a nursing

school Didn't get to the point right

away Too short Written facts

Based on the nursing features advertised, Figure 5 shows that this advertisement had

only 43 percent strongly agreeing it was understandable and having little impact on being

relevant or moving a consumer to act on it by applying to that program.

Figure 5. Community College

29%

43%

29%

The ad message is understandable

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

43%

43%

14%

The ad message was believable

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

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14%

43%

29%

14%

The ad's message was relevant to me

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

50%

33%

17%

The benefits described in the ad are believable

Strong Agree Somewhat Agree Neither

Somewhat Disagree Strongly Disagree

17%

17%

33%

33%

After viewing this ad, I would consider applying to this school

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

14%

29%

14%

43%

This ad is much better than other nursing school ads

Strong Agree Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

Focus Group Summary

The participants’ responses employed their college and choice, the definition of a nurse,

the deception of nursing on adverting and the role of social media. Through the course of

analyzing nursing school advertisements and focus group, the responses uncovered the

complexity of each participant’s story on why they want to be a nurse and the true definition of

the nurse. All participants’ answers on why they wanted to become were similar: help, caring,

compassionate, and making a difference. The participants used those same words to describe the

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definition of a nurse and believe those characteristics should be portrayed in advertising with

emotional as a main factor to draw viewers and readers in.

Using real-life situation and actual nurses or student nurses can create that emotion that

lacks emotion in advertising. The findings also present a social movement toward really defining

what nurses do. Even though advertising and social media was not used as in the final decision to

attend this university, advertising did play a role in the initial search process. Social media did a

play a role in helping them stay connected to the university and wanting to stay connected to the

nursing school.

Employer Interview Results

This section focuses on the use advertising to recruitment from an employee perspective.

Participants include four members of administration: The Dean of the Nursing School, Vice

President for Planning and Enrollment Services, Director of Marketing and one nursing faculty.

The following discussion reflects how each employer views and understands advertising and

social media in higher education. The responses evolve from position advertising social media

to attract potential nursing students and a deeper meaning of advertising and social use at this

university.

Dean of the Nursing School

The Dean of the Nursing school believed that “a successful nurse has to open to lifelong

learning, caring, change, hardworking, flexible, motivated, people-oriented and scholastic.”

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Participants from the focus group used some of the same characteristics when describing

themselves and a nurse. The dean expressed that there was no line item for advertising and

marketing in the nursing school budget. She noted that the nursing school has printed materials

and does mini education programs. Some of the educational programs are geared toward middle

school students so they can become familiar with the field of nursing. From her experience and

talking with students, the website is a popular place for students to shop when looking for

nursing schools. All participants’ did visit different nursing school websites in the initial college

search process. In addition to doing mini educational program, the nurse faculty attend job fairs

and hospitals to promote the school. Currently they have an articulation agreement with a

community college and want to expand their agreements with other community colleges in the

area.

The dean believed that the nursing school markets itself in many ways because of the

reputation of the nursing school. The focus group participants did express how word of mouth

was a major indicator in choosing this institution for pre-nursing studies. The dean further

explained that, “our students are out in the community through their clinics telling their story”.

Because of their small budget, the school does not do a lot of individual program marketing.

Overall, the university does radio sports for open houses and did a billboard for branding

purposes. The only marketing material the school has is a nursing brochure in a booklet format.

The undergraduate officers use this nursing booklet when recruiting students. Occasionally, the

school will advertise in community college newspapers. Social media does not have a presence

within the nursing school. The dean stated that the nursing school does not have a Facebook page

or twitter. She expressed doing mini You-Tube videos. The reason she believe the nursing school

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does not have a presence is because of, “technologically, we are behind the times.” She agrees

that it takes time and commitment to establish and update social media accounts:

“Commitment…people here are older and we are not in tune.” As a mother and knowing

first-hand how popular social media is, she shared that “social media is how young folks

are communicating. We need at least a half time individual for our undergraduate and

graduate communications.” Furthermore, she believed unique keywords can help the

university differ from the competition.

Vice President for Planning and Enrollment Services

The Vice President for Planning and Enrollment Services spoke directly of the nursing

school as having a strong reputation and having more applicants to the nursing school that they

can commit. He noted that, “the nursing program is a top program here and students need to be

aware of the demand and to make sure it fits their skill set.” Even though there is a nationwide

shortage of nurses, he assured me that, “they are good at informing students about the rigor of

the program.”

In addition to state regulation, he explained that “there are a limited number of seats. All

of the focus group participants valued the reputation of the nursing school and were aware of

their rigorous program. The current undergraduate admissions recruitment plan for the school of

nursing is indirect. The admissions officers attend high school functions and college fairs and

provide a nursing booklet to perspective students. Inquiries for the nursing school come through

the undergraduate office first until the student enrolls. After the student enrolls, they are declared

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pre-nursing and an academic officer from the nursing school will monitor their progress. It was

evident from the Vice President for Planning and Enrollment Services and the admissions officer

that the school of nursing is known throughout the state and around the country. The admissions

officer shared that, “In November and December, we get one hundred each month. In January

and February we get about seventy-five each month. And that’s students actively emailing and

calling us.” In addition she shares that, “the nursing program markets itself but there is always

room for growth and marketing.” The Vice President for Planning and Enrollment expressed that

he would like the university to continue being recognized as a premier nursing program. He

provided insight into why social media is important with the following statements:

“Social media is very important for audiences 18-30 years of age.”

“It’s a tool we need to continue to use and grow.”

“We have to be current and flexible to make sure we are reaching our target

audiences.”

“Social media is here to stay.”

“We need to keep up with our competitors and how the present themselves to the

marketplace.”

Focus group participants expressed the same ideas and especially using social media as a tool to

grow the school and reach students in other areas.

Director of Marketing

The Director of Marketing acknowledges that not everyone is a fit for nursing. She

explained, “not everyone can get into our nursing program…it’s so full. Health services are

another avenue for students who thought they were pre-nursing or nursing students.” Throughout

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our interview, her responses created an image of really staying true to the Catholic values. Her

responses reflect the need to keep this a part of advertising and social media strategies:

“Staying true to our values and focusing on what is distinctive about our university. So

our messaging could be including the personal attention you get.”

“We talk about faculty that cares about their students. One of our values is the respect for

dignity of all people.”

“Through the image of ads, copy…we are showing and talking about who we are and

how our mission and values makes us.”

“The stores that we tell are about our mission.”

Even though she believes in the power of marketing and advertising, her responses reflect

on that the university is pretty small school with over 100 undergraduate programs. They tried

cable advertising that didn’t work and wants to continue to reach male students because the

university is 75 percent female. Counter to believing in the power of marketing and advertising,

the director of marketing believes, “social media is a huge part of integrated marketing.” The

university may be conservative and she believe it’s her responsibility to select and use

advertising that is consistent with the universities’ values. Her expression of the use of social

media is noted as, “Instagram and Twitter are on the rise.” There was a concern of not keeping

the university as a whole and not one face: “We have about twenty different Facebook pages. We

need to consolidate all our Facebook pages so we have one face for the university. All of the

news should be on the university’s Facebook page. Instagram…we try to keep as a whole.

Athletics does its own thing because it’s big enough.” She did acknowledge that social media can

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help with the nursing shortage as long as social media stays a tool. “We can never lose sight of

the storytelling that needs to take place.”

Registered Nurse Faculty Member

The registered nurse faculty member was very passionate about the university and the

mission. She explained, “The universities’ mission talk about helping the poor and the vulnerable

and I read the mission before I came here. I am looking for caring and compassion equalities in

nursing students.” Furthermore, she shared that the work at the nursing school is really hard and

there has to be a passion for it. She became overwhelmed with the idea that faculty members

should help students grow the passion.

“Faculty members have to model that passion.”

When it came to passion in the nursing field she shared:

“We have to help that passion bloom and grow. The nursing profession has not

done that well. We have worked everyone to death in school and haven’t worked

on formation. Passion can be developed and beaten out of people. We have to

channel our passion. We see a lot of beat up nurses and no one is building them

up, telling them they do a good job.”

In addition to being a faculty member, she is nurse anthropologist, and the new director of the

health services program at the university. She acknowledged that nursing is not for everyone:

“There are a lot of ways to help people. I tell people this is a different way to help

people. It’s a really important way.”

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Portraying real life experiences was a major concern and notes that advertising does not

do a good job in realization of nurses and what nurses do:

“I don’t want things with manikins in it. I don’t want literature that has a manikin in bed

with girls and men and minorities standing around a bed. I want something that shows healing,

spirituality, caring, and love and that’s difficult to put on a piece of paper. I want something that

is going to invoke healing. I’m a nurse anthropologist so the context is important to me.”

She analyzed the use of babies and the elderly in advertising:

“Babies…makes nursing look all happy…people will not come to nursing if your

taking pictures of people dying because that’s not pretty. You can’t keep

portraying all elderly. You can’t have all happiness. You can’t have all dying.”

Her response to what can be done to change the image of nursing in advertising:

“I’ve been looking at nursing literature and wondering what makes us spiritually unique.

The public battles with what do nurses do. Is the spiritual component coming across in our

advertising?” “We are a part of the university. I have a strong commitment to the liberal arts and

we wouldn’t be a top premier program without our liberal arts. We always want to market

ourselves within that liberal arts foundation.”

Realizing that there is a shortage of nursing, her belief is that social media can help

spread the word if it plays a role increasing faculty.

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Summary

The participants’ responses of nursing, advertising and social media were initially

positioned within a tale of perspective and staying true to the universities’ values. The portrayal

of advertising to define nursing converged with the analysis to provide in depth understanding of

how this university made sense of advertising and social media. The perceptions and

expectations of advertising and social media aligned together as a tool to define their mission and

the truth behind nursing.

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CHAPTER 5: DISCUSSION

Overview

The purpose of this study was to explore the role of advertising strategies in the higher

education recruitment process of in-coming students at a private not-for-profit university who

applied to one or more pre-licensure Bachelor of Science (BSN) degree programs in nursing in

the state of Michigan. The completion of the focus group and employee interviews was inspired

by the choice to use a case study from which to inquire. This exploration provided an

opportunity to understand the admissions process, recruitment methods, advertising and social

media.

When we want to understand why people do things or engage in certain activities,

qualitative research gives a powerful voice to deeper meanings that cannot be explained or

measured through quantitative research. Only through understanding can we begin to experience

the challenges of knowing what advertising is, understanding the relationship between

advertising and college choice, the importance of nursing image and how social media is a tool

that must be kept constant. The discussion also provides an opportunity to findings within the

context of the research questions which guided the inquiry:

1. What are the key messages used in advertising at a private not-for-profit college

targeted at pre-nursing students?

2. How have prospective nursing students responded to key advertising messages? How

did these messages impact their college choice?

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3. What are effective advertising strategies employed at this university from the

perspectives of nursing students?

4. What are effective advertising strategies employed at this university from the

perspectives of those responsible for the development and implementation of these

strategies?

Theoretical Implications

Students learn about choices of college from multiple forms of advertising channels from

both traditional and new social media outlets such as television and radio commercials,

newspapers, magazines, billboards, internet, course catalogs, e-mail advertisements, and

brochures. Although this study does not focus on branding, institutions of higher education can

benefit from understanding their brand and how it can attract diverse populations of students

(Black, 2009). According to the Advertising Educational Foundation (2005), “an advertising

strategy identifies who the prospective target is and defines his/her needs, wants and desires”

(para 7).

From the analysis of this case study, some of the key messages used at this university are

furthering your education in a traditional Catholic setting, having professors that care about your

well-being and accomplishing something your family may not have done. The university has a

lot of first year generation students. This would be an opportunity for first generation students to

see if this university would be a good fit for them and their career choice. The university does

not do individual program advertising but uses a program booklet to promote the nursing

program. From talking with the Vice President for Planning and Enrollment Services and the

admissions officer, their form of advertising is indirect with every admissions officer promoting

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the nursing program. Each admissions officer assures all potential students about the rigor of the

program and to make sure it is a fit for their skillset. The admissions officer noted that the

nursing program sells itself because of their reputation.

According to the Advertising Educational Foundation (2005), “advertising is about

selling” (para 1). Since the undergraduate program is limited with the number of seats because of

state regulations, the doctoral nursing program could possibly invest in more advertising to

recruit nurses to pursue leadership and faculty roles. Advertising often begins with persuasion

and persuasion involves an attitude or behavior that influences feelings or reasoning. If the

undergraduate nursing program sells itself, others may be convinced that the doctoral program

has the same reputation. The pre-nursing students in this case study did not solely respond to

advertising. Advertising played an initial role in the college search but overall, they all knew this

university was a top choice for them because of the reputation of the nursing school. The

participants noted that they did not see a lot of traditional advertising like TV commercials,

billboards or hear radio spots from this university. So therefore, there were not any effective

advertising strategies that the participants could elaborate on. Word-of-Mouth was the biggest

source of enrolling into pre-nursing program. From the stories told by family, friends and current

nursing students, they were persuaded by the reputation of the nursing program.

Consumer behavior involves thoughts, feelings, experiences, and actions as well as

interactions and exchanges (Peter & Olson, 2005). Thought, feelings, experiences and actions

played a role in deciding whether or not this was the university for them. Interpreting

information plays a vital role in why consumers’ purchase products and services. The

participants interpreted that the university had a premier program and felt the need to apply and

enroll in pre-nursing courses. Once consumers are exposed to marketing information, the

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interpretation process of attention and comprehension begins (Peter& Olson, 2005). The

marketing information could have included how many students are in the program, job

opportunities, clinical sites, faculty and much more.

In response to financial, academic and economic pressures, higher education institutions

are now trying to understand the college choice factors among high school students. There is an

overwhelmingly amount of research involving college choice that exists (Hodges & Barbuto,

2002). Most of the current research focuses on several factors that model the Hosseler-Gallagher

(1987) three stage model: (1) predisposition; (2) search; and (3) choice. Spinoza, Bradshaw, &

Hausman (2002) explained there should be “more targeted advertising and promotions materials,

telemarketing initiatives, and increased visits to local high school” (p.19). Research conducted

by Spinoza, Bradshaw, and Hausman (2002) suggests that high school counselors may have an

influence on prospective students’ choice of college. Hossler and Gallagher (1987) created the

College Choice three-stage model to describe the decision making process of college choice. The

first phase of the model is predisposition: students develop a plan for education or work after

high school. The second phase of the model is search: students search, explore and gather

information about various colleges and universities. The third phase of the model is choice: a

choice is made and the student enrolls.

In the first phase of the model, this study’s findings concluded that the participants used

advertising as a resource to research nursing schools and requirements. However, based on the

information they saw, the second phase of the model – search – never happened. They made a

final decision once the other nursing schools and requirements did not seem of interest to them –

more through a process of elimination.

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Prior knowledge of the university and meeting with admissions officers helped them

make this decision. More targeted advertising and promotional materials does not seem to be

effective if the program is regulated with available seats. However, using this strategy for a

doctoral nursing program may be effective.

Hodges and Barbuto (2002) examine factors influencing the post-secondary institution

choice made by rural and urban high school students. Their study is based on a population

sample of eighty-one college freshman who applied and attended the host university. Hodges

and Barbuto (2002) concluded that respondents from rural backgrounds indicated that financial

aid, preparation, faculty, programs, and facilities were strong influential factors in their choice of

college. Urban students rated financial aid, career preparation, faculty, academics, and contacts

as highly influential. There seemed to be some similarities as to what rural and urban define as

an influence. Hodges and Barbuto (2002) suggest this as an “untapped opportunity for targeted

recruited strategies” (p. 21). The results of their study imply that rural students used the website

as a way to gain more information about various institutions. In the pre-screen telephone survey

conducted for this study, the results indicated that all participants stated the website as an

advertising resource to research nursing school and to gather more information. The website

continues to be a popular tool in providing information to perspective students.

Effective advertising strategies employed at this university, from the perspectives of

those responsible for the development and implementation of these strategies, were recruitment

through high school visits and college fairs, and open houses, and cable advertising. The

university setting for this case study has a small marketing budget and relies heavily on the

website and social media to attract students.

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Colleges and universities are beginning to increase the awareness of the demands

required to work in the medical field. The society’s overall demand for healthcare can be

grouped into four broad areas: changes in health; size and composition of the population; social

cultural factors; economic factors and organization of the health system (Buerhaus, Staiger, &

Auberback, 2009). Under these demanding conditions, the role of a nursing professional

deserves special attention. There is a documented need for nurses across the nation. Apparently,

despite its popularity, nursing is an underrepresented field.

Dr. Peter Berhaus (2009) states in Health Affairs that the U.S. shortage is projected to

grow to 260,000 registered nurses by 2025. In the State of Michigan, there will be 6,660

openings for registered nurses making it the most sought after career in the State (The Michigan

Bureau of Labor Market Information & Strategic Initiatives, 2008). All of the participants in this

study were aware of the nursing shortage and believed they have the passion, personality and

determination to become a nurse.

Traditionally, American advertising “portrayed nurses as trusted advisors and capable

professionals” (Johnson, 2012, p. 46). Based on nursing literature that the pre-nursing students

examined, advertising is not portraying the reality of nursing. The nurse faculty member believed

the field of nursing has lost touch of its’ responsibilities and duties and the happy images and

baby pictures do not provide a clear and accurate picture of what nursing students will face on

the job.

Hereford (2005) explored how baccalaureate-nursing students’ career perceptions were

influenced based on stereotypic images of nurses they observed in the media. Hereford’s

research findings suggest, “Fictional images of nursing are harmful to those individuals who may

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consider nursing as a career” (p. 187). The participants in this case study believed false images

will turn away prospective students whose calling is not nursing.

Auker (2004) conducted research involving the image of nursing in printed media and

observed, “there (still) remains an abyss between the reality and what the discourse in the media

is showcasing regarding the (nursing) profession” (p.93). One of the participants in this case

study wanted to see student nurses on the job helping patients and not student nurses working on

manikins.

The nurse faculty member had the same concern with using proper pictures and graphics

to display what nurses do. She was having a hard time finding an advertising strategy that

combined the mission of the university with health services without being false.

According to Byrd, Garza and Nieswiadomy (1999) “the primary mission of

baccalaureate nursing programs is to prepare undergraduate students for entry-level” (para 1).

The Dean of the Nursing School shared that nurses need to continue their education and become

aware of the latest trends in the healthcare field.

Looking at marketing strategies related to nursing, Rewers (2007) examined a study by

Curry (1994) who surveyed 649 nursing students to determine what societal and marketing

factors influenced their decision to pursue a baccalaureate nursing program. Campus meeting

with nursing dean/representative (18.6 percent), nursing program brochure (16.1 percent);

Personal contact by student(s) in the program (13.7 percent);;

College bulletin/catalogue (10.9 percent);

Open house hosted by nursing program (10 percent);

Personal contact by admissions personnel (9.5 percent);

Personal contact by nursing alumni (9.5 percent);

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Telephone call from nursing faculty/program representative (9.4 percent);

College view book (6.7 percent); and

Letter from nursing dean (4.6 percent)

Overall, this case study identified a different trend is societal and marketing factors. Even

though the participants did not know a lot of students in the program, they knew of family and

friends that graduated from the school. Based on their stories, they were convinced to apply and

enroll in pre-nursing programs. Social media had not evolved until the mid-nineties, but in

today’s society, social media has a role in keeping students connected to colleges and

universities.

In the college choice model, a student makes judgments and decisions and then takes

related actions. Although the study of college choice has great potential for providing higher

education leaders with insights, it faces difficulty of being short on clear and accepted definitions

and belief structures.

Advertising is often in the shadow of marketing but some researchers fail to really

understand that advertising links the consumer with the product or service. With that being said,

researchers tend to focus just on marketing but marketing consist of price, sales, consumer

research and etc. Often people tend to use the word marketing but are really referring to

advertising.

During the college search phrase of the college choice model, students are actively

researching colleges and deprograms. To help enrollment officials understand the concept of

marketing and where to invest their budget, advertising needs to be revisted as being an element

that drives marketing. Hossler and Gallaughter (1987) theory has been used by enrollment

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officials for decades. If we fast forward, the model is still effective but is missing elements such

as internal mental processes, action strategies and practical principles. This case study was

guided by the use of advertising, the reactions to advertisements, social media awareness and the

image of nursing.

The initial pre-screen telephone survey indicated that students still look to advertising or

have some influence from advertising but do not heavily reply on it to make a final decision on

where to attend college or what program to enroll in. A college website, internet search and

Facebook were used a lot during the search phase. With this particular group of students, word-

of-mouth advertising helped them make the final decision despite the nursing school having not

having any social media presence.

It was indicated that social media could help the students stay connected to the nursing

school. When a school has a good reputation, it does “sell” itself and advertising is good for

branding purposes, keeping the name out there, and reminding people why the reputation of the

school is good. Social media can help students stay connected to the school and continue to build

the reputation of the school. When a school hasn’t established creditability, advertising is a good

choice to educate potential students about the college. Advertising will make potential students

aware of the degree programs. Advertising will draw students in to learn more about the college

and inquire for information. Advertising is not just about selling; it is about displaying an image.

With discussion and examination, participants indicated that advertising doesn’t portray

the realities of nursing. The prettiness of nursing may be displayed but the expression of truth

should be the core message behind the creativity of the advertisement. The belief that nursing is

easy and can be done by anyone comes from the message in the advertisement. The

advertisement creates attitudes, beliefs and plays on the cognitive aspect of the ad. As stated

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before, participants agreed that nursing is not for everyone. If advertising keeps illustrating a

desperate need, excellent pay salary and pretty images, belief systems will be developed with no

clear logical rues to events or situations in real life.

This study proposes the speculation that students’ belief on what they hear and see can

strongly influence their decision to become a nurse or what nursing program that should apply to.

This research revealed that traditional advertising like TV, newspaper, billboards is diminishing.

Word-of-mouth advertising, social media and college websites still have a tremendous influence

of college choice.

Figure 6 gives an insight to what a current and more practical enrollment model could

look like and how the direction of the student influences college choice. It can be thought of as a

five-layered cake:

Predisposition – the foundation of the “cake” is when students decide whether or not to

pursue post-secondary education;

Search – in the search phase, students search for different degree programs, athletics,

rankings, tuition, faculty, size, scholarships, and grants;

Social Media – with the use of social media, students explore different channels to see

how colleges and universities are sharing information, pictures and videos;

Inquiry – in the inquiry phase, students request more information about the college or

university and take a deeper investigation into their choice;

Enrollment – by submitting the application, students have made a choice and await

admission to begin enrollment; and finally,

Registration – admission is granted of the student’s college choice – somewhat the

“icing” on the cake.

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Recommendations

I believe the understanding gained from listening to the voices of the participants will

help inform the strategic decisions made by administrators, faculty and staff. The participants

shared strategies that can lead to new social media growth at the university. The students

reported that advertising did not play a role in choosing this particular university but was a part

of their initial college search. Students recommended that social media can be used as a tool to

keep them connected to the nursing school and that it should be constantly updated with pictures,

articles and posts. Even though it was expressed to keep social media centralized, I think it

would help carry the reputation of the nursing school if at least a Facebook page was created to

keep students connected to the top program at the university.

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Figure 6. Enrollment Model

Employees also expressed that same idea and how it is important to have a presence even

though the university has a prestigious reputation and a premier program. The student population

at this school is 4,400. Several recommendations from this study can improve the social

environment of the university as it relates to current and prospective students. University

personnel need to develop a marketing strategy that is centralized to one department only since

the marketing department is the driving force behind creating the “voice” of the university. It

brings value to the university by utilizing resources strategically, cost savings and upholding the

brand by its’ mission statement. Marketing should stay within the expertise of personnel who

have duties and responsibilities to carry out the missions through marketing and advertising. I

recommend that all graphic design and public relations should be aligned with marketing.

Graphic design and public relations are all components of marketing and have an important role.

Inquiries and surveys should be shared with the director of marketing and nursing school so they

can keep up to date with how students are finding out by the university and program. Once that

information is shared, effective strategies for reaching new prospective students and obtaining

current students can be explored.

All participants agreed that social media is an effective tool. If the university does not

want to have separate social media accounts for the school of nursing, constant updates is very

important to current students. The school of nursing does have a reputation of being an elite

program. However, that reputation must be maintained on and off campus. Social media can

show people why the university has a top nursing program and why nurses who graduate from

this program are in demand. Social media can play a big role in recruiting nurses to pursue

doctoral degrees.

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Undergraduate nursing programs have a limited number of seats set by the State Board of

Nursing. Advertising may not be the most effective tool to recruit undergraduate students but can

be used as branding purposes. Social media can be used as a tool to keep current students

connected to the nursing school as well as prospective students.

I recommend radio spots for open houses, events, nursing school event. I further recommend:

An e-mail and mail campaign targeting health care organizations and hospitals

A recruiter just for the graduate and doctoral program

More nursing research and articles

A “University is Me” campaign (TV and radio) [using the name of the university]

Create student video testimonials

Less manikin advertising and more clinical experiences in literature and brochures

Health services vs. Nursing degree program brochure (to determine true skill set fit)

Finally, as discussed in detail above, in reviewing the original research questions back to this

study’s findings, we see the results depicted in Table 6 to map the findings back to the original

research questions.

Table 6. Summary of Findings

Research Question Findings

RQ 1. What are the key

messages used in advertising

at a private not-for-profit

college targeted at pre-nursing

students?

Furthering your education in a traditional Catholic

setting;

Having professors that care about your well-being and

accomplishing something your family may not have

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done; and

Appealing to first generation students to see if this

university would be a good fit for them and their career

choice.

RQ 2. How have prospective

nursing students responded to

key advertising messages?

How did these messages

impact their college choice?

The pre-nursing students in this case study did not solely

respond to advertising.

Advertising played an initial role in the college search

but overall, they all knew this university was a top

choice for them because of the reputation of the nursing

school.

Participants noted that they did not see a lot of

traditional advertising like TV commercials, billboards

or hear radio spots from this university. So therefore,

there were not any effective advertising strategies that

the participants could elaborate on.

RQ3. What are effective

advertising strategies

employed at this university

from the perspectives of

nursing students?

Word-of-Mouth was the biggest source of enrolling into

pre-nursing program.

They were persuaded by the reputation of the nursing

program.

Prior knowledge of the university and meeting with

admissions officers helped them make this decision.

RQ4. What are effective

advertising strategies

The university does not do individual program

advertising but uses a program booklet to promote the

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employed at this university

from the perspectives of those

responsible for the

development and

implementation of these

strategies?

nursing program.

To promote the university as a whole, cable advertising,

direct mail, and radio spots and sponsorships have been

a form of advertising for this university.

In discussions with the Vice President for Planning and

Enrollment Services and the admissions officer, their

form of advertising is indirect with every admissions

officer promoting the nursing program.

Each admissions officer assures all potential students

know about the rigor of the program and make sure it is

a fit for their skillset. The admissions officer noted that

the nursing program sells itself because of their

reputation.

Opportunities for Future Research

The analysis of this case study creates future research about the role of social media and

keeps students connected to the university. I believe it is imperative that more research is

conducted on the recruitment process of graduate and doctoral students at private and public

universities. The quality of nursing programs at for-profit colleges and universities can be an

area to research to make sure that future nurses are getting the proper education and clinical

experience. Future research can also examine the thoughts of nurse practitioners pursuing a

doctoral degree. Men are still underrepresented in the field of nursing. More opportunities in

qualitative research could get a deeper understanding on why men do not pursue nursing. 129

Furthermore, opportunities about first year nursing seminars, preparing high school minority

students for nursing school, minority career choices and STEM programs in secondary education

should be explored.

Conclusions

This study provides a unique understanding of how pre-nursing students select their

college and career choice. The participant responses tell a story of how nursing has influence

their career path and what they perceive nursing to be. Furthermore, the responses provide

insight into how this upcoming generation is responding to advertising and social media.

Advertising is not the sole decision marker when it comes to recruiting undergraduate students.

Social media is a tool that promotes and keeps students engaged. This study has significance for

the individual who wants to become an administrator, faculty, or pre-nursing/nursing student.

The dissemination of the findings may assist educations, deans, enrollment officials and

marketing personnel, stakeholders to understand college choice, career choice, advertising and

social media. An understanding of all four areas has the power to influence students to enter the

healthcare field and current professionals to pursue other careers paths in their field.

130

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APPENDIX A

Informed Consent

Dear prospective participant:

You are invited to be part of the study, How We Know It Works: A Case Study Examination of

the Role of Advertising in Pre-Nursing Students’ Career and College Choice, conducted by Anne

Sajo Grant, a doctoral candidate in the Higher Education and Organizational Change (HEOC)

program at Benedictine University. The purpose of this study is to explore the role of advertising

strategies in media and social media in the recruitment process of pre- nursing students at a

private not-for-profit university in Michigan.

I seek to address the following research questions: What are the key messages used in

advertising at a private not-for-profit college targeted at pre-nursing students? How have

prospective nursing students responded to key advertising messages? How did these messages

impact their college choice? What are effective advertising strategies employed at this university

from the perspectives of nursing students? What are effective advertising strategies employed at

this university from the perspectives of those responsible for the development and

implementation of these strategies?

Your participation in this study is strictly voluntary and you can voluntary withdraw from

it at any time with no penalty to you. If you decide to voluntary withdraw, please contact me at

248-705-1925 or Grantannes@gmail.com three days prior to the scheduled individual interview

or focus group. You will be asked to participate in individual and/or focus group interviews. The

interview may take about ninety minutes. It will be audio recorded (pending your consent) and

transcribed. The transcription of an interview will be presented to you for verification of

148

accuracy. I will maintain a copy of the data on a password-protected computer. Your responses

in the interview will be strictly confidential and will be used for research purposes only. The data

collected will also be available to the researcher and the dissertation committee members. Please

feel free to ask any questions you may have about this study and the information given below.

The study does not have any known risks. Your actual name will not be disclosed under any

circumstances. Pseudonyms, such as subject A, may be used for research requirements if

required, but no personal information will be used that could be used to potentially identify you.

The study has been approved by the Institutional Review Board of Benedictine

University. The Chair of Benedictine University’s Institutional Review Board is Dr. Alandra

Weller-Clarke. She can be reached at (630) 829 – 6295, and her email address is

aclarke@ben.edu. This study has also been approved by the Institutional Review Board of the

site University. The Chair of the site University’s Institutional Review Board is Carol

Vandenberg. She can be reached at (734) 432 – 5691.

If you have questions regarding this study, please feel free to contact me at (248) 705-

1925; or at: Grantannes@gmail.com. You can also contact my dissertation chair, Dr. Julie

Bjorkman at jbjorkman@ben.edu.

This study is being conducted in part to fulfill requirements for my EdD degree in the

HEOC program at the graduate school of Benedictine University in Lisle, Illinois. I would be

grateful if you consent to participate by signing the lines provided below.

149

Thank you.

I consent to participate in this study

Name: _________________________ Date:________________

Signature:_______________________

I consent to be audio-recorded

Name:__________________________ Date:______________

Signature:_______________________

150

APPENDIX B

Pre-Screen Telephone Survey Script (Available)

Hello, my name is Anne Grant and I am calling from Benedictine University. May I please speak with________?

I am conducting a study is to explore the role of media and social media advertising strategies in the higher education recruitment process of in-coming students at the site university who applied to one or more pre-licensure Bachelor of Science degree programs in the state of Michigan. The data results will help nursing schools improve their recruitment process for pre-nursing students. Your answers are very important to our study. The interview is completely voluntary and confidential and will not affect your enrollment or registration at the site university. The survey should take less than 5 minutes to complete.

Pre-Screen Telephone Survey Script (Voicemail)

Hello, my name is Anne Grant and I am calling from Benedictine University. I am conducting a study is to explore the role of media and social media advertising strategies in the higher education recruitment process of pre-nursing students at the site university. If you would like to participate, please call us back and ask from Anne at 248-705-1925. I will try back at a later time. Thank you and have a pleasant day!

151

APPENDIX C

Pre-Screen Telephone Survey

Interviewee Code: ______________________________

What were your sources of advertising during your nursing school search? Please check all that

apply.

___Television

___Radio

___Newspaper

___Magazine

___Billboard

___Brochure

___College Website

___College audio/video

___Internet search

___ Twitter

___Facebook

___Instragram

____Tumblr

__Pintrest

___YouTube

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APPENDIX D-Part I

Focus Group Guide

Interviewee Code: ______________________________

Gender: ________________________

What type of high school did you graduate from?

___Public ____Private ___Charter ___Private Religious/Parochial ____Home School

To how many colleges did you apply to pre-nursing for admission this year?

___1 ___2 ___3 ___4 ___5 ___6+

Where you accepted into your first college choice? Yes No

Do you have a second career choice? Yes No If yes, please name.________________

Do you have any family members that are nurses or know of any? If so, whom?

Why do you want to become a nurse?

What interests you about the field of nursing?

Why do you believe nursing would be a great fit for you?

153

APPENDIX D-Part II

Focus Group Guide

(nursing advertisements to survey)

1. Goodwin College: http://www.youtube.com/watch?v=Em3_jyBmujw

2. America Needs Nurses: http://www.youtube.com/watch?

v=FJb_Xg3MJew&list=PL4DF95BCE74317AE7&index=63

3. Intercoast Career Institute: http://www.youtube.com/watch?v=F48ntEG-v7g

4. Northwest Iowa Community College: http://www.youtube.com/watch?v=ApTmYMghy3w

5. PMCI Nursing Commercial: http://www.youtube.com/watch?v=G2w7LlhRLdA

6. Hondros College: http://www.youtube.com/watch?v=rDuec2TD7W8

154

APPENDIX D-Part III

Focus Group Guide

Name of Nursing Advertisement______________________________________________

1. What did you like most about this ad? Please be specific.

2. What did you like least about this ad? Please be specific.

3. If you were describing this ad to a friend, would you say this ad is... Check all that apply.

Active

Attention-getting

Boring

Cheerful

Creative

Emotional

Energetic

Genuine/sincere

Honest

Humorous

Informative

Irritating

155

Memorable

Natural

Offensive

Pleasant

Satisfying

Strong

Unique

Warm-hearted

Based on the Nursing Commercials features advertised, this ad...

ENTER PRODUCT OR SERVICE

Strongly Agree

Somewhat Agree

Neither Somewhat Disagree

Strongly Disagree

The ad message is understandable.

The advertisement is believable

The ad's message is relevant to me.

The benefits described in the ad are believable to me.

After viewing this ad, I would consider applying to this nursing school.

156

This ad is much better than other nursing school ads.

157

APPENDIX D – Part IV

Focus Interview Guide-Part IV

Group Discussion

If any, what type of advertising from the site university caught your attention?

How effective was the advertising in persuading you to apply?

What message did you take away from these advertisements?

What role did advertising help you to decide what college to attend?

Did social media play a role in helping you select nursing as a career choice?

If so, from what college did you see on social media? How was the nursing school

promoting their program?

What did you like most about the Johnson and Johnson videos?

What did you like least about the Johnson and Johnson videos?

After watching the Johnson and Johnson videos, are your thoughts about pursuing a

career in nursing more strong, less strong or about the same?

Do you currently follow nursing programs on social media?

On a scale of 1-10 with 1 being poor and 10 being excellent, how would you rate the

following social media outlets of twitter? Instagram? Facebook?

(1) University of Michigan T:__ I:___ F: ___

(2) Duke University T:__ I:__ F:__

(3) John Hopkins University T:__ I:__ F:__

(4) UCLA T: __I: __F: __

158

Do you think their social media outlets persuade people to go into the field of nursing?

How you rate them on persuasiveness (1=Poor, 2=Fair, 3=Good, 4=Excellent) (1)__

(2)__ (3)__ (4)__

Do you think social media can be an effective tool in recruiting students and promoting

nursing as a career? How? And Why?

What can college and universities do to promote nursing?

Do you think social media can help decrease the nursing shortage by recruiting students

into the field of nursing?

159

APPENDIX E

Dean of Nursing School and Vice President of Admissions and Enrollment Interview Guide

How do you employ advertising and marketing strategies to recruit nursing students?

Have your current strategies worked?

How do you promote the realities of nursing through your advertising and marketing?

Do you think social media can help decrease the nursing shortage by recruiting students

into the field of nursing?

What forms of advertising have you used? Did it work? If not, why?

Are you currently using social media to attract and recruit new students? If so, how? If

not, why?

What are your thoughts on social media to increase enrollment?

What type of student and nursing student are you looking for?

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APPENDIX F

Marketing and Advertising Individual Guide

How do you promote the mission of Rochester College through your advertising and

marketing strategies?

What do you do to promote Rochester College through the community?

What types of advertising do you participate in?

What has been most effective?

Are you currently using social media to attract and recruit new students? If so, how? If

not, why not?

What are your thoughts on social media to increase enrollment?

Do you think social media can help decrease the nursing shortage by recruiting students

into the field of nursing?

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APPENDIX G

Registered Nurse (RN) Faculty Interview Guide

What type of qualities are you looking for in a student?

Is this betrayed through your advertising messages?

Do you play a role in helping with advertising and marketing the Nursing Department?

Do you think social media can help decrease the nursing shortage by recruiting students

into the field of nursing?

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