Enrollments in bachelor's-degree nursing programs have declined consistently over the past five years nationwide, dropping 4.6 percent in 1999 alone, according to the latest annual survey by the American Association of Colleges of Nursing (AACN). And while enrollments in master's programs grew steadily through most of the 1990s -- thanks to increased interest in nurse practitioner and other advanced clinical nursing programs -- they too have experienced slight declines in the past two years.

In some cases, lower enrollments are the result of intentional cutbacks due to faculty shortages, state-mandated enrollment caps on baccalaureate programs, a limited supply of clinical training sites, or other resource constraints. But, in large part, the decline -- particularly in entry-level baccalaureate programs -- is an indication of lowered interest in nursing careers in recent years.

One reason is the proliferation of new career opportunities for women, who still make up more than 90 percent of the RN workforce. Another is lingering belief that nursing is not a secure job, a hangover from a few years ago when news media were awash with reports of hospital cost-cutting and RN layoffs under the pressures of managed care. But in many regions, today's workforce situation is the exact reverse, with escalating demand for baccalaureate- and graduate-prepared nurses being felt keenly throughout the health care industry. Already, increasing numbers of elderly, rapid expansion of front-line primary care, higher numbers of registered nurses (RNs) approaching retirement, and other pressures have led to mounting shortages of RNs in more markets across the nation. Indeed, the Bureau of Labor Statistics projects that employment for registered nurses will grow faster than the average for all U.S. occupations through 2008.

Some schools are seeing the change already. At the University of Texas at Tyler, Dean Linda Klotz says that while the College of Nursing is receiving fewer applications, "applicants are more qualified, so our enrollment has been consistently increasing slightly over the last six years." The news is the same for some private schools: Elaine Marshall, dean of nursing at Brigham Young University, notes, "We have a unique situation of high interest in nursing with more qualified applicants than our programs can accommodate." At Bethel College of Minnesota, "Our basic baccalaureate program has a longer waiting list than in previous years," reports nursing chair Sandra Peterson.

But for many nursing schools nationwide, it's been an ongoing challenge to keep application and enrollment numbers up. Instead of waiting for the tide of public perception to shift in favor of nursing careers, schools are battling slipping or stagnant enrollments on the home front with creative recruiting practices that range from movie theater advertising to innovative partnerships with hospitals in an effort to fill more student slots.

Proven Strategies

In a recent survey by AACN for this bulletin, deans were questioned about methods they've employed in recent years to boost enrollments, particularly in bachelor's-degree programs. Here are some of their proven approaches:

Recruiting from within. Encouraging associate-degree nursing graduates to continue their education is a simple, inexpensive way to boost enrollments in Bachelor's of Science in nursing (BSN) programs, deans are finding. "We go to job fairs put on by associate-degree programs, and we've been very successful in getting new students this way," says Connie Carpenter, director of nursing at Oklahoma Panhandle State University. "We are not talking about large numbers, because we are located in a very rural area, but I predict that our fall enrollment will be the largest we have had to date for our program that started in 1996." At Thomas Jefferson University in Philadelphia, Nursing Chair Pamela Watson goes to hospital-based diploma programs and associate-degree programs "to talk about the value of advancing one's career potential through advancing one's nursing education. Then I talk about what we are doing to promote career mobility."

Judith Karshmer, head of the Department of Nursing at New Mexico State University, has found success recruiting from bachelor's- to master's-degree programs. "We use a longitudinal approach. It starts when they are admitted to the bachelor's program -- I start to talk about grad school, planting the seeds," says Karshmer. "Each semester we have a group exit interview for the BSN students in which I give them a picture of their progress toward that master's degree. When they are close to graduating, I tell them I can guarantee a certain number of traineeships that pay tuition plus a $10,000 graduate assistantship, but they have to go straight into the program. Lots of them have never worked in nursing before, and they think it's pretty nifty to stay on for an advanced degree and be paid."