A MARKETING STRATEGY FOR A NURSING COLLEGE

The objective o f this study is to explore and describe a marketing strategy for a riw m gm llege^Ari e ^ lo ^ research design, within the context o f a nursing w ik g e and i0 lia ted hospitals, was followed. A literature study o f marketing models was undertaken and the Delphi-method was utilised to determine the contribution o f marketing stctff and the possible content o f a marketing strategy fo r a nursing college. The results were utilised to describe guidelines for such a strategy* consisting o f markelerslmarketing agents, target market, product, price, promotional activities, place and market research. Mecommendations include the planning, implementation and evaluation o f strategy, inservice training for potential tnarketing agents, inclusion c f marketing as p an o f the formal education c f tutors and nurse managers,as well as an impact study o f the scholar as the main consumer.


INTRODUCTION
Research has proven a shortage of nurses in the country.In 1991 the ratio of registered nurses to the population was 1:435 (Muller, 1991).To attain the ideal ratio of registered nurses to the population in South Africa, nursing education institutions are compelled to introduce m arketing strategies.This statement is qualified by the fact that 71% student nurses agreed that current recruitment program m es do not create realistic role expectations (Esterhuizen, 1989).As first year students are highly motivated and enthusiastic on entering the profession (Woolf, 1987:46), but dissatisfied toward the end of their ti^aining, it is evident that existing marketing strategies need to be examined.
As most health care institutions have been Concentrating on promotional activities only, •t has becom e clear that the concept of developing a marketing strategy needs to be explored.A marketing strategy is a structured plan which guides the organisation's activities to reach set goals (M assie, 1979:209).Strategic planning forms an integral part of the management function of a nursing college, so the development of a marketing strategy should feature (Schulz & Johnson, 1990:77).De Jager (1990) describes promotion as the p h y s ic a l p ro m o tin g o f a p ro d u c t by communicating the possible uses of trial tests to the consumer.Recruitment forms part of this element of a marketing strategy and nursing colleges indeed have been practising one element of marketing, but not all of them.Elements such as producer, market, place, price, product or market research have not fonned part of the plan.Recruitment is thus seen as one of the goals of a marketing strategy.Baird (1991) supports this opinion, adding that an institution can ensure growth through a marketing programme.
An active marketing programme contributes to the awareness of all nurses to their role in the marketing of nursing as a profession and of nursing education in particular.Nursing colleges nevertheless do not use formal m a rk e tin g stra te g ie s and th e p e rso n s responsible for marketing strategies do not have guidelines within which to operate, therefore the following questions arise: • of what should the content of a nursing college marketing strategy consist?
• how could the educational or affiliated staff of the nursing college contribute towards the marketing function of the coUege?
The aim of this study is to explore and describe a marketing strategy for a specific nursing college in Transvaal (now Gauteng).

TERM INOLOGY M arketing
Marketing is a total system of interactional activities in an organisation designed to plan, price, promote and distribute need satisfying products to existing and potential consumers (Stanton, 1975:5).In this study marketing refers to the activities in a nursing college to d esig n , p ric e , p ro m o te and d istrib u te information regarding a quality nursing course to existing potential consumers.

M arketing strategy
A m a rk e tin g stra te g y is a stru c tu re d p ro g ram m e or plan w hich g u id e s the organisation's marketing activities regarding format, actions and timing, with reference to the product, price, place, promotion and market research (Massie, 1979:209).The m a rk e tin g stra te g y also s p e c ifie s the contributions of potential marketers, as well as the content of the m arketing education programme.

M arketer
The marketer is the person involved with any marketing activity.In this study the marketer refers to the educational staff of a nursing college, as well as nursing staff working in any hospital affiliated to the nursing college.

Nurse
The nurse is a person who is registered with the South A frican Nursing Council as a professional nurse and on the staff of one of the six hospitals affiliated to the nursing college under study.

Nursing student
The nursing student is a person registered with the South African Nursing Council for the course leading to registration in Nursing (General, Psychiatric and Community Health) and Midwife.

RESEA R CH M ETH OD O LO GY
A d e s c rip tiv e ex p lo ra to ry design was followed, within the context of a nursing college and the affiliated hospitals, situated in Transvaal.The research was conducted in three phases:-a literature study to analyse e x istin g m arketing m odels for service professions as the conceptual framework, the D e lp h i te c h n iq u e in tw o ro u n d s, and verification of results by means of interviews.The final marketing strategy was verified by a marketing consultant during an interview.
The initial marketing strategy or conceptual fram ew ork was described, based on the literature study, mainly using the marketing models of Fine (1990) andStrasen (1987).The following main themes were identified and consequently utilised for categorising the first Delphi round results: • p ro d u cer or m arketer of the product (nursing college); • consumer in the market (potential nursing students); • product (nursing education programme and quality nursing care by well educated professional nurses); • price to sacrifice for the product (monetary and social sacrifices made); • promotion or consultation with the market (career selling); • place and availabiUty of product (nursing college and clinical facilities); • market research required to implement and evaluate the marketing strategy.
The Delphi method is a research technique w h e re b y th e o p in io n o f a g ro u p o f know ledgeable persons about a specific subject is collected through questionnaires.Group consensus is achieved without face to face confrontation (Lindeman, 1975).During the first round of the Delphi technique, biographical information was collected to determine the marketing status of the potential marketers.
In this first round the content of the nursing college's marketing strategy was investigated, as well as the possible contributions of the marketers.A content analysis was performed, using the main categories of the conceptual framework derived from the literature study, to categorise the results.The results of round one were prepared in the form of a structured questionnaire.These were presented in round two of Delphi to a representative panel of p o te n tia l m ark eters, d eriv ed from the population sample in round one, as well as to an experienced marketing consultant for final verification purposes.In this final Delphi round, the participants were also expected to in d ic a te the p o te n tia l im p act o f each marketing activity based on their own opinion and practice reality.Finally guidelines for a marketing strategy for the nursing college were described, based on these results.
The population for this study included all potential marketers in the nursing college, as well as the affiliated hospitals.Inclusion criteria were formulated after consultation with the marketing consultant and potential marketers.These criteria were the following: • appointment in a post of senior or chief professional nurse, or nursing service manager, in the nursing college and/or affiliated hospitals; • informed commitment and consent to participate in the research; • a positive attitude towards marketing a c tiv itie s v e rb a lis e d by p o te n tia l participants; • availability to participate during the research period.
Twenty participants in the nursing college, and twelve participants in each of the six affiliated hospitals, were identified in consultation with the statistical consultant and nursing service m a n a g e rs o f th e h o s p ita ls .A fie ld worker/mediator in each of the institutions (six hospitals and nursing college) assisted the researcher in the distribution and collection of the questionnaires in both rounds, ensuring ethical control during the research.The statistical consultant confirmed the sample as representative of the target population.(Lindeman, 1975).During the second Delphi round the questions were separated for value and impact rating.Results of the second phase were processed in a rigid scientific manner and verified by the marketing panel members and an experienced marketing consultant.

RESULTS
The results are described in three phases.In the first phase the first Delphi round results are given.The second phase deals with the second Delphi round results, followed by the final phase of describing the marketing strategy for the nursing college.
Phase According to the pane!members the nursing college, hospitals, educational and hospital staff, as well as the students, all could be potential marketers.The m ark eter is seen as the producer and presenter (Fine, 1990:4) of the nursing course.It is clear that the panel members view marketing as a promotion elem en t and the need for a structured educational programme for m arketing is confirmed.
Potential consumers w ere id e n tifie d as community and church leaders, scholars, parents, the general pubUc, the media, career counsillors and teachers.The results of this category show that panel members include all potential consumers as the target population, which can be very expensive -a more focused target group is required.
The product was identified as the whole nursing course, advantages and disadvantages o f a nursing career, professionalism , an appropriate curriculum to meet the health n e e d s o f th e p o p u la tio n s e rv e d , jo b satisfaction, personal and professional growth, paym ent w hile studying, acquisition of in te rp e rso n a l and life sk ills, v aluable education, service benefits, opportunities for promotion and realistic information about nursing, and above all -quality nursing care delivered by the nurses who have completed their studies at this particular nursing college.
The price of the product could be related to the value for the consum er, as well as significant inputs such as time, costs, and even changes in lifestyle (Fine, 1990:4).The price was seen as non-material and included asp>ects such as unrealistic role expectations, time consuming studies, exposure to inappropriate ro le m o dels, n o n -co m p e titiv e salaries, irregular hours, stress and anxiety.Price is thus viewed as input of time and sacrifices made by the nurse.A realistic marketing programme should therefore include all these price related matters.
Prom otion refers to the manner in which the p ro d u ce r co m m unicates w ith potential consumers (Fine, 1990:4).The promotion of the course was divided into advertisements which may be any paid form of providing inform ation, personal selling including interpersonal contact, and public relations including exhibitions.Sales promotions such as incentives were not mentioned.
The place is seen as the institution where the product is made available (Fine, 1990:4).
Respondents included the college, hospital and community institutions as the place, which required require clarification in the second Delphi round.
M arket research should assess the need for the product, as well as the evaluation of the marketing programme, including feedback from the consumer (Fine, 1990:4).The panel members identified the assessment of the supply and demand of nurses, a general situational analysis and market development as the content of market research.
As far as the specific content of a marketing p ro g ram m e for the n u rsin g co lleg e is co n cern ed , the p anel m em bers m ainly identified recruitment strategies like pubhc a p p e a ra n c e s, re c ru itm e n t p am p h lets / inform ation, press releases and general portrayal of a positive image.No suggestions regarding the market research, producer, product, price or consumers were made.

P h a se tw o ; In c lu s io n a n d im p a c t of m arkeling actions
The results of the first Delphi round were struclured and divided into three sections.Except for biographical information ui section (>nc, the marketing value of actions, indicating preferred inclusion of each action in the niarketing strategy, was collected in section Iwo and the third section dealt with the impact value of each marketing action.A seven point rating scale was used.A rating of five or higher indicated a positive inclusion of marketing actions into the marketing programme or strategy of the nursing college.The impact value was also calculated to verify the importance and priority of certain marketing ac tio n s .A lth o u g h the re su lts o f th is questionnaire were analysed according to the various institutions, as well as tlie post level of the respondents, only sum totals will be given in this article. This questionnaire was distributed to all the 77 panel members who responded to the first questionnaire.In this second round the sample realisation was 64 (85.3%).
A total of 68 items were generated during the first Delphi round.When analysing the results it was clear that the respondents included almost all the items in the marketing strategy (mean ratings of five or higher).
Table 1 reflects the results of the marketing strategies to be employed, as well as the marketing agents.It is interesting to note that the nursing college and hospital were evenly rated as marketers, with the emphasis on the team effort between the two institutions.
According to Britz (1989:15) marketing should be a team effort, but the success of a marketing programme is based on a structured team effort with a marketing committee and the various responsibilities assigned to specific committee members.
All professional nurses are seen as the most important agents in marketing the nursing profession.These results are supported by McKenna (1991) and Johnston (1991), who are of the opinion that marketing should be part of every person's job description in an organisation.The hospital's impact was seen as very important as being the place where the professional nurse should render quality nursing care.Professionahsm displayed by all nurses is rated high in tenns of the impact.
The target group ratings are illustrated m Table 2.Note that the scholars were not rated as the prunary target group -this was criticised later by the marketing consultant.The general public and influential community leaders received the highest rating and the teachers and school principals were seen as the priority target group in terms of im pact.Kirby (1 9 9 1 :1 1 5 ) b eliev e s th a t sc h o la rs are important at the age where subject choices are made, but information packages do not have significant impact on their career choice later.
As far as m arketing o f the p ro d u ct is concerned, the highest rating was given to realistic information to counteract unrealistic expectations (see Table 2).The highest impact value was given to information regarding nursing as a profession.This is confirmed by Green (1987) who is of the opinion that scholars highly value a career w hich is classified as a profession.The product should always be m arketed as valuable to the consumer and include an explanation of the value system upheld by that p articu lar institution (Cushman, 1987;Porter, 1985).
McKenna (1991) andJohnston (1991) are both of the opinion that the quality of the product should be marketed as well as the credibiUty of the marketing agent.Lindeman (1987) s u f ^r ts the fact that the theoretical content of a course should be marketed with focus on the market value of the product.
The highest rating to {yice related marketing actions was attributed to the length or duration of the study and the highest impact area was seen as the anxiety students may experience in the clinical j»^actice (see Table 2).Unsocial working hours received the lowest inclusion rating in this section.
S e v e ra l p ro m o tio n a l s tr a te g ie s w ere suggested, of which direct public relations or interpersonal contact received the highest inclusion ratmg (see Table 3).Highest impact rating in this section was given to the correct information to schools.The respondents show s ig n ific a n t in sig h t in to th e v a rio u s promotional strategies and dealt fully with this area.Most of these strategies are supported by lite r a tu r e and re s e a rc h .A te le p h o n e information service is recommended by Jolma and WeUer (1989).The nursing college and the hospitals seem to be the most important marketing places, with the h ighest im pact rating given to the hospitals, as reflected in Table 4.In terms of the market research, a supply and demand analysis of the nursing profession received the highest inclusion rating.This is very costly and has been carried out by the South African Nursing Council and Association in 1990.
Most of the authors emphasize the importance of the most realistic place where marketing will receive the necessary attention and in fo rm atio n is m ost ac c e ssib le to the consumer.
The respondents were very much in favour of a marketing educational programme, with the contents included as illustrated in Table 4.The highest im pact rating was attributed to p ro fessio n al im age and appearance.It therefore seems as if the potential marketers have a need for inservice U'aining in public speaking, as weU as in all the other aspects of marketing.Warwick (1987) and Thompson (1987) agree that those marketing agents in the profession who are exposed to public speaking and appearances, should receive the necessary education in this regard.
Phase three: Guidelines for a marketing; strategy for a nursing college The results obtained in the second phase were verified with some of the panel members as well as a marketing consultant.The marketing consultant confirmed that marketing is an interactional process of planned activities to communicate with potential consumers.Panel members agreed that a marketing committee, consisting of college and hospital staff, should be established.The nursing college remains, however, the main marketing agent and producer of the nursing course but both nursing college and hospital staff have co-responsibility in producing professional nurses of a high standard.A marketing strategy for the nursing college was designed based on the results of this study and the literature review.
F igure 1 illu strate s the co n ten t o f the marketing strategy, consisting of a general situational analysis, market analysis, mission form ulation, market segm ent, marketing strategy mix and a marketing audit.

General situational analysis
The execution o f a situational analysis provides information regarding the internal and external environment of the nursing college and health care institutions.Data collected in the market analysis should provide the basis for tactical planning to counteract the existing competition in the market and to increase the value of the product.The market analysis should focus on the following: • present and potential consumers; scholars, influential com munity leaders, school teachers/career counsellors, health care consumers, etc.; • other competitive careers; • other nursing colleges operating in the same market: type of courses offered, value systems, quality of product, etc.

Mission statem ent
A m issio n sta te m en t is fo rm u lated to accommodate the marketing strategy of the nursing college.The m ission statem ent (marketing strategy) of the nursing college should:- • strive towards effective communication with the consumer; • strive towards offering a high quality product (nursing course); • strive towards a significant a)ntribution to health care by appropriately educated professional nurses; • positively influence the image of nursing.

M arket segment
Market segment refers to the division of the market to enable the design of a marketing strategy for a sjjecific segment of the market (Fine, 1990:82).The market segment for the nursing college's marketing strategy is the following: • scholars as the main target group; • influential community leaders; • school teachers / career counsellors and principals.
T he gen eral p u b lic alw ays rem ain an important target group but it is not reahstic to focus on them in a marketing strategy.

M arketing strategy mix
The marketing strategy mix is categorised as follows: the producer or marketing agent, the consumer, product, price, promotion, place and market research.The marketing strategy can only be planned when information of previous strategic steps taken is available.It is important to identify the p>erson responsible for m arketing (m arketer) and appoint a m arketing committee to present a co-ordinated p ro g ra m m e .D e fin ite m a rk e tin g responsibilities should be assigned to the marketing agent and committee members.As the consumer is identified as the scholar, most actions should be focused on the inclusion of the scholar in the programme.The marketuig strategy mix of the nursmg college should include at least the following; a) product • quabty nursing course(s); • realistic information regarduig nursing; • nursing as a profession: status value; • advantages and disadvantages of nursing as a career/profession; • conditions o f service in the nursing profession; • jo b s a tis f a c tio n e x p e rie n c e d as a professional nurse; • personal and professional grow th in following a nursing career; • valuable / quality education.
c) Promotion strategies • direct interpersonal contact with target groups; • updated information to schools; • opinion surveys amongst scholars; • advertisements, pamphlets, exhibitions and media js'ogrammes; • open days at college and clinical areas; • holiday work by scholars; • telephone information service; • professional public appearances and speaking by nurse leaders; • mother/daughter days.

d) Place
• nursing college and clinical facilities; • community institutions.

e) M arket research
The general situational analysis, as described, in term s o f the in te rn a l and e x te rn a l environmental analysis, competitive market and strategic marketmg planning.

M arketing audit
The marketing audit refers to the continuous evaluation of the marketing strategy, as each step is implemented.The feasibility of the marketing strategy in terms of input and output (success) should be determined.The planning, implementation and evaluation of a professional development programme related to marketing as a responsibility of all n u rs e s as p o te n tia l m a rk e te rs, is recommended.Marketing models, strategies, skills and responsibilities should be included in the curricula of all nursing education and nursing administration programmes.
M arketing should always be part o f an institution's strategic plan.
Selected reliability and validity measures were employed during the research.The content validity of the final marketing strategy was confirmed by the literature study and results of the Delphi rounds.The marketing consultant also verified the final marketing strategy for th e n u rsin g c o lle g e .An in d e p en d e n t researcher was utilised during the content analysis of the Delphi results and an inter-rater reliability of almost 99% was confirmed.O perational reliability and validity was ensured by following the steps of the chosen re s e a rc h m e th o d o lo g y m e tic u lo u sly .Reliability of results also was controlled in that panel members gave theu opinions in a goal directed manner, writing their responses without being influenced by other panel members.A controlled situation in each research setting was ensured by the mediators, following the research instructions.The results of the questions were subjected to inductive processing to confirm objectivity C O N C L U SIO N AND R E C O M M E N D A T IO N SEvery nursing college requires a well planned marketing strategy, implemented to meet the n eed s o f th a t nursing co lleg e and the community at large.But marketing can be very costly -therefore the marketing strategy should be focused and feasible.In this study the content of a marketing strategy for a nursing college was explored and described.T he p ro fe ssio n a l n urse as a p o te n tia l marketing agent does not have the appropriate k n o w ledge reg ard in g m arketing.Some recommendations are highlighted.a)N ursing college practice and researchThe im plem entation and evaluation of a n u rsin g c o lle g e m ark eting strateg y is recommended.Research on the effectiveness of a marketing plan should be conducted, focusing on specific target groups to identify the significance of impact.It is recommended also that a marketing model for nursing colleges is developed.Intensive market research is recommended to determine the values and needs of the consumer, as weU as the b en efits and values o f the nursing profession.More research on the image of the nursing profession is required.b) N ursing education one: M arketing within the context of nursingDuring the first Delphi round panel members w ere asked to e x p lain the c o n c ep t of marketing, w hat it meant in the nursing p ro fe ssio n , w hat and how th ey co u ld contribute as marketers, and which subjects they could suggest for inclusion in a marketing programme / strategy for the nursing college.
A total of 92 questionnaires were distributed to the identified panel members and 77 (8 3 ,6 % ) re sp o n d e d , v a ry in g b etw een 75-100% sample realisation in the different research units.The responses were categorised according to the main themes of the conceptual framework for marketing, ie producer, consumer, product, price, promotion, place and market research.