Plugging the Gap
Nursing schools use creative strategies to expand their programs
and recruit faculty in order to ease the shortage
By Heather World
August 24, 2004
When Thomas Quayle applied to nursing school, he had 15 years’ experience as a dialysis technician as well as a straight-A record in prerequisites, yet he was still waitlisted for entry to Sacramento City College.
“I got the thin letter instead of the fat package,” said Quayle, who had just quit an interim job as a trucker and pinned his hopes on starting school that fall to fulfill his lifelong goal of being a nurse. “I knew City College had a really good program, and I knew it was difficult to get in.”
Despite the nursing shortage, nursing schools turned away nearly 10% of qualified applicants last year, the American Association of Colleges of Nursing reported in December. In California, applicants outnumbered seats by 40%, according to a California Strategic Planning Committee for Nursing report released in 2001.
Schools face a shortage of qualified instructors, inadequate clinical training from overworked hospital staff nurses, and a lack of clinical training space. A low student-to-teacher ratio and costly equipment make nursing programs expensive for schools to maintain.
At least one program has closed. The University of Southern California graduates its last nursing class this summer. Citing its private status, the school indicated it was not receiving enough tuition and private donations to continue the program.
Michael Diamond, vice president and executive vice provost, said in a press release that the nursing program required “too large an investment for too small of a program.”
Room for everyone
However, other schools are expanding their programs to meet demand. Many have added tracks to produce nurses with advanced degrees who are qualified to teach. Others have reached out to a wider population of students, scooping up baccalaureate holders interested in nursing, or foreign health care workers. And some in education hope California’s new staffing ratio laws will give hospital nurses more time to train students.
Some schools have partnered with hospitals, with the latter supplying resources and instructors in hopes of securing future employees. Sacramento City College joined forces with a division of Sutter Health to expand enrollment. The Sutter Health Sacramento Sierra Region committed $13.6 million over five years to add an extended campus to Sacramento City College’s nursing program, said Monica Small, RN, MSN, director of the Sutter Center for Health Professions.
Although the students receive their degree from the college, they use the facilities of the hospital, including a separate renovated 27,000-square-foot extended campus that resembles a hospital wing, complete with practice mannequins, which each cost $3,000 and up.
“There is no school working off public funding that could afford what the private sector is able to do,” Small said.
Instructors from the college teach prerequisites open only to nursing students, reducing competition in an area that can bottleneck a student’s degree track. Clinical courses are taught by Sutter nurses who can, in turn, use City College instructors as mentors for teaching skills.
Finally, the region’s hospitals were scoured to find more clinical rotation space, Small said.
For Quayle, the Sutter donation meant starting nursing school on time. Two weeks after applying, he looked in his mail and found the “fat package” that meant acceptance to the extended campus, he said.
Quayle will graduate in February. He eventually wants to earn a bachelor’s degree, and in the meantime, is interested in working for Sutter, he said.
“The facilities are really nice, the nurses are happy, plus they have good incentives,” he said.
The program aims to produce 500 nurses by 2008. Rather than require graduates to work at its facilities, Sutter relies instead on students wanting to work where they have learned and practiced.
Since the program has been advertised, the school has received about 6,500 inquiries, said Mary Turner, RDH-MS, dean of Sacramento City College Science and Allied Health Division.
Sharp HealthCare, which offers a handful of grants and scholarships to potential nurses or nurses who want more education, has entered a similar partnership with the University of California, San Diego. Sharp and other health care facilities in the area give the school $560,000 annually through a program called Nurses Now, which funds faculty and lab costs. Donating health organizations also provide clinical practice space to students.
As a result, UCSD increased enrollment from 50 to 90 students per semester and hired three tenure-track professors last year, said Patricia Wahl, RN, PhD, FAAN, director of UCSD’s school of nursing
Adding faculty and increasing enrollment cause their own set of bottlenecks. Sometimes prerequisites are not available — especially in public universities suffering from budget cuts — and clinical practice is harder to schedule.
New staffing ratios may help, but clinical instructors also may have more time to train on night shifts, when most students are at home. Taking advantage of off-peak facility times is one way Grossmont College in San Diego has expanded its nursing programs to attract students who do not fit the usual college mold.
Students with day jobs or families now can attend a weekend and evening associate degree nursing program, said Elisabeth Hamel, RN, PhD, associate dean of Grossmont College’s Health Professions Programs.
“We have had so many students come in through the doors saying they can only do the evening/weekend program,” she said.
The school now makes use of its classrooms at night, too, and the students do their clinical rotations at hospitals on the weekends when there is less competition for practice time.
Hamel secured $110,000 from the Grossmont Healthcare District, which allowed the first 20 students to start in January 2002. Later, Scripps Health joined the collaboration, allowing the school to add more students.
Grossmont also has created more space for students through a program that offers an associate nursing degree to foreign health care professionals, most of whom were physicians before coming to the United States.
“Some of them have been bus drivers, some have been phlebotomists, one is a guard in a shopping center,” Hamel said. None practiced medicine in the United States: some failed medical licensing exams, others could not get internships to practice as physicians.
With funding from Sharp Healthcare, Grossmont screened students for language skills and started its first class of 35 nursing students in August.
“I tried to value what they knew,” Hamel said. “Yet they still struggled with things nurses know that physicians don’t, like putting somebody on the bedpan or giving an injection.”
Experience counts
Other schools have tapped into what they hope is a dedicated nurse workforce with a proven track record of school success: baccalaureate holders interested in nursing as a second career. Most of these programs end in a master’s in nursing.
Samuel Merritt College in Oakland and Sacramento, which offers the traditional baccalaureate and master’s degrees in nursing, is one of four schools to offer an accelerated master’s degree in the San Francisco Bay Area.
Audrey Berman, RN, PhD, interim dean of the school of nursing, said her school’s 16-month program puts practicing nurses into the workforce as well as prepares potential instructors.
“Entry-level master’s [students] sometimes have degrees in teaching or science,” she said. “They already have another area of expertise that fits perfectly with becoming a nurse or nurse faculty.”
Roberta Boshears was already an LVN with a bachelor’s in gerontology before she entered the school’s program. Although she could have attended junior college for two years for her nursing license, she opted instead to spend the two years in the intensive master’s course. She notices her enthusiasm for nursing is shared by many of her classmates.
“The minute everybody got their license, it was like this letter from heaven — they all went to work,” she said.
Samuel Merritt also is developing an accelerated BSN program for the same candidate pool, Berman said. The school expects to admit students to the one-year program in June.
Providing baccalaureates to people who are not nurses remains expensive, according to educators who run nursing school programs. The University of San Diego Hahn School of Nursing and Health Science offers a bachelor’s for registered nurses, thereby cutting some of the prohibitive costs of instructor-intensive training, said Anita Hunter, MSN, PhD, CPNP, CNS, an associate professor who directs the program as well as the school’s master’s program for non-nurses.
Her 24 RN bachelor’s candidates need less clinical experience and therefore cost less, she said.
Forming faculty
Faculty at USD also are developing an accelerated doctoral track to produce nursing instructors in addition to the school’s full range of nursing degree programs.
While master’s-prepared nurses like Boshears can teach at the junior college level, where about two-thirds of all nurses are trained, only doctoral-prepared nurses are eligible for tenure in California’s four-year public universities. They account for nearly 60% of unfilled faculty positions in the United States, according to numbers released by the AACN in June 2003.
A 2002 University of California report found that 345 faculty positions were vacant in California, a number projected to double during the next five years.
In June, the University of California, San Francisco started offering an accelerated doctoral program, funded by the Gordon and Betty Moore Foundation, said Mark Boone, director of development for the school of nursing.
Ten nursing school graduates receive $60,000 per year for three years, enough to allow them to study full time, thereby shortening the usual path to a doctorate from eight years to three. The AACN has reported that the median age of full-time nursing faculty is 51.5 years old. An accelerated doctoral preparation means instructors can start their careers earlier and teach longer, thus helping to alleviate the shortage of teachers, Boone said.
The effort to recruit faculty extends beyond academic institutions. Nurses for a Healthier Tomorrow, a coalition of nursing and health care organizations dedicated to attracting people to nursing, has started its own outreach campaign through nursing journals, advertisements, and media to recruit nurse educators.
But increasing the number of qualified instructors alone does not solve the problem, said USD’s Hunter.
“Universities and colleges have to look at valuing nursing faculty at the same level as other professional faculty,” she said. “That is not the case now.”
Hunter said nursing faculty, which deals with human sociology, does not attract the large grants that the faculty of hard sciences brings in.
Furthermore, nurses trained at the graduate-school level have other, more lucrative, career choices. Pharmaceutical companies, information technology companies, and managed care firms recruit these highly trained professionals.
Even working in an emergency department will pay a master’s-prepared nurse practitioner about 25% more than the same nurse working as a professor, according to the 2003 National Salary Survey of Nurse Practitioners.
Few people become teachers for the money, said Berman of Samuel Merritt. Many choose faculty positions because they have a passion and a knack for teaching.
Instructors at Samuel Merritt try to identify students they think would make good faculty. Those students are mentored and encouraged to earn the kind of degrees and experience that would allow them to teach, Berman said.
The school also partners with Kaiser Permanente, John Muir/Mt. Diablo Health System and Sutter Health to identify practicing nurses who would make good clinical faculty.
Jennifer Jacoby, RN, MSN, chief nursing officer of the Sharp Metropolitan Medical Campus, said she has a couple of full-time employees who spend 20% of their time serving as clinical faculty at partner schools.
“I let them hire someone who has benefits and educational capacity,” Jacoby said.
Sharp’s approach illustrates how health care providers can benefit from helping schools. By providing such clinical instructors, as well as clinical rotation space, grants, scholarships, and donations to programs like Nurses Now, Sharp hopes to lure graduating nurses to its facilities.
“You’re sort of hoping that while they’re here, you have done something that makes them want to come back,” Jacoby said.