Growing Pains
Nursing schools turn away students as a result of another shortage:
Not enough faculty
By Lisette Hilton
January 10, 2005
A new survey suggests that nursing might be missing its golden opportunity to replenish the nursing workforce with bright, baccalaureate-trained young people who are willing and able to join its ranks.
According to 2004 data from the American Association of Colleges of Nursing (AACN), while enrollment in entry-level bachelor programs in nursing increased by 10.6% over 2003, U.S. nursing schools denied 26,340 qualified applications. In 2003, nursing schools turned away 15,944 qualified applicants from entry-level baccalaureate nursing programs, according to the AACN.
Nursing faculty shortages, a diminishing pool of clinical sites, and lack of government and other funding resources are among the roadblocks, nursing school administrators say.
“Deans and faculty have been creative at trying to expand the number of people that they can bring into the programs,” says AACN Executive Director Geraldine “Polly” Bednash, RN, PhD, FAAN. “But it’s clear that they’re reaching their maximum capacity to expand.”
While some students are opting to take prerequisites and other courses as they wait to reapply in nursing schools, others are abandoning the career choice, Bednash says.
Rise in interest
Many nursing schools have expanded in recent years, but not enough to meet the growing demand.
Graduations from entry-level baccalaureate nursing programs were up sharply in 2004, with a 14% increase over 2003. The recent rise in graduations follows a 4.3% increase in 2003 and 3.2% increase in 2002 — that’s following six straight years of graduation declines, according to the AACN.
The story at Florida Atlantic University’s Christine E. Lynn College of Nursing in Boca Raton is much the same: increasing enrollments and an inability to accommodate all the qualified students who apply.
“In the past 10 years, we’ve had 100-plus more applicants than we could accept,” says the school’s dean, Anne Boykin, RN, PhD. “This year, we turned away about 200 qualified applicants.”
Faculty shortfall
It’s a vicious cycle for deans trying to expand faculty rosters. There aren’t enough master’s- and doctorate-trained faculty to go around, and many of those who are qualified have significantly higher-paying jobs from which to choose.
In a July survey, the AACN reported a national nurse faculty vacancy rate of 8.1%, translating to about 2.9 faculty vacancies per school. More than half of those were faculty positions requiring a doctoral degree.
The situation might get worse: The average age of full-time nurse faculty members is 51.5 years and that of doctorally prepared faculty is 53.5, according to the AACN.
Universities and colleges are strapped when it comes to what they can pay to lure faculty. And government and state resources for expanding nursing school faculty and programs have been inconsistent, according to the AACN.
Boykin calls the faculty hiring situation “horrible” and “frightening.”
“Until we can support more persons to become faculty and encourage them and reward them for being faculty in nursing programs, this trend is not going to reverse itself,” she says. “We just can’t take more students without more faculty.”
Some baccalaureate programs had been banking on government and other funds that only partially materialized.
“We increased enrollments by almost a third from 200 to about 300 undergraduate student admissions a year,” Robin Froman, RN, PhD, FAAN, dean of the University of Texas Health Science Center at San Antonio School of Nursing, tells the AACN in a Dec. 15 press release. “Unfortunately, we only received 30% of the funding anticipated from the Nursing Shortage Reduction Act, while the community colleges and academic campuses received 100% of the expected funding. Though we demonstrated the ability to increase capacity, we cannot sustain increased enrollments without the financial resources to hire faculty for adequate instructional support for students.”
Private universities are facing similar challenges. According to Nancy Hoffart, RN, PhD, dean and professor at the School of Nursing, Northeastern University, Boston, the school, which admits between 85 and 90 freshmen, had close to 800 applications in 2004.
“My slots are limited by faculty — just as in every other institution,” Hoffart says. “We’re struggling the most right now for part-time faculty. We use a lot of part-time faculty to teach in the clinical setting.”
The Massachusetts Board of Registration in Nursing added a waiver option to its requirement that nursing faculty be master’s prepared, saying that schools could hire bachelor’s-prepared clinical faculty, with certain restrictions. Some other states are contemplating similar measures, according to Bednash.
While the move has made it easier to hire faculty in the state, proponents say the decision is shortsighted and doesn’t address the real problem of encouraging more nurses to earn masters and doctorates in nursing.
It’s ironic, Bednash says, that nursing is lowering its standards for educators when health care and the roles of nurses are becoming more complex.
Dwindling clinical sites
Access to facilities where nursing school faculty can take students for clinical training is limiting the nation’s schools from being able to expand programs.
“It’s not just schools of nursing wanting access, it’s medical schools, laboratory technician schools — all kinds of other health professions’ entities trying to get access,” says Bednash.
With so many large health care institutions in Boston, Hoffart says securing hospital clinical sites is not as worrisome as the challenge she faces finding community agencies. The agencies, she says, are trying to deal with their own nurse staffing shortages by stretching their staffs too far, and many are unable to take on the extra burden of students.
Associate degree programs are facing a similar plight. According to Patricia Brien, RN, MSN, MEd, department chair of the associate degree nursing program, Berkshire Community College, Pittsfield, Mass., in 2004, Berkshire’s class of 48 students filled up months earlier than it used to. And the waiting list for students to enter the nursing program is long. Brien says the program can’t expand — not only because of the faculty shortage, but also because there aren’t enough clinical sites in the rural area. “Once hospitals downsize,” she says, “clinical sites are harder to come by.”
Solutions
Some schools are looking to the private sector to help expand programs.
Florida Atlantic University landed a two-year grant from a health care corporation that’s sponsoring its accelerated baccalaureate program. That alone increased the school’s potential for enrollment by more than 20 students, to a total of 80.
“I think there are wonderful opportunities for health care systems to link with colleges and universities and to work together to help this production of nurses,” Boykin says.
Private and public money targeted at funding simulation technology could ease the burden on clinical sites, Hoffart says.
Another solution, Boykin says, is for states and the federal government to pump more money into nursing scholarships so students can go to school full time to earn higher degrees. “When I went for my master’s — a hundred years ago — there was a shortage, and the federal government had a program where they not only paid my tuition, but also paid me a stipend to be able to go to school full time,” Boykin says.
Need for policy change
Bednash says policy-makers are misdirected if they think funding should go to community colleges because they graduate students faster. Rather, she says, baccalaureate programs need money to grow.
“We know that only about 16% of [people who graduate from community colleges] go on for additional education,” Bednash says. Investing in those programs may produce the bedside nurses of today, but it shortchanges nursing schools that will need faculty in the future.
Community college grads “are not the people who are going on and getting additional education to become faculty,” she says. “Policy-makers are also under the impression that community college programs are faster — and they’re really not that much faster. We have programs for people with degrees from other fields, and they can graduate with baccalaureate degrees in nursing in a year to 15 months.”
Something’s gotta give
Nothing less than the future is at stake, Bednash says.
“The future of our nursing workforce depends on having a larger number of highly educated clinicians who can give care and who can teach about giving care,” she says. “This country needs to make some fundamental policy decisions, or we will not be able to meet the need for well-trained professionals for the future.”