Insert Teacher Here
Nursing schools, hospitals and comunities address faculty shortage by developing innovative partnerships designed to lure instructors into the classroom

By John Leighty
February 25, 2003

Reggie Ottem, MSN, RN, performs best when there's some variety in her life, which is why she decided to quit her job in a busy telemetry unit at Kaiser Permanente San Diego and return to the classroom-as an instructor.

She got her opportunity through the "Nurses Now" program at San Diego State University under which additional faculty are funded by a coalition of 10 hospitals and two foundations at an amount totaling $4.6 million. With each hospital supporting the equivalent of one full-time instructor, the school has been able to nearly double its undergraduate enrollment as a way to help meet the growing nursing shortage.

"To work as a mentor is very rewarding," said Ottem, who spent more than three years at Kaiser and previously was an ER nurse for Sharp Grossmont Hospital in La Mesa. "It allows me to share some of my experiences and philosophies of nursing and to have a hand in grooming future nurses."

With a major shortage of RNs predicted for the next decade, nursing schools across the country ironically turned away 5,823 qualified applicants last year mainly because of an insufficient number of faculty and limited resources, according to a survey by the American Association of Colleges of Nursing. As a result, many schools are partnering with hospitals and finding other creative ways to increase or retain faculty at a time when many tenure-track professors are nearing retirement age.

Expansion programs

The Nurses Now program is in its third year and has allowed the school to go from admitting 50 students a semester to 90. So far, 210 additional students are studying nursing because of the partnership with the hospitals and two other faculty-supporting grants, said Patricia Wahl, Ph.D., RN, FAAN, director of the San Diego State School of Nursing.

"The nice thing about the program is there are no strings attached by the hospitals," Wahl said, adding that most hospitals supply instructors on a part-time basis. "None of them have said they want to get a certain percentage of the graduates. They'll probably get their share since our graduates tend to stay and work in San Diego, but they haven't made an issue of it whatsoever."

In addition to the hospitals' contributions, the California Endowment in 2001 funded a three-year grant for $302,285 for supporting recruitment and mentorship, and the California Wellness Foundation kicked in $150,000 within a three-year period to fund a 0.75 full-time equivalent nursing faculty position that started in June, translating into an additional 15 students being enrolled for the fall semester.

In the greater Houston area, the need for additional faculty was seen as a major blockade to expanding enrollment in nursing schools and a strong community effort got under way to correct the situation. As a result, 65 nurses employed by 19 different hospitals have donated 12,000 hours of teaching during the fall and spring semesters of 2001-02.

The goal is to increase the present number of 800 entry-level RN graduates annually; so far, the 13 schools have been able to expand enrollment by 163 students in the first year, with even better results expected this year.

Back to the blackboard

Nancy Ray, MA, RN, chief nursing officer and associate administrator for University Health System in San Antonio, Texas, was instrumental in contacting hospitals and nursing schools and putting together a partnership program that would fill teaching needs while preparing future nurses to alleviate clinical staffing shortages.

"In essence, University Health System spends $250,000 to $300,000 a year on supporting its own master's-prepared nurses who teach in schools of nursing so that more students can be enrolled."

One of those who went back to a classroom setting to teach was Pamela Mann, MA, RN, who had eight years' experience as a clinical psychiatric nurse and who has spent the last 10 years as a learning consultant for UHS.

While retaining her position with UHS, she's teaching a back-to-back "Fundamentals of Nursing" clinical course to two groups of 10 students each. She spends 13 hours a week for five weeks on the course and has enjoyed the new role.

"The essential thing is having communication skills, both written and oral. They keep you sharp," said Mann, adding that the experience has been satisfying.

"The University of Texas Health Science Center needs a psychiatric instructor for the spring semester, so I'll be doing that, and hopefully they will ask me back next year," Mann said. "The need for instructors isn't going to go away and for those of us who qualify to teach, there's going to continue to be a need for what we're doing."

With the baby boom generation nearing retirement, Ray said that creative solutions must be sought to attract, retain and reward professors and to inspire more nursing graduates to go on and obtain advanced degrees. "The average age of the faculty is still 55 and that's not a very good sign," she said. "The UT Health Science Center is searching for a dean for the School of Nursing and the majority of applicants are in their 50s as well. What this says to me is, 'Where's the new blood?' "

In the 15-county Southwest Plains area of West Texas, a strong community coalition and an alliance of four nursing schools have been successful in increasing student enrollment and adding clinical instructors. Through a $2.9 million technical training grant from the U.S. Department of Labor and $2.1 million in contributions from community supporters, more than $1 million in scholarship money will go toward helping 240 new students become RNs. Other grant money is aimed at adding nine nurse educators. The grant was awarded directly to the regional workforce board and subcontracted to the coalition members.

Faculty finder

Alexia Green, Ph.D., RN, FAAN, dean of Texas Tech University Health Sciences Center School of Nursing and coordinator for the Community Coalition, said two approaches work to increasing faculty. The first is paying salaries for additional faculty from the South Plains Workforce grant money, and the second is to support nurses with bachelor's degrees who want to earn a master's degree in nursing education. "We gave $16,000 scholarships this year to each of 12 students who have committed to staying in the community and teaching at one of the nursing schools," Green said.

The state Legislature also has responded to an extensive research study by the Texas Nurses Association showing that 28,000 RNs were needed in the Lone Star State to meet the national ratio of nurse per 100,000 population criteria. The passage of the Nursing Shortage Reduction Act included giving an additional $26.2 million for nursing education for 2002-03.

Green said Texas Tech benefited by receiving $250,000 to retain disadvantaged enrolled students. The school also was given $150,000 for "dramatic growth" to increase faculty. One problem, Green said, is that only about 5 percent of RNs have a master's degree, making recruitment of new instructors difficult.

Texas Tech "hit the ground running" when the grant money was released in June and received funding to hire four nurses with doctorate degrees, Green said. To do this, a nurse recruiter was retained who found and hired two Ph.D. instructors during the summer and two more in the fall-all from out of state.

University a magnet

The University of Washington's School of Nursing hasn't felt a faculty shortage because it's always been a magnet for people who want to be nursing professors, according to Assistant Dean Julie Katz, M.Ed., RN. However, the school is emphasizing programs for higher degrees so that there will be a future supply of teachers.

"Something we've done here at UW is to increase enrollment in our doctoral program [for] the ones who usually end up being educators and researchers," Katz said. "If we take in more doctoral students now, we'll have more prepared in the future for faculty positions."

The school now takes 20 students annually into the doctoral program, compared to 12 students five years ago.

When it comes to clinical faculty, the school has initiated arrangements with the University of Washington Medical Center, Harborview Medical Center and the VA Puget Sound Health Care System.

For medical centers, a benefit of supplying the school with master's-prepared nurse instructors is the possibility that students will be drawn toward working at that institution after graduating.

Mary Hampton, MN, RN, associate deputy director for nursing services at the VA, said the government hospital places nurses in academic settings at various medical schools around the country to fill gaps and help get more nurses into the workforce.

The Washington program, she says, has been presented as a shared model that could be adopted nationally. The VA has one agreement with Seattle Pacific University, where the school's faculty comes on-site, giving instruction so associate degree nurses can earn their BSNs at their workplace.

The VA also has a nursing staff that fills clinical instructor positions at the various schools. "We have people with Ph.D.s and master's degrees who like to get involved in the educational process," Hampton said. "And there's a mutual benefit to be gained if we prepare them because they're then ready to work in our system."

The bottom line in supporting the educational efforts of schools is to graduate more nurses at all levels.

"It's nice to know you're involved with something that makes a difference in the profession," Hampton said. "The nursing shortage is everywhere. It's global."

Katz said the UW nursing school has about 160 students in its two-year junior and senior level BSN program, up from 64 students eight years ago. While budget and funding restraints have kept the school from adding staff and increasing enrollment, the partnerships under which the hospitals pay the salaries of advanced practice nurses loaned for instructional purposes have prevented the school from having to reduce enrollment.

"We'd love to increase the enrollment, but, in the meantime, these programs have prevented a decrease," Katz said.

On loan

In California, Kaiser Permanente has established programs with dozens of nursing schools in which it loans faculty and expertise, an example being an advanced anesthesiologist option in the master's program at California State University, Fullerton.

"Kaiser provides a lot of infrastructure and clinically prepared and, sometimes, nationally renowned faculty to teach the clinical component of the course," said Christine Latham, DNS, RN, a professor and dean of the School of Nursing at CSU Fullerton.

The school also partners with Kaiser in a distance program at eight sites throughout the state that is open for community nurses who want to obtain BSN degrees. The part-time program has attracted 140 students.

Latham said other partnerships with nearby medical facilities that loan or donate instructors has resulted in a dramatic increase in the number of nursing students who will graduate in the near future. The undergraduate class has jumped from about 60 FTE students in 1998 to the present enrollment of 220.

"About 80 percent to 85 percent of our students go on to graduate study," Latham said. "So I think we're helping increase the number of potential faculty for the future by getting them master's-prepared, particularly for the community college level and the clinical specialty level instructor roles."

One leading expert on the nursing and faculty shortage, Kathleen Dracup, DNS, RN, a professor and dean of the School of Nursing at the University of California, San Francisco, said nurse educators are retiring faster than positions are being filled, creating faculty shortages ranging from 7 percent to 15 percent at universities nationwide.

At UCSF, like other schools around the nation, a variety of programs try to attract and retain graduate-level instructors and tenured faculty with doctorate degrees. Full-time faculty members do receive incentive pay at UCSF and a program is in place to lure retired professors back to the classroom on flexible schedules. The school also recruits professors from other disciplines-economists, statisticians, psychologists, sociologists-to teach in nonclinical areas.

Disparity in salary also is a problem, Dracup said. Nurses with specialty degrees average only about $55,000 in base pay as an assistant professor and, depending upon their expertise, could demand $70,000 to $100,000 or more in clinical settings.

While UCSF does have a higher compensation package to help offset the industry lure, many schools in high-cost urban areas that may not have the resources to give incentives face the same problem.

"It's not a doom-and-gloom picture entirely," Dracup said. "The intellectual rewards and lifestyle benefits are stupendous, and those attracted to faculty positions recognize the incredible pleasure that comes from teaching the next generation of nurses."

Contact John Leighty at johnsan@aol.com