Crunch Time
As thousands of qualified applicants vie for a slim number of student slots, nursing schools scramble for scarce faculty funds to meet the demand

By Janet Wells
January 21, 2004

If nursing program administrators could have one wish granted in the new year, it would almost certainly be more faculty.

The solution to the nursing shortage used to be recruiting more people into nursing to fill burgeoning job vacancies. As little as three years ago, nursing programs couldn't find enough students to fill the classrooms. Now, in the wake of Sept. 11, a weak economy and aggressive local and national programs to promote nursing as a career, more people than ever want to be part of a profession that offers job security, satisfaction and decent pay.

But nursing programs are rejecting applicants in droves.

"The scary thing is that right now we have hundreds and hundreds of qualified, motivated, potentially wonderful nurses that we're going to turn away," said Beatrice Yorker, JD, MS, RN, FAAN, director of the San Francisco State University School of Nursing. "Word will get out that you can't get into nursing school. We will lose this current bolus of part of the solution to the nursing shortage unless we can create additional slots in nursing education."

But nursing programs cannot be expanded because not enough nurses are willing and/or qualified to teach, and new funding isn't available to add faculty.

Nursing education programs are in a double bind. They face an aging workforce nearing retirement and faculty salaries that are far outpaced by the marketplace. In addition, nearly every state is grappling with record budget shortfalls, which have meant significant cuts this year for many nursing programs.

So instead of adding more faculty-and increasing salaries to lure nurses into teaching-many nursing programs are squeezed tighter than ever. Although a few programs have found ways to hire more professors and increase enrollment through industry partnerships, most schools have either cut programs or are struggling to maintain the status quo.

Last year, after 1,000 people applied for 140 spots in its bachelor of science in nursing program, the University of Texas Health Science Center at Houston planned to increase enrollment by 20 students. Then the nursing school's budget was hit with a 16 percent decrease.

"We couldn't add 20 students," said Patricia Starck, DSN, RN, FAAN, dean of the UTHSC-Houston School of Nursing. "We were doing good just to hold the line. We're not expecting the state to rescue us here. We know the state has no money. The state gives the university less and less of its budget every year."

Sharon Job, Ph.D., RN, Fast Track nursing coordinator for Idaho State University, also wanted to expand her program. It allows second-career students who already hold degrees to earn a BSN in 18 months.

"I sat down with the comptroller," Job said. "To add 10 students is $217,000 a year, plus another $27,000 for supplies and equipment. That's almost a quarter of a million dollars. We have the interest, but without the money, we can't take them."

In addition, Job said she has tried for a year and a half to recruit a faculty member to fill an open spot. "I can't compete with the salary that [hospital] facilities are paying," she said. "They're not going to work for me for $25,000 less than they would make working in a facility."

Starck agreed that faculty salaries are a huge issue in nursing. "We have not had faculty salary raises in so long we can't even remember," she said. "We are concerned that our graduates are going out and making more than their faculty."

For Yorker, who has four faculty positions unfilled in San Francisco, low salaries are the "single greatest barrier" to getting nurses into the workforce. "We can't compete with the marketplace to attract credentialed faculty," she said. "Nurses in the Bay Area are the highest paid in the country because of the cost of living. However, our faculty salaries are national and state norm. We are at a serious disadvantage."

San Francisco State was hit with a $30.2 million budget cut this year. The amount represents almost 21 percent of the school's general fund budget. That trickled down to a $76,000 shortfall for the School of Nursing. According to one administrator, the School of Nursing took less of the pinch because "nursing is the best-funded discipline on campus."

With some creative budgeting, the school did not cut any faculty or enrollment. But students and staff felt the crunch. "Every day we're confronted with the fact that the existing staff is totally overworked," said Carolyn Foley, 34, a student in the RN/MSN program. "They are teaching extra classes or have accepted a ton of students. They don't have time."

Foley, along with a dozen other students in the RN/MSN track, were forced to delay taking elective classes for their advanced practice certification. For Foley, this means she will finish up units next fall, while working full time as a nurse. "I'm not sure I'm going to sleep," she said. "It's a bummer."

Foley's classmate Staci Smith will have to delay graduation by a semester to fulfill her elective requirements.

"It doesn't help the nursing shortage when there are people out there who are willing to work, but can't get out of school," said Smith, 34. "They do the best they can with limited resources. But the whole nursing education process is frustrating."

New blood needed

By 2020, there will be a shortage of 434,000 nurses in the United States. Today, more than 100,000 nursing positions are vacant, according to a Web site sponsored by Johnson & Johnson.

Almost every hospital has nursing jobs open, and the clamor is only going to get worse. In Collin County, Texas-which grew 86.2 percent between 1990 and 2000-expanding hospitals will need 1,000 nurses to staff the new facilities, according to a recent article in the Dallas Morning News.

UTHSC-Houston's Starck said she had just read a state report on the nursing shortage in Arkansas that echoed her own experience.

"Arkansas needs 1,925 nurses, and they are producing 683," Starck said. "They need 1,200 more nurses graduated per year. Every school is in the same boat. We have the jobs waiting in hospitals, we've got the labor force willing to fill the jobs. What we don't have is the means of educating them."

Overall enrollment in entry-level baccalaureate nursing programs increased this year by almost 17 percent. But the good news is tempered by the increase falling far short of the projected need to reverse the shortage: Enrollments of young people in nursing programs would have to increase at least 40 percent annually to replace those expected to leave the workforce through retirement, according to the American Association of Colleges of Nursing.

"Over the next 10 to 15 years, I think 50 percent of the faculty are going to be retiring," Job said. "It's going to be a huge crunch. For those of us in education and hospitals, it's a very scary thing."

With the average age for an RN at 46 years, the nursing workforce is quickly heading for retirement.

The nursing faculty workforce-with an average age of 51 years-will get there even faster: The percentage of RNs who are in education already has dropped dramatically, from 3.7 percent of the workforce in 1980 to 2.1 percent of the workforce in 2000, according to the National Sample Survey of Registered Nurses.

Positive partnerships

Idaho, for example, has only one MSN program in the state. And the number of graduates from the program doesn't meet the academic need. So Job, like many nursing program administrators, bolstered her program by reaching out to the local health care industry. The two big hospitals in Boise, St. Luke's Regional Medical Center and Saint Alphonsus Regional Medical Center, committed to providing multiyear funding to support faculty salaries.

"We want the university to have enough faculty to up the student enrollment to have enough nurses coming down the pipeline," said Randall Hudspeth, MS, APRN, Saint Alphonsus director of professional practice. Industry partnerships are a key component-both in keeping nursing programs afloat and in stemming the nursing shortage.

When Tina DeLapp, Ed.D., RN, director of the University of Alaska Anchorage School of Nursing, proposed doubling the baccalaureate program's enrollment in 1997, the state Legislature approved additional funds-with a catch: Facilities would have to agree to foot half the bill.

"If we were going to increase enrollment to meet the needs of industry, then industry should help us do that," DeLapp said. "The hospitals were spending a small fortune on hiring and training traveling nurses. They thought of it as a win-win to direct money in state to people who are committed to living in state."

At first, hospitals offered to provide scholarship money for students. "It won't do any good," DeLapp said she told administrators. "It won't let me buy the faculty I need to teach students."

So they agreed to let DeLapp put money toward faculty. Now, with $1.6 million in partnership funds annually from the university and eight hospitals, DeLapp has 40 faculty, up from 22 in 1997. She also has 120 students in the program, up from 64 six years ago.

The next step is to develop a nurse educator track in the master's program "so we can grow our own faculty," DeLapp said.

DeLapp conceded that getting funding may be easier for her because the university's school of nursing is the only publicly funded nursing education program in the state. "We're the only game in town," she said. "But it's a never-ending job to get money.

"It took me a long while to learn that if I don't ask for money, then I'm not going to get any," she added. "It's well worth developing ideas of how I would use a specific pot of money, then ask[ing] for it. Because sometimes you get it. And the Legislature is impressed by industry matching money."

Contact Janet Wells at janetawells@hotmail.com