Filling Stations
As more traditional colleges close their nursing programs, for-profit schools step in to meet student needs and workforce demands

By Rebecca Ray
March 11, 2004

Enrollment in entry-level baccalaureate nursing programs grew 16.6 percent in 2003—good news for the nationwide nursing shortage, which a Web site sponsored by Johnson & Johnson estimates to be at more than 100,000 vacant nursing positions.

But baccalaureate nursing programs also turned away more than 11,000 qualified students—more than twice the number of students turned away in 2002, according to the American Association of Colleges of Nursing.

In order to reverse the shortage, the enrollment of young people in nursing programs would have to increase at least 40 percent each year to replace the nurses expected to leave the workforce through retirement, the association said.

Clearly, prospective students are interested in nursing and health care facilities are clamoring for nurses. But with recent federal and state budget cuts, traditional colleges and universities have been unable to expand and add enough faculty members to meet demand.

Even some private schools are ending their nursing programs. While the University of Southern California is graduating its last nursing students in the spring, Syracuse University is phasing out its nursing program in 2006, according to an article in the Chronicle of Higher Education.

Michael Diamond, a vice president at USC, told the Chronicle that USC’s nursing program did not fit into the strategic goals of the university.

Maureen Thompson, Ph.D., APRN, director of Syracuse University’s School of Nursing, said the university decided to discontinue its program in part because it wanted to focus its resources on maintaining the high rankings of some of its other, nationally ranked programs—even though enrollment in the nursing program had increased for two years before the program stopped admitting students.

For-profit—or proprietary—colleges, however, are helping fill the void. These institutions, which aren’t at the mercy of federal and state funds, and which tend to be more sensitive to market forces than traditional colleges and universities, have begun to add and expand their nursing programs.

Last summer, Education Management Corp., which has 66 primary campus locations in the United States and Canada, did not offer any nursing degrees. However, since then, the company has acquired six institutions that do, and plans to add more nursing programs, according to the Chronicle article.

Keiser College, a multicampus system in Florida, added a nursing program to its Sarasota campus in the fall and plans to offer nursing education on two more campuses, the article said.

Corinthian Colleges and Concorde Career College also are expanding their nursing programs. Corinthian, which operates two licensed professional nursing schools in Indiana and Michigan, has a licensed vocational nursing program scheduled to begin in Anaheim, Calif., in June, and plans to start more nursing programs across the country.

Concorde, which has 12 campuses nationwide, has VN/PN programs at eight campuses and is preparing to add registered nursing programs, said Barbara Johnson, RN, Concorde’s national director of nursing education.

Mary Barry, executive vice president for academic affairs at Corinthian, said proprietary schools are uniquely qualified to have nursing programs because they generate their own investment money. Also, Barry said, Corinthian already maintains small class sizes of about 20 to 25 students maximum per classroom. State boards of nursing require nursing classrooms to maintain certain student-to-teacher ratios, similar to patient-to-nurse ratios in hospitals.

Instructors also are required to be active in helping students succeed. Concorde and Corinthian say they offer extensive remediation programs for students.

Corinthian officials added that computerization is integrated into all curricula, which some traditional public schools can’t afford, and that for-profit schools can offer supplementary facilities for students.

When hiring faculty members, traditional schools place more emphasis on degrees earned and research published than for-profit schools do. Most universities won’t hire a faculty member full time unless he or she has a doctorate, Priscilla Dunson Bartolone, director of the nursing program at South University, a proprietary college system based in Savannah, Ga., told the Chronicle.

Unlike traditional colleges and universities, proprietary colleges don’t have to “be all things to all people,” and have the luxury of being able to drop programs that aren’t profitable, Barry said.

Although Barry wasn’t allowed to say how much money Corinthian’s nursing program has generated for the college system, she said the program has been profitable and that it has a waiting list of students.

But despite the apparent advantages that proprietary schools have over traditional schools, proprietary schools adding nursing programs is a recent phenomenon. Just five or six years ago, for-profit schools generally didn’t start nursing programs because state boards were not as open to it, Barry said, not to mention the challenges associated with meeting prescribed student-to-teacher ratios, managing relationships with hospitals and ensuring high student completion rates.

A for-profit system that has nursing programs in more than one state also must meet the different program requirements of the different state nursing boards. State boards require students to perform from anywhere between 700 and more than 1,500 hours of clinical work, and have their own requirements for student-to-teacher ratios.

“It’s not one size fits all,” Barry said.

Barry said she believes for-profit schools have an easier time starting nursing programs now because state boards are more open to new solutions to the shortage, which is thought to be more pervasive than other nursing shortages of the recent past.

Based on trends in the supply of RNs and anticipated demand, the U.S. Department of Health & Human Services’ Health Resources and Services Administration predicts the shortage should double to 12 percent in 2010 and should continue to grow to 29 percent by 2020, according to a report the agency released in July 2002.

Timing out

Part of the reason the shortage is expected to worsen is because the nursing workforce—with an average age of 46—is quickly headed toward retirement.

The nursing faculty workforce—with an average age of 51—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.

With nurses and nurse instructors preparing to retire, for-profit schools know that nursing programs are needed more than ever and are tailoring their programs to meet nursing board standards.

Roberta Ramont, MS, RN, regional nursing director of Corinthian’s California LVN program, is developing a curriculum that meets the standards of the state’s Board of Vocational Nursing and Psychiatric Technicians, which requires LVNs to complete 954 hours of clinical work and 576 hours of theory. The curriculum that Ramont is developing focuses on critical thinking skills, which a lot of for-profit nursing programs haven’t done in the past, she said.

Students will study the transcultural nursing theories of Madeleine Leininger, Ph.D., RN, to become more aware of their cultural perspectives and the diversity of their clients.

Students also will use a book tailored specifically for VN/PN students, which Ramont says is unusual for the VN/PN population. Ramont co-authored the book, Fundamental Nursing Care, which is published by Prentice Hall.

Corinthian’s VN/PN students take the National Council Licensure Examination for Practical Nurses at the end of their 12th month in the program. Ellen Lee, MS, RN, Corinthian’s director of nursing and allied health, said the program is designed to serve as a career ladder to becoming a registered nurse.

Officials at proprietary colleges hope that as they create more nursing programs that meet state nursing board standards, they will help produce more qualified registered nurses—and prevent the shortage from reaching the Bureau of Labor Statistics’ prediction of more than 1 million vacant registered nursing positions by 2010.

Contact Rebecca Ray at rebeccar@nurseweek.com.