Elizabeth Moore, a highly motivated, articulate, college-educated, mother of two from Nashville, Tenn., is—at age 50—answering the call of the oldest profession. Furthermore, she doesn’t intend to retire until she’s 70 or so.

But don’t get the wrong idea. The profession isn’t … uhhhh …

Let’s put it this way: The profession is nursing education, where the mean age of assistant professors is pushing 50, up from 47.2 in 1995, according to the American Association of Colleges of Nursing in Washington.

Moore, MSN, RN, is a doctoral candidate at Vanderbilt University, where she teaches advanced practice nursing part time and is preparing for her oral comprehensive exam and dissertation.

Her area of interest and expertise is breast-feeding, borne of a series of RN positions in labor and delivery, as a clinical nurse specialist in a perinatal center, counselor in a breast-feeding center and operator of a breast pump rental station.

She comes by nursing on the advice of her father, and to education in a tradition that is failing nursing schools everywhere.

The tradition is years of clinical experience after a baccalaureate degree, which is one factor that keeps even the most promising RNs—the educators of tomorrow—out of graduate school while they are relatively young, and accounts for the age and relatively short academic careers of today’s faculty.

It’s a situation that AACN president Carolyn Williams, Ph.D., RN, calls unsustainable.

"We are in desperate need in our field of more people with master’s and doctoral preparation," Williams said. "We only have 10 percent of the nursing population with a master’s or doctorate. That’s not much. Some schools can’t expand their classes because of a lack of faculty; others have had to reduce their classes."

The Northwest Health Foundation, based in Portland, Ore., published a study in April that warned that 41 percent of the state’s baccalaureate and graduate degree faculty will retire by 2005, and an additional 46 percent will call it quits by 2010.

The study also projects that 24 percent of associate degree educators will retire by 2005. Another 33 percent are expected to retire by 2010.

"That’s only one state, but to be frank, I doubt the situation is entirely different elsewhere," Williams said.

Ada Hinshaw, Ph.D., MSN, RN, dean of nursing at the University of Michigan, said her college could see 40 percent of its faculty retire between 2006 and 2010. "That is a major investment you’re going to lose, [and causes] major problems with productivity and covering students," Hinshaw said.

In testimony before a congressional panel earlier this year, Linda Hodges, Ed.D., RN, dean of the University of Arkansas for Medical Sciences College of Nursing, labeled her state’s lack of nursing faculty "critical," and testified that in 1999, nursing schools there turned away 153 qualified applicants for lack of staff.

The issue of who is going to fill nursing faculty shoes, and for how long, largely is a reflection of federal policy and society’s demands on women, who are the overwhelming majority of RNs.

College administrators say that to a lesser degree, nursing schools contribute to the problem by not effectively raising the possibility of an academic career with undergraduate students.

Every year, the National League for Nursing, which among other things accredits schools, surveys the nation’s nearly 3,500 nursing programs about enrollment, graduate admissions, number of advanced practice nurses, faculty rank and tenure.

So Terry Valiga, Ph.D., RN, director of research and professional development at league headquarters in New York City, knows the aging faculty problem and the shortage of successors from top to bottom. The bottom line, of course, is money.

The trend—one indirectly encouraged by the federal government—has been for master’s degree programs with an emphasis on educator training to close in favor of advanced practice nurse programs, Valiga said.

"A great deal of the federal monies went into supporting programs that are preparing advanced practice nurses. Master’s programs have been cranking out nurse practitioners and nurse-midwives," Valiga said.

"People go into those tracks because they want to maintain a practice role. They are not a pool of people who are particularly interested in taking on a faculty role."

A preponderance of faculty in baccalaureate and associate degree programs hold master’s degrees and are from the ranks of advanced practice nurses. "Less than a doctoral degree is quite common," Valiga said, and some practical nursing programs have no doctorally prepared faculty.

Then there is the issue of faculty salaries and workload, which the league includes in its annual surveys. "Report after report says that full-time faculty typically put in a 60- to 70-hour workweek on average, so it’s a big commitment for a little bit of pay," compared to what clinicians can earn, Valiga said.

Michigan’s Hinshaw said university salaries are rising, but still not fast enough to keep pace with clinical practices.

Eventually, she said, "Universities will come to the point of understanding that they’re going to have to pay for really good individuals to come into academia. They’re not going to do it otherwise."

Entry-level nursing students tend to think in the short term, and practice roles have their attention, Valiga said. "They see that’s where the jobs are, that’s where the money is, that’s where the hype is and that’s where they want to go."

And go they do, from school to work. If they ever consider returning to the university for a career in the classroom and laboratory, usually it’s years later. The desire for clinical experience is only part of the reason for the delay.

Because most RNs are women, they tend to put off a graduate degree until after marriage and their children are grown.

Even then, enthusiasm for advanced training is tempered with the double whammy of giving up a full-time paycheck and taking on the expense of school at a time when there is a mortgage to pay, when elderly parents may require support and when teen-agers themselves are college bound.

Williams, the AACN president who also is dean of the University of Kentucky College of Nursing, was a beneficiary of what she called "very aggressive federal trainingships" for future educators in the 1960s.

Much of that money, as a matter of policy, has been shifted to advanced practice programs to meet the demand for primary care nurses and no longer supports full-time graduate-level study.

"There is no way a person could live on a trainingship today as they could in the ’60s," Williams said.

"The ethos in our field is reflected in our doctoral students," she said. "The majority of them have a gap of five years between their baccalaureate and their master’s, and then they have another gap of five to 10 years between their master’s and doctorate. By the time they get their doctorate, they’re fairly well along.

"You don’t expect a physician to drop out for years and years between a residency and a fellowship program. They usually move right on. Our pattern is the opposite."

By AACN figures, half of new doctoral graduates in nursing are between 45 and 55 years old. "It doesn’t give them much time to be productive at that level," Williams said.

National Institutes of Health data also reflect an aging nursing faculty, said Kathleen Dracup, DNSc, FNP, RN, FAAN, dean of nursing at the University of California, San Francisco. On average, research nurses receive their first federal grant at age 55, at least a decade later than others doing NIH-funded research, she said.

Michigan, Kentucky and UCSF, all renowned as research universities with first-rate nursing faculties, have different approaches—with some commonalities—to attract a younger, invigorated teaching and research corps.

The schools have set their sights on rising stars—whether they’re in practice or still in undergraduate programs—to teach the next generation of RNs.

"A number of us have implemented baccalaureate-to-Ph.D. programs," Hinshaw said.

The University of Michigan, using a Macy Foundation grant to propel recent BSN graduates into the master’s program and through doctoral work, has dramatically changed the demographics of its doctoral program, she said.

"At one time the average age was 37 or 38; this year it’s closer to 32. It’s really dropping fast, which is what we need."

The University of Michigan also recognizes that it takes years for educators to develop into effective teachers and solid nurse researchers, she said.

"You don’t read those things in a textbook; they come from working with people. Mentoring is a lot of work and a fine science. That’s one of the reasons we’re worried about a rapid turnover on the faculty," she said.

To slow the pace of retirements, the university tries to negotiate phased-out retirements in which senior educators steadily cut back on work but continue to research and mentor younger colleagues, Hinshaw said.

The University of Kentucky College of Nursing has developed a community internship program to compete with clinical practices for BSN graduates who show potential to be tomorrow’s educators.

"My operating hypothesis is that we’re losing them right out of their baccalaureate degree," Williams said.

As interns, the RNs earn one or two years of clinical experience with an underserved population, then tend to gravitate to graduate school because they still are connected to the university, she said.

Another possibility, Williams said, is to emulate nurse practitioner programs at the undergraduate level, building in the clinical experience that master’s and doctoral students feel they need. "They don’t have to have years of experience," she said.

Aside from the salary issue, UCSF’s Dracup is puzzled that academic careers aren’t more appealing. She said education is a logical career choice with professional benefits that RNs often complain are lacking in practice: challenges, autonomy and a career trajectory that rewards expertise.

UCSF’s approach is to develop future faculty for two distinct tracks, tapping baccalaureate programs for theorist-researchers and advanced practice nurses for university clinicians.

On the academic side, "We need to do a better job of targeting candidates and encouraging them into academia early, getting them excited about research," Dracup said. On the clinical side, advanced practice nurses, some of whom are doctorally prepared, need to realize that they have an opportunity to run faculty practice sites and create a career every bit the equal of academicians in a research-intensive university, she said.

Moore, the Vanderbilt Ph.D. candidate, said the need for better research skills, particularly related to overcoming breast-feeding problems, spurred her on to graduate school.

"One thing I really like about the Ph.D. faculty is that they encouraged me to go to other areas of the university," Moore said. That led to courses in psychology and human development and to a research relationship with a biology professor who was studying human instinct, particularly newborns seeking a mother’s breast, she said.

"Also, we were encouraged to get to know faculty in our area of expertise at other universities, and I developed a mentorship with a professor at Case Western Reserve University" in Cleveland.

Whatever the setting—research, clinical or both—Moore chooses when she graduates from Vanderbilt in two years with Ph.D. in hand, she’s committed to one thing: "I’m really interested in establishing a lactation consultant program that goes with the nurse practitioner program," she said. "This is such an applied field."