June 22, 2007

The Nursing Education Dilemma

The market for nursing graduates remains hot, and plenty of students are vying for those open positions. Enrollment in entry-level baccalaureate nursing programs increased by nearly 8 percent in 2006 from the previous year, which marked the sixth straight year of gains. Community college programs are also seeing increases in applications and enrollments.

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When it comes to clinical nursing courses, college programs are bound to strict faculty-to-student ratios, set by individual states. One instructor to every 10 or 12 students is a fairly common ratio. So even as administrators and state lawmakers seek more slots for students, there’s a ceiling on expansion unless more faculty are recruited or produced.

That’s not happening quickly. A survey released last year by the American Association of Colleges of Nursing identified at least 637 faculty vacancies at more than 300 nursing schools with baccalaureate or graduate programs — or what amounts to a nearly 8 percent faculty vacancy rate. The majority of the openings are tenure-track positions that require applicants have a doctorate, the survey shows.

Meanwhile, there continues to be a backlog of students. In 2006, more than 38,000 nursing school candidates deemed “qualified” by the AACN were turned away from entry-level baccalaureate programs, while a total of 50,783 nursing school applicants enrolled and registered in courses. When the new students are added to the pool of all students enrolled, total enrollment rises to 133,578.

Nearly three quarters of the colleges that responded to the AACN survey pointed to faculty shortages as a reason for not accepting the applicants. Community colleges are turning away 3.3 “qualified” applicants for every one turned away by four-year institutions, said Roxanne Fulcher, director of health professions policy at the American Association of Community Colleges.

At many nursing schools, wait lists are shrinking after years of growth, officials say, not because slots are opening up, but because students are becoming frustrated that their chances of enrolling are dim.

Some see a troubling pattern forming. Hospitals and medical offices make offers that top graduates can’t refuse. Students choose immediate employment over continuing their nursing educations. The pool of candidates who can become nursing faculty members diminishes and the profession eventually suffers.

“Faculty shortage is the biggest problem we have,” said Geraldine “Polly” Bednash, executive director of AACN. “Most of the focus is on producing people at the bottom of the pipeline, but we aren’t looking out for the future.”

Incentives to Teach

A major issue is pay. Data continue to reflect a longstanding trend — those who stay in academe are compensated worse than their counterparts with the same level of education who enter the practice.

Six-figure salaries aren’t uncommon for nursing graduates with doctoral degrees who work as top-level managers, Bednash said. That’s not the case for those who teach. In 2006, the average salary for a full-time nursing faculty member across all ranks was $88,476 for those with doctorates and $64,011 for those with master’s degrees, according to the AACN.

It’s particularly difficult to persuade graduates to choose teaching, many say, because they are likely to be supporting a family and reliant on immediate financial payoffs. (Subsequently, an increasing number of international faculty have been brought to teach in recent years.)

To begin with, there’s a fairly small pool of potential faculty. Roughly 13 percent of registered nurses have an MSN or doctoral degree, according to the National Organization for Associate Degree Nursing. Only a fraction of associate degree students ever go on to receiving higher degrees, Bednash said.

And part of the growing concern is that nursing faculty members — on average in their late 50s — are set to retire in droves. Since nursing students at all levels are often in their 30s or 40s by the time they graduate, their teaching years are limited.

That’s why community college and nursing groups are calling for an increase in RN to MSN programs as a way for colleges to groom teachers who start at an earlier age. These programs give students who have an associate degree a quicker path to earn their master’s degree at a given institution.

Fulcher, of AACC, said there are roughly 150 of these programs across the country. Alisa Schneider, 43, completed an RN to MSN program at George Mason University before accepting a nursing faculty job at Portland Community College.

Schneider had worked for 15 years, primarily in pediatrics, after receiving her associate degree. But she was feeling trapped. The program allowed her to work part-time for most of the three-plus years it took to finish.

“It saved my career,” she said. “But I don’t see it as being a quick-fix answer for getting more educators. You need to have some work experience first. I see this as a program that helps rejuvenate careers and gets people to move into the higher ed arena.”

In response to the faculty shortage, a number of incentive programs are underway:

The AACN and the California Endowment, a private, statewide health foundation, launched last year a new scholarship and mentorship program to increase the number of minority nursing faculty in California. Nursing students from underrepresented backgrounds are eligible to receive up to $18,000 in funding support to complete a graduate nursing degree. In exchange, students are asked to commit to teaching in a California nursing school after graduation.
Colorado’s state legislature passed two nurse faculty shortage bills last year that aimed to address the salary differential for working nurses and those in academe. The Nursing Teacher Loan Forgiveness Program is designed to provide up to $20,000 in loan forgiveness for students pursuing master’s or doctoral degrees in exchange for a five-year teaching commitment at a Colorado school of nursing. The Nursing Faculty Fellowship Program is intended to help nursing schools in filling faculty vacancies by giving fellowship payments of up to $10,000 a year for three years.

Patricia Moritz, dean of the School of Nursing at the University of Colorado at Denver and Health Sciences Center, said while the bills are “very well-intentioned,” there are major limitations. For instance, she said the way the regulations of the forgiveness program were written isn’t consistent with the way teaching positions are set up. Faculty are asked to teach in the classroom for 40 hours a week to be eligible for the program, she said, which makes it “virtually impossible” for them to apply.

Patsy Maloney, director of professional development and continuing studies and an associate professor at the Pacific Lutheran University School of Nursing, says a problem with federal loan forgiveness programs is that a faculty member must stay at one institution, even though there might not be a full-time position there.

Dealing with Supply and Demand

New nursing programs are sprouting across the country. Among them, Miami Dade College is starting a bachelor’s of science program in nursing. Western Governors University is starting two new master’s programs in nursing: one to train nurses to manage teams of nurses and one for those who will be involved in nursing education. Goshen College, in Indiana, is starting a master’s degree in nursing.

At Portland Community College, where Schneider teaches, 716 “qualified” applicants vied for 100 openings last year, according to Claudia Michel, director of the nursing program. The college uses a lottery system to determine which students are admitted and also selects 25 alternates to account for those who might drop out or enroll elsewhere.

But at a time when avoiding dropouts is crucial, many schools are avoiding random selection and looking at factors such as grade point average and work experience.

“Some schools can justify putting aside access to all in a time of great demand,” Fulcher, of AACC, said.

At Delaware Technical and Community College, admissions has always been merit-based, says Jerry McNesby, vice president for finance. To help with retention, the college has added a program that helps students prepare for tests and assignments. McNesby said the college has yet to measure whether retention has improved.

Five years ago, for every student admitted to the Delaware program there were 2.5 who were turned away. The state has helped decrease the waiting list by making use of proceeds from a tobacco settlement to fund an expansion of the nursing program in three counties. This program has grown to 814 students from 354, and more than 40 instructors were hired on top of 56 already teaching in the program.

Moritz, the Colorado dean, said her program “can’t go any higher” until it gets more faculty and state funding. The school has 1,000 applicants for 230 slots each year. There is no wait list, she said, because it does a disservice to students.

“We know there’s a shortage locally and nationally of nurses, but hospitals have limited slots open for new graduates,” she said, adding that the majority of vacancies are filled by more advanced nurses.

For that reason, Colorado staggers its start date for new students so that all of them aren’t released into the job market at the same time. (That way, the program also can accommodate students into the teaching clinics.)

Bednash, of AACN, points out that while enrollments are increasing nationwide, the rate of increase has slown for the past several years.

“I suspect it’s not going to be long before we see a flat line in enrollment,” she said. “There’s a clog, and faculty are the Drano.”

— Elia Powers

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Comments

Diploma schools of nursing

The casual dismissal of the closure of the diploma nursing educational model illustrates many issues within the profession. The facts of the matter are that diploma nursing schools have historically performed BETTER than BSN schools in passing the NCLEX, and at least as well as associate school nursing graduates. This is because diploma programs offer far more clinical experience than most BSN or associate degree programs and the NCLEX measures that hands on experience. The facts also show that diploma programs cost on average about one half of what tution is for BSN and associate degree programs. Finally, diploma schools offer an affordable alternative to many lower income students who simply cannot afford the debt burden of about $75,000 that many families are forced to incur to get a degree in nursing. Diploma programs offer lower income students a stepping stone into the nursing profession and most of them later earn their BSN’s via employer paid tuition benefits.

If you weigh all of the facts objectively, it is clear just how foolhardy it was to close the diploma sector. The bottom line is that the public has been ill-served by nursing academia over the past 25 years, and it has only itself to blame.

feudi pandola, at 9:10 am EDT on June 26, 2007

At the National League for Nursing, we read with interest the lead story in the June 22 edition of Inside Higher Ed, “The Nursing Education Dilemma.” The author cites important statistics from a survey highlighting the vacancy rate of nurse educators in baccalaureate and graduate programs of nursing. Indeed, the faculty shortage is the undisputed key contributing factor in the stubborn shortage of nurses nationwide.

In its just-concluded survey of 32,000 nurse educators teaching in programs at all levels of academia (including associate degree and certificate programs offered by community colleges), the NLN, in partnership with the Carnegie Foundation Preparation for the Professions Program, has documented critical challenges to faculty retention.

Among concerns regularly voiced by nurse educators is that they are seriously overworked. As reported in the latest issue of Nursing Education Perspectives (Vol. 28, No. 3; May/June 2007), the NLN’s respected, peer-reviewed journal, 40 percent of full-time faculty have additional administrative positions within their schools, extending their average work week to 56 hours. The study also showed that they are paid less than nurses holding advanced degrees who work in hospital or clinical settings and less than colleagues in higher education teaching in other academic disciplines.

With one in five nurse educators planning to retire within three to five years, another NLN-Carnegie Foundation survey finding, the profession and society can ill afford to ignore conditions that must be addressed by college and university administrators if this shortage is to be reversed.

Beverly L. Malone, Ph.D., CEO at National League for Nursing, at 2:15 pm EDT on June 26, 2007

Nursing education dilemma and diploma schools of nursing

A commenter here stated that all diploma nursing schools should be closed. This is the sort of shortsighted thinking that caused the nursing shortage in the first place. Historically, diploma schools have higher pass rates on the NCLEX than those of BSN schools of nursing and are about equal to the associate degree schools. Diploma schools cost about 1/3 of BSN schools, and many diploma nursing graduates pursuit higher nursing degrees, including MSN’s, and become nursing instructors after they graduate using employer paid tuition benefits...a very smart and economical career path.

As I wrote earlier, closing down diploma schools was extremely shortsighted, foolhardy, costly to the public, and just plain stupid. We are now reaping the fruit of poor leadership within the nursing profession.

feudi pandola, at 8:40 am EDT on June 27, 2007

lack of nursing faculty

I and close to 10 other faculty recently left a well-established school of nursing due to lack of faculty governance and other harassment.

Why doesn’t ANCC establish a magnet program for schools of nursing?

exaculty, at 4:25 am EDT on July 3, 2007

Doctorates

I have read with interest all the comments on the nursing faculty shortage. I have been accepted to a nursing focused EdD program and I am concerned about the viability of this doctorate. Will matter to employers if it is not a PhD or DNS? My career goal is still Nursing Education at a university level.Any input would be appreciated.

Madeline C., at 8:35 am EST on December 19, 2007

In universities around the country business faculty get paid substantially more than other faculty. The argument that one hears supporting this inequity is that market conditions for those with doctoral degrees in the business disciplines make these high salaries necessary. Universities could not attract faculty members from the private sector to the academy without offering them comparable salaries. Why do the laws of supply and demand not work for nursing faculty salaries? I suggest that if colleges of nursing began paying their faculty more they would attract all the faculty they need.

It’s about the money, at 8:31 am EDT on June 22, 2007

A brief history of Nursing education

Good article on nursing education...just a few points to add. The nursing profession itself bears much of the responsibility for the current shortage of teachers. First and foremost, the nursing discipline itself remains extremely sexist. Despite decades of attempts to include more men into nursing, males remain at about 5% of all nurses nationwide. This is a classic case of reverse sexism, plain and simple. Part of the problem is the name of this discpline, i.e., the word NURSING. Only women are physically of, literally, nursing another person. This may seem a minor point, but it presents a tremendous psychological impediment to many men contemplating a career in nursing. Historically, many men who did enter the profession were, in fact, homosexuals. That is certainly no longer the case, but it’s effects remain within the culture. Anyone who saw the movie “Meet the Parents” knows that men in nursing still cause raised eyebrows. In summary, you cannot exclude one half of the population, as nusring has done historically, and not expect repurcussions in the marketplace.

My last point is on the closing down of hospital based schools of nursing. These diploma schools of nursing once were dominant players in supplying nurses to the country. Since 1975, in Pennsylvania alone, over 80 diploma Schools of Nursing have shut down leaving only about twenty in the whole state. At about 100 students per school, you can see the effect this would have on the nursing supply and that of nursing teachers after 30 years in just one state, Pennsylvania.

The leaders at the very top echelons of the nursing profession bear direct responsibility for this woeful lack of foresight and planning. I can understand their goal of “professionalizing” the discipline by making it more in line with commonly accepted educational models such as associate degrees, bachelors degrees. But to basically shut down one whole sector such as the diploma schools with no expansion in other programs such as associate degree programs, made very little sense...particularly since everyone knew for a fact, what that a huge shortage loomed once the boomers started retiring.

Bottom line is that the ‘Nursing Education Dilemma’ was self-induced by the sexism that continues to this day, and by very poor planning within the profession itself.

feudi pandola, at 9:20 am EDT on June 22, 2007

Working Conditions

One reason nursing faculty aren’t paid higher is because their other option is going into practice. Working conditions are cushy at colleges compared to hospitals. There is a trade-off: less money for better working conditions. Compare this to business professors who can make big bucks in the private sector. They, too, probably take a pay cut to work at a college, but again, they have better working conditions.

mjb7e, at 9:20 am EDT on June 22, 2007

CSE Launches New MSN Program

The College of Saint Elizabeth in Morristown, NJ, will be launching a new MSN program this fall 2007 within its adult division, the School of Graduate and Continuing Studies.

The 37-credit, cohort-based program is ideal for registered nurses who are seeking to prepare for certification from the National League for Nursing and provides the foundation for doctoral study.

Students can earn their MSN either in two years as a full-time student, or three years as a part-time student. Additionally, students can receive credits for their professional experience that will apply directly toward their degree.

For more information about this exciting new program, visit www.cse.edu/nursingmaster.

Courtney Smolen, Communication Specialist at College of Saint Elizabeth, at 9:35 am EDT on June 22, 2007

Money is part of it, but only part. Sure, when I was a full professor of classics in New York City and my wife was using her MS in nursing in a clinical job, she was earning more money than I was. But when she got her PhD and taught college courses, her workload increased exponentially. My three-credit courses required three classroom hours per week. Her clinical courses in psych nursing took an eight hour day each, required extensive daily writing assignments which had to be graded by the next meeting of the class, and involved extensive after class psych consultations with the students in order to assess the students’ interactions with their patients. Followed, of course, by the usual campus service and research demands that are part of every faculty member’s life. It didn’t take long for her to drop the teaching and return to clinical practice, which is, of course, why she went into nursing in the first place. Dollars are very important, but unless the “solutions” to the nursing problem also address workload and work quality issues, the solutions are unlikely to yield a remedy to the teaching shortage.

W. Toboggan, at 9:35 am EDT on June 22, 2007

Several years ago, New York State put in place a teacher loan forgiveness program to address just this problem. Nurses with graduate degrees who go on to teach rather than practice receive substantial student loan forgiveness. Unlike Colorado’s program, the full time teaching equivalent requirement can be comprised of several adjunct positions at different colleges.

freecollege, at 10:45 am EDT on June 22, 2007

Nursing Faculty

After 22 years of bedside nursing in med/surg, ICU, ER, high-risk OB and a management position in assisted living, I was recruited by my current employer. I was extremely well supported in continuing towards my MSN, which I was already in the process of completing. I’d never formally taught, but I was willing to learn, and the faculty and administration was willing to teach me. I have coursework towards an MBA, and my opinions in that area, as well as nursing and teaching are valued and sought after. Workload (classroom and clinical) and committee and service expectations continue to amaze my PhD English professor husband. Most weeks I am putting in well over 40 hours. Yet, I am repeatedly reminded within my profession that none of this would count in a “true” academic setting of a college or university, because teaching in diploma programs does not count! And then, of course, there’s the gauntlet of tenure. Faculty who have left colleges/universities and other dipoma programs to come teach with us have commented that their starting salaries with us are higher than the salaries they left behind. Faculty and administrators are well aware of the impact the nursing shortage is having at the bedside and in the classroom, and have taken on the challenge. It’s not just a matter of supply and demand, or “better” working conditions. I, for one, feel very valued where I am.

Linda, RN, Faculty at The Reading Hospital School of Health Sciences, Nursing Program, at 11:40 am EDT on June 22, 2007

It seems to me that the nursing faculty issue is very much like the general nurse supply issue of the 1980s: there’s an adequate potential supply, but the pay isn’t high enough to get them into the workforce.

Presumably there are plenty of experienced nurses who can’t live with the shift hours, have hurt their backs, etc., etc., and might well be prepared to enter teaching.

Unfortunately, the primary locus of nursing education has been shifted to exactly those institutions — community colleges and compehensive colleges — that are most resistant to differential pay (yes, this has something to do with historical gender roles).

Perhaps, then, the way to solve the problem is (a) pay nursing faculty better; and (b)make experienced nurses, not new entrants, the main focus of recruitment and training programs.

Mr Punch, at 11:40 am EDT on June 22, 2007

Online education options

I read this article with a keen interest in the topic. I believe a key route to expanding the number of nurse educators is through on line degree prorgrams. Most nurses seeking advanced degrees can not step out of their lives or their jobs to attend MSN or Doctoral programs. Online education affords the opportunity for nurses to continue practice and juggle school and home life. At Kaplan University we now have about 500 students in the BSN completion program. It is clear that many of these students intend to seek advanced degrees as well. Within the next 10 years, one in 5 students will be attending higher ed programs online. I believe it is a viable solution for nurses.

Diann Martin, Dean School of Nursing at Kaplan University, at 12:00 pm EDT on June 22, 2007

We also need to look at the clinical-academic relationships as we strive to increase the numbers of students we can educate. For us (PA) the state board does not mandate ratios, but our clinical sites do. For some areas we are working with 1:5 and 1:7 ratios. In piloting the possibility of graduate prepared nurses who work in clinical settings devoting one or two days a week as both students and the clinicians and an excellent educational experience as well. The question will be how generalizable this kind of model can be across institutions.

Jacqueline Dunbar-Jacob, Dean & Professor at University of Pittsburgh, at 1:05 pm EDT on June 22, 2007

Online education not the answer

I have taught nursing since 1978 in a variety of states and settings. I began teaching online courses or hybrid courses (part online and part in class) in 1995 so I have had an abundance of experience. Online teaching requires even more faculty time than does pure classroom teaching. Additionally, at the risk of offending some folks, I wonder about the quality of education provided by solely online education programs. Most students I have spoken with really need some face to face time with their teacher and their colleagues in order to not only grasp abstract concepts, but also to get socialized into the new role in which they are being educated- whether BSN, NP, MS educator or administrator, PhD researcher, educator, administrator etc. I agree with those who have stated that faculty salaries are the major problem keeping nurses out of academia. We recently lost an excellent faculty candidate to a research position due to the salary difference. Very sad.

A. Stiles, PhD, RN, Professor at Texas Woman’s University, at 1:05 pm EDT on June 22, 2007

unique issues in California

It is great to see that concerns within nursing education are being covered in your journal. We have very difficult issues in the state of California within the community college system as we are covered by an Open Access Title 5 state mandate. This statue mandates an open access, non-selective basis for accepting nursing students into Associate Degree RN programs in state based community colleges. We have been able to slowly push for a 2.5 minimum g.p.a. with a small amount of selective criteria such as limiting the number of science repeated courses; however, attrition continues to be a huge problem for this reason. A second major issue is that we are having difficulty maintaining current nursing education program directors in the associate degree programs and few qualified applicants are applying for open director positions. Some of the difficulities are that we have multiple position titles, varying job responsibilities and inadequate clerical assistance. My doctoral research looked at the critical issues in this group and results will be published in the near future. A third issue is that we are struggling with recruiting potential candidates into faculty positions for the reasons indicated in the primary article. Industry pays significantly better than academia and this continues to be national issue. We know the problems and issues. What are the answers? Here may be a few: 1) Regarding nursing students in California...we must continue to put pressure on our legislature to increase our admission requirments for associate degree level students. 2) The California nursing director position needs to be critically analyzed across the state and decisions made to solidify and contain this position within the associate degree programs. 3)We must do a better marketing campaign for nursing faculty and begin recruitment during Masters programs. Additionally, we need to “grow our own” from clinical adjunct part time positions into full time faculty.

Dr. Ronda Mintz-Binder, Dean of Nursing at Los Angeles City College, at 1:05 pm EDT on June 22, 2007

Nursing Faculty Shortages

Yes, this is an issue everywhere. Every semester we are hiring more part-time and full-time faculty to provide for our student’s education. However, no one has mentioned another concern we have about admitting additional students to our nursing programs. There is a shortage of available clinical experiences to provide for the professional training that nursing students require. We have several nursing programs in our area and every hospital and health care agency has the maximum numbers of nursing students training in their facilities. Because of this, we have placed students in clinical experiences on nights, weekends, and evenings. This is not a optimal solution because many MSN and PhD faculty are unable to work these hours. We also utilize simulation experiences for our clinical requirements. However, the simulation equipment is expensive and the use of simulations for clinical requires more faculty time. In addition, specialized training must be completed to make it simulation a meaningful learning activity.

Danette Wood, Associate Professor, BSN Program Director at Georgia Southern University, at 2:20 pm EDT on June 22, 2007

Morale issues?

Two tiny additions to what has already been said about the nursing shortage: Two family members complain to me at every family gathering, that because of the nursing shortage, they rarely are allowed to use their accumulated sick or vacation time. Travel to professional development or continuing education opportunities are out of the question.

Add those de facto discriminations on an already over-worked segment of the health care industry to a perceived lack of respect from hospital administrators, physicians, and other medical specialists, and it makes “quitting one’s profession” seem very attractive.

Good pay and benefits aren’t worth much if one isn’t ever allowed out of the mucky trenches to be at home or at the beach to enjoy those “benefits” and MUST drive in to work even in the worst weather.

Dr. F. Gump, at 11:30 am EDT on June 23, 2007

Nursing Faculty Problem

The comment made that the nursing profession bears much of the responsibility for this nursing faculty shortage is very on point -except the comments about the diploma nursing programs (this is a dead issue and the profession needs to close all the remaining ones only left in Ohio, PA and NJ). When the leading nursing organizations saw this looming crisis in the number of doctorally prepared educators — the American Association of Colleges of Nursing (AACN) in particular chose to focus on upgrading the MSN requirement for the advanced practice nurse to the Doctor of Nursing Practice (DNP) instead of focusing on the more critical important problem of the supply of preparing qualified dctorally prepared nursing educators. Having recently attend the Harvard University Fellowship on Innovation in Health Professions Education I would highly recommend our nursing leaders read Clayton Christensen’s “Seeing What’s Next.” And finally, it really is about the money. Unless the AACN & National League for Nursing puts a major focus on improving nursing faculty salaries by putting this requirement in their re-accreditation criteria, we are going to be in for some well deserved sad times.....

H. Michael Dreher, Director of Doctoral Nursing Programs at Drexel University, at 9:45 pm EDT on June 23, 2007

Sometimes it is the Academy

I am a faculty member at a small private college that houses a BSN and MSN program. I have taught for 6 years and I am resigning in 20 days. I am young and have a desire to be a Nurse Practitioner. In my experience this is under valued in nursing education. I decided to pursue a post masters in Advance Practice Nursing and then pursue a doctorate. The doctorate that I selected a DNP is not supported. I am a clinically focused nurse. I value the idea of remaining clinically component at the bedside if one is going to teach nursing. In my experince as a student and an educator this is apparent when “one teaches and has no idea how to do.” This “set mentality” is what is causing me leave nursing education. It is a shame, I have been nominated many times for outstanding teaching and advising awards. I can not be made to feel “devalued” by my peers and continue to be a member of the academy. The reality is I can double my income when I finish my FNP program in 2 quarters. I feel that once “nursing” excepts all nurses the clinical experts and the researchers, the decline in nursing educators may subside.

Kermit MSN, RN, RN, MSN, at 9:45 pm EDT on June 24, 2007

Messed up priorities

We have billions — no, trillions — for the Iraq war and oil company subsidies, but yet a nursing shortage and millions of uninsured young children in this country alone (where is your Christain compassion?). This story is a sad, pathetic statement on the leadership of this country.

PS, at 4:35 am EDT on June 25, 2007

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