Nursing schools can't meet the demand for education

As faculty chair at the University of San Francisco’s School of Nursing, Sister M. Ellene Egan has definitely noticed some changes at the school over the past two years. There are more people interested in becoming nurses, but the school is finding it harder to fill positions necessary to teach them, says Sister Egan, an assistant professor of nursing and a member of the university’s Faculty Association.

When enrollment was down, the school lost a number of tenure-track positions. Now that enrollment is up again, the positions have been restored but it has been difficult to find candidates to fill them, says the native San Franciscan who has been a member of the faculty since 1979. The lack of instructors has gotten more serious in the past two years, she says, with the school forced to cancel clinical sections because it couldn’t find anyone to teach them.

What Sister Egan is seeing locally is being played out at colleges and universities across the nation. The increased awareness of a national nursing shortage has caused enrollment in nursing schools to soar, but a shortage of faculty is one of the main reasons thousands of qualified applicants are being turned away. Other reasons, of course, hamper efforts to engage more students—funding cuts, competition for students and a lack of clinical placement opportunities—but the lack of faculty is the most serious.

According to the American Association of Colleges of Nursing (AACN), while enrollment in entry-level baccalaureate programs in nursing rose by 14.1 percent in fall 2004, colleges and universities rejected more than 32,000 qualified applicants, primarily due to a shortage of nurse educators. The loss is disturbing, considering that the federal government has projected a shortfall of 800,000 nurses by 2020.

The shortage has been going on for some time, says Linda Berlin, AACN’s director of research. "It’s just starting to get attention because the lack of faculty has impacted nursing school enrollment," she says.

The roads that have led to the nursing and nurse faculty shortages run parallel. Nurse educator programs began to shrink in the early 1980s at the same time the lack of practicing nurses became a national priority. Money for nurse education was diverted to clinical nursing in an effort to get as many students as possible trained—at the associate and bachelor’s levels—and into practice. There was little financial incentive for students to pursue the master’s or doctoral degrees that nurse educators need. The result: Fewer students went out for advanced degrees, and the majority of faculty are now nearing retirement age.

As AFT Healthcare’s division director, Mary MacDonald, puts it: "We are on the leading edge of the shortage, and the problem is having a ripple effect on collective bargaining as well as our ability to push for nursing legislation, such as limits on mandatory overtime."

The backlog of students trying to get into nursing schools prompted the AFT to look at the situation more closely, says Candice Owley, chair of AFT Healthcare’s program and policy council, and an AFT vice president.

Recently, AFT Healthcare joined with AFT Higher Education to form the AFT nurse faculty shortage task force. The group met in February.

"More people are learning about the nursing shortage and want to become nurses, but the fact is that we can’t get them through the system fast enough," says Owley. "In some cases, students are on wait lists for years. We have to make sure we have strategies in place to increase our capacity to produce more nurses."

"It’s important to analyze why we have the shortage," adds Anne Goldman, a special representative for the Federation of Nurses/United Federation of Teachers and a member of the AFT task force.

"If you have people waiting three or four years [to get into nursing school], it delays our ability to address the nursing shortage. We must move the agenda forward by creating an awareness of the problem and build support for nurse education programs."

Start with compensation

Many task force members say the union can address the major obstacle to becoming a nurse educator: pay. Most students in today’s nursing programs are taking the clinical track because teaching just doesn’t pay enough. Consequently, schools are losing candidates to higher-paying jobs in hospitals, private practice, research, management and pharmaceutical companies.

"Nurse practitioners are being hired at $75,000 to start. All I can offer them is $48,000," says Jane Williams, chair of the nursing department at Rhode Island College in Providence, a member of the college’s AFT chapter and part of the task force.

Rhode Island College also has seen a dramatic increase in the number of applicants. So far, the college has been fortunate. "We have a full staff now, but there are a lot of faculty who are getting ready to retire. Looking toward the future, we will have vacancies," says Williams.

That’s where the union comes in. The union can have the most influence on salary and benefits, say task force members.

"Unions can play a very important role in addressing the nurse faculty shortage," says Williams. "We need to properly fund nursing education through competitive salaries, and we can help expand nursing education programs. We must put pressure on funding agencies so we can have enough nurses in this country. Otherwise, healthcare will suffer."

"Salary is the key and it needs to be looked at," agrees Sister Egan. Compensation will certainly be part of the conversation when the union and university go into negotiations this summer. Sister Egan says the union will likely encourage the University of San Francisco to address the lack of instructors at its School of Nursing by doing the same thing that business, law and engineering schools do: paying more for hard-to-fill positions.

The task force also wants the national union and state and local affiliates to advocate for legislation that benefits nursing education, including increased funding for federal Nursing Workforce Development programs.

"We will need the support of the union to go to our state legislators and make the case for more funding to recruit nurse educators," says Williams.

Then get creative

Nursing schools also are finding more creative ways to accommodate more students. Many schools are forming partnerships with hospitals and other healthcare facilities to support mutual needs and bridge the faculty gap. For example, the nursing school at the State University of New York (SUNY) in Stony Brook has partnered with its own University Hospital Medical Center, one of the best major teaching hospitals in the country, to produce more nurse educators.

The nurses not only have the opportunity for clinical practice, but they also are encouraged through scholarships to earn advanced degrees, says Ora James Bouey, assistant dean and director of international nursing studies at SUNY’s nursing school.

"It is a mutually beneficial partnership. Many of our students stay and work at the hospital and return to school," says Bouey, a member of United University Professions/AFT.

Mentoring students and encouraging them to consider teaching is another important strategy. Most nurses who enter the workforce through pre-baccalaureate programs do not advance their education beyond the minimal preparation required for licensure, says Geraldine Bednash, executive director of AACN. "As educators, we must encourage all nursing students to further their education in the interest of providing the best nursing care possible."

"Mentoring has to go on for the future of the faculty. We focus on that, even if it’s not exactly official," says Sister Egan, who is always careful to encourage students she believes would thrive at teaching. "I tell them that I hope they’ll return to teach, and some do."

The bottom line is "we are losing faculty we can’t replace, so we have to get as many people as we can prepared to teach," says AACN’s Berlin. "You can’t increase the supply of nurses without increasing the supply of nursing faculty."