With the current nursing shortage at an all time high, government agencies are scrambling to attract people into the nursing profession in never before heard of ways. According to the United States Bureau of Labor Statistics, approximately 1 million new and replacement registered nurses will be needed by 2010 as the demand for acute and long term care for the baby boomer generation increases (Whitlinger, 2004, p. 15). Recognizing the dire need for more nurses, the federal government passed the Nurse Reinvestment Act of 2002. This act appropriated funding for the promotion of the nursing profession through public service announcements, loan repayment programs, scholarships, and grants. Fortunately, the efforts of this program have not gone unnoticed and nursing schools all across the nation are receiving applications for admission in record numbers. Many would assume with the increased admissions to nursing schools that we all could breathe a collective sigh of relief. However, an even bigger problem is now plaguing the nursing profession and it has the potential to create dire consequences if we fail to address it immediately. We now must answer the unthinkable, “Who will be there to teach?”
Problem Identification and Significance
The realization of a pending nurse faculty shortage came to the forefront in 2001. In her article The Shortage of Educationally Prepared Nursing Faculty, Dr. Ada Hinshaw pointed out that the amount of nurses selecting academia as a career has declined. Advanced opportunities within the profession such as the nurse practioner or clinical nurse specialist role, the lack of competitive salaries for educators and the high expectations that are placed on those in academic positions have been stated as reasons for not entering academia (Hinshaw, 2001, p. 1). A shortage of faculty would create a negative impact on the profession as a whole. The lack of qualified nurse educators means that fewer nurses can be educated, the development of nursing’s scientific knowledge base will decrease and there will be fewer nursing leaders available to shape public policy at all levels (Hinshaw, 2001, p. 1).
In 2002, the Southern Regional Education Board released results from a study that was conducted on the nurse educator shortage. They found that for the 2001-2002 academic year there were only twenty-eight doctoral and 209 master’s graduates nation wide who received formal educational preparations. The study also found that there were 432 educator vacancies, 342 resignations, and 144 retirements. It was also estimated that by 2006 there would be 784 educators eligible for retirement (Southern Regional Education Board, 2002, p. IV).
The American Association of Colleges of Nursing (AACN) released a report in 2004 describing the scope of the shortage. They found that in the 2003-2004 academic year 15,944 qualified applicants to nursing schools nation wide were turned away because of a lack of qualified faculty available to teach (AACN, 2004, p. 1). It was also discovered that there were 614 vacant positions for faculty in 300 schools nation wide and that 59.8% of those reported vacancies were for doctorate positions (AACN, 2004, p. 1). As of December 2005, the AACN reported that 32,617 applicants were denied admission to nursing school simply because there was not enough qualified faculty to teach them (AACN, 2005, p. 1). Based on this information it is clear to see that we are indeed in a dire situation.
Factors Contributing to the Nursing Shortage
The main reasons for the shortage include issues such as faculty age, retirement, salaries, the cost and time of returning to school for an advanced degree, and opportunities elsewhere in the profession for advancement. Each of these issues has been cited throughout the literature consistently since 2001. Because these issues are so complex it is easy to understand just why solving the faculty shortage has been such a difficult task. However, in order to begin to develop potential solutions one must first understand each of these contributing factors.
According to the AACN, the average age of full-time doctorate faculty was 51.5 years and full-time master’s faculty was 49.0 years (AACN, 2004, p. 2). Due to the age of the current faculty pool, a wave of retirements is expected within the next 10 years. Approximately 200 to 300 doctoral faculty will be eligible for retirement from 2003-2012 followed by an additional 220 to280 master’s faculty from 2012-2018 (AACN, 2004, p. 2).
Unfortunately, programs across the nation are not producing enough doctoral and master’s graduates prepared in academia to compensate for the loss of faculty due to retirements. During the 2003-2004 academic year only forty-four doctoral and 251 master’s graduates were prepared to assume educator roles (AACN, 2004, p. 2). According to Judith Shindula-Rothschild, RN, PhD, “The typical pattern to turn an RN into a PhD goes like this: You graduate and go to work. Then you decide upon a specialty and pursue an MSN. You go back to work again. By the time you take the PhD plunge, you’re in your mid to late 40’s. You graduate around 50, begin teaching and 10 to 15 years later, retire” (Whitlinger, 2004, p. 17).
Salary discrepancies are another reason for the shortage of nurse educators. The average salary for a clinical nurse is much higher than that of an educator. On average, faculty that hold a doctoral degree earn between $53,355 to $61,000 annually whereas faculty that are masters prepared receive $45,214 to $49,546 annually (AACN, 2003, p. 6). Nurse practioners on the other hand were reported receiving an average of $80,697 annually according to a 2003 National Salary Survey of Nurse Practioners (AACN, 2004, p. 2). Even a new graduate nurse receives higher pay than most experienced faculty, earning anywhere from $50,000 to $70,000 annually (Whitlinger, 2004, p. 16). Because the salaries of educators do not even come close to being competitive with those offered in the clinical sector it is difficult to attract registered nurses into the academic setting.
The cost and time it takes to receive an advanced degree in nursing is another factor that is contributing to the current shortage. It takes on average eight years to complete the progression between master’s and doctoral programs in order to obtain faculty status (Whitlinger, 2004, p. 17). Tuition is also expensive and can range from $3,659 in a public institution to $11,000 in a private one (AACN, 2003, p.7). Not included in these figures are the added costs for books, thesis/dissertation supplies, transportation and the loss of income in order to take a full course load. Also compounding the problem is the fact that most nurses who are returning to school do not qualify for any type of grants to assist with tuition, thus forcing them to rely upon additional student loans to cover the cost of expenses.
Opportunities for alternative career paths are also having an impact on the amount of potential faculty. Since the mid 1990’s there has been a decline of graduates prepared to assume a faculty role. Today almost 66% of all graduates from programs nation wide have been trained as either nurse practioners or clinical nurse specialists (AACN, 2003, p. 26). Because of the increased autonomy and high salary that these two alternatives offer it is easy to understand why few willingly choose the nurse educator role.
Existing Policies Addressing the Faculty Shortage
During the nursing shortage of the 1970’s the federal government passed the Nurse Training Act of 1971 and 1975. This act appropriated funds in the form of Catpitation Grants. These grants were based on the actual number of students enrolled in a program at the time a request was submitted (AACN, 2006, p. 1). The Capitation Grants provided nursing institutions with $400 for each baccalaureate student, $275 for each associate degree student and $275 for each diploma student who was enrolled on a full-time basis (AACN, 2006, p. 1). These funds could be utilized by nursing schools at their discretion in areas of greatest need. Institutions used the monies to hire new faculty, equip learning/audiovisual laboratories, enhance clinical laboratories and recruit students (AACN, 2006, p. 1). Schools were eligible to receive grant monies from 1971 to 1978 and the result was increased enrollments to nursing school and resolution of the nursing workforce shortage.
The appropriations for Capitation Grants were widely supported during this time. In fact, the Institute of Medicine released a report in 1974 endorsing these grants stating that they were, “an appropriate federal undertaking to provide a stable source of financial support for nursing and other health profession schools” (AACN, 2006, p. 1). Capitation Grants were endorsed a second time in 2002 by the Health Resources and Services Administration. They recommended the use of these grants once again, “as a strategy to expand the nursing workforce pipeline” (AACN, 2006, p. 1).
By 1999, it was obvious that once again a shortage of nurses loomed on the horizon but this time was different. Along with the realization that yet another shortage of nurses was about to occur, evidence began to emerge that there would soon be a shortage of nursing faculty also. It was not until 2002 however that the federal government answered the outcries of nursing leaders by finally signing the Nurse Reinvestment Act of 2002. This bill was highly anticipated and really pushed the benefits of the nursing profession to the forefront. Because of the funding it provided to establish not only public service announcements such as the “Dare To Care” campaign which touted the glory of the nursing profession but also loan repayment and forgiveness programs as well as scholarship opportunities, nursing schools nation wide began to see huge influx of applications for admission (Library of Congress, 2006d, H. R. 3487).
Appropriations in the Nurse Reinvestment Act addressed the issue of nursing faculty but not as outwardly as it did the overall nursing shortage. Within the bill was a program that offered loan repayment opportunities for those wishing to return to school with the sole intention of entering the academic side of nursing. Information regarding this program is imbedded deep within the bill itself and has not been widely publicized.
The Nurse Faculty Loan Program provides funding directly aimed at increasing the number of nurse educators. In order to be eligible for the loan, the institution in which the student is enrolled applies directly for the loan on the students’ behalf. Amounts up to $30,000 per year are awarded directly to the institution to cover the cost of the student’s tuition and expenses. In acceptance of the loan, the student agrees to teach as a nursing educator for four years following graduation. For each year that is completed upon the loan contract the government forgives up to 25% of the loan value for a total of 85% forgiven by the end of the term. The remaining 15% of the loan value is paid out in equal payments by the student.
In 2004-2005 academic year $3,000,000 was allotted for this program (Nurse Faculty Loan Program, 2006). While this program seems like a fail proof solution, little has been done to publicize it. In fact few institutions are even aware that the program exists. How can we expect to attract registered nurses that might be considering a role as an educator if programs such as this one are not even advertised?
Several states have introduced legislation strictly addressing the faculty shortage and Texas is taking the lead on this issue. In 2005, Texas governor Rick Perry signed into law Senate Bill 132. This bill has two provision directly aimed at attracting more registered nurses to step into the educator role.
The first provision allows for the child age twenty-five and younger of master’s or doctoral prepared nursing faculty to attend college at the institution of which she is employed tuition free. Secondly, the bill provides low cost home loans to nursing faculty if they are qualified first time home buyers (Texas Legislature Online, 2006, S. B. 132). Once again, the provisions stipulated by this bill are enticing however a major loophole still exists. Many nurses that have decided to return for advanced degrees and enter into the academic realm are older, have already had children go off to college and purchased their first homes.
Congress Heads the Call for Educators
After many years of tireless efforts on the part of the nursing community, congress has finally realized the shortage of nursing faculty is indeed a grave problem that must be addressed. On July 28, 2005 Mrs. Nita Lowey (D-NY 18th) along with 36 co-sponsors introduced the Nurse Education, Expansion and Development Act of 2005 (H. R. 3569). This act is designed to award schools of nursing Capitation Grants under the direction of the Health Resources and Services Administration (HRSA) in order to increase the number of nursing faculty and students. This bill was sent to the House Subcommittee on Health where it is still under review today. Both the American Association of Colleges of Nursing (AACN) and the National League for Nursing (NLN) support this bill.
The provisions of this bill if passed are very similar to those of the Nurse Training Act of 1971 and 1975. Again schools of nursing are charged with utilizing the funds to “increase the number of faculty and students at the school, including by hiring new faculty, retaining current faculty, purchasing educational equipment and audiovisual laboratories, enhancing clinical laboratories, repairing and expanding infrastructure or recruiting students” (Library of Congress, 2006a, H. R. 3569).
Under the direction of the HRSA, this bill would appropriate $75,000,000 for fiscal year 2006, $85,000,000 for 2007 and $95,000,000 for 2008. In order to be eligible for the program schools must be accredited by an agency recognized by the Secretary of Education, have a passage rate on the National Council Licensure Examination for Registered Nurses (NCLEX-RN) greater than 80% and have a graduation rate greater that 80% for the three years prior to application for grant funds (Library of Congress, 2006a, H. R. 3569). Funds would be dispersed in the following fashion:
1. $1,800 for each full-time or part-time student enrolled in a graduate program that leads to a master’s or doctoral degree and prepares the individual for the nurse educator role
2. $1,405 for each full-time or part-time student enrolled in a baccalaureate degree program
3. $966 for each full-time or part-time student enrolled in an associate degree program (Library of Congress, 2006a, H. R. 3569).
In acceptance of the grant funds, the school would agree to maintain the above mentioned criteria along with evidence that they were increasing their enrollment by 5% for each academic year. Schools would also be expected to formulate and implement two of the following plans with in one year of receipt of the grant:
1. Establish or expand an accelerated baccalaureate program that would graduate students in 18 months
2. Establish an interdisciplinary program with other schools of nursing utilizing shared use of technological resources
3. Establish interdisciplinary education amongst schools of nursing, allied health, medicine, dentistry, osteopathy, optometry, podiatry, public health, veterinary medicine, for the use of a team approach for the delivery of healthcare services
4. Develop core competencies based on evidence based practice, quality improvements and patient-centered care
5. Increase admissions, enrollment and retention of minority students and those that are financially disadvantaged
6. Increase enrollments of newly graduated baccalaureate students directly into graduate programs designed for nurse educators
7. Formulate residency programs that aide in preparing the newly graduated nurse for practice in specialty areas
8. Integrate geriatric nursing into the core content curriculum
9. Develop partnerships with economically communities in order to provide nursing education (Library of Congress, 2006a, H. R. 3569).
It is also proposed in this bill that if passed the Comptroller General will conduct a study looking at ways to encourage nurses to enter academia. Findings of the study are to be reported to the Congress no later than one year after signing of the bill. Included in this study will be a list of master’s and doctoral degree programs that are successful in placing it’s graduates into the faculty role and examinations of the salary discrepancies between nurses, advanced practice nurses and nursing faculty (Library of Congress, 2006a, H. R. 3569).
Given the fact that the use of capitation grants has a history of being a proven solution to past nursing shortages, one would think that the passage of this bill would be swift and sure. Both the AACN and NLN publicly support this bill and are actively lobbying for its passage. Unfortunately government is likely to drag its proverbial feet in getting this bill passed anytime soon. It could be easily argued by the government that due to issues such as healthcare finance reform, social security woes Medicare/Medicaid cuts, prescription drug coverage costs for seniors, the war on terrorism, and soaring national debt that the funding for this program is simply just not available. It is imperative though that we as a profession unite and get this bill passed. Without the provisions provided by this bill the nursing profession will be left in dire straights and ultimately patient care will suffer. The federal government needs to understand that this issue will affect not only them personally but their families also if not passed.
In addition to H. R. 3569, two other bills have also been introduced as possible solutions to the faculty shortage. The Nurse Faculty Higher Education Act of 2005 (H. R. 3173) was introduced on June 30, 2005 and is supported by twenty-two sponsors. If passed the bill would enact a pilot program that would provide scholarships to nurses seeking advanced degrees in order to teach nursing. Under the plan a total of $10,000,000 would be appropriated for 2006 with additional monies being appropriated over the succeeding five years as needed. Currently this bill is under review by the house Subcommittee on Select Education and no action has been taken regarding it (Library of Congress, 2006b, H. R. 3173).
A second bill entitled the Nurse Faculty Education Act of 2005 (S. 1575) was introduced on July 29, 2005 with seventeen sponsors. This bill proposes awarding of grants to schools from states with the lowest number of employed nurses per 100,000 populations. Funding in the amount of $100,000 would be awarded to ten schools for fiscal years 2006-2010 (Library of Congress, 2006c, S. 1575). Institution awarded the grants monies would be required to utilize the funds to:
1. Hire new faculty, retain existing faculty, and purchase educational resources
2. Increase enrollment and graduation rates from doctoral programs
3. Assist graduates in finding faculty positions in nursing schools (Library of Congress, 2006c, S. 1575).
While these programs are solid and directly aimed at addressing the nursing shortage, they fail to include the option of utilizing the funds for master’s level education. Promoting the idea that one must first obtain a doctoral degree in order to secure an entry level position into nursing academia is absurd. Not only does this degree require initial completion of studies at the master’s level, it eliminates the utilization of the master’s level prepared nurse as faculty who with their experience and education are just as qualified to instruct at the baccalaureate level. If we waited for every nurse that wished to enter into nursing academics to finish the eight or more years that it takes to obtain a doctorate degree we would be wasting precious time and resources.
Another option would be to appropriate funding strictly for the use of public service announcements. Following in the footsteps of the widely popular “Dare to Care” campaign supported by Johnson & Johnson, perhaps announcement could be developed that tout the benefits of the nurse faculty role. Nursing schools continue to see an enormous number of applications for their programs as a direct result of this tactic and it could work for nursing academics also if approached correctly.
The utilization of the Perkins Loan Program needs to be considered as an option. Under this program a nurse is allowed to place her loans into a forgiveness clause if he/she is willing to work for a specified amount of years in a medically underserved region. After completion of the time required the loan amounts are completely forgiven. This program could also be a viable option for the person who wants to return to school but does not wish to tale out additional loans to finance graduate education. Forgiveness of these loans could be made available if the nurse is willing to serve as nursing faculty for a specified amount of time.
Nurses who are currently enrolled in a master’s level program that is preparing them for the educator role could also be used as adjunct staff. Several states have clauses within their individual board of nursing regulations that allow institution to apply for emergency faculty waivers so that these students can function within the faculty role before completion of a program. Perhaps all states would be willing to utilize this option to increase their faculty pool.
It has also been suggested that new graduate nurses be allowed to apply and be accepted directly into graduate level programs. While this may seem like a plausible solution that would possibly attract younger faculty it is not a well thought out plan. New nurses are novice in their skills and level of overall comfort within the profession. How can we expect them to be effective teachers of nursing art and science if they lack the level of comfort and expertise that more seasoned nurses have? It is unreasonable to expect any one to follow the “see one, do one, teach one” method when it comes to training our future generation of nurses.
Finally, the issue of salary discrepancies must be addressed. Nursing faculty are indeed advanced practice nurses just as nurse practioners and clinical nurse specialists are. Instead of being charge with providing primary care to patients, faculty is given the difficult task of teaching the art and science of nursing. Someone who has chosen the faculty role should not have to accept a pay cut in order to teach. If salaries were higher nurses would not have a problem with entering this critical role.
In order for H. R. 3569 or any of these other alternatives to work information must be made available to not only the institutions themselves but to financial aide officers as well. All of these programs could and probably would work only if the public was aware that they existed. It is no longer enough to assume that someone will just stumble across a program offering aide during a session on the internet. Detailed information is necessary so that those who are considering entering back into school are aware of all the options and feel less financially burdened when the decision to further education is made. Sources of guaranteed financial support and improved salaries are a must to give nurses the push that they need to enter into academia.
It is evident that we are indeed in a nurse faculty shortage. In order to entice more nurses into the academic side of nursing, funding must be appropriated. Failure to address this issue will indeed have grave consequences on not only the profession but on society as well. Kelly Amtmann, MSN, RN, FNP summed up the real seriousness of the faculty shortage best when she said, “What are we going to do when we don’t have enough nursing faculty? The quality of nursing programs will be affected and it will trickle down to the quality of care patients receive” (Trossman, 2002, p. 23). Maybe we should all heed Ms. Amtamann’s warning and work together to get this issue resolved once and for all.