Fall 2007 Issue
Nursing's Next Crisis
While the media focuses on the national nursing shortage, little attention has been paid to an equally severe shortage of nursing faculty
By Mike Laderman
Mary Margaret Collins could easily be a spokesperson for the nursing profession. During the course of her 50-year career, the Barry University Division of Nursing graduate has worked as a staff nurse in medical and surgical units, served as a staff nurse at a construction site and worked in home care, both as a nurse and as an area supervisor.
Collins, 72, now volunteers at a senior center in Midland, Michigan. She takes blood pressures, works as a part-time replacement for the regular dementia daycare center nurse and is a volunteer teacher of a caregiver class.
But within today's nursing profession, people such as Collins — nurses who have both continued on within their profession and also taught at universities and colleges — are few and far between. This shortage is one part of a three-pronged problem plaguing the nursing profession and, consequently, the health care industry as a whole: not only is there a shortage of nurses within hospitals and medical offices, but there is also a lack of qualified faculty within the nation's higher education system to teach a new wave of students. The faculty shortage, in turn, is growing as fewer nurses choose to pursue advanced academic degrees.
While media stories tend to focus on the overall nursing shortage, what is lost in translation is the age-old "chicken and egg" question: If there are no teachers to educate the nursing students, how can there be nursing students graduating into health care careers? And if there are no educated nurses with bachelor's, master's and doctoral degrees, then who will be teachers in the future?
"You can't talk about one issue without talking about the other issues," said Barry University's Dean of the Division of Nursing Dr. Pegge Bell. "There is little interest in becoming a nurse educator nowadays, either because it's not emphasized during one's nursing program, or because the appeal of working in community settings or hospitals with hi-tech environments is much greater."
Bell recently addressed the issue as a featured speaker at the 5th Annual Conference of State Nursing Workforce Centers in San Francisco in June. "We are not producing a significant number of future faculty, so we can't meet the current or projected demands of the health care industry. This faculty shortage is fueling a health care crisis. Projections for supply-and-demand are way off the mark," she said.
It is, as Bell calls it, a vicious cycle within health care. Organizations across the country, from the Florida Hospital Association to the American Association of Colleges of Nursing, are asking schools of nursing to produce more nurses to meet the shortage. At the same time, state legislators are being asked to fund initiatives that, Bell says, will lead to the expansion of nursing programs. Yet the colleges and universities maintain that they can't adequately meet that demand, unless they have more qualified faculty.
"[The faculty shortage] is clearly a significant problem in the state," said Mary Lou Brunell, executive director of the Florida Center for Nursing. "Just a few months ago, [the FCN] conducted a survey of nurse education programs where we asked three questions: how many vacancies they have; how many faculty are retiring this year; and what additional number of faculty would they need just to attend to the current student population. The responses were telling. Approximately 240 faculty positions are vacant. Now, obviously, that's far less than the amount of vacancies that many hospitals are experiencing. But there will not be a production of new nurses without replacement of the faculty."
According to the American Association of Colleges of Nursing's report on 2006-2007 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, almost three quarters (71 percent) of the nursing schools responding to a 2006 survey pointed to faculty shortages as a reason for not accepting all qualified applicants into entry-level nursing programs. The report went on to state that "U.S. nursing schools turned away 42,866 qualified applicants from baccalaureate and graduate nursing programs in 2006 due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors and budget constraints."
"All efforts to address the national shortage of registered nurses will fail unless solutions to the nurse faculty shortage can be found," said AACN's Executive Director Geraldine "Polly" Bednash, Ph.D. "Faculty shortages at nursing schools across the country are limiting student capacity at a time when the need for professional registered nurses continues to grow. Budget constraints at schools of nursing, an aging faculty, and increasing job competition from clinical sites have contributed to this crisis." The growth of nursing programs at two-year community colleges has helped to alleviate the nursing shortage in many states, according to Bell. However, very few of those nurses ever go on to achieve graduate education and become nursing faculty. So while community colleges appear to be reducing the nursing shortage by producing large numbers of graduates, they are actually creating a situation where more faculty is needed, she said. "It's all tied in together," Bell said. "The state wants and needs more students to enter the programs, but we can't realistically do that. Every time a school does expand, or a new school is created, to meet the demand, they are literally taking from the small pool of faculty that exists."
The shortage also puts an added pressure on existing nursing faculty who may delay retirement, knowing there is no one to replace them. "I love what I do, but I also realize that I need to try to stay working because there's such a shortage," said Dr. Sandra Walsh, a professor at BU's Division of Nursing. "I'm still in it for all the right reasons, but I also have a sense of urgency, because I am 69 years old… I'm trying to mentor new faculty, to encourage people to go back to school, to be nursing teachers, or to teach and take my place. And I'm also trying to keep others my age from leaving until we have people who can replace us."
Although Walsh, and those like her, remain the best hope of alleviating the problem in the short-term, they still represent a stop-gap measure rather than a long-term solution, according to Brunell. "We need to look at how we facilitate associate degree nurses; so that they want to seek the baccalaureate, so they'll want to seek a doctorate, so they can eventually teach," she said.
The AACN cites Nursing Outlook magazine, stating the average age of nurse faculty at retirement is 62.5 years. With the average age of doctorally-prepared faculty currently 52.5 years, a wave of retirements is expected within the next 10 years, which poses the continuous question: Who is there to replace those who retire?
The answer, according to Bell, is right in front of them.
"The boomers have all these years of experience working anywhere and everywhere. They have moved around from position to position and can bring all of that wealth of knowledge into the classroom," Bell said. "[They] have much to give nursing education, and they would be very valued by eager nursing students who want to hear about the world of nursing."
"We have to make a career as a nurse educator as crucial to health care as a nurse who works on an organ transplant team," she added.