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Who Will Teach the Nurses?
The shortage of nursing faculty is a growing problem that will affect us all.
By Susan A. LaRocco
By the late 1990s, health-care policy analysts and nursing administrators were worrying publicly about an impending nursing shortage. Many had experienced nursing shortages before, but the nature of this downturn differed from the cyclical fluctuations that had occurred in the past. Enrollments in baccalaureate nursing programs were falling off; indeed, they had dropped for six consecutive years by 2000. Meanwhile, the average age of nurses edged upward. By 2000, only 9 percent of the total population of registered nurses was under age thirty, compared with 25 percent in 1980. More alarming, the average age of graduates from all nursing programs had risen to thirty-one; in 1984, it had been twenty-four.
Other troublesome signs included the fact that in 2001, 68,709 candidates took the registered-nurse licensing exam, whereas only six years earlier, more than 96,000 had completed the test. Similarly, a 1999 study found that only 5 percent of women in their first year of college and fewer than 0.05 percent of men identified nursing among their top career choices. In 2002, the American Hospital Association reported 126,000 nursing positions unfilled at hospitals across the country. In addition, vacancies in nursing homes, home-care settings, and other outpatient venues had increased significantly. In the mid-1990s, the government projected a shortage of 291,000 registered nurses in the workforce by 2020.
The aging of the U.S. population can only exacerbate the problem. Just as nurses from the baby-boom generation leave the workforce, the baby-boom population will demand more extensive medical and nursing care, intensifying the crisis in health care now affecting this country. A 2002 report by a commission on accreditation of health-care organizations found that low nurse staffing levels had been a factor in 24 percent of “sentinel events,” or unanticipated occurrences that result in death, injury, or permanent loss of function.
Recruitment and Retention
Those with a stake in solving the nursing shortage focused initially on improving recruitment and retention of nurses and ensuring a safer work environment for them. In 2002, Johnson and Johnson, the manufacturer of health-care products, launched a multi-million-dollar campaign to improve the image of nursing. It featured television advertisements and a Web site (discovernursing. com) offering information about nursing as a career, including salary details and links to schools of nursing and scholarships. The firm aimed to show nursing as a well-paid profession for men and women as opposed to a poorly paid women’s job. After all, the U.S. Bureau of Labor Statistics reported that in 2002 nurses had earned significantly more than police officers, dieticians, and teachers. Nurses, with an annual median income of almost $50,000, made almost $11,000 more than social workers.
The public education campaign seemed to have an effect. In 2002, 1,800 more candidates took the registered-nurse licensing examination than had completed it the previous year. In 2003, the numbers increased to the 1999 level—which still lagged behind the 1995 level by 20,000. From 2002 to 2004, accelerated programs increased by 46 to 151. These programs allow students with a baccalaureate degree in another field to complete an intensive nursing course in twelve to eighteen months. The rising interest in nursing as a career was a relief to those of us in healthcare institutions, and we hoped that the nursing shortage would be contained. Our sense of relief was, however, short-lived. Although the trend was in the right direction, the improvement in numbers was insufficient. We realized that we had to shift our focus from recruitment and retention in the profession to recruitment and retention among those who make the profession possible—nursing faculty.
Nursing Faculty
In 1999, most deans of nursing schools that belonged to the American Association of Colleges of Nursing reported that they did not have a faculty shortage. By 2005, however, 75 percent of U.S. nursing schools cited faculty shortages as the major reason for denying admission to qualified students. The average age of nurse educators holding PhDs is almost fifty-four; the average age at which nursing faculty members retire is sixty-two and a half. In addition, the small numbers of graduates from nursing doctoral programs (just over four hundred annually), and the fact that only about three-fourths of them say they will seek a faculty position, make it clear that we will face a major shortage of nursing faculty for many years.
Because of the clinical component of nursing education, nursing programs require significant numbers of faculty. Beginning in the sophomore year, nursing students typically spend six to twelve hours a week in a hospital or other practice setting under the direction of a faculty member. The ratio of students to faculty is usually about eight to one. Specialty practices, such as pediatrics, may allow a nursing instructor to supervise only six students. Part-time clinical faculty provide the bulk of this labor-intensive supervision. They select the students’ patient assignments and correct their weekly patient case studies.
Although individual state boards of nursing regulate nursing education, clinical instructors must have a master’s degree in nursing in most states. In 2002, however, because of the shortage of qualified faculty, Massachusetts began to allow schools to obtain a waiver of this regulation. Nurses holding bachelor’s degrees with at least five years of full-time experience, those with master’s degrees in fields other than nursing, and nurses enrolled in master’s degree programs in nursing can be hired to teach in the clinical setting. Qualified (that is, master’s prepared) faculty must supervise these instructors who have a waiver, which adds to the faculty members’ workload.
Setting aside workload, one reason nurses may hesitate to join a nursing faculty is salary. The pay of nursing faculty has lagged behind that of clinical and administrative nurses. A recent report by the Massachusetts Board of Registration in Nursing stated that twenty-one of thirty-one nursing education programs cited salary as the most significant factor affecting faculty recruitment. In a typical Boston teaching hospital, the salaries of clinical nurses range from $54,000 to well over $100,000. These clinical nurses need only a bachelor’s degree. By contrast, the 2005 AAUP survey of faculty compensation reported that the average salary of a full professor at a baccalaureate institution was $74,408; the average salary of an associate professor was $57,468.
A nurse would only have to look at the Web site salary.com to determine that pursuing a doctoral education and an academic position would be costly. According to the site, the median salary for a chief nurse executive in the United States as of January 2006 was $161,472; for a chief nurse anesthetist, it was $146,478; for a head nurse in an intensive care unit, it was $82,912; and for an associate professor, it was $59,640.
The Future of Nursing Education
When the nursing division of one small New England college recently sought to hire a doctorally prepared nurse educator, only one qualified candidate applied. A certified nurse midwife with more than twenty-five years of nursing experience, she was known personally to some of the nursing faculty. Although her part-time clinical teaching experience had shown her to be an excellent clinical instructor, she was deemed eligible only for the rank of assistant professor. The college adjusted the base pay in its offer to her to account for her professional nursing experience. Still, the salary proposed to her was considerably lower than the salary that she, as a nurse manager in a suburban hospital, had offered to new graduates of this same nursing program the previous June. In fact, the salary offer for the faculty position was only 45 percent of what she was earning. Even adjusting for vacation time, accepting the academic position would have caused a serious financial problem for this nurse.
What is the solution to this dilemma? Without doubt, we have to increase the number of nurses who complete a doctoral degree to ensure the future of nursing education. More nurses with doctorates does not, however, automatically translate into more nursing professors. To encourage doctorally prepared nurses to choose a career in higher education, we must provide salaries equivalent to those paid to nurses in clinical and administrative positions.
Teaching future nurses is incredibly satisfying. The opportunity to educate and influence future health-care practitioners (those who will care for us as we age) is a privilege. In the end, however, the financial reward for leaving the clinical setting to embrace the academic life must be adequate.
Susan LaRocco is associate professor of nursing at Curry College. She has been a nurse for more than thirty years in various clinical, administrative, and academic positions. She is currently a board member of the American Assembly for Men in Nursing.
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