AACN - Government Affairs

The Nurse Education Act does not go far enough to address the nursing shortage.

AACN and the nursing community call for new NEA initiatives in the areas of faculty preparation, enrollment incentives, post-baccalaureate residency programs, and a National Nursing Corps to minimize the impact the nursing shortage will have on our nation's health care system.

RECOMMENDATION: Create a Fast-Track Nursing Faculty Scholarship and Loan Program.

Faculty shortages at nursing schools across the country are contributing to the overall decline in new enrollments at a time when the need for well-prepared nurses is continuing to grow. According to AACN's 2000-2001 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, nursing schools turned away 5,059 qualified students across the United States due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints. Higher compensation in clinical and private-sector consulting and research settings is luring current and potential nurse educators away from teaching. Compounding the problem is the fact that once nurses begin working full-time, it is very difficult to bring them back to study full-time for a doctoral degree. The majority of baccalaureate graduates enter the workforce after an undergraduate program due to financial need.

To address the nurse educator shortage, a Fast-Track Nursing Faculty Scholarship and Loan Program is needed to provide economic incentives to master's and doctoral students who commit to serving as faculty members at baccalaureate- or graduate-level nursing schools. Students would be required to work as faculty for each year of loan repayment or scholarship funding with commitment pay-off beginning when the graduate degree is awarded. $30 million in FY 2002 funding is needed for non-taxable scholarships, loans, and stipends to allow 1,500 nursing students to pursue full-time graduate study.

AACN's Special Survey on Vacant Faculty Positions released in October 2000 reported 379 vacancies from 209 responses out of a surveyed universe of 553 graduate schools of nursing. Sixty-four percent of these vacancies were for individuals with the doctoral degree.
With federal support, nursing schools could recruit their most talented students from a pool of over 103,000 baccalaureate students to enter the pipeline to become faculty members. Without federal support, less than 1% of baccalaureate nursing students are expected to become faculty members.
The fast-track faculty program would enable nursing students to complete their education without a break in their studies which would work to transition student to faculty roles more quickly and at a much younger age - under 30 as compared to the current median age of 45.7. Nearly half (49.4%) of new PhD graduates are age 45-54; 6.5% are 55 and older. With an increase in the number of full-time doctoral students, individuals would be ready to assume faculty positions at a younger age which would increase the number of productive teaching and research years.
State Boards of Nursing recommend a ratio of 1 faculty member to 8-10 undergraduate nursing students in clinical settings. Preceptors provide clinical education to students 1-to-1.
Preference in the fast-track program should be given to doctoral students since the doctoral degree is the appropriate and desired credential for nurse educators. Of today's full-time nurse faculty, 27.7% are doctorally prepared in nursing. More than half do not have a PhD.

RECOMMENDATION: Create a Post-Baccalaureate Nursing Residency Program.

In the face of a nursing shortage, a Post-Baccalaureate Nursing Residency Program is needed to create an attractive career trajectory to enhance recruitment to the profession and retain program graduates. A residency program will insure the successful transition of the newly licensed professional nurse from student to expert nurse and produce a nursing workforce with a high level of clinical experience necessary to care for patients in today's complex health care environment. The residency program would provide the recognition of the enhanced value of the baccalaureate degree at the federal level, on campuses, and in health care settings. Currently, diploma, associate- and baccalaureate-prepared nurses are equally licensed as RNs, equally compensated by employers, and often delegated identical responsibilities.

A Post-Baccalaureate Nursing Residency Program funded at the $25 million level in FY 2002 is needed to meet the current demand for more highly educated nursing staff. The program should be developed jointly by schools of nursing and practice settings to strengthen the nursing workforce, reduce practice errors, increase job satisfaction, and minimize burnout associated with under-preparation for the nursing role. Residencies would target critical shortage areas including critical care units, emergency departments, hospital operating rooms, and community settings such as public health and long-term care. Strengthening the workforce with well-educated nurses with baccalaureate or higher degrees will improve the image of nursing and attract highly qualified applicants to the profession.

Examples of successful Residency Programs

RECOMMENDATION: Initiate a Capitation Grant Program to strengthen the ability of nursing schools to recruit and educate students.

Nursing schools across the U.S. turn away thousands of qualified students each year due to an insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints. In the face of declining enrollments, schools are struggling to maintain current enrollment levels though an even greater influx of students is needed to meet the projected demand for nurses.

Adding to the problem is the fact that many of our nation's nursing schools are literally crumbling since funding support for infrastructures has not been granted by Congress since the mid-1970s. The cost to train nurses is comparatively high. Nursing schools require a high ratio of faculty to students, sophisticated clinical equipment, computer software, and simulated hospital units for student training.

Past Capitation Grant Programs (P.L. 92-158, Nurse Training Act of 1971) have had a stabilizing effect on nursing shortages by providing nursing schools with the means to increase enrollments. From 1971-78, Congress provided per capita funding to schools of nursing for support of nursing education programs. During the last years of the capitation program (1976-78), Congress provided collegiate schools of nursing with $400 per full-time student enrolled in the last two years of a nursing program, and set funding at $55 million for fiscal years 1977 and 1978. To qualify for the capitation grants, schools were required to increase their enrollments by a certain percent above the previous year. The Secretary could waive this requirement if the school's facilities limited it from enrolling more students. Schools were also required to develop projects recognized as having a national need.

A January 1974 Institute of Medicine cost study endorsed a capitation grant program as an appropriate federal undertaking to provide a stable source of financial support for nursing and other health profession schools. The study recommended that grants ranging between 25% and 40% of net educational expenditures would contribute to the financial support for the stability of nursing schools. The Senate committee recommended capitation grants at 12½ percent of the cost study figures.

In FY 2002, AACN and the nation's baccalaureate and graduate nursing schools urge Congress to create a Capitation Grant Program to provide each collegiate school of nursing with $1,200 for each full-time equivalent student. The $1,200 figure is consistent with the 1976-78 funding level adjusted for inflation. Schools would have the flexibility to direct capitation funds to hiring faculty; paying for overhead, benefits and salary; recruiting students; and supporting infrastructure and facility renovations to accommodate additional students and enhance student experiences.

RECOMMENDATION: Establish a National Nurse Corps.

Since most of the U.S. is experiencing a nursing shortage which is expected to intensify, a National Nurse Corps is needed to increase our country's overall supply of nurses. Funding at the $10 million for FY 2002 is needed to support non-taxable scholarship and loan repayment programs for all levels of nursing without requiring practice in a specific underserved area.

Updated June 7, 2001

Expand the Reach of the Nurse Education Act with New Initiatives

Expand the Reach of the Nurse Education Act
with New Initiatives