AACN - Media - News Releases

MASTER'S-DEGREE ENROLLMENTS RISE AT NATION'S NURSING SCHOOLS, AACN SURVEY FINDS

However, As Demand for RNs Climbs, Bachelor's-Degree Enrollments
See Continued Decline

WASHINGTON, D.C, December 30, 1997 -- Enrollment of master's-degree students at U.S. nursing schools rose in fall 1997 by 1.6 percent above a year ago, continuing a steady climb that has seen master's enrollments in RN programs increase in nine of the past ten years, according to the latest survey by the American Association of Colleges of Nursing (AACN).

But at the same time, enrollment of nursing students in entry-level bachelor's-degree programs fell by 6.6 percent below a year ago. The third consecutive decline in as many years, the drop comes as many communities are experiencing intensified demand for baccalaureate- and graduate-degreed nurses and as federal and other policy targets call for escalating supplies of such RNs for the near future.

"This year's data make two things clear. First, nurses firmly recognize the accelerating need for advanced levels of education, and particularly for graduate-degree preparation to assume roles as nurse practitioners and other advanced practice clinicians. Secondly, the perceptions of many students -- apparently guided by headlines of hospital downsizings in recent years -- have not caught up to today's reality of the climbing demand that also exists for registered nurses at the entry level for practice in primary care centers, home care, community clinics, as well as in hospitals," says AACN President Carole A. Anderson, PhD, RN, FAAN.

"Nor should anyone be quick to interpret the decline in undergraduate enrollments as a sign of waning interest in nursing careers," Dr. Anderson cautions. Indeed, although deans at some nursing schools report fewer applications for entry-level baccalaureate programs for fall 1997, others -- citing no drop in applications -- point to other reasons for their lower enrollments in such programs, including intentional enrollment cutbacks to cope with shortages of faculty or other resource constraints, or to unusually large graduating classes this year.

Job Placements High

Job placements for master's-degree nursing graduates were among the highest for any degree level at graduation, the AACN survey found. Among responding nursing schools, an estimated average of 94 percent of master's-degree graduates, 85.7 percent of graduates of master's-level nurse practitioner programs, and 72 percent of graduates of entry-level bachelor's-degree programs had jobs waiting upon graduation between August 1996 and July 1997.

Also among responding schools, 59.7 percent of master's-degree programs, 39.4 percent of master's-level nurse practitioner programs, and 16 percent of entry-level bachelor's-degree programs reported that an estimated 100 percent of their graduates had secured jobs between August 1996 and July 1997.

The survey, the latest annual report by AACN of nursing school enrollments and graduations at the nation's universities and four-year colleges, also found enrollment virtually unchanged (up 0.2 percent above a year ago) in so-called "RN-to-BSN" programs for registered nurses (with associate degrees or hospital diplomas) who are returning to school to pursue the Bachelor of Science degree in nursing (BSN). Enrollments in doctoral programs, which had increased by 3.7 percent in fall 1996, declined by 2.3 percent in fall 1997 below a year ago.

AACN's findings reflect responses from a total of 557 (84.3 percent) of the nation's nursing schools with bachelor's- and graduate-degree programs that were surveyed in fall 1997. Data reflect actual counts; projections are not used. Programs offering two-year associate-degrees and hospital diplomas are not included.

Two-year changes in enrollment and graduations are based on data from a matched group of 497 and 496 schools, respectively, reporting in both the 1996-97 and 1997-98 academic years.

Undergraduate Enrollments Lag Behind New Realities

As health care continues to shift outside the hospital to more primary and preventive care at other sites throughout the community, managed care has grown increasingly dominant and ushered in briefer patient stays, falling inpatient volumes, and increased consolidations and downsizings at hospitals that traditionally have employed two-thirds of all RNs. Media reports of downsizings and of resulting layoffs of nurses and other staff at hospitals across the last two years likely contributed to current enrollment declines, deans at several nursing schools suggest.

"However, it can take at least two years for enrollments to respond to changes in the marketplace," Dr. Anderson explains. "In several instances where schools reported fewer applications, students apparently were influenced by recent headlines that quickly have become outdated. Many potential students simply are not aware of recent upswings in RN hirings in many regions or the rapidly expanding spectrum of opportunities for nurses beyond the hospital setting."

According to the U.S. Bureau of Labor Statistics, employment of RNs will grow faster than the average for all occupations through 2006 due largely to growing demand in settings such as health maintenance organizations, community health centers, home care, and long-term care. Indeed, despite the recent trend of hospital downsizings, mergers, and closures, the ranks of registered nurses in hospitals increased by 3 percent between 1992 and 1996, according to the latest figures from the Division of Nursing of the U.S. Department of Health and Human Services. Although the number of RNs in hospital inpatient units fell by 6 percent in the same period, RN employment grew by 25 percent in outpatient and labor and delivery departments, increased by more than 15 percent in emergency rooms, and climbed nearly 10 percent in surgical facilities.

"Moreover, several deans report that the rush by many area hospitals to trim RN staffs and increase hiring of aides and other unlicensed assistive personnel has proved unsatisfactory, producing poor outcomes and prompting more hospitals to now boost their RN recruitment," Dr. Anderson notes. "In fact, reports of hospitals and other employers offering attractive signing bonuses to lure RNs, particularly those with experience, are increasing." In several regions, deans cite especially acute demand for registered nurses in specialty areas such as critical care and emergency and operating rooms, and for advanced clinicians such as family nurse practitioners.

Demand also is being fueled by an aging RN workforce. In 1996, the average age of RNs in the U.S. was 44 years, up from 40 years in 1980, according to the Division of Nursing. Only 9 percent of the nation's 2.5 million registered nurses were under age 30 in 1996. "Such numbers are enormously disturbing since they forecast a sizeable wave of RN retirements in the very near future and fewer years in the workforce for RNs who are now entering the pipeline. This, as demand for new and experienced nurses is projected to do nothing but accelerate," Dr. Anderson says.

"However, the solution to meeting that demand is not simply to provide 'more nurses,' " Dr. Anderson explains. Specifically, nursing and other health care leaders point to the mounting demand for RNs prepared at the baccalaureate and graduate-degree levels to meet the more complex conditions of today's patient care. The National Advisory Council on Nurse Education and Practice, an advisory panel to the federal Division of Nursing, has urged that at least two-thirds of the basic nurse workforce be prepared with baccalaureate or higher degrees in nursing by the year 2010. Currently, although 31 percent of RNs hold baccalaureate degrees as their highest educational credential, 32 percent have two-year associate degrees, 9 percent hold master's degrees, and fewer than 1 percent hold doctoral degrees, according to Division of Nursing data.

Other organizations, including the Pew Health Professions Commission and the Institute of Medicine, have called for expanded financial and other resources for graduate programs that produce advanced practice nurses in an effort to meet the accelerating demand for front-line primary care and acute care, particularly in underserved communities. The Pew commission also has urged the closure of up to 20 percent of associate-degree and diploma nursing programs in favor of more concentrated focus on baccalaureate and graduate-degree nurse education.

Graduations Up For Most Degrees

Overall, responding schools reported 127,322 students enrolled in baccalaureate-degree nursing programs. Included as part of this number are 85,488 entry-level students and 41,834 RN-to-BSN students.

Between August 1996 and July 1997, a total of 29,287 students graduated from entry-level baccalaureate programs at responding schools. Although the number of such graduations rose by 3.7 percent the previous year, the ranks of entry-level BSN graduates fell by 1.3 percent between August 1996 and July 1997 in a matched group of schools reporting over two years. "The increasing number of graduates from these programs in past years was due to higher enrollments that existed for several years before. However, this year's graduating class is the first to show the impact of recent downturns in entry-level baccalaureate enrollments," Dr. Anderson explains. "As a result, we are likely to see these programs produce declining numbers of graduates for the next several years."

However, graduations increased at all other degree levels between August 1996 and July 1997, the AACN survey found. Graduations from RN-to-BSN and master's-degree programs totaled 11,729 and 10,411, respectively, at responding schools. In same schools reporting over two years, the number of RN-to-BSN graduates rose by 3.7 percent, with master's-degree graduations increasing by 8.7 percent. The ranks of doctoral graduates grew by 18.3 percent in matched schools reporting over two years, from 366 to 433.

Full-Time Enrollments Rise in Graduate Programs

Master's-degree programs at responding schools reported a total of 34,352 nursing students enrolled in fall 1997, the AACN survey found. In matched schools reporting across two years, the number of full-time master's students increased by 5.5 percent. "It is at the master's level that schools prepare the cadre of advanced practice nurses -- nurse practitioners, clinical nurse specialists, certified nurse-midwives, and nurse anesthetists -- to deliver primary and acute care for a health system in expanding need, as well as talented candidates for practice in other nursing fields, such as administration and community health," Dr. Anderson says. In a matched group of schools reporting across the last five years, full-time master's enrollments increased by an average of 678 students nationwide per year.

In doctoral programs at responding schools, 2,906 students were enrolled in fall 1997. Full-time enrollments of doctoral students rose by 4.5 percent at a matched group of schools reporting across two years. "The rising numbers of full-time students is welcome news, especially given the fact that the majority of graduate-degree nursing students are engaged in part-time study due to family and work commitments, thus prolonging the production of needed nursing clinicians, educators, and researchers," Dr. Anderson explains. However, in a matched group of schools across the past five years, full-time doctoral enrollments grew by an average of only 21 students nationwide per year. "This still is greatly short of the numbers needed to generate a sufficient pool not only of nurse scientists to produce continued advances in health care, but also of doctorally prepared educators to teach future nurses," Dr. Anderson says.

RN-to-BSN Enrollments Still Increase, But Levels Unsatisfactory

Although virtually no change occurred this year in the number of RNs returning to school for the BSN degree, the trend in a matched set of schools across the last five years has seen such enrollments rise by an average of 776 students per year nationwide, AACN data show. Still, despite this growth, only about 16 percent of RNs prepared in associate-degree programs have obtained the BSN, according to the latest Division of Nursing figures.

"Far greater gains will be needed if we are to achieve a basic nurse workforce whose mix of educational preparation and skills are in sufficient balance to the needs of a changing health system," Dr. Anderson urges. "With broad preparation in clinical, scientific, community health, administrative, and patient education skills, the BSN nurse is the only basic nursing graduate prepared to practice in all health care settings -- critical care, outpatient care, public health, and mental health. Indeed, as health care shifts from hospital-centered, inpatient care to more community-based primary and preventive care, the health system requires baccalaureate- and graduate-prepared RNs who not only can practice across multiple settings -- both within and beyond hospitals -- but can function more independently in clinical decisionmaking, case management, providing direct bedside care, supervising aides and other support personnel, guiding patients through the maze of health care resources, and fostering health promotion and early detection of illnesses and risk factors."

Copies of the AACN survey, 1997-1998 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, will be available after January 15 for $35 (including postage), prepaid orders only, from AACN, Dept. 178, Washington, DC 20055-0178; (202) 463-6930.

The American Association of Colleges of Nursing is the national voice for university and four-year-college education programs in nursing. Representing more than 580 member schools of nursing at public and private institutions nationwide, AACN's educational, research, governmental advocacy, data collection, publications, and other programs work to establish quality standards for bachelor's- and graduate-degree nursing education, assist deans and directors to implement those standards, influence the nursing profession to improve health care, and promote public support of baccalaureate and graduate nursing education, research, and practice.

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CONTACT: Robert Rosseter
(202) 463-6930, x231
rrosseter@aacn.nche.edu