BACHELOR'S DEGREE ENROLLMENTS CONTINUE
DECLINE AT
NATION'S NURSING SCHOOLS, AACN SURVEY FINDS
Job Placements for Graduates Show
Market's Growing Demand for RNs With Advanced Degrees
WASHINGTON, D.C. -- Enrollment of
nursing students in entry-level bachelor's-degree programs
fell by 6.2 percent in fall 1996 compared to a year ago,
the second consecutive decline in two years as nursing schools
respond both to a changing marketplace and to resources
that are growing increasingly strained.
At the same time, master's-degree enrollments,
which had climbed steadily in recent years, saw their first
decline since 1988, down in fall 1996 by 3.4 percent below
a year ago, according to the latest survey by the American
Association of Colleges of Nursing (AACN).
Despite the downturn, job placements for
master's-degree nursing graduates were among the highest
of any degree level at graduation, a sign of the health
system's growing demand for registered nurses with advanced
clinical skills. Among responding schools, 67 percent and
41 percent of master's-degree and master's-level or post-master's
nurse practitioner programs, respectively, reported that
approximately 100 percent of graduates had employment commitments
upon graduation between August 1995 and July 1996, compared
to 12 percent of schools that reported a similar number
of commitments for entry-level bachelor's-degree graduates.
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
a continued increase (up 1.4 percent above a year ago) in
enrollments 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). Higher enrollments were also reported
in doctoral programs in nursing (up 3.7 percent above a
year ago).
AACN's findings reflect responses from a
total of 522 (79.3 percent) of the nation's nursing schools
with bachelor's-degree and graduate programs that were surveyed
in fall 1996. Data reflect actual counts; projections
and estimates 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 475 schools reporting
in both the 1995-96 and 1996-97 academic years.
Schools Face Mounting Resource
Pressures
As health care continues to shift outside
the hospital to more primary and preventive care at other
sites throughout the community, managed care has increased
its dominance by ushering in briefer patient stays, falling
inpatient volumes, and increased consolidations and downsizings
at hospitals that traditionally have employed two-thirds
of all RNs. At the same time, demand for registered nurses
across all settings -- including health maintenance organizations
(HMOs), community health centers, home care, and long-term
care -- continues to climb. Indeed, while hospital inpatient
units have seen only a tiny increase in RN employment in
recent years, the number of nurses in hospital outpatient
departments ballooned by nearly 70 percent between 1988-1992,
according to federal figures.
"Although news stories of hospital
downsizings may have contributed to this year's decline
in BSN enrollments, overall deans report that applications
remain strong," says AACN President Carole A. Anderson,
PhD, RN, FAAN. "It is resources, not student interest,
that are often in short supply and have led to current enrollment
declines. Many deans report they've had to deliberately
cut enrollments, both at the bachelor's- and master's-degree
levels, because of budget and other constraints that have
produced faculty shortages and limited the number of slots
for clinical training at a host of schools that have been
forced to hold down class size. At several schools, limited
resources has meant scaling back enrollments in entry-level
BSN programs to concentrate on meeting the escalating demand
for nurse practitioners and other master's-prepared nurses
with advanced practice skills," Dr. Anderson says.
Overall, responding schools reported 123,965
students enrolled in baccalaureate-degree nursing programs.
Included as part of this number are 87,315 entry-level students
and 36,360 RN-to-BSN students.
However, across the last five years, entry-level
baccalaureate enrollments at nursing schools have grown
at an unsteady rate, increasing by an average of only 266
students nationwide per year, according to AACN data.
Graduations Up, But Declines
Projected
Except for doctoral programs, graduations
increased in all degree levels between August 1995 and July
1996, the AACN survey found. Compared to the previous year,
the number of graduates rose in entry-level baccalaureate
(up 3.7 percent), RN-to-BSN (up 9.6 percent), and master's-degree
(up 7.6 percent) programs. In contrast, the ranks of doctoral
graduates fell by 5.4 percent in the same period.
"Taken by themselves, graduation rates
can be a misleading indicator of future nurse supply," Dr.
Anderson explains. "Because of rising enrollments in the
recent past, graduations likely will continue to climb before
leveling off in approximately the next three years, when
the impact of current enrollment declines is expected to
take effect."
Master's Enrollments See Slight
Decline
Though full-time master's enrollments rose
by 2.5 percent above a year ago, "this year's overall decline
of 3.4 percent is particularly disturbing," Dr. Anderson
says. "It is at the master's level that schools prepare
the cadre of advanced practice nurses to deliver primary
and acute care for a health system in accelerating need,
as well as talented candidates for practice in other nursing
fields, such as administration and community health. Still,
the rising enrollments among full-time master's students
and in doctoral programs is welcome news, especially given
the fact that part-time study continues to predominate at
the graduate level, greatly prolonging the production of
needed nursing providers, educators, and researchers."
"Moreover, this year's drop in master's
enrollments signals the heightened competition among nursing,
medicine, and other health professions schools to place
students in primary care centers, HMOs, hospitals, and other
settings for clinical training. The limited availability
of these slots already is taking a toll on enrollments at
many nursing schools nationwide," Dr. Anderson explains.
Indeed, in an AACN survey, while 27 percent of responding
schools cited too few faculty as the chief reason for not
accepting all qualified applicants to master's-degree nursing
programs in fall 1995, 23 percent cited insufficient clinical
or classroom space.
In addition, current enrollments indicate
that the role of the master's-prepared nurse has become
more solidified and focused on clinical practice. Of the
32,458 students enrolled in master's-degree nursing programs
in fall 1996 for both nursing and non-nursing college graduates,
the vast majority (75 percent) were concentrated in advanced
practice tracks, including students in nurse practitioner
(46.4 percent), clinical nurse specialist (14.8 percent),
combined NP/CNS (8.5 percent), nurse anesthesia (3.1 percent),
and nurse midwifery (2.4 percent) programs.
Within nurse practitioner tracks, enrollments
were led by students in family nurse practitioner programs
(49.2 percent), followed by adult (18.9 percent), pediatric
(10.5 percent), gerontological (4.7 percent), and ob-gyn/women's
health (4.2 percent) programs. Students enrolled in other
master's tracks included nursing administration (8.6 percent),
education (5.3 percent), and community health (3.4 percent).
Although the 2,954 doctoral students enrolled
in fall 1996 comprised an overall growth of 3.7 percent
above a year ago, enrollments across the last five years
grew by an average of only 26 students per year, "far short
of the numbers needed to produce a sufficient pool not only
of nurse scientists, but also educators to teach future
nurses," Dr. Anderson says.
Across the past five years, enrollments
of returning RNs in baccalaureate programs have risen significantly
by an average of 983 students per year nationwide, AACN
surveys show. Still, despite these increases, only 14 percent
of RNs prepared in associate-degree programs have obtained
the nursing baccalaureate degree, according to the latest
figures from the Division of Nursing of the U.S. Department
of Health and Human Services.
"Greater gains will be needed if we
are to achieve the Division's recommended target of a basic
nursing workforce in which at least two-thirds hold a baccalaureate
or higher-degree in nursing by the year 2010," Dr. Anderson
urges. "With broad preparation in clinical, scientific,
community health, and patient education skills, the BSN
nurse is well-positioned to move across settings as hospitals
focus more on acute care and as health care itself moves
beyond the hospital to more community-based sites."
Employment Opportunities Show
Strong Regional Differences
The highest employment rates at graduation
were realized by programs for registered nurses who are
returning to school to pursue the nursing baccalaureate
degree. Of these responding RN-to-BSN programs, 76.4 percent
reported that approximately 100 percent of graduates had
secured employment upon graduation.
On the average, 67.7 percent of baccalaureate
graduates at responding schools had employment commitments
upon graduation between August 1995 and July 1996, the AACN
survey found. At the master's-degree level, an average of
95.6 percent and 86 percent of graduates from master's and
from master's-degree or post-master's nurse practitioner
programs, respectively, had jobs waiting upon graduation.
However, strong regional differences exist.
For example, while only 2.1 percent of responding schools
in North Atlantic states reported that approximately 100
percent of graduates from entry-level baccalaureate programs
had found employment upon graduation, 17.8 percent of schools
in the South did so. In addition, although 33.3 percent
of responding schools in Western states reported that approximately
100 percent of graduates from master's and post-master's
nurse practitioner programs had employment commitments upon
graduation, 51.5 percent of schools in the Midwest did so.
In the West, 31.2 percent of responding
schools reported that approximately 76 percent to 90 percent
of graduates from entry-level baccalaureate programs secured
employment upon graduation. In North Atlantic states, however,
only 12.5 percent of responding schools did so.
"As health care shifts increasingly
from hospital-based, inpatient care to other points of delivery,
flexibility will be key both for entering and moving within
the profession," Dr. Anderson says. "As more hospitals downsize,
merge, or close, graduates may need to seek hospital employment
in different parts of their home states, in another state,
or another region where hiring is less constricted. Unlike
the past, where most nursing graduates began their careers
in acute-care hospitals, today's newly-licensed RNs are
practicing more in other settings, such as home care, community
health, other outpatient sites, and long-term care, where
opportunities are fast expanding."
Federal figures project not only that employment
for RNs will grow much faster than the average for all occupations
through 2005, but that beginning approximately 2010, demand
for registered nurses will outstrip the expected supply.
With such demand, "reports of students being turned away
for limited space should not discourage students from applying
to the nursing schools of their choice," Dr. Anderson says.
"Although space constraints are a growing concern, schools
are still accepting, and enrolling, far greater numbers
of students than those who cannot be accommodated."
Copies of the AACN Survey, 1996-1997
Enrollment and Graduations in Baccalaureate and Graduate
Programs in Nursing, are available 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.
###
CONTACT: Robert Rosseter
(202) 463-6930, x231
rrosseter@aacn.nche.edu
