NURSING SCHOOL ENROLLMENTS LAG
BEHIND RISING
DEMAND FOR RNs, AACN SURVEY SHOWS
Bachelor’s-Degree Enrollments See
Continued Decline, While Ranks of Master’s-Degree Graduates
and Full-Time Master’s Students Continue Upward Climb
WASHINGTON, DC --As health care facilities
in many markets strive to meet their accelerating demand
for registered nurses, enrollments of entry-level bachelor’s-degree
students in the nation’s nursing schools fell by 5.5 percent
in fall 1998, and total master’s-degree nursing enrollments
fell slightly by 2.1 percent, compared to a year ago, according
to the latest annual survey by the American Association
of Colleges of Nursing (AACN).
At the same time, enrollments of full-time
master’s-degree nursing students and the ranks of nursing
graduates from master’s-degree programs continued their
recent steady climbs. Full-time master’s enrollments at
nursing schools rose by 3.2 percent over fall 1997, while
the number of master’s graduates grew by 4.3 percent between
August 1997 and July 1998 compared to the previous year,
the AACN survey found.
The drop in enrollments in entry-level bachelor’s-degree
nursing programs -- the fourth consecutive decline in as
many years -- sparks concern especially as federal and other
advisory panels have urged escalating numbers of baccalaureate-
and graduate-prepared nurses to meet health system needs
for the near future.
However, the modest decline in total master’s
enrollments marked only the third time in the past 12 years
for such a decrease at nursing schools, which have seen
their ranks of master’s-degree students rise steadily largely
in response to growing demand for nurse practitioners, clinical
nurse specialists, and other RNs with advanced clinical
skills. The decline also comes as overall graduate enrollments
in all fields in the U.S. fell for the second consecutive
year in 1997, down by 1 percent, according to preliminary
data by the Council of Graduate Schools.
AACN’s findings are based on responses from
a total of 531 (80 percent) of the nation’s nursing schools
with bachelor’s- and graduate-degree programs that were
surveyed in fall 1998. Data reflect actual counts; projections
are not used. Programs offering two-year associate-degrees
and hospital diplomas are not included.
Two-year changes in enrollments and graduations,
respectively, are based on responses from a matched group
of 495 and 493 schools reporting in both 1997 and 1998.
Outdated Perceptions
A convergence of circumstances has contributed
to the declines in entry-level baccalaureate enrollments.
Application levels remain strong. But headlines several
years ago of hospital downsizings and of RNs layoffs in
various markets apparently created lasting, but now outdated,
perceptions in many potential students who remain unaware
of today’s new reality. "That reality is the accelerated
hiring of RNs to meet demand fueled by a host of factors
-- including growing numbers of elderly, an increasing population
of hospitalized patients who are older and more acutely
ill, the rapid expansion of front-line primary care at a
host of community-based sites, and technological advances
requiring more highly skilled nursing care," says AACN President
Andrea R. Lindell, DNSc, RN.
Moreover, in recent years, several nursing
schools have chosen to cut back their baccalaureate admissions
because of faculty shortages or other resource constraints,
or have redirected their limited resources to focus more
heavily on meeting market demand for advanced practice nurses
prepared in master’s-degree programs. Indeed, of the 107
responding schools that reported reasons for not accepting
all qualified applicants to entry-level baccalaureate nursing
programs in fall 1998, 37 percent cited insufficient numbers
of faculty, while other schools cited a shortage of clinical
training sites (26 percent) or insufficient classroom space
(13 percent), according to the AACN survey. Though most
schools reporting too few faculty cited budget constraints,
30 percent attributed the shortage to increasing job competition
from clinical sites.
Hiring Intensifies
"Again, we are encouraged by the continued
growth in graduations and full-time enrollments in master’s
programs. But it is imperative that students recognize the
increasing opportunities, as well, for baccalaureate-prepared
nurses at the entry level. Hospitals, HMOs, outpatient surgical
centers, community health centers, and other sites are intensifying
their hiring of nurses to meet the expanding needs of today’s
patient care," Dr. Lindell explains.
"Students need to know, too, that while many
nursing schools with resource constraints had to turn away
numbers of qualified applicants to entry-level bachelor’s-degree
programs this past fall, other schools reported having several
vacant seats remaining."
RN-to-Baccalaureate Graduations Increase
Overall, responding schools reported 113,413
students enrolled in bachelor’s-degree nursing programs.
Included in this total are 77,679 entry-level students,
and 35,734 registered nurses (with two-year associate degrees
or hospital diplomas) who returned to school to obtain the
bachelor’s degree in nursing in so-called RN-to-Baccalaureate
programs.
Between August 1997 and July 1998, 27,137
students graduated from entry-level baccalaureate programs
at responding schools. In a matched sample of schools reporting
in both years, graduations in these programs fell by 4.7
percent, reflecting past enrollment declines.
RN-to-Baccalaureate programs graduated 11,027
students at responding schools between August 1997 and July
1998, the AACN survey found. While enrollments in these
tracks fell by 3.3 percent in fall 1998 compared to a year
ago, graduations rose by 3.8 percent between August 1997
and July 1998 in matched schools reporting over two years.
At the master’s-degree level, nursing programs
graduated a total of 10,765 students between August 1997
and July 1998, the AACN survey reported.
Meanwhile, nursing enrollments in doctoral
programs that prepare nurse researchers and future faculty
totaled 2,928 students at responding schools in fall 1998,
and remained virtually unchanged, up by 0.8 percent (22
students), in matched schools responding over two years.
The ranks of doctoral nursing graduates, who totaled 411
in fall 1998, fell by 5.5 percent (22 students) between
August 1997 and July 1998 in schools reporting in both years.
Meeting Demand with the Right Mix
Smaller bachelor’s-degree classes come at
a critically inopportune time, educators warn, as more communities
face steeper demand for bachelor’s- and graduate-prepared
nurses and as an aging RN workforce increases concerns about
high numbers of RNs who are projected to retire within the
next 10 to 15 years. If current trends continue, rising
demand will outstrip the supply of RNs beginning approximately
2010, according to the Division of Nursing of the U.S. Department
of Health and Human Services. But already, in an expanding
number of markets, hospitals and other employers are struggling
to meet rising need for RN care and are stepping up recruitment.
A recent report by the National Advisory
Council on Nurse Education and Practice, an advisory body
to the federal Division of Nursing, urged that at least
two-thirds of the basic nurse workforce hold baccalaureate
or higher degrees in nursing by 2010. Moreover, a 1995 report
by the Pew Health Professions Commission called for the
closing of up to 20 percent of associate-degree and hospital
diploma nursing programs in favor of more concentrated production
of bachelor’s- and higher-degree nursing graduates. Although
32 percent of RNs employed in nursing in 1996 held baccalaureate
degrees as their highest educational credential, 34 percent
held associate degrees, 24 percent had hospital diplomas,
9 percent had obtained master’s degrees, and fewer than
1 percent held doctoral degrees, according to the Division
of Nursing.
What is needed today, educators and health
planners explain, isn’t simply more RNs, but more RNs in
the right educational mix to handle the more complex requirements
of the current health care environment. Specifically, demand
has intensified for higher numbers of nurses prepared in
baccalaureate programs that emphasize leadership, patient
education, case management, and care across a variety of
acute care and outpatient settings, and for graduate-prepared
RNs with advanced practice skills to provide both acute
and primary care. In many local markets, deans report especially
strong demand for RNs in high-need specialties such as critical
care, emergency and operating room nursing, pediatric nursing,
and nursing management, as well as for intensive care and
labor and delivery units.
Part-time Study Dominates Master’s Tracks
Despite higher enrollments of full-time master’s
students, the AACN survey reported continued concentration
of master’s-degree nursing students (66 percent) in part-time
study. Though part-time master’s enrollments have declined
significantly across the past five years, their levels remain
a key concern to nursing educators. "Although master’s tracks
also prepare needed nurse administrators and educators,
the largest number of master’s students are pursuing study
in advanced practice programs that prepare nurse practitioners,
certified-nurse midwives, clinical nurse specialists, and
nurse anesthetists. At the same time as the health system
is experiencing mounting demand for these advanced clinicians,
part-time study is greatly delaying their entry into the
RN workforce," Dr. Lindell explains.
Regional Impacts
Across the country, declines in entry-level
baccalaureate nursing enrollments were seen in every region
in fall 1998, ranging from a drop of 2.9 percent in Western
states to a decline of 7.6 percent in the Midwest, compared
to a year ago. In the same period, total master’s-degree
enrollments in nursing ranged from a gain of 2.8 percent
in the West to a decline of 4.7 percent in North Atlantic
states. Doctoral enrollments in nursing, which remained
virtually unchanged in North Atlantic schools with an increase
of 0.5 percent (4 students), grew by 10.5 percent (41 students)
in the West in fall 1998.
Copies of the AACN report, 1998-1999 Enrollment
and Graduations in Baccalaureate and Graduate Programs in
Nursing, will be available after February 1 for $35
(including postage), prepaid orders only, from AACN, Dept.
178, Washington, DC 20055-0178; (202) 463-6930. Copies also
can be ordered at AACN’s World Wide Web site at www.aacn.nche.edu
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.
Media
Backgrounder on Nursing School Enrollments
###
CONTACT: Robert Rosseter
(202) 463-6930, x231
rrosseter@aacn.nche.edu
