NURSING SCHOOL ENROLLMENTS
DECLINE AS DEMAND
FOR RNs CONTINUES TO CLIMB
Bachelor's-Degree
Enrollments See Continued Decline; Master's and Doctoral
Classes, Though Larger in Some Regions, Down Slightly Nationally
Students' Outdated
Perceptions of Market a Contributing Factor, Educators Say
WASHINGTON, D.C.. February 17, 2000 -- Enrollments
of nursing students in entry-level bachelor's-degree programs
fell by 4.6 percent in fall 1999, while master's-degree
enrollments at nursing schools declined slightly by 1.9
percent, compared to a year ago, according to the latest
annual survey by the American Association of Colleges of
Nursing (AACN).
The decline in bachelor's-degree enrollments
-- the fifth consecutive drop in as many years in a matched
group of schools -- is in sharp contrast to the health system's
escalating demand for baccalaureate- and graduate-prepared
nurses to meet health care and health promotion needs for
the near future. Aggressive recruiting by hospitals, health
maintenance organizations, primary care centers, outpatient
surgical centers, and other employers is striving to stem
a mounting shortage of registered nurses -- the largest
health care profession -- affecting an increasing number
of cities and regions across the nation.
Declines in entry-level baccalaureate nursing
enrollments were seen in every region in fall 1999, ranging
from a decline of 2 percent in Western states to a decrease
of 7.4 percent in North Atlantic schools, compared to a
year ago, according to the AACN survey.
However, in the same period, graduate enrollments
grew in several regions. Master's-degree nursing enrollments
increased in the West (up 6.1 percent), stayed virtually
unchanged (up 0.4 percent) in Southern schools, but fell
elsewhere, declining by 6 percent in the Midwest and down
4.2 percent in North Atlantic states. Doctoral enrollments
in nursing rose in most regions, ranging from increases
of 1 percent (9 students) and 6 percent (26 students) in
Southern and Western schools, respectively, but fell 4.9
percent (37 students) in the Midwest.
AACN's findings are based on responses from
a total of 548 (81.7 percent) of the nation's nursing schools
with bachelor's- and graduate-degree programs that were
surveyed in fall 1999. 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 498 and 493 schools reporting in both 1998 and 1999.
Public Perceptions Out
of Touch with Expanding Market
"Prominent, frequent news reporting of the
growing nursing shortage did not begin to appear until spring
1999, too late in most cases to influence students applying
for fall admission," explains AACN President Andrea R. Lindell,
DNSc, RN. Indeed, deans note many students may have based
their career choices on now-outdated news stories from a
few years ago, when cost cutting and RN layoffs occurred
in many hospitals reacting to pressures under the influx
of managed care.
"Now, however, demand has continued to escalate,
producing a dramatically transformed market, intensified
hiring, and expanding opportunities for RNs in a host of
settings, but word has only recently begun to reach students."
says Dr. Lindell. In addition, "the public's prevailing
view of nursing as a hospital-based profession has limited
many students' awareness of other exciting careers for RNs
in an array of venues such as independent practice, business,
and research to teaching, private industry, law, and health
policy."
The Bureau of Labor Statistics projects that
employment for registered nurses will grow faster than the
average for all U.S. occupations through 2008.
Many Factors Converge to
Drive Demand
Today's climbing need for bachelor's and
graduate-prepared nurses, particularly for emergency, operating
room, critical care, and other key clinical specialties
in acute-care and long-term-care settings, is being spurred
by a host of converging factors, among them:
- an increasing elderly population;
- growing numbers of hospitalized patients
who are older and more acutely ill;
- expanding opportunities for nurses in
front-line primary care, HMOs, home care, outpatient surgical
centers, and other settings as more health care moves
beyond the hospital to other sites throughout the community;
- increased recruiting of nurses by managed
care firms, pharmaceutical companies and information technology
companies;
- expanded career opportunities for women,
who comprise 94 percent of all RNs; and
- technological
advances requiring more highly skilled nursing personnel.
Foreover, with the average age of registered
nurses currently at 44, up from 40 in 1980, high numbers
of RN retirements are projected in the next 10 to 15 years.
If current trends continue, rising demand will outstrip
the supply of registered nurses beginning in approximately
2010, according to the Division of Nursing of the U.S. Department
of Health and Human Services. But already, in growing numbers
of cities and regions, hospitals and other employers are
struggling to meet their rising need for RN care and have
launched aggressive recruitment drives offering increased
benefits and, in many cases, high sign-on bonuses.
Complex Causes for Enrollment
Declines
Though nursing enrollments in entry-level
bachelor's-degree programs declined nationally, several
schools in the AACN survey reported enrollment increases,
citing new pools of students drawn by stepped-up recruiting,
Internet and other distance education technology, and the
addition of more convenient regional training sites.
Moreover, while several schools whose enrollments
declined point to decreased numbers of applicants, others
report their student shortfalls were due to intentional
cutbacks because of faculty shortages, increased competition
with other schools for clinical training sites, or other
resource constraints. In a few cases, schools redirected
their limited resources to graduate-degree programs to concentrate
on producing higher numbers of nurses needed for advanced
clinical practice, administration, teaching, and research.
Seeing Declining Master's
Enrollments in Context
Although master's-degree nursing enrollments
declined for the second consecutive year in fall 1999, the
drop was only the fourth time in the past 13 years for such
a decrease at nursing schools, which have seen the size
of master's-degree classes climb largely in response to
rising demand for nurse practitioners, clinical nurse specialists,
and other RNs with advanced clinical skills. Moreover, the
current decline comes as overall graduate enrollments in
all fields in the U.S. fell for the third consecutive year
in 1998, down by 1 percent, according to preliminary data
by the Council of Graduate Schools.
RN-to-Baccalaureate Graduations
Increase
Overall, schools responding to the AACN
survey reported 111,186 students enrolled in bachelor's-degree
nursing programs in fall 1999. Included in this total
are 75,909 entry-level students, and 35,277 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 1998 and July 1999, 25,444
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 7.7
percent, reflecting past enrollment declines.
RN-to-Baccalaureate programs graduated
12,104 students at responding schools between August 1998
and July 1999, the AACN survey found. The number of RN-to-Baccalaureate
graduates rose 4.2 percent in a matched sample of schools
reporting in both 1998 and 1999. Fall 1999 enrollments of
RN-to-Baccalaureate students declined, however, falling
by 5.7 percent below the year before.
In master's-degree programs, nursing
schools graduated a total of 10,342 students between August
1998 and July 1999, the AACN survey reported.
Meanwhile, enrollments in doctoral programs
that prepare nurse researchers and future nurse faculty
totaled 2,879 students at responding schools in fall 1999,
and remained virtually unchanged, up by 0.8 percent (24
students) in matched schools responding over two years.
Responding nursing schools graduated 360 students with doctoral
degrees between August 1998 and July 1999, with the ranks
of doctoral graduates declining by 10.2 percent (41 students)
in a matched group of schools reporting in both years.
Not a Shortage of Numbers,
but of Right Mix of RNs
Unlike the pervasive nationwide nursing shortage
of the mid-1980s, the current shortfall varies region by
region, market by market, depending upon local conditions.
Moreover, meeting today's heightened demand for registered
nurses requires not simply more RNs, but more RNs of the
right types and right educational mix for
a health care environment that has grown increasingly complex.
Specifically, demand has intensified for
higher numbers of nurses prepared in baccalaureate programs
that emphasize leadership, health promotion, 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.
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. Presently, only about
40 percent do. (Although 32 percent of RNs employed in
nursing in 1996 held baccalaureate degrees as their highest
educational credential, 34 percent held associate degrees
from community colleges, 24 percent had hospital diplomas,
9 percent had obtained master's degrees, and fewer than
1 percent held doctoral degrees, according to Division of
Nursing figures.)
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.
Indeed, many hospitals not already requiring
the Bachelor's of Science degree in nursing (BSN) have established
"BSN-preferred" policies for new hires. For example, the
Veteran's Administration, the nation's largest employer
of registered nurses, has established the baccalaureate
degree as the minimum preparation its nurses must have for
promotion beyond entry-level beginning in 2005, and has
committed $50 million over the next five years to help VA
nurses obtain baccalaureate or higher nursing degrees.
In addition, chief nurse officers at university
health systems report they prefer an average of 70 percent
of their staff nurses to be BSN-prepared, according to a
recent survey by the University HealthSystem Consortium.
More than 70 percent of the CNOs stated they perceive a
difference in the practice of baccalaureate- and associate-degree-prepared
RNs, citing better critical thinking skills and leadership
abilities among baccalaureate nurses.
Removing Barriers
Under contract to the federal Division of
Nursing, AACN held a series of regional meetings in 1999
on strategies to reverse the continued decline in baccalaureate
nursing enrollments. Held from Atlanta, Ga. to Phoenix,
Az., the six meetings provided nursing deans the opportunity
to advise Division staff on steps for returning baccalaureate
enrollments to sufficient levels. Among the approaches urged
was expanding nursing schools' linkages with high school
guidance counselors, many of whom, deans report, provide
students with inaccurate and outdated information about
the profession.
In addition, AACN has joined 16 of the nation's
leading nursing and health care organizations to form a
new coalition, "Nurses for a Healthier Tomorrow," to boost
recruitment of young people to the profession through a
national image campaign. Central to the TV-advertising campaign,
which has launched a national fund-raising effort, will
be boosting public awareness of nursing's central role in
quality health care and the array of nurses' roles that
make positive, tangible differences in people's lives.
Employment Commitments
Strong
Job placements for master's-degree nursing
graduates were among the highest for any degree level, the
AACN survey found. The vast majority (91 percent) of responding
schools estimated that 85 percent or more of their master's-degree
students had jobs waiting at graduation between August 1998
and July 1999. Slightly more than half (58.7 percent) of
responding schools estimated that 85 percent or more of
entry-level baccalaureate graduates had jobs waiting. However,
RN-to-Baccalaureate program graduates -- most of whom were
employed part-time as nurses -- realized the highest placement
rate. Virtually all responding schools (97.4 percent) estimated
that 85 percent or more of RN-to-Baccalaureate graduates
had jobs waiting.
Copies of the AACN report, 1999-2000
Enrollment and Graduations in Baccalaureate and Graduate
Programs in Nursing, will be available after March
1 for $35 (including postage), prepaid orders only, from
AACN, Dept. 178, Washington, DC 20055-0178; (202) 463-6930.
Copies also can be ordered here online.
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.
###
Related AACN Documents
Amid
Nursing Shortages, Schools Employ Strategies to Boost Enrollment
(AACN Issue Bulletin - June 2000)
With
Demand for RNs Climbing, And Shortening Supply, What's Ahead
Isn't Typical "Shortage Cycle" (AACN Issue Bulletin - February
1998)
CONTACT: Robert Rosseter
(202) 463-6930, x231
rrosseter@aacn.nche.edu
