AACN Issue Bulletin
April 1999

The deficit will likely persist, for in recent years the pipeline of undergraduate nurses has ebbed dramatically. Nursing school enrollments have shrunk across the nation in recent years as many potential applicants, concerned about media reports of RN layoffs, looked to other careers. According to data from the American Association of Colleges of Nursing (AACN), enrollment in entry-level Bachelor of Science (BSN) nursing programs fell 6.6 percent in 1997, and 5.5 percent in 1998, continuing a four-year downward trend, possibly fueled by lingering perceptions of oversupply. Demand for nurses has turned around in the meantime, but public awareness has not caught up with reality.

Exacerbating the nursing shortage overall are inadequate numbers of doctorally prepared nursing faculty. In its core guidelines for master's education, AACN notes that the primary thrust of master's programs should be to prepare nurses for clinical roles and that the doctoral degree "should be considered the appropriate and desirable credential for a nurse educator." But of more than 9,000 faculty at AACN-member nursing schools at universities and senior colleges around the country, only slightly more than 50 percent are doctorally prepared.

Meanwhile, the percentage of master's nursing students pursuing academic careers is on a steep decline, dropping 27.5 percent from 1997 to 1998 alone, according to AACN figures. And with the average age of full-time nursing faculty now 49, a wave of retirements is expected to peak in just ten years.

In an informal poll of 159 AACN-member deans, most (94) said they had yet to feel the effects of faculty shortages, but 64 schools reported that recruitment difficulties were hampering their ability to increase school enrollments.

Faculty shortages is a critical issue for us," says Dean Lea Acord of Montana State University College of Nursing, which currently has 12 unfilled positions for four campus sites. "Enrollments have not been affected yet because of a committed full-time faculty who are taking on more responsibilities, and part-time faculty who are helping us during this difficult situation. However, there's only so much current faculty can do to maintain a quality program when the number of faculty is not adequate. Fortunately, we are shortly bringing in highly qualified candidates to interview with the hope of filling at least some of the positions."

Ironically, lower enrollments can be a contributor, as well as an outcome, of faculty shortages. As Pamela Watson, chair of the Department of Nursing at Thomas Jefferson University in Philadelphia, succinctly puts it, "Lower enrollment equals less revenue equals less faculty." Indeed, several schools report they have reduced faculty numbers because of lower enrollments. Educators warn that while applicant numbers inevitably will increase as word of the growing demand for nurses spreads, enough teachers simply won't be there to train the nursing workforce on which the nation depends.

Schools are facing a number of serious barriers to attracting the faculty they need:

Comparatively low salaries; competition from the clinical and private sectors.

Universally tight budgets have allowed only modest increases in nursing faculty earnings. New AACN data show doctorally prepared full-time nursing professors at four-year colleges and universities earned an average of $66,132 in the 1998-99 academic year, up just 2.7 percent over 1997-98. According to the College and University Personnel Association, while associate and assistant nursing professors' pay tallied fairly evenly with other disciplines in 1997-98, full professors of nursing trailed considerably behind their peers elsewhere on campus, particularly in private institutions.

No wonder, then, that the AACN survey returned reports of many faculty opting for lucrative early retirement packages or resigning for greener clinical or administrative pastures. Dorrie Fontaine, associate dean for Student and Academic Affairs at Georgetown University School of Nursing in Washington, says she has particular difficulty keeping APN nurse faculty -- particularly nurse practitioners, nurse-midwives, and nurse anesthetists. "The opportunities in the private sector are so lucrative for them," she says. "One of our younger [graduates] recently accepted an offer of $90,000 for a clinical post -- that was the extreme." But it's an example of how recruiting nurse practitioner faculty "is a real problem for us." Georgetown encourages joint appointments for nursing faculty, and recently started a faculty practice with a bonus plan as a way to boost compensation for its nurse educators.

"In general, clinical positions pay at a much higher rate than we are able to pay," says Jeannine Muldoon, director of nursing at the College of Our Lady of the Elms in Chicopee, Mass. "Also, other programs -- mostly public education -- are able to offer much higher salaries. It's difficult to hire and keep high-caliber clinical faculty, especially doctorally prepared faculty." To bring salaries up to more attractive levels, creative funding approaches are frequently necessary. Like Georgetown, some schools supplement salaries with earnings from faculty practice plans or share salaries through joint appointments with clinical agencies. Others look to grants, awards, and other external sources to boost faculty income.

Not enough doctorally prepared faculty qualified or willing to teach.

In 1998, 411 people graduated from doctoral programs in nursing, according to AACN data. Of those, only 43 percent had an employment commitment to serve as nursing school faculty. Another 17 percent had accepted non-academic positions. Moreover, the master's-level academic track -- a traditional source of qualified faculty -- is eroding at schools nationwide. AACN data show that the 85 such programs responding to an AACN survey in 1998 graduated just 348 students, down from 480 in 1997. In 1998, 3.3 percent of master's graduates in nursing were coming out of educator tracks, compared to 6.5 percent in 1995.

Schools are finding that filling faculty posts with doctorally prepared nurses who have not come via an education program can be problematic. Carole Anderson, nursing dean at The Ohio State University and AACN immediate past president, cites lack of academic experience as a real barrier. Many PhDs, she says, "do not appear to have a 'fundable' program of research defined, or they lack teaching skills."

Then there are other candidates "who know that research is the name of the game, and that is what they want to do," says Pamela Watson of Thomas Jefferson. "Often they don't want to teach at the baccalaureate level at all -- only graduate -- and there they only want to teach selected courses; most don't have a clinical specialty." Rita Carty, dean of the College of Nursing and Health Science at George Mason University in Fairfax, Va., concurs: "It is becoming increasingly difficult to have a sufficient resource of doctorally prepared faculty to work at all levels in nursing education, especially clinical supervision of undergraduate students."

Difficult working conditions.

Faculty life presents a harder road than private practice or administration, many educators say. "People do it for the love of teaching," says Linda Hodges, dean of the University of Arkansas for Medical Sciences (UAMS) College of Nursing. "But faculty feel so stressed and unfulfilled, their altruism eventually goes right out the window." For clinical faculty in particular, hours are long and working conditions increasingly arduous. RN staffing constraints and sicker patients have driven many hospitals to limit or lower the number of nursing students they will accommodate for clinical training. This forces faculty to scatter their charges more thinly over several floors while still trying to provide adequate instruction and supervision, as well as take responsibility for the students' assigned patients. "Faculty may be looking out for 12 to 14 patients in addition to their educational role," says Barbara Williams, chair of the Department of Nursing at the University of Central Arkansas (UCA). "This ultimately becomes a patient safety issue." And when worn-out faculty are offered early retirement, "They're gone."

In the absence of their ability to promise attractive compensation, several schools are experimenting with other ways to attract qualified faculty. "We are spending a lot of money in advertising, bringing in candidates, sending out special faculty recruitment-focused brochures, etc.," says Elisabeth Pennington, dean of the University of Massachusetts-Dartmouth College of Nursing. Others are reducing teaching loads to make an academic career more enticing to research-oriented PhDs and clinicians. A mechanism at Georgia State University School of Nursing "allows faculty more time for research -- hiring more part-time faculty for clinical positions and allowing the full-time faculty to mentor them," says director Judith Lupo Wold.

Some schools are trying to create better working conditions and opportunities to supplement income. At the University of Maine, "We are trying to make it easy for faculty to work in various clinical settings for additional salary," says nursing director Therese Shipps. "It's not part of their official workload but we are very tolerant of their time away from campus."

Schools also attempt to plug staffing gaps in other ways. "I will hire people with a PhD in another field, but they must have graduate preparation in nursing or they cannot teach in either our undergraduate or graduate programs," says Sandra Ferketich, dean of the College of Nursing at the University of New Mexico. She also hires part-time faculty, but says, "This is killing us since part-time people don't carry the full college service load." Other deans indicate that if necessary, they will hire nurses prepared with a Master of Science in nursing (MSN) degree as faculty under the right conditions, although not on a tenure track.

But positioning master's-prepared nurses as faculty raises some quality issues, especially at the graduate level, says Ohio State's Carole Anderson. "Quality suggests that you have at least a degree higher than your students. [MSNs] may be really good at, for example, teaching disease management, but don't have the research training to do a good job with helping students utilize research findings, conceptualize problems, and synthesize knowledge."

Aggressively recruiting experienced faculty from other institutions may be a short-term band-aid, but it is difficult and costly, and just moves people around, educators explain. "I am not interested in any quick fix for this problem," says Elisabeth Pennington. "Nursing's legacy is full of quick fixes that have, over the long run, hurt the profession. We need to develop a substantive, coordinated effort to increase the number of doctorally prepared nurses who select an academic career."

This message has not been lost on nursing schools, and most are actively engaged in bolstering the academic pipeline. Their approaches include:

Compressing education time.

Many institutions are working to telescope the time from baccalaureate enrollment to doctoral degree. Experience shows when students are engaged in education full-time, they are more likely to complete the program. Plus, they are in the faculty workforce that much sooner. At the University of Florida, state funds are available to allow exceptional PhD candidates to attend full-time, says nursing dean Kathleen Long. "And we are exploring a fast-track BSN to PhD that will include the MSN."

Financial incentives for students and faculty.

Offering financial aid to help graduate nurses move on to doctoral programs is gaining ground in many places. Some schools offer scholarships in exchange for teaching help. And masters-prepared faculty are frequently funded into educational programs toward a doctoral degree.

Retaining the master's-level educator track.

Many schools are determined to keep their master's-level educator tracks, although enrollment has dropped. West Texas A&M University "has pledged to maintain our nursing education program at the master's level," says Heidi Taylor, head of the Division of Nursing. "We have a responsibility to be good stewards of the profession, and that means ensuring there are qualified educators to train the future workforce." The university is engaged in a substantive effort to interest students in academic careers. "When students express an interest in our popular family nurse practitioner program, we counsel them about other master's options, including the teaching track. We've found that many really are interested in teaching, but weren't aware of the opportunities." Since the counseling efforts began, "We've seen education track enrollment grow a little," Taylor says. In addition, a number of schools actively encourage bachelor's graduates and master's students to consider academic careers by involving them in research projects and courses early in their education.

Arkansas, with the least-educated nursing workforce in the nation -- with a ratio of 2.5 BSNs to every 8 vocationally prepared Licensed Practical Nurses -- and one of the lowest RN-to-population ratios, "is at the leading edge of the nursing crisis," says Linda Hodges of UAMS. She and Barbara Williams of UCA are co-chairs of a task force that has developed a white paper on the state's nurse educator shortage and its impact on the RN workforce. The paper, to be disseminated to nursing education programs and major agencies throughout the state, is a wake-up call on the seriousness of the situation.

Among other issues, the paper addresses the losses suffered by the nursing education track. It reports that before the 1992 movement in Arkansas to prepare advanced practice nurses, approximately 50 percent of master's-level nursing graduates at UCA, and 25 percent at UAMS, chose a career in academia. Today those figures are 10 percent and 7 percent, respectively. Although, as Hodges says, "there are no easy solutions," the white paper sets some goals aimed at easing the state's nursing faculty shortage.

Those goals include building grassroots advocacy by educating the nursing community, major stakeholders in the Arkansas health system, and community leaders about the current situation, so all can be conversant with various audiences on the issue and its implications. Also urged are increased efforts to market nursing as a desirable profession, amending the Rural Nursing Loan Scholarship Program to allow for a similar loan and payback program for nurses who choose to teach in an Arkansas school of nursing, and legislation to establish a special appropriation to be set aside to raise the state's nursing faculty salaries.

And the ball is already rolling. The Arkansas General Assembly recently passed a resolution for an interim study on the shortage of RNs and nurse educators that will produce "recommendations for appropriate statutory changes" to be promulgated for the 2001 legislative period.

"I can't believe other states are not going to face the same thing a short way down the road," says Hodges. "States owe it to themselves to study potential shortages in their own region, to see where they will be in five or ten years. It's like an oil tanker; we're not going to be able to turn it around quickly."

For its part, the Association is engaged in two ongoing advocacy efforts to increase federal funding for nursing education and research. In the first, AACN has asked for a 10-percent increase in appropriations for the Nurse Education Act (Title VIII of the Public Health Service Act), for a total of $74.6 million in fiscal year 2000. More than 70 percent of doctoral programs that prepare nursing faculty are supported by NEA money. The Act also provides stipend money to 95 percent of graduate nursing students.

Second, as founding member of the Coalition for Nursing Research Funding, AACN is pushing for a markedly increased budget in FY00 for the National Institute of Nursing Research (NINR), asserting that current funding for the agency cannot build a sufficient number of new nurse scientists -- an important wellspring of nursing faculty. NINR has by far the smallest funding base of all entities of the National Institutes of Health. NINR's FY98 individual and institutional training awards amounted to about $4.7 million -- enough to fund just 199 nurse scientists. By contrast, the National Institute of General Medical Sciences funded 4,331 training awards that year, valued at $114.5 million. The coalition is seeking an increase of $20.4 million, for a total of $90.2 million.

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