AACN Issue Bulletin
June 1998

At 49 years and 4 months, the average age of full-time nursing faculty in U.S. universities and four-year colleges already inched higher in 1997 -- by slightly more than a year -- than the average just three years earlier, according to data from the American Association of Colleges of Nursing (AACN). Even with the increase, the graying of the nation's nursing professoriate is running only narrowly ahead of the rate for all higher education faculty and staff, whose average age was 48 in 1992, say the latest figures from the National Center for Education Statistics.

Moreover, nursing faculty are aging at roughly the same rate as counterparts in other health fields. While the average age of nursing professors was 55 in 1997, the largest single group of medical school professors -- 45 percent -- was age 50 to 59, according to the Association of American Medical Colleges. In pharmacy, nearly half of all professors (48 percent) were age 50 to 59 last year, says the American Association of Colleges of Pharmacy.

Still, such close ranking with other colleagues is little comfort to a profession under mounting pressures to reverse a growing shortage of specialist RNs in many cities nationwide and supply nurses for a rapidly expanding array of roles and practice sites. With the proliferation of front-line primary care, an increasing elderly population, and the need to manage a growing population of patients who are chronically or acutely ill, demand for registered nurses will outstrip supply by approximately 2010, according to the Division of Nursing of the U.S. Department of Health and Human Services. By 2020, the Division projects, demand will climb nearly twice as fast as the expected increase in the RN workforce. As a result, educators are facing a double-barreled challenge to not only steer more RNs to teaching careers to prepare the higher numbers of nurses needed, but also to increase the pool of younger faculty.

The Current Situation

Nursing school associate professors and assistant professors were an average age of 52.1 and 48.5 years, respectively, at bachelor's- and graduate-degree programs in fall 1997, according to AACN figures. "Of our 18 full-time faculty, 7 are over 60. I am concerned," says Shannon Perry, director of the School of Nursing at San Francisco State University. She adds, however, that the school has just hired two tenure-track faculty early in their academic careers. "So I have hope."

"Our faculty match or exceed [AACN's] 'graying' averages," says dean Sandra Rogers of the Brigham Young University College of Nursing. "One of the difficulties I see in recruitment is that two-thirds of the master's students are in [advanced practice clinical] programs. Students in these areas are generally looking for full-time practice roles [and] at higher salaries than many schools can afford," she says.

Indeed, of all nursing students in master's-degree programs in fall 1997, AACN reports that fully 75 percent were preparing for careers as advanced practice nurses - an umbrella category of clinicians that includes nurse practitioners, certified nurse-midwives, clinical specialists, and nurse anesthetists. At the same time, only a slim minority -- just barely more than 4 percent of master's students in nursing schools -- were enrolled in specialties pursuing roles as educators to prepare future nurses.

With the growing dominance of advanced practice, master's-degree programs that produce nurse educators have seen their enrollments slide. Last fall's roughly 4 percent of master's students who made up educator-track enrollments in nursing was down from 7.5 percent in 1995, according to AACN figures. Meanwhile, nurse practitioner programs that comprised 42 percent of master's enrollments at nursing schools in 1995 accounted for more than half -- 57 percent -- in fall 1997.

"Our [master's-degree] enrollments in nursing education have dropped about in half in the last year. Fall '98 looks grim as well," says director Sandra Baird of the School of Nursing at the University of Northern Colorado. "We are experiencing a nursing shortage, though, and when that happens [education-track] enrollments go down. But they don't seem to in the family nurse practitioner program."

Of the 130 master's students at South Dakota State University's College of Nursing in fall 1997, most were enrolled in the family nurse practitioner program. "Only two took the nurse educator practicum," explains dean Roberta Olson. Five years ago, she says, the nurse educator class had about 10 more students than it does today.

Elsewhere, the picture is at least stable, and in some cases growing. After a two-year drop, class sizes have increased in the master's-degree nurse educator program at the University of North Carolina-Greensboro. Meanwhile, at the University of Rhode Island's master's program, educator-track nursing classes that usually have 8 or 9 students have remained "fairly constant" over the past five years, notes interim nursing dean Dayle Joseph.

"Stopping Out" Won't Do

Of paramount concern to educators, however, is doctoral activity. While acknowledging that master's-prepared nurses are needed on faculty as expert clinicians, AACN's core education standards stress that "the primary focus" of master's programs should be to prepare RNs for clinical, not educator, roles. The doctoral degree is the "appropriate and desired" credential for nurse educators, AACN's standards note. It is at the doctoral level, educators explain, where nurse scholars learn the skills to generate new science and to pass on research know-how to future nurse scientists.

And time is of the essence. Although their average age ranks close to other higher education faculty, the time it takes for most nurses to obtain the doctoral degree lags years behind counterparts in other fields. At 45, the average age of new doctorate recipients in nursing in 1996 trailed averages of 33.8 in all fields, 38.5 in the health sciences, and 44.3 for education majors, according to data from the National Research Council and the National Opinion Research Center.

Granted, the ranks of doctoral nursing graduates are increasing, growing by 18 percent between 1996 and 1997, from 366 to 433, according to AACN figures, and rising across the last five years. Still, deans say, steeper gains, younger recruits, and faster production time will be needed if nursing is to have enough doctorally prepared faculty who serve enough years as productive scientists and teachers.

"Our tradition and norm of encouraging students to work between degrees considerably lengthens the amount of time it takes for nurses to be fully prepared for academic/research roles," said Carole Anderson, dean of The Ohio State University College of Nursing and editor of the journal Nursing Outlook, in an editorial this year. "We have to change the culture" by moving more students on a direct path from bachelor's, to master's, and on to the doctoral degree without interruption, Anderson says. "This stopping out isn't good. Once [master's graduates] get out and work full-time, it's hard to get them to give up their $50,000-a-year jobs and come back to study full time."

Off to a Later Start

Deans and other observers share mounting concerns, too, over the advancing age -- and resulting fewer years as productive clinicians and educators -- of new nursing grads at the entry level. At 28, the average age of bachelor's-degree nursing graduates in 1996 was up from 26 in 1992 and climbed from 23 in 1977, according to the federal Division of Nursing.

The need to finance more of one's education with work has prolonged degree completion for many students in nursing and other professions. In addition, many RNs who graduate from bachelor's-degree programs (about 4 out of every 10 who did so in 1997) had returned to school after first receiving associate degrees from community colleges, which tend to attract older students. Largely as a result, nursing increasingly is beset with an aging workforce. In 1996, the average age of RNs in the U.S. was 44, up from 40 in 1980, according to federal figures. Only 9 percent of the nation's 2.5 million registered nurses were under age 30 in 1996.

Breaking Down Barriers

But as they try to fill their faculty rosters with younger recruits, schools have encountered a number of obstacles. Many deans point to competition from higher-paying clinical sites and private-sector research jobs as a chief roadblock. Market changes, however, may brighten education's appeal as a career choice. "I have several former faculty working as clinical specialists in regional hospitals. However, the turmoil of restructuring may eliminate some of their jobs and make academe look attractive again," says Sharon Jacques, acting head of the Department of Nursing at Western Carolina University.

For many schools, coming up with attractive salaries and fringe benefits are only part of the formula for drawing and keeping talented educators, especially younger faculty. "We have had difficulty attracting new, young doctoral faculty. They seem mostly interested in going to large institutions to pursue their research interests," explains Esther Haloburdo, nursing chair at Saint Joseph College in West Hartford, Connecticut.

Elsewhere, old attitudes can stand in the way. "Regardless if the student is pursuing a career in health policy, we have some faculty who believe students must have 'x' years [of nursing experience] in a hospital or whatever" before beginning doctoral study, says nursing dean Rita Carty at George Mason University in Fairfax, Virginia. Still other deans point to some new doctoral graduates who are reluctant to teach undergraduates and seek instead to concentrate on research pursuits.

Putting Solutions into Place

Many nursing schools expose students to research and teaching roles early in their curricula, such as encouraging bachelor's-degree students to go on to a nursing research class in their senior year or encouraging master's-degree students to participate in research seminars or to do an optional thesis for graduation. Several institutions, such as the University of Scranton and University of Missouri, offer opportunities for undergraduate nursing students to work closely with faculty by assisting on research projects.

At the University of Kentucky this fall, a new honors option will give selected bachelor's-degree students research exposure in addition to special individualized clinical practice opportunities. "We have designed this to enhance the recruitment of highly capable students into nursing and then to encourage them early to move into graduate study," says nursing dean Carolyn Williams.

Other schools, concerned over the majority of graduate students who attend part-time and intent on moving more of them on a fast track to academic careers, have opened new programs to help graduates with Bachelor of Science in Nursing (BSN) degrees to complete their doctorates more speedily. Opened in 1991, the new BSN-to-PhD track at the University of Texas (UT) Health Science Center in San Antonio -- a collaborative effort with the School of Nursing at Texas Tech University Health Science Center in Lubbock -- enables BSN grads to earn their doctorates after 4 ½ years of full-time study, compared to the often 7 or more years for full-time students to earn their master's and doctoral degrees in turn. Other BSN-to-PhD programs have opened at the University of Maryland and the University of Pittsburgh.

Some caution, however, that fast-track efforts should not bypass essential study at the master's level. Without the advanced clinical knowledge that comes from master's preparation, will doctoral-degreed faculty "understand the clinical issues" behind what they're researching, asks dean Kathleen Ann Long of the University of Florida School of Nursing? "Clearly we do need to position our scientists to begin their research careers sooner. Still, we wonder if without advanced practice education they can be well-prepared to explore research questions in a field that is inherently practice-based," she says. Among its incentives, the school is using private funds to provide financial support to help more PhD students attend full-time. Elsewhere, educators also urge increasing public dollars for stipends and other support to encourage full-time doctoral study.

In Houston, the UT Health Science Center has instituted "a mechanism to admit a doctoral student who is not yet graduated from the master's program," says dean Patricia Starck of the School of Nursing. This year, the doctoral track admitted a student who had two semesters left to finish her master's degree, permitting her to also take doctoral courses. "She has now completed her master's program with a 4.0 GPA, and has [completed] two semesters of the DSN degree program." A similar fast-track option at Duquesne University in Pittsburgh allows qualified master's students to also take doctoral-level electives.

A New Counterbalance

Meanwhile, to help counterbalance the surge in advanced practice nurse (APN) training, "we've just started an APN option which will provide for sub-specialization in education," says Helen Streubert, chair of the Nursing Department at College Misericordia in northeast Pennsylvania. With the opening of a family nurse practitioner program four years ago, enrollments in the school's nurse educator track have dropped "tremendously," she says.

Other efforts have reached out to former graduates. The Division of Nursing at Louisiana College has used alumni who are working on their graduate degrees to substitute as instructors for on-site clinical training. "This seems to stimulate the appetite for academia and we have been able to recruit 'young' professors as a result," says chair Anne Fortenberry. The push for younger faculty is not to devalue age or the continued productive output of more senior educators, several deans are careful to note. "Our 67-year old is still going strong and still innovating. And only one of our 'approaching retirement age' faculty is making serious noises about dropping back to half-time," says Sharon Jacques of Western Carolina University.

Nevertheless, observers point to the increasing questions by federal and state policy leaders and some legislators over the practice, for example, of awarding research funds to investigators who earned doctorates in their 40s and likely will have fewer years as active scientists than younger talent. "Until quite recently, we told our new grads to go to work for a couple of years before starting graduate school," says the University of Rhode Island's Dayle Joseph. But lately, "we have looked at the experience piece a bit differently. It's possible for some students to work while attending school. Other disciplines encourage their young to move quickly through the academic ranks," she says. Nursing, other deans agree, should follow suit.

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