TAN Issue: January/February 2002: Who Will be There to Teach?

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Shortage of nursing faculty a growing problem

by Susan Trossman, RN

No teacher

The nursing community is facing a twist on the age-old conundrum: Which came first -- the chicken or the egg?

Health care facilities -- urban, rural, acute care and long-term care -- are clamoring for more nurses. Yet how do nursing schools turn out more grads at a time when nurse educators are in even shorter supply?

"RN shortages exist -- and they are only going to get worse," said South Dakota Nurses Association member Mary Brendtro, EdD, RN, C, a nursing professor at Augustana College, a small liberal arts college in South Dakota. "But you can't admit students if there are not enough faculty."

Some of the factors behind the nurse educator shortage parallel those of the staff nurse shortage: an aging workforce, the after-effects of hospital downsizing and salary issues. Others are unique to education, such as full-time faculty members having little time to maintain their clinical practice and certification.

Because the shortage is fueled by many factors, nurse leaders say that solutions to boost the ranks of nurse educators must be broad in scope and include short- and long-term strategies.

Reaching the boiling point

In an October 2000 survey, the American Association of Colleges of Nursing (AACN) reported a vacancy rate of 7.4 percent among the 220 schools that responded. Only 20 of these schools reported no vacancies.

"These vacancies are funded, core faculty positions," said AACN President Carolyn Williams, PhD, RN, FAAN, a member of the Kentucky Nurses Association. "They're what we call the 'heavy lifting' positions that include classroom and clinical responsibilities."

The AACN survey showed that 74.6 percent of the vacant positions identified were of the 'heavy lifting' kind, and almost 95 percent either required or preferred a doctorate degree.

Further, the vacancy rate is only destined to grow considering that many faculty are poised to retire in the next decade and few replacements are in the wings.

The average age of full-time faculty in baccalaureate and graduate nursing programs in 2000 was just over 50 years old, according to AACN statistics. Further, the average age of doctorally prepared professors alone in 2000 was 55.9.

"In the next five to 10 years, we are going to have some very experienced people retiring who are the cornerstone of our program," said Lea Acord, PhD, RN, dean of Montana State University -- Bozeman College of Nursing and a member of the Montana Nurses Association. "There are not a lot nurses graduating with doctorates, and the competition for them among schools of nursing is horrendous."

For example, the AACN reported 411 nurses graduating from doctoral programs in nursing in 1998, and only 43 percent planned on taking on a faculty role. On the pipeline side, enrollment in master's degrees programs in fall 2000 continued to decline -- though only 0.9 percent less than the previous year. Enrollment in doctoral programs, on the other hand, increased by 2.5 percent -- or 71 students -- over the previous academic year, according to an AACN survey.

Nursing school enrollment is cyclical, just like the profession, and those fluctuations invariably affect nursing faculty.

Brendtro, a faculty member for 35 years, pointed to the ripple effect hospital downsizing had on academia in the '80s.

"Declining enrollments in nursing programs caused schools to cut faculty positions," said Brendtro. "Some of the nursing faculty moved on to other things, and it's been difficult to attract them back to education."

One of the factors keeping former and potential nurse educators from teaching is economics.

Nurses, particularly advanced practice registered nurses (APRNs), typically can make more money in clinical practice than their counterparts in education. And some nurses might not want to pursue doctoral degrees if they can't count on them paying off in the long run.

"There are some new nurses who are making more than their faculty at graduation," said Colleagues in Caring Deputy Director Becky Rice, EdD, RN, MPH. Colleagues in Caring is a national grant program funded by the Robert Wood Johnson Foundation aimed at ensuring an adequate health care workforce. "So how can we recruit nurses into education when the clinical practice salaries are more attractive?"

Competitive salaries is an important issue that must be addressed for nurse educator numbers to improve, said Kelly Amtmann, MSN, RN, FNP. She has been working as a full-time instructor at an associate degree program in Butte, MT. In her fifth year teaching there, she makes $34,000.

"If I would have stayed in a hospital position, I'd be making $10,000 more, especially with on-call pay," said the Montana Nurses Association member.

Salaries at four-year programs, however, have risen somewhat. During the 1999-2000 academic year, full-time doctorally prepared instructors made on average $44,359, and non-doctorally prepared assistant professors, $41,870, according to an AACN salary survey. Doctorally prepared professors earned an average of $68,779.

The salary issue aside, nurse educators also face workload issues.

More APRNs and other qualified candidates might consider full-time educator roles if they still had time to practice clinically. However, most universities have a tri-partite mission: teaching, service and scholarship. That leaves little time within a regular work schedule for clinical practice, a must for APRNs who need to maintain their certification.

Further, to qualify for tenured positions, universities tend to look at faculty members' publishing efforts and how many grants they bring in, Acord said. Clinical expertise and practice are not the priority.

"Also, health care has changed so much," said Acord. "We're trying to incorporate everything and squeeze it into four years, and I see frustration in faculty as how to best accommodate required ongoing changes to the curriculum."

Workload is an issue within AD programs, as well. When assigning faculty workloads, Amtmann said that colleges tend to view clinical rotations like science lab courses. They don't realize that overseeing students during clinical rotations is extremely labor intensive.

"When we are in clinicals, we go full guns," she said. "It's a lot of responsibility."

What it means to teach

Despite the drawbacks, nurse educators say their role has many rewards.

"One of the wonderful things about teaching is having the opportunity to mentor students, see them grow into the role and understand what nursing is all about," Acord said. "They come in with a narrow perspective, but by their senior year, they finally get it. It's like an 'a ha!' moment when everything comes together. Then they go on to do great things."

Amtmann, who followed her mother into teaching, said she also enjoys her experience with students.

"I live in a small town where everybody is connected," she said. "We take a lot of time making sure students get what they need, because they're the ones who are going to provide care to our families."

Amtmann pointed out that her hours and time off have been good for raising her family. She also doesn't miss conflicts between physicians and nurses and other workplace issues that lead to burn-out.

Brendtro said that although salaries aren't great, there are other benefits. For example, in some institutions nurse educators can take sabbaticals, which provide them the opportunity to focus on their scholarship as well as to get re-charged.

"I'm in the best of all places to be in nursing," Brendtro said. "It's intellectually stimulating -- there are always opportunities to be stretched by your colleagues. And I work with people who want to be in nursing and who want to make a difference."

She said her college takes faculty development seriously, which makes for a satisfying workplace. She also said that nurse faculty's contributions to the profession are valued at her institution.

Added Amtmann, "My coworkers are just an awesome bunch of women. I get so much out of our working relationships. They are always up for everything that will improve the program."

Solving the conundrum

To solve the nurse educator shortage, nurse leaders said that some long-standing traditions must be broken, while other tried and true methods of developing nurses professionally must be strengthened.

Teacher

One solution involves looking at a fast-track approach to develop doctorally prepared nurse educators, in particular.

"Graduate programs generally prefer to admit students with at least one year of clinical practice experience," said Brendtro who pursued her first graduate degree 17 years after earning her BSN. "And many students decide to take a breather and to pay off their loans before thinking about graduate school. But if some students are ready to move directly into graduate study after earning their baccalaureate degrees, why should we discourage them?"

Acord takes it a step further. "It should be the responsibility of all faculty to identify and support baccalaureate graduates who show potential to succeed in a doctoral program. If we don't, there will not be enough nurse educators."

Williams said AACN has been working with the University Healthsystem Consortium, comprising university hospitals, to build post-residency programs for BSN graduates throughout the nation.

"It's different from an orientation program," said Williams, dean of nursing at the University of Kentucky. "This is more like a medical residency -- a mentored practice where nursing graduates go through a formal process that helps them grow and develop as clinicians."

These "residencies" would allow nurses to get clinical experience sooner and move on to graduate school sooner.

Another key to solving the faculty shortage is the ongoing mentoring of new and experienced nurses, according to Brendtro. She said that she had mentors throughout her career who encouraged her to move into the educator role and to continue to develop professionally.

Her employer also saw the importance of "growing their own" faculty. Several nursing faculty at Augustana, including Brendtro, were given two-year leaves with partial salaries to pursue their doctorates a decade or more ago.

"As many faculty approach retirement, we will need to look at using that approach again," Brendtro said. She also said that her institution assigns new faculty members a formal mentor to ease their transition into academia.

Other key solutions raised by nurse leaders include:

* Increase public funding to schools of nursing to attract and retain nurse faculty.

* Increase access to graduate programs, including long-distance learning opportunities.

* Ensure APRNs have the time within their work schedules to pursue continued education credits and clinical time.

* Increase faculty salaries and loan repayment programs.

* Build partnerships with hospitals to "borrow" APRNs to teach at nursing programs part time.

* Reconsider the way promotions and tenure are granted, so clinical practice and clinical responsibilities are valued.

* Find the right balance between clinical practice and other traditional responsibilities.

And finally, to recruit more nurses into the educator role, non-nurses must be educated.

"We need to convince lawmakers that the nursing shortage -- including nurse educators -- is a public policy issue," Rice said.

Added Amtmann, "What are we going to do when we don't have enough nursing faculty? The quality of nursing programs will be affected and it will trickle down to the quality of care patients receive."

Susan Trossman is the senior reporter for The American Nurse.

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