By Debra Wood, RN, contributor
Beverly Malone, Ph.D., RN, FAAN, reported a new emphasis on progression in nursing to higher degrees.
September 3, 2010 - The lingering sour economy combined with expanding opportunities for nurses associated with passage of health care reform have resulted in increased demand for nursing education—both at the undergraduate and graduate levels.
“The projections for the next few years is that nursing is still the fastest growing profession, and health is the fastest growing sector in the nation,” said Beverly L. Malone, Ph.D, RN, FAAN, chief executive officer of the National League for Nursing in New York.
Even though new graduate nurses experienced more difficulty securing jobs this year, in large part due to older nurses holding off on retirement or returning to the workforce to support their families, it has not dampened enthusiasm for nursing.
“We are definitely seeing a sustained interest in nursing careers, even though the nurse vacancy rate has stabilized in many parts of the country,” said Kathleen Potempa, Ph.D., RN, FAAN, president of the American Association of Colleges of Nursing (AACN) in Washington, D.C. “Workforce analysts all agree that the current easing of the nurse vacancy rate is only temporary.”
Yet nursing education programs are having a hard time meeting the demand. AACN found that almost 55,000 qualified applications were turned away from baccalaureate and graduate nursing schools last year, which represents the highest volume of students turned away within the last 10 years.
“There are waiting lists everywhere,” said Leila McKinney, DNP, ARNP, NP-C, RN, dean of nursing at Rasmussen College in Maitland, Fla.
Hazel M. Sanderson-Marcoux, EdD, RN, reported an increase in male applicants to nursing school.
The effect of the economy
Hazel M. Sanderson-Marcoux, EdD, RN, associate dean of the school of nursing at Long Island University’s Brooklyn campus in New York, said the school has noted an increased interest in nursing, with people—including men with families—going back to school and into nursing for the job security.
Sharon Pontious, Ph.D., RN, CNE, interim dean and professor at Florida International University College of Nursing and Health Sciences in Miami, also reported an increase in the number of qualified undergraduate and graduate applicants, but the school cannot admit them all. For instance, it accepted 100 of more than 300 qualified applicants for its generic BSN program and 50 of 363 qualified applicants for its graduate programs.
“Students see that nursing is a profession where people always have jobs,” Pontious said.
Gloria Jacobson, RN, Ph.D., reported that a lack of faculty limits the ability to expand enrollment.
That belief has led Gloria Jacobson, Ph.D., RN, dean of Saint Xavier’s School of Nursing in Chicago, to become more cautious about admissions.
“We see students come into it for that reason, without being aware of what the work really is,” Jacobson said. “[Providing outstanding patient care] takes a person who is a good fit for the profession.”
Mary C. Brucker, Ph.D., CNM, said that society needs more well-educated nurses to care for the aging population while providing more preventive and early care for individuals who previously had no health care coverage. Photo courtesy Baylor photography.
Cost is a factor holding some students back from nursing careers. Mary C. Brucker, Ph.D., CNM, associate dean of the Baylor University Louise Herrington School of Nursing in Dallas, reported that this year approximately 100 qualified students were accepted or wait-listed for the traditional undergraduate program, but approximately a dozen were compelled to deny or delay due to cost, even in light of the largest scholarship packages ever offered in the school. Baylor has made scholarships a high priority, she said, and the nursing school is seeking endowed scholarships, grants, individual support and partnerships with hospitals to help candidates become nurses.
Other private schools also expressed the importance scholarships play in allowing candidates to pursue nursing degrees.
The effects of health care reform
Educators expect that health care reform will spur a need for even more registered nurses and advanced practice nurses.
Courtney H. Lyder, ND, GNP, FAAN, dean of the University of California, Los Angles (UCLA) School of Nursing, said, “In the next three to five years, demand for nursing is going to continue, especially because of health care reform. Nurse practitioners are stepping into the role left behind by the decrease in primary care physicians. I think you will also see more nurses in alternate settings independent of hospitals.”
Nurses understand the opportunities ahead. Texas Tech University Health Sciences Center Anita Thigpen Perry School of Nursing in Lubbock is receiving five to six qualified applicants for every available nurse practitioner opening, said Interim Dean Chandice Covington, Ph.D., RN. About 400 nurses are in the nurse practitioner program.
Chandice Covington, Ph.D., RN, reported that Texas Tech is receiving five to six qualified applicants for every available nurse practitioner educational opening. Photo courtesy Texas Tech.
“Nurse practitioners are going to be the backbone of serving the previously uninsured population,” Covington said. “That’s going to hit fast, and we need nurse practitioners who are seasoned.”
Recognizing the need for more nurse practitioners in the coming years, Emory University’s Nell Hodgson Woodruff School of Nursing in Atlanta increased its enrollment in this year’s master’s program to 115 students.
Marsha L. Lewis, Ph.D., RN, reported that this year, Emory University’s School of Nursing enrolled the largest class of students in its history. Photo courtesy Emory University.
“In this era of health care reform, advanced practice nurses will be a vital element in improving care and reducing health care costs,” said Marsha L. Lewis, Ph.D., RN, associate dean for education at Emory’s nursing school. “The nurse practitioner programs grew by 16 percent overall, but interest in the pediatric primary care and pediatric acute care programs increased by 112 percent and 71 percent, respectively.”
Fran Roberts, Ph.D., RN, vice president of strategic business alliances for Grand Canyon University College of Nursing and Health Sciences in Phoenix, cautions that the “demand for nurse practitioners will only exacerbate the shortage of nurses at the bedside and elsewhere.”
Adding undergraduate capacity
Hence, the country will need more registered nurses. Boosting enrollment, though, depends on securing sufficient nursing faculty and clinical training space, and both commodities are in short supply.
“Schools are getting creative to increase capacity,” said Malone, citing partnerships with corporate organizations, the use of simulators and development of new clinical placements, such as community settings, prisons and retail clinics.
The University of Pennsylvania (Penn) School of Nursing in Philadelphia has increased its undergraduate enrollment by more than 40 percent in recent years, said Kathleen McCauley, Ph.D., RN, ACNS-BC, FAAN, FAHA, the nursing school’s associate dean for academic programs. Penn has improved its partnerships with clinical sites; holds weekend and evening clinical opportunities, including 12-hour shifts; and has enhanced use of the learning lab and simulation.
“Partnerships with our clinical agencies are critical,” McCauley said. “We find some of our best clinical faculty within our clinical sites.”
Hila Richardson, DrPH, RN, FAAN, a professor and associate dean for the undergraduate program at New York University College of Nursing, reported that the college has steadily increased enrollment during the past five years and exceeded its admission targets for the fall semester. It has hired more faculty members and supplements the clinical experience with simulation.
Long Island University has started an accelerated program for students with bachelor’s degrees in other fields and plans to expand its generic evening/weekend program to accommodate more students who work full-time.
Creighton University School of Nursing in Omaha is offering a second class for accelerated nursing students, and it has expanded the nursing program at its Hastings campus in rural Nebraska.
Grand Canyon University, another private institution, has increased capacity by partnering with health systems—including Saint Joseph’s Hospital and John C. Lincoln North Mountain Hospital, both in Phoenix. It recently added a program at Presbyterian Health System in New Mexico. It rents space at the hospital, and students complete most of their clinical experiences at the facility.
Fran Roberts, Ph.D., RN, believes the demand for nurse practitioners will create a need for more bedside registered nurses, as those now in practice return to school.
“We take the best of the old diploma programs—they come out clinically grounded and with an affinity for a certain organization—and we embed it with our baccalaureate program,” Roberts said.
Oklahoma City University’s Kramer School of Nursing, a private school, has added more faculty members and is building a new addition to the school, quadrupling space to accommodate applicants’ demand for nursing education.
“Our university is not typical, because we have a policy at the nursing school to accept all qualified applicants,” said Marvel Williamson, Ph.D., RN, CNE, ANEF, dean of the Kramer School. She reports more nursing schools have opened recently.
Florida Career College in Boynton Beach, Fla., in response to a community need, recently expanded from allied health care education to offering an associate’s degree in nursing program, accepting its inaugural class of 30 students this fall.
Leila McKinney, RN, DNP, ARNP, NP-C, anticipates the demand for nurses will continue and that the nursing shortage will return.
Rasmussen College has added campuses in Fort Myers and Brandon, Fla., and expanded enrollment. McKinney has found clinical facilities more open to welcoming new programs, especially those that offer greater supervision. Rasmussen students in Florida spend 25 percent of their clinical time working with simulators.
Florida International University (FIU) has built a virtual hospital with simulators, and students spend between 10 percent and 15 percent of their time working with the mannequins. It is used primarily for developing teamwork, including interdisciplinary collaboration.
With the opening of a new facility, Texas Tech will increase from 30 percent of its clinical experiences being simulated to 50 percent. It offers a special program for nurses from rural areas, allowing them to rotate through simulation training and weeks in their community with a nurse mentor.
“They have time at home and time here and still have roots back to the community that sent them and is paying for their school, but it’s small numbers,” Covington said.
Not all states allow that level of simulator training to apply toward clinical experience.
Creighton University and Grand Canyon University use simulation to supplement rather than replace on-site clinical experiences.
Emory has increased the number of students a faculty member can oversee during clinical experiences by developing dedicated education units at Emory Healthcare hospitals. On the units, BSN-prepared staff nurses are trained to be clinical instructors for two students.
Sharon Pontious, Ph.D., RN, CNE, said with health care professions deemed recession proof, the FIU nursing program is seeing a greater interest from older prospective students looking to trade in their current jobs.
FIU helped pioneer an electronic program to match clinical sites with nursing program needs in South Florida, which has “maximized our ability to use the clinical sites that are available,” Pontious said.
Boosting graduate school enrollment
The lack of nursing instructors remains a concern for nursing leaders. Potempa reported that some schools are moving to develop their own faculty by offering incentives to students willing to quickly move into graduate programs that offer a fast-track baccalaureate-to-doctoral option, entry-level master’s programs and online offerings.
UCLA established an accelerated Ph.D. program that moves the freshman bachelor's level student through to a Ph.D. in six years, Lyder reported.
Florida International University (FIU) developed a “grow our own faculty” program, with grant funding and in collaboration with two local community colleges, providing 10 students with full tuition and fee reimbursement for the master’s program, in exchange for teaching two years as nursing faculty at the community college level. FIU also has developed an online graduate and post-graduate certificate program.
Creighton also has developed a “grow your own faculty” program, allowing instructors to teach part time while pursuing a doctoral degree.
Baylor University teaches all of its family nurse practitioner, neonatal nurse practitioner and nurse-midwifery courses on either Wednesday or Thursday so nurses can continue to work while in school. Multiple online options, including high-definition conferencing, digital recording of classes and use of Wikis, enrich the programs, Brucker said.
The University of Pennsylvania has collaborated with clinical partners in creative tuition structuring to help graduate students’ tuition benefits go further. But the number of clinical sites and preceptors available to the school limits further growth in the master’s programs.
Kathleen Potempa, Ph.D., RN, FAAN, indicated the passage of health care reform legislation has heightened the need to expand capacity in nursing education programs.
Federal funds to increase capacity
Potempa reported that both chambers of Congress have proposed $292 million in funding for Title VIII Nursing Workforce Development programs, a 20 percent increase since last year. The programs provide loans, scholarships, traineeships and other assistance to students.
In addition, new federal funding came through this summer for the Advanced Nursing Education Expansion Program, which will provide graduate nursing students with stipends, educational expenses, or other reasonable living expenses for $22,000 per year, for a maximum of two years per student. The new program was launched to increase the number of students enrolled in accredited primary care nurse practitioner and certified nurse midwifery programs and to encourage current students to move from part- to full-time enrollment, Potempa said.
Federal support for nursing education is welcomed.
“Over the next few years, we expect nursing workforce acute shortage patterns to reappear again, revealing the underlying nursing production shortage related to the aging workforce and increasing demand for health care services,” Potempa said. “Given the health care reform law, population demographics, and growing demand for care, AACN projects that interest in nursing careers will remain strong as opportunities for practice expand.”
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