Monica McLemore likely won't finish her nursing Ph.D. for another year, but already she's getting prime job offers and facing pressure to choose among careers with strikingly different prospects.
"Everybody's forcing me to answer this question," says McLemore, 35, who already makes a comfortable salary working three days a week as an RN at San Francisco General Hospital and teaching about a dozen students twice a week for San Francisco State University. But if she joined the university faculty it would mean a pay cut. Her graduate research in cancer genetics makes McLemore attractive not only to academia but also to industry, where salaries can be significantly higher. California giant Kaiser Permanente has already offered her a "dream job," she says. "The nursing Ph.D. opens up a lot of opportunities."
Fierce competition for highly educated nurses like McLemore means huge headaches for the nation's nursing schools as they struggle to turn out enough graduates to ease America's nursing shortage. Colleges and universities need nurses with master's degrees or doctorates to teach courses, advise students and oversee hands-on training in hospitals. But academic salaries, hamstrung by tight budgets, usually fall significantly short of those offered by hospitals or drug manufacturers.
Without more faculty, schools can't boost enrollment for undergraduates who will become tomorrow's bedside nurses, say deans and academic directors. "It's a pretty vicious cycle," says Terry Valiga, chief program officer for the National League for Nursing, a professional organization for nursing faculty.
Less than 1% of U.S. nurses held a doctoral degree in 2000 and roughly 9% held a master's degree, according to a federal survey. Little improvement in enrollment or graduation trends makes it doubtful much has changed, says Geraldine Bednash, executive director of the American Association of Colleges of Nursing.
Nursing schools rejected 32,000 applications from qualified students in 2004 despite a 14% gain in enrollment from 2003, AACN figures show. Nearly 3,000 rejected applicants were for graduate programs. The No. 1 reason schools reported turning away students was too few faculty members.
It will likely get worse before it gets better. The average nursing professor holding a doctorate is 56, the AACN reports. The average age of an associate professor with a doctorate is 54. Assistant professors are 50 on average. The average age for faculty with master's degrees is only slightly lower at 49.
And it takes time to earn a graduate degree, warns Joanne Disch, director of the Katherine J. Densford International Center for Nursing Leadership on the Twin Cities campus of the University of Minnesota and interim dean of the university's School of Nursing. Registered nurses with associate's or bachelor's degrees graduate after two to four years -- and into a tight labor market with competitive salaries. Nurses who do decide to earn a graduate degree often take time away from academia to work before returning to school, Disch says.
Classroom innovation, private investment and public policies are needed to ease the burden of graduate education and entice students into faculty roles, say educators and healthcare employers. Some schools have launched fast-track bachelor's-to-doctorate degrees that graduate students in four to five years. The number of such accelerated degree programs increased in 2004 to 49 from 45 a year earlier, according to the AACN. Another 12 fast-track doctorate degrees are under development.
Valiga says graduate programs must also boost offerings in educational theory. Too often schools overlook such training and emphasize clinical specialties and research, leaving nursing faculty with no preparation to teach, she says. "They're learning on the job."
The job isn't easy. Faculty members prepare coursework, teach, advise students, govern, conduct research and publish. It's a 60- to 80-hour workweek on a noncompetitive salary, she says. The average full-time faculty salary for a nurse with a doctorate was $78,000, and $58,437 for those with a master's degree, according to the AACN.
Employer-sponsored initiatives have helped alleviate demand for faculty or clinical teaching space, another barrier to expanding nursing school enrollment, Bednash says.
Kaiser Permanente is recruiting nurses with master's degrees to become members of Kaiser's clinical faculty, says Barbara Norrish, director for education and career development. It's a newly created position and still under development. The job will allow clinical faculty members to teach but earn a Kaiser nursing salary, erasing the wage disparity, she says.
Nursing educators say stronger public support is needed to address the demand for nursing faculty. Federal funding for faculty loan repayment under the Nurse Reinvestment Act totaled $4.8 million in 2005. "That's only going to get us 65 more faculty" nationwide, Bednash says. Tripling or quadrupling the amount would still fall short, she says. The AACN called for a $25 million increase in 2006 to the $150 million spent on federal Nurse Workforce Development programs this year.
Bednash says she expects a bill to be introduced that would fund nursing schools' expanded enrollment, faculty retention and equipment upgrades to improve laboratories. The AACN supports a second bill known as the Teacher and Nurse Support Act that would broaden a federal loan forgiveness program for teachers to include nursing faculty. "It motivates people" to join a faculty, she says. "Once we get them there, I think they stay."
Scholarships and grants helped pay for McLemore's degrees, which leaves her without the sizable student loans that can accompany higher education, she says. She is unmarried and has no children. "I've got a lot of freedom," when choosing a career, she says. "I'm trying not to let money factor into my decision."
Beatrice Yorker, director of the San Francisco State University School of Nursing, where McLemore is a clinical professor, agrees emphatically. "We could not attract faculty if salary is all we're hiring on," she says. Yorker relies heavily on networking to recruit prospects. She hires doctoral candidates as clinical faculty members hoping to cultivate a relationship. "Absolutely, we love to grow our own," says Yorker, who must fill three full-time faculty positions this year and five next year on her roster of 15 tenure-track faculty posts. Once tenured, a process that typically takes five years, faculty members earn more, she says.
San Francisco State University's expanding enrollment has added stress to Yorker's faculty. In fall 2004, the university, Ca¤ada College and the Sequoia Healthcare District, both headquartered in Redwood City, Calif., opened a satellite campus at Ca¤ada College's campus. "It means we're stretched to the absolute max," she says.
Mary Ann van Dam joined San Francisco State University's tenure-track faculty in 2002 after a dozen years on the part-time clinical faculty. Her base pay as an assistant professor, $55,000, is $20,000 less than her salary as a pediatric nurse. "I'm a weird person," she says. "I know that. There's no reason, other than the love of teaching, that I'm here. It's not a luxurious life." Van Dam and her partner, who is a bedside nurse, have two sons. "After so many years of education, it's very depressing to feel like I'm trying to make ends meet for my children."