Looming nursing shortage fueled by faculty shortfall

A nursing faculty shortage is producing a circular crisis, as students are being turned away from understaffed nursing schools at a time when more nurses are needed in the U.S. healthcare system.

Indeed, more than 56% of the 714 nursing schools that responded to a recent American Association of Colleges of Nursing survey reported 1,236 full-time faculty vacancies for the 2014-15 academic year. The limited pool of candidates with post-graduate degrees and noncompetitive teacher salaries were cited as major barriers to faculty recruitment.

And while 7% of nurse faculty positions nationwide remain vacant, 78,000 applicants to bachelor and advanced-degree nursing programs were turned away last year because there weren't enough faculty available to teach them.

This statistic is especially troubling because the U.S. Bureau of Labor Statistics projects a demand for 1.1 million new nurses over the next seven years to fill 575,000 newly created positions, as well as a need to replace some 550,000 nurses who will retire by 2022.

The New York-based Jonas Center for Nursing Excellence estimated that each nurse educator position left vacant could affect the care of 3.6 million patients if the number of nurses each instructor could teach is considered along with the number of patients for whom those nurses could provide care.

But the picture is not as bleak as the numbers might make it appear. “We did see this shortage coming,” said Pamela Cipriano, president of the American Nurses Association and a research associate professor at the University of Virginia School of Nursing. “So the good news is that we have been preparing to bring more faculty on board.”

A graduate degree is required to teach nursing and efforts are underway to boost the number of nurses with advanced degrees, said AACN President Eileen Breslin.

“We have targeted individuals in baccalaureate programs to enter into graduate programs sooner rather than later,” said Breslin, dean of the School of Nursing at the University of Texas Health Science Center at San Antonio.

To help build the faculty pipeline, an Institute of Medicine 2011 report recommended that the number of nurses with doctorates be doubled by 2020. The number of graduates with a Master of Science in nursing increased 43% between 2000 and 2008, from 202,639 to 290,084 master's grads, the report noted. And doctorate nursing graduates boosted their numbers 64.4% during that period, from 17,256 to 28,369. But only 555 students graduated with Ph.Ds in nursing in 2009, the report found.

Peter McMenamin, a healthcare economist with the ANA, said nurse faculty salaries generally hover around $70,000, the same as for registered nurses. But nurse practitioners and nurse midwives earn about $90,000, and a certified registered nurse anesthetist can make $160,000, he said.

As a result, “You have to have a real calling if you want to be a nurse faculty member,” he said.

Cipriano points to another problem—having positions that offer the right balance of teaching and clinical workload. “Salary is not the single determinant,” she said.

Cipriano also said she thinks the 78,000 total for the number of applicants being turned away from baccalaureate or advanced-degree programs may be inflated by the number of individuals applying simultaneously to multiple institutions and how those applicants are counted in the tally.

But the frustration for those being turned down is real. While some may choose another career or wait another semester to reapply, others may choose to go into a two-year associate-degree program instead.

“But that could also complicate their career trajectory,” Cipriano said, explaining that more hospitals are hiring candidates with four-year degrees, forcing associate-degree nursing graduates to endure longer waits for their first job.

Breslin said her institution is fully staffed, but maintaining the status quo is not the same as meeting a growing need. “The limiting factor is that we have enough faculty to manage the existing program, but not enough to expand,” she said. “We do turn away qualified applicants.”

Nursing colleges face another major challenge beyond faculty shortages, Breslin said. As healthcare delivery transitions from inpatient to outpatient care, the number of clinical-training opportunities are dwindling for a growing number of students.

“In 2014, we had 16,000 graduates of nurse-practitioner programs, so we have a very robust pipeline,” said Kenneth Miller, president of the American Association of Nurse Practitioners. “But we're competing for clinical-training sites with physician assistants, we're competing with medical students.”

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