Addressing theAddressing theNursing Faculty ShortageNursing Faculty Shortage

in the Statesin the States

Nancy DeBasio, PhD, RNNancy DeBasio, PhD, RNBoard MemberBoard Member--atat--Large,Large,

American Association of Colleges of NursingAmerican Association of Colleges of NursingDean, Research College of Nursing, Kansas City, MODean, Research College of Nursing, Kansas City, MO

Understanding the Nursing ShortageUnderstanding the Nursing Shortage

The current and projected shortage of Registered The current and projected shortage of Registered Nurses (RNs) has been wellNurses (RNs) has been well--documented in the documented in the media and the professional literature.media and the professional literature.

Leading researchers project a shortage of Leading researchers project a shortage of 340,000 nurses by 2020340,000 nurses by 2020 (Auerbach et al., (Auerbach et al., 2007).2007).

This translates into an RN shortage roughly three This translates into an RN shortage roughly three times what we are now experiencing across the times what we are now experiencing across the country.country.

In Missouri, the vacancy rate for RNs was 7.5% In Missouri, the vacancy rate for RNs was 7.5% in 2006 according to the Missouri Hospital in 2006 according to the Missouri Hospital Association (MHA).Association (MHA).

Understanding the Nursing ShortageUnderstanding the Nursing Shortage

In response to the growing demand of RNs, In response to the growing demand of RNs, schools of nursing have worked diligently to schools of nursing have worked diligently to expand student enrollments to meet the nation’s expand student enrollments to meet the nation’s nursing needs.nursing needs.

In fact, entryIn fact, entry--level baccalaureate nursing level baccalaureate nursing programs have experienced programs have experienced six years of growth six years of growth in enrollment and graduationsin enrollment and graduations..

Since 2000, data collected through AACN’s Since 2000, data collected through AACN’s annual survey show that annual survey show that enrollments enrollments increased by 84%increased by 84% -- from 72K to 133K.from 72K to 133K.

Enrollments and Graduations in Generic (EntryEnrollments and Graduations in Generic (Entry--Level) Level) Baccalaureate Nursing Programs, 1993Baccalaureate Nursing Programs, 1993--20062006

79,43585,469

124,814133,578

37,851

112,18095,766

72,741

92,79499,658

97,23989,724 85,439

80,108 76,848

27,394 31,827 27,39423,15423,117

25,76527,93329,85029,03028,59126,79920,912

23,687

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Enrollments

Graduations

N of Programs: 408 4351 4411 4391 456 443 455 443 476 487 479 564 577 585Response Rate: - - - - - - - - 88% 85% 69% 78% 84% 86% 85% 88% 88% 89%

Source: Tabulations of AACN databases, 1994-2007. © American Association of Colleges of Nursing. All Rights Reserved

1 No denominator data for 1993 - 1996.

Understanding the Nursing ShortageUnderstanding the Nursing Shortage

Though enrollments are up, schools are still not Though enrollments are up, schools are still not graduating enough nurses to meet the project graduating enough nurses to meet the project demand.demand.

Even at the current rate of nurse production, the Even at the current rate of nurse production, the country is now experiencing a shortage of more country is now experiencing a shortage of more than 118,000 RNs; this shortage will likely than 118,000 RNs; this shortage will likely increase each year through 2020.increase each year through 2020.

The demand for nurses far outpaces the ability of The demand for nurses far outpaces the ability of schools of nursing to respond.schools of nursing to respond.

So why can’t schools of nursing just expand So why can’t schools of nursing just expand student capacity even farther?student capacity even farther?

The Other Nursing ShortageThe Other Nursing Shortage

Nursing schools at all levels are struggling to Nursing schools at all levels are struggling to further expand student capacity in the face of too further expand student capacity in the face of too few faculty, budget constraints, and limited few faculty, budget constraints, and limited clinical training and classroom space.clinical training and classroom space.

Future increases in nursing student enrollment Future increases in nursing student enrollment may not be possible since many schools are now may not be possible since many schools are now operating at capacity.operating at capacity.

In fact, thousands of qualified nursing students In fact, thousands of qualified nursing students are turned away each year due primarily to a are turned away each year due primarily to a short supply of nurse educators.short supply of nurse educators.

Many students turned away Many students turned away give up on nursing give up on nursing and pursue alternate career optionsand pursue alternate career options..

5,283

18,105

32,797

41,68342,866

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000Q

ualif

ied

App

licat

ions

Tur

ned

Aw

ay

2002 2003 2004 2005 2006Year

Qualified Applicants Turned Away from Baccalaureate & Graduate Nursing Programs: 2002-2006

SOURCE: American Association of Colleges of Nursing, Research and Data Center, 2003-2007AACN is not responsible for reporting errors by respondent institutions.

The Competition for Nurse FacultyThe Competition for Nurse Faculty

According to AACN’s latest survey, the current According to AACN’s latest survey, the current faculty vacancy rate is 8.8%.faculty vacancy rate is 8.8%.

The faculty shortage is a result of many issues:The faculty shortage is a result of many issues:

•• Heightened competitionHeightened competition from the practice setting for from the practice setting for nurses with advanced degreesnurses with advanced degrees

•• Significantly Significantly lower salarieslower salaries in academia compared to in academia compared to the private sectorthe private sector

•• An An insufficient number of graduate nursing insufficient number of graduate nursing studentsstudents in the educational pipelinein the educational pipeline

•• A A rapidly agingrapidly aging nurse faculty population; a large wave nurse faculty population; a large wave of retirements is expected over the next 10 yearsof retirements is expected over the next 10 years

The Federal Government’s ResponseThe Federal Government’s Response

In response to the nursing shortage, the federal In response to the nursing shortage, the federal government increased funding for Nursing government increased funding for Nursing Workforce Development programs (Title VIII, Workforce Development programs (Title VIII, Public Health Service Act) from FY 2001Public Health Service Act) from FY 2001--2005.2005.

Despite these increases, funding has been level Despite these increases, funding has been level for the past two years.for the past two years.

Earlier this year, President Bush called for the Earlier this year, President Bush called for the elimination of the Advanced Education Nursing elimination of the Advanced Education Nursing program which supports graduate study.program which supports graduate study.

Funding for the Nurse Faculty Loan Program has Funding for the Nurse Faculty Loan Program has been flat since FY 2004.been flat since FY 2004.

Federal Funding for Nursing Education: Federal Funding for Nursing Education: FY 2001 FY 2001 -- FY 2007FY 2007

Funding in the Millions of Dollars

Title VIII Funding: Nursing Ed Advanced Education Nursing Nurse Faculty Loan Program

FY 2001 $78.74 $59.00 NA

FY 2002 $92.74 $60.04 NA

FY 2003 $112.76 $50.17 $2.96

FY 2004 $141.92 $58.65 $4.87

FY 2005 $150.67 $58.17 $4.63

FY 2006 $149.68 $57.05 $4.77

FY 2007 $149.68 $57.05 $4.77

States Address the Nursing ShortageStates Address the Nursing Shortage

In the absence of a comprehensive federal In the absence of a comprehensive federal response to the nursing shortage, individual response to the nursing shortage, individual states have been at the forefront of addressing states have been at the forefront of addressing this critical healthcare issue.this critical healthcare issue.

States have been instrumental in advancing States have been instrumental in advancing solutions and meeting local needs.solutions and meeting local needs.

Legislators recognize the strong connection Legislators recognize the strong connection between the faculty shortage and the production between the faculty shortage and the production of RNs.of RNs.

Within the past two years, Within the past two years, most efforts to most efforts to address the nursing shortage have included address the nursing shortage have included a faculty componenta faculty component..

What’s Working in the StatesWhat’s Working in the States

Statewide InitiativesStatewide Initiatives•• Most involve advancing new legislation and Most involve advancing new legislation and

funding to address the shortage.funding to address the shortage.

•• Illinois, Kansas, Maryland, and Utah have all Illinois, Kansas, Maryland, and Utah have all recently launched sweeping initiatives.recently launched sweeping initiatives.

For example, the Kansas Board of Regents approved For example, the Kansas Board of Regents approved a tena ten--year, $30 million initiative in 2006 aimed at year, $30 million initiative in 2006 aimed at increasing nursing capacity in the state by 25%.increasing nursing capacity in the state by 25%.

This program will provide funding for nursing This program will provide funding for nursing equipment and facility upgrades; nursing faculty equipment and facility upgrades; nursing faculty salaries; and scholarships. salaries; and scholarships.

What’s Working in the StatesWhat’s Working in the StatesLoan Forgiveness ProgramsLoan Forgiveness Programs•• Programs typically provide loan repayment in Programs typically provide loan repayment in

return for a service commitment.return for a service commitment.

•• More than a dozen states offer these programs More than a dozen states offer these programs including GA, MN, MO, ND, NE, TX and VT. including GA, MN, MO, ND, NE, TX and VT.

In Illinois, the In Illinois, the Nurse Educator Assistance ActNurse Educator Assistance Actwhich provides up to $5,000 in loan repayment and which provides up to $5,000 in loan repayment and $10,000 in scholarship to graduate nursing students. $10,000 in scholarship to graduate nursing students.

In Colorado, the In Colorado, the Nursing Teacher Loan Nursing Teacher Loan Forgiveness ProgramForgiveness Program (SB 136) provides up to (SB 136) provides up to $20,000 in loan forgiveness in exchange for a five$20,000 in loan forgiveness in exchange for a five--year teaching commitment.year teaching commitment.

What’s Working in the StatesWhat’s Working in the States

Raising Faculty SalariesRaising Faculty Salaries•• Established by the Mississippi Legislature, the Established by the Mississippi Legislature, the

Mississippi Office of Nursing Workforce was Mississippi Office of Nursing Workforce was able to secure funding for a $6,000 salary able to secure funding for a $6,000 salary increase for all 500 nurse faculty working in increase for all 500 nurse faculty working in the state in July 2007. the state in July 2007.

•• Though its comprehensive Nursing Education Though its comprehensive Nursing Education Capacity Initiative, the Pennsylvania Higher Capacity Initiative, the Pennsylvania Higher Education Foundation together with the state Education Foundation together with the state hospital association funds the hospital association funds the Nurse Faculty Nurse Faculty Lines ProgramLines Program which provides funding to which provides funding to schools to underwrite nursing faculty positions schools to underwrite nursing faculty positions (up to $150,000 over three years). (up to $150,000 over three years).

What’s Working in the StatesWhat’s Working in the StatesInnovative ResponsesInnovative Responses

•• Many state initiatives show great creativity in Many state initiatives show great creativity in meeting local needsmeeting local needs

In 2006, Maryland Governor Robert L. Ehrlich, Jr. In 2006, Maryland Governor Robert L. Ehrlich, Jr. created the created the Nurse Support Program Assistance Nurse Support Program Assistance FundFund which provides funding for graduate fellowships which provides funding for graduate fellowships and scholarships.and scholarships.

Funding for the program is generated by the state’s Funding for the program is generated by the state’s Health Services Cost Review Commission which levies Health Services Cost Review Commission which levies a 0.1% increase to the rate structure of all hospitals.a 0.1% increase to the rate structure of all hospitals.

Approximately $8.8 million is generated annually Approximately $8.8 million is generated annually through this mechanism. through this mechanism.

What’s Working in the StatesWhat’s Working in the StatesInnovative ResponsesInnovative Responses•• In October 2006, Pennsylvania Governor In October 2006, Pennsylvania Governor

Edward G. Rendell unveiled initiatives to Edward G. Rendell unveiled initiatives to increase the number of nurse educators and increase the number of nurse educators and expand clinical education.expand clinical education.

The $4 million "Loaned Faculty" initiative provides The $4 million "Loaned Faculty" initiative provides funding so health care employers and nursing funding so health care employers and nursing education providers can loan qualified teachers to education providers can loan qualified teachers to nursing schools experiencing faculty shortages.nursing schools experiencing faculty shortages.

The "Clinical Education" expansion initiative provides The "Clinical Education" expansion initiative provides $3 million in grants to help nursing schools and $3 million in grants to help nursing schools and health care providers expand clinical education health care providers expand clinical education opportunities for the growing number of nursing opportunities for the growing number of nursing students in the state. students in the state.

What’s Working in MissouriWhat’s Working in Missouri

MHA’s Graduate Nursing Faculty MHA’s Graduate Nursing Faculty Financial Assistance Program Financial Assistance Program •• This program provides up to $10,000 a year This program provides up to $10,000 a year

for fullfor full--time students and $5,000 annually for time students and $5,000 annually for partpart--time students.time students.

•• Participants commit to 1Participants commit to 1--2 years of teaching 2 years of teaching for every year assistance is received.for every year assistance is received.

•• In July 2007, the MHA announced that 31 In July 2007, the MHA announced that 31 graduate nursing students were selected to graduate nursing students were selected to receive funding through this program.receive funding through this program.

What’s Working in MissouriWhat’s Working in Missouri

Kansas City Metropolitan Healthcare Kansas City Metropolitan Healthcare Council (KCMHC)Council (KCMHC)•• The KCMHC launched the The KCMHC launched the Graduate Nursing Graduate Nursing

Faculty Financial Assistance ProgramFaculty Financial Assistance Program to to provide $193,000 in funding in 2007 and 2008 provide $193,000 in funding in 2007 and 2008 to nurses from Kansas or Missouri who have to nurses from Kansas or Missouri who have completed up to 12 credit hours towards a completed up to 12 credit hours towards a master's degree.master's degree.

•• Nurses receiving financial assistance through Nurses receiving financial assistance through this program must work either fullthis program must work either full-- or partor part--time as a clinical faculty member at a local time as a clinical faculty member at a local nursing school after graduation. nursing school after graduation.

What’s Working in MissouriWhat’s Working in Missouri

OneKC WIREDOneKC WIRED

•• This unique initiative demonstrates the power This unique initiative demonstrates the power of partnering among diverse stakeholders.of partnering among diverse stakeholders.

•• The focus of the healthcare component of this The focus of the healthcare component of this larger initiative is the expansion of the nursing larger initiative is the expansion of the nursing workforce in the Kansas City region.workforce in the Kansas City region.

•• Collaborators include representatives from Collaborators include representatives from manufacturing, life sciences, health care, manufacturing, life sciences, health care, nursing education, and the public workforce nursing education, and the public workforce system. system.

What’s Working in MissouriWhat’s Working in MissouriWorkforce Collaborative ProjectWorkforce Collaborative Project•• Clinical Faculty AcademyClinical Faculty Academy

Expand the pool of educators needed to prepare the Expand the pool of educators needed to prepare the next generation of nursesnext generation of nursesIncrease nursing school enrollmentsIncrease nursing school enrollmentsEvaluate innovative educational models that could be Evaluate innovative educational models that could be sustained and replicatedsustained and replicatedNumber of participating hospitals: 54Number of participating hospitals: 54Number of participating nursing programs: 27Number of participating nursing programs: 27

What’s Working in MissouriWhat’s Working in Missouri

Results for 2006Results for 2006——20072007•• 71 nurses were loaned to area schools 71 nurses were loaned to area schools

to serve as clinical facultyto serve as clinical faculty•• 97 participants in 2 297 participants in 2 2--day academiesday academies•• PostPost--conference follow up sessions:34 conference follow up sessions:34

participantsparticipants•• 602 additional new students enrolled602 additional new students enrolled•• By 2009 30 participants in the CFA will By 2009 30 participants in the CFA will

complete their MSNcomplete their MSN

Thank YouThank You

I look forward to your questions.I look forward to your questions.

ReferencesReferencesAACN. (2007). AACN. (2007). 20062006--2007 Enrollment and 2007 Enrollment and

Graduations in Baccalaureate and Graduate Graduations in Baccalaureate and Graduate Programs in NursingPrograms in Nursing. Washington, DC: Author.. Washington, DC: Author.

AACN. (2007). AACN. (2007). Special AACN Member Survey on Special AACN Member Survey on Vacant Faculty Positions for Academic Year 2007Vacant Faculty Positions for Academic Year 2007--20082008. Washington, DC: Author.. Washington, DC: Author.

Auerbach, D.I., Buerhaus, P.I. & Staiger, D.O. Auerbach, D.I., Buerhaus, P.I. & Staiger, D.O. (2007, January/February). Better late than never: (2007, January/February). Better late than never: Workforce supply implications of later entry into Workforce supply implications of later entry into nursing. nursing. Health AffairsHealth Affairs, 26(1), 178, 26(1), 178--185.185.

Reference MaterialReference MaterialAACN State Advocacy Resources for Nursing EducationAACN State Advocacy Resources for Nursing EducationSample legislation, loan forgiveness programs, stateSample legislation, loan forgiveness programs, stateworkforce reports, statewide nursing shortage initiativesworkforce reports, statewide nursing shortage initiativeshttp://www.aacn.nche.edu/Government/StateResources.htmhttp://www.aacn.nche.edu/Government/StateResources.htm

AACN Issue Bulletin: State Legislative InitiativesAACN Issue Bulletin: State Legislative Initiativesto Address the Nursing Shortageto Address the Nursing Shortagehttp://www.aacn.nche.edu/Publications/issues/Oct06.htmhttp://www.aacn.nche.edu/Publications/issues/Oct06.htm

AACN Government Affairs StaffAACN Government Affairs Staff

Stacey Pine: Stacey Pine: Spine@aacn.nche.eduSpine@aacn.nche.eduSuzanne Begeny: Suzanne Begeny: Sbegeny@aacn.nche.eduSbegeny@aacn.nche.edu