There were reports coming out as early as 2010 discussing the looming nursing shortage, and the many trends that have been leading to that. However, while a lot of attention has been paid to the low number of graduates, few have been looking in the faculties’ direction. Nursing schools around the country have been turning down applicants in droves, not because they were unqualified, but because of a lack of teaching personnel. And if you don’t have enough nurses with BSNs relative to demand, few can go on to earn master’s degrees and teach the next generation of nurses. Could lack of faculty actually be the main contributor to the nursing shortage?
An overview of the nursing shortage
The number of registered nursing jobs is expected to increase nearly 20 percent over the next ten years, a full eight percentage points higher than the overall growth in the job market. However, we don’t have enough new nurses in the pipeline to meet this demand, and the shortage of advanced nurses is compounding the problem.
There is already a 44 percent gap between the number of healthcare positions and the number of applicants. This healthcare shortage affects everything from registered nurses to biostatisticians. Furthermore, it contributes to a shortage of nursing instructors.
The states with the worst nursing shortages are:
- South Carolina
- New Jersey
- South Dakota
“The shortage is not just one thing. There is a wide number of factors that contribute to this shortage,” said Heidi Sanborn, assistant professor at Arizona State University in Phoenix. “Not all areas will be hit the same. In some states, the issues will be very regional. And some states might actually experience surpluses.” She added.
This shortage of nurses isn’t limited to registered nurses with a BSN. It includes LPN, too. Thirty-three states are expected to need more LPNs than the number available. That shortage is seen across the United States. Those states with the greatest shortfall of LPNs are also those that are going to fall short of the number of required RNs.
Shortages are not due to lack of interest
The nursing shortage cannot be blamed on a lack of applicants. Around 80,000 potential nursing students were denied BSN and graduate nursing program placements due to a lack of funding and slots. An estimated two thousand doctoral candidates were turned away, while over 13,000 MSN applicants were turned away. These masters and doctoral level students would be the advanced practice nurses that hospitals need as well as potential future nursing educators. Roughly two thirds of nursing schools had to turn away applicants because they didn’t have enough faculty, funding, clinical sites or facilities.
How bad is the shortage of nursing faculty? An AACN survey found that there were around 1600 faculty vacancies in the more than seven hundred nursing schools around the country. This means that around eight percent of full-time nursing faculty positions are vacant, and about seven percent of part-time nursing education positions are vacant. Yet schools would have to hire at least 120 additional nursing educators in order to meet the growing demand for nursing school slots.
The factors contributing to the nursing shortage
The nursing shortage can be partially blamed on demographic shifts. Healthcare and especially nursing are among the fastest growing professions in the United States. And there will be an estimated half million more nurses in the U.S. by 2022 than there were just a few years prior. However, an aging population calls for far more nurses than this, and the supply is constrained by the many Baby Boomer nurses slated to retire in coming years. One study of nurses found that 55 percent were nearing retirement. Over the next ten to fifteen years, an estimated one million RNs will hit retirement age. Yet demand for nurses in assisted living and long-term care facilities is only going to grow.
The demographic shift is affecting staff and faculty as well
A related problem is the aging of nursing faculty themselves. A 2013 study found that the average nursing instructor was 58 years old. Making matters worse, nursing faculty tends to retire younger than average; they tend to retire around 64. This means we’re going to see a wave of retirements among nursing faculty even as nursing schools are turning away candidates for lack of classroom spots. Even top ranked programs have to work to attract qualified nursing faculty. This is why some schools are holding international recruitment drives for nursing educators.
Not only that, but forming new teachers takes time. “The process to getting nurses into faculty positions takes longer,” Sanbord said. “They need to have clinical experience, and a master’s at the very least, when it’s not a doctorate.” She also stated that faculty positions naturally attract older nurses, which complicates matters further. “With the number of faculty members retiring, we don’t have enough people coming through the pipeline to fill new faculty positions, and without teachers, we won’t have enough bedside nurses who will be able to fill positions in the future.”
Why we need to solve the nursing shortage
The nursing shortage is having a ripple effect that is affecting much more than the nurses themselves. Some of the direct effects of nursing shortages include:
- Lower quality of care
- Higher burnout rates
- Lower retention rates
- High patient readmission rates
- Higher patient mortality rates
When nurses have four or more patients, quality of care suffers. This is why a 2013 study found that patient readmission rates rise in these situations. Readmissions like these also increase the nurse’s daily workload.
One 2012 study found that by increasing the patient load by just one patient, there is an increased risk of hospital acquired infections. Patient mortality rates also go up as nurses are stretched thin. Nursing burnout increases the odds nurses quit, too, leaving those who remain all the more stressed. This is why healthcare employers try to offer additional incentives to hire new talent. After all, more flexible schedules, empathy and healthy snacks offered for free can’t make up for demands to work double shifts and seven days in a row.
A number of short-term solutions for the nursing shortage
Healthcare facilities are already competing for limited skilled nursing talent. They’re paying a premium to hire travel nurses or offering money to relocate and work for the employer. Healthcare employers are also paying for nurses to earn advanced degrees. This allows nurses to move into specialized roles, and it reduces turnover. Furthermore, it increases the qualifications of the staff. For example, LPNs who complete an RN to BSN program are now allowed to do that much more in the workplace.
The best long-term solutions for the nursing shortage
One possible solution is evaluating the work LPNs are allowed to do. If they are legally allowed to do more, then the demand for and on RNs will go down. This is one way to reduce the burden on overworked RNs. California passed a law limiting the number of patients that can be assigned to a nurse. While this reduces the workload of individual nurses, it ironically increases demand for nurses.
Another potential solution is pushing back on accreditation commissions that are revoking accreditation for community colleges. This is due to the accreditation commissions that consider someone with a master’s degree in nursing the only acceptable teacher of future nurses. Yet community colleges tend to rely on part-time instructors with a bachelor’s degree in nursing. The ACEN standard says that at least half of the teachers in associate degree nursing programs must hold a graduate degree in nursing. If the school lacks ACEN accreditation, the graduates of the nursing program may not be allowed to get a nursing license, though that depends on the state. Unfortunately, many potential nurses must go to community colleges to be able to afford to earn a nursing degree.
More scholarship and funding could help
Offering more scholarships for nursing students who want to become nursing educators would lead to more people in nursing programs becoming professors. Compensating them for the clinical work they do in preparation for the degree would have the same effect. Increased mentorship and professional conferences would broaden the pipeline, too. However, that doesn’t matter if we don’t have the space in nursing education programs.
One solution would be increasing funding for nursing faculty. This would keep many existing educators working in the classroom and lure qualified instructors into teaching from higher paying disciplines. It would also make nursing education more attractive over clinical nursing. Right now, active nurses are paid much more than nurse educators. A full-time nursing professor earns around $100,000 a year on average. For comparison, a nurse practitioner could earn $110-125,000 a year. The top quartile of nurse educators earns around $120,000 a year.
Online programs could be a solution
Expanding online nursing education would certainly address the long-term shortage of nursing slots. For example, professionals can access FNP programs online through institutions like Spring Arbor University. This could allow them to complete a master’s degree in nursing as they continue working. Online education also opens up advanced nursing degrees to students who don’t live near nursing schools accepting students. Online nursing programs let you connect with schools that offer specialized degrees from nurse practitioner to nursing educator programs. And you don’t have to quit your job and move to complete the degree. This lowers the overall cost of pursuing the advanced nursing degree, because you simply connect with the courses online.
This also solves the problem of nursing programs having to share facilities with other programs, because online students don’t use classrooms and dorms. A side benefit of expanding online programs is that it can handle wild fluctuations in enrollment. This is attractive to schools afraid to hire full-time staff and dedicated buildings to train nurses due to the layoffs they had to go through in the 1990s.
The rise of managed care led to layoffs of RNs by 2000 and resulted in a decline in nursing students. Another benefit of online education is that it allows nursing students to continue their education at their pace, even if this is one class at a time. This reduces the odds they quit their education because they don’t have time, wasting a nursing school slot that could have gone to someone else who would have finished their degree.
If demand for nurses somehow declines, online students don’t have the same debt load and can more easily switch to a program that keeps them in demand. For example, we’re seeing a serious shortage of mental health experts and pharmacists.
Incentivize teaching post tenure
Another possibility is eliminating the financial incentive to work in a clinical environment. For example, there are already several programs that offer student loan forgiveness for future nurse educators who agree to teach after graduation.
Schools could emphasize the benefits of working in academia, thus attracting nurses with advanced degrees to teaching. For example, they could present the schedule flexibility and reduced work hours as benefits of working in nursing education. Schools are already determining how they could reduce the workload of nursing educators approaching retirement to keep them in the classroom at least part time.
This could lead many nurses with advanced degrees to consider teaching as a second career, once they feel no longer capable of working in the wards or a doctor’s office. This would dovetail into the traditional career path for nurses as they move from the bedside to desk jobs. They’d also bring invaluable experience to the classroom. They’d be ideal for preparing students for the evolving healthcare environment.
Another potential avenue is attracting younger nurses to the teaching field. This would result in nursing educators who would remain in the role for decades. Some schools are trying to interest their prospective students in both teaching and direct patient care so that some would consider becoming a faculty member as soon as possible. A side benefit of this approach is that it then isn’t as hard to recruit faculty, since it is someone coming up through the ranks at that institution.
The general nursing shortage is contributing to the shortage of nursing faculty. That in turn leads to a worsening of the nursing shortage. It is a vicious cycle. However, there are a variety of ways this cycle can be broken, and we can’t afford not to try to solve the problem at all levels.