Last year, the first cohort of 79 million baby boomers entered the U.S. Medicare system, bringing with them chronic health problems and high health care expectations. Older Americans require far more health care services than their younger counterparts, making the current shortage of nurses critical. And as health care reform is enacted and millions of previously uninsured crowd into the system, even while the U.S. population continues to expand, the nursing shortage will only become more urgent.
Unfortunately, nurses can't be trained without nurse educators, and that shortage is even more dire. Last year, more than 75,000 qualified nursing applicants were turned away from nursing schools across the country, in large part because school administrators are simply unable to fill numerous vacant positions. In fact, this fall many schools will not know until the week before classes whether they will have enough faculty. Searches for deans can last for years and currently there are 64 open dean positions.
Ironically, the need for nurses comes at a time when nurses are required to make far more independent, critical judgments about care, judgments that often affect life or death outcomes. The shortage in nursing is not related to there being a technical skills gap but is related to a gap of professional nurses.
Higher Workload, Lower Salaries Discourage Nurses From Entering Academia
Several factors contribute to the scarcity of nurse educators. Unlike typical doctoral-prepared college professors who begin their academic career in their early 30s, the average nurse educator with a doctoral degree doesn't begin teaching until she or he is almost 50. They also retire earlier, leaving a small cohort of graying professors to educate the country's new nurses. These short academic careers are causing havoc for our health care system.
Less than 1 percent of nurses have doctorates, and with good reason. After taking on graduate school debt, nursing professors with doctoral degrees work longer hours and, on average, make less than nurses with bachelor's degrees. Competition for nurses with graduate degrees also lures many potential nursing professors out of academia and into lucrative private and clinical sectors that pay significantly higher salaries.
Lower salaries aren't the only reason that nursing educators are in short supply. Unrealistic expectations about academic roles can frequently result in 60 to 80-hour work weeks. Like non-nursing faculty on the tenure track, nursing faculty are expected to carry out teaching assignments, advise students, engage in scholarship and provide service to their school, their profession and their community. However, nursing faculty must also remain current in their clinical practice. This requirement is typically not taken into account by academic institutions, and doesn't play into promotion or tenure decisions. It is extremely difficult for nursing faculty to balance academic roles while enhancing expertise and maintaining clinical practice.
Interestingly, faculty salaries for other professional programs, such as engineering, business management and computer science, are far more competitive. I suspect that universities don't lack the funding. Decision-makers simply value many other professional academic programs more highly than nursing programs.
The number of doctoral graduates has remained flat even as more students enroll in graduate programs. The nation awarded just over 400 doctoral nursing degrees each year from 1965 to 2006. The shortage also threatens nursing research, which typically takes place in academic settings. This research informs nursing practice and improves patient outcomes. It is invaluable to each of us.
Financial Support, Technology and Revised Faculty Expectations Can Alleviate Shortage
Although the country is struggling with an economic recession, we must address the nursing faculty shortage before it becomes even more expensive and more burdensome. This issue should be foremost on the national health policy agenda.
Recruitment of nursing faculty should ideally begin in undergraduate nursing programs, and even in high school and junior high school, and once students get into graduate school, federal and state government programs should provide scholarships. Student loans carried by graduates of doctoral and master's programs could be reimbursed in exchange for post-graduate teaching for specified periods of time. Colleges and universities with nursing programs should reimburse school loans of junior faculty who have completed or are completing doctoral programs.
Other solutions include the integration of technologies, which will allow schools to educate more students with fewer faculty. For example, simulation labs allow students to practice taking vital signs and life-saving measures on computerized mannequins, before they practice on live patients. We would also do well to revise state nursing regulations, permitting graduate students to intern as teachers of undergraduate students, with careful oversight and mentoring by experienced nursing faculty.
Academic institutions could also address the faculty shortage by offering two options to nurse educators, a tenure track for those who choose to take on the role and full expectations of academia, and a non-tenure track for those who choose to be experts in teaching and clinical practice.
Concerned researchers have surveyed nursing professors at hundreds of schools and issued recommendations. Once new faculty have been successfully recruited, it is important not to overload them with classes, so they are able to develop as effective teachers and role models. It is equally important to lower the workload of senior faculty who serve as mentors to junior faculty. Teaching expectations should also take into account the time required for clinical practice.
The health of the nation depends on professional nurses. In the hospital, nurses provide the majority of hands-on, frontline, direct care to patients 24-hours a day -- managing complex health situations, working with families, collaborating with other health care providers -- in other words, doing the work. In the community setting, nurses provide effective health promotion and disease prevention care to individuals and communities.
Research has shown that people die without adequate nursing care. Consequently, in order to solve the nursing shortage we have to solve the nursing faculty shortage first. Addressing the nursing faculty shortage will assure that future nurses are taught to practice evidence-based nursing care professionally and safely.