Shrinking nursing faculty adds up to a growing -- if hidden -- problem
Schools are turning away eager students due to the lack of nursing faculty. What can we do to reverse the trend?
By Doug Childers

As the current faculty in schools of nursing reach retirement age, the demand for new faculty will inevitably go up. But will the number of job candidates be adequate to teach the next generation of nurses?

The growing crisis surrounding the shortage of nurses who provide direct patient care in hospitals is well-documented. According to a report released by the American Hospital Association in April, hospitals in the Unites States now face a shortage of 118,000 registered nurses. And it's going to get worse, as aging boomers require more health care. The U.S. Bureau of Labor Statistics projects that more than 1.2 million new and replacement nurses will be needed by 2014.

The nursing shortage has received considerable press coverage, as it should. But another, equally troubling shortage lies largely hidden from public view. Today, a shortage of professors in schools of nursing is becoming significant enough to inhibit the push to train more nurses, even as an increasing number of potential nursing students steps forward. According to a report released by the American Association of Colleges of Nursing (AACN), nursing schools turned away more than 41,683 qualified applicants to entry-level baccalaureate and graduate nursing programs last year because of insufficient number of faculty, clinical sites, classroom space, clinical preceptors and budget constraints.

"It's like the chicken and the egg," said Dr. Nancy Langston, dean of the Virginia Commonwealth University School of Nursing. "If we don't have faculty, we don't have students." Despite the lack of media attention, Dr. Langston said schools of nursing have been worrying about the faculty shortage for six years. "We started saying 'Uh oh' in 2000 nationwide and regionally. 'We're not able to fill our faculty lines. We've got a problem.' That was at a time when enrollment was down. Now that enrollment is trying to rebound, it's making our shortage more severe."

Dr. Jeanette Lancaster, Sadie Heath Cabaniss professor and dean of the University of Virginia School of Nursing, agrees. "There are vast numbers of applicants to schools of nursing. What schools tend to lack are faculty, space in their educational buildings and clinical facilities - these factors reduce the ability to expand enrollment."

That may mean turning away well-qualified applicants. This year, George Mason University School of Nursing, which has the largest bachelor's program in Virginia, had 600 applicants for all undergraduate programs in nursing. It accepted 200. Each year, 200 George Mason graduates seek licensure.

And Dr. Lancaster said that U.Va. received "369 applications to our BSN program [first years] and we were able to accept 56" this year. "With more faculty, we could accept more students. Many of those whom we turn away are well-qualified to come to U.Va. and to become nurses."

"There is no doubt that the unavailability of nurse educators is hampering the ability to expand programs," said Shirley S. Travis, dean of George Mason's College of Health and Human Services.

Nationally, the estimated number of budgeted, unfilled, full-time positions this year is 1,390, according to the National League for Nursing's Faculty Census Survey. Since 2002, the vacancy rate in baccalaureate and higher degree programs (7.9 percent) has increased 32 percent since 2002. And the vacancy rate in associate degree programs (5.6 percent) has increased 10 percent in the same period.

The problem is just as severe for Virginia's schools of nursing. VCU School of Nursing, for example, currently has 38 full-time faculty and 10 vacant positions - roughly, a 25 percent vacancy. "We've been recruiting and recruiting and recruiting," Dr. Langston said. "Recently, we have had three faculty resign. On the other hand, we recruited four new young faculty, so we have a net of plus-one."

The reasons for the faculty shortage are simple: The current faculty are aging, and the salaries being offered to replace them are often too low to draw enough candidates away from highpaying jobs in the private sector.

Nationally, the average age of doctorally-prepared nurse faculty is 57.9 for full professors, 55.4 for associate professors and 51.5 for assistant professors, according to a recent report from AACN. Nursing faculty tend to retire at about the age of 62.5.

Virginia's schools of nursing are in line with the national numbers. The State Council of Higher Education in Virginia reported that the average age of the state's nursing faculty in 2002 was 53 and the general nursing population was 45, on average. At VCU, the ages of its doctorally prepared faculty on a tenure track ranged last year from 41 to 68. The mean age was 54.3 years of age. The range of the school's master's degree faculty was 31 to 63. Their mean was 46. About 35 percent of U.Va.'s faculty is 55 years or older. George Mason's faculty with senior positions are in their late 50s; junior faculty are in their late 30s, 40s and early 50s.

One reason for the relatively high age of nurse faculty is the simple fact that "attaining the right level of preparation takes several years," which in turn makes addressing the faculty shortage a long-term project, Dr. Lancaster said.

In addition, many nurses tend to follow a cycle in which they go to school for a degree, then work for a period of time, then go back to school for another degree. Consequently, doctoral candidates in schools of nursing are often in their 40s and 50s.

The fact that the salaries typically offered to nurse faculty can't compete with the salaries offered in clinical and privatesector settings hurts the ability of schools to recruit younger replacements for retiring faculty. A 2003 salary survey compiled by ADVANCE for Nurse Practitioners Magazine determined that the average salary of a master's-prepared nurse practitioner in an emergency department was $80,697. By comparison, an AACN report found that master's-prepared nurse professors earned an annual average salary of $69,340 in 2005.

"One of our faculty had been talking to a researcher about the possibility of coming to VCU," Dr. Langston said. "The young woman was saying that her husband couldn't move. Then they decided to move after all. She's currently making $165,000. The minimum she needs is $125,000. Our highest paid professor is $114,000."

Unable to meet her minimum salary requirements, she didn't come to VCU.

Likewise, Dr. Langston recounts the story of "a gentleman at the University of Texas at El Paso who might have been interested" in coming to VCU, "but our salary was 20 percent less than he is currently making." And an undergraduate student whom Dr. Langston was encouraging to consider a career in teaching told her that she "couldn't work for our salaries."

Even instructors with master's degrees, who are not on a tenure track and don't have to do research, face teaching salaries that are lower than they could make in the private sector. One instructor, Dr. Langston said, took a $20,000 pay cut to join the VCU faculty. "You wouldn't do that if you didn't have some value systems. But we're simply not able to compete with salaries here at VCU."

VCU is not alone. "Nurses with master's or doctoral preparation are highly recruited by health care and other industries and often at sizable salaries," U.Va.'s Dr. Lancaster said.

The faculty shortage will not be fixed by a single, short-term plan.

"It takes three to five years for a doctoral student to complete his or her program of study," George Mason University's Dr. Travis said. "Thus, even if we were able to take major corrective action tomorrow to increase the number of doctorally prepared nurse educators, there is no quick fix to rapidly expanding the number of Ph.D. nurses in the country."

Still, many schools of nursing are proposing changes and launching programs designed to address the shortage. An increase in salaries paid to nurse faculty is central to many proposals, but as Dr. Langston pointed out, while offering competitive salaries is necessary, "it will not be sufficient unto itself."

Dr. Lancaster suggested that a good first step would be "a faculty preparation loan repayment plan. That is, for each year of tuition support, the recipient agrees to teach a year in the Commonwealth."

Staggering faculty retirements to reduce their impact and asking retired faculty to return to the university setting to perform limited tasks, like teaching part-time or even grading papers, are also being considered.

Some schools are pursuing larger campaigns, as well. In June, George Mason University launched a new bi-annual program, the Nurse Educator Academy, which "is intended to attract nurses working in clinical settings who are interested in learning more about a job in nursing education or in educational settings where they are novice teachers and would like to learn more about strengthening their skills as teachers," said Dr. Chris Langley, George Mason's acting associate dean for nursing programs and director of the School of Nursing. "We bring them to the campus for three or four days and then have a continuing relationship with them."

Dr. Langston also suggests actively recruiting undergraduates to become faculty. "Start with freshmen. Don't let being a faculty member 'be an afterthought' for them. We need to talk to young, impressionable students before they see the bright lights of the critical care unit."

Currently, she said, in a class of 110 undergraduate nursing students, three might consider a career in teaching.

VCU is also developing a bachelor's degree to doctorate program, to speed up the education process and avoid the "get degree, work, get degree" cycle. "We're recruiting our students to stay with us," Dr. Langston said.

Dr. Langston proposed that the state's university nursing programs come together to recruit faculty into Virginia rather than simply moving faculty among the commonwealth's various programs. "Our schools of nursing in Virginia are making a booth to take to national meetings and recruit together for faculty to come to a faculty position somewhere in Virginia."

The theme would be straightforward: "Somewhere in Virginia, there is a school that could fit your career." The plan is being discussed now, and the state's association of university programs has allocated $2,000 for the initiative.

"I'd prefer that we bring people into Virginia," Dr. Langston said. "It's an innovative strategy. We're united in Virginia. We care about each other and the health of the citizens of the Commonwealth."

No matter what form the efforts will take, the bottom line is simple, said Dr. Lancaster: "Teaching is a fulfilling role, and those of us who love it need to be more vocal in encouraging others to join us."