April 2, 2012 - The call has gone out that the United States needs a more highly educated nursing workforce for the future. And future nurses have responded to that call by applying to nursing school.
Unfortunately, the nation’s nursing schools are not currently able to accommodate all of them.
According to updated enrollment data released recently by the American Association of Colleges of Nursing (AACN), enrollments were up across the board last year: baccalaureate, master’s and doctoral programs all logged increases in enrollment.
Issues impacting supply and demand
Nearly 76,000 qualified applicants were turned away last year, including more than 15,000 applicants to graduate programs--a new high. Faculty shortages and shortfalls in resources such as clinical teaching sites were cited as the most common obstacles to expanding capacity.
Jane Kirschling, DNS, RN, AACN president, calls the increasing demand in nursing higher education a "good news/bad news" story.
AACN President Jane Kirschling, DNS, RN, calls it a “good news/bad news story.”
“The exciting news is that we have nurses who are actively looking to continue their education,” she said.
But the challenge still lies ahead: how will the nation’s nursing schools find ways to educate enough nurses to insure a robust stream of highly educated nurses who will be prepared to meet the increasingly complex health care needs of the public?
The Institute of Medicine’s (IOM’s) landmark 2010 report “The Future of Nursing: Leading Change, Advancing Health” called for a more highly educated nursing workforce. Among the recommendations outlined by the report was the call for 80 percent of the workforce to have earned a baccalaureate degree by 2020, which leaders hope will then boost the stream of nurses into graduate education programs. And better patient outcomes are another oft-cited benefit of a more highly educated workforce.
Experts noted that nurses usually need a baccalaureate degree if they want to go on to pursue a graduate degree, although the AACN data shows that there are growing numbers of bridge programs, including 169 RN-to-Master’s programs with 37 more in development.
Researcher Linda Aiken, Ph.D., RN, said there are not enough nurses going into graduate level programs to replenish the nursing faculty that will be needed in the future.
However, if nurses enter the profession without a baccalaureate degree, they will have to return to school to get at least two degrees in order to become an advanced practice registered nurse (APRN) or a faculty member. And research by scholars such as Linda Aiken, Ph.D., have found that’s just not feasible for most working nurses, many of whom are juggling families and other responsibilities.
Funding tends to be a major hurdle when it comes to getting more nurses into graduate level programs. Aiken noted that student aid tends to be the least generous at the master’s level, which is a deterrent for many students who might be interested in returning to school. Schools are hurting for resources, too, and are having trouble coming up with enough clinical sites and preceptors for master’s level students.
The result is that there are just not enough nurses going into graduate programs, especially to adequately replenish the faculty necessary to educate the future workforce. “There’s just too few that are getting to that level,” said Aiken, professor of nursing and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania.
Beverly Malone, Ph.D., RN, CEO of NLN, sees promise in new initiatives that can help close the gap in nursing education supply and demand.
“It’s a conundrum,” agreed Beverly Malone, Ph.D., RN, CEO of the National League for Nursing (NLN).
New programs and educational pathways making a difference
But Malone has high hopes for the latest initiative sponsored by the Tri-Council for Nursing. The AACN, NLN, the American Nurses Association and the American Organization of Nurse Executives are collaborating on a new two-year initiative called Academic Progression in Nursing, or APIN.
With funding from the Robert Wood Johnson Foundation, the APIN program will fund nine state action coalitions that are working to achieve the IOM’s 80 percent goal and will encourage academic-service partnerships to enable students to experience a seamless transition to higher degree programs.
Kirschling said that some states have already demonstrated success in initiating programs in this area. For example, community colleges and public and private university schools of nursing in Oregon collaborated to create the Oregon Consortium for Nursing Education in an effort to expand their capacity and enrollment. She looks forward to seeing other creative approaches in the works in other states.
“We need every strategy we can put into play,” she said.
And the AACN enrollment data shows that baccalaureate-to-doctoral programs are becoming increasingly popular--another way to help nurses achieve a higher level degree without having to return to school multiple times. There are 77 research-focused programs, with seven more in development. In fact, doctoral programs in general are experiencing a surge of interest; the number of schools with a DNP program grew from 20 in 2006 to 184 n 2011, with 101 more in development.
Aiken maintains that changes are necessary to insure that the first degree for nurses entering practice is a baccalaureate degree; currently about 60,000 nurses enter the workforce each year without one. As she wrote in the New England Journal of Medicine in 2011, public funding should be used to steer this change in basic education.
“Unless that changes, we’ll never catch up,” she said.
Malone noted adequate Title VIII funds need to be appropriated in the future to support nursing education. In February, the president released his proposed budget for 2013, which included $251 million for Title VIII nursing workforce development programs, an 8 percent increase from 2012. The nursing profession’s support for that funding is critical, she said.
What’s the risk of not deliberately investing in the future workforce, including efforts to diversify the workforce to reflect the population? Said Malone, “We won’t be prepared to take care of people in the future. We will have a discordant kind of situation.”