The Nursing
Faculty Shortage: National League for
Nursing Perspective
Presented to the National Advisory
Council on Nurse Education and Practice
(NACNEP)
Theresa M. Valiga, Ed.D., R.N.
Director of Research and Professional
Development
National League for Nursing
On behalf of the National League of Nursing
Board of Governors, the more than 10,000
individual NLN members, 1,500 nursing
schools and agencies the organization
represents, and its 38 constituent leagues,
I thank you for the opportunity to talk
with you today about a very significant
issue: the shortage of qualified faculty
to teach in nursing programs. My name
is Terry Valiga, and I am the Director
of Research and Professional Development
at the NLN … a member of the Senior
Management Team.
Our entire nation is painfully aware
of the shortage of nurses to provide direct
care in hospitals, homes, schools, clinics,
and other health care settings. Many studies
are underway to document the extent and
severity of this crisis in various parts
of the country. And there are a number
of national, regional, and legislative
strategies currently being implemented
that are designed to resolve the crisis
and eliminate the shortage of nurses in
practice.
But there is another dimension of the
"shortage" that has, to date, received
little attention, and it's an aspect that
can have even more far-reaching consequences.
I speak, of course, to the shortage of
faculty to teach in schools of nursing.
Various states' efforts, federal legislative
initiatives, the ANSR Coalition (Americans
for Nursing Shortage Relief), the Nurses
for a Healthier Tomorrow coalition,
recruitment efforts underway by our schools
of nursing and professional associations,
the Call to the Profession coalition,
and the Johnson & Johnson Campaign
for Nursing's Future all may be incredibly
successful in attracting young men and
women, underrepresented minorities, and
second-career individuals to pursue a
career in Nursing. But if those individuals
are then told that they cannot be admitted
to nursing programs because there are
not adequate numbers of qualified faculty
to teach them, then we need to question
the ethics of all these recruitment efforts.
We must, therefore, address the nursing
faculty workforce shortage before we find
ourselves turning away qualified, enthusiastic
"recruits" to our profession. And the
National League for Nursing commends the
National Advisory Council for Nursing
Education and Practice for doing just
that through today's hearings and, hopefully,
subsequent initiatives.
Statistics
Allow me to tell you something about
this shortage in the nursing faculty workforce.
You have received a document (Nursing
Faculty Shortage, 2001) that reports
on a study conducted by the SREB (Southern
Regional Educational Board) Council on
Collegiate Education for Nursing. A May
2001 survey conducted by this Council
of the 491 institutions in the 16 SREB
states and the District of Columbia revealed
the following:
- More than 425 unfilled faculty positions
were reported
- 86 institutions reported that they
did not have enough faculty to "cover"
their undergraduate and graduate programs
- 144 faculty members retired in that
academic year
- More than 550 resignations had been
experienced in that academic year or
were expected in the coming two years,
and
- Most of the 6,322 nurse educators
had a master's degree in nursing
Texas, one of the states included in
the SREB survey, also conducted its own
survey called "Nursing Education: An Assessment
of Educational System Capacity to Meet
Nurse Workforce Demand" (Douglas, 2002).
This study identified four constraints
on the capacity of the Texas nursing education
system to meet workforce needs:
- an aging nurse faculty workforce
- barriers to recruiting and retaining
qualified faculty
- declining enrollments in all programs;
and
- under-representation of minority groups
in nurse faculty and student populations
And this is not an issue in the U.S.
only. Dr. Tony Butterworth (Chief Executive
of a National Health Service Workforce
Development Confederation in England)
noted the following in a March 2002 article:
"Soon, … and somewhat sadly, our
universities [in the United Kingdom] will
begin to experience a shortage of good
teaching staff because of an aging workforce"
(p. 24).
The NLN currently has a study underway
to describe our national nursing faculty
population. As the only professional organization
that focuses on faculty development, supports
nursing education research, and attends
to all types of nursing programs, the
NLN is in a unique position to address
this issue, and we are pleased to be taking
the lead in relation to it. Nursing faculty
are the primary stakeholders of the NLN,
and our organizational goals and initiatives
clearly are focused on meeting faculty
needs and supporting the preparation of
qualified faculty.
Specifically, the mission of the National
League for Nursing is to advance quality
nursing education that prepares the nursing
workforce to meet the needs of diverse
populations in an ever-changing healthcare
environment. We believe that quality nursing
education cannot occur without faculty
who understand their role, can implement
that role effectively, and can influence
the future of nursing education. Thus,
included among the NLN's five major goals
are the following:
- The NLN will lead in promoting the
professional growth and continuous quality
improvement of educators for the nursing
workforce
- The NLN will lead in promoting evidence-based
teaching in nursing and the ongoing
development of research that informs
and improves nursing education
- The NLN will be the authority in providing
and interpreting comprehensive nursing
workforce supply data
Our Faculty Census 2002 survey
is designed to provide information about
the faculty component of the nursing workforce.
For full-time and part-time faculty, this
survey will document their educational
preparation, credentials, rank, age, salary,
tenure status, teaching experience, resignations
and retirements, and race/ethnicity. It
also will answer a series of questions
related to budgeted unfilled faculty positions:
how many of them are there, in what specialty
areas are they most significant, and how
are schools dealing with such vacancies,
among other things.
The survey has been constructed so that
we will be able to (a) draw comparisons
to information in the Division of Nursing's
2000 National Sample Survey of RNs
and (b) report trends in comparison to
the Faculty Census survey conducted by
the NLN in 1997. Informal feedback we
and the National League for Nursing Accrediting
Commission (NLNAC) have received to date
suggests that a vast majority of schools
have at least one full-time position they
are unable to fill with a qualified candidate.
Many schools also report that they have
placed a limit on student admissions,
increased class sizes, or delayed students'
progression in their programs as ways
to deal with the vacancies. Finally, nearly
all schools informally report that they
expect the problem to worsen before it
improves … if it improves. Let me
explain.
In 1993 — less than 10 years ago
— there were a little more than 3,000
students enrolled in master's programs
who were preparing for an educator role.
This number represented 9.9% of all full-time
and part-time graduate student enrollments
at the time. In that same year, 755 of
the 7,926 master's graduates (or 9.5%)
had prepared for a career in nursing education.
These numbers decreased slightly in
1994 and again in 1995. Enrollments dropped
to 2,989 (8.8%) then 2,954 (8.3%). And
graduations rose slightly in 1994 to 854
(9.9%), but dropped down to 765 in 1995
(8.3%).
By 1999 the picture was more disturbing,
with the number of full-time and part-time
students enrolled in master's programs
education "tracks" down to 1,229. For
the 30,537 students enrolled that year,
those preparing for a faculty role represented
only 4.0%. And the number of graduations
in 2000 fell to only 247 (of 9,969) …
a mere 2.5%.
As dismaying as these numbers are, the
2000 data are even more shocking. Our
unofficial data indicate that there are
only 64 (of more than 375) master's programs
that offer an "academic" nursing education
"track" and/or a post-master's certificate
program in "academic" nursing education.
Less than 2% of all full-time and part-time
enrolled students are in this "track,"
and little more than 1% of the approximately
9,000 master's graduates in 2000 were
nursing education "majors." That's 900
individuals … not even one for each
of our LPN programs (of which there are
approximately 1,100) or one for each of
our RN programs (of which there are approximately
1,500!).
In 2001, the number of programs offering
academic nursing education tracks and
the number of students enrolled in this
area of specialization seem to have risen
slightly. And that's good. But we don't
know if this will be a trend, and even
if it is, there still is much work to
be done in relation to master's programs
… and doctoral ones, as well.
There are 79 doctoral programs in nursing
today. One of those programs focuses on
the preparation of nursing faculty and
confers a Doctor of Education degree in
Nursing Education. Twelve other schools
indicate that "education" is an option
of focus in their Ph.D. or D.N.Sc. program.
Since most doctoral programs do not ask
students to declare a "major" such as
nursing education, it is not possible
to know how many of the graduates from
doctoral programs focused on this role.
But even if every doctoral graduate from
these 13 programs did so, that is only
approximately 60 individuals per year.
And if experience is any indicator, many
of these new doctorates probably already
hold a faculty position, so they are not
"adding to the ranks" of faculty.
To illustrate this problem even more
dramatically, if every doctoral graduate
each year assumed a faculty position upon
completion of his or her program —
and we know from Dr. Ada Sue Hinshaw's
(2001) analysis that many nurses with
graduate degrees are not selecting academic
careers — but even if every doctoral
graduate did choose a career in academe,
that still would be less than 400 individuals
annually. This would be enough to provide
one new doctoral graduate to every master's
program in the U.S., but it would leave
no new doctoral graduates for the 79 doctoral
programs themselves, and none for the
more than 550 baccalaureate programs in
the country.
It is true that many nurses earn their
doctorates in fields other than nursing,
some even in education or educational
administration, and then they assume faculty
positions. I do not know what these numbers
are, but we might want to be careful to
look to this as the "solution" to the
shortage of doctorally-prepared nursing
faculty since these programs do not address
the uniqueness of nursing education.
One also can argue that many individuals
who graduate from master's programs with
preparation as nurse practitioners, nurse
midwives, or clinical nurse specialists
go on to assume teaching roles. This is
true. In fact, most of our faculty, historically,
have had this type of preparation. But
we must ask if this is the best type of
preparation for a faculty role?
We in Nursing would never think of allowing
an individual to practice as a nurse practitioner
if she or he did not have a sound knowledge
base and highly developed skills in assessment,
diagnosis, pharmacotherapeutics, reimbursement
issues, parameters of the role, and so
on. Yet, we constantly allow individuals
to practice as teachers with no or only
cursory knowledge and skill in teaching,
advisement, curriculum design, program
evaluation, outcomes assessment, accreditation
processes, citizenship in the academic
community, principles of higher education,
evaluation strategies, and so on. This
must change. The faculty shortage issue,
then, is not only an issue of numbers
but an issue of appropriate preparation
as well, a topic that is addressed very
clearly in the editorial by Dr. Joyce
Fitzpatrick (2001) and the "cry for action"
by Cheryle Kelly (2002), both of which
you received.
Armed with the appropriate preparation
and sound commitment to the role, faculty
in our nursing programs would be better
equipped to design programs that are of
the highest quality and that graduate
individuals who are exceptionally well
prepared to practice in today's and tomorrow's
complex health care arena. Such faculty
also would engage in evidence-based practice
as teachers. They would conduct research
to determine what practices are most effective
in facilitating learning, how we can best
use the clinical setting to enhance student
self-confidence, ways in which simulated
learning can best prepare students for
clinical practice, strategies that best
facilitate interdisciplinary practice,
and — among other things — what
we can do in the educational setting to
promote students' critical thinking and
their ability to be flexible and adaptable
in an ever-changing, uncertain, ambiguous,
unpredictable world. As noted in the editorial
by Dr. Chris Tanner (1999, pp. 51-52),
"We have pressing questions [in nursing
education] that beg for answers …
[and] … there is no doubt we will
need a cadre of well-educated scholars
who have immersed themselves in the study
of how people learn to conduct this research."
Without preparation for the faculty
role … without role models and mentors
to help them manage the unique issues
one faces in that role … without
a strong commitment to a role where teaching
is primary and one's own clinical practice
is secondary … and without a science
to undermine their practice, individuals
whose preparation was as a nurse practitioner
or clinical nurse specialist struggle
to implement the faculty role. They often
teach only as they were taught (which,
by the way, typically uses strategies
that are being shown to be quite ineffective
with today's learners). They fail to innovate.
And they are likely to prefer to engage
in a clinical role that fits much more
closely to what they went to graduate
school for in the first place … and
where they are likely to earn more money!
The nursing faculty crisis, therefore,
is real, and the potential for it to grow
in severity very soon is high. And, as
noted, it is a crisis not only in quantity
— numbers — but a crisis in
quality as well.
Solutions
Our profession has witnessed the incredible
success we've had in graduating advanced
practice nurses from our master's programs.
In fact, with the exception of CRNAs (who
seem to be in short supply nationally),
many parts of our country now seem to
be experiencing somewhat of an over-supply
of nurse practitioners, and some new graduates
are finding it difficult to secure positions
that allow them to use their advanced
practice skills. This success of nurse
practitioner programs has been due, in
part, to the attractiveness of this advanced
practice role in terms of autonomy and
salary. It also is due, in part, to the
fact that this role has received a great
deal of attention in the media as one
that is significant, results in positive
patient outcomes, and is cost-effective.
But the success in graduating large
numbers of advanced practice nurses (particularly
nurse practitioners) also can be attributed
to the funding that has been available
over the past 10-15 years to support the
development of such educational program
in schools of nursing and the "re-tooling"
of faculty to teach in such programs.
This is an excellent example of what wonderful
things can happen when an institution
or agency invests substantial resources
over time in programs that are desperately
needed.
If we are to solve the "nursing shortage"
by attracting increasing numbers of men
and women to the field … and having
adequate numbers of qualified faculty
to teach them … we now need to shift
the funding emphasis away from the preparation
of nurse practitioners and toward the
preparation of nursing faculty. Faculty
members do need advanced clinical knowledge
and skill. I am not suggesting that this
should be ignored. And they do need research
skills. But the role they will assume
in most of our programs is that of teacher,
not clinician or researcher.
They, therefore, need knowledge and
skills in education, as well as clinical
practice and research. Our schools need
individuals who want to be faculty …
who want to work with students as their
primary "clients" … who know how
to and will design and implement effective
curricula … who know how to and will
be contributing members of the academic
community … who accept that their
primary responsibility is as a teacher,
and their clinical responsibilities are
secondary … who are excited about
and dedicated to their role … and
who can and will encourage other nurses
to pursue such a career.
As noted by Dr. Tony Butterworth (of
England), "It is important … to recognize
and develop skilled teaching and make
it an attractive career choice for nurses"
(2002, p. 24). Resolving the shortage
of nursing faculty for all our programs
will require an examination of workload
issues, salary issues, and promotion and
tenure issues. But, it also requires more.
We need substantial funding to support
nursing education research so that we
can build a science of nursing education,
just as we have built (and continue to
build) a science of nursing practice.
We need funding and programs to support
continuous faculty development. We need
leadership to encourage colleges and universities
to re-examine their tenure and promotion
criteria and processes to assure that
teaching, program design, student advisement,
and other educator skills are highly valued
and rewarded.
To resolve this crisis, we need faculty
in schools of nursing to spend time talking
with each other about education issues
… issues like how to attract and
retain minority students, how to design
curricula for RNs that truly challenge
them to grow as professionals, how to
promote students' critical thinking, how
to design effective collaborative learning
strategies, how to develop innovative
evaluation methods that assess what students
truly have learned, how to design interdisciplinary
learning experiences that have valuable
outcomes, and how to avoid "wasting" our
time with students focusing on minute
"factoids" so that we can "cover it all."
Clearly we need substantial funds to
support the development of master's, post-master's,
and doctoral programs that are designed
to prepare faculty for the complex, challenging
role they will face. And we need scholarships
and fellowships to support students who
are enrolled in such programs.
Summary
As noted earlier, the National League
for Nursing is the only professional nursing
organization that focuses on faculty development,
supports nursing education research, and
attends to all types of nursing programs.
We offer an intensive Faculty Development
Institute each summer, and an Education
Summit every fall. We offer grants to
support research that addresses the Priorities
for Research in Nursing Education
formulated by our Blue Ribbon Panel, and
will initiate our Nursing Education Research
Institute in 2003.
The NLN also offers regional programs,
online courses, and collaborative workshops
that address the learning needs of faculty.
And most recently, we have partnered with
Johnson & Johnson (as part of their
"Campaign for Nursing's Future") to award
scholarships to support full-time and
part-time master's/post-master's students
who are preparing for the faculty role,
and fellowships to support full-time doctoral
study and dissertation research in nursing
education.
The NLN's member task groups and councils
are focusing on significant issues in
nursing education: educational standards,
recruitment and retention of students
… and faculty, articulation and mobility,
the infusion of technology into nursing
education, new teaching/learning/ evaluation
paradigms, and the development of a minimum
data set for nursing education research.
And finally, our Think Tank on Graduate
Preparation for the Nurse Educator Role
will be issuing its report by the fall,
a report in which they will lay the foundation
for ongoing work related to the clarification
of nurse educator competencies …
those that are common to all types of
nursing programs, and those that are unique
to each type of program.
In light of its mission and goals, the
NLN is pleased to be taking a lead in
addressing the nursing faculty shortage
issue and promoting lifelong learning
of faculty in their role as educators.
The National League for Nursing looks
forward to collaborating with the National
Advisory Council on Nursing Education
and Practice, the Division of Nursing,
other agencies, and other professional
associations to advance the agendas outlined
here, as we believe this is a "solvable"
problem.
Again, I thank you for this opportunity
to speak to you about the nursing faculty
shortage, and I would welcome your questions
or comments.
References
Butterworth, T. (2002). Nurses as clinicians,
teachers, and researchers. Reflections
on Nursing Leadership, 28(1), 22-25,
50.
Douglas, W. (2002). Invitational forum
on nursing education. Texas Nursing,
February 2002, p. 10.
Fitzpatrick, J.J. (2001). The best scientists
do not the best teachers make (Editorial).
Nursing and Health Care Perspectives,
22(2), 61.
Hinshaw, A.S. (2001). A continuing challenge:
The shortage of educationally prepared
nursing faculty. Online Journal of
Issues in Nursing, 6(1), Manuscript
3. (www.nursingworld.org/ojin/topic14/tpc14_3.htm,
3/20/02)
Kelly, C.M. (2002). Investing in the
future of nursing education: A cry for
action. Nursing Education Perspectives,
23(1), 24-29.
National League for Nursing. (2002).
Unpublished data. New York, NY: Author.
Nursing faculty shortage worsens in
SREB states. Business Wire, November
29, 2001. (http://library.northernlight.com
11/30/01)
Tanner, C.A. (1999). Developing the
new professorate (Editorial). Journal
of Nursing Education, 38(2), 51-52.
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