Although there has been increased awareness of Colorado’s nursing workforce issues over the last five years, there has been much less attention paid to the ultimately more significant shortage of nursing school academic and clinical faculty.
The 2004 Colorado Nursing Faculty Supply and Demand Study: Summary of Findings.
Colorado’s shortage of qualified nursing faculty at its two-year nursing schools is three times the national average; the shortage at our four-year schools is nearly double the national average. Vacancy rates are greatest among clinical faculty, and the overall faculty shortage is expected to worsen as faculty retirements increase. The primary reason for the shortfall: Program expansions, designed to put as many nurses in the workplace as soon as possible, have accelerated demand for nursing education, while cash-strapped schools lack the resources to attract and keep faculty.
The lack of qualified instructors, in turn, is one reason that more than 2600 applicants were turned away from nursing programs in Colorado in 2008. Colorado cannot resolve its nursing shortage – currently estimated at 11 percent, and expected to nearly triple, to 30 percent, by 2020 if current trends continue – without an adequate supply of qualified nursing faculty. The 2004 Colorado Nursing Faculty Supply and Demand Study illustrates the scope of the faculty shortage, identifies contributing factors and points toward strategies to address those issues. Compared to other states, Colorado has already actively pursued many promising strategies to strengthen faculty recruitment and retention. Our state has laid a firm foundation of collaboration between educational institutions and health care providers. Still, more remains to be done. Five main themes emerged from this study that set the context for developing new policies and practices to increase the number of nursing faculty. These themes are laid out below.
The Relationship Between Quality and Capacity.
After a period of rapid expansion in the quantity of nursing programs and enrollments, we must now ensure simultaneous focus on the quality of graduates being produced. Quality-related issues cover the spectrum, from the preparedness of new enrollees for the academic demands of nursing school (especially in terms of science and math), to the curriculum at both the undergraduate and graduate level, to the clinical competency of new graduates.
Recommendations: Emerging technologies, including patient simulation technologies must be harnessed to increase clinical proficiency of both student nurses and those already in practice. Access to these technologies should be expanded. However, it is important to train instructors so that they may utilize these tools for maximum benefit. In addition, we recommend establishing admission policies that ensure readiness for the academic rigor of nursing education.
Key Barriers to Recruiting and Retaining Faculty.
In general, salaries for nursing faculty at all levels in Colorado lag both clinical nurse salaries and those offered by nursing schools in other states. Increased numbers of students, and a plethora of new programs, have created an increased need for faculty at the same time that many instructors are approaching retirement. The majority of schools report a limited pool of qualified applicants. Both students and practicing nurses demonstrate a decreased interest in the educator role. As experienced faculty have become harder to recruit and retain, many programs have turned to “provisionally” prepared instructors – that is, faculty who are still engaged in their own graduate studies while simultaneously teaching newer students.
Recommendations: Expand use of the “Clinical Scholar” model, which enables practicing clinicians to teach at an educational institution. Already in use in some areas of the state, this model increases compensation and provides new opportunities for instructors and clinicians alike. In addition, expand access to graduate degrees through distance learning and cooperative agreements among institutions. And, while the state’s budget woes may make the expansion of tuition support for graduate nursing education problematic, Colorado should examine the feasibility of loan forgiveness and other incentive programs.
Program expansions, designed to put as many nurses in the workplace as soon as possible, have yielded an array of educational opportunities developed to respond to local needs that do not form a cohesive whole. For example, the community college system – the backbone of Colorado’s nurse education system – includes schools whose resources, curricula and performance (as measured by their nursing graduates’ pass rate on the licensure exam) vary widely. In addition, the lack of clinical rotations limits the number of students we can enroll and train statewide.
Recommendations: Balance grassroots innovation and expansion with system-wide solutions, disseminating “best practices” where possible. For example, obtaining national accreditation for Colorado’s community college nursing programs, a process now in progress, will support new standardization among programs, without eliminating the local focus that is so important to those schools’ missions. It will also set new expectations for quality that would benefit all schools in the system. We encourage exploration of new opportunities to expand the range of clinical rotations, such as flexible scheduling and a statewide tracking system to monitor availability.
Aligning State Policy in Support of the Quality-Capacity Equation.
Because nursing education takes place under the aegis of both educational and health care institutions, it is subject to numerous regulatory bodies, statutes and licensure requirements. In addition, because most nursing education in Colorado is publicly funded, the state’s budget crisis frames all efforts to address the nurse faculty shortage. Questions as to the appropriate baseline level of public investment in nursing education abound. While the study finds that industry resources and grant funds play a critical role in filling resource gaps, those sources are limited and may exacerbate the health care cost shift.
Recommendations: In the interest of aligning competing interests and supporting system improvements, the various authorities that impact nursing education must work together to foster conditions favorable to increasing our supply of both faculty and students. We must support strategies that balance quantity and quality. Further, any solution to the shortage of nursing faculty, and nurses, in Colorado depends upon timely solutions to the state’s budget problems and, as a result, increased funding for higher education.
Investing in Data, Monitoring and Educational Research.
We can only understand, and develop effective strategies to address, the nursing faculty shortage with
routine data collection. Currently, no such capacity exists.
Recommendations: The Colorado Center for Nursing Excellence encourages regulatory bodies, education institutions and health care organizations to work together to develop reliable, longitudinal data; fund research to evaluate promising practices; and provide information necessary for evidence-based decision-making and resource allocation.