As Enrollments Surge, Thousands Turned Away from Our Nation's Nursing Schools

12/22/2003

From: Robert Rosseter of the American Association of Colleges of Nursing, 202-463-6930 ext. 231 or rrosseter@aacn.nche.edu

WASHINGTON, Dec. 22 -- The following was released today by the American Association of Colleges of Nursing:

According to the results of the annual survey released today by the American Association of Colleges of Nursing (AACN), enrollments in entry-level baccalaureate programs in nursing increased by 16.6 percent in fall 2003 over last year. This enrollment increase is even greater than AACN's preliminary estimate (15.9 percent increase) released on Dec. 1. Despite this significant gain, more than 11,000 qualified students were turned away from baccalaureate nursing programs due to limited numbers of faculty, clinical sites, and classroom space. Without increased federal support, the potential for future growth in nursing education programs may be limited at a time when the demand for well-educated nurses is rising.

AACN's findings are based on responses from a total of 564 (82.7 percent) of the nation's nursing schools with baccalaureate- and graduate-degree programs that were surveyed in fall 2003. The survey found that total enrollment in all nursing programs leading to the baccalaureate degree was 126,954, up from 116,099 in 2002. This year marks the third year of enrollment increases in baccalaureate programs, which had declined steadily from 1995 to 2000. During that six-year period, enrollments in baccalaureate programs dropped by almost 19 percent from 127,683 to 103,999 students.

AACN determines enrollment trends by comparing data from the same schools reporting in both 2002 and 2003. Data show that nursing school enrollments are up in all regions of the United States with the greatest increase found in the North Atlantic states where enrollments in entry-level baccalaureate programs rose by 22.1 percent. Increases were also realized in the South, Midwest, and West where enrollments rose by 16.7 percent, 15.9 percent, and 8.6 percent, respectively.

"AACN applauds the vigorous efforts of nursing schools nationwide to expand student capacity in light of the nursing shortage," said Kathleen Ann Long, PhD, APRN, FAAN, president of AACN. "The significant increase in enrollments this year represents an important step toward meeting the health care system's growing need for nurses prepared at the baccalaureate and higher degree levels."

Interest Runs High in Accelerated Programs

For the first time, AACN's annual survey captured data related to accelerated nursing programs, which are designed to transition adults with baccalaureate and graduate degrees in other fields into nursing. Accelerated baccalaureate programs, which may be completed in 12-18 months, provide the fastest route to licensure as a registered nurse for individuals with a prior degree. These intense programs have high admission standards, require continuous study without session breaks, and incorporate the same number of clinical hours as traditional programs.

Last year, 24 new accelerated baccalaureate programs were launched, bringing the total number of programs offered nationwide to 129. This total represents a 22.9 percent increase since fall 2002 when 105 such programs existed. AACN's latest survey found that 4,794 students were enrolled in accelerated baccalaureate programs while another 1,352 students graduated from these programs as entry-level clinicians last year.

"Accelerated programs provide the best option for career changers and professionals with at least a four-year degree looking to enter the nursing profession," said AACN Executive Director Geraldine Bednash, PhD, RN, FAAN. "Graduates of second- degree programs are in high demand by nurse employers since they bring many layers of education and experience to the table that enrich their clinical practice. To better address the needs of the nursing workforce and enhance RN supply, more federal funding should be directed toward accelerated nursing programs to provide student scholarships and facilitate program growth."

Raising the Level of Nursing Education

Given the calls for a better educated nurse workforce, AACN was pleased to see an increase in the number of registered nurses (RN) pursuing baccalaureate level education. RN-to-Baccalaureate programs are specifically designed to enable nurses prepared with a diploma or associate's degree to earn a baccalaureate degree and enhance their clinical skills. From 2002 to 2003, enrollments in RN-to-Baccalaureate programs increased by 8.1 percent or 2,215 students, which makes this enrollment increase the first in six years.

"New research from Dr. Linda Aiken at the University of Pennsylvania confirms that baccalaureate nursing education has a direct impact on patient outcomes and saving lives," said Dr. Bednash. "AACN encourages nurses prepared in diploma and associate degree programs to advance their education in the interest of patient safety and as a mechanism for career advancement." According to AACN data, there are currently 624 RN-to-Baccalaureate and 137 RN-to-Master's Degree programs offered at nursing schools nationwide.

Graduate Enrollments and Nurse Faculty Shortage

The AACN survey also found that though enrollments were up in both master's and doctoral degree nursing programs, the number of graduates from these programs is still declining. Enrollments in master's degree programs rose 10.2 percent (3,350 students) with a total student population of 37,251. In doctoral programs, enrollments increased by 5.6 percent (171 students) bringing the total student population to 3,229. Though enrollments increased, the number of graduates from master's and doctoral programs declined by 2.5 percent and 9.9 percent, respectively.

The slight enrollment increase in graduate programs is good news given the growing concern about the nurse faculty shortage. According to AACN's recent white paper titled Faculty Shortages in Baccalaureate and Graduate Nursing Programs, the shortage of nurse educators is expected to intensify over the next 20 years as significant numbers of faculty members retire and fewer nurses with advanced educational preparation are choosing careers in academia. In fact, AACN projects that between 200 and 300 doctorally-prepared faculty will be eligible for retirement each year from 2003 through 2012, and between 220-280 master's- prepared nurse faculty will be eligible for retirement each year between 2012 and 2018. Given the competition for nurses prepared at advanced levels and the salary differential between positions in higher education and private practice, the nurse faculty shortage is expected to intensify and impact nursing education programs at all levels.

"Creating a robust nursing workforce hinges on our ability to attract faculty to teach the next generation of registered nurses," said Dr. Long. "Increasing the pool of future faculty members, securing federal funding for advanced nursing education, and encouraging careers in nursing education are all primary concerns for AACN and the nursing profession."

Limits on Future Enrollment Growth

Though interest in baccalaureate and graduate nursing education programs is high, not all qualified applications are being accepted at four-year colleges and universities. In fact, AACN's survey found that 11,304 applicants who satisfied or exceeded admissions requirements were denied admittance to entry- level nursing programs due to insufficient numbers of faculty, clinical placement sites, classroom space, and other factors. The 11,304 figure is based on preliminary data provided by 353 schools of nursing with entry-level baccalaureate programs. A final number will be available in February 2004 after data from additional schools with entry-level programs are analyzed.

From coast to coast, schools are limited in how far they can expand student capacity even though there is a great need for nurses. For example, the University of Texas-Arlington turned away 281 students last year alone. The University of Iowa (159 students), State University of New York-Stony Brook (200 students), Old Dominion University (280 students), University of Utah (153 students) and many other schools are also turning away qualified students.

Despite these challenges, nursing schools across the country are finding creative ways to expand student capacity. Many schools are forming partnerships with clinical agencies to support mutual needs and bridge the faculty gap. Other strategies include lobbying for continued state and federal monies, launching accelerated programs, and stepping up efforts to expand diversity and recruit new populations into nursing. (See the Enrollment Success Stories and Challenges to Future Growth section below.)

"Though the enrollment numbers are encouraging this year, the crisis is far from over, especially given the government's projections that more than a million new and replacement nurses will be needed by 2010," said Dr. Bednash. "A successful solution to the nursing shortage will require a collaborative effort on the part of the nursing profession, the health care system, the federal government, and all stakeholders. Together, we must remove barriers to nursing careers, provide incentives for nurses to advance their education, and create practice environments that encourage professional development and foster nurse retention."

AACN is actively involved in efforts to advocate for legislation that benefits nursing education; seek appropriations for existing Nursing Workforce programs (including those created by the Nurse Reinvestment Act); share best practices, innovations and opportunities with the full body of nursing schools; and form collaborations to seek solutions to the nursing shortage.

About the AACN Survey

AACN's 23rd Annual Survey of Institutions with Baccalaureate and Higher Degree Nursing Programs is conducted each year by the association's Research Center. Information from the survey forms the basis for the nation's premier database on trends in enrollments and graduations, student and faculty demographics, and faculty and deans' salaries. Complete survey results are compiled in three separate reports, which will be available in February 2004:

-- 2003-2004 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing

-- 2003-2004 Salaries of Instructional and Administrative Nursing Faculty in Baccalaureate and Graduate Programs in Nursing

-- 2003-2004 Salaries of Deans in Baccalaureate and Graduate Programs in Nursing

Editor's Note: News media may obtain selected tables from these data reports by contacting Robert Rosseter at rrosseter@aacn.nche.edu or 202-463-6930, extension 231.

The American Association of Colleges of Nursing is the national voice for university and four-year-college education programs in nursing. Representing more than 575 schools of nursing at public and private institutions nationwide, AACN's educational, research, governmental advocacy, data collection, publications, and other programs work to establish quality standards for bachelor's- and graduate-degree nursing education, assist deans and directors to implement those standards, influence the nursing profession to improve health care, and promote public support of baccalaureate and graduate nursing education, research, and practice. ------

Enrollment Success Stories and Challenges to Future Growth Below are snapshots of how some four-year colleges and universities are addressing the strong surge of interest in nursing careers. Academic leaders also address some of the opportunities and challenges confronting schools trying to expand student capacity.

At San Francisco State University, more than 400 potential students applied for 90 slots in the Bachelor of Science (BSN) degree program, and another 200 applied for admission to the school's accelerated program that accommodates 50 students. The nursing director, Beatrice Yorker, JD, RN, attributes the rise in applications to many factors, including higher salaries and better working conditions for nurses. "Nursing is a very stable profession, and nurses are in high demand across the country. This makes nursing a very appealing career choice, especially in a slow economy." To further increase student capacity, Dr. Yorker sees the need for more classroom space and higher salaries to recruit and retain qualified nursing professors.

This fall, Drexel University in Philadelphia enrolled a record number of students in its Accelerated Career-Entry BSN program and saw the school's full-time undergraduate nursing student population grow to about 400 students. One hundred and seventy students are enrolled in the BSN Co-Op Program in which half of the students take clinical and didactic courses while the other half are engaged in co-operative work experiences. This unique arrangement helps increase student capacity since only half of the enrolled students are engaged in classroom study at any given time.

"For the past two years, Drexel's administration has increased our faculty lines according to our needs, and we've been able to add 15 new faculty to support our growing programs," said Gloria Donnelly, PhD, RN, FAAN, dean of the College of Nursing and Health Professions. "We also have two faculty tracks, a tenure track and a non-tenure track, which gives us flexibility to deal with enrollment vagaries. Because we use a considerable number of adjunct faculty for clinical practica, we created an Adjunct Faculty Clinical Manager position to screen, hire, support and monitor the quality of adjunct faculty instruction. This manager also holds a faculty appointment and is a nurse practitioner. This system is working very well and insures quality."

Boise State University was able to expand capacity with financial assistance from community health care facilities and through targeted marketing efforts aimed at both students and faculty. According to nursing department chair Pam Springer, PhD, RN, the school turned away approximately 400 students last year and about 500 students the preceding year. "We are working to accommodate the growing demand for our courses by offering many creative educational options, scheduling courses at many different times, and using a variety of educational media to increase course availability." Though pleased with the recent growth, the school recognizes that there are limits to future expansion. "We insist on maintaining quality over and above numbers, so we are cautious about increasing capacity too rapidly," added Dr. Springer.

"Our enrollment increase is the result of an aggressive recruitment plan launched three years ago," said Pamela V. Hammond, PhD, RN, FAAN, dean of the School at Hampton University in Virginia. "In addition to a student recruiter, all faculty members, staff, and students are actively engaged in recruitment activities." The school's efforts to reach out to new populations are working given the 25 percent increase in enrollments at the main campus, and a 50 percent increase overall when students from the school's new campus, the College of Virginia Beach, are included in the total. Hampton's growth is supported by a number of grants from the Department of Health and Human Services. "We worked hard to secure federal funding for our PhD program, a Pediatric Nurse Practitioner program, and a Women's Health Nurse Practitioner program," added Dr. Hammond. "We were successful in our efforts to receive a Workforce Diversity Grant and two basic nurse education grants, one of which funded our accelerated program."

At Regis University in Colorado, the Department of Nursing was able to expand student capacity with support from the university's administration, which gave the school five new faculty members and funded new lab space for the nursing program. "We have developed partnerships with Health One and the University of Colorado Hospital to offer an on-site BSN programs for their employees, which has been very well received," said nursing program director Candace Berardinelli, PhD, RN. "We have also seen an increase in applicants to the traditional BSN program and more pre-nursing students are being accommodated in our freshman and sophomore classes." The nursing program also added a second admission date to its accelerated baccalaureate program in order to enroll more students. The accelerated program at Regis is full through May 2005 and the traditional BSN program beginning Fall 2004 is also full.

John Lantz, PhD, RN, dean of the University of San Francisco School of Nursing, attributes the school's growth in enrollments in part to renewed interest in nursing careers among second- degree students and career changers. "Our master's degree entry program, although not new, has been a big draw this year with over 400 applicants vying for less than 40 slots," said Dr. Lantz. We are looking at how we can expand this program to meet the demand while maintaining our high quality standards." Dr. Lantz also credits a partnership with Kaiser Permanente, California Division, for the school's ability to hire graduate teaching assistants and personnel for its learning resource center. When asked about barriers to future growth, Dr. Lantz cited the need for more faculty. "In a national search for a tenure track position, we had only two applicants. "It's difficult to find part-time persons since they can make much more money in acute care settings."

Similar concerns about recruiting faculty were raised by Marilyn Klainberg, EdD, RN, interim dean of Adelphi University School of Nursing (N.Y.), which increased its baccalaureate enrollments by 179 students this year. "Our biggest obstacle to future growth is finding faculty with outstanding credentials to teach the courses we must provide for our students to complete their programs in a timely manner," said Dr. Klainberg. "In order to secure clinical faculty, we have embarked on a collaborative and creative program with one of the hospitals at which we have a clinical site to extend our faculty pool."

At the University of Connecticut, nursing school dean Laura Dzurec, PhD, RN, CS, credits her school's enrollment growth this year to many factors, including a statewide marketing initiative; a strong articulation agreement with Three Rivers Community College; and a partnership with Eastern Connecticut Health Network which provides enhanced clinical study for nursing students. To address the faculty shortage, which could curtail future growth, the school has created the Endowment for Excellence in Nursing to provide scholarships and other support for doctoral students. Academic leaders are also in the early stages of developing a partnership with the University of Hartford to support nurses moving quickly into doctoral programs. "We are looking at a potential opportunity for our master's and doctoral programs to partner strategically to help students, most of whom come with established clinical backgrounds, complete the doctoral program in a timely fashion while also taking courses related to teaching nursing," explained Dr. Dzurec.