Nursing instructor needed in classroom 101! Stat-istical!

Attention: Nursing instructor needed in classroom 101! Stat-istical!

Barna, Ed

Efforts to address the well-known and likely to worsen shortage of nurses have been successful enough to uncover another shortage. Without enough teachers in nursing schools, those seeking to enter the profession have in too many cases been getting firsthand experience of what it will be like for patients if there aren’t enough nurses.

It’s an issue that has been building its siege engines for some time. A September 2006 Fact Sheet from the American Association of Colleges of Nursing lists papers on how to meet the need, going back to one in 1999 titled “Faculty Shortages Intensify Nation’s Nursing Deficit.” (It reported that “nursing schools across the country are seeking creative solutions to the faculty shortage, including joint appointments, aggressive internal and external marketing, financial incentives, compressed education programs, and legislative advocacy.”)

Vermont has plenty of company. For instance, in April of this year, two of the states leaders in efforts to remedy the instructor shortage – Mary Val Palumbo and Betty Rambur attended the 4th National Conference of State Nursing Workforce Centers. (Palumbo, a UVM researcher as well as a teacher, heads the Office of Nursing Workforce for Vermont; Rambur is a teacher and Dean of the College of Nursing and Health Sciences at UVM. Barbara McIntosh went as well.)

California, Iowa, Mississippi, New Jersey, North Carolina, North Dakota, Pennsylvania, Texas and Vermont had speakers or panelists at the event. The “End Note” from Julia Plotnik bore the title “The Global Nursing Shortage and Health Policy.” Her summary observed that a disconnect exists between need and supply, with urban areas having proportionally more nurses and nursing faculty that rural regions, and areas of the world (particularly the United States) where there are fewer health problems left unsolved are better supplied with practitioners.

To the extent that broad awareness of a problem helps to create comprehensive solutions, Vermont might benefit. But Rambur and Palumbo, when interviewed, said that for now the state is in competition for nursing faculty members, who typically can find better pay elsewhere. That’s not the entire equation – for some, Vermont’s natural environment or quality of life can weigh heavily – but for many others, money matters more.

Palumbo said that ironically, the success of efforts to solve the impending nursing shortage crisis have spotlighted the faculty shortage. The previously mentioned Fact Sheet states that “U.S. nursing schools turned away 41,683 qualified applicants to baccalaureate and graduate nursing programs in 2005 due to an insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints. Almost three-quarters (73.5 percent) of the nursing schools responding to the 2005 survey pointed to faculty shortages as a reason for not accepting all qualified applicants into nursing programs.”

An AACN Special Survey on Vacant Faculty Positions, released in July, found 637 vacancies at 329 nursing schools (55.3 percent response rate). That translated into a vacancy rate of 7.9 percent, of which 53.7 percent were positions requiring a doctoral degree.

Rambur, who had passed along that Fact Sheet, said “Vermont’s situation parallels (the national situation) or perhaps is even slightly more pronounced.”

Several factors combine to make the faculty shortage more stubborn than many other workforce problems. Rambur and Palumbo both said money is an issue in-state as well as interstate, because a highly trained nurse can often make more money practicing than teaching. The demand part of the supply-and-demand situation is particularly elastic in the medical field: if someone suddenly needs heart surgery, the presence of an experienced operating room nurse can be critically important in an immediate way.

Quantitatively, the Fact Sheet said the average salary of a practicing nurse with a master’s degree was $72,480 in 2006, according to a survey by The Nurse Practitioner, while the AACN reported that master’s-prepared faculty across all ranks earned an average of $55,712. Further, the Fact Sheet said there had been a steady decline in the percentage of registered nurses with doctorates employed in nursing schools, from 68 percent In 1992 to 49 percent in 2000. A 2003-2004 survey of doctoral graduates by AACN found that 22 percent had committed to employment elsewhere than nursing schools.

Rambur said the low student-faculty ratio required of nursing programs works against higher salaries. Typically a teacher will have around 10 students, while a professor in some other discipline will be lecturing to a hall filled with students, she said.

Palumbo added that it can be a very long workday, being a professor. Those in such positions want to maintain their nursing skills by putting in practice hours, they may want to do research as well, and in addition to the time actually spent being a mentor, they need to deal with planning, papers and other administrative details. A duty nurse, on the other hand, can go home after an eight or nine-hour shift (if a nursing shortage doesn’t make it essential to put in more time) and shift gears.

Not only that, it’s often a very long road to the end of a doctoral degree, Rambur said. Physicians get out of medical school and being their practices before they are 30, usually, she said, while nursing students more often obtain their doctoral degrees in their 40’s or even their 50’s. A 200502006 AACN report found the average age of doctorally prepared nurse faculty for the positions of professor, associate professor and assistant professor was 57.9, 55.4 and 51.5 years; for master’s -prepared faculty, it was 57.8, 54.5 and 50.0 for the same positions. Nursing Outlook said in 2002 that the average age at retirement was 62.5 years.

So, what is Vermont doing to cope?

Keeping up an active recruitment effort, for one thing, said Rambur (here the business readers may be saying, “Right – the time to advertise more is when you’re hurting, not when you’re sitting pretty.”). That recruitment effort is international as well as national, she said.

Then there is the Freeman Nurse Scholars Program, from the Stowe-based Freeman Foundation. For the past five years, it’s helped undergraduates, Palumbo said, and now it’s going to assist graduate students as well.

Like many professionals, nursing graduate students leave with debt loads as well as degrees. Palumbo cited Vermont’s loan repayment program for people who go into nursing faculty roles as a significant factor in successful recruitment. In one case, she said, someone from Hawaii look at programs in a variety of states, and was interested in several, but came to Vermont because she could deduct as much as $10,000 annually from her indebtedness. For someone coming out of school at an age when starting a family and buying a home may be issues, that kind of help can be “very important,” Rambur said.

Anyone who has spent much time around a college knows there are often dozens or hundreds of dedicated scholarships that individuals, families or organizations have set up through the years. Palumbo said the Vermont Organization of Nurse Leaders and the Vermont State Nurses Association are actively trying to help graduate students in that way. “It’s not going to solve the problem, but it helped a little bit,” she said of the four scholarships that had been furnished in the past two years.

With recognition of the problem by hospitals has come support for efforts to get qualified professionals to take on part-time teaching roles, Palumbo said. Dartmouth-Hitchcock as well as UVM is doing this, helping with salaries as well as scheduling. She herself, Palumbo said, is a UVM employee who also gets paid by Fletcher Allen Health Care when she keeps up her practicing skills by working in that environment.

Vermont’s nursing programs at UVM, Norwich, Castleton, Vermont Technical College (which has several satellite programs around the state) and Southern Vermont College don’t have to carry the full load. The Vermont Board of Nursing has approved registered nurse and licensed practical nurse programs in other rural states that have a similar problem and interest: Georgia, South Carolina, and North Dakota, as well as a Connecticut League of Nursing program.

Rural can mean distant or it can mean desirable. Vermont’s quality of life – its good air and water, relative safety, access to nature, community life, outdoor sports opportunities and more – plays an important role in recruitment, according to Anne Smeglin, chairman of the Nursing Department at Castleton State College. Their salaries depend on the decisions of the Vermont State College system, and are not always competitive, she said, but “currently we’re fine” for faculty, though keeping their program that way is ‘increasingly more challenging.” Quality of life assets are “absolutely” a draw, she said, particularly when raising a family is involved.

Smeglin herself drives an hour and a half each way to her job in Castleton, from Massachusetts, where there are two other nursing programs within 15 minutes. “I don’t want to sound like an advertisement,” she said, but Castleton has excellent leadership under President David Wolk, high standards of faculty excellence, and programs which truly nurture the students.

“I am commuting because of the quality of the work environment,” she said.

Copyright Boutin-McQuiston, Inc. Dec 01, 2006

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