Rx for Shortage of Nurses: More Teachers

Hospitals across the country are desperately seeking nurses like Tracey Rasmussen, a 34-year-old mom with a warm, down-to-earth bedside manner and a 3.9 GPA.

But she was rejected twice from nursing school -- one of thousands of qualified would-be nurses turned away each year because nursing colleges lack space, faculty and funding.

Anyone who has spent time in a hospital lately knows about the nation’s nursing shortage. By 2020, the shortage is expected to grow to nearly 30%, a shortfall of more than 800,000 nurses nationwide, according to projections by the U.S. Department of Health and Human Services.

Finding people who want to be nurses isn’t hard. Getting them into nursing schools is.

“It was so frustrating,” said Rasmussen, who was finally accepted into Washington State University’s Yakima nursing program and has a job waiting for her in the maternity ward of a local hospital when she graduates in May.

Despite the looming shortage, nursing schools in the United States turned away nearly 6,000 qualified applicants last year, according to a survey by the American Assn. of Colleges of Nursing.

“Some of them will reapply. Some of them go to other schools, community colleges and private schools. A significant pool will be lost to nursing,” Dorothy Detlor, dean of Washington State’s College of Nursing, said of the two-thirds of qualified applicants her program rejects each year. “It’s a serious problem across the country.”

A generation ago, women had few options in the workplace beyond nurse, teacher or secretary. As opportunities expanded, the allure of nursing faded. The outdated Florence Nightingale image didn’t help attract young people to what has become a high-tech career. Over the past two decades, nursing schools have struggled at times to recruit students.

But nursing today has overcome its history and image problem. In a struggling economy, nobody sneers at a profession that offers college graduates multiple job offers with starting salaries of up to $60,000 in some areas. The median annual salary for nurses was $45,000 two years ago, according to the Bureau of Labor Statistics’ most recent data.

“We’ve gotten the message out there that nursing is an exciting career,” said Kathleen Ann Long, dean of the College of Nursing at the University of Florida and president of the American Assn. of Colleges of Nursing. “That’s the good news.”

The bad news is that there’s not enough faculty.

Nurses are in such high demand that they invariably must take a pay cut to teach. A 2001 salary survey found that nurses with master’s degrees earn an average of $24,000 more in practice than they do teaching.

“The universities are just not able to compete,” said Johnie Mozingo, associate dean of academic affairs at the University of Tennessee College of Nursing, which rejected half its nursing applicants this year.

Cramming more students into classes isn’t an option. Most states mandate student-teacher ratios of 12-to-1 or less, especially for hands-on classes.

The average age of nursing faculty nationally is 51. When the current generation retires, replacements will be hard to find.

“Without those faculty, we cannot prepare the nurses of the future,” Long said.

To expand programs, nursing schools need more money. Unfortunately, most rely heavily on state budgets, which are facing their worst crisis in a decade.

Educating a nurse costs more than training the average liberal arts major, and nursing schools compete for limited dollars within universities. At Washington State, for example, tuition and state funds pay $8,200 per student -- but it costs $20,000 a year to educate nurses. Other departments end up subsidizing nursing schools.

Earlier this year, Congress passed the Nursing Reinvestment Act in a bid to ease the shortage. The measure, signed into law by President Bush, expands scholarships, offers grants for nursing schools, and includes loan forgiveness for nurses who earn advanced degrees and become teachers.

Nursing educators applaud the law, but with their fingers crossed, as they wait to see whether Congress puts money behind it. The House Appropriations Committee will determine funding next year.

The new law alone won’t solve the problem. In many areas, hospitals are stepping in to expand nursing programs when government funding falls short.

In Ohio, Cleveland State University will start a fast-track nursing degree program this spring, backed financially by the Cleveland Clinic Health System.

North Carolina Baptist Hospital is giving Winston-Salem State University $750,000 to hire more nursing faculty members for an accelerated nursing program that starts in January.

And in Alaska, five hospitals and health care agencies have promised the University of Alaska $1.8 million to double the number of nursing graduates.

Hospitals have a keen interest in producing more nurses: Studies show that when hospitals cut nursing staff and increase workloads, patient deaths increase. But they also have tight budgets to consider.

“It’s a matter of looking at those scarce resources and investing them where you’re going to get the most benefit,” said Pamela Thompson, chief executive of the American Organization of Nurse Executives, a subsidiary of the American Hospital Assn. “Hospitals only have so much money.”

Nursing experts agree that there’s no magic solution. They say expanding enrollments at nursing colleges will require time, money and attention from states, the federal government, private health agencies -- as well as patients and families who expect a nurse to answer when they press that hospital call button.

“We are pressed to the wall, and it’s going to take maybe one crisis to push us over the edge,” said Laura Dzurec, University of Connecticut School of Nursing dean. “It’s a huge need and, unfortunately, it’s an invisible need. There isn’t anything more essential than this.”