THE NURSING FACULTY SHORTAGE:
NATIONAL LEAGUE FOR NURSING PERSPECTIVE

Presented to the

NATIONAL ADVISORY COUNCIL ON
NURSE EDUCATION AND PRACTICE (NACNEP)

Presented by

Theresa M. Valiga, Ed.D., RN
Director of Research and Professional Development
National League for Nursing

APRIL 11, 2002

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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:

1. an aging nurse faculty workforce
2. barriers to recruiting and retaining qualified faculty
3. declining enrollments in all programs; and
4. 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. 12 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 practice 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.

NOTE: A copy of each of these references was distributed to all
NACNEP members.