Challenges Faced by Nursing Schools

Do you remember life before the pandemic? Nurses were in high demand. Then, COVID-19 made the nursing shortage even worse. Many nurses decided to retire or leave the career altogether.

The shortage doesn’t appear to be getting any better. The U.S. Bureau of Labor Statistics projects 203,200 openings for registered nurses (RNs) each year through 2031. That statistic factors retirements and workforce exits into determining the number of nurses needed in the United States.

An April 2022 nursing workforce analysis published in Health Affairs found that the total number of RNs decreased by more than 100,000 from 2020 to 2021 – the largest drop ever observed over the past four decades. More importantly, a significant number of nurses leaving the workforce were under the age of 35, and most had jobs in hospitals.

Schools can’t keep up with the demand

While hospitals ultimately feel the impact of the shortage, experts partially trace it back to nursing schools. These institutions are struggling to train and graduate new nurses in order to keep up with the demand. There are plenty of qualified applicants. Aspiring nurses are eager to fill the shoes of retired ones and care for patients during the next pandemic.

But part of the problem is that there’s no room for these students. In fact, in 2020, undergraduate nursing programs at colleges and universities turned away 80,000 eager, qualified applicants.

The situation is no better at community colleges, where nursing programs received as many as 800 applicants for 50 available spots. And even for graduate students, it’s no different. In 2021, the American Association of Colleges of Nursing (AACN) found that 9,574 qualified applicants were turned away from master’s programs, and 5,169 of them were turned away from doctoral programs. The primary reason for not accepting all qualified students was a shortage of faculty, preceptors, and clinical education sites.

The University of Washington School of Nursing elaborates on challenges facing nursing schools:

  • Colleges are graduating too few nurses with advanced degrees who can become educators of the next generation of nurses
  • A large number of nurse educators are approaching retirement age
  • Federal funding for nursing education has lagged far behind the demand
  • Federal and state funding for nursing school facilities has also trailed the need
  • Funding from tuition is not sufficient for the higher cost of nursing education that results from mandated faculty-to-student ratios for clinical and laboratory settings
  • Opportunities for clinical placement with hospital and clinic partners can disappear on short notice, as during the pandemic, leaving nursing students short of clinical experience hours required for licensing exams
  • Many experienced nurses who would have become nursing faculty a decade ago now have lucrative options as executives and managers of healthcare organizations and entrepreneurial endeavors; they are also becoming researchers and administrators of national and international nongovernmental organizations

A need for more faculty

It would be easy if nursing schools could just find more faculty. But one of the long-standing challenges is that teaching only pays about half what a typical hospital nurse makes. And it requires an advanced degree such as a master’s or a Ph.D. The fact that a nurse can earn more elsewhere means that many have been driven out of teaching positions as they seek higher-paying work.

To put this in perspective, according to the Nurse Salary Research Report issued by Nurse.com, the median salary across advanced practice registered nurse roles is $120,000. By contrast, the AACN reported in March 2022 that the average salary for a master’s-prepared professor of nursing is $87,325.

Sharon Goldfarb, who teaches nursing at several schools near San Francisco, said in an interview on NPR that she surveyed 91 community colleges in California and found faculty declined by 30% during the pandemic. “To lose an additional 30% has been devastating. There is not a school I know of that isn’t desperately looking for nursing faculty,” she said.

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According to A Special Survey on Vacant Faculty Positions by AACN (October 2022), a total of 2,166 full-time faculty vacancies were identified in a survey of 909 U.S. nursing schools with baccalaureate and/or graduate programs (84.4% response rate). Besides the vacancies, schools cited the need to create an additional 128 faculty positions to accommodate student demand.

The data show a national nurse faculty vacancy rate of 8.8%. Most vacancies (84.9%) are faculty positions requiring or preferring a doctoral degree. In addition, the study predicts that one-third of faculty in baccalaureate and graduate programs will retire by 2025. This finding underscores the urgency for the nursing education community to address the impending exodus of senior faculty and to develop younger faculty to succeed them.

Nursing simulation can help

Before the pandemic, in-person instruction was the standard for most nursing programs, giving students a chance to see their instructors face-to-face so they could easily ask questions. Near-daily lectures, labs, and clinical activities were the norm, and students had the opportunity to receive immediate feedback. Once the pandemic hit, nursing schools and most segments of society shifted to a virtual experience. Now, the pandemic may be over, and nursing students may be back in the classroom, but schools are using simulation to adapt their lab and clinical experiences.

The scarcity of clinical site opportunities for nursing students has led to an increase in the use of simulation. At the same time, the nursing simulation lab creates a risk-free, hands-on learning environment. Simulation provides realistic opportunities for learning that are consistently available. Over years of use in nursing education, simulation has changed with time. These changes, along with the requirement for virtual learning during the pandemic, have facilitated the wider adoption of virtual simulation.

Diversity in the student population

While it’s vital to increase the number of nursing school graduates, it’s also important to grow the diversity of those students. Kathryn Tart, EdD, MSN, RN is the University of Houston College of Nursing Founding Dean and Humana Endowed Dean’s Chair in Nursing. She said in a story on nurse.com that one way to do that is by reaching out to diverse nursing groups.

In a 2021 paper in Creative Nursing, Recruiting Underrepresented Students for Nursing Schools, the authors wrote, “Preparing a richly diverse nursing student population is essential to improving health outcomes for the nation and achieving a robust supply of healthcare providers who better reflect the society we serve. As the U.S. population becomes more diverse, cultural competence is necessary among healthcare professionals in order to practice with cultural humility. Cultural humility refers to a commitment and active engagement in a lifelong learning process that allows individuals to better meet the complex healthcare needs of patients, communities, and colleagues. The design of an effective recruitment strategy should be driven by the mission of the educational institution and aligned to reflect the targeted population of potential students. Recruitment efforts and activities should be designed to improve the ability to attract a diverse population and more firmly establish a continuing pipeline of possible students.”

Their article presented strategies such as building relationships and partnerships with two-year community colleges with upper-division nursing programs, and employing technology solutions to enhance recruitment and admissions of a diverse pool of applicants. Technology solutions can help manage large applicant pools, coordinate a communication campaign to frequently contact prospects, and capture notes throughout the recruitment process that can be utilized in a holistic admission strategy.

While the article said that recruitment is the first step to address retention, students must perceive that they’re entering an inclusive learning environment where they can successfully advance, in order to achieve the goal of a more diverse nursing workforce.

Addressing the faculty shortage

There are a number strategies in use by different organizations and the U.S. government to address the shortage of nursing school faculty:

  • AACN is working with the Jonas Philanthropies to support doctoral nursing students: by advocating for new federal legislation and increased funding for graduate education; hosting an annual faculty development conference; collecting data to quantify the scope of the shortage; promoting faculty careers through the Graduate Nursing Student Academy; and collaborating with national nursing organizations and practice partners to help identify solutions.
  • The U.S. government administers several programs specifically targeted at addressing the nursing faculty shortage:
    • The Nurse Faculty Loan Program, existing within the Health Resources and Services Administration (HRSA), assists graduate students pursuing faculty careers. Students must agree to teach at a school of nursing in exchange for the cancellation of up to 85% of their educational loans, plus interest, over a four-year period.
      HRSA’s Bureau of Health Workforce also administers the Faculty Loan Repayment Program, which provides up to $40,000 in loan repayment for individuals from disadvantaged backgrounds who serve as faculty at eligible health professions schools for a minimum of two years.
    • HRSA’s Nurse Corps Repayment Program provides nurse faculty who commit to working in an eligible nursing school with up to 60% in debt cancellation for two years of service, and an additional 25% for a third year of service.
    • In October 2022, the Department of Labor announced a new $80 million initiative, the Nursing Expansion Grant Program, which includes funding for the Nurse Education Professional Track to prepare experienced current or former nurses for teaching roles.
    • The Department of Education routinely identifies programs that prepare nurse faculty as eligible for funding through the Graduate Assistance in Areas of National Need program.
  • AACN operates NursingCAS, the nation’s centralized application service for prelicensure and graduate nursing programs. One of the primary reasons for launching NursingCAS was to ensure that all vacant seats in nursing schools are filled. In 2021, data showed more than 14,700 vacant seats in master’s and doctoral nursing programs alone. NursingCAS provides a mechanism to fill these seats and maximize the educational capacity of schools of nursing.