13.     States Try to Expand Nursing School Capacity

A report by the Robert Wood Johnson Foundation describes the efforts taken by 12 states to expand capacity at their nursing schools.  Within the next 15 years, the current nursing shortage in the United States will grow to over 260,000 unless nursing schools improve efforts to educate more nurses.  Each year, thousands of nursing school applicants are rejected due to lack of nursing faculty, clinical placements, and other lacks in student capacity.  According to the report, in 2008, 41,385 qualified applicants were rejected to capacity issues; in 2009, the number of qualified applicants rejected by nursing schools grew to 42, 981.

Texas reported a nursing shortage of 22,000 in 2009.  This number is predicted to grow to 70,000 by 2019.  To address the shortage, Texas must double the number of graduates of nursing programs by 2013.  It was found that Texas nursing programs had high enrollment numbers, but low a low number of graduates.  The Texas Workforce Shortage Coalition categorized all of Texas’s nursing schools into two categories: those who had 70% or more graduates and those who had below 70% graduates.  The schools with a higher percentage of graduates are to focus on increasing enrollment, while those schools with a low percentage of graduates must improve their graduation rates.  Schools who do not meet target percentages set by the state legislature will have to return state appropriated funds.

Michigan had a projected shortage of 18,000 nurses by 2015.  The governor of Michigan therefore made increasing the number of nurses in the state a high priority.  She appropriated $30 million in grants to partnerships among nursing schools, hospitals and the Regional Skills Alliance to provide accelerated second degree programs.  These programs attracted unemployed auto workers, engineers, lab technicians, and architects.  These programs have produced an additional 4,000 nurses and 277 new clinical faculty members.  The governor also saw the need to increase nursing faculty, and further appropriated $6.8 million quickly train clinical and classroom faculty.  This has resulted in 150 new faculty-in-training.

In Virginia, a group of nursing leaders has developed ideas for increasing nursing students.  The group created a nursing policy agenda that is presented to Virginia legislators before elections.  Through their effective policy, the group has achieved among other things, a 10% pay raise for nursing school faculty, which resulted in a 50% increase in nursing graduates. 

Competitive tensions between Associate Degree and Bachelor’s Degree nursing programs in both New York and North Carolina led the two states to create RIBN, Regionally Increased Baccalaureate Nurses, whose purpose is to increase and encourage students to earn a baccalaureate nursing degree.  RIBN combines the strengths of community colleges, such as larges diverse classes, supportive learning environments, and focus on practical skills, with the baccalaureate degree’s significance to allow one to pursue graduate education and faculty roles.  Schools participating in RIBN will begin classes in 2010.  Students will spend 3 years at a community college and then a fourth year at a university, after passing the NCLEX.  Students in the North Carolina program will receive full scholarships, while those in the New York program will pay community college tuition for all four years.

In Oregon, the Oregon Consortium for Nursing Education (OCNE) created a partnership of eight community colleges and the five Oregon Health and Science University campuses.  These schools now share common admission procedures and other educational resources.  Associate and bachelor’s degree programs have also collaborated to improve education standards and create a common curriculum.  This has resulted in an increase in the number of nurses pursuing baccalaureate degrees in the state.  Also, nurses in Oregon who become faculty can make use of a loan repayment program for their nursing education.

Massachusetts created the Nurse of the Future Core Nursing Competencies in order to increase the number of nursing school graduates and see what competencies they need to care for patients.  Several nursing programs in the state have received funding to develop nursing curriculum models to produce more efficient nurses.

In California, several regional collaborations have resulted in increased clinical placements, recruitment of additional faculty, and increased access to higher education for nursing students. 

Hawaii has been using innovative education techniques, such as distance learning and simulation, to make up for faculty shortages and lack of classroom space.  These techniques allow instructors to reach more students, thereby resulting in more students in Hawaii’s nursing programs.  Four groups in Hawaii have contributed over $1 million to the Hawaii Nursing Simulation Center Fund.  The center will connect existing campus and hospital simulation laboratories across the state. 

Mississippi is one of the state with the highest nursing shortage due to nursing students dropping out of their programs prior to graduation.  The Mississippi Office of Nursing Workforce conducted a number of surveys to determine why students did not finish their nursing education.  The surveys found that lack of finances, inability to balance family and school, and inability to simultaneously work and attend school all contributed to the high number of drop-outs.  In response, the group created the Mississippi Student Navigator, which provided students with information on financial assistance, legal services, child care, stress management, and academic preparation.  This caused the number of nursing graduates in Mississippi to double.

Florida is facing an expected shortage of 52,200 registered nurses by the year 2020.  The Florida Center for Nursing (FCN) has found that shortages are caused by a lack of faculty and limited clinical training sites.  FCN plans to address these issues by using grant money for simulation training.  More use of simulation could reduce the need for clinical sites. 

In North Dakota, three programs are working on increasing the number of nurses and nursing education in small rural communities in the state.  The Dakota Nursing Program (DNP) is an association of five community colleges that use a common curriculum to educate those pursuing an Associate’s Degree in nursing.  Graduates are encouraged pursue a Bachelor’s Degree at two cooperating universities.  Those who receive a Bachelor’s Degree are then encourages to pursue higher nursing education and to teach for the DNP.  This allows the nurses to have increased job prospects while remaining in their rural communities.  The Nurse Faculty Intern Program (FNI) was launched by the State Board of Nursing to allow registered nurses with a Bachelor’s Degree and at least two years of clinical experience to teach in nursing schools while pursuing graduate degrees.  These faculty interns are supervised by a faculty member and a consulting PhD-level educator.  The third program is the RAIN Program – Recruitment and Retention of American Indians into Nursing.  North Dakota has over 30,000 Native American residents and five reservations, but only 19 Native Americans earned Bachelor’s Degrees in nursing from the University of North Dakota since 1990.  RAIN offers cultural and emotional support for Native American students, as well as special scholarships, orientation, mentors, free taxi service, and other financial assistance.  Since its inception, RAIN has helped 149 graduates with Bachelor’s Degrees and 39 with Master’s Degrees.

The report can be found at http://www.rwjf.org/files/research/20100608cnf.pdf.