The profession is facing a unique shortage of nursing faculty. Schools of Nursing have always had a shortage of doctorally prepared nursing faculty. The academic norm for faculty teaching in baccalaureate and graduate programs to hold earned doctoral degrees was established later in nursing than for other disciplines. At best, 50% of nursing faculty in such programs have met this academic standard. In addition, the shortage is predicted to escalate in the next decade due to the retirement of a "graying professoriate" of nursing faculty.
The shortage of nursing faculty is interwoven with the current national shortage of nurses. The shortage of nurses requires the educational programs of the profession to supply more graduates. But the shortage of nursing faculty will limit student enrollments and likely decrease the number of graduates. Conversely, the shortage of nurses will offer many opportunities and choices to nurses and may decrease the number selecting graduate studies and an academic career, thus contributing to the shortage of nursing faculty
The shortage of nursing faculty will also have consequences for the generation of the knowledge base for nursing practice. With a decreased number of individuals to conduct research and the loss of senior investigators through retirement, continuing development of nursing's knowledge base may be curtailed. The shortage of nursing faculty will also limit the professional leaders who are able to shape health policy in the state, national, and international arenas.
This article outlines a number of factors influencing the shortage of nursing faculty. Several institutional School of Nursing strategies are suggested for countering the shortage situation. In addition, several national professional and policy strategies are suggested. More creative strategies need to be developed and evaluated by Schools of Nursing and by the profession.
Key words: shortage of nursing faculty, nursing faculty shortage, strategies for shortage of faculty, consequences of nursing faculty shortage
The shortage of educationally well-prepared nursing faculty is not a new issue in the nursing discipline and profession. As Anderson (1998) noted in a Nursing Outlook editorial, the American Association of Colleges of Nursing (AACN) data showed that in 1996-1997, only 50% of all faculty teaching in baccalaureate and higher degree programs were doctorally prepared. By 1999-2000 (AACN, 2000b), that percentage had not changed, with only 50.2% of such faculty with earned doctorates at that point. Thus, nursing has always between short of doctorally prepared faculty since the academic norm is that all tenured and tenure track faculty hold such credentials. However, a number of socio-economic factors suggest the shortage may dramatically escalate due to the aging trend of current nursing faculty and as part of the more general nursing shortage, which may narrow the pipeline of baccalaureate and master's prepared nurses entering doctoral study. This article will primarily focus on career full-time, tenure and tenure-track faculty, who would be expected to be doctorally prepared to teach within a baccalaureate or higher degree program in nursing. The purpose of this article is to examine the escalating shortage of nursing faculty in relation to:
- The current general nursing shortage that is predicted to increase;
- The specific factors that influence the nursing faculty shortage; and,
- The types of strategies, which can be used to counter the consequences of the faculty shortage within nursing schools.
The uniqueness of the shortage of faculty within the nursing discipline is the relatively recent doctoral preparation required for tenured and tenure track individuals. As recently as 1978, only 15% of faculty teaching in nursing schools with baccalaureate and higher degree programs were educationally well-prepared, i.e., held earned doctorates in nursing or another field. In the past five years, the percentage of doctoral preparation of faculty in such programs has increased to 50% and stabilized (AACN, 2000b). Clearly, nursing faculties are not yet at the level of doctoral preparation expected of most academic disciplines. Thus, nursing is facing a shortage of new faculty at a critical point when the current cadre of faculty is still building toward the level of preparation needed to meet academic norms.
It is important to examine this issue because the nursing faculty shortage has major consequences for the discipline/profession. Obviously, a decreasing number of doctorally prepared faculty will limit the number of students who can be educated at a time when a nursing shortage is evident in the profession. The general shortage of nurses who are educated with baccalaureate and master's degrees to handle increased acuity of patients and the need for more independent critical judgments in the hospital settings and in community or home care situations could become more critical (Bednash, 2000). The scientific knowledge base of the discipline, i.e., information required to guide nursing practice, is only beginning to be available through the research programs of, primarily, nursing faculty. Such a knowledge base could be curtailed in its development, given the escalating nursing faculty shortage. In addition, nurse leaders are now represented in many state and national health policy arenas and have been instrumental in shaping policy issues and statements. Thus, the increase in faculty shortage could severely affect the profession in terms of providing the needed supply of nurses and developing the scientific knowledge base of the discipline, as well as curtailing the leadership capabilities of nursing among interdisciplinary colleagues and in shaping health policy.
Nursing is not alone with the faculty shortage problem. The Chronicle of Higher Education reported on "The Graying Professoriate" in its September 3, 1999 issue. The author, Magner, suggested that "nearly a third of the nation's full-time faculty members" were 55 years of age or older in comparison to a decade ago, when only one-fourth were over that age. Dentistry, and other health professions, are also reporting shortages in prepared faculty (Krebsbach & Ignelzi, 2000).
Shortage of Nursing Faculty in Relation to the Shortage of Nurses
Shortages of nurses exist both in the clinical workplace and among nursing faculty. Both have major consequences for the outcomes of the parallel shortage. Within the clinical workplace are essentially two shortages of nurses: one that is immediate and one that is long term (Buerhaus, 1998; Buerhaus, 2000). The unique feature of the long-term shortage that is predicted for 2010 through the ensuing decade is that the increased demand for nurses is contrasted to a decline in the supply of nurses. According to Buerhaus, Staiger, and Auerbach's study (2000) on the aging of the RN workforce, the supply of full time equivalent nurses will reach a peak in 2007 and then decline steadily with a 20% drop possible by 2020.
The decline in enrollments in nursing schools will be directly influenced by the increasing shortage of nursing faculty.
The factors influencing both the immediate and long-term shortages of nurses are numerous. One factor is a strong, increased demand for nurses in multiple clinical workplaces, specifically in the hospital setting where two-third's of nurses have functioned traditionally, the home setting which has grown rapidly in the past several years, and other community based and entrepreneurial positions which have opened for nurses. In addition, a focus on customer or client/family satisfaction and an enhanced emphasis on the quality of care provided have also increased the demand for nurses as these foci are a major factor in achieving current goals within health care organizations. Thus, the career opportunities within the profession and the expectations of nursing have increased dramatically.
On the supply side of the shortage of the nurse equation, fewer individuals are selecting nursing as a profession due to greater career opportunities available to women, who are the predominant gender in nursing. Buerhaus (1998) summarizes the supply issues which render nursing less attractive as a chosen profession. From an economic perspective, the wages for nurses have been flat, in terms of real dollars, for most of the 1990's and actually declined from 1994 to 1996. Nurses, however, continued to participate in the workforce, probably due to the economic recession in the early 1990's and because of fear of losing their positions due to widespread hospital restructuring initiatives undertaken in that decade. Investigating the influence of managed care on the shortage of nurses issue, Buerhaus and Staiger (1999) concluded that the hospital restructuring, that has been part of that era and that resulted in numerous layoffs of nurses, made nurses uncertain about their job security for one of the first times in the profession's history. In addition to the uncertainty, nurses holding positions were reporting longer hours of work, highly stressed environments, and concern over the quality of care they were able to provide. None of these conditions facilitated other individuals' choice of nursing as a viable and valuable career. The situation this poses is critical since fewer young people are available for the job market; and those who are available have multiple opportunities.
The other major factor in the shortage of nurses is the "aging out" phenomenon that Buerhaus, et al. (2000) addressed in their latest study, "Implications of an Aging Registered Nurse Workforce". These predictions, concerning the long-term shortage suggested for 2010-2020, resulted from a retrospective cohort analysis of employment trends and ages of RNs over their lifetimes. These predictions were based on US Bureau of the Census Current Populations Surveys between 1973 and 1998. The investigators suggested that the aging of the RN workforce will have several "serious" effects in the next several decades: the total number of RNs will decrease, the number of new graduates will have to escalate significantly to replace those leaving the workforce, the older RNs currently functioning in the workforce will probably decrease their commitment and hours of work, and RNs will gradually withdraw from the workplace. Since one of the major strategies for countering this shortage of nurses is increasing the number of graduates from the schools of nursing, the shortage of nursing faculty is again highlighted as a critical issue.
Factors Influencing the Shortage of Nursing Faculty
As noted earlier, Schools of Nursing have never been fully staffed with educationally well-prepared faculty. In the past five years, only 50.2% of the faculty teaching in the baccalaureate and graduate programs have had doctoral preparation (AACN, 2000b). Anderson (1998) suggests this is in "stark contrast" to other disciplines that require an earned doctorate to enter the academic ranks.
Several factors are similar for both the shortage of nurses and the shortage of nursing faculty. The "aging out" phenomenon evident in the shortage of nurses (Buerhaus, et. al., 2000) is also evident with the "graying" of nurse faculty (Tanner, 1999). The narrowing of the pipeline due to fewer young people entering the work force, as well as individuals selecting different career options, is obviously a factor for both shortage situations. Other factors that need to be considered for why a shortage of nursing faculty exists include, i.e., the historical pattern of the last two decades which have contributed to this faculty shortage, and the reasons why a decreased number of graduate nurses are selecting academic careers.
Historical Pattern Contributing to Nurse Faculty Shortage
The discipline has witnessed two time periods with decreased enrollments of students in the schools of nursing in the past two decades. In the 1980's, Brendtro and Hegge (2000) noted that there were "marked decreases" in nursing program enrollments, which subsequently led to decreases in faculty positions.
When enrollment rebounded in the early 1990's, many programs were not able to recruit full-time faculty, since faculty had found other opportunities and positions in nursing.
Aging of Nursing Faculty
AACN (2000) reports for the 1999-2000 faculty data that the average age has increased to a mean of 50.2 years for all faculty. This problem is not unique to the nursing discipline. Bowen and Sosa (1989) reported in the late 1980's, that the age of the academy in general was increasing and that faculty shortages for many fields would be evident between 1997 and 2012.
The problem of the nursing faculty shortage is being compounded by the lack of individuals replacing the older generation of faculty. In 1994, Ryan and Irvine predicted that one third of the nursing faculty would retire or resign from 1992-2006. Buerhaus (2000), in a recent Nursing Economics article, suggested that the number of women interested in nursing is dropping drastically. According to his research, 35% less women would be apt to choose nursing as a career in the 1990's than in the 1970's. A number of scholars (Brendtro & Hegge, 2000; DeYoung & Bliss, 1995; Tanner, 1999) agree that fewer graduate nurses are selecting academic or teaching careers in nursing.
...the pipeline for replacing the current generation of nursing faculty seems to have narrowed.
The other major problem is not only that nursing faculty are aging (AACN, 2000b) , but the average age for assistant professors is also increasing due to nurses entering academia later in their careers. This means that their time for potential productivity as leaders and scholars is being curtailed (Anderson, 1998; Anderson, 2000; Hinshaw & Ketefian,1996). Using the average age of the assistant professors as a proxy measure to indicate the time available for a productive academic career, the age has increased dramatically in the past several years, i.e., 45 years in 1996 to 49.5 years in 1999 (AACN,1997; AACN, 2000b). Assuming that most individuals will choose to retire about age 65, faculty have approximately 15 years to become master teachers, build their research programs to generate knowledge for the discipline and professional practice, and based on that expertise, become nursing leaders in the state, national, and international health policy arenas. So, part of the nurse faculty shortage issue is not just numbers of individuals, but the need to lengthen academic career time; thus, decreasing the turnover rate from retirement.
Selection of an Academic Career
Why are not more nurses with graduate degrees selecting academic careers? Several factors contribute to this dilemma: increased number of opportunities within the profession, along with non-competitive salaries in academia in relation to a major financial investment in doctoral education, and also the high expectations for academic positions. These will be discussed in turn.
Nurses with graduate preparation have many choices among administrative, entrepreneurial, clinical research, and academic positions (Anderson, 1998; Brendtro & Hegge, 2000; DeYoung & Bliss, 1995). In addition, a number of these opportunities provide better financial compensation and render faculty salaries non-competitive. This is especially evident with administrative nursing positions, clinical researcher positions in hospitals (although these positions are limited in number), and in corporate entities. In addition, corporate organizations utilize the leadership and research knowledge and skills of doctorally prepared nurses in areas such as quality assurance programs and health care studies. These positions use and reinforce the competencies with which doctorally prepared nurses feel most comfortable and value highly. From their master's programs and clinical experience, they developed strong practice expertise, while in their doctoral programs they developed research capability. In contrast, in most graduate programs, individuals do not have opportunities to develop teaching knowledge and skill, except when they function as teaching assistants. Hence they may not be as comfortable with the teaching aspect of the academic career. Some authors suggest that nursing programs should offer a functional area in teaching (Accord, 2000; Brendtro & Hegge, 2000; Tanner, 1999), while others suggest graduate programs should be flexible enough to encourage the student to select teaching courses as electives. Might this enhance graduate nurses choice of academics as a career?
There are also high expectations for individuals who select academic careers.
There are also high expectations for individuals who select academic careers.
Although academic careers have high expectations, there are a number of satisfying characteristics in such careers. Academia provides many opportunities, e.g.:
- To develop and shape new professionals through education
- To engage in creative, intellectual discussions with faculty colleagues, and students
- To pursue a research and/or scholarly program of professional and personal interest
- To contribute to improving health care through student education and the generation of knowledge
- To provide professional, disciplinary, and interdisciplinary leadership and
- To shape health policy based on professional and scholarly expertise.
In Brendtro and Hegge's study (2000) in one midwestern state, faculty members and graduate nurses in other positions were both satisfied with their positions. They reported being pleased with their positions because of challenge, variety, flexibility, collegiality, and opportunity for service. All of these characteristics can be ascribed to academic careers and offset the high expectations which might be a disincentive.
Strategies for Countering the Shortage of Nursing Faculty
Strategies for countering the shortage of nursing faculty need to focus on several educational institution methods such as retaining productive senior faculty and attracting new faculty in a timely manner in relation to anticipated retirements. From a national professional perspective, several other strategies need to be considered, such as establishing a new educational and research training tradition of motivating nurses to enter doctoral study earlier in their careers and providing them with needed support.
...the nursing faculty shortage needs to be positioned as an important and imminent issue on the national health policy agenda.
Educational Institution Strategies
Schools of Nursing, their educational institutions, and the profession need to develop and evaluate new and creative strategies for countering the shortage of nursing faculty. Several ideas are outlined but many other possibilities need to be developed and evaluated.
Retaining Productive Senior Faculty. Nursing has a long history of facilitating the academic careers of junior faculty, e.g., providing time for research in their positional responsibilities, being sure junior faculty have mentors as they develop their teaching and research programs, and helping them to secure intramural and extramural funding for their scholarly endeavors. Current senior faculty have not had the same intense level of attention or resources; they often were the resource for their junior colleagues.
Academic administrators and faculty need to explore and examine new strategies for retaining the expertise of senior faculty as they enter the retirement phase of their career. The strategies suggested below are only a few of the methods that need to be developed based on the respect held for the senior faculty members expertise and on the needs of the nursing program as new junior faculty are recruited.
Several examples of such strategies include:
- Negotiate with senior faculty for new experiences or challenges that they would enjoy developing at a later point in their career. For example, many nursing programs are now establishing international programs; some senior faculty might be interested in developing such a program for their schools. Senior faculty, with their maturity and advanced leadership and organizational capabilities are perfect for such new challenges.
- Suggest that retirement could be phased in over several years for senior faculty who are master teachers and/or seasoned, well-funded researchers. For example, if a new faculty member is working with such a senior person as a mentor, the senior individual could be offered several years at part-time to continue to provide the needed mentorship and expertise for multiple faculty. This author has found this a valuable strategy for retaining important expertise to have available to the junior faculty while showing respect (and remuneration) for the senior faculty involved. Such phased retirement also allows the senior faculty to continue to represent the school and the profession in critical scientific and health policy arenas and sponsor younger faculty in these areas.
- Establish "intellectual homes" such as Centers of Excellence that are based on research but also have teaching and service components to retain senior faculty, as well as take advantage of their expertise and leadership capabilities. Such Centers provide an infrastructure for a vital network of colleagues who gain intellectual stimulation from each other and give collegial support as well. Developing such a network stimulates intellectual ideas and promotes an environment for critique and exploration needed to build scholarship. Every faculty needs an "intellectual home" and colleagues with whom to challenge ideas and methods as well as gain support. However, the leadership provided by senior faculty in such "intellectual homes" needs to be explicitly rewarded. DeYoung and Bliss (1995) suggest that nursing programs with a "good work climate" will have less difficulty retaining or recruiting faculty.
It is important to focus on incentives, which enhance the academic careers of senior faculty for the purpose of facilitating their satisfaction and productivity in their positions. Such incentives may also encourage senior faculty to remain in academia.
Recruitment of New Faculty in a Timely Manner. Given that a number of nursing faculty potentially will be retiring within the next several years, it is important for nursing programs to consider their cadre of tenured and tenure track faculty and construct a cohort analysis of how many can be expected to retire within each year from 2000 to 2010. These data provide an estimate of how many individuals could be leaving over the decade and what the pattern is for when the most individuals might retire. The type of clinical and research expertise which will be lost within each year can also be analyzed. These data provide information for planning for early replacement of such senior expertise through new faculty that are to be recruited.
A strategy for preplanning for the replacement of faculty in a timely manner is to negotiate a loan from the parent institution of the nursing program, which will be paid back as senior individuals retire. Granted there is a lag time prior to the return payment. However, most institutions have a sizeable investment in the recruitment of faculty and the development of schools of nursing as professional teaching and research-intensive units.
A strategy for preplanning for the replacement of faculty in a timely manner is to negotiate a loan from the parent institution of the nursing program, which will be paid back as senior individuals retire.
The major benefit of such a loan program is that it allows for the recruitment of new faculty while the experienced senior faculty are in place and provides several years for mentoring relationships between the two groups. Such a cadrÃ© of new and senior faculty can also build a strong climate for teaching mastery, research programs, and sponsorship into leadership positions in the profession because time is available for the new individuals to develop in a more comfortable, less stressed environment. At the same time, the expertise of the senior faculty is respected and acknowledged.
Professional and Health Policy Strategies
A national professional strategy which needs to be developed and evaluated is the establishment of a new educational and research training tradition to support nurses entering doctoral study earlier in their careers. The current tradition or accepted pattern is to enter doctoral study after obtaining clinical experience following both the baccalaureate and master's degrees. This means doctoral students are usually in their mid to late thirties when starting their programs (Hinshaw, Ketefian, & Lee 2001). Several doctoral programs do offer a BS to PhD option, but the professional norm supports nurses adopting a later career pattern. This issue needs national debate and discussion.
How will earlier entry and completion of doctoral programs influence the shortage of nursing faculty? The shortage is partially a problem of the number of doctorally prepared faculty, but also a problem with the short timeframe individuals are in the faculty role. Nursing faculty enter and retire from academia within 15-20 years. This is an estimate based on the average age of Assistant Professors in Schools of Nursing being 49.5 years (AACN, 2000b). This means a short timeframe in academia with an increased turnover due to retirement. Thus, a new professional tradition needs to be considered in order to lengthen the number of years nursing faculty have to be productive in academia.
A major health policy strategy for the profession is to place the shortage of nursing faculty issue and its relationship to the shortage of nurse's dilemma on the state and national agendas for health professions education. Several authors (Brendtro & Hegge, 2000; DeYoung & Bliss, 1995) have suggested that a strategy for obtaining federal funding for nursing education will be critical to countering both shortage situations. Funding for the recruitment of bright, young people into the nursing profession through financial aid, as well as funding to support graduate education for the development of advanced practice nurses and nursing faculty, will be imperative.
Many policy makers are not aware of the critical nature of the shortage of nursing faculty; although, most are knowledgeable about the shortage of nurses in general. By linking the two shortages, the need for aid in increasing the number of graduate and doctorally prepared nurses is evident as well.
A visible educational report in the media about the value of nursing and nursing education in terms of health care is needed.
The nursing discipline is confronted with a unique shortage of nursing faculty. It is unique in the sense that there has never been a fully prepared faculty with earned doctorates in the baccalaureate and master's programs. At the same time, a further shortage is pending due to the aging of current faculty and a possible decrease in individuals selecting academic careers.
Several strategies for countering the nursing faculty shortage have been suggested. However, this situation will be one of the most challenging concerns of the next decade. What occurs with the nursing faculty shortage will have a major influence on curtailing and controlling the shortage of nurses with which the profession is also grappling. New creative strategies need to be developed, tested and shared in terms of their effectiveness. Each nursing program is confronted with the issue of a shortage of nursing faculty and each must treat this major dilemma as a challenge that demands the best of each one's intellectual creativity. As Bednash (2000) suggests, this crisis must be a "call to action"!
Ada Sue Hinshaw, PhD, RN, FAAN
Dr. Ada Sue Hinshaw, PhD, RN, FAAN, is Dean and Professor with the University of Michigan School of Nursing (UMSN). She was the first Director of the National Institute of Nursing Research and established several research training, funding mechanisms for individuals in doctoral programs and for Schools of Nursing. She received her BS from the University of Kansas; her MA in Sociology from the University of Arizona; her MSN from Yale University; and her PhD in Sociology from the University of Arizona. Additionally she has received numerous Honorary Doctor of Science Degrees. Recent awards include: The Presidential Meritorious Executive Rank Award (1994), Salute to Nurses Award, ANA (1994); Health Leader of the Year Award, Public Health Service (1993); and the Distinguished Service Citation, University of Kansas (1992).
In her academic career she has mentored a number of doctoral students, postdoctoral fellows, and junior faculty. Currently, UMSN faculty colleagues and Dr. Hinshaw are implementing and evaluating strategies to counter the escalating shortage of nursing faculty. The goal is to continue the educational, research and service leadership of the faculty cadrÃ© at UMSN.
Article published January 31, 2001
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