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Nursing Shortage

Wanted: More Instructors and More Nurses

If you wind up in the hospital today, you’ll see plenty of nurses. Looks are deceiving in this instance.

“Because of the recession, some people are becoming complacent that there is not a nursing shortage,” said Brenda L. Cleary, a registered nurse and director of the Center to Champion Nursing in America, a collaboration of AARP, the AARP Foundation and the Robert Wood Johnson Foundation. “It’s a temporary thing.”

The recession has temporarily eased the looming nursing shortage as older RNs who expected to hang up their uniforms instead are hanging on until their retirement accounts recover. Others who left or reduced their work hours to raise children came back for full-time salaries and benefits.

“As the economy recovers, nurses who had to delay retirement will retire; nurses who wanted to stay home with their kids are going to,” said Mary Lou Brunell, executive director of the Orlando-based Florida Center for Nursing. Their exodus could refuel the nursing crisis.

America’s medical institutions already operate in the shadow of a worst-case scenario that projects a shortage of nurses as high as 1 million by 2020, when the boomers will be well into their gray years.

The advancing age of instructors with master’s and doctoral degrees—average age 53.5—threatens to hamper nursing schools’ ability to train enough nurses. Schools also struggle to find enough clinical settings for hands-on practice.

Health care reform could add millions of newly insured Americans to the medical system, which is already highly dependent on nurses. More faculty will be needed to produce new graduates to fill roles as nurse specialists, such as midwives or anesthetists.

One clue to nursing schools’ inability to keep up can be found in the rising numbers of rejected applications from qualified candidates. Last year, four-year nursing programs turned away 41,385 qualified applications, up from 3,600 in 2002, according to the American Association of Colleges of Nursing. (Because there’s no way to track how many aspiring nurses applied to multiple programs, application figures don’t reveal actual numbers of applicants accepted or rejected.)

Nursing schools cannot accommodate all applicants for two principal reasons. “One is faculty shortage, the other clinical space capacity,” said Brunell. Nursing programs cannot arrange enough faculty-supervised training time at hospitals and clinics for all their prospective nursing students.

"The root of the faculty shortage is an inadequate supply of RNs with graduate degrees prepared for faculty roles, but the salary issue doesn’t provide much incentive,” Cleary said. Starting nursing salaries are good enough that many registered nurses aren’t driven to continue their schooling. For those who do, salaries for practicing nurses with advanced degrees can be $25,000 to $30,000 a year higher than academic salaries.

“In some cases, newly graduated nursing students may make more than their faculty teaching them,” said Deloras Jones, executive director for the California Institute for Nursing & Health Care in Berkeley.

States are trying to nurture new nurses. In 2005, California launched a five-year, $90 million initiative that pumped private and public money into nursing education. In August, the state approved a five-year, $60 million extension—even as other programs fell to budget cuts. The money supports incentives such as loan forgiveness for nursing students who pledge to teach after earning advanced degrees.

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