On December 9, 2021, Kentucky’s Governor Andy Beshear declared the state’s chronic nursing shortage an emergency and issued an executive order aimed at adding 16,000 nurses to Kentucky’s workforce by 2024.
The state’s immediate actions aim to boost enrollment at nursing schools, according to an ABC News article.
Kentucky is by no means the only state experiencing a nursing shortage that has worsened during the pandemic, which has made nurses more likely to retire, suffer from burnout, or quit. Demand for nurses is putting pressure on nursing schools to increase enrollment.
The good news in this scenario is that people seemingly want to pursue nursing careers. The bad news: U.S. nursing schools are struggling to expand due to a lack in clinical sites and other challenges, and many turn away eligible candidates.
Finding Clinical Sites a Challenge
The American Association of Colleges of Nursing (AACN) released data in April 2021 that revealed student enrollment rose in 2020, in baccalaureate, master’s, and doctoral nursing programs. Though interest in nursing programs is strong, U.S. nursing schools were reportedly forced to turn away 80,521 qualified applications in 2020 due primarily to a shortage of clinical sites and faculty and resource constraints, according to AACN. The total included 66,274 turned away from entry-level baccalaureate programs.
“We could admit more students if we had more faculty and if we had more clinical sites where we can send our students,” said Kathryn Tart, EdD, MSN, RN, University of Houston College of Nursing Founding Dean and Humana Endowed Dean’s Chair in Nursing.
Undergraduate nursing students go through eight to 10 different clinical rotations. Each clinical rotation used to have a limit of about 10 students, but with COVID-19, it has been limited to six to eight students per faculty member at each clinical site, Tart explained.
Students must trust that if a nursing school admits them, the school will have a clinical site available, according to Tart. “We work hard with our practice partners to make sure that we can do that” she said. “It really takes all of us together to be able to have our students graduate and graduate on time.”
That hasn’t been easy through the pandemic.
“We were very fortunate that we were able to graduate our students on time, even during the pandemic. And they are extraordinarily needed,” Tart said.
Florida Atlantic University’s (FAU’s) Christine E. Lynn College of Nursing in Boca Raton is experiencing those same challenges, according to Joy Longo, PhD, RNC-NIC, CNE, Associate Professor and Assistant Dean of undergraduate nursing programs at FAU.
With a total nursing student enrollment of nearly 1,400 for its nursing programs and tracks, FAU is accommodating all the students it can. But clinical placement challenges and a faculty shortage are among the factors keeping FAU from expanding its nursing program.
“The biggest challenge is clinical placement. When the pandemic first hit, the hospitals in South Florida would not allow students in, so we had to find alternative methods for clinical education. Now they’ve reopened, some of them in a limited capacity so it is still a little bit of a struggle, but it is better,” Longo said.
Some hospitals found a way to continue providing clinical sites for students during pandemic peaks. UC Davis provided senior students in Sacramento State University’s Bachelor of Nursing program slots when other hospitals closed.
This was so senior students who needed to complete their clinical education hours could graduate on time, according to a UC Davis Health May 7, 2020, press release.
“Everybody was committed,” Kelly MacPherson, manager of the UC Davis Center for Professional Practice of Nursing, said in the press release. “It was one of those things we really held onto during these tough times: ‘We can get them through this so they can graduate.’”
Faculty Pipeline Remains a Concern
Another expansion challenge for nursing schools: competing for adjunct faculty when there are other more lucrative options.
“Many of the adjuncts we get are working nurses,” Longo said. “As we all know, there are opportunities out there to do traveling and pick up extra shifts.”
This is not a problem unique to South Florida. According to the AACN, higher compensation in clinical and private-sector settings is luring nurse educators away from teaching around the U.S.
In 2020, there were 12,871 nursing school applicants turned away from graduate programs, which according to AACN, could limit the future nursing faculty pipeline.
According to the AACN’s report on 2019-2020 Enrollment and Graduations in baccalaureate and graduate programs in nursing, most nursing schools responding to the survey pointed to faculty shortages as a top reason for not accepting all qualified applicants into their programs. The AACN’s Special Survey on Vacant Faculty Positions, which surveyed 892 U.S. nursing schools, identified 1,637 faculty vacancies in 2019. Schools also cited the need to create an additional 134 faculty positions to accommodate student demand.
One reason for the concern about continued and worsening faculty shortages is that about one third of today’ nursing faculty workforce is expected to retire by 2025, according to a study published in Nursing Outlook in 2017.
Creating More Slots and More Diversity
It’s just as important to grow nursing workforce diversity as it is to increase the number of nurses coming out of schools.
“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,” wrote the authors of a paper published February 2021 in Creative Nursing.
But achieving diversity in a nursing student population takes commitment. The University of Houston College of Nursing program received the 2021 Health Professions Higher Education Excellence in Diversity (HEED) award, the only national award in higher education recognizing U.S. health colleges and universities demonstrating an outstanding commitment to diversity and inclusion.
This is the fifth HEED award for the University of Houston College of Nursing. The college was among 50 HEED recipients in 2021, 12 of which were nursing schools, according to Tart.
“What we’ve created at the University of Houston College of Nursing is a place where excellence and diversity are not mutually exclusive,” Tart said. “Not only in 2020 did we have 100% first-time NCLEX pass rate for the NCLEX-RN licensure exam, but we also were able to win this diversity award for the fifth time.”
Less than one-third of the students in University of Houston’s nursing program are white and about 15% of the student population is male, according to Tart.
One way to achieve diversity in a nursing school program is to lead by example, according to Tart.
“Diversity has to be part of your mission statement,” she said. “[Then,] you make sure you are living your mission. You make sure diversity is represented in everything you do.”
That includes reaching out to diverse nursing groups, including “going, talking, and participating,” she said.
In the interview process for prelicensure students, interviewers do not have access to the applicant’s name, race, gender, or photo to prevent bias, according to Tart, ensuring students are vetted on their merits alone.
A New Normal for Nursing Schools
Hospitals and other clinical sites have reopened, relieving some stress on nursing schools. Schools also are looking at creative options in clinical education, including telehealth training and virtual simulation, according to Longo.
“Hospitals are looking differently at clinicals and what opportunities they have with clinicals to recruit students,” Longo said. “So, we are looking at academic partnerships and how we both can benefit … when students go into the sites for clinical experiences.”
Truly expanding, however, continues to be a resource issue for FAU and other nursing schools.
“We have to have the clinical sites and resources. Being a state school, [one question that remains is] do we get the resources from legislators and then could expand our numbers that way,” Longo said.
Kentucky is taking steps to help nursing schools. The executive order requires that the state Board of Nursing approve requests for enrollment increases from schools that show sufficient resources to accommodate more students.
“And schools unable to accommodate their full student capacity due to staffing shortages will be expected to notify state officials, with the goal of helping them hire more faculty,” according to a Times-Tribune article.
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