Thursday, September 27, 2007

Information from the HR Advisory Group

Efforts to address nursing faculty shortage through legislation, grants intensify
Even as new reports continue to raise concern over the nursing faculty shortage, both national and local efforts to expand the teaching pool have mounted. Three bills currently before Congress would put millions of dollars toward faculty recruitment and training, while state governments and health care providers increasingly are offering grants to back new nursing programs and pursuing innovative solutions to the faculty deficit.Among the more recent reports measuring the effect of the faculty shortage was a brief released last week by the Association of Academic Health Centers (AAHC) that surveyed CEOs at 31 academic institutions nationwide and concluded that faculty shortages have prompted program and enrollment cuts. Similarly, a report released by PriceWaterhouseCoopers Health Research Institute this month revisits how the faculty shortage hampers training capacity, finding that while nursing enrollments have increased at double-digit rates since 2003, the number of qualified applicants turned away has grown even faster.

To some extent, the faculty shortage is traditionally ascribed to changing demographics and somewhat unfavorable conditions for nurse educators; the AAHC report cites retirement among baby boomers, heavy faculty workloads, salary disparities between academic and private practice positions, and waning interest in academic careers among students entering health professions. Yet an oft-overlooked driver of the shortage is that public nursing schools have limited financial incentive to expand their nursing programs. According to the acting provost of one Virginia community college, the school “lose[s] $8,000 per year for every nurse” it trains; as public colleges’ tuition rates are set by the state, many schools are unable to raise student fees to cover these higher costs and instead incur significant losses. For example, North Carolina community colleges—which provide the state with nearly one-half of its RNs and more than 80% of its LPNs—say that they annually lose $30 million in training nurses. As a result, many administrators are calling for increased subsidization of nurse educational programs (PwC report, July 2007; Simmons, Raleigh News & Observer, 6/16/07).
Pending federal spending bills could boost funding for nurse education…
While Congress has touched on the faculty shortage before, such as by amending last year’s defense appropriations bill with a $500,000 measure designed to encourage former military nurses to become faculty in nursing schools, several new pieces of legislation offer far greater scope and funding, should they be approved. For example, the Senate Appropriations Committee last month approved the Labor, Health and Human Services and Education 2008 spending bill, which would earmark $169 million for nursing programs, a $20 million increase over last year’s allocation, and would support new initiatives to boost faculty numbers, such as $1 million for the University of Maryland-Baltimore to establish a Nursing Institute dedicated to training nurse educators. The bill currently awaits the full vote of the Senate (Schultz, Baltimore Business Journal, 6/22/07; House website, accessed 7/17/07). Two other bills proposed last month also hold promise to address faculty shortage concerns. In the Senate, Sens. Hillary Clinton (D-N.Y.) and Gordon Smith (R-Ore.) introduced the Nursing Education and Quality of Health Care Act of 2007, which would establish grants and programs to improve nurse training, recruitment, and retention in rural areas. The bill—endorsed by the American Nurses Association, the American Organization of Nurse Executives and the American Association of Colleges of Nursing, according to a release from Sen. Clinton’s office—also would fund demonstration projects that integrate patient safety practices into nursing education and bolster nurse leadership in hospital-based patient safety initiatives. Meanwhile, in the House, Rep. Ed Pastor (D-Ariz.) proposed the America’s Partnership for Nursing Education Act of 2007, which would allocate $20 million annually during fiscal years 2008 through 2012 and grant eligible states a minimum of $2 million annually to increase capacity in nursing education programs. To qualify, states must have federal data projecting both a population increase of more than 50% between 1990 and 2025 and fewer than 555 employed RNs per 100,000 residents by 2020, in addition to sponsoring other programs to increase the number of nursing faculty (AHA News Now, 6/13/07; 7/9/07; Clinton release, 6/13/07; Arizona Hospital and Healthcare Association release, 7/3/07; GovTrack, accessed 7/17/07).
…but states, hospitals backing new initiatives in the interim
However, some experts are pessimistic that either act will be passed, noting that similar legislation was proposed during the previous session of Congress and failed to progress to a vote. Instead, they note that rather than wait on uncertain federal funds and a national solution, states and local health care providers instead have taken the lead on addressing the faculty shortage, spawning a “patchwork” variety of new initiatives (Watch interview, 7/18/07).

For their part, many states are seeking evidence that their grants will offer instant relief for nurse training shortfalls, such as a $1.23 million state grant made this week to Arizona Western College in Yuma; the funds will be used to hire 10 nursing faculty members, acquire new lab supplies, and introduce Web-based virtual training components—measures that immediately will increase enrollment from 80 to 96 students. Similarly, many hospitals and health care systems are recognizing the potential downstream staffing benefits of underwriting nurse faculty efforts. For example, the University of South Carolina last month received a $1 million grant from nearby Piedmont Medical Center; the grant will allow USC to fund new faculty positions and nearly double enrollment in the school’s BSN program. Meanwhile, USC nursing students will have the opportunity to participate in clinical rotations at Piedmont, better positioning that facility to hire the new nurses upon graduation (Reynolds, Yuma Sun, 7/17/07; Clay, Rock Hill Herald, 6/28/07).


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