Despite interest, too few nurses enter work force

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According to new survey data released today by the American Association of Colleges of Nursing (AACN), less than half of all qualified applicants to entry-level baccalaureate nursing programs were enrolled last year despite calls to increase the number of well-educated registered nurses (RNs) in the U.S. workforce. Though interest in nursing careers is high, the latest data show that almost 50,000 qualified applications to professional nursing programs were turned away in 2008, including nearly 6,000 applicants to master’s and doctoral degree programs.

“Nursing schools nationwide continue to see a strong interest in nursing careers among high school graduates and career changers looking for a dynamic, secure profession,” said AACN President Fay Raines.

“Tempering this good news, however, is the fact that academic administrators are facing many barriers to accepting all qualified applicants into their nursing programs, including funding cuts, limited classroom and clinical space, and a diminishing pool of faculty. All efforts to end the nursing shortage and enhance the pipeline of nursing students must focus on addressing these serious concerns.”

“AACN has zeroed in on a growing national problem – a nursing shortage and a desperate lack of nursing teachers,” said Senator Richard Durbin (D-IL), Majority Whip. “Every year, our colleges and universities turn away more and more aspiring healthcare professionals due to lack of faculty. Last year over 2,500 potential nursing students in my home state of Illinois were turned away. The Nurse Education, Expansion, and Development (NEED) Act that I introduced with Congresswoman Lowey will strike at the heart of the nursing shortage by giving colleges the resources they need to train more nurses.”

AACN’s latest data report updates the preliminary data released in December 2008 and determines enrollment trends by comparing data from the same schools reporting in both 2007 and 2008. Final survey data show that enrollments in entry-level baccalaureate programs in nursing rose by 2.2% in 2008, a slight increase above the earlier reported increase of 2.0%. Though this growth is welcome, the number of new students in baccalaureate programs falls far short of meeting projected needs. Last year, The Council on Physician and Nurse Supply, an independent group of healthcare leaders based at the University of Pennsylvania, called for 30,000 additional baccalaureate-prepared nurses to be graduated annually to meet the nation's workforce needs, an expansion of 30%. This year’s 2.2% increase translates into an increase of only 3,069 entry-level students.

"Increasing enrollment in baccalaureate nursing programs is a critical first step to correcting an imbalance in the nursing student population and reversing our nation's diminishing supply of nurse educators," said AACN CEO and Executive Director Geraldine “Polly” Bednash. "In almost all jurisdictions, nursing faculty must possess a graduate degree in order to assume a full-time teaching role. Since the overwhelming majority of nurses with master's and doctoral degrees began their education in baccalaureate programs, efforts to alleviate the faculty shortage must focus on expanding enrollments in four-year nursing programs."
Other key findings include:

Applications & Acceptance Rate: In the 2007-2008 academic year, 190,483 completed applications were received for entry-level baccalaureate nursing programs with 122,001 meeting admission criteria and 80,616 applications accepted. These data translate into an acceptance rate of 42.3%. For a graphic showing a five-trend in applications received, see http://www.aacn.nche.edu/Media/pdf/EnrollChanges.pdf. <LI class=bwlistitemmarginbottom>Total Enrollment: The AACN survey foundthat total enrollment in all nursing programs leading to the baccalaureate degree is 201,407, an increase from 192,698 in 2007. Within this universe, 145,845 students are enrolled in entry-level baccalaureate nursing programs. In graduate programs, 69,565 students are enrolled in master’s programs, and 7,391 are enrolled in doctoral nursing programs. <LI class=bwlistitemmarginbottom>Student Diversity: Graduate nursing programs realized the greatest gains in the number of students from minority backgrounds over the past year. Though representation in baccalaureate nursing programs remained high at 26%, the proportion of minority students in master’s programs increased to 24% (up 1,803 students) and to 22.2% in research-focused doctoral programs (up 41 students). For 10-year data on diversity in nursing education programs, see http://www.aacn.nche.edu/IDS/statedata.htm.

Men in Nursing: Though men represent only5.8% of the U.S. nursing workforce, the percentage of men in baccalaureate and master’s nursing programs are 10.4% and 8.9%, respectively. In doctoral programs, 7.1% of students in research-focused programs and 10.2% of students in practice-focused programs are men.

Accelerated Programs: Accelerated nursing programs continue to be an important pathway into nursing for individuals with degrees in other fields who are looking to change careers. Last year, 13 new accelerated baccalaureate programs were launched, bringing the nationwide total to 218 programs. Currently, 11,018 students are enrolled in these programs, up from 9,938 in 2007, and the number of graduates has climbed to 6,870 graduates in 2008. In the 57 accelerated master's degree programs now available, 4,577 students are enrolled, and 1,177 students graduated last year. See http://www.aacn.nche.edu/Media/FactSheets/AcceleratedProg.htm.

Clinical Nurse Leader: The national movement to advance the new Clinical Nurse Leader® (CNL) role gained momentum last year with 11 new CNL programs opening, which brings the total number of programs to 81. Currently, 1,650 students are enrolled in these generalist master’s programs (up 29.9%) and 467 CNLs graduated last year (up 76.2%). For details on the CNL, see http://www.aacn.nche.edu/CNL.

Doctoral Nursing Programs: Though the overall number of nursing students in doctoral programs has increased by 20.9% from 2007 to 2008, enrollment growth has been limited to Doctor of Nursing Practice (DNP) programs. In research-focused doctoral programs (i.e. PhD, DNSc), enrollments increased by only 0.1% or 3 students last year with the total student population reaching 3,976. The number of enrollees in DNP programs nearly doubled during that same timeframe with the student population growing from 1,874 to 3,415 students (82.2%). In terms of doctoral program graduates, 555 students graduated from research-focused programs in 2008, and 361 graduated from DNP programs.

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Continued:

Though interest in baccalaureate and graduate nursing programs is strong, thousands of qualified applicants are being turned away from four-year colleges and universities. In fact, AACN's survey found that 49,948 qualified applications were not accepted at schools of nursing last year due primarily to a shortage of faculty and resource constraints. Within this total, applications turned away include 41,385 from entry-level baccalaureate, 1,659 from RN-to-Baccalaureate, 5,902 from master's, and 1,002 from doctoral programs.

The top reasons reported by nursing schools for not accepting all qualified students into entry-level baccalaureate programs, include a lack of faculty (62.5%), insufficient clinical teaching sites (53.8%), limited classroom space (42.3%), insufficient preceptors (25.4%) and budget cuts (14.8%). See http://www.aacn.nche.edu/Media/pdf/TurnedAway.pdf.

With the goal of expanding student capacity, schools of nursing across the country are working to find creative ways to accept more qualified students into their programs. AACN is working to facilitate these efforts by advocating for federal legislation that benefits nursing education, including the establishment of a capitation grant program through the NEED Act that was introduced today by Senator Richard Durbin (D-IL). In the 110th Congress, this legislation was championed by Reps. Nita Lowey (D-NY), Peter King (R-NY), and Lois Capps (D-CA) in the House and Senator Richard Durbin (D-IL) in the Senate.

"At a time when job loss and unemployment have affected so many sectors of our economy, it is inexcusable that funding and resource constraints at nursing schools are preventing us from filling gaps in the nursing workforce,” said Congresswoman Nita Lowey (NY-18). “In 2008, baccalaureate and graduate nursing schools in New York turned away 2,134 qualified applicants, 550 more students than last year. That is why I have introduced and supported the NEED Act since 2004. This legislation will help schools of nursing accommodate and train more qualified applicants so health care providers can hire the workforce they need.”

AACN commends the work of President Obama and Congress in the past few weeks to enact legislation that will support nursing students and schools across the country. The American Recovery and Reinvestment Act, the House passage of the Omnibus Appropriations Act, and the President’s FY 2010 budget overview document (released today) all support solutions to address the critical shortage of nurses.

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