The sun hasn’t even risen yet, but Katie Notch ’16, a Master of Science in Nursing (MSN) graduate, has already started her work day. An associate instructor in an associate degree in nursing program in St. Cloud, Minnesota, Notch is on her way to the clinical site where she’ll oversee the care, assessments, and care planning her students provide to the residents of a long-term care facility.
For the past three academic quarters, Notch, who previously worked as a nurse in medical/surgical and intensive care units, has been working time and a half as a nursing faculty member. She’s been teaching lecture sections of about 30 students each, two to four lab sections of up to 16 students each, and four sections of clinicals. Her intense workload is the result of both the college’s no-waitlist policy—which means the institution has a large and growing number of nursing students—and the pressing national nursing faculty shortage.
“What we’re seeing is a graying in the population,” says Dr. Andrea Lindell, vice provost of the College of Health Sciences. “A lot of the nursing faculty nationwide is moving toward retirement, and the discipline is losing a lot of the wisdom, knowledge, and experience that’s made nursing what it is today. We’re looking to the new generation to step into those roles and continue to advance the profession of nursing.”
That shortage not only affects current nursing faculty, but it also has a significant impact on the continuing shortage of nursing professionals across the country, the workload nurses face in hospitals and other clinical settings, and the quality of care patients receive.
“In my experience, for every 3% to 4% vacancy in nursing positions, there’s a 20% to 25% increase in overtime hours required by the current nursing staff,” says Dr. Robert McWhirt ’13, a Doctor of Nursing Practice (DNP) graduate and School of Nursing contributing faculty member. McWhirt is a former chief nursing officer with more than 25 years’ experience in nursing operations at hospitals in Maryland, New Jersey, and Virginia.
“It’s not like you can decrease patient numbers when your hospital doesn’t have enough nurses, so burnout, stress, and turnover rates tend to rise,” he says. “Nurses end up needing to triage patients’ needs, which can increase the risk of readmission, hospital-acquired infections, and patient mortality.”
Many people probably don’t think that this shortage of nurses stems from a shortage of nursing educators, but that’s exactly the problem. And it touches everyone who could potentially need medical care.
Notch remembers this as she arrives at her clinical site around 5 a.m. “Frequently, I am met with the same nurse who was there the day before who was convinced to work a double shift,” she says. “I watch him struggle through report and silently pray that sleep deprivation did not negatively impact his care.”
Much like the care of patients with complicated medical histories, the nursing faculty shortage won’t be solved with a single strategy. Nursing schools, faculty members, healthcare organizations, and other stakeholders need to come together to develop a range of tactics that address the different causes of the shortage.
Lindell, McWhirt, and Notch note four key areas that are contributing to this crisis—and the strategies that could help solve those issues.
ISSUE: Working as a clinical nurse leaves little time for furthering your education.
A critical shortage of nursing professionals leaves many nurses working overtime and burning out sooner. Add families and personal lives into the mix, and how are they to find time for an advanced degree?
STRATEGY: Take education out of the traditional classroom.
Online graduate nursing programs are the future, according to Lindell. Walden’s MSN students who specialize in education learn to design, implement, evaluate, and revise educational programs. The online curriculum is supplemented by fieldwork experience, which gives students an opportunity to apply learning in a real-world environment. Those in the PhD in Nursing program who specialize in education focus on distance learning principles and the use of multimedia technology to facilitate learning—topics that will improve access to nursing education for those who cannot find time to report to a classroom a couple times a week.
“Walden produces more nurses with advanced degrees than any other university,”† Lindell says. “We currently have students in the bachelor’s, master’s, and doctoral nursing programs, and we are eager to see these students make a dent in the national shortage—both as practitioners and scholars. Walden’s model for education works very well for a generation of nurses that is looking for ways to advance in their careers while continuing to treat patients and raise families.”
ISSUE: There is a lack of diversity in the profession.
Diversity in the nursing profession and among nursing faculty can be a challenging obstacle—or a key differentiator. In many places, nurses and nursing faculty all look the same. But that doesn’t have to be the case.
STRATEGY: Look beyond traditional candidates.
Students benefit from diverse faculty members who prepare them to serve all populations. Nursing schools should be focusing on recruitment and retention of groups that are underrepresented in nursing education—including men, Hispanics, African Americans, Asians, and Native Americans—through mentoring and targeted recruitment programs.
Walden’s master’s and doctoral programs—in fields including public health, health professions, nursing, health services, mental health and social services, psychology, management, and education—were ranked among the top five in multiple categories in Diverse: Issues in Higher Education’s 2016 Top 100 Producers of Minority Graduate Degrees. Walden’s MSN program ranked No. 1 among African Americans, Asian Americans, Hispanics, Native Americans, and total minorities‡.
“As an industry, we need faculty who can teach from diverse perspectives and backgrounds so our students have models of those like them who have excelled in the profession,” McWhirt says. “Nursing institutions need to highlight the value of the faculty member and how their diversity can and will enrich the student experience.”
ISSUE: Nursing faculty positions often pay less than clinical nurse positions.
“I believe the biggest barrier to recruiting highly qualified nursing faculty is the financial compensation for the position,” Notch says. “After investing time and money in graduate school, full-time instructors in a nursing program may end up earning less than they were making as a full-time floor nurse.”
STRATEGY: Offer help with graduate school costs and recruitment incentives.
Statewide initiatives to lower or offset the cost of the graduate education needed to teach in a Bachelor of Science in Nursing (BSN), MSN, or doctoral nursing education program are increasing in number. The University of Wisconsin, for example, provides $3.2 million to fund fellowships and loan forgiveness for future nurse faculty who agree to teach in the state after graduation.
Walden offers a Higher Education Professional Development Program, which provides a 10% tuition reduction on degree programs to faculty or staff employed at a U.S. institution of higher education, as well as scholarship opportunities for new students and returning alumni who are registered nurses.
As for healthcare organizations, McWhirt says it’s not uncommon for them to dedicate as much as 33% of their budgets to recruiting and retaining nurses through scholarships, signing bonuses, or professional development opportunities.
STRATEGY: Emphasize the benefits of working in academia.
“We’re very fortunate that we have all of our nursing faculty positions filled at Walden,” Lindell says. She believes more people would consider teaching positions if they were aware of the many benefits that are available at educational institutions.
“We provide our faculty members with a wide range of benefits, including financial support for ongoing professional development and opportunities to write research development grants and present their findings at conventions and workshops,” Lindell says. “We really work to motivate and keep our faculty involved in developing curriculum, working with students, serving on committees, attending our national faculty meetings, and building a community.”
Notch thinks that connection to students is paramount. “Teaching the next generation of nurses means you aren’t just having a positive impact on your students; you’re affecting all the patients they will help throughout their careers,” she says. “Walden helped me think of it that way and prepared me for all the joys and challenges of teaching future nurses.”
Notch is tireless in her efforts to spread the word about the need for nursing faculty and the benefits the job offers. “I never stop recruiting,” she says. “I’m always talking about it. I plant the seed wherever I can and let people know that as an adjunct faculty member, they can choose to work 2 hours in a lab or 1 clinical day per week and choose times that work best for them.”
ISSUE: An increasing number of nurses and nursing faculty are reaching retirement age.
Lindell’s note about the “graying” of the profession is supported by the article “The Shortage of Doctorally Prepared Nursing Faculty: A Dire Situation.” The authors projected a wave of nursing faculty retirements, with up to 300 doctorally prepared faculty members eligible for retirement annually from 2003 to 2012.
STRATEGY: Take steps to retain faculty and nurses near retirement.
As nursing faculty approach retirement age, nursing schools need to develop creative approaches that will encourage them to continue teaching or sharing their expertise. Some options include creating opportunities to help develop new programs, offering a phased approach to retirement that allows faculty to lower the number of hours they teach or switch to a mentoring role for junior faculty, and providing the option to increase their focus on research while teaching one or two classes in their area of expertise per year.
“We value the expertise and wisdom of the individuals who are at the end of their clinical or faculty careers,” Lindell says. “But we need to look at their retirement as a second career.”
Nursing is a physically and emotionally demanding career, which can get even more challenging as the years progress. Traditionally, nurses look to move from bedside to desk jobs, but there’s no reason they shouldn’t be looking at classrooms, too. “Many in the industry don’t want to lose the collegial interaction and want to continue to advance the profession,” Lindell says.
McWhirt has seen this throughout his career. “As nurses get into their 40s, many can’t or no longer want to tackle such strenuous work,” he says. “I teach many nurses in this situation in Walden’s DNP program.”
Because these seasoned nurses have seen successes and failures throughout many transitions in models of care delivery, McWhirt says they are well suited to prepare students for constantly evolving healthcare environments. “They are in a great position to coach, mentor, and educate future leaders,” he says.
STRATEGY: Attract younger nurses to faculty positions.
Helping students who are interested in pursuing an MSN, PhD in Nursing, or DNP explore the wide range of career options possible with those degrees is an effective way of getting a teaching career on their radar. Despite the urgent clinical need, there is also a need for faculty members to help groom those traditional bedside nurses.
“At Walden, our enrollment staff works with prospective students who are not interested in direct patient care to get an understanding of what other options are available, including teaching,” Lindell says. “We find out where their interests lie and what their goal is and talk about becoming a faculty member as one option to consider.”
As Notch wraps up her day and thinks about her alarm going off at 4 a.m. yet again, she fights with herself about the reality of getting up so early. But she is reminded of why she’s doing it.
“I chose to teach in a nursing program because it’s a chance to impact the future of nursing through classrooms full of students, rather than one nurse trainee at a time like when I worked in a hospital,” Notch says. “One faculty member can make a huge difference in the lives of hundreds of students and thousands of patients over time.”
Not every institution has been hit by the faculty shortage, but Lindell notes that Walden has had some difficulty recruiting faculty members for the MSN Psychiatric-Mental Health Nurse Practitioner specialization. “We require a doctoral degree in that specialty, and there aren’t many prepared at that level nationally,” she says. “We’re having to work hard to recruit and/or develop faculty in those areas.”
With Walden having so many students depending on it to get their degrees, Lindell hopes the university won’t be facing a widespread shortage anytime soon. But she knows the problem is not being overhyped, and she’s still engaging in discussions to create strategies to address it.
“I’m part of a deans’ group, and there is a lot of conversation about the faculty shortage,” Lindell says. “I read in journals and receive the numerous requests from other academic nursing programs needing faculty members. We’re constantly talking about how to garner and even share the expertise of the faculty members in our networks.”
Notch sees the reality of the problem every day. As a lab section enters its third or fourth hour, Notch’s students start to ask if they can leave early. Although she’s sometimes been up for 12 hours at that point, she reminds them—always with a smile—that the next time they perform these skills will be on a real patient, so they need to take advantage of the time to practice proper procedure to ensure competency. “When fatigue tries to overtake me, I think of my parents, grandparents, children, and myself,” she says. “We all need and deserve high-quality care from nurses in all care settings. The golden rule prevails, and I am carried through another day focused on teaching my passion.”
Sometimes tasked with covering eight chapters in a week, Notch faces a daunting task, but it’s a worthy one. Dedicated nursing faculty leads to dedicated nurses, and dedicated nurses benefit us all.
† Source: National Center for Education Statistics (NCES) IPEDS database. Retrieved July 2017, using CIP codes 51.3801 (Registered Nursing/Registered Nurse), 51.3808 (Nursing Science), and 51.3818 (Nursing Practice). Includes 2016 preliminary data.
‡Source: Diverse: Issues in Higher Education analysis of U.S. Department of Education reports submitted by institutions, on the internet at http://diverseeducation.com/top100/.