According to survey data released on March 8 by the American Association of Colleges of Nursing (AACN), enrollments in entry-level baccalaureate programs in nursing increased by 14.1 percent in fall 2004 over the previous year. This enrollment increase is even greater than AACN's preliminary data released on December 15, 2004 which showed a 10.6 percent increase. Despite this significant gain, more than 32,000 qualified applications were turned away from baccalaureate and graduate nursing programs last year, including almost 3,000 students who could potentially fill faculty roles, according to an AACN news release.
AACN's findings are based on responses from 590 nursing schools (85.9 percent) in the U.S. and its territories that grant baccalaureate- and/or graduate-degrees. AACN data reflects actual counts reported in fall 2004 by nursing schools, not projections or estimates based on past reporting. The survey found that total enrollment in all nursing programs leading to the baccalaureate degree was 147,170, up from 126,954 in 2003. Within this universe, 112,180 students were enrolled in entry-level baccalaureate nursing programs.
AACN determines enrollment trends by comparing data from the same schools reporting in both 2003 and 2004. Data show that nursing school enrollments are up in all regions of the United States. The greatest increase was found in the North Atlantic states where enrollments in entry-level baccalaureate programs rose by 21.5 percent. Enrollments in the Midwest, South and West increased by 12.5 percent, 12.2 percent and 10.2 percent, respectively.
"Increasing enrollment in baccalaureate programs is a key first step to addressing the nation's diminishing supply of nurse educators," said AACN President Jean E. Bartels, PhD, RN. "Since the overwhelming majority of nurses with master's and doctoral degrees began their education in baccalaureate programs, efforts to overcome the faculty shortage must focus on boosting enrollment in four-year nursing programs."
Graduate Enrollments and Nurse Faculty Shortage
The latest AACN survey found that both enrollments and graduations increased in master's and doctoral degree nursing programs last year. Enrollments in master's degree programs rose 13.7 percent (4,929 students) bringing the total student population to 42,751. In research-focused doctoral programs, enrollments increased by 7.3 percent (229 students) with the total student population at 3,439. Ending a downward trend, the number of graduates from master's degree and doctoral programs increased slightly in 2004 by 6.9 percent (669 students) and 2 percent (8 students), respectively.
"Since the doctoral degree is the desired credential for a nurse educator, an increase of only 8 additional graduates last year is very disappointing news," said Dr. Bartels. "AACN will continue to work with the larger healthcare community to advocate for more federal funding for doctoral level education and with nurse educators to identify creative ways to expand enrollments at the graduate level."
One innovative program that is gaining momentum and helping to bring younger faculty into nursing is the Baccalaureate to Doctoral degree program. These accelerated programs provide an efficient pathway to careers as nurse educators, researchers, and leaders for highly motivated students. Intense clinical experiences are embedded in these 4-5 year graduate programs, which build on the solid foundation provided in baccalaureate programs. AACN's latest survey shows that 49 Baccalaureate to Doctoral programs are available nationwide, up from 45 programs in 2003, with an additional 12 programs under development.
Raising the Level of Nursing Education
Given the calls for a better educated nurse workforce, AACN is pleased to see more registered nurses (RN) pursuing baccalaureate level education. RN-to-Baccalaureate programs enable nurses prepared with a diploma or associate's degree to earn a baccalaureate degree and enhance their clinical skills. From 2003 to 2004, enrollment in RN-to-Baccalaureate programs increased by 6.2 percent or 1,826 students, which marks the second year of enrollment increases. This trend is encouraging since the National Sample Survey of Registered Nurses (U.S. Dept. of Health and Human Services) found that only 17.4 percent of nurses educated in associate degree programs go on to complete a four-year nursing degree program.
"As educators, we must encourage all nursing students to further their education in the interest of providing the best nursing care possible," said Geraldine "Polly" Bednash, PhD, RN, FAAN, executive director of AACN. "Unfortunately, most nurses who enter the workforce through pre-baccalaureate programs do not advance their education beyond the minimal preparation required for licensure. AACN is committed to working with nurse educators at all levels to send a message that education makes a difference in care delivery and is key to career advancement." Currently, there are 628 RN-to-Baccalaureate and 137 RN-to-Master's Degree programs available at U.S. nursing schools, many of which are offered completely online.
Interest Runs High in Accelerated Programs
For the second year, AACN collected data on accelerated nursing programs, which transition adults with baccalaureate and graduate degrees in other fields into nursing. Accelerated baccalaureate programs may be completed in 12-18 months and provide the fastest route to RN licensure for individuals with a prior degree. These intense programs have high admission standards, require continuous study without session breaks, and incorporate the same number of clinical hours as traditional programs.
Last year, 22 new accelerated baccalaureate programs were launched, bringing the nationwide total to 151 programs. This total represents a 43.8 percent increase since fall 2002 when 105 such programs existed. AACN's latest survey found that 6,090 students are enrolled in accelerated baccalaureate programs, up from 4,794 students in 2003. The number of program graduates nearly doubled with 2,422 graduates in 2004 compared to 1,352 in 2003. In the 41 accelerated master's degree programs now available, 2,666 students are enrolled and 542 students graduated last year. In addition to the existing programs, 66 new accelerated programs are under development, including 46 baccalaureate and 20 master's degree programs.
"For career changers who have already completed a four-year degree, accelerated programs provide the most efficient educational path to careers in professional nursing," said Dr. Bednash. "AACN encourages partnerships between nursing schools and practice settings that facilitate the growth of accelerated programs and provide more financial assistance to students." Last year alone, nurse employers including Tenet Healthcare, Carondelet Health Network, North Carolina Baptist Hospital, Duke University Health System, and many others actively supported the development and growth of accelerated nursing programs.
Students Turned Away Despite Nursing Shortage
Though interest in baccalaureate and graduate nursing education programs is high, not all qualified applications are being accepted at four-year colleges and universities. In fact, AACN's survey found that 32,797 qualified applicants were not accepted at schools of nursing last year due primarily to a shortage of faculty and resource constraints. Within this total, applicants turned away include 29,425 from entry-level baccalaureate programs; 422 from RN-to-Baccalaureate programs; 2,748 from master's programs; and 202 from doctoral programs.
The top reasons reported by nursing schools for not accepting all qualified students into entry-level baccalaureate programs, include insufficient faculty (76.1 percent), admissions seats filled (75 percent), and insufficient clinical teaching space (54.5 percent). In the 2004-2005 academic year, 122,194 completed applications were received at schools of nursing with 84,002 meeting admission criteria and 54,577 applications accepted. The application acceptance rate was 44.7 percent.
"Given the nation's diminishing supply of nurse faculty, it's particularly disturbing to see that almost 3,000 qualified applicants were denied entry into graduate nursing programs last year," said Dr. Bartels. "Efforts to address the faculty shortage will fail unless we can ensure that all qualified nursing students seeking graduate education can be accommodated."
In response to qualified students being turned away from nursing schools, AACN is engaged in efforts to advocate for legislation that benefits nursing education, including increased funding for federal Nursing Workforce Development programs. The organization strives to identify best practices related to nursing program expansion and share this knowledge with the full body of nursing schools. AACN actively seeks collaboration on initiatives to address the nursing shortage, which include working with Johnson & Johnson's Campaign for Nursing's Future and the Nurses for a Healthier Tomorrow coalition.
"A successful solution to the shortage of RNs and nurse faculty will require a collaborative effort on the part of the nursing profession, the health care system, the federal government, and all stakeholders," said Dr. Bartels. "Together, we must remove barriers to nursing careers, provide incentives for nurses to advance their education, and create practice environments that encourage professional development and foster nurse retention."
Despite the challenges, nursing schools across the country are finding creative ways to expand student capacity and accommodate more students. Many schools are forming partnerships with clinical agencies to support mutual needs and bridge the faculty gap. Other strategies include lobbying for continued state and federal monies, launching accelerated programs, and stepping up efforts to expand diversity and recruit new populations into nursing. For some examples of how individual nursing schools have expanded enrollment despite facing challenges, see http://www.aacn.nche.edu/Media/NewsReleases/2005/enrollments05.htm#successstories
About the AACN Survey
AACN's 24th Annual Survey of Institutions with Baccalaureate and Higher Degree Nursing Programs is conducted each year by the association's Research Center. Information from the survey forms the basis for the nation's premier database on trends in enrollments and graduations, student and faculty demographics, and faculty and deans' salaries. AACN's survey is based on actual counts, not projections or estimates.
The AACN survey is a collaborative process involving two of the nation's leading advanced practice nursing organizations. For the seventh year, AACN has jointly collected data on nurse practitioner programs with the National Organization of Nurse Practitioner Faculties. In a parallel initiative, AACN collects information on clinical nurse specialist programs with the National Association of Clinical Nurse Specialists.
Complete survey results are compiled in the following reports:
2004-2005 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing
2004-2005 Salaries of Instructional and Administrative Nursing Faculty in Baccalaureate and Graduate Programs in Nursing
2004-2005 Salaries of Deans in Baccalaureate and Graduate Programs in Nursing
For more details or to order a data report, see http://www.aacn.nche.edu/IDS/datarep.htm
The American Association of Colleges of Nursing is the national voice for university and four-year-college education programs in nursing. Representing more than 580 member schools of nursing at public and private institutions nationwide, AACN's educational, research, governmental advocacy, data collection, publications, and other programs work to establish quality standards for bachelor's- and graduate-degree nursing education, assist deans and directors to implement those standards, influence the nursing profession to improve health care, and promote public support of baccalaureate and graduate nursing education, research, and practice. Web site: http://www.aacn.nche.edu
CONTACT: Robert Rosseter
(202) 463-6930, x231
Enrollment Success Stories and Challenges to Future Growth
Below are snapshots of how some four-year colleges and universities are addressing the strong surge of interest in nursing careers. Academic leaders also address some of the opportunities and challenges confronting schools trying to expand student capacity.
At Vanderbilt University, collaboration has been the key to impressive enrollment growth in entry-level nursing programs. Last year, Vanderbilt partnered with two liberal arts schools in Nashville, Fisk University and Lipscomb University, to launch new Bachelor of Science in Nursing degree programs. �These arrangements between an Academic Health Center and liberal arts schools are unique and serve as a new model for national collaboration,� said Dr. Colleen Conway-Welch, dean of the School of Nursing.
The School of Nursing at Oregon Health and Science University (OHSU) was able to expand its enrollment due to a shared vision within the university that nursing education is extremely important to health of the State of Oregon. "Without additional federal or state funding, the OHSU leadership and Board committed to take a one-time additional cohort of undergraduate students to ease the local shortage of nurses," said Dr. Kathleen Potempa, dean of the OHSU School of Nursing. "While we still turn many qualified students away, OHSU and its School of Nursing are deeply committed to the critical role nurses play in health care."
Dr. Silvana Richardson, dean of the School of Nursing at Viterbo University in La Crosse, Wisconsin, is "thrilled by the growing interest in nursing as a viable career. Our program has benefited from both national and local efforts to recruit people into the nursing profession." Enrollment growth at this institution is attributed to outreach to local high schools and middle schools, collaboration with a neighboring associate degree nursing program, and the creation of a summer camp for youth to promote interest in all of the health professions. Dr. Richardson added that "we would like to increase enrollment further based on the high demand but are limited by funding for and availability of qualified faculty as well as by the short supply of clinical education sites."
To accommodate the larger nursing student population at Pace University in New York, administrators used a variety of creative strategies, including hiring part-time faculty from affiliated agencies to teach students in clinical settings, reconfiguring the school's Learning Resource Center to add classroom space, and expanding the accelerated baccalaureate program to a second location in New York City. "Pace's accelerated program for adults with non-nursing degrees has proven to be an effective way to bring a diverse group of highly educated professionals into nursing," said dean Harriet Feldman. "We recently surveyed our new students to learn more about their backgrounds and found that 39.5 percent are male, 58.1 percent are from minority backgrounds, ages range from 23-49, and students were born in 18 different countries. Also, 14 students have master's degrees, one is a dentist, and one is a doctorally-prepared physical therapist. We are excited by the rich diversity these students bring to the nursing profession."
Dr. Feldman added that "the shortage of nurse educators, particularly those prepared at the doctoral level, continues to be a major barrier to program expansion. A second barrier relates to space at the university, and we are actively seeking additional space to meet our growing needs. We have outgrown the space for computerized testing as well as clinical practice."
Launching a new accelerated baccalaureate program and doubling the size of an existing fast-track master's degree program for non-nursing college graduates helped boost enrollments at the University of Miami in 2004. "Our greatest need right now is for state subsidies to fund scholarships for our nursing students," said Dr. Nilda Peragallo, dean of School of Nursing. "States need to step up and provide more financial aid to nursing students attending private institutions, especially when public institutions are rejecting qualified applicants due to a lack of resources."
The impressive enrollment increase at Arizona State University (ASU) is attributed to the school's plan to grow its baccalaureate nursing program on three regional campuses and in partnership with the Mayo Clinic as well as the move to shorten degree completion times by switching to a year-round format. "The college designed an expansion plan that would capitalize on our locations and geographically distribute baccalaureate program graduates throughout the state," said Dr. Karen Sousa, interim dean at ASU's College of Nursing. "We addressed the time to complete the four-semester nursing major by utilizing the calendar year and creating a summer semester to enable students to complete their studies in 16 months rather than 24 months." When asked about future growth, Dr. Sousa explained that the high demand for clinical placements from all nursing programs "is limiting access to these learning centers and presents a barrier."
Institutions that have increased the nursing student population face new challenges to further expansion. At Johns Hopkins University in Baltimore, the nursing school's physical limitations present the largest obstacle to addressing the nursing shortage. "Among the serious barriers we face are the very walls of our building," said dean Martha N. Hill. "We need space � space for more students, space for more faculty, space for more programs and space for staff to support our faculty and programs. Our campaign to expand our building is underway, but in the meantime, we are doubling up in both classrooms and offices."
In Texas, Dramatic Growth Funds were designated in the Nursing Shortage Reduction Act of 2001 to support increased enrollments in community colleges, general academic universities, and health science center schools of nursing. On average, health science centers in the state showed the largest increase in enrollments with a 27 percent increase, while community colleges and academic campuses increased enrollments by about 23 and 7 percent, respectively.
�We increased enrollments by almost a third from 200 to about 300 undergraduate student admissions a year,� said Dr. Robin D. Froman, dean of the University of Texas Health Science Center at San Antonio School of Nursing. �Unfortunately, we only received 30 percent of the funding anticipated from the Nursing Shortage Reduction Act while the community colleges and academic campuses received 100 percent of the expected funding. Though we demonstrated the ability to increase capacity, we cannot, sustain increased enrollments without the financial resources to hire faculty for adequate instructional support for students.�
The nursing program at the University of Florida turns away 3 or more students for every space available in the school's upper division baccalaureate courses. Given this internal competition, many freshmen and sophomore students are now changing majors in an effort to complete a degree program in four years. "Many bright new college students are not even trying to get into nursing because they have heard that admission into the upper division courses is so competitive," said Dr. Kathleen Ann Long, dean of the University of Florida's College of Nursing. "Without more faculty and clinical placement sites, nursing schools will not be able to graduate enough students to sustain a strong nursing workforce."