News

August 2, 2002

Tom Quinn is quick to acknowledge that as a middle-aged former police officer with three children, he's not a traditional nursing student, and certainly not a traditional nurse.

But Mr. Quinn, new president of the National Student Nurses' Association, says that bringing more nontraditional students like himself into the profession is an important part of the group's efforts to recruit students of all ages, to alleviate a growing shortage of trained nurses.

"There are many, many students out there today that are nontraditional students, that are in the same boat as I am and really starting to go toward nursing," he says.

As the nation faces the largest shortage of nurses in its history, nursing schools are struggling to increase their enrollments. The American Hospital Association estimated 126,000 nursing-job vacancies last year, and it projected 400,000 by the year 2020.

Part of the problem, according to nursing-school officials, is the profession's lack of success in attracting more students like Mr. Quinn -- a result, in no small part, of the outdated perception of nurses as deferential women in white dresses changing bedpans and taking orders. According to the National Sample Survey of Registered Nurses, men made up only 5.4 percent of the ranks of RN's in 2000; nonwhite nurses made up only 13.4 percent.

To appeal to a new generation and to underrepresented groups -- mainly male and minority students -- nursing schools are working to revamp their image, using aggressive recruiting tactics that include publicity campaigns, personal follow-up calls, and even visits to elementary schools.

Nursing-school officials are wooing state legislatures as well. Many colleges have begun lobbying for -- and getting -- hefty checks to expand their programs. But at the same time, nursing programs are struggling with a shortage of qualified faculty members, which prevents them from accepting all of the students who do apply.

"Unless some drastic measures are taken to shore up these schools of nursing, we're going to move deeper and deeper into crisis," says Linda C. Hodges, dean of the College of Nursing at the University of Arkansas for Medical Sciences.

"You're going to see hospitals closing. They will be unable to see patients in the emergency room."

Putting Out the Call

The nursing shortage is a simple case of supply and demand. More and more nurses are retiring each year, while enrollments in nursing schools, at both four-year and two-year colleges, have generally declined. Meanwhile, health-care needs are increasing. "We have been unable to replace those who are leaving the profession," says Jean Whalen, a nursing historian at the University of Pennsylvania. "In the past, there was always a new supply of fresh recruits coming out of the schools."

But colleges and nursing associations hope that soon -- with the help of ambitious publicity campaigns -- prospective students will see nursing as a modern profession, with opportunities on the cutting edge of science and medicine.

On the recently redesigned Web site of Georgetown University's School of Nursing and Health Sciences, for example, a click on the slogan "Not your grandmother's nursing" provides prospective students with answers to frequently asked questions under the heading "Nurses Are Not Just Women in White Caps." Another click takes visitors to a page where smiling students explain their reasons for choosing the profession.

"We're hoping to dispel the stereotypes and reach out to people who might not have thought about nursing," says Michael Bergin, an executive dean at the school. Georgetown also is working with a local NBC-TV station to create a series of ads to promote the profession.

"We really do have to re-educate people about the types of work that nurses really do, particularly for male nurses and for some minority populations," says Nancy Hallahan, director of admissions and student services at Emory University's nursing school. "It's not just white hats and ugly white shoes anymore."

Sharon L. Bernier, director of the nursing program at Montgomery College, a two-year institution in Maryland, says its marketing efforts have led to an "unheard of" number of students -- 223 -- enrolled for the 2002-3 academic year.

Another campaign, created by Johnson & Johnson, takes the message to a wider audience. In February, the health-care-products manufacturer pledged $20-million over the next two years to finance television advertisements and recruitment brochures, in English and Spanish, urging students to "be a nurse" and "dare to care." The campaign also supports scholarships for nursing students.

"What we've tried to do is show people of many different backgrounds -- men and women and people who are obviously proud to be nurses," says John McKeegan, a company spokesman.

Mr. Quinn, whose student association is one of several national nursing groups tied to the campaign, says it provides a foundation for efforts to ease the nursing shortage. "It has to go further. You can't just do a Band-Aid fix," he says. "Citizens have to address [the problem] with legislators to create long-term solutions."

Who Will Teach Them?

Even when more students do heed the call, though, some nursing schools don't have enough professors to teach them.

More than a third (38.8 percent) of the four-year nursing schools surveyed in 2000 cited a shortage of faculty members as a reason for not accepting a larger number of qualified applicants, according to a report from the American Association of Colleges of Nursing, which represents 560 baccalaureate and advanced-degree nursing programs. The shortage is a problem in community colleges as well. Few nurses have the advanced degrees necessary to become a faculty member, and many current professors are rapidly approaching retirement.

"Most of us couldn't expand greatly even if we wanted to, because we don't have the faculty or the facilities to pull it off," says Barbara Munro, dean of the nursing school at Boston College.

And, compared with other opportunities for nurses with advanced degrees, salaries for nursing-faculty members don't amount to much. The average salary in 2000, according to a report by the nursing-college group, was under $69,000, significantly less than such highly qualified nurses can make at clinical and private-sector jobs. The income gap depends on the job and its location but could reach $20,000, according to Ms. Bernier, of Montgomery College.

"We need to find ways of making the nursing-teaching profession attractive," says Antonio Perez, president of the Borough of Manhattan Community College of the City University of New York. "They can make much more money outside the profession. Nursing students who go out make a higher salary than our faculty."

Some legislatures have been quick to provide nursing schools with additional financial support, resulting in enrollment expansions, the addition of programs that make nursing more accessible to nontraditional students, and the creation of fast-track programs to higher degrees, to encourage students to become faculty members.

With universities pinching more pennies, such government support is crucial to nursing education, many college officials say. The problem, says Ms. Hodges, of the Arkansas nursing school, is that "the chancellors and presidents of universities tend not to support such initiatives, because they single out one discipline over another."

States Step In

At the Texas Tech University Health Sciences Center, a $265,000 grant from the state and $600,000 from the U.S. Department of Health and Human Services last year has led to the hiring of new professors and the creation of scholarships, says Alexia Green, dean of the School of Nursing. Those efforts helped the school increase its enrollment by more than 25 percent, she says.

The City University of New York, following the recommendations of its own committee, recently announced a $2-million effort to add 30 professors to its nursing programs, and to improve high-school math-and-science education in the city, supported by extra money from the state and the city.

In June, the Nevada Board of Regents approved a $27-million plan to double enrollment in community-college nursing programs by 2006.

The plan includes increased distance-education opportunities, partnerships with health-care providers, a media campaign to promote nursing, and outreach efforts with students in elementary, middle, and high schools.

And this year, the U.S. Department of Health and Human Services will provide $18.5-million in grants to colleges across the country to increase the number of nurses with advanced degrees.

The Nurse Reinvestment Act, which would allow Congress to authorize money for several major initiatives geared toward increasing nursing school enrollment, passed the House and Senate last week. It includes provisions for the creation of loan-repayment plans, more scholarships, and a study of the faculty shortage by the General Accounting Office, the investigative arm of Congress. But the bill would not directly provide money for such efforts, and many nursing-school officials worry that even if it is signed into law, they won't get the funds they need. President Bush is expected to sign the bill.

A continuing feud in nursing education between four-year baccalaureate programs and two-year associate-degree programs may stymie efforts to combat the nursing shortage. Some four-year schools argue that a bachelor's degree should be the minimum standard for professional nursing. Meanwhile, colleges with two-year programs say they serve an important role by training a greater number of nurses, and argue that a mandate for four-year training could reduce their enrollments and possibly shut them down.

'Why Aren't You a Doctor?'

The debate might even discourage some students from pursuing nursing careers, says Ms. Bernier, if they worry that "maybe the degree they're working for won't be recognized."

Students who do decide to go to nursing school often face questions from their friends. "All my friends ask, 'Why don't you go to medical school? Why aren't you a doctor?'" says Melissa L. Barrett, who will be a junior at Boston College's nursing school this fall. "I like the patient contact. I think a lot of people look past that. They think nursing is taking the easy way out."

For some students, however, nursing is an easy sell. While many of their peers scramble for jobs as dot-coms go bust and the economy slumps, nursing students graduate into a hot job market with salaries on the rise. According to the U.S. Department of Labor, the median salary for a registered nurse was $44,840 in 2000 -- and nursing is among the 10 professions named by the department this year as having the largest number of new jobs available.

"We could all walk out of here and get really good jobs anywhere in the world," says Rachel A. Shaw, a nursing student who will be a senior at Emory this fall.

But Ms. Shaw says her decision to pursue nursing was not driven by the job market. Her ailing grandfather's difficulty in getting good medical care at a nursing home sparked her interest in the field. "The treatment he was receiving because of the nursing shortage was significantly below par. It was devastating for our family, and I decided I had to do this."

Meanwhile, hospitals are so desperate for nurses that they're often willing to shell out extra cash, along with perks like spa memberships. As a result, nursing-school administrators say they must remind students to look beyond the signing bonuses, at the work environment itself.

Conditions in the workplace -- not just salaries -- must improve if enough nurses are going to stay in the profession, says Kathleen Ann Long, president of the American Association of Colleges of Nursing. Many nurses tire of the long hours and grueling workload of hospitals, where the greatest need lies.

"Half of my classmates don't want to set foot in a hospital. Nobody wants to be a floor nurse anymore," says Ms. Shaw. "Working conditions are very stressful. A lot of respect isn't there."

Enrolling more nursing students is only the first step in easing the shortage, says Penn's Ms. Whalen. "It's not just to educate them, but to get them working. It seems to me that these recent increases are showing some promise. But it's going to have to be a very sustained effort."