Closing the Nursing Shortage Demands Creativity, Collaboration

By
 - Susan Reinhard, PhD, RN, FAAN, Senior Vice President and Director, AARP Public Policy Institute; Chief Strategist, Center to Champion Nursing in America
 - Brenda Cleary, PhD, RN, FAAN, Director, Center to Champion Nursing in America

Note: This perspective was originally published in the November 2, 2009 edition of Community College Week.

In light of the work of the RWJF Initiative on the Future of Nursing at the IOM and its upcoming February Forum on the Future of Nursing: Education, we feel it is important to highlight the innovative approaches to redesign nursing education being implemented across the country by the Center to Champion Nursing in America (CCNA) and our 30 state teams across the country.

The United States faces a nursing shortage, perhaps like none we’ve experienced: by 2025, the shortfall in registered nurses is expected to reach 260,000, according to Dr. Peter Buerhaus of Vanderbilt University. And, as baby boomers age and require greater attention and care, this shortage poses a growing threat to the quality and availability of health care services in our system.

This shortage is not due to a lack of qualified aspiring nurses. In fact, would-be nursing students are flooding admissions offices with applications every year; there is simply no place for them to go.  In 2008, almost 99,000 qualified applications were turned away by U.S. nursing schools, according to the National League for Nursing.

We do not have enough nurses, in part, because of systemic problems in nursing education in the U.S. In order to stem the tide of this shortage, colleges and universities need to be equipped to graduate tens of thousands of additional nurses each year.  This is no small feat. The current system is beset by too few faculty, a lack of strategic partnerships between community college and university programs, and insufficient clinical sites to provide the hands-on experience that is required for competency development. 

To address these specific challenges in nursing education, the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation, is working with 30 state teams across the country to redesign the system to enable new graduates to enter the workforce with the skills they need to serve patients in hospitals and long term care facilities as well as in the community, and to become faculty members themselves. The Center seeks to spread best practices from around the nation that are ensuring the best in clinical education, as well as sharing innovative approaches to building the teaching capacity in nursing schools.  In late 2009 in Portland, Ore., the Center brought together teams of nurses and other leaders from 11 states to demonstrate how they are addressing these challenges.  The Oregon Consortium for Nursing Education (OCNE) was co-host of the conference and a featured model program, considered one of the most innovative nursing education redesign approaches in the country.

Oregon was one of the first states to respond to this critical need to redesign nursing education. Formed as a part of the state’s 2001 strategic plan to combat the nursing shortage, OCNE is a unique statewide partnership that includes faculty from eight community colleges and Oregon Health & Science University School of Nursing. As a part of its charge, it created a shared curriculum for nurses based on necessary core competencies. All consortium campuses teach the same courses, helping students move seamlessly from Associate’s degree to Bachelor’s degree programs, without having the take additional prerequisites, thus decreasing the time needed to graduate and begin direct patient care. 

All of the Oregon consortium members have increased enrollment in their programs, and greater numbers of nursing students are opting to pursue higher-level degree programs. At Rogue Community College in Oregon, for example, enrollment has nearly doubled, according to Linda Wagner, the head of the college’s nursing department.  During the first year that associate degree students had the option to continue on in their program, some 22 percent chose to pursue their Bachelor’s; this year, that number had risen to 44 percent. 

Perhaps most beneficial to the state is that these new nurses who graduate all have the skills required to care for an aging population, whether they obtain a bachelor’s or an associate’s degree. The end goal is to increase both the number and skill level of new nurses to manage the needs of the 21st century patient in a reformed U.S. health system as well as to create a pipeline for the faculty that are desperately needed by all levels of nursing education programs.
 
In California, as well as Oregon and other states, many aspiring nurses have faced roadblocks in finding the necessary clinical education necessary to meet their degree requirements. The state’s shortage is expected to reach 109,00 next year, yet current rates of graduation will only produce half the required number of new nurses to fill the gap. Thus, the state has recently implemented the Centralized Clinical Placement System (CCPS), a web-based tool that is streamlining the clinical placement process, helping nursing students secure rotations in hospitals and other previously untapped medical facilities.  So far, the system has helped increased Bay Area nursing student enrollment by 47 percent over the last five years.

To be sure, combating the nursing shortage and building a 21st century nursing workforce is not solely the responsibility of educators. However, we do know that within the education system, there are deliberate steps we can take to ensure that greater numbers of students enter the workforce with the skills they will need to succeed in this ever-changing health care landscape. The more we can work together and learn from each other – across communities, states and the nation – the more likely we are to reduce the nursing education bottleneck and create a nursing workforce ready to care for today’s patients and for generations to come.