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July 25, 2002

NURSING SHORTAGE: Pitt school tackles national problem

NURSING SHORTAGE: Pitt school tackles national problem

(Second of 2 parts)

The national nursing shortage — currently there are 120,000 unfilled nursing positions, and that is expected to rise to a half-million vacancies in the next decade — has already strained the country's health care system, recent surveys and news reports indicate.

Reports of hospitals delaying elective surgeries, a shortage in some nursing specialty areas and the diversion of emergency room patients to other health care settings are indications of an industry-wide problem.

The current shortage is driven by a growing demand for health care as baby boomers age, coupled with an inadequate supply of new people entering the profession. The nursing population is getting older and many are leaving the profession, sometimes as a result of pressures caused by the nursing shortage.

The shortage also carries implications for nursing schools, according to Jacqueline Dunbar-Jacob, dean of Pitt's School of Nursing. At Pitt, the curriculum, scheduling, recruitment and fund-raising all have been affected, she said.

She added that the current generation of nursing students faces a self-image problem. "First, we have to instill in our students the fact that nursing is a profession, as opposed to a short-term vocation, or a stepping stone to something else," said Dunbar-Jacob.

Data indicate that the current generation of U.S. college students will change careers on average four times, she said. "Even if we can get enough people entering nursing, we're losing them at various points along the way. So we need to give them the opportunity to 'change careers' without getting out of nursing entirely."

Pitt's undergraduate nursing program is intentionally broad-based, she said, preparing "nursing generalists" who, through work experience or through a combination of more study and work, will be able to develop a specialty.

"Research tells us that while the need for nurses to work in hospitals will certainly continue to grow, that rate of growth is actually less than the projected needs in home health care, long-term care and ambulatory care for our aging population," Dunbar-Jacob said.

Currently, 59 percent of nurses work in hospitals nationwide; 18 percent are employed in public or community settings; 9.5 percent in ambulatory care; 6.5 percent in nursing homes and extended care, and the balance in assorted other jobs such as nursing education, student health, occupational health and health planning agencies.

"What this tells us in terms of preparation for our nurses is to have well-prepared nurses not just for in-hospital care, but well prepared for possible careers in these other growing nursing care areas," the nursing dean said. "The implication for us as educators, starting at the undergraduate level, is to turn out nursing generalists who will have career flexibility."

Curriculum, scheduling and recruiting implications Pitt's nursing school has expanded its curriculum recently, partly as a response to the current nursing shortage, Dunbar-Jacob said.

For example, Pitt is one of the few nursing schools that requires undergraduate courses in informatics, leadership development and community health.

Nursing undergrads at Pitt learn how information is processed within a health care system, which opens specialty options in a number of informatics subfields and prepares students to pursue a master's in informatics, the nursing dean said.

Similarly, studying leadership lays the groundwork for a master's degree in nursing administration and other nursing care areas, she said, while the course in community health includes a component in home care nursing, which is expected to be among the fastest growing areas of need.

Moreover, the school is trying to expand the field of potential nurses to include nontraditional students who want to enter nursing after being in the workforce or raising a family.

"We're [planning] to offer an accelerated program, a second-degree program, for individuals who have already completed a baccalaureate degree in another area and are interested in nursing," she said. "We want to make our programs available regardless of how long the person has been out working. So we might take someone into the informatics grad program, for example, who just finished an undergraduate degree, or someone who wants to re-tool from another career, or someone who has been in another area of nursing."

Dunbar-Jacob said the target pool is there, it just needs to be tapped.

"We have a significant number of people expressing interest in that kind of program. Together with a favorable job market, the more flexibility we have in terms of acceleration, the more people we're likely to attract to come into nursing," she said.

At the master's level, the school has waived the Graduate Record Examination and the Miller Analogies Test as requirements for admission to several of its 11 graduate programs, which helps attract nontraditional students.

"Starting this fall, we're also accommodating the population that's likely to make career changes by making adjustments in our scheduling, so more students [at Pitt] have the flexibility to develop minors or double majors in nursing," Dunbar-Jacob said.

Each year, Pitt awards about 100 bachelor of science in nursing degrees; 300 first professional degrees; 260 master's degrees; 170 R.N. option program degrees, and 40 doctorates.

Pitt's nursing baccalaureate program is ranked sixth nationally in the most recent Gorman report, an annual quantitative evaluation of American and International undergraduate and professional programs. Almost half of Pitt's recent B.S.N. graduates stay in the Pittsburgh region, most at UPMC Health System hospitals.

Currently, the nursing school employs 69 full-time faculty, 26 part-timers and 12 research associates. Eight faculty members have administrative appointments.

Dunbar-Jacob acknowledged that there were no plans in place to increase the size of the faculty or the undergraduate or master's programs, but said she is hopeful that the school, in light of the critical nursing shortage, will expand in the not-too-distant future.

"As long as we maintain the high quality of our graduates and have the necessary faculty in place, we would have no objections to expanding our programs," Dunbar-Jacob said. "[Pitt's] central administration clearly has priority areas for growth within the University, which are established years in advance. But given the contribution that our graduates make into the economy, and to the health care industry in this region, I would hope that our school would be relatively high up on the priority list," the dean said.

Dunbar-Jacob said that one of her primary responsibilities as dean is to pursue more "entrepreneurial opportunities" that would increase the school's funding. "In today's economic situation, we have to look beyond support from Pitt's administration for more foundation support and other revenue streams to expand the undergraduate student body and our programs," she said.

One part of the school that is expected to grow in the near future is the doctoral program, Dunbar-Jacob said. Pitt currently has about 35 doctoral students. The program ranks fifth among schools of nursing nationally in research funding from the National Institutes of Health. Increasing the number of doctoral candidates can impact the nursing educator shortage, which is both a regional and national problem, Dunbar-Jacob said. "One of the things we can do without needing exorbitant amounts of money is increase enrollments in our doctoral program to turn out more science-based educators. This would help ease the shortage in certain nursing specialties," which is as much due to a lack of teachers as it is a lack of students.

Some good news In the last year, according to Hospital & Healthsystem Association of Pennsylvania, admissions to state nursing schools rose from 3,500 to 4,350 (up 24 percent) between 2000 and 2001, reversing a five-year decline.

Pitt followed that trend, according to Jacqueline Lever, executive director of Student Services at Pitt's nursing school. Undergraduate admissions were up 19 percent between 2000 and 2001 — the school had to turn away some 75 admits to keep to its class limit of about 100 — and applications were up 45 percent, from 292 to 423, she said. "In addition to the quantity, the quality of our students has risen, with 39 percent of [freshman] undergraduates in the top 10 percent of their high school class. And we've had a 90-92 percent passing rate of our students on their state boards," Lever said, which is higher than recent national rates of 85-87 percent. "About 75 percent of our undergrads express an interest in pursuing a higher nursing degree."

There are several reasons for the upward swing in applications, Lever said, although the number of applicants nationally still lags far behind the need. One reason is the job market, which allows nurses a choice of places to work, she said. In addition, student recruiting efforts are reaching into the middle schools and recruitment advertising has increased dramatically. "Even the exposure of nurses on popular shows like 'ER' has improved the image of the nurse," Lever maintained.

Ironically, a weak job market in other areas traditionally has helped ease nursing shortages. Nursing is often the second income in a household, and a nurse typically will hold onto a job when a spouse's job is in jeopardy. And part-time nurses tend to increase their working hours under such circumstances. Unemployed and displaced workers gravitate toward secure jobs.

Producing higher-quality and better-educated nurses can have a ripple effect, Dunbar-Jacob pointed out. "Nurses have increasing responsibilities, partly because technology has increased the number of medical procedures requiring more training and partly because many more nurses — public health personnel, nurse practitioners, nurse clinicians in psychiatry — are delivering direct care. The better trained our nurses, the more patients that can be helped."

This is especially true in the hospital setting, she said. "Hospitals are looking at ways to restructure work to accommodate the vacancies and shortage of nurses. But if we look at outcomes of hospital care, the one thing in general that seems to predict patient outcomes is the level of R.N. staffing at the hospital. The real risk is the alteration of the work environment that doesn't include adequate numbers of R.N.s. If we in education can rise to the challenge of providing enough R.N.s, we can really strengthen the profession."

Nationally, 41 percent of employed nurses have at least a baccalaureate degree, she pointed out. "Many of us would like to see that rate higher," she said.

–Peter Hart

(Part 1 of this article on the current national nursing shortage appeared in the July 11 University Times.)

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