Six Questions with Sue

Susan Hassmiller, Ph.D., R.N., F.A.A.N., the Robert Wood Johnson Foundation senior adviser for nursing, discusses the future of nursing education.

    • February 25, 2010

It seems that there are two challenges facing the nursing education field—capacity and content. Which is most urgent, and what do you think needs to happen most immediately?

I hope I don’t have to pick one or the other…as it is both. Capacity has to do with both the need to increase the number of faculty, and the need to increase and improve the tools/resources that faculty members use to teach. It is well documented that we need more faculty, and will need even more in the future. According to a Special Survey on Vacant Faculty Positions released by American Association of Colleges of Nursing last August, 803 faculty vacancies were identified at 554 nursing schools around the country with baccalaureate and/or graduate programs. Besides the vacancies, schools cited the need to create an additional 279 faculty positions to accommodate student demand.

The top reasons schools cited for the difficulty finding faculty were noncompetitive salaries compared to positions in the practice arena and a limited pool of doctorally prepared faculty. It is also important to note that 200 to 300 doctorally prepared faculty members are eligible for retirement each year from 2003 to 2012. So, just when we will need more nursing faculty, they will be leaving in droves.

Tools and resources have to do with building infrastructure, which includes using technology, partnerships and other strategies to enhance and multiply the number of students a school can teach. Nursing schools can partner with other schools on campus—such as engineering, business and medicine—and with service partners in a community. Technology, such as online education, distance learning and simulation also can enhance a school’s capacity to produce more students and in many cases, more competent students.

With regard to content, we must pay strict attention to society’s emerging health care needs. There is growing need for chronic disease management, palliative and end of life care, geriatric care, transitional care, home care, and attention to prevention and wellness. Schools of nursing must ask themselves if they are paying attention to these emerging needs. If not, we will be preparing a workforce for yesterday’s issues.

With a nursing shortage looming, and nursing schools turning away qualified students, what steps would you like to see educators, policy-makers and others take to increase our nation's capacity to prepare the next generation of nurses?

It is really all about building capacity, as noted above. But I also think one of the most important issues we face is how to get more ADN (Associate Degree in Nursing) graduates continuing on for BSN (Bachelor of Science in Nursing) degrees. With little incentive, very few continue. This is a real bottleneck for getting nurses into faculty and advanced practice positions in the area of primary care. We must find better ways to make it easier for students to continue their education. Solutions involve providing scholarships, online education, and taking advantage of community colleges that have turned themselves into colleges for the purpose of granting BS degrees.

Oregon has led the way in creating a partnership between a major university and local community colleges that seamlessly brings ADN students into higher education. We should all be working to create more nurses with advanced degrees, for the sake of our profession. Policy-makers need to understand that supporting these efforts with scholarships and loan forgiveness programs is essential to meeting this goal.

Are the curricula, teaching methods and education systems we have in place now adequate to prepare the nursing workforce to meet future needs?

Curricula must address the evolving needs of today’s society and, as I mentioned before, pay attention to meeting the needs of tomorrow’s patients. That is why schools of nursing must work very closely with their practice partners to ensure that nursing students are being taught relevant material. Principles of safety and quality, and quality improvement techniques, for example, are very important concepts that should be in all curricula. But they aren’t. The Robert Wood Johnson Foundation (RWJF) has funded a national effort to bring a standardized curriculum in safety and quality into all schools of nursing. The program is called Quality and Safety Education for Nurses.

Teaching methods are very important to ensuring competence in our future nursing workforce. Nursing faculty must keep themselves updated within their areas of expertise and find ways to bring nursing students in contact with clinical instructors who are excellent preceptors and experts in their field. Simulation is another important tool for today’s schools of nursing. An added bonus is exposing nursing students to other health professionals, especially those from medicine, during simulation labs. Carrying this inter-professional collaboration over to real clinical training sites is a critical step in helping students adjust to what lies ahead.

What impact is the recession having on efforts to address the challenges facing the nursing education field?

The recession has added an interesting twist to the nursing shortage. Nursing has been hit as hard by the recession as other professions have. Very experienced nurses who are older, some of whom really wanted to retire, continue to work. And many experienced nurses who may have worked only part time are now working full time. Nurses are worried about the economy and in many cases their spouses have lost jobs. At the same time, some health care systems have had to cut back and even terminate employment for some workers because their bottom lines have been affected as fewer people have elective procedures.

All this has come together to create a situation where some brand new nursing graduates, without any experience, cannot find work. This is very worrisome for those of us who realize that, as soon as the recession eases and experienced nurses retire, there will indeed be an even greater shortage. We are also worried that, with our recent success in getting more students into nursing schools, applications have dropped off this year. We don’t want potential nursing students to be discouraged and not apply …and we don’t want new graduates going to other jobs because they cannot get jobs in nursing. We fully expect all of this to be temporary. In fact, according to the U.S. Bureau of Labor Statistics, about 233,000 additional jobs for registered nurses will open each year through 2016, in addition to about 2.5 million existing positions.

Is the nation doing enough to promote diversity of all kinds among the ranks of nurses and nurse faculty?

The Robert Wood Johnson Foundation, other foundations, and state and federal governments have a number of programs to increase the pool of diverse candidates in nursing by supporting scholarships and loan forgiveness. We need all of that, and we need to add to this mix strict attention to recruiting and retaining people from historically disadvantaged backgrounds. And we need more men! In particular, we need more and better mentoring programs so we can be assured that no person who has made it through the rigors of a nursing program feels compelled to leave.

The Initiative on the Future of Nursing is working on a report on this topic. Please tell us when that report will be released, who is working on it, and what it will cover.

We anticipate that the report from the RWJF Initiative on the Future of Nursing, at the Institute of Medicine (IOM), will be released later this year. The IOM committee is working hard on recommendations now, and deliberating on many of the issues that one would expect, including nursing practice and education. Once the recommendations have been published, RWJF and the IOM will host a very large conference late this year, which will officially kick off the implementation phase of the Initiative on the Future of Nursing. During this phase, RWJF will work with various partners, both inside and outside of the nursing community, to facilitate adoption of the committee’s recommendations.

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