Problem: There aren’t enough nurse faculty members to fill vacancies at the nation’s nursing schools and, as a result, thousands of qualified applicants are being turned away at a time when more nurses are needed to meet current and future health care needs. Academic leaders and researchers are working to figure out effective ways to better recruit and retain nurse faculty with the aim of increasing the number of nursing school graduates.
Background: Michael Yedidia never expected to adopt his current role: an expert on, and passionate champion of, nurses and nursing education. A native of California, he majored in sociology, and went on to earn a master’s in public health and a doctorate in sociology. There are no nurses in his family, and early on he did not have close friends who were nurses—until he began to conduct research into the profession, that is. “Now it’s no accident that I have a lot of friends and colleagues who are nurses,” he says.
It was as a doctoral student that Yedidia discovered the tremendous, and underutilized, power of nurses. He’s focused on many different areas since then—health policy and management, access to and quality of care, and childhood obesity prevention. But in recent years, Yedidia has returned to his earlier interest in the nursing profession as director of Evaluating Innovations in Nursing Education (EIN), a program funded by the Robert Wood Johnson Foundation (RWJF) that oversees research into ways to recruit and retain nurse faculty.
Back in the 1970s, Yedidia was pursuing a dissertation on the “democratization of knowledge” in health care delivery, and decided to focus on the use of knowledge among nurse practitioners, a large and expanding group of health care professionals. Rigorous, randomized trials at that time—comparing nurses and doctors—had established that nurse practitioners deliver high-quality primary care. Yedidia spent nine months in clinics throughout North Carolina identifying social and economic factors that facilitate and impede nurse practitioners’ ability to make use of their expertise in delivering primary care. Later on, he spent a similar period observing nurses deliver babies and comprehensive primary care to coal-mining families at the Frontier Nursing Service in Kentucky.
He found then what remains true today: The contribution of nurses depends largely on whether or not they are permitted to practice to the full extent of their training and abilities. Scope of practice “is still a major issue,” Yedidia says, noting that it is a key focus of a groundbreaking report on the future of nursing that was released in 2010 by the Institute of Medicine (IOM).
Solution: Another key recommendation in the IOM report—The Future of Nursing: Leading Change, Advancing Health—calls for significant changes in the capacity and scope of nursing education to meet the demands of a reformed health care system. Nursing education is the focus of his current role as director of EIN, which supports evaluations of interventions designed to expand teaching capacity and promote faculty recruitment and retention in nursing schools.
The program is based on the premise that if we can recruit and retain more nurse faculty and increase teaching productivity among existing faculty members, then nursing schools will be able to accept more nursing students into their programs, Yedidia says. And that, in turn, will help assure the adequacy of the nurse workforce in meeting future health needs.
Demands for nursing expertise are projected to increase given the aging population, increases in chronic disease, and the expanded roles of nurses in the reformed health care system envisioned by authors of the IOM report and others.
A key goal of the EIN program is to understand what works and why in addressing the nurse faculty shortage. Among those factors that are thought to contribute to the shortage are relatively low salaries of faculty compared to those of nurses in clinical or administrative roles; late entry into faculty positions and early retirement; the nature of the workload and other aspects of nurse faculty work-life; and competing employment opportunities in a range of clinical and administrative settings for nurses with advanced degrees.
To better understand the problem, in 2011 the EIN program fielded a nationally representative survey of full-time nurse faculty—more than 3,000 faculty in 270 programs—collecting data on more than 60 characteristics of workload and attitudes toward work-life. The data set has recently been installed on the EIN website with an interface that permits users to customize the findings on selected aspects of work-life and explore how they differ among faculty subgroups of interest.
Yedidia believes this will be a useful resource to educators and deans, permitting them to compare themselves, their colleagues, or their schools to nurse faculty members in similar programs across the country on their choice of myriad aspects of work-life.
The major aim of EIN program is to generate sound evidence of the effectiveness of promising interventions addressing the faculty shortage. The program supported three funding cycles: seven grantees are currently pursuing two-year, controlled evaluations, and another five will be funded this month.
Among the ongoing evaluation projects are:
- Two studies of dedicated education units (DEUs)—hospital units in which staff nurses and nursing faculty take on new educational roles to deliver more efficient and effective clinical education to nursing students. Collaborative relationships between nursing schools and hospitals can help expand teaching capacity, Yedidia says. Nursing schools are limited by a shortage of clinical sites and, as a result, “nurses often end up observing instead of doing.” Collaborative units enable nursing schools to increase the number of nursing students who actively participate in clinical rotations and by doing so, can improve the efficiency and quality of clinical education.
- Evaluation of the impact of substituting clinical simulation experiences for half of the traditional clinical days in the hospital for the medical surgical rotation for all nursing students. The project addresses the impact on educational productivity, faculty burden, and quality of education.
- An assessment of the impact of a statewide consortium of nursing programs (including baccalaureate and associates-degree programs) relying upon a single curriculum and facilitating seamless progression associates’ degrees in nursing offered by community colleges to baccalaureate degrees offered by universities.
- A study of the impact of state-based support-for-service programs on recruitment, retention, and nurse faculty work-life. The evaluation includes programs that support graduate students pursuing nursing degrees as well as those that provide loan repayment for recently prepared nurse faculty members.
Research grants to be awarded this month will focus largely on factors influencing students’ decisions to pursue doctoral degrees in nursing, the choice of academic careers among doctoral students, hiring practices and intentions of deans and directors of nursing programs, and salary differentials among nurses with similar educational preparation levels who choose academic as compared to clinical careers.
When the program concludes in October of 2014, Yedidia expects it will have made a contribution to identifying sound strategies for increasing the supply of nurse faculty as well as providing guidelines for their successful implementation. As a by-product, he hopes that EIN will contribute to expanding the capacity of nursing schools to evaluate the outcomes of their educational programs. And while he may turn to other subjects in the future, he says he will always retain his belief in the promise of nursing to play a key role in transforming and improving health care delivery. Collaborating with nursing leaders and educators has been compelling and rewarding and, Yedidia says, he has learned a great deal from these experiences.
RWJF Perspective: RWJF is committed to addressing nursing workforce issues. The Foundation’s programs seek to ensure that our nation has enough well-prepared nurses from diverse backgrounds to meet our current and future needs. Central to these efforts, RWJF commissioned the IOM report on the future of nursing and is supporting the Campaign for Action, a collaborative effort to implement solutions to the challenges facing the nursing profession, and to build upon nurse-based approaches to improving quality of care. Furthering this commitment, EIN funds research projects that illuminate issues relating to teaching productivity and faculty preparation whose resolution is critical to achieving the IOM recommendations.