Lack of schools, not applicants, is cause of nursing shortage

Hospitals across the country are desperate for nurses like Tracey Rasmussen, a 34-year-old mom with a warm, down-to-earth bedside manner and a 3.9 grade point average.

There's a nationwide shortage of nurses, as anyone who's spent time in a hospital lately knows. And by 2020 that shortage is expected to grow to more than 800,000 nurses nationwide, according to projections by the U.S. Department of Health and Human Services.

But the problem isn't finding people who want to be nurses, it's getting them into nursing schools.

Rasmussen was rejected twice from nursing school -- one of thousands of qualified people turned away from the profession each year because nursing colleges lack space, faculty and funding.

"It was so frustrating," said Rasmussen, who was finally accepted into Washington State University's Yakima nursing program. She has a job waiting for her in a hospital maternity ward when she graduates in May.

U.S. nursing schools turned away nearly 6,000 qualified applicants last year, according to a survey by the American Association of Colleges of Nursing.

"Some of them will reapply. Some of them go to other schools, community colleges and private schools. A significant pool will be lost to nursing," said Washington State University College of Nursing Dean Dorothy Detlor, whose program rejects two-thirds of its qualified applicants each year. "It's a serious problem across the country."

In Southeast Missouri, there isn't a nursing crisis yet, but things are fragile. Both Southeast Missouri Hospital and St. Francis Medical Center operate on a 2 percent vacancy rate in their nursing divisions.

The shortage isn't at crisis level locally but that doesn't mean area hospitals and medical centers aren't feeling its effects. "It means there won't be the access to an adequate number of nurses," said Dr. Karen Hendrickson, nurse executive at Southeast Missouri Hospital.

St. Francis hired about 30 percent of the December graduating class at Southeast Missouri State University to fill its current nursing openings. "The challenge is that all hospitals have grown, from the ER to surgery and in-patient care, and the population is aging so that just compounds the problem," said Jeannie Fadler, vice president of patient services at St. Francis Medical Center.

Not enough faculty

A couple of years ago, there weren't enough applicants for nursing school and today there are too many with too few faculty, she said.

A new federal law, the Nursing Reinvestment Act, expands scholarships for student nurses, offers grants for nursing schools and includes loan forgiveness programs for nurses who earn advanced degrees and become teachers.

Nursing educators applaud the law, but are waiting to see if Congress puts money behind it. The House Appropriations Committee will determine funding next year.

Southeast's School of Nursing has expanded its number of available seats per class from 30 to 35 recently. But Dr. A. Louise Hart, chair of the school, said she doesn't want to expand numbers just for the fun of it.

"We are trying to produce a caring graduate who will care not only for patients but for fellow nurses," she said.

While the university does have a waiting list for the nursing program, students are admitted twice a year and most gain entrance. "We try to have a level playing board," Hart said. High school students with high ACT scores and grades who enroll at the university are often given a place in the school. But the students must complete 24 credit hours in core classes, like anatomy, physiology and chemistry with a C average before actually enrolling in the nursing program.

Sometimes that can trip up a student, Hart said. "But there is a decent chance they'll get in the next time around."

A generation ago, women had few options in the workplace beyond nurse, teacher or secretary. As opportunities expanded, however, the allure of nursing faded, and nursing schools sometimes struggled to recruit students.

Changing times

Times have changed. Today, even in a struggling economy, college graduates get multiple job offers with starting salaries of up to $60,000 in some areas.

"We've gotten the message out there that nursing is an exciting career," said Kathleen Ann Long, Dean of the College of Nursing at the University of Florida and president of the American Association of Colleges of Nursing. "That's the good news."

The bad news is there's not enough faculty to teach them.

Nurses are in such high demand that they invariably must take a pay cut to teach. A 2001 survey found that nurses with master's degrees earn an average of $24,000 more in practice than they do teaching.

"The universities are just not able to compete," said Johnie Mozingo, associate dean of Academic Affairs at the University of Tennessee College of Nursing, which rejected half its nursing applicants this year.

Cramming more students into classes isn't an option. Most states mandate student-to-teacher ratios of 12-to-1 or less. In Missouri that ratio is 10-to-1 in a clinical setting.

And the national average age of nursing faculty is 51. When the current generation retires, their replacements will be hard to find.

"Without those faculty we cannot prepare the nurses of the future," Long said.

Nursing schools need more money to expand their programs, but most rely heavily on state budgets -- and states are facing their worst budget crises in a decade.

Nursing experts agree there's no one magic solution.

"We are pressed to the wall, and it's going to take maybe one crisis to push us over the edge," said University of Connecticut School of Nursing Dean Laura Dzurec. "It's a huge need and unfortunately it's an invisible need. There isn't anything more essential than this."

Features editor Laura Johnston contributed to this report.