Center for the Future of Health Professions Jan. 2023 digest
Posted: January 11, 2023
Happy New Year! The Center for the Future of the Health Professions will post its first monthly op-ed column for 2023. Our columns represent strong, informed, focused opinions on issues affecting the health professions’ future. As mentioned previously, the center was developed to provide state, local, and national policymakers and health system stakeholders with accurate, reliable, and comprehensive data and research about the healthcare workforce to effectively plan for a sustainable future and make the best use of available resources.
This month we feature Filling the need for graduate nursing education, authored by Bobbi Winter, DHSc, MBA, MSc, MSN. Dr. Winter lives in Scottsdale, Arizona, has been an RN for 42 years, and has developed nursing, medical, and dental continuing education content for the past 25 years. She has taught graduate nursing, healthcare administration, and business courses since 2015. In addition to a diploma nursing degree, she completed a BA in healthcare administration at Graceland University, an MBA focused on quality and lean from New England College, an MSc in health systems management from New England College, an MSN in nursing leadership from Loyola University, and a DHSc with a certificate in fundamentals of education, at A.T. Still University.
Dr. Winter has extensive clinical nursing experience where she held multiple positions in inpatient and outpatient care. She is an entrepreneur who in addition to starting several healthcare related businesses, was a home health administrator for 11 years, served as Chair of the Wisconsin Homecare Organization, acted as the Wisconsin representative to the Medicare Advisory Board, and chaired numerous state reimbursement committees. Later in her career she worked in medical/RN staffing, where her last position was as vice president of Western U.S. Operations for a large international company. There she oversaw a $55+ million budget and more than 10,000 employees in 12 states. In addition to teaching, she is currently president/CEO of a dental laboratory in Irvine, California, where she also manages her husband’s prosthodontic practice and lecture business.
There is no argument that this country has an overall shortage of healthcare professionals. This is especially critical for the nursing profession. The U.S. has experienced nursing shortages throughout the past century, but the magnitude of the nursing crisis has increased since the COVID pandemic. Dr. Winter addresses this issue in this short essay.
We look forward to your comments on this month’s digest.
Randy Danielsen, PhD, DHL(h), PA-C Emeritus, DFAAPA
Professor & Director
The Center for the Future of the Health Professions
A.T. Still University
Filling the need for graduate nursing education
There is an overall shortage of healthcare professionals, but the situation is especially critical for nursing. More than one million registered nurses are expected to retire by 2030. At the same time, the nation’s aging population will increase the strain on an often-overwhelmed U.S. healthcare system (National League for Nursing, 2021). In addition, the SARS-CoV-2 pandemic exacerbated the current shortage of nurses, often leaving them overwhelmed, exhausted, and unsupported by management. As a result, many have left bedside nursing for less stressful positions or resigned from the profession altogether.
The U.S. has experienced nursing shortages throughout the past century, but the magnitude of the nursing crisis has increased since the pandemic. The shortage is exacerbated by the use of more complex technology to deliver care, including growth in telehealth, expanding nurse practitioner ranks, the movement of nurses into nonclinical careers, growing practice authority, and expanding healthcare services to settings other than acute care hospitals. To address nursing shortages, healthcare leaders have tried numerous strategies, including increasing the class size of nursing programs, expanding the use of less educated and trained personnel, and shortening or accelerating the time needed to obtain a nursing degree.
Graduates of shorter associate degree programs have increased. However, research has repeatedly shown that hospitals with a higher percentage of nurses from baccalaureate and graduate nursing programs have better patient outcomes (Porat-Dahlerbruch et al., 2022). In addition, research suggests that obtaining a BSN or graduate degree prepares RNs for greater professional responsibility and more complex practice (National Academies of Sciences, Engineering, and Medicine, 2021). In 2010, studies conducted over the past two decades on nursing education prompted the Institute of Medicine to recommend that the nurse workforce achieve a composition of at least 80% with a BSN or higher qualification by 2020. Unfortunately, we have yet to reach that goal.
Replacing nurses who are retiring or dropping out of the profession is a daunting task. While the pandemic stimulated an increased interest in the nursing profession and the number of applicants applying to nursing schools, 91,938 qualified applicants were denied admission to a baccalaureate or graduate nursing program in the U.S. in 2021 due to a lack of program capacity and nursing faculty (American Association of Colleges of Nursing [AACN], 2021). According to a survey of nursing schools conducted by the AACN in October 2022, a shortage of qualified faculty was the main reason for not accepting applicants. In addition, there were 2,166 full-time faculty vacancies at 909 baccalaureate/graduate schools when the survey was taken (AACN, 2022). Vacancies were highest (84.9%) for programs where a doctorate is preferred (or required) to teach. In 2021 alone, 9,574 qualified applicants were turned away from master’s programs and 5,169 from doctoral programs (AACN, 2022). This is especially troubling since nurse practitioners, who require a graduate degree to enter practice, recently ranked as the fastest-growing occupation with a projected growth rate of 46% between 2021-31 (U.S. Bureau of Labor Statistics, 2022).
Earning an advanced nursing degree provides other opportunities besides working as a clinical practitioner. While some clinical and management positions may be attainable with a Master of Science in nursing (MSN), a Doctor of Nursing Practice (DNP) can provide students with the advanced skill set and knowledge to pursue more competitive career paths, including those in the C-Suite. In addition, it enables them to be innovative practitioners and act as change facilitators throughout the industry by developing strategies that help institutions deliver high-quality healthcare, reduce costs, and improve patient outcomes.
To address the need for additional graduate nursing opportunities, A.T. Still University began accepting students into its DNP program in 2020. There is a crucial focus on admitting students with diverse backgrounds who will reflect the populations they serve and are prepared to promote health in their communities. To expand students’ ability to be leaders while advancing scientific principles, the online program focuses on strategic organizational leadership and educating professional nurses to translate evidence-based practice into various employment and practice settings. The program is staffed by a diverse and highly qualified adjunct nursing faculty working to ensure students are well-prepared to take their place as leaders in their areas of interest. The faculty’s focus is to produce qualified professional nurses by mentoring the students through the development and implementation of their chosen clinical projects, with the overall goal of improving health outcomes, especially in underserved populations.
Faculty work closely with students and their preceptors to develop solutions to problems or deficits in a specific area of quality concern as they design and implement their DNP project in organizational systems leadership or practice management specialization. ATSU adjunct faculty, under program chair Karin Polifko, are incorporating innovative learning principles to ensure the program meets the criteria for accreditation by the Commission on Collegiate Nursing Education. DNP faculty review and adjust curriculum in response to changes in practice standards and to incorporate the AACN’s re-envisioned Essential Series, which includes the elements and framework for developing nursing curricula for competency-based education and assessment. This will ensure equitable learning experiences for all students and achieve a consistent level of competency in primary care, coordination of care, public health, and population health management.
Even though applicants are being turned away from graduate nursing programs, the ATSU DNP program has been slow to recruit students. The key to accomplishing program goals will be to develop strategic partnerships with local and regional healthcare organizations and undergraduate nursing programs to cultivate a conduit to improve staffing in critical areas of need. The ATSU-CGHS nursing program is committed to recruiting students and expanding access to graduate nursing education where there is a rich history of interdisciplinary education and preparing students to understand the needs of our increasingly diverse and often underserved patient populations.
References:
American Association of Colleges of Nursing. (2021). Fact sheet: Nursing faculty shortage. https://www.aacnnursing.org/news-information/fact-sheets/nursing-faculty-shortage
Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. National Academies Press.
National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing 2020–2030: Charting a path to achieve health equity. The National Academies Press. https://doi.org/10.17226/25982.
Porat-Dahlerbruch, J., Aiken, L. H., Lasater, K. B., Sloan, D.M. & McHugh, M. D. (2022).
Variations in nursing baccalaureate education and 30-day inpatient surgical mortality.
Nursing Outlook, (70)2, 300-308.
U.S. Bureau of Labor Statistics. (2022). Fastest growing occupations. https://www.bls.gov/ooh/fastest-growing.htm