Los Angeles Daily News. December 1, 2013. A need for more nurses across the state has been compounded by the lack of faculty to train students looking to enter the field, according to officials in the Cal State University system.
The federal Bureau of Health Professions ranks California 46th in the nation when it comes to nurses per capita, at 743 registered nurses per 100,000 people, and CSU administrators say the problem could worsen in the years to come.
“Let me put it this way, we have over 1,200 pre-nursing students,” said Dwight Sweeney, interim chairman of nursing at Cal State San Bernardino. “I can only take about 108 a year. In the fall, we had over 600 applicants for 44 positions. Realistically, we are turning away people with 3.6 and 3.7 GPAs. And I think that story is playing out on CSU campuses everywhere.”
Cal State Long Beach received 450 applications for 82 spots this fall, an acceptance rate of just 18 percent. Cal State Northridge had about 300 applicants for its accelerated bachelor’s of nursing program, accepting 60 from “a very highly qualified pool of applicants,” said Marianne Hattar-Pollara, nursing program director.
CSU Chico couldn’t admit 86 percent of its fully qualified nursing applicants, and CSU San Marcos turned away almost 89 percent.
“The issue is that you can’t expand until you have more faculty, and you can’t have more faculty until you have the money to pay them,” said Margaret Brady, professor in the School of Nursing at CSULB.
That means not only hiring more faculty but paying them more, CSU officials said.
The average nurse salary is $89,940, according to a 2012 UC San Francisco survey of more than 5,500 registered nurses in the state, conducted for the California Board of Registered Nursing.
In 2011, the average salary for a newly hired nursing faculty member was $70,929, according to figures provided by CSU.
“It’s lucrative to go into clinical work and hospital administration, compared to what one can earn as a faculty member,” said Christine Mallon, assistant vice chancellor of academic programs and faculty development for CSU.
“The problem is, you have to find someone who’s a good clinician, with an educational background, to make it through the tenure process, and you expect them to take less money to do so,” he said.
With an aging population in need of health care, and lawmakers pushing for every American to be covered by insurance, CSU nursing programs are turning away multitudes of next-generation nurses.
The problem is playing out across the country. According to the American Association of Colleges of Nursing, U.S. nursing schools turned away 75,587 qualified applicants from baccalaureate and graduate nursing programs in 2011.
In October 2012, the association found a total of 1,181 faculty vacancies in a survey of 662 nursing schools with baccalaureate or graduate programs.
Nurses work in hospitals, ambulatory care, clinics, outpatient surgery centers, nursing homes and extended care facilities, among other places. Nursing shortages have been proclaimed in California over the last decade.
In 2004, a shortage drove employers to offer salary increases and big bonuses for new hires, according to the UC San Francisco survey. When the recession hit in 2008, layoffs in the industry were reported in some parts of California.
At the same time, younger nursing graduates found it increasingly difficult to obtain jobs in the field. A driving factor was, and continues to be, older nurses delaying retirement to earn income during economic uncertainty.
The average age of a registered nurse in California is 46, according to the UC San Francisco survey. Nearly 86 percent of nurses 55 to 59 years old were working in 2012. The survey found that the employment rate for nurses 60 to 64 years climbed from 75.5 percent in 2008 to 81.4 percent in 2010, before dropping slightly in 2012, to 79.3 percent.
“We have a nursing shortage, but it may appear that we do not have one, and the reason for that is that during the recession, a lot of nurses who were going to retire decided not to retire, those working part-time went full-time and nurses who were not working came back to the workforce, therefore making it difficult for the new grads to get a job,” said Louise Bailey, executive officer of the Board of Registered Nursing in Sacramento.
Bailey called it “a vicious cycle” that qualified applicants to CSU nursing programs are turned away because of a the lack of faculty, a cycle she fears will prolong the nursing shortage as the Affordable Care Act could dramatically expand the health care system at the same time that Baby Boomers require more health care and older nurses retire.
In a November report to CSU trustees, Mallon said more than 3 million nurses serve the nation, with the U.S. Bureau of Labor Statistics projecting that 1.2 million more will be needed by 2020 to fill new and vacant nursing positions.
‘A REWARDING CAREER’
Nursing programs are offered on 20 of CSU’s 23 campuses, including bachelor’s, master’s and, as of fall 2012, doctor of nursing practice. In 2011-2012, the CSU system awarded 2,575 bachelor of science degrees in nursing, and 709 master of science in nursing degrees.
Many schools are using technology to fit more students into nursing programs.
At Cal State Dominguez Hills, registered nurses go back to school and take bachelor’s courses online. Catherine Earl, director of the School of Nursing, said 850 applied for the program and were accepted recently.
The nurse practitioner program, a graduate program for those wanting to develop advanced skills, has limited slots.
“Well over 113 applied for that program, and we only serve 20 nurse practitioners,” Earl said.
Cal State Los Angeles has a direct partnership with 10 area community colleges allowing nursing students to transfer to the university and finish their bachelor’s degrees in a year.
Cynthia B. Hughes, director of the School of Nursing, said the program accepts between eight and 10 students from the community colleges each year.
“The truth of the matter is there’s a lot of good students trying to get into nursing,” she said. “Thirty students want to get into this program from each (community college).”
George Higgins graduated from Cal State Northridge in August and has a job lined up in January with Providence Health and Services. Both his parents were nurses.
“The joy of nursing is you get to tangibly give back to the community,” he said. “Even though you’re tired at the end of the day, it’s a rewarding career.”
Higgins previously earned degrees in English, with a focus on creative writing, and Asian-American studies. He decided that nursing provided a more stable career.
Higgins said the competition for nursing school is stiff, and prior training helped him get into CSUN’s program.
Before applying, he already had an EMT license and was a certified nursing assistant.
Nursing program directors said those who can’t get into CSU basic programs are encouraged to pursue education in other health-related areas, including health science, nutrition and physical therapy.
“We’re trying to come up with alternative pathways for them and steer them away to other programs, because realistically, they have no chance of ever getting into our program,” Sweeney said.
At Cal State Long Beach, accepted nursing applicants average a GPA of 3.8 or higher, according to Brady. Prerequisite courses include microbiology, chemistry, critical thinking and statistics.
“We don’t major them until they finish the eight pre-req courses,” Brady said. “If you’re getting a D and repeat anatomy, (we help you) look at another area (of health study).”
Brady said a related concern to training the next generation of nurses is a lower number of supervising instructors in hospitals who can give them hands-on experience.
“Many of them are being rationed down to only 10 students,” Earl said. “That’s what makes our program more expensive, because we have to pay someone to train those students. It’s a national trend. Many hospitals have lowered those numbers. You might have one instructor to 40 students learning theory, but you have to have five instructors to bring them up to clinical standards.”
Brady said a 10-year partnership with Long Beach Memorial Medical Center has helped solve the problem. In exchange for the hospital paying expenses for students in a specialized nursing baccalaureate program at CSULB, nursing students get clinical training at the hospital, and registered nurses agree to work at the hospital for two years after graduation and becoming licensed.
“It’s a great investment,” Brady said.
REASONS TO TEACH
Nursing professors get into teaching for a variety of reasons, program directors said. Some have always had a desire to teach. Others enjoy being able to do research in academia.
“One of the things I’ve noticed, and it’s good for education, is sometimes nurses who have been in the clinical field for many years, and are wise and experienced, feel like it’s a great change of focus, and wage and salary is not (a significant factor), and they may have retired from nursing,” Hughes said.
Cal State Los Angeles was able to bring in four new faculty members in 2012, which Hughes said was the most the university has hired at once since she joined the campus in 2000.
Hattar-Pollara, director of Cal State Northridge’s program, said from her experience, the sacrifices of taking less pay, working long hours and meeting deadlines for grant and manuscript writing are offset by the reward and excitement of research.
“The mind of a professor is always engaged in thinking, reflection and in finding workable solutions,” she said in an email. “And for many this is a very rewarding way of living.”
There’s also the much lower stress level in a classroom environment, versus the life and death situations faced in the medical field, she said. And while faculty may not be in the emergency room any more, they still have a profound effect on the industry.
“What we hear from our faculty is how rewarding it is to know you are teaching so many nurses who can touch so many lives of patients,” Mallon said.