| Washington, DC — In 2021, multiple reports have been issued about the situation confronting nursing with attention directed at nurses’ preparation, faculty shortages, and the future of healthcare, as Appendix A illustrates. Many of these reports have addressed issues consistent with the National League for Nursing’s (NLN) core values of Diversity/Inclusion, Integrity, Caring, and Excellence. These eight reports have the potential to reshape nursing at a time when the profession is highly vulnerable. Most of these documents cite the ongoing concern for the shortage of nurses to deliver care in multiple settings and to clients of diverse cultures and needs. These reports also focus on advancing education and suggest strategies for seamless educational progression. Additionally, several of these reports directly address the value and need for a well-prepared nurse educator workforce ready to confront educational challenges. However, few of these reports address in detail the growing and alarming shortage related to who will provide the education for this future nursing workforce. Nor do these reports identify who will generate the evolving science related to teaching and learning and who will collaborate with the practice community to address issues threatening higher education and health care. These omissions regarding nurse educators are of great concern to the NLN.
Statistics recently reported by Berlin, et. al. (2021) from the McKinsey & Company survey, noted 22% of the remaining nurse workforce may leave their positions within the upcoming year. A similar survey report from the American Organization for Nursing Leadership (AONL) cited 17% of nurse leaders were considering leaving the profession, up 116% since February 2021. Additionally, 36% of nurse managers indicated they were “not at all emotionally healthy,” an increase of 50% since February 2021. Another significant finding was a 165% increase in nurse leaders reported a staffing shortage is very likely to continue within their organization post pandemic. Overall, 90% of nurse leaders reported anticipating a staffing shortage beyond the pandemic. Together these data indicate this is not a temporal concern but one with a long range, dramatic impact.
Nursing entered 2021 with a shortage, which has been exacerbated by the resurgence of COVID-19 worldwide and the resultant mental health strain on health care providers, the exodus of many providers, including nurses, and the growing public dissension related to the pandemic. In addition, the COVID-19 took a physical and emotional toll on the nursing faculty. A total number of 178 full-time faculty across 317 NLN member nursing schools resigned or retired early with a stated reason of COVID-19 according to the National League for Nursing Deans’ and Directors’ Survey Regarding COVID-19 (National League for Nursing, 2021).
These issues, along with the impact of Social Determinants of Health (SDH) and structural racism on health equity and outcomes, intensify the need for nurses (demand). These issues further intensify the need for nurses to assume leadership roles in affecting change in health care, and in doing so, to refocus nursing education and practice. The demand to prepare and engage the actual and potential workforce to be relevant to the future has never been greater --and that demand will continue to intensify.
A key element in preparing nurses for the future is determining what the workforce needs to be and how the capacity is distributed both nationally and globally. To do this, the full spectrum of the nursing workforce must be addressed, including practical/vocational nurses, registered nurses and advanced practice registered nurses. Consideration must be given to both clinical and role specialties. At a time when great concern is expressed about diversity, equity, inclusion, and structural racism, issues surrounding what age, gender, race, and ethnicity the professional profile represents must be addressed in each of those clinical and role specialties. The outcome must direct a clear path forward to achieve an inclusive, diverse, qualified, and competent workforce in sufficient numbers to meet the needs for the population’s health care. The same is true in considering the preparation of the nurse educator workforce.
Over the past several years, nursing education programs have declined admission of well-qualified applicants primarily for one of two reasons: lack of clinical accommodations or lack of qualified faculty (National League for Nursing, 2020). For example, over 80, 000 such applicants could not be accepted into baccalaureate and graduate programs, according to the American Association of Colleges of Nursing (AACN, 2020a). The National League for Nursing (2020) reported the following numbers and rates of qualified applicants turned away by program type:
• LPN/LVN (n = 8,865; 25%)
• ADN (n= 46,306; 35%)
• Diploma (n= 1,842; 17%)
• BSN (n= 68,279; 29%)
• BSRN (n= 59,175; 1%)
• MSN (n= 30,382; 12%)
• Doctorate (n= 9,224; 23%)
This is reflective of an October 2019 faculty survey (AACN) showing 1,637 faculty vacancies in 892 nursing schools. Similarly, a 2019 National League for Nursing (NLN) Faculty Census Survey showed a total of 669 nursing faculty vacancies across 1,018 schools (National League for Nursing, 2019). The shortage of faculty continues to grow at a faster pace than prior decades. According to The NLN Faculty Census Survey, 82.1 percent of 358 NLN member nursing schools sought to hire new faculty in 2019, and about 74 percent experienced difficulty in hiring new faculty (National League for Nursing, 2019). According to NACNEP (National Advisory Council on Nursing Education and Practice) in the 17th Report to the Secretary of Health and Human Services and the U.S. Congress (2020), 30 percent of nurse faculty active in 2015 are expected to retire by 2025. That is a prediction of 1 out of every 3 faculty members who were teaching in 2015.
Because nurse educators are prepared at graduate levels, the pathway to creating sufficient numbers of graduates of all nursing education programs is vital to leading toward the potential for entry into graduate programs. Currently, 1.9% of the nursing workforce holds a doctoral degree and 58 percent of faculty vacancies require a doctorate degree (AACN, 2020b). The success of these, and emerging, programs can determine how readily qualified faculty can be produced to diminish the severity of the current faculty shortage.
A new approach to create a workforce projection of needs and demands must be considered that allows for the rapid changes that occur in a global society. This approach needs to take into account the expectation of pandemics of the future; rapid and dramatic changes in society; technological developments, including telehealth, that will augment the care of people; the transition of care to less costly sites; and the impact of numerous start-up health care services designed to focus on wellness and prevention rather than tertiary care.
Many of the lessons we have learned from COVID-19 have magnified the issues of health care inequity and access for minority groups and persons residing in designated medically underserved areas. Tremendous health care needs exist; and nurse educators can enhance nursing workforce development through educational programming within those areas. Nurse educators also learned how to leverage the use of technology to enhance learning when traditional clinical and classroom learning opportunities were limited or eliminated.
As many students and families face the high costs of higher education, nursing must recommit to educational articulation and mobility in nursing education. Additionally, with a focus on competencies, all programs must address that issue within their curricula. The Josiah Macy Jr. Foundation addressed that issue in its 2017 annual report and noted five recommendations:
1. Conducting system redesign
2. Creating a continuum of education, training and practice
3. Implementing a robust assessment system
4. Enabling technologies
5. Continuing outcomes evaluation
These recommendations address the key issues related to cost, time, program completion designation, nurse educator assignment and role in the evolving focus on competency rather than courses.
On September 1, 2021, the American Nurses Association wrote to the Secretary of the Department of Health and Human Services to call for a “robust and immediate action to address the unsustainable nurse staffing shortage facing our country.” In order to achieve a resolution of this dire situation, the alarming shortage of nurse educators must also be addressed. Throughout its history, the NLN has issued many Vision statements reflective of its commitment to nursing education (see Appendix B). NLN continues its commitment to a diverse workforce and supports collaboration in co-creating and implementing diverse paths forward in nursing education. In support of nursing education, and based upon the NLN Mission, Vision, and Core Values, NLN will continue to move forward with the following steps.
1) Continue to support diversity and excellence within all levels of nursing education, in all regions of the country and the world.
2) Promote articulation and mobility within nursing education.
3) Facilitate the development of competency-based models of education and valid tools that accurately measure competency.
4) Encourage incorporation of technology, including artificial intelligence, in nursing education and practice to enhance the ability of nurses to meet the demands of healthcare needs in the world.
5) Evaluate innovative approaches to education in real time with the expectation of rapid incorporation into practice.
6) Support the development of nurse faculty through scholarships, research grants, and professional development opportunities.
7) Advocate for financial support for students in nursing programs through public and private funding sources.
Now, however, the NLN also calls upon the Federal Government for specific action to support the crisis within nursing education by the following actions:
1. Provide funding to graduate level (master’s and doctoral) nursing education programs designed to prepare nurse educators.
2. Provide stipends to nurses who wish to pursue graduate level preparation as nurse educators.
3. Create a scholarship matching program to support schools of nursing’s existing need-based, entry-level scholarships to create the pathway toward a career in the profession.
Further, the NLN calls upon Charitable Foundations to work with their local schools of nursing to match need-based, entry-level scholarships, in effect, doubling the financial support available to students.
The possibility for success in creating a strong workforce is high and requires collaboration with all the various stakeholders, organizations, and nursing voices addressing the needs for the educational preparation for the workforce of the future.
1. Health Workforce UHL (2020, April 6). “State of the World’s Nursing Report – 2020,” World Health Organization (https://www.who.int/publications/i/item/9789240003279).
2. The National Academies of Sciences, Engineering and Medicine (2021, May 11). “The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.” (https://nam.edu/publications/the-future-of-nursing-2020-2030/).
3. Tri-Council of Nursing.(2020, December 3)“Transforming Together: Implications and Opportunities from the COVID-19 Pandemic for Nursing Education, Practice, and Regulation.” (https://img1.wsimg.com/blobby/go/3d8c2b58-0c32-4b54-adbd-efe8f931b2df/downloads/Tri-Council-COVID-19-Report-5-2021.pdf?ver=1620247943137).
4. National Advisory Council on Nurse Education and Practice. (2020, December) Preparing Nursing Faculty and Addressing the Shortage of Nurse Faculty and Clinical Preceptors. http://www.hrsa.gov/sites/default/files/hrsa/advisory-committees/nursing/reports/nacnep-17report-2021.pdf.
5. International Council of Nurses (2021, May 12). Nurses: A Voice to Lead—A Vison for Future Healthcare. https://www.icn.ch/system/files/documents/2021-05/ICN%20Toolkit_2021_ENG_Final.pdf.
6. American Association of Colleges of Nursing. (2021, April 6). The Essentials: Core Competencies for Professional Nursing Education. https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf
7. Johnson & Johnson, American Nurses Association, American Organization for Nursing Leadership. (2021). Accelerating nursing, Transforming healthcare. https://nursing.jnj.com/anth-executive-summary.
8. AONL COVID-19 Longitudinal Study (August, 2021) Nurse Leaders’ Top Challenges, Emotional Health, and Areas of Needed Support, July 2020 to August 2021.
9. National League for Nursing (2019), NLN Faculty Census Survey for Academic Year 2018-2019. Retrieved from http://www.nln.org/newsroom/nursing-education-statistics/nln-faculty-census-survey-2018-2019.
10. National League for Nursing. (2020). NLN Biennial Survey of Schools of Nursing for Academic Year 2019-2020. Retrieved from http://www.nln.org/docs/default-source/research-statistics/2019-2020-nln-biennial-survey-executive-summary-for-website.pdf?sfvrsn=2.
11. National League for Nursing. (2021). National League for Nursing Deans’ and Directors’ Survey Regarding COVID-19. Retrieved from http://www.nln.org/docs/default-source/default-document-library/nln-deans-and-directors-covid-19-survey.pdf?sfvrsn=2.
NLN VISION STATEMENTS
#1 Academic Progression in Nursing Education
#3 A Vision for Post-Baccalaureate Nursing Education
#5 Vision for Doctoral Preparation for Nurse Educators
#11 Achieving Diversity and Meaningful Inclusion in Nursing Education
#13 A Vision for Expanding US Nursing Education for Global Health Engagement
#14 Graduate Preparation for Academic Nurse Educators
#15 Doctoral Faculty Collaboration in Nursing Education
American Association of Colleges of Nursing. (2019). Special survey on vacant faculty positions for academic year 2019-2020. Retrieved from https://www.aacnnursing.org/Portals/42/News/Surveys-Data/Vacancy19.pdf.
American Association of Colleges of Nursing. (2020a). Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing. Washington, DC.
American Association of Colleges of Nursing. (2020b). The PhD pathway in nursing: sustaining the science discussion questions. Retrieved from https://www.aacnnursing.org/Portals/42/news/surveys-data/PhD-Pathway.pdf.
Josiah Macy Jr. Foundation. (2017). Annual Report: Achieving competency-based, time-variable health professions education. The Foundation.
Berlin, G., Lapointe, M., Murphy, M., & Viscardi, M. (2021). Nursing in 2021: Retaining the healthcare workforce when we need it most. McKinsey & Company.