April24, Paul D. Lack, Ph.D. Executive Vice President and Dean Stevenson University 1525 Greenspring Valley Road Stevenson, MD 21153

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1 Office ofthe Provost Dr. N. John DiNardo Professor ofphysics Senior Vice Provost foracademicaffairs April24, 2014 Paul D. Lack, Ph.D. Executive Vice President and Dean Stevenson University 1525 Greenspring Valley Road Stevenson, MD Dear Dr. Lack: Drexel University is responding to the objection by Stevenson University dated April 9, 2014 regarding offering of a Bachelor of Science in Nursing, Master of Science in Nursing and a RN to BSN on the bases of program duplication resulting in competition for practicum sites. Drexel University's nursing programs do not present "unreasonable duplication" to any the Stevenson University Nursing Programs as demonstrated by the following: Drexel's Master of Science in Nursing Program, both the Role Development and Nurse Practitioner Tracks, are hybrid programs with all didactic coursework online, with in person residencies in simulation at Drexel University in Philadelphia and with preceptored clinical experiences in practices that are mutually identified and vetted by faculty, students and by agency personnel who verify that such experiences can be supported with the appropriate patient base and personnel. It should be noted that Stevenson University does not offer a Nurse Practitioner Program with any of the standard tracks, or a program in Clinical Trials Management and Nursing Leadership and Administration. Drexel does offer the Masters in Nursing Education and Nursing Leadership and Administration. With respect to the Nursing Education Masters program, given the nationally documented shortage of qualified nursing faculty, providing preceptored experiences for nurse educator graduate students should be welcomed by Maryland schools. Drexel's Doctor of Nursing Practice Program is also fully online with the exception of an evidence based practicum in which the student is assigned to a preceptor in a variety ofhealth organizational settings. The DNP students conduct evidence based projects during this placement which provides invaluable data and information to the institution while achieving educational goals. Stevenson University does not offer a DNP Program. All of Drexel University's graduate nursing programs are intended to increase the number of advanced practice nurses in response to the Affordable Care Act and the number of nurse educators in response to the continuing shortage of nursing faculty. Unlike Stevenson's RN-BSN program, Drexel's RN-BSN program is fully online with only one clinical course that is community instead of hospital based presenting no risk of limiting the ability of Stevenson to place its students in qualified practica sites in 3141 Chestnut Street, Philadelphia, PA ITel: IFax: drexel.edu

2 Maryland. Drexel has a long history of strong online degree and certificate programs that are intended to serve students in our region and far beyond. We offer academic programs that are aligned with Drexel's strengths in various majors that employ experiential learning and have a career focus. With a commitment to comply with state regulatory requirements, Drexel has proposed several online programs to the State of Maryland to provide choices to residents there; these programs do not target the geographic area of a particular institution and are open to all qualified students. Serving individuals through an online approach allows students who are not able to study on-site to obtain a degree, particularly in regions that might be underserved. Towson University is not able to fulfill all the demands for the State of Maryland. While we respect the concern of Towson University, we are offering programs that have a strong demand as discussed below. These programs are staffed by Drexel faculty and preceptors. Drexel University's Center for Labor Markets and Policy analyzed the labor market for nursing professionals to further our conviction that delivery of an online alternative in Maryland with placements presents an opportunity that meets a true need in the state. As for most states, the healthcare industry in Maryland has played a central role in fostering economic and employment stability. Since the end ofthe economic expansion, Maryland has entered into a period of slow economic growth and very sluggish new job creation. Over the entire period between 2000 and 2013, Maryland has added just wage and salary jobs to business and government payrolls in the state, yielding an annual average rate ofnew job creation ofjust 0.4 percent per year. The mainstay of employment stability in the state during this period has been the Maryland healthcare delivery system. Healthcare employment in the state rose by a total of79,900 jobs, representing a 36 percent increase over the period; a rate ofnew job creation that was 13 times greater than the 2.7 percent mean employment growth that occurred in all other industries in the state over this time period. All three major components of the Maryland healthcare delivery system have maintained strong and steady rates ofnew job creation, unfettered by the cyclical instability that has characterized much ofthe rest of the state's industries. Employment in the ambulatory care industry rose by 48 percent since Employment in the state's hospitals has increased by 30 percent between 2000 and 2013, while nursing and residential facility employment has increased by about one quarter over the 13 year period. The health care industry is the primary and overwhelming source of employment for nursing professionals. A look at the Bureau of Labor Statistics (BLS) national industry occupational matrix for 2012 reveals that 85 percent of all registered nurses worked in one ofthe three primary healthcare industries discussed above. This suggests that as demand for workers in these three healthcare industries increases, the demand for nurses will rise rapidly. Strong and persistent growth in an occupation in which substantial post-secondary education is required can sometimes lead to labor supply constraints that limit output and income growth in a state, region or nation. We have frequently read and heard of discussions ofprofessional nursing supply problems in many states in the nation including Maryland. However, such discussions do not offer any real

3 evidence ofregistered nurse labor supply capacity constraints in the state. One fundamental measure ofthe availability ofunutilized labor supply is one with which most readers are very familiar - the BLS official unemployment rate. The BLS unemployment rate is used as an indicator of the underutilization ofavailable labor supply. A high unemployment rate, as today's 6.7 percent national rate is typically characterized by considerable excess labor supply. Maryland's current overall unemployment rate of 5.6 percent (which has been declining quite markedly since the summer of2013) is still above the full employment rate ofunemployment, but indicates a condition of much less excess labor supply in Maryland than the nation as a whole and raises the possibility ofproblems in hiring workers with certain educational backgrounds-including computer science and some engineering fields. In order to gain insight into the basic supply-demand conditions in the nursing and related health fields in Maryland, an analysis of unemployment rates for registered nurses and other healthrelated occupations in Maryland was conducted using the public use micro data files from the Current Population Survey, the same statistical survey used by BLS to produce the national unemployment rate released each month. Current Population Survey data from 36 months in were combined to ensure sufficient sample to produce statistically reliable unemployment rate measures for nursing and related occupations at the state level. During the period the mean unemployment rate oflabor force participants in Maryland with prior work experience averaged 6.4 percent. Within the health occupations, low skill healthcare support occupations, where education and training times are quite short, labor is plentiful with an overall unemployment rate ofthese workers of 7.4 percent. Among health care practitioners and technicians (including jobs ranging from physicians to radiology tech), the unemployment rate is just 2.6 percent, a level of unemployment that indicates very tight labor markets with firms likely experiencing some degree of difficulty in hiring labor to meet their output requirements. Among registered nurses in Maryland, the unemployment rate is just 1.5 percent, suggesting extraordinarily tight labor markets and the prospect ofpotentially severe labor supply constraints on the healthcare industry's ability to meet rising demand for services. Furthermore the demand for registered nurses in the coming years appears to be quite high relative to most other occupations in the American job market. Just released national projections of employment by industry and occupation produced by the U.S. Bureau of Labor Statistics suggest continued strong growth in all three major sectors within the healthcare industry which in tum will result in large and rapid gains in the employment ofregistered nurses in the next decade. The pace ofnew job creation in the nation's non-farm industries is expected to be quite slow. BLS forecasts that overall non-farm payroll employment in the nation will rise by just 15.6 million jobs, resulting in a very modest 11 percent rise in employment over the 2012 to 2022 period. While most of the American labor market is expected to add jobs at a slow pace, BLS forecasts rapid growth in the demand for labor in the nation's healthcare industries. Overall employment in the healthcare industry is expected to rise by more than one-quarter over the next decade; a pace of projected job growth that is 2.4 times the pace ofthe nation's overall projected payroll employment growth. Noting that employment in the healthcare sector in Maryland played a critical role as a source of employment and earnings in the state since 2000, BLS employment projections suggest that this

4 role will expand to the nation as a whole in the next decade. BLS projections indicate that the nation's healthcare industry will account for more than one in four net new jobs created in the country over the 2012 to 2022 period. Ambulatory care providers will expand rapidly, with employment rising by nearly 2.5 million jobs representing an increase of 39 percent over the decade. Hospital employment is projected to rise by 825,000 jobs and the nursing and residential care sector is projected to add more than 760,000 jobs; a growth rate of24 percent over the projection period. Registered nurses will continue to play a central role in the organization and delivery of healthcare in the nation in the coming years. The findings provided in the attached table examine expected employment trends in the registered nursing occupations within the three key industry components ofthe nation's healthcare delivery system as well as a summary projection of overall employment levels for the registered nurse occupation through Projections of Employment in the Registered Nurse Occupation, by Selected Industry, U.S., 2012 to 2022 (Employment in thousands) Projected Actual Projected Projected % Industry Change Change Ambulatory Care % Hospitals 1, , % Nursing and Residential Care % All Health Industries 2, , % Non Health Industries % All Registered Nurses 2, , % The data reveal strong expected gains in the employment of nurses within the nation's healthcare delivery system. Employment of registered nurses in the ambulatory care health industry is expected to rise by nearly 190,000 jobs or 41 percent. This pace of growth makes nursing employment within the ambulatory care industry among the most rapidly growing labor market segments in the nation. Hospitals will continue to account for the largest share ofjob creation in the registered nurse field. Between 2012 and 2022, hospitals are expected to increase their RN staffby about 260,000; a 16 percent rise that is 1.5 times the expected overall rate of employment growth in the nation through Registered nurse employment in the nursing and residential care industry is also expected to grow at a rapid pace increasing by 24 percent between 2012 and It is important to note that other nursing occupations that do not require an RN certification are not included in these employment measures for the registered nurse occupation. Nurse anesthetists, nurse midwives, nurse practitioners and nursing instructors and teachers are all measured in separate occupations under the BLS occupational taxonomy. However, it is useful to note that all of these occupations have very strong levels ofprojected employment growth.

5 A relatively small fraction ofregistered nurses work outside the nation's healthcare industries, primarily in government, education and temporary help industries. Nursing employment in these non-health care industries is expected to grow slowly particularly as the employment outlook for non-defense government sector jobs dims in the coming years. All of these developments, taken together paint a bright employment outlook for the registered nurse occupation. BLS expects registered nurse employment to rise by 526,000 jobs, growing by 19 percent over the decade. It is important to note that new job creation is not the only source of demand for registered nurses in the coming decade; replacement demand associated with death, disability, retirement and occupational mobility also play an important role in influencing the level of demand for labor in a given year. Indeed, this is a major reason why, even during periods of massive job losses such as that which occurred during the Great Recession, firms continue to post job vacancies and seek new workers to hire. BLS provides projections ofjob openings due to permanent labor force separations that can help provide insights into future labor demand levels and trends in an occupation. BLS expects that over the next decade, about 525,000 or about one in five registered nurses employed during 2012 will separate from their occupation creating new (replacement) demand for nurses. This increase in demand is essentially the same as expected rise in employment in the nursing occupation of 526,000 jobs through This means that BLS expects a total of million registered nurse job openings requiring new labor supply from firms to fill these openings (this measure ofjob openings excludes job turnover associated with changing a job within the RN profession). This appraisal of the employment situation of registered nurses in the state of Maryland reveals an occupation characterized by over a decade of very rapid employment growth dating back to 2000, a current unemployment rate that suggests virtually no unutilized registered nurse labor supply in the state, and a job outlook that is among the brightest in the nation. Nursing is clearly a career field with a bright future for those able to acquire the knowledge, skills, abilities and behavioral characteristics required for employment in this field. Drexel takes great pride in its degrees and seeks to bring these degrees to students across the nation (and the world) with strong, innovative pedagogy and career-focused learning to improve workforce needs. We trust that Stevenson University and the State of Maryland will recognize that Maryland students choosing to participate in Drexel education programs will be well-prepared for nursing careers at various levels. This is the mission of all institutions of higher education. Sincerely, Senior Vice Provost for Academic Affairs

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