Wisconsin Nursing Education and Nurse Faculty: 2013 Survey Results

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1 Wisconsin Nursing Education and Nurse Faculty: 2013 Survey Results Stephanie Stewart PhD, RN Brent MacWilliams PhD, ANP-BC Barbara Pinekenstein DNP(c), RN-BC, CPHIMS Bonnie Schmidt PhD, RN This report is a product of a State Implementation Program (SIP) grant, # 70696, awarded by the Robert Wood Johnson Foundation to the Wisconsin Center for Nursing, Inc. Copyright January 15

2 Acknowledgements The Wisconsin Center for Nursing (WCN) Wisconsin Nursing Education and Nurse Faculty: 2013 Survey Report was accomplished with help of key partners and support from the Taking the LEAD for Nursing in Wisconsin: Leadership, Educational Advancement & Diversity, a State Implementation Program (SIP) grant (#70696) from the Robert Wood Johnson Foundation and grant staff members Dr. Stephanie Stewart, Project Coordinator, and Molly Gottfried, Administrative Assistant. The Wisconsin Nursing Education and Nurse Faculty Survey yields critical information on the status of nursing education in Wisconsin. This survey serves as a foundation to assess the capacity for nurses needed to address predicted future nursing shortages which will impact the healthcare in our state. We are grateful to the authors: Stephanie Stewart PhD, RN Dean of Academic Affairs, Bellin College of Nursing; Brent MacWilliams PhD, ANP-BC, Assistant Professor, UW Oshkosh - College of Nursing; Barbara Pinekenstein DNP(c), RN-BC, CPHIMS, Clinical Professor and the Richard E. Sinaiko Professor in Health Care Leadership, University of Wisconsin- Madison School of Nursing; and Bonnie Schmidt PhD, RN Assistant Professor, UW Oshkosh - College of Nursing. Special thanks to Seneca Bivens, Research Assistant, who assisted in the compilation of data. WCN greatly appreciates the work of the Administrators of Nursing Education of Wisconsin (ANEW) as a partner organization dedicated to this effort. This vital organization brings together leadership from all public and private, baccalaureate, and associate degree nursing programs throughout Wisconsin. ANEW provides a collaborative structure to advance nursing education and ensure the educational capacity needed for adequate numbers and types of nurses for the people of our state. As a member of the National Forum of Nursing Workforce Centers, WCN appreciates the work of this organization to provide resources for systematic data collection for the nursing workforce. The National Minimum Data Set: Education developed by the Forum was a significant resource in the creation of the survey design. Finally, we would like to acknowledge and express our gratitude to the many schools and organizations that will utilize this information to advance nursing education and practice to assure a sufficient, competent, and diverse nursing workforce for the people of Wisconsin. The Wisconsin Center for Nursing looks forward to continued collaborative relationships to insure a bright future for nursing in our state. Thank you, Carolyn Krause, PhD, RN WCN Board President

3 1 Executive Summary This report presents the findings from the 2013 Wisconsin Survey of Nursing Education and Nurse Faculty sponsored by the Wisconsin Center for Nursing (WCN). These results provide insight into the current state of nursing programs in the state. Key findings in the 2013 survey include: The response rate for the 2013 Wisconsin Center for Nursing Survey of Nursing Programs improved to 93%, which is the best response rate since the survey was started in The response rate for the 2013 Wisconsin Center for Nursing Survey of Nursing Programs improved to 93%; however, some key data are missing because respondents did not answer all questions. For example, some large institutions did not answer questions related to faculty age and ethnicity of students. Analysis and interpretation of the survey results continues to be limited by this response rate and missing data. Bachelors of Science in Nursing (BSN) and higher schools are showing increased faculty vacancies, while Associate Degree in Nursing (ADN) faculty vacancies remain low. The increasing faculty vacancy rate in BSN and higher schools, combined with fewer Doctor of Philosophy (PhD) prepared faculty numbers with more schools reporting, indicates a looming shortage of PhD-prepared nursing faculty. The percentage of PhD-prepared nurse faculty in BSN and higher also dropped from 56.5% in 2012 to 43.2% in Lack of funds to hire faculty was the factor most commonly identified as limiting prelicensure student admissions, especially for LPN programs (50%). Limited clinical sites was identified as another limiting factor, especially for ADN programs (36%). This may be related to healthcare agencies working to increase their numbers of BSN-prepared nurses. The number of reported PhD-prepared faculty has decreased almost 13% in BSN and higher schools from the prior survey in Due to expectations that PhD faculty play a leadership role in nursing programs, this finding is alarming. This decrease probably reflects retirements. Anecdotal reports indicate nurses desiring doctoral degrees are seeking the Doctor of Nursing Practice (DNP) degree. Grant monies and other strategies must be geared toward increasing the numbers of PhD-prepared faculty. Given the mean age (55) of doctoral faculty in the State, nursing schools should continue to focus on recruitment and retention strategies to assure an adequate number and mix of doctoral faculty.

4 2 Wisconsin lags behind national data in the number of men in nursing programs. The National League for Nursing (NLN) National Survey for the latest academic year reported that males comprised 13% and 16% of baccalaureate and ADN programs, respectively (NLN, 2012); Wisconsin continues to hover at 10%. Recommendations 1. Continue efforts to increase the response rate to 100% through follow-up reminders and exploring ways to decrease barriers to reporting (e.g. timing of surveys). Increasing the response rate of participating nursing education institutions will allow for clearer analysis of changes in student enrollment patterns and faculty characteristics. The data missing from the nursing programs across the state at the ADN and BSN levels continues to make interpretation of what may be emerging student enrollment patterns difficult. 2. Monitor the changes that were reported in faculty characteristics (age, gender, and diversity) for potential impact on the delivery of nursing programs and the future nursing workforce in Wisconsin. 3. Evaluate potential strategies to address the factors limiting enrollment, especially related to limited clinical sites for pre-licensure and advanced practice nursing programs. In the context that lack of clinical sites continues to be a factor limiting prelicensure nursing program admissions, the NLN (2014) supports the use of simulation to prepare nurses for practice, based on the results of the National Council of State Boards of Nursing (NCSBN), which indicates that replacing clinical hours with simulation results in similar positive outcomes (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014). 4. Encourage development of pathways for students from diverse backgrounds to become nursing faculty. Ideally, the racial, gender, and cultural mix should better reflect the student population being served. 5. Monitor the development of relatively new educational programs, such as the DNP and CNL that reflect preparation for emerging nursing roles. 6. Continue to actively support academic progression and BSN completion in Wisconsin to achieve 80% BSN or higher of the nursing workforce by 2020 through WCN and collaborative efforts to implement the Institute of Medicine s (IOM) recommendations throughout Wisconsin (IOM, 2010). 7. Continue to assess the factors that limit diversity, especially within BSN programs, and evaluate potential strategies to promote inclusion. Pilot the use of the Wisconsin Diversity Assessment Tool (WCN, in press) in nursing programs.

5 3 8. Evaluate potential strategies to address the factors limiting enrollment for male students across all nursing programs, such as increasing the number of chapters of the American Assembly for Men in Nursing in Wisconsin. 9. Support collaboration with workforce centers to create a standardized educational survey to improve the data reliability and to help unify the national workforce data set. 10. Create innovative strategies to rapidly develop, recruit, and retain faculty to address the doctoral faculty shortages in BSN and higher degree schools. Wisconsin Center for Nursing 2013 Survey of Nursing Programs in Wisconsin Background The 2013 Survey of Nursing Programs in Wisconsin is the fourth survey by the Wisconsin Center for Nursing (WCN) to collect and analyze comprehensive data on the status of nursing education programs in the state. These surveys are intended to track trends in student enrollment, program capacity, faculty recruitment and retention, and other important variables. As was indicated in the 2012 survey (WCN, 2014, p. 4), Such findings are also integral to the fulfillment of WCN s mission to assure an adequate, well-prepared and diverse nurse workforce to meet the needs of the people of Wisconsin, since state nursing education programs provide the pipeline of future nurses into diverse employment settings. WCN is mandated by legislation and supported by a grant from the WI Department of Workforce Development (DWD) to (a) monitor and validate trends in the applicant pool for programs in nursing; (b) evaluate the effectiveness of nursing education, including the interaction amongst nursing schools to ensure a uniform education and the transferability of student credits, to increase access to nursing education and enhance career mobility, especially for populations that are under-represented in the nursing profession; and (c) facilitate partnerships between the nursing community and other health care providers, licensing authority, business and industry, consumers, legislators, and educators to achieve policy consensus, promote diversity within the profession, and enhance nursing career mobility and nursing leadership development (WISCONSIN ACT 28 Wisconsin State Statute Nursing Workforce Survey & Grant, 2009). National Perspective As stated in the 2012 WCN Education Report (WCN, 2014), Nurses continue to play key roles in the delivery of safe, high quality, affordable, accessible healthcare, especially as healthcare reform unfolds and as nurse educators respond to calls for radical transformation of nursing education (Benner, Sutphen, Leonard, & Day, 2010). Key stakeholders have undertaken coordinated national efforts to assure that the recommendations of the 2010 Institute of Medicine (IOM) Report The Future of Nursing: Leading Change, Advancing Health are

6 4 implemented. A prominent example is The Campaign for Action, which is a national initiative coordinated through the Center to Champion Nursing in America (CCNA), an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation. The campaign has mobilized diverse stakeholders nationally and in 49 states to address the nation s most pressing health care challenges access, quality and increasing cost by utilizing nurses more effectively and preparing nursing for the future (Robert Wood Johnson Foundation [RWJF], 2014). Nursing workforce shortages remain a major concern. The American Association of College of Nursing (AACN), citing the Bureau of Labor Statistics Employment Projections , offers these projections: According to the Bureau of Labor Statistics Employment Projections released in December 2013, Registered Nursing (RN) is listed among the top occupations in terms of job growth through The RN workforce is expected to grow from 2.71 million in 2012 to 3.24 million in 2022, an increase of 526,800 or 19%. The Bureau also projects the need for 525,000 replacements nurses in the workforce bringing the total number of job openings for nurses due to growth and replacements to 1.05 million by 2022 (AACN, 2014). Wisconsin Perspective The 2010, 2011, 2012, and 2013 efforts in Wisconsin to systematically gather and analyze nursing workforce data, including nursing education, were more successful than in the past. Survey responses have improved to 93%, but still have not approached the desired 100% level. The current survey is being analyzed to streamline data gathering for nursing programs to help increase consistency of reporting and trend data validity. The long-term success of these efforts is dependent on the commitment of administrators in nursing education programs throughout the state to consistently complete the survey. If trends in student enrollment, program capacity, faculty recruitment and retention, and other important variables are going to be valid and reliable, the data set must be complete. As identified in the 2012 Wisconsin Education Survey (WCN, 2014), WCN, in partnership with the Rural Wisconsin Health Cooperative (RWHC) and charged with carrying forth the vision of the IOM report, received designation as an Action Coalition from the Robert Wood Johnson Foundation. The Wisconsin Action Coalition has actively endeavored to create regional work groups and has received funding for a Robert Wood Johnson Foundation State Implementation Project (SIP) grant, Taking the LEAD for Nursing in Wisconsin, a 2-year grant project to implement recommendations of the Future of Nursing Campaign for Action - IOM Report. WCN has also co-sponsored three statewide conferences to advance its work on bringing the IOM recommendations to fruition in Wisconsin.

7 5 Data Source Data for this report are from the 2013 Wisconsin Center for Nursing Survey of Nursing Programs. This was the fourth survey of all educational programs conducted on site in the state of Wisconsin. The survey was distributed to the deans or directors of all nursing education institutions in the state through an that included a link to a secure site for data entry. The survey was distributed to 43 nursing education institutions in June Repeated follow-up requests were sent to the deans and directors, and the original deadline was extended to December, 2014 to improve the response rate. Deans and directors were asked to provide data on current students and faculty based on the fall semester 2012 through summer semester 2013, as well as program capacity data for academic year The overall response rate for the 2013 survey was 93%, an increase over the 2012 response rate of 83%. As with the 2011 and 2012 surveys, caution must be taken in interpreting and using data from the 2013 survey. We experienced missing data in all three years from those who completed the survey, which limits our ability to offer reliable trend data. Educators have expressed concern as to the time needed for completion of the survey and the nature of the data requested. To ensure trend data through complete data sets, we will be meeting with educators to explore ways to coordinate future survey requests to coincide with credentialing reporting. Another significant limitation of this survey is that it does not include out-of-state online universities, which have large student and faculty bodies. Although there have been small increases in the overall response rate from the previous years, the survey results continue to describe an incomplete picture of the status of both students and faculty in nursing education because of the missing data from some of the educational institutions preparing nurses in Wisconsin. Results Program, Curriculum Options, and Accreditation Table 1 describes the programs and curriculum options reported by the participating institutions in the 2013 Survey of Nursing Programs. 40 institutions participated in this year s survey. Respondents reported on four Licensed Practical Nursing (LPN) programs, 21 Associate Degree Nursing (ADN) programs, and 19 Bachelors of Science Nursing (BSN) programs. The 2013 survey also includes reporting for Masters of Science Nursing (MSN) in the clinical track and non-clinical track. Respondents reported on nine MSN clinical track programs and eight MSN non-clinical track programs. Respondents reported on two types of Doctoral programs Doctor of Philosophy (PhD) and Doctorate of Nursing Practice (DNP). Respondents reported eight DNP and three PhD programs in With 93% of the schools reporting, this is the most accurate program accounting to date.

8 6 Table 1. Programs and Curriculum Options Reported by Respondents Programs 2013 Responses Pre-licensure Programs LPN Programs 4 ADN Programs 21 Generic/Traditional Curriculum 21 Bridge Curriculum 16 Pre-licensure BSN Programs 19 Generic/Traditional Curriculum 15 2nd Degree Curriculum 4 Pre-licensure MSN Programs 2 Post-licensure and Certificate Programs RN-BSN Program (Post-licensure) 15 MSN Programs Clinical track Master Program 9 Nurse Practitioner (NP) Curriculum 7 Combined CNS/Educator Curriculum 1 Clinical Nurse Specialist (CNS) Curriculum 1 Nurse Midwifery Curriculum 1 Clinical Nurse Leader (CNL) Curriculum 3 Nurse Anesthetist 1 Other 3 Non-clinical track Master Programs Nurse Educator Curriculum 5 Leadership/Management Curriculum 3 Other 0 Doctoral Programs PhD Curriculum 3 DNP Curriculum 8 Certificate Programs 10 Nurse Education 4 Nurse Practitioner 1 CNS/MSN to NP 2

9 7 NP to CNS 1 Other 8 Regarding Accreditation Status by Program Type, there is a clear distinction in preferred accreditation bodies, with all but one ADN programs reporting accreditation through the National League for Nursing Accrediting Commission (NLNAC) or the Accreditation Commission for Education in Nursing (ACEN), and all BSN programs reporting accreditation through the Commission on Collegiate Nursing Education (CCNE) (Table 2). One BSN program reported dual accreditation (both NLNAC and CCNE). One LPN program did not report accreditation, while three ADN and one BSN program reported that they were not accredited. Table 2. Accreditation Status by Program Type 2013 Accreditation Status LPN n (%) ADN n (%) BSN n (%) Pre-licensure MSN n (%) Not Accredited 3 (16%) 1 (5%) NLNAC/ACEN and/or CCNE 3 (100%) 16 (84%) 18 (95%) 1 (100%) NLNAC/ACEN 3 (100%) 16 (100%) 1 (6%) CCNE 18 (100%) 1 (100%) Program Capacity The capacity of pre-licensure LPN and RN nursing education programs for academic year is shown in Table 3. The 2013 LPN data identified 225 qualified candidates, with 164 new student admissions and 27% rejected applications. The ADN program data identified 2,831 qualified candidates, with 1,866 new student admissions and 34% rejected applications. The ADN Bridge BSN programs identified 235 qualified candidates, with 134 new student admissions and 43% rejected applications. The BSN program data identified 3,266 qualified candidates, with 2,249 new student admissions and 31% rejected applications. The BSN 2 nd Degree program data identified 263 qualified candidates, with 98 new student admissions and 63% rejected applications. The pre-licensure MSN program data identified 263 qualified candidates, with 152 new student admissions and 24% rejected applications. Identification of program capacity based on the available seats is underrepresented in the BSN generic and prelicensure MSN due to missing data.

10 8 Table 3. Program Capacity Measures for Pre-licensure Programs, AY * Qualified applicants Student seats Students admitted Rejected applications Rejected applications New enrollees Seats left vacant LPN Generic ADN Generic ADN Bridge BSN Generic BSN 2 nd Degree Prelicensure MSN * * % 34% 43% 31% 63% 24% ** 7-72** *Academic Year ** The reporting of seats is underrepresented in the BSN generic and pre-licensure MSN due to missing data. Figure 1 shows that there were 2,990 graduates from pre-licensure RN programs in ADN programs added 1,593 (53%) of new graduates to the workforce, while BSN programs added 1,397 (47%). Only 116 out of 1,593 ADN graduates were in bridge to BSN programs. There were also 137 new LPN graduates added to the workforce. Figure 1. Number of Graduates from Pre-licensure Programs AY

11 9 Information on factors limiting pre-licensure student admissions is shown in Figure 2. Lack of funds to hire faculty was the factor most commonly identified as limiting student admissions (50% of LPN, 26% of ADN, and 15% of BSN programs). Limited clinical sites was identified as another limiting factor (36% of ADN, 17% of LPN, and 15% of BSN programs). Figure 2. Factors Limiting Pre-licensure Student Admissions in AY Program capacity in both masters and DNP post-licensure clinical programs is shown in Table 4. The total number of new enrollees in Advanced Practice Nurse (APN) programs increased from 327 in 2012 to 412 in Graduates from DNP programs were less, with 285 in 2012 and 230 in This drop may be related to the transition from the number of students interested in post master s DNP to direct entry DNP. The post master s DNP also dropped from 52 to 41. The CNS dropped from 23 to only 2 graduates in Nurse midwifery-msn remains steady at 7 graduates. Nurse Anesthetist-MSN graduates were 10. It should be noted that the percent of rejected applicants for Nurse Anesthetist programs was 44%. In 2012, the survey distinguished between nurse educator and combined CNS/educator programs. There were no CNS/educator programs reporting in 2013, which may reflect a program closing.

12 10 Table 4. Program Capacity Measures for Post-licensure Clinical Masters and DNP Programs AY Nurse Midwifery- MSN Nurse Anesthetist- MSN Post-master DNP Clinical Other CNS NP Qualified applicants Students Admitted Rejected applications Rejected applications 0% 0% 1% 44% 3% 4% New enrollees Students graduated * The reporting of seats has been removed due to missing data. The number of qualified applicants and students admitted to RN to BSN programs increased from 2012 to 2013 (Table 5). The applicant rejection rate was very low at only 1%. The number of new enrollees in RN to BSN programs in 2013 was 667. There was an increase in the number of RN to BSN graduates from 2012 (425) to 2013(497). CNL program capacity measures indicate that there is capacity in AY , but the program had only 12 new enrollees and one graduate. The number of students enrolling in and graduating from CNL programs continues to be very small. In 2013, PhD programs admitted 43 students, with 38 as new enrollees. There were only 13 PhD graduates; this is well below the number needed to fill faculty positions (see Table 8).

13 11 Table 5. Program Capacity Measures for RN-BSN, CNL, and Post-Licensure Programs 2013 Post-licensure Non-clinical Track Master Programs RN-BSN CNL Nurse Leadership/ Other PhD Educator Management (Research) Qualified Applicants 1, Student Seats 1, Students Admitted 1, Rejected Applications Rejected Applications 1% 13% 6% 19% 0% 9% New Enrollees Students Graduated Lack of qualified student applicants was the highest limitation for doctoral and post masters students. Lack of qualified faculty, funds to hire faculty, lack of campus resources, and clinical sites were also identified as significant issues (Figure 3). As the number of DNP students increase, there is a need to expand clinical sites with appropriate preceptors. Figure 3. Factors Limiting Post-licensure Student Admissions in AY Table 6 summarizes enrollment of students by curriculum track. LPN enrollment increased to 250 students, with three schools reporting. Overall reported enrollment in ADN nursing

14 12 programs decreased from 2012 to 2013, based on the reporting schools (Table 6). Total prelicensure BSN students significantly increased from 3,992 to 4,889. RN to BSN enrollments also increased from 1,266 in 2012 to 1,596 in The post licensure clinical track MSN continued to be strong with 1,180 enrollments. PhD enrollment stayed constant at 141 and represents complete numbers, since the response rate for these institutions was 100% in both years. The total doctoral enrollment (PhD, DNP, and other doctorate) was 884. Table 6. Enrollment of Students by Curriculum Track Fall 2013 Curriculum Track 2013 Curriculum Track 2013 LPN 250 MSN: CNS 4 Generic/ traditional ADN 4,922 MSN: CNS/Educator 34 Bridge ADN 203 MSN: CNM Total ADN 5,125* MSN: Nurse Midwifery 22 Generic BSN 4,791 MSN: NP 1,002 2nd Degree BSN 98 MSN: Nurse anesthetist 20 Total prelicensure BSN 4,889 MSN: CNL 38 Pre-licensure MSN 124 MSN: other post-licensure clinical 60 RN to BSN 1,596 Total post-licensure clinical track MSN 1,180 MSN: Nurse educator 119 MSN: Management/leadership 68 MSN: other post-licensure non-clincial Total post-licensure nonclinical track MSN DNP: CNS 8

15 13 * Three ADN programs missing from database DNP: CNS/Educator 3 DNP: NP 249 DNP: System 14 DNP: Post-Masters 97 Doctoral: PhD 141 Doctoral: DNP 372 Total Doctoral 884 Figure 4 depicts the race and ethnicity of nursing students by program. According to the 2012 statistics, Wisconsin s population was 88.2% Caucasian and 6.5% Black (U.S. Census Bureau, 2013b). Several schools did not report student racial and ethnic demographics, with 773/4,409 ADN and 308/6,480 BSN as unknown. For those reporting, it suggests that progress has been made in the racial and ethnic makeup of the students in all types of nursing programs in this survey. The 2013 ADN data indicates 70.5% and BSN 82% Caucasian; however, the Black/African American student population of 3.8% in BSN programs and 4.6% in ADN programs is lower than the state population. Doctoral programs continued to show a decrease in Black/African American students, from 6.1% in and 5.1% in , to 3.3% in Wisconsin reported 6.3% of its population as Hispanic (U.S. Census Bureau, 2013b); of the Wisconsin nursing programs, Hispanic students in the pre-licensure ADN programs were significantly lower this year at 2.7%, potentially due to the unknown reporting. American Indian and Alaskan Natives continued to be underrepresented across Wisconsin nursing programs, when compared to the 1.1% that makes up the Wisconsin population (U.S. Census Bureau, 2013 b).

16 14 Figure 4. Race and Ethnicity of Nursing Students by Program AY Figure 5 shows that Wisconsin nursing students continue to be predominately female across all programs. The doctoral programs reported the smallest number of male students (7.2%), while ADN programs reported the largest number of male students in 2013 (10%). The percent of men in BSN programs remained relatively stable at 9.1%; however, this is well below nationally reported rates. The NLN National Survey reported that males comprised 13% and 16% of baccalaureate and ADN programs, respectively (NLN, 2012); WCN data indicate that Wisconsin nursing programs continue to have room for improvement in attracting and retaining male students.

17 15 Figure 5. Gender of Nursing Students by Program AY Table 7 depicts a comparison of the percentage of students over age 30 between national data, as reported by the NLN (2012), and the current WCN 2013 Survey data. These findings suggest that Wisconsin nursing students in post-licensure programs are younger than reported nationally. Students in Wisconsin pre-licensure ADN programs are younger; whereas, BSN students are generally older than national data. As might be expected, the number of doctoral students over age 30 is quite large. Table 7. Comparison of Percentage of Students Over Age 30 by Program Type Source Pre-licensure Programs Post-licensure Programs LPN ADN BSN RN-BSN MSN Doctoral NLN WCN Institutions reported on the number of full- and part-time faculty, as well as other faculty characteristics, which allows for the continued development of a profile of nursing faculty in Wisconsin. The 2011 survey includes responses from 34 institutions. The 2012 survey response rate of 36 institutions continues to result in a less than complete profile of nursing faculty across the state. The 2011 survey also includes responses from three LPN programs. The 2012 survey has data from only one LPN program. In 2012, the total number of full-time faculty across all institutions grew to 764 from 651 in The 2013 survey included responses from 39 institutions and shows 833 total full-time faculty members with filled positions. BSN and higher schools are showing higher faculty vacancy rates than ADN programs. The increasing

18 16 vacancy rate in BSN and higher schools, combined with fewer PhD-prepared faculty numbers with more schools reporting, indicates a looming shortage of PhD-prepared nursing faculty. This is consistent with concerns expressed on a national basis (IOM, 2010). Table 8. Comparison Filled and Vacant Faculty Positions by Institution Type Filled Faculty Positions Vacant Faculty Positions Full-time Part-time Full-time Part-time LPN ADN BSN and higher Totals Institutions were asked to report on new faculty hired in (Table 9). The average time to fill a vacancy in weeks continues to be longer in BSN and higher institutions. The average number of weeks to fill full-time faculty positons was greater in BSN and higher programs. Table 9 depicts new faculty hired in BSN and higher schools reported 36 new full-time faculty and over 87 part-time faculty hired. Table 9. New Faculty Hired in AY Number of New Faculty Hired Average Weeks to Fill Faculty Vacancies Full-time Part-time Full-time Part-time LPN ADN BSN and higher Totals Table 10 shows the number of full-time and part-time budgeted faculty positions that are anticipated to be added over the next two years. It is projected that 197 positions will be added over the next two years. The greatest growth is anticipated in BSN and higher programs.

19 17 Table 10. New Faculty Positions Expected Over Next Two Academic Years LPN Institutions ADN Institutions BSN + Institutions New Full-time Positions Expected New Part-time Positions Expected Total New Faculty Members Needed % Growth Over Current Positions Table 11 describes the educational background of nursing faculty members. In 2013, 42.6% of full-time faculty in BSN and higher Institutions had doctorates. The 2012 survey revealed that 56.5% of full-time faculty in BSN and higher Institutions had doctorates. This indicates that a large number of doctoral-prepared faculty have left the educational work place or have retired. The majority of part-time faculty members in these institutions hold a master s degree. In LPN and ADN programs, the majority of full-time and part-time faculty members hold a master s degree. The mean average age for PhD faculty, based on the 2014 Wisconsin re-licensure data, is 56 years of age, while DNP faculty have an average age of 51 (WCN, 2015, in press). An increased number of faculty may be nearing retirement. Table 11. Full-time Faculty Education Distribution by Institution Type Highest Degree Earned LPN Programs ADN Institutions BSN + Institutions Total Institutions Full-time Faculty % % % % PhD in Nursing Doctorate of Nursing Practice Other Nursing Doctorate Non-nursing Doctorate Masters in Nursing Non-nursing Masters Bachelors in Nursing Part-time/Adjunct % % % % Faculty PhD in Nursing Doctorate of Nursing Practice

20 18 Other Nursing Doctorate Non-nursing Doctorate Masters in Nursing Non-nursing Masters Bachelors in Nursing Non-nursing Bachelors Summary, Conclusions, and Recommendations Nationally, nursing faculty shortages are limiting enrollment of nursing students. In , U.S. nursing schools turned away approximately 80,000 qualified applicants from baccalaureate and graduate nursing programs due to insufficient numbers of faculty, budget constraints, and insufficient classroom space, clinical sites, and preceptors (AACN, 2014). The American Association of Colleges of Nursing (AACN) surveyed 680 nursing schools, and the results indicate a national nurse faculty vacancy rate of 8.3% (Fang & Yi, 2013). In Wisconsin, 3,256 nursing graduates took the National Council Licensure Examination (NCLEX) in Faculty is an essential resource to increase capacity. The nursing workforce is integrally related to the delivery of healthcare, and as a professional group, nurses are a critical asset and economic driver for Wisconsin. "As the largest professional healthcare workforce in the state, the supply of nurses directly impacts the availability of most health services and the health outcomes for Wisconsin s population. Projections indicate there is a pending nursing workforce crisis with the shortage of Registered Nurses (RNs) growing to nearly 20,000 nurses in Wisconsin by 2035 (WCN, 2013, p.5). According to the U.S. Nursing Workforce: Trends in Supply and Education (Health Resources and Services Administration [HRSA], 2013), Wisconsin ranks 13th in the nation for its supply of registered nurses per 100,000 population. An aging population and workforce drive the need for additional nursing staff population. The Institute of Medicine s report recommends doubling the number of nurses prepared at the doctorate level by 2020 to prepare nursing faculty to meet future educational needs (IOM, 2010). As a result, steps must be taken now to assure an adequate nursing pipeline and an adequate faculty supply. This survey indicates that approximately 200 new faculty positions are needed over the next two years. Key Findings The response rate for the 2012 Wisconsin Center for Nursing Survey of Nursing Programs improved to 93%; however, some key data are missing because respondents did not answer all questions. For example, some large institutions did not answer questions related to faculty age

21 19 and ethnicity of students. Analysis and interpretation of the survey results continues to be limited by this response rate and missing data. BSN and higher schools are showing increased faculty vacancies, while ADN faculty vacancies remain low. The increasing faculty vacancy rate in BSN and higher schools, combined with fewer PhD-prepared faculty numbers with more schools reporting, indicates a looming shortage of PhD-prepared nursing faculty. The percentage of PhD-prepared nurse faculty in BSN and higher institutions also dropped from 56.5% in 2012 to 2013 in 43.2%. Lack of funds to hire faculty was the factor most commonly identified as limiting pre-licensure student admissions, especially for LPN programs (50%). Limited clinical sites was identified as another limiting factor, especially for ADN programs (36%). This may be related to healthcare agencies working to increase their numbers of BSN prepared nurses. The number of reported PhD-prepared faculty has decreased almost 13% in BSN and higher schools from last year s survey. Due to expectations that PhD faculty play a leadership role in nursing programs, this finding is alarming. This decrease probably reflects retirements. Anecdotal reports indicate nurses desiring doctoral degrees are seeking the DNP. Grant monies and other strategies must be geared toward increasing the number of PhD-prepared faculty. Given the mean age (55) of doctoral nursing faculty in the State (WCN, 2015), nursing schools should continue to focus on recruitment and retention strategies to assure an adequate number and mix of doctoral faculty. Wisconsin lags behind national data in the number of men in nursing programs. The NLN National Survey for the latest academic year reported that males comprised 13% and 16% of baccalaureate and ADN programs, respectively (NLN, 2012); Wisconsin continues to hover at 10%. Recommendations 1. Continue efforts to increase the response rate to 100% through follow-up reminders and exploring ways to decrease barriers to reporting (e.g. timing of surveys). Increasing the response rate of participating nursing education institutions will allow for clearer analysis of changes in student enrollment patterns and faculty characteristics. The data missing from the nursing programs across the state at the ADN and BSN levels continues to make interpretation of what may be emerging student enrollment patterns difficult. 2. Monitor the changes that were reported in faculty characteristics (age, gender, and diversity) for potential impact on the delivery of nursing programs and the future nursing workforce in Wisconsin.

22 20 3. Evaluate potential strategies to address the factors limiting enrollment, especially related to limited clinical sites for pre-licensure and advanced practice nursing programs. In the context that lack of clinical sites continues to be a factor limiting prelicensure nursing program admissions, the NLN (2014) supports the use of simulation to prepare nurses for practice, based on the results of the NCSBN indicating that replacing clinical hours with simulation results in similar positive outcomes (Hayden et al., 2014). 4. Encourage development of pathways for students from diverse backgrounds to become nursing faculty. Ideally, the racial, gender, and cultural mix should better reflect the student population being served. 5. Monitor the development of relatively new educational programs, such as the DNP and CNL that reflect preparation for emerging nursing roles. 6. Continue to actively support academic progression and BSN completion in Wisconsin to achieve 80% BSN or higher of the nursing workforce by 2020 through WCN and collaborative efforts to implement the IOM Future of Nursing recommendations throughout Wisconsin 7. Continue to assess the factors that limit diversity, especially within BSN programs, and evaluate potential strategies to promote inclusion. Pilot the use of the Wisconsin Diversity Assessment Tool (WCN, in press) in nursing programs. 8. Evaluate potential strategies to address the factors limiting enrollment for male students across all nursing programs, such as increasing the number of chapters of the American Assembly for Men in Nursing in Wisconsin. 9. Support collaboration with workforce centers to create a standardized educational survey to improve the data reliability and to help unify the national workforce data set. 10. Create innovative strategies to rapidly develop, recruit, and retain faculty to address the doctoral faculty shortages in BSN and higher degree schools.

23 21 References American Association of Colleges of Nursing [AACN]. (2014). Media relations: Nursing shortage. Retrieved from Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. Stanford, CA: The Carnegie Foundation for the Advancement of Teaching. Health Resources and Services Administration (HRSA), Bureau of Health Professions. (2013). U.S. nursing workforce: Trends in supply and education. Retrieved from gworkforcefullreport.pdf Fang, D., & Li, Y. (2013). Special survey on vacant faculty positions for academic year Retrieved from Hayden, J. K., Smiley, R. A., Alexander, M., Kardong-Edgren, S., & Jeffries, P. R. (2014 Supplement). The NCSBN national simulation study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2), S3-S64. Institute of Medicine (IOM). (2010). The future of nursing: Leading change, advancing health. Retrieved from Change-Advancing-Health.aspx National League for Nursing (NLN). (2012). Annual survey of schools of nursing, academic year Retrieved from National League for Nursing (NLN). (2014). National League for Nursing response to NCSBN simulation study. Retrieved from: Robert Wood Johnson Foundation. (2014). Initiative on the future of nursing. Retrieved from United States Census Bureau. (2014a). State and county quick facts: USA. Retrieved from

24 22 United States Census Bureau. (2014b). State and county quick facts: Wisconsin. Retrieved from Wisconsin State Statute Nursing Workforce Survey & Grant. (2009). Retrieved from https://docs.legis.wisconsin.gov/statutes/statutes/106/ii/30 Wisconsin Center for Nursing (WCN). (2011). Wisconsin nursing education and nurse faculty: 2010 survey results. Retrieved from: rt.pdf Wisconsin Center for Nursing (WCN). (2013). Wisconsin nursing education and nurse faculty: 2011 survey results. Retrieved from 20Report%20FINAL% pdf Wisconsin Center for Nursing (WCN). (2014). Wisconsin nursing education and nurse faculty: 2012 survey results. Retrieved from %20Education%20Survey%20Report%20Final% pdf Wisconsin Center for Nursing (WCN). (2014, in press). Wisconsin 2014 RN survey report.

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