The State of Arkansas' Nursing Education Programs and Its Impact on the Arkansas Nursing Workforce Shortage, Fall 2 Follow-up Report to HCR 12 of 1999 Interim Study on the Nurse Educator and Nursing Workforce Shortage, 1999and2 February 21 White Paper Task Force of NANEP Barbara G. Williams, PhD, RN UCA, Co-Chair Linda C. Hodges, EdD, RN, UAMS, Co-Chair
TABLE OF CONTENTS Section I. 11. 111. IV. V. VI. VII. VIII. IX. Introduction Executive Summary Analysis Report for RN and PN Programs Table: RN Programs Student and Faculty Data Table: Arkansas RN Program Enrollment and Graduation Data, 1988 to Present Graph: Arkansas RN Enrollment and Graduation Data, 1988 to Present Table: PN Programs Data Student and Faculty Data Table: PN Program Enrollment and Graduation Data, 1996 to 2 Graph: PN Enrollment and Graduation Data, 1996 to 2 Pages 1 2 3-12 13-19 2 21 22-24 25 26 X. XI. XI. XI11. Table: Full-Time Faculty Teaching in Nursing Programs, RN and PN Programs Table: Nursing Faculty Salary Range - RN and PN Programs Table: Age of Arkansas Nursing Faculty - RN Programs Graph: Age of Arkansas Nursing Faculty - RN Programs 27-28 29 3 31 XIV. Graph Age of Arkansas Doctorally Prepared Faculty XV. Table: Age of Arkansas Nursing Faculty - PN Programs 32 33 XVI. Table: DedChairDirector Survey Data - RN and PN Programs 34 XVII. Tables: 1999 Salaries of Nurse Educators & Other Educators XVIII. Table: Academic Disciplines by Gender XIX. L. Hodges U.S. Senate Testimony, 2/13/21 35-39 4 41. - 48 XX. L. Hodges Arkansas HB 1645 Testimony, 2/1 Y2 I 49-53
1 The State of Arkansas Nursing Education Programs and its impact on the Arkansas Nursing Workforce Shortage, Fall 2 Introduction When you or your family are ill, will there be a nurse to care for you? Due to inadequate numbers of qualified nurses to provide patient care, many hospitals emergency rooms across the state and nation have resorted to ambulance diversion, requiring travel as far as 144 miles to another hospital. Patient visits of 36 plus hours are now common in some emergency rooms prior to admission and hospitals have closed entire units and ICU beds, not due to a lack of patients, but because of inadequate numbers of nurses to staff them. The nursing shortage is also causing delays of elective and even required surgery. Hospitals exist primarily to provide nursing care. Nurses are the backbone of the vast industry of health care. This follow-up report to HCR 12 of 1999, Interim Study on the Shortage of Nurses and Nurse Educators, by the House and Senate Committees on Education and on Public Health, Welfare and Labor, provides new information that addresses the status of Arkansas nursing and nurse educator shortage. Findings indicate that unless corrective measures are taken now to ensure more nursing students are recruited; faculty are educated, recruited, and retained; and sufficient budgetary support is given to nursing education programs, a nurse may not be there for you or your family. Without commitment by the state to a clear and timely plan to address the nursing faculty shortage and allow for educating increased numbers of students, the state will not meet its social and ethical responsibility to provide quality health care for its citizens. The health care industry will also be severely crippled. C:Wy DocumentKarpenterWuning ShortageEummary introduction.doc 2/2/1 256 PM; CJCarpenter
Summary of Findings The State of Arkansas Nursing Education Programs and Its Impact on the Arkansas Nursing Workforce Shortage, Fall 2 Nursing Enrollment and Graduation * Since peak enrollment in 1992 there has been a 44.8% decline in enrollment in Registered Nurse (RN) programs (Associate Degree, Diploma, and Baccalaureate Degree). It is estimated that only 844 new RNs will enter the workforce in 21. Not all of that number will remain in Arkansas. Practical Nursing (PN) programs show a similar enrollment and graduation decline. It is estimated that only 6 students will enter the LPN field in 21. Nursing Workforce Shortage Health care annually contributes billions of dollars to the state s economy/tax base. A fall 2 Arkansas Hospital Association survey, with only 52.92% responding, found 752 budgeted unfilled RN positions for an RN vacancy rate of 23.35% and 272 budgeted unfilled LPN positions for an LPN vacancy rate of 6.29%. The actual vacancy rate is much higher when including those hospitals not responding and all of the other sectors of health care employing nurses, such as long-term care, clinics, health departments, home health,.industry, etc. The future need for nurses is growing, as the population ages, as health care technology increases, and as a large number of nurses currently employed reach retirement age. Arkansas RN programs will not graduate the number of students required to fill the vacant positions in 21,22 or for the foreseeable future. Nursing Faculty The average age of faculty in RN programs is 46.84 years and 45.81 years in PN programs. The average age of doctoral prepared faculty is 52.7 years. These faculty are required to administer baccalaureate programs and teach in graduate nursing programs and serve in leadership positions throughout nursing education and in service areas. From 1999 to 2, the state lost 8 doctoral prepared faculty who were unable to be replaced. 13 budgeted full-time faculty positions in RN programs were unfilled in fall 2, an increase of 44.44% in only one year. Salaries of nursing faculty remain at least $15, less than comparably prepared nurses earn in noneducation settings. Arkansas nursing programs, both RN and PN programs, are unable to educate the increase number of students required to meet the nursing workforce shortage due to the nurse faculty shortage. To Address the Nursing Workforce Shortage The only way Arkansas s nursing crisis can be solved is to educate more nurses in Arkansas. The only way programs can educate more nurses is to recruit and retain more qualified faculty. * The only way to ensure adequate numbers of qualified nursing faculty is to pay salaries comparable with those in the clinical arena and schools in other states. The number of qualified nursing students at all educational levels must be increased through recruitment campaigns and lodscholarship programs. * Nursing faculty salary equity adjustments must be provided for nursing faculty in all state programs through state appropriation. e A Nursing Workforce Commission located in the Arkansas State Board of Nursing must be funded to collect, analyze, and monitor the nursing shortage. * Without commitment by the state to a clear and timely plan to address the nursing faculty shortage and allow for educating increased numbers of students, the state will not meet its social and ethical responsibility to provide quality health care for its citizens, and the health care industry will be severely crippled.
3 The State of Arkansas Nursing Education Programs and Its Impact on the Arkansas Nursing Workforce Shortage, Fall 2 Sources of Data ANALYSIS REPORT This report reflects the analyses of data collected from 23 of 23 RN programs preparing Registered Nurses (RN) in 1999 and 22 of 23 programs in 2 and from Practical Nursing (PN) programs in 2. The survey results were supplemented by data collected from annual ASBN reports in 1999 and 2. Results from the RN programs are presented first, followed by results from the PN programs. Student Enrollment in RN Programs Enrollment Study Findinm - RN Proerams 5 I or 4.68% fewer students were admitted in 2 as in 1999. Total enrollment declined by 5.44% or 136 students between 1999-2. A decline of 44.48% or 1,895 students has occurred between 1992-2. 3 schools in 2 reported more qualified students than could be admitted compared to 5 schools in 1999. 86 qualified applicants in 2 could not be admitted down from 153 in 1999. 15 registered nursing (RN) students were enrolled in 2, an increase of 26.51% since 1998. 37 licensed practical nursing (LPN) students enrolled in RN programs in 2, and increase of 35.84% since 1998. Total enrollment in RN programs, at all levels of preparation and throughout the state, continue to decline approaching nearly one half of peak enrollment in 1992. The numbers of non-licensed qualified applicants that could be admitted has decreased, clearly demonstrating a declining interest in the nursing field. The numbers of RN and LPN students returning for further education is increasing at a significantly higher rate, while generic student enrollment continues a steep downward decline. While the return of RNs for higher degrees increases the quality of the RN workforce, the size of the workforce is not increased. The articulation of LPNs enhances the credentials of the students and increases the size of the RN workforce, but decreases the size of the LPN workforce, compounding shortages in that sector. Graduation Rate of RN Programs Graduation rates declined by 7.13% or 75 graduates between 1999 and 2 for a total of 977. 91 seniors are expected to graduate in 21 based on the 1999-2 senior year attrition rate.
4 A decline of 35.64% or 54 graduates from RN programs has occurred between 1994, when the graduation rate peaked, and 2. Of the 91 students expected to graduate in 21, only 844 new RNs will potentially be added to the RN workforce based on a 1% attrition rate of generic seniors during 1999-2. Graduation rates from RN programs at all levels of preparation throughout the state continue to decline to well over one h rd of the peak graduation rate in 1994. The reported RN graduation rate by the ASBN includes those nurses who were previously registered, thereby distorting the numbers of new registered nurses that would potentially join the state s RN workforce. Faculty in RN Programs A reduction of 4.96% in full-time associate and diploma nursing program positions occurred for a total of 6 positions. Baccalaureate and higher degree positions increased by 7.75% or 1 for a net increase of 4 new full-time positions all programs. Numbers of part-time faculty positions declined by 1.81 % or 8 part-time positions. The increase of 4 new faculty positions cannot be attributed to new permanent positions given the increase in faculty lines funded by grants and service contracts at UAMS. However, of the 1 new baccalaureate faculty positions, five permanent faculty positions were funded to support the off-campus generic UAMS nursing program located at Hope, Arkansas. The decrease in faculty at the Associate and Diploma levels may be refective of the declining enrollment in these schools. Faculty Race and Gender 92.6% of RN nursing faculty in 2 were white, an increase of 2.9% since 1999. Minority faculty in 2 comprised 12% or 15 faculty of the total number of faculty, in baccalaureate and higher degree programs Minority faculty in 2 comprised 5.7% or 4 faculty of the total in associate degree programs and 9.7% or 3 faculty in diploma programs are minorities. Of the 22 minority faculty in 2,63.64% are African American, 4.55% are Hispanic, 13.64% are American Indian, 9.1% are AsiadPacific Island, 4.55% are East Indian and 4.55% are unknown. 96.8% of nursing faculty in 2 are female and 3.2% are male. The numbers of raciauethnic faculty members in RN programs poorly reflect the sociodemographic population profile in Arkansas with a 16% African American and growing Hispanic populations now estimated at over 6,. Clearly, there is a critical need to increase the numbers of minority master s and doctorally prepared nurse educators in the state as well as male faculty. These faculty are more sensitive to the cultural and
5 healthcare needs of their respective groups and also serve as valuable role models for prospective minority students interested in a nursing career. Age of Faculty in RN Programs The average age of nursing faculty in 2 was 46.84 years, down fiom 47.44 years in 1999. 33.45% of the nursing faculty in RN programs in 2 were younger than 45 years, while in 1999 there were only 23.75% of the faculty below this age level. Of the total number of doctoral faculty and administrators in 2 reporting their ages, 17 or 34% were over the age of 55. In 2, programs were able to hire master s prepared faculty at a younger age to replace those resigning or retiring. Doctoral Faculty in RN Programs The average age of doctoral faculty, 52.7 years has not changed significantly since 1999 In April 2 there were 57 doctoral faculty (including administrators) employed in RN schools of nursing. In December 2, schools reported to ASBN a total of 49 doctoral faculty (including administrators). Of the 8 doctorally prepared faculty lost, 4 resigned and 4 retired. Whde the age of doctorally prepared faculty remains approximately the same since 1999, the state has seen a decrease of 8 or 14% of the faculty with doctoral degrees. This is particularly alarming due to the need for these faculty to teach in the state s masters and doctoral programs in order to supply the state with advanced practice nurses and qualified nursing faculty. Doctoral faculty are also needed to fill leadership and administrative positions in all RN programs and research and administrative positions in the service arena. Educational Preparation of RN Faculty 45 of 273 (16.48%) RN program full-time faculty, including program administrators failed to meet the national accreditation standards of a minimum of a master s degree in nursing in 1999. In 2 this number had decreased to 35 or 12.68% of 276 faculty. 35 of 63 (53.85%) of part-time faculty in RN programs did not meet national accreditation standards in 1999. In 2 this number increased to 4 of 63 (63.35%). While programs were able to increase the academic standards of a greater number of fulltime faculty in 2 as compared with 1999, they had to hire more unqualified part-time faculty. The continued practice of employing unqualified faculty to prepare the RN workforce places nursing programs in jeopardy for denial of accreditation and production of inferior, unqualified graduates. Not only is there a critical need to increase the
6 numbers of qualified faculty to fill new positions and replace those resigning or retiring, but there is an acute need to replace the unqualified faculty teaching in the state s RN schools with those holding a minimum of the master s degree in nursing. Salaries of RN Faculty Faculty salaries based on a 9 month academic contract from 1999-2 increased by an average of $549, $493, and $8,68 respectively in associate, baccalaureate, and baccalaureate/graduate programs. Faculty salaries for those teaching at the graduate level and in diploma programs from 1999-2 decreased over the past year by $4,997 and $3,162 respectively. Faculty salaries remain significantly lower than those similarly prepared in positions clinical areas and nursing services administration. The gap continues to be greater than $15,. Faculty salaries are also lower than those in surrounding states. These disparities in salaries continue to be the major factor in the eroding ranks of faculty to clinical positions, early retirements, and faculty positions out of state. The low salaries are also a deterrent to recruitment of students into master s programs preparing nurse educators and the doctoral program preparing nurses as faculty and nursing program heads. Arkansas s low nursing faculty salaries make it almost impossible to recruit qualified faculty from out of state to fill vacant positions. The lower salaries for faculty in diploma programs and those teaching at the graduate level might be due to several factors: hiring of younger, less qualified or experienced faculty at lower salaries; the way faculty in BSN and Higher Degree programs were classified in 2 as compared to 1999; or the adequacy of the data. Faculty Resignationsrnetirements 13 budgeted unfilled full-time faculty positions were available in fall 2, an increase of 44.44% from 1999. 9 faculty were predicted by program heads to retire or resign in 2, however 37 resigned or retired, 75.6% more than expected. 16 faculty in 2, are predicted by program heads to retire or resign in 21. Nursing faculty retired at the average age of 62.66 years. The numbers of faculty resignations and retires far exceeded those expected in 2. Faculty are also retiring at earlier ages than the traditional retirement age of 65 years. The fact programs began the 2-21 academic year with 37 replacement faculty, a net of 4 new ones in added positions, and 13 budgeted unfilled positions, indicate that schools of nursing continue to be extremely unstable and the workload of remaining faculty has increased significantly; a primary reason for faculty resignations. Employment of and Reasons for Faculty Resignations Of the 28 faculty resigning in 2,2 or 74% left nursing education as a career. Of the 28,7 or 26% in 2 took positions in another nursing education program.
7 Low salary and work demands were cited by 61% of those resigning in 2 as the primary reasons for leaving positions. 9 faculty retired in 2. Faculty continue to leave their careers as nurse educators at an alarming rate while for the past two years the retirement rate has remained steady. It is clear faculty are protesting in the most damaging way their discontent with salaries and workplace demands. In order to stop the hemorrhaging of Arkansas nursing faculty ranks, salaries must be increased and brought in line with those in the private sector. Additional positions must also be added to share the increased workload brought about by less qualified students and faculty, rapid turnover of faculty, and the high patient acuity and stress in clinical areas. Recruitment of Specialty Faculty 11 faculty positions in the medical surgical area were open in 2 the area with the greatest faculty need. Only 2.2 applicants were available per vacant faculty positions on average with a range of 1-6 applicants. Positions in psychiatric/mental health nursing and community health were the most difficult to fill with some schools having no applicants and the highest number to apply was 2 for a program. Recruiting faculty with master s preparation in specialty areas remains almost impossible, particularly in the areas of psychiatric/mental health and community nursing. Those schools in rural areas are faced with major difficulties in attracting qualified specialty faculty to their areas not only due to the rural nature of the program but also due to increased hiring competition from clinical settings. Arkansas Market Demand for Registered Nurses In fall 2, the Arkansas Hospital Association (AHA) conducted a survey which included a component to determine the nursing shortage level. A total of 12 hospitals were surveyed with 54 or 52.92% responding. The same survey was conducted in fall 1998, with a comparable number of hospitals responding, 55 or 53.4% of 13 hospitals. In fall 2 of the 54 hospitals reporting, there were 8,22 budgeted RN positions and 752 budgeted, vacant RN positions for a vacancy rate of 9.15%. In the fall 1998 of the 55 hospitals responding, there were 41 vacant RN positions out of 6,66 budgeted RN positions were reported, a vacancy rate of 6.21 %. In fall 2, 5 or 92.59% of the hospitals reported that the nursing shortage had grown worse over the past year. In fall 1998,31 or 56.4% reported the shortage had grown worse over the past year. In fall 2, 16 or 3.19% of the hospitals rely on agency nurses to meet RN staffing levels. In fall 1998, 9 or 17.31% reported they had to rely on agency nurses.
8 The hospitals responding to the AHA surveys have 1,62 more budgeted RN positions in 2 than they did in 1998, an increase of 24.54%. It should be noted that different hospitals might have responded to the 2 survey than to the 1998 survey, thus partially accounting for the differences in RN positions. But it is recognized that the state needs more RNs today than it did in 1998, due to the aging of the population, the increased incidence of chronic illness in our population, the increased sophistication of health care requiring more of the skills and abilities of RNs, among other factors. In addition more RNs are required in schools, freestanding surgery centers, longer-term care and other sectors of the health care industry than were required two years ago. The number of vacant RN positions has grown by 342 or an increase of 83.42% over the past two years. Nearly 1% of the responding hospitals report the RN nursing crisis has grown worse over the past year in 2, while little more than half the hospitals believed that in 1998. The dependency of hospitals on agency nurses has increased by 77.77% over the past two years. Clearly, Arkansas nursing education programs are not graduating the number of new RNs to enable hospitals to hire the number of RNs required for patient care, and the crisis has grown significantly in the past two years. Interpretation of Findings from RN Programs The number of newly licensed registered nurses expected to be added to the workforce from Arkansas RN nursing programs in 21 is 844. This is based on the following assumptions: 1. The attrition rate of generic seniors will not exceed 1%. 2. All generic graduates will be successful on the NCLEX examination. 3. All generic graduates will remain in Arkansas. 4. All newly licensed graduates will seek employment as RNs preferably on a full-time basis. Based on past experience, it is known that these assumptions are not all valid. Not all new graduates will pass the NCLEX examination the first time nor will they take it in Arkansas and a number graduates seek employment out of state. Due to a declining interest in nursing as a career, declining enrollment, and lack of qualified faculty, graduation rates are expected to have steadily declined over the next 6-7 years. With only 52.9% of Arkansas hospitals reporting a total of 752 budgeted unfilled vacancies, the following is summarized relative to the demand for registered - nurses: 1. Vacancy rates will continue to increase as the fiscal year progresses with rates peaking late spring 21. 2. The vacancy rate of 752 reflects less than the total vacancy rate for all 12 hospitals. 3. The total vacancy rate in the state in all RN employment sectors such as long term care, community-based care, home health and other employment settings outside of the hospital is also increasing. It is expected these sectors will be competitively recruiting experienced and newly licensed nurses. 4. The demand for more RNs in the state s health care system will continue to grow with the advancing age of Arkansans, the increased numbers of medically underserved and growing numbers without health insurance. All of these factors will require a higher ratio of RN staffing per patient than in the past. Opportunities for RN employment outside of traditional health care
9 settings will continue to expand as RNs fill positions in insurance companies, schools, occupational health and in traveling nurse agencies both in the US and foreign countries. 5. The pool of RNs in the state will be highly recruited out of state due to higher salaries and benefits. Student Enrollment in PN Programs Studv FindinrJs - PN Programs 52 fewer students were admitted in 2 as in 1998, a 5.44% decline. Over the past 5 years, there has been a 16.76% drop in enrollment. Only 5 schools reported more qualified applicants than they could admit in 2, as compared to 11 in 1999. The number of qualified denied applicants dropped by 72.58% from 1999 to 2, a decline of 225 students. Enrollment in and applications to PN programs shows a rapid decline. The enrollment drop is comparable to the drop in RN programs, while the decrease in qualified denied applicants is considerably higher. These numbers joined with the declined enrollment in RN programs show serious lack of interest in nursing as a career field. Graduation Rate of PN Programs Graduation rate declined by 35 students or by 5.35% over the three year period of 1998 to 2, with a 1.43% or 9 students in the past year. Over the past 5 years, there has been a drop of 1 15 graduates, a 15.6% decline. PN programs show a 33.26 attrition rate over the three year period to 1998 to 2. It is estimated that fewer than 6 students will graduate from PN programs in 2 1. Graduation rates from PN programs across the state continue to decline. Faculty in PN Programs The number of full-time faculty increased by 2 fiom 1999-2, 84 to 86. The number of part-time faculty decreased by 15 during that same period, fiom 4 to 25. While enrollments have decreased, programs have been able to hire more full-time faculty and reduce the number of part-time faculty, thus creating more stabilized programs. In addition, full-time faculty tend to be more academically prepared, contributing to higher quality programs.
1 Faculty Race and Gender * 6 or 96.77% of PN faculty and directors are white, with I.63% reporting as Ahcan American and 1.6% as other. 1% of PN faculty and directors are female. PN faculty do not reflect the diversity of our society in Arkansas with a 16% African American and a growing Hispanic populations now estimated at over 6,. Minority faculty are more sensitive to the cultural and healthcare needs of their respective groups and serve as role models for student and the profession. Age of Faculty in PN Programs * The average age of PN faculty was 45.81 years, with a range fiom 3 to 61 years of age. The average of age of PN program directors was 48.4 years. The age of PN faculty are comparable to their peers in RN programs, as are the ages of PN directors when compared with administrators of RN programs. Educational Preparation of PN Faculty Of the 86 full-time faculty in 2, 1 or 11.63% had a master s degree in nursing. 57.32% had less than a baccalaureate degree in nursing. 85.71% of part-time faculty in PN programs had less than a baccalaureate degree in nursing. 26.32% of PN program directors have less than a baccalaureate degree, 31.58% report a baccalaureate The education level of PN faculty and directors is not comparable to that in surrounding states or what is required for national accreditation. This practice prevents the preparation of a quality workforce and prevents from achieving national accreditation. There is a serious need for current PN faculty to articulate into higher RN educational preparation and for new PN faculty to be hired with higher education preparation. Salaries of PN Faculty The average PN faculty member earned $3 1,883 in 2, based on 9 month adjustment. The average PN director earned $36,929, based on 9 month equivalency or $49,239 12 month equivalent. As with faculty in RN programs, PN faculty make considerably less than their counterparts in clinical agencies. This disparity in salaries continues to be the major factor in the eroding ranks for faculty. The low PN salaries will make it very difficult for programs to recruit faculty with higher educational preparation.
11 Faculty ResignationsRtetirements In 1998 PN programs experienced 3 faculty resignationshetirements, a loss of 35.71% of all PN faculty in the state. In 2 only 22 faculty resigned or retired, a 25.58% rate. Programs were able to replace all of the faculty, and had no unfilled FT positions in 2. The average age of those faculty retiring and not seeking employment elsewhere was 63 years of age, comparable with retirement age of RN program faculty. Program directors anticipate 6 resignations/retirements in 21, while actual resignations/retirements ranged from 3 to 22 per year for the past three years. The high resignatiodturnover rate in PN programs is critical. This high turnover rate, coupled with the lack of prior teaching experience of new faculty, and the lower educational preparation level of faculty results in programs that are unable to maintain quality, have remaining or continuing faculty who have an increased workload and are dissatisfied, and have graduates unable to provide high quality health care. Employment of and Reasons for Faculty Resignations 76.92% of those faculty who resigned in 1999 assumed positions in the clinical sector of the profession, comparable to the percentage of resigned RN faculty obtaining employment in the clinical sector. 54.55% of the faculty who resigned did so because of salary and other work related reasons. Arkansas Hospital Market Demand for Licensed Practical Nurses In the fall 2 the Arkansas Hospital Association s survey with 54 of 12 hospitals responding, reported a total of 3,479 budgeted LPN positions and 272 budgeted, vacant LPN positions. Hospitals are currently recruiting to fill 219 of these positions, creating a vacancy rate of 6.29% in those hospitals responding to the survey. Summary of Findings from PN Programs The enrollment rate and graduation rate of PN programs continues to steadily decline, greatly comprising the technical nursing workforce required for safe, effective healthcare delivery. It is predicted that these numbers will continue to decline over the next several years. Hospitals only employ a portion of the LPNs in the state. Long-term care and home health are two sectors of health care that rely heavily on these nurses. With 272 vacant LPN positions in the 54 reporting hospitals, it is known that true state-wide LPN vacancy rate in all sectors of health care is much higher. PN programs experience a high faculty turnover rate, coupled with low faculty salaries, resulting in unstable programs, with graduates of comprised quality.
The low salaries will make it difficult for programs to recruit faculty with higher nursing academic credentials, required for programs to be recognized as meeting nationals standards and for the needed curricula changes to increase the critical. thinking required of PN graduates. CONCLUSIONS It is imperative that measures be taken in Arkansas to address the many variables contributing to the nurse educator and nursing shortage. Strategies are needed to increase recruitment of qualified students to the nursing field and to acquire resources for educating them including adequate operating budgets and competitive faculty salaries. Major changes must also be made in the workplace in order to retain the experienced nurses and new graduates once employed. Without commitment by the state to a clear and timely plan to rectify these problems the state will not meet its social and ethical responsibility to provide quality health care for its citizens, and the health care industry will be severely crippled. C:Wy DocurnentF\CarpenterWursing ShortageiSurnrnary Analysis Report-White Paper.doc ZO/O I 4:24 PM: CJCarpenter
White Papc, Ask Force, Fall 2 RN Program Analysis January 31,2143, Williams, UCA RN Programs Students 1998 1999 (ASBN Summary) (ASBN Summary) Total Enrolled # in 1" year (admitting) class A 1,65 D 496 B 956 T 2,517 A 1,82 D 5 B 919 T 2,51 (-.64%) A 546 D 189 B 349 T 1,9 ## in last year of program A 536 i.e. Senior year D 167 B 427 T 1,13 LPN students A 176 A 166 D 4 D 63 B 18 B 24 T 226 T 253 (+ 11.95%) RN students B 83 B. 87 T 83 T 87 (+4.82%) Graduates # qualified denied # programs with qualified denials A 533 D 26 B 37 T 1,19 A 52 D B 62 T 114 A 494 D 164 B 394 T 1,52 (- 5.14%) A 68 D B 85 T 153 (+ 34.21%) A 4ofll A 2ofll D Oof3 D Oof3 B 3of9 B 3of9 T 7of23 T 5of23 ;N Propams Student and Faculty Data 2 Comments (ASBN Reports) A 1,2 D 465 B 898 T 2,365 (- 5.44%) A 519 D 153 B 361 T 1,39 (- 4.68%) A 52 D 154 B 386 T 1,42 (- 7.79%) A 218 D 6 B 29 T 37 (+ 21.43%) Baccaiaureate student data includes SAU's RN to BSN numbers, which are not in ASBN data 91 projected to graduate in 21 based on 13.54% attrition of 1999 seniors and 2 graduates. B 15 Potential of only 85 new graduates (not T 15 (+ 2.69%) already RNs) in 21 A 449 13.54% attrition between seniors in 1999 D 166 (n=l,13) and graduates in 2 (n=977). B 362 T 977 (- 7.13%) A 35 D B 51 T 86 (- 43.8%) A I of13 D Oof3 B 2of 1 T 3 of25
~ (ASBN White Paper Task Force, Fall 2 RN Program Analysis January 3 1,2OOl/B. Williams, UCA RN Programs Faculty 1998 (ASBN Summary) 1999 Summary) 2 (ASBN Reports) Comments Full time faculty (excluding administrator) A 83 D 36 B 122 T 241 A 86 D 35 B 129 T 25 (+ 3.73%) A 82 D 33 B' 139 T 254 (+ 1.6%) Part-time faculty A 29 D 5 B 35 T 69 A 32 D 7 B 35 T 74 (+ 7.25%) A 36 D 6 B 24 T 66 (+ 1.81%) I Resignations & retirements since previous December A 18 D 16 B 19 T 53 A 1 D 7 B 32 T 49 (- 7.55%) A 12 D 6 B 19 T 37 (- 24.49%) Appointments since previous December A 18 D 6 B 21 T 45 A 14 D 6 B 4 T 6 (+33.33%) A 8 D 5 B 25 T 38 (- 36.66%) Unfilled FT positions A 5 D 2 B 6 A 2 D 2 B 5 T 9 (- 3.77%) A 4 D l B 8 T 13 (+ 44.44%) ;acuity retirements not including,esignations) A 2 D O B 8 T 1 A 2 D 3 B 4 T 9 ( - 1.%) Data from White Paper Task Force Survey, not ASBN reports 2
White Paper Task Force, Fall 2 RN Program Analysis January 3 1,21/B. Williams, UCA RN Programs Faculty Con t. 1998 1999 (White Paper Survey) 2 (White Paper Survey) Comments Average age of retirees A 62. yrs D 63.66 yrs B 62.33 yrs T 62.66 yrs Anticipated retirements/ resignations this year A D 2 B 7 T 9 A 4 D 5 B 7 T 16 ( + 77.77%) Specialities Recruited for Speciality Med-Surg Peds PsyMH MatChild ComHlth FNP Inform/Mng Any Spec #&I&. #Programs 11 1-6, ~ 2.2 2 2, x2 3-2,~.33 2 2, x2 3-1,~.33 2 2, x2 1 1 4 3mployment of Resignees Teaching in-state Teaching out-of-state Clin agencypriv Practice UnknowdOther 8 2 15 7 4 3 12 8 'rimary Reason - resignat. Salary Other Work factors Family Personal Other Unknown 4 15 3 1 1 )! ) 3
White Paper Task Force, Fall 2 RN Program Analysis January 3 I, 21/B. Williams, UCA RN Programs Faculty Cont. 1998 1999 (White Paper Survey) 2 (ASBN Rpt ) Comments FT w/ doctorate A 5 D 2 B 46 T 53 A 6 D l B 42 T 49 (- 7.55%) Fall 2 Survey reports 52 doctoral prepared faculty and administrators w/ one school not reporting. Dec 2 ASBN reports show only 49 w/ all schools reporting. FT w/ Masters Nsg A 54 D 22 B 99 T 175 A 72 D 19 B 11 T 192 (+ 9.71%) FT w/ Non-Nsg MS A 5 D 9 B 2 T 17 A 4 D 1 B 3 T 17 FT w/ BSN A 12 D 4 B 1 r 26 A 8 D 5 B 5 T 18 (- 3.69%) FT w/ NonNsg BS A D l B O r 1 A D O B O T O FT w/ ADN or Diploma A D l B O r 1 A D O B O T O 4
White Paper Task Force, Fall 2 RN Program Analysis January 31,21h3. Williams, UCA RN Programs Faculty Cont. 1998 PT w/ doctorate A 1 D O B 3 T 4 PT w/ Masters Nsg A 12 D 2 B 1 T 24 PT w/ Non-Nsg MS?T w/ BSN 'T w/ NonNsg BS 1999 (White Paper Survey) A 1 D 2 B 1 T 4 A 14 D O B 12 T 26 A 1 D O B O T 1 'T w/ ADN or Diploma A 2 D 2 B O T 4 2 (ASBN Rpt & WP Sum) A 1 D O B 2 T 3 A 8 D O B 12 T 2 A 4 D 3 B 1 T 8 A 2 D l B 5 T 26 A 1 D O B O T 1 A 4 D l B O T 5 Comments 5
~ White Paper Task Force, Fall 2 RN Program Analysis January 3 1,21/8. Williams, UCA RN Programs Faculty Con t. 1998 1999 2 (mite Paper'survey) Comments Resignations FT w/ doctorate A D O B 4 T 4 Resignations FT w/ Masters Nsg A 5 D 3 B 15 T 23 Resignations FT w/ Non-Nsg MS A D O B O T O Resignations FT w/ BSN A 1 D O B O T O Resignations FT w/ NonNsg BS A D O B O T O Resignations FT w/ ADN or Diploma A D O B O T O 6
White Paper Task Force, Fall 2 RN Program Analysis January 3 1, 2 1/B. Williams, UCA RN Programs Faculty 1998 Con t. Retirements FT w/ doctorate Retirements FT w/ Masters Nsg I Retirements FT w/ Non-Nsg MS Retirements FT w/ BSN Retirements FT w/ NonNsg BS Retirements FT w/ ADN or Diploma A D B T A ID B T A D B T A D B T A D B T A D B T L Respondents to Survey A D B T 1999 2 (White Paper Survey) A D l B 3 T 4 A A 1 D D 2 B B 1 T T 4 A A 1 D D O B B O T T 1 A A D D O B B O r T O 4 D B r 4 D B T A O D O B O T O A D O B O T O A 11 of11 A 11 of11 D 3of3 D 3of3 B 9of9 B 8of9 Comments
~~ ~~~ ~ ~ ~- 2 ARKANSAS RN PROGRAM ENROLLMENT AND GRADUATION DATA 1988 to Present Source: Arkansas State Board of Nursing Year RN Program Enrollment Increase/decrease from previous year RN Program Graduation Increase/decrease from previous year 1988 2,27 1 75 1989 199 1991 1992 1993 1994 1995 1996 1997 1998 1999 2,279 3,32 3,64 4,26 3,659 3,434 3,189 2,99 ~ ~ _ ~ 2,881 2,5 17 2,5 I +8 (+<I%) +523 (+18.82%) +338 (+IO.24%) +62 (+17.3%) -61 (-14.12%) -225 (-6.15%) -245 (-7.13%) -199 (-6.24%) ~~ -19 (-3.65%) -364 (-12.63%) -16 (-.64%) 2 2,365-136 (-5.44%) 21 proj 727 916 +22 (t-3.1 Yo) +189 (+26%) 1,117 +2 1 (+21.94%) 1,269 +152 (+13.61%) 1,265-4 (-<1%) 1,414 +I26 (+9.96%) 1,339-75 (-5.3%) 1,266-73 (-5.45%) 1,116-15 (-11.85) I11O9-7 (-< 1 Yo) 1,52-57 (-5.14%) 977 91-75 (-7.13%) -67 (-6.86%) Since the 1992 high enrollment of 4,26, there has been a decrease of 1,895 students (44.48%). Since the 1994 high graduation rate of 1,414, there has been a decrease of 54 graduates (35.64%).
Arkansas RN Enrollment and Graduation Data 4,5 1 1 4, -. 3, 2,5 I RN Enrollment I RN Graduation 1-
~ White P; Task Force, Fall 2 PN Programs Analysis January I -, LOO 11 B. Williams, UCA - PN ograms Students and Faculty Data Variable (ASBN Summary) (ASBN Summary) 2 (ASBN Reports) Comments Number of Programs 28 Admitted 956 I 913 (- 4.5%) 94 (- 1.OO%) Graduates 654 I 628 (- 3.98%) 619 (- 1.43%) # Qualified denied # Programs with qualified denials Full time faculty (including administrator) 332 31 (- 6.62%) I 84 84 85 (- 72.58%) Part-time faculty 42 4 25 Resignations & retirements since previous October 3 32 22 (-3 1.25%) Appointments since previous October 35 33 14 Unfilled FT positions FT w/ Masters Nursing FT w/ Non-Nsg Masters FT w/ BSN FT w/ NonNsg Baccalaureate FT w/ ADN or Diploma 1 6 I 25! 3 37
White Pay ~sk Force, Fall 2 PN Programs Analysis January Ib,.JOl/ B. Williams, UCA Variable 1998 1999 (ASBN Summary) (ASBN Summary) FT w/ LPN PT w/ Masters Nursing PT w/ Non-Nsg Masters PT w/ BSN PT w/ NonNsg Baccalaureate PT w/ ADN or Diploma PT w/ LPN 6 3 2 6 1 2 (ASBN Reports) Comments Variable # of Programs Responding Faculty retirements (not including resignations) Average age of retirees Anticipated retirements or resignations this year Employment of Resignees. tchg in other in-state prog - clinical arena ' unknow ' pursue higher education I 2 (White Paper Survey) 22 of 28 3 63 years 6 1 1 1 1 Consistent w/ RN program data Based on 1998-2 retirements, this number is probably low 76.92% resigned to assume positions in the clinical sector of the profession; higher than RN program data 2 N w
White Papr January 18,.sk Force, Fall 2 PN Programs Analysis J I / B. Williams, UCA Variable Primary reason for resign - salary - other work factors - family, personal - unknown - other Resignations w/ Masters Nsg Resign w/ NonNsg Masters Resign w/ BSN Resign w/ NonNsg BSN Resign w/ ADN or Diploma Resign w/ LPN Retirements w/ Masters Nsg Retire w/ NonNsg Masters Retire w/ BSN getire w/ NonNsg BSN ietire w/ ADN or Diploma I I 2 (White Paper Survey) 2 4 1 2 2 3 6 1 1 1 1 3
25 ARKANSAS PN PROGRAM ENROLLMENT AND GRADUATION DATA 1996 to Present Source: Arkansas State Board of Nursing Year PN Program Increase/decrease PN Program Enrollment from previous Graduation year 1996 1,86 734 1997 1,47-39 (-3.59%) 73 5 1998 956-91 (-8.67%) 664 1999 913-43 (4.5%) 628 2 94-9 (-1.OO%) 619 Increase/decrease from previous +1 I I -71 (-9.66%) I -36 (-5.42%) 1-9 (-1.43%) 1 From 1996 to 2: 182 drop in enrollment, 16.76% 1 15 drop in graduates, 15.67%
Arkansas PN Enrollment and 1,2 Graduation Data 1 1, -' 8 -I 6 - I 4 -I 2 -I -' From 1996 to 2: QQQ % 182 drop in enrollment, 16.76% 1 15 drop in graduates, 15.67% N CT
White Paper Task Force, Fall 2 Nursing Faculty Analysis January 12,21h3. Williams, UCA Full-Time Facultv RenortinP - Teachinp in Nursinp Proprams (Source of Data: Fail 2 White Paper Task Force Survey) Category by Level of Teaching # Programs 1999 Reporting 2 NA LPN ADN Diploma BSN BSN & Graduate 11 of I1 i3 of 12 3 of3 3 of3 5 of5 5 of5 4 of4 3 of4 Graduate Total Comments # Faculty per 1999 ASBN reports 2 NA 86 82 35 33 129 (BSN+) 139 (BSN+) 25 254 1999 Average N= NA 47.12 66 43.78 23 48.34 38 46.45 31 49.98 4 47.44 198 2 Average Range N= 45.8 1 3 to 61 47 47.68 27 to 62 74 47.13 3 to 61 31 46.1 26 to 64 79 5.69 39 to 65 26 49.77 29 to 59 22 47.35 26 to 65 279 Race 1999 White Black Other N= NA NA NA 59 (89.4%) 3 (4.5%) 4 (6.%) 66 21 (87.5%) 3 (12.5%) 24 32 (8.%) 5 (1 2.5%) 3 (7.5%) 4 3 1 (93.9%) 1 (3%) 1 (3%) 34 39 (97.5%) 1 (2.5%) 4 182 (89.7%) 13 (6.4%) 8 (4.%) 23 2 White Black Other N= 42 (97.7%) 1 (2.3%) 43 66 (94.3%) 1 (1.4%) 3 (4.3%) 7 28 (9.3%) 2 (6.5%) I (3.2%) 31 69 (95.2%) 9 (1 1.4%) 1 (1.3%) 79 21 (84%) 2 (8.%) 2 (8.%) 25 2 (95.2%) 1 (4.8%) 21 246 (92.6%) 15 (5.6%) 8 (2.9%) 269
White Paper Task Force, Fall 2 Nursing Faculty Analysis January 12,21A3. Williams, UCA Category by Level of Teaching LPN I ADN Diploma BSN BSN & Graduate Gender 1999 Female Male N= 2 Female Male N= Salary - 1999 Average 9 month N= 2 Average N= NA 57 (98.3%) 1 (1.7%) I 58 47 (1%) 7 (97.2%) 2 (2.8%) 47 72 NA $38,84 I + 66 $3 1,883 $38,633 39 24 (1%) 24 3 1 (1%) 31 $4,95 24 $35,98 29 39 (97.5%) 1 (2.5%) 4 76 (96.2%) 3 (3.8%) 79 $38,392 4 $39,885 72 33 (1%) 33 25 (96.2%) 1 (3.8%) 26 $39,37 33 $47,7 17 26 36 (9%) 188 (96.9%) 4 (1%) 6 (3.1%) 4 I 194 19 (86.4%) I 268 (96.8%) I 3 (13.6%) 9 (3.2%) 22 $58,669 4 $55,57 22 I 277 $42,689 23 $39,749 (all programs) $4 1,375 (RN only) 11 and 12 month salaries converted to 9 months
29 - < $24,999 Arkansas NursinF - Facultv Salary Range - Adiusted to 9 Months White Paper Task Force Survey, 1999 and 2 PN Faculty & Administrators 6 (6.5%) $25, - 29,999 1 (1.8%) 7 (3.1%) - 2 RN Faculty $3, - 34,999 18 (19.4%) $35, - 39,999 $4, - 44,999 $45, - 49,999 $5, - 54,999 18 (19.4%) 4 (4.3%) 5 (5.4%) 17 (7.52%) 31 (13.72%) 6 ( 26.55%) $55, - 59,999 $6, + 14 (6.19%) Total Average 61 PN Faculty $3 1,883 PN Admin. - $36,929 226 $41,375 Averages - White Paper Task Force Averages - ADE & DWFE 1999 NA - PN $38,84 ADN $4,95 Diploma $38,392 BSN $39,37 BSN+ $58,669 Graduate $42,689 - RN av $35,777 - Tech $34,367 - lyr Col $36,376-2yr Col $38,9-4yr Unv a $31,883 - PN $38,633 - ADN $35,98 - Diploma $39,885 - BSN $47,717 - BSN+ $55,57 - Graduate $39,749 - total av $41,375 - RN av Not Available B. Williams, UCA, 1/3/21
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Age of Arkansas Nursing Faculty in RN Programs 8 7 6 5 4 3 1998 W 1999 tl2 2 1 x29 3-34 35-39 4-44 45-49 5-54 55-59 6+ White Paper Task Force Survey
Age of Arkansas RN Doct Prepared Faculty N for spring 2 = 57 N for fall 2 = 5 8 1 Source: White Paper Task Force Survey, Average Age spring 2 = 52.7 19 of 2 schools reporting Average Age fall 2 = 52.58
m is x v, E, 8 a a - w W W 9 s vt P E, 8 a a P P m \o s - cn + c - c P W g 4 - v, v, I v, W w c T c P id g 4 - vt P P W I c h, T c w 2 c W 4 - v, w I w W - w w P I c w h c P id g W w 1J
~~ ~~~ ~~ - Dean/Chair/Director Survev Data (Source: White Paper Task Force Survey, Fail 2) Category Practical Program Adm s Associate Program Adm s Diploma Program Adm s Baccalaureate Pr # of Programs 29 3 9 # of Programs Responding 19 1 3 8 Average Age 48.4 yrs 5.5 yrs 53.3 yrs 5.75 yrs Race - White - Black - Other Academic Prep - Diploma - Associate Degree - BSNursing - BS/BA Other - MSNursing - MS other - Doctorate 18 1 2 3 6 2 3 3 9 7 3 Salary Basis varies from 9 months to 12 12 months - all 12 months - all months, 1 were 11 or 12 months Salary Average $49,239 $58,399 $7,339 $75,965 (12 month equivalent) ~ 2 I 7 1 B. Williams, UCA, 1/21
TABLE 2 Full-Time Faculty Salaries for Arkansas Four-Year Public Institutions 1998 $14. $12, $1, $8, $6, $4, $2, $ 112,617 1 11,188 r 61,575 69,857 58.382 58,44 1 41,727 I 29,133 71,19 I 41,257 16,747 41,13 T 24,79 53,926 1 3,99 81,82-2, L Recommended Salary for Nursing Facub 69.29 5,231 Minimum Mean Maximum1 Data Source: Arkansas Department of Higher Education Data Analysis: UCA Office of lnstilulional Research and Department of Nursing Exclusion: UAMS, department chairs, and faculty on elevenllwelve-month conlract
Table i (cont'd) Full-Time Faculty Salaries for Arkansas Public Institutions Nursing Program Fall 1998' - Number of Salary Standard Skewness Kurtosis Nursing (CIP: 51.16) Faculty Maximum Minimum Mean Deviation Skewness Std Error Kurtosis Std Error - Four-Year institutions: Dtrpartment Chair 7 $78,6 $59,75 $68,564 $6,981 -.81.794-1.266 ' 1.587 Professor 4 62,29 5,329 56,242 5,355.5 1.14-2.692 2.619 Associate Prof Assistant Prof Instructor 21 48 22 55,22 53, 39,911 34,773 27, 25,5 44,739 37,343 33,569 4,784 5,921 3,51.62.578 -.511.51.343.491.177.247.18.972.674.953 Two-Year Community Colleges: Department Chair Instructor 2 54, 5,781 52,391 2,276 34 48,768 24,876 36,376 5,156.238.43.222.788 One-Year Technical Collegesllnstitutions: Instructor 2 49,99 24,188 34,367 6,375.572.512.65.992 Fall 1998 is the latest available dataset. Data Source: Arkansas Department of Higher Education Data Analysis: UCA Office of Institutional Research and Department of Nursing Exclusion: Faculty on elevenhelve-month contract and UAMS due to its data which was not reported by health-related discipline. One-year Technical Institutes: Nursing Faculty Average: $35,777. High : $46,19. Low: $22,838. Data Source & Analysis: Department of Workforce Education, 4/2 Institutional Research 4/6/
\ m N a Table 4: 1999-2 Academic Year Based FuU-time Instructional Mume Faculty Salaries: Comparison Schools by Rank and Degree Level Qw)WnGrarp (N=25 Institutions'; VaM N437 Full-ti Nusing Facultyz).- - Professor Valid N Min Max c)ocewal 89 $33,625 $91,73 Nondocbral Mean $65,356 SD $13,328 25* $78,691 756 $95,858 W u tt tl Y a W a Assodate Rofessor Doclord 219 $36;869 $92,327 Nondodoral 31 34,535 62,697 Assis(ant Professor mtmd 21 7 $31,669 $97,315 Nondactrrat 21 a 3,57 85,6 $52,72 48,781 $45,779 47 $5 $9.992 8,724 98,42 8,W $63,635 62,257 $55'8 I 9 49,89 $75,347 7, $65,78 61,175 5 $28,85 $37.592 156 14,429 6,427 $35,361 37,463 $5,2 9,249 $43,432 KM $5,52 56,63 4 6) rn m c4.. U 4 W 6) m
TABLE 3 AVERAGE NATIONAL CUPA FACULTY SALARIES AT PUBLIC 4-YEAR INSTITUTIONS, 1998-1999 (Rank Order) Law (L.L.B., J.D.) $95,655 Engineering, General $76,655 Chemical Engineering $73,863 Financial Management and Services $73,576 Physical Sciences, General $72,448 Business Management and Administrative Services $71,282 Electrical, Electronics and Communications Engineering $71,259 Dentistry (D.D.S., D.M.D.) $7,196 Mechanical Engineering $68,34 Social Sciences, General $68,8 1 Accounting $67,276 Enterprise Management and Operation Businesshfanagerial Economics S6 i,925 561,122 Agricultural Business and Production $6,99 I Cell and Molecular Biology I $6,22 I Public Health I $6,4 I Zoology $58,53 ReligiodReligious Studies $58,153 Public Administration $58,44 $57,44 Human Resources Management $67,253 Marketing Management and Research $66,571 Civil engineering $66,382 Bioengineering and Biomedical Engineering $66,46 Business Administration and Management $64,22 Information Sciences and Systems $64,49 Economics $63,714 Computer and Information Services $62,784 Mathematics Multflnterdisciplinary Studies $55,156 $54,837 $56,88 I Physical Therapy I $56,458 I Gec!:;ic.-l and Related Sciences 1 $56,249 I I 1 1 All Discipline Average $56,12 Biology, General $55,633 Psychology, General $55,633 Education Administration and $55,482 Social Work $5,88 Technology Teacher Edu./lndusmal Arts Teacher Edu $52,32 Philosophy and Religion Political Science and Government Anthropology $54,83 $54,328 $54,16 General Teacher Education $5,23 Clinical Psychology $49,737 I Criminal Justice and Corrections 1 I $49,734 I
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4 Table 6 FACULTY BY GENDER Select Disciplines in Arkansas Public Institutions Of Higher Education, Fail 1998 DISCIPLINE MALE FEMALE TOTAL # % # % I Art 48 69.6% 21 3.4% 69 Business Management & Administrative Services 24 59.7% 162 4.3% 42 Computer Sciences 61 63.5% 35 36.5% 96 Education, Elementary 32 46.4% 37 53.6% 69 Education, Secondary 123 59.4% 84 4.6% 27 Engineering 11 92.4% 9 7.6% 119 English 154 46.8% 175 53.2% 329 History 92 74.8% 31 25.2% 123 Home Economics 8 2.5% 31 79.5% 39 Music 96 68.6% 44 3 1.4% 14 Nursing 9 4.9% 174 95.1 Yo 183 Phlosophy 29 93.5% 2 6.5% 31 Physical Therapy 11 55.% 9 45.% 2 Speech Pathology 9 42.9% 12 57.1% 21 All Facub. Public Institutions 1556 51.2% 1484 48.9% 3 4 Data Source: Arkansas Department of Higher Education Data analysis: UCA Department of Nursing, 4/2