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Critical Condition

Jean Wortock, the nursing dean at St. Petersburg College, is worried. With just weeks to go before classes begin, she's short about five instructors and is wondering whether she'll be able to fill the slots in time. "It's a challenge. Finding faculty is a real issue," says Wortock. Meanwhile, prospective nursing students continue to line up -- hundreds are wait-listed until January 2008, with little hope of starting their studies earlier.

Wortock finds herself in the bottleneck of a problem that begins with a shortage of registered nurses. The Florida Hospital Association estimates there are about 3,000 vacant registered nurse positions in hospitals around the state -- an 8.2% vacancy rate -- and says the shortage is going to get worse.

The demand for professionals has prompted a surge in applications from people wanting to become nurses. Schools, in turn, have scrambled to ramp up their nurse-training programs; the Legislature has even chipped in $10 million in the form of a grant program that pays schools up to $500,000 to fund programs to increase enrollment.

The schools' biggest problem, they say, is finding faculty -- even when they have funded positions. While the number of teaching positions increased by 7.1% in 2004 to 1,708, faculty vacancies escalated by nearly 20% to 92.

Florida's overall nursing faculty vacancy rate last year was 9%. In the Panhandle, more than one in five budgeted nursing faculty positions is vacant, according to the Florida Center for Nursing. The Agency for Workforce Innovation, Labor Market Services predicts that there will be 94 annual openings for nursing instructors statewide through 2009. Vacancies can commonly take up to six months to fill, and some positions can stay open for up to two years, the nursing center estimates.

Kathleen Ann Long, University of Florida College of Nursing dean, calls the faculty deficit the "dirty little secret" that no one wants to talk about. "The nursing shortage actually pales in comparison to the nursing faculty shortage, which is anticipated to get much worse over the next decade," Long says.

Complicating matters is the fact that the schools are competing for talent in the same labor market they're trying to serve -- research institutions, hospitals and other healthcare providers, including health staffing services that find highly paid "per diem" work for nurses.

Increasingly, the private sector is offering incentives that schools can't match. Employee referral fees, sign-on bonuses and relocation or startup bonuses can boost a nurse practitioner's pay to at least $60,000 annually. The average sign-on bonus in Florida for an RN was $4,366 last year, according to the Florida Hospital Association.

Teaching spots don't pay nearly as well. Nursing instructors can expect to earn somewhere in the mid-$40,000s to the mid-$50,000s, or $50,000 to $60,000 if they have a doctorate.

Further complicating matters is age. The average nurse in Florida is 47.3 years old -- compared to 43.3 nationally -- and the average age of nursing faculty in Florida is 56. Within three years, an estimated 143 of Florida's 795 nursing school instructors will retire, predicts the Florida Council of Nursing Education Administration.

"The nursing shortage actually pales in comparison to the nursing faculty shortage, which is anticipated to get much worse over the next decade," says Kathleen Ann Long, dean of the University of Florida College of Nursing.With too few teachers, schools are having to turn away potential students in droves. The nursing center reports that 6,243 qualified applicants were turned away from educational programs last fall. Florida Atlantic University recently said no to 350 qualified students applying for the 2005 fall semester. At the University of North Florida, more than 1,200 applicants recently applied for a mere 120 spots.

UF estimates that for every student it accepts into the nursing program, it places one to two other qualified applicants on waiting lists. "People realize that nursing is a good job. It offers great flexibility, great financial security, and if there's such a shortage, why not come and join this wonderful profession?" says Pam Chally, dean of UNF's College of Health. "But now we can't accommodate everyone who wants to join this wonderful profession."

Adds Anne Boykin, dean and professor at FAU's Christine E. Lynn College of Nursing: "I think that we in the state of Florida, as well as nationally, all face a similar situation. We are all turning away huge numbers of students."

Getting Creative
Schools are pioneering new approaches to meet the demand for nurses and nursing faculty.

To try to meet the simultaneous demand for nursing faculty and nursing practitioners, many of the state's schools are pioneering new programs. "Every school is interested in how they can expand capacity without compromising the quality of the program," says Robert Rosseter, spokesman for the American Association of Colleges of Nursing. Some programs involve accelerated academic programs or partnerships with private healthcare companies that use the hospitals' clinicians to teach students, thereby relieving faculty and staff workloads.

Of particular concern is the need for faculty with advanced degrees. The nursing colleges association is recommending that schools also adopt revised retirement policies to allow retiring faculty to work part time and develop non-monetary incentives -- like conference reimbursement, recognition programs and adding graduate assistants -- to improve retention rates.

A look at the range of responses from schools:

Accelerated Programs
In 2004, Tenet Healthcare Corp. and Tenet South Florida gave FAU's College of Nursing a $547,740, two-year grant to help fund the school's accelerated bachelor of science nursing program. The fast-track programs, which are taking hold around the state, allow students who already have a degree in another field to pursue their nursing degree in just 12 to 14 months instead of the usual four to five years. All 22 of the students enrolled in FAU's first accelerated program graduated this past May and found nursing positions. "Every single one has a job. All of them stayed in Florida," says Anne Boykin, FAU's nursing school dean.

"We are all turning away huge numbers of students," says Anne Boykin, dean of FAU's Christine E. Lynn College of Nursing. Boykin's school received a $547,740 grant from Tenet Healthcare and Tenet South Florida for its accelerated nursing program.It's not uncommon for such students to double up on classes to earn their master's degree and then advance directly into a doctoral program -- putting them in line for faculty positions in their late 20s.

At UF, three graduates from the school's BSN-to-Ph.D. track are already working in nursing education. Patrick Heyman, a 1999 graduate of the program, for instance, is an assistant professor at Palm Beach Atlantic University's School of Nursing.

Tenet has funded similar grants elsewhere in the state: Nova Southeastern University received a two-year, $341,050 grant last year to fund the first ever entry-level accelerated bachelor of science in nursing program in Broward County.

Boykin notes that there are no promises for future funding for the school's accelerated baccalaureate program past the first two-year window. She says contributions are "soft" and worries that the money could dry up. "What if everybody said 'Sorry, we have no money.' We're back to 60 students," she says.

Faculty Incentives
The West Palm Beach-based Quantum Foundation has donated more than $1 million to FAU and Palm Beach Community College to help the schools recruit and retain nursing faculty. Quantum's funding of FAU's Nursing Faculty Enhancement Awards allows the school to recognize faculty members with $5,000 or $10,000 lump sum awards.

Recruitment Efforts
In February, 25 nurse practitioners participated in the new "A Day in the Life of a Faculty Nurse" program sponsored by the West Central Florida Health Care Recruiters Association. The program allowed nurses considering a career switch to shadow a nursing school faculty member for a day. At Manatee Community College, one of the three nurses who shadowed an instructor has applied for a job at the college.

St. Petersburg College has teamed up with local hospitals to supplement its faculty. Bay Pines VA Medical Center, for instance, provides a full-time "doctorally prepared" professor to coordinate the school's clinical placements. All Children's Hospital has provided the school with a nursing care management instructor. Wortock, SPC's dean, says that St. Petersburg College President Carl Kuttler convened a lunch meeting in the spring of 2003 for chief nursing officers and healthcare company CFOs -- a key move that got the ball rolling.

FAU has also received financial support from several local hospitals and healthcare organizations -- such as JFK Medical Center, Martin Memorial Health System, HCA, Holy Cross Hospital, Boca Raton Community Hospital -- to help support faculty positions. With the donations, the school increased its number of students from 60 to 80. Adding a program at the university's Port St. Lucie campus, where Martin Memorial is supporting a faculty position, has allowed another 20 students to come on board, boosting the program's enrollment to 100.

Last year, Manatee Community College was able to cut its waiting list for prospective students thanks to HCA Affiliated Hospitals, which provided the school with two additional clinical instructors, allowing it to accommodate another two dozen students. An HCA spokeswoman says the company has spent over a quarter of a million dollars on funding faculty positions for schools in southwest Florida.

Long-distance Learning
UF organized the North Florida Ph.D. Consortium in 2002 to allow students across the northern part of the state to have access to doctoral level nursing education through distance learning technology, including the web. UF, Florida A&M University, Florida State University and the University of North Florida all participate in the program. The University of West Florida is considering taking part.

Long, UF's nursing school dean, says the program is a cost-effective approach to widening the reach of doctoral programs. Already into its fourth year, the program will graduate its first students this summer.