Nursing Education Programs 2005 - 2006
September 2007 (download pdf file)

Archive: 2004 - 2005

Written by:
Associate Professor Sandra A. LeVasseur
Associate Director, Research
Hawaii State Center for Nursing
University of Hawaii at Manoa
School of Nursing & Dental Hygiene,
2528 McCarthy Mall
Webster Hall 439
Honolulu, Hawaii
Phone: (808) 956-0894
Fax: (808) 956-3257
Email: sandraal@hawaii.edu

Abstract
Forecast data of the registered nurse workforce indicates that Hawaii will experience a growing nursing shortage over the next fifteen years as veterans and baby boomers retire from the profession. Out of this group the most significant effect will be felt in the tertiary education arena where 65% of faculty were 50 years or older in 2006. The aging trend in faculty indicates that we may have young people interested in entering the nursing profession and apply to nursing programs however the qualified applicants will be unable to enter nursing programs because of declining numbers of faculty to teach.

The state of Hawaii has eight nursing education programs. Two are private institutions and six programs are part of the University of Hawaii public system. Nursing programs are located on the islands Oahu, Maui, Hawaii, and Kauai. As of 2006, nursing programs in Hawaii are turning away approximately 14% (255) of qualified applicants from Associate Degree (AS), Bachelor’s Degree (BS), RN-BS programs and 29% (34) from Master’s in Nursing (MSN) and PhD programs.

To strategically address the growing workforce shortage the Hawaii State Center for Nursing and the nursing programs across the state have implemented an annual survey to collect ongoing student enrollment data, student and faculty demographics, and faculty vacancy rates. Trending data will be generated over time to inform workforce planning and policy at the state and regional level.

The University of Hawaii System, School of Nursing and Dental Hygiene and Community Colleges, approves the maximum number of pre-licensure students that may be enrolled (i.e., admission slots) in programs that offer a licensed practical nursing (LPN) diploma or certificate, an associate’s degree in nursing (AS), or a bachelor of science in nursing (BS). Private institutions have unlimited admission slots. However, all programs may have difficulty filling admission slots if they currently lack faculty, facilities, or clinical placement sites to support the number of admission slots. They also may not fill admission slots if there are few qualified applicants, or if admitted applicants do not enroll because of financial or personal reasons or
acceptance to another educational program.

Survey findings indicate that during 2005-06 the percent of admission slots unfilled or filled in the public system were
• 36% (48) of the admission slots for clinical ladder programs were unfilled
• 2% (1) of admission slot for LPN program was unfilled
• 100% (90) of admission slots for AS program were filled
• 9% (13) of admission slots for BS program were unfilled i.e., all of these unfilled slots were in RN to BS programs

In 2005 - 2006, the majority of nursing programs reported they had more qualified applicants than the number of approved / available admission slots. The one exception was the public institutions offering the RN to BS program. These programs had more admission slots available than qualified applicants.

Overall, for the public institutions providing data and enrollment information, an estimated 542 qualified applicants were not enrolled.
• LPN programs reported that 131 qualified applicants were not enrolled
• Ladder programs reported that 122 qualified applicants were not enrolled
• AS programs reported that 210 qualified applicants were not enrolled
• Public pre-licensed BS programs reported 45 qualified applicants were not offered
enrolment and 12 did not take up an offer to enroll. Private pre-licensed BS programs
where an unset number of admission slots are available reported that 791 of qualified
applicants did not take up the offer to enroll
• RN to BS programs offered by two public programs reported 13 slots were unfilled and 2 qualified applicants did not take up the offer to enroll. The one private program reported 1 qualified applicant did not take up the offer to enroll
• MSN programs reported 29 qualified applicants were not enrolled
• PhD program reported 5 qualified applicants were not enrolled

A total of 574 graduates received a LPN, AS or BS in the undergraduate programs; 28 graduates received a MSN and 8 graduates received a PhD in graduate nursing programs in Hawaii for 2005-06. Survey results for the 2005-06 school year show that;
• 71 graduates received a certificate or diploma through a LPN program,
• 79 students in the ladder program completed requirements for the LPN portion of the
program,
• 56 graduates completed the ladder program and received an AS,
• 65 graduates received an AS,
• 302 graduates received a BS,
• 28 graduates received a MSN, and
• 8 graduates received a PhD in nursing.

However, not all undergraduates are new to the practice of nursing. For example, survey data identifies that approximately 7 percent (41) of BS students newly enrolled during 2005-2006 were already licensed as registered nurses (RNs) and returning to upgrade their level of education.
The immediate capacity of nursing education programs to accept students is determined by the availability of faculty, facilities, and clinical placement opportunities. Survey findings related to faculty in Hawaii nursing programs show that:
• Out of the race/ ethnicity data provided on 252 faculty, an estimated 1.2% of faculty
members are identified as African American, 3.2% as of mixed racial / ethnic descent, <1% as Pacific Islander, 3.2% as Hispanic, 3.2% as Native Hawaiian, 23% as Asian, and 65% as Caucasian.
• Out of the age data provided on 132 full time faculty, 68% of full-time faculty are 50
years or older.
• Out of age data provided on 122 adjunct faculty, 63% of adjunct faculty are 50 years or older.
• The overall vacancy rate for full-time faculty positions in nursing education programs is 15% (20 out of 133 positions) and the vacancy rate for adjunct faculty positions is 0% (0 out of 149 positions).

When asked about issues of concern for their nursing program, survey respondents reported most frequently difficulties in filling full-time faculty positions. The lack of sites for clinical placements; followed by the lack of faculty for clinical placements and the lack of classroom facilities were also identified as issues of concern.

Of the eight institutions surveyed:
• 75% report difficulty filling full-time or 50% adjunct faculty positions with a particular
emphasis on certain specialty areas such as medical/surgical, pediatrics, obstetrics, and mental health.
• 63% lack enough sites for clinical placements for nursing students.
• 63% lack faculty to support the clinical placements of students.
• 50% lack classroom space.
• 50% lack funding support.

Numerous factors such as faculty vacancies, limited clinical placement sites and classroom facilities continue to diminish the capacity of nursing education programs to accept greater numbers of students. Even if there is an increase in the number of young people seeking to become nurses in Hawaii, we cannot increase current production without increasing nursing faculty and redesigning how we do business.

In response to the education capacity issues the University of Hawaii statewide nursing consortium is redesigning nursing curriculum and learning strategies to increase flexibility and accessibility. Other initiatives such as simulation labs across the state will help alleviate some of the issues concerning lack of clinical placement sites.

Background
Registered nurses (RNs) are the largest licensed healthcare professional group in the nation with 83.2% (2,421,461 RNs) employed in 2004.¹ The number of RNs with an associate degree increased from 19% (308,616 nurses) in 1980 to 42.2% (1,227,256) of the workforce in 2004. For RNs who completed their initial education in a baccalaureate degree program (BS), the data indicate an increase from 17.3% (287,993) in 1980 to 30.5% (887,223) in 2004. In addition, an estimated 0.5% of RNs in 2004 (15,511) received their initial nursing education through a master’s or doctoral degree program.¹

The supply of registered nurses is said to be dependent upon the number of new nursing graduates entering the profession, and the number of existing nurses remaining in the workforce. However the rapidly aging population will have significant impact on the number of nurses working in the profession. In March 2004, the National Sample Survey of Registered Nurses (NSSRN) identified that the national average age of the registered nurse population was 46.8 years, more than 4 years greater than in 1996 when the average age was 42.3 years.¹ Nursing faculty who educate new nurses, have an average age of 46.8, but more concerning is those with doctorates in nursing or related fields average 55.7 years.¹

The global nursing shortage is projected to worsen as RNs in the veteran and baby boomers generations retire; fewer young people choose nursing as a career; and high burnout rates up to 40% in the present international nursing workforce continue.^2-4 The American Association of Colleges of Nursing (2004)⁵ reported that 614 faculty vacancies were identified at 300 nursing schools across the country. This vacancy rate is projected to increase as the rate of retirement accelerates over the next ten years.⁵ Lack of faculty is affecting both the overall nursing shortage and the capacity of nursing programs to accept and teach students who could join the nursing workforce.⁶ Nursing programs across the country will not be able to slow the decline in workforce without increasing nursing faculty.

The Hawai’i State Center for Nursing (HSCFN) was established by the Hawaii State Legislature in 2003 “to address nursing workforce issues” Act 198 (HB 422 HD2, SD2, CD1, SB 2072). The primary functions of the HSCFN include:

1. Collect and analyze data and prepare and disseminate written reports and
recommendations regarding the current and future status and trends of the nursing
workforce;
2. Conduct research on best practice and quality outcomes;
3. Develop a plan for implementing strategies to recruit and retain nurses;
4. Research and report data related to the retention of the nursing workforce.

The Center’s mission focuses on a number of workforce issues underlying the nursing shortage. These include capturing nursing supply and demand data, developing and implementing recruitment and retention strategies that target nursing staff and faculty, and establishing data surveillance and reporting system to trend educational capacity of nursing programs.

Purpose
In light of the growing nursing shortage in Hawaii the HSCFN has identified the need for the annual collection of statewide data concerning student enrollments and nursing education capacity. The primary purpose of annual surveying will be to collect and track; the types of programs offered, enrollment capacity, the number of graduates, student and faculty demographics, and current factors impacting program capacity. The data will provide the means for trending Hawaii’s nursing supply and inform statewide nursing workforce planning.

Methods
In 2005, the Hawaii State Center for Nursing began conducting annual surveying of all nursing education programs in the State. The Hawaii State Center for Nursing utilizes the Michigan Center for Nursing’s survey instrument developed by the Public Sector Consultants Inc. (PSC).⁷

In November 2006, the second annual survey ‘Survey of Nursing Education Programs’ was mailed to the eight education institutions that offer nursing education programs in the State of Hawaii. Several follow-up phone calls and e-mail notices were used to prompt response to the survey. By March 2007, surveys were returned by all eight institutions.

Survey recipients were requested to complete the survey with information for all nursing education programs offered during the 2005-2006 school year. If they were unable to report actual numbers, they were offered the options of providing an estimate (and labeling the data as an estimate) or indicating that the data were not available. Several programs indicated that they did not keep information on the demographic variables’ and/or break out information on the demographic variables of their student population and/or faculty. Some programs were unable to provide the number of students enrolled. Some programs provided an estimate of student numbers. Response rates are indicated in the data tables.