Thursday, December 17, 2009

The Supply of and Demand for Nursing Faculty in Rhode Island

Commentary

By Professor Matthew M. Bodah
Director of Research
Chair, Department of Economics

The demand for nursing faculty in Rhode Island
    In 2004, the Rhode Island SHAPE Foundation published a report entitled Help Wanted: The Growing Crisis in Rhode Island's Nursing Workforce (also known as the SHAPE II study.1 According to the report, if the "inflow" and "attrition" rates of 2004 persisted, by 2020 the Rhode Island would have only about 50 percent of the approximately 16,000 nurses needed to care for its population.2
Trends in enrollments in nursing programs
    Since the SHAPE II study, however, enrollments in Rhode Island's five nursing programs3 have grown approximately five percent per year
.4 Further, in the three years prior to the SHAPE II the study (2001 to 2003), the programs graduated an average of 390 pre-licensed students.5 per year. But, by 2007, the number of graduates had risen to 506.6 If Rhode Island programs had continued to graduate approximately 390 students per year, then between 2007 and 2020 they would have produced fewer than 5500 graduates. But if programs continue to grow at the same rate they have since the SHAPE II study, that number could be more than 10000. This difference of nearly 5000 graduates would erase a good portion of the projected deficit of 8000 nurses.7
    Table 1 displays the estimated number of new students and total enrollments in Rhode Island nursing programs under three growth scenarios: zero percent, two and one-half percent, and five percent annual growth in the number of new pre-licensed students over the 2007-2008 academic year. Total enrollment figures also include licensed students, such as those in graduate or RN to BSN8 programs.

Table 1. New students and total enrollments in Rhode Island nursing programs assuming 0%, 2.5%, and 5% growth over 2007-2008 figures, 2009-2020.

New students
Total enrollment

0%

growth
2.5% growth
5%

growth
0%

Growth
2.5% growth
5%

growth
2009
668
702
736
2124
2332
2342
2010
668
719
773
2124
2287
2459
2011
668
737
812
2124
2344
2582
2012
668
756
853
2124
2403
2711
2013
668
775
895
2124
2463
2846
2014
668
794
940
2124
2525
2989
2015
668
814
987
2124
2588
3138
2016
668
834
1036
2124
2653
3295
2017
668
855
1088
2124
2719
3460
2018
668
876
1143
2124
2787
3633
2019
668
898
1200
2124
2857
3814
2020
668
921
1260
2124
2928
4005
Cumulative growth
0%
38%
87%
0%
38%
87%

    In Table 2, total enrollment data are separated by program type. The public programs are at the Community College of Rhode Island, Rhode Island College, and the University of Rhode Island. The private programs are at Salve Regina University and Saint Joseph School of Nursing. As we can see, over eighty percent of Rhode Island nursing students are enrolled at public colleges and universities.

Table 2. Total enrollment in Rhode Island nursing programs assuming 0%, 2.5%, and 5% growth over 2007-2008 figures, by program type, 2009-2020.

Public
Private

0%

growth
2.5% growth
5%

growth
0%

Growth
2.5% growth
5%

growth
2009
1725
1812
1902
399
419
440
2010
1725
1858
1997
399
430
462
2011
1725
1904
2097
399
440
485
2012
1725
1952
2202
399
451
509
2013
1725
2000
2312
399
463
535
2014
1725
2050
2427
399
474
561
2015
1725
2102
2549
399
486
590
2016
1725
2154
2676
399
498
619
2017
1725
2208
2810
399
511
650
2018
1725
2263
2950
399
524
682
2019
1725
2320
3098
399
537
717
2020
1725
2378
3253
399
550
752
Cumulative growth
0%
38%
87%
0%
38%
87%

Are the recent growth rates likely to continue?  
    According to the Rhode Island Department of Labor and Training's Occupational Outlook 2016, nursing is expected to have 4530 openings between 2006 and 2016, which is more than any other occupation in the state.
9 Further, nearly all other occupations expected to have more than one thousand openings are relatively low-paying (e.g. food preparation workers and home health aides). Therefore, it is likely that interest in nursing will continue for those who are willing and able to gain the required education. 
    Working against this trend is the current economic situation, which, according to recent press reports, has led to a slowdown in hiring at many of the state's hospitals.
10 Once the economy improves, however, it is likely that hospitals will once again begin hiring nurses. According to the System Wide Labor Forecast Report 2007-2025 prepared by Lifespan, the state's largest hospital network and largest employer of nurses, the most critical shortage will occur after 2015 when the current cohort of nurses begins to retire in large numbers.11
    Therefore, we believe that through 2020 there will be a growth of interest in nursing. Whether Rhode Island can accommodate this growth depends largely on the educational capacity of the state's nursing programs. And while educational capacity depends on a number of factors—classroom space, equipment, etc.—most critical is the number of faculty qualified to teach in nursing programs.
The supply of nursing faculty in Rhode Island
     Table 3 displays the number of faculty by type of appointment and type of institution in Rhode Island nursing programs at the beginning of the 2008-2009 academic year.
12

Table 3. Number of faculty by type of appointment and institution, 2008-2009 academic year.

Public institutions
Private institutions
Tenured
51
3
Tenure track
37
0
Limited appointment
39
17
Total full-time
127
20
Per course
68
25
Note: St. Joseph School of Nursing does not use the same faculty ranks that the colleges and universities. Its "nursing instructors" are classified as limited appointment faculty, since their employment situation is similar to full-time instructors on year-to-year contracts at the colleges and universities.

    The average age of a faculty member, however, is 53 years, and only five percent of all current faculty members are over 65. Therefore, if we assume that most faculty members will retire by 65, we are facing substantial attrition of current faculty members in the near future. The percent of faculty members likely to retire and the percent of teaching capacity
13 lost by 2020 are displayed in Table 4.

Table 4. Percent of faculty like to retire and teaching capacity lost due to retirement by 2020 by type of appointment and institution.

Public institutions
Private institutions
Tenured
78%
100%
Tenure track
43
NA
Limited appointment
41
65
Per course
40
44
Teaching capacity lost
56
63

    A further point is that retirement is not the only reason faculty members leave. According to data from Rhode Island nursing programs, during years 2003 to 2008, 36 faculty members, including per course faculty, left for reasons other than retirement. If approximately seven faculty members per year continue to leave for reasons other than retirement, by 2020 approximately 200 of the current cohort of 240 faculty will no longer be teaching. That is a loss of nearly 85 percent of all faculty by 2020. 
Bringing supply and demand together
Current student/full-time faculty ratios across public programs are approximately 14:1, and across private programs approximately 20:1. Focusing exclusively on full-time faculty, Table 5 display the number faculty members that will be needed in 2020 if enrollments grow at the rates suggested in Table 1.

Table 5. Number of full-time faculty needed at current student/teacher ratios, in 2020, assuming zero, two and one-half, five percent growth rates.
Public institutions

0%
2.5%
5%
Current number
127
127
127
Number needed
127
170
232
Number remaining
43
43
43
Number to hire
84
127
189
Replacements
84
84
84
New positions
0
45
107




Private institutions
Current number
20
20
20
Number needed
20
28
38
Number remaining
4
4
4
Number to hire
16
24
34
Replacements
16
16
16
New positions
0
8
18




Note: "Number remaining" accounts for likely retirements and further assumes that twelve faculty members will leave public institutions and two will leave private institutions by 2020 for reasons other than retirement.

Conclusions
    Recruiting and retaining nursing faculty to support a growing demand for educational capacity is a nationwide problem. Scores of studies have documented findings similar to ours: faculties are likely to shrink just as the demand for faculty is rising. In Rhode Island, even if there were no growth in the nursing programs to 2020, approximately one hundred new full-time faculty members would need to be hired to maintain current—and not necessarily optimal—student/full-time faculty ratios. But if a growth rate of one-half of recent trends (i.e. 2.5 %) is sustained through 2020, we would likely need to hire over 150 new full-time faculty members. If five percent growth rates continue, then approximately 225 new full-time faculty members would be needed.
    Since the situation at public programs is likely to require a response from government, it is useful to focus on the hiring needs of those institutions. Across institutions, we estimate that approximately 84 full-time faculty members will need to be hired simply to replace those likely to retire or to leave by 2020, even without any growth in the numbers of students. If programs grow by 2.5 to five percent, then between 127 and 189 new full-time faculty members would be needed, including between 45 and 107 on new lines rather than on the existing lines of those currently employed.
    In light of national trends, these numbers are daunting, require quick action, and novel solutions. We must recognize that the task is difficult and made more so by the competition with other states. 


Notes
1. Rhode Island SHAPE Foundation. 2004. Help Wanted: The Growing Crisis in Rhode Island’s Nursing Workforce.
2. According to the Rhode Island Department of Labor and Training’s Occupational Employment Survey, there were 11360 Registered Nurses in the state in May, 2008. There were also 1610 Licensed Practical and Licensed Vocational Nurses. See www.dlt.ri.gov/lmi/oes.htm.
3. This research is based solely on the five nursing programs existing in 2008. Since then, the New England Institute of Technology has begun creating a nursing program.
4. Based on original research conducted in the summer and fall of 2008.
5. “Pre-licensed students” are those who do not hold a RN license. Also enrolled in RI nursing programs are students who hold RN licenses, but are working toward a bachelors or graduate degree.
6. See Hospital Association of Rhode Island “RI School of Nursing Data, 2001-2008 at http://www.hari.org/nurse/sondata.pdf
7. According to data from the Hospital Association of Rhode Island, since 2000 approximately two-thirds of RNs in Rhode Island have become licensed through endorsement rather than examination. Those licensed through endorsement were first licensed in other states. Although the high proportion of those licensed through endorsement is likely symptomatic of the current nursing shortage and not optimal in the long run (e.g. many such nurses work for staffing firms, are expensive to employ, and have little long-term attachment to the Rhode Island force), Rhode Island nursing programs need not produce one hundred percent of the nurses practicing in the state.
8. An RN to BSN program is a bachelor’s degree program designed for someone who obtained an RN license after completing an associate degree or nursing diploma program.
9. See Rhode Island Department of Labor and Training Occupational Outlook 2016 at www.dlt.ri.gov/lmi/pdf/opportunities.pdf
10. See, for example, Hamilton, William. 2009. Nursing demand slowing in Rhode Island. Providence Business News on-line edition, www.pbn.com, posted May 16.
11. Scott, Cynthia. 2007. Lifespan System Wide Labor Forecast Report: Staff RNs, Radiologic Technologists, Managers.
12. Based on original research conducted in the summer and fall of 2008.
13. Programs were asked to provide data on the “full-time teaching equivalency” of faculty. For example, a the normal teaching load for a full-time faculty member were six courses per year, and an individual teaches three courses per year, then full-time teaching equivalency would be .5. From this data, teaching capacity was calculated.

No comments:

Post a Comment

Post a Comment