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 capacity¹³ 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. 

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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.