Faculty Shortages in Doctoral Nursing Programs
The most important resource for doctoral nursing education programs is the faculty (Wood and Ross-Kerr, 2003), if the stated purpose of doctoral education for preparing scholars and scientists who will develop disciplinary knowledge is to be fulfilled. Recruitment and retention of qualified faculty members creates a greater challenge for leaders in developing and sustaining quality doctoral programs.
As nursing and nursing education advance worldwide, there is an increasing need for doctoral nursing programs. Likewise, there is a growing need for qualified faculty to offer mentorship and guidance to graduate students studying in doctoral programs. This chapter focuses on the worldwide faculty shortage in doctoral programs, and possible reasons for such shortages.
We will give examples of the prevalence of this faculty shortage in several countries and discuss the relationship between the nursing shortage in general and the faculty shortage in doctoral programs.
The challenges of faculty recruitment, retention and return will be discussed as well as the effects of faculty shortage on recruitment and retention of doctoral students. Finally, we will discuss creative solutions to the problems presented and give examples of strategies already in use to address faculty shortages in doctoral programs.
Prevalence Of Faculty Shortages in Doctoral Programs
In Canada, the need for doctorly prepared faculty continues to increase for a variety of reasons. First and foremost, over the past 12 years, the number of Canadian doctoral nursing programs has increased from one in 1991 to 11 in 2003. In addition, the earlier programs that began with limited numbers of doctoral students are now expanding.
As the number of doctoral programs increases and the student numbers in each program increases, there is a corresponding need for qualified faculty. At the same time, Canadian nursing continues to move towards baccalaureate level entry for practice. Schools of nursing across the country are therefore seeking doctorly prepared faculty to offer leadership in a growing number of undergraduate programs.
Also, governments across Canada are increasing the numbers of seats allocated to nursing programs to prepare an appropriate number of nurses for the changing Canadian population of the future. As a result of all of these factors, Canadian educational institutions face severe shortages of adequately prepared faculty for the growing number of undergraduate and graduate programs (Association of Universities and Colleges of Canada (AUCC), 2002).
While the number of nursing education seats filled across Canada has increased by approximately 40% between 1998/99 and 2000/01 (O’Brien-Pallas et al, 2002), and is expected to continue increasing, the number of faculty members is predicted to decrease. This decrease is due largely to the fact that 49.6% of university professors and 37.7% of college instructors will retire by 2010 (Association of Colleges of Applied Arts and Technology, 2001).
While geographically close, the dynamics of faculty shortages in the USA are quite different from those seen in Canada. Some basic statistics will help to put the picture in perspective: despite concerted efforts by the profession and governmental agencies to have at least 1–2% of nurses educated at the doctoral level, as of the year 2000, only 0.6% of all nurses in the USA held a doctorate.
Only 82% of these are employed in nursing; 66% of those not employed are 55 years or older, suggesting a relatively early retirement age. The average age of faculty was 52.6 years; the average age when the doctoral degree was received was 43.9 years; and 20.8 years had elapsed between receipt of basic nursing education and the doctoral degree ( Geolot , 2003).
These figures reflect a longstanding tradition that has built around graduate nursing education; it is only recently that we have come to realize its negative ramifications. In the USA, for example, the average age of assistant professors (with doctoral preparation) is 50.4 years (Berlin et al, 2002).
Due to late entry into doctoral study and late graduation, individuals with doctorates assume beginning faculty positions in their mid-forties, at a time when other faculty are attaining seniority. This leaves them 15–20 years during which they have to develop into expert teachers, obtain significant external funding for their programmatic research in an area of nursing science, publish their findings and have serious impact on practice.
They also have to provide leadership within the profession at the national and international levels and become recognized as experts (Hinshaw and Ketefian , 2001). Clearly, the short time available to these individuals is insufficient to build the kind of scholarly academic careers expected of senior university faculty and creates a high degree of pressure and stress in these individuals that is counterproductive.
In the next 5–10 years large numbers of nursing faculty are expected to retire. Some institutions are developing plans to hire a certain number of new graduates each year to groom them to fill the expected vacancies.
At the same time, many states across the USA are in financial crises and are reducing their budgets, including those of the universities they support. Thus the plans some institutions have made are not being realized due to retrenchment as a result of budget constraints.
Relationship Between Nursing Shortage and Faculty Shortage
Some of the increased need for doctorally prepared faculty in North American countries relates directly to the increased need for nurses in general. These countries will need increased numbers of nurses to provide care required for an increasing proportion of elderly people in the population.
Some of the increased need for nurses also relates to the decline in the number of registered nursing graduates each year. In Canada, for example, the numbers have decreased from approximately 8000 graduates per year in the early 1990s to 4000 graduates in the year 2000 ( Ryten , 2002).
The Ryten Report suggests that approximately 12,000 nursing graduates are required per year to sustain the nursing profession. While approximately 12,000 registered nursing students enroll in Canadian nursing programs each year (O’Brien-Pallas et al, 2002), there is approximately a 30–50% attrition rate (Registered Nurses Association of Ontario, 2002).
The shortages of nurses in general led to governments increasing the number of seats in educational institutions preparing nurses and this in turn leads to a need for increased numbers of qualified faculty members.
Nursing shortages are reported in various countries around the world, with varying causes.
For example, Thailand is undergoing healthcare reform, following adoption of a new constitution. The philosophy and concept of universal health coverage has been adopted, which requires that 10,000 health centers around the country be staffed by professional nurses, and many do not have qualified nurses yet.
Finland reports a nursing shortage, which is expected to get worse as the population ages, while the Netherlands and Sweden report shortages in specialized areas of practice rather than across the board. The USA has been experiencing a severe shortage of nurses for a number of years.
This situation, while serious, has been a cyclical occurrence since the late 1940s and in different eras, different explanations have been offered by economists, nurses and policy makers. Some of these shortages have occurred during economic downturns, but others have not. During economic hard times, schools of nursing have seen an increase in the number of graduate students enrolled at the master’s and doctoral levels.
Currently, while the nursing shortage continues, there has been no appreciable decrease in applications and enrollment into doctoral programs. This is not an unreasonable picture, when one remembers that, typically, 15–20 years elapse before most individuals begin doctoral study following graduation from their basic nursing education programs, so that the pool of applicants for these programs is not newly graduating individuals, but rather, those who have been in practice for some time.
In Europe, a shortage of nurses has been developing since the 1980s. The main reason for this was the view of some conservative governments that there were too many nurses and that unqualified nursing aides could undertake much of nursing work. Furthermore, the number of other non-nursing university degree programs that were open to young women increased, making it easier for them to gain a place in medical school or fields such as engineering, mathematics and architecture.
This, alongside a trend towards smaller family size, meant that the recruitment pool for nursing schools was shrinking. Across Europe, the response to the shortage of nurses has been threefold: increase in number of nursing students and nursing schools, increase in recruitment from overseas (mostly from the Philippines) and introduction of initiatives to recruit, retain and encourage nurses to return to the profession.
The first of these initiatives has had great implications for university schools of nursing. Unlike the USA, Australia and Canada, nursing within Europe has only recently entered the university sector. In the UK, for instance, there were only ten university-based schools of nursing in the early 1990s.
Due to changes in governmental policies and mandates, today there are 72, each requiring well-qualified faculty. Other European countries have experienced similar, although more modest increases.
Many of the faculty who were recruited came from hospital-based schools of nursing which were not affiliated with universities. Hence, they were not qualified at the doctoral level and in some cases did not even possess a baccalaureate degree. They tended to be experienced in teaching and in administering educational programs and soon realized that the route to better pay and promotion within the universities was through research and publication.
Therefore, many enrolled in doctoral programs on a part-time basis while holding down heavy teaching and administration roles. Furthermore, many were, and continue to be, over the age of 50. This age is even higher than that reported for the USA. In some European countries, the increase in the number of faculty undertaking doctoral studies has been matched by an increase in the number of doctoral students who are not faculty.
These individuals tend to be clinically based, over the age of 35, who begin doctoral study because they are disenchanted by clinical nursing and desire to find a job in the burgeoning university schools of nursing. In contrast, some individuals from this group are seeking to obtain a doctorate so that they could obtain a promotion to a clinically based advanced nursing practice role.
As in other countries and regions, there is a shortage of faculty with doctoral degrees in Europe. This has implications for the mentoring of the increased number of doctoral students referred to above. Some faculty have taken early retirement or simply resigned because of stress caused by trying to juggle research, teaching, administration and clinical roles. With improvements in pay and conditions within clinical settings and the drive there for research expertise, many of these have gained employment in hospitals.
The adequacy of faculty numbers and the level of their qualifications vary greatly across countries. Some countries report having a sufficient number of graduate programs, but at the same time, experience faculty shortages. Most countries desire a doctoral qualification for teaching at the graduate level, but have not achieved this goal.
In some cases master’s-prepared individuals are teaching at the graduate level due to insufficient number of faculty qualified at the doctoral level. Another ‘cost’ that is paid but not frequently discussed is the reality that due to insufficient number of qualified faculty, the workload of those with appropriate qualifications is so heavy that it precludes research activity, which seems to be sacrificed to make room for more teaching responsibilities.
Additionally, some countries are in the process of educating more individuals at the doctoral level, but upon assuming faculty roles, these new faculty are given limited graduate teaching responsibilities due to their inexperience; They themselves need some years of mentoring before they can mentor graduate students.
In the case of other countries, the shortage is that of positions not being available or funded, rather than having a shortage of individuals, who could be recruited and hired were funded to be made available.
In these instances, individuals with doctoral preparation work in a variety of settings while, in some countries such as Brazil, doctoral graduates work mainly in faculty roles, as there is not sufficient appreciation or understanding in other sectors and markets of the type of contribution such individuals can make.
As the examples from Canada, the USA and Europe illustrate, each country presents its own dynamic reasons and factors that impinge on nurse faculty supply. It needs to be noted that some countries do not report shortages. However, this has to be seen in perspective, and one has to consider who is doing the reporting, and for what purpose.
For example, the nurses in the Philippines report a severe shortage of nursing and nursing faculty, yet, the country is a major exporter of nurses. The Philippines was the first country in the world that standardized its educational system by offering all nursing education within four year colleges and universities. It now produces more qualified nurses than the country can absorb; Therefore, it has become a major exporter of nurses to the rest of the world.
These nurses travel elsewhere and earn higher wages than they would be able to at home, and send funds to support their families, thus contributing to the national economy in significant ways. In Europe, hospital managers have recruited many Filipino nurses. These nurses can get five times the salary they get in the Philippines. This has had the effect of Filipino doctors training to be nurses so that they can get a job overseas.
The question that still needs to be answered is Does the Philippines have a nursing shortage? Those assessing the health care system in that country would give a resounding yes answer.
Those taking an economic view of the picture would say that the country cannot employ these nurses, nor would most nurses prefer to work at the low salaries they would receive in their home country, and that exporting them makes sense for the country when considering the overall economic health of the country.
In some other countries such as Brazil, the number of nursing personnel has been historically insufficient, a situation that has led to the creation of different types of personnel to meet the needs of the population.
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