Jan. 18, 2002
Volume XXXV, No. 3


Of Note


Q & A on nursing shortage



The UTHSC School of Nursing is educating nurses to serve San Antonio and South Texas. The School of Nursing offers the bachelor of science in nursing degree and collaborates with the Graduate School of Biomedical Sciences to offer the master of science in nursing and doctor of philosophy in nursing and doctor of philosophy degrees. We sat down with Dr. Janet Allan, dean of the school, and Dr. Brenda Jackson, associate dean, to discuss today's shortage of nurses and the school's response.

Q: How do we know what types nurses are in the scarcest supply?
A: We get figures from the Nursing Workforce Center, which collected the data for the Texas Nurses Association (TNA). Dr. Antonio Furino, professor in the department of family and community medicine, led the group compiling the figures. TNA is the only organization that has elicited comprehensive statistics statewide. The Texas Board of Nurse Examiners has data on the number of licensed registered nurses (RNs) in the state, and a similar board keeps data on licensed vocational nurses (LVNs). We also receive informal data from our clinical partners — local tertiary, skilled nursing and community health facilities. The shortage affects both "generalist" nurses with associate's or bachelor's degrees and "advanced practice" nurses with master's degrees.

Q: What does the School of Nursing do to meet the nursing shortage?
A: In the last two years, we have increased the undergraduate enrollment. We began admitting larger classes in the spring of 2000. We have gone from 60 students admitted per semester to 100. But last fall we admitted an even larger number — 170 new students (120 generic and 50 flexible-process RNs and LVNs) — and our total undergraduate enrollment is now 485. The undergraduate program is general in that the students rotate through all the clinical specialties of nursing. The graduate programs are devoted to specialties. Students can study to become pediatric nurse practitioners, family nurse practitioners, acute care clinical specialists or nursing administrators. In the last few months, we received federal funding to develop a major for students who want to become geriatric nurse practitioners.

Q: Do we have figures on how many School of Nursing graduates are practicing in the various counties of South Texas?
A: We monitor the percentage of our graduates who work in South Texas. From our undergraduate program, it's close to 90 percent. Most of the graduates with nurse practitioner majors also work in South Texas.

Q: We encourage some nurses to stay in South Texas by offering courses in their own cities, such as Del Rio. How is that going?
A: A number of nurses who are already LVNs or RNs are coming to us to get their baccalaureate degrees in nursing. They need the advanced education to move into nursing administration roles. This strengthens nursing professional practice in South Texas. One of the problems in the state of Texas, and particularly in South Texas, is the shortage of baccalaureate-prepared and advanced practice nurses. We are meeting that need by providing distance-education classes in Del Rio and other cities. The nurses with baccalaureate and advanced practice backgrounds can function in less structured settings, such as community health and other rural practice sites, where they would need to be more independent.

In another initiative, we helped UT Brownsville develop its baccalaureate and master's degree programs in nursing between 1990 and 1998. We sent faculty to the Rio Grande Valley to teach the courses. We still consult with UT Brownsville. In that way, we helped meet the region's need and strengthened another university. We also offer our doctoral program through a combination of interactive video and on-site instruction at Texas A&M University, Corpus Christi.

Q: What other ways is the School of Nursing addressing the nurse shortage problem?
A: One of the direct ways is working with the Greater San Antonio Hospital Council. A Health Care Summit was held under the leadership of County Judge Nelson Wolff and the Greater San Antonio Hospital Council to address five critical community health issues — financial challenges, trauma care, the workforce, disease prevention and mental health. Dr. Marilyn Harrington, dean of the School of Allied Health Sciences, Dr. Mickey Parsons, associate professor in the School of Nursing, and [Dr. Allan] developed the briefing paper on workforce issues. For the workforce issue, four task force panels have been appointed to address issues including recruitment of nurses and faculty, developing clinical experiences for students and developing the health care team of the future, and resources to accommodate the increased numbers of students and faculty through scholarships and support for faculty salaries.

I want to emphasize that the faculty shortage is as acute as, if not more troubling than, the shortage of clinical nurses. To educate increased numbers of students, we must educate more faculty. To be hired in a faculty position, an individual must have either an MS in nursing or a doctoral degree. The average age of current employed faculty in nursing programs in the state is 55. The rate-limiting factor to increasing nursing enrollments is the lack of sufficient faculty. The Board of Nurse Examiners requires a 1 faculty to 10 students ratio for clinical instruction. We must increase our recruitment and enrollment of students into master's and doctoral programs.

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