Increasing Capacity and Efficiency in Programs Leading to RN Licensure in Texas

Increasing Capacity and Efficiency in Increasing Capacity and Efficiency in Programs Leading to RN Licensure in TexasPrograms Leading to RN Licensure in Texas

Texas Higher EducationTexas Higher Education

Coordinating BoardCoordinating Board

July 2004July 2004

Full report available at: Full report available at: http://www.thecb.state.tx.us/UHRI/ProfSchools.htm

SHEEO Professional Development ConferenceSHEEO Professional Development Conference August 14, 2004August 14, 2004Marshall A. HillMarshall A. Hill

Number of Institutions Offering InitialNumber of Institutions Offering InitialRN Licensure Programs in Texas (2003)RN Licensure Programs in Texas (2003)

THECB 07/2004

Diploma ProgramsDiploma Programs 22

Associate Degree Programs Associate Degree Programs (ADN)(ADN)

5050

Baccalaureate Degree Programs Baccalaureate Degree Programs (BSN)(BSN)

2525

Map 1: Initial RN Licensure Programs at Public and Map 1: Initial RN Licensure Programs at Public and Independent Institutions in Texas Independent Institutions in Texas

Sources: Texas Higher Education Coordinating Board and Board of Nurse Examiners for the State of Texas THECB 07/2004

Academic DemographicsAcademic Demographics

THECB 07/2004

From 1997 to 2003 the state’s nursing From 1997 to 2003 the state’s nursing programs have done a good job of programs have done a good job of increasing interest in nursing, admitting increasing interest in nursing, admitting more students, and graduating more more students, and graduating more RNs. RNs.

16,048

11,646

8,004

9,610 9,504

7,322

5,324

6,7236,544

4,324

2,6802,887

0

3,000

6,000

9,000

12,000

15,000

18,000

1997 1998 1999 2000 2001 2002 2003

All RN Programs Diploma & ADN Programs BSN Programs

Source: Board of Nurse Examiners for the State of Texas THECB 07/2004

Note: Applications are duplicated. Numbers may include multiple applications sent by one applicant.

Qualified applicants (duplicated) to RN programs have Qualified applicants (duplicated) to RN programs have increased 67% since 1997 and 38% since 2001.increased 67% since 1997 and 38% since 2001.

8,585

6,967

4,0874,582

5,181

4,333

2,6533,111 3,404

2,634

1,4341,471

0

3,000

6,000

9,000

12,000

1997 1998 1999 2000 2001 2002 2003

All RN Programs Diploma & ADN Programs BSN Programs


First-year entering enrollment in RN First-year entering enrollment in RN programs has increased by 87% since 1997.programs has increased by 87% since 1997.

5,2065,042

4,531

5,242

3,250 3,371

2,832

3,368

1,956 1,6711,699

1,874

0

2,000

4,000

6,000

1997 1998 1999 2000 2001 2002 2003

All Initial RN Programs Diploma & ADN Programs BSN Programs


After a three-year decline, the number of RN After a three-year decline, the number of RN graduates has returned to 1997 levels.graduates has returned to 1997 levels.

Ethnic Diversity of GraduatesEthnic Diversity of Graduates

THECB 07/2004

The state’s nursing programs have shown The state’s nursing programs have shown steady increases in the ethnic diversity of steady increases in the ethnic diversity of their RN graduates at a time when their RN graduates at a time when graduates of other health care professions graduates of other health care professions have seen no change or declines in have seen no change or declines in diversity. diversity.

Total Graduates from RN Licensure Programs* at Texas Public Institutions by Ethnicity (1994-2003)

77.8% 76.9%

61.6%62.0%

72.1%

65.9%

6.8%

12.0%

7.6%

12.8%

9.3%10.2%

11.8% 11.8%

21.5%19.6%

13.8%18.6%

2.5% 2.7% 3.6% 3.9% 3.7% 2.9%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Academic Year

Per

cen

tag

e o

f R

N G

rad

uat

es

White Black Hispanic Asian

Source: Texas Higher Education Coordinating Board THECB 07/2004

Total #: 5,848 5,741 5,477 5,143 5,182 5,031 4,748 4,646 4,750 5,329

*Percentages include graduates from initial licensure programs and RN-to-BSN programs.

Educational PipelineEducational Pipeline

THECB 07/2004

CB staff estimates that of those offered CB staff estimates that of those offered admission to initial RN licensure admission to initial RN licensure programs in Texas, 88% will enroll and programs in Texas, 88% will enroll and 65% of these enrollees will complete 65% of these enrollees will complete their program.their program.

9,504

5,662

5,737

3,410

5,181

2,831

3,368

1,874

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

Nu

mb

er

Applications in 2003(Duplicated)

Offers of Admission(Duplicated)

First-Year EnteringStudents

Graduates (Projected)**

Educational Pipeline to Obtaining a Nursing Degree from an Initial RN Licensure Program* in Texas (2003)

Diploma & ADN Programs Only BSN Programs Only

15,166 (total duplicated applications to initial progs)

9,147 (total offers from initial progs) 8,012 (total entering

into initial progs)5,242 (total grads from initial progs**)


** Graduate projections are based on the number of graduates from Diploma, ADN, and BSN programs in 2003.

* Numbers exclude the RN-to-BSN track within Basic Nursing Programs.

Nursing Faculty Nursing Faculty

THECB 07/2004

Average entering class size of RN Average entering class size of RN licensure programs increased 108% from licensure programs increased 108% from 1999 to 2003; average FTE faculty 1999 to 2003; average FTE faculty increased by only 13%.increased by only 13%.

Average Average EnteringEntering Class Size and Average Faculty FTEs Class Size and Average Faculty FTEsin RN Licensure Programs* in Texas (1999- 2003)in RN Licensure Programs* in Texas (1999- 2003)

15 16 16 17 17

53

8190

101110

0

20

40

60

80

100

120

140

1999 2000 2001 2002 2003

Average Class Size Average Faculty FTEs


Nursing Faculty Nursing Faculty

THECB 07/2004

Inability to hire new nursing faculty Inability to hire new nursing faculty appears to be the greatest impediment to appears to be the greatest impediment to increasing enrollment in initial RN increasing enrollment in initial RN licensure programs.licensure programs.

Stated Reasons Why Qualified Applicants Are Not Admitted to ADN and BSN Programs in Texas (2003)

Lack of Qualified Faculty Applicants

20%

Lack of Budgeted Faculty Positions

33%

Lack of Clinical Spaces

16%

Limited Classroom Space19%

Other12%

53% Faculty Limits

35% Space Limits


Nursing Faculty SalariesNursing Faculty Salaries

THECB 07/2004

The higher salaries paid to practicing The higher salaries paid to practicing nurses is often the greatest obstacle in nurses is often the greatest obstacle in hiring nursing faculty.hiring nursing faculty.

Nursing deans and directors say it is Nursing deans and directors say it is difficult to hire faculty at all levels of difficult to hire faculty at all levels of faculty rank.faculty rank.

Nursing faculty at community colleges Nursing faculty at community colleges have the greatest disparity in salaries.have the greatest disparity in salaries.

Ranges of Average Salaries for Nursing Faculty atCommunity Colleges versus Salaries for Practicing Nurses (2003)

$35,000

$45,000

$55,000

$65,000

$75,000

$85,000

$95,000

$105,000

$115,000

Faculty Salaries (9 mos)* Faculty Salaries (12 mos)** Practitioner Salaries (12 mos)***

Average$41,463

Average$55,146

THECB 07/2004

* Range of average 9-month salaries reported by institutions to the THECB (dark line depicts average salary for all ranks).** Range of average salaries converted to 12 months for comparison with salaried positions in a hospital (dark line depicts average salary for all ranks).*** Range of average salaries for selected administrative and specialty positions from a 2004 survey of 70 hospitals of the Dallas/Fort Worth Hospital Council.

Sources: 1) Faculty salaries: Institution data reported to the THECB, 2) Practitioner salaries: Dallas/Fort Worth Hospital Council provided by the Dallas/Fort Worth Area Health Education Center.

Potential Nursing FacultyPotential Nursing Faculty

THECB 07/2004

While enrollment in graduate nursing While enrollment in graduate nursing programs is up, the total number of programs is up, the total number of graduates is at a 10-year low.graduates is at a 10-year low.

Graduate students are specializing in Graduate students are specializing in areas which more likely prepare them for areas which more likely prepare them for practice rather than for academic practice rather than for academic positions.positions.

Total Enrollment in Master’s and Doctoral Total Enrollment in Master’s and Doctoral Nursing Programs at Texas Public Institutions Nursing Programs at Texas Public Institutions

of Higher Education (1994 - 2003)of Higher Education (1994 - 2003)2,278

1,8231,950

2,132 2,1092,057

1,865 1,895 1,836 1,815

302229 243251 235 221 220 221 210 232

0

500

1,000

1,500

2,000

2,500

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Master's Enrollees Doctoral Enrollees


Graduates of Master’s and Doctoral Nursing Graduates of Master’s and Doctoral Nursing Programs at Texas Public Institutions of Programs at Texas Public Institutions of

Higher Education (1994 - 2003)Higher Education (1994 - 2003)

463

531514

597555 599

525 508 509460

2440 3434 47 26 42 29 27 33

0

100

200

300

400

500

600

700

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Master's Graduates Doctoral Graduates


THECB Activities & Programs THECB Activities & Programs

THECB 07/2004

Survey of Deans and DirectorsSurvey of Deans and DirectorsStudent Capacity StudyStudent Capacity StudyFunding recommendations for the 2006/07 Funding recommendations for the 2006/07 bienniumbienniumFinancial aid to nursing studentsFinancial aid to nursing studentsGrant fundingGrant fundingCoordination of nursing education (e.g., Coordination of nursing education (e.g., FOSC)FOSC)New degree program approvalNew degree program approval

Survey of Deans and Directors Survey of Deans and Directors

THECB 07/2004

Major deterrents to increasing enrollmentMajor deterrents to increasing enrollment– Lack of parity between faculty and practice salariesLack of parity between faculty and practice salaries– Number of clinical facultyNumber of clinical faculty– Lack of qualified applicants for faculty positionsLack of qualified applicants for faculty positions– Poorly prepared incoming students – attrition in Poorly prepared incoming students – attrition in some programssome programs

SolutionsSolutions– More state formula funding and special item funding More state formula funding and special item funding

for nursing programsfor nursing programs– Better academic preparation of studentsBetter academic preparation of students

Survey (Continued) Survey (Continued)

THECB 07/2004

Reasons for premature attrition in nurse practiceReasons for premature attrition in nurse practice– Stressful work environmentStressful work environment– Unattractive work hoursUnattractive work hours– Little autonomy in the workplaceLittle autonomy in the workplace

Reasons for not returning to nurse practiceReasons for not returning to nurse practice– Working conditions perceived to be same as when Working conditions perceived to be same as when

they left practicethey left practice– Refresher programs not easily availableRefresher programs not easily available– Need for flexible schedulingNeed for flexible scheduling– Other occupations more attractiveOther occupations more attractive

Key FindingsKey Findings

THECB 07/2004

Federal and state agencies project a significant need for Federal and state agencies project a significant need for nurses in the next 10 years.nurses in the next 10 years.

Employers will need to replace a large number of retiring Employers will need to replace a large number of retiring nurses.nurses.

Since 2001, applications to RN licensure programs Since 2001, applications to RN licensure programs increased by 38%. Approximately 6,000 applicants increased by 38%. Approximately 6,000 applicants (duplicated) were not offered admission in fall 2003.(duplicated) were not offered admission in fall 2003.

Average entering class size of RN licensure programs Average entering class size of RN licensure programs increased 108% from 1999 to 2003; average FTE faculty increased 108% from 1999 to 2003; average FTE faculty in those programs increased by only 13%. If this in those programs increased by only 13%. If this disparity continues, it will likely affect educational quality.disparity continues, it will likely affect educational quality.

Graduations are not yet increasing at the same rate as Graduations are not yet increasing at the same rate as applications and enrollments.applications and enrollments.

Key FindingsKey Findings

THECB 07/2004

The lack of budgeted faculty positions is the greatest The lack of budgeted faculty positions is the greatest impediment to increasing enrollments.impediment to increasing enrollments.

Faculty salaries are not competitive, particularly at community Faculty salaries are not competitive, particularly at community colleges where 61% of RN graduates are produced.colleges where 61% of RN graduates are produced.

Despite increases in the number of new graduate programs, Despite increases in the number of new graduate programs, master’s and doctoral nursing graduates are at a 10-year low.master’s and doctoral nursing graduates are at a 10-year low.

Students in graduate nursing programs appear to be focusing Students in graduate nursing programs appear to be focusing on clinical practice, not education.on clinical practice, not education.

There is a duplication of program offerings and a lack of There is a duplication of program offerings and a lack of statewide and regional coordination of best practices and statewide and regional coordination of best practices and common administrative tasks. common administrative tasks.

Key RecommendationsKey Recommendations

THECB 07/2004

Set statewide goals for increasing the number of initial RN Set statewide goals for increasing the number of initial RN licensure graduates, and identify funding required to licensure graduates, and identify funding required to produce these results.produce these results.Study retention rates of nursing programs, and establish a Study retention rates of nursing programs, and establish a forum for promoting best practices.forum for promoting best practices.Increase financial aid funding for the Professional Nursing Increase financial aid funding for the Professional Nursing Aid Program from $.5 to $3.5 million for the biennium (a Aid Program from $.5 to $3.5 million for the biennium (a reallocation of $1.5 million in existing funds and $1.5 reallocation of $1.5 million in existing funds and $1.5 million in new funds; cost: $1.5 million).million in new funds; cost: $1.5 million).Promote innovation in nursing education through the Promote innovation in nursing education through the “regionalization” of common administrative and “regionalization” of common administrative and instructional functions, interdisciplinary instruction, pooled instructional functions, interdisciplinary instruction, pooled or shared faculty, and new clinical instruction models to or shared faculty, and new clinical instruction models to maximize use of existing resources and faculty.maximize use of existing resources and faculty.

Key RecommendationsKey Recommendations

THECB 07/2004

Continue to develop new accelerated and alternate entry Continue to develop new accelerated and alternate entry degree programs to speed the graduation of nurses and degree programs to speed the graduation of nurses and to help attract students from underrepresented groups to to help attract students from underrepresented groups to the profession.the profession.Establish incentives such as a loan repayment program Establish incentives such as a loan repayment program for graduate students, particularly those fromfor graduate students, particularly those from underrepresented groups, who are interested in careers in underrepresented groups, who are interested in careers in nursing education (cost: $1.4 million for the biennium).nursing education (cost: $1.4 million for the biennium).Increase ADN faculty salaries, and, in some cases, Increase ADN faculty salaries, and, in some cases, instructor salaries at universities, to be more competitive instructor salaries at universities, to be more competitive with nurse practice salaries (cost: $11 million for the with nurse practice salaries (cost: $11 million for the biennium).biennium).Reward nurses (e.g., academic credit or a stipend) who Reward nurses (e.g., academic credit or a stipend) who serve as preceptors for nursing education programs.serve as preceptors for nursing education programs.

Documents

Increasing Capacity and Efficiency in Programs Leading to RN Licensure in Texas