Nursing schools turn away thousands of qualified applicants

COLUMBIA — Kirsten Straub thought she was a shoo-in.

She graduated from Portland State University in 2006 with a 3.4 grade-point average and a degree in general science. She’s worked as a certified nurse’s assistant and as a helper in a chemical lab. A volunteer for Preferred Hospice, she reads the Doctors Without Borders newsletter every month.

“Health care is an area of great disparity in this country,” Straub, of Columbia, said. “There should be good health care for everyone.”

But instead of doing her part to solve the health care crisis, Straub, 29, is waiting tables at Sycamore, a downtown restaurant. She’s one of 36,400 qualified applicants who were turned away from bachelor’s level nursing programs in 2007, according to the American Association of Colleges of Nursing.

“Nursing sounded so right to me,” Straub said. “I was very disappointed because I really thought I was going to get in.”

Straub was rejected from MU’s 15-month accelerated bachelor’s degree program, reserved for students who already have a bachelor’s in a field other than nursing.

She was one of 120 applicants for 40 slots this past year.

Students who applied to MU’s traditional bachelor’s degree program didn’t fare much better. Of 104 qualified applicants to the Sinclair School of Nursing in March, 47 were turned away.

With those odds, MU senior Megan Hedgepeth wasn’t optimistic about her chances despite her qualifications: a 3.2 GPA, experience that included working in a physical therapy clinic, volunteering in the emergency room at St. Luke’s Hospital in Kansas City and joining the Nursing Christian Fellowship. She even waited an extra semester before applying because she had heard that second-semester admissions were less competitive.

She applied to two other nursing schools — Avila University and St. Luke’s College, both in Kansas City — in case MU didn’t work out.

But still, she was anxious about the “intimidating” application process.

“I almost threw up on the morning of the interview because I was so nervous,” she said. “As a nursing major, I felt like I was where I belonged … . I didn’t know what I would do if I didn’t get in.”

Hedgepeth checked the mail every day after turning in her application. Finally, a friend called to say the acceptance letters had arrived. With half of her toenails painted, she dropped everything to run to the mailbox.

“I saw that the letter was thick, and I think I screamed,” she said.

The Problem

Thousands of students across the country face similar situations. Qualified students who want to be nurses can’t get into schools, which lack adequate faculty and space. Others are discouraged from applying because of the competitive, high-pressure application process.

But nurses are in demand. Hospitals need about 120,000 registered nurses to fill vacant positions nationwide, according to a 2006 report released by the American Hospital Association.

That shortage — driven by rising numbers of retiring nurses and the aging baby boomer generation — will worsen in the future. By 2020, the U.S. will be 340,000 nurses short – almost triple today’s shortage, according to a study published in the January/February issue of Health Affairs.

“This means a lot of people will not be getting cared for by registered nurses,” said Sherri Ulbrich, clinical instructor of nursing at MU. “And that’s been known to make a big difference in patient care.”

To meet the projected demand, nursing programs nationwide would have to nearly double the number of nurses they graduate each year, according to figures compiled by the American Association of Colleges of Nursing.

But that won’t be easy. What’s happening is the result of a “perfect storm,” said Dean Rosemary Porter of the MU Sinclair School of Nursing. Just as the demand for health care is rising, nursing schools are short on space and faculty, making the competition for spots fierce.

To qualify for MU’s nursing school, students need a minimum 2.5 GPA and must have completed six science prerequisites. But the average undergraduate GPA of students admitted for the fall 2008 semester was 3.7. For the past several years, average GPAs have ranged from 3.4 to 3.7.

“People come into it thinking that they just have to meet the minimum admittance requirements, but the GPA average is getting higher and higher,” said MU nursing student Julia Micotto.

Nursing programs nationwide face the same problems.
The University of Kansas only admits about one-third of qualified applicants to its traditional bachelor’s degree program. At the University of Colorado, more than 800 students apply for about 200 slots. Truman State University gets twice as many qualified applicants as it can admit. The University of Iowa only has room for about 30 percent of qualified applicants each year.

Associate degree programs are experiencing the competition, too. At Columbia College’s two-year associate degree program, 44 of 76 qualified applicants were turned away in January.

The Cause

Nursing schools admit students based on approval by state boards of nursing, based on available clinic space, classroom space and size of nursing faculty. MU has had the same enrollment cap since the 1970s.

Over time, the competition for spots in four-year nursing schools has fluctuated. But at MU, Associate Dean of Nursing Roxanne McDaniel said there have always been more applicants than spots, especially in the past five years.

“We’re at the absolute stop point,” Ulbrich said. “We are filled.”

MU’s Sinclair nursing building, located behind Stankowski Field, opened in 1979, but the program looks much different now than it did then. The building was designed for undergraduates, as the doctorate program didn’t yet exist. The school had no major research; it now ranks third in nation for scholarly faculty productivity.

That means some faculty members, such as Ulbrich, share offices. Others are housed at the Ellis Fischel Cancer Center on Business Loop 70. Some administrative assistants work from home.

And that’s only half the space squeeze. Nursing students need clinical experience, and clinical space can be hard to come by, especially in rural areas.

“There are limits on clinical placements,” said Pete Wolfe, assistant dean at the University of Colorado nursing school. “Unless someone builds a hospital, there’s no expansion of clinical sites.”

Mary Kennish, director of nursing at Columbia College, said there are limits in Columbia in specialty areas, such as mental health or pediatrics, because not every hospital offers those services.

In addition to MU and Columbia College, schools that use the Columbia health care system include Moberly Area Community College, Central Methodist University, Lincoln University, State Fair Community College and the Columbia Public Schools Program of Practical Nursing.

As bad as the space limitations are, the shortage of nursing faculty nationwide is worse. Kennish calls it “grave.”

Data collected by the American Association of Colleges of Nursing show a national nurse faculty vacancy rate of 8.8 percent, which translates to about two faculty vacancies per school. MU has one vacancy for a position approved in early March.

It’s hard to recruit qualified nursing faculty because of salary discrepancies; Working as a nurse or administrator in a private hospital typically pays more than a master’s level teaching job at a university, Porter said.

Ulbrich said that most beginning master’s level nurse practitioners average between $8,000 and $12,0000 more than teachers. MU clinical instructor Ardith Harmon estimated that she could make as much as $30,000 a year more working as a nurse practitioner.

The Solution

Schools are looking for ways to graduate more nursing students, but solutions require commitment, steep increases in funding and the cooperation of practicing staff nurses, not just nurse educators. Stakeholders agree, however, that it’s a problem that needs attention now rather than later.

“In terms of finding a solution, are we going to fix it now or wait 10 to 20 years when there’s a crisis and fix it with a Band-Aid?” Ulbirch asked. “Can we be proactive? Or are we going to wait until there aren’t enough teachers, and then try to graduate more nurses?”

In Missouri, an initiative spearheaded by former interim UM System President Gordon Lamb has been proposed to increase the number of graduates from nursing schools and other health care programs. Lamb called for $38 million to be put toward increasing graduates in health professions, but Gov. Matt Blunt recommended about a third of that this year.

In March, the Missouri House failed to include funding in its budget; the Senate hasn’t voted on the matter yet. The General Assembly won’t produce its final budget until May.

In the meantime, schools have tried to find ways to admit more students without increasing the size of the traditional bachelor’s degree class.

MU offers a program for nurses with associate degrees to complete their bachelor’s degrees online. Students can partner with hospitals where they live, often in rural areas, which improves the quality of the work force in those communities.

MU also created the accelerated bachelor’s degree of nursing program to which Straub applied. The 15-month program is funded through University Hospital and allows MU to graduate an additional 40 students — almost a third class — each year.

But to really increase enrollment, Porter said that MU needs a new building. She said that the nursing school is talking with the School of Health Professions about moving together to a new building, where the two programs could share an auditorium, a student lounge and a library.

“It’s a little seed that we’re starting to plant … ,” Porter said. “What we really need is a donor to give this big kick-off.”

At Columbia College, Kennish said the faculty situation is her biggest concern. She suggested that schools find better ways to work with clinical facilities, maybe giving staff nurses at hospitals some teaching responsibilities.

“We need to really look at how we can collaborate with clinical facilities to get more instructors,” she said. “It’s going to be the key.” Straub, despite a discouraging start, said she won’t give up on her goal of becoming a registered nurse. She plans to re-apply to MU’s nursing school in December.

And if she doesn’t get in?

“I don’t know,” she said. “It took me awhile to find my path, but now I know what I want to be doing.”