Increasing Capacity and Efficiency in Programs Leading to RN Licensure in Texas Texas Higher Education Coordinating Board July 2004 Full report available at: SHEEO Professional Development Conference August 14, 2004 August 14, 2004 Marshall A. Hill

Number of Institutions Offering Initial RN Licensure Programs in Texas (2003) THECB 07/2004 Diploma Programs 2 Associate Degree Programs (ADN) 50 Baccalaureate Degree Programs (BSN) 25

Map 1: Initial RN Licensure Programs at Public and Independent Institutions in Texas Sources: Texas Higher Education Coordinating Board and Board of Nurse Examiners for the State of Texas THECB 07/2004

Academic Demographics THECB 07/2004 From 1997 to 2003 the state’s nursing programs have done a good job of increasing interest in nursing, admitting more students, and graduating more RNs.

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 increased 67% since 1997 and 38% since 2001.

Source: Board of Nurse Examiners for the State of Texas THECB 07/2004 First-year entering enrollment in RN programs has increased by 87% since 1997.

Source: Board of Nurse Examiners for the State of Texas THECB 07/2004 After a three-year decline, the number of RN graduates has returned to 1997 levels.

Ethnic Diversity of Graduates THECB 07/2004 The state’s nursing programs have shown steady increases in the ethnic diversity of their RN graduates at a time when graduates of other health care professions have seen no change or declines in diversity.

Educational Pipeline THECB 07/2004 CB staff estimates that of those offered admission to initial RN licensure programs in Texas, 88% will enroll and 65% of these enrollees will complete their program.

Nursing Faculty THECB 07/2004 Average entering class size of RN licensure programs increased 108% from 1999 to 2003; average FTE faculty increased by only 13%.

Average Entering Class Size and Average Faculty FTEs in RN Licensure Programs* in Texas ( ) Source: Board of Nurse Examiners for the State of Texas THECB 07/2004

Nursing Faculty THECB 07/2004 Inability to hire new nursing faculty appears to be the greatest impediment to increasing enrollment in initial RN licensure programs.

Nursing Faculty Salaries THECB 07/2004 The higher salaries paid to practicing nurses is often the greatest obstacle in hiring nursing faculty. Nursing deans and directors say it is difficult to hire faculty at all levels of faculty rank. Nursing faculty at community colleges have the greatest disparity in salaries.

Potential Nursing Faculty THECB 07/2004 While enrollment in graduate nursing programs is up, the total number of graduates is at a 10-year low. Graduate students are specializing in areas which more likely prepare them for practice rather than for academic positions.

Total Enrollment in Master’s and Doctoral Nursing Programs at Texas Public Institutions of Higher Education ( ) Source: Texas Higher Education Coordinating Board THECB 07/2004

Graduates of Master’s and Doctoral Nursing Programs at Texas Public Institutions of Higher Education ( ) Source: Texas Higher Education Coordinating Board THECB 07/2004

THECB Activities & Programs THECB 07/2004 Survey of Deans and Directors Student Capacity Study Funding recommendations for the 2006/07 biennium Financial aid to nursing students Grant funding Coordination of nursing education (e.g., FOSC) New degree program approval

Survey of Deans and Directors THECB 07/2004 Major deterrents to increasing enrollment –Lack of parity between faculty and practice salaries –Number of clinical faculty –Lack of qualified applicants for faculty positions –Poorly prepared incoming students – attrition in some programs some programsSolutions –More state formula funding and special item funding for nursing programs –Better academic preparation of students

Survey (Continued) THECB 07/2004 Reasons for premature attrition in nurse practice –Stressful work environment –Unattractive work hours –Little autonomy in the workplace Reasons for not returning to nurse practice –Working conditions perceived to be same as when they left practice –Refresher programs not easily available –Need for flexible scheduling –Other occupations more attractive

Key Findings THECB 07/2004 Federal and state agencies project a significant need for nurses in the next 10 years. Employers will need to replace a large number of retiring nurses. Since 2001, applications to RN licensure programs increased by 38%. Approximately 6,000 applicants (duplicated) were not offered admission in fall Average entering class size of RN licensure programs increased 108% from 1999 to 2003; average FTE faculty in those programs increased by only 13%. If this disparity continues, it will likely affect educational quality. Graduations are not yet increasing at the same rate as applications and enrollments.

Key Findings THECB 07/2004 The lack of budgeted faculty positions is the greatest impediment to increasing enrollments. Faculty salaries are not competitive, particularly at community colleges where 61% of RN graduates are produced. Despite increases in the number of new graduate programs, master’s and doctoral nursing graduates are at a 10-year low. Students in graduate nursing programs appear to be focusing on clinical practice, not education. There is a duplication of program offerings and a lack of statewide and regional coordination of best practices and common administrative tasks.

Key Recommendations THECB 07/2004 Set statewide goals for increasing the number of initial RN licensure graduates, and identify funding required to produce these results. Study retention rates of nursing programs, and establish a forum for promoting best practices. Increase financial aid funding for the Professional Nursing Aid Program from $.5 to $3.5 million for the biennium (a reallocation of $1.5 million in existing funds and $1.5 million in new funds; cost: $1.5 million). Promote innovation in nursing education through the “regionalization” of common administrative and instructional functions, interdisciplinary instruction, pooled or shared faculty, and new clinical instruction models to maximize use of existing resources and faculty.

Key Recommendations THECB 07/2004 Continue to develop new accelerated and alternate entry degree programs to speed the graduation of nurses and to help attract students from underrepresented groups to the profession. Establish incentives such as a loan repayment program for graduate students, particularly those from underrepresented groups, who are interested in careers in nursing education (cost: $1.4 million for the biennium). Increase ADN faculty salaries, and, in some cases, instructor salaries at universities, to be more competitive with nurse practice salaries (cost: $11 million for the biennium). Reward nurses (e.g., academic credit or a stipend) who serve as preceptors for nursing education programs.