PROFESSION AND SOCIETY
The Global Nursing Faculty Shortage: Status and Solutions
for Change
Deena A. Nardi, PhD, PMHCNS-BC...
The Global Nursing Faculty Shortage Nardi & Gyurko
faculty positions. Additionally, the number of master’s-
prepared and d...
Nardi & Gyurko The Global Nursing Faculty Shortage
Equitable academic compensation salaries are not only
a problem in the ...
The Global Nursing Faculty Shortage Nardi & Gyurko
Table 1. Documents Analyzed for Solutions Are From These Professional O...
Nardi & Gyurko The Global Nursing Faculty Shortage
Table 2. Eight Solutions to the Nurse Faculty Shortage and Their
Source...
The Global Nursing Faculty Shortage Nardi & Gyurko
Table 2. Continued
Solution Year Source
8. Competitive 2010 AACN
facult...
Nardi & Gyurko The Global Nursing Faculty Shortage
enhancement is inefficient when funding is arbitrary and
significant chan...
The Global Nursing Faculty Shortage Nardi & Gyurko
be defined in comparative studies, and data and strategy
management shou...
Nardi & Gyurko The Global Nursing Faculty Shortage
American Association of Colleges of Nursing. (2012). Nursing
faculty sh...
The Global Nursing Faculty Shortage Nardi & Gyurko
Rukholm, E., Stamler, L., Talbot, L., Bednash, P., Raines, F.,
Potempa,...
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NArdi and GYurko SRGlobal NUrsing Faculty SHortage (1)

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  • 1. PROFESSION AND SOCIETY The Global Nursing Faculty Shortage: Status and Solutions for Change Deena A. Nardi, PhD, PMHCNS-BC, FAAN1 & Charlene C. Gyurko, PhD, RN, CNE2 1 Alpha and Delta Upsilon, Professor and Director, DNP Program, University of St, Francis, Joliet, IL, USA 2 Mu Omega, Assistant Professor, Purdue University North Central, Westville, IN, USA Key words Global nursing faculty shortage, nursing faculty shortage, solutions to the nursing faculty shortage, systematic review Correspondence Dr. Deena Nardi, Director DNP Program, University of St. Francis, 500 Wilcox St., Joliet, IL 60435. E-mail: dnardi@stfrancis.edu Accepted: February 25, 2013 doi: 10.1111/jnu.12030 Abstract Background: In addition to a global shortage of nurses, there is also a shortage of academically qualified faculty available to teach in schools of nursing. Methods: A systematic review examined proposed solutions to the global shortage of nursing faculty. Metasynthesis was used to compare and critically appraise strategies offered for solving or ameliorating the global nursing faculty shortage by premier nursing organizations. Findings: 181 recommendations in 62 publications were categorized into eight major themed solutions, including centralizing data management, inter- national collaboration in nursing research, and increased funding for full-time faculty positions in nursing programs. Discussion: The nursing faculty shortage is due to a confluence of factors, including the global migration of nurses, a seeming persistent devaluation of faculty by academic programs, disincentives, and an overall reduction in full- time equivalent faculty positions. Conclusions: Results point to a needed change in direction and approach to solving the nursing faculty shortage. By designing new education models that fit global healthcare needs and pooling teaching resources, designing and us- ing the same databases across organizations to track and project faculty needs, and collaborating between schools and businesses to create mutually benefi- cial agreements for services, nursing faculty capacity can be enhanced, and nursing’s capacity to meet global healthcare needs can be expanded. Clinical Relevance: The results of this systematic review can be used as a rubric for the design and development of strategies to end the nursing faculty shortage and expand global nursing capacity. The International Council of Nurses (ICN), the largest in- ternational health professional organization in the world, considers the global shortage of nurses a serious cri- sis that continues to adversely impact health care for everyone (Oulton, 2006). In addition to a shortage of nurses with at least a baccalaureate degree, there is also a shortage of academically qualified faculty available to teach in schools of nursing. Over 75,000 qualified ap- plicants to nursing programs in the United States alone are turned away each year because of a lack of nurse faculty, clinical sites, and inadequate education budgets (American Association of Colleges of Nursing [AACN], 2010). This need for an increased educational capacity is not being met, however, since there is a correspond- ing critical shortage of nursing faculty, the major edu- cation resource used in the preparation of tomorrow’s nurses (Allen & Aldebron, 2008). The nursing faculty shortage is due to a confluence of factors, including the global migration of nurses, an aging faculty, a reduced younger faculty hiring pool, decreased satisfaction with the faculty role, lack of funding and poor salaries, a seeming persistent devaluation of faculty by academic institutions, increased dependence on contingent fac- ulty, and overall reduction in full time equivalent (FTE) Journal of Nursing Scholarship, 2013; 45:3, 317–326. 317 C 2013 Sigma Theta Tau International
  • 2. The Global Nursing Faculty Shortage Nardi & Gyurko faculty positions. Additionally, the number of master’s- prepared and doctorally prepared advanced practice nurses planning to teach has decreased throughout the years. After tracking the nursing faculty shortage for the past 6 years, we noted that the number of documents pub- lished about it was increasing, with no consensus or or- ganized plan to address this ongoing problem, one that nursing organizations would collaboratively work on or commit to. We decided a systematic review (SR) of pub- lished solutions to the problem was needed to determine if there were common threads or themed solutions em- bedded in the now numerous published recommenda- tions to address the shortage. This article uses an SR ap- proach to the examination of the economic, social, and educational factors that contribute to the global shortage of nursing faculty, and its resolution. Metasynthesis was used to compare and critically appraise recommended strategies for attracting qualified nurses to the full-time faculty role and supporting them once they arrive, by premier nursing organizations such as the International Council of Nurses (ICN), Tri-Council of Nursing, Royal College of Nursing, AACN, American Academy of Nurs- ing, Sigma Theta Tau International, and Robert Wood Johnson (RWJ) Foundation. Results of this SR point to a needed change in direction and approach to solving the nursing faculty shortage. These results can be used as an evidence-based rubric by nursing organizations and lead- ers globally to combine strategies and resources to more effectively manage this problem of decreasing nursing ed- ucational capacity. Background Nurses who pursue academia as a career often do so later in their careers. This does not lend itself to lengthy employment in an academic setting. One major drawback that causes nurse educators to leave the academic arena, arrive to it late, or never enter it is that faculty salaries are not competitive with positions outside of academia (Lewallen, Crane, Letvak, Jones, & Hu, 2003). This fact was further supported by research findings of the AACN and reported in a Congressional Briefing in Washington, DC, on September 8, 2004 (Valiga, 2004). The AACN, national voice for its baccalaureate- and higher-degree nursing education programs in the United States, stated in its White Paper in 2005 that the nursing faculty shortage is a grave and persistent problem threat- ening the United States’ health professions’ educational infrastructure (National League for Nursing, 2010). By 2012, the AACN reported that there was a 7.6% national nursing faculty vacancy rate (AACN, 2012). Several proposed solutions from international and state-based professional nursing organizations stress the need to aggressively intervene in the areas of recruitment and retention, with attention on funding and macroe- conomics. One such response to this proposed solution is the International Nursing Education Network (NEN) and its collaboration between the ICN and the U.S. Na- tional League for Nursing (NLN) to address the inter- national shortages of nurses and nurse faculty that ex- ist in many countries. Its inaugural meeting occurred in Durban, South Africa, in 2009, at the 24th ICN Quadren- nial Congress. The network created a forum for the global nursing education community to share resources in the examination and response of global issues surrounding issues of nurse educators worldwide (ICN, 2012; Se- nior, 2010). By September 2012, membership had grown to 1,400 members from 89 countries (NEN, 2012). Al- though its mission includes addressing the nurse faculty shortage and it shows promise as a think tank to ad- dress issues challenging nursing educators, it currently functions as a formal venue for information sharing and informal communication network through Internet forums. The RWJ Foundation advocates efforts that persuade more nurses and nursing students to pursue academic ca- reers, and to do so at an earlier age. In May 2010 in its document “Charting Nursing’s Future,” the RWJ Foun- dation announced that it was working with the Center to Champion Nursing in America, the U.S. Department of Labor, and the Health Resources and Services Admin- istration to address issues associated with increasing the capacity of nursing schools to include changes associ- ated with redesigning educational programs in their states by deploying revised curricula, new technology, and up- dated clinical education models. It was felt that these initiatives would increase faculty capacity and diversity (RWJ Foundation, 2010). In 2010, the Tri Council of Nursing reported that the health of the nation will be put further at risk unless there is a more educated workforce. This organization also en- couraged all nurses, regardless of entry point into the pro- fession, to continue their education at all program levels, including master’s and doctoral (Tri Council of Nursing, 2010). A White Paper published by the American Academy of Nursing Expert Panel on Global Nursing and Health advocated for the promotion of faculty exchanges, more budgeted full-time nursing faculty positions, and funding “required to support advanced educational preparation of nurses who would (a) commit to teach nursing, and (b) conduct research that will enhance the educational preparation of nurses” (Rosenkoetter & Nardi, 2007, p. 311). 318 Journal of Nursing Scholarship, 2013; 45:3, 317–326. C 2013 Sigma Theta Tau International
  • 3. Nardi & Gyurko The Global Nursing Faculty Shortage Equitable academic compensation salaries are not only a problem in the United States. For instance, the United States seems to fare a little better, with nursing faculty averaging salaries between $70,410 and $81,552 as com- pared with nursing faculty salaries in the United Kingdom averaging between $52,662.97 and $62,079.73. The Institute of Medicine’s (IOM’s) “Future of Nursing” seminal report proposed an increase in number of bac- calaureate prepared nurses from 50% to 80% and to dou- ble numbers of doctorally prepared nurses by 2010. In ad- dition, the IOM addressed the need for salary and benefits for faculty that must be market competitive while remov- ing the scope of practice barriers to advanced practice reg- istered nurse practice (Institute of Medicine, 2010). Pro- posed recommendations were to create an international body to coordinate and recommend national and inter- national workforce policies (Institute of Medicine, 2010). In 2000, The European Union European Higher Educa- tion Area launched the Bologna Process, meant to ensure more comparable, compatible, and coherent systems of higher education in Europe. Its goals are, in part, to help facilitate mobility of students, graduates, and higher ed- ucation staff, and to help prepare students for their fu- ture careers and for life as active citizens in democratic societies, while supporting their personal development. It continues to offer broad access to high-quality higher education, based on democratic principles and academic freedom. Currently 47 countries are participating in the Bologna Process (Adelman, 2009). Global nurse faculty migration is defined as nurse ed- ucators or researchers leaving their country of origin to work in a different destination. Following the adoption of the Code of Practice of International Recruitment of Health Personnel at the World Health Assembly in 2012, the World Health Organization and the Organization for Economic Cooperation and Development have joined to begin work on its implementation, and to monitor the problem of international nurse migration (International Centre on Nurse Migration, 2011). In 2013, the global faculty nursing shortage contin- ues. It is exacerbated by global migration and brain drain, most prevalent in countries such as the Philippines and Ireland, causing further shortages of nurses in these countries. Associated with these problems are the ubiqui- tous inequality in basic levels of nurse training and incon- sistency in how training is provided. Therefore, inconsis- tency in expectations and hiring for qualified faculty is also a problem. Methods An SR is a comprehensive and unbiased review pro- cess that systematically locates, appraises, and synthesizes evidence from published documents to obtain a reliable perspective or more compelling findings (Polit & Beck, 2012). This SR methodology required a re-analysis of published documents, white papers, and position state- ments. The key words of nurse faculty shortage, nurse faculty global migration, global nurse faculty shortage, and nurse faculty shortage solutions were used to search the databases of the Cumulative Index to Nursing and Al- lied Health Literature (CINAHL), CINAHL PLUS, Pubmed Central, Google Scholar, Ebsco Full Text, Medline, Med- scape, and Proquest. A total of 1,287 unfiltered cita- tions were received; 225 citations were discarded due to the mismatch of actual content to search criteria. 1,062 citations were filtered by date (2002–2012), leaving 174 citations with a filtered match of date match and no duplicates, and the publication must have been peer reviewed. Of these 174 documents, 62 documents of- fered solutions, and 181 separate solutions were then identified and entered into the database. The next step reviewed, aggregated, and analyzed these 181 solutions to identify commonalities and themes among them, us- ing open coding methodology and comparative analy- sis. Interrater consensus was used to first decide cat- egories of recommendations, and then to extract so- lution themes from the categories. Table 1 lists the global professional nursing and health organizations that expressed their concerns about the shortage, and whose position papers and solutions were reviewed for this SR. Results When the 181 recommendations by these interna- tional nursing organizations were separated out and com- pared, eight common solution themes emerged. The first solution, to centralize international data gathering and evidence-based strategies design, was expressed in 30.88% of these solutions. This was followed by creating an educational paradigm change (28.33%). Developing international cooperative policies and programs was ex- pressed in 10% of these recommendations, and removing barriers to advanced practice was identified in 9.17%. The eight common solutions are described in the ensuing text (Table 2, Figure 1). Centralize Data Recording and Strategy Management This strategy was expressed by 30.83% of the pub- lished recommendations. The terms and definitions used, tools, research designs, settings, and sample numbers were widely divergent in the material reviewed, leav- ing us to wonder what many authors meant by the Journal of Nursing Scholarship, 2013; 45:3, 317–326. 319 C 2013 Sigma Theta Tau International
  • 4. The Global Nursing Faculty Shortage Nardi & Gyurko Table 1. Documents Analyzed for Solutions Are From These Professional Organizations World Health Organization American Association of Colleges of Nursing International Council on Nurses American Association of Nurse Executives International Centre on Nurse Migration U.S. Department of Health and Human Services International Centre for Human Resources in Nursing American Academy of Nursing (AAN) Sigma Theta Tau International AAN Expert Panel on Global Nursing and Health Bologna Secretariat, European Commission USA Institute of Medicine Royal College of Nurses, United Kingdom Robert Wood Johnson Foundation Global Alliance for Leadership in Nursing Education and Science Carnegie Foundation for the Advancement of Teaching Global Alliance for Nursing Education and Scholarship American Association of University Professors International Academy for Nurse Editors American Association of Retired People Commission on Graduates of Foreign Nursing Schools, International Association of Academic Health Centers Medical Association of Jamaica Truth About Nursing: Center for Nurse Advocacy Registered Nurses Association of Ontario Georgia Nurses Association National Advisory Council on Nurse Education and Practice word faculty. Few publications defined their terms, mak- ing the results and recommendations useless for appli- cation or adaptation by the global nursing community. For instance, the term faculty can be used to describe a full professor, a clinical instructor, an adjunct teacher who can contract for as few as one credit hour of teach- ing, or even a preceptor, who usually receives no pay or employment benefits for supervising and directing students in a wide variety of practice settings. Many publications expressed the critical need for a unified nursing voice, with an international nursing workforce center, or think tank, to collect and disseminate all nursing workforce data as well as related data such as education planning projections and treatment trends (Allen & Aldebron, 2008; AACN, 2010; Kingma, 2007). One of the purposes of such a centralized data and strat- egy management source for nursing would be to create a more rigorous body of literature on the nursing fac- ulty crisis (Aiken, Buchan, Sochalski, Nichols, & Powell, 2004), the trends in healthcare and concomitant trends in nursing education. Educational Paradigm Change This strategy was expressed by 28.32% of recommen- dations published. In many ways, nursing education ap- pears to be stuck in the 19th and 20th centuries’ appren- tice model of a small group of nursing students following a clinical instructor around a hospital ward of inpatients for instruction and experience. In the real world of out- patient and nontraditional settings, quick and fragmented encounters, and high-tech delivery systems, this process is anachronistic and inefficient. It also makes nursing ed- ucation, with its additional clinical practice component, a very expensive and time-consuming endeavor. Even though there is a call for a higher-educated nurs- ing workforce, the shrinking of the faculty pool is per- petuated by the persistence of the associate degree pro- gram model of education. In the United States, approxi- mately 60% of registered nurses (RNs) are prepared at the associate degree level, and of these, only approximately 21% continue their education, even to the baccalaure- ate level (Stokowski, 2011). Although professional nurs- ing organizations have recommended the bachelor of sci- ence in nursing (BSN) as the basic level of education for nurses for over 40 years, there have been few motiva- tors, other than personal desire, to compel associate of science in nursing (ASN)-degreed nurses to pursue higher education—thus the pool of qualified faculty continues to shrink. More emphasis on the recruitment of nurses into faculty roles, as recommended by Evans (2009), must be paired with other motivating factors such as targeted tu- ition reimbursements for practicing working nurses. In addition, a planned out, determined ending of 2-year ed- ucational programs in the United States must be imple- mented in order to end the mixed messages that nurses receive from their profession, which is that higher edu- cation levels are required for competent practice in the complex healthcare field, yet ASN-prepared nurses prac- tice competently. There are relatively few PhD or doctor of nursing prac- tice (DNP) role models with whom nursing students can work and emulate in the practice setting. However, many publications, such as Educating Nurses: A Call for Rad- ical Transformation (Benner, Sutphen, Leonard & Day, 2010), offer many specific recommendations for curricu- lum, student recruitment, learning activities, entry to practice, and organizational oversight change. New roles for nurses must be created and expanded, and these roles must address the gaps between professional practice and classroom education (Oulton, 2006). Employment-based transition to practice, or nurse residency programs, for new RNs and APNs is another transformative recommen- dation espoused by several organizations, including the 320 Journal of Nursing Scholarship, 2013; 45:3, 317–326. C 2013 Sigma Theta Tau International
  • 5. Nardi & Gyurko The Global Nursing Faculty Shortage Table 2. Eight Solutions to the Nurse Faculty Shortage and Their Sources Solution Year Source 1. Centralize data 2004 Health Affairs recording and 2009 Nursing Economic$ strategy 2008 Nursing Outlook management 2005, 2006, 2009, 2010, 2011 ICN 2010 Nursing Forum 2010 AACN 2008 Tri-Council for Nursing 2009 ANA 2011 CFAT 2004 Nurse Educator 2010 WHO 2011 European Hospital 2009, 2011 GANES 2007, 2012 AAN 2012 Journal of Nursing Scholarship 2010 NACNEP 2010 Medical Association of Jamaica 2007 Health Services Research 2009 NLN 2012 Milbank Memorial Fund 2009 Educational Dimension 2010 Georgia Nurses Association 2011 Robert Wood Johnson Foundation 2008 Institute of International Relations 2011 RCN 2007 AAHC 2009 AACN 2008 Australia and New Zealand Health Policy 2010 Journal of Critical Care 2012 International Migration Research Centre 2. Educational 2009 Nursing Economic$ paradigm 2005, 2006, 2010, ICN change 2011 2009, 2010 AACN 2008 ANA 2009 CFAT 2011 Nurse Educator 2010, 2011 International Nursing Review 2009 Medical Surgical Nursing 2010 Japan Journal of Nursing Science 2009 Journal of Nursing Education 2012 Japan Journal of Nursing Science 2010 Nursing Outlook 2009 NCSBN 2006 NLN 2009 Nursing Management 2009 Educational Dimension Table 2. Continued Solution Year Source 2012 Nurses Association of Ontario 2011 Robert Wood Johnson Foundation 2008 Institute of International Relations 2007 AAN 2009 GANES 2011 Nursing Perspectives 2012 International Migration Research Centre 2010 AONE 3. International 2008 ANA cooperative 2011 International Nursing Review policies and 2010 Japan Journal of Nursing programs Science 2006, 2009 ICN 2010 Nursing Outlook 2007 Health Services Research 2007 AAN 2009 GANES 2008 Australia and New Zealand Health Policy 4. Removal of 2009 Nursing Economic$ barriers to 2011 ICN advanced 2010 International Nursing Review practice 2011 RCN 2010 Georgia Nurses Association 2011 Robert Wood Johnson Foundation 2008 Institute of International Relations 2012 International Migration Research Centre 5. Stabilize funding 2009, 2011 GANES of all 2006 NACNEP educational 2010 Nursing Outlook programs. 2007 Health Services Research 2012 Milbank Memorial Fund 2006 ICN 2012 Nurses Association of Ontario 6. Managed 2004 Health Affairs migration 2010 Medical Association of Jamaica 2006, 2009, 2010 ICN 2007 Health Services Research 2007 Int. Centre on Nurse 2012 Migration Milbank Memorial Fund 2012 Nurses Association of Ontario 7. Improved 2012 Journal of Nursing Scholarship nursing 2006 NACNEP scholarship 2010 Georgia Nurses Association Continued. Journal of Nursing Scholarship, 2013; 45:3, 317–326. 321 C 2013 Sigma Theta Tau International
  • 6. The Global Nursing Faculty Shortage Nardi & Gyurko Table 2. Continued Solution Year Source 8. Competitive 2010 AACN faculty salaries 2009 Medical Surgical Nursing 2010 Medical Association of Jamaica 2010 ICN 2010 Nursing Forum 2011 Robert Wood Johnson Foundation 2009 GANES Note. ICN = International Council of Nurses; AACN = American Academy of Colleges of Nursing; ANA = American Nurses Association; WHO = World Health Organization; GANES = Global Alliance for Leader- shipinNursingEducationandScience;NACNEP=NationalAdvisoryCoun- cil on Nurse Education and Practice; NLN = National League for Nursing; RCN = Royal College of Nurses; AAHC = Association of Academic Health Centers; CFAT = Carnegie Foundation for the Advancement of Teaching; NCSBN = National Council of State Boards of Nursing; AONE = Ameri- can Organization of Nurse Executives. For the full systematic review table of all 181 recommendations, linked to the themed solutions, e-mail the corresponding author, Dr. Nardi, at dnardi@stfrancis.edu. RWJ Foundation in partnership with the IOM (Commit- tee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine, 2011; Olmstead, 2009). In addition, a move to incorpo- rate global health in the curriculum, such as using and creating global nursing education standards, can better prepare faculty to practice and teach among diverse pop- ulations, thus improving their satisfaction with their pro- fessional identity (Baumann & Blythe, 2010; Berent & Anderko, 2011). International Cooperative Policies and Programs This solution was expressed by 10% of the recom- mendations published. More workshops, training, and conferences can be offered through collaborative train- ing and international exchanges in order to support cur- rent faculty and attract more nurses to the faculty role (Rosenkoetter & Nardi, 2007). There should be more cooperation between educational institutions across na- tions so that nursing students can transfer credit from one academic bridging program to another if they move or migrate to other countries (Kolawole, 2009). Oulton (2006the chief executive of the ICN in 2006, called for a globally unified nursing voice in order to create stronger alliances to combat the nursing shortage and insufficient numbers of faculty. These international cooperatives and collaborative teaching would make possible more sharing of new simulation and distance-based learning technol- ogy across academic institutions, and sharing of curricu- lum and faculty (Rukholm et al., 2009). Figure 1. Eight common solutions emerge. Removal of Barriers to Advanced Practice This solution was expressed by 9.17% of the rec- ommendations published. For nursing education in the United States, this solution gains even more currency after the release of the new IOM report that ranks the U.S. healthcare system dead last among developed coun- tries in many health outcomes, including overall mor- bidity and mortality rates and outcomes of chronic yet treatable conditions such as diabetes, hypertension, and cardiac disease (IOM, 2013). It cites a weak foundation in primary health care and a shortage of family practice physicians as a major weakness and contributor to these poor outcomes. These weaknesses can be addressed by removing barriers to full practice by all advanced prac- tice nurses, primarily nurse practitioners, whose educa- tion is grounded in primary health. Removing barriers to practice would allow APNs to partner and collabo- rate more fully with their physician colleagues to pro- vide health care to a wider population of patients. This in turn will encourage more nurses to pursue higher education degrees in nursing (i.e., master’s and doctor- ate) and increase the pool for qualified nursing faculty (AACN, 2010; Committee on the RWJ Foundation, 2011; Reinhold & Hassmiller, 2009). Stabilize Funding of BSN Degree and Higher Nursing Education Programs This solution was expressed by 8.33% of the recom- mendations published. The Global Alliance for Leadership in Nursing Education and Science (2011) noted that the faculty shortage is compounded by funding cutbacks and a shortage of clinical placement sites. Furthermore, fu- ture planning for academic program support and faculty 322 Journal of Nursing Scholarship, 2013; 45:3, 317–326. C 2013 Sigma Theta Tau International
  • 7. Nardi & Gyurko The Global Nursing Faculty Shortage enhancement is inefficient when funding is arbitrary and significant changes are made to the funding sources’ cri- teria within funding periods. Countries can establish and use a dedicated funding stream to stabilize nursing edu- cation support and training instead of relying on annual arbitrary appropriations that cannot be depended upon by schools of nursing when projecting long-term budget strategies. This funding should also support faculty aca- demic and scholarly productivity (Geolot et al., 2008). In addition, more emphasis and resources must be di- rected to preparing master’s- and doctoral-level prepared nurses, who would then be mentored into nursing faculty careers (Registered Nurses Association of Ontario, 2012). Managed Migration This solution was expressed by 6.67% of the recom- mendations published. Migration has been defined as nurse educators or researchers leaving their country of origin to work in a different destination (McLaughlin & Walker, 2010). Local workforce development planners and employers take a narrow, local view and do not con- sider future demands for nursing education, nursing fac- ulty, and direct line providers when developing plans or allocating resources. These actions contribute to future nursing shortages (i.e., determining clinical sites needed, and projecting future number of nurses to be trained or recruited, and global recruiting needs). Many countries do not collect data on who migrates (Kingma, 2007), thus preventing a clear picture of the human capital drain from countries of export, as well as preventing the collec- tion and use of accurate data that are necessary for the de- velopment of relevant education policies, workforce hir- ing projections, and healthcare infrastructure. Countries that are major importers of international nurses, such as the United Kingdom and United States, must make a concerted effort to follow ethical recruiting practices and not contribute to the brain drain and human capi- tal waste that follows in many countries of export. This can be done through better monitoring of those who mi- grate and compliance with international codes on ethical recruitment as it applies to nurse educators and nurses qualified to be faculty (Little & Buchan, 2007; Registered Nurses Association of Ontario, 2012). Improved Nursing Scholarship This solution was expressed by 3.33% of the rec- ommendations published. Nursing scholarship must link nursing work to patient outcomes. In some countries, nursing leaders could insist that Medicare and Medicaid plus all other reimbursers cost out nursing services in or- der to concretely link nursing practice to patient health outcomes. This increases the visibility of nursing’s con- tribution to healthcare planning and research, empower- ing more nurses to further their education, thus widen- ing the pool for qualified nursing faculty. Global research and practice linkages or partnerships among faculty and educational institutions must be encouraged and sup- ported to make the most of human capital in these areas (Geolot et al., 2008; Rukholm et al., 2009). These part- nerships can provide for the sharing of costs, resources, and other goods among faculty across the globe, regard- less of in-country economic resources and opportunity. Funding of nursing education should thus support and require faculty research productivity (Geolot et al., 2008), particularly as it addresses global questions and con- tributes to the infrastructure needed to strengthen nurs- ing education and improve patient outcomes (Gennaro, 2012). Competitive Faculty Salaries This solution was expressed by only 3.33% of the rec- ommendations published. Nursing faculty salaries, how- ever, must be competitive with other private and public sector positions that attract graduate-prepared advanced practice and advanced role nurses (AACN, 2010). Reten- tion must be a priority. Recruitment of nurses into faculty positions should be a major strategy in ending the nurs- ing faculty shortage. Nurses practicing in clinical settings should be educated about the rewards of a faculty ca- reer (Evans, 2009). There are too few graduate-prepared nurses to meet the need for healthcare providers who are fully prepared to address the complex healthcare needs of the 21st century, yet there is a lack of interest in a faculty career (McLaughlin and Walker, 2010). The rela- tively newly created DNP degree was considered one so- lution to the faculty shortage, but as one document con- cludes, there is no evidence to support that DNP-prepared nurses would be any more willing to a accept a signif- icantly lower wage from one they could earn in other careers than PhD-prepared nurses (Kelly, 2010). Incentives such as access to research funding, oppor- tunities to work with expert peers and participate in research collaboratives, and changes to minimum edu- cational preparation for beginning nursing faculty can at- tract new nursing audiences to faculty careers (McLaugh- lin & Walker, 2010). Most data on faculty salaries do not account for the customary 9- or 10-month appointments of full-time faculty, but these are then compared with 12- month salaries of comparably prepared nurses practicing in the clinical or medical settings. If the data are faulty, then the conclusions drawn from it are flawed. The first themed solution in this study, however, can be applied to obtain a correct picture of faculty salaries. Terms should Journal of Nursing Scholarship, 2013; 45:3, 317–326. 323 C 2013 Sigma Theta Tau International
  • 8. The Global Nursing Faculty Shortage Nardi & Gyurko be defined in comparative studies, and data and strategy management should be monitored and centralized to cre- ate a more rigorous body of literature on faculty salary, benefits, and trends in healthcare and nursing education (see the first solution theme, “centralize data recording and strategy management”). Conclusions and Recommendations To conclude, these eight main solutions that the 62 documents containing 181 recommendations hold in common speak to the critical need by nursing organi- zations to work together as one collaborative body to solve the common challenges related to the nursing fac- ulty shortage. Nursing leaders must strive to use the same terms to describe data. They must develop plans within a global context, collaborate globally on projects to in- crease the number and qualifications of nursing faculty, and consider the effect of increasing globalization and mi- gration as they project local faculty needs. Nursing faculty recruitment and retention is critical to increasing the global capacity of the nursing professions’ education infrastructure. The need for more full-time, tenure-track nursing faculty positions should be empha- sized to university administration. To retain qualified fac- ulty, benefits should include reimbursement for confer- ences, support for clinical research, and teaching release time for professional, research, and scholarship activities. Faculty should have reasoned input into clerical and ad- visory workload. Retired faculty would receive incentives to continue teaching. All strategies point to the need for the role and work of nurse educators to be as highly val- ued as, and comparable with, the advanced roles of grad- uate level-prepared nurses in direct care and direct line positions. For the past several years, nursing leadership seems to be on a carousel of forming more task force and meet- ings to explore the problem of faculty shortages and its causes and challenges. Yet the published results of these meetings are not uncovering new evidence. Qualitative research has a name for this process—it is called satu- ration, and it occurs when there is no more new infor- mation to learn about a particular construct, because ev- ery new note, data source, or story becomes redundant, describing the same phenomenon (Polit & Beck, 2012). We submit that a similar process is happening in nursing education, and it is time to move on. The themed solu- tions emerging from these documents strongly point the way to a shift in focus, energies, and action by nursing leaders. This change in direction would be to implement these evidence-based strategies now, collaborating to use the best resources across nations to increase the number of qualified nursing faculty essential to expand nursing capacity worldwide. The eight solutions provide a rubric that identifies the dimensions, or areas, these strategies should address, since the faculty shortage problem is multifactorial with no easy answers. New education models that fit global healthcare needs can be designed. By abandoning the ap- prenticeship model for clinical education, pooling teach- ing learning resources, designing and using the same databases across organizations to track and project fac- ulty needs, ending associate degree nursing education programs, and collaborating between schools and busi- nesses to create mutually beneficial agreements for ser- vices (i.e., international faculty exchanges, professional development for staff, and preceptors for students), nurs- ing faculty capacity can be enhanced, and nursing’s ca- pacity to meet global healthcare needs can be expanded. Clinical Resources r American Association of Colleges of Nursing Nurse Faculty Shortage Fact Sheet: http://www.aacn. nche.edu/media-relations/fact-sheets/nursing- faculty-shortage r Global Alliance for Leadership in Nursing Educa- tion and Science: http://www.ganes.info/ r Nursing Education Network: http://www.icn.ch/ networks/nursing-education-network/ r Tri-Council for Nursing: http://www. tricouncilfornursing.org/ r International Centre on Nurse Migration: http://www.intlnursemigration.org/ References Adelman, C. (2009). The Bologna process for U.S. eyes: Re-learning higher education in the age of convergence. Retrieved from http://www.ihep.org/assets/files/ EYESFINAL.pdf Aiken, L., Buchan, J., Sochalski, J., Nichols, B., & Powell, M. (2004). Trends in international nurse migration. Health Affairs, 23, 69–77. doi:10.1377/hlthaff.23.3.69 Allen, J., & Aldebron, J. (2008). A systematic assessment of strategies to address the nursing faculty shortage, U.S. Nursing Outlook, 56(6), 286–297. American Association of Colleges of Nursing. (2010). AACN applauds the new IOM report calling for transformational change in nursing education and practice. Retrieved from http://www.businesswire.com/news/home/ 20101005006711/en/AACN-Applauds-Institute-Medicine- Report-Calling-Transformational 324 Journal of Nursing Scholarship, 2013; 45:3, 317–326. C 2013 Sigma Theta Tau International
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