Nursing Education

Data Nursing Educational System Capacity vs. Demand Introduction The current nursing shortage began in the late nineties. This is probably the most persistent of all nursing shortages in nursing history. One very important underlying reason for that persistence is that the nursing educational system has been unable to expand its capacity (the number of students able to admit and put through the nursing curriculum) enough to keep pace with rising demand and increasing retirements (decrease in supply). Although many initiatives in Illinois and across the United States have been extremely successful in recent years in raising career awareness and improving the image of nursing, as evidenced by overwhelming numbers of qualified applicants for nursing programs, the schools simply do not have room to admit all those interested.

Much of the data and many of the initiatives described in the Nursing Education section of this website are reports related to this issue and what can be done to resolve it. With continued diligence it is our hope that Illinois’ nursing educational system will ultimately be large enough to meet the increasing demand for qualified nurses in Illinois.

Capacity of the Illinois Education System for new nurses:
In order to obtain data about nursing education in Illinois, the ICNR developed a survey to ask pertinent questions directly of the schools of nursing in Illinois. In the fall of 2004 the ICNR Nursing Education Task Force sent its survey to 81 (IDFPR) “approved” schools. The targeted schools included all who provide Registered Professional Nurse (BSN, ADN and Diploma), Practical Nurse, Refresher (Current Nurse Practice Update) Courses, BSN completion and graduate programs. Information was also obtained about the CNA programs housed in the targeted surveyed schools.

For fall of 2004 admissions, twelve BSN programs answering the survey had a total of 2422 qualified applicants for maximum admission slots of 747. That is 324% more qualified applicants than capacity. In other words, our BSN programs had to turn away two of every three qualified potential nurses.

Sixteen ADN programs had a total of 1948 qualified applicants for maximum admission slots numbering 969. That is 200 % more qualified applicants than capacity. They could accept only one of every two persons interested in achieving a nursing education at their schools.

LPN and CNA programs had similar, although not quite as dramatic, issues with 58% of the responding LPN programs stating they had more applicants than they could accommodate and 77% of the CNA programs also stating they had no room for all of the qualified applicants. Five of the LPN programs reported exact numbers. They had 294 total qualified applicants for the class of fall 2004 and could admit only 201. Of the four CNA programs reporting numbers, there were 455 applicants for 431 slots. ¹
The ICNR asked nursing deans and directors to list reasons for not admitting more. Their responses were:
#1: Inability to recruit more faculty. (71%)
#2: Inability to secure sufficient clinical training sites. (61%)
3. Lack of space at the college (51%)
4. Lack of financial resources (42%). This response was often linked with others.
Increasing the Capacity
Between 2004 and 2006 six of fifteen schools in Illinois reported increasing the number of RN students they could admit (maximum capacity) from 545 to 750 (an increase in capacity of 205 students (38%). Two more of the fifteen reported larger increases occurring between 2003 and 2004 when one of the schools added 40 students per year and the other added 8, for a total increase in seven of the 15 schools of 253 students.
However, four of the fifteen had to decrease their capacity by a total of 66 students, primarily due to inability to recruit faculty to fill vacant positions. These increases and decreases in capacity left a net gain in admission capacity of 187 between 2003 and 2006 in this cohort sample of fifteen Illinois schools².
Hospitals have been responding to the need for increased clinical sites for nursing students’ clinical experiences. In 2006 six ICNR member hospitals reported increasing the number of students and college affiliations they had between academic years 04 and 05 by 186 students and two new affiliations. The range of increase of students was between 20 and 84 more students per hospital in this time period.¹

Faculty: Staffing nursing programs in Illinois
One of the principle reasons for inability to expand the capacity of nursing programs is the inability to hire qualified nursing faculty. In Illinois schools of nursing must maintain a 10-12: 1 ratio of student to teacher for clinical courses and the instructors must have an MSN (Masters of Science in Nursing). There are a few exceptions, i.e., working with preceptors or RN faculty who hold a Masters in a few select related and relevant fields, but it has been difficult for schools to recruit enough qualified nurses to teach in their programs. (Note: Several initiatives to overcome this barrier are described in the Nursing Education Initiatives section of this website.)

In May of 2006 18 community colleges reported number of full-time faculty and enrollment numbers in their ADN programs. The average full-time faculty to students (enrolled) ratio was 20:1.³

Age of faculty
In March 2004 it was estimated that 48,666 RNs held faculty positions nation-wide as their principal nursing position. Thirty percent of them were over 55 and only 12% were under 34. Twenty-two percent were between 50 and 54 and 25% between 40 and 50⁴. This is a startling indication of the “aging problem”. The majority of faculty members are over 50 and almost a third are over 55, and nearing retirement rapidly. If there is already a faculty shortage (and there is) the shortage of faculty and resulting capacity to educate new nurses will be at catastrophic levels in the next five years.

Enrollments versus success: Attrition
In 2004 seventeen community colleges in the Greater Metropolitan Chicago area reported average enrollment versus capacity as 87.5% for RN (ADN) students. The average percentage of capacity enrolled in LPN programs in the nine schools with LPN programs was 92.2% and CNA programs were enrolled at 94.4% of capacity (13 programs).⁵ One reason enrollments are not at capacity is the high attrition rates in nursing programs.

Once nursing students are admitted, it is very important that they successfully complete their program and become licensed in Illinois. Attrition rates in nursing schools were analyzed in 2004 by ICNR. At that time the range of attrition was between zero and 53%.⁶ For BSN programs the average rate was 26% for the class of 2004 and 20% for the ADN programs. This is distressing to many nurses, faculty, and potential students who were not admitted due to capacity limitations. Since “seats” in programs are at a premium and widely sought after, when someone who is successfully enrolled does not complete the program, a coveted seat has essentially gone unused.
When questioned about reasons for high attrition in the ICNR survey, responders listed the following:
“Why they leave”:

1. Academic
2. Financial including need to work results in too much stress
3. Personal
4. Nursing is not what they want

(Note: Some of the programs addressing these issues are or will be described in the Initiatives sub tab of the Nursing Education section on this web site.)

NCLEX pass rates in Illinois are slightly above the national average. According to IDFPR in 2005 there were 3600 first time test takers (NCLEX-RN) in Illinois as compared to 99,186 nationally. The Illinois pass rate was 89% while nationally the average was 87%. Similarly, 1463 LPNs took the exam in Illinois in 2005 and 91% of them passed. Nation-wide 53,213 LPNs took the exam for the first time and 89% of them passed. While this is good for Illinois, it still means 396 new graduates could not enter the workforce as RNs in Illinois and 132 LPNs were either delayed or lost to employers and patients.
(Note: Schools are continuing there efforts to improve pass rates. Some of these efforts are or will be described in the Initiatives sub tab of the Nursing Education section on this web site.)

Additional Data Regarding Nursing Education
The National Sample Survey of Registered Nurses, 2004⁷ findings included the following: RNs initial preparation for nursing:

In 1980 63% of RNs (nationally) initially graduated from Diploma programs, 19% from ADN programs, and 17% earned BSNs as their first nursing degree. By 2004 those figures had shifted dramatically with only 27% from Diploma schools, 42.2% from ADN programs and 30.4% from baccalaureate colleges or universities. Also in 2004, 0.5% of new nurses were initially educated in graduate programs.

Much of this shift was due to the demise of diploma schools and the subsequent rapid increase of ADN programs. At one time Illinois had over 40 hospital-based schools of nursing. Only one remains: Graham Hospital School of Nursing in Canton.

Highest Level of Preparation
In 2004, the National Sample reported 17.5% of nurses held diplomas as their highest level of preparation, 33.7% had Associate Degrees in Nursing, 34.2% had Bachelor’s Degrees and 13% had either a Masters or Doctoral degree in nursing. This last is the most dramatic as the survey states that between 1980 and 2004 the estimated number of nurses with graduate degrees in nursing rose 339%.

Average age of Graduates from initial RN program
The aging of the nursing workforce is a concern for this shortage and the future of nursing. One encouraging statistic however is the age of graduates when they complete their initial program. In 2000 that average age was 30.5 years but it had decreased (slightly) to 29.6 years by 2004. Age cohorts of those graduating from initial program between 2000 and 2004 were reported as “under 25”-39.2% and “35-49”:-20.9%. The average age of ADN graduates during that period was 31.9 years and of
BSN graduates, 26.2 years.

Graduates from programs outside the United States
3.5% of RNs practicing in the US received their basic nursing education outside the US. (Doesn’t include Guam, Puerto Rico, or Virgin Islands – all territories of the US.) The Philippines send the most foreign nurse graduates to the US- 50.2%. Canadian nurses comprise 20.2% of the graduates of other countries practicing in the US.
59.9% of foreign nurse graduates practicing in the US have baccalaureate and higher degrees (2% have doctoral degrees.) 68.5% of these nurses are bilingual with English being one of their primary languages.

¹ Illinois Coalition for Nursing Resources, “Educators and Practitioners Working Together to Expand Nursing Education Capacity” Illinois Schools of Nursing Data, 2004
² Illinois Coalition for Nursing Resources, Rapid Response Brief Survey, May 19, 2006
³ Vickie Gukenberger, ICCB Nursing Program Survey, May 2006
⁴ National Sample Survey of Registered Nurses
⁵ Workforce Boards of Metropolitan Chicago, Inventory of Producers, 2004
⁶ ICNR survey
⁷ National Sample Survey of Registered Nurses