Nursing school enrollments lag behind rising demand for RNs, AACN survey shows

Connecticut Nursing News, Mar-May 1999

Bachelor's-Degree Enrollments See Continued Decline, While Ranks of Master's-Degree Graduates and Full-Time Master's Students Continue Upward Climb

WASHINGTON, DC-As health care facilities in many markets strive to meet their accelerating demand for registered nurses, enrollments of entry-level bachelor's-degree students in the nation's nursing schools fell by 5.5 percent in fall 1998, and total master's-degree nursing enrollments fell slightly by 2.1 percent, compared to a year ago, according to the latest annual survey by the American Association of Colleges of Nursing (AACN).

At the same time, enrollments of full-time master's-degree nursing students and the ranks of nursing graduates from master's-degree programs continued their recent steady climbs. Full-time master's enrollments at nursing schools rose by 3.2 percent over fall 1997, while the number of master's graduates grew by 4.3 percent between August 1997 and July 1998 compared to the previous year, the AACN survey found.

The drop in enrollments in entry-level bachelor's-degree nursing programs-the fourth consecutive decline in as many years-sparks concern especially as federal and other advisory panels have urged escalating numbers of baccalaureate-and graduate-prepared nurses to meet health system needs for the near future.

However, the modest decline in total master's enrollments marked only the third time in the past 12 years for such a decrease at nursing schools, which have seen their ranks of master's-degree students rise steadily largely in response to growing demand for nurse practitioners, clinical nurse specialists, and other RNs with advanced clinical skills. The decline also comes as overall graduate enrollments in all fields in the U.S. fell for the second consecutive year in 1997, down by 1 percent, according to preliminary data by the Council of Graduate Schools.

AACN's findings are based on responses from a total of 531 (80 percent) of the nation's nursing schools with bachelor's- and graduate-degree programs that were surveyed in fall 1998. Data reflect actual counts; projections are not used. Programs offering two-year associate-degrees and hospital diplomas are not included.

Two-year changes in enrollments and graduations, respectively, are based on responses from a matched group of 495 and 493 schools reporting in both 1997 and 1998.

Outdated Perceptions

A convergence of circumstances has contributed to the declines in entry-level baccalaureate enrollments. "Application levels remain strong. But headlines several years ago of hospital downsizings and of RNs layoffs in various markets apparently created lasting, but now outdated, perceptions in many potential students who remain unaware of today's new reality. That reality is the accelerated hiring of RNs to meet demands fueled by a host of factors-including growing numbers of elderly, an increasing population of hospitalized patients who are older and more acutely ill, the rapid expansion of front-line primary care at a host of communitybased sites, and technological advances requiring more highly skilled nursing care," says AACN President Andrea R. Lindell, DNSc, RN.

Moreover, in recent years, several nursing schools have chosen to cut back their baccalaureate admissions because of faculty shortages or other resource constraints, or have redirected their limited resources to focus more heavily on meeting market demand for advanced practice nurses prepared in master's-degree programs. Indeed, of the 107 responding schools that reported reasons for not accepting all qualified applicants to entrylevel baccalaureate nursing programs in fall 1998, 37 percent cited insufficient numbers of faculty, while other schools cited a shortage of clinical training sites (26 percent) or insufficient classroom space (13 percent), according to the AACN survey. Though most schools reporting too few faculty cited budget constraints, 30 percent attributed the shortage to increasing job competition from clinical sites.

Hiring Intensifies

"Again, we are encouraged by the continued growth in graduations and full-time enrollments in master's programs. But it is imperative that students recognize the increasing opportunities, as well, for baccalaureate-prepared nurses at the entry level. Hospitals, HMOs, outpatient surgical centers, community health centers, and other sites are intensifying their hiring of nurses to meet the expanding needs of today's patient care," Dr. Lindell explains.

"Students need to know, too, that while many nursing schools with resource constraints had to turn away numbers of qualified applicants to entry-level bachelor's-degree programs this past fall, other schools reported having several vacant seats remaining."

RN-to-Baccalaureate Graduations Increase

Overall, responding schools reported 113,413 students enrolled in bachelor's-degree nursing programs. Included in this total are 77,679 entrylevel students, and 35,734 registered nurses (with two-year associate degrees or hospital diplomas) who returned to school to obtain the bachelor's degree in nursing in so-called "RN-to-- Baccalaureate" programs.