[House Hearing, 109 Congress]
[From the U.S. Government Publishing Office]
HOW THE LACK OF HIGHER EDUCATION FACULTY CONTRIBUTES TO AMERICA'S
NURSING
SHORTAGE, PART I
=======================================================================
FIELD HEARING
before the
SUBCOMMITTEE ON SELECT EDUCATION
of the
COMMITTEE ON EDUCATION
AND THE WORKFORCE
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED NINTH CONGRESS
FIRST SESSION
__________
November 30, 2005 in Greeley, Colorado
__________
Serial No. 109-29
__________
Printed for the use of the Committee on Education and the Workforce
Available via the World Wide Web: http://www.access.gpo.gov/congress/
house
or
Committee address: http://edworkforce.house.gov
_____
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COMMITTEE ON EDUCATION AND THE WORKFORCE
JOHN A. BOEHNER, Ohio, Chairman
Thomas E. Petri, Wisconsin, Vice George Miller, California
Chairman Dale E. Kildee, Michigan
Howard P. ``Buck'' McKeon, Major R. Owens, New York
California Donald M. Payne, New Jersey
Michael N. Castle, Delaware Robert E. Andrews, New Jersey
Sam Johnson, Texas Robert C. Scott, Virginia
Mark E. Souder, Indiana Lynn C. Woolsey, California
Charlie Norwood, Georgia Ruben Hinojosa, Texas
Vernon J. Ehlers, Michigan Carolyn McCarthy, New York
Judy Biggert, Illinois John F. Tierney, Massachusetts
Todd Russell Platts, Pennsylvania Ron Kind, Wisconsin
Patrick J. Tiberi, Ohio Dennis J. Kucinich, Ohio
Ric Keller, Florida David Wu, Oregon
Tom Osborne, Nebraska Rush D. Holt, New Jersey
Joe Wilson, South Carolina Susan A. Davis, California
Jon C. Porter, Nevada Betty McCollum, Minnesota
John Kline, Minnesota Danny K. Davis, Illinois
Marilyn N. Musgrave, Colorado Raul M. Grijalva, Arizona
Bob Inglis, South Carolina Chris Van Hollen, Maryland
Cathy McMorris, Washington Tim Ryan, Ohio
Kenny Marchant, Texas Timothy H. Bishop, New York
Tom Price, Georgia John Barrow, Georgia
Luis G. Fortuno, Puerto Rico
Bobby Jindal, Louisiana
Charles W. Boustany, Jr., Louisiana
Virginia Foxx, North Carolina
Thelma D. Drake, Virginia
John R. ``Randy'' Kuhl, Jr., New
York
Paula Nowakowski, Staff Director
Mark Zuckerman, Minority Staff Director
------
SUBCOMMITTEE ON SELECT EDUCATION
PATRICK J. TIBERI, Ohio, Chairman
Cathy McMorris, Washington Vice Ruben Hinojosa, Texas
Chairman Danny K. Davis, Illinois
Mark E. Souder, Indiana Chris Van Hollen, Maryland
Jon C. Porter, Nevada Tim Ryan, Ohio
Bob Inglis, South Carolina George Miller, California, ex
Luis P. Fortuno, Puerto Rico officio
John A. Boehner, Ohio, ex officio
------
C O N T E N T S
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Page
Hearing held on November 30, 2005................................ 1
Statement of Members:
Musgrave, Hon. Marilyn N., a Representative in Congress from
the State of Colorado...................................... 1
Prepared statement of.................................... 2
Porter, Hon. Jon C., a Representative in Congress from the
State of Nevada............................................ 3
Prepared statement of.................................... 5
Statement of Witnesses:
Carparelli, Sue, President & CEO, Colorado Center for Nursing
Excellence, Denver, CO..................................... 6
Prepared statement of.................................... 9
Dierker, Lynn, R.N., Director for Community Initiatives,
Colorado Health Institute, Denver, CO...................... 12
Prepared statement of.................................... 14
Lowe-Vaughn, Elise, Operations Director, Workforce
Development Programs, Colorado Department of Labor and
Employment, Denver, CO..................................... 16
Prepared statement of.................................... 18
Norton, Kay, President, University of Northern Colorado,
Greeley, CO................................................ 20
Prepared statement of.................................... 23
HOW THE LACK OF HIGHER EDUCATION FACULTY CONTRIBUTES TO AMERICA'S
NURSING SHORTAGE, PART I
----------
Thursday, November 30, 2005
U.S. House of Representatives
Subcommittee on Select Education
Committee on Education and the Workforce
Greeley, Colorado
----------
The Subcommittee met, pursuant to call, at 10 a.m., at the
University of Northern Colorado, University Center, Panorama
Room, 2045 10th Avenue, Greeley, Colorado, Hon. Marilyn
Musgrave presiding.
Present: Representatives Musgrave and Porter.
Mrs. Musgrave. A quorum being present, the Subcommittee on
Select Education of the Committee on Education in the Workforce
will come to order.
We are meeting today to hear testimony on how the lack of
higher education faculty contributes to America's nursing
shortage.
I am very pleased to be here in Greeley today, and I'm
eager to hear from our witnesses. But, before I begin, I ask
for unanimous consent for the hearing to remain open for 14
days to allow Member statements and other extraneous material
referred to during the hearing to be submitted in the official
hearing record. Without objection, so ordered.
STATEMENT OF HON. MARILYN N. MUSGRAVE, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF COLORADO
Mrs. Musgrave. I'd like to thank all of you for being here
today, and I certainly would like to extend my appreciation to
Congressman Jon Porter for traveling to Greeley, and I do
apologize for the weather, Congressman. It's a bit brutal
today.
Mr. Porter. It's a beautiful day.
Mrs. Musgrave. And I'm glad that he's here to learn much
about this urgent matter. He has been a leader on this issue,
and I'm very grateful for the insight that he has.
We all know that our country is facing a nursing shortage
that will have a significant impact on healthcare in our
country. Last year, the U.S. Bureau of Labor Statistics
projected that more than one million new and replacement nurses
will be needed by 2012.
According to a 2002 health report, 44 states are expected
to have shortages of registered nurses by the year 2020. In
Colorado, the lack of registered nurses is twice the national
average. The nursing shortage in our state is currently
estimated to be 11 percent short of demand, and is expected to
nearly triple to 30 percent by 2020 if current trends continue.
This is a growing problem that demands our urgent attention.
Demand for nurses is projected to increase as population
grows, baby boomers enter retirement, and medical advances
extend our lifespans. In contrast, the supply of nursing
professionals is expected to decline, as the number of nurses
leaving the profession exceeds the number that are entering.
What many Americans do not realize is that this shortage is
not simply a matter of inadequate enrollment in nursing
schools. Thousands of qualified applicants to graduate nursing
programs are turned away each year because there is a shortage
of graduate-level nursing faculty.
A report by the American Association of Colleges of Nursing
shows that U.S. Nursing schools turned away 32,797 qualified
applicants from baccalaureate and graduate nursing programs in
2004 due to insignificant number of faculty, clinical sites,
classroom space, and budget constraints. More than 2,600
applicants were turned away from the nursing program in
Colorado--from nursing programs in Colorado, in 2003.
Three quarters of the nursing schools point to faculty
shortages as a reason for not accepting all qualified
applicants into nursing programs. This academic year, 66
percent of nursing schools report that they have vacancies and
they are in need of additional nursing faculty to meet
additional demand.
Colorado's shortage of qualified nursing faculty at its 2
year nursing schools is three times the national average, and
nearly double the national average at its 4 year schools.
We anticipate this faculty shortage to escalate in the next
decade due to budget constraints, increased job competition
from clinics sites, and the retirement of a greying
professional of the nursing faculty.
A wave of faculty retirements is expected within the next
10 years, between 200 and 300 doctrinally prepared faculty will
be eligible for retirement each year from 2003 through 2012.
I am anxious to hear the testimony from our witnesses
today. I very much appreciate your expertise and I'm proud of
the efforts that are going on in Colorado to address the
nursing shortage.
Colorado educational institutions and health care providers
are working together to pursue strategies, to strengthen
faculty recruitment and retention, and it's important for all
of us that these efforts are very successful.
I hope that we can identify some strategies today that will
address the problem of faculty shortage, and I also am very
pleased to have Mr. Porter here, and I would now like to yield
to him for any statements that he might have.
[The prepared statement of Mrs. Musgrave follows:]
Statement of Hon. Marilyn N. Musgrave, a Representative in Congress
from the State of Colorado
Good morning. Thank you all for being here today. I would like to
extend my appreciation to Congressman Jon Porter for traveling to
Greeley to learn more about this urgent matter. He has been a leader on
this issue and I am grateful for his insight this morning.
Our country is confronting a nursing shortage that will have a
significant impact on the health care in our country. Last year, the
U.S. Bureau of Labor Statistics projected that more than one million
new and replacement nurses will be needed by 2012.
According to a 2002 health report, 44 states are expected to have
shortages of registered nurses by the year 2020.
In Colorado, the lack of registered nurses is twice the national
average. The nursing shortage in our state is currently estimated to be
11 percent short of demand, and is expected to nearly triple, to 30
percent, by 2020 if current trends continue. This is a growing problem
that demands our urgent attention.
Demand for nurses is projected to increase as population grows,
baby boomers enter retirement, and medical advances extend life span.
In contrast, the supply of nursing professionals is expected to decline
as the number of nurses leaving the profession exceeds the number that
enter.
What many Americans do not realize is that this shortage is not
simply a matter of inadequate enrollment in nursing programs. Thousands
of qualified applicants to graduate nursing programs are turned away
each year because there is a shortage of graduate-level nursing
faculty.
A report by the American Association of Colleges of Nursing (AACN)
shows that US nursing schools turned away 32,797 qualified applicants
from baccalaureate and graduate nursing programs in 2004 due to
insufficient number of faculty, clinical sites, classroom space,
clinical preceptors, and budget constraints. More than 2600 applicants
were turned away from nursing programs in Colorado in 2003.
Three quarters (76.1%) of the nursing schools point to faculty
shortages as a reason for not accepting all qualified applicants into
nursing programs. This academic year (2005-2006), 66% of nursing
schools report that they have vacancies and are in need of additional
nursing faculty to meet additional demand.
Colorado's shortage of qualified nursing faculty at its two-year
nursing schools is three times the national average, and nearly double
the national average at its four-year schools.
We anticipate this faculty shortage to escalate in the next decade
due budget constraints, increased job competition from clinical sites,
and the retirement of a ``graying professoriate'' of nursing faculty.
A wave of faculty retirements is expected within the next ten
years. Between 200 and 300 doctorally-prepared faculty will be eligible
for retirement each year from 2003 through 2012.
I am anxious to hear the testimony from our witnesses today. I am
very proud of the collaborative efforts in Colorado to address the
nursing faculty shortage. Colorado educational institutions and health
care providers are working together to pursue strategies to strengthen
faculty recruitment and retention.
It is my hope that we can identify some strategies to address the
faculty shortage in our country. I welcome your insight so that we may
work together to prepare a nursing workforce that is prepared to meet
the health care needs of the nation.
______
STATEMENT OF HON. JON C. PORTER, A REPRESENTATIVE IN CONGRESS
FROM THE STATE OF NEVADA
Mr. Porter. Thank you, Marilyn. I appreciate the kind and
warm welcome. Certainly, coming from the great State of Nevada,
I can appreciate the air and the wind is probably blowing from
Nevada into Colorado. Normally we say, ``What happens in Las
Vegas, stays in Las Vegas,'' but I think maybe the winds are
coming from Nevada.
But, Marilyn, I appreciate your hospitality and your
friendship, but also your leadership. Marilyn and I were
elected at the same time, so we were sophomores together.
Mrs. Musgrave. Yes.
Mr. Porter. We've been working closely on a number of key
issues, and one that really cuts to the chase, and it has to do
with the quality of life of not only residents in Colorado and
Nevada, but in the country. That's health care and
professionals.
To my friend, President Norton, thank you. We had a chance
to meet in D.C. A few months back, talked about this very
issue, and I appreciate your leadership for the State of
Colorado, but also for the country. Thank you for what's
happening.
I want to pick on Dan Weaver. Dan didn't make it to the
airport to pick us up last night, so we had to take a cab. So,
Dan, I'm sorry that you probably aren't going to have a job
after today.
But in all seriousness, Dan, I appreciate your help and
working with you. I know that Dan's that liaison between the
process and the professionals, but also the politicians that
are trying to do the right thing. So, Dan, thank you for
helping out and being at the airport and getting us here
safely. Thank you very much.
My staff is not with me today, so I don't have to use my
notes, right? I can put these aside? I think we talked about
this last night, Wanda. I just want to talk a little bit about
Nevada for a moment, and then give some of my perspectives how
that impacts Colorado and the rest of the country.
You know, we're experiencing very similar challenges to
Colorado. We're, of course, not as large of a state, but we
have the same challenges. We are one of the fastest growing
states in the country. We're seeing seven, eight, nine thousand
people a month moving into Nevada.
Now, I have no doubt you're experiencing similar growth, if
not more, but when you look at the size of our state of about
2.2 million people, it's substantial. And we've grown almost a
million people in the last decade, so that puts a lot of
pressure on our infrastructure, our schools, our health care,
our highways, our air quality--all of these things that we are
working, and I believe quite effectively in Nevada.
But we have 18,000 new students, high school and grade
school students a year. Imagine that, 18,000, and we're being
two and a half new schools a month in the community of Southern
Nevada. We're hiring close to 2,500 new teachers a year. We're
hiring 5,000 new support staff a year into our school district.
But all of that aside, health care is right in there with
the challenges. So we have multiple level of challenges. One,
of course, is recruiting and finding health care professionals
because of the massive growth. We need 1,000--minimum 1,000 new
nurses and professionals in health care a year. A thousand. We
have a shortage, really, of higher education institutions
that--because we're a small state, but fortunately there's a
few that have been specializing in health care.
Nevada State College, which is one of my favorite projects,
it's a new college in Southern Nevada, part of the university
system, that's specializing in accelerated nursing, and we've
been working with President Norton and the president of the
school in Henderson, Nevada, trying to learn from each other's
challenges and each other's successes.
But, quality of life is really the key, and we want to make
sure that Nevadans and Coloradans and the rest of the country
have the absolute best health care in the world, and I believe
that we have it, but there are times we have a challenge in
delivering it because of a shortage.
And there's multiple ways to reach that goal, but not only
do we need more educating professionals, we need, of course,
more teachers that have expertise in health care. We need to
make sure that our neighbors and friends and graduates, and
even those looking for a change in career who want to get into
the nursing profession. We want to make sure we can elevate
that as a very primary role in the delivery of health care.
What's happened in the country is that we're used to now 1-
800 dial-a-number, or pull it up on the web, and if you dial
the 1-800 number, you have to wait or you push another number
and eventually you find someone to talk to you about your
health care problem. Or you go to the web or WebMD or whatever
it is out there.
But American people are still begging to be taken care of
and to have someone that cares. And the nursing profession and
the professionals in delivery of health care, still are a
good--and I'm not an expert--but 80 percent of health care is
how you're treated. And I'll tell you, we need to elevate the
position of nurses, find a way to make sure that they receive,
one, the funding and the training and the pay that they
deserve, because they play such a major--you all that are here,
the professionals, play such a major role in health care. We
want to make sure we continue with the best in the world, and
we certainly all want to make sure if we're ill, or a friend or
a relative is ill, that they receive the absolute best care.
So today is really about a lot of things, and I've learned
from working with Marilyn and spending some time on this issue
the last at least three full years that a key link in health
care delivery is finding and encouraging professionals that
would like to help teach and train.
We want to make sure that we're doing everything we can
from the Federal level, and I know Marilyn and I would agree,
all politics are local. We don't want to get in the way, as the
Federal Government, and the Federal Government should be
providing opportunities, providing incentives, but we want to
make sure that the State of Colorado and the private sector and
the professionals here are given the tools by the Federal
Government to do what they need to do.
When I was elected, and I know when Marilyn was elected, we
weren't elected to be the superintendent of schools or the
president of a school, we were elected to provide support from
the Federal level.
So today, I'm honored to be here, I'm excited, this is a
passion for me, and I want to make sure that I can learn as
much as I can from all of you and take it and share it with my
community in Nevada. We're having a similar hearing in Nevada
on Friday with Nevada State College, and I hope to again take
some things that I've learned today and share with our folks in
Nevada.
So, again, thank you very much to the school and to all of
those who are here today. I'm honored, and look forward to your
testimonies.
[The prepared statement of Mr. Porter follows:]
Statement of Hon. Jon C. Porter, a Representative in Congress from the
State of Nevada
Good morning. Thank you all for joining us for this hearing to
examine the causes and possible solutions to address the shortage of
qualified nursing faculty at our nation's institutions of higher
education. I'm pleased to welcome all of our witnesses here today. I
appreciate you taking time out of your busy schedules to appear before
the Subcommittee. I am also glad that those of you in the audience were
able to attend.
As many of you know, according to the American Association of State
Colleges and Universities, by 2020 experts believe there will be a
national shortage of more than 800,000 registered nurses. The National
League of Nursing estimates that more than 125,000 qualified applicants
were rejected by nursing programs in the 2003-2004 academic year. The
shortage of nursing faculty is one of several factors that are most
commonly cited as reasons behind this trend.
This problem is even more severe in the state of Nevada, where I am
from, than in some other states. In fact, according to the U.S.
Department of Health and Human Services' National Center for Health
Workforce Analysis, Nevada's projected shortage of nurses will increase
from 11% in 2000 to 27.5% in 2020.
While I am troubled by the magnitude of this problem, and its
impact on our nation I am also hopeful that the testimony we hear today
will provide us with some additional insights as to what can be done to
address the issue. I look forward to hearing more from our witnesses
about the challenges our nation is facing and what is being done to
find solutions.
I believe that this national crisis must be confronted with
coordinated efforts at the federal, state, and local levels. While the
federal government must work harder to provide the resources to enhance
the ability to train nurses, state and local governments, as well as
private entities, will play a major role in reversing the declines in
the nursing workforce. The national health implications of this dilemma
are too serious, and the cost to patients too great to remain inactive.
We must continue to look to build relationships and develop plans of
action that will address these problems in a comprehensive manner.
Through hearings like this, and the continued efforts of schools of
nursing, we can educate Members of Congress as to how we can best
overcome these issues.
I'd also like to take this opportunity to thank Congresswoman
Marilyn Musgrave for her interest in this issue, and her invitation to
come to Greeley to discuss this issue further.--I look forward to
working with her as we continue to examine what can be done at all
levels of government to address the shortage of qualified nursing
faculty.
Again, thank you for joining us today to provide your valuable
insight into this most important issue. I look forward to continuing
our work to alleviate the pressures currently being placed on the
nursing workforce.
______
Mrs. Musgrave. Thank you, Jon, very much.
Our first witness today is Ms. Sue Carparelli. She's the
president and chief executive officer of the Colorado Center
for Nursing Excellence in Denver. Ms. Carparelli has a
background in both workforce development and health care, and
is spearheading the only collaborative statewide initiative to
improve access to quality health care through the development
and support of Colorado's nursing workforce.
She also works on a wide variety of educational issues,
with a special emphasis on the nursing shortage. Thank you for
being here, and we're looking forward to hearing from you.
You know, when we're in Washington, D.C., we have a very
prominent light that limits you to 5 minutes, but we're going
to be merciful. We don't have the light, so we're just going to
guess at it. Thank you very much.
STATEMENT OF SUE CARPARELLI, PRESIDENT AND CEO, COLORADO CENTER
FOR NURSING EXCELLENCE, DENVER, CO
Ms. Carparelli. Thank you. Thank you. I will attempt to
keep that light in my eyes nevertheless, and I want to thank
you very much for being here. We are very grateful for your
attention to what we think is a very important issue as well.
As I look around this room, I'm also humble in my having the
opportunity to speak to you, because there are many, many
experts in this room who could provide a great deal of
information on this issue for you. But let me see if I can't
summarize some of the key issues from our perspective.
First, the Center for Nursing Excellence is an independent,
nonprofit organization. It was established in 2002 to be
working as a convener, broker, facilitator of solution building
in our state as we address nursing workforce issues. As such,
we have the opportunity to work with many stakeholder groups
across the state and have learned a great deal about what works
and doesn't work in that process.
The Center's funding comes from industry investment, it
comes from state and Federal grants and foundation grants.
First of all, let me just put some things in context for
you as we then focus more specifically on the nursing faculty
shortage.
Health care in our state is a very important economic
engine, and I think it would be critical that we keep that in
focus as we consider the communities large and small, rural and
urban, across our state.
One in 10 Coloradans work in health care, and the health
care sector is expected to create more jobs than any other
industry sector in Colorado over the next decade, yet the
efficiency of the engine is stymied by shortages. The
Department of Labor in our state predicts that more than 7,300
health care jobs will go unfilled each year for the next decade
because there will not be enough workers prepared to meet that
demand.
Registered nurses in our state make up 25 percent of that
health care work force, and you talked about the shortages in
our state and the rate of growth that is projected by 2020 to
be about a 31 percent shortage.
This shortage in our state, as in other states, results
from the interplay of both supply side and demand side factors.
First, we are losing nurses faster than we can produce them.
They are old. The average age of nurses----
Mr. Porter. You'd better be careful.
Ms. Carparelli.--in Colorado--I know, I know, but I'm--
we're going to talk honestly here. Average age in our state of
Colorado nurses is 47 years old.
Importantly, it is essential that you note that only 7
percent of our nursing workforce is under 30. So the point in
that is that we are missing essentially an entire generation of
nurses.
We also have a mismatch of diversity. The racial and ethnic
make-up of our current nursing workforce does not reflect the
increasing diversity of the state. Only 7.6 percent of Colorado
nurses are nonwhite. Of that, 3 percent are Hispanic, while we
are a state that has about 16 percent of our population of
Hispanic descent.
You have referenced the fact that nurses are predominantly
women. In our state, that is 95 percent. We have not seen men
enter this profession at the same rate as we have seen women
leave it.
Against this backdrop, we face an aging population whose
health care needs will only increase in the years to come,
placing more stress on an already overburdened system.
As you referenced, our state is one that is growing. By
2020, Colorado's total population is expected to grow by 16
percent with 113 percent growth in our population of persons
age 65 and over. That becomes a critical factor in considering
demand for health care.
Our efforts to increase the supply of registered nurses to
meet this demand are greatly complicated by an education system
that struggles to produce enough graduates to replace our
diminishing and aging work force.
While we enjoy a large supply of willing students, and
you've noted both nationally and our state, that we are not
able to respond to the number of people who are interested in
entering this profession because of a variety of factors.
The No. 1 reason for this trend in our ability to absorb
those who are interested in entering this profession has to do
with the insufficient numbers of qualified faculty to meet the
demand of prospective students.
In our state, as in other areas, the faculty shortage is
most acute among clinical faculty, and those are the nursing
educators who oversee students' hands on learning experiences
at the bedside, which is a very essential component of nursing
education.
My colleague, Lynn Dierker, will tell you more about the
reasons and implications and some of the specific solutions in
terms of Colorado's nursing faculty shortage based on a study
that was recently completed by the Colorado Health Institute.
But let me make some additional observations in relation to the
findings that you'll hear from her.
First, in our state, we have at this point, I think, an
unprecedented level of collaboration amongst our schools of
nursing and amongst the faculty and leaders within those
schools. This is affording us an opportunity to learn from one
another, to look at best practices, and to share those ideas
which work best.
An information clearing house, on a national basis for best
practices on nursing education and faculty development, is also
crucial. And models such as that outlined by the University of
Northern Colorado's proposal for the National Center for
Nursing Education, offering coordination and technical
assistance, resources, and professional development for nursing
educators, is an excellent way to continue this work on a
national level.
Second, we can address the shortage of clinical leaning
opportunities, in part, by taking advantage of emerging
technologies, new opportunities and methods for learning.
Colorado is poised to become a national leader in the effective
use of those technologies, and we are grateful for the
leadership that has been provided by the Colorado Department of
Labor, which led to funding of a new collaborative simulation
center, which will be on the Fitzsimons Campus; that project
being funded by the U.S. Department of Labor.
The Colorado Center for Nursing Excellence has been charged
to operate this new resource, which will make the state-of-the-
art patient simulation resources available to students and
faculty from around the state--in particular, to help develop
the capacity of faculty to use these new technologies.
And third, we have found that clinical practitioners, those
clinical experts practicing within the health care delivery
system, are willing partner in education when we provide them
preparation and support to perform the clinical instructor
role.
We have been benefited in our state by a grant through the
Colorado Department of Labor, which has allowed us to develop
and proliferate what's referred to as a clinical scholar model.
This trains practicing nurses to become clinical scholars,
overseeing the rotations at practice sites, and the response to
this particular program has been extremely gratifying. We have
filled out grant-funded slots and nurses continue to be
interested in these roles and we are seeing industry--in other
words, the employers, particular in the acute care setting,
support the cost of their participation.
We are looking next at creating a statewide inventory of
both supply and demand of clinical sites. This is another
element that's contributing to our inability to support student
learning. And what we believe is that we have the opportunity
to create a technology platform that will support, then, that
information enabling us to have a better sense and more
efficient use of what is also a scarce resource in terms of
clinical sites.
These examples and others, which will be noted by Elise
Lowe-Vaughn from the Department of Labor, illustrate the role
of state and Federal agencies in addressing Colorado's and the
nation's nursing faculty shortage.
While the Colorado Center for Nursing Excellence is
fortunate to have strong support from Colorado's hospital and
foundation community, ongoing Federal support and investment in
efforts such as ours across the country, is essential.
Agencies, such as the U.S. Department of Labor and the
Department of Health and Human Services, play an integral role
in solving our nursing labor shortage.
In closing, I wish to draw the community's attention to one
inescapable fact: Health care workers are knowledge workers.
While many of those currently employed within the health care
sector are prepared through on-the-job training programs,
generally funded by employers, nursing requires highly
specialized and costly education and lifelong learning
opportunities which are accessible only through our colleges
and universities.
In order to prepare these essential health care workers, we
must have a viable, accessible, educational system that is
responsive to the evolving needs of current health care
practice.
And I welcome any questions that you have, and thank you
for this opportunity.
Mrs. Musgrave. That was very excellent testimony.
[The prepared statement of Ms. Carparelli follows:]
Statement of Sue Carparelli, President & CEO, Colorado Center for
Nursing Excellence, Denver, CO
Thank you, members of the Committee. My name is Sue Carparelli; I
am president and chief executive officer of the Colorado Center for
Nursing Excellence.
The Center is an independent, nonprofit organization established in
2002. It is the only organization in Colorado exclusively dedicated to
ensuring that our state has adequate numbers of highly-qualified
nurses. We bring together educational institutions, health care
providers, governmental agencies and foundations to investigate the
sources of the nursing shortfall, to develop strategies to address it
and to secure resources needed for effective solution building. The
Center serves as a source of information and technical assistance, a
broker and convener of collaborative partnerships and as a catalyst for
innovation.
Center funding comes from industry investments, grants from federal
and state agencies, and foundation grants.
My purpose today is to support my colleagues in illuminating the
factors contributing to Colorado's shortage of qualified nursing
faculty, and help them and members of this committee explore solutions
to this crucial problem.
I would like to begin my remarks by creating context around
Colorado's nursing faculty shortage. I will provide some important
facts about Colorado's healthcare workforce, and explain our state's
nursing shortage. Then I will explore the impact of the shortage of
nursing faculty on our ability to fill the nursing gap. I will furnish
examples of efforts the Colorado Center for Nursing Excellence has
underway to alleviate the faculty shortage, and offer recommendations
to the Committee as you consider the federal government's role in
addressing this nationwide problem.
Healthcare is an economic engine in Colorado. One in 10 Coloradans
work in healthcare, and the healthcare sector is expected to create
more jobs than any other industry sector in Colorado over the next
decade.
Yet, the efficiency of that engine is stymied by shortages. The
Colorado Department of Labor predicts that more than 7300 healthcare
jobs will go unfilled each year for the next decade because there will
not be enough workers prepared to meet the demand.
The shortage is especially acute among registered nurses. Members
of the committee are already, I am sure, well aware of the nationwide
nursing shortage. Colorado's shortage is especially dire.
While registered nurses currently make up 25 percent of all
healthcare workers in our state, Colorado is estimated to have about
5,000 fewer nurses than we need, or a 13 percent shortfall. That's
about double the national average. And, that figure is expected to grow
to 31 percent--or nearly 17,000 fewer nurses than needed in Colorado--
by 2020 if current trends continue. This shortfall results from the
interplay of both supply side and demand side factors.
First, we are losing nurses faster than we produce them. The
average age of a Colorado hospital nurse is currently 47. Only 7
percent are under age 30. A 2003 study found that 45 percent of
Colorado nurses did not expect to be practicing in five years.
Further, the racial and ethnic makeup of the current nursing
workforce does not reflect the increasing diversity of the state. Only
7.6 percent of Colorado nurses are non-white; 3 percent are Hispanic,
in a state whose population is nearly 16 percent Hispanic.
In addition, women have left nursing for other professions and few
men have entered the profession to take their place. Today, 95 percent
of Colorado nurses are female, while only 5 percent are male.
Against this backdrop, we face--as do all other states--an aging
population whose healthcare needs will only increase in the years to
come, placing still more stress on an already overburdened system. Our
population is also growing. By 2020, Colorado's total population is
expected to grow 16 percent, with 113 percent growth among those age 65
and older.
Our efforts to increase the supply of registered nurses to meet
this demand are greatly complicated by a higher education system that
is failing to produce enough graduates to replace our diminishing,
aging workforce. While we enjoy a large supply of willing students, our
nursing education programs are severely constrained by a lack of
qualified faculty.
From a national perspective, it is important--and somewhat
disheartening--to note that Colorado's nursing faculty shortage is
typical, not unique. A study earlier this year by the American
Association of Colleges of Nursing found that nursing schools around
the country rejected 32,000 qualified students in 2004, despite a 14
percent gain in enrollment from the previous year. In Colorado in 2003
(the most recent year for which data are available), 2600 qualified
applicants were turned away from nursing programs. The number one
reason for this disturbing trend is that Colorado's nursing schools, as
well as those elsewhere in the country, simply do not have sufficient
numbers of faculty to meet the demand from prospective students.
Our faculty shortage is most acute among clinical faculty, the
professionals who oversee student nurses' hands-on experiences at the
bedside. The bottleneck for clinical rotations means that nursing
students wait longer for placements and have less time on rotations
once they secure them. This essential element in nurse preparation, and
one which is especially critical for developing the observation and
treatment skills necessary to providing high quality care, is thus
jeopardized.
My colleague Lynn Dierker will tell you more about the reasons for,
implications of, and specific solutions to Colorado's nursing faculty
shortage, based on a recent study conducted by the Colorado Health
Institute under the Center's auspices. I want to set the stage for her
comments by making a few observations of my own.
First, our nursing schools must have opportunities to learn from
each others' successes and tap into the latest thinking on nurse
education. An information clearinghouse for best practices on nursing
education and faculty development is crucial. The model outlined in the
University of Northern Colorado's proposal for the National Center for
Nursing Education, offering coordination, technical assistance,
resources and professional development for nursing educators, is an
excellent way to fill this need.
Second, we can address the shortage of clinical learning
opportunities, in part, by taking advantage of emerging simulation
technologies. In fact, Colorado is posed to become a national leader in
the effective use of these technologies. The U.S. Department of Labor
recently awarded funds to the Colorado Dept. of Labor and Employment to
create the Work, Education and Lifelong Learning Simulation Center,
known as the WELLS Center. The Colorado Center for Nursing Excellence
is overseeing this important new resource, which will make state-of-the
art patient simulation resources accessible to students and faculty
from around the state through high-speed datacasting.
Third, and perhaps most encouraging, we have found that clinical
practitioners become more willing to oversee student rotations when the
practitioners are trained in how to fill that role. Indeed, practicing
nurses have signed up eagerly for a new training program provided by
the Colorado Center for Nursing Excellence under a grant from the
Colorado Department of Labor and Employment. This Faculty Development
Project trains practicing nurses to become ``clinical scholars,''
overseeing student rotations at practice sites throughout Colorado.
Response to the program has been so overwhelming that the grant-funded
slots were filled long ago, yet nurses continue to sign up for the
opportunity, with their institutions covering the cost of their
participation.
The Colorado Center for Nursing Excellence is also poised to
develop a statewide inventory of both the supply and demand for
clinical teaching sites, supported by a technology platform which will
enable efficient matching based on tailored selection criteria. We are
currently seeking funding for this initiative.
These examples--and others that will be noted by my colleague Tom
Looft from the Colorado Department of Labor--all illustrate the role of
state and federal agencies in addressing Colorado's, and the nation's,
nursing faculty shortage. While the Colorado Center for Nursing
Excellence is fortunate to have strong support from Colorado's hospital
and foundation community, ongoing federal support and investment is
essential for our efforts--and similar programs around the country--to
be successful. Agencies such as the U.S. Department of Labor and the
Department of Health and Human Services play an integral role in
solving our nursing labor shortage, providing the funds that fuel good
ideas.
In closing, I wish to draw the committee's attention to one
inescapable fact. Healthcare workers are knowledge workers. While many
of those currently employed within the healthcare sector are prepared
through on the job training programs generally funded by employers,
nursing requires highly specialized and costly education and training
accessible only through our colleges and universities. In order to
prepare these essential health care workers we must have a viable,
accessible educational system that is responsive to the evolving needs
of current health care practice.
I welcome any questions from the committee. Thank you.
______
Mrs. Musgrave. I think we'll hear from all of the witnesses
and then we'll come back for questions.
Ms. Carparelli. Thank you.
Mrs. Musgrave. That was very good.
Our next witness is Ms. Lynn Dierker. She's an R.N. Who
currently serves as the deputy director for community
initiatives at the Colorado Health Institute, and she holds a
bachelor of science in nursing from Emory University, and a
bachelor of arts from Drew University.
As deputy director for community initiatives, she is
responsible for building sustained partnerships for distancing
nursing education between the institute and its diverse
constituents throughout the state. Welcome.
STATEMENT OF LYNN DIERKER, R.N., DIRECTOR FOR COMMUNITY
INITIATIVES, COLORADO HEALTH INSTITUTE, DENVER, CO
Ms. Dierker. Thank you very much. I appreciate the
opportunity to speak to you today.
The Colorado Health Institute is an independent 501(C)(3)
created by three foundations in Colorado to be an independent
source of information, objective nonpartial information, for
policymakers at both community and statewide levels.
I'm here today to provide brief highlights from the 2004
study that we completed related to the Colorado nursing
workforce and the shortage of nursing faculty. And we completed
this at the request of the Colorado Center for Nursing
Excellent, and with funding by the Colorado State Workforce
Council.
A copy of the entire study is provided to you, and I think
you have one with you there today----
Mrs. Musgrave. Yes.
Ms. Dierker.--and I recommend it as a rich resource of
information. However, during the next few minutes, I hope to
put into context the key findings from the study and discuss
their implications, particularly as you consider how best to
partner with states to promote nursing workforce development.
As I make my few remarks here today, I don't know about you,
but in listening to study findings, it's awfully difficult to
hear data rattled off. So, what I've done is really refer you
to the study for specific numbers and findings, and I'm going
to try and this sort of the key concepts and implications of
the findings in the study.
The study was designed to identify and analyze key factors
and issues affecting the supply of and demand for nursing
faculty; in particular, the relationship between nurse
education programs and the market for nurses and the health
care industry.
The study focuses on four primary areas: Economic factors,
noneconomic factors, education infrastructure, and the role
played by the private sector. And the study included issues
related to both licensed practical nursing and registered
nursing education programs.
The research we did took full advantage of what is
available in the current nursing workforce literature, and we
also collected primary data through two Web-based surveys; one
of clinical sites that employ nurses and train them, and one of
educational programs across our state. We also interviewed many
key informants from both practice and education and used an
advisory panel to advise us on our study design and
methodology.
So, as to our key findings, let me put these in the context
of what you're already hearing about the national workforce
shortage and faculty shortages, and what you've already heard
today about Colorado's situation.
Our current nurse faculty shortage is significantly greater
than the national average, as you've heard. The national
shortage of faculty being around 8.6 percent, our shortages
range from 15 percent in our 4 year institutions to 25 percent
among our 2 year programs, including, importantly, our
community colleges.
In the face of this nationwide shortage, Colorado struggles
to compete with other states to attract faculty due to these
economic and noneconomic factors, including compensation
levels, workload demands, and budget constraints that
disproportionately affect our state-supported higher education.
With population growth, as you've heard, and increasing
demand for nursing services, Colorado, like other states, has
called upon its education system to produce greater numbers of
nursing graduates. The study found that nursing education
deployed significant and rapid program expansions over the past
3 years. However, in a number of ways, these expansions
exacerbated our faculty shortage and increased job
dissatisfaction.
Entry-level faculty salaries are low; less than $40,000 on
average, and even less in rural areas, and especially related
to available positions within clinical institutions offering
greatly higher rates of pay.
Workloads are heavy, especially for clinical instructors
who most often work on an hourly contract basis without
benefits.
In this context, concerns, as you've mentioned, are growing
about faculty attrition due to retirements which are projected
to increase significantly due to the average age of Colorado
faculty, 50, especially within the state's 4 year colleges and
universities.
Preparing adequate numbers of qualified faculty is another
corollary issue. The study reveals a lack of incentives and
opportunities for graduate level preparation for nurses
interested in a teaching role. Anecdotally, we heard from many
who report that nurses who are in clinical settings and
interested in taking on faculty roles can't afford the time and
the resources to go full time to an education program and to
have access to graduate level preparation.
The majority of the state's nursing programs in Colorado
are publicly funded and are, therefore, caught up in the
current fiscal crisis facing all of higher education in our
state. The study found that the private sector, particularly
those clinical facilities employing newly graduated nurses, in
particular, hospitals and long-term care facilities, private
sectors already spending millions of dollars per year to
support nursing education.
However, clinical facilities report that newly graduated
nurses are often unprepared to assume the full responsibilities
of independent practice and they, therefore, require continuing
training and supports that range again to the tune of millions
of dollars annually.
In addition to providing examples of widespread stress and
concern related to faculty shortages, our study informants
provided a rich picture of the types of innovation that are
beginning to take hold within nursing education. As Sue has
mentioned, these include advances in technology to enhance
teaching methods and collaborative relationships with clinical
facilities to strengthen the level of preparedness of new
graduates and improve faculty job satisfaction. The study found
that Colorado's nursing programs and health care facilities are
pursuing many of the promising strategies that we identified
nationally and by other states.
CHI was charged to provide timely information that would
support stakeholder decisionmaking about opportunities and
investments in programs and interventions. This study is a
starting point. It's a snapshot in time, and highlights the
need for more robust, well-defined, and reliable data
monitoring efforts by which to understand the full picture of
nursing workforce supply and demand over time.
However, the findings make it clear that Colorado
educators, clinical training sites, and policymakers face both
substantial challenges and exciting opportunities related to
strengthening not only the nursing workforce, but also the
healthcare system as a whole.
In conclusion, I want to offer observations regarding the
important three-level partnership that exists between Federal,
state, and local leaders and policymakers. At the community
level, even in our rural areas, nursing educators and
clinicians perceive the need for strategic alignment of goals
and strategies to meet the healthcare challenges before us.
Study informants note that many of the issues related to
nursing workforce, and particularly faculty development, should
be addressed by a policy framework and resources made available
at the national level.
At the same time, as a system in need of innovation,
nursing education must rely on and have the support for
creativity and the ability to be responsive at the local and
state system level among institutions, and with leadership that
nurse practice and education leaders provide.
Collaboration, flexibility, funding, and strategic and
sustained alignment of efforts are themes that emerge from this
study, and are offered for your consideration.
Again, I am grateful for the opportunity to present this
very brief overview, and welcome any questions or comments you
may have. Thank you.
Mrs. Musgrave. Thank you. We'll have questions for you a
little later, I'm sure.
[The prepared statement of Ms. Dierker follows:]
Statement of Lynn Dierker, R.N., Director for Community Institute,
Colorado Health Institute, Denver, CO
Thank you for the opportunity to speak to you today. My name is
Lynn Dierker. I am Director for Community Initiatives with the Colorado
Health Institute.
The Colorado Health Institute is an independent 501(c)(3) created
by three Colorado foundations to be an information resource for policy
makers at both community and state levels. CHI's mission is to improve
the health of Coloradans through informed decision making. To carry out
this mission, CHI works to improve the availability of data, conduct
policy research and analysis, and perhaps most importantly, facilitate
the dissemination of information so that it is used most effectively to
understand and address the pressing issues affecting our communities
and our state. As an organization, CHI is distinct in its independence
and ability to serve as a neutral convener, bringing together
stakeholders with diverse perspectives to work collaboratively to
collect, analyze, and discuss data and their implications for health
improvement in our state.
I am here to provide brief highlights from a 2004 study of
Colorado's nursing workforce and the shortage of nursing faculty that
CHI completed at the request of the Colorado Center for Nursing
Excellence. A copy of the entire study is being provided to you as a
resource. However, during the next few minutes I hope to put into
context key findings from the study and discuss their implications,
particularly as you consider how best to partner with states to promote
nursing workforce development.
The Colorado Nursing Faculty Supply and Demand Study (Study) was
designed to identify and analyze key factors and issues affecting the
supply of and demand for nursing faculty, including the relationship
between nurse education programs and the market for professional nurses
in Colorado. The Study focuses on four primary areas: 1) economic
factors including the economic rewards of teaching; 2) non-economic
factors such as faculty workload, work environment, opportunities for
professional development, and faculty educational requirements; 3) the
infrastructure of Colorado nurse education programs; and 4) the role
played by the private sector. The Study examined issues related to both
licensed practical nursing (LPN) and registered nursing (RN)
educational programs.
The research effort took full advantage of information available in
the current nursing workforce literature, and also collected primary
data from Colorado nursing programs and clinical training sites related
to the recruitment and retention of nursing faculty. An advisory panel
of experts informed the study design and methodology.
I want to highlight key findings from the Study in the context of
what you are learning about nursing workforce issues nationwide.
Colorado's current nurse faculty shortage is significantly greater than
the national average shortage of 8.6 %, with shortages ranging from 15%
in our four year institutions, to 25% among two year institutions
including community colleges.
In the face of a nationwide shortage, Colorado struggles to compete
with other states to attract faculty due to economic and non-economic
factors including compensation levels, workload demands and budget
constraints that disproportionately affect state-supported higher
education.
With population growth and increasing demand for nursing services,
Colorado, like other states, has called upon its education system to
produce greater numbers of nursing graduates. The Study found that
nursing education deployed significant and rapid program expansions
over the past three years in response to the workforce shortage.
However, in a number of ways, these expansions exacerbated the faculty
shortage and increased job dissatisfaction. Entry level faculty
salaries are low, especially related to available positions within
clinical institutions at higher rates of pay. Work loads are heavy
especially for clinical instructors who most often work on a hourly
contract basis without benefits. In this context, concerns are growing
about faculty attrition due to retirements, which are projected to
increase significantly due to the average age of Colorado faculty,
especially within the state's four year colleges and universities.
Preparing adequate numbers of qualified faculty is another corollary
issue. The Study reveals a lack of incentives and opportunities for
graduate level preparation for nurses interested in a teaching role.
The majority of the state's nursing programs are publicly funded
and are therefore caught up in the current fiscal crisis facing all of
higher education in Colorado. The Study found that the private sector,
particularly clinical facilities employing newly graduated nurses
(hospitals and long term care facilities), is already spending millions
of dollars per year to support nursing education. This support takes
the form of subsidizing clinical faculty; providing clinical
instruction; offering scholarships and tuition reimbursement; and
expanding clinical rotations to meet the increased demand for clinical
training sites. However, clinical facilities report that newly
graduated nurses are often unprepared to assume the responsibilities of
independent practice. Concerns over the quality of patient care require
them to provide orientation programs to new graduates ranging from four
weeks to greater than three months and costing in excess of $2 million
dollars annually.
In addition to providing examples of widespread stress and concern
related to faculty shortages, Study informants provided a rich picture
of the types of innovation beginning to take hold within nursing
education. These include advances in technology to enhance teaching
methods, and collaborative relationships with clinical facilities to
strengthen the level of preparedness of new graduates and improve
faculty job satisfaction. Nursing programs have begun to utilize
technology to enhance existing teaching methods and the overall
educational experience. Together with clinical training sites,
educational programs are striving to develop sustainable collaborative
approaches to strengthen the competencies of new nurse graduates. The
challenges inherent in these innovative projects are how to
successfully achieve technology transfer and ensure widespread adoption
of those practices that yield the best results.
The findings from this study point to the need for coordinated and
strategic action. A solid foundation of public and private sector
collaboration has been established. Reporting new levels of
partnership, Colorado's nursing programs and health care facilities are
pursuing many of the most promising strategies identified nationally
and by other states, particularly related to cultivating an adequate
supply of clinical faculty. Colorado-specific initiatives designed to
support and strengthen faculty roles and resources are emerging.
There are additional opportunities to further the use of non-
traditional and multidisciplinary approaches to faculty development
such as streamlining graduate program requirements, use of
interdisciplinary faculty teams, and expansion of regional
institutional collaborations. Regulatory and institutional policies
warrant further examination related to the continuum of educational
opportunities for practicing nurses including opportunities to better
utilize Colorado's pool of retired nurse educators.
As Study informants note, nurse faculty issues are inexorably
linked to the complex range of factors that contribute to the overall
nursing workforce shortage. Other states offer approaches for
recruiting and training nurse educators that Colorado should consider.
State experiences suggest that it is necessary to dig below the surface
to address fundamental components of a transformed 21st health care
system that can deliver quality health care in a cost-effective manner.
These key questions must be answered by each state, but also
collectively. What are the numbers and qualifications of nurse
educators that are needed? What array of nursing education programs is
needed to yield the right mix of practicing nurses? What data is needed
to inform these decisions?
CHI was charged to provide timely information that would support
stakeholder decision-making about opportunities and investments in
programs and interventions. This study is a starting point for
understanding both the contributing factors and potential solutions for
Colorado's nurse faculty shortages. It is a snapshot in time and
highlights the need for more robust, well-defined and reliable data
monitoring efforts by which to understand the full picture of nursing
workforce supply and demand over time and the factors associated with
affecting noted trends. However, the findings make it clear that
Colorado educators, clinical training sites and policy makers face both
substantial challenges and exciting opportunities related to
strengthening not only the nursing workforce, but also the health care
system as a whole.
In conclusion, I want to offer observations regarding the important
three-way partnership that exists between federal, state and local
leaders and policy makers. At the community level, even in rural areas,
nursing educators and clinicians perceive the need for strategic
alignment of goals and strategies to meet the health care challenges
before us. Study informants note that many of the issues related to
nursing workforce and particularly faculty development should be
addressed by a policy framework and resources made available at the
national level. At the same time, as a system in need of innovation,
nursing education must rely on the creativity and responsiveness of
local and state systems, institutions, and leaders. Collaboration,
flexibility, funding, and strategic and sustained alignment of efforts
are themes that emerged from this Study and are offered for your
consideration.
I welcome any questions or comments from the committee. Thank you!
______
Mrs. Musgrave. Our next witness is Elise Lowe-Vaughn, and
she's the operations director for the workforce programs and
the Colorado Department of Labor and Employment. She has an
undergraduate degree in humanities and has done graduate work
in counseling. She also helped to develop a multilevel computer
literacy curricula for the Electronic Colorado Learning Portal
that targets the hardest to serve and adult education
participants. Thank you for being here.
STATEMENT OF ELISE LOWE-VAUGHN, OPERATIONS DIRECTOR, WORKFORCE
DEVELOPMENT PROGRAMS, COLORADO DEPARTMENT OF LABOR AND
EMPLOYMENT, DENVER, CO
Ms. Lowe-Vaughn. Thank you, Members of the Committee. I'm
honored to speak with you today about the nursing shortage and
its impact on our economy and the variety of nursing and
faculty initiatives funded by the Colorado Department of Labor
and Employment and the Colorado State Workforce Development
Council.
Colorado's workforce system is a national leader because of
its unique collaborative partnerships, its innovation, and its
ability to embrace the emerging technologies to meet industries
demands in critical workforce occupations.
Worker shortages in healthcare occupations, particularly in
nursing, have been the focus of Federal, state, and local
initiatives the past several years.
In Colorado, during the past 3 years, the Colorado
Department of Labor and Employment and the State Workforce
Development Council, have funded over $3 million in
discretionary workforce investment act and Wagner-Peyser
projects that are targeted at improving the supply of nurses
and allied healthcare professionals and providing career
ladders to support advancement opportunity, and also faculty
development opportunities.
Some examples of the projects that have been funded include
scholarships to upgrade bachelors and graduate-level nurses,
recruitment of minority and youth populations into the
profession, development of assessment tools to support
students' ability to succeed in nursing programs, remediation
programs to mentor high-risk nursing students, expansion of
clinical rotationsites, the creation of associates and
bachelors degrees in rural areas, and the state community
colleges' nursing program accreditation.
Concurrently, the Department, acting as a neutral convener
of industry leaders and educational institutions, held forums
around the state to identify creative approaches to the nursing
shortage so that we could positively effect the nursing supply
pipeline.
We solicited the Center for Nursing Excellence to develop
the Colorado nursing faculty supply and demand study. The
findings from the study, and the results of the various forums
around the state, highlighted the need to take the statewide
system building approach to nursing and faculty development.
From these conversations, the idea for the Work, Education,
and Life-long Learning Simulation Center was spawned and a
grant was requested and funded from the U.S. Department of
Labor. This technology-based public-private venture weaves
together the insights learned from the past 3 years, and has
helped us identify a 5-year multiphase course of action.
The center will be located at the Fitzsimons Redevelopment
Center, and the space was contributed in part from the
University of Colorado Hospital and partially funded from the
state. This center will probably be the most sophisticated
clinical training facility in the country for nurses and for
nursing faculty.
In the first year, we have purchased over a million dollars
of state-of-the-art equipment. The center will harness various
technologies and employ a variety of procedure-specific
simulations that meld virtual reality and computerized
simulation, and transmit these via the airwaves using the
public broadcast system's data casting. It is anticipated that
this national demonstration will expand the depth and breadth
of statewide healthcare training, and be a template for
replication around the country.
Partners in this grant included Department of Labor and
Employment, the State Workforce Council, the University of
Colorado Hospital, the Center for Nursing Excellence, Touch of
Life, the Rocky Mountain Public Broadcast System, the
University of Colorado Health Sciences Simulation Center, the
Colorado Area Health Education Center, and all of the
collaborations of the many healthcare industry leaders, as well
as educational facilities around the state. And we have over 55
partners involved in this, and it is a statewide grant.
Deeply embedded in the state's holistic strategy for
expanding and improving the number, the quality, and the
quantity of nursing professionals is the nursing faculty
development grant. We funded this grant with the Center for
Nursing Excellence with a four-to-one match from our industry
and educational partners. This initiative seeks to increase the
number of clinical scholars, clinical instructors, classroom
instructors, lecturers, and preceptors.
Through this 2 year, million dollars project, subject
matter experts have partnered to develop curricula and train
clinical scholars and preceptors in the use of simulation
technology to enhance skill-based competencies.
The Department's workforce learning management system will
be a repository for statewide and natural virtual mentor
clearing house for faculty development support.
The aforementioned approaches to this health care crisis
are examples of what the state workforce development system has
developed in response to President Bush's call for innovative
workforce solutions, built and sustained through strategic
partnerships.
Critical to all of our efforts are the public-private
collaborative partnerships, which all of us have been talking
about. Though they present unprecedented challenges for
government and its processes, these unique initiatives afford
us the opportunity to confront the status quo and build for the
future.
Mrs. Musgrave. Thank you very much for your testimony.
[The prepared statement of Ms. Lowe-Vaughn follows:]
Statement of Elise Lowe-Vaughn, Operations Director, Workforce
Development Programs, Colorado Department of Labor and Employment,
Denver, CO
Thank you members of the Committee, I am honored to speak with you
today. My name is Elise Lowe-Vaughn; I am the Operations Director for
Workforce Programs at the Colorado Department of Labor and Employment
Being competitive in today's global economy requires innovative
workforce solutions. In 2003, the Miliken Institute ranked Colorado
third in the nation for future technology growth. I am here today to
speak to the variety of nursing and faculty initiatives funded by the
Colorado Department of Labor and Employment (CDLE) and the Colorado
State Workforce Development Council (CSWDC). These initiatives have
been targeted to meet industry demands for critical workforce
occupations and employ emerging technology-based solutions. Worker
shortages in healthcare occupations, particularly in nursing, have been
the focus of federal, state and local workforce initiatives the past
few years.
In Colorado, during the last three years, the CDLE and the CSWDC
funded over three million dollars in Discretionary Workforce Investment
Act (WIA) and Wagner-Peyser (WP) projects targeted at improving the
supply of nurses and allied healthcare professionals, providing career
ladders to support advancement opportunities, and faculty development
opportunities. Funds were competitively awarded to regional workforce
development programs that partnered with industry and education to
develop locally driven solutions to their healthcare worker shortages.
Grantees were required to have partners that brought non-federal in-
kind or matching funds. Grant funds were intended to seed initiatives
that would directly affect change at the local, community level.
Examples of projects funded include: Scholarships to upgrade two year,
four year and graduate level Nurses; recruitment of minority
populations and youth into healthcare professions; development of
assessment tools geared to assess an individual's readiness to handle
the rigors of nursing education programs; remediation programs to
mentor high-risk nursing students; expansion of clinical rotation
sites; creation of Associate and Bachelor degreed programs for nurses
in rural areas of the state; and accreditation of the State's Community
College Nursing Programs.
Concurrently, the CDLE and the CSWDC, acting as neutral conveners
of industry leaders and educational institutions, held healthcare
forums around the State to identify creative approaches to the nursing
shortage that could positively impact the nursing supply pipeline. The
CSWDC also solicited the Center for Nursing Excellence (CNE) to develop
the Colorado Nursing Faculty Supply and Demand Study. The findings from
this study, and the results from the various forums and funded
initiatives, highlighted the need to take a statewide system-building
approach to nursing and faculty development rather than using
individual initiatives that weren't able to be replicated on a grand
scale or didn't have the momentum to ameliorate the healthcare worker
shortages.
Galvanized by the results of the statewide healthcare forums, the
Nursing Faculty Supply and Demand Study, and the locally funded CDLE
and CSWDC initiatives, many within the healthcare community, have come
to see the value added by public/private alliances.
These conversations spawned the idea for a grant request to the US
Department of Labor (USDOL) to create the Work, Education and Lifelong
Learning Simulation (WELLS) Center. This technology-based public/
private joint venture weaves together the insights learned over the
past three years, and has helped us identify a five-year, multi-phased
course of action. The WELLS Center will be located at the Fitzsimons
Redevelopment Center in space contributed by the University of Colorado
Hospital, and partially funded by CDLE and CSWDC. It took over eighteen
months to conceive the design framework for the Center; and it will be
one of the most sophisticated clinical training facilities in the
country for nurses and nursing faculty.
USDOL funded this national model in phases, with first-year funds
targeted at purchasing a million dollars of state-of-the-art equipment.
The Center will harness various technologies and employ a variety of
procedure specific simulators that meld virtual reality and
computerized simulation, and transmit this learning via the air waves
using high-speed data-casting. Through the use of technology, students
can build their clinical competencies without risk or harm to patients,
and faculty can hone their teaching skills using cutting edge systems.
The WELLS Center grant was submitted to USDOL by the CDLE and
CSWDC, and represents a partnership on a grand scale among government,
education, the public broadcast system, and industry competitors.
Industry and non-federal partners contributed a two-to-one in-kind fund
match for all federal funds invested into the grant. It is anticipated
that this national demonstration will expand the depth and breadth of
statewide healthcare training and be a template for replication around
the country. This alignment of resources will afford all a benefit
beyond their individual means. Partners in the grant included:
Colorado Department of Labor and Employment
Colorado State Workforce Development Council
University of Colorado Hospital
Center for Nursing Excellence
Touch of Life
Rocky Mountain Public Broadcasting System
University of Colorado Health Sciences Simulation Center
Colorado Area Health Education Centers
In addition, investors and collaborators in the Nursing Faculty
Development Initiative and Simulation Development Group that played key
roles in this process included:
Adams State College
Banner Health
Centura Health Systems
Colorado Community College System
Colorado Permanente Medical Group
Columbine Health System
Craig Hospital
Denver Health Medical Center
Emily Griffith Opportunity School
Exempla Healthcare
HealthONE
Kaiser Permanente
Mesa State College
Metropolitan State College of Denver
Platt College
Poudre Valley Hospital
Regis University-Loretto Heights Department of Nursing
University of Colorado at Denver and Health Sciences Center
University of Colorado, Colorado Springs
Beth El College of Nursing and Health Sciences
University of Northern Colorado
T.H. Pickens Technical Center
San Luis Valley Regional Medical Center
St. Mary's Hospital
We have learned that the nursing shortage is compounded by a
deficit of clinical practitioners and faculty needed to train the
additional number of nurse needed to meet the nation's healthcare
needs. Deeply embedded in the State's holistic strategy for expanding
and improving the number, the quality and the quantity of nursing
professionals is the Nursing Faculty Development Grant. Funded by the
CDLE, with a four-to-one in-kind match from our industry and
educational partners, this initiative seeks to increase the number of
clinical scholars, clinical instructors, classroom instructors/
lecturers, and preceptors. Through this two-year, million dollar
project, subject matter experts have partnered to develop curricula and
train clinical scholars and preceptors in the use of simulation
technology to enhance skill-based competencies. Faculty orientation
workshops for the use and application of simulation tools will be
developed and held at the WELLS Center, and on-line coaching and skill-
building workshops will be developed to support the use of various
technologies to train educators and clinical staff. In addition, the
Departments e-Colorado workforce learning management system portal will
become the repository for a statewide and/or national virtual mentor
clearinghouse for faculty development support.
The aforementioned approaches to the healthcare crisis are examples
the State Workforce Development System has developed in response to
President Bush's call for innovative workforce solutions built and
sustained through strategic partnerships. Critical to all our efforts
are the public/ private collaborative partnerships. Though they present
unprecedented challenges for government and its processes, these unique
initiatives afford us the opportunity to confront the status quo and
build for the future.
______
Mrs. Musgrave. Our last witness is Ms. Kay Norton. I would
just like to say, President Norton, I very much appreciate you
coming to Washington, D.C., and I look forward to working with
you on issues for the University. I know you have a number of
things to deal with, but this one today is critically important
for our quality of life. And with the growth in Colorado, it
sounds very similar to the growth in Nevada, Jon, very similar.
And demographics being what they are, and of course, in the
fourth district of Colorado, I serve a vast rural area.
Seventy-five percent of the population is up in Weld and
Larimer Counties and Boulder County, but 75 percent of the land
mass is out there in those remote rural areas, so some very
unique challenges that we're facing here in Colorado.
Ms. Norton has an undergraduate degree in English and a
juris doctorate from the University of Denver, College of Law.
She joined the University staff in 1998 as Vice-President for
University Affairs, General Counsel, and Secretary to the Board
of Trustees.
During her tenure at UNC, she has created opportunities to
enhance the public health training and service in Colorado.
Through the Colorado School of Public Health for Rural, Native
American, Hispanic and Inner-City Populations. We're looking
forward to your testimony.
STATEMENT OF KAY NORTON, PRESIDENT, UNIVERSITY OF NORTHERN
COLORADO, GREELEY, CO
Ms. Norton. Thank you very much, Congresswoman Musgrave.
And it is a privilege to be here with you and with Mr. Porter,
and I appreciate the opportunity.
I was at a meeting this morning when I heard for the
umteenth time a reference to a very popular book by Thomas
Friedman called ``The World is Flat,'' which is about the fact
that we are in a global economy, and that from the perspective
of a higher education institution, we have to prepare our
students for competition on a global basis. And the issue of
the preparation of nurses and the shortage of nursing
professionals is a worldwide issue. But we can no longer solve
that by stealing from each other, or even by recruiting from
the Philippines, which has certainly occurred in this country.
So I'm pleased to be able to participate in talking with
you today about some of the things that we are doing locally in
Colorado, regionally in the western United States, and
nationally to address this critical issue.
Most of the statistics have already been mentioned, and
there are also some contained in my written testimony, which
you have in the record. I would note something that hasn't been
mentioned that only 1 percent of the nursing professionals in
the State of Colorado have a Ph.D., which is the entry degree
required for full faculty status at a university. I appreciate
very much Ms. Carparelli's remarks about the importance of
higher education institution-based preparation of nursing
professionals as we go forward, although the clinical piece is
vitally important. On-the-job-training is not enough to really
advance the profession and its role in our health care system
in the United States.
The University of Northern Colorado School of Nursing is a
microcosm of the issue about faculty retirements. One-third of
our doctorally prepared nursing faculty retired in 2004 and
2005. And, in fact, our current codirector of our nursing
program, we literally talked out of retirement to come back and
provide that leadership for us because we knew where she lived.
So, she could not escape completely.
But it's an issue that we have already seen played out here
on our campus. And it was mentioned that one of the major
issues that universities and colleges and community colleges
face is that the market has not served us well in terms of the
salaries that we are able to pay to faculty. They aren't
appropriate for the responsibility and the learning that's
required, and we have an issue, as well, in terms of price
sensitivity in terms of tuition that we should charge for a
professional preparation program for nurses.
Some programs, you can have differential tuition because
the market will bear it. Let's say in a business program or
particularly at the graduate level. But when you're talking
about a public service profession like teaching or like
nursing, it's a different question as to how much should you
put on the student in order to bear the cost of paying faculty
appropriately. It's something with which we've wrestled, and we
need to take a good hard look at that in terms of what the role
of state and the Federal Government might be in helping us to
perhaps shape the market forces, to make the adjustments that
are going to be necessary for us to compensate these
professionals appropriately.
I would like to talk to you a bit today about what the
University of Northern Colorado has done to respond to the
nursing faculty shortage. Most prominently, we started 2 years
ago an on-line Ph.D. Program in nursing education. This is not
the same sort of Ph.D. That one would acquire at the University
of Colorado Health Sciences Center, for example, where a
nursing Ph.D. Is in clinical practice areas and research, as
opposed to education. The University of Northern Colorado, as
many of you know, began as a teacher preparation institution, a
normal school in 1889. It is still by law the center of our
reason for being and our public mission is the preparation of
education professionals, and particularly at the graduate
level.
The program, as I mentioned, was launched in 2004 and it's
committed to increasing the number of doctorally prepared nurse
educators. Graduates of the Ph.D. Program are qualified,
therefore, to fill nursing faculty positions in educational
institutions and in health care agencies. It was mentioned,
also, that the clinical settings in which nurses are employed
also have a significant education and continuing education
activity and role in our health care system. Therefore, the
graduates of our program are prepared to meet those different
types of needs.
The program is delivered on line. We admitted 18 students
in the `04-`05 ``cohort'' we call it, a group that goes through
together. Another 18 were admitted in `05-`06.
We're excited about those possibilities and are looking
forward to the work that those students are going to be
contributing to the research base her and nationally.
We are also proposing that the University of Northern
Colorado be the home for a national center for nursing
education. We have a similar concept in place here at the
University of Northern Colorado that--called the National
Center for Low Incidence Disabilities, which addresses another
critical need for the education of educators for the blind and
the deaf. And that center, as the Center for Nursing Education
would do, uses technology to research and develop best
practices for providing that type of education and
disseminating that information, again, using technology.
Our proposal for the National Center for Nursing Education
is in collaboration with the Colorado Center for Nursing
Excellence, which has been mentioned a number of times. The
National Council of State Boards of Nursing and other state
college and university degree programs in nursing, and it has
three purposes: To provide academic programs in nursing
education, master's and post-master's certificates, Ph.D.
Through course offerings on campus, on line, and at outreach
sites. Potential outreach sites include locations in the
northern, the southern, and the western slope regions of this
state, especially in rural and underserved areas that have
community colleges that operate associate degree programs in
nursing.
Our community colleges and 4 year schools in these areas
have attempted to expand their nursing programs, but have the
problems that have been described in terms of qualified faculty
to staff those programs.
Second, the center would provide professional development
opportunities for nurse educators who are in place through
summer institutes, teleconferences, webcasts, and on-line
educational programs.
And last, we want to establish a national nursing education
resource center. Ms. Carparelli mentioned this. That would
enable nursing faculty to access information and resources
pertaining to contemporary issues and trends in nursing
education through a centralized data base, and create a center
for evidence-based nursing education; that is research into
what works, that will provide faculty and graduate students
opportunities to work together in advancing and addressing the
question of what should nursing education be. Not only what is
it now and what are the current best practices, but how should
it fit into the healthcare system as it's developing given that
not only the demographics are changing, but the demands and the
type of care and the role of the nurse in the continuum from
physicians down through what used to be called orderlies,
really needs to be addressed. And we are eager to participate
and thinking very hard about, well, what should--not only what
should a nurse be and how should he or she be prepared, but,
you know, how do we accomplish that?
The University has also been partners in developing a
multistate consortium that's called NEXUS, N-E-X-U-S. It
includes the University of Colorado, the University of Arizona,
the University of Utah, and Oregon Health Sciences University
to develop a mechanism for students to access Ph.D. Courses on
line through a collaborative arrangement.
This is really a sophisticated form of outsourcing, if you
will. These courses exist. One of these institutions in the
consortium will have the course material and the means for
delivering it. It makes no sense to reinvent the wheel and have
each state or institution do that work, so we're very excited
about that.
Our other efforts are listed in my written testimony, so I
will stop here. I do notice, Congressman Porter, that Nevada--
there is no Nevada institution listed as a consortium in NEXUS,
but perhaps there should be.
Mr. Porter. I agree.
Mrs. Musgrave. Thank you very much for your testimony.
[The prepared statement of Ms. Norton follows:]
Statement of Kay Norton, President, University of Northern Colorado,
Greeley, CO
The Nursing Faculty Shortage
By the year 2020 the U.S. Bureau of Labor (2003) projects that
there will be a shortfall of 800,000 nurses. The shortage is more acute
in rural areas as it is more difficult for rural health care providers
to recruit qualified nursing staff; rural health care facilities take
60% longer than urban facilities to fill nursing vacancies \1\; almost
half of frontier nurses have the ADN as their highest degree compared
to non-frontier nurses. Although enrollment in entry-level
baccalaureate programs in nursing increased 10.6% in 2004 over the
previous year, nursing colleges and universities denied 26,340
qualified applications due primarily to a shortage of nurse educators
(American Association of Colleges of Nursing, 2004).
---------------------------------------------------------------------------
\1\ MacPhee, M and Scott, J. (2002) The role of social support
networks for rural hospital nurses: Supporting and sustaining the rural
nursing work force. Journal of Nursing Administration, 32(5):264-272.
---------------------------------------------------------------------------
The Colorado Center for Nursing Excellence Report, ``The 2004
Colorado Nursing Faculty Supply and Demand Study'' outlines a critical
problem. While enrollment in nursing schools has increased in recent
years, it is stalling now at a critical juncture, because there are not
enough faculty to handle the workload. Colorado's shortage of qualified
nursing faculty at its two year nursing schools is three times the
national average, and nearly double the national average at its four
year schools. Only 1% of nursing professionals in the state have a
Ph.D.
It is anticipated that the faculty shortage will worsen as the
average age of nursing faculty is 53 with increasing numbers of faculty
preparing to retire. It is estimated that between 200 to 300 doctorally
prepared faculty are eligible for retirement from 2003 to 2012. The
University of Northern Colorado's School of Nursing is a microcosm of
this problem as one-third of the doctorally prepared nursing faculty at
UNC retired in 2004 and 2005.
The University of Northern Colorado is taking the lead in
addressing the shortage of nurses and nursing educators. UNC prepares
master's and doctoral nursing faculty through the delivery of an online
Ph.D. program in Nursing Education, the creation of the National Center
for Nursing Education, and the master's and baccalaureate degrees in
nursing.
The University of Northern Colorado Online Ph.D. Program in Nursing
Education
The primary mission of UNC's online Ph.D. in Nursing Education is
to establish excellence in nursing education. The doctoral program
prepares nurses to contribute to developing leadership in nursing
education, the scholarship of teaching, and education based-research in
the discipline. The program is committed to increasing the number of
doctorally prepared nurse educators. Graduates of the PhD program are
qualified to fill nursing faculty positions in educational institutions
and health care agencies. The program is delivered online. We admitted
18 students in our first year (04-05) and 18 students in our second
year (05-06). The interest in and demand for the program has been
overwhelming. Although the program is certainly designed to address the
shortage of faculty in the state of Colorado, students from across the
country compete for admission to this unique program. Each summer the
students from UNC's PhD program come together at the National Nurse
Educator Conference of the Rockies where they share the latest in
educational research and ``best practice'' with nurse educators from
around the country. Last summer, PhD students were presented with the
opportunity to dialogue with Dr. Patricia Benner, nationally known
nurse theorist and researcher. Furthermore UNC's PhD students have been
participating in collaborative research efforts with the Colorado
Center for Nursing Excellence to address nurse recruitment and
retention issues in Colorado. The University of Northern Colorado's PhD
program and the Colorado Center for Nursing Excellence will partner to
conduct research to address future issues of importance to nursing
education in Colorado.
We have also been partners in a multi-state consortium, NEXUS,
which includes University of Northern Colorado, University of Colorado,
University of Arizona, University of Utah, and Oregon Health Sciences
University to develop a mechanism for students to access PhD courses
on-line through a collaborative arrangement.
The University of Northern Colorado's National Center for Nursing
Education
The UNC School of Nursing, in partnership with the Colorado Center
for Nursing Excellence, the National Council of State Boards of
Nursing, and state associate degree, baccalaureate, and higher degree
programs in nursing, is working to develop the National Center for
Nursing Education. The Center will have the following three purposes:
1) Provide academic programs in nursing education (master's, post-
master's certificate, and PhD) through course offerings on the main
campus in Greeley, online, and at outreach sites. Potential outreach
sites include locations in the northern, southern, and western-slope
regions of the state, especially in rural and underserved areas having
community colleges that operate associate degree programs in nursing.
2) Provide professional development opportunities for nurse educators
through summer institutes, teleconferences, webcasts, and online
educational programs; and 3) Establish a National Nursing Education
Resource Center that will a) enable nursing faculty to access
information and resources pertaining to contemporary issues and trends
in nursing education through a centralized database; and b) create a
center for evidence-based nursing education that will provide faculty
and graduate students in nursing education with opportunities for
multidisciplinary, interdisciplinary, and multi-institutional research
in nursing education.
Other University of Northern Colorado Nursing Programs
Online Graduate Program in Nursing Education
UNC's School of Nursing also offers a Graduate Certificate in
Nursing Education program online to master's prepared nurses,
matriculated master's nursing students, and matriculated doctoral
students who wish to augment their professional studies with advanced
coursework in nursing education and academic roles. We have 9 new
admits in Fall 2005.
Online RN to BSN program
Student demand for easier access to the Bachelor of Science in
Nursing program, particularly in rural Colorado, led to the development
of the RN to BSN online program in 1998. The RN to BSN program is 2
year online program for individuals who have an Associates Degree in
Nursing or a Diploma in nursing. The online RN to BSN program takes 4
semesters to complete, clinical hours are arranged where students are
living, and nurses are able to work full-time while completing the
program. Students are admitted every Fall. The program has averaged 12
students per cohort. We've received 30 applications for Fall 2005.
Second Degree Accelerated BSN program with local hospitals
The second degree accelerated BSN program is designed to meet the
needs of those students who are seeking a BSN as a second bachelor's
degree. Admission to the accelerated second degree program is
competitive. First priority is given to qualified candidates who are
committed to living and working in the Northern Colorado area. All
applicants are sponsored by and commit to work for a minimum of two
years at Poudre Valley Health System or North Colorado Medical Center/
Banner Health upon graduation. This program is privately funded by
these two facilities and each system provides financial support to
their selected candidates and students complete their applicable
clinical courses at the sponsoring facility. Students admitted to the
second degree accelerated program will be able to complete the nursing
courses in 20 months (vs. 26). The program has been in place since 2002
and we admit approximately 18 students each year.
Summary
The inception of UNC's PhD nursing program has been instrumental in
laying the foundation for increasing the number of highly qualified
nurse educators. Our participation in the NEXUS partnership reflects
the recognition that UNC provides a unique resource in addressing the
acute shortage of nurse educators in the region as well as the state.
In keeping with UNC's education mission, we have taken the lead in
addressing the shortage of doctorally prepared nursing educators and
will be a national leader in nursing education with the creation of the
National Center for Nursing Education.
______
Mrs. Musgrave. It has been brought to my attention that the
service workers' union are out in the foyer and I don't know if
they can hear me, but I just want them to know that they can
submit written material for the record and I'd be happy to
include that in the record today. And if any of the witnesses
here will include all of your written material, and if you have
any other studies or anything that you would like to submit,
we'd be happy to have those.
We'll go ahead and start the questioning now. I think I'll
start with you, Sue, if I may. And you talked about not very
many men or minorities being attracted to the profession right
now. I can imagine that it's a great advantage if a nurse has a
second language also, and so there are many benefits for
bringing men and minorities into the profession, and I'd just
like to know strategies that you have for bringing more in.
Ms. Carparelli. The statistics that I quoted to you
reflect, I think the patterns, the historical patterns, which
certainly, obviously, nursing has been a profession that has
attracted many more women than men. What we know is that we are
going a better job of recruiting both males and females into
the profession, and our schools are becoming more diverse in
their enrollment, both by gender as well as by ethnicity.
We have observed some interesting trends in our state, and
I would imagine that they would be consistent with other states
as well. In relation to the attractiveness of the profession
post 9/11, there were several things that happened in our
country. We had tremendous job loss, and that job loss, in our
state in particular, was experienced by those who were at high
educational levels. They were knowledge workers. And the other
phenomenon that I observed was that that experience post-9/11
caused us to really reflect purpose and meaning of work and
that folks who had previously been employed, for example, in
the tech sector, which was very high growth, high paid
positions in our state, but perhaps low personal fulfillment.
People who were looking to retool for jobs that were never
going to return to our economy looked at jobs that provided
more personal fulfillment by virtue of service to others. And I
think that that has been benefited us greatly in terms of the
numbers of both men and women who have considered these career
fields.
I would say to you that we have very important work to do
in our K through 12 educational process. If we do not do a good
job of science and math, foundational skill building, people
who may have aptitude and interest will not be able to be
successful in what is a very rigorous academic program.
And our state, as other states, is challenged by that
reality and we find ourselves in our schools of nursing, at
times, having to do remedial work in order to retain very
capable students who come perhaps not with the essential
foundational skills that are required, and we find that in
particular within our community college programs.
Elise spoke about some of the skill building programs that
the Department of Labor has helped to fund and maintains in our
state that are essential to that process.
Mrs. Musgrave. How do you think that's being communicated
to K-12 educators and administrators?
Ms. Carparelli. I think that--I think that K through 12
administrators and teachers do understand that these math and
science skills are essential. I think that they don't
necessarily connect all the dots in terms of relevancy to the
array of career fields that those skills require as
foundational. I certainly know that UNC, amongst other of our
teacher preparation programs, are working to assist in that
effort, and I know that our school districts across the state
are looking at curriculum and teaching methodologies that will
support student learning in that area.
That said, it's a long path, and one that we must persist
in, not just for these health care careers, but for the array
of knowledge-based jobs and professions that now are the future
of our economy.
Mrs. Musgrave. I appreciate that. Having served on a local
board of education, I wish that boards of education around the
State of Colorado could hear these remarks today. And one of my
goals as a board member was academic rigor. You know, we know
that students have--they mature--the maturation levels are very
difference, and I would like academic rigor in K-12 so that
when they want to make a choice, they then can.
And remedial efforts are very expensive and time consuming,
and you know, we would hope that school boards around the
Nation would hear these things, because you're talking about
the world being flat, the book and the global economy and the
academic rigor is so important, again, as you said, not only in
this field, but for our students to be ready for that global
economy out there. Thank you.
Mr. Porter, do you have questions?
Mr. Porter. My first question is about getting old.
Mrs. Musgrave. I thought 47 sounded kind of young.
Mr. Porter. Sue, I appreciate it. But having crossed that
half century mark, I think I'm pretty young, but I guess I'm
not.
But thank you all for your testimony today. I actually have
some questions, and you're all welcome to answer or if you
choose not to, that's OK. But I'm trying to compile some data
for my own decisionmaking.
Maybe it's in the background, and I read your testimony
prior to today, but also was looking and may have missed it.
But how many professional instructors do we need? I know we're
going to be short by almost 800,000-some health care
professionals in the next 10, 15, 20 years, but what should our
goal be for the professional in the classroom? What percentage
should we be--what should be our goal?
Ms. Dierker. I'll say while we need we need more, one of
the things that the study showed is that really we don't have a
very good baseline, we don't have really well-defined data
elements and data collection, so that even among educators in
programs, there's been so much rapid sort of change and
dislocation and numbers and the use of technology and the
change from old models of teaching to what we should do with
new ways of teaching, using technology, that there are some
fundamental questions that we need to really get to in terms of
what should education look like to prepare the competent
professional for the 21st century. What does that really look
like? How do we take advantage of distance learning and all of
these other things to sort of say there are numbers, there are
ratios of how many we need?
What we do recognize, and this is, again, I'm speaking on
behalf of the informants who really brought it forward out of
the study, is that we've really got to do some fundamental
innovation in what nursing education looks like to go from the
old sort of apprentice model to really a really solid
professional knowledge worker who has real critical thinking
skills that can be applied in diverse and increasingly
challenging settings.
And so I think that's where we really need to work with
some of the leaders in education and practice to really get at
your question, which is ``what does the model look like?'' and
then how would we project and then collect data over some time
and really do that in a concerted way with a research agenda
that gives us some rapid but sound answers.
Mr. Porter. What concerns me is we have state-of-the-art
operating rooms now across the country, the latest in
technology. But it seems to me that some of the training may
still be from 50 years ago or 100 years ago, and I want to make
sure we know what the goal is. And you say 800,000
professionals, I think there's a weak link and that's something
we need to work on is how we can come up with some form of
delivery and consistency.
Ms. Dierker. Well, and I will say in Colorado, and I'm sure
this is happening in Nevada, but in states, as everyone's
grappling with this, we have some remarkable demonstration
projects underway, as you've heard. And I think we need to be
listening and talking and learning from them on an ongoing,
constant, basis to get at your issue of ``what's the model?''
and ``what should we be striving for?'' because those are the
laboratories where people are trying to figure it out, and use
these technologies and examples from other industries,
actually, like the airline industry, where they realize that
you get precision and safety when you use simulation and you
use certain teaching methods so that pilots don't make
mistakes.
And so we have some ways to learn about that. And like I
say, in our study, it showed that even in rural areas and--as
soon as people are introduced to these technologies and these
new teaching methods, there is a hunger for them. We just need
to--people want the support and the help to design curriculum
and have resources to connect all the dots and have the
programmatic sort of institutionalized ways to go at it.
Mr. Porter. And by the way, and I appreciate the study, I'm
sure we could just cross out Colorado and put Nevada and it
would be almost identical, so I look forward to using this as a
resource, too. Thank you.
Anyone else want to comment?
Ms. Norton. I might just give you an estimate. If we made
no changed in how we educate nurses, and I certainly think we
do need to, everything that Lynn has just described, needs to
happen. But we do know that 200-300 doctorally prepared faculty
will be eligible to retire nationally from 2003 to 2012, and so
if we were going to replace them and expand capacity, we'd be
looking at needing Ph.D.s in the 100's or low thousands would
be a very rough estimate. The number is probably higher than
lower----
Mr. Porter. Excuse me, so what you're saying is that the
status quo----
Ms. Norton. Right.
Mr. Porter.--we're going to lose 300.
Ms. Norton. Right.
Mr. Porter. And even with status quo, it's really not
enough.
Ms. Norton. And that--and status quo hasn't allowed us to
expand programs to meet the need for the 800,000----
Mr. Porter. Because we're already short 800,000----
Ms. Norton. Correct.
Mr. Porter.--or whatever it is.
Ms. Norton. Correct.
Mr. Porter. So you think in the thousands.
Ms. Norton. Yeah, in the low thousands, right. Four
figures.
Mr. Porter. Thank you. And I know it was mentioned earlier
about the book, ``The World is Flat,'' and I'd like to
reference--if I could write a book, and I'm not a very good
writer, it would be about the world as we know it, even here
inside of the boundaries of the U.S. I have found that, when it
comes to education, whether it be higher education, health care
profession, or even primary and secondary, we have created
these paradigms and these little worlds and each one has their
own thing. You've got the school district doing their own
thing, you've got the universities doing their own thing,
you've got local governments doing their own thing, you've got
private sector doing their own thing. And the world really is
flat right here in Colorado and Nevada and Iowa where I grew
up. We have everyone in their little worlds, and I think it's
time that, as mentioned in the collaborative effort, I think it
was mentioned here numerous times, that it's the responsibility
for health care for local government also. It's a
responsibility for the legislature. Of course, they know that
they have a role. But we have created little worlds and little
boxes and we're not crossing over, and I think that we need to
do a cultural change ourselves as policymakers and leaders that
health care is as important to the local government as it is to
the University of Northern Colorado or CU, which we were
talking about earlier. I hear a lot about CU from my chief of
staff, but I am very concerned that we also have this paradigm
when it comes to retired professionals.
I know Nevada is fastest growing in retirees. Well, there's
a wealth of talent in our retiree health care professionals,
and as I mention that, I guess I'd like to know, is there a
program in place to help bring those retirees back into
educational processes and use them in a clinical setting to
help train nurses? Is there something in place in Colorado for
the retirees?
Ms. Carparelli. OK, since I'm the one that raised the age
issues, I'll tackle that one. And let me just respond to that
first by saying that age is important in these very physically
demanding jobs. That we know that, for example, in an acute
care environment, that the physical rigor of being a staff
nurse, a direct care provider, makes it difficult for people to
perform in that role much past mid-50's because of the demands
of that job. And so,----
Mr. Porter. If I may interrupt, what would the average
tenure be, then, of someone to retire in their mid-50's? How
long would they have been in the profession? Is that 30 years,
20 years, 10 years.
Ms. Carparelli. Well, it would obviously depend when they
entered into the profession, and we have many nurses who began
their educational process right out of high school and have
been practicing in that profession since that time.
Increasingly, as you look at the age of our students
currently enrolled, we are seeing a much older student
population, particularly in our community colleges and our
accelerated nursing programs. We are seeing people retooling,
as I spoke about before, from other professions to prepare for
a new career path within nursing. And so they are in their late
20's to early 30's as they are starting this profession.
Mr. Porter. Is it as much age as it is the length of time
in the profession? Is there just a burnout happening after so
many years or is it a combination of age and just worn out from
the profession.
Ms. Carparelli. I think there are a variety of factors. I
think that the work environment has many elements that create
burnout and dissatisfaction for those who work within that
environment. I think that the increased level of acuity within
our--patient acuity within the acute care environment means
that people are sicker and they stay a very short period of
time, and so it makes for a very intense work experience with
little time for the satisfiers that those within this
profession are looking for in terms of a relationship with that
patient.
I think that there are also substantial cost pressures that
providers struggle with that create productivity pressures upon
individual care providers that in turn create dissatisfaction
on the part of those that are in direct care delivery modes.
I think that there are a whole host of issues that need to
be addressed in effort to retain health care providers, nurses,
amongst them.
We do know that we have to make some modifications in the
process of work, and we have a variety of initiatives that
reflect that. If you've not heard about efforts, particularly
on the part of acute care environments to create magnate
status, which is an element that focuses on the work
environment for the professional practice of nursing, and we
don't have necessarily time to get into that, but it is an
example of efforts being undertaken to substantially modify and
make more satisfying and more rewarding the professional
practice of nursing within the care delivery system.
That said, as is the case with K through 12 education, we
have a great deal of work to be done in that regard, and it is
essential that nurses, as participants in that process, have
substantial input and say as to how that works for them. Their
voice in this process is essential.
There is opportunity for us with the aging; particularly of
the clinical experts to be able to bring them into teaching
roles. What we know is that it is imperative that those----
Mr. Porter. Excuse me, when you say--so I understand--
"clinical expert'' is someone that has field training is now in
the training position? Is that the term you use for teachers.
Ms. Carparelli. A clinical expert is someone who has
clinical expertise--current knowledge and practice within a
particular area of practice. As an example,----
Mr. Porter. And those are more apt to be the--those
individuals would be the instructors.
Ms. Carparelli. Those are the people, for example, who may
have 20 years of experience in labor and delivery, 30 years of
experience in labor delivery, and either are looking for a
means to augment their practice by adding a teaching component
to that, or are looking for a way to move into a next stage of
a professional career.
My point is that what we are finding is that these people
whose job it is to provide care, and who are experts in the
delivery of certain kinds of care, are able and willing to
participate as clinical instructors, teaching students those
clinical skills in partnership with their educational
institutions when supported through some basic orientation,
training, mentoring, and coaching around how to teach.
Now, that said, they will not nor should they ever
substitute for the kind of folks that President Norton is
speaking about as it relates to faculty, but they can augment
and support the learning and bring to the student experience
great expertise and experience in certain kinds of clinical
areas.
So it's an example of the kind of collaboration between
practice and education that can happen and must happen to
create the kind of quality learning experiences that students
need.
Mr. Porter. I have more questions, but I'll wait if that's
OK.
Mrs. Musgrave. OK, I'll bring some forth. Could you comment
on technology, whichever one wants to, particularly simulation?
I don't know who wants to take that.
Ms. Dierker. Certainly in the study, we asked our
informants to what degree they were already starting to and
were interested in using technology so that I can comment to
some degree on what came out of the study and some of what I
know otherwise just by way of background.
But the kinds of technologies that are really emerging now
include some of the things that President Norton mentioned,
which are ways of education that rely on on-line curriculum and
sort of didactic methods. But in the clinical setting, there
are simulation technologies that are partially self-directed
on-line methods, but also involve literally mannequins and
lifelike--very life-like mannequins who can provide a kind of
experience much like, again, to use the airline example, of
being in a cockpit where you really have a patient and you can
simulate situations of physical crisis, birth, certain kinds of
physical--physiologic states, and students and teams of
students can literally practice taking care of a patient in
that environment.
And so that what you have, then, is a way for an
instructor--for people to not only watch and observe, like the
old days when I went to nursing school, and you might crowd
around a bed and get to actually see someone in a certain
state. And this way, with simulation, you really have students
who can go through the entire continuum of how you'd care for
that patient, have instruction, repeat it, practice it, and get
it right.
And so these are the kinds of technologies that both
hospitals and schools are putting into place and that they are
referring to when they talk about trying to rely on technology.
What the study found is that while you can buy a mannequin
and you can put it there and say, ``OK, here we have it,''
there's a lot--there's a big gap between that and having
faculty who know how to teach using it and really know how to
integrate a student who has come in with computer-based
background and the simulation technology and integrate all of
that into a valuable learning experience. And that's where
faculty needs support.
Mrs. Musgrave. That's what I was really hoping to
understand. You know, I see how it could very much improve the
quality of the education, but what I don't understand is how it
really addresses the shortage of faculty, you know. I know that
instructors can use that, but you still have to have the
instructors, I would imagine, the teachers there. So, I don't
know if you want to comment further on that or not.
Ms. Carparelli. I'd like to comment on that. Your point is
exactly right on. The use of these emerging technologies does
not take the place of the instructor nor does it take the place
of learning that takes place in the clinical environment. But
what it can do is to augment the student learning or to
rehearse, essentially, things that the student will see in the
clinical environment in preparation for that clinical
experience.
And I think the important point is that faculty need time
and support to be able to, themselves, learn how to use these
emerging technologies effectively and they need time to conduct
the research to determine efficacy relative to learning and
outcomes.
And, again, it's part of what President Norton referred to
in terms of evidence-based education. We need to learn how to
use this stuff effectively, and we're in many instances at the
front end in the use of this technology and the faculty experts
haven't yet had the opportunity to test it and evaluate it and
research it in the ways that we have more historically teaching
methodology.
So that becomes a very important aspect of what needs to
happen as it relates to education.
Ms. Norton. If I may add, four of doctoral students in our
nursing education Ph.D. Program are focusing on the use of
simulation technology and nursing education right now.
Ms. Dierker. And I just wanted to, again, make a point
about, I think your issue about how does this really contribute
to supply and where we're going to get it. I think one of the
things that we revealed, which was pretty stunning in our
study, when we asked representatives from the hospitals and
long-term care facilities, you know, ``how much money are you
really spending on nursing education?'' And we got a large
number. I mean, when you think of $2 million in a year from the
people we surveyed who, you know, they range, of course, some
of the big systems with the larger numbers, but still, that's a
lot where they're literally putting up money to backfill, to
support the need for further education and strengthening of
those students.
So to your question, Mr. Porter, about how many do we need,
when and where? We've got to incorporate these sort of methods
to sort of answer that question, because out there in the
practicing world, you have these hospital systems that have a
large component of their budget going to staff that need to
cover their new grads just because they can't practice
independently, full practice yet, and need to train students.
And so how many of them do we need, how many could we free
up? How much do we take a financial burden off of the industry?
That, of course, cycles back into costs and cycles around to
what we all pay.
So, I mean, they're all interrelated, which is why we're
got to figure an efficiency equation about how we can best
educated people.
Mrs. Musgrave. I was interested, President Norton, when you
talked about the difference between 2 year schools and 4 year
schools and the shortage of faculty. Could you address that,
please.
Ms. Norton. Yes. Well, there are different levels of
preparation of nursing professionals because a nurse is not
necessarily a nurse is a nurse. You have the traditional
licensure frame of references, LPN, more like a 2-year program;
BSN--RN, more like a bachelor's program, although they're not
the same thing. This is all something that I had to learn a lot
about as we addressed the issue here at the University.
And the 2 year programs produce an AND nurse, who is
certainly fully prepared to do many functions in an acute care
facility and in long-term care facilities, but would not
necessarily be prepared, for example, to do work in the
surgical units or other more sophisticated areas.
And so as we look at need, we have to look at what sort of
nurse do we need where and how many and at what level can we
adequately prepare those students. So the answer is not simply
to say, ``Well, let's just have everybody do a 2-year
program,'' because that won't necessarily be the right level of
preparation for where the need is.
So it's another mismatch in this rather complicated picture
that we have to take a look at. And if I may, I'd like to just
mention in terms of the issue about technology and how does it
help. Our experience in higher education has been that
technology tends not to save money so much as it enables us to
increase quality and, very importantly, increase access and the
dissemination of information. But it adds sophistication and it
can contribute to quality and it can certainly cost a lot of
money, but it doesn't necessarily eliminate the need for human
beings and those knowledge workers.
Mrs. Musgrave. Mr. Porter.
Mr. Porter. You're going to be sorry you invited me today,
but I'm----
Mrs. Musgrave. Good thing we don't have the light.
Mr. Porter. It's probably a good thing. I would be in
trouble. In my approach to public services, I am not an expert;
you're the expert, so I try to learn as much as I can from you.
I'd rather hear from you than you hear from me.
But there is a few things. Average tenure; what is it for a
professional? How long do they stay in the profession? Is it--I
know we started to go down that path; is it 10 years, 20 years,
15? I know there's lots of variables, but how long would they
stay?
Ms. Carparelli. Are you talking about practicing?
Mr. Porter. Practicing.
Ms. Carparelli. Practicing nurses, I think it's extremely
variable, and I think that we can learn a lot by looking at
that variability. We have a high rate of attrition from the
profession in the first three to 5 years out of school. And
that has to do, again, with a variety of factors, but it's an
important consideration because we do not get the full benefit
of all of those that we educated.
Mr. Porter. As part of that, leaving a family or relocation
or spouse's relocation, or some of those things.
Ms. Carparelli. As I said, there are a variety of factors.
Some leave because it wasn't what they expected----
Mr. Porter. Absolutely.
Ms. Carparelli.--and they do not find it be a satisfying
work environment, they don't find----
Mr. Porter. But is it higher in nursing than in other
industries.
Ms. Carparelli. I would not feel qualified to fully answer
that question. I think it would be important to, you know,
perhaps think about who you wanted to compare that to.
Mr. Porter. Yeah.
Ms. Carparelli. I think----
Mr. Porter. So we don't--and I hate to interrupt, because I
know we're running a little low on time, but so right now we'd
say we really don't know an average tenure, right? Is that what
I'm hearing? That's something we'd probably need to find out.
Employer. Who is the largest employer? Is it the hospitals?
Ms. Carparelli. Yes.
Mr. Porter. That's the largest. And I'll be honest with
you, I don't have a lot of sympathy for the private sector when
it comes to training. I think they share a huge responsibility.
I don't think this is just a public sector responsibility to
train and to recruit and encourage health care professionals. I
think industry should be the leader in helping find not only
the nurses, but the clinical instructor. They should play a
bigger role in all of this, so I don't have a lot of sympathy
in that they've made an investment. That's their responsibility
also, because the Federal Government, the state and local
governments, even though health care is a quality of life
issue, I think the hospitals need to do more, and I've heard
even the hospitals in Nevada talk about the trouble they're
having getting qualified and trained professionals, and well,
if you compare nursing to other areas in the private sector,
the private sector steps up and trains people to fit into their
profession, whether it be at Southwest Airlines, Microsoft, or
a Ma & Pa restaurant, they train and they feel that they want
to have the best and the brightest working for them.
So I guess one thing, and I know that I'm going to carry
forward with my colleague, is finding ways--where the barriers
are to the private sector. I'm sure there's lots of reasons,
from the costs and there may be more incentives, but they need
to step up to the plate and help us more than they are, and
this is something that I plan on working with, and I'd say in a
proactive way. I'm not into mandates and penalizing, but we
need to find out from the professional--the hospitals what we
can do to help them get more involved, because they're hands on
and they need to have some training--more training internally.
Ms. Lowe-Vaughn. Representative Porter, one of the things
that's so exciting about the partnerships in Colorado is this
very issue. Our partners from the private sector, the
hospitals, the acute care, the long-term care, all of these
partners, including education, have stepped forward and have
put together four-to-one matches on all of the grants that
we've been doing. They're working with all of our local
workforce regions and private regional collaboratives to
improve the nursing population and allied health care. So I
think Colorado is a model for those kind of collaborative
partnerships, and we're very pleased that industry has come to
the table and talked to us about the very issues which started
the dialog here.
Mr. Porter. And I appreciate that, but I think that the
private sector can do more.
Ms. Lowe-Vaughn. Sure.
Mr. Porter. And when I talk about the flat world we live
in, I'm including the private sector because I do hear from
private sector, not only in Nevada, but across the country, and
their resistance to being more involved in training that they
want someone else to do more. So I applaud those here in
Colorado, and I'm sure that it's probably even unique. But I
think we can do more, and we can encourage more of that.
A question, and again, the study is great, and I've just
had a chance to leaf through it and you've spent some time, you
know, talking about what the clinical professional makes in the
rural and urban areas, but if we could just summarize real
briefly. If you were to take a practicing registered nurse,
where they would max out in a salary, if we look at a career
path, where they would max out as opposed to a trainer or a
teacher or a clinical professional? How do they compare; the
practicing nurse to the professional? And you may have touched
upon it earlier, but I missed it.
Ms. Dierker. Well, we didn't do a great deal on the study
because of the time and the way in which we went about it given
the issues at hand. But, I would say that especially with the
competitiveness for a nurse in the hospital setting now, where
salaries and bonuses for nurses to be employed in certain
settings have really bumped up the clinical range. I think, you
know, I'm going to ballpark, because we don't have a lot to go
there, but I would say even starting, you know, you're going to
end up with a differential of maybe, you know, it depends where
you are, of course, but even $10,000. And so then it just sort
of widens and it depends on your experience and----
Mr. Porter. So $10,000 more to be an instructor.
Ms. Dierker. Clinical--in a clinical--less to be an
instructor. Less. I mean, we came up with an average salary for
an entry-level faculty of $39,000. Well, you can go in as----
Mr. Porter. Well, that's a serious problem.
Ms. Dierker. That's a serious problem.
Mr. Porter. When you look at a career path.
Ms. Dierker. And it's worse in rural areas.
Ms. Norton. The gap is really more like $20,000.
Ms. Dierker. Right.
Ms. Norton. At least.
Mr. Porter. How are they, then, compared to other--let me
use the word teacher.
Ms. Norton. Right.
Mr. Porter. That's easier for me. For the teacher compared
to another field of study, how are they paid; is it similar.
Ms. Norton. Our faculty salaries in nursing are at the mid-
range of our faculty salaries,----
Mr. Porter. They top out at the mid-range.
Ms. Norton.--generally based on market, and that's why I
say the market has failed us somewhat in not really recognizing
a shortage, and I think it will adjust. But, for example, a
business faculty, the highest paid professors that you'll find
on a campus or faculty in a medical school or a law school, the
professional--and engineers are also--engineering faculty are
in very short supply and command high salaries, often
approaching or into the six figures. And your nursing
professional faculty, education faculty, are going to be
somewhat below that.
Mr. Porter. So from a career path----
Ms. Norton. Yeah.
Mr. Porter.--it's difficult for someone to maybe go
backwards.
Ms. Norton. Exactly. That's the issue. That is absolutely
the issue is our faculty may decide that they want to retire
because they can make $20,000 or $30,000 a year more going back
into clinical practice. And so how do we deal with that gap is
an immediate issue that we have to figure out how we deal with.
Mr. Porter. Again, looking at--the reason we're here, of
course, is pretty broad, but specifically to the nursing
faculty, you know, there's recruiting problems for new nurses,
I mean, there's four or five keys, but when we get down to a
career path----
Ms. Norton. Right.
Mr. Porter.--why would someone want to leave--unless they
were just burnt out and wanted to move on in their profession,
why would they want to become a faculty member.
Ms. Norton. And I think it's also the job satisfaction and
really the passion issue that Sue Carparelli mentioned. And
maybe they just don't know any better, I don't know.
Mr. Porter. And don't get me wrong, I applaud everyone for
that.
Ms. Norton. It is a matter of finding that kind of
satisfaction, but obviously there's no--we have a huge hurdle
in terms of convincing individuals that they want to be nursing
faculty, although we turned away students for our Ph.D. Program
because of lack of capacity. There's only so much pin-up
demand. I mean, the real issue is how do we get some of these
younger folks, when you look at the numbers of how many--how
few practitioners in nursing generally are under the age of 30.
It's striking. Therefore, how many----
Mr. Porter. Excuse me, if I can interrupt. I think whatever
the business profession, people like to have kind of a path and
I have spent the bulk of my time in public service with primary
and secondary education, so I know more about it, and I see a
lot of great classroom teachers that max out that have to
become principals and administrators just--not because they
really want to do that, but they have to for their career path
to support their family.
So I guess the one thing I'm hearing consistently this
morning and in fairness I applaud those folks that go to the
faculty, but we need to find a way to elevate that position to
help as part of a full career path to keep these young folks,
when they shoot down the road, that there are some things that
they could look forward to because we need those professionals
to go--to become faculty. And it's very difficult, I would
think, to make that jump.
Ms. Norton. It is, and it's very challenging and we have to
figure out how do we assist the market in figuring that out. I
mean, certainly we're willing to do our part. I certainly
understand, as an administrator of a university, that we're
going to have to figure out how we make those adjustments and
really respond as a market generally would respond to the fact
that this is a shortage and we have to make it attractive.
And I think you've also mentioned an issue that we see
every day in the nursing profession and the teaching profession
is the people going into leadership positions not because they
want to be leaders, but because of the financial goals that--
and needs that they may have and the creation of true leaders
in these professions is also crucial. Leaders and educators.
Mrs. Musgrave. It's kind of bewildering to me that this lag
time in the market is--I don't know, this seems like an
exceptionally long lag time, because we're all seen this
coming. You know, we've been talking about it for years, we
know what the demographics are, and so this, you know, trying
to ascertain why the market has not responded more quicker, is
kind of bewildering to me.
Ms. Dierker. Well, I think one of the things I certainly
heard in the study is the sense that our constraints on higher
education in our state, in our fiscal situation related to
higher ed, has made it difficult for schools to respond by
bumping up the salaries. So, because most of our nursing
programs are publicly funded here, we don't have a lot of
private, so that's been a big issue. It's a convergence of
factors that have really been especially difficult.
Mrs. Musgrave. You know, I don't know too many people that
want to move forward in a career and take less money.
Mr. Porter. Well, this is politics, Marilyn.
Mrs. Musgrave. Well, you have a bigger title.
Mr. Porter. No, that's a choice.
Mrs. Musgrave. You begged for the job, you know.
Mr. Porter. That's true.
Mrs. Musgrave. Well, I thank you for your testimony today.
It has been just extraordinary, and I know that the Congressman
and I both would like to do more with this issue and we expect,
President Norton, that you will let us know how we can do that.
Again, the quality of life issue is out there for the entire
United States, but it seems that some areas have even more
severe shortages than others, and we need to address that.
Congressman Porter, do you have any final remarks you'd
like to make?
Mr. Porter. Well, I could talk for hours, so I won't. I
just appreciate your insights, your comments, your research,
because if you don't tell us, as Members of Congress, we don't
know. You know, we deal with thousands of issues every day, and
I think we're ADD to be Members of Congress, because there are
so many issues. But I firmly believe there's not an issue more
important to the future of our country than our health care.
And there's no one that's more important than the nursing
professionals--the professionals in health care delivery, and I
get the terms wrong, but those folks out there that are on the
front line, the professionals, and we need to find a way to
elevate this profession and encourage our young folks and those
who want a career change to get into the field.
But I firmly believe there's not a more important issue for
us as a country than to focus on getting folks into this field.
We can't afford to have the attrition. We can't afford to allow
the rest of the world to move in front of us. But more
importantly, we need to make sure that, as Members of Congress,
we're able to give you the tools you need to get the job done,
and that's why I really appreciate being here, I appreciate
your insights, and we'll take what I've learned today and move
forward. And you will be hearing from me more in the future. So
thank you all very, very much. I appreciate it.
And to--we brought staff here from D.C., thank you.
Mrs. Musgrave. Yes.
Mr. Porter. There's two that came from D.C. I'd like to
thank our Committee staff for being here today also. Thank you.
Mrs. Musgrave. I, too, appreciate the staff and their work
very much. All of those issues that we deal with as Members of
Congress, we are very much assisted by our staff and we
appreciate them so very much. I have one of mine traveling with
me today, Nina, so Amanda and Nina and whoever else helped out,
we appreciate it so very much.
I think it's somewhat paradoxical that when we talk about
these shortages of faculty training the nurses, and we hope
more and more will come into the profession, men and minorities
joining, women, I believe the expectations of patients are even
higher and higher. So we really have an interesting dilemma
here. We expect quality, excellent health care. And thank
goodness there are folks that want to get into the profession
and those that want to teach, so we can have that quality of
health care.
Thank you very much.
Mr. Porter. Excuse me, Marilyn, can I add one more thing?
Mrs. Musgrave. Certainly.
Mr. Porter. It's important to note that I think we're in
our infancy and I think now is the time. Even with my concerns,
I think we're in our infancy in the future of health care, and
that's why what we're talking about today I think can make such
a difference in the future, because what's around the corner
with technology, and you've talked about it this morning, and
what's around the corner in health care, and I just want to
again to reiterate my optimism that this is a field that's
changing with a lot of complex issues, but you get along very
well. We deal with issues where it's divide and conquer,
because there are so many folks on issues that hate each other.
But what's great about this issue is there is a spirit of
cooperation. And I know that we have our--you know, we hang our
laundry out in different places, and maybe there are times that
we don't agree, but that's another reason why I'm so optimistic
about my--what I believe as the challenges for health care,
because of the cooperation. It's really refreshing that this
industry, even with its differences and its competing partners,
it really works well together. So I wanted to really conclude
with saying I think we have a lot of work to do, but we're in
our infancy and a lot of good things can happen.
Thank you. I promise I'm finished.
Mrs. Musgrave. We appreciate your comments very much. Thank
you for coming to this hearing today, and we appreciate
everyone being here.
The meeting is adjourned.
[Whereupon, at 11:45 a.m., the Subcommittee was adjourned.]