RALEIGH (November 19, 2023) – Only through “robust resource allocation” – a polite way to say money – can North Carolina produce 50% more nursing graduates by 2028 or 2029, according to state leaders in nursing education.
If the coronavirus pandemic didn’t underscore the importance of nurses – people who cared for the dreadfully sick, sometimes held the phone for their last moments with family, sometimes caught the virus and died from it themselves – we don’t know what will.
Even before the pandemic, North Carolina didn’t produce enough nurses: NC Nursecast predicted a shortage of 12,500 registered nurses (RNs) and 5,000 practical nurses (PNs, or LPNs once they earn a license) by 2033.
State legislators asked education leaders last year to recommend how to increase nursing graduates in the state by 50%.
In their report, nursing leaders from the UNC and NC Community College Systems said that about half the state’s RNs and more than a third of its PNs were trained outside the state.
In 2021, NC community colleges graduated 2,357 RNs and 688 PNs. The UNC System graduated 1,167 RNs, for a total of 4,212 graduates. A 50% increase would mean 6,318 graduates.
But at current rates, North Carolina won’t generate 6,318 nursing graduates until the late 2030s.
THE STUDY FOUND, just as Higher Ed Works did in our 2021 Nursing Education Series, that the crux of North Carolina’s nursing shortage is a shortage of instructors.
“The issue is particularly acute for experienced nurses, who can earn significantly more as practicing nurses than as faculty,” the report says.
To increase enrollment, the state must recruit and retain more teaching faculty, provide more clinical space and build or expand instructional space, the report says – though it doesn’t offer dollar estimates for those costs. It also recommends more mentoring and other supports to reduce attrition among nursing students.
“Obviously, this is a critical workforce need,” said Kirk Bradley, Vice Chair of the UNC Board of Governors’ Education Planning Committee, which heard the report Wednesday.
This isn’t complicated. For those who advocate the free market, the market is working just fine – just as it is with the state’s shortage of K-12 teachers.
And nurses who might otherwise be willing to teach are voting with their feet.
UNC System colleges of nursing have seen significant faculty turnover in the past two years, led by UNC Greensboro (29 instructors), UNC-Chapel Hill (26) and East Carolina University (23), which the report attributes to retirements and the lure of private sector salaries. It also notes that faculty turnover has a negative impact on student success.
NC COMMUNITY COLLEGES face similar problems.
The report cites one unnamed college where faculty earn between $31.88 and $35.76 an hour, while nurses in a health system within an hour’s drive earn $37.80 to $40.29 an hour – a loss of $4,000 to more than $17,500 a year for a nurse who leaves practice to teach.
“First, faculty who hold the BSN (Bachelor of Science in Nursing) consistently earn less money than their clinical counterparts who also hold the BSN,” the report says.
“Second, faculty are required to have education in adult teaching and learning, and some are required to have graduate degrees. Many potential faculty do not see the benefit of paying for additional education for a job that pays less than a clinical position.
“Finally, faculty are required to work a five-day work week, while many clinical faculty work three 12-hour shifts.”
Similarly, public institutions often don’t pay preceptors – nurses with at least a bachelor’s degree who supervise students in clinical settings. While East Carolina University is one of the few public institutions that pays preceptors, its rate of $450 a semester pales against private institutions that pay $600-1,200 a semester, the report says.
There’s no shortage of demand from students. From 2018-22, UNC System nursing programs were only able to admit two-thirds of qualified applicants. And from 2019-22, the state’s community colleges could only admit 58% of qualified applicants, the report says.1
Once again, the market is working.
And we can boil “robust resource allocation” down to just two syllables: