A dire diagnosis
The Observer is a big fan of nurses.
They're the ones who monitor our post-op pain while the docs are five-putting on the 16th green, who insert the catheters and traffic in our intimacies.
They're the sentinels of the ICUs and the caregivers in nursing homes, the indispensables in operating rooms. They're the ones who increasingly make you say "Aaahh," diagnose maladies, and call in prescriptions.
Not to put too fine a point on it, but nurses are becoming the face of medicine in this bloodcurdling age of managed care.
There is, God knows, enough in the world to lose sleep over these days, so I don't know why I'm telling you this. But if you want another reason to assume the womb position under your bed, take a look at the shortage of nursing school faculty.
Not the shortage of nurses.
We all know that there aren't enough of them. I'm talking about the shortage of the teachers who train future nurses. Simply put, if there aren't enough future teachers in the pipeline, there won't be enough future nurses.
And there aren't enough future teachers in the pipeline to meet the growing demands placed on nurses by a managed-care system consumed with saving simoleons. This, experts agree, is the real time bomb in the nursing crisis.
Fact: 583 qualified applicants to four-year nursing schools in Massachusetts last year were turned down because there weren't the faculty to teach them, according to a study by the American Association of Colleges of Nursing. When you consider that 1,751 nurses graduated from all nursing schools in the state last year, this is scary.
Fact: There is a projected faculty vacancy rate of 8 percent the next academic year among nursing schools of all stripes in the state, according to a survey this year by the state Board of Registration in Nursing.
Things got really hairy at some nursing schools last spring after a bunch of faculty, spurred by an incentive package provided by the state, took early retirement at the end of December.
Susan Maciewicz, chairwoman of the nursing department at North Shore Community College, says the effect was brutal on her two-year associate degree program. She faced three full-time and two part-time vacancies for the spring semester and was forced in May to reduce enrollment for this academic year by 20 students. After a lot of hard work, she managed to include the 20 in this year's entering class.
The good news is that there are plenty of applicants to nursing schools. Salem State College's four-year School of Nursing had 665 applicants for 120 slots this year. That said, all the registered nurses in the world won't help the teaching shortage if they don't have master's degrees, which are required to teach. And according to a state study in 2001, only 13 percent of RNs in Massachusetts had them.
The bad news is that nursing faculties are getting old. They are a hoary group, many over 50, who will be slip-sliding into retirement in the next decade.
"There is a huge sucking sound of people into the nursing profession and then the graying of the nursing professoriate," says Ann Caldwell, president of the Institute of Health Professions, or IHP, an affiliate of Massachusetts General Hospital that pioneered the master's degree in nursing.
The other problem is money. Nursing faculty are paid chump change, often half or less of the $100,000 and more top clinical nurses can receive in subspecialties like acute care. "When I recruit new faculty, the salaries I can offer are laughable -- between $38,000 and $42,000," says Maciewicz.
"I go out every year in March to beat the bushes," adds Nancy Terres, an IHP faculty member with a doctorate in nursing who recently gave up her clinical life as a pediatric nurse at MGH to teach full time. "It's very difficult to find subspecialty faculty. You can't rearrange your schedule to teach at a set time each week because the shortage at hospitals is so severe. They ask, why should I go into teaching when I can go into practice?" If the coin of the teaching realm is a master's in nursing science, universities like Boston College and Northeastern require a doctorate. Neither the two-year associate degree nor four-year baccalaureate, then, addresses the faculty shortage. And while the elite teaching hospitals hire almost exclusively from the four-year institutions, a master's is increasingly the fast track to the best nursing jobs.
Beacon Hill has not bathed itself in glory on this issue. There exists no signi.cant law to confront the problem. Some $500,000 was earmarked for the Board of Higher Education in the state supplemental budget signed by Governor Mitt Romney last month to develop strategies to bring and retain more nurses into teaching-track programs.
But then Romney vetoed another part that would have granted retroactive pay to some state employees, including community college nursing faculty.
Credit the state Board of Registration in Nursing for action. In June it provided waivers from the master's requirement that would allow nurses with four-year degrees to teach under certain circumstances. This makes sense, providing standards don't go out the window for a good cause.
I say we steer serious bucks into the nursing faculty pipeline. Sooner or later, we'll all end up on our backs in a hospital bed in need of help. It's the middle of the night. We press the buzzer and pray like hell that someone good shows up.
Sam Allis's e-mail address is allis@globe.com.
