State Money Key to Fixing Nursing Crisis: Experts

What are states to do?

In California, new legislation that will mandate specific nurse-to-patient ratios is getting a lot of attention.

Stateline.org asked several nursing experts to suggest other actions states could take to help them address the shortage. Among their recommendations: increasing state funds for nursing faculty at state colleges and universities, creating new state-funded programs designed to track nurses in the workforce and using state funds to increase enrollment at both public and private nursing schools.

Karen Hanford, dean of the College of Graduate Nursing at Western University of Health Sciences in Pomona, Calif., said it was necessary for states to:

  • Help fund hospitals that provide clinical training for nursing students. While hospitals get Medicare money to help educate doctors, no such provision exists to help hospitals educate nurses. Among the benefits of having nursing students in hospitals is the possibility that mentor relationships will entice nurses to stay after graduation.
  • Raise salaries for nursing teachers at state schools. Many of them now earn annual salaries in the $50,000-60,000 range, while practicing RNs often make $80,000 to $100,000 a year. Hanford said state schools should consider putting nursing instructors on a par with business instructors, for example, in order to give people incentives to go into nursing education. 

Terry Misener, dean of the School of Nursing at the University of Portland in Oregon, recommended that states:

  • Give scholarship funds to nursing students rather than nursing schools. "Rather than sending a lump of money to U. of Hmmm' or Hmmm Community College,' you tie money to nursing students, so it doesn't matter if that student is at a private or public school," Misener said. "About 35 percent of all nurses in Oregon graduate from the four private schools" that offer nursing degrees.
  • Give tax breaks to people who teach in nursing schools. "Faculty positions pay less than service positions," Misener said. "It's difficult to recruit masters- or PhD-prepared faculty when students with an undergraduate degree are going out and making more money than they are." 

Betty Rambur, dean of the College of Nursing at the University of Vermont, recommended that states:  

  • Appropriate state money for loan-repayment and loan-forgiveness programs. "One way state legislatures can really make a difference is to offer loan repayment to individuals who agree to stay in the state that educated them," she said.
  • Fund a new program to track the status of a state's nursing workforce. Vermont created a Blue Ribbon Nursing Commission, which first met in the summer of 2000. With a $95,000 state grant, the commission set up the Office of Nursing Workforce Research, Planning and Development at the University of Vermont. Among issues the office is working on is how to retain "older" workers, meaning people older than 40.
  • Spend more to expand continuing-education programs. With a specific effort to watch nursing-employment trends in a specific state, funds could be directed at specialties in which a shortage is predicted.
  • Partner with educators and healthcare providers in promoting the profession of nursing. With the same $95,000 grant used to start the Office of Nursing Workforce Research, University of Vermont representatives have gone to middle schools in the state to promote the work of nurses. "Oftentimes, an individual's decision to enter a profession is set in middle school," Rambur said.
  • Fund merit-based scholarships. Rambur said she believes a $3 million scholarship program for University of Vermont nursing students was largely responsible for a 74 percent increase in applications this fall compared with applications made in the fall of 2001. The program was funded by a private foundation. 

 Rambur noted that solutions to the nursing shortage vary from state to state. "It probably isn't a one-size-fits-all situation -- although some ideas, like the merit-based scholarships, would work anywhere," she said.