Forensic nursing degree

For all the baby boomers who've embraced and adopted healthier lifestyles, including proper diet and exercise, there may be an even more compelling reason. If you get sick or become hospitalized, you may not have the critically needed services of a well-trained nurse.

It's been widely reported that there is a nursing shortage in the United States, and it is expected to grow worse as the population increases and ages and new medical procedures are developed. Hospitals, nursing homes, adult-care facilities and home-care services will suffer increasingly, industry experts say, as the current trend seems likely to continue.

The U.S. Department of Health and Human Services (DHHS) projects a 29 percent shortage in registered nurses by 2020, compared to 2002, when the shortage was measured at 6 percent. The American Association of Colleges of Nursing (AACN) predicts that by 2020, 44 states and the District of Columbia will be affected by the dearth of registered nurses. And Trendwatch, a publication of the American Hospital Association, reported in 2001 that nursing career opportunities comprised 75 percent of national hospital vacancies.

But does the nationwide nursing shortage reflect what's going on in colleges of nursing across the country? And how is the higher education community responding to this challenge?

RECRUITMENT AND RETENTION

According to reports issued by organizations including the U.S. Department of Health and Human Services, the American Association of Colleges of Nursing and the Health Resources and Services Administration, there are a number of factors such as lack of adequate funding, long hours and unfavorable working conditions contributing to the nursing shortage that arguably threatens the quality of national health care.

There are several other well-documented reasons for the growing scarcity. In spite of recent increases in the number of nursing students matriculating at the undergraduate level, enrollments fall short of both the current and the projected gap in the number of available caregivers. Additionally, many practicing nurses are now reaching retirement age.

"(A previous) decline in enrollment has resulted in a decline in the educational pipeline," says Lisa Fuller, program coordinator/advisor at the Wayne State University College of Nursing in Detroit.

To complicate matters even further, there are fewer people to educate would-be nurses, especially as nurse educators also move closer to retirement. In addition, nurses with Ph.D.s, who are qualified to teach, are difficult to find. As a result, qualified nursing school applicants are often turned away, and for those who make it through a bachelor of science in nursing (BSN) program, teaching in the academy may not necessarily be the goal.

"A lot of nurses are not interested in teaching," says Dr. Rosie Calvin, professor of nursing, principal investigator and director of the Jackson Heart TRAIN (Training for Research Awareness in Nursing) program in the School of Nursing at the University of Mississippi Medical Center in Jackson. "They can make more money doing things other than teaching. Not many are interested, or feel they can do it."

"It," in this case, is the pursuit of the doctoral degree that is required for nurse educators at the postsecondary level.

"You have to be in the market before you are in the market," says Dr. Clinton Bristow Jr., president of Alcorn State University in Mississippi, about recruiting doctorally prepared nurses. "You can't start looking in November for January. You've got to start a year or so in advance and do national searches," he explains.

Nursing schools are now taking deliberate steps to address the complexities of the nursing shortage with an array of initiatives designed to attract more students at both the undergraduate and graduate levels, particularly those from underrepresented groups.

Historically, African Americans, as part of the underrepresented population, were not flocking in great numbers to become nurses, says Dr. Cornelia P. Porter, dean and professor in the School of Nursing at Florida A&M University. Porter says looking at the issue from a social psychological framework, nursing was not a field that African Americans were encouraged to pursue because of the perception that the profession perpetuated the type of servitude into which Blacks--particularly Black women--had historically been forced. Even now, Porter points out, the percentage of African American nurses in the United States is small, accounting for 4.8 percent of all registered nurses, according to the March 2002 National Sample Survey of Registered Nurses. (Data from 2004 are currently under analysis.) Alcorn's Bristow offers similar sentiments about the history of African Americans in the nursing profession, but adds that contemporary notions of the nursing profession have shifted to the point that many African Americans--male and female--now perceive the profession as a means for upward mobility.

And many educational programs see this and other underrepresented segments of the population as important resources for the future of the nursing profession.

At Wayne State University, for example, the Future Nurse Professionals (FNP) program was established with a grant from the King-Chavez-Parks Initiative from the state of Michigan five years ago.

"The university realized the critical need for retention for underrepresented minority students," explains Fuller, who created and developed the FNP program. "There is a great emphasis on the economically and academically disadvantaged to bring them into nursing at the entry level."

FNP participants are students with Pell grants whose SAT and ACT scores prohibit their entrance into the general nursing school population. Twelve to 14 applicants enter the FNP program as pre-nursing students and must complete a rigorous fall and winter program that includes chemistry and microbiology courses. Students have the benefit of tutors and learning specialists as they work toward admission into the first-year nursing program.

Fuller says the goal of the FNP program is to make sure pre-nursing students who might be at risk are successful by providing academic support and additional educational services including instruction in time management skills, test taking, money management, health assessment seminars, interactions with physicians and other activities designed to enhance their academic preparedness, as well as their confidence. "When their confidence levels are high, they don't drop out," Fuller says.

Part of the FNP program confidence-building strategy includes a mentorship component that has been successful, she adds, and is the only part of the FNP program that is open to all nursing students. A mentorship advisory board at Wayne State, including nursing faculty and nurses from the surrounding Detroit area, oversees this part of the program. Mentors are College of Nursing faculty, senior student nurses and nurses actively recruited from area hospitals who volunteer their services. Although mentoring is voluntary, participating nurses can use this activity as part of their professional development. Certificates are issued twice a year during a reception for mentors and their proteges.

"We have about 34 mentors, many who work with two or three students because they love mentoring, to see (the students) progress over time," Fuller says. "Students become more purposeful as well."

Producing culturally competent nurses able to work with diverse populations who can become nurse leaders is the ultimate aim of the FNP program. In May 2004, five female FNP program participants, four African American students and one Middle Eastern student, graduated from Wayne State, and next year another FNP cohort will do the same. Fuller is now working on funding to make the FNP program institutional and at that point hopes to open FNP to all Wayne State nursing students, many of whom are now asking to participate. "We need to offer this to all of our students," Fuller says.

At the University of Mississippi, Calvin gives her perspective on the current nursing shortage.

"This is not the first time," says Calvin, who has been a nurse since 1976. "There have been three periods that we had shortages. This is the longest, though, and the worst."

Calvin explains that this shortage is complicated by the numerous options that have recently emerged for nurses.

Schools of nursing develop programs for the consumer, she says. "Forensic nursing has become popular because of "CSI" (the popular television series). Several schools are not focused on the more traditional bedside programs," Calvin says.