Journal of Nursing Education

Major Article 

A Systematic Review of Strategies to Address the Clinical Nursing Faculty Shortage

Tamar Wyte-Lake, DPT, MPH; Kim Tran, PhD, RN; Candice C. Bowman, PhD, RN; Jack Needleman, PhD; Aram Dobalian, PhD, JD

Abstract

This systematic review provides a comprehensive assessment of models used to expand the ranks of clinical nursing faculty. Nursing faculty shortages constrict the pipeline for educating nurses and make addressing the projected nursing shortage more difficult. Schools of nursing have denied admission to qualified applicants, citing insufficient numbers of nursing faculty as one major reason. Using key search terms in PubMed® and CINAHL®, we identified 14 peer-reviewed articles published between 1980 and 2010 about models for expanding clinical faculty. Partnership models (n = 11) and expanded use of faculty resources (n = 9) were the most common strategies. Few (n = 8) studies assessed program efficacy. A need was identified for studies to assess the effect of alternative models on educational capacity and student performance and to examine the subcomponents of academic–practice partnerships and other innovative approaches to understand the essential factors necessary to implement successful programs. [J Nurs Educ. 2013;52(5):245-252.]

 Dr. Wyte-Lake is Research Health Scientist, Dr. Tran is Health Service Research Postdoctoral Fellow, and Dr. Bowman is Research Health Scientist, Health Services Research & Development Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System; Dr. Needleman is Professor, Department of Health Policy and Management, University of California Los Angeles, Fielding School of Public Health, Los Angeles; and Dr. Dobalian is Director, Veterans Emergency Management Evaluation Center, North Hills, California.

This article is based on work supported by the Robert Wood Johnson Foundation (Project 64104) and the Department of Veterans Affairs, Veterans Health Administration, Office of Academic Affiliations (Project XVA 65-010). Dr. Tran receives support from the Veterans Health Administration Health Service Research Postdoctoral Fellowship program. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Robert Wood Johnson Foundation, the Department of Veterans Affairs, or the United States government.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Tamar Wyte-Lake, DPT, MPH, Research Health Scientist, Health Services Research & Development Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, 16111 Plummer St (152), Sepulveda, CA 91343; e-mail: Tamar.wyte@va.gov.

Received: May 24, 2012
Accepted: October 3, 2012
Posted Online: February 13, 2013

 

Abstract

This systematic review provides a comprehensive assessment of models used to expand the ranks of clinical nursing faculty. Nursing faculty shortages constrict the pipeline for educating nurses and make addressing the projected nursing shortage more difficult. Schools of nursing have denied admission to qualified applicants, citing insufficient numbers of nursing faculty as one major reason. Using key search terms in PubMed® and CINAHL®, we identified 14 peer-reviewed articles published between 1980 and 2010 about models for expanding clinical faculty. Partnership models (n = 11) and expanded use of faculty resources (n = 9) were the most common strategies. Few (n = 8) studies assessed program efficacy. A need was identified for studies to assess the effect of alternative models on educational capacity and student performance and to examine the subcomponents of academic–practice partnerships and other innovative approaches to understand the essential factors necessary to implement successful programs. [J Nurs Educ. 2013;52(5):245-252.]

 Dr. Wyte-Lake is Research Health Scientist, Dr. Tran is Health Service Research Postdoctoral Fellow, and Dr. Bowman is Research Health Scientist, Health Services Research & Development Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System; Dr. Needleman is Professor, Department of Health Policy and Management, University of California Los Angeles, Fielding School of Public Health, Los Angeles; and Dr. Dobalian is Director, Veterans Emergency Management Evaluation Center, North Hills, California.

This article is based on work supported by the Robert Wood Johnson Foundation (Project 64104) and the Department of Veterans Affairs, Veterans Health Administration, Office of Academic Affiliations (Project XVA 65-010). Dr. Tran receives support from the Veterans Health Administration Health Service Research Postdoctoral Fellowship program. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Robert Wood Johnson Foundation, the Department of Veterans Affairs, or the United States government.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Tamar Wyte-Lake, DPT, MPH, Research Health Scientist, Health Services Research & Development Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, 16111 Plummer St (152), Sepulveda, CA 91343; e-mail: Tamar.wyte@va.gov.

Received: May 24, 2012
Accepted: October 3, 2012
Posted Online: February 13, 2013

 

Nursing in the United States has been plagued by recurrent shortages. A 2002 report by the U.S. Department of Health and Human Services estimated that in 2000 the national shortage of RNs was at 6% and was expected to double to 12% by 2010. Even with the current economic crisis affecting those initial projections, the U.S. Department of Labor, Bureau of Labor Statistics (2009) estimated that more than one million new and replacement nurses will be needed by 2018 to meet the increased demands of the health care workforce. Although there is evidence that these projections are softening (Auerbach, Buerhaus, & Staiger, 2011; Buerhaus & Auerbach, 2011), the need for increasing the number of nursing faculty still remains. Research suggests that one reason for the shortage is an insufficient number of students entering nursing (American Association of Colleges of Nursing [AACN], 2012a). Nursing schools are turning away qualified applicants, citing an insufficient number of nursing faculty, lack of clinical placements, and shortage of classroom space as the major reasons (AACN, 2012).

The recent AACN Special Survey on Faculty Positions (2012b) reports 1,181 full-time and 753 part-time faculty vacancies of the 2012–2013 academic year. The faculty shortage is a multifaceted problem, with the following often cited as causes: (a) low salaries (U.S. Department of Health and Human Services, 2002), (b) older age (48% of nurse educators are age 55 and over, compared with 35% of other U.S. academics faculty; one half of the nurse faculty said they expected to retire within the next 10 years and 21% expected to retire within the next 5 years; National League for Nursing, 2010), (c) changing faculty workload demands and role expectations challenging faculty satisfaction (AACN, 2005), (d) alternative career opportunities (e.g., practitioner positions in private sectors that offer greater compensation) (U.S. Department of Health and Human Services, 2002), and (e) a diminishing pipeline of students preparing for faculty positions (AACN, 2005).

Buerhaus, Staiger, and Auerbach (2000) proposed ways to keep older RNs in the workforce as one of their five strategies to increase the supply of nurses. The engagement of experienced RNs in clinical education may encourage RNs to remain in the workforce. Programs that focus on academic–practice partnerships, such as the Veterans Affairs Nursing Academy, have adopted this strategy by encouraging older, clinically expert nurses, who are prepared at the minimum of a master’s level, to reenter academia by being hired as clinical faculty in the partnering academic institution (Bowman et al., 2011). This strategy not only addresses the clinical nursing faculty shortage but may also strengthen the relationship between the academic and practice partners, allow for expanding opportunities for clinical placements, and create an environment for other potential benefits to be nurtured (Bowman et al., 2011). It is also possible that academic–practice partnerships will address issues of compensation and will improve the clinical experience for both the students and the unit nursing staff; however, these factors remain to be demonstrated.

The aim of our study was to evaluate the nursing literature related to strategies that address the clinical nursing faculty shortage to summarize the current state of knowledge and identify gaps for future research. Understanding that institutions define clinical faculty differently, we chose to define clinical nursing faculty as those faculty who supervise students in clinical agencies (AACN, 2005). The specific purpose of this study was to identify strategies that schools of nursing have used to address the nurse faculty shortage, particularly as it relates to increasing the number of clinical nurse faculty. Little research has been conducted in this area. Allan and Aldebron (2008) conducted a systematic review of strategies to alleviate the faculty shortage and reported on studies published between 2000 and 2008. They discovered a dearth of literature on the subject. Our study looks at a wider swath of time but focuses more narrowly on strategies that expand opportunities specifically for clinical faculty. We also focused on evaluations used to assess the effectiveness of the approaches, in recognition of the fact that limited economic resources should be devoted to strategies that have been demonstrated to be more effective than alternative approaches.

We used the following research questions to guide our examination of organizational and program characteristics:

  • What strategies have been used or proposed to expand the number of clinical nursing faculty in the United States, with a focus on Bachelor of Science in Nursing (BSN) and Associate Degree in Nursing (ADN) programs only?
  • What methodological approaches, if any, have been used to evaluate these strategies?
  • What factors, if any, have been used to define the strategies as successful?

Method

We conducted an electronic literature search for strategies used to expand the number of clinical nursing faculty, as defined above, to synthesize the current knowledge present in the literature by using a standardized approach (Moher, Liberati, Tetzlaff, & Altman, 2009; Shekelle, Ruelaz, Miake-Lye, Beroes, & Newberry, 2012). We concentrated on the BSN and ADN programs to focus on the entry points into the nursing profession. A series of trial searches were initially performed using a wide array of relevant search terms. We conducted our search in the Cumulative Index to Nursing and Allied Health Literature (CINAHL®) and PubMed® to identify relevant studies published between January 1, 1980 and June 10, 2010. To search CINAHL, we used 17 key terms, such as faculty shortage AND nurse, clinical nursing educator, and faculty, nursing utilization. Using similar MeSH (Medical Subject Headings) terms in PubMed, 12 key terms were used (Table 1). The search process was saved in CINAHL and PubMed to provide weekly updates on newly published articles. Electronic bibliographic databases, reference lists from relevant publications, conference proceedings, and the Internet (using general search engines such as Google) were also examined to ensure a thorough critical search for existing research studies.

Keywords Used in Database Searches of Articles Published Between 1980 and 2010

Table 1:

Keywords Used in Database Searches of Articles Published Between 1980 and 2010

Inclusion Criteria

To be accepted for analysis, titles and abstracts resulting from the search process were reviewed independently by two members of the study team (T.W-L., K.T.). To be retrieved for full analysis, the terms BSN or ADN had to be mentioned in the title or abstract of the article. Next, the articles were separated into one of three categories: (a) clearly relevant, (b) clearly not relevant, or (c) lack of sufficient information to make a decision. Articles marked as clearly not relevant were excluded from the study. All other articles were reviewed by the study team. Differences in opinion among members of the study team about the relevance of an article were resolved by discussion or with the consensus of a content expert (A.D.).

To be included in our full review, the source articles had to meet the following criteria:

  • Be reported in a peer-reviewed journal. Dissertations and trade publications were excluded, as were commentaries and editorials, regardless of where they were published.
  • Be published between January 1, 1980 and June 10, 2010.
  • Be focused on a strategy that examined the expansion of clinical nursing faculty.
  • Be published in English and implemented in the United States, United Kingdom, Canada, Australia, or New Zealand.

Data Abstraction

Full-text articles of abstracts deemed to be relevant were retrieved and assessed using a screener tool developed for this study. The screener tool included information on study design, participants, funding source, proposed strategies for expanding capacity, and program evaluation method. To establish interrater reliability, all reviewers, including the content expert, independently reviewed several test articles using the screener tool, until consensus was reached on each item in the screener tool. After consensus was reached, the reviewers were divided into two teams of two individuals. Each two-member team consisted of at least one clinician (e.g., nurse practitioner). All reviewers were master’s or doctorally prepared. The two teams split the remaining articles, and each reviewer independently reviewed their assigned articles. The two teams then combined and reviewed the remaining articles using the screener tool until consensus was reached on each item. Disagreements that were not easily resolved were referred to the content expert to reach consensus.

Results

Of the 781 articles initially identified, only 14 met our inclusion criteria. The Figure shows the flow of the systematic review. Keyword searches yielded 605 abstracts from CINAHL and 291 abstracts from PubMed. After duplicate abstracts (n = 115) were removed, a total of 781 remained. Subsequently, 408 abstracts were excluded, as they did not fulfill the inclusion criteria. Of the 373 abstracts that required full-article review, 36 were not available (the majority of which were from local trade magazines), and 323 articles were rejected after full review (e.g., nonpeer-review journals, dissertations, inappropriate population, editorials, and commentaries). A single systematic review (Allan & Aldebron, 2008) did not fit our criteria and was therefore not included in our analysis.

Flow diagram of article inclusion for systematic review.

Figure.

Flow diagram of article inclusion for systematic review.

Among the 14 articles reviewed, only two studies used a quasi-experimental observational design. The remaining articles were categorized as preexperimental or case study or descriptive study. All studies reviewed are described herein. Results of our systematic review are organized according to the four organizational and 11 program characteristics identified, as well as by the methodological approaches that were used to evaluate the strategies.

Organizational Characteristics

We grouped a number of themes under the domain of organizational characteristics to better understand the features of the institutions involved.

Of the studies reviewed, the partnerships between health care systems and academic teaching institutions were the most common strategies for increasing the number of clinical faculty. We defined the types of health care institutions and academic settings to characterize the participating organizations. Ownership was not routinely specified, but where it was, we identified one hospital as being for-profit, three were not-for-profit, and two were county hospitals. Fourteen strategies involved at least one partner from an academic setting, 10 of which were public, four were private, and, three had a religious affiliation. Two articles described programs involving a community college and two articles did not specify the type of academic setting.

Organizational structures can be affected by whether they are based in urban or rural areas; thus, we chose to include definitions relating to urbanicity. A strategy was defined as having a rural component if it was defined as such by the authors. This was not a mutually exclusive category, as rural strategies could include urban partners. Of the 14 articles, six described a rural component to their approach. Scope was defined as the number of regions involved in the strategy. Eleven articles described a strategy that took place only in one part of a state (e.g., one city and its neighboring suburbs). Two articles described strategies that involved institutions in multiple parts of a state (e.g., two or more cities). One article described an approach that involved multiple states, and two articles did not specify the scope.

Research Question One

We reviewed the articles that met the inclusion criteria to answer the first research question: “What strategies have been used or proposed to expand the number of clinical nursing faculty in the United States, with a focus on BSN and ADN programs only.”

Twelve characteristics were delineated to describe the activities and structures of faculty expansion, as shown below. Selected findings are presented (Table A; available as supplemental material in the online version of this article).

Program Focus. We found two general strategic goals: the production of new clinical faculty (e.g., nonstandard masters’ programs, whose focus is the creation of clinical faculty) (n = 10) or the development and support of the clinical faculty after the strategy was in place (e.g., academic–practice partnerships that use already academically prepared nurses in new clinical faculty roles) (n = 8). These categories were not mutually exclusive.

Partnership Strategy. Ten programs described a partnership as their strategy for increasing clinical faculty. Of these, three described a partnership between a single university and a single hospital. Others included consortiums of multiple universities and multiple hospitals or universities and ADN programs in partnership with either each other and local health care institutions, with support from local community resources.

Funding Source. Funding source is defined as any funding provided for the development or implementation of the strategy. Five articles described strategies that received no external funding, meaning that all funding was arranged internally. Three strategies were funded by private foundations, four by state grants, and two by federal grants.

Incentives. Incentives (i.e., compensation not in the form of a salary) were separated from faculty pay for the purpose of this review. Four articles discussed incentives, three of which described tuition compensation if the graduate agreed to teach in the region for a specified amount of time as payback.

Curricular Changes. Eight studies described curricular changes in their strategy to expand clinical nursing faculty. Six studies described the development of either a new online curriculum or the addition of an online component to their current curriculum structure. Other curricular changes included adding an educational theory component to existing master’s in nursing programs and the development of a preceptor course to better prepare clinically expert hospital RNs to function in preceptor roles, primarily those RNs who work as preceptors in off-shifts and have less access to clinical faculty.

Professional Faculty Development. Four studies that addressed the concept of professional faculty development discussed developing training opportunities for clinical nurses to better prepare them to step into a clinical faculty role. One article described five schools of nursing that did not provide any training or development opportunities for new faculty, putting the entire onus of preparation on the new faculty members themselves.

Resources for Faculty. Nine studies discussed the provision of resources for faculty. Seven of these studies described some type of mentorship program for new clinical faculty. Other activities mentioned included the provision of office equipment and teaching activities.

Expanded Use of Teaching Aids. All three of the studies that described any type of expanded use of teaching aids discussed an expansion of simulation laboratory activities.

Faculty Pay. Seven studies discussed a policy by which clinical faculty were either paid their existing hospital-level salaries while acting as clinical faculty or were offered hospital-level salaries in their new roles as clinical faculty.

Availability of More Rotations. Four studies discussed an expansion in the number of rotations available at the health care institution(s) to their academic partners. Two of these studies specifically addressed the benefits of having nursing staff act as clinical faculty on their home units. Two studies discussed having health care institutions encourage their academic partners to use nontraditional care units and innovative scheduling.

Encouragement to Pursue Higher Degrees. Encouraging clinical faculty to pursue higher degrees was discussed in eight studies. Two of these studies discussed the benefit of exposure to academia by clinical nursing staff, specifically an increased interest in returning to school for further education. One study discussed pairing undergraduate leadership students with seasoned clinical faculty to share clinical teaching responsibilities that would inspire them to focus on clinical instruction.

Research Activities. One partnership program developed collaborative research opportunities between the academic and health care institution, including a collaborative research day and a collaborative research grant. These shared initiatives resulted in new opportunities, such as published studies, national presentations, and larger grants (Horns et al., 2007).

Research Questions Two and Three

The articles that met the study inclusion criteria were evaluated to answer the research questions: “What methodological approaches, if any, have been used to evaluate these strategies?” and “What factors, if any, have been used to define the strategies as successful?”

Ten of the 14 articles mentioned at least one evaluation tool that was used to assess outcomes from the strategy. The most common tool used was the survey. Of the seven studies that mentioned using a survey, three surveyed a faculty population and six surveyed a student population (these categories were not mutually exclusive). One also surveyed stakeholders at the participating schools and clinical agencies involved in the partnership. The second most common evaluation method was the individual interview. Of the three studies that mentioned using an individual interview, one interviewed both faculty and leadership, one interviewed students only, and one noted that relevant staff were interviewed. Only three articles explicitly mentioned the use of validated tools.

Seven broad topics were covered within our review. As shown in Table 2, these topics can be grouped into four major categories: (a) program operations, (b) quality of the program, (c) satisfaction, and (d) recruitment and retention. Program operations were assessed by one article’s nursing education program that measured the direct cost of the strategy. Quality of the strategy was assessed by students via the quality of the clinical instruction (two articles), the quality of the clinical education experience (two articles; one assessed the quality of the clinical education experience by faculty and one was assessed by students), and the use of evidence-based practice in the health care setting (one article). Satisfaction of the participants was evaluated in 12 studies and measured both the satisfaction of the clinical faculty (seven studies) and the satisfaction of the students (five studies). Recruitment and retention was measured by the recruitment of students into the program (two studies), recruitment of students into the workforce (two studies), recruitment of faculty into the program (two studies), the transition of students into the workforce (two studies), and the retention of nursing staff and clinical faculty (two studies).

Tools and Measurements Used to Evaluate Programs: General Overview of the Published Literature

Table 2:

Tools and Measurements Used to Evaluate Programs: General Overview of the Published Literature

Discussion

The nursing faculty shortage has been well described (U.S. Department of Health and Human Services, 2002). Efforts should now shift to focus on how to best address this shortage and widen the pipeline for educating new nurses. Therefore, the aim of this article was to comprehensively identify successful and sustainable ways of expanding the size of the clinical nursing faculty workforce that have been described in the literature. The most notable finding from this systematic literature review is that most studies describing strategies for expanding the number of clinical faculty are descriptive in nature, and few, if any, include an evaluative component with which to assess programmatic success. The absence of quasi-experimental and experimental research designs and the lack of reliable, validated measures provide little evidence to evaluate the described innovations.

Nevertheless, several findings from this study provide guidelines regarding the steps that are necessary to provide the evidence required by policy makers and others who are seeking remedies to the nursing faculty shortage. First, the most commonly found approach used to increase the number of clinical faculty was the academic–practice partnership model. The most frequently described characteristics of this model were (a) the participation of a public university, (b) no external funding used to support the partnership, and (c) efficient means used to reimburse faculty as a result of involving multiple organizations. This combination of characteristics suggests a potentially sustainable model that would address some of the primary fiscal challenges of the clinical faculty shortage. Partnerships that are able to utilize internal resources in innovative ways may be especially attractive to policy makers, although more avenues need to be explored to evaluate the long-term sustainability and effectiveness of such programs. The most common partnership model was a health care institution partnering with an academic institution, with the health care institution funding the salaries of its own nurses who act as faculty. This variant of the partnership model has also been proposed to increase retention of expert clinicians in both the academic and clinical settings (Bowman et al., 2011) and to stimulate peers to further their own education (Kowalski et al., 2007; Murray, 2007).

Another key finding relates to the programs that discussed curricular changes, almost all of which referred to either adding an online component to their curriculum or converting an existing program into an online format. This attempt to provide a more flexible option for completing nursing courses addresses two needs: (a) it allows practicing nurses to take courses at home when it is convenient, and (b) it provides an option for those individuals in rural areas who may not have access to a local master’s program. The online option also reduces the demand on the academic institution by circumventing the need to find additional classroom space, thus removing this barrier that limits the school’s ability to increase its enrollment.

Our findings showed that six of the 14 articles discussed mentorship and faculty development. Transitioning into the faculty role from a clinical position can be extremely challenging. Culture shock—where the demands of academia, such as evaluating student performance, communicating with students, and having a more flexible interpretation of the work schedule, are sufficiently different from the demands of practice—likely makes the transition from practice to academia difficult for many. Providing a mentor to novice faculty may help to guide them through this initial period. A mentor can also provide opportunities for teaching development. This support, in turn, may help retain the novice faculty member in his or her new role. Taking advantage of an opportunity to assign mentors recognizes that such efforts may reduce the turnover of new faculty and is a particularly important consideration given the resources in which programs invest to increase their faculty numbers.

Finally, our results showed that the health care institutions that chose to be part of academic–practice partnerships are beginning to recognize that they are partners with the shared goal of increasing the number of clinical faculty. The partnership model, where the health care institution funds the clinical faculty positions by using one of their own clinically expert nursing staff, was the most common approach to providing a more competitive salary. Although in the short term the clinical partner loses the time that the nurse formerly spent on the unit, the clinical partner may secure long-term benefits by building resources for themselves in the form of new nurses. Furthermore, by providing a clinical expert who is paid at the institution’s nursing staff salary level while working at the school of nursing, the partnership addresses the potential for dissatisfaction with salary differentials among faculty and practitioners. It is also possible that this arrangement may produce secondary benefits, such as improving satisfaction among unit staff, by providing a comfortable and familiar environment for the nursing staff. In turn, this may improve the nature and quality of the students’ clinical rotations. Ultimately, such arrangements may improve the recruitment of new staff, but additional research must be done to assess whether such potential benefits are borne out by these partnerships.

Of the limited number of studies that discuss funding and the implementation of strategies to increase the number of clinical nursing faculty, few discuss the efforts to evaluate the effectiveness of those strategies. (Allan & Aldebron, 2008; Teel, MacIntyre, Murray, & Rock, 2011). Given the significant resources required to fund these innovations, the field should better understand the benefits and shortcomings of various strategies or approaches to ensure that scarce resources are devoted to the most efficient and effective strategies. Academic institutions and health care facilities, as well as grant-making organizations, would benefit from a greater understanding of local environmental factors (e.g., urbanicity and ownership of involved institutions) and other factors related to programmatic success when considering the adoption of a strategy.

Recommendations for designing the strategies to increase the numbers of clinical nursing faculty gleaned from this systematic review can be summarized as follows:

  • Academic–practice partnerships should, if possible, rely on internal resources and funding to avoid excess reliance on external fixed-term funding, such as grants.
  • The addition of an online component to nursing school curricula can increase recruitment of practicing nurses into master’s-level programs by allowing for more flexible class options and reducing the resource demand on the academic institution.
  • The implementation of a mentorship program for new clinical faculty can improve their retention by providing guidance during the initial period of culture shock that often accompanies their entrance into academia.
  • Having the practice partner in a partnership use one of their own clinically expert nursing staff can attract clinically expert nurses into faculty positions while avoiding conflict over salary differentials.

These recommendations can be used as a guide until further studies can evaluate the effectiveness of one strategy over another.

Limitations

Some published articles regarding strategies of expanding the number of nursing faculty may not have been identified for a number of reasons. For example, some articles may not have been captured by the search terms used, despite our attempts to make them as inclusive as possible. Also, this review included only peer-reviewed articles and excluded editorials and commentaries that loosely described strategies. Such publications often lacked adequate data to complete our abstraction tool, and they did not include data regarding evaluation of the programs.

Another limitation is that some of the implemented strategies may have included an evaluation component, such as a routine faculty evaluation, but simply did not describe it in the article. For example, it is likely that most, if not all, schools of nursing routinely provide standardized evaluation forms for students to evaluate their satisfaction with a course following its completion.

Finally, the lack of research-supported strategies available for our review brings into question the amount of confidence one can have in the effectiveness of these strategies, but the large amount of anecdotal evidence we found does lend credence to our conclusions.

Conclusion

In this systematic literature review, we found a limited number of peer-reviewed articles that specifically described strategies to address the expansion of the clinical faculty workforce. The absence of formal evaluations of the efficacy of these strategies presents a quandary for policy makers who are concerned about the nursing faculty shortage. The weak evidence base fails to provide a consensus understanding of appropriate approaches to address the national nursing faculty shortage and leaves policy makers with limited guidance regarding which alternatives to consider when designing strategies to alleviate the shortage.

Moreover, most of the strategies we examined indicated the number of faculty who completed the implemented approach, but they did not examine whether the faculty chose to remain faculty members in the longer term. It is possible that some approaches currently underway have not yet had sufficient time to assess and publish their results; if this is the case, we would strongly encourage program participants to publish their results regarding long-term continuation of the faculty role as data become available. Publication of these data will provide opportunities for the exchange of innovative ideas that strengthen nursing education and may also serve to influence efforts to address shortages in other health professions.

Although many articles in our systematic review discussed successful implementation of a strategy or idea, few articles reported on how they evaluated this success. The majority of approaches were implemented at a single locale and thus lacked comparison to programs in other locations. Because programs do not exist de novo and unique structural and contextual factors must be taken into account when designing a strategy and evaluating its success, it would be beneficial to compare several strategies with varied demographic characteristics to determine the essential components that make these approaches successful. Specific domains to be investigated should include the various elements this literature review suggests may make up a successful partnership. These studies should also include a formal examination of the effects of partnerships on the recruitment and retention of hospital staff. The difficulty of conducting a randomized study in this context suggests that using a comparative case study design would be a more reasonable approach.

This systematic literature review provides a foundation for more informed decision making by policy makers and the field. Nevertheless, there is a significant need for a scientifically rigorous study of the effect of various factors on educational capacity and the options that are available to policy makers and the field to quickly reduce these constraints on the supply of nursing faculty. A stronger evidence base would provide policy makers with the information needed regarding how to best design and target policies to alleviate the nursing faculty shortage, thus expanding nursing school and clinical training capacity in the fastest and most cost-effective manner.

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  • Shekelle, P.G., Ruelaz, A., Miake-Lye, I.M., Beroes, J.M. & Newberry, S. (2012). Maintaining research integrity: A systematic review of the role of the institutional review board in managing conflict of interest. Washington, DC: Department of Veterans Affairs.
  • Stahl, A.M., Lewandowski, M.L. & Connolly, M.A. (2008). An online dual-certification program in advanced practice nursing and nursing education: One university’s response to faculty shortages. AACN Advanced Critical Care, 19, 59–65. doi:10.1097/01.AACN.0000310752.31406.d5 [CrossRef]
  • Teel, C.S., MacIntyre, R.C., Murray, T.A. & Rock, M.A. (2011). Common themes in clinical education partnerships. Journal of Nursing Education, 49, 365–372 doi:10.3928/01484834-20110429-01 [CrossRef].
  • Twedell, D.M. & Frusti, D.K. (2008). The trifecta: Harnessing the power of philanthropy, joint appointments, and practice to ease the faculty shortage: Academia, practice, and philanthropy. Journal of Nursing Administration, 38, 401–403 doi:10.1097/01.NNA.0000323955.99049.a1 [CrossRef].
  • U.S. Department of Health and Human Services, Health Resources and Services Administration. (2002). New HRSA report predicts deepening nursing shortage. Retrieved from http://archive.hrsa.gov/newsroom/NewsBriefs/2002/nurseshortagereport.htm
  • U.S. Department of Labor, Bureau of Labor Statistics. (2009). Economic news release. Table 10. The 30 occupations with the largest projected number of total job openings due to growth and replacements, 2010–20. Retrieved from http://www.bls.gov/news.release/ecopro.t10.htm/
  • Warren, J.I. & Mills, M.E. (2009). Motivating registered nurses to return for an advanced degree. The Journal of Continuing Education in Nursing, 40, 200–207 doi:10.3928/00220124-20090422-01 [CrossRef].
  • Wellard, S.J., Williams, A. & Bethune, E. (2000). Staffing of undergraduate clinical learning programs in Australia. Nurse Education Today, 20, 548–554. doi:10.1054/nedt.2000.0480 [CrossRef]

Note. BSN = Baccalaureate of Science in Nursing; ADN = Associate Degree in Nursing; MSN = Master of Science in Nursing; ABSN = Accelerated Baccalaureate of Science in Nursing; RN = registered nurse; IT = Information Technology.

Keywords Used in Database Searches of Articles Published Between 1980 and 2010

DatabaseKeywordsArticle Yield
CINAHL®(“faculty shortage” AND nurs*) OR (“educator shortage” AND nurs*) OR “clinical nurse educator” OR “clinical nurse educators” OR “clinical nursing educator” OR “clinical nursing educators” OR (“education capacity” AND nurs*) OR (“educational capacity” AND nurs*) OR (“clinical instructor” AND nurs*) OR (faculty AND manpower AND nurs*) OR (faculty AND supply AND nurs*) OR “clinical nurse teacher” OR “clinical nurse teachers” OR “clinical nursing teacher” OR “clinical nursing teachers” OR MM “Schools, Nursing Manpower” OR MM “Faculty, Nursing Utilization”605
PubMed®“nurse faculty shortage” OR “nursing faculty shortage” OR “nurse educator shortage” OR “clinical nurse educator” OR “clinical nurse educators” OR “clinical nursing educator” OR “clinical nurse teacher” OR “nursing education capacity” OR “clinical nursing instructor” OR “clinical nurse teachers” OR “clinical nursing teachers” OR “Faculty, Nursing/supply and distribution” (MeSH Terms) 1980:2010 [dp]291a

Tools and Measurements Used to Evaluate Programs: General Overview of the Published Literature

Topic (No. of Articles)Selected FindingSource
Program operations (n = 1)Direct cost of the programWarren & Mills, 2009
Needs assessment of the programWarren & Mills, 2009
Quality of the program (n = 2)Quality of clinical instruction by students.Delunas & Rooda, 2009; Seldomridge, 2004
Quality of clinical education experience
  By faculty peer evaluationBonnel et al., 2003
  By studentsDelunas & Rooda, 2009
Use of EBP in the health care settingStahl et al., 2008
Satisfaction (n = 12)Satisfaction of clinical facultyDelunas & Rooda, 2009; Ganley & Sheets, 2009; Kowalski et al., 2007; Murray, 2007; Warren & Mills, 2009; Bonnel et al., 2003; Seldomridge, 2004
Satisfaction of students.Delunas & Rooda, 2009; Kowalski et al., 2007; Murray, 2007; Bonnel et al., 2003; Seldomridge, 2004
Recruitment and retention (n = 6)Recruitment
  Students into the programGanley & Sheets, 2009; Warren & Mills, 2009
  Faculty into the programGanley & Sheets, 2009; Wellard et al., 2000
  Students into workforceGanley & Sheets, 2009; Warren & Mills, 2009
Retention of nursing staff and clinical faculty.Warren & Mills, 2009; Wellard et al., 2000
Transition of students into the workforceGanley & Sheets, 2009; Warren & Mills, 2009

10.3928/01484834-20130213-02

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