When evaluating nursing school enrollment, students and educators can generally be satisfied with the current status while being mindful of specific concerns.
In April, the American Association of Colleges of Nursing (AACN) released data revealing that enrollment in programs designed to prepare entry-level registered nurses held steady, up 0.3% compared with the previous survey. However, fewer students are entering baccalaureate degree-completion, master’s, and PhD programs.
Each year, AACN surveys nursing schools offering baccalaureate and higher degrees nationally. Conducted in fall 2023, AACN’s latest annual survey, “2023-2024 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing,” contains data reported by 975 nursing schools.
RN to BSN
While the number of students in RN-to-BSN programs decreased significantly for the fifth straight year, that decline needs to be put into context, notes Jean Giddens, PhD, RN, FAAN, ANEF, dean of the University of Kansas School of Nursing and chair of the AACN Board of Directors.
She noted in an interview that in 2002, roughly 30,800 students were enrolled in RN-to-BSN programs. That number skyrocketed to almost 140,000 students enrolled in these programs in 2018-19.
One major factor for that increase was the release in 2010 of the Institute of Medicine’s The Future of Nursing report, notes Giddens. With that landmark report, she notes, there was a national goal to increase the number of baccalaureate-prepared nurses.
In 2010, only 49% of the nursing workforce was prepared at the bachelor’s level. The goal was for 80% of the workforce to have a bachelor’s degree by 2020, she notes.
Following the report, many nurses returned to school to get their bachelor’s degree, “so that triggered a very significant uptick in RN-to-BSN enrollments,” explains Giddens. In 2020, 59% of the nursing workforce was prepared at the bachelor’s level, and now, in 2024, the number is close to 69% baccalaureate prepared, says Giddens.
According to Giddens, another factor for the decline in enrollment in RN-to-BSN programs is that “for the first time, more people are earning their initial degree in a baccalaureate degree. We now have a time where more people are earning their bachelor’s degree at the time of licensure.”
With the current report, conducted in fall 2023, some 89,000 students were enrolled in RN-to-BSN programs, she notes. That’s a decrease of 9.9% compared to the previous survey. “The enrollment is probably balancing back out a bit, reflecting reduced demand,” says Giddens.
DNP Shift
The AACN survey found that enrollment in PhD programs continued to decline, decreasing by 3.1%, while enrollment in DNP programs increased by 2.0%, marking 20 consecutive years of enrollment expansion. Concern about low PhD enrollment, notes Giddens, is far from new, as this has been a topic of discussion for 30 years.
Giddens notes the DNP degree doesn’t compete with the PhD because “it is a different focus from the PhD. It’s a practice doctorate.” These are nurses in clinical practice who are focused on patient care outcomes in a clinical practice environment. The PhD is a research doctorate and prepares nurse scientists, she says.
Giddens says most nurses who enroll in a DNP program fall into one of two categories. The first are nurses with master’s degrees in an advanced practice role who return to school to obtain the DNP degree. The second are bachelor’s-prepared nurses seeking a DNP degree in an advanced practice role or specialty (as opposed to enrolling in a master’s degree program). “What you see here is a big shift in enrollment for the DNP, which is considered the preferred degree for nurses in advanced practice roles.”
“We need to do more to help people understand what a research doctorate is and what kind of careers you can have with a research doctorate,” says Giddens. She points to federal advocacy efforts with AACN and partnerships with organizations such as Jonas Philanthropies.
Faculty Gap
Despite the high demand for nurses, the AACN survey found that thousands of qualified applications were turned away from four-year institutions. In 2023, 65,766 qualified applications (not applicants) were not accepted at nursing schools nationwide, though the students submitting applications may have been accepted and enrolled elsewhere.
Within this total, the AACN survey notes, applications turned away included 55,111 from entry-level baccalaureate, 703 from RN-to-BSN, 5,491 from master’s, 4,225 from DNP, and 236 from PhD nursing programs. Given the persistent shortage of nurse faculty, AACN says it remains concerned that nearly 10,000 applications were turned away from graduate programs, which may further limit the pool of potential nurse educators.
One method that may help increase enrollment in nursing school involves NursingCAS, a Centralized Application Service for Nursing that provides accredited nursing colleges with an admissions platform to manage application reviews. With this system, notes Giddens, a student can submit one application and direct it to multiple schools.
“If I put in an application through NursingCAS, it will share my application with the schools I’m interested in sharing it with,” explains Giddens. The system allows for“maximizing the potential for placements of students in nursing programs.”
Understanding the Trends
Giddens suggests that placing the survey results within a larger context is key to understanding them. “These enrollment trends don’t make major leaps in one year; rather, they evolve. I wasn’t surprised by any of the results. These are continuing trends.”
Concerns of a nationwide nursing shortage have loomed for decades, and the COVID-19 pandemic only fast-tracked the profession toward crisis.
Nursing is integral to safe healthcare delivery, and the threat of a nursing shortage should concern everyone.
When it comes to patient safety, nurses are the nervous system of a hospital. They sense, perceive, connect, communicate, and solve. Critical to patient safety, appropriately staffed nursing staff protects patients through decreased mortality rates, reduced duration of hospitalization, and decreased preventable errors, such as falls or infection [1].
Despite being the country’s largest healthcare profession[2], nurses overwhelmingly feel undervalued, understaffed, and underappreciated. And after Covid-19, they’re walking away from the bedside.
This Mayo Clinic study from 2021 surveyed the pandemic’s impact on clinicians. They found that 1/3 of surveyed physicians and nurses planned to reduce work hours within a year, and approximately 40% of nurses planned to leave their current jobs within two years [3]. Why? Stress, burnout, and heavy workload.
Nurses who are leaving the bedside aren’t retirement age. Analysis from 2022 found that the total number of registered nurses decreased by more than 100,000 between 2020 and 2021–the most significant observed drop in the past 40 years. Many were under 35 and employed in hospitals [4].
The nurses who should be the profession’s future are leaving it behind.
The threat of a shortage existed before Covid-19. The pandemic poured salt in the profession’s wounds. This American Association of Colleges of Nursing (AACN) reviewed a nursing workplace survey from 2022. It indicated that the median age of a registered nurse is 46 and estimated that a quarter of nurses plan to retire or leave the profession over the next five years [5].
By 2030, there will be an estimated exodus of one million nurses into retirement [6].
This is detrimental to patient safety. Experienced nurses leaving the bedside leave a large and dangerous void. New nurses and physicians rely on the knowledge, expertise, and intuition of experienced nurses. These intangibles, combined with their ability to lead, mentor, and educate, are challenging to quantify and replicate.
While nurses continue to retire from or leave the bedside, the demand for quality healthcare only increases. Modern medicine means longer life expectancies, resulting in increased hospitalization utilization and geriatric care.
According to the U.S. Census Bureau, as baby boomers age, they will outnumber children for the first time in the country’s history, and by 2034, there will be 77 million people who are 65 years old or older [7].
As baby boomer nurses leave the bedside, they’ll find themselves as patients in an overwhelmed, understaffed healthcare system.
There is no straightforward answer to this imminent shortage. You might think, can’t hospitals hire more nurses? Unfortunately, it isn’t as simple as that.
Demand for Nurses is Growing Faster Than Supply
According to the AACN, nursing school enrollment can’t meet anticipated demand [5]. Nursing college programs and their resources are finite.
The AACN’s report showed that schools often reject qualified applications due to inadequate faculty, professors, clinical sites, clinical preceptors, and budget constraints [5]. This means that even with increased interest in nursing education, nursing programs cannot churn out new graduate nurses quickly enough to fill job openings.
Still, new nurse recruitment isn’t practical if you can’t retain them.
Early in the pandemic, nurses pushed their fears aside to care for patients under immense pressure and uncertainty. Nurses are at the patient’s side more than any other clinician, assuming the highest burden of risk for disease transmission. Still, nurses answered the call and remained dedicated to the profession.
Supply shortages left frontline healthcare workers lacking basic personal protective equipment (PPE), like masks, gloves, and gowns. In 2020, the World Health Organization called for a 40% increase in production in response to dangerously low supplies of PPE, putting frontline workers’ health in jeopardy [8].
Nurses found themselves understaffed, overworked, and under-appreciated. Insufficient nurse staffing negatively impacts both patients and nurses. Staffing concerns during the pandemic plagued the profession, raising stress and decreasing morale.
A study published in Nursing Outlook examined the impact of insufficient staffing and higher nurse-to-patient ratios. As seen in the pandemic, higher nurse-to-patient ratios contribute to a higher degree of burnout, increased job dissatisfaction, and higher intent to leave [9].
This 2022 COVID-19 impact survey released by the American Nurses Foundation and the American Nurses Association showed that 52% of nurses are considering leaving their current roles. Why?
Insufficient staffing
Work negatively impacting health and well-being
Inability to deliver quality care
A staggering 6 out of 10 nurses report feeling burnt out, and three out of 4 nurses report feeling stressed, frustrated, and exhausted [10].
These aren’t the concerns of a small minority. This is endemic to the profession.
Unsurprisingly, the pandemic prompted many nurses to explore opportunities beyond traditional bedside nursing. The profession provides many opportunities: ambulatory centers, outpatient departments, school nursing, aesthetic nursing, administrative nursing, and telehealth and remote work.
As more appealing nursing positions pull nurses away from the bedside, urgent healthcare executive action and governmental involvement are necessary to keep hospitals functioning.
The AACN is currently focused on solutions to the impending shortage through such measures as:
Advocacy for federal legislation and increased funding for nursing education
Applying innovation in nursing programs, such as accelerated education pathways like BSN and MSN programs
Working with organizational partners to encourage interest in the career [2]
As we approach this crisis, certain regions will feel the shortage’s impact more directly. These predictions are partly due to population data showing an aging population that will outnumber the nursing supply. This study shows 37 out of 50 states will experience significant shortages [11]. This will negatively impact safe and quality patient care and nursing morale.
For nurses, the professional outlook is a double-edged sword.
You’ll almost definitely be hired, but there’s no guarantee that your job won’t push you out of the profession.
At a time of significant instability and uncertainty in 21st-century healthcare, holding onto valuable nursing staff could not be a smarter focus for organizations that want to stay ahead of the game. If nurse attrition is an arch-enemy of high-quality patient care, how can prudent facilities ensure their nurses stick around?
It’s Not About Pizza and Tote Bags
According to the 2023 NSI National Health Care Retention & RN Staffing Report published by NSI Nursing Solutions, a hospital-based RN turnover rate of 22.5% is our reality, with nurses employed in pediatrics, surgical services, and women’s health showing the lowest rate of attrition, and those working in telemetry, step down, and med-surg being the most likely to leave.
“In a competitive market where nurses can easily become well-paid travelers or find a better compensation package and more positive workplace culture down the street or across state lines, healthcare organizations can’t be lazy,” states Sharon M. Weinstein, MS, BSN, RN, CRNI-R, CVP, CSP, FACW, FAAN, a certified coach, speaking professional, and consultant to healthcare organizations. “Nurses are valuable, and those employers that reflect their knowledge of that value will be much more likely to reap the rewards of nurse retention.”
If the average cost of turning over an RN position is $52,350, as NSI reports, inspiring nurses’ sense of workplace loyalty should be top of mind for healthcare administrators, managers, and executives who are watching their profit margins shrink. A constantly revolving door isn’t healthy for any unit, let alone the facility of which it’s a part.
While free pizza, a tote bag, or a new thermal coffee cup can provide a few feel-good moments and a full stomach for a hard-working nurse, these initiatives fall flat when it comes to long-term nurse retention. Pizza and coffee cups don’t put money in nurses’ pockets or decrease their workload, so these shallow band-aids are not central to any retention strategy.
What Will Make Them Stick Around?
When considering the need to create a workplace environment where nurse retention is a direct result, we’ve already established that pizza and tote bags should not be your go-to. So, where do we look beyond such simplistic would-be incentives?
According to Weinstein, things have changed. “The pandemic brought a perfect storm of challenges for healthcare providers with a disruptive impact on practice and process; one thing that did not change was our commitment to the profession.”
“This is the time for wellbeing to prevail as a core retention strategy,” Weinstein admonishes healthcare leaders. “We must be attuned to nurses’ needs for active listening, respect for their mental health, and the constant threat of burnout. We must offer a stress-free, psychologically safe work environment and reinforce that there is joy in the journey. We want their place of work to be the focus of that joy.”
Compensation: Nurses want and deserve proper compensation, and they’ll vote with their feet when they know certain facilities or employers pay more. Sign-on bonuses, money for relocation, tuition reimbursement, childcare, generous health insurance, and other benefits are all incentives for nurses to come on board and remain loyal.
Positive work environment/workplace culture:Flowery words on the company website are nice, but creating a positive workplace culture takes work. Work-life balance initiatives, zero tolerance for bullying and incivility, a culture of appreciation and camaraderie, and an atmosphere encouraging kindness and rejecting negative behaviors don’t just happen organically. There must be a commitment from the top. When it comes to a positive workplace environment, safe staffing is at the top of most nurses’ agendas — we can’t practice safely if we’re asked to do too much in too little time with too few resources.
Professional growth and development: Generous tuition reimbursement (as mentioned above) is a good start. Ongoing in-house training and educational opportunities are essential, as are pathways for career advancement. Nurses interested in professional growth should be aware of a leadership funnel and/or clinical ladder in which they can participate. Mentorship programs can also be part of a culture that encourages professional growth. A culture of learning is a dynamic and healthy culture.
Engage staff in the organization’s life: Weinstein suggests employers can engage their staff in organizational development. “Offer diagnostic design thinking to your teams in small group workshops, and have them think differently about themselves, their roles, and their futures.” These experiences can enhance a sense of “ownership” of the process by both staff and leaders.
Recognition and rewards: Like any other strategy, employee recognition programs are just one of many ways to give back to hard-working staff. Performance-based rewards, promotions, financial incentives for specific achievements, and celebrating professional milestones can all contribute to employee satisfaction. From her experience as a consultant, Weinstein knows what works: “Offer meaningful recognition — recognize and reward your nurses.”
Flexible scheduling: Flexible work schedules must also include understanding and consideration for the needs of nurses and their families. Smart employers make allowances for employees with young children and disabled or elderly family members to care for. “Nurses have lives beyond the clinical space,” states Weinstein, “and they need to engage in flexible scheduling and comprehensive benefits packages to get a life and enjoy it!”
Health and wellness benefits: Employee Assistance Programs (EAPs) and anonymous mental health and counseling services for employees are a must in this day and age. Stress management programs, financial wellness support, and other programs that show employees that they’re cared about make nurses feel appreciated and seen.
No Silver Bullet
There is no silver bullet in nurse retention, but organizations that approach this crucial issue with a thoughtful, intelligent, and well-planned strategy will engender more loyalty and positive regard from their nursing staff than organizations that rely on the tired pizza-and-tote-bag approach. Nurses are valuable, and those employers that reflect their knowledge of that value will be much more likely to reap the rewards of nurse retention.
“Turning attrition to attraction begins with the relationship you build with your team, concludes Weinstein. “An organization with top talent can navigate change, mitigate uncertainty, exceed staff and patient expectations, and soar to success. It can create loyalty and reignite passion, even in unprecedented times.”
Burnout and high turnover have been taking a toll on nurse clinicians, resulting in a staffing deficit that will only worsen. According to McKinsey & Company, the U.S. will be short 200,000 to 450,00 registered nurses for direct patient care by 2025. Research from NCSBN further reports almost 900,000 RNs intend to leave the workforce by 2027.
With this in mind, leaders from our company wanted to examine what could be done to mitigate this growing crisis, one already impacting nearly every healthcare facility daily. So, we surveyed our traveling clinicians to find out what motivates and keeps them in the industry. Analysis of the data revealed the benefits that matter, what they appreciate in a facility, and perhaps more importantly, why they continue taking travel assignments and remain in the profession. Here are a few of the highlights.
Control Leads to Satisfaction
Over three-quarters of respondents surveyed said they were satisfied with their most recent travel job, whereas only half felt the same about their last permanent staff post. Burnout was a significant factor for staff clinicians due to problematic patient-to-staff ratios, lengthy shifts, and hospital politics. These issues were major influences in prompting clinicians to pursue traveling opportunities.
Not surprisingly, higher compensation and the ability to meet financial goals were the foremost reasons nurses seek traveling opportunities, cited by 84% of respondents. Other motivators included freedom and flexibility at 71%, followed by a sense of adventure (39%), work-life balance (28%), and an “ability to focus on the patient, not hospital politics” at 22%.
Top 5 Motivators for Seeking a Travel Position
Having experienced the freedom and flexibility afforded by traveling, 41% of respondents said they would never return to a staff position. Additionally, after completing their first assignment, data showed work-life balance increased in value by 4%, as did the chance to focus more on patients, not politics.
Traveling Nurses: The Value of Pay, Place, and Perks
Pay was the top motivator when selecting a travel assignment at 26%, followed closely by location at 20%. This is supported by what we see internally as many clinicians begin their searches filtering by city and state. Shift structures and the facility came in at 11%, with contract length (10%) and start date (8%).
Travel clinicians are particularly adept at negotiating monetary benefits. That said, we asked them to rank the compensation package features they find most important. The top responses were: Pay rate guarantees (18%), housing stipends (14%), travel reimbursement (12%), paid time off between assignments (8%), licensing and certification reimbursement (7%), affordable healthcare (7%), retirement contributions/401k matching (5%), support while on assignment (5%), scrubs reimbursement (4%), housing coordination and support (4%), and continuing education unit (CEU) reimbursement (3%).
As the data shows, pay, place, and perks are a few of the best ways to retain and attract these talented nurses.
Flexibility and Safety
Every healthcare facility has its processes and systems, ranging from unique float parameters to the type of electronic medical records (EMR) software it uses. When evaluating offers from a specific facility, traveling clinicians cared most about flexible scheduling (14%) and staff-to-patient ratios (13%).
Yet, while patient safety and support are critical, other factors have an impact, including facility reputation (9%), floating frequency (8%), charting systems (7%), opportunity for overtime shifts (7%), ability to request time off (RTO – 7%), thorough onboarding (7%), parking (7%), float parameters (6%), number of unit clinicians (6%), and lunch breaks (5%).
Interestingly, after completing their first assignment, responses showed some changes in value. “Work-life balance” grew by another four points, as did the ability to focus on the patient, “not the politics.” While still overwhelmingly important, money became somewhat less of a motivator for repeat travelers, dropping eight points.
Top 5 Motivators for Seeing a Travel Position
We also included a body of allied health professionals in our survey, those providing various diagnostic, technical, therapeutic, and support services. Topping their list of essential factors is thorough onboarding (12%), followed closely by the number of clinicians per unit. These healthcare professionals, on the whole, tend to be newer to traveling, likely explaining why they emphasize onboarding and ratios at a facility when considering offers. On a related note, Staffing Industry Analysts project continued growth in this space, with allied health travel jobs increasing by 5% in 2023 and 2024.
Satisfaction Guarantees?
The NCSBN study noted that more than 60% of nurses experienced workload increases during the pandemic. This left many feeling exhausted, emotionally drained, and disillusioned. With healthcare workforce shortages showing no signs of stopping and every indication they will continue to climb, the nursing profession must focus on rebuilding, or tragic consequences may follow.
Retaining talented, tenured RNs and attracting new talent are essential. The traveling nurses in our study have provided vital feedback related to job satisfaction. While there are no guarantees, their insights are important to consider across the industry as we work together to position healthcare for a healthier future.
Data is being incorporated for medical advancements to improve patient outcomes, and the same techniques can help recruit and retain healthcare professionals. This is especially true about one type of healthcare professional we could not live without – nurses.
Nurses form the bedrock of the healthcare system in the U.S. and are regularly ranked among the most trusted professions. Many of the most basic and humane healthcare services wouldn’t be provided without them. Unfortunately, many healthcare facilities are now struggling to attract and retain enough nurses to meet the needs of their communities. New data-driven recruitment strategies may help.
Addressing a Growing Nursing Shortage
It is hard not to be shell-shocked by the stark statistics associated with the gap between the number of nurses needed in the U.S. and the number that are currently projected to be available and in the workforce in the coming decade. The U.S. Bureau of Labor Statistics projects that the number of registered nurses will increase by over 6% in the next decade, adding nearly 200,000 positions. However, many nurses are expected to leave the workforce during that same period due to retirements or career path changes.
This means that enough new nurses may be entering the workforce to sustain current levels, but there will need to be more to account for the increase in the need for nurses. The shortage in available nurses is anticipated to impact nearly every state in the nation but is particularly acute in rural Western states. Programs seek to lessen the impact of the projected shortages in rural areas, such as those that place nurses in rural areas in exchange for student loan repayment assistance.
The COVID-19 pandemic was an even more powerful blow to a field struggling to retain quality employees. The field of nursing saw an estimated 3% decline in the number of people in the workforce between 2020 and 2022. The pandemic and associated stresses were particularly difficult for nurses and those in the medical field. Many cited burnout, a lack of support, challenges with patients, and public perception of the pandemic as reasons for leaving nursing altogether.
Hospital administration officials and other healthcare leaders recognize the problem and are actively searching for effective methods of educating, recruiting, and retaining more nurses. Some of these strategies are starting to pay off already, while others are just getting off the ground, including using data to help bridge the gap.
Data-Driven Nurse Recruitment
Many hospitals are putting renewed energy into fostering relationships with nursing schools. Likewise, the schools are working hard to utilize state-approved funding to develop the infrastructure to accept and train more aspiring nurses. For example, Arizona recently passed a bill allocating over $15 million to develop a pilot program focused on nurse education. To do this, they attend career fairs or technical events, collect information on students interested in the program, and follow up. Schools collect valuable and useful information at events, such as demographics, contact information, social media platforms, and event feedback.
Incorporating data analytics into the recruitment process can significantly increase hiring efficiency and improve the quality of the candidates brought on. For instance, it can be easier to identify nurses most interested in working in certain cities or departments and strategically hire them for positions they are more likely to be invested in.
Data analytics can also help identify issues within the hiring process itself. Making a few tweaks to the interview questions may make a big difference. Likewise, data can point out problems with diversity hiring or subconscious biases that a panel might pick up. Data can look deeper under the surface to ensure diversity goals are met at all levels.
Using Data to Create a Valued Culture
Data can also be a powerful tool for building a positive culture that makes employees want to stay at their workplace rather than move on to a different position. For instance, data can be used to build a more transparent workplace where employees feel they have a real connection and line of communication with management. Issues can be more easily tracked and evaluated over time – company leaders can make policy changes and collect data to assess how they are helping.
One example could be a hospital that is getting several reports that its nurses are burnt out and struggling with some of the trauma they see every day. It is a stressful job, and many locations are likely already dealing with similar issues. Administrative staff could implement several solutions, such as rotating nurses to different floors to give them a break or bringing in a professional mental health expert to help nurses process. Data collected before and after these changes are made can help determine the actual impacts of policies and how they improve conditions.
Data can play a significant role in helping healthcare facilities attract and retain nurses. The tools can be used to improve the hiring process and assess the effectiveness of policy changes to improve workplace conditions. Incorporating data could play an essential role in helping alleviate the growing nursing shortage nationwide.
The U.S. nursing shortage is projected to hit the hundreds of thousands, and the ability to educate and train nurses is more vital than ever. Yet, prospective caregivers still encounter barriers within nursing education that can limit their degree completion. And this disproportionately includes college applicants from diverse communities.
The nursing leadership team at Adtalem Global Education helps nursing schools better meet the needs of their students through the Social Determinants of Learning (SDOL). Principles that emphasize access over exclusivity and put students at the center, and ultimately, help decrease the nursing shortage. If adopted more widely, the framework can help nursing schools better meet the needs of their students and, ultimately, help reduce the nursing shortage.
Among the core principles are:
Student Admissions: The process evaluates factors beyond standardized test scores and GPA.
Mindfulness: An 8-week program integrated into a pre-licensure BSN program helps manage the stress that can hinder student progress.
Daily Nurse spoke with Karen Cox, PhD, RN, FACHE, FAAN, president of Chamberlain University and member of the leadership team at Adtalem Global Education, who helped create and implement a learning framework to adjust for those factors. She’s committed to assisting students to overcome all barriers, including past academic performance. As a healthcare executive and a former clinical nurse specializing in pediatric intensive care, burn care, and infectious diseases, she leads the largest school of nursing in the U.S. with nearly 38,000 students across 23 campuses and online programs. As a result, Chamberlain University is the leading grantor of bachelor of science in nursing degrees to underrepresented minority students in the U.S.
Karen Cox, president of Chamberlain University, talks about how the Social Determinants of Learning can help schools build a nursing pipeline
Prospective nursing students encounter barriers within nursing education that limit their degree completion, and this disproportionately includes college applicants from diverse communities. What can nursing schools do to adjust those factors?
First, nursing programs don’t tend to look at students as a whole. Their gold standard is the GPA. And that gets them the students with the most privilege and advantage. Those will be students that are usually independent or dependent, do not have to work full time, are very likely to be highly successful and pass the boards at a high rate.
As long as the profession generally does that, diversity in general, and I’m talking about ethnic and socio-economic diversity, diversity won’t be accomplished because people are more than their GPA. And so our approach is what nursing and other parts of higher ed talk about holistic admissions. And that’s where you look at the person, their life experiences, and their GPA, but you also try to understand what was behind that GPA if it was lower. And figure out if they will likely succeed, knowing they need more support.
And that’s where the Social Determinants of Learning framework comes in. We did a study at Chamberlain that shows only 30% of success or progress is related to people’s academic abilities. Seventy percent is related to psychosocial factors. So we have students that are independent, work full time, and if they lose a job, or if their car breaks down on the way to one of their clinicals, they can’t figure out what to do to get there. Those are nuisances to many people, but it could be the difference between success and failure to our students. So you have to look at supporting people. I will tell you I saw a school admitting students before they accepted your application. You have to take a test that you have reliable transportation, which is code for lots of things. But number one, if you say yes, and then you don’t, they won’t have to work with you on it. And what I find so interesting is that nursing is the most caring profession. And we’re not caring for students, and then we wonder why they’re not as caring for patients and families as we’d like them to be.
So we role model that level of care. And nurses have to accept people in all situations, all walks of life. And if nursing faculty can’t accommodate that, it doesn’t send the right message. Some schools say, “We want more diverse students, but we can’t get them.” And it’s not just that some diverse individuals haven’t had privileges. So you’re setting up another factor that could cause structural racism. You build the procedures that are the advantage—the majority group.
As a leadership team member at Adtalem Global Education, what are you doing to create and implement a learning framework to adjust for those factors?
A couple of different things. As mentioned in the admissions piece, we look at the faculty role differently. Faculty teach a class for three hours once a week or twice a week. And go home. Faculty are coaches and mentors, and guides and help us identify resources that students need. And then, we ensure we have the requisite resources that we need on-site or connections. We recently identified an organization that can help people who find themselves without a home and how to navigate that system and find them housing. We can’t provide all these things for people, but we can help them identify what that looks like in a crisis.
Food insecurity is an issue for many of our students, and we’re working to make sure we have either food available, or a pantry available on campus, but also, if we can’t, for whatever reason, have a connection and a seamless way to work with community services. So it’s paying attention not just to their learning but the things that get in the way of their learning. The other piece we’re doing at Chamberlain is that our students have to work full-time. But we don’t want them to work in retail, not because it is bad, but because it’s a couple of things. Retail work isn’t as flexible in considering the schedule of nursing clinicals and courses. But the bigger issue is if they can work in a hospital or healthcare setting, that’s one more experiential option where they see healthcare in action. And they get some hands-on experience. And they get to know an employer. It’s called “Earn to Learn” because the next step is that so many state boards now allow students to do some of their clinical work in an organization while getting paid not all but some hours for each specialty. And again, they’re not with faculty in the same way as they are typically, so they get yet another look at the day in the life of nurses. The nurse has extra pair of hands. And so we feel like it’s important. And if we had had something like this setup before COVID started, we’d have over 13,000 pre-licensure students nationwide. We could have been a force to support the workforce in a very seamless, organized ready-to-go way.
How has Chamberlain University become the leading grantor of bachelor of science in nursing degrees to underrepresented minority students in the U.S.?
So right now, getting into nursing school takes work. And I’m not saying it should be easy. But a 3.8 or 3.9 gets you looked at for nursing admission. What we do is look, again, we have students with a 3.2, who turn out to be extraordinary nurses with a high level of resilience and a high level of passion and excitement about being in the nursing profession. And so it’s about feeling that belonging. And if you walk onto one of our campuses, you will immediately see the diversity. It’s not in pockets. It’s prominent. And we’re so proud of it because of our scale. We can have an outsized impact on sending diverse nurses into the workplace. And the bigger we get, the more outsized that impact is.
So nursing graduates match what it’s like out there in the real world?
Exactly. Health equity has a chance. And we feel very strongly about that. I can’t tell you the disappointment when you read about well-educated Black women who died in childbirth. I tell people we see that disparity because it’s not normal, and you shouldn’t ever die at birth. But if two people get colon cancer, colon cancer is bad no matter what. So it’s hard to measure when you look at outcomes, but it’s harder and takes longer. But when you’re talking about something that’s supposed to be a normal part of life, yeah. It’s just stark.
Some of it comes down to not listening to or believing people. And if somebody says, I don’t feel right, and this is going on, I always tell students and new nurses, if a patient says or a parent says, this is not right, then something’s wrong. You stop in your tracks. And you investigate, and you get a colleague to look at it. The worst that can happen is everything’s okay. But often, patients know their kids, especially when you work with children and their families. And so what I think the piece about structural racism, there are lots of factors in healthcare. But the fundamental thing of listening and trusting someone and not just making assumptions or the notion of biases that have no basis effect.
How can the framework – the Social Determinants of Learning help other nursing schools better meet the needs of their students and, ultimately, help decrease the nursing shortage?
Education overall is about elitism, it’s about the best of the best going to the best schools. And the best, you know, promulgating that notion that it’s for the people with the highest abilities, the money to go to school. And so, we published that framework in 2021. And we’ve had a lot of interest. I would say the interest has been more at the faculty level than the leadership level. We plan to speak about it at a few conferences, but it’s a fairly new kind of name that we put on and developed this framework. I think that if people are honest, they know that your chances of diversifying go down dramatically if you don’t have a holistic admissions process. Still, we’re going to struggle with this because this was developed and discussed ten years ago at a national level how important the holistic admissions process is, and it’s just simply not there to the degree it needs to be.
When you sat down and created the SDOL framework, what did you envision as the desired outcome for nursing schools and the nursing profession?
It was to scale it, share it, and disseminate and hopefully get the attention of people who go to it who say to themselves, “Oh, yeah, I can now see that I know the social determinants of health because I teach that.” Now I can see how you brought that out to somebody in education. And, of course, this has applicability past nursing for any education situation looking at people’s barriers. And what can you do about those barriers? If you want to do something, there are a lot of people who still like the survival of the fittest. You met ten people, and two aren’t making it, and that’s okay. That’s not Chamberlain. We take it personally when we lose a student we went with and invested in. And that could be a real asset to the profession.
When creating this framework, you anticipated there would be pushback. What are your thoughts about selling the idea and having it makes sense?
The narrative is that everybody should have a level playing field and be at a certain place. And we’re not talking about not having the same outcomes. We’re talking about coming into a program. The other pieces, it takes more people, more work, different structures, different ways of organizing classes. Some schools will say they don’t have the dollars to do it. Or they don’t see the need. And that’s why I think that, at some point, the accrediting bodies will have to talk about being more holistic. But they don’t. They’re going about their business. They’ve got a busy school. They got plenty of applicants. They have twice as many applicant slots. In their mind it doesn’t make a difference, but it sure does nationally.
Chamberlain can influence, and as we grow with purpose and quality in mind, the more that we have, the more have to listen to us. We aren’t just going to sit over here. We’re in a category of one in terms of our mission, scale, and national presence. And so we’ve been more about just making sure that we have that impact and that people know about it and see it and the people who see it or the health system leaders locally hiring our graduates
Anything else to add?
There is a study that came out recently that talked about how many lost years and lost dollars occur in this country because of health inequities. And when we say the cost of healthcare in the U.S. is unsustainable, and I believe it is, one big component is addressing health disparities. And if we got busy and worked on that, we could work together across sectors. We could make an impact.
