You asked for information concerning the state's nursing shortage. Specifically, you want to know (1) how nursing program enrollment and graduation rates have changed in the past few years, (2) whether increasing numbers of nursing program graduates are affecting the state's projected nursing shortage, (3) whether the state's public colleges and universities have increased their nursing faculty, and (4) the steps the state's colleges and universities are taking to prepare more students to be nursing instructors.

The demand for registered nurses (RNs) is due in part to an aging population and rising consumer demand for quality healthcare. Many RNs are approaching retirement age and salaries and working conditions in other industries, such as insurance and pharmaceutical research and manufacturing, attract nurses away from direct health care. Consequently, the nursing profession is faced with the difficulty of attracting new entrants to fill job vacancies and retaining its existing workforce.

In the past four years, nursing program enrollment in the state has increased over 18%. In the same time period, nursing program graduates have increased over 45%. This increase in graduates has been mainly driven by associate degree programs. The number of associate degrees awarded in the state has doubled in four years. Bachelor's and master's degrees awarded have increased 37% and 17% respectively over the same time period.

The data limit our ability to accurately determine whether the supply of nurses is sufficient to meet the projected demand. The Department of Labor (DOL) projects between 1,114 to 1,677 annual job openings for RNs in Connecticut. The Department of Higher Education graduate data indicates that 1,486 students received nursing degrees last year. Nonetheless, the number of nursing program graduates does not equate to the number of nurses entering the workforce.

The demand for RN training has also resulted in a shortage of qualified nursing instructors. The nursing faculty shortage directly affects the state's ability to build a nursing workforce to meet its needs over the next several years. But preparing nursing instructors is a complex challenge because of the time and expense associated with preparatory programs. Most colleges require faculty to have a master's degree to teach undergraduate students and a doctoral degree with advanced practice certification, coupled with nursing education or administration expertise, to teach graduate students in specialty nursing programs. Many of the state's graduate programs only offer clinical specializations; a few offer nursing education or administrative specialization.

The demand for RNs is due in part to an aging population and rising consumer demand for quality healthcare. Many RNs are approaching retirement age and salaries and working conditions in other industries, such as insurance and pharmaceutical research and manufacturing, attract nurses away from direct health care. Consequently, the nursing profession is faced with the difficulty of attracting new entrants to fill job vacancies and retaining its existing workforce.

The demand for RNs has led the state's colleges and universities to expand programs to accommodate more nursing students. Nursing program enrollment and graduates have increased steadily in the past five years. Nonetheless, it is difficult to determine whether these increasing numbers are meeting the state's healthcare workforce needs.

Table 1 lists all of the state's nursing programs, from associate's degree through doctoral program level. Bachelor's degree nursing programs are designed for students new to nursing and for RNs returning to college to complete their baccalaureate education. Most of the master's degree programs are designed for RNs seeking an advanced practice or specialty.

*iTV courses are offered simultaneously to several sites by interactive television.

Source: Compiled using the DHE Comprehensive Program Search tool and information provided by each institution

Table 2 shows nursing program enrollment by institution from fall 2004 through 2007. The data, provided by each institution, includes associate's through doctoral degree programs. In all, nursing program enrollment across the state has increased approximately 18% since 2004. Sacred Heart University and Southern Connecticut State University have seen the largest percentage increases in enrollment over the four year period. Gateway Community College's nursing program held its first classes in 2004 and has since increased its enrollment by over 100%. Goodwin College also began admitting students in 2004 and has experienced a nearly 41% increase in enrollment since then.

Table 2: Nursing Program Enrollment 2004 — 2007

Degree Level: A= associate; B= bachelor; M= master; PB= post-baccalaureate; D= doctorate; SYC= sixth-year certificate.

Source: Institutional data

Table 3 and Graph 1 show the number of nursing program graduates, including diploma programs (e.g. licensed practical nurse programs), in the last 10 academic years by the degree they obtained. The data, provided by the DOL's Office of Research, indicate that the supply of nursing graduates has steadily increased since the 2002-03 academic year. The 2000-01 academic year had 887 nursing graduates, the fewest in the 10-year period. Since 2000, the number of nursing graduates has increased over 78% to 1,581 in 2006-07.

Table 3: Supply of Nursing Program Graduates

* Does not include figures for the diploma program at Bridgeport Hospital School for Nursing

Source: DOL Office of Research

Graph 1 illustrates the trend. The supply of nursing graduates remained relatively flat from 1999 through 2002. The 2005-06 academic year had the largest increase in graduates over the prior year with a nearly 18% increase over 2004-05. This increase coincides with the first cohort of nursing graduates at Goodwin College. Goodwin College graduated 108 nurses in June 2006, which accounts for almost half of the increase over the prior year.

Graph 1: Supply of Nursing Program Graduates 1997-2007

Table 4 shows nursing program graduates by institution from 2003-04 through 2006-07. The number of nursing program graduates has increased over 45% over the four year period. Several institutions, including Housatonic Community College, Quinnipiac University, Three Rivers Community, and the University of Hartford more than doubled their undergraduate or graduate nursing degree recipients in four years.

Table 4: Nursing Program Graduates 2004—2007

Degree Level: A= associate; B= bachelor; M= master; PB= post-baccalaureate; D= doctorate; SYC= sixth-year certificate.

Source: DHE Degree Completions Database (updated with institutional data, if available)

Table 5 lists the total degrees awarded by degree level. It shows that the increase in nursing program graduates has been mainly driven by associate degree recipients. The number of associate degrees awarded in the state has doubled in four years. Bachelor's and master's degrees awarded have increased 37% and 17% respectively over the same time period. The number of graduates from doctoral level programs fluctuates widely from 16 graduates in 2004 and 2006 to one in 2007.

Charter Oak State College. Charter Oak offers an online refresher course for RNs who have been out of the workforce for three to 10 years and want to return to active practice in medical and surgical staff positions in hospitals, long-term care facilities, or home healthcare. While it is not a traditional nursing program, 90 students completed the RN refresher program from 2004 through 2007, allowing them to re-enter the nursing workforce. (Charter Oak projects an additional 37 RN refresher completers for 2008.)

Table 6 shows the DOL's employment projections for RNs for three 10-year periods. The reports indicate that while employment levels for RNs are growing, job growth projections are diminishing. The first projection, issued in July 2003, shows 30,560 RNs employed in 2000, and a projected employment in 2010 of 36,740, a 20.2% increase for the 10-year period. The 2005 report showed a 16.7% projected increase in employment from 2002 to 2012. The 2006 report shows 31,890 RNs employed in 2004, projected to reach 36,020 in 2014, a 13% increase.

Table 6: DOL Employment Projections for Registered Nurses 2000-2004

Source: DOL, Connecticut's Industries & Occupations Forecast: 2003, 2005, and 2006.

The total annual openings column shows the projected average annual demand for RNs over the ten year period. While actual employment increased from 30,560 to 31,890 from 2000 to 2004, the number of annual RN job openings decreased from 1,235 to 1,081. According to the DOL's Office of Research, the most recent projections for the 10-year period from 2006 through 2016 estimate an annual demand of 1,114 RNs, a slight gain over the 2004 projections. However, actual demand may be higher than the projections indicate. A 2005 DOL job vacancy survey of randomly selected firms throughout the state estimated that there were 1,677 RN job vacancies; RNs were the third highest occupation in demand.

The Connecticut Hospital Association also conducts annual vacancy rate surveys for nursing and allied health professions in the state's acute care hospitals. Table 7 shows the vacancy rate for staff RNs from 1998 through 2007. The vacancy rate hit its highest point in 2001, followed by three years of declines. Most recently, the vacancy rate has leveled off to around 7%.

Table 7: 10-Year Vacancy Rate Trend for Staff RNs in Connecticut Acute Care Hospitals

The data limit our ability to accurately determine whether the supply of nurses is sufficient to meet the projected demand. The DOL reports suggest that Connecticut is currently facing between 1,114 to 1,677 annual job openings for RNs. The DHE graduate data indicates that 1,486 students received nursing degrees last year. Nonetheless, the number of nursing program graduates does not equate to the number of nurses entering the workforce. Many bachelor's and master's level nursing students are already working as RNs and return to school to obtain an advanced degree needed to transition into a job with higher pay and more responsibility. Some graduates may move out-of-state or return to their home states after graduation. Similarly, graduates of other nursing programs may relocate to Connecticut. As a result, it is difficult to measure whether the supply of new RNs coming out of Connecticut nursing programs is sufficient to meet the current or future demand.

Table 8 shows the number of nursing graduates working while enrolled in nursing programs at public colleges and universities from 2002 though 2004. Approximately 73% of nursing graduates were working when they registered for the program, or shortly thereafter; 39% were already working in the health care industry. Overall, about 89% had been employed at some time during their studies, while 72% were employed in the health care industry while in school. While it is probable that many of these students were working to support their education, it is likely that some of them were already working as nurses.

Table 8: Nursing Program Students' Employment Status

Source: Department of Labor's Office of Research

The state's public higher education institutions have added nursing faculty to their programs to accommodate the increasing nursing student enrollment.

Connecticut State University System (CSUS). Table 9 and Graph 2 show the number of nursing faculty and support staff in the CSUS in the past five fiscal years. Southern Connecticut State University has the most notable increase, from 3 to 15 nursing faculty members in five years. Similarly, Western Connecticut State University has increased its nursing faculty from 13 to 18.

Table 9: CSUS Nursing Faculty and Support Staff

Graph 2: CSUS Faculty and Support Staff

UConn. Table 10 shows faculty counts from fall 2003 through fall 2007 by tenure track. The total includes all faculty, including assistant and associate deans, regardless of their teaching functions (professors, associate professors, assistant professors, instructors, and lecturers). It shows a 76% increase in total nursing faculty over the five year period due mainly to the increase in non-tenure track full-time appointments. The count does not include hospital or health care facility staff members who are not university employees but who contribute to and are affiliated with the academic and clinical nursing programs.

Table 10: UConn Nursing Faculty Count by Tenure Status, Fall 2003- 2007

Source: UConn's Office of Institutional Research

Similarly, Table 11 shows the number of non-faculty support staff for UConn's School of Nursing. It includes students employed as graduate assistants. It shows a 37.5% increase in nursing program support staff, driven by an increase in professional support in 2006. The 2006 increase was a result of certain employees being reclassified from clerical to UConn Professional Employee Association (UCPEA) employees.

Table 11: UConn Nursing Non-Faculty Count by Category, Fall 2003-2007

Community-Technical Colleges. Table 12 shows the number of nursing faculty, both full- and part-time, and support staff, excluding student workers, from the 2004 through 2007 academic years. Norwalk and Gateway Community Colleges have had the greatest increase in nursing faculty members over the four years. Most notably, Gateway's nursing faculty increased 88% from its first four years in operation.

Table 12: CTC's Nursing Faculty, 2004-05 through 2007-08

The demand for RN training has also resulted in a shortage of qualified nursing instructors. The nursing faculty shortage directly affects the state's ability to build a nursing workforce to meet its growing needs over the next several years. But preparing nursing instructors is a challenge because of the time and expense associated with preparatory programs. Most higher education institutions require faculty to have a master's degree to teach undergraduate students and a doctoral degree with advanced practice certification, coupled with nursing education or administration expertise, to teach graduate students in specialty nursing programs. Many of the state's graduate programs only offer clinical specializations; a few offer nursing education or administrative specialization.

The state has nearly 30 master's level and specialty or advanced practice nursing programs (see Table 13). Many of the programs are designed to prepare existing RNs for clinical specializations, such as anesthesia, adult or family nurse practice, or mental health nursing. A few of the programs have an education or administrative focus to prepare nurses for leadership or academic positions. As such, it is difficult to determine how many of the master's level graduates intend on pursuing careers as nursing faculty.

UConn and Yale are the only two universities in the state offering doctoral programs in nursing. UConn's School of Nursing's PhD program emphasizes nursing research scholarship and practice. UConn is also opening a new Doctor of Nursing Practice program in fall 2008. Yale discontinued its doctorate of nursing science program in 2008 but currently has four nursing students enrolled in its PhD program. The PhD students also participate as teaching fellows to prepare them for academic nursing faculty positions.

UConn identified a number of steps it has taken to address nursing faculty preparation. These include educator preparation courses for its existing nursing faculty to develop their skills and competencies as educators.

● In 2006, faculty introduced a two course, six credit sequence for nursing students interested in teaching.

● The School of Nursing received a federal grant (U.S. Department of Education's Graduate Assistance in Areas of Need grant program) to support three doctoral students who include nursing education as part of their doctoral program. To date, four students have been funded. UConn plans to reapply for a subsequent grant in 2009.

● In spring 2008, the School of Nursing received a grant from the Connecticut Healthcare and Facilities Authority (CHEFA) to create a certificate program for faculty to develop their teaching skills as instructors in accelerated programs for post-baccalaureate students. The certificate program is open to faculty from UConn and other institutions. The first offering will be in January 2009.

● In May 2008, the UConn Institute of Teaching and Learning offered 18 selected graduate assistants, including two nursing majors, a two-week intensive course in educational pedagogy to prepare them to be effective teachers. They expect to repeat the course in May 2009 and enroll as many graduate assistants as space permits.

● UConn is implementing a pilot program on educator preparation in August 2008 for current School of Nursing faculty. They have enrolled 15 faculty members, including first-time teachers and those with less than three years of experience.

The CSUS has undertaken a number of initiatives to expand its nursing programs and admit more nursing students. Its efforts to address the nursing faculty shortage are centered on increasing the number of students in the pipeline from bachelors through doctoral programs.

WCSU. WCSU received state funding in FY 2008 for one additional nursing faculty position to meet enrollment demands. The university also received $130,659 in federal funds for scholarships for all its nursing programs and intensive care unit simulation equipment. According to the 2008 Allied Health Workforce Policy Board report, WCSU has developed a partnership with Naugatuck Valley Community College (NVCC) and UConn to establish a nursing career ladder. Students who begin the associate's degree work at NVCC can transition to WCSU and UConn to pursue their bachelor's and master's degrees.

SCSU and WCSU Partnerships. The CSUS established a partnership between SCSU and WCSU to increase student access to graduate programs in nursing education. Beginning in 2006, SCSU has offered two of its graduate nursing education courses online to WCSU students to allow them to complete their MSN in Education degree. SCSU will offer an additional three online graduate courses for the 2008-09 academic year. To date, there are 16 students within a few credits of completing the program and a total of 26 students who have taken the nursing education course requirements. These students will be ideal candidates for a doctoral degree in nursing education.

SCSU and WCSU are also collaboratively designing a joint Ed.D. (doctorate in educational leadership) in Nursing Education program. It will combine traditional, online, weekend, and summer courses to accommodate a large range of participants.

CCSU. CCSU will begin offering a BSN program in the fall of 2008. This is in addition to its current RN to BSN program. According to public hearing testimony submitted during the 2008 session, CCSU expects to admit 50 students into the first cohort of this new program. When it is fully operational, the program will have 150 students. The university has hired a senior nursing educator to lead the program and, as of March, was searching for three full-time nursing faculty members. It is using $80,000 in internal resources and $34,970 in FY 2008 federal grant funds to purchase necessary laboratory equipment.

ECSU. ECSU does not currently offer a nursing program but it is implementing a pre-nursing advising program to support students transitioning into second degree nursing programs at SCSU or UConn. It is also identifying course equivalences that would allow students to transition to the BSN program at WCSU.

Approximately half of the state's nursing students graduate from independent colleges. The following information, provided by the Connecticut Conference of Independent Colleges (CCIC), summarizes a few of their recent initiatives to increase nursing enrollment and transition students into nursing faculty preparatory programs. These updates and others are also included in the 2008 Allied Health Workforce Policy Board report. The CCIC noted that its member colleges face three particular challenges in expanding their nursing programs: creating or expanding laboratory space, developing curricula, and recruiting nursing faculty.

Fairfield University. Fairfield is one of four nursing schools in the country selected to partner with the Department of Veterans Affairs to launch a new initiative to expand the number of nursing faculty, enhance the professional and scholarly development of nurses, increase student enrollment by 1,000 students, and promote innovations in nursing education. The university has also (1) partnered with the Bridgeport Hospital Nurse Anesthesia Program to recruit a second cohort of graduate nurses in the nurse anesthesia track, (2) negotiated

articulation agreements with and conducted on-campus recruiting events for local two-year colleges and regional hospitals, and (3) established a clinical nurse leader track in the MSN program.

Goodwin College. Goodwin is currently developing an RN to BSN program and anticipates enrolling students in January 2009. The college also has a number of employer partnerships in place to address workforce shortages. This includes partnerships with St. Francis and Hartford Hospital for clinical preceptors and Eastern Connecticut Health Network and Jefferson Radiology for advanced training for their employees.

Quinnipiac University. Quinnipiac's graduate nursing program received a training grant for the fourth consecutive year from the U.S. Department of Health and Human Services' Health Resources and Health Services Administration. The grant provides scholarships for students pursuing an MSN degree.

Sacred Heart University. Sacred Heart received a CHEFA grant to (1) support faculty pursuing doctoral degrees, (2) create a Nursing Education Certificate for MSN students, and (3) recruit and award scholarships to minority students who commit to participating in nursing education as preceptors or faculty. In the grant's first year, four nursing faculty enrolled in doctoral programs and one completed a PhD.

Saint Joseph College. Saint Joseph's has expanded its enrollment in the traditional pre-licensure program and established a 16-month second degree program. Saint Joseph's also received a CHEFA grant to address workforce issues by (1) promoting nursing careers to high school students, (2) establishing academic supports to reduce nursing students' attrition rates, and (3) developing transition options for associate's degree and diploma graduates interested in earning a BS degree.

Saint Vincent's College. St. Vincent's has increased its entering cohort to 120 students and has added adjunct faculty to lower its faculty-student ratio. It also offers an RN Refresher program that had 9 students enrolled in 2008.

University of Hartford. The University of Hartford has a long-standing MSN program in nursing education, management, and community public health. These areas address specialties that are increasingly challenged by the nursing shortage.

Yale University. Yale received a Grants in Area of National Need (GANNS) grant to support individuals from disadvantaged backgrounds pursuing doctoral study. The GANNS grant supports two to three full-time PhD students per year. Yale admits a total of 4 to 6 students per year in the nursing faculty preparatory program.

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