“I’ve found the challenges and opportunities as a nurse educator have just been endless,” says Joanne Pohl, PhD, RN, ANP, FAAN, associate professor and associate dean for Community Partnerships, Uni­ver­sity of Michigan School of Nursing.

The Michigan Nurses Association (MNA) member is one of four nurse educators featured in a national faculty recruitment campaign launched by Nurses for a Healthier Tomorrow, a coalition of 43 health care and nursing organizations, including the ANA, aimed at solving the nursing shortage. The coalition’s first campaign focused on recruiting both men and women into the profession.

That campaign and other nursing career-awareness efforts were so successful that now schools of nursing find themselves feeling the pinch of the nurse faculty shortage even more acutely.

“For so long, we’ve focused our efforts on introducing nurses to other advanced nursing roles, such as nurse practitioner,” says Carol Toussie Weingarten, PhD, RN, associate professor at Villanova University College of Nursing in Philadelphia. “This new campaign aims to introduce nurses to the benefits and job satisfaction that come with being a nurse educator. We want nurses to see a career in education as a viable option.”

As part of its campaign, Nurses for a Healthier Tomorrow pulled together research that illustrates the extent of the nurse faculty shortage. Among the research is a report from the American Association of Colleges of Nursing (AACN), which showed that baccalaureate nursing programs nationwide were forced to turn away more than 11,000 qualified applicants last year because there were too few faculty and clinical sites, and not enough classroom space, to accommodate them. And the Faculty Census Survey of RN and Graduate Programs conducted in 2002 by the National League for Nursing (NLN) of all types of nursing programs placed the estimated number of budgeted, unfilled, full-time positions at 1,106 nationwide.

Nurse educators and campaign literature cite numerous reasons for the growing faculty shortage, from the age factor to too few nurse educator candidates currently in the pipeline.

Looking at the age factor, the majority of nurse faculty are slightly more than 51 years old. (By comparison, the 2002 National Sample Survey of Registered Nurses placed the average age of all working RNs at 43.3 in March 2000). There is also a substantial pool of nursing faculty poised to retire over the next 10 years.

Also coming into play is a misperception of the role. “Many times people I’ve met away from the hospital have asked me, ‘Are you still a nurse?’” says Weingarten, a Pennsylvania State Nurses Association member. “I tell them that nurse educators are, first and foremost, nurses.”

The Players

RNs interested in the campaign need only check out the Nurses for a Healthier Tomorrow web site at www.nursesource.org to find information about the shortage; downloadable, four-color advertisements designed to spark interest in this career track; general information about the campaign; and short biographies of the nurse educators, among other components.

Besides being featured on the web site and in the advertisements, the four nurse educators have agreed to share their stories with the media.

When MNA member Debi Vendittelli, MSN, RN, was a child, she asked her mom if she could be a nurse and a teacher. Her mom responded, “Sure,” and Vendittelli launched a career in nursing where she initially served in staff nurse and managerial roles. However, she maintained an interest in education. Today, she works full time as an associate professor at School­craft College in Livonia, Michigan.

Vendittelli believes it’s an honor to teach what she describes as the “art and science” of nursing. She particularly derives great satisfaction from helping students develop from novice students to nursing graduates.

“I love being a nurse educator,” Vendittelli says. “This campaign sounded like a good way for me to help get more people interested in teaching.”

Nurse educator Randolph Rasch, PhD, RN, FNP, contends that serendipity frequently plays a role in how people choose their careers, so nurse educators can help boost their own numbers simply by talking to other RNs and the public about their work.

“Many times it’s about the people you meet and what you talk to them about,” says Rasch, professor and program director for the family nurse practi­tioner specialty at Vanderbilt University School of Nursing in Nashville, Tennessee. For example, he recalled walking into his high school counselor’s office to discuss a future career as a physician. His counselor suggested nursing—at least as a way to get started in health care. Once immersed in the profession, Rasch’s nursing career was shaped further by mentors who influenced him to become a nurse practitioner and then an educator.

The Tennessee Nurses Association member currently talks with students about nursing education and its many possibilities.

“As a clinician, you focus on your own practice and how you provide care to one person at a time,” Rasch says. “When you’re an educator, you essentially multiply your effect by helping to shape the way other nurses provide care.”

“Chance and a couple of good mentors also led Weingarten into her career in nursing education.

Weingarten loved her staff nurse job and believed she could be a clinical nurse or life.” However, while stopping to visit her husband, a surgical intern at a neighboring New York City hospital, she chatted with some nurses who were pursuing their doctoral degrees.

“They told me grants were available [for advanced nursing degrees] and encouraged me to apply,” Weingarten says. That led to a teaching fellowship and the start of her career as a nurse educator.

“I never thought of becoming an educator until then, because no one ever talked to me about it,” she says.

Weingarten then made a pact with herself.

“I told myself, the day I didn’t love what I did, I’d be done,’” says Weingarten. “I’m still here, because being an educator is the best of all worlds.”

For Pohl, too, the nurse faculty role is a powerful combination of teaching, practice, research, professional involvement, and service.

“I think there is a misperception among some nurses that the educator is off in an ivory tower and not involved in practice and research,” Pohl says. “That’s simply not true. To be a good educator, you need to be involved in practice and research.

“When I’m teaching, I’m sharing my practice. And it’s not a one-way street,” Pohl says. “My students challenge me to think about things in different ways all the time.”

When Pohl looks back on her career in nursing, she’s amazed at the varied opportunities she’s experienced, particularly those connected with her faculty position. She recently accompanied students and other faculty to Honduras on a community service learning project.

“For me, that’s part of the excitement of a teaching career—having opportunities that one might not normally think of,” she says.

In addition to working to increase RNs’ interest in nurse educator careers, the ANA and other nursing organizations realize that adequate education funding is crucial to solving the faculty shortage.

For example, the ANA and AACN have been working together to convince lawmakers to increase federal dollars going toward the Faculty Loan Repayment Program, according to Erin McKeon, associate director of the ANA’s Governmental Affairs Department. Under that program, the U.S. Department of Health and Human Services cancels up to 85% of a nurse’s loan if he or she works full time as a faculty member after completing an advanced degree.

In another broad-reaching effort, the NLN is working to recruit and retain nurse educators through the efforts of a task group staffed by the league’s director for professional development, Mary Anne Rizzolo, EdD, RN, FAAN.

The NLN recently completed a national study to determine factors that contribute to nurse educators’ job satisfaction, says Rizzolo, a New Jersey State Nurses Association member. Preliminary results show that low salaries and an increased workload caused by the faculty shortage are viewed as negatives, while working with students, autonomy, and flexibility in scheduling are viewed as positives.

The NLN task force’s next effort is to develop a plan of action that schools of nursing can use to create environments that will attract and retain faculty, as well as promote innovation in nursing educational programs.

More information on the NLN study will be available on its web site at www.nln.org.

Nurses routinely find themselves in the midst of the frenzied activity that is a Joint Commission on Accreditation of Healthcare Organizations (JCAHO) visit. Suddenly, opened bottles of sodium chloride solution are triple-checked to make sure they're labeled with a nurse's initials, as well as the date and time opened or are just chucked to avoid any potential slip-up. Wheelchairs are nowhere in sight, and staff are drilled on the location of every fire extinguisher on the unit.

Perhaps what has frustrated RNs most about accreditation visits, however, involves staffing practices. The ANA and nurses have long contended that hospitals tend to boost staffing levels on days JCAHO surveyors are present, which gives a false picture of RNs' working conditions and, in turn, patient care. The ANA, for example, received calls from some Washington, DC, nurses who complained that extra staff were sent home immediately after surveyors left their hospital.

"We've all seen what goes on with JCAHO visits the feverish period of preparation and the celebration afterward" says Michael Evans, PhD, RN, CNAA, FACHE, the ANA’s representative to a JCAHO Professional and Tech­nical Advisory Committee that focuses on hospital accreditation processes and standards. “And then things go back to the way they were before.

“This rollercoaster of events makes staff nurses, and even managers and administrators, cynical about the survey process,” he adds.

However, the JCAHO survey process is changing, and the ANA and many nurses welcome these efforts aimed at ensuring that standards of care are followed 365 days of the year. JCAHO standards focus on a wide range of patient care-related activities and policies, from patient rights to infection control.

The new survey process is called “Shared Visions–New Path­ways” (Go to www.jcaho.org for more information). Health care facilities are expected to implement certain components of the accreditation process this year, while other components will be phased in later, according to JCAHO.

A State of Readiness

One of the changes that the ANA strongly lobbied for is the implementation of unannounced site visits, according to Rita Munley Gallagher, PhD, RN,C, senior policy fellow in the ANA’s nursing practice and policy department. Previously, organization administrators knew many months in advance when accreditation visits would take place.

“With this JCAHO change, hospitals will need to be ready 24 hours a day, seven days a week,” Gallagher says.

South Carolina Nurses Association member Ingrid Pearson, MS, RN, CPNP, agrees.

“We should not be ‘getting ready for the guests,’” says Pearson, former ANA representative to JCAHO’s ambulatory care advisory committee. “We should be meeting set standards of care everyday.”

Adds Evans, “If all the things that surveyors look for when they come into a hospital are so im­portant, such as maintaining the temperature of refrigerators where pharmaceuticals are kept, they should be done all the time.”

The JCAHO Web site points out that reasons for the shift to unannounced surveys range from enhancing the credibility of the survey process by having surveyors observe a health care facility’s operation under normal circumstances to promoting safe, high quality care at all times. Currently, JCAHO is testing unannounced surveys of volunteer organizations over the next two years, with a goal of implementing this process throughout the health care industry by 2006. If they’re not participating in the pilot program, health care facilities now have at least four weeks notice before a scheduled site visit.

Ongoing Performance Review

In addition to unannounced visits, JCAHO is implementing other changes designed to promote continuous quality assurance among its accredited facilities.

“JCAHO wanted to help health care facilities be more efficient, safer, and provide higher quality care,” says Evans, a Texas Nurses Association member. “And it really listened to nurse committee members to help them find ways to ensure institutional readiness and compliance.”

JCAHO is now requiring that health care organizations seeking accreditation conduct a midcycle self-assessment using applicable JCAHO standards. (JCAHO accreditation lasts for three years.) They then must develop a plan to solve deficiencies, as well as prove they resolved those deficiencies.

And when on-site, surveyors will use the “tracer methodology” system that gauges how care is being provided to patients selected at random.  

Angie King, BSN, CPHQ, quality management director at Tift Regional Medical Center in south-central Georgia, saw first-hand the positive effects of these new changes. At King’s urging, Tift administrators agreed to test the new accreditation process last year.

“We saw this as an opportunity to have some say-so in survey changes and get a heads-up on how JCAHO planned to change the accreditation process,” King says.

In explaining the tracer methodology, King says surveyors select current patients and look back on how their care has been provided at every step during their hospital stay. For example, if surveyors opt to follow a pediatric patient, they’d assess the care given from staff in the ED to the critical care unit to the pediatrics unit.

King likes this approach because it breaks down the “silo effect” that often occurs among hospital departments.

“I think it’s a big change for nursing in particular, because nurses can see how the care they gave in the ED, for example, has affected the patient throughout the course of his stay,” she says. “It makes nurses realize that we are all part of the same journey in providing patient care.”

The new process also has alleviated some of the anxiety surrounding JCAHO visits, because, in the past, staff often worried that the organization’s accreditation hinged on what they did or said during the course of the on-site evaluation.

During the pilot on-site survey, staff were more relaxed because they had worked to create a state of continuous survey readiness, according to King.

For example, while conducting the new periodic performance appraisals, King worked with staff to ensure they knew what JCAHO standards were, ways to comply with those standards, and how they would ultimately be evaluated.

Gallagher adds that the periodic self-surveys also benefit surveyors.

“Surveyors used to go into the process cold,” Gallagher says. “They didn’t have the information related to problematic areas. Now they can focus more closely on areas of potential concern.”  

Another major change in the accreditation process involves the development of better avenues for staff input.

“Historically, staff were having problems with their ability to provide potentially sensitive information to surveyors about patient care or procedures,” Gallagher says. Because surveyors were located on-site, staff members who wanted to share their concerns could be observed talking with them.

Now, staff can provide their comments to JCAHO online or call in their concerns without fear of retribution, she notes.

King and other nurses believe that JCAHO is on the right track in terms of improving the accreditation process. They also believe that both organization staff and surveyors will need time to become accustomed to the new system.

“Anytime there is change, there is some cause for fear or trepidation,” King says. “I believe there is going to be a huge learning curve, particularly among surveyors, who will need to get accustomed to the new process quickly, particularly the way they now will evaluate facilities’ compliance with the standards.”

Pearson adds that an effective way to deal with staffs’ understanding of JCAHO changes is to talk about the standards, what they mean, and what surveyors typically look for in relation to compliance.

“The standards represent good practice,” Pearson says. “They are not meant to be outlandish.”

Further, she says, the standards provide people with the security of knowing what is expected of them; they ensure that facilities conform to certain practices, as opposed to allowing facilities to develop their own ideas of what high-quality care means.

Susan Trossman is the senior reporter for the American Nurse, published by the ANA.

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