Student enrollment in entry-level baccalaureate nursing programs increased by 3.3% in 2021, according to recently released data from the American Association of Colleges of Nursing (AACN). The increase comes on the heels of a 5.6% uptick in 2020 and keeps a 20-plus year streak of continuous enrollment growth alive, according to the organization, which conducts the student enrollment survey annually.

Cynthia McCurren, PhD, RN, dean and professor of nursing at the University of Michigan-Flint, and chair of the AACN board of directors, told Medscape Medical News that the results are “great news given concerns about the nursing shortage.”

These encouraging numbers alone, however, might not be enough to quench mounting concerns about nursing shortages — especially as factors such as the COVID-19 pandemic, clinician burnout, an aging workforce, and the RaDonda Vaught case threaten to turn both current and prospective nurses away from the profession.

In addition, the 2021 AACN survey, based on responses collected from 964 nursing schools across the country, also uncovered some findings that do not bode well for healthcare organizations looking to meet the demand for nurses in their ranks moving forward.

Shrinking Pool of Professors

Perhaps most concerning, enrollment in PhD nursing programs continued to decline, with a 0.7% decrease from 2020 to 2021, coming on top of a 0.9% decrease from 2019 to 2020. Since PhD program enrollment began to dip in 2013, enrollments have decreased by 13%, from 5145 students in 2013 to 4476 students in 2021.

This, in turn, could make it difficult for nursing schools to employ the faculty needed to meet the demand for nursing education. Indeed, 91,938 qualified applications (not applicants) were not accepted at schools of nursing nationwide in 2021.

Dr Cynthia McCurren

“Though nursing schools have been successful in expanding enrollment over the last two decades, expanding programs even further may be a challenge given the shortage of clinical learning sites, faculty and preceptors, and other resource constraints,” McCurren said. “We know that the current faculty vacancy rate has climbed to 8% — the highest rate since 2013 — and that the large majority of open positions are for faculty with a doctoral degree.”

McCurren added that the AACN is working with stakeholders to advocate for new resources and funding to grow PhD programs and accommodate all those seeking a research-focused doctorate.

Lawmakers in several states also are answering the call to help by passing bills designed to expand nursing schools. For example, a new Indiana law drops limits on how fast 2- and 4-year nursing programs can grow, allows nursing schools to replace some required clinical hours with simulation hours, and permits 2-year programs to hire more part-time faculty.

A Kentucky bill lifts limits on program growth and loosens the degree credentials required of nursing school faculty. 

Mounting Quality Concerns

The 2021 survey also showed that for the third consecutive year, the number of students in baccalaureate degree completion programs — commonly known as RN to BSN programs — decreased, with 12,579 fewer students enrolled last year (a 9.6% decline). This downward trend — which is provoking quality concerns — reverses an enrollment surge that occurred between 2002 and 2018, when the number of students in nursing programs increased from 30,684 to 139,587, a 355% increase.

“The Institute of Medicine has called for at least 80% of RNs to be baccalaureate prepared, though the latest data show that only 65% of the RN population is educated at this level or above. Research has shown that more highly educated RNs are linked to lower patient mortality rates, fewer errors, improved care coordination, and other positive outcomes. Thus, a shortage of baccalaureate-prepared nurses can impact the overall quality of care,” McCurren warned.

McCurren pointed out that AACN is continuing to study nursing school enrollment and to support initiatives that could help to meet the industry’s nurse staffing needs but also noted that stakeholders need to collaboratively address ongoing challenges, such as workforce burnout.

“The nursing profession as a whole — both clinical and academic settings — has prioritized nurse well-being to directly address some of the issues connected to nurse burnout and stress.” McCurren concluded. “Nursing schools are working to expand capacity, but the places where our graduates work must also adapt if we are to sustain a healthy nursing workforce.”

John McCormack is a Riverside, Illinois-based freelance writer covering healthcare information technology, policy, and clinical care issues.

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