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[Transcript] State of Nursing Education Conference Call

By Cindy Wheatley, Ph.D., and Chris Gardiner
The latest data and trends in nursing education.

The State of Nursing Education Conference Call covered the latest data surrounding nursing education. Cindy Wheatley, Ph.D., covered the highest-growth programs – RN-BSN, FNP (MSN and DNP), BSN-DNP, MSN, Nurse Administrator, MSN Nurse Educator – and offered the following recommendations: 

  • Offer online programs structured for scalability
  • Offer a suite of nurse practitioner programs with FNP as the anchor
  • Offer BSN-DNP NP programs along with MSN NP programs
  • Identify a national pool of qualified faculty and preceptors
  • Seek authorization to operate in other states to expand your audience 
  • Produce your own faculty base by offering Nurse Educator and DNP programs
  • Establish relationships with employers
  • Evaluate your program’s ability to be competitive in the marke
  • Invest in marketing and recruitment

For a complete transcription of the call, see below: 

“[Chris Gardiner] Hello, everyone. Welcome to today's call on the State of Nursing Education. I'm Chris Gardiner, Keypath Education's Director of Market Research. I work closely with our academic partners to understand the online degree marketplace and help them select high-demand online programs based on market data. We're excited to dive into the nursing market data and answer your questions. […] We published the original nursing market study early this year in June. Since we published it, the new 2015 IPEDS data came out as well as a new report from the American Association of Colleges of Nursing or AACN. We'll cover some of this new data in today's presentation along with an expanded view of the nursing study and answer most of the great questions that you sent us. If we do not get to your question, we'll follow up with you on an individual basis.

Before we begin, let me just say a few words about Keypath Education. Keypath Education has been in business for more than 25 years, exclusively serving colleges and universities. We address key market challenges through our suite of student lifecycle solutions. We launch new programs and grow existing programs through our online program management approach. We grow enrollment through our proven marketing expertise, and we improve learning and outcomes through our proprietary course design and development approach and career preparation technology, which is Seelio. Additionally, our GlobalHealth by Keypath Education division provides highly customized solutions for healthcare programs and grants access to a proprietary network of employees at health systems across the country. In the end, our goal is to help you achieve success and sustainability for your programs. 

At this point, I'd like to introduce Keypath Education's senior vice president of research, Dr. Cindy Wheatley. Cindy has been in higher education for more than 25 years serving as a faculty member, associate dean, instructional designer and market researcher. She's been working in the OPM market for 16 years and leads Keypath's research and new development team. So, let's get this started. Cindy, we've had a lot of great questions, and the first is, ‘Where is the demand in the nursing market? What does the data show?’

[Cindy Wheatley, Ph.D.] Thanks, Chris. Well, our most detailed data comes from the AACN nursing enrollment graduations report. At the highest level, we see in the 2015 data growth in all levels except the Ph.D. The strongest year-over-year growth occurred in DNP programs, where enrollment grew by 20 percent and graduations grew by 34 percent. The DNP is about five times larger than the Ph.D. The vast majority of enrollments, however, are still at the bachelor's and master's levels.

[Chris Gardiner] So that's over 333,000 students, just at the bachelor's level alone. Is that right?

[Cindy Wheatley, Ph.D.] That's right, but the real story is the growth of the RN to BSN, so let's take a closer look at that data. Looking at IPED's data, which does not distinguish between entry-level BSN and RN to BSN graduate, we see that there were 122,015 completions in 2015. That represents 10 percent growth over 2014 levels and 50 percent growth over 5 years. Now we know from the AACN data that 46 percent of those completions were in RN to BSN programs, and that graduates grew by 17 percent between 2014 and 2015, while entry-level graduates grew by just 3 percent. We'll talk about some of the possible reasons for that later in the presentation. We can also see that the RN and the BSN market is getting crowded. The number of programs grew by 7 percent between 2014 and 2015. It's also worth noting that 59 percent of all BSN degrees in 2015 were conferred by the top 20 percent of programs.

[Chris Gardiner] Now Cindy, you mentioned the top programs. Why is it significant to look at those top programs?

[Cindy Wheatley, Ph.D.] That's a great question. The statistic tells us a few important things. First it's an indicator of how competitive a particular degree market is. For example, the top six BSN programs represent 16 percent of all the degrees conferred in 2015. The second thing we learn from that statistic is how large these programs can get. When we take the average completion of the top 20 percent, which is 391 graduates for BSN programs, that gives us a proxy number for average program size. These programs can get quite large as you can see from the range, which is 5,172 completions. 

We also know from IPEDS data that 53 percent of the top 20 percent of BSNs are delivered via distance learning. So we know that for these programs, online is a major growth strategy. Moving on to the master's level, we can see that enrollments in master's programs have grown by 29 percent over the past five years, and graduations grew by 55 percent. The vast majority, or 85 percent of students are enrolled in nurse practitioner, nursing administration, and nursing education programs, but nursing practitioner programs are the big winner, with 58 percent of master's students and 54 percent of graduations in 2015. It looks like nursing education is the second largest master's specialization, although there is a large discrepancy between the AACN data and IPEDS data on this point.

[Chris Gardiner] What do you think accounts for that discrepancy?

[Cindy Wheatley, Ph.D.] I suspect that a large number of schools are reporting their nursing education programs under the general master's category. In IPEDS, this zip code accounts for 42 percent of all nursing master's degrees conferred. Given the critical shortage of nursing faculty, I'm delighted to see that nursing education programs are thriving.

[Chris Gardiner] Now there's a lot of nurse practitioner specializations. Is there one that stands out?

[Cindy Wheatley, Ph.D.] No question, it's family nurse practitioner with 78 percent of all students in nurse practitioner programs enrolled FNP programs. Between 2014 and 2015 FNP enrollment grew by 11 percent and graduations grew by 28 percent. The next largest specialization, which is adult gerontology, represents just 9 percent of nurse practitioner students, although these programs also experienced double-digit growth. Surprisingly, the third-highest category was psychiatric mental health nurse practitioner.

[Chris Gardiner] I know that a growing number of nurse practitioner programs are moving to the DNP level, is that a significant trend?

[Cindy Wheatley, Ph.D.] I think it's fair to say that growth at the DNP level has exploded. What we see in the AACN data is that 81 percent of all doctoral enrollments are in DNP programs, and 64 percent of DNP students were enrolled in nurse practitioner programs. Another somewhat surprising statistic is that 58 percent of DNP students were enrolled BSN to DNP programs, and 75 percent of the DNP nurse practitioner students were enrolled in BSN to DNP programs. Eighty-nine percent of DNP family nurse practitioner students were enrolled in post-baccalaureate programs. The second-highest enrollment growth in the BSN to DNP programs is in nurse anesthesia, but among post master's DNP programs, the top specializations where nurse practitioner, leadership, and administration. So we are seeing a difference between the two.

[Chris Gardiner] We had a couple of questions about the role of online learning in the nursing market. What trends are use seeing for post licenser programs being delivered online?

[Cindy Wheatley, Ph.D.] AACN gives us a great view of what happening online in nursing programs, and it's clear that there's been significant growth there. Not surprisingly, we see the largest online percentage among RN to BSN programs where 45 percent of all programs are delivered 100 percent online, although 69 percent of RN to BSN programs are more than 50 percent online. We also see significant numbers of MSN to DNP programs that are online; 65 percent are delivered at least 50 percent online.
 
But the real story is the growth of online programs since 2014. While we've seen increases at all levels, the biggest jump was among RN to BSN and DNP programs. Nurse practitioner programs lag behind with just 11 percent fully online, although 40 percent of nurse practitioner's programs are hybrid. But this is not surprising given the clinical requirements in those programs.

[Chris Gardiner] This is really interesting data, and I think it raises some questions. So two questions: If you have a program and it has just 11 percent of programs online, does that mean someone listening should go and put that program online now? And maybe secondly, do you think online programs will eventually outnumber on-ground programs?

[Cindy Wheatley, Ph.D.] Those are great questions and we get those a lot when we're talking to schools. I would say with the exception of beyond the BSN, and possibly the DNP, I don't think that online programs will outnumber on-ground programs. However, I do think that more and more working nurses are choosing an online program that allows them to manage their busy schedules and does not require significant travel. Online delivery also allows schools to develop partnerships with hospital systems that can send their employees to reputable programs that are not geographically restricted. I think we'll continue to see growth in the online nursing market due to convenience and affordability.

[Chris Gardiner] Right. So programs are growing and more are going online. What's driving the demand?

[Cindy Wheatley, Ph.D.] They look at demand drivers in two ways: external drivers and internal drivers. External drivers would be things like employer preferences and certification. Internal drivers would be things like increased salary, advancement and professional autonomy. The external drivers for advanced nursing education are very strong. Starting in 2010, the Institute of Medicine called for 80 percent of the nursing workforce to hold a bachelor's degree by 2020.
 
Research shows that an increase in bachelor's prepared nurses leads to lower mortality rates, fewer patient complications and shorter lengths of stay in hospitals. As a result, more and more hospitals are requiring new hires to have a bachelor's degree, and 79 percent of employers are expressing a preference for BSN graduates. Also, many hospitals offer tuition reimbursement or loan forgiveness as incentives for their RNs to get a BSN or MSN. And the government has a nursing education loan repayment program for RNs who work or are willing to work in areas with critical nursing shortages.

[Chris Gardiner] Good. We got some questions about employment transfer nursing and the nursing shortage. What does the labor market look like?

[Cindy Wheatley, Ph.D.] The labor market is very strong for nursing. According to the Bureau of Labor Statistics, there are 2.8 million registered nurses in the U.S. and 136,000 nurse practitioners. RN jobs are expected to grow by 16 percent and nurse practitioners jobs are expected to grow by 35 percent by 2024. BLS is projecting that we'll need 1 million new RNs and 75,000 new nurse practitioners. Registered nurses were the number two job in the U.S. in the past year with 1.3 million jobs.
 
I think it's safe to say that the job market for nurses is very strong. It's also worth noting that according to BLS, about 47 percent of RNs hold a bachelor's degree. I've seen numbers as high as 65 percent. If we're going to reach the IOM goal of 80 percent by 2020, we've got a ways to go.

[Chris Gardiner] Right, so there's huge job growth. We got some questions about what motivates nurses to continue their education. If the demand is for registered nurses, what motivates an RN to get an advanced degree?

[Cindy Wheatley, Ph.D.] There are a number of reasons why RNs would decide to pursue higher education. As we've seen, some do because their employers are requiring it. Some get burned out in their current role and want advancement or more professional autonomy. One of the strongest motivators is the potential to significantly increase their salary. As this slide shows, nurses can command very high salaries as they get more education and advance into roles such as management, clinical nurse specialist, nurse practitioner and executive leadership. Among the highest nursing salaries are for nurse anesthetists who can easily command six-figure salaries. Nurse practitioners are also in high demand, especially in rural areas where there's a shortage of doctors.

[Chris Gardiner] That’s impressive. Especially with the median national salary across all occupations being just under $36,000. With such high salaries, what would attract a nurse to become a nurse educator?

[Cindy Wheatley, Ph.D.] That's a great question. And a big problem for nursing schools trying to find enough qualified faculty. According to AACN, the number one reason why schools did not accept all qualified applicants into their nursing programs was an insufficient number of faculty. The problem is most acute for entry-level BSN programs, where 27 percent of qualified applicants were not admitted. 17 percent of qualified nurse practitioner applicants were not admitted. 

When we look at the top three reasons for the insufficient number of faculty, the first is insufficient budget to hire new faculty. And number two is an inability to recruit faculty due to competition from the marketplace as we've just seen. The third reason is a lack of qualified applicants in their area. The problem is exacerbated by the aging of nursing faculty. The average age of the doctorally prepared nursing faculty member is 55. And the average age of a master's-prepared faculty member is 51. We need to generate more qualified nurse educators. Since the nursing faculty shortage can be directly linked to the shortage of nurses.

[Chris Gardiner] Looking at nursing faculty salaries here, I can see why it would be difficult to compete with nursing jobs on salary alone.

[Cindy Wheatley, Ph.D.] Yes, it is. However, many nurses enjoy the lifestyle of the nurse educator and find teaching highly gratifying. As we've seen, however, there are far more DNP graduates than Ph.D. graduates. Programs can also look to the workforce to find nurses who might want to teach a class or two rather than become full-time faculty. This is where having online programs can be an advantage. We need more MSN nurse educator and DNP programs to produce qualified faculty.

[Chris Gardiner] We've seen online nursing programs that are finding it challenging to locate clinical sites. Is that a big problem nation-wide?

[Cindy Wheatley, Ph.D.] Absolutely. We hear that from a lot of schools that we work with, and certainly the research agrees. This was the second-biggest reason why schools could not accept all qualified applicants. This is an especially sticky problem for online programs that have clinical requirements. The schools have to identify qualified healthcare settings and preceptors for their students in other states. They first have to get approval by boards of nursing in those states. Our research shows that 31 states require boarded nursing approval for distance learning programs to conduct clinical experiences in their state. Another issue to consider is whether faculty need to be licensed in those states. Twenty-five states are members of the Nurse Licenser Compact that allows for reciprocity. Distance learning programs also have to be authorized for delivery in each state. These are just some of the factors that make growing nursing programs complex and challenging.

[Chris Gardiner] That's great information. We also have some questions about how programs can differentiate themselves in the nursing market. What does it take to compete for these nursing students?

[Cindy Wheatley, Ph.D.] As I mentioned earlier, with strong demand comes strong competition. Students have more choices than ever and with online programs your competition isn't necessarily local or even regional anymore. Schools really need to look at their competition and understand what factors prospective students consider when selecting a program. We've identified on this slide what some of those factors are from our experience recruiting nursing students. 

Obviously, cost is a big factor, especially in the RN to BSN market. There is strong downward pressure on tuition for those programs. The significant block transfer credits or work experience, some programs are as short as 30 credits and as little as $9,000. At the master's and doctoral levels, cost isn't as much of a factor. Those students care about time to completion, whether they have to take the GRE and where they can do their clinical. Other differentiators are things like no residencies for online programs that require extra cost and time away from work and the availability of bridge programs that allow students to accelerate their degree completion.

[Chris Gardiner] Wow, so that's a lot of factors to consider. What would you say would maybe be the most important or top priority for someone listening?

[Cindy Wheatley, Ph.D.] That really depends on the type of program, but as a general rule, working professional students care about time and money. For example, taking the GRE requires both extra time and money/cost. So do on-campus residencies. These can be big considerations for students comparing multiple programs. In general, prospective students want to know the total cost of the degree and how soon they can graduate.

[Chris Gardiner] I imagine our audience has lots of questions after hearing all this kind of information like, ‘Where can I find faculty to grow my program? How do I generate the revenue to pay for them? Should I move my program online and how can I grow my program and ensure that academic quality?’ As we start to wrap up, in summary, what can we tell them?

[Cindy Wheatley, Ph.D.] Each of these questions requires careful consideration of the market trends and the resource requirements. I'm hoping that the information that we've presented here is helpful with that, but we can make some, I think, broad generalizations. Clearly the biggest growth opportunities are in the RN to BSN, family nurse practitioner and DNP programs, although master's in nursing administration and nursing education are also showing very strong potential.
 
For nurse practitioner programs, we recommend offering a suite of specializations with the family nurse practitioner as the anchor. The more options that you offer, the higher your conversion rates will be. Also, larger specializations like FNP and adult gerontology can often subsidize smaller ones like pediatrics.

While the majority of nurse practitioner enrollments are still at the master's level, we recommend offering the DNP track as well, especially the BSN to DNP. This gives you the double benefit of attracting more students and producing graduates who are also qualified to teach. The final recommendation would be to pay attention to marketing and recruitment. The top programs are spending tremendous amounts of money in marketing and have built relationships with hospital systems and employers. To be attractive to prospective students and employers, your program really needs to be structured to be competitive in regards to delivery modality, admission requirements, costs of intakes per year and time to completion. We encourage you to make data-driven decisions based on market research and an understanding of the competitive landscape.

[Chris Gardiner] Thank you and thank you for attending the webinar today. I hope you've found this information helpful. […]”

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