Sustainability in Nursing Education: The Future Advancement of Academic Nursing Act

Sustainability in Nursing Education: The Future Advancement of Academic Nursing Act

Amber Hammer

The World Health Organization declared 2020 the “Year of the Nurse and Midwife” to acknowledge the essential and tireless work of devoted nurses around the world. The designation coincidentally aligned with the onslaught of the COVID-19 pandemic, which called nurses to action in unprecedented ways. Moreover, the pandemic highlighted the severity of racial and social inequities in healthcare, and public discourse centered on how to ameliorate the egregious disparities. [1] COVID-19 exacerbated previous deficits in the nursing workforce, such as increasing clinical nurse and nurse faculty shortages, lack of representation in nursing academia and practice, and inadequate or outdated infrastructure in schools of nursing. [2,3] In response, the Future Advancement of Academic Nursing (FAAN) Act(S.4396/H.R.7945) was introduced on August 4, 2020, by Representative Lauren Underwood (D-IL-14) and Representative Eddie Bernice Johnson (D-TX-30), the only two nurses serving in Congress at the time of submission. [4] The goal of FAAN was to improve access to high quality and equitable nursing care by allocating funding to nursing schools to address the critical workforce deficiencies, to promote social justice in nursing, and to increase preparedness for the growing demands of our nation’s health and wellbeing. [3,4]

Nurses constitute the largest sector of the US healthcare workforce, with three million nurses nationwide. [5] A significant nursing shortage has been an enduring national issue since the late 1990s, and the current nursing shortage is projected to worsen over the next twenty years. [6] With a large aging population, increased rates of chronic conditions, and an aging nursing workforce, the demand for nurses will continue to rise. [7,6] COVID-19has contributed to additional burnout, and it is currently unknown what long-term effects the pandemic will have on recruitment, retention, and engagement in the nursing workforce. To adequately respond to the workforce shortage, nursing schools will need to increase graduating RNs by 8% annually. [3]

A deficit in nursing faculty also persists. In 2019, nursing schools across the nation declined admittance to 80,407 qualified applicants due to a lack of faculty and infrastructure. [8] A reported 7.2% nurse faculty vacancy rate plagues nursing schools nationwide, and the majority of vacancies require doctoral degrees. [8] Contributing factors to the faculty shortage include an aging workforce, limited number of nurses with advanced degrees, and lack of competitive salaries. [9]

Race-based health disparities are well documented as a public health crisis in our country. [10,11] Racial inequities in higher education are also widely acknowledged, and are even more profound in the field of nursing. [10,11,12,13] In the United States, the dominant identity within nursing demographics is white, middle and working class women, revealing that whiteness shapes the values, practices, and cultural norms of nursing culture. [13] As the US population becomes increasingly diverse, it is essential that the nursing workforce reflects the ethnicities and races of the population receiving care. [2]

In addition to ethnic and racial inequities, individuals from rural communities are also underrepresented in the nursing workforce and in desperate need of improved access to quality nursing care and education. Rural regions are noted to have increased nursing shortages when compared to national averages. [14] Rural communities have increasing morbidity and mortality rates, with an aging, less-educated, and more economically impoverished population. [14] FAAN aimed to address these issues by bolstering funding for schools in medically underserved communities with a projected outcome that training nurses from rural communities will facilitate improved workforce retention in those regions. [4]

Key stakeholders of FAAN include leaders, populations, students, and faculty. Leaders with a vested interest in an improved nursing workforce via bolstered nursing education include local, national, and global government and nongovernment organizations; healthcare system administrators; and university and nursing school administrators. [3,6] Populations likely to benefit from improved nursing care include aging populations, individuals with chronic illness, and rural and underserved populations. [3] FAAN would benefit nursing students by ensuring that financial, faculty, and infrastructure support is available to help them thrive in their educational pursuits. [4] Lastly, a larger and more diverse nurse faculty pool will better support current faculty and address the growing needs of aspiring nurses and the populations for which they provide care. [2]

The enactment of FAAN into law would have addressed the nursing workforce shortage and lack of diverse representation in nursing. As such, the guiding goal was to improve access to care and ameliorate patient outcomes in minority populations. Furthermore, funding aimed to advance nursing education by creating resources to modernize nursing curriculum and academic technologies. Unfortunately, FAAN did not receive a vote and died in the 116th Congress. [15]

Current policies and funding are inadequate to support the advancement of nursing education. 3 Additional research efforts are needed to evaluate deficits in local and federal funding available to nursing schools: How should federal funding for nursing education be distributed to achieve equity and sustainability? What tools are available and should be developed to analyze public policy from a critical nursing perspective? How can policy efforts gain traction and meaningfully influence the advancement of nursing education? Answering these questions through collaborative efforts can help establish a strategic plan built to meet the demands of a growing nursing workforce, establish sustainable nursing education, and provide quality care to diverse populations.

References

1. Cato T. Laurencin and Aneesah McClinton, “The COVID-19 Pandemic: A Call to Action to Identify and Address Racial and Ethnic Disparities,” Journal of Racial and Ethnic Health Disparities 7, no. 3 (2020): 389–402. https://doi.org/10.1007/s40615- 020-00756-0. 2. Nalo Hamilton and Emily A. Haozous, “Retention of Faculty of Color in Academic Nursing,” Nursing Outlook 65, no. 2 (2017): 212–221. https://doi.org/10.1016/j. outlook.2016.11.003. 3. World Health Organization, “State of the World’s Nursing 2020: Investing in Education, Jobs, and Leadership,” 2020, https://www.who.int/publications/i/ item/9789240003279. 4. Future Advancement of Academic Nursing Act. H.R. 7945, 116th Congress, 2020, https://www.congress.gov/116/bills/hr7945/BILLS-116hr7945ih.pdf. 5. Bureau of Labor Statistics, U.S. Department of Labor, “Occupational Outlook Handbook: Registered Nurses,” 2020, https://www.bls.gov/ooh/healthcare/ registered-nurses.htm. 6. Stephen P. Juraschek et al., “United States Registered Nurse Workforce Report Card and Shortage Forecast,” American Journal of Medical Quality 34, no. 5 (2019): 473–481. doi.org/10.1177/1062860619873217. 7. American Association of Colleges of Nurses, “Nursing Fact Sheet,” 2019, https:// www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Fact-Sheet. 8. American Association of Colleges of Nurses, “Nursing Faculty Storage,” 2020, https://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Faculty- Shortage. 9. Nancy P. Bittner and Cynthia F. Bechtel, “Identifying and Describing Nurse Faculty Workload Issues: A Looming Faculty Shortage,” Nursing Education Perspectives 38, no. 4 (2017): 171–176. https://doi.org/10.1097/01.NEP.0000000000000178. 10. Whitney A. Thurman, Karen E. Johnson, and Danica F. Sumpter, “Words Matter: An Integrative Review of Institutionalized Racism in Nursing Literature,” Advances in Nursing Science 42, no. 2 (2019): 89–108. https://doi.org/10.1097/ ANS.0000000000000265. 11. David R. Williams, Jourdyn A. Lawrence, and Brigette A. Davis, “Racism and Health: Evidence and Needed Research,” Annual Review of Public Health 40, (2019): 105–125. https://doi.org/10.1146/annurev-publhealth-040218-043750. 12. Jacqueline K. DeBrew, Lynne P. Lewallen, and Edna Chun, “Outsiders in Nursing Education: Cultural Sensitivity in Clinical Education,” Journal of Professional Nursing 30, no. 2 (2014): 149–154. https://doi.org/10.1016/j.profnurs.2013.08.005. 13. Roberta Waite and Deena Nardi, “Nursing Colonialism in America: Implications for Nursing Leadership,” Journal of Professional Nursing 35, no. 1 (2017): 18–25. https://doi.org/10.1016/j.profnurs.2017.12.013. 14. Sarah Smith, Jenny Sim, and Elizabeth Halcomb, “Nurses’ Experiences of Working in Rural Hospitals: An Integrative Review,” Journal of Nursing Management 27, no. 3 (2019): 482–490. https://doi-org.libproxy.lib.unc.edu/10.1111/jonm.12716. 15. “H.R. 7945 (116th): FAAN Act,” GovTrack, accessed March 24, 2021, www. govtrack.us/congress/bills/116/hr7945.

-Amber Hammer is a second-year MSN student in the UNC School of Nursing from San Diego, CA.-