Traditional colleges have been slow to meet the growing demand for health-care training
Officials of South University, a proprietary-college system based in Savannah, Ga., took a calculated risk five years ago. At a time when nursing programs at many traditional colleges were struggling to attract students, South figured that it could profitably enter the field of nursing education.
The financial commitment was considerable, although company officials decline to specify the amount. Nursing programs require costly equipment and small faculty-student ratios. What’s more, nursing education is a highly regulated field, and gaining accreditation a complicated, lengthy process. If enrollment fell short of the company’s projections, the failure would have been an expensive one.
But the decision to offer three-year bachelor’s degrees in nursing paid off. South met its projections and, before its first class of nursing students graduated, had cashed in on its investment. Last April Education Management Corporation bought the four-campus institution for $50-million, largely because of the health-sciences programs. Robert B. Knutson, the company’s chairman and chief executive, said at the time that South University’s health-sciences programs were “well suited to meet the needs of students in the years to come.”
South’s ability to foresee and swiftly react to the growing demand for nursing education illustrates the biggest advantage that for-profit institutions have over traditional colleges: agility. Unencumbered by administrative and cultural inertia, proprietary colleges are gaining hard-earned legitimacy by solving problems that continue to vex traditional institutions.
One reason that for-profit institutions have been able to expand into nursing is that community colleges and four-year institutions could not increase the size of their programs fast enough to keep pace with student interest and market demand.
A survey conducted by the American Association of Colleges of Nursing found that 5,200 qualified students were turned away from traditional bachelor’s-degree nursing programs last year because of a lack of financial resources and qualified faculty members.
“We get more and more students applying, and we can’t accept them because the one thing we haven’t done is increase enrollments,” says Virginia W. Adams, dean of the School of Nursing at the University of North Carolina at Wilmington.
The situation has created an opportunity for proprietary colleges to play a bigger role in educating the nursing work force:
- Education Management, which owns almost 70 institutions enrolling more than 50,000 students in all, has lost no time in expanding into training for health-science careers, including nursing. Six months ago, the company did not offer any nursing degrees. Since then, it has acquired six institutions that do, and it plans to offer more such programs.
- Recruitment materials from the University of Phoenix boast of the for-profit giant’s status as “the largest school of nursing in the nation,” with 6,000 nursing students enrolled in 10 states or online.
- Keiser College, a multicampus system in Florida, received tentative approval from its accreditor for a nursing program on its Melbourne campus last year, added a program in Sarasota in September, and plans to offer nursing education on two more campuses.
- Concorde Career College, with 12 campuses nationwide, has doubled the number of students enrolled in its nursing programs, to 1,200.
- Career Education Corporation and Corinthian Colleges are in the process of expanding their nursing programs.
- One of the major accrediting bodies for proprietary institutions, the Accrediting Council for Independent Colleges and Schools, received three applications for tentative approval of nursing programs in November. “We usually don’t receive that many in a year,” says Robert E. Patterson, the council’s chief of staff.
Government regulation of nursing programs -- which some proprietary colleges have seen as onerous -- has discouraged many for-profit colleges from entering the field.
Accreditors are hardly relaxing their standards, but some for-profit systems say the regulators’ apparent bias against their institutions has declined, making it easier to work with them.
Gaining approval for most nursing programs is a three-tiered process. After initial approval from an institution’s accreditor, a program must earn a license from one of the two national boards: the National League for Nursing Accreditation Commission or the Commission on Collegiate Nursing Education. Finally, it must satisfy its state’s professional nursing board. Those boards tend to keep an eye on student-faculty ratios, making it difficult to expand programs without going through even more approval procedures.
Even so, Mary H. Barry, vice president for academic affairs at Corinthian, encounters “much more of a sense of cooperation” on the part of the state boards. “We’re finding that we’re being welcomed with open arms,” she says. “People are finding that you can’t solve the shortage with the current infrastructure.”
Proprietary colleges have helped themselves by becoming savvier about the approval process. By getting accredited for medical-training programs that also require state approval, like certificate programs for X-ray technicians and medical assistants, for-profit systems have improved their credibility as educators, according to industry analysts and education professionals.
“We’ve been talking with several for-profit groups who are interested in nursing,” says Barbara R. Grumet, executive director of the league for nursing accreditation. “At least the ones I’ve dealt with seem willing to invest the resources and time necessary, and I encourage them to go for it.”
A Narrow Range of Offerings
Proprietary institutions tend to concentrate their resources on a narrow range of offerings, a business model that makes it easier for them to respond to changes in student demand.
Large proprietary systems, like Phoenix, decided long ago to focus on allied-health, technology-training, and business programs, among a few others. While traditional institutions insisted on being all-you-can-eat buffets, Phoenix reasoned, it would be a Starbucks.
The U.S. Bureau of Labor Statistics estimates that the country will need more than a million new and replacement nurses by 2010. But administrators at many large public colleges and even private ones can’t respond to the need for expansion effectively or swiftly, because their budgets and resources are stretched across many disciplines.
“A lot of our schools need money, so it’s difficult for the university to give more to us unless it is specially earmarked for our program,” says Janet B. Younger, associate dean of nursing at Virginia Commonwealth University, a public institution with a large nursing program. She says VCU could accommodate more students if it had the money to hire more faculty and support-staff members.
In fact, some large, private research institutions with big endowments have decided to phase out their nursing programs. Syracuse University will graduate its final nursing students in the spring of 2006, and the University of Southern California will graduate its last nursing students this spring. A few years ago, the University of Rochester gave up its traditional undergraduate nursing programs but continues to offer accelerated bachelor’s degrees in nursing to college graduates.
Didn’t Fit Strategic Goals
“You can’t really be all things to all people,” says Michael A. Diamond, a vice president at Southern California. “When we reviewed our nursing program, we came to the conclusion that it didn’t fit into the strategic goals of the university.”
But at public universities, where institutional missions usually contain provisions about serving work-force needs, nursing programs are among the many departments feeling the pinch of sharp cuts in state and federal financing, despite the well-publicized need for more nurses.
At Virginia Commonwealth, Ms. Younger says, 35 full-time faculty members teach 800 nursing students. The state-ordered ratio is one faculty member for every 10 students, so the program uses part-timers. If it had the money, she says, it could increase enrollment by at least a third. But, she says, “we are at our limit.”
Federal funds, too, have come up short. Last year Congress approved $20-million for the National Nursing Reinvestment Act, which is intended to improve nursing education and retention. But that amounts to less than a tenth of the $250-million that health-care experts had requested.
Traditional colleges often blame a shortage of qualified professors for their inability to expand nursing programs. With many nurses reaching retirement age and fewer coming up through the pipeline, the colleges argue that there are just not enough academic nurses to go around.
Nursing Professors Earn Less
A study completed by the American Association of Colleges of Nursing found that professors in nursing earn far less than do those in some other disciplines, and less than clinical nurses as well. A nurse practitioner in specialty care earns a median salary of approximately $69,000, while the median salary for assistant professors with master’s degrees is about $55,000. Consequently, qualified instructors often find it more lucrative to return to their nursing jobs.
Yet for-profit institutions with new nursing programs seem to be able to find instructors that meet the standards required by accreditation boards.
“There’s not a shortage of potential faculty,” says Ms. Younger. “The state has to give you enough money to pay them competitively, and right now the salaries are unattractive to people in practice, who are making a lot more money.”
Proprietary institutions, like Concorde and Keiser, say they pay more than their traditional counterparts, on average, although they won’t divulge exact salary figures.
“It’s expensive to get the right people,” says Arthur E. Keiser, chancellor of the Keiser system. “We don’t have restrictions on salary allocations like nonprofits do, and I’d venture to say we pay more for our top positions.”
Another difficulty for the traditional institutions is that their faculty-hiring practices place more emphasis on degrees earned and publication in academic journals than do for-profit colleges, which usually favor hiring people with established careers in their fields.
“Most of the universities won’t hire someone full time unless they have a doctorate,” says Priscilla Dunson Bartolone, director of the nursing program at South University. “I just hired someone with a master’s because she has excellent work experience and just loves teaching.”
Shortage Here to Stay
The emphasis on tenure-driven positions further impedes traditional colleges because it makes them more hesitant to add faculty positions, says Ms. Grumet, of the nursing-accreditation league. During her 23 years in nursing, she says, there have been three separate nursing shortages, during each of which many colleges approved additional faculty positions only to find that by the time they brought on the new professors, the shortage no longer existed.
Now, however, many analysts maintain that the nursing shortage is here to stay.
“There’s so many people leaving the field, we just don’t have enough replacing them,” says Jeffrey M. Silber, an education analyst with Harris Nesbitt Gerard Inc., an equities-research firm. “This nursing shortage is going to get a lot worse before it gets better.”
http://chronicle.com Section: Money & Management Volume 50, Issue 19, Page A29