Hospitals, schools should 'build a bridge' to incentivize nurse educators: ANA's Dr. Katie Boston-Leary

Unless significant efforts are made to increase recruitment and retention, the world is facing a projected shortage of up to 13 million nurses by 2030, according to a 2021 report from the International Council of Nurses.

But 2030 seems a world away when the current nursing shortage is crippling hospitals throughout the U.S. today. 

So how do we get from here to there? Katie Boston-Leary, PhD, RN, director of nursing programs at the American Nurses Association, says the answer is to focus on expanding nurse educator programs in hospitals.

A bit of perspective

Today, the nursing shortage is affecting healthcare facilities in all areas of the country, especially in rural regions, and nurses are leaving the bedside to pursue more lucrative careers. 

Some are becoming travel nurses or nurse practitioners where they can make more money and have more authority. Others are flat out leaving the profession — burnt out and disillusioned by not only the pandemic but the fact that they don't just feel overworked, they are overworked because there aren't enough nurses to handle shifts. And many seasoned nurses at or nearing retirement age are naturally leaving the profession.

In what seems like the second of a one-two punch, nursing schools are turning away would-be nursing students because of a shortage of faculty. 

"U.S. nursing schools turned away 91,938 qualified applications from baccalaureate and graduate nursing programs in 2021 due to an insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints," according to a 2021-22 report from the American Association of Colleges of Nursing. "Most nursing schools responding to the survey pointed to faculty shortages as a top reason for not accepting all qualified applicants into their programs."

Which brings us back to hospitals and the role they can play in offering nurses incentives to take on educator roles. Dr. Boston-Leary said she views it as "building a bridge" between schools and hospitals to train nurses in real-world healthcare situations. Additionally, she said, growing an in-house team of nurse educators provides a pipeline for hospitals who can be actively involved in cultivating their own future workforces.

Becker's spoke with Dr. Boston-Leary to clarify the challenges caused by a lack of nurse educators in hospitals. She also identified some real-world solutions she believes can turn the tide in the right direction — because 2030 will be here before we know it. 

Editor's note: Responses have been lightly edited for length and clarity.

Question: Why do you think hospital nurses are shying away from stepping into nurse educator roles?

Dr. Katie Boston-Leary: It's a tough job to be an educator because you're caught in the middle most times. You are responsible for educating staff, and yet you feel accountable when there are errors. One example is, whenever there's an adverse event, educators are assembled to review whether competencies were done appropriately. Then there's retraining, new education and audits that have to be done. 

Further, nurse educators don't necessarily see newer nurses engaging in self-agency and managing their own continuing education and development. So then, as a leader, you have to deal with finger-pointing when things get tough. Educators are typically stuck in the middle. 

Additionally, nurse educators are not paid enough for what they do. It's an important role but, because hospitals don't recognize direct revenue from these roles, nurse educators don't get paid adequately. 

Q: If nurse educators are so important, why does the position not command a higher salary?

KBL: There are several things going on. First, a lot of hospitals over the years have cut nurse educator positions due to tight budgets because hospital leadership doesn't necessarily support the role. 

Also, the true importance of the role isn't realized. I think we need to rebrand nurse educators in a different way. I think we need to look at that role and see how we can build today's nurse educator roles around clinical nurse specialists. This will elevate the role and give it the respect that it's due. 

Nurse educator is absolutely not a dispensable type of role. And if we rebrand the role, I think we'll be able to get more people interested in that role. 

Q: So hospitals and nursing schools have to work together. What could that look like?

KBL: It looks like a collaboration. I've always felt that there's an opportunity for nurse leaders and nurses to get appointed as adjunct faculty where they can part-time teach at nursing schools. I think creating faculty appointments is about building a bridge between hospitals and academic institutions. The bridge makes it less taxing for both sides. 

There would be a number of benefits that come with this solution. First, it would allow more slots for nursing students at schools because the program inherently provides more faculty. Additionally, experienced hospital nurses in part-time teaching roles give students the ability to see what's really going on, in real time, in hospital settings. How many members of a nursing school's teaching faculty are familiar with the technology and other systems being used in hospitals right now?

That's why we hear a lot about how nurses are underprepared. When they get hired, some newly hired nurses will experience certain hands-on skills (like IV starts or medication administration) for the first time.

Q: If there is a lack of emphasis, and therefore compensation, for nurse educators, why would a nurse want to take on the extra teaching duties and all the responsibilities that come with the teaching role?

KBL: There would have to be agreements between hospitals and nursing schools. These agreements outline how nurses can be appointed as part-time instructors or adjunct faculty. 

This solution solves two challenges. Nurse educators are contributing to retention when the students they train stay and take positions at the hospital. It also saves money because the mentoring, coaching and, essentially, onboarding of new nurses to a hospital's protocols is being done concurrently. 

Q: Who is going to pay to build the "bridge" you describe?

KBL: I believe hospitals should pay their nurses to teach at those nursing institutions and bring the nursing students into the hospital for hands-on learning. This can be directly tied to retention efforts.

Perhaps educators can receive bonuses based on the number of nurses they train who take positions at the hospital. For example, if 75 percent of the students a nurse educator teaches take jobs at the hospital, the educator gets X in bonus pay. If 50 percent are retained, the educator gets X amount of money. 

The key is to set up a pipeline of educators where when you have someone that's doing a great job they're compensated appropriately. This way if you lose a nurse educator, you already have others to step in.

Q: So do you think "building a bridge" is a win-win?

KBL: I would actually call it a win-win-win. Creating partnerships between hospitals and nursing schools has many benefits: there are more nurses teaching, there is a pipeline for new nurses at hospitals and it's great for new nurses coming out of school. They already know what the expectations are and it's a seamless transition from student to bedside nurse.

If you talk to nursing students, they will tell you the first time they inserted an IV is when they finally were employed and faced a patient. Makes you shudder, right? People assume that just because nursing students have clinical rotations, they've already had basic experience doing procedures. But that's not true. In a lot of cases they just observe when they're doing their clinical rotations due to risks.

That's why this bridge is important. It helps cut through all of that and mitigates risk because the nurse educator is employed by the hospital. New nurses would already know their communities and have access to all the resources they need to be successful.


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