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25-552 PDF 2006

HOW THE LACK OF HIGHER EDUCATION FACULTY

CONTRIBUTES TO AMERICA’S NURSING

SHORTAGE, PART I

FIELD HEARING

BEFORE THE

SUBCOMMITTEE ON SELECT EDUCATION

OF THE

COMMITTEE ON EDUCATION 

AND THE WORKFORCE 

U.S. HOUSE OF REPRESENTATIVES

ONE HUNDRED NINTH CONGRESS

FIRST SESSION

November 30, 2005 in Greeley, Colorado

Serial No. 109-29

Printed for the use of the Committee on Education and the Workforce

(

Available via the World Wide Web: http://www.access.gpo.gov/congress/house 

or 

Committee address: http://edworkforce.house.gov 

(II)

COMMITTEE ON EDUCATION AND THE WORKFORCE 

JOHN A. BOEHNER, Ohio, Chairman

Thomas E. Petri, Wisconsin, Vice Chairman 

Howard P. ‘‘Buck’’ McKeon, California 

Michael N. Castle, Delaware 

Sam Johnson, Texas 

Mark E. Souder, Indiana 

Charlie Norwood, Georgia 

Vernon J. Ehlers, Michigan 

Judy Biggert, Illinois 

Todd Russell Platts, Pennsylvania 

Patrick J. Tiberi, Ohio 

Ric Keller, Florida 

Tom Osborne, Nebraska 

Joe Wilson, South Carolina 

Jon C. Porter, Nevada 

John Kline, Minnesota 

Marilyn N. Musgrave, Colorado 

Bob Inglis, South Carolina 

Cathy McMorris, Washington 

Kenny Marchant, Texas 

Tom Price, Georgia 

Luis G. Fortun ̃ o, Puerto Rico 

Bobby Jindal, Louisiana 

Charles W. Boustany, Jr., Louisiana 

Virginia Foxx, North Carolina 

Thelma D. Drake, Virginia 

John R. ‘‘Randy’’ Kuhl, Jr., New York 

George Miller, California 

Dale E. Kildee, Michigan 

Major R. Owens, New York 

Donald M. Payne, New Jersey 

Robert E. Andrews, New Jersey 

Robert C. Scott, Virginia 

Lynn C. Woolsey, California 

Rube ́n Hinojosa, Texas 

Carolyn McCarthy, New York 

John F. Tierney, Massachusetts 

Ron Kind, Wisconsin 

Dennis J. Kucinich, Ohio 

David Wu, Oregon 

Rush D. Holt, New Jersey 

Susan A. Davis, California 

Betty McCollum, Minnesota 

Danny K. Davis, Illinois 

Rau ́l M. Grijalva, Arizona 

Chris Van Hollen, Maryland 

Tim Ryan, Ohio 

Timothy H. Bishop, New York 

John Barrow, Georgia

Paula Nowakowski, Staff Director 

Mark Zuckerman, Minority Staff Director 

SUBCOMMITTEE ON SELECT EDUCATION 

PATRICK J. TIBERI, Ohio, Chairman

Cathy McMorris, Washington Vice Chairman 

Mark E. Souder, Indiana 

Jon C. Porter, Nevada 

Bob Inglis, South Carolina 

Luis P. Fortun ̃ o, Puerto Rico 

John A. Boehner, Ohio, ex officio 

Rube ́n Hinojosa, Texas 

Danny K. Davis, Illinois 

Chris Van Hollen, Maryland 

Tim Ryan, Ohio 

George Miller, California, ex officio 

(III)

C O N T E N T S 

Page

Hearing held on November 30, 2005 ...................................................................... 1

Statement of Members: 

Musgrave, Hon. Marilyn N., a Representative in Congress from the State 

of Colorado ..................................................................................................... 1

Prepared statement of ............................................................................... 2

Porter, Hon. Jon C., a Representative in Congress from the State of 

Nevada ........................................................................................................... 3

Prepared statement of ............................................................................... 5

Statement of Witnesses: 

Carparelli, Sue, President & CEO, Colorado Center for Nursing Excellence, Denver, CO ......................................................................................... 6

Prepared statement of ............................................................................... 9

Dierker, Lynn, R.N., Director for Community Initiatives, Colorado Health 

Institute, Denver, CO ................................................................................... 12

Prepared statement of ............................................................................... 14

Lowe-Vaughn, Elise, Operations Director, Workforce Development Programs, Colorado Department of Labor and Employment, Denver, CO .... 16

Prepared statement of ............................................................................... 18

Norton, Kay, President, University of Northern Colorado, Greeley, CO ..... 20

Prepared statement of ............................................................................... 23

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HOW THE LACK OF HIGHER EDUCATION FACULTY CONTRIBUTES TO AMERICA’S NURSING SHORTAGE, PART I 

Thursday, November 30, 2005

U.S. House of Representatives 

Subcommittee on Select Education 

Committee on Education and the Workforce 

Greeley, Colorado 

The Subcommittee met, pursuant to call, at 10 a.m., at the University of Northern Colorado, University Center, Panorama Room, 

2045 10th Avenue, Greeley, Colorado, Hon. Marilyn Musgrave presiding. 

Present: Representatives Musgrave and Porter. 

Mrs. MUSGRAVE. A quorum being present, the Subcommittee on 

Select Education of the Committee on Education in the Workforce 

will come to order. 

We are meeting today to hear testimony on how the lack of higher education faculty contributes to America’s nursing shortage. 

I am very pleased to be here in Greeley today, and I’m eager to 

hear from our witnesses. But, before I begin, I ask for unanimous 

consent for the hearing to remain open for 14 days to allow Member statements and other extraneous material referred to during 

the hearing to be submitted in the official hearing record. Without 

objection, so ordered. 

STATEMENT OF HON. MARILYN N. MUSGRAVE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF COLORADO 

Mrs. MUSGRAVE. I’d like to thank all of you for being here today, 

and I certainly would like to extend my appreciation to Congressman Jon Porter for traveling to Greeley, and I do apologize for the 

weather, Congressman. It’s a bit brutal today. 

Mr. PORTER. It’s a beautiful day. 

Mrs. MUSGRAVE. And I’m glad that he’s here to learn much about 

this urgent matter. He has been a leader on this issue, and I’m 

very grateful for the insight that he has. 

We all know that our country is facing a nursing shortage that 

will have a significant impact on healthcare in our country. Last 

year, the U.S. Bureau of Labor Statistics projected that more than 

one million new and replacement nurses will be needed by 2012. 

According to a 2002 health report, 44 states are expected to have 

shortages of registered nurses by the year 2020. In Colorado, the 

2

lack of registered nurses is twice the national average. The nursing 

shortage in our state is currently estimated to be 11 percent short 

of demand, and is expected to nearly triple to 30 percent by 2020 

if current trends continue. This is a growing problem that demands 

our urgent attention. 

Demand for nurses is projected to increase as population grows, 

baby boomers enter retirement, and medical advances extend our 

lifespans. In contrast, the supply of nursing professionals is expected to decline, as the number of nurses leaving the profession 

exceeds the number that are entering. 

What many Americans do not realize is that this shortage is not 

simply a matter of inadequate enrollment in nursing schools. Thousands of qualified applicants to graduate nursing programs are 

turned away each year because there is a shortage of graduatelevel nursing faculty. 

A report by the American Association of Colleges of Nursing 

shows that U.S. Nursing schools turned away 32,797 qualified applicants from baccalaureate and graduate nursing programs in 

2004 due to insignificant number of faculty, clinical sites, classroom 

space, and budget constraints. More than 2,600 applicants were 

turned away from the nursing program in Colorado—from nursing 

programs in Colorado, in 2003. 

Three quarters of the nursing schools point to faculty shortages 

as a reason for not accepting all qualified applicants into nursing 

programs. This academic year, 66 percent of nursing schools report 

that they have vacancies and they are in need of additional nursing 

faculty to meet additional demand. 

Colorado’s shortage of qualified nursing faculty at its 2 year 

nursing schools is three times the national average, and nearly 

double the national average at its 4 year schools. 

We anticipate this faculty shortage to escalate in the next decade 

due to budget constraints, increased job competition from clinics 

sites, and the retirement of a greying professional of the nursing 

faculty. 

A wave of faculty retirements is expected within the next 10 

years, between 200 and 300 doctrinally prepared faculty will be eligible for retirement each year from 2003 through 2012. 

I am anxious to hear the testimony from our witnesses today. I 

very much appreciate your expertise and I’m proud of the efforts 

that are going on in Colorado to address the nursing shortage. 

Colorado educational institutions and health care providers are 

working together to pursue strategies, to strengthen faculty recruitment and retention, and it’s important for all of us that these 

efforts are very successful. 

I hope that we can identify some strategies today that will address the problem of faculty shortage, and I also am very pleased 

to have Mr. Porter here, and I would now like to yield to him for 

any statements that he might have. 

[The prepared statement of Mrs. Musgrave follows:]

Statement of Hon. Marilyn N. Musgrave, a Representative in Congress from 

the State of Colorado 

Good morning. Thank you all for being here today. I would like to extend my appreciation to Congressman Jon Porter for traveling to Greeley to learn more about 

3

this urgent matter. He has been a leader on this issue and I am grateful for his 

insight this morning. 

Our country is confronting a nursing shortage that will have a significant impact 

on the health care in our country. Last year, the U.S. Bureau of Labor Statistics 

projected that more than one million new and replacement nurses will be needed 

by 2012. 

According to a 2002 health report, 44 states are expected to have shortages of registered nurses by the year 2020. 

In Colorado, the lack of registered nurses is twice the national average. The nursing shortage in our state is currently estimated to be 11 percent short of demand, 

and is expected to nearly triple, to 30 percent, by 2020 if current trends continue. 

This is a growing problem that demands our urgent attention. 

Demand for nurses is projected to increase as population grows, baby boomers 

enter retirement, and medical advances extend life span. In contrast, the supply of 

nursing professionals is expected to decline as the number of nurses leaving the profession exceeds the number that enter. 

What many Americans do not realize is that this shortage is not simply a matter 

of inadequate enrollment in nursing programs. Thousands of qualified applicants to 

graduate nursing programs are turned away each year because there is a shortage 

of graduate-level nursing faculty. 

A report by the American Association of Colleges of Nursing (AACN) shows that 

US nursing schools turned away 32,797 qualified applicants from baccalaureate and 

graduate nursing programs in 2004 due to insufficient number of faculty, clinical 

sites, classroom space, clinical preceptors, and budget constraints. More than 2600 

applicants were turned away from nursing programs in Colorado in 2003. 

Three quarters (76.1%) of the nursing schools point to faculty shortages as a reason for not accepting all qualified applicants into nursing programs. This academic 

year (2005–2006), 66% of nursing schools report that they have vacancies and are 

in need of additional nursing faculty to meet additional demand. 

Colorado’s shortage of qualified nursing faculty at its two-year nursing schools is 

three times the national average, and nearly double the national average at its fouryear schools. 

We anticipate this faculty shortage to escalate in the next decade due budget constraints, increased job competition from clinical sites, and the retirement of a 

‘‘graying professoriate’’ of nursing faculty. 

A wave of faculty retirements is expected within the next ten years. Between 200 

and 300 doctorally-prepared faculty will be eligible for retirement each year from 

2003 through 2012. 

I am anxious to hear the testimony from our witnesses today. I am very proud 

of the collaborative efforts in Colorado to address the nursing faculty shortage. Colorado educational institutions and health care providers are working together to pursue strategies to strengthen faculty recruitment and retention. 

It is my hope that we can identify some strategies to address the faculty shortage 

in our country. I welcome your insight so that we may work together to prepare a 

nursing workforce that is prepared to meet the health care needs of the nation. 

STATEMENT OF HON. JON C. PORTER, A REPRESENTATIVE IN 

CONGRESS FROM THE STATE OF NEVADA 

Mr. PORTER. Thank you, Marilyn. I appreciate the kind and 

warm welcome. Certainly, coming from the great State of Nevada, 

I can appreciate the air and the wind is probably blowing from Nevada into Colorado. Normally we say, ‘‘What happens in Las Vegas, 

stays in Las Vegas,’’ but I think maybe the winds are coming from 

Nevada. 

But, Marilyn, I appreciate your hospitality and your friendship, 

but also your leadership. Marilyn and I were elected at the same 

time, so we were sophomores together. 

Mrs. MUSGRAVE. Yes. 

Mr. PORTER. We’ve been working closely on a number of key 

issues, and one that really cuts to the chase, and it has to do with 

the quality of life of not only residents in Colorado and Nevada, but 

in the country. That’s health care and professionals. 

4

To my friend, President Norton, thank you. We had a chance to 

meet in D.C. A few months back, talked about this very issue, and 

I appreciate your leadership for the State of Colorado, but also for 

the country. Thank you for what’s happening. 

I want to pick on Dan Weaver. Dan didn’t make it to the airport 

to pick us up last night, so we had to take a cab. So, Dan, I’m sorry 

that you probably aren’t going to have a job after today. 

But in all seriousness, Dan, I appreciate your help and working 

with you. I know that Dan’s that liaison between the process and 

the professionals, but also the politicians that are trying to do the 

right thing. So, Dan, thank you for helping out and being at the 

airport and getting us here safely. Thank you very much. 

My staff is not with me today, so I don’t have to use my notes, 

right? I can put these aside? I think we talked about this last 

night, Wanda. I just want to talk a little bit about Nevada for a 

moment, and then give some of my perspectives how that impacts 

Colorado and the rest of the country. 

You know, we’re experiencing very similar challenges to Colorado. We’re, of course, not as large of a state, but we have the same 

challenges. We are one of the fastest growing states in the country. 

We’re seeing seven, eight, nine thousand people a month moving 

into Nevada. 

Now, I have no doubt you’re experiencing similar growth, if not 

more, but when you look at the size of our state of about 2.2 million people, it’s substantial. And we’ve grown almost a million people in the last decade, so that puts a lot of pressure on our infrastructure, our schools, our health care, our highways, our air quality—all of these things that we are working, and I believe quite effectively in Nevada. 

But we have 18,000 new students, high school and grade school 

students a year. Imagine that, 18,000, and we’re being two and a 

half new schools a month in the community of Southern Nevada. 

We’re hiring close to 2,500 new teachers a year. We’re hiring 5,000 

new support staff a year into our school district. 

But all of that aside, health care is right in there with the challenges. So we have multiple level of challenges. One, of course, is 

recruiting and finding health care professionals because of the massive growth. We need 1,000—minimum 1,000 new nurses and professionals in health care a year. A thousand. We have a shortage, 

really, of higher education institutions that—because we’re a small 

state, but fortunately there’s a few that have been specializing in 

health care. 

Nevada State College, which is one of my favorite projects, it’s 

a new college in Southern Nevada, part of the university system, 

that’s specializing in accelerated nursing, and we’ve been working 

with President Norton and the president of the school in Henderson, Nevada, trying to learn from each other’s challenges and each 

other’s successes. 

But, quality of life is really the key, and we want to make sure 

that Nevadans and Coloradans and the rest of the country have the 

absolute best health care in the world, and I believe that we have 

it, but there are times we have a challenge in delivering it because 

of a shortage. 

5

And there’s multiple ways to reach that goal, but not only do we 

need more educating professionals, we need, of course, more teachers that have expertise in health care. We need to make sure that 

our neighbors and friends and graduates, and even those looking 

for a change in career who want to get into the nursing profession. 

We want to make sure we can elevate that as a very primary role 

in the delivery of health care. 

What’s happened in the country is that we’re used to now 1–800 

dial-a-number, or pull it up on the web, and if you dial the 1–800 

number, you have to wait or you push another number and eventually you find someone to talk to you about your health care problem. Or you go to the web or WebMD or whatever it is out there. 

But American people are still begging to be taken care of and to 

have someone that cares. And the nursing profession and the professionals in delivery of health care, still are a good—and I’m not 

an expert—but 80 percent of health care is how you’re treated. And 

I’ll tell you, we need to elevate the position of nurses, find a way 

to make sure that they receive, one, the funding and the training 

and the pay that they deserve, because they play such a major—

you all that are here, the professionals, play such a major role in 

health care. We want to make sure we continue with the best in 

the world, and we certainly all want to make sure if we’re ill, or 

a friend or a relative is ill, that they receive the absolute best care. 

So today is really about a lot of things, and I’ve learned from 

working with Marilyn and spending some time on this issue the 

last at least three full years that a key link in health care delivery 

is finding and encouraging professionals that would like to help 

teach and train. 

We want to make sure that we’re doing everything we can from 

the Federal level, and I know Marilyn and I would agree, all politics are local. We don’t want to get in the way, as the Federal Government, and the Federal Government should be providing opportunities, providing incentives, but we want to make sure that the 

State of Colorado and the private sector and the professionals here 

are given the tools by the Federal Government to do what they 

need to do. 

When I was elected, and I know when Marilyn was elected, we 

weren’t elected to be the superintendent of schools or the president 

of a school, we were elected to provide support from the Federal 

level. 

So today, I’m honored to be here, I’m excited, this is a passion 

for me, and I want to make sure that I can learn as much as I can 

from all of you and take it and share it with my community in Nevada. We’re having a similar hearing in Nevada on Friday with Nevada State College, and I hope to again take some things that I’ve 

learned today and share with our folks in Nevada. 

So, again, thank you very much to the school and to all of those 

who are here today. I’m honored, and look forward to your testimonies. 

[The prepared statement of Mr. Porter follows:]

Statement of Hon. Jon C. Porter, a Representative in Congress from the 

State of Nevada 

Good morning. Thank you all for joining us for this hearing to examine the causes 

and possible solutions to address the shortage of qualified nursing faculty at our naVerDate 0ct 09 2002 16:44 May 11, 2006 Jkt 000000 PO 00000 Frm 00009 Fmt 6633 Sfmt 6621 F:\DOCS\EWDOCS\25552.TXT HBUD1 PsN: DICK
6

tion’s institutions of higher education. I’m pleased to welcome all of our witnesses 

here today. I appreciate you taking time out of your busy schedules to appear before 

the Subcommittee. I am also glad that those of you in the audience were able to 

attend. 

As many of you know, according to the American Association of State Colleges 

and Universities, by 2020 experts believe there will be a national shortage of more 

than 800,000 registered nurses. The National League of Nursing estimates that 

more than 125,000 qualified applicants were rejected by nursing programs in the 

2003–2004 academic year. The shortage of nursing faculty is one of several factors 

that are most commonly cited as reasons behind this trend. 

This problem is even more severe in the state of Nevada, where I am from, than 

in some other states. In fact, according to the U.S. Department of Health and 

Human Services’ National Center for Health Workforce Analysis, Nevada’s projected 

shortage of nurses will increase from 11% in 2000 to 27.5% in 2020. 

While I am troubled by the magnitude of this problem, and its impact on our nation I am also hopeful that the testimony we hear today will provide us with some 

additional insights as to what can be done to address the issue. I look forward to 

hearing more from our witnesses about the challenges our nation is facing and what 

is being done to find solutions. 

I believe that this national crisis must be confronted with coordinated efforts at 

the federal, state, and local levels. While the federal government must work harder 

to provide the resources to enhance the ability to train nurses, state and local governments, as well as private entities, will play a major role in reversing the declines 

in the nursing workforce. The national health implications of this dilemma are too 

serious, and the cost to patients too great to remain inactive. We must continue to 

look to build relationships and develop plans of action that will address these problems in a comprehensive manner. Through hearings like this, and the continued efforts of schools of nursing, we can educate Members of Congress as to how we can 

best overcome these issues. 

I’d also like to take this opportunity to thank Congresswoman Marilyn Musgrave 

for her interest in this issue, and her invitation to come to Greeley to discuss this 

issue further.—I look forward to working with her as we continue to examine what 

can be done at all levels of government to address the shortage of qualified nursing 

faculty. 

Again, thank you for joining us today to provide your valuable insight into this 

most important issue. I look forward to continuing our work to alleviate the pressures currently being placed on the nursing workforce. 

Mrs. MUSGRAVE. Thank you, Jon, very much. 

Our first witness today is Ms. Sue Carparelli. She’s the president 

and chief executive officer of the Colorado Center for Nursing Excellence in Denver. Ms. Carparelli has a background in both workforce development and health care, and is spearheading the only 

collaborative statewide initiative to improve access to quality 

health care through the development and support of Colorado’s 

nursing workforce. 

She also works on a wide variety of educational issues, with a 

special emphasis on the nursing shortage. Thank you for being 

here, and we’re looking forward to hearing from you. 

You know, when we’re in Washington, D.C., we have a very 

prominent light that limits you to 5 minutes, but we’re going to be 

merciful. We don’t have the light, so we’re just going to guess at 

it. Thank you very much. 

STATEMENT OF SUE CARPARELLI, PRESIDENT AND CEO, 

COLORADO CENTER FOR NURSING EXCELLENCE, DENVER, CO 

Ms. CARPARELLI. Thank you. Thank you. I will attempt to keep 

that light in my eyes nevertheless, and I want to thank you very 

much for being here. We are very grateful for your attention to 

what we think is a very important issue as well. As I look around 

this room, I’m also humble in my having the opportunity to speak 

7

to you, because there are many, many experts in this room who 

could provide a great deal of information on this issue for you. But 

let me see if I can’t summarize some of the key issues from our perspective. 

First, the Center for Nursing Excellence is an independent, nonprofit organization. It was established in 2002 to be working as a 

convener, broker, facilitator of solution building in our state as we 

address nursing workforce issues. As such, we have the opportunity 

to work with many stakeholder groups across the state and have 

learned a great deal about what works and doesn’t work in that 

process. 

The Center’s funding comes from industry investment, it comes 

from state and Federal grants and foundation grants. 

First of all, let me just put some things in context for you as we 

then focus more specifically on the nursing faculty shortage. 

Health care in our state is a very important economic engine, 

and I think it would be critical that we keep that in focus as we 

consider the communities large and small, rural and urban, across 

our state. 

One in 10 Coloradans work in health care, and the health care 

sector is expected to create more jobs than any other industry sector in Colorado over the next decade, yet the efficiency of the engine is stymied by shortages. The Department of Labor in our state 

predicts that more than 7,300 health care jobs will go unfilled each 

year for the next decade because there will not be enough workers 

prepared to meet that demand. 

Registered nurses in our state make up 25 percent of that health 

care work force, and you talked about the shortages in our state 

and the rate of growth that is projected by 2020 to be about a 31 

percent shortage. 

This shortage in our state, as in other states, results from the 

interplay of both supply side and demand side factors. First, we are 

losing nurses faster than we can produce them. They are old. The 

average age of nurses——

Mr. PORTER. You’d better be careful. 

Ms. CARPARELLI.—in Colorado—I know, I know, but I’m—we’re 

going to talk honestly here. Average age in our state of Colorado 

nurses is 47 years old. 

Importantly, it is essential that you note that only 7 percent of 

our nursing workforce is under 30. So the point in that is that we 

are missing essentially an entire generation of nurses. 

We also have a mismatch of diversity. The racial and ethnic 

make-up of our current nursing workforce does not reflect the increasing diversity of the state. Only 7.6 percent of Colorado nurses 

are nonwhite. Of that, 3 percent are Hispanic, while we are a state 

that has about 16 percent of our population of Hispanic descent. 

You have referenced the fact that nurses are predominantly 

women. In our state, that is 95 percent. We have not seen men 

enter this profession at the same rate as we have seen women 

leave it. 

Against this backdrop, we face an aging population whose health 

care needs will only increase in the years to come, placing more 

stress on an already overburdened system. 

8

As you referenced, our state is one that is growing. By 2020, 

Colorado’s total population is expected to grow by 16 percent with 

113 percent growth in our population of persons age 65 and over. 

That becomes a critical factor in considering demand for health 

care. 

Our efforts to increase the supply of registered nurses to meet 

this demand are greatly complicated by an education system that 

struggles to produce enough graduates to replace our diminishing 

and aging work force. 

While we enjoy a large supply of willing students, and you’ve 

noted both nationally and our state, that we are not able to respond to the number of people who are interested in entering this 

profession because of a variety of factors. 

The No. 1 reason for this trend in our ability to absorb those who 

are interested in entering this profession has to do with the insufficient numbers of qualified faculty to meet the demand of prospective students. 

In our state, as in other areas, the faculty shortage is most acute 

among clinical faculty, and those are the nursing educators who 

oversee students’ hands on learning experiences at the bedside, 

which is a very essential component of nursing education. 

My colleague, Lynn Dierker, will tell you more about the reasons 

and implications and some of the specific solutions in terms of 

Colorado’s nursing faculty shortage based on a study that was recently completed by the Colorado Health Institute. But let me 

make some additional observations in relation to the findings that 

you’ll hear from her. 

First, in our state, we have at this point, I think, an unprecedented level of collaboration amongst our schools of nursing and 

amongst the faculty and leaders within those schools. This is affording us an opportunity to learn from one another, to look at best 

practices, and to share those ideas which work best. 

An information clearing house, on a national basis for best practices on nursing education and faculty development, is also crucial. 

And models such as that outlined by the University of Northern 

Colorado’s proposal for the National Center for Nursing Education, 

offering coordination and technical assistance, resources, and professional development for nursing educators, is an excellent way to 

continue this work on a national level. 

Second, we can address the shortage of clinical leaning opportunities, in part, by taking advantage of emerging technologies, new 

opportunities and methods for learning. Colorado is poised to become a national leader in the effective use of those technologies, 

and we are grateful for the leadership that has been provided by 

the Colorado Department of Labor, which led to funding of a new 

collaborative simulation center, which will be on the Fitzsimons 

Campus; that project being funded by the U.S. Department of 

Labor. 

The Colorado Center for Nursing Excellence has been charged to 

operate this new resource, which will make the state-of-the-art patient simulation resources available to students and faculty from 

around the state—in particular, to help develop the capacity of faculty to use these new technologies. 

9

And third, we have found that clinical practitioners, those clinical experts practicing within the health care delivery system, are 

willing partner in education when we provide them preparation 

and support to perform the clinical instructor role. 

We have been benefited in our state by a grant through the Colorado Department of Labor, which has allowed us to develop and 

proliferate what’s referred to as a clinical scholar model. This 

trains practicing nurses to become clinical scholars, overseeing the 

rotations at practice sites, and the response to this particular program has been extremely gratifying. We have filled out grant-funded slots and nurses continue to be interested in these roles and we 

are seeing industry—in other words, the employers, particular in 

the acute care setting, support the cost of their participation. 

We are looking next at creating a statewide inventory of both 

supply and demand of clinical sites. This is another element that’s 

contributing to our inability to support student learning. And what 

we believe is that we have the opportunity to create a technology 

platform that will support, then, that information enabling us to 

have a better sense and more efficient use of what is also a scarce 

resource in terms of clinical sites. 

These examples and others, which will be noted by Elise LoweVaughn from the Department of Labor, illustrate the role of state 

and Federal agencies in addressing Colorado’s and the nation’s 

nursing faculty shortage. 

While the Colorado Center for Nursing Excellence is fortunate to 

have strong support from Colorado’s hospital and foundation community, ongoing Federal support and investment in efforts such as 

ours across the country, is essential. 

Agencies, such as the U.S. Department of Labor and the Department of Health and Human Services, play an integral role in solving our nursing labor shortage. 

In closing, I wish to draw the community’s attention to one inescapable fact: Health care workers are knowledge workers. While 

many of those currently employed within the health care sector are 

prepared through on-the-job training programs, generally funded 

by employers, nursing requires highly specialized and costly education and lifelong learning opportunities which are accessible only 

through our colleges and universities. 

In order to prepare these essential health care workers, we must 

have a viable, accessible, educational system that is responsive to 

the evolving needs of current health care practice. 

And I welcome any questions that you have, and thank you for 

this opportunity. 

Mrs. MUSGRAVE. That was very excellent testimony. 

[The prepared statement of Ms. Carparelli follows:]

Statement of Sue Carparelli, President & CEO, Colorado Center for 

Nursing Excellence, Denver, CO 

Thank you, members of the Committee. My name is Sue Carparelli; I am president and chief executive officer of the Colorado Center for Nursing Excellence. 

The Center is an independent, nonprofit organization established in 2002. It is the 

only organization in Colorado exclusively dedicated to ensuring that our state has 

adequate numbers of highly-qualified nurses. We bring together educational institutions, health care providers, governmental agencies and foundations to investigate 

the sources of the nursing shortfall, to develop strategies to address it and to secure 

resources needed for effective solution building. The Center serves as a source of inVerDate 0ct 09 2002 16:44 May 11, 2006 Jkt 000000 PO 00000 Frm 00013 Fmt 6633 Sfmt 6621 F:\DOCS\EWDOCS\25552.TXT HBUD1 PsN: DICK
10

formation and technical assistance, a broker and convener of collaborative partnerships and as a catalyst for innovation. 

Center funding comes from industry investments, grants from federal and state 

agencies, and foundation grants. 

My purpose today is to support my colleagues in illuminating the factors contributing to Colorado’s shortage of qualified nursing faculty, and help them and members of this committee explore solutions to this crucial problem. 

I would like to begin my remarks by creating context around Colorado’s nursing 

faculty shortage. I will provide some important facts about Colorado’s healthcare 

workforce, and explain our state’s nursing shortage. Then I will explore the impact 

of the shortage of nursing faculty on our ability to fill the nursing gap. I will furnish 

examples of efforts the Colorado Center for Nursing Excellence has underway to alleviate the faculty shortage, and offer recommendations to the Committee as you 

consider the federal government’s role in addressing this nationwide problem. 

Healthcare is an economic engine in Colorado. One in 10 Coloradans work in 

healthcare, and the healthcare sector is expected to create more jobs than any other 

industry sector in Colorado over the next decade. 

Yet, the efficiency of that engine is stymied by shortages. The Colorado Department of Labor predicts that more than 7300 healthcare jobs will go unfilled each 

year for the next decade because there will not be enough workers prepared to meet 

the demand. 

The shortage is especially acute among registered nurses. Members of the committee are already, I am sure, well aware of the nationwide nursing shortage. Colorado’s shortage is especially dire. 

While registered nurses currently make up 25 percent of all healthcare workers 

in our state, Colorado is estimated to have about 5,000 fewer nurses than we need, 

or a 13 percent shortfall. That’s about double the national average. And, that figure 

is expected to grow to 31 percent—or nearly 17,000 fewer nurses than needed in 

Colorado—by 2020 if current trends continue. This shortfall results from the interplay of both supply side and demand side factors. 

First, we are losing nurses faster than we produce them. The average age of a 

Colorado hospital nurse is currently 47. Only 7 percent are under age 30. A 2003 

study found that 45 percent of Colorado nurses did not expect to be practicing in 

five years. 

Further, the racial and ethnic makeup of the current nursing workforce does not 

reflect the increasing diversity of the state. Only 7.6 percent of Colorado nurses are 

non-white; 3 percent are Hispanic, in a state whose population is nearly 16 percent 

Hispanic. 

In addition, women have left nursing for other professions and few men have entered the profession to take their place. Today, 95 percent of Colorado nurses are 

female, while only 5 percent are male. 

Against this backdrop, we face—as do all other states—an aging population whose 

healthcare needs will only increase in the years to come, placing still more stress 

on an already overburdened system. Our population is also growing. By 2020, Colorado’s total population is expected to grow 16 percent, with 113 percent growth 

among those age 65 and older. 

Our efforts to increase the supply of registered nurses to meet this demand are 

greatly complicated by a higher education system that is failing to produce enough 

graduates to replace our diminishing, aging workforce. While we enjoy a large supply of willing students, our nursing education programs are severely constrained by 

a lack of qualified faculty. 

From a national perspective, it is important—and somewhat disheartening—to 

note that Colorado’s nursing faculty shortage is typical, not unique. A study earlier 

this year by the American Association of Colleges of Nursing found that nursing 

schools around the country rejected 32,000 qualified students in 2004, despite a 14 

percent gain in enrollment from the previous year. In Colorado in 2003 (the most 

recent year for which data are available), 2600 qualified applicants were turned 

away from nursing programs. The number one reason for this disturbing trend is 

that Colorado’s nursing schools, as well as those elsewhere in the country, simply 

do not have sufficient numbers of faculty to meet the demand from prospective students. 

Our faculty shortage is most acute among clinical faculty, the professionals who 

oversee student nurses’ hands-on experiences at the bedside. The bottleneck for clinical rotations means that nursing students wait longer for placements and have less 

time on rotations once they secure them. This essential element in nurse preparation, and one which is especially critical for developing the observation and treatment skills necessary to providing high quality care, is thus jeopardized. 

11

My colleague Lynn Dierker will tell you more about the reasons for, implications 

of, and specific solutions to Colorado’s nursing faculty shortage, based on a recent 

study conducted by the Colorado Health Institute under the Center’s auspices. I 

want to set the stage for her comments by making a few observations of my own. 

First, our nursing schools must have opportunities to learn from each others’ successes and tap into the latest thinking on nurse education. An information clearinghouse for best practices on nursing education and faculty development is crucial. 

The model outlined in the University of Northern Colorado’s proposal for the National Center for Nursing Education, offering coordination, technical assistance, resources and professional development for nursing educators, is an excellent way to 

fill this need. 

Second, we can address the shortage of clinical learning opportunities, in part, by 

taking advantage of emerging simulation technologies. In fact, Colorado is posed to 

become a national leader in the effective use of these technologies. The U.S. Department of Labor recently awarded funds to the Colorado Dept. of Labor and Employment to create the Work, Education and Lifelong Learning Simulation Center, 

known as the WELLS Center. The Colorado Center for Nursing Excellence is overseeing this important new resource, which will make state-of-the art patient simulation resources accessible to students and faculty from around the state through 

high-speed datacasting. 

Third, and perhaps most encouraging, we have found that clinical practitioners 

become more willing to oversee student rotations when the practitioners are trained 

in how to fill that role. Indeed, practicing nurses have signed up eagerly for a new 

training program provided by the Colorado Center for Nursing Excellence under a 

grant from the Colorado Department of Labor and Employment. This Faculty Development Project trains practicing nurses to become ‘‘clinical scholars,’’ overseeing student rotations at practice sites throughout Colorado. Response to the program has 

been so overwhelming that the grant-funded slots were filled long ago, yet nurses 

continue to sign up for the opportunity, with their institutions covering the cost of 

their participation. 

The Colorado Center for Nursing Excellence is also poised to develop a statewide 

inventory of both the supply and demand for clinical teaching sites, supported by 

a technology platform which will enable efficient matching based on tailored selection criteria. We are currently seeking funding for this initiative. 

These examples—and others that will be noted by my colleague Tom Looft from 

the Colorado Department of Labor—all illustrate the role of state and federal agencies in addressing Colorado’s, and the nation’s, nursing faculty shortage. While the 

Colorado Center for Nursing Excellence is fortunate to have strong support from 

Colorado’s hospital and foundation community, ongoing federal support and investment is essential for our efforts—and similar programs around the country—to be 

successful. Agencies such as the U.S. Department of Labor and the Department of 

Health and Human Services play an integral role in solving our nursing labor shortage, providing the funds that fuel good ideas. 

In closing, I wish to draw the committee’s attention to one inescapable fact. 

Healthcare workers are knowledge workers. While many of those currently employed within the healthcare sector are prepared through on the job training programs generally funded by employers, nursing requires highly specialized and costly 

education and training accessible only through our colleges and universities. In 

order to prepare these essential health care workers we must have a viable, accessible educational system that is responsive to the evolving needs of current health 

care practice. 

I welcome any questions from the committee. Thank you. 

Mrs. MUSGRAVE. I think we’ll hear from all of the witnesses and 

then we’ll come back for questions. 

Ms. CARPARELLI. Thank you. 

Mrs. MUSGRAVE. That was very good. 

Our next witness is Ms. Lynn Dierker. She’s an R.N. Who currently serves as the deputy director for community initiatives at 

the Colorado Health Institute, and she holds a bachelor of science 

in nursing from Emory University, and a bachelor of arts from 

Drew University. 

As deputy director for community initiatives, she is responsible 

for building sustained partnerships for distancing nursing eduVerDate 0ct 09 2002 16:44 May 11, 2006 Jkt 000000 PO 00000 Frm 00015 Fmt 6633 Sfmt 6602 F:\DOCS\EWDOCS\25552.TXT HBUD1 PsN: DICK
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cation between the institute and its diverse constituents throughout the state. Welcome. 

STATEMENT OF LYNN DIERKER, R.N., DIRECTOR FOR COMMUNITY INITIATIVES, COLORADO HEALTH INSTITUTE, DENVER, 

CO 

Ms. DIERKER. Thank you very much. I appreciate the opportunity 

to speak to you today. 

The Colorado Health Institute is an independent 501(C)(3) created by three foundations in Colorado to be an independent source 

of information, objective nonpartial information, for policymakers 

at both community and statewide levels. 

I’m here today to provide brief highlights from the 2004 study 

that we completed related to the Colorado nursing workforce and 

the shortage of nursing faculty. And we completed this at the request of the Colorado Center for Nursing Excellent, and with funding by the Colorado State Workforce Council. 

A copy of the entire study is provided to you, and I think you 

have one with you there today——

Mrs. MUSGRAVE. Yes. 

Ms. DIERKER.—and I recommend it as a rich resource of information. However, during the next few minutes, I hope to put into context the key findings from the study and discuss their implications, 

particularly as you consider how best to partner with states to promote nursing workforce development. As I make my few remarks 

here today, I don’t know about you, but in listening to study findings, it’s awfully difficult to hear data rattled off. So, what I’ve 

done is really refer you to the study for specific numbers and findings, and I’m going to try and this sort of the key concepts and implications of the findings in the study. 

The study was designed to identify and analyze key factors and 

issues affecting the supply of and demand for nursing faculty; in 

particular, the relationship between nurse education programs and 

the market for nurses and the health care industry. 

The study focuses on four primary areas: Economic factors, noneconomic factors, education infrastructure, and the role played by 

the private sector. And the study included issues related to both licensed practical nursing and registered nursing education programs. 

The research we did took full advantage of what is available in 

the current nursing workforce literature, and we also collected primary data through two Web-based surveys; one of clinical sites 

that employ nurses and train them, and one of educational programs across our state. We also interviewed many key informants 

from both practice and education and used an advisory panel to advise us on our study design and methodology. 

So, as to our key findings, let me put these in the context of what 

you’re already hearing about the national workforce shortage and 

faculty shortages, and what you’ve already heard today about Colorado’s situation. 

Our current nurse faculty shortage is significantly greater than 

the national average, as you’ve heard. The national shortage of faculty being around 8.6 percent, our shortages range from 15 percent 

13

in our 4 year institutions to 25 percent among our 2 year programs, 

including, importantly, our community colleges. 

In the face of this nationwide shortage, Colorado struggles to 

compete with other states to attract faculty due to these economic 

and noneconomic factors, including compensation levels, workload 

demands, and budget constraints that disproportionately affect our 

state-supported higher education. 

With population growth, as you’ve heard, and increasing demand 

for nursing services, Colorado, like other states, has called upon its 

education system to produce greater numbers of nursing graduates. 

The study found that nursing education deployed significant and 

rapid program expansions over the past 3 years. However, in a 

number of ways, these expansions exacerbated our faculty shortage 

and increased job dissatisfaction. 

Entry-level faculty salaries are low; less than $40,000 on average, and even less in rural areas, and especially related to available positions within clinical institutions offering greatly higher 

rates of pay. 

Workloads are heavy, especially for clinical instructors who most 

often work on an hourly contract basis without benefits. 

In this context, concerns, as you’ve mentioned, are growing about 

faculty attrition due to retirements which are projected to increase 

significantly due to the average age of Colorado faculty, 50, especially within the state’s 4 year colleges and universities. 

Preparing adequate numbers of qualified faculty is another corollary issue. The study reveals a lack of incentives and opportunities for graduate level preparation for nurses interested in a teaching role. Anecdotally, we heard from many who report that nurses 

who are in clinical settings and interested in taking on faculty roles 

can’t afford the time and the resources to go full time to an education program and to have access to graduate level preparation. 

The majority of the state’s nursing programs in Colorado are 

publicly funded and are, therefore, caught up in the current fiscal 

crisis facing all of higher education in our state. The study found 

that the private sector, particularly those clinical facilities employing newly graduated nurses, in particular, hospitals and long-term 

care facilities, private sectors already spending millions of dollars 

per year to support nursing education. 

However, clinical facilities report that newly graduated nurses 

are often unprepared to assume the full responsibilities of independent practice and they, therefore, require continuing training 

and supports that range again to the tune of millions of dollars annually. 

In addition to providing examples of widespread stress and concern related to faculty shortages, our study informants provided a 

rich picture of the types of innovation that are beginning to take 

hold within nursing education. As Sue has mentioned, these include advances in technology to enhance teaching methods and collaborative relationships with clinical facilities to strengthen the 

level of preparedness of new graduates and improve faculty job satisfaction. The study found that Colorado’s nursing programs and 

health care facilities are pursuing many of the promising strategies 

that we identified nationally and by other states. 

14

CHI was charged to provide timely information that would support stakeholder decisionmaking about opportunities and investments in programs and interventions. This study is a starting 

point. It’s a snapshot in time, and highlights the need for more robust, well-defined, and reliable data monitoring efforts by which to 

understand the full picture of nursing workforce supply and demand over time. 

However, the findings make it clear that Colorado educators, 

clinical training sites, and policymakers face both substantial challenges and exciting opportunities related to strengthening not only 

the nursing workforce, but also the healthcare system as a whole. 

In conclusion, I want to offer observations regarding the important three-level partnership that exists between Federal, state, and 

local leaders and policymakers. At the community level, even in our 

rural areas, nursing educators and clinicians perceive the need for 

strategic alignment of goals and strategies to meet the healthcare 

challenges before us. Study informants note that many of the 

issues related to nursing workforce, and particularly faculty development, should be addressed by a policy framework and resources 

made available at the national level. 

At the same time, as a system in need of innovation, nursing 

education must rely on and have the support for creativity and the 

ability to be responsive at the local and state system level among 

institutions, and with leadership that nurse practice and education 

leaders provide. 

Collaboration, flexibility, funding, and strategic and sustained 

alignment of efforts are themes that emerge from this study, and 

are offered for your consideration. 

Again, I am grateful for the opportunity to present this very brief 

overview, and welcome any questions or comments you may have. 

Thank you. 

Mrs. MUSGRAVE. Thank you. We’ll have questions for you a little 

later, I’m sure. 

[The prepared statement of Ms. Dierker follows:]

Statement of Lynn Dierker, R.N., Director for Community Institute, 

Colorado Health Institute, Denver, CO 

Thank you for the opportunity to speak to you today. My name is Lynn Dierker. 

I am Director for Community Initiatives with the Colorado Health Institute. 

The Colorado Health Institute is an independent 501(c)(3) created by three Colorado foundations to be an information resource for policy makers at both community 

and state levels. CHI’s mission is to improve the health of Coloradans through informed decision making. To carry out this mission, CHI works to improve the availability of data, conduct policy research and analysis, and perhaps most importantly, 

facilitate the dissemination of information so that it is used most effectively to understand and address the pressing issues affecting our communities and our state. 

As an organization, CHI is distinct in its independence and ability to serve as a neutral convener, bringing together stakeholders with diverse perspectives to work collaboratively to collect, analyze, and discuss data and their implications for health 

improvement in our state. 

I am here to provide brief highlights from a 2004 study of Colorado’s nursing 

workforce and the shortage of nursing faculty that CHI completed at the request 

of the Colorado Center for Nursing Excellence. A copy of the entire study is being 

provided to you as a resource. However, during the next few minutes I hope to put 

into context key findings from the study and discuss their implications, particularly 

as you consider how best to partner with states to promote nursing workforce development. 

The Colorado Nursing Faculty Supply and Demand Study (Study) was designed 

to identify and analyze key factors and issues affecting the supply of and demand 

15

for nursing faculty, including the relationship between nurse education programs 

and the market for professional nurses in Colorado. The Study focuses on four primary areas: 1) economic factors including the economic rewards of teaching; 2) noneconomic factors such as faculty workload, work environment, opportunities for professional development, and faculty educational requirements; 3) the infrastructure 

of Colorado nurse education programs; and 4) the role played by the private sector. 

The Study examined issues related to both licensed practical nursing (LPN) and registered nursing (RN) educational programs. 

The research effort took full advantage of information available in the current 

nursing workforce literature, and also collected primary data from Colorado nursing 

programs and clinical training sites related to the recruitment and retention of 

nursing faculty. An advisory panel of experts informed the study design and methodology. 

I want to highlight key findings from the Study in the context of what you are 

learning about nursing workforce issues nationwide. Colorado’s current nurse faculty shortage is significantly greater than the national average shortage of 8.6 %, 

with shortages ranging from 15% in our four year institutions, to 25% among two 

year institutions including community colleges. 

In the face of a nationwide shortage, Colorado struggles to compete with other 

states to attract faculty due to economic and non-economic factors including compensation levels, workload demands and budget constraints that disproportionately 

affect state-supported higher education. 

With population growth and increasing demand for nursing services, Colorado, 

like other states, has called upon its education system to produce greater numbers 

of nursing graduates. The Study found that nursing education deployed significant 

and rapid program expansions over the past three years in response to the workforce shortage. However, in a number of ways, these expansions exacerbated the faculty shortage and increased job dissatisfaction. Entry level faculty salaries are low, 

especially related to available positions within clinical institutions at higher rates 

of pay. Work loads are heavy especially for clinical instructors who most often work 

on a hourly contract basis without benefits. In this context, concerns are growing 

about faculty attrition due to retirements, which are projected to increase significantly due to the average age of Colorado faculty, especially within the state’s four 

year colleges and universities. Preparing adequate numbers of qualified faculty is 

another corollary issue. The Study reveals a lack of incentives and opportunities for 

graduate level preparation for nurses interested in a teaching role. 

The majority of the state’s nursing programs are publicly funded and are therefore caught up in the current fiscal crisis facing all of higher education in Colorado. 

The Study found that the private sector, particularly clinical facilities employing 

newly graduated nurses (hospitals and long term care facilities), is already spending 

millions of dollars per year to support nursing education. This support takes the 

form of subsidizing clinical faculty; providing clinical instruction; offering scholarships and tuition reimbursement; and expanding clinical rotations to meet the increased demand for clinical training sites. However, clinical facilities report that 

newly graduated nurses are often unprepared to assume the responsibilities of independent practice. Concerns over the quality of patient care require them to provide 

orientation programs to new graduates ranging from four weeks to greater than 

three months and costing in excess of $2 million dollars annually. 

In addition to providing examples of widespread stress and concern related to faculty shortages, Study informants provided a rich picture of the types of innovation 

beginning to take hold within nursing education. These include advances in technology to enhance teaching methods, and collaborative relationships with clinical facilities to strengthen the level of preparedness of new graduates and improve faculty 

job satisfaction. Nursing programs have begun to utilize technology to enhance existing teaching methods and the overall educational experience. Together with clinical training sites, educational programs are striving to develop sustainable collaborative approaches to strengthen the competencies of new nurse graduates. The challenges inherent in these innovative projects are how to successfully achieve technology transfer and ensure widespread adoption of those practices that yield the 

best results. 

The findings from this study point to the need for coordinated and strategic action. A solid foundation of public and private sector collaboration has been established. Reporting new levels of partnership, Colorado’s nursing programs and health 

care facilities are pursuing many of the most promising strategies identified nationally and by other states, particularly related to cultivating an adequate supply of 

clinical faculty. Colorado-specific initiatives designed to support and strengthen faculty roles and resources are emerging. 

16

There are additional opportunities to further the use of non-traditional and multidisciplinary approaches to faculty development such as streamlining graduate program requirements, use of interdisciplinary faculty teams, and expansion of regional 

institutional collaborations. Regulatory and institutional policies warrant further examination related to the continuum of educational opportunities for practicing 

nurses including opportunities to better utilize Colorado’s pool of retired nurse educators. 

As Study informants note, nurse faculty issues are inexorably linked to the complex range of factors that contribute to the overall nursing workforce shortage. 

Other states offer approaches for recruiting and training nurse educators that Colorado should consider. State experiences suggest that it is necessary to dig below the 

surface to address fundamental components of a transformed 21st health care system that can deliver quality health care in a cost-effective manner. These key questions must be answered by each state, but also collectively. What are the numbers 

and qualifications of nurse educators that are needed? What array of nursing education programs is needed to yield the right mix of practicing nurses? What data 

is needed to inform these decisions? 

CHI was charged to provide timely information that would support stakeholder 

decision-making about opportunities and investments in programs and interventions. This study is a starting point for understanding both the contributing factors 

and potential solutions for Colorado’s nurse faculty shortages. It is a snapshot in 

time and highlights the need for more robust, well-defined and reliable data monitoring efforts by which to understand the full picture of nursing workforce supply 

and demand over time and the factors associated with affecting noted trends. However, the findings make it clear that Colorado educators, clinical training sites and 

policy makers face both substantial challenges and exciting opportunities related to 

strengthening not only the nursing workforce, but also the health care system as 

a whole. 

In conclusion, I want to offer observations regarding the important three-way 

partnership that exists between federal, state and local leaders and policy makers. 

At the community level, even in rural areas, nursing educators and clinicians perceive the need for strategic alignment of goals and strategies to meet the health care 

challenges before us. Study informants note that many of the issues related to nursing workforce and particularly faculty development should be addressed by a policy 

framework and resources made available at the national level. At the same time, 

as a system in need of innovation, nursing education must rely on the creativity and 

responsiveness of local and state systems, institutions, and leaders. Collaboration, 

flexibility, funding, and strategic and sustained alignment of efforts are themes that 

emerged from this Study and are offered for your consideration. 

I welcome any questions or comments from the committee. Thank you! 

Mrs. MUSGRAVE. Our next witness is Elise Lowe-Vaughn, and 

she’s the operations director for the workforce programs and the 

Colorado Department of Labor and Employment. She has an undergraduate degree in humanities and has done graduate work in 

counseling. She also helped to develop a multilevel computer literacy curricula for the Electronic Colorado Learning Portal that 

targets the hardest to serve and adult education participants. 

Thank you for being here. 

STATEMENT OF ELISE LOWE-VAUGHN, OPERATIONS DIRECTOR, WORKFORCE DEVELOPMENT PROGRAMS, COLORADO 

DEPARTMENT OF LABOR AND EMPLOYMENT, DENVER, CO 

Ms. LOWE-VAUGHN. Thank you, Members of the Committee. I’m 

honored to speak with you today about the nursing shortage and 

its impact on our economy and the variety of nursing and faculty 

initiatives funded by the Colorado Department of Labor and Employment and the Colorado State Workforce Development Council. 

Colorado’s workforce system is a national leader because of its 

unique collaborative partnerships, its innovation, and its ability to 

embrace the emerging technologies to meet industries demands in 

critical workforce occupations. 

17

Worker shortages in healthcare occupations, particularly in nursing, have been the focus of Federal, state, and local initiatives the 

past several years. 

In Colorado, during the past 3 years, the Colorado Department 

of Labor and Employment and the State Workforce Development 

Council, have funded over $3 million in discretionary workforce investment act and Wagner-Peyser projects that are targeted at improving the supply of nurses and allied healthcare professionals 

and providing career ladders to support advancement opportunity, 

and also faculty development opportunities. 

Some examples of the projects that have been funded include 

scholarships to upgrade bachelors and graduate-level nurses, recruitment of minority and youth populations into the profession, 

development of assessment tools to support students’ ability to succeed in nursing programs, remediation programs to mentor highrisk nursing students, expansion of clinical rotationsites, the creation of associates and bachelors degrees in rural areas, and the 

state community colleges’ nursing program accreditation. 

Concurrently, the Department, acting as a neutral convener of 

industry leaders and educational institutions, held forums around 

the state to identify creative approaches to the nursing shortage so 

that we could positively effect the nursing supply pipeline. 

We solicited the Center for Nursing Excellence to develop the 

Colorado nursing faculty supply and demand study. The findings 

from the study, and the results of the various forums around the 

state, highlighted the need to take the statewide system building 

approach to nursing and faculty development. 

From these conversations, the idea for the Work, Education, and 

Life-long Learning Simulation Center was spawned and a grant 

was requested and funded from the U.S. Department of Labor. This 

technology-based public-private venture weaves together the insights learned from the past 3 years, and has helped us identify a 

5-year multiphase course of action. 

The center will be located at the Fitzsimons Redevelopment Center, and the space was contributed in part from the University of 

Colorado Hospital and partially funded from the state. This center 

will probably be the most sophisticated clinical training facility in 

the country for nurses and for nursing faculty. 

In the first year, we have purchased over a million dollars of 

state-of-the-art equipment. The center will harness various technologies and employ a variety of procedure-specific simulations that 

meld virtual reality and computerized simulation, and transmit 

these via the airwaves using the public broadcast system’s data 

casting. It is anticipated that this national demonstration will expand the depth and breadth of statewide healthcare training, and 

be a template for replication around the country. 

Partners in this grant included Department of Labor and Employment, the State Workforce Council, the University of Colorado 

Hospital, the Center for Nursing Excellence, Touch of Life, the 

Rocky Mountain Public Broadcast System, the University of Colorado Health Sciences Simulation Center, the Colorado Area Health 

Education Center, and all of the collaborations of the many 

healthcare industry leaders, as well as educational facilities around 

18

the state. And we have over 55 partners involved in this, and it is 

a statewide grant. 

Deeply embedded in the state’s holistic strategy for expanding 

and improving the number, the quality, and the quantity of nursing professionals is the nursing faculty development grant. We 

funded this grant with the Center for Nursing Excellence with a 

four-to-one match from our industry and educational partners. This 

initiative seeks to increase the number of clinical scholars, clinical 

instructors, classroom instructors, lecturers, and preceptors. 

Through this 2 year, million dollars project, subject matter experts have partnered to develop curricula and train clinical scholars and preceptors in the use of simulation technology to enhance 

skill-based competencies. 

The Department’s workforce learning management system will 

be a repository for statewide and natural virtual mentor clearing 

house for faculty development support. 

The aforementioned approaches to this health care crisis are examples of what the state workforce development system has developed in response to President Bush’s call for innovative workforce 

solutions, built and sustained through strategic partnerships. 

Critical to all of our efforts are the public-private collaborative 

partnerships, which all of us have been talking about. Though they 

present unprecedented challenges for government and its processes, these unique initiatives afford us the opportunity to confront 

the status quo and build for the future. 

Mrs. MUSGRAVE. Thank you very much for your testimony. 

[The prepared statement of Ms. Lowe-Vaughn follows:]

Statement of Elise Lowe–Vaughn, Operations Director, Workforce Development Programs, Colorado Department of Labor and Employment, Denver, 

CO 

Thank you members of the Committee, I am honored to speak with you today. 

My name is Elise Lowe–Vaughn; I am the Operations Director for Workforce Programs at the Colorado Department of Labor and Employment 

Being competitive in today’s global economy requires innovative workforce solutions. In 2003, the Miliken Institute ranked Colorado third in the nation for future 

technology growth. I am here today to speak to the variety of nursing and faculty 

initiatives funded by the Colorado Department of Labor and Employment (CDLE) 

and the Colorado State Workforce Development Council (CSWDC). These initiatives 

have been targeted to meet industry demands for critical workforce occupations and 

employ emerging technology-based solutions. Worker shortages in healthcare occupations, particularly in nursing, have been the focus of federal, state and local workforce initiatives the past few years. 

In Colorado, during the last three years, the CDLE and the CSWDC funded over 

three million dollars in Discretionary Workforce Investment Act (WIA) and Wagner–

Peyser (WP) projects targeted at improving the supply of nurses and allied 

healthcare professionals, providing career ladders to support advancement opportunities, and faculty development opportunities. Funds were competitively awarded to 

regional workforce development programs that partnered with industry and education to develop locally driven solutions to their healthcare worker shortages. 

Grantees were required to have partners that brought non-federal in-kind or matching funds. Grant funds were intended to seed initiatives that would directly affect 

change at the local, community level. Examples of projects funded include: Scholarships to upgrade two year, four year and graduate level Nurses; recruitment of minority populations and youth into healthcare professions; development of assessment tools geared to assess an individual’s readiness to handle the rigors of nursing 

education programs; remediation programs to mentor high-risk nursing students; 

expansion of clinical rotation sites; creation of Associate and Bachelor degreed programs for nurses in rural areas of the state; and accreditation of the State’s Community College Nursing Programs. 

19

Concurrently, the CDLE and the CSWDC, acting as neutral conveners of industry 

leaders and educational institutions, held healthcare forums around the State to 

identify creative approaches to the nursing shortage that could positively impact the 

nursing supply pipeline. The CSWDC also solicited the Center for Nursing Excellence (CNE) to develop the Colorado Nursing Faculty Supply and Demand Study. 

The findings from this study, and the results from the various forums and funded 

initiatives, highlighted the need to take a statewide system-building approach to 

nursing and faculty development rather than using individual initiatives that 

weren’t able to be replicated on a grand scale or didn’t have the momentum to ameliorate the healthcare worker shortages. 

Galvanized by the results of the statewide healthcare forums, the Nursing Faculty 

Supply and Demand Study, and the locally funded CDLE and CSWDC initiatives, 

many within the healthcare community, have come to see the value added by public/

private alliances. 

These conversations spawned the idea for a grant request to the US Department 

of Labor (USDOL) to create the Work, Education and Lifelong Learning Simulation 

(WELLS) Center. This technology-based public/private joint venture weaves together 

the insights learned over the past three years, and has helped us identify a fiveyear, multi-phased course of action. The WELLS Center will be located at the 

Fitzsimons Redevelopment Center in space contributed by the University of Colorado Hospital, and partially funded by CDLE and CSWDC. It took over eighteen 

months to conceive the design framework for the Center; and it will be one of the 

most sophisticated clinical training facilities in the country for nurses and nursing 

faculty. 

USDOL funded this national model in phases, with first-year funds targeted at 

purchasing a million dollars of state-of-the-art equipment. The Center will harness 

various technologies and employ a variety of procedure specific simulators that meld 

virtual reality and computerized simulation, and transmit this learning via the air 

waves using high-speed data-casting. Through the use of technology, students can 

build their clinical competencies without risk or harm to patients, and faculty can 

hone their teaching skills using cutting edge systems. 

The WELLS Center grant was submitted to USDOL by the CDLE and CSWDC, 

and represents a partnership on a grand scale among government, education, the 

public broadcast system, and industry competitors. Industry and non-federal partners contributed a two-to-one in-kind fund match for all federal funds invested into 

the grant. It is anticipated that this national demonstration will expand the depth 

and breadth of statewide healthcare training and be a template for replication 

around the country. This alignment of resources will afford all a benefit beyond 

their individual means. Partners in the grant included: 

Colorado Department of Labor and Employment 

Colorado State Workforce Development Council 

University of Colorado Hospital 

Center for Nursing Excellence 

Touch of Life 

Rocky Mountain Public Broadcasting System 

University of Colorado Health Sciences Simulation Center 

Colorado Area Health Education Centers 

In addition, investors and collaborators in the Nursing Faculty Development Initiative and Simulation Development Group that played key roles in this process included: 

Adams State College 

Banner Health 

Centura Health Systems 

Colorado Community College System 

Colorado Permanente Medical Group 

Columbine Health System 

Craig Hospital 

Denver Health Medical Center 

Emily Griffith Opportunity School 

Exempla Healthcare 

HealthONE 

Kaiser Permanente 

Mesa State College 

Metropolitan State College of Denver 

Platt College 

Poudre Valley Hospital 

Regis University–Loretto Heights Department of Nursing 

University of Colorado at Denver and Health Sciences Center 

20

University of Colorado, Colorado Springs 

Beth El College of Nursing and Health Sciences 

University of Northern Colorado 

T.H. Pickens Technical Center 

San Luis Valley Regional Medical Center 

St. Mary’s Hospital 

We have learned that the nursing shortage is compounded by a deficit of clinical 

practitioners and faculty needed to train the additional number of nurse needed to 

meet the nation’s healthcare needs. Deeply embedded in the State’s holistic strategy 

for expanding and improving the number, the quality and the quantity of nursing 

professionals is the Nursing Faculty Development Grant. Funded by the CDLE, 

with a four-to-one in-kind match from our industry and educational partners, this 

initiative seeks to increase the number of clinical scholars, clinical instructors, classroom instructors/lecturers, and preceptors. Through this two-year, million dollar 

project, subject matter experts have partnered to develop curricula and train clinical 

scholars and preceptors in the use of simulation technology to enhance skill-based 

competencies. Faculty orientation workshops for the use and application of simulation tools will be developed and held at the WELLS Center, and on-line coaching 

and skill- building workshops will be developed to support the use of various technologies to train educators and clinical staff. In addition, the Departments e–Colorado workforce learning management system portal will become the repository for 

a statewide and/or national virtual mentor clearinghouse for faculty development 

support. 

The aforementioned approaches to the healthcare crisis are examples the State 

Workforce Development System has developed in response to President Bush’s call 

for innovative workforce solutions built and sustained through strategic partnerships. Critical to all our efforts are the public/ private collaborative partnerships. 

Though they present unprecedented challenges for government and its processes, 

these unique initiatives afford us the opportunity to confront the status quo and 

build for the future. 

Mrs. MUSGRAVE. Our last witness is Ms. Kay Norton. I would 

just like to say, President Norton, I very much appreciate you coming to Washington, D.C., and I look forward to working with you 

on issues for the University. I know you have a number of things 

to deal with, but this one today is critically important for our quality of life. And with the growth in Colorado, it sounds very similar 

to the growth in Nevada, Jon, very similar. And demographics 

being what they are, and of course, in the fourth district of Colorado, I serve a vast rural area. Seventy-five percent of the population is up in Weld and Larimer Counties and Boulder County, 

but 75 percent of the land mass is out there in those remote rural 

areas, so some very unique challenges that we’re facing here in 

Colorado. 

Ms. Norton has an undergraduate degree in English and a juris 

doctorate from the University of Denver, College of Law. She joined 

the University staff in 1998 as Vice-President for University Affairs, General Counsel, and Secretary to the Board of Trustees. 

During her tenure at UNC, she has created opportunities to enhance the public health training and service in Colorado. Through 

the Colorado School of Public Health for Rural, Native American, 

Hispanic and Inner-City Populations. We’re looking forward to your 

testimony. 

STATEMENT OF KAY NORTON, PRESIDENT, UNIVERSITY OF 

NORTHERN COLORADO, GREELEY, CO 

Ms. NORTON. Thank you very much, Congresswoman Musgrave. 

And it is a privilege to be here with you and with Mr. Porter, and 

I appreciate the opportunity. 

21

I was at a meeting this morning when I heard for the umteenth 

time a reference to a very popular book by Thomas Friedman called 

‘‘The World is Flat,’’ which is about the fact that we are in a global 

economy, and that from the perspective of a higher education institution, we have to prepare our students for competition on a global 

basis. And the issue of the preparation of nurses and the shortage 

of nursing professionals is a worldwide issue. But we can no longer 

solve that by stealing from each other, or even by recruiting from 

the Philippines, which has certainly occurred in this country. 

So I’m pleased to be able to participate in talking with you today 

about some of the things that we are doing locally in Colorado, regionally in the western United States, and nationally to address 

this critical issue. 

Most of the statistics have already been mentioned, and there 

are also some contained in my written testimony, which you have 

in the record. I would note something that hasn’t been mentioned 

that only 1 percent of the nursing professionals in the State of Colorado have a Ph.D., which is the entry degree required for full faculty status at a university. I appreciate very much Ms. Carparelli’s 

remarks about the importance of higher education institution-based 

preparation of nursing professionals as we go forward, although the 

clinical piece is vitally important. On-the-job-training is not enough 

to really advance the profession and its role in our health care system in the United States. 

The University of Northern Colorado School of Nursing is a microcosm of the issue about faculty retirements. One-third of our 

doctorally prepared nursing faculty retired in 2004 and 2005. And, 

in fact, our current codirector of our nursing program, we literally 

talked out of retirement to come back and provide that leadership 

for us because we knew where she lived. So, she could not escape 

completely. 

But it’s an issue that we have already seen played out here on 

our campus. And it was mentioned that one of the major issues 

that universities and colleges and community colleges face is that 

the market has not served us well in terms of the salaries that we 

are able to pay to faculty. They aren’t appropriate for the responsibility and the learning that’s required, and we have an issue, as 

well, in terms of price sensitivity in terms of tuition that we should 

charge for a professional preparation program for nurses. 

Some programs, you can have differential tuition because the 

market will bear it. Let’s say in a business program or particularly 

at the graduate level. But when you’re talking about a public service profession like teaching or like nursing, it’s a different question 

as to how much should you put on the student in order to bear the 

cost of paying faculty appropriately. It’s something with which 

we’ve wrestled, and we need to take a good hard look at that in 

terms of what the role of state and the Federal Government might 

be in helping us to perhaps shape the market forces, to make the 

adjustments that are going to be necessary for us to compensate 

these professionals appropriately. 

I would like to talk to you a bit today about what the University 

of Northern Colorado has done to respond to the nursing faculty 

shortage. Most prominently, we started 2 years ago an on-line 

Ph.D. Program in nursing education. This is not the same sort of 

22

Ph.D. That one would acquire at the University of Colorado Health 

Sciences Center, for example, where a nursing Ph.D. Is in clinical 

practice areas and research, as opposed to education. The University of Northern Colorado, as many of you know, began as a teacher preparation institution, a normal school in 1889. It is still by law 

the center of our reason for being and our public mission is the 

preparation of education professionals, and particularly at the 

graduate level. 

The program, as I mentioned, was launched in 2004 and it’s committed to increasing the number of doctorally prepared nurse educators. Graduates of the Ph.D. Program are qualified, therefore, to 

fill nursing faculty positions in educational institutions and in 

health care agencies. It was mentioned, also, that the clinical settings in which nurses are employed also have a significant education and continuing education activity and role in our health care 

system. Therefore, the graduates of our program are prepared to 

meet those different types of needs. 

The program is delivered on line. We admitted 18 students in the 

‘04-‘05 ‘‘cohort’’ we call it, a group that goes through together. Another 18 were admitted in ‘05-‘06. 

We’re excited about those possibilities and are looking forward to 

the work that those students are going to be contributing to the research base her and nationally. 

We are also proposing that the University of Northern Colorado 

be the home for a national center for nursing education. We have 

a similar concept in place here at the University of Northern Colorado that—called the National Center for Low Incidence Disabilities, which addresses another critical need for the education of 

educators for the blind and the deaf. And that center, as the Center 

for Nursing Education would do, uses technology to research and 

develop best practices for providing that type of education and disseminating that information, again, using technology. 

Our proposal for the National Center for Nursing Education is in 

collaboration with the Colorado Center for Nursing Excellence, 

which has been mentioned a number of times. The National Council of State Boards of Nursing and other state college and university degree programs in nursing, and it has three purposes: To provide academic programs in nursing education, master’s and postmaster’s certificates, Ph.D. Through course offerings on campus, on 

line, and at outreach sites. Potential outreach sites include locations in the northern, the southern, and the western slope regions 

of this state, especially in rural and underserved areas that have 

community colleges that operate associate degree programs in 

nursing. 

Our community colleges and 4 year schools in these areas have 

attempted to expand their nursing programs, but have the problems that have been described in terms of qualified faculty to staff 

those programs. 

Second, the center would provide professional development opportunities for nurse educators who are in place through summer 

institutes, teleconferences, webcasts, and on-line educational programs. 

And last, we want to establish a national nursing education resource center. Ms. Carparelli mentioned this. That would enable 

23

1MacPhee, M and Scott, J. (2002) The role of social support networks for rural hospital 

nurses: Supporting and sustaining the rural nursing work force. Journal of Nursing Administration, 32(5):264–272. 

nursing faculty to access information and resources pertaining to 

contemporary issues and trends in nursing education through a 

centralized data base, and create a center for evidence-based nursing education; that is research into what works, that will provide 

faculty and graduate students opportunities to work together in advancing and addressing the question of what should nursing education be. Not only what is it now and what are the current best 

practices, but how should it fit into the healthcare system as it’s 

developing given that not only the demographics are changing, but 

the demands and the type of care and the role of the nurse in the 

continuum from physicians down through what used to be called 

orderlies, really needs to be addressed. And we are eager to participate and thinking very hard about, well, what should—not only 

what should a nurse be and how should he or she be prepared, but, 

you know, how do we accomplish that? 

The University has also been partners in developing a multistate 

consortium that’s called NEXUS, N-E-X-U-S. It includes the University of Colorado, the University of Arizona, the University of 

Utah, and Oregon Health Sciences University to develop a mechanism for students to access Ph.D. Courses on line through a collaborative arrangement. 

This is really a sophisticated form of outsourcing, if you will. 

These courses exist. One of these institutions in the consortium 

will have the course material and the means for delivering it. It 

makes no sense to reinvent the wheel and have each state or institution do that work, so we’re very excited about that. 

Our other efforts are listed in my written testimony, so I will 

stop here. I do notice, Congressman Porter, that Nevada—there is 

no Nevada institution listed as a consortium in NEXUS, but perhaps there should be. 

Mr. PORTER. I agree. 

Mrs. MUSGRAVE. Thank you very much for your testimony. 

[The prepared statement of Ms. Norton follows:]

Statement of Kay Norton, President, University of Northern Colorado, 

Greeley, CO 

The Nursing Faculty Shortage 

By the year 2020 the U.S. Bureau of Labor (2003) projects that there will be a 

shortfall of 800,000 nurses. The shortage is more acute in rural areas as it is more 

difficult for rural health care providers to recruit qualified nursing staff; rural 

health care facilities take 60% longer than urban facilities to fill nursing vacancies 1; 

almost half of frontier nurses have the ADN as their highest degree compared to 

non-frontier nurses. Although enrollment in entry-level baccalaureate programs in 

nursing increased 10.6% in 2004 over the previous year, nursing colleges and universities denied 26,340 qualified applications due primarily to a shortage of nurse 

educators (American Association of Colleges of Nursing, 2004). 

The Colorado Center for Nursing Excellence Report, ‘‘The 2004 Colorado Nursing 

Faculty Supply and Demand Study’’ outlines a critical problem. While enrollment 

in nursing schools has increased in recent years, it is stalling now at a critical juncture, because there are not enough faculty to handle the workload. Colorado’s shortage of qualified nursing faculty at its two year nursing schools is three times the 

national average, and nearly double the national average at its four year schools. 

Only 1% of nursing professionals in the state have a Ph.D. 

It is anticipated that the faculty shortage will worsen as the average age of nursing faculty is 53 with increasing numbers of faculty preparing to retire. It is estiVerDate 0ct 09 2002 16:44 May 11, 2006 Jkt 000000 PO 00000 Frm 00027 Fmt 6633 Sfmt 6621 F:\DOCS\EWDOCS\25552.TXT HBUD1 PsN: DICK
24

mated that between 200 to 300 doctorally prepared faculty are eligible for retirement from 2003 to 2012. The University of Northern Colorado’s School of Nursing 

is a microcosm of this problem as one-third of the doctorally prepared nursing faculty at UNC retired in 2004 and 2005. 

The University of Northern Colorado is taking the lead in addressing the shortage 

of nurses and nursing educators. UNC prepares master’s and doctoral nursing faculty through the delivery of an online Ph.D. program in Nursing Education, the creation of the National Center for Nursing Education, and the master’s and baccalaureate degrees in nursing. 

The University of Northern Colorado Online Ph.D. Program in Nursing Education 

The primary mission of UNC’s online Ph.D. in Nursing Education is to establish 

excellence in nursing education. The doctoral program prepares nurses to contribute 

to developing leadership in nursing education, the scholarship of teaching, and education based-research in the discipline. The program is committed to increasing the 

number of doctorally prepared nurse educators. Graduates of the PhD program are 

qualified to fill nursing faculty positions in educational institutions and health care 

agencies. The program is delivered online. We admitted 18 students in our first year 

(04–05) and 18 students in our second year (05–06). The interest in and demand 

for the program has been overwhelming. Although the program is certainly designed 

to address the shortage of faculty in the state of Colorado, students from across the 

country compete for admission to this unique program. Each summer the students 

from UNC’s PhD program come together at the National Nurse Educator Conference 

of the Rockies where they share the latest in educational research and ‘‘best practice’’ with nurse educators from around the country. Last summer, PhD students 

were presented with the opportunity to dialogue with Dr. Patricia Benner, nationally known nurse theorist and researcher. Furthermore UNC’s PhD students have 

been participating in collaborative research efforts with the Colorado Center for 

Nursing Excellence to address nurse recruitment and retention issues in Colorado. 

The University of Northern Colorado’s PhD program and the Colorado Center for 

Nursing Excellence will partner to conduct research to address future issues of importance to nursing education in Colorado. 

We have also been partners in a multi-state consortium, NEXUS, which includes 

University of Northern Colorado, University of Colorado, University of Arizona, University of Utah, and Oregon Health Sciences University to develop a mechanism for 

students to access PhD courses on-line through a collaborative arrangement. 

The University of Northern Colorado’s National Center for Nursing Education 

The UNC School of Nursing, in partnership with the Colorado Center for Nursing 

Excellence, the National Council of State Boards of Nursing, and state associate degree, baccalaureate, and higher degree programs in nursing, is working to develop 

the National Center for Nursing Education. The Center will have the following 

three purposes: 1) Provide academic programs in nursing education (master’s, postmaster’s certificate, and PhD) through course offerings on the main campus in Greeley, online, and at outreach sites. Potential outreach sites include locations in the 

northern, southern, and western-slope regions of the state, especially in rural and 

underserved areas having community colleges that operate associate degree programs in nursing. 2) Provide professional development opportunities for nurse educators through summer institutes, teleconferences, webcasts, and online educational 

programs; and 3) Establish a National Nursing Education Resource Center that will 

a) enable nursing faculty to access information and resources pertaining to contemporary issues and trends in nursing education through a centralized database; and 

b) create a center for evidence-based nursing education that will provide faculty and 

graduate students in nursing education with opportunities for multidisciplinary, 

interdisciplinary, and multi-institutional research in nursing education. 

Other University of Northern Colorado Nursing Programs 

Online Graduate Program in Nursing Education 

UNC’s School of Nursing also offers a Graduate Certificate in Nursing Education 

program online to master’s prepared nurses, matriculated master’s nursing students, and matriculated doctoral students who wish to augment their professional 

studies with advanced coursework in nursing education and academic roles. We 

have 9 new admits in Fall 2005. 

Online RN to BSN program 

Student demand for easier access to the Bachelor of Science in Nursing program, 

particularly in rural Colorado, led to the development of the RN to BSN online program in 1998. The RN to BSN program is 2 year online program for individuals who 

25

have an Associates Degree in Nursing or a Diploma in nursing. The online RN to 

BSN program takes 4 semesters to complete, clinical hours are arranged where students are living, and nurses are able to work full-time while completing the program. Students are admitted every Fall. The program has averaged 12 students per 

cohort. We’ve received 30 applications for Fall 2005. 

Second Degree Accelerated BSN program with local hospitals 

The second degree accelerated BSN program is designed to meet the needs of 

those students who are seeking a BSN as a second bachelor’s degree. Admission to 

the accelerated second degree program is competitive. First priority is given to 

qualified candidates who are committed to living and working in the Northern Colorado area. All applicants are sponsored by and commit to work for a minimum of 

two years at Poudre Valley Health System or North Colorado Medical Center/Banner Health upon graduation. This program is privately funded by these two facilities 

and each system provides financial support to their selected candidates and students complete their applicable clinical courses at the sponsoring facility. Students 

admitted to the second degree accelerated program will be able to complete the 

nursing courses in 20 months (vs. 26). The program has been in place since 2002 

and we admit approximately 18 students each year. 

Summary 

The inception of UNC’s PhD nursing program has been instrumental in laying the 

foundation for increasing the number of highly qualified nurse educators. Our participation in the NEXUS partnership reflects the recognition that UNC provides a 

unique resource in addressing the acute shortage of nurse educators in the region 

as well as the state. In keeping with UNC’s education mission, we have taken the 

lead in addressing the shortage of doctorally prepared nursing educators and will 

be a national leader in nursing education with the creation of the National Center 

for Nursing Education. 

Mrs. MUSGRAVE. It has been brought to my attention that the 

service workers’ union are out in the foyer and I don’t know if they 

can hear me, but I just want them to know that they can submit 

written material for the record and I’d be happy to include that in 

the record today. And if any of the witnesses here will include all 

of your written material, and if you have any other studies or anything that you would like to submit, we’d be happy to have those. 

We’ll go ahead and start the questioning now. I think I’ll start 

with you, Sue, if I may. And you talked about not very many men 

or minorities being attracted to the profession right now. I can 

imagine that it’s a great advantage if a nurse has a second language also, and so there are many benefits for bringing men and 

minorities into the profession, and I’d just like to know strategies 

that you have for bringing more in. 

Ms. CARPARELLI. The statistics that I quoted to you reflect, I 

think the patterns, the historical patterns, which certainly, obviously, nursing has been a profession that has attracted many more 

women than men. What we know is that we are going a better job 

of recruiting both males and females into the profession, and our 

schools are becoming more diverse in their enrollment, both by gender as well as by ethnicity. 

We have observed some interesting trends in our state, and I 

would imagine that they would be consistent with other states as 

well. In relation to the attractiveness of the profession post 9/11, 

there were several things that happened in our country. We had 

tremendous job loss, and that job loss, in our state in particular, 

was experienced by those who were at high educational levels. 

They were knowledge workers. And the other phenomenon that I 

observed was that that experience post–9/11 caused us to really reflect purpose and meaning of work and that folks who had preVerDate 0ct 09 2002 16:44 May 11, 2006 Jkt 000000 PO 00000 Frm 00029 Fmt 6633 Sfmt 6602 F:\DOCS\EWDOCS\25552.TXT HBUD1 PsN: DICK
26

viously been employed, for example, in the tech sector, which was 

very high growth, high paid positions in our state, but perhaps low 

personal fulfillment. 

People who were looking to retool for jobs that were never going 

to return to our economy looked at jobs that provided more personal fulfillment by virtue of service to others. And I think that 

that has been benefited us greatly in terms of the numbers of both 

men and women who have considered these career fields. 

I would say to you that we have very important work to do in 

our K through 12 educational process. If we do not do a good job 

of science and math, foundational skill building, people who may 

have aptitude and interest will not be able to be successful in what 

is a very rigorous academic program. 

And our state, as other states, is challenged by that reality and 

we find ourselves in our schools of nursing, at times, having to do 

remedial work in order to retain very capable students who come 

perhaps not with the essential foundational skills that are required, and we find that in particular within our community college programs. 

Elise spoke about some of the skill building programs that the 

Department of Labor has helped to fund and maintains in our state 

that are essential to that process. 

Mrs. MUSGRAVE. How do you think that’s being communicated to 

K–12 educators and administrators? 

Ms. CARPARELLI. I think that—I think that K through 12 administrators and teachers do understand that these math and science 

skills are essential. I think that they don’t necessarily connect all 

the dots in terms of relevancy to the array of career fields that 

those skills require as foundational. I certainly know that UNC, 

amongst other of our teacher preparation programs, are working to 

assist in that effort, and I know that our school districts across the 

state are looking at curriculum and teaching methodologies that 

will support student learning in that area. 

That said, it’s a long path, and one that we must persist in, not 

just for these health care careers, but for the array of knowledgebased jobs and professions that now are the future of our economy. 

Mrs. MUSGRAVE. I appreciate that. Having served on a local 

board of education, I wish that boards of education around the 

State of Colorado could hear these remarks today. And one of my 

goals as a board member was academic rigor. You know, we know 

that students have—they mature—the maturation levels are very 

difference, and I would like academic rigor in K–12 so that when 

they want to make a choice, they then can. 

And remedial efforts are very expensive and time consuming, 

and you know, we would hope that school boards around the Nation would hear these things, because you’re talking about the 

world being flat, the book and the global economy and the academic 

rigor is so important, again, as you said, not only in this field, but 

for our students to be ready for that global economy out there. 

Thank you. 

Mr. Porter, do you have questions? 

Mr. PORTER. My first question is about getting old. 

Mrs. MUSGRAVE. I thought 47 sounded kind of young. 

27

Mr. PORTER. Sue, I appreciate it. But having crossed that half 

century mark, I think I’m pretty young, but I guess I’m not. 

But thank you all for your testimony today. I actually have some 

questions, and you’re all welcome to answer or if you choose not to, 

that’s OK. But I’m trying to compile some data for my own decisionmaking. 

Maybe it’s in the background, and I read your testimony prior to 

today, but also was looking and may have missed it. But how many 

professional instructors do we need? I know we’re going to be short 

by almost 800,000-some health care professionals in the next 10, 

15, 20 years, but what should our goal be for the professional in 

the classroom? What percentage should we be—what should be our 

goal? 

Ms. DIERKER. I’ll say while we need we need more, one of the 

things that the study showed is that really we don’t have a very 

good baseline, we don’t have really well-defined data elements and 

data collection, so that even among educators in programs, there’s 

been so much rapid sort of change and dislocation and numbers 

and the use of technology and the change from old models of teaching to what we should do with new ways of teaching, using technology, that there are some fundamental questions that we need to 

really get to in terms of what should education look like to prepare 

the competent professional for the 21st century. What does that 

really look like? How do we take advantage of distance learning 

and all of these other things to sort of say there are numbers, there 

are ratios of how many we need? 

What we do recognize, and this is, again, I’m speaking on behalf 

of the informants who really brought it forward out of the study, 

is that we’ve really got to do some fundamental innovation in what 

nursing education looks like to go from the old sort of apprentice 

model to really a really solid professional knowledge worker who 

has real critical thinking skills that can be applied in diverse and 

increasingly challenging settings. 

And so I think that’s where we really need to work with some 

of the leaders in education and practice to really get at your question, which is ‘‘what does the model look like?’’ and then how would 

we project and then collect data over some time and really do that 

in a concerted way with a research agenda that gives us some 

rapid but sound answers. 

Mr. PORTER. What concerns me is we have state-of-the-art operating rooms now across the country, the latest in technology. But 

it seems to me that some of the training may still be from 50 years 

ago or 100 years ago, and I want to make sure we know what the 

goal is. And you say 800,000 professionals, I think there’s a weak 

link and that’s something we need to work on is how we can come 

up with some form of delivery and consistency. 

Ms. DIERKER. Well, and I will say in Colorado, and I’m sure this 

is happening in Nevada, but in states, as everyone’s grappling with 

this, we have some remarkable demonstration projects underway, 

as you’ve heard. And I think we need to be listening and talking 

and learning from them on an ongoing, constant, basis to get at 

your issue of ‘‘what’s the model?’’ and ‘‘what should we be striving 

for?’’ because those are the laboratories where people are trying to 

figure it out, and use these technologies and examples from other 

28

industries, actually, like the airline industry, where they realize 

that you get precision and safety when you use simulation and you 

use certain teaching methods so that pilots don’t make mistakes. 

And so we have some ways to learn about that. And like I say, 

in our study, it showed that even in rural areas and—as soon as 

people are introduced to these technologies and these new teaching 

methods, there is a hunger for them. We just need to—people want 

the support and the help to design curriculum and have resources 

to connect all the dots and have the programmatic sort of institutionalized ways to go at it. 

Mr. PORTER. And by the way, and I appreciate the study, I’m 

sure we could just cross out Colorado and put Nevada and it would 

be almost identical, so I look forward to using this as a resource, 

too. Thank you. 

Anyone else want to comment? 

Ms. NORTON. I might just give you an estimate. If we made no 

changed in how we educate nurses, and I certainly think we do 

need to, everything that Lynn has just described, needs to happen. 

But we do know that 200–300 doctorally prepared faculty will be 

eligible to retire nationally from 2003 to 2012, and so if we were 

going to replace them and expand capacity, we’d be looking at 

needing Ph.D.s in the 100’s or low thousands would be a very 

rough estimate. The number is probably higher than lower——

Mr. PORTER. Excuse me, so what you’re saying is that the status 

quo——

Ms. NORTON. Right. 

Mr. PORTER.—we’re going to lose 300. 

Ms. NORTON. Right. 

Mr. PORTER. And even with status quo, it’s really not enough. 

Ms. NORTON. And that—and status quo hasn’t allowed us to expand programs to meet the need for the 800,000——

Mr. PORTER. Because we’re already short 800,000——

Ms. NORTON. Correct. 

Mr. PORTER.—or whatever it is. 

Ms. NORTON. Correct. 

Mr. PORTER. So you think in the thousands. 

Ms. NORTON. Yeah, in the low thousands, right. Four figures. 

Mr. PORTER. Thank you. And I know it was mentioned earlier 

about the book, ‘‘The World is Flat,’’ and I’d like to reference—if 

I could write a book, and I’m not a very good writer, it would be 

about the world as we know it, even here inside of the boundaries 

of the U.S. I have found that, when it comes to education, whether 

it be higher education, health care profession, or even primary and 

secondary, we have created these paradigms and these little worlds 

and each one has their own thing. You’ve got the school district 

doing their own thing, you’ve got the universities doing their own 

thing, you’ve got local governments doing their own thing, you’ve 

got private sector doing their own thing. And the world really is 

flat right here in Colorado and Nevada and Iowa where I grew up. 

We have everyone in their little worlds, and I think it’s time that, 

as mentioned in the collaborative effort, I think it was mentioned 

here numerous times, that it’s the responsibility for health care for 

local government also. It’s a responsibility for the legislature. Of 

course, they know that they have a role. But we have created little 

29

worlds and little boxes and we’re not crossing over, and I think 

that we need to do a cultural change ourselves as policymakers and 

leaders that health care is as important to the local government as 

it is to the University of Northern Colorado or CU, which we were 

talking about earlier. I hear a lot about CU from my chief of staff, 

but I am very concerned that we also have this paradigm when it 

comes to retired professionals. 

I know Nevada is fastest growing in retirees. Well, there’s a 

wealth of talent in our retiree health care professionals, and as I 

mention that, I guess I’d like to know, is there a program in place 

to help bring those retirees back into educational processes and use 

them in a clinical setting to help train nurses? Is there something 

in place in Colorado for the retirees? 

Ms. CARPARELLI. OK, since I’m the one that raised the age 

issues, I’ll tackle that one. And let me just respond to that first by 

saying that age is important in these very physically demanding 

jobs. That we know that, for example, in an acute care environment, that the physical rigor of being a staff nurse, a direct care 

provider, makes it difficult for people to perform in that role much 

past mid-50’s because of the demands of that job. And so,——

Mr. PORTER. If I may interrupt, what would the average tenure 

be, then, of someone to retire in their mid-50’s? How long would 

they have been in the profession? Is that 30 years, 20 years, 10 

years. 

Ms. CARPARELLI. Well, it would obviously depend when they entered into the profession, and we have many nurses who began 

their educational process right out of high school and have been 

practicing in that profession since that time. 

Increasingly, as you look at the age of our students currently enrolled, we are seeing a much older student population, particularly 

in our community colleges and our accelerated nursing programs. 

We are seeing people retooling, as I spoke about before, from other 

professions to prepare for a new career path within nursing. And 

so they are in their late 20’s to early 30’s as they are starting this 

profession. 

Mr. PORTER. Is it as much age as it is the length of time in the 

profession? Is there just a burnout happening after so many years 

or is it a combination of age and just worn out from the profession. 

Ms. CARPARELLI. I think there are a variety of factors. I think 

that the work environment has many elements that create burnout 

and dissatisfaction for those who work within that environment. I 

think that the increased level of acuity within our—patient acuity 

within the acute care environment means that people are sicker 

and they stay a very short period of time, and so it makes for a 

very intense work experience with little time for the satisfiers that 

those within this profession are looking for in terms of a relationship with that patient. 

I think that there are also substantial cost pressures that providers struggle with that create productivity pressures upon individual care providers that in turn create dissatisfaction on the part 

of those that are in direct care delivery modes. 

I think that there are a whole host of issues that need to be addressed in effort to retain health care providers, nurses, amongst 

them. 

30

We do know that we have to make some modifications in the 

process of work, and we have a variety of initiatives that reflect 

that. If you’ve not heard about efforts, particularly on the part of 

acute care environments to create magnate status, which is an element that focuses on the work environment for the professional 

practice of nursing, and we don’t have necessarily time to get into 

that, but it is an example of efforts being undertaken to substantially modify and make more satisfying and more rewarding the 

professional practice of nursing within the care delivery system. 

That said, as is the case with K through 12 education, we have 

a great deal of work to be done in that regard, and it is essential 

that nurses, as participants in that process, have substantial input 

and say as to how that works for them. Their voice in this process 

is essential. 

There is opportunity for us with the aging; particularly of the 

clinical experts to be able to bring them into teaching roles. What 

we know is that it is imperative that those——

Mr. PORTER. Excuse me, when you say—so I understand—

′′clinical expert’’ is someone that has field training is now in the 

training position? Is that the term you use for teachers. 

Ms. CARPARELLI. A clinical expert is someone who has clinical expertise—current knowledge and practice within a particular area of 

practice. As an example,——

Mr. PORTER. And those are more apt to be the—those individuals 

would be the instructors. 

Ms. CARPARELLI. Those are the people, for example, who may 

have 20 years of experience in labor and delivery, 30 years of experience in labor delivery, and either are looking for a means to augment their practice by adding a teaching component to that, or are 

looking for a way to move into a next stage of a professional career. 

My point is that what we are finding is that these people whose 

job it is to provide care, and who are experts in the delivery of certain kinds of care, are able and willing to participate as clinical instructors, teaching students those clinical skills in partnership with 

their educational institutions when supported through some basic 

orientation, training, mentoring, and coaching around how to teach. 

Now, that said, they will not nor should they ever substitute for 

the kind of folks that President Norton is speaking about as it relates to faculty, but they can augment and support the learning 

and bring to the student experience great expertise and experience 

in certain kinds of clinical areas. 

So it’s an example of the kind of collaboration between practice 

and education that can happen and must happen to create the kind 

of quality learning experiences that students need. 

Mr. PORTER. I have more questions, but I’ll wait if that’s OK. 

Mrs. MUSGRAVE. OK, I’ll bring some forth. Could you comment 

on technology, whichever one wants to, particularly simulation? I 

don’t know who wants to take that. 

Ms. DIERKER. Certainly in the study, we asked our informants to 

what degree they were already starting to and were interested in 

using technology so that I can comment to some degree on what 

came out of the study and some of what I know otherwise just by 

way of background. 

31

But the kinds of technologies that are really emerging now include some of the things that President Norton mentioned, which 

are ways of education that rely on on-line curriculum and sort of 

didactic methods. But in the clinical setting, there are simulation 

technologies that are partially self-directed on-line methods, but 

also involve literally mannequins and lifelike—very life-like mannequins who can provide a kind of experience much like, again, to 

use the airline example, of being in a cockpit where you really have 

a patient and you can simulate situations of physical crisis, birth, 

certain kinds of physical—physiologic states, and students and 

teams of students can literally practice taking care of a patient in 

that environment. 

And so that what you have, then, is a way for an instructor—

for people to not only watch and observe, like the old days when 

I went to nursing school, and you might crowd around a bed and 

get to actually see someone in a certain state. And this way, with 

simulation, you really have students who can go through the entire 

continuum of how you’d care for that patient, have instruction, repeat it, practice it, and get it right. 

And so these are the kinds of technologies that both hospitals 

and schools are putting into place and that they are referring to 

when they talk about trying to rely on technology. 

What the study found is that while you can buy a mannequin 

and you can put it there and say, ‘‘OK, here we have it,’’ there’s 

a lot—there’s a big gap between that and having faculty who know 

how to teach using it and really know how to integrate a student 

who has come in with computer-based background and the simulation technology and integrate all of that into a valuable learning 

experience. And that’s where faculty needs support. 

Mrs. MUSGRAVE. That’s what I was really hoping to understand. 

You know, I see how it could very much improve the quality of the 

education, but what I don’t understand is how it really addresses 

the shortage of faculty, you know. I know that instructors can use 

that, but you still have to have the instructors, I would imagine, 

the teachers there. So, I don’t know if you want to comment further 

on that or not. 

Ms. CARPARELLI. I’d like to comment on that. Your point is exactly right on. The use of these emerging technologies does not take 

the place of the instructor nor does it take the place of learning 

that takes place in the clinical environment. But what it can do is 

to augment the student learning or to rehearse, essentially, things 

that the student will see in the clinical environment in preparation 

for that clinical experience. 

And I think the important point is that faculty need time and 

support to be able to, themselves, learn how to use these emerging 

technologies effectively and they need time to conduct the research 

to determine efficacy relative to learning and outcomes. 

And, again, it’s part of what President Norton referred to in 

terms of evidence-based education. We need to learn how to use 

this stuff effectively, and we’re in many instances at the front end 

in the use of this technology and the faculty experts haven’t yet 

had the opportunity to test it and evaluate it and research it in the 

ways that we have more historically teaching methodology. 

32

So that becomes a very important aspect of what needs to happen as it relates to education. 

Ms. NORTON. If I may add, four of doctoral students in our nursing education Ph.D. Program are focusing on the use of simulation 

technology and nursing education right now. 

Ms. DIERKER. And I just wanted to, again, make a point about, 

I think your issue about how does this really contribute to supply 

and where we’re going to get it. I think one of the things that we 

revealed, which was pretty stunning in our study, when we asked 

representatives from the hospitals and long-term care facilities, you 

know, ‘‘how much money are you really spending on nursing education?’’ And we got a large number. I mean, when you think of $2 

million in a year from the people we surveyed who, you know, they 

range, of course, some of the big systems with the larger numbers, 

but still, that’s a lot where they’re literally putting up money to 

backfill, to support the need for further education and strengthening of those students. 

So to your question, Mr. Porter, about how many do we need, 

when and where? We’ve got to incorporate these sort of methods to 

sort of answer that question, because out there in the practicing 

world, you have these hospital systems that have a large component of their budget going to staff that need to cover their new 

grads just because they can’t practice independently, full practice 

yet, and need to train students. 

And so how many of them do we need, how many could we free 

up? How much do we take a financial burden off of the industry? 

That, of course, cycles back into costs and cycles around to what 

we all pay. 

So, I mean, they’re all interrelated, which is why we’re got to figure an efficiency equation about how we can best educated people. 

Mrs. MUSGRAVE. I was interested, President Norton, when you 

talked about the difference between 2 year schools and 4 year 

schools and the shortage of faculty. Could you address that, please. 

Ms. NORTON. Yes. Well, there are different levels of preparation 

of nursing professionals because a nurse is not necessarily a nurse 

is a nurse. You have the traditional licensure frame of references, 

LPN, more like a 2-year program; BSN—RN, more like a bachelor’s 

program, although they’re not the same thing. This is all something that I had to learn a lot about as we addressed the issue here 

at the University. 

And the 2 year programs produce an AND nurse, who is certainly fully prepared to do many functions in an acute care facility 

and in long-term care facilities, but would not necessarily be prepared, for example, to do work in the surgical units or other more 

sophisticated areas. 

And so as we look at need, we have to look at what sort of nurse 

do we need where and how many and at what level can we adequately prepare those students. So the answer is not simply to say, 

‘‘Well, let’s just have everybody do a 2-year program,’’ because that 

won’t necessarily be the right level of preparation for where the 

need is. 

So it’s another mismatch in this rather complicated picture that 

we have to take a look at. And if I may, I’d like to just mention 

in terms of the issue about technology and how does it help. Our 

33

experience in higher education has been that technology tends not 

to save money so much as it enables us to increase quality and, 

very importantly, increase access and the dissemination of information. But it adds sophistication and it can contribute to quality and 

it can certainly cost a lot of money, but it doesn’t necessarily eliminate the need for human beings and those knowledge workers. 

Mrs. MUSGRAVE. Mr. Porter. 

Mr. PORTER. You’re going to be sorry you invited me today, but 

I’m——

Mrs. MUSGRAVE. Good thing we don’t have the light. 

Mr. PORTER. It’s probably a good thing. I would be in trouble. In 

my approach to public services, I am not an expert; you’re the expert, so I try to learn as much as I can from you. I’d rather hear 

from you than you hear from me. 

But there is a few things. Average tenure; what is it for a professional? How long do they stay in the profession? Is it—I know we 

started to go down that path; is it 10 years, 20 years, 15? I know 

there’s lots of variables, but how long would they stay? 

Ms. CARPARELLI. Are you talking about practicing? 

Mr. PORTER. Practicing. 

Ms. CARPARELLI. Practicing nurses, I think it’s extremely variable, and I think that we can learn a lot by looking at that variability. We have a high rate of attrition from the profession in the 

first three to 5 years out of school. And that has to do, again, with 

a variety of factors, but it’s an important consideration because we 

do not get the full benefit of all of those that we educated. 

Mr. PORTER. As part of that, leaving a family or relocation or 

spouse’s relocation, or some of those things. 

Ms. CARPARELLI. As I said, there are a variety of factors. Some 

leave because it wasn’t what they expected——

Mr. PORTER. Absolutely. 

Ms. CARPARELLI.—and they do not find it be a satisfying work 

environment, they don’t find——

Mr. PORTER. But is it higher in nursing than in other industries. 

Ms. CARPARELLI. I would not feel qualified to fully answer that 

question. I think it would be important to, you know, perhaps think 

about who you wanted to compare that to. 

Mr. PORTER. Yeah. 

Ms. CARPARELLI. I think——

Mr. PORTER. So we don’t—and I hate to interrupt, because I 

know we’re running a little low on time, but so right now we’d say 

we really don’t know an average tenure, right? Is that what I’m 

hearing? That’s something we’d probably need to find out. 

Employer. Who is the largest employer? Is it the hospitals? 

Ms. CARPARELLI. Yes. 

Mr. PORTER. That’s the largest. And I’ll be honest with you, I 

don’t have a lot of sympathy for the private sector when it comes 

to training. I think they share a huge responsibility. I don’t think 

this is just a public sector responsibility to train and to recruit and 

encourage health care professionals. I think industry should be the 

leader in helping find not only the nurses, but the clinical instructor. They should play a bigger role in all of this, so I don’t have 

a lot of sympathy in that they’ve made an investment. That’s their 

responsibility also, because the Federal Government, the state and 

34

local governments, even though health care is a quality of life 

issue, I think the hospitals need to do more, and I’ve heard even 

the hospitals in Nevada talk about the trouble they’re having getting qualified and trained professionals, and well, if you compare 

nursing to other areas in the private sector, the private sector steps 

up and trains people to fit into their profession, whether it be at 

Southwest Airlines, Microsoft, or a Ma & Pa restaurant, they train 

and they feel that they want to have the best and the brightest 

working for them. 

So I guess one thing, and I know that I’m going to carry forward 

with my colleague, is finding ways—where the barriers are to the 

private sector. I’m sure there’s lots of reasons, from the costs and 

there may be more incentives, but they need to step up to the plate 

and help us more than they are, and this is something that I plan 

on working with, and I’d say in a proactive way. I’m not into mandates and penalizing, but we need to find out from the professional—the hospitals what we can do to help them get more involved, because they’re hands on and they need to have some training—more training internally. 

Ms. LOWE-VAUGHN. Representative Porter, one of the things 

that’s so exciting about the partnerships in Colorado is this very 

issue. Our partners from the private sector, the hospitals, the acute 

care, the long-term care, all of these partners, including education, 

have stepped forward and have put together four-to-one matches on 

all of the grants that we’ve been doing. They’re working with all 

of our local workforce regions and private regional collaboratives to 

improve the nursing population and allied health care. So I think 

Colorado is a model for those kind of collaborative partnerships, 

and we’re very pleased that industry has come to the table and 

talked to us about the very issues which started the dialog here. 

Mr. PORTER. And I appreciate that, but I think that the private 

sector can do more. 

Ms. LOWE-VAUGHN. Sure. 

Mr. PORTER. And when I talk about the flat world we live in, I’m 

including the private sector because I do hear from private sector, 

not only in Nevada, but across the country, and their resistance to 

being more involved in training that they want someone else to do 

more. So I applaud those here in Colorado, and I’m sure that it’s 

probably even unique. But I think we can do more, and we can encourage more of that. 

A question, and again, the study is great, and I’ve just had a 

chance to leaf through it and you’ve spent some time, you know, 

talking about what the clinical professional makes in the rural and 

urban areas, but if we could just summarize real briefly. If you 

were to take a practicing registered nurse, where they would max 

out in a salary, if we look at a career path, where they would max 

out as opposed to a trainer or a teacher or a clinical professional? 

How do they compare; the practicing nurse to the professional? And 

you may have touched upon it earlier, but I missed it. 

Ms. DIERKER. Well, we didn’t do a great deal on the study because of the time and the way in which we went about it given the 

issues at hand. But, I would say that especially with the competitiveness for a nurse in the hospital setting now, where salaries and 

bonuses for nurses to be employed in certain settings have really 

35

bumped up the clinical range. I think, you know, I’m going to ballpark, because we don’t have a lot to go there, but I would say even 

starting, you know, you’re going to end up with a differential of 

maybe, you know, it depends where you are, of course, but even 

$10,000. And so then it just sort of widens and it depends on your 

experience and——

Mr. PORTER. So $10,000 more to be an instructor. 

Ms. DIERKER. Clinical—in a clinical—less to be an instructor. 

Less. I mean, we came up with an average salary for an entry-level 

faculty of $39,000. Well, you can go in as——

Mr. PORTER. Well, that’s a serious problem. 

Ms. DIERKER. That’s a serious problem. 

Mr. PORTER. When you look at a career path. 

Ms. DIERKER. And it’s worse in rural areas. 

Ms. NORTON. The gap is really more like $20,000. 

Ms. DIERKER. Right. 

Ms. NORTON. At least. 

Mr. PORTER. How are they, then, compared to other—let me use 

the word teacher. 

Ms. NORTON. Right. 

Mr. PORTER. That’s easier for me. For the teacher compared to 

another field of study, how are they paid; is it similar. 

Ms. NORTON. Our faculty salaries in nursing are at the midrange of our faculty salaries,——

Mr. PORTER. They top out at the mid-range. 

Ms. NORTON.—generally based on market, and that’s why I say 

the market has failed us somewhat in not really recognizing a 

shortage, and I think it will adjust. But, for example, a business 

faculty, the highest paid professors that you’ll find on a campus or 

faculty in a medical school or a law school, the professional—and 

engineers are also—engineering faculty are in very short supply 

and command high salaries, often approaching or into the six figures. And your nursing professional faculty, education faculty, are 

going to be somewhat below that. 

Mr. PORTER. So from a career path——

Ms. NORTON. Yeah. 

Mr. PORTER.—it’s difficult for someone to maybe go backwards. 

Ms. NORTON. Exactly. That’s the issue. That is absolutely the 

issue is our faculty may decide that they want to retire because 

they can make $20,000 or $30,000 a year more going back into clinical practice. And so how do we deal with that gap is an immediate 

issue that we have to figure out how we deal with. 

Mr. PORTER. Again, looking at—the reason we’re here, of course, 

is pretty broad, but specifically to the nursing faculty, you know, 

there’s recruiting problems for new nurses, I mean, there’s four or 

five keys, but when we get down to a career path——

Ms. NORTON. Right. 

Mr. PORTER.—why would someone want to leave—unless they 

were just burnt out and wanted to move on in their profession, why 

would they want to become a faculty member. 

Ms. NORTON. And I think it’s also the job satisfaction and really 

the passion issue that Sue Carparelli mentioned. And maybe they 

just don’t know any better, I don’t know. 

36

Mr. PORTER. And don’t get me wrong, I applaud everyone for 

that. 

Ms. NORTON. It is a matter of finding that kind of satisfaction, 

but obviously there’s no—we have a huge hurdle in terms of convincing individuals that they want to be nursing faculty, although 

we turned away students for our Ph.D. Program because of lack of 

capacity. There’s only so much pin-up demand. I mean, the real 

issue is how do we get some of these younger folks, when you look 

at the numbers of how many—how few practitioners in nursing 

generally are under the age of 30. It’s striking. Therefore, how 

many——

Mr. PORTER. Excuse me, if I can interrupt. I think whatever the 

business profession, people like to have kind of a path and I have 

spent the bulk of my time in public service with primary and secondary education, so I know more about it, and I see a lot of great 

classroom teachers that max out that have to become principals 

and administrators just—not because they really want to do that, 

but they have to for their career path to support their family. 

So I guess the one thing I’m hearing consistently this morning 

and in fairness I applaud those folks that go to the faculty, but we 

need to find a way to elevate that position to help as part of a full 

career path to keep these young folks, when they shoot down the 

road, that there are some things that they could look forward to 

because we need those professionals to go—to become faculty. And 

it’s very difficult, I would think, to make that jump. 

Ms. NORTON. It is, and it’s very challenging and we have to figure out how do we assist the market in figuring that out. I mean, 

certainly we’re willing to do our part. I certainly understand, as an 

administrator of a university, that we’re going to have to figure out 

how we make those adjustments and really respond as a market 

generally would respond to the fact that this is a shortage and we 

have to make it attractive. 

And I think you’ve also mentioned an issue that we see every day 

in the nursing profession and the teaching profession is the people 

going into leadership positions not because they want to be leaders, 

but because of the financial goals that—and needs that they may 

have and the creation of true leaders in these professions is also 

crucial. Leaders and educators. 

Mrs. MUSGRAVE. It’s kind of bewildering to me that this lag time 

in the market is—I don’t know, this seems like an exceptionally 

long lag time, because we’re all seen this coming. You know, we’ve 

been talking about it for years, we know what the demographics 

are, and so this, you know, trying to ascertain why the market has 

not responded more quicker, is kind of bewildering to me. 

Ms. DIERKER. Well, I think one of the things I certainly heard 

in the study is the sense that our constraints on higher education 

in our state, in our fiscal situation related to higher ed, has made 

it difficult for schools to respond by bumping up the salaries. So, 

because most of our nursing programs are publicly funded here, we 

don’t have a lot of private, so that’s been a big issue. It’s a convergence of factors that have really been especially difficult. 

Mrs. MUSGRAVE. You know, I don’t know too many people that 

want to move forward in a career and take less money. 

Mr. PORTER. Well, this is politics, Marilyn. 

37

Mrs. MUSGRAVE. Well, you have a bigger title. 

Mr. PORTER. No, that’s a choice. 

Mrs. MUSGRAVE. You begged for the job, you know. 

Mr. PORTER. That’s true. 

Mrs. MUSGRAVE. Well, I thank you for your testimony today. It 

has been just extraordinary, and I know that the Congressman and 

I both would like to do more with this issue and we expect, President Norton, that you will let us know how we can do that. Again, 

the quality of life issue is out there for the entire United States, 

but it seems that some areas have even more severe shortages than 

others, and we need to address that. 

Congressman Porter, do you have any final remarks you’d like to 

make? 

Mr. PORTER. Well, I could talk for hours, so I won’t. I just appreciate your insights, your comments, your research, because if you 

don’t tell us, as Members of Congress, we don’t know. You know, 

we deal with thousands of issues every day, and I think we’re ADD 

to be Members of Congress, because there are so many issues. But 

I firmly believe there’s not an issue more important to the future 

of our country than our health care. And there’s no one that’s more 

important than the nursing professionals—the professionals in 

health care delivery, and I get the terms wrong, but those folks out 

there that are on the front line, the professionals, and we need to 

find a way to elevate this profession and encourage our young folks 

and those who want a career change to get into the field. 

But I firmly believe there’s not a more important issue for us as 

a country than to focus on getting folks into this field. We can’t afford to have the attrition. We can’t afford to allow the rest of the 

world to move in front of us. But more importantly, we need to 

make sure that, as Members of Congress, we’re able to give you the 

tools you need to get the job done, and that’s why I really appreciate being here, I appreciate your insights, and we’ll take what 

I’ve learned today and move forward. And you will be hearing from 

me more in the future. So thank you all very, very much. I appreciate it. 

And to—we brought staff here from D.C., thank you. 

Mrs. MUSGRAVE. Yes. 

Mr. PORTER. There’s two that came from D.C. I’d like to thank 

our Committee staff for being here today also. Thank you. 

Mrs. MUSGRAVE. I, too, appreciate the staff and their work very 

much. All of those issues that we deal with as Members of Congress, we are very much assisted by our staff and we appreciate 

them so very much. I have one of mine traveling with me today, 

Nina, so Amanda and Nina and whoever else helped out, we appreciate it so very much. 

I think it’s somewhat paradoxical that when we talk about these 

shortages of faculty training the nurses, and we hope more and 

more will come into the profession, men and minorities joining, 

women, I believe the expectations of patients are even higher and 

higher. So we really have an interesting dilemma here. We expect 

quality, excellent health care. And thank goodness there are folks 

that want to get into the profession and those that want to teach, 

so we can have that quality of health care. 

Thank you very much. 

38

Mr. PORTER. Excuse me, Marilyn, can I add one more thing? 

Mrs. MUSGRAVE. Certainly. 

Mr. PORTER. It’s important to note that I think we’re in our infancy and I think now is the time. Even with my concerns, I think 

we’re in our infancy in the future of health care, and that’s why 

what we’re talking about today I think can make such a difference 

in the future, because what’s around the corner with technology, 

and you’ve talked about it this morning, and what’s around the corner in health care, and I just want to again to reiterate my optimism that this is a field that’s changing with a lot of complex 

issues, but you get along very well. We deal with issues where it’s 

divide and conquer, because there are so many folks on issues that 

hate each other. But what’s great about this issue is there is a spirit of cooperation. And I know that we have our—you know, we 

hang our laundry out in different places, and maybe there are 

times that we don’t agree, but that’s another reason why I’m so optimistic about my—what I believe as the challenges for health care, 

because of the cooperation. It’s really refreshing that this industry, 

even with its differences and its competing partners, it really works 

well together. So I wanted to really conclude with saying I think 

we have a lot of work to do, but we’re in our infancy and a lot of 

good things can happen. 

Thank you. I promise I’m finished. 

Mrs. MUSGRAVE. We appreciate your comments very much. 

Thank you for coming to this hearing today, and we appreciate everyone being here. 

The meeting is adjourned. 

[Whereupon, at 11:45 a.m., the Subcommittee was adjourned.]

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