Responding to the nursing shortage: collaborations in an innovative paradigm for nursing education.

Texas, like other states, is experiencing a growing nurse faculty shortage as more educators reach retirement age. A report by the Texas Center for Nursing Workforce Studies (TCNWS, 2007) on nursing education demographics and trends stated that "the loss of ... experienced faculty members would cripple the educational system if there are not enough nurse educators to replace faculty as they retire" (p. 21). An earlier study (TCNWS, 2005) identified two trends as contributing to the nursing shortage: the increasing average age of nurse faculty and the decreasing percentage of faculty under the age of 40. At the onset of the project discussed in this article, the largest nursing program in the state had 50 percent of nurse faculty 60 years of age and older; 70 percent were eligible to retire within five years, and 13 full-time faculty were eligible to retire immediately. Also affecting the ability to produce adequate numbers of nurse graduates is the lack of clinical space for training. Hospitals and agencies are inundated with requests to instruct students in all areas of the health professions. Despite intense work to resolve these problems, it has been difficult to realize additional enrollments of nursing students. SOLUTIONS TO THE IMPENDING CRISIS In 2001, San Antonio city officials convened a health care summit that brought to light the impending crisis of a nursing shortage in the city. As a result, the Methodist Healthcare Ministries Foundation initiated financial support to encourage the growth of nursing programs in the city. Several schools of nursing were fortunate to be recipients of funds, and at least one has been able to maintain increased enrollments. In 2005, a significant portion of the Alamo College bond issue was dedicated to respond to the community's request to increase nursing student enrollment and provide quality education. More than $60 million in local tax funds were allocated to build nursing, teaching, and learning complexes with state-of-the-art simulation labs. These were completed in the 2009 academic year. In 2008, the foundation once again sought ways to support further growth of nursing programs. A proposal was submitted with the intent to increase enrollments and create an innovative paradigm to address the various aspects of the nursing shortage. A three-year award, totaling $4.5 million, was received. The acquisition of financial support for the project added further value to the funds allocated for the building of state-of-the art facilities. AN INNOVATIVE PARADIGM FOR NURSING EDUCATION The goals of increasing qualified nurse faculty, developing new instructional experiences, increasing the numbers of nursing students enrolled, and ultimately increasing the numbers of qualified nurses in the community were all targeted in this three-year project. The first strategy provides opportunities for nurses with baccalaureate degrees to serve as clinical teaching assistants (CTAs) in the simulation lab while pursuing a master's of science in nursing degree. In this way, registered nurses begin to experience a nursing education career. The second strategy includes the use of the simulation lab as an actual clinical experience, permitting increased enrollments without adding to the need for clinical space. A third strategy introduces the concept of the Combination Inpatient and Simulation Clinical Experience, in which best practices are investigated, developed, and utilized. In an effort to be responsive to the multiple learning styles of students, this experience consists of a blend of traditional clinical experiences in the hospital setting and student-centered experiences in the simulation clinical lab. Groups of 15 students are assigned to teams with one master's-prepared faculty member and one CTA. Ten students rotate through the traditional inpatient clinical experience with the faculty member, while five are involved in the simulation clinical experience with the CTA. …