Nursing Education Workforce Research Articles

An Introduction to Faculty Diversity, Equity, and Inclusion for Excellence in Nurse Education: Literature Review.

The diversity of the world's population is increasing, along with the health inequities of underrepresented minority populations. To provide high-quality care to all patients, nurses require an understanding of diversity, equity, and inclusion (DEI) as well as how to implement best practices. Nurse educators are the ones to lead the way for DEI education for students. This paper aims to describe the findings of a literature review that introduces DEI concepts for excellence in nurse education and their related benefits. Best practices for actions to address DEI in nursing education will be described. After institutional review board approval, a literature search yielded 61 articles using 15 distinct keywords in 4 global, peer-reviewed literature databases. Melynk and Fineout-Overholt's (2023) Levels of Evidence guided the process of selecting 26 peer-reviewed articles and resources. Common themes for best practices in DEI were identified. These themes included recruiting underrepresented minority nursing faculty, incorporating DEI into an institution's mission statement, addressing DEI topics in curricula, providing leadership, having a DEI strategic plan, developing education, developing data-based interventions, instilling policy change, partnering in outreach, targeting impact on hiring committees, recognizing DEI work, and providing mentorship. In summary, this literature review provides several strategies to address DEI for nurse educators. Committing to DEI efforts and improving diversity in the nurse educator workforce are integral steps in improving the quality and inclusivity of nursing education and ultimately improving the health of our communities.

Effectiveness of an Occupational Well-being Intervention Among Nurse Educators: A Quasi-Experimental Study.

Occupational well-being supports the retention of the nurse educator workforce and their ability to manage workload. There is a research gap regarding interventions promoting occupational well-being. To evaluate the effectiveness of an 8-workweek digital occupational well-being intervention using self-conducted exercises among nurse educators in secondary vocational nursing schools in Finland. A quasi-experimental study design was applied using an intervention group (n = 37) and a control group (n = 40). Data were collected at baseline, post, and 1-month follow-up using a questionnaire and a heart rate sensor to assess the resource-workload-balance and its associating and promoting factors. This study found no statistical effects on the resource-workload-balance. Positive effects were found on associating factors (general well-being) and promoting factors (recovery experiences and self-regulation). Self-Help INtervention for Educators (SHINE) has the potential to promote recovery experiences during working hours; however, the intervention needs more investigation.

Let's Co-create a Sustainable Nurse Educator Workforce Development Plan.

Let's Co-create a Sustainable Nurse Educator Workforce Development Plan.

Developing New Clinical Nurse Specialist Educational Opportunities in Ambulatory Care Settings

Purpose The purpose of this project was to develop an ambulatory clinical practicum for clinical nurse specialist (CNS) students in rural and underserved Eastern North Carolina. Description of the Program A 14-week clinical practicum was designed for CNS students who participated in a Health Resources and Services Administration Advanced Nursing Education Workforce grant–sponsored program entitled “Advanced Practice Registered Nurse RURAL Scholars Program.” The objectives of the clinical practicum were to increase student competence in ambulatory care, identify critical knowledge and competencies in CNS ambulatory care, and determine potential opportunities for CNS practice in ambulatory settings. Outcome Students demonstrated increased awareness and interest in specific health challenges faced by rural and underserved communities and became aware of services available for individuals with complex healthcare needs. Deficiencies in the CNS curricula regarding ambulatory care were identified by students. Although the value of the CNS in ambulatory practice was appreciated by students, staff, and preceptors alike, opportunities for employment in ambulatory settings in rural and underserved communities continue to remain a challenge. Conclusion Student experiences in an ambulatory care CNS clinical practicum support the need for the development of knowledge and competencies in ambulatory care that will allow for the expansion of CNS practice in rural and underserved communities.

Simulating Treating in Place in Long-Term Care: Interprofessional Team Care Video Case for Nurse Practitioners

As a means of enhancing clinical simulation opportunities for adult-gerontology nurse practitioner students, a series of video simulations were created for use for nurse practitioner education. With funding through the Health Resources and Service Administration (HRSA) Advanced Nursing Education Workforce grant and partnering with nurse practitioner clinical educators from Optum Health Care, a video simulation focused on the concept of treating an older veteran within a long-term care facility rather than transferring to the acute care setting was developed. The case Treating in Place: Nurse Practitioner-Led Team Management of a Long-Term Care Patient Video involved a nurse practitioner collaborating with a physician, a registered nurse, a social worker, and a family member. The interactive simulation video was developed using the eLearning authoring tool H5P to create learning experiences for students that can be used either in face-to-face classroom experiences or embedded in learning management systems. H5P is a web-based authoring tool that helps faculty build interactive course content. H5P activities provide instant feedback to students, allowing them to self-assess their understanding of the dynamic video simulation case. A faculty handbook that describes the case scenario with the interactive questions and suggested discussion questions is available. The adult-gerontology primary care nurse practitioner competencies addressed for this case are identified in the faculty handbook. These videos have been widely disseminated and are being included in nurse practitioner curriculum across the country. A QR code with access to direct viewing of the video will be included in the presentation.

The association between the practice environment and selected nurse educator outcomes in public nursing education institutions: A cross-sectional study

AimThe purpose of this study is to describe the association between the practice environment and nurse educator outcomes (burnout, engagement, incivility, job satisfaction and intention to leave) in public nursing education institutions in the Gauteng province of South Africa. BackgroundThe practice environment holds the most promise for recruiting and retaining a qualified and engaged nurse workforce; however, the association between the practice environment and nurse educator outcomes has been relatively unexplored. DesignCross-sectional design. MethodsThe Gauteng province was purposively selected, as it has the highest number of public nursing education institutions in South Africa. All-inclusive sampling was applied to public nursing educations institutions in Gauteng province (N = 6) and then to Heads of Department (N = 30; n = 17) and nurse educators (senior lecturers [N = 162; n = 45] and lecturers [N = 257; n = 80]). Data were collected during March to November 2018. The data were collected using the Practice Environment Scale of the Nursing Work Index; Maslach Burnout Inventory - Educators Survey; Utrecht Work Engagement Scale (UWES); Incivility in Nursing Education-Revised (INE-R); job satisfaction and Propensity to Leave Scale. ResultsThe results show that nurse educators are an aging population, with limited numbers having master’s and doctoral qualifications. The most job dissatisfaction is regarding wages (M=2.0; SD 1.07); appreciation, recognition and rewards for good work (M=2.1; SD 1.01); and opportunities for advancement (M=2.2; SD 1.01). The nurse educators do not experience their public nursing education institutions as having a positive practice environment. Nurse educators experienced high levels of work engagement, moderate levels of burnout and low levels of incivility, that were highly correlated with the subscale of foundations of quality outcomes. They experienced moderate levels of job satisfaction but did not intend to leave their places of employment, which was highly correlated with the subscale of manager’s ability, leadership and support. ConclusionsA positive practice environment improves nurse educator outcomes. The subscale of foundations of quality outcomes and manager’s ability, leadership and support had the most impact on nurse educator outcomes, thus quality teaching practices should be cultivated and recognised; and managers must have the necessary skill and knowledge to lead effectively, while also including nurse educators in decisions that impact them and involving them in the affairs of the nursing education institution. There is a shortage of qualified nurse educators globally and in South Africa and urgent attention must be given to factors that influence the recruitment and retention of nurse educators. Twitter abstractThe practice environment holds the most promise for recruiting and retaining a qualified and engaged nurse educator workforce, especially regarding foundations of quality outcomes and manager’s ability, leadership and support.

ANEW Project to Develop and Support Rural Primary Practice

South Dakota is one of the nation’s most rural and frontier states and has the highest proportion of rural dwellers in the Midwest. Many of the state’s counties suffer from provider shortages, with nurse practitioners increasingly being called upon to fill the role of the primary care provider in clinics and critical access hospitals. However, family nurse practitioner (FNP) education programs are not required to provide the training and skills necessary to meet the unique challenges of rural practice.
 An Upper Midwest land grant university prepares both masters and doctoral FNP students to fill primary care provider needs in South Dakota and the surrounding region. The purpose and scope of this two-year Advanced Nursing Education Workforce (ANEW) project was to enhance an existing academic/practice partnership to prepare primary care advanced practice registered nursing (APRN) students for practice in rural and/or underserved settings in the state and region. The ANEW project provided FNP students with a longitudinal primary care clinical traineeship experience in rural clinical settings.
 Trainees benefited from traineeship funds, learning advanced procedures and skill concepts through attendance at a series of educational workshops, and job placement efforts postgraduation. The ANEW project also provided for a comprehensive preceptor development collaborative designed to enhance competence and confidence for independent rural practice and facilitate job placement in rural communities after graduation.
 This project strengthened the quality of FNP education through an academic/practice partnership which resulted in a symbiotic, synergistic relationship to address rural work force supply and the identification of the knowledge and skills needed for current and future rural healthcare providers.
 Keywords: family nurse practitioner, education, preceptor, academic, practice partnership, rural primary healthcare, healthcare provider shortage
 DOI: https://doi.org/10.14574/ojrnhc.v21i1.649

Nursing higher education mergers: Do the benefits outweigh the risks?

Merger as an organizational change has the potential to create turmoil, unrest, and uncertainty among the employees. Despite the shortage of nursing education workforce, global economic hardships have brought on a recent increase in nursing higher education mergers. The focus on integrated operations of the newly merged organization can burden all involved. Financial and business survival factors can create an unintentional oversight of the employee feelings. Nursing education faculty and administrator’s quality of work lives are related to their performance, which ultimately determines organizational performance. The purpose of this qualitative case study was to evaluate the influence of a nursing higher education merger on the quality of work lives of faculty and administrators. Principal results of this research revealed that faculty and administrators perceived the influence of the nursing higher education merger to be negative in the beginning with a transition to a positive influence over 5 years. Challenges in this merger were related to cultural integration and the magnitude of work required for operationalization. Exact timing of transition of the negative influence to positive was not established and needs further research. These results have implications on the nursing higher education institutions planning future mergers. Nursing education leaders must utilize strategies to address the quality of work life factors during the nursing higher education mergers. Implications of maintaining quality of work lives during an organizational change has the potential to address the nursing and nursing education workforce issues.

Faculty Formation: Philosophical Perspectives, Issues, and Considerations

With a looming nurse faculty shortage, it is imperative that schools of nursing develop and maintain the nurse educator workforce to meet the demands of today’s complex healthcare system. One component needed for workforce preparation is structure regarding formation of the faculty role. This article first defines faculty formation and why faculty formation is a relevant philosophical issue within nursing education. Next, we discuss current issues in faculty formation including: educational training; the orientation process; mentorship and role modeling; communities of practice; and faculty workload. We offer brief exemplars to illustrate current concerns with formation that faculty experience during role transition and recommend considerations for nurse leaders to support faculty formation.

An Exploratory Study of Bullying Directed Toward Clinical Nursing Faculty: Prevalence and Impact.

Clinical education is an integral component of nursing education and relies heavily on clinical nursing faculty (CNF). However, there are not enough nurses seeking CNF positions to meet the current demand of the nursing workforce. The purpose of this study was to examine the prevalence and impact of workplace bullying directed toward CNF. For this exploratory cross-sectional study, a web-based survey was distributed to CNF working in New England states. A total of 76 participant responses were analyzed. Eighteen percent of the participants met the criteria for being either occasionally or frequently bullied. Nursing staff in the clinical agencies and colleagues and administrators in the nursing program where CNF teach were identified as the most frequent perpetrators. Understanding the prevalence and impact of bullying of CNF helps inform the development of strategies to support and retain these essential members of the nursing education workforce.

Using Participatory Action Research to Explore the Nursing Academic Work Environment

Abstract Aim Engage faculty in conversations about their work environment to identify perceptions of their academic work environment (AWE) over a three-year period. Background Research pertaining to the clinical work environment is prevalent, however there is a paucity of research investigating the nursing AWE. Method Fifteen faculty were interviewed and involved with a participatory action research (PAR) study. Results Faculty identified four themes: (1) faculty need to be engaged in defining healthy work environments (HWEs); (2) faculty identified challenges in developing and maintaining a HWE; (3) “time and space” are required to focus on HWE; and (4) respect for colleagues and care of self are essential for maintaining a HWE. Conclusions This study identified characteristics of an AWE. It adds to the existing literature on HWE by including the academic setting. The study findings contributes to nurse educator workforce development by providing practical information for nursing educators, academic administrators, and faculty preceptors. Many future recommendations will continue to add to this body of literature.

PROGRESSIVE CARE OF AN AGING WOMAN: INTERACTIVE VIDEO SIMULATION CASES SPANNING 15 YEARS

As a means of enhancing experiential educational opportunities for adult-gerontology nurse practitioner students who are prepared to manage the complex care of older adults, interactive simulation videos were developed using the eLearning authoring tool H5P to create learning experiences for students that can be used either in face to face classroom experiences or embedded in learning management systems. H5P is a web-based authoring tool that helps faculty build interactive course content. H5P activities provide instant feedback to students, allowing them to self-assess their understanding of the dynamic video simulation case. With funding through the Health Resources and Service Administration Advanced Nursing Education Workforce grant, four video simulation cases were developed that address emerging chronic care conditions in an older women who aged 15 years presenting initially with signs of hypothyroidism, progressed to early frailty, through moderate dementia and eventually along with her daughter face end of life health care issues. Partnering with the university instructional design experts, nurse practitioner faculty created questions that were inserted throughout the video as a means of keeping students engaged in problem-solving and decision making. A faculty handbook that described the case scenario with the interactive questions with suggested discussion questions was developed for each video simulation. The adult-gerontology primary care nurse practitioner competencies addressed in each case are identified in the handbook. Recommendations for the interactive question format will be presented and QR codes with access to direct viewing of the videos will be presented on the poster.

Unique experiences of direct entry BSN/BS-PhD nursing students: A Delphi study

BackgroundGiven the aging nursing education workforce and the persistent high demand for doctorally-prepared nursing faculty, there is a critical need to increase the number of nurses entering and completing PhD programs. To fill this need, accelerated PhD education pathways, such as the direct entry BSN/BS-PhD education pathway, have become popular. ObjectiveThe objective of this study was to explore the unique characteristics of the direct entry BSN/BS-PhD student experience. This study defines and details the experiences of current and past direct entry BSN/BS-PhD students. DesignThis was a qualitative, descriptive study. SettingWeb-based journals and feedback. ParticipantsOur sample includes four former and current direct entry BSN/BS-PhD students. MethodsWe used the Delphi method to first analyze participants' journal entries on their lived experiences, and then iteratively summarize and classify the experiences into summative themes. ResultsWe found four themes unique to participants' experiences: commitment to science, nursing identity, exploring prospects, and balancing family and student expectations. ConclusionsTo ensure that BSN/BS-PhD students have a high-quality education, nurse leaders should be aware of the unique perspectives of direct entry BSN/BS-PhD students. Results from this study can be used to evaluate BSN/BS-PhD programs from students' perspectives.

Nurses for Wisconsin: A Collaborative Initiative to Enhance the Nurse Educator Workforce.

Wisconsin, like much of the nation, is currently suffering from a growing nursing shortage. The University of Wisconsin-Eau Claire College of Nursing and Health Sciences, in partnership with the University of Wisconsin-Madison, University of Wisconsin-Milwaukee, and University of Wisconsin Oshkosh nursing programs, took advantage of a University of Wisconsin System Incentive Grant for economic and workforce development to address this problem. With a $3.2 million award, the Nurses for Wisconsin goal is to increase the number of baccalaureate registered nurses by expanding the nursing education capacity within the University of Wisconsin System. Nurses for Wisconsin is accelerating the preparation of nursing faculty by supporting nurses to enroll in doctor of nursing practice or nursing doctor of philosophy programs with pre- and postdoctoral fellowship awards ranging from $21,500 to $90,000 and the recruitment of faculty with a loan repayment program of up to $50,000. In exchange for the financial support, fellows and faculty must make a 3-year commitment to teach in a UW System nursing program. Two conferences for program participants are also funded through the award. The first conference was held in October 2014. The second conference is scheduled for summer 2015. With the first year of the 2-year project completed, this article describes Nurses for Wisconsin from inception to implementation and midterm assessment with a focus on lessons learned. A follow-up article addressing final outcomes and next steps is planned.

A Pilot Study to Explore Nurse Educator Workforce Issues

As the demand for nurses continues to rise, the recruitment and retention of qualified nurse educators (NEs) is essential. The purpose of this descriptive study was to explore NE workforce issues using the Faculty Satisfaction Survey at a single nursing program. Respondents were somewhat to very satisfied with their job; however, they were less satisfied with salary/compensation and stated they would leave academia for higher wages. Satisfaction differences were noted between full-time and part-time NEs. Job motivators may be the key to recruitment and retention of NEs and a way to avoid a nursing shortage crisis.

Factors Influencing Recruitment and Retention of Nurse Educators Reported by Current Nurse Faculty

Nursing education will have to increase the number of new nurse graduates by 30% a year over the next decade to meet the growing demand for registered nurses. Building the nursing education workforce has become imperative. Strategies for recruiting and retaining nurse faculty have been outlined, but we do not know which are effective. This descriptive study used a nationwide Internet survey to ask teaching nurse educators what they believe are effective strategies to increase the number of nurse faculty. More than 2,100 associate degree in nursing, bachelor of science in nursing, master's, and doctoral nurse educators participated. Although the majority of the participants were White females age 46 and older, the proportions of men and minorities in the group younger than 46 years were twice that of the older group. The respondents said that they became nurse educators to work with students and to help shape the nursing profession. They identified 11 effective recruitment strategies and 14 effective strategies in retention. They confirmed that compensation inequities threaten the future of the profession. They recommended further study in building diversity, collaborative practice relationships, and salary parity while further evaluating the effectiveness of recruitment and retention strategies.

Findings from the 2009 Faculty Census: study confirms reported demographic trends and inequities in faculty salaries.

Since 1962, the NLN has periodically conducted a faculty census survey designed to gauge the size and characteristics of the nurse educator population, including demographic characteristics, distribution by rank, credentials, and program type, and the number of vacant positions. The 2009 Faculty Census was administered as a subsection of the spring 2009 Annual Survey of Schools of Nursing. Responses were accepted between May and September 2009 and data reflect the nurse educator population as of February 2009. Because an increasing quantity of instruction in nursing education programs is performed by individuals who lack formal faculty status, the 2009 Faculty Census survey broke with past practice, asking schools to report on instructors at all ranks and in all faculty status categories, rather than on faculty alone. We are hopeful that this more expansive format provides the most complete picture possible of the contemporary nurse educator workforce. To supplement this synopsis, a comprehensive set of tables and figures is available in a variety of easy-to-use electronic formats at the NLN DataView[TM] website (www.nln.org/research/slides). Demographics AGE Both the percentage of faculty ages 30 to 45 and ages 46 to 60 dropped by 3 percent between 2006 and 2009. At the same time, the percentage of full-time educators over age 60 grew dramatically, from only 9 percent in 2006 to nearly 16 percent in 2009. Overall, 57 percent of part-time educators and nearly 76 percent of full-timers were over the age of 45 in 2009. Fourteen percent of full-time nurse educators belonged to a racial-ethnic minority in 2009, in comparison with 10.5 percent when the last faculty census was conducted in 2006. However. a great deal of that difference is likely attributable to the most recent survey's inclusion of educators without faculty status. Although race breakdowns within rank were not available in 2006, in 2009 the percentage of African-American and Hispanic faculty was about one percent higher among junior faculty (instructor and assistant professor ranks) than among senior faculty (associate professor or professor), suggesting that inclusion of nonfaculty in the 2009 survey would indeed boost the number of minority educators reported. Given these survey changes, comparing the diversity of the nurse educator population with that of the general United States postsecondary faculty population offers a useful, alternative reference point. The 2009 faculty Census found that nurses had slightly larger proportions of African-American colleagues--with 7.5 percent among full-timers and 8.5 percent among part-timers--and Hispanic representation was similar to that found among academies overall. However, Asians were strikingly underrepresented among nurse educators, at less than half the level found more broadly in academia. A glance at the racial-ethnic distribution of the US female civilian labor force does more to underscore the gulf between nursing education and the rest of the American working population in terms of diversity. In 2009, almost 13 percent of female worker's over age 20 were African American, a proportion that dwarfed the fraction of African Americans found in nursing education (approximately 8 percent). And a similar percentage of the female labor force was Hispanic, nearly triple the proportion of Hispanics found among nurse educators. (See Figure 1.) Salaries Despite a national shortage of nurse educators, the salaries of nurse educators in 2009 remained notably below those earned by similarly ranked faculty across higher education. This was true at almost every rank. At the professor rank nurse educators suffer the largest deficit, with salaries averaging 45 percent lower than those of their nonnurse colleagues. Associate and assistant nursing professors were also at a disadvantage, earning 19 and 15 percent less than similarly ranked faculty in other fields, respectively. …

Expanding Diversity in the Nurse Educator Workforce

Abstract In January 2008, the NLN convened a think tank to help conceptualize strategies for expanding diversity in the nurse educator workforce. Co-facilitating the think tank were Sr. Rosemary Donley, PhD, RN, ordinary professor and director of community and public health nursing at the Catholic University of America, and Francis Henderson, EdD, RN, director of the Jackson Heart Center. Other representatives, nurse leaders recognized for their experience, advocacy, and devotion to building diversity in nursing education, were: May Mayor, Beverly Patchell, Drs. Rumay Alexander, Bronwynne Evans, Audwin Fletcher, Diane Mancino, Cheryl Taylor, Sara Torres, Antonia Villaruel, and Lin Zahn. Also participating were NLN CEO Dr. Beverly Malone and president Dr. Elaine Tagliareni.

Cultivation of a Scarce Resource: Nursing Faculty

President 's Message While the growing crisis in the shortage of nurses continues to receive national attention, the concurrent concern regarding the adequacy of qualified for schools of nursing is escalating. Most schools of nursing, at all levels of educational endeavor, are reporting recruitment issues. Some of these difficulties are related to specific content areas, while other schools report a complete inability to fill vacant nursing positions. The factors underlying this scarcity are multiple and interrelated. Although the development of higher education in nursing historically included an option at the graduate level to emphasize teaching of nursing and the role, opportunities in advanced practice shifted the emphasis in graduate education to refinement of the clinical role. This trend has had a strong and positive effect on improving the provision of primary and acute care services available to our patients. During the nineties, as these changes in nursing education occurred, there was a commitment and belief that doctoral education would expand, and that recruitment would be accomplished through an anticipated pool of new members. Unfortunately, the expansion in doctoral education has not been adequate to compensate for the graying of the faculty and their retirement, nor to offset the attractiveness the advanced practice role has for many nurses in preference to a career in higher education. Certainly, a number of qualified nurse practitioners combine their love of practice and their commitment to education in a dual emphasis for their careers. There are too few of these individuals, however, to fill the mounting void in a prepared nurse education workforce. The NLN is concerned about these trends and committed to being responsive to the needs of and for nurse faculty. The establishment of the Nursing Workforce Development Advisory Council is indicative of this awareness. The purpose of NWDAC is to provide leadership for the advancement of the lifelong learning goals of nurses whose primary role is education in academic, practice, or other service settings. Specific goals include the development of action plans to recruit and retain individuals in the nurse educator role, promote the value of educational practice, and foster the development of the nurse educator workforce. A number of task forces will be established to accomplish NWDAC goals and assist educators in achieving the support they need to provide excellence in instruction. Many of the new members of the academic community in nursing have had little, if any, preparation for the role. As a result, they must develop the basic skills of teaching, including course and curriculum development, testing and evaluation processes, and dimensions of the role in the overall development of the discipline within the academic setting. …

Nurse recruitment and retention: Imperatives of imagining the future and taking a proactive stance

The need to imagine, examine, study, take a proactive stance in regard to and make a steadfast commitment to the future of nursing has never been more imperative. As Bezold et al. (1999: 4) persuasively argue, the nursing profession (and others) have:never had a greater need to understand the future, to envision a preferred future, and to develop strategies to create the preferred future than it does today. Vision and commitment are needed more than ever.The reasons for this are twofold. First, the nursing profession world-wide is facing a crisis in recruitment and retention. This crisis, widely recognised as involving 'the worst nursing shortage in the last 50 years' (Hodges et al. 2002), is having a significant and negative impact on health care and the capacities of the health care systems around the world (including the Australian health care system) to respond appropriately, safely, and effectively to the health needs of the individuals, groups and communities they serve. There is a critical need for stakeholders to collectively and creatively 'think and work' their way out of this crisis.A second key reason is that the health, welfare and well-being of both current and future generations depends on the access, equity, quality and viability of professional nursing services. The accessibility and sustainability of quality nursing services, in turn, depend on nursing futures work and the capacity of this work to 'confront the will to act' in regard to the realisation ol a preferred healthier future for all (Bezold et al. 1999: 4). In sum, the future of nursing is imperative because:Nursing's future is inextricably, and rightly so, bound to society's future and the future of health care. (Bezold et al. 1999: 8)AUSTRALIAN HEALTH CARE CRISISFew would disagree that Australian health care is in a crisis. Despite policies that advocate access and equity to Australia's health care services, thousands of Australians do not have timely access to appropriate and effective health care. Furthermore, as is the case in the United States of America, in Australia:* health care costs are increasing, in spite of efforts to contain costs;* quality of care is decreasing in spite of increasing regulations to enhance quality care; and* the existing health care system is reactive rather than proactive (Jardin 2001: 615).A key contributor to the present crisis in Australian health care is the local and global shortage of registered nurses (Duffield & O'Brien-Pallas 2003; Preston 2006). This shortage is not only affecting patient care delivery, but also the education of nurses on account of their being a commensurate decline in the nurse educator workforce - a problem that has not yet been formally recognised or strategically addressed in Australia.In Australia, nurses constitute the largest group of health care professionals, with 30% being employed in the health care sector (National Review of Nursing Education 2001 : 10). Nurses provide care across the continuum of care and work within a wide range of models of service 'which are constantly evolving due to advances in science and technology, consumer expectations, an aging population and the drive to find efficiencies in an industry where expenditure continues to increase' (National Review of Nursing Education 2001: 10).The current nursing shortage is serious. Not only does the shortage of nurses threaten the quality and safety of patient care (Duffield & O'Brien-Pallas 2003), but also 'the economic viability of the hospitals and other health care agencies where [nurses] are employed' (Hodges et al. 2001: 15). As the Key Performance Indicators (KPIs) of most Australian hospitals currently demonstrate, when there are insufficient numbers of registered nurses available, beds have to be closed, wait times in emergency departments increase, ambulance by-pass rates increase, delays are experienced in elective surgery as well as emergency surgery, intensive care admissions, and general medical-surgical admissions - all of which have a significant (negative) effect on a health care facility's funding entitlements and overall economic performance. …