At what cost? Stewardship of our most important resources

Article Outline

• References
• Copyright

• 
  • View Large Image
  • Download to PowerPoint

• Marion E. Broome, PhD, RN, FAAN

“Costly thy habit [dress] as thy purse can buy; But not expressed in fancy–rich, not gaudy. For the apparel oft proclaims the man.”

— William Shakespeare, ‘Hamlet’ Act I Scene III

The current economic challenges in higher education are like few, if any, we have experienced before. In past recessions, universities may have delayed or passed over annual raises, but rarely did faculty find themselves in the position of being furloughed or having a permanent pay reduction levied. Now, in some disciplines, faculty have even been “let go” and entire departments closed. Fortunately, this has not happened in nursing—yet. As a citizen of one of the few states that have come late to the downturn, I am often silent but carefully listen to my dean colleagues as they discuss how financial events have affected them, their faculty and schools. They share, with much consternation and discomfort, the painful decisions they have made—and will continue to make—to reduce costs while trying to maintain productivity and quality. That is quite an order. Oh, we have been there before. But this time it is about more than just money. It is about people, time, effort, and conserving the resources we have.

It appears the timing could not be worse. Many factors have converged that make current financial constraints very challenging. The reality is that 90-95% of a budget in most schools of nursing provides for compensation of faculty and staff. There is little “fat” to trim and still maintain the critical missions of teaching, research, and service. Almost every school in the country has expanded student numbers over the past 5 years to meet the demands for more nurses in practice.¹ Not only are many faculty approaching retirement age, but there is a small pool of qualified faculty available to take their place, especially in senior universities that must meet critical research missions and support PhD programs.¹ And as healthcare facilities also face cost-cutting measures, they have fewer nurses to provide to schools to precept and/or provide for clinical instruction at both the undergraduate and graduate levels. Faculty members have developed many creative and innovative approaches over the past several years to address these issues. But there comes a time (and I believe we are there) when even those approaches can't address the larger constraints facing the profession. Some of which we have created ourselves. Finally, it is becoming clear in many parts of the country that graduates are having difficulty finding employment.

Deans are often told that reducing student admissions is not an option, especially if the university relies on undergraduate tuition dollars. Many believe that the scarcity of jobs in practice is a temporary situation and that the shortage will return. We shall see. Although health care legislation is still pending as I write this editorial, it does appear that, at the very least, there will be an increased demand for nurses as many more individuals will be provided access to much-needed health care. Specifically, the pressure for increased access will require a greater number of advanced practice nurses. But the rules governing how these nurses are educated—as well as their entry into practice—appear to be changing, although I must admit the logical and/or empirical rationale for the change still escapes me. Now it appears that academic nursing must also contend with numerous changes in the profession with calls for more education for unknown roles in health care. It is quite a conundrum!

So the perfect storm has arrived. As state support for education decreases,² the pool of qualified faculty decreases; rigid regulations and standards for curricula remove the little academic freedom faculty had to determine what, when, and how students learn; expandsion of physician and physician assistant programs increases competition for clinical placements; and universities raise tuition to cover costs. One is left to conclude the obvious; it just doesn't add up!

As the demand for credit hours, content, innovative programs, and student numbers increases, and faculty resources and clinical placement opportunities decrease, “something has to give.” The only option is to reduce the actual number of students in the pipeline and, ultimately, the number who graduate (at all levels). Will we, this time, price ourselves out of the very new healthcare market? If we do, I fear we may very well find ourselves in a place we did not envision even 2 years ago.

It seems to me our moral obligation goes way beyond simple fiscal management principles. Is this not the time to steward the very high quality and precious resources we have to meet the demand? Kay Herr Gillepse claims being a steward is not to own something, but to take the responsibility for and care of something on the behalf of another.² Early in my tenure, as a dean of a large state supported school, the difference between stewardship and fundraising seemed subtle. I now see clearly that stewardship is actually one of the most important aspects of being a leader in academic nursing. If “donors” to the mission of nursing education—be they alumni, faculty, students, practice settings, government, or foundations—do not perceive we are caring for current resources conscientiously, they are much less likely to continue to invest in the enterprise in the future. Their investment goes beyond dollars; it also means time, effort, loyalty, and commitment to the future of the profession.², ³ In today's context, stewardship is not just money. Rather, it is about individuals—the talents of faculty, the need for financial transparency, for developing new skills for vision setting and taking responsibility. We must demonstrate that we in academe and those who regulate us are accountable and committed to efficiency of programming as well as quality.

In a recent editorial, Hamid Shirvani, President of California State University, challenges academics to examine what we do best and what is reasonable and possible.⁴ I think it is time for nursing as a profession to do so as well. We must examine prospectively the costs of our aspirations for higher status and we must use data and evidence to shape those aspirations. I think each of us has our own sphere of stewardship. For some it is our patients, for some our students and, for all, our profession and our colleagues who need our validation and encouragement. We need to take this opportunity to pause and reconsider the ramifications of our demands before we bind our preferred future so tightly that the only unraveling will be our undoing.

Back to Article Outline

References 

1. Allan J, Aldebron J. A systematic assessment of strategies to address the nursing faculty shortage. U.S. Nurs Outlook. 2009;563:286–297
   • View In Article
2. Gillepse KH. Rumination: A Concept of Stewardship Applied to Higher Education. Innovations High Educ. 2003;27(3):147
   • View In Article
3. Ross J, Contento J. Second thoughts on stewardship in higher education. Acad Lead. 2009;10:4–6
   • View In Article
4. Shirvani H. Will a culture of entitlement bankrupt higher education?. Chron High Educ. 2009;October, 18:A96
   • View In Article