"A major problem," adds Lewis Freeman, "is the low pay for nursing teachers.

RNs start at around $50 to $60K a year, and despite 12-hour shifts, usually work three or four days week. "It's hard for colleges to compete with that (kind of pay scale)," Freeman explains, adding, "Colleges need to expand and offer more competitive salaries for its nursing faculty."


Megan Palmer, a highly-regarded intensive care nurse at NYU Medical, is a classic example of both the shortage and teaching issues.

Palmer is a "floating nurse." She lives in Ohio, but three months of the year, NYU pays her to move to New York and "fill in." On top of her salary, Palmer has her room and board and travel expenses covered. While her three-day weeks are often 12 to 15 hour shifts, it still allows her to perform at night in New York City bands.

Despite all those perks, however, Palmer says she really would love to teach nursing and does, back in Ohio. But the pay scale is miserable.

"I don't mind the long hours and the difficulty of the work," she says. "You know going in that is part of the job. It's the lack of money." According to Palmer, she still needs additional part time work to meet expenses.

Worse still, she could leave all together.

Poor Working Conditions Contribute to the Exodus

"The current work environment is not greatly sympathetic to keeping nurses," Peterson says. "We have staffing problems, fueled by wages and working conditions that are not conducive (to nurse retention). Nurses are looking elsewhere for work and are finding it in surgery centers, out patient care, and home care. Hospitals just haven't competed well, demanding weekends, holidays, and nighttime hours, which those other sources of employment do not."

Extra duties required by the HMOs have cost hospitals plenty. According to Freeman, who works as an RN case manager, "My job is to communicate with the HMOs in order for a hospital to get reimbursed. The HMOS used to send their own RNs to do that. No more. Case Management Overtime is costing hospitals billions of dollars."

One State College Answers the Nursing Education Shortfall

The Rhode Island College School of Nursing prides itself as rising to the task, despite all the obstacles. A state college that focuses primarily on teaching, in 1970, RIC created a separate department of nursing. Forty students applied. By 1999, that number grew to 156.

RIC achieved those numbers by making the program tougher. Funds were found to create a separate School of Nursing offering a BSN. Currently, over 400 students are enrolled, an enormous increase. Over 30 nursing faculty are on campus as full or assistant professors. A new masters program (MSN) is now available and the nursing college boasts a 95 percent pass rate for its students gaining nursing accreditation.

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