America Needs More Nurses Teaching Nurses, but the System has to Change to Get Them

By Susan Kelly, EdD, MSN, RN, CNE, CHSE, CMSRN

Nursing isn’t only taught in the classroom. It’s taught by nurses working in the hospital caring for patients and showing students how it’s done.

Nursing schools combine classroom learning with hands-on experiences, assigning students to clinical instructors — practicing nurses who can teach while working — for rotations in a clinical setting. A vital component to nursing education, these experiences provide nursing students invaluable skills needed to deliver safe and competent care.

But American medical care has a serious problem. The COVID-19 pandemic made the nationwide nursing shortage worse — and with it the shortage of clinical instructors and of nursing school faculty. The American Association of College of Nursing reports that significant faculty shortages, and not student interest, are limiting the number of students being admitted to nursing schools.

Barriers to teaching

New nurses learn from experienced nurses, and without enough nurses to care for patients, fewer experienced nurses will be available to teach as clinical instructors. Additionally, many nurse educators begin their careers as clinical instructors before going on the further education (a Master’s in Nursing, called an MSN) that will qualify them to teach in a nursing school.

Unfortunately, graduate school is not an option for many nurses due to family obligations, finances or current career obligations. These are people who already teach and have much to offer, facing a barrier that affects them and, increasingly, all of us.

The Pennsylvania State Board of Nursing — which oversees regulatory mandates for nursing schools — and the Commission on Collegiate Nursing Education require nurses who teach for a school of nursing, college or university have a minimum education level of an MSN degree or an active plan to earn one in five years.

That usually makes sense. But during this unprecedented nursing shortage, this requirement impedes our ability to hire qualified clinical instructors — not to mention prepare more nurses.

I have personally had to turn away qualified nurses who are educators in the hospital but who do not hold an MSN. A highly qualified registered nurse (RN) who has obtained a master’s in science in another discipline, even if they work at a hospital as a nurse educator or administrator, cannot teach clinical instruction unless they return to school to obtain the required MSN or a doctorate in nursing.

The reason? The graduate degree must be in nursing. Graduate degrees in public health, business administration or health care leadership are not acceptable.

Review standards

During this nursing shortage — a problem that affects patient care — we need to review the standards and offer practical solutions that will enable students to receive a quality clinical education. We need to examine the educational requirements for clinical instructors.

First, nursing could waive the required criteria of having or obtaining an MSN for clinical instructors without jeopardizing patient safety or diminishing nursing clinical education. (The Post-Gazette has editorialized in favor of this.) Nurses with a bachelor’s degree in nursing (a BSN) working at the bedside have the best clinical expertise to teach students at the bedside. The MSN could easily be postponed.

In K-12 education, Pennsylvania waived select certification criteria in order to hire teachers across the Commonwealth. Why can’t the nursing profession be afforded similar solutions?

I recommend a two-year grace period during which BSN-prepared nurses be permitted to work as a clinical instructor without the requirement of enrollment in a graduate program. Instead, appropriate continuing nursing education seminars and webinars — which are offered by many institutions — can be required to further educate new clinical faculty on clinical teaching theory, skills and evaluation.

Second, we must review candidates who want to teach nursing holistically. Nurses with graduate degrees in public health or healthcare leadership can provide valuable insight, especially on complex patient care after enduring a global pandemic.

Third, academic institutions and clinical partners must work to find solutions to help nurses who want to teach. They should consider offering substantial tuition remission and flexible scheduling to allow them time to teach. The grace period and flexibility will allow them to pursue higher degrees and eventually enter the classroom, and thus help to solve the nurse faculty shortage.

The drastic and worsening nursing shortage affects all of us as all of us will be touched by a nurse within our lifetime. A person who desires to be a nurse should not be turned away because of outdated and rigid barriers impeding highly qualified registered nurses who have the desire to teach the next generation of nurses.

Susan Kelly is Clinical Associate Professor and Director of Undergraduate Clinical Faculty and Affairs, Duquesne University School of Nursing. For more information, contact nursing@duq.edu or (412) 396-6550.