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At many colleges and universities, nursing is the highest demand major. At Hunter College in New York City, 700 entering students, fully one-fifth of entering freshmen and transfer students, list nursing as their prospective major.
Nursing’s appeal is not surprising. Nursing, which consistently ranks as the nation’s most trusted profession, provides the high-touch care that our health-care system promises but sometimes fails to deliver.
Nursing offers practical, high-demand skills, a high entry salary and a chance to deliver care to those in need. Nurses’ schedules are onerous and demanding but, in many instances, offer three days on duty and four days off.
A B.S.N. combines the opportunity to do good and do well. Yet at most four-year institutions, only a small fraction of prospective majors will enter a nursing program.
A CNN report captured the irony of our current situation: “There's an acute nursing shortage in the United States, but schools are turning away thousands of qualified applicants as they struggle to expand class size and hire more teachers for nursing programs.” (In fact, the CNN headline is hyperbolic. The nursing shortage varies sharply by region and specialty.)
Competition for entry into nursing programs is intense, and even students with high grade point averages find themselves closed out. Nationwide, a third of qualified applicants to B.S.N. programs are rejected, but this statistic may actually understate the rejection rate, since many prospective nursing students transfer or shift majors when the writing appears on the wall.
Rejection from entry into a nursing program can be profoundly demoralizing, resulting in shattered hopes and dreams.
The problem is insufficient capacity: a shortage of faculty, expensive facilities and technologies, and limited placements. Some suspect that the barriers to entry have more to do with restricting supply and raising salaries and prestige than capacity constraints. However, the capacity constraints are real.
To be sure, a handful of programs have very large bachelor’s programs. The University of Cincinnati graduated 463 bachelor’s students in nursing in 2017-18, and the University of Texas at Arlington a mind-bending 3,563. But most programs only serve around a hundred students or fewer.
Nursing is a calling, and many students who want to become nurses will complete a bachelor’s degree in psychology or human biology or biomedical sciences and then enter an accelerated nursing program at great expense.
There must be a better way, right?
Two options stand out. One is to encourage prospective nursing students to enter another applied or allied health-care field, such as community health education, exercise science, kinesiology, medical imaging, medical technology, nutrition, orthotics and prosthetics, physical therapy, public health, speech language pathology, or sports medicine.
This is the dominant approach, but many nursing hopefuls unfortunately regard this option as a rather disappointing consolation prize.
There is, however, another option we might consider: encouraging students to consider the health sciences within a liberal arts context. This latter path will likely require a student to pursue a master’s degree but will likely result in a rewarding outcome, both economically and in terms of personal and professional satisfaction.
Options include aging, biostatistics, children’s health, global health, health economics, health informatics, health policy, and medical ethics. These might lead, in turn, to careers in addiction studies, biomedical informatics, environmental health, epidemiology, geriatrics, health administration, health communication, health policy, health-care quality and safety, or immunology,
We have a responsibility to provide our students with windows into careers. For all of the current fears about a looming apocalypse of technological displacement, there are a host of new jobs that are not easily outsourced or automated. Some involve caregiving, others advanced analytic and managerial skills.
Students who fail to be admitted into a nursing program should not feel that they have reached a dead end, any more than those who aren’t accepted into medical school should feel that their career prospects are kaput.
We should reflect on Hamlet’s words: “There are more things in heaven and Earth, Horatio, / Than are dreamt of in your philosophy.” There are many more career possibilities in health care than exist on our students’ radar screen. Let’s help them leverage a liberal arts education and find careers that speak to their passions and talents.
Steven Mintz is professor of history at the University of Texas at Austin.
