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Dr. Margaret Wacker, director of nursing at Lake-Sumter State College, is not surprised 75,587 qualified, top applicants were turned away across the country in 2011 because many colleges are plagued with budget challenges and lack sufficient faculty to teach nursing students.

This comes at a critical time when the demand for registered nurses far outweighs the supply. In some larger Florida markets, like the Tampa Bay area, it's not uncommon to see health care facilities offering signing bonuses of $1,500 or more just to get applicants through the front door.

The U.S. Bureau of Labor Statistics projects the need for nurses will intensify in 2020 with 1.2 million nursing job openings, but will there be enough nurses to fill the slots? The question more pressing to Wacker is who will teach the aspiring nurses?

"Most people do not know the average age of a nursing faculty member is 56 in the United States and, if we can't handle a lot of qualified applicants now, within the next five or six years, with retirement, it's going to be much worse," Wacker said. "Absolutely, I'm concerned about it."

LSSC has 14 full-time and 12 adjunct part-time clinical instructors, along with three staff members, one researcher and a technical assistant.

"Our faculty, with the exception of one, they're over 50, all of them," said Wacker, who noted she is "way over retirement age" and has no idea when she will step down.

"What's going to happen in six years? There is going to be nobody to teach," she said.

Wacker said low salaries are keeping experienced BSN level nurses from becoming teachers.

"If a staff nurse is making twice what a faculty member makes, there is no incentive for them to then spend a lot of money to get a master's degree," Wacker said. "Any one of us (faculty) could be making two to three times our salary if we were in a clinical setting."

Wacker said surveys from LSSC nursing students show they are averaging $44,000 when they graduate with an associate degree, while the college's nursing faculty with a master's degree start at $40,000.

The nursing educators are currently teaching 72 applicants who were accepted out of 115 in LSSC's general nursing program. The selected students had top GPAs of 3.5 and higher, while 24 more advanced nursing students out of 28 applicants qualified for the concurrent program at LSSC, where they're being taught University of Central Florida courses at the local campus.

"They are very close to the baccalaureate when they graduate from us and then in another year they get their BSN from UCF," Wacker said. "They learn so much, but it's tough. It's very, very tough. ... We take the brightest who can make it."

Holly Kolozsvary, RN, human resources director for Central Florida Health Alliance, the health system for Leesburg Regional Medical Center and The Villages Regional Hospital, along with Tina Hayes, RN, who does all of the nurse recruiting for the two hospitals, praise the nursing curriculum offered at LSSC, Lake Technical Center and other colleges and universities.

"They have great programs. I would probably say that 50 percent or more of our nursing staff is from right here," Kolozsvary said. "We're always looking for ways to bring in students for various occupations. Certainly, nursing is one of our primary areas with the largest percentage of employees being nurses."

Hayes noted the schools are "constantly seeking our advice" to improve the nursing program.

Florida Waterman said nearly 85 percent of the hospital's new graduate nurses are from Lake County, with about 50 percent from Lake-Sumter State College while the remaining from surrounding counties, south Florida and out-of-state.

"Several of the graduate nurses we have hired over the past 18 months have been employees who worked in a variety of positions at Florida Hospital Waterman while attending nursing school," said Patricia Dolan, RN, vice president/chief nursing officer.

"We make every attempt to be flexible with their work schedules while they are attending school," she said. "Through the nursing scholarship program and tuition assistance we have been able to advance and promote our employees. Retention is the key to developing a stable workforce."

The hospitals work closely with LSSC and Lake Tech to provide a clinical site for nursing students to gain experience as they complete their studies. Nursing leaders from the hospitals also sit on advisory boards to promote nursing within the community.

"Since the fall of 2011, FHW has provided an extended nurse internship program to 90 graduates from central Florida and other states," Dolan said.

"This program consists of a 12-week extension of an orientation program that includes didactic classes to establish comfort with assessment and critical thinking skills with the use of SimMan laboratory, and a mentoring program where more experienced nurses' nurture new nurses to help them develop their skills. The nursing internship program is our attempt to "grow our own.'"

The medical field also requires nurses to constantly continue their education to keep up with new procedures, technologies and medical advances. Obamacare also is spurring the way nurses do their jobs.

"The charting has changed," Hayes said. "We are going more computerized; we are adding new systems. Eventually, it will make it easier, but right now it's just a big learning curve for everyone."

"We have to be very smart and work smarter not harder," added Kolozsvary. "All industry is like this. On a daily basis we need to do more with less and be very, very smart and be challenged and positive. We take care of people and it's not like we can cop an attitude ... The patient deserves the best when we are in that room. They do not deserve to hear any grumbling about what is going on. They need to be taken care of, so that's a challenge to teach people that attitude has to stay outside. We are here to take care of patients. That's our mission and this is the community that we serve."

Lake and Sumter County is touted as an ideal place for nurses to work as more people move to Florida to retire. The boom of The Villages also spurs the demand for the registered nursing workforce.

"We are in a good market," Kolozsvary said. "We have had graduate nurses and new nurses from a lot of other states who apply to us, along with a lot of other counties in Florida. ... We are very marketable with our pay scales and certainly our benefits are extremely lucrative."

Hayes said it sparks applications when nurses hear about Central Florida Health Alliance's hospitals being on the top "100 Best Employers for Working Families," and being the recipient of other employee honors.

"We have a daycare on site here at Leesburg and we have the charter schools at the other hospital," Hayes said of The Villages. "We are one of the few hospitals that are still growing."

"There are hospitals that are closing down right now and we are still adding beds," Kolozsvary said. "We are very fortunate to sit in Central Florida right in the middle of the state where we still have growth."

The growth is happening as the area strives to rebound from the 2007 recession.

Florida Hospital Waterman officials noted a Florida Center for Nursing 2011 survey shows Florida's unemployment rate has consistently been higher than the national unemployment rate since January 2008. However, employment in Florida's healthcare sector has remained a shining point in these tough economic times. RN employment has increased during the recession.

The number of full-time equivalent RNs employed in hospitals has increased every year since the recession began in 2007 (with the exception of 2009), according to the publication Medical. Nationally, in 2009 and 2010, RNs over age 50 comprised approximately 30 percent of the hospital workforce.

The Florida Hospital Association said current nursing employment is being driven by several factors: Nurses who are delaying retirement, nurses who had previously left the workforce returning to work, and part-time nurses who are working more hours.

Older nurses will eventually leave the workforce and need to be replaced, yet some officials believe it will remain a slow, steady workforce transformation until the economy improves and the overall unemployment rate declines.

Wacker said Lake-Sumter State College is noticing the slow transformation.

"Because of the economy, people are staying longer and they are not retiring," Wacker said. "So our new graduates, and I just looked at a survey, some of them can't get jobs and they are going into other things. So it's a bad situation at three levels: Qualified applicants are being refused admission because we can only take the best and the brightest and who can make it; the faculty aging issue and nobody going into education; and then we the economic issue of the hospitals having to limit new hires because they don't have the attrition rates they would normally have for retirement."

The U.S. Bureau of Labor Statistics projects the registered nursing workforce will remain the "top occupation" in terms of job growth through 2020 across the country, with the number of employed nurses rising from 2.74 million in 2010 to 3.45 million in 2020. In addition to 712,000 new job openings, the department predicted 495,000 replacement hirings, bringing the total number of nursing job openings to 1.2 million in the next seven years.

The American Association of Colleges of Nursing said nursing school enrollment is not growing fast enough to meet the projected demand for registered nurses, given that 75,587 qualified applicants were turned away from U.S. nursing schools in 2011 because of an insufficient number of faculty, clinical sites, classroom space and budget challenges.

Wacker believes residents can make a difference on the future of nursing education.

"I think it's important if they write to their legislators to see if more money can become available for BSN level nurses to get master's degrees in education to be able to teach, because that is the minimum requirement," said Wacker, who believes there needs to be an incentive for experienced BSN nurses to return to school to become teachers to teach future generations of aspiring nurses.