ASU's cuts worry nursing community

Two student nurses hover over their latest patient, an 84-year-old man named Harry Chester, who is suffering from pneumonia. They assess the condition of the World War II veteran, check his vital signs and prepare to turn him over to the next shift of nurses.

"Can I go home?" asks the "patient," a mannequin that talks courtesy of an instructor in another room.

Not yet, sir," says 23-year-old Ashley Harrington, who graduates with her bachelor's degree in nursing this month from Arizona State University. "We have to make you better first."

The lab is a key - and costly - part of instruction at ASU's College of Nursing and Healthcare Innovation. It is used, along with real clinical settings, to give students hands-on experience. It is also part of the reason ASU's undergraduate nursing program, a money-loser for the university, has become a prime target for budget cuts despite a statewide shortage of nurses.

Educating nurses-to-be is expensive. Nursing schools need specialized labs and medical equipment. School officials cannot stuff more students into the classrooms to save money, as their counterparts in literature and biology can do, because the state limits classes to one instructor for every 10 students in clinical settings.

Still, ASU's decision to cut annual admissions to its undergraduate nursing program by 26 percent over the next year has sparked opposition in medical circles. Critics say the move is short-sighted, and they worry the cuts will contribute to the nursing shortage, translating into longer wait times in emergency rooms and clinics, delays in scheduling elective surgery and even affecting the quality of patient care.

The Arizona Nurses Association wants university officials to rescind the cuts. President Jennifer Mensik said nursing schools have worked hard to increase their enrollments in the past five years.

"All the work we've done moving forward, we've just taken a giant step backward," said Mensik, a registered nurse.

She is especially concerned that the cuts are coming at the bachelor's-degree level, rather than for graduate students.

The state does need nurses with graduate degrees, she said, "but if we don't produce RNs to begin with, who is going to go back to school?" she said.

ASU plans to cut admissions to the bachelor's degree program from 300 students to 220 students a semester over the next year. The university's Polytechnic campus will decrease admissions from 80 to 40 this spring, while plans call for the West campus to reduce admissions by the same amount in fall 2009. The cuts will make admission to the already competitive program even more rigorous.

Officials say the cuts are unavoidable given the state's budget crisis and reductions in state funding. The three Arizona universities saw a $50 million cut in their state funding this year because state tax revenues are down.

About half of the ASU nursing school's $22 million budget is funded by the state. Cuts have cost the program about $1.5 million to date. Cutting back on enrollment will save about $350,000 a year.

Bernadette Melnyk, dean of ASU's nursing school, also has held off hiring for research positions and added fees for the nurse-practitioner program. She also requested permission to implement a $750-per-semester fee beginning in fall 2009 for incoming bachelor's-degree students. The Arizona Board of Regents approved the fee on Thursday.

"I don't have a lot of options," said Melnyk, who sent a two-page letter to students explaining her decision to limit enrollment. "I have been so firm on 'We will not produce quantity without high quality.' We just won't."

The cuts come as the state faces a severe nursing shortage that is projected to get worse.

Twelve of Arizona's 15 counties fall below the national average of 825 registered nurses for every 100,000 residents, according to the Arizona RN Shortage: 2007 Results by the Arizona Healthcare Workforce Center, which tracks health-care workforce trends. The problem is especially pronounced in rural areas.

In 10 years, the state will need an estimated 49,000 more registered nurses to replace retirements, keep up with population growth and reach the national average, according to the report.

"Unless we act quickly, boldly and innovatively, Arizona will experience a crisis of epic proportions in our hospitals, long-term care facilities, hospices and provider offices," the report says.

Melnyk said she hopes enrollment can be boosted when the state budget situation improves. Even the reduced annual admissions, to 220, are more than the 160 the university admitted a few years ago.

ASU Provost Betty Capaldi said the university loses money on every nursing student and provides about $6 million in annual subsidies to the college. Students in the bachelor's-degree program pay the same tuition as students in other majors even though their tuition covers only about 25 percent of the cost of their education. Tuition and fees cover 58 percent of the cost, on average, for other colleges.

"They are a money-losing operation. And I know it's a horrible way to talk about it, but we are a business," Capaldi said. "So if you have part of your operation that's losing money, you have to generate enough revenue elsewhere, and right now our revenue is being decreased."


Nursing schools in Arizona have expanded enrollments in recent years as part of a state push to double enrollment, but it's still not enough to meet the projected demands of 4,900 more nurses per year.

Last year, associate- and bachelor's-degree programs admitted nearly 3,000 students, up from about 1,400 in 2001, according to the state Board of Nursing.

Competition for spots is so tough that schools last year were unable to admit 2,700 qualified applicants, according to the state.

Because nursing programs are so expensive to run, it's not as simple as just opening the doors and letting in more students.

Northern Arizona University and University of Arizona have no plans to expand. Officials with Maricopa Community Colleges say they are looking for ways to add more students.

For-profit universities, which charge more than public schools, are positioning themselves to pick up additional students.

Grand Canyon University in Phoenix has announced it has plenty of room available. College officials issued a news release shortly after the ASU admissions cuts were announced, saying they can meet the demand and have financial aid available. Grand Canyon charges $7,000 a semester for its nursing program, more than twice what ASU charges.

University of Phoenix also recently added a new degree program at its Hohokam campus in Phoenix that helps licensed nurses get their bachelor's degree. The first class of 17 students recently graduated.

Students most affected by the cuts at ASU are freshmen and sophomores who are working to get nursing prerequisites out of the way before applying for the bachelor's-degree program.

"The freshmen now have to make a decision, 'Do I stay? Am I committed to this?' " said Nathan Caulk, a senior and president of the ASU College Council of Nursing Students, a group that represents students at ASU's downtown Phoenix campus.

"They know it's more competitive now. Maybe they'll try to get into a community college," he said. The group has not taken a position on the reductions, primarily because students just found out about the change.

ASU's provost said the college plans to move forward with cuts despite pleas from nurses to reverse the decision.

"It breaks our heart as much as theirs," ASU's Capaldi said. "We're doing our very best to produce as many nurses as we can with the budget we have."

Back at ASU's simulated lab, the students who hovered over World War II veteran Harry Chester are preparing to graduate this month and begin their careers.

Chester isn't going home, however. He will still be there helping to train the incoming, although somewhat smaller, nursing class.