Closing the nursing shortage demands creativity, collaboration.

The United States faces a nursing shortage perhaps like none we've experienced: by 2025, the shortfall in registered nurses is expected to reach 260,000, according to Peter Buerhaus of Vanderbilt University. And as baby boomers age and require greater attention and care, this looming shortage poses a growing threat to the quality and availability of health care services.

This shortage is not due to a lack of qualified aspiring nurses. On the contrary, would-be nursing students are flooding admissions offices with applications every year; there is simply no place for many of them to go. In 2008, almost 99,000 qualified applications were turned away by U.S. nursing schools, according to the National League for Nursing.

We do not have enough nurses, in part, because of systemic problems in nursing education in the U.S. In order to stem the tide of this shortage, colleges and universities need to be equipped to graduate tens of thousands of additional nurses each year. This is no small feat. The current system is beset by too few faculty, a lack of strategic partnerships between community college and university programs, and insufficient clinical sites to provide the hands-on experience required for competency development.

To address these specific challenges in nursing education, the Center to Champion Nursing in America, a joint initiative of AARP, the AARP Foundation and the Robert Wood Johnson Foundation, is working with 30 state teams across the country to redesign the system to enable new graduates to enter the workforce with the skills they need to serve patients in hospitals and long-term care facilities as well as in the community and to become faculty members themselves.

The CCNA seeks to spread best practices from around the nation to ensure the best in clinical education, as well as share innovative approaches to building the teaching capacity in nursing schools. Last month in Portland, Ore., the CCNA brought together teams of nurses and other leaders from 11 states to demonstrate how they are addressing these challenges.

The Oregon Consortium for Nursing Education (OCNE), one of the most innovative nursing education redesign approaches in the country, was co-host of the conference and a featured model program. Oregon was one of the first states to respond to this critical need to redesign nursing education.

Formed as part of the state's 2001 strategic plan to combat the nursing shortage, OCNE is a statewide partnership that includes faculty from eight community colleges and Oregon Health & Science University School of Nursing. As a part of its charge, it created a shared curriculum for nurses based on necessary core competencies. All consortium campuses teach the same courses, helping students move seamlessly from associate degree to bachelor's degree programs without having to take additional prerequisites, thus decreasing the time needed to graduate and begin direct patient care.

All of the Oregon consortium members have increased enrollment in their programs, and greater numbers of nursing students are opting to pursue higher-level degrees. At Rogue Community College in Oregon, for example, enrollment has nearly doubled, according to Linda Wagner, the head of the college's nursing department. During the first year, associate degree students had the option to continue on in their program and 22 percent chose to pursue their bachelor's degree. This year, that number had risen to 44 percent.

Perhaps most beneficial to the state is that all new nurses who graduate have the skills required to care for an aging population, whether they obtain a bachelor's or an associate degree. The end goal is to increase both the number and skill level of new nurses to manage the needs of the 21st century patient in a reformed U.S. health system, as well as to create a pipeline for faculty who are desperately needed at all levels of nursing education.

In California, as well as Oregon and other states, many aspiring nurses face roadblocks in finding the clinical education necessary to meet their degree requirements. California's nursing shortage is expected to reach 109,000 next year, yet current rates of graduation will only produce half the number of new nurses required to fill the gap. Thus, the state has recently implemented the Centralized Clinical Placement System (CCPS), a web-based tool that is streamlining the clinical placement process, helping nursing students secure rotations in hospitals and other previously untapped medical facilities. So far, the system has helped increase Bay Area nursing student enrollment by 47 percent over the last five years.

To be sure, combating the nursing shortage and building a 21st century nursing workforce is not solely the responsibility of educators. However, we do know that within the educational system, there are steps we can take to ensure that greater numbers of students enter the workforce with the skills they will need to succeed in an ever-changing health care landscape. The more we can work together and learn from each other--across communities, states and the nation--the more likely we are to reduce the nursing education bottleneck and create a nursing workforce ready to care for today's patients and to serve the needs of generations to come.

SUSAN REINHARD

SENIOR VICE PRESIDENT AND DIRECTOR, AARP PUBLIC POLICY INSTITUTE

BRENDA CLEARY

DIRECTOR, CENTER TO CHAMPION NURSING IN AMERICA

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