Two decades and three children after she graduated with a nursing degree from the University of Pennsylvania, Connie Kartoz is headed back to school in September. And with her will go the hopes of New Jersey health-care officials.
Kartoz is among 46 nursing master's and doctoral students who will receive free tuition through the New Jersey Nursing Initiative, a new $22 million program aimed at averting a critical nursing shortage in the state. The Princeton Junction resident, who plans to pursue her doctorate at Seton Hall University in South Orange, also will receive a $50,000 stipend.
But there's a catch. Kartoz and her fellow scholarship recipients at eight in-state schools must instruct nursing students at a New Jersey college for at least three years following graduation.
The Nursing Initiative, privately funded by the Robert Wood Johnson Foundation in Princeton, is dedicated to resolving a quandary that has stifled growth in the health field: Which comes first, the teacher or the nurse?
During the 1990s, applications to nursing programs nationwide quietly fell off because of a combination of factors, said Susan Bakewell-Sachs, director of the program and nursing dean at the College of New Jersey. Tuition assistance for nursing declined during the 1980s, and women, who have traditionally dominated the field, explored a wider range of professions, she said.
"It took us a little while to see what was happening," Bakewell-Sachs said.
A 2002 study released by the U.S. Department of Health and Human Services predicted a nationwide shortfall of about 800,000 registered nurses by 2020. The implications for a rapidly aging U.S. population were startling, Bakewell-Sachs said.
Sensing career opportunity, prospective students flooded nursing schools with applications. From 2000 to 2006, enrollment in the College of New Jersey's program swelled from 147 to 300.
Since then, the number of students has remained steady. The problem hasn't been lack of interest, Bakewell-Sachs said; it's been lack of faculty.
Other schools are in the same situation, said Linda Aiken, whose research at the University of Pennsylvania has linked overworked nurses to higher mortality rates among patients. About 50,000 qualified nursing applicants are turned away nationwide each year because of faculty or program constraints, she said.
In Philadelphia, billboards dotting Center City urge nurses to become educators. Bearing the slogan "Care is in the classroom," the ads are sponsored by FutureinNursing.org, an effort headed in 2003 by the Pennsylvania Higher Education Foundation, which is funded primarily by PHEAA and insurance companies.
The foundation is a statewide operation, but the billboards are found only in the Philadelphia area, spokesman Keith New said. Though the foundation supported several programs for nurse educators earlier this decade, the economy has diminished the foundation's endowment, and only a program for 12 Philadelphia-area graduate schools remains.
That initiative, the Independence Blue Cross Nurse Scholars program, has doled out $4.5 million in block grants since 2004 for schools to support graduate students who will become nursing educators. It will continue to give out $1 million for scholarships annually through 2011, New said.
Not addressed in either state, say some, is a key reason more veteran nurses don't enter academia: A nurse can earn up to $50,000 per year more in the clinical setting, said Maryjoan Ladden, who oversees the New Jersey initiative.
Nursing doctoral students also tend to be older. The average age of those receiving a nursing Ph.D. is 46 nationally, Bakewell-Sachs said. In other fields, the average is 33.
After years of working at health clinics and with private physicians, as well as part-time adjunct teaching, Kartoz - who is 45 - had eyed a move toward a full-time professorship, but returning to school wasn't economically viable until the foundation accepted her.
"To go back to school and take the income hit, it just wasn't possible. I think for a lot of people that's the case, and that's why we have this nursing shortage," she said.
The lack of adequate nursing faculty must be solved soon, before New Jersey's shortage of registered nurses reaches a crisis, many say.
In the 2002 federal report, authorities predicted that Pennsylvania and New Jersey would see their pools of nurses shrink about 25 percent by 2020. The demand for care in the Garden State was expected to be 10 percent greater than in Pennsylvania, however. New Jersey would have about half the nurses it required, the report said.
The recession has bought health officials some time, Aiken said.
In 2007, the New Jersey Collaborating Center for Nursing at Rutgers calculated that a third of New Jersey nurses would retire within 10 years, but many of those retirements have been delayed out of financial necessity. Kathleen Yhlen, a clinical nursing educator at Cooper University Hospital, said that Cooper had seen a number of longtime nurses who previously worked only when needed now seeking permanent positions.
Yhlen also said nursing students applying for the hospital's apprenticeship program this year remarked that Cooper was one of few in the area that continued their program during the recession. Despite concerns about shortages, some recent nursing graduates have found that jobs are hard to come by.
"It's not as easy [to get a job] in South Jersey anymore because there's a limited amount of positions," said Jana Nelson, nursing recruiter at the University of Medicine and Dentistry's Stratford campus.
But when the recession ends, the nursing crisis will arrive "with a vengeance," especially if the Obama administration expands health care, Aiken said.
The Robert Wood Johnson Foundation felt that New Jersey could not wait to take the necessary steps, Bakewell-Sachs said. Of the $22 million the nonprofit has put into the nursing initiative, $13.5 million will go toward scholarships. Recipients of the first 46 are now being chosen.
"There's pressure, but it's like, 'OK, I'm going to help solve this problem,' " Kartoz said.
No funding is planned beyond the conclusion of the program in 2013, but the foundation is working with local business and government officials through the state's Chamber of Commerce Foundation in hopes of securing sustainable funding, Bakewell-Sachs said.
Other states have funded incentives for nursing professors through the legislature or the governor's office, Bakewell-Sachs said, but funding of this scale by a private foundation was "unprecedented."
"We've still got an opportunity to reverse this trend," she said. "We've got to seize that opportunity and do it."