Who wouldn't want to go to school in a sunny tropical paradise? Brandon Bartholme, for one. When the 30-year-old Californian enrolled at the International University of Nursing (IUON) in St. Kitts earlier this year, it was a last resort. He had applied to several nursing schools in the U.S. but couldn't get in. He was qualified, but the schools simply didn't have room. "On the waiting list to start in 2009 was the best offer I got," Bartholme says. "I realized that to be a nurse, I'd have to leave the U.S."
The irony, of course, is that the U.S. has never needed Bartholme more. The health-care system faces a deficit of as many as 1 million RNs by 2020. Yet American nursing programs turned away nearly 150,000 qualified applicants for all degree levels last year--including 38,415 from bachelor's programs--according to the National League for Nursing (NLN). The profession is trapped in a catch-22: hospitals, desperate for staff, poach nurses from one another with bonuses and perks. Nursing colleges can't fill the gap with new graduates because the schools can't compete in this overheated marketplace for the experienced nurses they need as teachers. "Clinical salaries are so high that nurses don't want to leave for academia," says NLN CEO Beverly Malone. "But how do you train new nurses without teachers?"
One quick Rx: offshore outsourcing. In addition to St. Kitts, India, Britain, Belize and Jamaica are using the nursing-school slot shortage as a selling point to recruit American students. The pioneer of this movement is an 88-year-old entrepreneur named Robert Ross. He made his mark in the 1980s when he founded medical and veterinary schools in Dominica, despite having no background in either medicine or education. Ross University grew into a profitable institution with more than 2,000 students, and Ross sold it for $135 million in 2000 to a private-equity firm. He has reapplied his winning formula to nursing, and IUON welcomed its first class in 2005. Ross admits that his school alone can't solve the nursing crisis, but advocates say it's a start. "There's such dire need," NLN's Malone says. "I welcome any innovation."
Ross has grand plans for IUON and hopes to make it the largest nursing school in the world. He has sunk at least $10 million into the 50,000-sq.-ft. (4,600 sq m) campus on 10 acres (4 hectares) of land in gorgeous St. Kitts. Ross has attracted more than 20 faculty members from the U.S. with competitive salaries of $70,000 to $80,000 a year, plus overseas tax breaks. "The island life is definitely a bonus," says assistant provost Frank Wagner.
About 200 students are enrolled this semester, and they pay IUON's hefty price tag: $8,800 a semester, about four times the in-state tuition for an associate degree at a U.S. community college. "It's a scary obstacle," says fourth-semester student Kristal Nicks. But the 25-year-old Florida native says the loans she took out will be worth it. "I was sick of waiting to become a nurse," she says.
Rebecca Patton, head of the American Nurses Association, warns that IUON hasn't yet proved that it can produce qualified nurses. "We need to watch the school closely," she says. "Can students come back and sit successfully for the licensing exam?" To improve their odds, IUON nursing students attend classes in St. Kitts for three semesters but finish their clinical studies at one of six partner schools in the U.S. Ross pays these cash-strapped schools tuition plus an undisclosed fee. Dr. James Utterback, president of Oklahoma's Seminole State College, was one of Ross's first partners. "We benefit from the extra funds and added diversity on our campus," Utterback says. Seminole doesn't have enough teachers to enroll IUON'S students fully, but it can accommodate a few for a semester's worth of instruction.
Truly filling the nursing gap will require some homegrown solutions. Congress devoted $500,000 last year to a pilot project to encourage returning military medical troops to become nursing educators. The federal Health Resources and Services Administration is developing online degree programs. This month the U.S. Department of Veterans Affairs said it would spend $40 million to boost nursing faculty at 12 institutions, while the University of California at Davis plans to open a nursing school next year funded by a $100 million gift from local philanthropists.
Ross applauds such efforts. He always sells IUON as an alternative for students who aren't accepted into an American nursing school first. "We tell applicants, If you got into a school in the U.S., go there." If only it were that easy.