The U.S. Faces a Severe Nursing Shortage. Who's Giving to Close the Gap?

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One of the hottest trends in higher ed fundraising right now is donors’ ambitious efforts to support STEM-related initiatives in fields like engineering, artificial intelligence, and data science and analytics.

But a recent Bureau of Labor Statistics forecast cites a far more disruptive job shortage on the horizon— registered nurses (RNs). The bureau projects the need for an additional 203,700 new RNs each year through 2026 to fill newly created positions and to replace retiring nurses. That’s close to 1.5 million new nurses required to provide care for tens of millions of aging baby boomers—a number far beyond the capacity of the U.S.’s current training pipeline for RNs.

Despite these dire predictions, higher ed funders have been quiet on this issue, especially when compared to their extravagant giving in the STEM space. More broadly, philanthropy has been remarkably inattentive to issues of aging, even as the rapid greying of the U.S. population promises to have huge impacts on local communities, social service agencies and national entitlement programs. Hospitals, assisted living centers and hospice facilities are on the frontlines of this demographic revolution—and all are facing major long-term labor shortages.

Bill Conway and his wife Joanne are two of the few higher ed donors calling attention to the country’s projected nursing shortage. Most recently, they gave a $20 million gift to Washington, D.C.’s Catholic University to increase the number of nurses in the Beltway region.

The couple’s commitment will partially fund a new nursing and sciences building, enabling the university to double its number of nursing graduates to more than 700 students. The school will be renamed the Bill and Joanne Conway School of Nursing in recognition of the $40 million the couple has donated over time. Of the Conways’ total giving, $20 million has funded full and partial scholarships for nursing students, and will continue to do so. The Conway Scholars program started in 2014, and is currently supporting its third cohort, 15 students that started classes in August 2018.

“We have been so pleased with the exceptional quality of Catholic University-educated nurses and can see the tremendous impact they will each have on thousands of patients throughout their careers,” Bill said. “While we have generally been very focused on scholarships, when we learned that the main obstacle to producing more of these great nurses was the university's current facilities, we knew we had to invest in a new building.”

Bill is a member of the university’s board of trustees. Bill and Joanne also helm the Bedford Falls Foundation. The couple received honorary degrees from Catholic University in 2017 in recognition of their generosity, which “enables students who lack the financial resources to receive an education that directly affects the lives of patients in the region.”

A Focus on Nursing Education

The Conways are well positioned to address the U.S. nursing shortage. In fact, with the withdrawal of the Gordon and Betty Moore Foundation from this space a few years ago, it’s hard to think of any living donors who are more dialed in to the neglected nursing issue than the Conways—and certainly none with as much money in the bank. With a net worth of $2.9 billion, Conway is the co-executive chairman of the Carlyle Group, which he founded in 1987 with Daniel A. D’Aniello and David Rubenstein.

The Conways’ commitment to closing the nursing shortage isn’t a whimsical fly-by-night operation. Conway made waves a few years ago when he announced that he wanted to give away at least $1 billion to the Washington, D.C., community. Soon after, he solicited ideas from the public via a Washington Post article titled “Where to Donate $1 Billion? Local Philanthropist Seeks Ideas.” He went so far as to encourage folks to email him directly at Carlyle. As my colleague Ade Adeniji noted at the time, Conway’s approach was pretty unique. Billionaire investment bankers typically turn to consultants, colleagues, or (so we’d like to think) astute bloggers for advice on directing their giving.

After reviewing over 2,500 suggestions, the couple’s philanthropic priorities soon crystallized: workforce training, education and human services, regional food banks, and addressing the nursing shortage. According to Bill, the “majority” of their philanthropy focuses on the latter cause.

Bill and Joanne set a goal to educate 10,000 new nurses in Washington, D.C., Maryland and Virginia. Since 2012, the couple has given at least $55 million towards scholarships and tuition assistance for nursing students attending LAYC Career Academy. As thing currently stand, the couple has funded the education of 1,707 new nurses through major gifts to six Washington-area universities.

Given the couples’ ambition and sizeable fortune, the Washington Post’s Susan Svrluga concluded that the Conways’ $20 million gift to Catholic represents a “small fraction” of the amount the couple plans to give away. Bill Conway doesn’t dispute this analysis. He said he expects the couple may add scholarship programs at five or more nursing schools in the next several years. “It’s hard to get to 10,000 nurses with only six schools,” he said.

A Study in Contrasts

To fully grasp the dire state of nursing education funding across higher ed, consider the ongoing STEM gold rush. Donors remain bullish on the field for a whole host of reasons. Many are responding to warnings that a shortage of talent in this area will translate into an ever growing hit to the U.S. economy. Others see a robust STEM workforce as a key component to sustainable regional economic growth. And corporate funders, with an eye on the bottom line, have a vested interest in building a talent pipeline of skilled workers.

In the last four months, we’ve reported on Henry and Susan Samueli’s $100 million gift to the UCLA Samueli School of Engineering, the Grainger Foundation’s $100 million unrestricted gift to the University of Illinois at Urbana-Champaign’s College of Engineering, the Pritzker Foundation’s $75 million gift earmarked for molecular engineering at the University of Chicago, and American Family Insurance’s $20 million investment in data science initiatives at the University of Wisconsin-Madison.

The total number of articles devoted to nursing grants during that time frame? Zero. In January, we reported on a $2.8 million grant made by the Rita & Alex Hillman Foundation to the Johns Hopkins School of Nursing’s Center for Innovative Care in Aging. Back in 2017, we covered a $1.5 million Harold Alfond Foundation grant to Maine’s Saint Joseph’s College to address the state’s nursing shortage.

Of course, Inside Philanthropy isn’t a comprehensive source of all giving, so I ran a search on “nursing” in the higher ed space across the past six months on Philanthropy News Digest’s more robust grants database. The results were equally underwhelming.

Creighton University received a $10 million grant from the Virginia G. Piper Charitable Trust for a new health sciences building to serve students seeking degrees in, among other things, nursing. The University of Kansas netted a $4.2 million gift from the estate of Margaret Ann Zimmerman to fund scholarships for nursing students at KU Medical Center. And Arizona State University announced a gift of $50 million from Charlene and J. Orin Edson, a portion of which will enhance education and training for nurses and caregivers.

A review of these commitments reveals two important points. First, with the exception of the Harold Alfond Foundation’s grant to Saint Joseph's College, each of these gifts primarily focuses on financial support and training for existing nursing students. This cause alone is worthy of significant donor attention, given rapid advancements in treatment and technology. According to Marc Triola, director of NYU Langone’s Institute for Innovations in Medical Education, the gap between medical education and real-world care has “become a chasm.”

Second, these grants are relatively meager in size, considering that, according to Triola, “the health care delivery system is changing every day, and our medical education system has been lagging.” I suspect he would consider donors’ level of support in this area to be woefully insufficient.

The Conway gift, by contrast, funds the construction of a new building to enable Catholic University to admit approximately 350 brand new nursing students. And while the gift is significant and frustratingly rare, it, too, requires additional context—the total amount of $20 million pales in comparison to many of these eye-popping STEM-related gifts, some of which are earmarked to close skills gaps that may not even exist, or to make products and services that aren’t really needed.

Explaining the Disconnect

The average American’s eyes will probably glaze over if you tell them that donors are allocating tens of millions of dollars to ensure companies have enough data mining analysts 10 years from now.

You’d get a very different reaction, however, if you cited research claiming that an increase in a nurses’ workload by one patient increased the likelihood of dying within 30 days of admission by 7 percent, and that despite these well-documented risks, funders haven’t shown an urgent interest in addressing a shortage that everyone agrees is inevitable. Moreover, funders profess an interest in combating inequality. Yet many well-paying nursing jobs are now likely to be unfilled, even as too many Americans languish in dead-end careers in industries like retail and restaurants.

This is why the Conways’ listening tour across the D.C. region was so important. The people they spoke with asked for more nurses. I suspect “more cloud computing engineers” ranked pretty low on the list. This exercise serves as a useful reminder that higher ed mega-donors’ pet projects, while well-intentioned, don’t always align with what the public wants, much less what it needs. Throw in the fact that the American public foots the bill for what amounts to eight- and nine-figure tax write-offs, and it’s easy to see why some folks view the gilded philanthropic class with suspicion.

According to the Voluntary Support of Education Survey conducted annually by the Council for Aid to Education (CAE), colleges and universities raised $46.7 billion in 2018. There’s enough money to go around if higher ed funders decided to meaningfully tackle the nursing shortage. What’s holding them back? A few theories spring to mind.

First, some donors may assume that institutional health funders have this terrain sufficiently covered. They’d be mistaken. Not only is the Moore Foundation no longer funding here, but the most obvious alternative candidate to invest in nursing education, the Robert Wood Johnson Foundation, has a very different agenda when it comes to grantmaking for nurses, reflecting its goal to create a “culture of health” in the U.S. As we’ve previously noted, “RWJF’s work in the nursing space is more about empowering nurses to be agents of change than tackling the vast looming shortages of nursing that are coming at us fast.”

Second, consider the philanthropic truism that only incredibly wealthy individuals can afford to make eight- or nine-figure gifts. Most of these massive commitments to STEM-related causes come from millionaire and billionaire alumni who made their fortunes in tech, high finance and business. The nursing profession, with an average salary of $73,550, lacks a comparable bench of extremely affluent professionals.

The field isn’t alone in this regard. Community colleges, trade schools and historically black universities also enjoy less-than-robust philanthropic support, in part, because fundraisers can’t tap a broad network of wealthy alumni looking to give back.

Similarly, most alumni give based on their personal and professional experiences. Of course tech companies and engineers will dig deep to close the STEM skills shortage. They have an intimate understanding of where fields like engineering, artificial intelligence and data analytics are heading.

Consider Jaffray Woodriff, the donor behind a $120 million gift to create a new data science school at UVA. He is the co-founder and CEO of Quantitative Investment Management, $3 billion hedge fund. He has been a key player in Charlottesville’s startup and entrepreneurial community. His interest in data science has been a “lifelong passion.” Regarding his gift, he said he believes that “data science is still in its infancy. I would like the University of Virginia to be a true global leader improving data science for the betterment of the world.”

When critics nonetheless pushed back, arguing that the new school would drive up Charlottesville’s already exorbitant cost of living, William Foshay, executive director of Woodriff’s Quantitative Foundation, drove home an obvious point. Woodriff, he said, “is a domain expert of data science, and he pursues philanthropy in the area he knows the most about.”

Corporate STEM funders give from a similar vantage point of “seeing around corners” with the added impetus of enlightened self-interest. As American Family Insurance (AmFam) chair and CEO Jack Salzwedel stated after his company announced its own data science gift to the University of Wisconsin-Madison, “The institute will also develop a pipeline of potential future employees in the data science field, as well as provide valuable learning opportunities for our current employees.”

Translation: Why commit $20 million to workforce training internally when AmFam can outsource the work, tax-free, to the University of Wisconsin? These kinds of economic- and tax-based incentives simply aren’t as pronounced in the nursing field, where only 18 percent of U.S. hospitals are private, for-profit hospitals.

A Coming Workforce Crisis

While these theories may help to explain why funders haven’t paid much attention to the looming nursing shortage, they don’t fundamentally alter the facts on the ground: The U.S. healthcare industry needs to upskill tens of thousands of existing nurses rapidly, and recruit 1.5 million new nurses by 2026.

Fortunately, there are two encouraging takeaways from the Conway gift to Catholic University. First, on a pragmatic level, the Conways have pledged to fund the education for an additional 8,293 new nurses in the Beltway region. And second, the nursing shortage may not be higher ed donors’ priority now, but given Bill Conway’s own Road to Damascus experience, that could eventually change.

He told the Washington Post that he appreciated how nurses helped his parents as they aged. “I saw that if a person could get a nursing degree, they could take care of themselves, their family and ultimately the rest of us.”