Outsourcing nursing education

California needs more nurses. Californians want to study nursing. But qualified candidates are sitting on waiting lists, in part because there aren’t enough nursing instructors. Why? The average pay for an instructor is no more than the average pay for an RN and well below the pay for a senior nurse. You’d think there would be a solution. And there is: Train nurses in Mexico at half the cost of U.S. training.

If all goes as planned, as many as 40 bilingual Californians now stuck on nursing school waiting lists will begin classes in January at a college in Guadalajara, Mexico – apparently the first attempt by any state to outsource nursing education to another country.

Program supporters say it’s a reasonable way to train more Californians, especially those who can work in communities that need more Spanish-speaking health care workers.

In another approach, a hospital group is offering a 14-month online nursing course — plus clinical training — to college graduates interested in switching careers.

Given the very high demand for nurses, which is sure to continue as the baby boomers age, why is it so difficult to offer competitive salaries to instructors and expand U.S. nursing schools?

About Joanne


  1. Why not turn nursing over to for profit schools, rather than state colleges? If nursing is such a high-growth career with great pay, then women who want to be nurses can get loans and pay a high price for the ability to make more money. For profit schools could pay higher rates for teachers.

  2. Way back when, didn’t private hospitals train nurses? I was told the Army trained nurses till about the time Vietnam ended. Is the problem that nurses now need a BS and not just an RN?

  3. I’ve read that many states provide funding to schools based on numbr of students—so a nursing student, who requires expensive instructors plus certain facilities costs, yields no more funding than an English student, who is much cheaper to educate.

    Also, univeristies like to focus on what they perceive as “prestige” fields. You had a post a while back on California’s decision to fund a new law school instead of a nursing school.

  4. The short answer to your question is prop 13.

    The long answer goes something like this. Universities in California get paid the same amount to produce an English major as they get paid to produce a nurse. English majors are much cheaper. They don’t need labs, they don’t need equipment and supplies, and they don’t need clinical practica where the student teacher ratio is 8:1. There’s no incentive for the university to expand their nursing program and there’s certainly no money to do it. Some states (North Dakota for example) offer a premium for allied health majors because they are trying to deal with crippling workforce shortages. But our solution has been/will be to import nurses from other countries – because we can.

    The problem with recruiting more faculty also has its roots in the tenure system. If you hire them now and don’t need them later, you can’t lay them off; another disincentive to hire more instructors. Also, on the supply side, why would nurses go to school and get a PhD when they can make plenty of money doing what they do at the hospital? Add to that the fact that PhD programs for nurses are in short supply (there’s not a lot of prestige associated with training a nurse, even at the doctoral level – UC Irvine just opened a law school instead of opening a school of nursing – I’m not aware of any shortage of lawyers) and you’ve got a compelling list of reasons we don’t have enough nursing instructors.

    Just to address a few other comments:

    Hospitals stopped training nurses when training became too expensive to continue. This has to do with capitation and HMOs and lowered reimbursement for medical care in the 80’s.

    For profits do not pay higher rates for teachers. That’s part of the way they make a profit. They also offer crummy benefits and usually, no tenure. Few college teachers would choose that path if they had another choice.

  5. Walter E. Wallis says:

    Time to reopen the Army medical schools around San Antonio that were closed by the anti-military democrats.
    A nursing academy or even a medical academy would make a lot of sense.

  6. There already is:

    The Uniformed Services University of the Health Sciences (USUHS), was established in 1972 by F. Edward Hebert, a Louisiana Congressman, and graduated its first class in 1980. The university is a center for military medical education and research. It is the United States’ only fully accredited federal school of medicine (SOM) and graduate school of nursing.

    From Wikipedia

  7. And I thought that here in Brazil we have so many people studying to be nurses…

  8. superdestroyer says:

    Nursing schools also produce no grants. A physics major is more expensive than an English major but the physics department are any research university (like UC-Irvine) will bring in funds from research. A nursing school brings in little in research dollars.

    I also suspect that nurses make lousy alumnist. Why spend resources creating a ton of alumnist who do not donate anything.

  9. superdestroyer

    I am sure you are right, but I find it amusing that nonprofit organizations are driven primarily by money and not by underserved social needs just like the profit oriented ones. Bureaucracies are the same no matter what their label.

  10. Catch Thirty Thr33 says:

    Walter – As a San Antonio native, I can assure you that Fort Sam Houston is alive and well, and still does much medical training. In fact, it is due to train ALL in the medical field from ALL branches of the military eventually.

  11. Registered Nurses do not need a Bachelors degree, they only need an Associates. The clinical and medical training is exactly the same, a Bachelors degree just adds more general ed and a few management classes.

    The starting pay is the same for either degree.

    My wife graduated nursing school (ADN) and got her first nursing job today.

    She was originally on a two year waiting list, but when she moved in with me, she changed to a school that had merit admissions and got in right away.

    It should be noted that the drop out rate for nursing schools is high. Many people go into nursing, not realizing how challenging it is, and the standards are very very high.

    Even after graduating from nursing school, there is still a significant number of graduates that can’t pass the NCLEX test that is required to become a certified RN.

    Even after people become nurses, there is a relatively high change of occupation rate because the workload is high. My WAG is that roughly 50% (maybe lower) of people who enter nursing school will be nurses in 10 years.

    Then again, there aren’t many other occupations that offer 40-50K starting salaries.

  12. Walter E. Wallis says:

    Happy to hear about Fort Sam.
    Prop 13 didn’t slow the growth of public employee salaries both directly and in relation to private industries. I believe tidelands oil royalties used to go to the universitys, but we brilliantly cut that off.

  13. CT is also having a huge nursing shortage.. and doctors (especially ob-gyn’s) are leaving the state because of huge malpractice insurance fees.
    With all the talk about universal healthcare – I wonder if there will be any providers around to care for everyone.
    I understand they are importing nurses from countries where the nursing education is not exactly up to par.

  14. “The short answer to your question is prop 13.”

    Really? Please explain in detail. I thought property taxes went mostly towards K-12, and K-12 is getting substantially more in real dollars now than when Prop. 13 passed.


  1. The California Nursing Shortage…

    The state of California is outsourcing the training of nurses to Mexico due to cheaper labor costs and the ready availability of nursing instructors. Right now, up to 40 bilingual California nursing students are being considered for training in Mexic…..