California State University system versus the California Community Colleges Part 6 – The Elephant in the Room: Nursing
I have been writing about the development of community college baccalaureate degrees in California, and the objections of the California State University system to specific Bachelors degree programs. ?As I ended the last installment, quite a lot of the current objection by CSU is a proxy fight for a future objection.? The real fight is over…
NURSING
??????????? Let’s jump into that.?
In the current California system only CSU or UC campuses can offer a BSN, a Bachelors of Science in Nursing.? (Training the bulk of BSNs falls to CSU; of the University of California campuses, only UCLA, UC Davis, UC Irvine, and UC San Francisco offer a BSN.)? Many community colleges have a nursing program, but their graduates earn an Associates degree in Nursing.? Our college provides an example:?
The Registered Nursing Program at Solano Community College is a 2-year Associate Degree Program fully approved by the CA Board of Registered Nursing and is subject to its regulations regarding the education and training of nurses. Successful completion of the program qualifies the student to apply to the National Council Licensing Examination (NCLEX-RN) to become a Registered Nurse.
Multiple points support the proposal :
1.???? In Nursing, a Bachelors of Science in Nursing (BSN) degree is increasingly required for most positions.
2.???? The current system is inadequate and untenable.
3.???? A massive nursing shortage is looming.
4.???? The community college nursing program already is a four year degree – a two year program on top of two years of prerequisites
5.???? graduates take the same RN exam as current BSN graduates.
6.???? The trainees receive the same clinical experience.
7.???? Quality is assured by an outside accreditation process.
8.???? Community colleges offering BSNs are routine in other states.
9.???? This is a social justice issue.
10.? We cannot cripple the health care system of California because of the objections of one branch of higher education.
11.? The dropping of the non-duplication for community college baccalaureates provision is inevitable.
12.? A bill currently proposed in the California legislature would change this
If you go back to read the old accounts of the early meetings that first discussed the idea of offering Bachelors degrees in California community colleges the discussion was dominated by Nursing.? These early meetings dreamed of offering a BSN.? ?
And if you followed the subsequent political debate when those discussions became legislative debates, much of the opposition to community colleges offering any Bachelors degrees was generated by specific (and fierce) opposition to them offering BSN degrees. ?The discussion to pursue Community College Bachelors degrees could only go forward with the political compromise that these degrees could not duplicate degrees offered at CSU or UC campuses.? (I have been writing about how messy the duplication determination has been).? There are now 39 Bachelors degrees in California with the potential of adding 30 per year, and the program has been successful by any criterion.?
This Nursing showdown was delayed, but now it is here.? ??
??
In 2000 when my son was young he was in Oakland Children’s Hospital for four months.? I asked every one of his nurses where they were trained.? The answer was “at my local community college,” for 90% of them.? Their training had been sufficient then, but in the interim, hospitals changed their criteria and now typically want a Bachelors degree on paper.? All of the Respiratory Therapists that I talked to had been community college trained, and every X-ray was taken by a community college trained radiation technician.? Since I taught pre-nursing microbiology I ran into quite a few former students – 39, but who’s counting.
?Now when I run into former students in nursing, all of them have earned a BSN through an Associates degree in Nursing to BSN transition program.
“Was that expensive,” I ask.
“Very.”
“Was it worthwhile?”
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“I learned some things.? But the skills and knowledge that I use day-to-day I learned in the community college program, especially in the clinic.”??
This experience of encountering CC trained Nurses would be common at any hospital.? In the community colleges there are 77 Registered Nursing program in the 116 college system.? ??A 2022 report examined the impact of community college Nursing programs:?
This report underscores the importance of these schools:?
The supply of nurses relies heavily on the state’s higher education system, specifically California community college nursing programs, which train and supply a large proportion of the nurses in California. California community college Associate Degree for Nursing (ADN) programs account for 55.4% of the total nursing schools in the state (77 of 139 nursing schools), graduate about half of the state’s nurses and satisfy about 21% of the state’s demand for nurses (California Board of Registered Nursing).
?And it outlines the benefit of the programs to the graduates:?
California community college nursing programs are essential to addressing the nursing shortage and provide a source of high-wage, high-demand occupations for California community college students. California provides the highest employment level of registered nurses in the US and is the top paying state in the country with an hourly mean wage of $64.10 and an annual mean wage of $133,340 (Bureau of Labor Statistics, 2022a). Thus, registered nursing is a path that promotes upward mobility and family-sustaining wages for California community college students.
??????????? A 2010 “Future of Nursing” report from the Institute of Medicine recommended that health care facilities hire 80% BSNs.? ?
??????????? Hospitals responded to this report.? A 2021 Health Impact report reported that “18% of California hospitals surveyed stated that a BSN was required for employment – twice the percentage noted in 2017 – and 54.3% reported a preference for hiring BSNs.”
??????????? California State Senator Richard Roth introduced Senate Bill 895 which would create a pilot program that would allow 15 community college districts with existing nationally accredited associate degree in nursing (ADN) programs to offer a Bachelor of Science in Nursing (BSN) degree.? The “pilot program” approach is how the first 15 Bachelors degrees began.? The approach softens the opposition, but delays widespread implementation. ?The bill had been scheduled to be heard in the Senate Education Committee last week, and I was going to listen to the public hearing, but “the bill was pulled by the author” at the last minute.? This likely means that the opposition rallied and the situation needed more massaging.?
A national Nursing shortage is looming:
?Registered nurses (RNs) play a critical role in health care delivery. With an aging US population, health care demand is growing at an unprecedented pace. Using projected changes in population size and age, the authors developed demand and supply models to forecast the RN job shortage in each of the 50 states. Letter grades were assigned based on projected RN job shortage ratios. The number of states receiving a grade of "D" or "F" for their RN shortage ratio will increase from 5 in 2009 to 30 by 2030, for a total national deficit of 918 232 (725 619 - 1 112 112) RN jobs. There will be significant RN workforce shortages throughout the country in 2030; the western region will have the largest shortage ratio of 389 RN jobs per 100 000. Increased efforts to understand shortage dynamics are warranted.
?And another report from the American Association of Colleges of Nursing outlines the shortages:?
The RN workforce is expected to grow from 3.1 million in 2021 to 3.3 million in 2031, an increase of 195,400 nurses. The Bureau also projects 203,200 openings for RNs each year through 2031.
? The Advanced Practice Registered Nurse (APRN) workforce, including Nurse Practitioners, Nurse Anesthetists, and Nurse Midwives, is expected to grow much faster than average for all occupation, by 40% from 2021 through 2031,
? a shortage of registered nurses is projected to spread across the country through 2030. In this state-by-state analysis, the authors forecast a significant RN shortage in 30 states with the most intense shortage in the Western region of the U.S.
According to AACN’s report on 2021-2022 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, U.S. nursing schools turned away 91,938 qualified applications (not applicants) from baccalaureate and graduate nursing programs in 2021 due to insufficient number of faculty, clinical sites, classroom space, and clinical preceptors, as well as budget constraints.
These reports highlight the impact of the COVID19 pandemic on the workforce and the wave of upcoming retirements.? “a 2020 National Nursing Workforce Survey conducted by the National Council of State Boards of Nursing found that the average age for an RN is 52 years old, which may signal a large wave over the next 15 years.”
For the sake of the state, for the sake of the students, for the sake of the nursing profession, and on ethical grounds, this ultimately must be changed.? As in the other Bachelors degrees, this proposal does not really threatened enrollment at the CSU, but it poses more threat to the expensive ADN to BSN programs at for-profit and private institutions.?
As with the other programs, I expect a political fight, but ultimate victory.? Logic will likely overrule politics.
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Update: As of July 2024 the California legislature has a bill working its way through the process to become law that would authorize 15 of the community college RN programs to offer a BSN. The bill is still opposed by administrators of the CSU system, but it handily passed the education committees of both houses of the legislature and is expected to pass when it reaches the floor of the Senate and Assembly. The governor is expected to sign the bill into law and this might happen by October 2024. Reenacting the process where 15 community colleges were initially authorized to pilot offering a baccalaureate, it is now likely that 15 colleges will be able to offer a Bachelors of Science in Nursing by Fall 2026.
Holistic Counselor, Managerial Advisor.
7 个月Costly is the word. On fees paid. Rethink on this. For locals admissions. According to their income levels and aptitude for nursing. Because Indian nurses galore are migration. Besides supply in Kerala of such inclined nurses is qualitatively low Genetically running out of supply from India.
Dean of External Programs @ Solano Community College | Educational Leadership
10 个月Great work, Jim!
Passionate Agribusiness Leader | Mentor & Coach |
11 个月Great article, Jim!
Strategic Advisor & Grants Manager, Workforce & Talent, Georgia Bio Consultant: education, government, workforce and economic development at Philip G Gibson
11 个月Well-written and appropriately documented. How refreshing.