board of registered nursing education/licensing · pdf file · 2017-04-04board of...

BOARD OF REGISTERED NURSING Education/Licensing Committee

Agenda Item Summary AGENDA ITEM: 7.1

DATE: April 5, 2017 ACTION REQUESTED: Vote On Whether To Recommend Ratification Of Minor Curriculum

Revision and Acknowledge Receipt Of Program Progress Report REQUESTED BY: Michael Jackson, RN, MSN Chairperson, Education/Licensing Committee BACKGROUND: According to Board policy, Nursing Education Consultants may approve minor curriculum changes that do not significantly alter philosophy, objectives, or content. Approvals must be reported to the Education/Licensing Committee and the Board. Minor Curriculum revisions include the following categories: • Curriculum changes • Work Study programs • Preceptor programs • Public Health Nurse (PHN) certificate programs

• Progress reports that are not related to continuing approval

• Approved Nurse Practitioner program adding a category of specialization

The following programs have submitted minor curriculum revisions that have been approved by the NECs:

7.1.1 California State University, Bakersfield Baccalaureate Degree Nursing Program 7.1.2 California State University, Stanislaus Baccalaureate Degree Nursing Program 7.1.3 Carrington College LVN to RN Associate Degree Nursing Program 7.1.4 City College of San Francisco Associate Degree Nursing Program 7.1.5 Mission College Associate Degree Nursing Program 7.1.6 Napa Valley College Associate Degree Nursing Program 7.1.7 San Joaquin Delta College Associate Degree Nursing Program 7.1.8 Sierra College Associate Degree Nursing Program Acknowledge Receipt of Program Progress Report:

7.1.9 Charles R. Drew University of Medicine and Science, Mervyn M. Dymally School of Nursing Entry Level Master’s Degree Nursing Program 7.1.10 Holy Names University LVN to BSN Baccalaureate Degree Nursing Program 7.1.11 Simpson University Baccalaureate Nursing Program 7.1.12 University of Phoenix, Modesto LVN-BSN Degree Nursing Program 7.1.13 Bakersfield College Associate Degree Nursing Program 7.1.14 East Los Angeles College Associate Degree Nursing Program 7.1.15 Mendocino College Associate Degree Nursing Program 7.1.16 Shepherd University Associate Degree Nursing Program 7.1.17 Unitek College Associate Degree Nursing Program 7.1.18 Weimar Institute Associate Degree Nursing Program 7.1.19 University of Phoenix Nurse Practitioner Program (Costa Mesa, Pasadena, Ontario) 7.1.20 University of Phoenix Nurse Practitioner Program (Sacramento) NEXT STEP: Notify programs of Board action. PERSON TO CONTACT: Leslie A. Moody, RN, MSN, MAEd Nursing Education Consultant

MINOR CURRICULUM REVISIONS Education/Licensing Committee

DATE: April 5, 2017

SCHOOL NAME APPROVED BY NEC

DATE APPROVED

SUMMARY OF CHANGES

California State University, Bakersfield Baccalaureate Degree Nursing Program

C. Velas 02/08/2017 The program is reinstating the NURS 4870 Cooperative Education Work Study Course as an elective. This work-study course would be offered by the Department of Nursing in cooperation with selected clinical agencies holding current clinical contracts with the Department. Students apply previously learned nursing theory and clinical skills in assigned patient care settings under the supervision of selected RN nurse preceptors and with the oversight of CSUB faculty clinical coordinator. The addition of this elective does not impact the current units of the approved curriculum.

California State University, Stanislaus Baccalaureate Degree Nursing Program

S. Engle 01/03/2017 ASBSN program requests to move NURS 2810 Professional Nursing from session I to session II. This move will mirror with the pre-licensure program at the Turlock campus in a condensed time frame. Updated TCP form received.

Carrington College LVN to RN Associate Degree Nursing Program

K. Daugherty 01/10/2017

01/25/2017

02/06 /2017

Update CRL and TCP to accurately reflect high risk OB/Peds courses RN 231 and RN 245 and courses descriptions reflecting inclusion of these two content areas as included in course syllabi and update of college catalog. Students will use an e-book platform instead of traditional hard copy texts. This change will reduce book costs for students. Student fees will cover students receiving an iPAD with a 2 year service plan and a 5 years e-book license. Per CCR 1432, DeVry Education Group and the Sacramento Program Director/Dean of Nursing provided written notification regarding changes in the leadership/organizational structures for the (7) for- profit Carrington Colleges (CC) nursing education programs located throughout the Western United States. Effective 1/30/17 former CC campus level leadership was replaced by a model of (4) Regional Directors for four different regions. The CC Sacramento campus is part of the new Region 1 with Regional Directors of Operations, Finance, Career Services, and Enrollment Services replacing the previous campus level Dean of Academic Affairs and Executive Director positions. Under the new leadership model, the Sacramento campus Nursing Dean/RN Program Director reports to a CC Senior Nursing Dean and CC Provost/VP Academic Affairs for all (4) regions. These senior leaders reports

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DATE: April 5, 2017


DATE APPROVED

SUMMARY OF CHANGES directly to the CC President for all regions. Sacramento campus nursing students will have the same levels of support staff, access, and resources available. According to the Sacramento RN Program Director/Dean of Nursing, the program’s resources, policies, procedures, enrollment patterns etc. are unchanged. Campus level staff will report to one of the four Region1 Directors who will in turn report to the CC VP of Operations and CC President. The CC President reports to DeVry University President who reports to the CEO/President of the DeVry Education Group.

City College of San Francisco Associate Degree Nursing Program

S. Ward 01/27/2017 The program is removing NURS 50T LVN to RN Transition course (1 unit theory, 1 unit clinical) from the curriculum.

Mission College Associate Degree Nursing Program.

B. Caraway 02/09/2017 The college is in the process of making a change in the college data information system (Banner). In the new system, the courses will have a prefix of “M” for Mission, (the “M” will not show on transcripts), then “HOC” for “Health Occupations.” The program made changes in the numerical reference numbers, as well as course identifiers to be in alignment with the college new data information system (Banner), and with other Health Occupations courses. This change will make it easier for students to follow the college catalog and schedule of classes, and has no impact on the program curriculum, course content, or required program units. The revised Total Curriculum plan (EDP-P-05) and Required Curriculum (EDP-P-06) forms are reflecting these changes. The anticipated date of implementation for the new curriculum will be Summer, 2017.

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DATE: April 5, 2017


DATE APPROVED

SUMMARY OF CHANGES

Napa Valley College Associate Degree Nursing Program

J. Wackerly 02/01/2017 Replace Nurs250 Preceptorship clinical component with faculty led advanced medical-surgical/leadership management learning experiences in caring for acute complex patients in fourth semester for a total of 108 clinical hours and that includes 18 hours of didactic for Spring 2017 semester. Nursing students will be assigned to clinical facility sites working with RN staff and faculty to meet Nurs 250 clinical objectives. Nurs 250 clinical hours/units unchanged effective Spring 2017. Nurs 249 acute care pediatric content for the hospitalized child clinical rotation was canceled by the acute care hospital over 2016 holidays. The faculty refocused acute care pediatric curriculum to acute pediatric alterations with 18 hours pediatric simulation with acute scenarios. The faculty refocused pediatric content to community based includes 16 hours pediatric teach-learn project: health promotion, 8 hours pediatric environment home assessment & family care plan.

San Joaquin Delta College Associate Degree Nursing Program

K. Daugherty 01/10/2017 Revise CRL and TCP forms to eliminate HS 043 as a required course for the LVN 30 unit option so the option does not exceed 30 units. The course can be taken as an elective course, if desired. The program has not had any students admitted to this option in a number of years.

Sierra College Associate Degree Nursing Program

K. Daugherty 01/27/2017 Replace NR24 Preceptorship component with a faculty-led advanced medical-surgical/leadership management set of learning experiences in caring for 4-5 acutely ill complex patients in the fourth and final semester. Course clinical hours/units are unchanged effective for the Spring 2017 semester and indefinitely thereafter until sufficient type and number of preceptorships are available to support re-implementation of the previously successful and effective clinical preceptorship learning experiences available.

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DATE: April 5, 2017


DATE APPROVED

PROGRESS REPORT

Charles R. Drew University of Medicine and Science, Mervyn M. Dymally School of Nursing Entry Level Master’s Degree Nursing Program

L. Shainian 02/08/2017 CDU Quarterly Progress Report for Sept-Dec 2016: Program tracking of NCLEX performance to-date for Cohort 9 (August 2016) and Cohort 10 (December 2016) graduates shows Cohort 9 graduated 29 students with 26 passs/1 fail/1 pending; and Cohort 10 graduated 29 students with 23 pass/1 fail/5 pending. The program continues with outside NCLEX Review Consultant and structured review/testing/remediation in the 5th semester prior to being cleared for NCLEX. Analysis of student profiles/performance in the program yielded predictive at-risk characteristics for which all student resources – including advisement, mentoring, and intense oversight – will be utilized to ensure success. Faculty completed an exhaustive mapping of the curriculum with the NCLEX-RN test plan which showed 90% coverage of all content/categories, and identified gaps of weakness for which follow-up is to be completed by Fall 2017. Faculty are reviewing/revising test strategies for consistent exposure to NCLEX-style questions in each course. Work on a major curriculum revision proposal continues with an updated target date of completion as Spring 2018. Faculty committees meet weekly to review online survey data and HESI results by courses and cohort. Program Evaluation Committee members continue to work on revising the Total Program Evaluation plan which is to reflect analysis of Spring and Fall 2016 evaluation data. There are two new faculty (MS & Peds). An updated faculty roster is pending. Adjunct clinical faculty participating in restructured faculty orientation – to be finalized end of Spring 2017. Revised clinical evaluation tool piloted Fall 2016. Nanette Leonard to replace Dr. Ebere Ume as Assistant Program Director.

Holy Names University LVN to BSN Baccalaureate Degree Nursing Program

K. Daugherty 01/10/2017 Program graduated its final 6 enrollment students and officially closed this program option upon completion of these graduates. Program continues to encourage its graduates take the test within 3 months of graduation. The Oct-Dec 2016 quarter of first time NCLEX results will be available February 2017. Program has submitted a letter of intent to move ahead with seeking approval for a generic BSN program in the future and has hired an experienced pre-licensure generic BSN degree nurse educator/consultant to assist the program

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DATE: April 5, 2017


DATE APPROVED

PROGRESS REPORT leadership and faculty in this endeavor.

Simpson University Baccalaureate Nursing Program

K. Daugherty 02/13/2017 SU has a total of (84) enrolled in traditional undergraduate BSN degree option at this time consisting of (58) continuing students and (6) Fall 2016 and (20) Spring 2017 enrolled students. This is the first AY the program has admitted in both the Fall and Spring terms. The program was approved to admit up to (18) beginning in Fall 2016 but only (6) were admitted. A total of (20) were admitted in Spring 2017 although BRN approved to admit up to (27). No clinical placement/displacement have been identified or reported by SU, other nursing programs in the region or the clinical agencies in the region. The program is approved to admitted up to (24) in Fall 2017 and (27) in Spring 2018. From Fall 2018 forward SU is approved to admit (27) each Fall and Spring terms. BRN approved admission cycles are based on the program demonstrating sufficient resources to implement the program.

University of Phoenix, Modesto LVN-BSN Degree Nursing Program

S. Engle 01/03/2017 Received Change of Ownership of Apollo Group UOP to Apollo Global Management, The Vistria Group, LLC & Najafi Companies collectively known as the “Investors”.

Bakersfield College Associate Degree Nursing Program

L. Sperling 01/04/2017 Program advised of their closure of the Cero Coso Satellite campus as of Fall, 2016. 10 LVN-RN students were brought over to the Bakersfield campus progressing into the 4th semester, to complete their program. 6 LVN-RN students that were accepted to begin in the fall at the Cero Coso campus were also admitted into the Bakersfield College campus. Bakersfield College accepts 10 students into their LVN-RN program each Fall. Current number of students in LVN-RN program is 24 which include the students currently at the Bakersfield campus.

East Los Angeles College Associate Degree Nursing Program

L.Shainian 02/08/2017 ELAC Quarterly Progress Report for Oct. 2016-Jan. 2017: The final semester of the new curriculum was implemented Fall 2016. Faculty completed a comparison review of student grades in each course for old-vs-new curriculum which showed no significant change as a result of the new curriculum. However, faculty are seeing increased student performance since implementing mandatory Kaplan testing in each course (5% of grade) over the

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DATE: April 5, 2017


DATE APPROVED

PROGRESS REPORT past year, with benchmarks that must be met before progressing in the program – this has been well-received by students. Students who fail or withdraw from a course are required to complete a remediation plan over the next quarter before reentering the program. A full-time faculty member has been assigned as Remediation Specialist (RS) until this position can be filled. Remediation is more structured and includes signing up for “independent study” (credit/no credit), meeting weekly with the course faculty and RS, and completing assignments on a timeline – “the process is working!”. Faculty are utilizing Mountain Measurements to identify areas that need to be strengthened in the curriculum, and a review of tests in each course (and the grading rubric) was completed with plans to strengthen test questions beyond application and comprehension. NCLEX results for July-Sept 2016: 77.27%. Face-to-face NCLEX reviews conducted by Kaplan post-graduation are confirming to graduates that they are on target for passing the NCLEX. The ELAC nursing program, along with six other nursing programs, has received a $2,000,000 donation so that ELAC graduates can be reimbursed up to $500 for NCLEX application and testing fees/expenses. Anecdotal data received by the program from employers of ELAC graduates is that they are 100% satisfied. 20 new students were oriented in Nov 2016 to start Jan 3, 2017. Two full-time faculty hired for MS and PMH (were previous long-term substitutes) started Fall 2016. The program is looking for an additional Instructional Assistant for the Learning Lab evenings & weekends.

Mendocino College Associate Degree Nursing Program

S. Ward 01/30/2017 An interim visit was conducted on 1/30/17 related to status of program administration, organization and faculty resources.

Shepherd University Associate Degree Nursing Program

M. Minato 02/06/2017

The program submitted a status report to address continued progress with NCLEX Exam pass rate improvement. The progress report showed that an updated action plan to the issues identified from last school visit and that faculty development and simulation integration are continuing. The NCLEX Exam pass rate from the last three quarters (Apr-Dec. 2016) for the graduates

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DATE: April 5, 2017


DATE APPROVED

PROGRESS REPORT

02/14/2017

who have completed the revised curriculum has an average of 90.5% (19/21) pass rate. However, the program, also, indicated that admission policies are being reviewed to address attrition rate above 40%. Next progress report is due in May and a site visit to the school is to be scheduled. The BPPE sent a letter notifying the school that the BPPE approval for SU’s ADN program that was based on ACICS’s accreditation was expiring on 2/13/17 and that the school needed to submit a new application by March 1, 2017. SU provided information on 2/14/17 that the school plans to submit the required application by March 1 and that the WASC accreditation process, which the school had started when the ADN program is continuing with candidacy and is expecting a final review by WASC on 3/7-8/17.

Unitek College Associate Degree Nursing Program

S. Engle 12/31/2016 The BRN notified the program by letter dated September 12, 2016 that 2015-16 NCLEX-RN exam were below the threshold of 75% pass for first time takers (CCR 1431). The program submitted a comprehensive assessment of the program and identified admission & selection criteria, diversity, academic performance, and NCLEX testing timeline as factors contributing to the below 75% pass rate. Multicriteria screening will be implemented January 2017.

Weimar Institute Associate Degree Nursing Program

K. Daugherty 02/13/2017 The first routine post initial program approval visit has been made following the first cohort’s (6) completion of two terms and the summer session pediatric clinical rotations completed as LLU. The LLU Pediatric clinical arrangement was part of the Board’s initial program approval. As initially approved, clinical placement arrangements included various clinical facilities within the Adventist Health Care systems in southern and northern CA. The program demonstrated compliance with the regulations and Board policies/guidelines when visited. Students report overall satisfaction with the program of study. Faculty is viewed as knowledgeable, competent and supportive of student learning. The program has been successful in obtaining clinical placements in medical-surgical, gero and psych/mental health within the Sacramento region

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DATE: April 5, 2017


DATE APPROVED

PROGRESS REPORT with favorable student and faculty feedback from local clinical agencies. The program continues to participate in two of the three local regional planning groups in the Sacramento region. Despite ongoing participation in two of the three local Sacramento region clinical planning groups, the program has been unable to secure t additional OB and PEDS placements closer to the campus for the second cohort (9) of students. Program evidence shows the students are performing well using the Kaplan NCLEX Predictive testing system. The first cohort of (6) students will complete the AD and graduate at the end of Spring 2017 term. Since inception, expected program admissions and second cohorts have been less than (20) once a year as initially expected/approved. The program reports it has (21) in its pre-nursing courses but will make its decisions regarding total number to admit in Fall 2017 based on resources including clinical placements and faculty.

University of Phoenix Nurse Practitioner Program (Costa Mesa, Pasadena, Ontario)

S. Ward 01/03/2017 The University of Phoenix provided a letter of notice of change in ownership anticipated to become effective 2-1-2017, per CCR Section 1432- Changes to an Approved Program.

University of Phoenix Nurse Practitioner Program (Sacramento)

S. Engle 01/03/2017 Received Change of Ownership of Apollo Group UOP to Apollo Global Management, The Vistria Group, LLC & Najafi Companies collectively known as the “Investors”.

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Agenda Item Summary

AGENDA ITEM: 7.2 DATE: April 5, 2017

ACTION REQUESTED: Vote On Whether To Approve Education/Licensing Committee

Recommendations REQUESTED BY: Michael Jackson, MSN, RN

Chairperson, Education/Licensing Committee BACKGROUND: The Education/Licensing Committee met on March 8, 2017 and makes the following recommendations: 7.2.1 Continue Approval of Prelicensure Nursing Program

College of San Mateo Associate Degree Nursing Program Butte College Associate Degree Nursing Program Sierra College Associate Degree Nursing Program

7.2.2 Continue Approval of Advanced Practice Nursing Program

San Francisco State University Nurse Practitioner Program 7.2.3 Approve Major Curriculum Revision

Biola University Baccalaureate Degree Nursing Program (curriculum revision) California State University, Channel Islands Baccalaureate Degree Nursing Program

(curriculum revision) Western Governors University Baccalaureate Degree Nursing Program (curriculum

revision) Bakersfield College Associate Degree Nursing Program (curriculum revision) College of the Redwoods Associate Degree Nursing Program (curriculum revision)

7.2.4 Defer Action to Continue Approval of Prelicensure Nursing Program

San Francisco State University Baccalaureate and Entry Level Master’s Degree Nursing Program

7.2.5 Continue Warning Status and Approve Enrollment of One Additional Cohort

Charles R. Drew University of Medicine and Science, Mervyn M. Dymally School of Nursing Entry Level Master’s Degree Nursing Program

East Los Angeles College Associate Degree Nursing Program A summary of the above requests and actions is attached. NEXT STEPS: Notify the programs of Board action. PERSON TO CONTACT: Leslie A. Moody, RN, MSN, MAEd

Nursing Education Consultant

Att to Board agenda item 7.2 ELC Committee Recommendations From 03/08/2017 meeting

Education/Licensing Committee Recommendations The Education/Licensing Committee met on March 8, 2017 and makes the following recommendations: 7.2.1 CONTINUE APPROVAL OF PRELICENSURE NURSING PROGRAM • College of San Mateo Associate Degree Nursing Program. Ms. Jane McAteer, Program Directom. A regularly scheduled continuing approval visit was conducted by Susan Engle, NEC and Janette Wackerly, SNEC on September 26-28, 2016. One area of non-compliance was identified CCR 1424. Administration and Organization of the Nursing Program subsections (e) The director and the assistant director shall dedicate sufficient time for the administration of the program and (g) Faculty members shall have the primary responsibility for developing policies and procedures, planning, organizing, implementing and evaluating all aspects of the program. Four recommendations were made: CCR 1424 (b)(1) and (d) Administration and Organization of the Nursing Program; CCR 1425.1.(b) Faculty Responsibilities; CCR 1426(b) Required Curriculum; and CCR1427 Clinical Facilities. The program submitted a report that includes improvement activities to address area of non-compliance and recommendations. ACTION: Continue approval of College of San Mateo Associate Degree Nursing Program. • Butte College Associate Degree Nursing Program. Ms. Susan Craig, Program Director, and Ms. Denise Adams, Dean-CTE. Katie Daugherty, NEC presented this report. A continuing approval visit was conducted December 5-7, 2016 by Katie Daugherty, NEC and Janette Wackerly, SNEC. One area of non-compliance, CCR 1424 (e) Program Administration and CCR 1427 (c ) was identified, and two areas of recommendations were made: CCR 1424 (d), (h)/Faculty Resources and CCR 1426 Curriculum/1427 Clinical Facilities. The program took immediate action to correct the area of non-compliance and address the visit recommendations. Sufficient evidence has been provided to correct the area of non-compliance. The total RN program enrollment at the time of the visit was ~ 216 students. A lottery admission process is used and applicants may wait up to 3-4 years before being admitted into the program. Retention rates have been typically in the range of 80-90% or higher the last five years. The program back fills program vacancies with re-admissions, transfer, and/or LVN-RN advanced placement eligible admissions with the goal to achieve a total of 48 graduates each AY. ACTION: Continue approval of Butte College Associate Degree Nursing Program. 7.2.4 Sierra College (SC) Associate Degree Nursing Program. Ms. Nancy James, Program Director. A continuing approval visit was conducted by Katie Daugherty, NEC and Janette Wackerly, SNEC November 15-17, 2016. The program was found to be in non-compliance in one area, CCR 1425/CCR 1425.1 Faculty related to required geriatric faculty approval. Two recommendations were made in the areas of CCR 1424 (b), (b) (1), Program Administration/ Policies & Procedures/Evaluation and CCR 1424 (g) Administration/ Faculty and CCR 1426 Curriculum/CCR 1427 Clinical Facilities. The program promptly corrected the area of non-compliance and submitted a written response outlining planned actions to address the recommendations. For the past two admission cycles, the program has carefully monitored first semester retention rates in order to determine the need for further admission criteria revisions that ensure maximum retention and on-time program completion. The program is considering implementation of the Community College Chancellor’s Office Multi-criteria formula and other pre-nursing preparation activities/support services to improve retention rates, particularly first semester. Annual first time

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Att to Board agenda item 7.2 ELC Committee Recommendations From 03/08/2017 meeting NCLEX-RN pass rates have consistently been 92 %-100% the last nine academic years. SC participates in an AD to BSN Merger/Collaborative with two other Sacramento region AD programs (up to 45 students). In December 2016 a total of 33 graduates completed the CSU Sacramento RN to BSN program within six months of completing their AD program. A second cohort is enrolled now and a third cohort is slated to participate in the collaborative project beginning in Summer 2017. ACTION: Continue approval of Sierra College Associate Degree Nursing Program. 7.2.2 CONTINUE APPROVAL OF ADVANCED PRACTICE NURSING PROGRAM • San Francisco State University Nurse Practitioner Program. Ms. Connie Carr, Program Director. The Family Nurse Practitioner program confers a Master of Science in Nursing Degree and also offers a Post-Master’s Certificate option. There were (23) students in the master’s degree option, and (10) in the post- master’s option at the time of the approval visit. The MSN degree option is offered full-time (2 yr.) or part-time (3 yr.), and consists of a total of (52) semester units. The post-master’s certificate option (2 yr.) is a total of (31) semester units. The full-time program and certificate option is scheduled over (4) semesters. A continuing approval visit was conducted by Shelley Ward, NEC and Dr. Susan Engle, NEC on November 16-17, 2016, to the San Francisco State University Family Nurse Practitioner Program, in conjunction with the prelicensure program visit. No areas of non-compliance were identified. Two recommendations were rendered in the area of curriculum - CCR Section 1484 (d)(12)(I) – Pharmacology and 1484 (d)(12 (P) –Legal Implications of Advanced Practice. The program submitted a response to address the recommendations. The program meets requirements for nurse practitioner programs as stated in CCR 1484 Standards of Education Sections (a) - (d). ACTION: Continue approval of San Francisco State University Nurse Practitioner Program.

7.2.3 APPROVE MAJOR CURRICULUM REVISION • Biola University Baccalaureate Degree Nursing Program. (curriculum revision)

Dr. Rachel Van Niekerk, Program Director. Biola is a private, Christian University offering a five-year generic baccalaureate degree nursing program. Through student evaluations and in being responsible to their student’s time and money, the major curriculum revision request proposes to decrease the length of the program from 5 years to 4.5 years, decreasing the required content from 55 units to 48.5 units (29 units of nursing theory to 27 units, 26 units of clinical to 21.5 units). Level 1 Spring semester was heavy with units/content so some content was moved into the Level 1 Fall semester. NURS 440 Intro to Nsg Research and NURS 207 Pharmacology are available online in the summer so their sixth and eighth semesters are lighter. Biola is making a concerted effort to graduate generalist versus specialist and therefore devote more time and energy into their medical surgical courses. Psych/mental health, obstetrics, and pediatrics clinicals have decreased by ½ unit, from 90 to 67.5 hours. ACTION: Approve major curriculum revision for Biola University Baccalaureate Degree Nursing Program. • California State University, Channel Islands (CSUCI) Baccalaureate Degree Nursing Program. (curriculum revision)

Dr. Karen Jensen, Dean and Program Director. The CSUCI baccalaureate degree nursing program received initial program approval from the BRN in 2007. In September 2010 the CSUCI nursing program received BRN approval to open an extension campus near Santa Barbara in Goleta where they admit a cohort of 22 students annually each Spring. Both campuses share the same curriculum. A major curriculum revision was proposed in response to the

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Att to Board agenda item 7.2 ELC Committee Recommendations From 03/08/2017 meeting Commission on Collegiate Nursing Education accreditation interim report. The changes reflect the consistency of the Program Mission, Goals, and Student Learning Outcomes to insure they meet the Essentials of Baccalaureate Education for Professional Nursing Practice 2008 as published by the American Association of Colleges of Nursing. There is no change in units. ACTION: Approve major curriculum revision for California State University, Channel Islands. • Western Governors University (WGU) Baccalaureate Degree Nursing Program (curriculum revision) Dr. Alice Martanegara, Program Director. WGU is a unique competency-based, asynchronous, single-curriculum prelicensure program partnering with hospitals to develop Baccalaureate prepared registered nurses who complete all clinical practice in their hospital settings. Clinical practicums use hospital registered nurses as clinical instructors who oversee a cohort of 10 students, and 1:1 RN Clinical Coach assigned to each student for each clinical rotation. Students gain competency-based knowledge, skill, and ability for each course in WGU’s Skills/Simulation lab in Santa Ana prior to entering the clinical setting. WGU is eight semesters in length and the tuition is $35,865.00 for the total program (8 terms). Most students come into the program with prerequisites already completed and the cost for only the nursing content (5 terms) is $22,680.00. A proposal for a Major Curriculum Revision and enrollment increase was submitted with planned implementation in April 2017. WGU is requesting replacement, addition, and sun-setting of some courses and course code changes for other courses as follows: Replace C132 Elements of Effective Communication (3.0 CU) with C464 Introduction to Communication (3.0 CU); Replace C459 Introduction to Probability and Statistics (3.0 CU) with C784 Applied Healthcare Statistics (4.0 CU); Add C820 Professional Communication and Leadership in Healthcare (2.0 CU); Sunset C457 Foundations of Math (3.0 CU); Change course code numbering for Biochemistry from C437 (3.0 CU) to C785 (3.0 CU), Introduction to Nursing Arts & Science from C485 (3.0 CU) to C825 (3.0CU), Community Health and Population-Focused Nursing from C228 (3.0 CU) to C826 (3.0 CU); Change course code number and title for Nutrition from C274 Nutrition for Contemporary Society (3.0 CU) to C787 Health and Wellness through Nutritional Science (3.0 CU). There is no change to total program units. ACTION: Approve major curriculum revision for Western Governors University Baccalaureate Degree Nursing Program. • Bakersfield College Associate Degree Nursing Program (curriculum revision) Ms. Carla Gard, Program Director and Ms. Debra Kennedy, Assistant Director. The program submitted a major curriculum revision proposal to be implemented in the Fall 2017. This process started in response to subsequent findings during an ongoing comprehensive analysis of data from the Annual Program Reviews. This change will support the educational needs of the students by better aligning with the rapidly changing healthcare environment and the knowledge, skills, and attitudes needed for the student to safely transition into practice as an entry level nurse. Specific benefits for the students include a more seamless transition from simple to complex levels within the program, while simultaneously strengthening the student’s clinical reasoning and judgement skills, and will provide an uninterrupted clinical experience. Revised units: Total Nursing Units decreased from 41 to 38 units: Theory decreased from 21.5 to 19.5 units; Clinical hours decreased from 19.5 to 18.5 units. Total Units for Licensure decreased from 71 to 68 units. No changes to Communication or Science units, or Other Degree Requirements. Total Units for Graduation decreased from 81 to 78 units. ACTION: Approve major curriculum revision for Bakersfield College Associate Degree Nursing Program.

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Att to Board agenda item 7.2 ELC Committee Recommendations From 03/08/2017 meeting • College of the Redwoods (COR) Associate Degree Nursing Program (curriculum revision) Dr. Alison Pritchard-Stull, Program Director and Ms. Roberta Farrar, Assistant Director. A major curriculum revision proposal was submitted with planned implementation Fall 2018. During the last continuing approval visit (2015), the faculty verbalized their understanding that a major curriculum revision was needed. The entire faculty attended a Concept-Based Curriculum (CBC) conference and returned with enthusiastic agreement to move forward with CBC. Other considerations for this revision included the need to meet changing needs of the nursing profession, nursing education, and the provision of quality healthcare. For the past two years the entire faculty have worked intensively and collaboratively to develop this curriculum, incorporate active teaching/learning strategies, thoughtful and thorough scaffolding of concepts, and course/clinical syllabi that are consistent across all four semesters. COR has adopted an organizing framework based on Quality and Safety in Nursing Education (QSEN), supplemented by Massachusetts Nurse of the Future (2010), NLN Education Competencies Model (2010), and BRN regulations. The faculty adopted the conceptual approach described by Jean Giddens PhD, RN, FAAN, Linda Caputi, EdD, MSN, RN, CNE, and others including 43 curricular concepts chosen using Giddens Concepts for Nursing Practice (2017) text and based on the most serious and commonly occurring health problems in the US and /or their community. The prerequisites for this program have not been impacted by the new curriculum. No clinical sites were impacted by these changes. ACTION: Approve major curriculum revision for College of the Redwoods Associate Degree Nursing Program. 7.2.4 DEFER ACTION TO CONTINUE APPROVAL OF PRELICENSURE NURSING

PROGRAM • San Francisco State University Baccalaureate and Entry Level Master’s Degree Nursing

Program. Dr. Elaine Musselman, Assistant Program Director. A continuing approval visit was conducted by Shelley Ward, NEC and Dr. Susan Engle, NEC on November 14-17, 2016, to the San Francisco State University Baccalaureate Degree and Entry Level Master’s Degree Program. Areas of non-compliance: CCR Sections 1424 (d) – Resources,1425.1 (d) – Faculty Responsibilities, 1426 (a) – Required Curriculum, 1426.1 (b)(6)- Preceptorship, 1427 (a)- Clinical Facilities and 1431- Licensing Examination Pass Rate Standard. Two recommendations were rendered. Annual NCLEX examination pass rates for the BSN program ranged from 76.98% to 90.38% from 2009-2016. ELM-MSN pass rates ranged from 63.64% to 100% from 2009-2016. The below 75% pass rate requirement specific to the ELM option occurred in the July 2015- June 2016 time frame. The assessment and plan for correction addressing the ELM option submitted in 2016 notes that low number of test takers ( N=11), and the prior curriculum were in part contributing factors. The program implemented a major curriculum revision for the BSN program in fall 2013, and for the ELM option in fall 2014; in part, to align with changes in healthcare, nursing education, technology and community population profiles. The pass rate is at 88.24% for all ELM-MSN test takers from July 2016- December 2016. A reassessment of the annual NCLEX pass rate for the ELM option will occur when the pass rates for July 2016- June 2017 are available. ACTION: Defer action to continue approval for San Francisco State University Baccalaureate and Entry Level Master’s Degree Nursing Program. Program to submit progress report and return to ELC in October 2017.

7.2.5 CONTINUE WARNING STATUS AND APPROVE ENROLLMENT OF ONE

ADDITIONAL COHORT Page 4 of 5

Att to Board agenda item 7.2 ELC Committee Recommendations From 03/08/2017 meeting • Charles R. Drew University of Medicine and Science, Mervyn M. Dymally School of Nursing Entry Level Master’s Degree Nursing Program. Dr. Margaret Avila, Program Director and Dr. Steven O. Michael, Provost. A progress report subsequent to the Boards’ decision to continue Warning Status at the November 10, 2016 meeting was presented. The program was placed on Warning Status June 16, 2016 as a result of the program’s persistent substandard NCLEX pass rate (CCR 1431 NCLEX Pass Rate). The two recent quarters of NCLEX results for 2016-17 have been received for the program: 80.00% (July-Sept 2016) and 89.47% (Oct-Dec 2016). The combined average to date is 87.5%. The 87.5% is not too far from the program’s predictive testing data for the two most recent graduating cohorts (Aug & Dec 2016) which indicated a strong probability of passing the NCLEX (95%-98.32%). Currently, before 5th semester students are cleared to take the NCLEX, they must complete an intensive, structured review, and meet required HESI benchmarks. Changes are producing positive outcomes which has created an atmosphere of success & support for students, and provided the faculty with a renewed sense of ownership and commitment to their role in the program. The program requests permission to admit an additional cohort. ACTION: Continue warning status for Charles Drew University of Medicine and Science, Mervyn M. Dymally School of Nursing Entry Level Master’s Degree Nursing Program with program to provide progress report and return to ELC in October 2017. Grant approval for enrollment of one new cohort of up to thirty students. • East Los Angeles College Associate Degree Nursing Program. Ms. Lurelean Gaines, Program Director. The program is being presented for progress report subsequent to the Board’s decision to continue Warning Status (February 6, 2014) as a result of continued non-compliance for substandard NCLEX pass rate at the program’s October 7-8, 2013 continuing approval visit. Since the September 2016 Board meeting, two quarters of NCLEX results for 2016-17 have been received for the program: 77.27% (July-Sept 2016) and 76.19% (Oct-Dec 2016), with the combined average to date of 76.92%. Data for July-Sept & Oct-Dec showed more graduates testing within 3 months as previously reported by the program, and that even a majority of those who tested within 4-6 months were successful (86.6%). This upward trend has been long-awaited as the program has struggled with up to a third of graduates from each cohort either delaying testing or not testing at all. With only 61.49% of delayed testers passing, it has negatively impacted the program’s NCLEX pass rate. Over the past year, one of the factors which has contributed significantly to student performance in the program has been use of Kaplan standardized testing. As a result, faculty have noticed a positive change in students as they progress in the program – they have increased confidence and are more intent on working to achieve success. Students identified as “at risk” are referred to the program’s Remediation Specialist (RS) for individual remediation. Students who fail or withdraw from a course are required to complete a remediation plan over the next quarter before reentering the program. A full-time faculty member has been assigned as Remediation Specialist (RS) until this position can be filled. Ms. Gaines reported the program received a $2,000,000.00 donation for the ELAC and six other programs disbursed over eight years. $500.00 will be paid to students who take and pass the NCLEX within 3 months of graduation. ACTION: Continue warning status for East Los Angeles College Associate Degree Nursing Program with program to provide progress report and return to ELC in October 2017. Grant approval for enrollment of one new cohort of up to thirty students.

Page 5 of 5


Agenda Item Summary

AGENDA ITEM: 7.3.1 DATE: April 5, 2017

ACTION REQUESTED: Vote on Whether to Approve Major Curriculum Revision (enrollment

increase) for Biola University Baccalaureate Degree Nursing Program

REQUESTED BY: Michael Jackson, RN, MSN Chairperson, Education/Licensing Committee BACKGROUND: Rachel Van Niekerk, PhD, MSN has been the program director since June 2016. Biola University (BU) is a private, Christian University, founded in 1908 and has offered the five-year generic baccalaureate degree nursing program since 1966. Graduates are awarded a Baccalaureate Degree with a major in nursing and a minor in biblical studies. A proposal for enrollment pattern change and an enrollment increase was submitted for the BU Baccalaureate Degree Nursing Program with planned implementation in Fall 2017. BU currently admits a cohort of 40 students in the Fall and would like to decrease the size of this cohort to 30 and admit an additional cohort of 30 students each Spring resulting in an enrollment increase of 20 students annually for a total annual enrollment of 60 new students. By admitting twice a year instead of annually, students who are not accepted in Fall do not have to wait an entire year before re-applying. This proposal is also in response to the aging nursing work force and the need for more BSN bedside nurses to meet the increasingly complex needs of patients. Several partner hospitals are either Magnet status or working toward Magnet, requiring more baccalaureate prepared nurses. On March 20, 2017 Dr. Van Niekerk sent an email to 25 nursing Program Directors who share clinical sites with BU, and requested a response by March 23, 2017. Nineteen of the 25 schools did not respond. Two of the schools (West Coast University and Golden West College) asked for more information, which was provided but there was no further response. There was one program who opposed (CSU-Long Beach); two who supported the increase (Stanbridge University and University of California, Irvine); and Santa Ana College indicating that “the addition of Nursing students does have a negative impact” while also stating that, to date, the Biola program has not directly displaced Santa Ana College students. The following table presents contact/response information:

School Response Career Network Institute No response West Coast University Responded with request for more information

which was provided, no other response received

CSU-Long Beach Declined to support stating not providing support letters

CSU-Dominguez Hills No response American University of Health Science No response

Western Governors University No response University of San Francisco No response

Stanbridge University Provided a letter of support Santa Ana College Engaged in dialogue regarding concerns,

received letter Pacific College No response

Northwest College No response North Orange County ROP No response

Golden West College Responded with request for more information which was provided, no other response received

Concord Career College No response Coastline ROP No response

Cerritos College No response Central Orange County CTE Partnership No response

Rio Hondo College No response Mount San Antonio College No response

Mount Saint Mary’s University No response Los Angeles City College No response

Los Angeles Southwest College No response Los Angeles Harbor College No response

Los Angeles College of Nursing No response El Camino College No response

There is concern that lack of response from some of the ‘no response’ schools may be due to Spring Break and Program Directors who have not yet seen the email from Dr. Van Niekerk. ELC Recommendation: The program’s proposal was heard at the March 2017 meeting of the Education/Licensing Committee. The Committee has requested that all programs proposing enrollment increase provide evidence that schools using clinical facilities in common with the requesting program have been contacted so they may provide input regarding any potential displacement of existing students. NEXT STEPS: Notify program of Board action. PERSON(S) TO CONTACT: Carol A. Velas, EdD, MSN, RN Nursing Education Consultant


Agenda Item Summary

AGENDA ITEM: 7.3.2 DATE: April 5, 2017

ACTION REQUESTED: Vote on Whether to Approve Major Curriculum Revision (enrollment

increase) for Western Governors University Baccalaureate Degree Nursing Program

REQUESTED BY: Michael Jackson, RN, MSN Chairperson, Education/Licensing Committee BACKGROUND: Alice Martanegara DNP, RN has been the Program Director for Western Governors University (WGU) since December, 2014. A proposal for an enrollment increase for the Baccalaureate Degree in Nursing Program was submitted with proposed implementation in April, 2017. WGU is requesting an increase of 70 students for a total program enrollment of 100 students annually. This increase would occur on a rolling basis as clinical sites are identified by new service partners. WGU is a unique competency-based, asynchronous, single-curriculum prelicensure program partnering with hospitals to bring in Baccalaureate prepared registered nurses who complete all clinical practice in their hospital settings. Clinical practicums use hospital registered nurses as Clinical Instructors who oversee 10 students, and Clinical Coaches who work 1:1 with students during each rotation. Students gain competency-based knowledge, skill, and ability for each course in WGU’s Skills/Simulation lab in Santa Ana prior to entering the clinical setting. WGU has been asked to increase enrollment with current partners and have been approached by new service partners. The partnership between hospitals and WGU includes clinical sites at those hospitals with students on different units and during different shifts. Students are placed on both day and night shifts and dispersed across several different units. Dr. Martanegara sent an initial email on March 13, 2017 to 14 Program Directors of Nursing Programs who share clinical sites with WGU. In light of the low response rate and the timing of Spring Break for many colleges a second email was sent by Dr. Martanegara on March 21, 2017 to all Program Directors that did not initially respond. Short turn-around time and Spring Break scheduling might have contributed to persistent lack of response from some programs. The following are responses to Dr. Martanegara’s email:

School Response American University of Health Science No response Azusa Pacific University No response CSU-Los Angeles No response CSU-Long Beach No response CSU-Northridge No response

CSU-Fullerton No response Golden West College The Program Directors from Golden West College

and Saddleback College shared their concern with clinical displacement at Fountain Valley Hospital; Dr. Fishman’s comments -M/S and Pediatric rotations are threatened -Difficult to believe an additional 100 students will not severely impact the clinical placements for all current nursing programs. -Orange County is saturated -This is the fifth school announcing plans to expand and move into OC facilities -The only way hundreds of additional new nursing students are going to get clinical experience and future employment is by pushing the successful community college programs out of existence. -The Community Colleges successfully took on the task of increasing nursing graduates over the last 15 years with support of state grants. Dr. Pestolesi’s comments -Saddleback College has several clinical rotations at Fountain Valley Hospital including M/S, Pediatrics, Women’s Health and Preceptorship. -Students in pediatrics would likely be displaced -students in Preceptorships would also be displaced because of the nature of your program that uses preceptors exclusively. -Students in Women’s Health and M/S areas would likely be impacted but would not be as likely to be displaced.

Mt. Saint Mary’s University Opposed to proposal, would negatively impact clinical sites and community health resources.

Pasadena City College No response Santa Ana College No direct impact to students Saddleback College See Golden West College UCLA No response West Coast University Dr. Nelson from West Coast University asked for

the names of the hospitals and for clarification of the total increase in enrollment. Dr. Martanegara responded to her request. No other correspondence was received from Dr. Nelson.

Charles Drew University Called school for contact information, did not get a response back

Dr. Martanegara invited four of the fourteen colleges/universities to a meeting to address clinical displacement. This meeting was scheduled on Monday March 20, 2017 at 10 am at Fountain Valley Hospital. The meeting included; Dr. Diane Pestolesi (Saddleback Community College), Dr. Darlene Fishman (Cypress College), Dr. Diane Resteli (Golden West College) and Becky Miller (Santa Ana College), Julie Irby (Manager of Clinical Education, Fountain Valley

Hospital), and Brandi M. (Clinical Program Coordinator, Fountain Valley Hospital). The conversation included Dr. Martanegara explaining the WGU model and its year-round single clinical site immersion preceptorship that makes it difficult to schedule in the Orange County/Long Beach Consortium which was a concern of these Program Directors. Fountain Valley Hospital representatives explained their clinical placement approval process and the clinical master calendar was shared with all meeting participants. The hospital representatives also included the traditional school’s clinical requests do not depend on the WGU student cohorts as they are all approved through the consortium. The meeting concluded with all participants being appreciative of the dialogue and transparency of WGU and the discussion with the representatives of Fountain Valley Hospital. ELC Recommendation: The program’s proposal was heard at the March 2017 meeting of the Education/Licensing Committee. The Committee requested that the program obtain/provide additional information relative to potential clinical facility displacement of other programs’ students, to be presented at the April 2017 Board meeting. NEXT STEPS: Notify program of Board action. PERSON(S) TO CONTACT: Carol Velas, EdD, MSN, RN Nursing Education Consultant

Department of Nursing

Chalon Campus 12001 Chalon Road, Los Angeles, CA 90049-1599 Tel (310) 954-.4230 fax (310) 954-4229

March 22, 2017 Board of Registered Nursing 1747 N. Market Blvd, Suite 150 Sacramento, CA 95834-1924 To Whom It May Concern, RE: OPPOSITION STATEMENT TO INCREASE IN ENROLLMENT POSITION After a careful review of the proposed Western Governors University Nursing Program proposal to increase their enrollment, we are opposed to this proposal. The impact would adversely affect our Mount Saint Mary’s University Department of Nursing clinical rotation placement sites and community health resources. The request to increase any additional students per semester will negatively impact our school or clinical sites. Thank you for your serious consideration of our position statement regarding this request. Sincerely, Signature Line

Leah FitzGerald, Ph,D. FNP-BC Dean of Nursing Fletcher Jones Endowed Chair Nursing Partnerships Mount Saint Mary’s University 12001 Chalon Road Los Angeles, CA 90049 (m) 310-384-1189


Agenda Item Summary


ACTION REQUESTED: Vote On Whether To Accept Feasibility Study for Vanguard

University Southern California Baccalaureate Degree Nursing Program

REQUESTED BY: Michael Jackson, RN, MSN Chairperson, Education/Licensing Committee BACKGROUND: Vanguard University Southern California (VUSC) submitted a Feasibility Study (FS) November 9, 2016 and addendum January 12, 2017, for a new prelicensure Baccalaureate Degree Nursing program. Dr. Mary Wickman, Professor and Director of Nursing developed the FS. Details of the FS information are presented in the Nursing Education Consultant Report and additional documents attached. The following summary presents highlights of the proposal: Description of Institution: VUSC is a private, not-for-profit Christian university originally opened in Los Angeles in 1920 as the Southern California Bible School and relocated to the present Costa Mesa location (55 Fair Drive, Costa Mesa, CA 92626) in 1950, with a name change in 1999 to the current Vanguard University Southern California. The 40-acre campus and buildings are owned by the university. The single-campus university offers 29 baccalaureate majors, 5 graduate programs and 6 adult degree completion programs, with an enrollment of 2,077 degree seeking students in Fall 2016. The Nursing Department, established in 2006, offers RN-BSN and RN-MSN programs with Dr. Mary Wickman as the Director of Nursing. Total post-licensure nursing program enrollment in Fall 2016 is 100 students. Kinesiology is the other health related degree program offered. VUSC was accredited by WASC Senior College and University Commission since 1964 and has maintained continuous accreditation. WASC identified areas of concern that resulted in VUSC being placed on probation in June 2009 and required a Special Visit in spring 2010. Following the 2010 Special Visit the “public sanction of Probation” was removed. A 7/7/2014 letter from WASC to VUSC subsequent to an on-site Special Visit of March 2014 notes the Commission acted to continue accreditation, remove the Notice of Concern, require an Interim Report due March 12015, and schedule an Offsite Review Fall 2016. The related onsite Accreditation Visit is scheduled for February 28-March 2, 2017. Commission on Collegiate Nursing Education (CCNE) accreditation is held by the RN-BSN (to 2024) and RN-MSN (to 2019) nursing programs.

Proposed Program and Curriculum: VUSC proposes to begin enrollment of students into prerequisite courses beginning Fall 2017. The generic prelicensure BSN program will be presented in 16-week semester format of 8 semesters, Fall and Spring. Students will complete general education and nursing prerequisites in years 1-2 and nursing courses in years 3-4. All courses required for degree/program completion will be offered at the VUSC campus. Total units for graduation 128: Core 48 units, Sciences 24units, and nursing 56 units (35 Lecture; 21 Clinical). A BSN degree will be awarded upon successful completion. The school would like to begin Fall 2017 with initial enrollment of 24 students into prerequisite courses and those students would begin nursing courses in Fall 2018, with subsequent annual admission of 30 students thereafter. This would produce total enrollment of 54 students in nursing courses by 2019-20, and 60 students in nursing courses beginning 2020-21 academic year and forward. The plan to begin Fall 2017 admissions does not comply with BRN recommendation of projecting the first student enrollment two years from BRN acceptance of the FS. However, students would not be planned to begin actual nursing courses until Fall 2018. Applicant Pool: VUSC conducted an informal survey (January 2017) of area prelicensure programs including Cerritos College, Long Beach City College, Saddleback College, Santa Ana College, Stanbridge College, UCI, and Concordia University – Irvine to obtain information regarding the number of recent applicants who were not admitted, and informs that all programs reported turning away a large number of students. Recruitment for the new program will primarily target high school students to enter the university as undergraduate students with an interest in pursuing nursing education. Transfer students internally as well as from other universities would also be accepted and the university currently has approximately 30 Kinesiology majors who would like to transfer to nursing if it becomes available. Resources: VUSC already has in operation the usual array of student services provided on the campus including physical/psychological health, financial aid, career center, writing center, physical & online services library. Physical plant includes classrooms, faculty offices, computer labs and a nursing skills/simulation lab. The skills/sim lab is 760 square feet and has two hospital style furnished/equipped work stations with two adult mannequins, one hi-fidelity and one low-fidelity. The school is seeking funds for purchase of infant warmer and infant/child mannequins. The lab is currently utilized by students of existing RN-BSN (evenings 6:00-10:00 pm) and MSN programs (16 evening/weekend hours 1-2 times per year), some of which activities could be moved to an alternate classroom space if needed to increase prelicensure student access. The program is planning to utilize 25% simulation for clinical hours in all clinical nursing courses. Budget: The university plans to seek additional grant and partner funds to supplement the existing $50,000 start-up budget. The program will rely primarily upon tuition as the ongoing funding source which is projected to exceed expenses and provide excess to build a reserve. Budget assumes all seats will be filled every semester with transfer students filling seats vacated through attrition.

Clinical Facilities: The program plans to assign students to 50% acute care, 25% outpatient/community-based, and 25% simulation for each course’s clinical hours. The school will utilize the Orange County/Long Beach Consortium and direct arrangement with existing clinical partners to arrange clinical placements for the prelicensure students. VUSC has provided Facility Verification Forms (EDP-I-01) reflecting clinical placement commitments from the following area acute care facilities: Fountain Valley Regional Hospital (Peds) Children’s Hospital Los Angeles (Peds) Children’s Hospital Orange County (Peds) Fountain Valley Regional Hospital (Peds) Anaheim Global Medical Center (MS, OB, PMH) Hoag Hospital (MS, OB) Chapman Global Medical Center (MS, PMH, G) South Coast Global Medical Center (MS, OB, G, G-PMH) Orange County Global Medical Center (MS, OB, PMH, G) St. Joseph Hospital (MS, OB, PMH) St. Jude Medical Center (MS, OB) Mission Hospital (MS, OB, G) Placement availability varies by facility to include weekday shifts as well as night shift and weekends. A list of 13 outpatient/community facilities with whom VUSC has existing relationships for student’s clinical placements was also presented in the FS. These facilities provide a variety of care services, including mental health, to a variety of age, ethnic and special need populations. Type and number of clinical facility placements indicated are adequate to accommodate the initial enrollment proposed. Clinical facilities are within 50 miles of the VUSC campus with only one exception. VUSC has commitment from Victor Valley Global Medical Center to provide clinical placement but would only be utilized for the program’s terminal preceptorship course if a student resided in that area and wished to be placed at that facility. The school has provided letters in support of the program received from:

- Community: Assembly California Legislature; City of Costa Mesa, Costa Mesa Chamber of Commerce, Newport-Mesa Unified School District, Orange County Board of Supervisors - Nursing Programs: Biola University, Concorida University, Stanbridge University, University of California – Irvine, Western Governors University - Chief Nursing Officers: Hoag Hospital – Newport Beach, Orange County Global Medical Center – Santa Ana, St. Joseph Hospital - Orange

Conclusion: The VUSC Feasibility Study meets BRN requirements. Areas of concern to be further explored and developed in the Self-Study phase (pending ELC and Board approval of FS) are in regards to the skills/lab space and equipment which may not be

adequate to support prelicensure student enrollment in addition to the university’s existing nursing students, especially considering the plan to utilize 25% simulation for clinical hours. The budget does not currently include adequate start-up monies to fund addition of space and/or equipment for the skills/simulation lab. The school provided verbal update at the March 2017 ELC meeting that commitment had been received from an external partner for donation of funds to support lab expansion and equipment. ELC Recommendation: Accept the Feasibility Study for Vanguard University Southern California Baccalaureate Degree Nursing Program. NEXT STEPS: Notify school of Board action. PERSON(S) TO CONTACT: Leslie A. Moody, RN, MSN, MAEd Nursing Education Consultant

State of California Department of Consumer Affairs Board of Registered Nursing

(916) 322-3350

NURSING EDUCATION CONSULTANT REPORT: FEASIBILITY STUDY REVIEW FOR ACCEPTANCE WORK COPY PROPROSED PROGRAM NAME: Vanguard University of Southern California Baccalaureate Degree Nursing Program DATE OF REVIEW: November-December 2016

AREAS REVIEWED To evaluate the need for the program and the program applicant’s ability to develop, implement, and sustain a viable prelicensure registered nursing program.

ACCEPT

NOT ACCEPT COMMENTS

INSTITUTION A. Description of the institution and the institution’s

experience providing nursing or other health-related educational programs. The description must include:

1. History, organizational structure and programs (attach an organization chart), funding sources

VUSC is a private, not-for-profit Christian university originally opened in Los Angeles in 1920 as the Southern California Bible School and relocated to the present Costa Mesa location (55 Fair Drive, Costa Mesa, CA 92626) in 1950, with a name change in 1999 to the current Vanguard University of Southern California. The 40-acre campus and buildings are owned by the university. The single-campus university offers 29 baccalaureate majors, 5 graduate programs and 6 adult degree completion programs, with an enrollment of 2,077 degree seeking students in Fall 2016. The Nursing Department, established in 2006, offers RN-BSN and RN-MSN programs with Dr. Mary Wickman as the Director of Nursing. Total nursing program enrollment in Fall 2016 is 100 students. Organizational chart was provided in the Feasibility Study (FS). The university’s main funding source is tuition with additional funding obtained from private foundations and government agencies. The new prelicensure program would primarily rely upon tuition as a funding source with additional grant funding sought for start-up expenses.

EDP-S-10 FEASIBILITY STUDY REVIEW (WRITTEN 9/9/2015)


ACCEPT

NOT ACCEPT COMMENTS

2. Accreditation status and history (i.e., date of initial accreditation, denials, revocations, warnings) for the institution and any programs offered by the institution

VUSC was originally accredited by WASC Senior College and University Commission in 1964 under the name of Southern California College and has maintained continuous accreditation. WASC identified areas of concern that resulted in VUSC being placed on probation in June 2009 and required a Special Visit in spring 2010. Following the 2010 Special Visit the “public sanction of Probation” was removed. A 7/7/2014 letter from WASC to VUSC subsequent to an on-site Special Visit of March 2014 acknowledges substantial improvement and addresses other improvements needed to continue. The letter notes that the Commission acted to continue accreditation, remove the Notice of Concern, require an Interim Report due March 12015, and schedule an Offsite Review Fall 2016. The related onsite Accreditation Visit is scheduled for February 28-March 2, 2017. Commission on Collegiate Nursing Education (CCNE) accreditation is held by the RN-BSN (2024) and RN-MSN (2019) nursing programs.

3. Type of nursing or other health-related programs including number: of students currently enrolled and graduates by program type; passage rate on any required certification or licensing examination for the past five years (as applicable); and status of the program with any state, regional, or federal agency

VUSC offers RN-BSN degree (total enrollment 231 for 2013-16; 88% on time graduation for period), RN-MSN degree (total enrollment 50 for 2013-16; 100% on time graduation for period). There is a Post-Masters Adult/Gero CNS certificate program that has been available since 2015 but has not yet achieved sufficient enrollment to begin a cohort. . Fall 2016 enrollment is 74. Kinesiology is the only other health-related program offered with a total enrollment of 166 and 81% on time graduation for 2013-16..

4. If the applicant does not have a nursing program or other health-related programs, provide a statement related to the processes and resources it will utilize to start and sustain a prelicensure registered nursing program.

Refer to section F. Budget.



ACCEPT

NOT ACCEPT COMMENTS

B. Geographic area (community) served by the institution and a description of the community and its population.

The proposed BSN program will be located in the city of Costa Mesa, Orange County, CA. The FS described the geographic area and its population, and healthcare needs for the service area/community including analysis of current and future nursing workforce needs.

C. Description of the type of program being proposed (e.g., associate, baccalaureate, entry-level master’s, etc.), the intended start date, projected size of the first class and enrollment projection for the first five years, and method for determining the projected enrollment.

A generic prelicensure BSN program is planned to start Fall 2017 with initial enrollment of 24 students into prerequisite courses and begin nursing courses in Fall 2018, with subsequent annual admission of 30 students thereafter. This would produce total enrollment of 54 students in nursing courses beginning 2019-20, and 60 students in nursing courses beginning 2020-21 and forward. Planned enrollment levels are primarily driven by clinical placement availability and facility limits on clinical rotation cohort size.

D. Information on the applicant pool and sustainability of enrollment for the proposed new prelicensure registered nursing program. Include data on existing nursing programs preparing students for licensure (vocational, associate, baccalaureate, or entry level master’s) within a 50-mile radius. Include a statement on plans for promoting the proposed program.

The nursing program has a dedicated full-time recruiter with support for recruiting activities provided by other staff and faculty. Recruitment for the new program will primarily target high school students to enter the university as undergraduate students with an interest in pursuing nursing education. Informal information was provided in the FS regarding prospective students interest in the program. Transfer students would also be accepted and the university currently has approximately 30 Kinesiology majors who would like to transfer to nursing if it becomes available. VUSC has identified 30 colleges/universities within a 50-mile radius offering prelicensure nursing programs: 5 offer an ELM program; 13 offer a BSN program (some accelerated and two LVN-BSN pathway); 15 offer an ADN program.. Fourteen of the schools are within 25 miles and sixteen are 25-48 miles away from the intended new program campus.



ACCEPT

NOT ACCEPT COMMENTS

E. Description of proposed provisions for required subject matter and support areas, including faculty and resources. The proposed program must be at least two academic years, not less than 58 semester or 87 quarter units, and must include all course areas specified in CCR 1426. Consult CCR section 1426, Required Curriculum, for required subject matter. Support areas include such items as the library, skills learning lab, computer labs, simulation labs, and tutorial and counseling services.

Students will complete general education and nursing prerequisites in years 1-2 and nursing courses in years 3-4. The program will be presented in 16-week (15 weeks instruction + 1 week final exams) semester format of 8 semesters, attending Fall and Spring. Total units for graduation 128: Core 48 units, Sciences 24units, and nursing 56 units (35 Lecture; 21 Clinical). A BSN degree will be awarded upon successful completion. VUSC will offer all courses required for program/degree completion. Existing RN-BSN and MSN program faculty would also teach prelicensure courses and additional faculty would be hired as needed. An administrative assistant would be half-time the first year, then increase to full-time in the second year of the program. A half-time Student Success Coordinator and a Simulation Lab Coordinator are planned for the first year with both increased to full-time beginning year two. VUSC has existing resources to meet student academic/emotional, psychological/spiritual needs including psychological counseling, career center, financial aid, health services, writing center. The on campus library provides print as well as electronic nursing resources and provides library orientations and student support. Nursing students will have access to computer labs located in the library, in the Scott Building and in the Nursing Program modular building. Existing Heath Academic Center, Scott building and Nursing Program modular contains classrooms, faculty offices and the nursing skills/simulation lab. The skills/sim lab is 760 square feet and has two hospital style furnished/equipped work stations with two adult mannequins, one hi-fidelity and one low-fidelity. The school is seeking funds to purchase of infant warmer and infant/child mannequins. The lab is currently utilized by students of existing RN-BSN (evenings 6:00-10:00 pm) and MSN programs (16 evening/weekend hours 1-2 times per year), some of which activities could be moved to an alternate classroom space if needed to increase prelicensure student access.



ACCEPT

NOT ACCEPT COMMENTS

F. Budget projection that demonstrates initial and sustainable budgetary provisions for a full enrollment of the initial cohort. The projected budget demonstrates building of reserves to sustain the proposed program.

A five year budget projection reflects: reliance upon tuition-based revenue to exceed costs of program delivery for operational expenses and building a reserve (~10% of total tuition revenue); continuous enrollment to capacity; and adequate transfer students to fill vacant seats created by attrition. Annual tuition will be $32,980 plus $500 annual simulation lab fee per student. Start-up budget of $50,000 is allotted for 2017 to cover cost of Assistant Director ($35,000) and Faculty Development ($15,000). The university is seeking additional amount of $250,000 through grants and from clinical partners to provide start-up funds for classroom and lab equipment/supplies.

G. Evidence of availability of clinical placements for students of the proposed program. Include a list of the clinical facilities that may be utilized for learning experiences and a description of any plans for future addition or expansion of health facilities. Provide a completed “Facility Verification Form” (EDP-I-01 Rev 3/10) for each health care facility that has agreed to provide clinical placement for students of the proposed program. When available, verification shall include the accommodations specifying shift and days. Note: Clinical placement of the new program must take into consideration the impact of the use of the clinical facility by existing prelicensure registered nursing programs and must be coordinated with any process for clinical placement, such as consortium for regional planning. Include a description of your coordination and collaboration efforts with any existing registered nursing programs and any regional planning consortium

The program would use 50% acute care placement, 25% outpatient/community-based placement, and 25% simulation for each course’s clinical hours. VUSC currently participates in the Orange County/Long Beach Consortium to schedule clinical experiences for RN-BSN and MSN students. The school will utilize the Consortium and direct arrangement with existing clinical partners to arrange clinical placements for the prelicensure students. The Consortium gives preference to existing programs when allotting clinical placements which reduces the incidence of displacement of students by new program requests. The FS provided tables listing acute inpatient and outpatient/community clinical placements available for the 5 content areas. Thirteen completed Facility Verification Forms (EDP-I-01) were submitted for inpatient acute care facilities indicating the facility will provide clinical placements. The type and number of clinical placements available appear to be adequate to meet needs for each of the five content areas. Clinical facilities are all less than 50 miles from the main campus with one exception (Victor Valley Global Medical Center) which would only be utilized as a preceptorship site if it was appropriate placement for a student who lived near that facility.



ACCEPT

NOT ACCEPT COMMENTS

For Pediatrics, VUSCCM reports inpatient acute placements available in 3 hospitals as follows: Fountain Valley Regional Hospital indicates placement available for 3-4 students without indicating number of days or hours of shift; CHLA indicates placement available for 1-5 students on night shift (19-07); St. Jude 12 hour shifts on days including weekends.

Feasibility review completed by: Leslie A. Moody, NEC Date completed: February 10, 2017 Next step(s) and follow up actions to be taken: Present FS to Education/Licensing Committee.



Agenda Item Summary


ACTION REQUESTED: Vote On Whether To Approve Education/Licensing

Committee Goals and Objectives 2017-19 - Draft REQUESTED BY: Michael Jackson, RN, MSN Chairperson, Education/Licensing Committee BACKGROUND: Education/Licensing Committee goals and objectives are reviewed biennially and revised as needed. The 2015-17 ELC Goals and Objectives have been reviewed and revised to produce the attached recommended DRAFT - 2017-2019 ELC Goals and Objectives. Substantive changes include:

• Deletion of some objectives that have been met, completed or have become institutionalized as part of routine procedure (old numbers 1.6, 1.9, 2.6, 2.7, 3.4 – refer to 2015-17 Goals/Objectives adopted Feb 2015)

• Addition of new objectives or re-wording of existing objectives to address new topics of relevance are highlighted in yellow.

• Renumbering of objectives relevant to deletions and additions. ELC Recommendation: Approve the Education/Licensing Committee Goals and Objectives 2017-2019 as presented. NEXT STEPS: Per direction of Board. PERSON(S) TO CONTACT: Leslie A. Moody, RN, MSN, MAEd Nursing Education Consultant

Board Approved: DRAFT

BOARD OF REGISTERED NURSING EDUCATION/LICENSING COMMITTEE

2017-19 GOALS AND OBJECTIVES (for period 7/1/2017 – 6/30/2019)

GOAL 1 Ensure that nursing education programs meet regulatory requirements, and that the curriculum content addresses contemporary political, technical, economic, healthcare and nursing practice developments. 1.1 Review prelicensure and advanced practice program content, including public health nurse

content, to determine compliance with regulatory requirements and Board policy, and if content reflects current trends in healthcare and nursing practice.

1.2 Maintain BRN policy statements that reflect current statute, regulation and policy. 1.3 Ensure that nursing education programs include the Scope of Practice of Registered Nurses

in California (BPC 2725), Standards for Competent Performance (CCR 1443.5), and Substantial Relationship Criteria (CCR 1444) in their curriculum, and that advanced practice education program curriculum additionally includes instruction on standardized procedures and furnishing authority.

1.4 Maintain awareness of current political, technical, economic, healthcare and nursing practice trends through attending and participating in educational conferences, committees and other events within California and nationally, for development of regulation and policy.

1.5 Monitor legislation affecting nursing education and convene advisory committees when appropriate.

1.6 Evaluate proposed new programs to ensure regulatory compliance and ability to secure necessary resources with timely program implementation adhering to the application process and timeline identified in regulations and policy.

1.7 Encourage and support graduate nursing education programs to prepare nurse educators and other nursing specialists, and advanced practice nurses to meet changing healthcare needs.

1.8 Monitor prelicensure programs for compliance with regulations regarding credit for military experience/education.

1.9 Work collaboratively with advanced nursing education programs to implement new advanced practice regulations.

GOAL 2

Provide leadership in the development of new approaches to nursing education. 2.1 Encourage creative approaches to theory and clinical curriculum and instruction, and

strategic partnerships between nursing education programs, healthcare industry and the community, to ensure registered nurses are prepared to meet current nursing and community needs.

2.2 Review Nursing Practice Act regulations for congruence with current prelicensure and advanced practice nursing education practice standards and trends, and recommend or promulgate proposals for revisions to regulation that will promote high quality nursing education.

2.3 Explore issues regarding displacement of nursing students from clinical sites and expanded use of simulation for clinical instruction in prelicensure nursing programs, to identify

ELC 2015-2017 Goals/Objectives Page 1 of 4


potential solutions and determine whether regulatory revision is needed. 2.4 Support and encourage professional development opportunities for nursing educators and

directors in service and academia. 2.5 Evaluate the use and effectiveness of technology in the delivery of didactic and clinical

nursing instruction, including use of distance education modalities, simulation, telehealth, and interprofessional care, consistent with Board regulations and requirements.

2.6 Encourage and support programs’ development of articulation agreements and other practices that facilitate seamless transition between programs for transfer and admission into higher degree programs. 2.7 Encourage programs to evaluate curriculum for inclusion of objectives and content to support learning emerging nursing roles of care coordinator, faculty team leader, informatics specialist, nurse/family cooperative facilitator, and primary care partner. 2.8 Encourage nursing programs to consider ambulatory settings and other alternatives for

clinical sites when appropriate and in compliance with CCR 1424(i).

GOAL 3 Ensure that reports and data sources related to nursing education in California are made available to nurse educators, the public, and others, and are utilized in nursing program design. 3.1 Collaborate with the BRN contracted provider retained to conduct the consolidated online

annual school survey of the prelicensure nursing education programs in California, communicate with prelicensure programs regarding the survey and annual instructional webinar, and publish survey results on the BRN Website.

3.2 Maintain, analyze and disseminate systematic data sources related to prelicensure and advanced nursing education.

3.3 Maintain information related to each prelicensure program and provide information about nursing programs to the public.

3.4 Provide data to assist nursing programs in making grant or funding applications. 3.5 Encourage prelicensure programs to utilize NCSBN data and analysis of entry level RN

practice and other evidence-based sources, to evaluate the effectiveness of their nursing education programs in preparing graduates for competent entry-level practice.

GOAL 4

Facilitate and maintain an environment of collegial relationships with deans/directors of nursing education programs and other customers to ensure effective communication, service and protection. 4.1 Conduct an annual orientation and update for new and continuing prelicensure program

directors. 4.2 Maintain open communication and provide consultation and support services to prelicensure

and advanced practice nursing programs in California. 4.3 Convene or participate in meetings, workgroups and other forums as needed with

prelicensure and advanced practice program directors and other stakeholders to seek input, provide updates and foster discussion relevant to nursing education.

4.4 Ensure consumer complaints related to nursing education programs are managed systematically and timely, including communications and coordination with other agencies as appropriate.



GOAL 5

Monitor and evaluate the NCLEX-RN examination construction, process and test-taker outcomes, and maintain a collaborative relationship with the National Council of State Boards of Nursing. 5.1 Participate in periodic review of the NCLEX-RN examination process to ensure established

security, test administration procedures and other testing standards are met. 5.2 Encourage nurse educators and working RNs to participate in NCLEX-RN examination

panels to ensure consistent representation from California. 5.3 Participate in NCSBN committees, conferences and other forums to maintain representation

from California. 5.4 Monitor California and national NCLEX-RN first time pass rates of California candidates,

including results for internationally educated candidates. 5.5 Provide input into the NCSBN-RN Practice Analysis, NCLEX-RN Test Plan revision and

Passing Standard as requested or appropriate.

GOAL 6 Maintain licensure and certification application processes in compliance with regulation and to ensure applicants meet all licensure and certification requirements. 6.1 Monitor licensure/certification activities to ensure compliance with regulations and policy, and implement improvements as needed. 6.2 Track and trend areas of concern regarding application/certification, and communicate significant findings to the Board and stakeholders as appropriate. 6.2 Continue evaluation and improvement of the online licensure and tracking system to ensure timely, efficient and accurate processing of applications, and capability for data retrieval in report formats. 6.3 Provide instructions to licensure/certification applicants regarding application requirements and process. 6.4 Evaluate effectiveness of using the “Cloud” technology to streamline the application process.

GOAL 7

GOAL 7 Provide ongoing monitoring of the Continuing Education (CE) Program and verify compliance with BRN requirements by licensees and providers. 7.1 Review and consider for approval CE provider applications to ensure that the content is relevant to the practice of nursing and is related to the scientific knowledge or technical skills required for the practice of nursing or be related to direct or indirect patient or client care. 7.2 Conduct systematic random audits of registered nurses to monitor compliance with renewal requirements 7.3 Audit continuing education providers at least once every five years to ensure adherence to regulatory requirements, and shall withhold or rescind approval from any provider that is in violation of the regulatory requirements. 7.4 Review existing continuing education regulation, policy and guidelines and propose revision as needed.



7.5 Assess sufficiency of resources to support the work of the BRN continuing nursing education.


BOARD OF REGISTERED NURSING

Education/Licensing Committee

Agenda Item Summary

AGENDA ITEM: 7.6

DATE: April 5, 2017

ACTION REQUESTED: Discussion and Possible Recommendation With Direction to Staff

Regarding Continuing Education - B&PC 2811.5 and CCR

Sections 1450-1459.1

This Agenda Item has been moved to May 2017 Education/ Licensing Committee Meeting


Agenda Item Summary


ACTION REQUESTED: 2015-2016 Regional Annual School Reports (Draft) REQUESTED BY: Michael Jackson, RN, MSN

Chairperson, Education/Licensing Committee

BACKGROUND: The Regional Annual School Reports present the historical analyses of nursing program data from the 2006-2007 BRN Annual School Survey through the 2015-2016 survey for the nine economic regions in California. Each region has a separate report. All data are presented in aggregate form, and describe the overall trends in these regions over the specified time periods. The data items addressed include the numbers of nursing programs, enrollments, completions, retention rates, student and faculty census information, simulation centers and student access to clinical sites and experiences. The nine regions include: (1) Northern California, (2) Northern Sacramento Valley, (3) Greater Sacramento, (4) Bay Area, (5) San Joaquin Valley, (7) Central Coast, (8) Southern California I (Los Angeles and Ventura Counties), (9) Southern California II (Orange, Riverside, and San Bernardino Counties), and (10) Southern Border Region. Counties within each region are detailed in the corresponding report. The Central Sierra (Region 6) does not have any nursing programs and was, therefore, not included in the analyses. The San Francisco Bay Area Report (Region 4) is attached as a sample. Final reports will be made available to the public on the BRN website after review by the full Board and they are finalized. NEXT STEPS: Finalize and publish reports. PERSON(S) TO CONTACT: Julie Campbell-Warnock

Research Program Specialist (916) 574-7681

California Board of Registered Nursing 2015-2016 Annual School Report

Data Summary and Historical Trend Analysis

Bay Area

March 23, 2017

Prepared by: Lisel Blash, MPA Amy Shinoki, BA Joanne Spetz, PhD University of California, San Francisco 3333 California Street, Suite 265 San Francisco, CA 94118

Contents PREFACE ............................................................................................................................................................. 1

DATA SUMMARY AND HISTORICAL TREND ANALYSIS ............................................................................. 2

TRENDS IN PRE-LICENSURE NURSING PROGRAMS ................................................................................................. 2 Number of Nursing Programs ........................................................................................................................... 2 Admission Spaces and New Student Enrollments ........................................................................................ 3 Student Census Data ......................................................................................................................................... 6 Student Completions .......................................................................................................................................... 6 Retention and Attrition Rates ............................................................................................................................ 7 NCLEX Pass Rates ............................................................................................................................................ 8 Employment of Recent Nursing Program Graduates .................................................................................... 9 Clinical Training in Nursing Education ........................................................................................................... 10 Clinical Space & Clinical Practice Restrictions............................................................................................. 14 Faculty Census Data ........................................................................................................................................ 20

SUMMARY ................................................................................................................................................................. 22

APPENDICES ..................................................................................................................................................... 23

APPENDIX A – BAY AREA NURSING EDUCATION PROGRAMS ........................................................................... 23 APPENDIX B – BRN EDUCATION ISSUES WORKGROUP MEMBERS ................................................................... 24

Tables Table 1. Number of Nursing Programs by Academic Year ................................................................................... 2 Table 2. Partnerships by Academic Year ............................................................................................................. 3 Table 3. Availability and Utilization of Admission Spaces by Academic Year ...................................................... 3 Table 4. Student Admission Applications by Academic Year ............................................................................... 4 Table 5. New Student Enrollment by Program Type by Academic Year .............................................................. 4 Table 6. Percent of Programs that Enrolled Fewer Students by Academic Year ................................................. 5 Table 7. Reasons for Enrolling Fewer Students by Academic Year ..................................................................... 5 Table 8. Student Census Data by Program Type by Year.................................................................................... 6 Table 9. Student Completions by Program Type by Academic Year ................................................................... 6 Table 10. Student Retention and Attrition by Academic Year............................................................................... 7 Table 11. Attrition Rates by Program Type by Academic Year ............................................................................ 7 Table 12. First Time NCLEX Pass Rates by Program Type by Academic Year .................................................. 8 Table 13. Employment Location for Recent Nursing Program Graduates by Academic Year ............................. 9 Table 14. Average Hours Spent in Clinical Training by Content Area by Academic Year ................................. 10 Table 15. Average Hours Spent in Clinical Training by Program Area and Content Type, 2015-2016 ............. 11 Table 16. Planned Increase or Decrease in Clinical Hours by Content Area and Clinical Experience Type,

2016-2016 ........................................................................................................................................... 11 Table 17. Why Program is Reducing Clinical Hours by Academic Year ............................................................ 13 Table 18. RN Programs Denied Clinical Space by Academic Year ................................................................... 14 Table 19. RN Programs That Reported Fewer Students Allowed for a Clinical Space by Acadmic Year ......... 14 Table 20. Reasons for Clinical Space Being Unavailable by Academic Year .................................................... 15 Table 21. Reasons for Clinical Space Being Unavailable by Program Type, 2015-2016 .................................. 16 Table 22. Strategies to Address the Loss of Clinical Space by Academic Year ................................................ 16 Table 23. Alternative Out-of-Hospital Clinical Sites Used by RN Programs by Academic Year ........................ 17 Table 24. Common Types of Restricted Access in the Clinical Setting for RN Students by Academic Year ..... 18 Table 25. Share of Schools Reporting Reasons for Restricting Student Access to Electronic Medical Records

and Medication Administration by Academic Year ............................................................................. 19 Table 26. How the Nursing Program Compensates for Training in Areas of Restricted Access by Acadmic

Year ................................................................................................................................................... 19 Table 27. Faculty Census Data by Year ............................................................................................................. 20 Table 28. Reasons for Hiring More Part-time Faculty, 2015-2016 ..................................................................... 20 Table 29. Faculty with Overloaded Schedules by Academic Year ..................................................................... 21

PREFACE

Each year, the California Board of Registered Nursing (BRN) requires all pre-licensure registered nursing programs in California to complete a survey detailing statistics of their programs, students and faculty. The survey collects data from August 1 through July 31. Information gathered from these surveys is compiled into a database and used to analyze trends in nursing education.

The BRN commissioned the University of California, San Francisco (UCSF) to develop the online survey instrument, administer the survey, and report data collected from the survey. This report presents ten years of historical data from the BRN Annual School Survey. Data analyses were conducted statewide and for nine economic regions1 in California, with a separate report for each region. All reports are available on the BRN website (http://www.rn.ca.gov/).

This report presents data from the 10-county Bay Area. Counties in the region include Alameda, Contra Costa, Marin, Napa, San Francisco, San Mateo, Santa Clara, Santa Cruz, Solano, and Sonoma. All data are presented in aggregate form and describe overall trends in the areas and over the times specified and, therefore, may not be applicable to individual nursing education programs. Additional data from the past ten years of the BRN Annual School Survey are available in an interactive database on the BRN website.

Beginning with the 2011-2012 Annual School Survey, certain questions were revised to allow schools to report data separately for satellite campuses located in regions different from their home campus. This change was made in an attempt to more accurately report student and faculty data by region, and it resulted in data that were previously reported in one region being reported in a different region. This is important because changes in regional totals that appear to signal either an increase or a decrease may in fact be the result of a program reporting satellite campus data in a different region. However, due to the small number of students impacted and the added complication in collecting the data, accounting for satellite programs in different regions was discontinued in 2014-2015.

Data for 2005-2006 through 2010-2011 and 2014-2015 through 2015-2016 is not impacted by differences in satellite campus data reporting while 2011-2012 through 2013-2014 includes the regional data separately for satellite campuses. Data tables impacted by these change will be footnoted and in these instances, caution should be used when comparing data across years. 2015-2016 reporting for the Bay Area region may be affected by the change in reporting for satellite campus data.

1 The regions include: (1) Bay Area, (2) Central Coast, (3) Central Sierra (no programs), (4) Greater Sacramento, (5) Northern California, (6) Northern Sacramento Valley, (7) San Joaquin Valley, (8) Los Angeles Area (Los Angeles and Ventura counties), (9) Inland Empire (Orange, Riverside, and San Bernardino counties), and (10) Southern Border Region. Counties within each region are detailed in the corresponding regional report.

http://www.rn.ca.gov/

Bay Area 2015-2016 BRN Annual School Report

DATA SUMMARY AND HISTORICAL TREND ANALYSIS2

This analysis presents pre-licensure program data from the 2015-2016 BRN School Survey in comparison with data from previous years of the survey. Data items addressed include the number of nursing programs, enrollments, completions, retention rates, NCLEX pass rates, new graduate employment, student and faculty census data, the use of clinical simulation, availability of clinical space, and student clinical practice restrictions.

Trends in Pre-Licensure Nursing Programs

Number of Nursing Programs

In 2015-2016, the Bay Area had a total of 30 pre-licensure nursing programs. Of these programs, 18 are ADN programs, 8 are BSN programs, and 4 are ELM programs. The number of programs in the region has remained about the same over the last eight years. Nearly three-quarters (73%, n=22) of pre-licensure nursing programs in the Bay Area are public. The share of private programs has increased over the last ten years, from 24% (n=7) in 2006-2007 to its current share of 27% (n=8) in 2015-2016.

Table 1. Number of Nursing Programs* by Academic Year 2006-

2007 2007-2008

2008-2009

2009-2010

2010-2011

2011-2012

2012-2013

2013-2014

2014-2015

2015-2016

Total nursing programs 29 30 30 30 31 30 30 30 30 30

ADN 17 18 18 18 18 18 18 18 18 18

BSN 7 7 7 7 8 8 8 8 8 8

ELM 5 5 5 5 5 4 4 4 4 4

Public 22 23 23 23 23 22 22 22 22 22

Private 7 7 7 7 8 8 8 8 8 8

Total number of schools 25 26 26 26 27 27 27 27 27 27

*Since some nursing schools admit students in more than one program, the number of nursing programs is greater than the number of nursing schools.

2 Between 2011-2012 and 2013-2014 data may be influenced by satellite campus data being reported and allocated to their proper region. Tables affected by this change are noted, and readers are cautioned against comparing data collected these years with data collected before and after this change.

University of California, San Francisco 2


In 2015-2016, 50% (n=15) of Bay Area nursing programs collaborated with another program that offered a higher degree than offered at their own school. While there has been some fluctuation in the share of programs that partner with other schools since 2009-2010, overall these collaborations have increased dramatically in the last ten years.

Table 2. Partnerships* by Academic Year

2006- 2007

2007- 2008

2008- 2009

2009- 2010

2010- 2011

2011- 2012

2012- 2013

2013- 2014

2014-2015

2015-2016

Programs that partner with another program that leads to a higher degree

1 3 8 13 15 12 14 16 14 15

Formal collaboration 42.9% 50.0% 42.9%

Informal collaboration 71.4% 68.8% 71.4%

Number of programs that reported 28 29 30 30 31 30 30 30 30 30

Note: Blank cells indicate the information was not requested.

Admission Spaces and New Student Enrollments The number of spaces available in Bay Area pre-licensure nursing programs and the number of new students enrolling in these spaces has fluctuated over the last ten years. In 2015-2016, the number of students enrolling in these spaces reached a ten year low of 2,349, the second lowest on record. One-third (n=10) of Bay Area nursing programs enrolled more students than they had admission spaces for in 2015-2016.

Table 3. Availability and Utilization of Admission Spaces† by Academic Year 2006-

2007 2007-2008

2008-2009

2009- 2010

2010-2011

2011-2012

2012-2013

2013-2014

2014-2015

2015-2016

Spaces available 2,319 2,368 2,513 2,152 2,523 2,375 2,380 2,254 2,306 2,208

New student enrollments 2,521 2,752 2,874 2,640 2,805 2,545 2,411 2,361 2,525 2,349

% Spaces filled with new student enrollments

108.7% 116.2% 114.4% 122.7% 111.2% 107.2% 101.3% 104.7% 109.5% 106.4%

† Between 2011-2012 and 2013-2014 data may be influenced by satellite campus data being reported and allocated to their proper region. Readers are cautioned against comparing data collected these years with data collected before and after this change.



Bay Area nursing programs have seen an overall decline in the number of qualified applications received in the last ten years (27%, n=2,175), with the majority of the decline taking place in ADN programs (46%). Even with this decline, Bay Area nursing programs continue to receive more applications requesting entrance into their programs than can be accommodated. Of the 5,895 qualified applications received in 2015-2016, 60% did not result in enrollments.

Table 4. Student Admission Applications*† by Academic Year

2006-2007

2007-2008

2008-2009

2009- 2010

2010-2011

2011-2012

2012-2013

2013-2014

2014-2015

2015-2016

Qualified applications 8,070 7,910 8,077 8,063 7,574 7,812 6,595 7,060 6,765 5,895

ADN 4,429 4,603 4,363 4,572 4,212 4,422 3,143 2,944 2,971 2,381 BSN 2,605 2,485 2,665 2,522 2,567 2,724 2,366 3,488 2,919 2,541 ELM 1,036 822 1,049 969 795 666 1,086 628 875 973 % Qualified applications not enrolled

68.8% 65.2% 64.4% 67.3% 63.0% 67.4% 63.4% 66.6% 62.7% 60.2%

*These data represent applications, not individuals. A change in the number of applications may not represent an equivalent change in the number of individuals applying to nursing school. †Between 2011-2012 and 2013-2014 data may be influenced by satellite campus data being reported and allocated to their proper region. Readers are cautioned against comparing data collected these years with data collected before and after this change.

New student enrollment in Bay Area nursing programs has declined in 2015-2016. The distribution of new enrollments by program type was 45% ADN (n=1,067), 42% BSN (n=985), and 13% ELM (n=297). A majority of the new students enrolled are at the region’s public programs, accounting for 55% (n=1,296) of total new student enrollments in 2015-2016. The proportion of new enrollments at private schools has increased dramatically since 2006-2007, when it made up only 30% of all enrollments, to 45% in 2015-2016 which has decreased from its high of 49% in 2014-2015.

Table 5. New Student Enrollment by Program Type† by Academic Year

2006-2007

2007-2008

2008-2009

2009- 2010

2010-2011

2011-2012

2012-2013

2013-2014

2014-2015

2015-2016

New student enrollment 2,521 2,752 2,874 2,640 2,805 2,545 2,411 2,361 2,525 2,349

ADN 1,332 1,378 1,426 1,313 1,284 1,130 1,107 1,118 1,105 1,067

BSN 872 1,043 1,173 1,031 1,246 1,179 1,090 1,067 1,040 985

ELM 317 331 275 296 275 236 214 176 380 297

Private 764 900 1,042 1,037 1,189 1,096 1,025 1,028 1,234 1,053

Public 1,757 1,852 1,832 1,603 1,616 1,449 1,386 1,333 1,291 1,296 † Between 2011-2012 and 2013-2014 data may be influenced by satellite campus data being reported and allocated to their proper region.

Readers are cautioned against comparing data collected these years with data collected before and after this change.



Four programs reported that they enrolled fewer students in 2015-2016 compared to the previous year. The most common reasons programs gave for enrolling fewer students were “accepted students did not enroll” and “College/university / BRN requirement to reduce enrollment.”

Table 6. Percent of Programs that Enrolled Fewer Students by Academic Year Type of

Program 2014-2015 2015-2016

Enrolled Fewer

#of programs reporting

Enrolled Fewer

#of programs reporting

ADN 11.1% 18 11.1% 18

BSN 50.0% 8 12.5% 8

ELM 0.0% 4 25.0% 4

Total 20.0% 30 13.3% 30

Table 7. Reasons for Enrolling Fewer Students by Academic Year

2014-2015 2015-2016

Accepted students did not enroll 83.3% 25.0% College/university / BRN requirement to reduce enrollment 0.0% 25.0%

Other 0.0% 25.0%

Lost funding 33.3% 0.0%

To reduce costs 50.0% 0.0%

Insufficient faculty 33.3% 0.0% Unable to secure clinical placements for all students 33.3% 0.0%

Number of programs that reported 6 4



Student Census Data

The total number of students enrolled in Bay Area nursing programs has shown a slow rate of decline since 2009 – from 5,558 students on October 15, 2009 to 4,934 students on the same date in 2016. The composition of currently enrolled students shows 35% (n=1,718) of students were enrolled in ADN programs, 55% (n=2,718) in BSN programs, and 10% (n=498) in ELM programs.

Table 8. Student Census Data*† by Program Type by Year

*Census data represent the number of students on October 15th of the given year. † Between 2011-2012 and 2013-2014 data may be influenced by satellite campus data being reported and allocated to their proper region. Readers are cautioned against comparing data collected these years with data collected before and after this change.

Student Completions

While the Bay Area has seen an increase in the number of students completing its nursing programs compared to ten years ago, there was an increase and then a decline. Most of this growth has to do with an increase in the number of BSN graduates, although BSN graduates declined steeply in 2015-2016. In 2015-2016, 2,054 students completed a nursing program in the Bay Area. Of these students, 42% earned an ADN (n=872), 47% a BSN (n=957), and 11% an ELM (n=225).

Table 9. Student Completions† by Program Type by Academic Year

2006-2007

2007-2008

2008-2009

2009-2010

2010-2011

2011-2012

2012-2013

2013-2014

2014-2015

2015-2016

ADN 863 993 1,055 1,148 1,124 961 968 936 942 872 BSN 697 973 979 986 1,017 965 1,060 1,046 1,354 957 ELM 228 227 285 290 200 222 229 211 176 225

Total student completions 1,788 2,193 2,319 2,424 2,341 2,148 2,257 2,193 2,472 2,054

† Between 2011-2012 and 2013-2014 data may be influenced by satellite campus data being reported and allocated to their proper region. Readers are cautioned against comparing data collected these years with data collected before and after this change.

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

ADN 1,935 2,208 2,176 2,072 1,964 1,786 1,872 1,826 1,789 1,718

BSN 2,179 2,556 2,790 2,890 2,851 3,029 2,886 2,678 2,681 2,718

ELM 586 601 592 542 664 528 507 478 552 498

Total nursing students 4,700 5,365 5,558 5,504 5,479 5,343 5,265 4,982 5,022 4,934



Retention and Attrition Rates

Of the 1,849 students scheduled to complete a Bay Area nursing program in the 2015-2016 academic year, 83% (n=1,541) completed the program on-time, 6% (n=106) are still enrolled, and 11% (n=202) dropped out or were disqualified from the program. Retention rates have shown overall steady improvement over the last decade and the 11% attrition rate in 2015-2016 is one of the lowest reported in the last ten years.

Table 10. Student Retention and Attrition† by Academic Year

2006-2007

2007-2008

2008-2009

2009- 2010

2010-2011

2011-2012

2012-2013

2013-2014

2014-2015

2015-2016

Students scheduled to complete the program 1,965 2,427 2,547 2,497 2,138 2,165 2,065 2,080 2,053 1,849

Completed on time 1,591 1,959 2,071 2,038 1,724 1,787 1,684 1,779 1,724 1,541

Still enrolled 137 157 162 156 95 67 129 83 82 106

Total attrition 237 311 314 303 319 311 252 218 247 202

Attrition-dropped out 121 99

Attrition-dismissed 126 103

Completed late‡ 97 102 62 84 85 105 0

Retention rate* 81.0% 80.7% 81.3% 81.6% 80.6% 82.5% 81.5% 85.5% 84.0% 83.3%

Attrition rate** 12.1% 12.8% 12.3% 12.1% 14.9% 14.4% 12.2% 10.5% 12.0% 10.9%

% Still enrolled 7.0% 6.5% 6.4% 6.2% 4.4% 3.1% 6.2% 4.0% 4.0% 5.7% ‡ These completions are not included in the calculation of either retention or attrition rates. † Between 2011-2012 and 2013-2014 data may be influenced by satellite campus data being reported and allocated to their proper region. Readers are cautioned against comparing data collected these years with data collected before and after this change. *Retention rate = (students completing the program on-time) / (students scheduled to complete) **Attrition rate = (students dropped or disqualified who were scheduled to complete) / (students scheduled to complete the program) Note: Blank cells indicate the information was not requested. Data for traditional and accelerated program tracks is now combined and reported here.

Attrition rates among the region’s pre-license nursing programs vary by program type. Average attrition rates have declined for all program types over the past ten years. The most significant declines have been in ELM and BSN programs. ADN programs continue to have the highest attrition rates. Private programs have consistently had lower attrition rates than public programs.

Table 11. Attrition Rates by Program Type*† by Academic Year

2006-2007

2007-2008

2008-2009

2009- 2010

2010-2011

2011-2012

2012-2013

2013-2014

2014-2015

2015-2016

ADN 17.0% 21.0% 17.9% 18.3% 18.2% 19.3% 18.0% 16.7% 18.8% 16.3%

BSN 6.5% 5.4% 7.1% 5.6% 13.4% 10.4% 7.1% 4.6% 5.8% 5.6%

ELM 8.8% 5.5% 7.1% 7.2% 2.9% 5.1% 3.5% 0.5% 3.0% 2.9%

Private 9.6% 5.2% 8.3% 7.8% 16.2% 13.5% 10.3% 7.4% 8.3% 8.8%

Public 13.1% 16.6% 14.6% 14.5% 14.3% 14.8% 13.2% 12.3% 14.1% 12.1% *Changes to the survey that occurred prior to 2005-2006 may have affected the comparability of these data to data in subsequent years. †Between 2011-2012 and 2013-2014 data may be influenced by satellite campus data being reported and allocated to their proper region. Readers are cautioned against comparing data collected these years with data collected before and after this change. Data for traditional and accelerated program tracks is now combined and reported here.



NCLEX Pass Rates

Over the last ten years, NCLEX pass rates in the Bay Area have been higher for ELM graduates than for ADN or BSN program graduates. In 2015-2016, ELM program graduates again had the highest average NCLEX pass rate. While ADN pass rates stayed about the same over the last three years, BSN and ELM pass rates rose in 2015-2016, although not as high as their pre-2013-2014 levels. The NCLEX passing standard was increased in April 2013, which may have impacted NCLEX passing rates for the subsequent years.

Table 12. First Time NCLEX Pass Rates* by Program Type by Academic Year

2006-2007

2007-2008

2008-2009

2009-2010

2010-2011

2011-2012

2012-2013

2013-2014

2014-2015

2015-2016

ADN 86.8% 84.3% 87.1% 87.0% 86.8% 88.8% 89.0% 83.1% 83.7% 83.3%

BSN 90.3% 85.3% 86.2% 89.0% 86.6% 87.7% 86.6% 80.1% 81.4% 86.5%

ELM 96.2% 93.8% 91.4% 93.0% 90.5% 92.8% 93.2% 87.0% 84.7% 88.5% *NCLEX pass rates for students who took the exam for the first time in the given year.



Employment of Recent Nursing Program Graduates3

Hospitals have historically been the most common employment setting for recent RN graduates. While hospitals continue to employ the largest share of new graduates in the Bay Area, this share has been declining and no longer represents the majority of recent RN graduates in the region. In 2015-2016, the region’s programs reported that 46% of recent graduates were working in a hospital setting. Programs also reported that 5% of students had not found employment in nursing at the time of the survey, which is the lowest level since these data were first collected. However, it was also reported that 9% were pursuing additional nursing education. More than half (68%) of recent Bay Area RN graduates were employed in California, a share that has declined from a high of 90% of graduates in 2007-2008 but has been increasing again in recent years.

Table 13. Employment Location for Recent Nursing Program Graduates† by Academic Year

2006-2007

2007-2008

2008-2009

2009-2010

2010-2011

2011-2012

2012-2013

2013-2014

2014-2015

2015-2016

Hospital 89.3% 84.5% 53.8% 42.7% 34.5% 48.4% 37.0% 37.9% 46.2% 46.0%

Community/public health facilities 4.3% 1.0% 3.0% 1.8% 5.7% 4.8% 3.5% 6.5% 5.6% 19.4%

Pursuing additional nursing education 13.3% 23.9% 21.8% 9.0%

Other 11.5% 11.2% 43.7% 15.3% 14.3% 3.3% 2.0% 0.9% 2.3% 9.0%

Not yet licensed 7.3%

Unable to find employment 37.6% 41.8% 26.5% 30.3% 15.4% 10.7% 4.5%

Long-term care facilities 0.8% 1.8% 13.4% 12.6% 12.3% 9.7% 8.2% 10.0% 9.2% 3.6%

Other healthcare facilities 2.1% 1.5% 8.6% 5.4% 7.4% 7.3% 5.6% 6.4% 4.2% 1.2%

Employed in California 89.9% 89.8% 70.5% 75.6% 56.4% 54.0% 50.8% 56.3% 61.1% 68.2%

†Between 2011-2012 and 2013-2014 data may be influenced by satellite campus data being reported and allocated to their proper region. Readers are cautioned against comparing data collected these years with data collected before and after this change. Note: Blank cells indicated that the applicable information was not requested in the given year.

3 Graduates whose employment setting was reported as “unknown” have been excluded from this table. In 2015-2016, on average, the employment setting was unknown for 12% of recent graduates.



Clinical Training in Nursing Education

Questions regarding clinical simulation4 were revised in the 2014-2015 survey to collect data on average amount of hours students spend in clinical areas including simulation in various content areas and plans for future use. All thirty Bay Area nursing programs reported using clinical simulation in 2015-2016. About a quarter (23%, n=7) of the 30 programs have plans to increase staff dedicated to administering clinical simulation at their program in the next 12 months.

The content areas using the most hours of clinical simulation on average are Medical/Surgical (19.7) and Fundamentals (13.5). The largest proportion of clinical hours in all programs is in direct patient care (80%) followed by skills labs (13%) and simulation (8%).

Allocation of clinical hours by experience type and content area were similar over the last two years, with slightly more hours on average reported in 2015-2016.

Table 14. Average Hours Spent in Clinical Training by Content Area by Academic Year

Direct Patient Care Skills Labs* Clinical Simulation All Clinical Hours

Content Area 2014-2015

2015-2016

2014-2015

2015-2016

2014-2015

2015-2016

2014-2015

2015-2016

Medical/surgical 228.0 239.0 22.4 32.7 18.6 19.7 269.0 291.4

Fundamentals 88.7 97.7 38.3 52.8 8.9 13.5 135.9 163.1

Obstetrics 83.7 84.6 6.2 14.1 10.6 10.3 100.6 108.9

Pediatrics 79.0 79.4 6.4 10.0 11.3 9.3 96.2 98.7

Geriatrics 71.6 82.9 3.1 4.6 7.5 7.6 82.2 94.5

Psychiatry/mental health 97.4 92.5 3.1 6.2 7.5 7.4 108.1 105.8

Leadership/management 65.8 58.9 4.4 2.0 6.4 5.3 76.6 65.9

Other 59.6 51.5 0.0 2.9 6.8 2.6 66.4 57.0 Total average clinical hours 773.9 786.6 84.0 125.3 77.1 73.5 935.0 985.3

Percent of clinical hours 82.8% 79.8% 9.0% 12.7% 8.3% 7.5% 100.0% 100.0% Number of programs that reported 27 30 27 30 27 30 27 30

* In 2014-2015, this category was listed as “non-direct patient care”.

4 Clinical simulation provides a simulated real-time nursing care experience which allows students to integrate, apply, and refine specific skills and abilities that are based on theoretical concepts and scientific knowledge. It may include videotaping, de-briefing and dialogue as part of the learning process.



The largest proportion of clinical hours in all programs is in direct patient care. In 2015-2016, program types allocated roughly the same proportion of time to direct patient care (79-81%), skills labs (11-13%), and clinical simulation (7-8%).

Table 15. Average Hours Spent in Clinical Training by Program Area and Content Type, 2015-2016

Content Area Direct Patient Care Skills Labs Clinical Simulation All Clinical Hours

ADN BSN ELM ADN BSN ELM ADN BSN ELM ADN BSN ELM

Medical/surgical 288.8 147.1 198.8 35.9 25.0 33.3 20.3 14.8 26.5 345.1 186.9 258.5

Fundamentals 112.8 70.1 84.5 56.9 50.4 39.3 12.0 12.6 24.3 181.8 131.5 142.0

Obstetrics 75.5 91.3 112.5 12.1 15.3 20.5 8.0 13.0 14.8 95.6 119.5 147.8

Pediatrics 69.5 89.9 103.3 7.3 14.0 14.0 8.9 9.6 10.3 85.7 113.5 127.5

Geriatrics 66.1 110.3 103.5 4.5 7.0 0.0 5.2 14.7 5.3 75.8 130.1 107.5 Psychiatry/ mental health 84.6 93.3 126.8 4.6 9.6 6.5 5.6 10.9 8.7 94.8 113.8 139.8

Leadership/ management 62.9 61.6 35.8 1.1 3.1 4.0 4.7 9.0 0.0 68.7 72.6 39.8

Other 16.8 106.9 97.3 4.8 0.3 0.0 2.1 2.5 4.8 23.7 109.6 102.0

Total Average Clinical Hours 776.9 770.4 862.3 127.3 124.6 117.5 66.9 82.5 85.0 971.2 977.5 1064.8

Number of programs that reported

18 8 4 18 8 4 18 8 4 18 8 4

In the 2015-2016 survey, programs were asked to report whether over the next 12 months they planned to increase, decrease, or maintain the number of hours in direct patient care, non-direct patient care, and clinical simulation for each of the eight content areas listed above.

In each content area and clinical experience, the majority planned to maintain the current balance of hours. Respondents were more likely to indicate plans to increase rather than decrease clinical simulation hours.

Table 16. Planned Increase or Decrease in Clinical Hours by Content Area and Clinical Experience Type*, 2015-2016

Medical/Surgical Decrease hours

Maintain hours

Increase hours

Direct Patient Care 3.5% 96.6% 0.0%

Skills Labs 0.0% 96.6% 0.0%

Clinical Simulation 0.0% 89.7% 10.3%

Total clinical hours 0.0% 96.6% 3.5%

Fundamentals Decrease hours

Maintain hours

Increase hours


Skills Labs 0.0% 96.5% 0.0%





Table 16. Planned Increase or Decrease in Clinical Hours by Content Area and Clinical Experience Type*, 2015-2016 (Continued)

Obstetrics Decrease hours

Maintain hours

Increase hours


Skills Labs 0.0% 100.0% 0.0%


All clinical hours 6.9% 86.2% 6.9%

Pediatrics Decrease hours

Maintain hours

Increase hours


Skills Labs 0.0% 93.1% 0.0%



Geriatrics Decrease hours

Maintain hours

Increase hours


Skills Labs 0.0% 96.6% 0.0%



Psychiatry/Mental Health Decrease hours

Maintain hours

Increase hours


Skills Labs 0.0% 96.6% 0.0%



Leadership/Management Decrease hours

Maintain hours

Increase hours


Skills Labs 0.0% 89.3% 0.0%



Other Decrease hours

Maintain hours

Increase hours


Skills Labs 0.0% 90.0% 10.0%


All clinical hours 0.0% 100.0% 0.0% * Totals do not always sum to 100% because some programs answered “not applicable” or “unknown”.



Respondents were asked why they were reducing the clinical hours in their program if they indicated in the prior questions that they were decreasing clinical hours in any content area or clinical experience type. Three programs reported they would be reducing clinical hours. The inability to find sufficient clinical space (67%) and insufficient clinical faculty (67%) were cited by the majority of respondents as the top reasons for reducing clinical hours.

Table 17. Why Program is Reducing Clinical Hours by Academic Year Reason 2014-

2015 2015-2016

Unable to find sufficient clinical space 50.0% 66.7%

Insufficient clinical faculty 33.3% 66.7%

Other 16.7% 33.3% Can teach required content/Students can meet learning objectives in less time 0.0% 0.0%

Funding issues or unavailable funding 0.0% 0.0%

Total reporting 6 3



Clinical Space & Clinical Practice Restrictions5

The majority (57%, n=17) of Bay Area nursing programs reported being denied access to a clinical placement, unit or shift in 2015-2016.

In 2015-2016, 25% of programs that had been denied clinical placements, units or shifts were offered an alternative by the same clinical site. The lack of access to clinical space resulted in a loss of 42 clinical placements, units or shifts, which affected 325 students.

Table 18. RN Programs Denied Clinical Space by Academic Year 2010-

2011 2011-2012

2012-2013

2013-2014

2014-2015

2015-2016

Number of programs denied a clinical placement, unit or shift 23 16 24 24 17 17

Programs offered alternative by site* 4 4 Placements, units or shifts lost* 39 42

Number of programs that reported 31 30 30 30 29 30 Total number of students affected 694 152 592 619 503 325

*Significant changes to these questions beginning with the 2014-2015 administration prevent comparison to the data from prior years.

In the 2015-2016 survey, 14 programs reported that there were fewer students allowed for a clinical placement, unit, or shift in this year than in the prior year.

Table 19. RN Programs Allowed Fewer Students for a Clinical Space by Academic Year Type of Program

2014-2015

2015-2016

ADN 3 6

BSN 4 6

ELM 3 2

Total reporting 29 30

5 Some of these data were collected for the first time in 2009-2010. However, changes in these questions for the 2010-2011 administration of the survey prevent comparability of the data. Therefore, data prior to 2010-2011 may not be shown.



Closure – or partial closure – of clinical facility, was the most commonly reported reason why Bay Area programs were denied clinical space while the second most commonly reported reason was competition for clinical space due to the number of nursing students in the region. This has declined significantly from that first reported in 2009-2010.

No Bay Area programs reported that the facility charging a fee for the placement was a reason for clinical space being unavailable.

Table 20. Reasons for Clinical Space Being Unavailable* by Academic Year

Note: Blank cells indicated that the applicable information was not requested in the given year.

2009-2010

2010-2011

2011-2012

2012-2013

2013-2014

2014-2015

2015-2016

Closure, or partial closure, of clinical facility 26.1% 6.3% 20.8% 33.3% 44.4% 47.1%

Competition for clinical space due to increase in number of nursing students in region

79.0% 73.9% 50.0% 50.0% 29.2% 44.4% 35.3%

Displaced by another program 63.2% 39.1% 31.3% 33.3% 25.0% 38.9% 23.5% Staff nurse overload or insufficient qualified staff 52.6% 65.2% 68.8% 45.8% 41.7% 22.2% 23.5%

No longer accepting ADN students 36.8% 17.4% 18.8% 16.7% 12.5% 22.2% 23.5% Decrease in patient census 36.8% 43.5% 37.5% 29.2% 29.2% 22.2% 17.6% Visit from Joint Commission or other accrediting agency 37.5% 33.3% 16.7% 11.8%

Nurse residency programs 31.6% 13.0% 25.0% 0.0% 20.8% 16.7% 11.8% Change in facility ownership/management 8.7% 18.8% 12.5% 16.7% 16.7% 11.8%

Other 10.5% 17.4% 18.8% 4.2% 8.3% 16.7% 23.5% Implementation of Electronic Health Records system 6.3% 45.8% 37.5% 11.1% 5.9%

Clinical facility seeking magnet status 47.4% 8.7% 18.8% 12.5% 4.2% 22.2% 0.0%

The facility began charging a fee (or other RN program offered to pay a fee) for the placement and the RN program would not pay

0.0% 0.0% 0.0%

Number of programs that reported 19 23 16 24 24 18 17



ADN programs reported “no longer accepting ADN students” as the most frequently reported barrier to finding clinical space. For BSN programs, competition for clinical space due to an increase in the number of students in the region, and staff nurse overload or insufficient qualified staff tied for first place as barriers. For ELM programs, closure or partial closure, of a clinical facility was the top reason for clinical space being unavailable.

Table 21. Reasons for Clinical Space Being Unavailable by Program Type, 2015-2016 ADN BSN ELM Total

Closure, or partial closure, of clinical facility 28.6% 33.3% 100.0% 47.1% Competition for clinical space due to increase in number of nursing students in region 28.6% 50.0% 25.0% 35.3%

Displaced by another program 28.6% 16.7% 25.0% 23.5% Staff nurse overload or insufficient qualified staff 0.0% 50.0% 25.0% 23.5% No longer accepting ADN students 42.9% 0.0% 25.0% 23.5% Other 0.0% 33.3% 50.0% 23.5% Decrease in patient census 0.0% 33.3% 25.0% 17.6% Visit from Joint Commission or other accrediting agency 14.3% 16.7% 0.0% 11.8% Change in facility ownership/management 28.6% 0.0% 0.0% 11.8% Nurse residency programs 0.0% 16.7% 25.0% 11.8% Implementation of Electronic Health Records system 0.0% 16.7% 0.0% 5.9% Clinical facility seeking magnet status 0.0% 0.0% 0.0% 0.0% The facility began charging a fee (or other RN program offered to pay a fee) for the placement and the RN program would not pay

0.0% 0.0% 0.0% 0.0%

Number of programs that reported 7 6 4 17

Programs that lost access to clinical space were asked to report on the strategies used to cover the lost placements, sites, or shifts. In 2015-2016, the most frequently reported strategy (94%) was to replace the lost clinical space with a new site. This strategy has become more common among Bay Area programs over the last three years. Many programs also reported being able to replace the lost space at the same clinical site (41%).

Table 22. Strategies to Address the Loss of Clinical Space* by Academic Year 2011-

2012 2012- 2013

2013- 2014

2014-2015

2015-2016

Added/replaced lost space with new site 56.3% 41.7% 58.3% 61.1% 94.1%

Replaced lost space at same clinical site 62.5% 45.8% 50.0% 16.7% 41.2%

Clinical simulation 50.0% 54.2% 45.8% 44.4% 23.5% Replaced lost space at different site currently used by nursing program 56.3% 58.3% 75.0% 66.7% 17.6%

Reduced student admissions 6.3% 0.0% 0.0% 0.0% 5.9%

Other 6.3% 0.0% 0.0% 5.6% 5.9%

Number of programs that reported 16 24 24 18 17



The share of Bay Area nursing programs that reported using out-of-hospital clinical placements has declined over the past three years. In 2015-2016, only 23% (n=7) of Bay Area nursing programs reported an increase in out-of-hospital clinical placements. This represents a decrease from the 45% (n=14) of nursing programs reporting an increase in out-of-hospital clinical placements in 2010-2011. In 2015-2016, the most frequently reported non-hospital site was a School health service (K-12 or college) (reported by 57% of all responding programs) or surgery center/ambulatory care center.

Table 23. Alternative Out-of-Hospital Clinical Sites* Used by RN Programs by Academic Year 2010-

2011 2011-2012

2012-2013

2013-2014

2014-2015

2015-2016

School health service (K-12 or college) 50.0% 30.0% 37.5% 42.9% 30.0% 57.1% Surgery center/ambulatory care center 35.7% 20.0% 0.0% 0.0% 30.0% 57.1% Public health or community health agency 57.1% 70.0% 50.0% 71.4% 30.0% 42.9% Home health agency/home health service 28.6% 20.0% 0.0% 14.3% 20.0% 42.9% Skilled nursing/rehabilitation facility 42.9% 40.0% 25.0% 14.3% 80.0% 28.6% Hospice 28.6% 30.0% 12.5% 14.3% 20.0% 28.6% Case management/disease management 14.3% 0.0% 0.0% 14.3% 0.0% 28.6% Outpatient mental health/substance abuse 50.0% 50.0% 0.0% 28.6% 20.0% 14.3% Medical practice, clinic, physician office 14.3% 30.0% 25.0% 14.3% 20.0% 14.3% Other 21.4% 40.0% 0.0% 28.6% 10.0% 14.3% Urgent care, not hospital-based 0.0% 0.0% 0.0% 0.0% 0.0% 14.3% Correctional facility, prison or jail 0.0% 0.0% 0.0% 0.0% 10.0% 0.0% Renal dialysis unit 14.3% 10.0% 0.0% 0.0% 0.0% 0.0% Occupational health or employee health service 7.1% 0.0% 0.0% 0.0% 0.0% 0.0%

Number of programs that reported 14 10 8 7 10 7



The number of Bay Area nursing schools reporting that pre-licensure students in their programs had encountered restrictions to clinical practice imposed on them by clinical facilities has decreased slightly over the last five years. The most common types of restrictions students face continue to be access to the clinical site due to a visit from the Joint Commission or other accrediting agency (78%) and bar coding medication administration (56%). Alternative setting due to liability (6%) has decreased in importance over time, as has electronic medical records (44%), but other categories do not demonstrate a clear pattern of increase or decrease.

Table 24. Common Types of Restricted Access in the Clinical Setting for RN Students by Academic Year

2009- 2010

2010- 2011

2011- 2012

2012- 2013

2013- 2014

2014-2105

2015-2016

Clinical site due to visit from accrediting agency (Joint Commission) 72.7% 91.7% 77.3% 78.3% 81.0% 80.0% 77.8%

Bar coding medication administration 68.2% 70.8% 68.2% 56.5% 57.1% 65.0% 55.6%

Student health and safety requirements 50.0% 31.8% 43.5% 38.1% 50.0% 44.4%

Electronic medical records 68.2% 41.7% 63.6% 69.6% 57.1% 35.0% 44.4%

Automated medical supply cabinets 54.5% 37.5% 40.9% 52.2% 42.9% 35.0% 44.4%

Glucometers 40.9% 54.2% 22.7% 43.5% 47.6% 30.0% 44.4%

IV medication administration 36.4% 45.8% 31.8% 30.4% 23.8% 40.0% 33.3%

Some patients due to staff workload 37.5% 59.1% 30.4% 47.6% 40.0% 27.8%

Direct communication with health team 18.2% 12.5% 9.1% 13.0% 9.5% 0.0% 16.7%

Alternative setting due to liability 22.7% 16.7% 27.3% 17.4% 14.3% 15.0% 5.6%

Number of schools that reported 22 24 22 23 21 20 18 Note: Blank cells indicated that the applicable information was not requested in the given year. Numbers indicate the percent of schools reporting these restrictions as “common” or “very common”.



In 2015-2016, the top reasons schools reported for restricted student access to electronic medical records were insufficient time for clinical site staff to train students (68%), clinical site staff still learning the system (58%), and the cost of training (33%). The proportion of schools reporting clinical site staff still learning the system as a reason for restricting student access decreased over the last three years from a high of 80% in 2013-2014, the first year these data were collected.

In 2015-2016, the top reasons schools reported for student restricted student access to medication administration systems were liability (33%), clinical site staff still learning the system (25%), limited time for clinical staff to train students (25%), or cost for training (25%). Liability was the primary reason for restricting student access to medication administration systems in all three years in which these data were collected, although the percent of those reporting this restriction was considerably lower in 2015-2016 than in prior years.

Table 25. Share of Schools Reporting Reasons for Restricting Student Access to Electronic Medical Records and Medication Administration by Academic Year

Electronic Medical Records Medication Administration

2013-2014 2014-2015 2015-2016 2013-2014 2014-2015 2015-2016

Insufficient time to train students 60.0% 68.8% 66.7% 46.2% 26.7% 25.0% Staff still learning and unable to assure documentation standards are being met

80.0% 62.5% 58.3% 46.2% 40.0% 25.0%

Cost for training 35.0% 43.8% 33.3% 38.5% 20.0% 25.0% Liability 15.0% 6.3% 25.0% 61.5% 60.0% 33.3% Patient confidentiality 25.0% 31.3% 25.0% 7.7% 0.0% 8.3% Staff fatigue/burnout 30.0% 25.0% 16.7% 30.8% 26.7% 16.7% Other 0% 0.0% 16.7% 0% 6.7% 16.7% Number of schools that reported 20 16 12 13 15 12

Numbers indicate the percent of schools reporting these restrictions as “uncommon”, “common” or “very common” to capture any instances where reasons were reported.

The majority of nursing schools in the Bay Area that experienced student restrictions to clinical practice compensated for training in these areas of restricted access by providing training in the simulation lab (88%) and training students in the classroom (71%).

Table 26. How the Nursing Program Compensates for Training in Areas of Restricted Access by Academic Year 2013-2014

% Schools 2014-2015 % Schools

2015-2016 % Schools

Training students in the simulation lab 90.5% 85.7% 88.2% Training students in the classroom 52.4% 52.4% 70.6% Purchase practice software, such as SIM Chart 52.4% 52.4% 41.2%

Ensuring all students have access to sites that train them in this area 61.9% 61.9% 29.4%

Other 0.0% 4.8% 11.8% Training students in the skills lab -- 9.5% -- Number of schools that reported 21 21 17



Faculty Census Data6

On October 15, 2016 there were 911 total nursing faculty7 teaching at Bay Area nursing programs, 32% of whom (n=288) were full-time while 68% (n=618) were part-time. In addition, there were 112 vacant faculty positions. These vacancies represent a 10.9% faculty vacancy rate overall (14.5% for full-time faculty and 9.3% for part-time faculty).

Table 27. Faculty Census Data† by Year 2006 2007* 2008 2009 2010 2011 2012¥ 2013 2014* 2015* 2016*

Total Faculty 652 802 855 836 875 932 788 885 938 1,021 911 Full-time 237 334 333 321 319 314 244 283 322 315 288 Part-time 415 466 522 515 556 618 544 602 591 707 618

Vacancy Rate** 10.7% 4.8% 3.5% 3.9% 2.9% 4.1% 14.4% 9.7% 8.9% 9.6% 10.9% Vacancies 78 40 31 34 26 40 133 95 92 109 112

† Between 2011-2012 and 2013-2014 data may be influenced by satellite campus data being reported and allocated to their proper region. Readers are cautioned against comparing data collected these years with data collected before and after this change. *The sum of full- and part-time faculty did not equal the total faculty reported in these years. **Vacancy rate = number of vacancies/(total faculty + number of vacancies) ¥ One program in the region did not report faculty data for the 2011-2012 survey.

In 2015-2016, schools were asked if the school/program began hiring significantly more part-time than full-time active faculty over the past 5 years than previously. 50% (n=13) of 26 schools responding agreed. These 13 schools were asked to rank the reason for this shift.

The top ranked reason was non-competitive salaries for full-time faculty, followed by a shortage of RNs applying for full-time faculty positions.

Table 28. Reasons for Hiring More Part-time Faculty, 2015-2016 Average

Rank Programs reporting

Non-competitive salaries for full time faculty 2.0 12

Shortage of RNs applying for full time faculty positions 3.2 12

Insufficient number of full time faculty applicants with required credential 3.8 12

Insufficient budget to afford benefits and other costs of FT faculty 3.9 9

Need for part-time faculty to teach specialty content 4.8 10

Private, state university or community college laws, rules or policies 5.0 9

Need for faculty to have time for clinical practice 6.1 7 Need for full-time faculty to have teaching release time for scholarship, clinical practice, sabbaticals, etc. 6.4 8

To allow for flexibility with respect to enrollment changes 6.8 8

Other 7.0 3 *The lower the ranking, the greater the importance of the reason (1 has the highest importance and 10 has the lowest importance.)

6 Census data represent the number of faculty on October 15th of the given year. 7 Since faculty may work at more than one school, the number of faculty reported may be greater than the actual number of individuals who serve as faculty in nursing schools in the region.



In 2015-2016, the majority (67%, n=18) of Bay Area nursing schools reported that their faculty worked overloaded schedules. Of these schools, 94% (n=17) pay the faculty extra for the overloaded schedule.

Table 29. Faculty with Overloaded Schedules* by Academic Year

2008-2009

2009-2010

2010-2011

2011-2012

2012-2013

2013-2014

2014-2015

2015-2016

Schools with overloaded faculty 17 17 21 19 20 24 19 18

Share of schools that pay faculty extra for the overload 94.1% 94.1% 90.5% 84.2% 90.0% 91.7% 94.7% 94.4%

Number of schools that reported 26 26 27 27 27 27 27 27



Summary

Over the past decade, the number of Bay Area pre-licensure nursing programs has remained relatively constant, with 29 in 2006-2007 and 30 in 2015-2016. The number of nursing programs that partner with other schools that offer programs that lead to a higher degree has increased dramatically over the last nine years – from only 1 program in 2006-2007 to 15 programs in 2015-2016.

Bay Area programs reported a total of 2,208 spaces available for new students in 2015-2016, which were filled with a total of 2,349 students. For nine out of the past ten years pre-licensure nursing programs in the Bay Area have enrolled more students than were spaces available. There were 5,895 qualified applications to the region’s programs in 2015-2016; 40% (n=2,349) of these applicants enrolled.

In 2015-2016, pre-licensure nursing programs in the Bay Area reported 2,054 student completions. This is a decrease from 2014-2015. With retention rates remaining between 80% and 85%, there will likely be fewer graduates from Bay Area nursing programs in the future. At the time of the survey, 9% of recent graduates from Bay Area RN programs were pursuing additional nursing education and 5% were unable to find employment in nursing which is significantly lower than that reported in previous years.

Clinical simulation has become widespread in nursing education, with all nursing schools in the Bay Area reporting using it in some capacity, and nearly a quarter of programs (23%) reporting plans to increase staff dedicated to administering clinical simulation in the next 12 months. The majority of programs plan to maintain their number of clinical training hours and if any changes were reported, they were more likely to increase the number of clinical simulation hours. Reasons for decreasing overall clinical hours when reported were most often inability to find sufficient clinical space and clinical faculty. The importance of clinical simulation is underscored by data showing that the majority (57%) of Bay Area programs are being denied access to clinical placement sites that were previously available to them. In addition, almost half (47%, n=14) were allowed fewer students for a clinical placement, unit, or shift in this year than in the prior year.

While the total number of prelicensure nursing students has declined by about 11% since 2009, the number of nursing faculty has increased in the same period (9%), largely driven by an increase in part-time faculty. Half of Bay Area schools reported that they had begun hiring significantly more part-time than full-time faculty over the last 5 years. This shift had to do primarily with non-competitive salaries for full-time faculty and a shortage of RNs applying for full-time faculty positions. In 2015-2016, 112 faculty vacancies were reported, representing a 10.9% faculty vacancy rate overall (14.5% for full-time faculty and 9.3% for part-time faculty).



APPENDICES

APPENDIX A – Bay Area Nursing Education Programs ADN Programs (15) Cabrillo College Chabot College City College of San Francisco College of Marin College of San Mateo Contra Costa College De Anza College Evergreen Valley College

Los Medaños College Merritt College Napa Valley College Ohlone College Pacific Union College Santa Rosa Junior College Solano Community College

LVN to ADN Programs Only (3) Gavilan College Mission College Unitek College BSN Programs (8)

CSU East Bay Dominican University of California Holy Names University Samuel Merritt University San Francisco State University

Sonoma State University University of San Francisco The Valley Foundation School of Nursing at

San Jose State University

ELM Programs (4)

Samuel Merritt University San Francisco State University University of California San Francisco University of San Francisco



APPENDIX B – BRN Education Issues Workgroup Members

Members Organization

Loucine Huckabay, Chair California State University, Long Beach Judee Berg HealthImpact (formerly CINHC) Audrey Berman Samuel Merritt University Stephanie L. Decker Kaiser Permanente National Patient Care Services Brenda Fong Community College Chancellor’s Office Judy Martin-Holland University of California, San Francisco Robyn Nelson West Coast University Tammy Rice Saddleback College Stephanie R. Robinson Fresno City College Paulina Van Samuel Merritt University Ex-Officio Member Dr. Joseph Morris California Board of Registered Nursing

Project Manager Julie Campbell-Warnock California Board of Registered Nursing



Agenda Item Summary


ACTION REQUESTED: Report of the Nursing Education and Workforce Advisory

Committee (NEWAC) Meeting REQUESTED BY: Michael Jackson, RN, MSN

Chairperson, Education/Licensing Committee

BACKGROUND: The newly formed NEWAC is the combination of the EducationIssues Workgroup (EIW) and the Nursing Workforce Advisory Committee (NWAC) as recommended by the legislature during the BRNs Sunset Review process and approved by the Board in June 2015. The first meeting was held on January 26, 2017. There was a meeting location at the BRN in Sacramento and three teleconference sites. The purpose of the NEWAC is to bring together educator and employer representatives and stakeholders to communicate, collaborate and assist one another on relevant nursing issues and identify how the Board might assist in these efforts. Current committee members include representatives from:

ADN, BSN, ELM and Post-licensure Nursing Programs (from geographically diverse and public/private programs)

RN employer RN and APRN practice Public Office of State Health Planning and Development - Health Professions Education Foundation

and Health Workforce Development Division Institute for Health Policy Studies, Center for the Health Professions – UCSF HealthImpact California Hospital Association UNAC/UHCP Community Colleges Chancellor’s Office American Nurses Association/California California Nurses Association Association of California Nurse Leaders BRN Board Member

At future meetings, the BRN and committee will be reviewing and formalizing membership representatives, membership terms, and committee purpose and goals. The committee addressed many topics at this first meeting which included:

Annual School Survey Work – In the past, the EIW has played an important role in working with the BRN staff and the BRN contractor, UCSF, in providing input to the Annual School Surveys questions and data review, the committee approved a subgroup of the education committee representatives and perhaps some stakeholders to work with the staff and report back to the NEWAC.

RN Recruitment in California – Ways to Increase Diversity – The committee discussed the lack of diversity in the current RN population and how it is slowly changing with the increased diversity of the new graduates. Nursing education pipeline issues were discussed. The committee reviewed and provided feedback on a BRN recently developed flyer about careers in

nursing targeted to men and minority groups. The committee discussed beginning with compiling resources for best practices, partners and contacts related to increasing the diversity of RNs that they know about. BRN staff is collecting and compiling this information from the committee members for consideration at future meetings.

Clinical Practice Sites – Issues Related to Educators and Employers and Displacement Issues – A variety of issues surrounding this subject were discussed by the committee, including: concern that some private programs may be able to provide more support and resources to the clinical agencies than public programs, thus giving them an advantage; clinical space may sometimes be taken by students enrolled in out-of- state programs, thus leaving less space for students of schools in California; and, data was provided from the draft 2015-2016 BRN Annual School Report showing the trend of programs reporting being denied a clinical placement, unit or shift. This data appears to be showing a decline, however data showing programs that reported fewer students allowed for a clinical placement showed an increase from the previous year. In order to avoid some of these issues, the committee discussed the importance of strong academic/practice partnerships being in place; schools should encourage service agencies to agree not to let students from out-of-state programs displace current students from California based programs; use of regional consortiums; the use of alternative and non-traditional sites and looking to other states to see how they are handling these issues. This issue will continue to be discussed by the committee.

Clinical Simulation – This issue was discussed along with the clinical practice sites issue. BRN Annual School Survey data regarding the use of clinical simulation in the nursing programs and a summary of the data was shared with the committee. The data shows on average overall, nursing programs report 7% to 8% of clinical training is spent in simulation. This percentage varies slightly by content area with the highest percentage (9%) reported in obstetrics and pediatrics. The NCSBN study regarding clinical simulation was discussed and the idea of working on a pilot project in California to idenfity simulation standards and identifying schools with best practices in simulation. Other states practices were discussed as possible models or places to obtain information. Discussion of forming a subgroup to review these issues and determine the best process for moving forward transpired. As a result, HealthImpact is spearheading the sub group with funding assistance from the Community College Chancellor’s Office. Representatives from COADN, CACN, the BRN, and other simulation experts will be included on the workgroup. Reports will be provided back to the NEWAC.

Changes in RN Education for Ambulatory Care – RN care is moving more and more outside of the traditional hospital setting and into the community. Two papers were discussed which provide some good information in this area, one from the Macy Foundation (June 2016) titled “Registered Nurses: Partners in Transforming Primary Care – Recommendations from the Macy Foundation Conference on Preparing RNs for Enhanced Roles in Primary Care” and one from the California HealthCare Foundaton (August 2015) titled “RN Role Reimagined: How Emporing RNs Can Improve Primary Care”. These papers will be used by the committee as background for future discussion on this subject.

Recent Nursing Research & Ideas for Possible Additional Research – Some areas identified where research would be helpful included: successful methods for recruiting and retaining diverse student populations; assessments of current diversity and forecasts on a regional basis; onboarding/retention of new graduates from graduate and employer perspective. Some parts of these topics are being collected on existing surveys. These research areas and others will continue to be discussed by the committee.

PERSON(S) TO CONTACT: Julie Campbell-Warnock

Research Program Specialist (916) 574-7681

BOARD OF REGISTERED NURSING Education/Licensing

Agenda Item Summary


ACTION REQUESTED: Licensing Program Report REQUESTED BY: Michael Jackson, MSN, RN

Chairperson Education/Licensing Committee PROGRAM UPDATE LICENSING: The Licensing Program evaluators are currently processing the initial review of exam and endorsement applications received in early February 2017. To assist students on how to apply to the Board, the Licensing’s management team continues to present an overview regarding the application and eligibility process to California students at every Board petitioner hearing day. Currently the Licensing unit has two vacancies, one Office Services Supervisor II and one Office Technician in US Evaluations. The Board has taken into consideration the current budget projections and will advertise and recruit to fill these positions by the beginning of July 2017. Also, the Board has testified at the Senate and Assembly sub 4 budget hearings regarding Budget Change Proposals that have been submitted for additional positions within the Licensing unit. The Board’s licensing subject matter experts (SMEs) and management meet collaboratively with other Boards and Bureaus within DCA on a monthly basis at the Licensing User Group (LUG) to discuss current and future updates as well as a multitude of topics that deals with the BreEZe system. In addition, the licensing SMEs and management continues to meet with the DCA BreEZe Business Integration Analyst (BIAs) on a bi-weekly basis to discuss potential changes in BreEZe that would assist the Board with streamlining some of our business processes. Currently the DCAs SOLID Occupational Change Management (OCM) unit is continuing to meet with staff and management regarding our business processes. Once the process is completed they will provide comprehensive reports regarding our current processes and procedures along with recommendations for potential changes that could assist in streamlining and reducing processing timeframes. This will also provide the Board with detailed business flowcharts and will assist in the updating of our existing procedure manuals. Since October 2016 we have been utilizing the CloudDrive to receive electronic transcripts from California programs. The Board has received 3,363 electronic transcripts from 100 California programs for fall graduation. Unfortunately, not every California program has sent their transcripts electronically and the Board is expecting this will change during the upcoming spring graduation. Prior to spring graduation an email will be sent to all deans, directors and their associates outlining the Board’s expectation and procedures on how to successfully send transcripts electronically.

FINGERPRINTS: The Board testified at the March 6, 2017 Sunset Hearing before the Senate Committee on Business, Professions and Economic Development and the Assembly Committee on Business and Professions. One area of discussion was regarding licensee notification if fingerprint submission required for license renewal. The current status of the fingerprint project is as follows: Board staff worked with DCA to reconcile the DOJ fingerprint data (approx. 29,000 active licensees) and since December 2016 have been in the process of notifying licensees of the need to submit fingerprints. In December 2016 we identified approximate 4,300 licensees with no FBI and DOJ fingerprint results. We initiated a roll out plan to notify this population that they need to submit fingerprints. Two notification letters were sent over a 60 day period to the licensees and a final third non-compliance notification letter has been sent to those still not in compliance (approx. 417). On March 22nd the group of 417 non-compliant licensees were referred to the enforcement unit for potential disciplinary action. As of today from the approximate 29,000 active licensees identified, approximate 12,000 active licensees with one level of service (i.e. either FBI or DOJ) in the BreEze system remain incomplete. For this remaining group we have already initiated notification to approximate 1,400 licensees due to expire in the next 3 months and have implemented a new roll out plan to ensure we notify the remaining population by the end of the year. As notifications have been sent out, licensees are spreading the word and board staff is seeing an increase in the number of fingerprint results the Board is receiving and an increase in compliance with the fingerprint requirement. In addition, we have also identified a population of licensees who have paid license renewal fees and have a pending renewal due to the fingerprint requirement. This population is fluid and changes frequently as renewal fees are paid and fingerprint submissions are received. We have implemented additional oversight measures to ensure we are notifying licensees in a timely manner that they need to submit fingerprints to compete renewal. As we have reviewed our business processes we have been able to submit BreEZe change requests to our online renewal application. In May 2017 a change to BreEZe is scheduled to be implemented to display fingerprint data on the online license renewal. STATISTICS: The Board is currently using Quality Business Interactive Report Tool (QBIRT) and is able to create and run various reports upon request. The Board sent additional licensing staff to the QBIRT basics training on March 13, 2017 to ensure we have an adequate amount of staff that is able to run reports. The Licensing Unit’s report analyst and management are in the process of creating a reports catalog which will include a list of various reports the Board can run on demand at any given time. We currently run specific reports on a weekly basis to review pending applications by received date. This report assists us in ensuring we are meeting our regulatory timeframes to conduct an initial application evaluation within 90 days. Below is the total number of applications the Board has received by fiscal year:

Applications ReceivedApplication Type Fiscal Year

2013 – 2014Fiscal Year 2014-2015

Fiscal Year 2015-2016

Fiscal Year 2016-Current

Exams 14,284 15,777 16,059 9,532 Endorsement 9,679 13,534 15,713 13,370Repeat/Reapply 5,716 7,734 6,879 5,146Advanced Practice 6,921 8,084 6,701 6,576Total 36,600 45,129 45,352 34,624 NEXT STEPS: None. PERSON TO CONTACT: Christina Sprigg Chief, Licensing and Administrative Services (916) 574-7600

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