BILL ANALYSIS                                                                                                                                                                                                    

                                                                  AB 867
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          Date of Hearing:   April 21, 2009

                              Anthony Portantino, Chair
                     AB 867 (Nava) - As Amended:  April 14, 2009
          SUBJECT  :   California State University: Doctor of Nursing  
          Practice degree.

           SUMMARY  :   Authorizes the California State University (CSU) to  
          independently award a Doctor of Nursing Practice (DNP) degree,  
          subject to the following specifications:

          1)This authority shall be limited to the field of "nursing  

          2)The DNP degree shall be distinct from the doctor of philosophy  
            (Ph.D) degree offered at, or in conjunction with, the  
            University of California (UC) and shall allow professionals to  
            earn the DNP degree while working full time.

          3)Funding shall be provided through the enrollment growth  
            provided to CSU in the annual Budget Act.

          4)Enrollments in the DNP program shall not alter CSU's ratio of  
            graduate instruction to total enrollment and shall not  
            diminish enrollment growth in CSU undergraduate programs.

          5)Funding provided from the state for each Full Time Equivalent  
            Students (FTES) shall be at the agreed-upon marginal cost  
            calculation that CSU receives for graduate enrollment.

          6)CSU shall provide any needed startup funding from within  
            existing budgets for academic program support without  
            diminishing the quality of program support offered to CSU  
            undergraduate programs.   

          7)Requires CSU to annually report on the status of the degree  
            program to the California Postsecondary Education Commission  
            (CPEC), the Legislative Analyst's Office (LAO), and the  
            appropriate budget subcommittees in each house of the  
            legislature, prior to any legislative budget subcommittee  
            hearing related to the degree program.

          8)Codifies legislative intent that this authority is an  


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            exception to the Master Plan for Higher Education (Master  

           FISCAL EFFECT  :   Unknown

           COMMENTS  :  This bill is double-referred to the Assembly Business  
          and Professions Committee.

           Master Plan  :  One of the major features of the Master Plan is  
          the differentiation of functions among the public postsecondary  
          segments. One of the advantages of this structure is that it  
          focuses limited state resourses on a few key responsibilities in  
          each of the three public sectors, as follows:

          1)The University of California (UC) is designated as the State's  
            primary academic research institution and is to provide  
            undergraduate, graduate, and professional education.  UC is  
            given exclusive jurisdiction in public higher education for  
            doctoral degrees (with the exception that CSU can award joint  
            doctorates) and for instruction in law, medicine, dentistry,  
            and veterinary medicine.

          2)CSU's primary mission is undergraduate education and graduate  
            education through the master's degree including professional  
            and teacher education. Faculty research is authorized  
            consistent with the primary function of instruction.   
            Doctorates can be awarded jointly with UC or an independent  
            institution, with the approval of CPEC.

          3)The California Community Colleges (CCC) have the primary  
            mission of providing academic and vocational instruction for  
            older and younger students through the first two years of  
            undergraduate education.  In addition, CCC is authorized to  
            provide remedial instruction, English as a Second Language  
            courses, adult noncredit instruction, community service  
            courses, and workforce training services.

          In 2005, an exception to the Master Plan was approved to  
          authorize CSU to offer the Ed.D degree because data indicated  
          that California lagged behind the nation in Ed.D degrees per  
          K-12 students, and UC did not offer Ed.D programs [AB 724  
          (Scott), Chapter 269, Statutes of 2005]. 
           Need for this bill  :  This bill resulted from a study by the CSU  
          Nursing Doctorate Advisory Committee (CSU Advisory Committee),  


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          comprised of CSU representatives and a research consultant, to  
          determine how best to address California's nursing faculty  
          shortage.  According to CSU, this bill is necessary to allow CSU  
          to train future CSU and CCC nursing faculty.  CSU's 18  
          pre-licensure nursing programs are full and unable to expand, in  
          part because there are not enough faculty available to meet the  
          low student-to-faculty ratios required by accreditors and  
          licensing boards for these programs.  In addition, CSU points  
          out that it will be able to train more advance practice nurses,  
          which may be the educational level necessary for certification  
          in the future.  
          Nurse educator shortage  :  According to a June 2008 study by the  
          California Institute for Nursing & Health Care (CINHC), more  
          baccalaureate- and graduate-prepared nurses will be needed as  
          California strives to fill a forecasted shortage of 116,000  
          nurses by 2020.  Currently, 70% of graduating nurses have  
          two-year Associate of Arts degrees, and only 26% of these go on  
          to secure a Bachelor of Science in Nursing or graduate-level  

           Why the DNP  ?  The CSU Advisory Committee considered several  
          types of degrees, including the Ph.D, the Doctor of Nursing  
          Science (DNS), the Ed.D, and the DNP, and surveyed CSU and CCC  
          nursing faculty to ascertain which degree is most useful for  
          educating nursing faculty.  The CSU Advisory Committee  
          determined that CSU does not have the research capacity to  
          provide the Ph.D or DNS.  While the nursing faculty surveyed  
          preferred the Ed.D, the CSU Advisory Committee determined that  
          the DNP would allow CSU to both educate nursing faculty and to  
          produce more DNPs in the event the doctoral degree becomes the  
          industry standard for advanced practice nurses.  

           Licensure requirements for advanced practice nurses  :  In  
          addition to being licensed by the state as RNs, advanced  
          practice nurses are certified by the state upon completion of an  
          accredited master's program per the standards contained in  
          section 1484 of the California Code of Regulations.  In October  
          2006, the American Association of Colleges of Nursing (AACN)  
          issued a recommendation that advanced practice nurses, including  
          nurse practitioners, nurse anesthetists, midwives, and clinical  
          nurse specialists, be prepared with a professional degree  
          beginning in 2015.  However, the advanced nursing community has  
          mixed views on the issue, since it would increase the cost to  
          students who seek to be advance practice nurses, may further  


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          increase health care costs, and would likely limit the supply of  
          advanced practice nurses.  Since the California Board of  
          Registered Nurses (CBRN) accredits California's nursing  
          programs, it would take action on the part of the state to adopt  
          professional degree requirements for advanced practice nurses.

           Is additional capacity needed ?  According to the AACN, 86  
          institutions nationwide offer DNP programs and more than 50  
          nursing schools are considering starting DNP programs.  In  
          California, the University of San Francisco, the University of  
          San Diego, and the Western University of Health Sciences in  
          Pomona have DNP programs; one of the programs is full, and two  
          have capacity for more students.  While UC offers Ph.D degrees  
          in nursing, it does not currently offer DNPs; although, UC  
          Irvine is considering a DNP program.  If existing DNP programs  
          have capacity, are more DNP programs necessary, or should the  
          state consider other options, such as providing Cal Grants or  
          other incentives for students to enroll in existing DNP  
          Are DNP programs the answer to the nursing faculty shortage  ?   
          While numerous studies point to the need for more nurse  
          educators, they do not identify additional DNP programs as the  
          primary solution.  For example, a critical barrier to improving  
          the state's nursing education infrastructure, according to the  
          CINHC report, is the difficulty in recruiting experienced nurse  
          educators.  Entry level teaching salaries may be only half of  
          what can be earned as clinical nurse with 20 years of  
          experience.  While the report identified seven critical areas  
          for strategic nursing education redesign, additional DNP  
          programs were not part of the recommendations.  Further, the  
          CBRN, in its 2007-08 Annual School Report, found that the most  
          common barriers to nursing program expansion were lack of  
          clinical sites and uncompetitive faculty salaries.  

           What's the cost  ?  Doctoral degree programs are more costly to  
          operate than baccalaureate or master's level programs, and  
          nursing programs are among the most expensive programs.  Given  
          this, what is the expected cost to CSU to start-up and operate  
          such programs, and what fees are students expected to pay?  How  
          will CSU fund these costs?  Will other graduate programs,  
          including masters nursing programs, be affected?  

          Should the DNP program take priority over other CSU funding  
          needs  ?  CSU has sustained significant budget cuts in recent  


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          years, including $97.6 million in 2008-09 Budget Act and an  
          additional $66.3 million in 2009-10.  According to CSU, these  
          reductions place it $283 million below its operational  
          needs-approximately 10%.  CSU is reducing enrollments by 10,000  
          undergraduate students for the 2009-10 academic year because of  
          the lack of funding for enrollment growth in the budget.  At the  
          same time, several recent reports have found that California's  
          economy will require a 50% increase in the number workers with  
          baccalaureate degrees.  Should future enrollment growth funds be  
          used for DNP programs or for other system needs, including  
          baccalaureate degree production, increased financial aid,  
          decreased time-to-degree, and more slots for undergraduate  
          Other options  :  Instead of the initiating DNP programs, which  
          are costly and compete with other funding priorities, the  
          following options for increasing nursing faculty could be  
          1)Joint degrees  :  Since current law authorizes CSU to establish  
            joint doctoral degree programs, its campuses can partner with  
            other institutions to provide a joint doctoral degree, which  
            may be a more cost-effective first step for beginning these  
            programs.  They can do this with the private universities that  
            have DNP programs or with institutions interested in starting  
            a new program.  CSU can also offer joint degrees with UC;  
            however, the CSU Advisory Committee report indicates that  
            efforts to initiate joint nursing doctoral programs with UC  
            have been unsuccessful.  

          2)Ed.D in nursing  :  The CSU Advisory Committee found that an  
            Ed.D program focusing on nursing education would likely meet  
            the needs of nursing faculty, and the Ed.D was the preferred  
            doctoral degree of CSU and CCC nursing directors surveyed by  
            the CSU Advisory Committee.  

           3)Address other impediments  :  As mentioned previously, studies  
            have identified other avenues for increasing nursing faculty  
            ahead of creating new DNP programs, including lack of clinical  
            sites and noncompetitive faculty salaries.  

           Should this issue be further studied  ?  At its March 2009  
          meeting, CPEC approved a statewide study of nursing education  
          and supply issues with the following goals: 1) modeling nursing  
          supply and demand; 2) assessing the general and unique  


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          contributions and benefits of the four systems of higher  
          education on nursing education; and 3) determining the  
          cost-effectiveness of recent nursing legislation and  
          initiatives.  The second goal will seek to determine the  
          appropriate mix of nursing degree programs by system and degree  
          level to meet California's nursing needs.  In addition, the  
          Legislature may be establishing a joint committee to review the  
          Master Plan as it approaches its 50th anniversary.  Should  
          expansion of CSU's authority to award doctorate degrees be  
          considered in greater context?

           Related legislation  :  SB 1288 (Scott) of 2008, which was held in  
          the Senate Appropriations Committee, was substantially similar  
          to this bill.  AB 1295 (Fuller), set for hearing in this  
          Committee, establishes a transfer pathway between CCC and CSU  
          nursing programs.  SB 1309 (Scott), Chapter 837, Statutes of  
          2006, enacted numerous programs to increase the number of  
          registered nurses.  


          American Nurses Association/California
          California Association for Nurse Practitioners
          California Association of Nurse Anesthetists
          California Hospital Association
          California Nurse-Midwives Association
          California School Nurses Organization
          California State University
          California State University, Fresno
          California State University, Long Beach
          California State University, Sacramento
          Carol Chandler, California State University Trustee
          Coalition of Orange County Community Clinics
          Cynthia Sterling, Fresno City Council President
          Cypress College
          Kaiser Permanente
          Mendocino College
          MiraCosta College
          Simi Valley Chamber of Commerce
          St. John's Pleasant Valley Hospital
          St. John's Regional Medical Center
          United Nurses Associations of California/Union of Health Care  


                                                                  AB 867
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          Workforce Investment Board of Venture County
          Yuba Community College District
          8 Individuals

          None on file.

          Analysis Prepared by :    Sandra Fried / HIGHER ED. / (916)