BILL ANALYSIS AB 867 Page 1 Date of Hearing: April 21, 2009 ASSEMBLY COMMITTEE ON HIGHER EDUCATION 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 practice." 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 AB 867 Page 2 exception to the Master Plan for Higher Education (Master Plan). 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), AB 867 Page 3 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 degree. 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 AB 867 Page 4 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 programs? 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 AB 867 Page 5 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 students? 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 pursued: 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 AB 867 Page 6 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. REGISTERED SUPPORT / OPPOSITION : Support 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 Professionals AB 867 Page 7 Workforce Investment Board of Venture County Yuba Community College District 8 Individuals Opposition None on file. Analysis Prepared by : Sandra Fried / HIGHER ED. / (916) 319-3960