BILL ANALYSIS                                                                                                                                                                                                    



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          Date of Hearing:   April 28, 2009

                   ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
                                 Mary Hayashi, 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.   
          Specifically,  this bill  :  

          1)Limits the degree to the field of "nursing practice."

          2)Requires the DNP degree to 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)Requires funding to be provided through the enrollment growth  
            provided to CSU in the annual Budget Act.

          4)Prohibits enrollments in the DNP program from altering CSU's  
            ratio of graduate instruction to total enrollment and from  
            diminishing enrollment growth in CSU undergraduate programs.

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

          6)Requires CSU to 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  
            exception to the Master Plan for Higher Education (Master  








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            Plan).

           EXISTING LAW  : 

          1)Establishes the California State University and its various  
            campuses under the administration of the Trustees of the  
            California State University. 

          2)Requires the California State University to offer  
            undergraduate and graduate instruction through the master's  
            degree in the liberal arts and sciences and professional  
            education, including teacher education.

           FISCAL EFFECT  :   Unknown

           COMMENTS  :   

           Purpose of this bill  .  According to the author's office,  
          "Alleviating the current nursing faculty shortage is crucial and  
          the Board of Registered Nursing concluded in their 2005-2006  
          Annual School Report, 'Without more faculty, RN programs will  
          not be able to continue their expansion.'"  

           Background  .  This bill resulted from a study by the CSU Nursing  
          Doctorate Advisory Committee (CSU Advisory Committee), 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.

          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.

          The CSU Advisory Committee considered several types of degrees,  








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          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.

          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.  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 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.

          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; UC Irvine is considering a DNP program,  
          however.  
          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  








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          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.

          Doctoral degree programs are more costly to operate than  
          baccalaureate or master's level programs, and nursing programs  
          are among the most expensive programs.  CSU has sustained  
          significant budget cuts in recent 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.  
           

           Related legislation  .  SB 1288 (Scott) of 2008, which was held in  
          the Senate Appropriations Committee, was substantially similar  
          to this bill.  

          AB 1295 (Fuller) of 2009, 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 
           
          California State University (sponsor)
          American Nurses Association/California
          Cypress College
          MiraCosta College
          United Nurses Associations of California/Union of Health Care  
          Professionals (UNAC/UHAP)

           Opposition 
           
          None on file.
           
          Analysis Prepared by  :    Sarah Huchel / B. & P. / (916) 319-3301  








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