BILL ANALYSIS                                                                                                                                                                                                    Ó






                         SENATE COMMITTEE ON EDUCATION
                                Carol Liu, Chair
                           2013-2014 Regular Session
                                        

          BILL NO:       AB 548
          AUTHOR:        Salas
          AMENDED:       January 7, 2014
          FISCAL COMM:   Yes            HEARING DATE:  May 14, 2014
          URGENCY:       No             CONSULTANT:    Daniel Alvarez

           SUBJECT  :  Public postsecondary education: community college  
          registered nursing programs.
          
           SUMMARY  

          This bill removes the sunset on the California Community  
          College (CCC) districts' associate degree nursing (ADN)  
          programs admissions process that must be followed under  
          Education Code § 78261.5.  

           BACKGROUND  

          Current law, allows California Community College (CCC)  
          districts to use any diagnostic assessment tools that are  
          commonly used in registered nursing programs and approved  
          by the CCC Chancellor and, if, after using an approved  
          diagnostic tool, the CCC registered nursing program  
          determines that the number of applicants to the program  
          exceeds its capacity, the program is authorized to use  
          additional multicriteria screening measures.  

          Current law also specifies that a CCC district may not:   
          (a) exclude an applicant to a registered nursing program if  
          the applicant is not a resident of that district or has not  
          completed prerequisite courses in that district; and (b)  
          implement policies, procedures, and systems, including, but  
          not limited to, priority registration systems, that have  
          the effect of excluding an applicant or student who is not  
          a resident of that district from a registered nursing  
          program of that district.  (Education Code § 78261.3)

          In addition, current law permits, until January 1, 2016, a  
          community college to admit students to a registered nursing  
          program if, for any academic term, there are more  
          applicants seeking enrollment in that program than may  




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          reasonably be accommodated using the following procedures:

             1)   Administration of a multicriteria screening  
               process, as authorized in       EC § 78261.3, that  
               includes, but is not limited to (1) academic degrees  
               or diplomas held by the applicant, (2) grade point  
               average in relevant coursework, (3) any relevant work  
               or volunteer experience, and (4) life experiences or  
               circumstances, such as disabilities, income status,  
               veteran status, proficiency in languages other than  
               English, and additional criteria - personal  
               interviews, letters of recommendation, or personal  
               statements.

             2)   A random selection process.

             3)   A blended combination of random selection and  
               multicriteria screening process.  (EC § 78261.5)

           ANALYSIS

           This bill removes the sunset on the California Community  
          College (CCC) districts' associate degree nursing (ADN)  
          programs admissions process that must be followed under  
          Education Code § 78261.5.

           STAFF COMMENTS  

           1)   Need for the bill  .  According to the author's office,  
               California suffers from a serious nursing shortage,  
               there are many individuals seeking admission to the  
               California Community College nursing programs, and yet  
               approximately 12,000 applicants are turned away every  
               year due to lack of space. 

           2)   Nursing shortage  .  According to the California  
               Healthcare Foundation, California's registered nurse  
               (RN) per capita ratio (726 RNs per 100,000) remains  
               significantly lower than the rest the nation (929 RNs  
               per 100,000).  The California RN workforce is aging.   
               More RNs are approaching retirement age with fewer RNs  
               to replace them.  Nearly half of the nursing workforce  
               is over 50 and a recent survey found that 12 percent  
               are planning to retire over the next 5 years.  The  
               California Board of Registered Nursing forecasts,  
               accounting for the Affordable Care Act, the total need  




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               for RNs in 2013 ranged from 234,516 to 286,985, and  
               that demand in 2030 is forecasted to be between  
               291,679 and 350,166 total RNs.  These lower figures  
               are not likely to accurately represent total future  
               demand, because they do not account for additional  
               demand caused by future population growth and aging.
                
                California's RN workforce has become increasingly  
               racially/ethnically diverse over the past two decades  
               -- non-whites grew from 23 percent to 41 percent of  
               the RN workforce since 1990.  Although registered  
               nurses are one of the more racially/ethnically diverse  
               health professions in California, Latino RNs remain  
               substantially underrepresented in relation to the  
               state's general Latino population.  In contrast,  
               Filipinos account for 18 percent of the RN workforce  
               but just 3 percent of the general population. Despite  
               the growth in the number of degree programs, the  
               demand for nursing education has far exceeded the  
               number of available spots.  In 2009, 60 percent of  
               applicants meeting the admission criteria were not  
               accepted.  A recent survey found that the most common  
               barriers to program expansion were lack of clinical  
               sites, insufficient funding for faculty salaries and  
               noncompetitive faculty salaries.

               Based on a 2011 presentation to the Legislature by the  
               Legislative Analyst's Office (LAO), it was recommended  
               that the Legislature should implement additional  
               measures to reduce CCC attrition rates.  During this  
               same presentation, the LAO also opined that despite  
               recent efforts to expand access to nursing programs,  
               the number of applicants to CCC nursing programs far  
               exceeds available slots.  To note, the LAO found that  
               the CCC is able to accommodate less than 30 percent of  
               their applications.

           3)   The measure does not address lack of program capacity,  
               but rather the preparedness of the applicant pool  .   
               Notwithstanding the need for nurses, this measure  
               deals only with maintaining the ability of community  
               colleges to utilize multiple criteria for enrollment  
               purposes in its nursing programs, in those instances  
               where student interest and applicants exceed the  
               supply of slots for programs.  It is clear that more  
               slots for nursing programs is critical, but that  




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               entails a greater commitment of fiscal and  
               infrastructure resources on an on-going basis - well  
               beyond the scope of this measure.  So insuring  
               retention and completion of nursing programs by  
               current and future students, while minimizing  
               attrition in the high cost academically challenging  
               program like nursing is critical.  Part of this  
               approach also needs to be balanced in a fair and  
               equitable manner that reviews the preparedness of  
               students that may be highly motivated and experienced,  
               but lack some requisite preparatory coursework.  

               This bill insures the continued option of reviewing  
               multiple aspects of an applicant's background and  
               merit in relation to enrollment in a nursing program -  
               and not solely relying on strict course or diagnostic  
               requirements, coupled with a possible lottery of slots  
               when demand exceeds program capacity.  However, at  
               this point in time, there is no thorough reporting on  
               whether the use of multicriteria is (1) achieving its  
               intended goal of maintaining a diverse student  
               population and balancing the concept of "open access"  
               with student academic preparedness for the rigorous  
               subject matter, (2) whether retention and completion  
               is occurring at similar or different rates when  
               compared to the strict language of        EC section  
               78261.3, (3) whether the alternative approach of using  
               multicriteria continues to be necessary in light of  
               state grants targeted for both slots and diagnostic  
               and support services to reduce student attrition, and   
               (4) whether the Student Success Act has provided  
               supplemental assistance in assessing and assisting  
               students in nursing programs.  Some survey information  
               was presented to the committee, but this information  
               was not as thorough in answering the four points  
               above.  

               As such, staff recommends amendments that (1) extend  
               the sunset until January 1, 2020 (this will provide  
               the Chancellor's office an ability to gather  
               information from at least two cohorts of nursing  
               students (a typical ADN program is two years in  
               length) enrolled using multiple criteria and;  (2)  
               require an annual report beginning in 2015, by the  
               Chancellor's Office that thoroughly examines and  
               includes, but is not limited to (a) the participation,  




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               retention, and completion rates in its nursing  
               programs of students admitted using the multicriteria  
               entailed in Education Code section 78261.5; (b)  
               presents information disaggregated by age, gender,  
               ethnicity, and language spoken at home; and (c)  
               provides information on what impact, if any, has the  
               Seymour-Campbell Student Success Act had on the  
               matriculation of services for students admitted using  
               the multicriteria approach in Education Code 78261.5.   
               Finally, allow the required report to be provided in  
               conjunction with the report on nursing educational  
               programs required pursuant to Education Code 78261.

           4)   Background  .  According to the Assembly Higher  
               Education analysis, in the early 1990s, a controversy  
               arose over merit-based or competitive admissions to  
               associate degree nursing (ADN) programs.  The  
               Mexican-American Legal Defense and Education Fund  
               (MALDEF) threatened a lawsuit because students of  
               color were being disproportionately denied admission  
               to impacted programs.  In the negotiations that  
               ensued, MALDEF agreed not to bring suit, and the CCC  
               Board of Governors (BOG) agreed to develop program  
               admissions criteria that would be validated as  
               relevant to future performance.  BOG regulations in  
               the mid- 1990s prohibited ADN programs from using  
               evaluative mechanisms---usually grade point average  
               (GPA) - unless the district could validate its  
               practices in a complex research initiative, a  
               requirement that proved too difficult for colleges  
               without sufficient research staff.  CCC districts were  
               told to undertake the research or rely on lottery or  
               other non-evaluative mechanisms.  Lotteries and wait  
               lists were instituted; completion rates fell.

               The California Community College Chancellor's Office  
               (CCCCO) then began a project (as a district grant) to  
               research a full range of variables, seeking those that  
               would be statistically correlated with nursing program  
               student success in the hopes of finding six colleges  
               for which validation could be achieved.  In 2002, the  
               CCCCO announced results, finding that four factors  
               best predict student success in completing nursing  
               programs:  Overall college GPA, English GPA, Core  
               Biology GPA (Anatomy, Physiology, Microbiology), and  
               Core Biology course repetitions.  (Students with fewer  




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               repetitions have a higher probability of success.)   
               CCC districts were then advised in an October 2002  
               memo that they could begin using these criteria, but  
               in order to do so, local research must first be  
               performed, "?If the decision is made to adopt the  
               measures as a prerequisite, and to set cut scores that  
               will result in defined program completion rates, then  
               districts must analyze and monitor the possibility of  
               disproportionate impact on particular groups of  
               students defined in terms of race, ethnicity, gender,  
               age, or disability."  

               The districts were also warned, "?It is appropriate to  
               consider potential risks of implementing this  
               research. The adoption of the prerequisite measures  
               and the implementation of the composite formula could  
               result in rationing access.  Unless the implementation  
               of these measures is done carefully according to the  
               guidelines discussed later in this memo, it could  
               conflict with the requirement for open access."

               At that time, the CCCCO acknowledged the severity of  
               the nursing shortage and asserted to its ADN program  
               directors, "The biggest part of the solution is in  
               increasing the number of spaces; ?the lesser part of  
               the solution is in improving success rates."

           SUPPORT  

          California Hospital Association
          Kern Community College District (CCD)
          Los Angeles CCD
          Los Rios CCD
          Mt. San Jacinto CCD
          Rio Hondo CCD
          South Orange County CCD
          United Nurses Associations of California / Union of Health  
          Care Professionals
          Yosemite CCD

           OPPOSITION

           None on file.







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