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 AB 548 Page 2 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 AB 548 Page 3 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 AB 548 Page 4 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, AB 548 Page 5 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 AB 548 Page 6 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. AB 548 Page 7