BILL ANALYSIS
SB 139
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Date of Hearing: June 26, 2007
ASSEMBLY COMMITTEE ON HEALTH
Mervyn Dymally, Chair
SB 139 (Scott) - As Amended: May 2, 2007
SENATE VOTE : 34-2
SUBJECT : Nursing education.
SUMMARY : Establishes the Health Care Workforce Clearinghouse
(clearinghouse) within the Office of Statewide Health Planning
and Development (OSHPD) to serve as the central source of health
care workforce and educational data in the state. Makes other
changes relating to nursing education. Specifically, this bill :
1)Requires the clearinghouse to be responsible for the
collection, analysis, and distribution of information on the
educational and employment trends for health care occupations
in the state. Requires the activities of the clearinghouse to
be funded by appropriations made from the California Health
Data and Planning Fund (Fund), as specified.
2)Requires OSHPD to work with the Employment Development
Department's (EDD) Labor Market Division, state licensing
boards, and state higher education entities to collect, to the
extent available data regarding the current supply,
geographical distribution, and diversity of health care
workers (including data on race, ethnicity and language
spoken), the current and forecasted demand for health care
workers, and the educational capacity to produce trained,
certified, and licensed health care workers, as specified.
3)Requires OSHPD to prepare an annual report to the Legislature
that identifies education and employment trends in the health
care profession, reports on the current supply and demand for
health care workers in California and gaps in the educational
pipeline producing workers in specific occupations and
geographic areas, and recommends state policy needed to
address issues of workforce shortage and distribution.
4)States that it is the intent of the Legislature that colleges
and universities that operate registered nursing (RN) programs
should not require students who have already earned a
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baccalaureate degree, to complete general education
requirements, but rather should require these students to
complete only the coursework necessary to prepare them for
licensing as RNs.
5)Prohibits a campus of the California State University (CSU) or
the California Community Colleges (CCC) that operates an RN
program from requiring a student who has been admitted to an
RN program and who has already earned a baccalaureate degree
from an accredited institution to complete general education
requirements, and instead requires that student to complete
only the coursework that is necessary to prepare him or her
for licensing as an RN.
6)Allows any college, university or other entity that operates
an accredited RN program to require any prospective student to
provide criminal clearance, as specified, prior to enrollment.
7)Allows a person who is currently employed as an RN in a
state-operated 24-hour facility to be eligible to enter into
an agreement for loan assumption under the State Nursing
Assumption Program of Loans for Education Nursing Faculty
(SNAPLE Nursing Faculty) but not for SNAPLE State Facilities
program (SNAPLE-SF).
8)Clarifies that if a natural disaster prevents a participant
from completing a year of work required under SNAPLE-SF, the
loan assumption agreement is extended for the amount of time
equal to the period between the interruption of employment in
a state facility to the resumption of employment. Prohibits
the Student Aid Commission from making further payments under
the loan assumption agreement until specified employment
requirements have been satisfied.
9)Limits to 3% the amount to be used for statewide
administration, program development, program evaluation, and
program accountability under the Nursing Enrollment Growth and
Retention Program (NEGRP).
10)Allows any community college district, regardless of whether
it participates in the NEGRP to use any diagnostic assessment
tool that is commonly used in RN programs. Authorizes a
community college district to use additional multicriteria
screening measures if after using an approved assessment tool,
a community college district determines that the number of
applicants to its RN program exceeds its capacity.
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11) States that funding for the nursing enrollment expansion
programs be funded within the general enrollment growth
funding that is traditionally provided to the CSU during the
annual state budget process.
12)Makes other minor, technical and clarifying changes.
EXISTING LAW :
1)Establishes OSHPD to administer functions of health planning
and research development for the state. Requires OSHPD to
maintain a Health Professions Career Opportunity Program to
increase the number of ethnic minorities in health
professional training and increase the number of minority
health professionals practicing in health manpower shortage
areas.
2)Establishes the Fund within OSHPD for the purpose of receiving
and expending revenues collected by fees imposed by OSHPD on
specified health facilities based on a percentage of their
gross operating costs, as specified. Limits use of the Fund
to pay for the functions required to be performed by OSHPD
for, among other things, data collection and health planning
purposes.
3)Establishes the SNAPLE program, administered by the California
Student Aid Commission (CSAC). Provides loan assumption for a
person that completes their graduate education and serve as
nursing faculty in an RN program at an accredited California
college or university (SNAPLE Nursing Faculty). Provides loan
assumption for any person who agrees to work full time as a
registered nurse in a state-operated 24-hour facility that
employs registered nurses, upon becoming employed, as
specified (SNAPLE-SF). Establishes separate criteria for
program participants under SNAPLE Nursing Faculty and
SNAPLE-SF.
4)Establishes the NEGRP in the Chancellor's Office of the CCC to
provide grants to community college associate degree of
nursing programs that meet specified conditions.
FISCAL EFFECT : According to the Senate Appropriations Committee
analysis:
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Fiscal Impact (in thousands)
Major Provisions 2007-08 2008-09 2009-10 Fund
Health workforce $2,200 startup and $1,500 ongoing
costSpecial
database
SNAPLE increased Minor, unknown cost pressure General
eligibility
SNAPLE-SF reduced Minor, unknown savings General
eligibility
UC/CSU reduced Minor, unknown savings General
general education
coursework
CSU absorbed $4,300 annually General
nursing FTE growth
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill is a
follow-up and clean-up to SB 1309 (Scott), Chapter 837,
Statutes of 2006. The author indicates that SB 1309 was
comprehensive legislation designed to address the shortage of
RNs in California.
2)SB 1309 . SB 1309 enacted an array of initiatives and
established new programs to address the nursing shortage in
California, including an expansion of existing loan assumption
benefits, a new loan assumption program under SNAPLE,
employees of state facilities, a new program of grants to
attract and retain CCC nursing instructors, a new program for
enrollment growth and retention of CCC nursing students, a new
regional system for matching students and clinical placements,
exemptions from existing CCC employment laws, and new nursing
enrollment targets for the CSU and the University of
California (UC).
3)INFORMATIONAL HEARING : On May 15, 2007 the Assembly Health
Committee held an informational hearing titled, "Developing
the California Health Care Workforce of Tomorrow: Addressing
Shortages and Diversity." The hearing provided a review of
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demographic information and projections, health profession
education programs, state government programs, and various
initiatives. Of all states, California has the largest and
most diverse population and is facing a dramatic and pressing
challenge related to the supply and distribution of health
care professionals in many disciplines. A report prepared by
the University of California, titled A Compelling Case for
Growth projects that that California will face a shortage of
nearly 17,000 doctors by 2015. Among the recommendations from
this hearing included the need for analysis, forecasting, and
reporting of workforce data.
4)CALIFORNIA NURSING SHORTAGE . California is experiencing a
severe nursing shortage, as is the case nationwide. According
to EDD, California has an annual shortage of 9,900 RNs and
this number is expected to increase over the next five to ten
years. The Health Resources and Services Administration's
National Center for Health Workforce Analysis projects that
California will need an estimated 47,600 RNs by 2010, and
116,600 by 2020. Several factors contribute to the nursing
shortage, including an aging and growing population, retiring
RNs, lack of educational capacity in nursing programs, and
lack of qualified nursing instructors.
5)CALIFORNIA NURSING PROGRAMS . Approximately 70% of RNs are
prepared at the community college level in California through
Associate Degree in Nursing programs. These two-year programs
generally require one to two semesters of prerequisites prior
to admission. Approximately 26% of RNs receive their
preparation as part of a four-year Bachelor of Science in
Nursing program and about 4% are prepared through Entry-Levels
Master's (ELM) programs. ELM programs are designed for
individuals who already have a bachelor's degree in a subject
other than nursing. These students received their RN in about
18 months and a Master's Degree in Nursing in another 18
months. According to the 2006 Annual Report of the California
Nurse Education Initiative, California currently graduates
approximately 6,000 nursing students a year. However, the
Board of Registered Nursing reports that nearly 60% of
qualified applicants are turned away from nursing programs
each year due to barriers such as a lack of clinical education
sites, limited classroom space, and a lack of qualified
faculty.
6)HEALTHCARE Workforce shortages . There have been ongoing
efforts among advocates and policymakers to increase the
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number of providers who are able to meet the health care needs
of patients in California. One area in particular is related
to the racial and ethnic diversity of the state's workforce.
For example, by the year 2020, it is estimated that
California's population will grow to nearly 49 million, more
than half of which will be non-white. While African
Americans, Latinos, and Native Americans as a group constitute
nearly 25% of the U.S. population, these three groups account
for less than 9% of nurses, 6% of physicians, and 5% of
dentists. Non-white individuals make up less than 10% of
baccalaureate nursing faculty, 8.6% of dental school faculty,
and only 4.2% of medical school faculty. A number of studies
have shown a strong correlation between greater diversity
among health professionals and enhanced access to care for
racial and ethnic minority patients, expanded patient choice
and satisfaction, better patient-provider communication, and
better educational experiences for all students in the medical
school setting. In the Nation's Compelling Interest , a 2003
publication by the Institute of Medicine, states that racial
and ethnic minority health care professionals are
significantly more likely than their white peers to serve
minority and medically underserved communities, thereby
helping to improve problems of access to care for populations
of color.
7)Related legislation . SB 764 (Migden) would require the OSHPD
to report five year projections on the primary care physician
workforce in the state to the Legislature by June 1, 2009. SB
764 passed the Assembly Health Committee, and is pending in
the Assembly Appropriations Committee.
8)PREVIOUS LEGISLATION .
a) SB 63 (Committee on Budget and Fiscal Review) Chapter
73, Statues of 2005, establishes the SNAPLE program, which
was modeled after the existing teacher Assumption Program
of Loans for Education program, to encourage individuals to
complete their graduate education and serve as nursing
faculty at an accredited California college or university.
b) AB 1241 (Parra), Chapter 396, Statutes of 2003, requires
OSHPD to establish an Associate Degree Nursing Scholarship
Pilot Program, funded from the Health Professions Education
Foundation, to provide scholarships to associate degree
nursing students in counties determined to have high need.
c) AB 652 (Horton) Chapter 459, Statutes of 2001,
establishes the Health Professions Education and Outreach
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for Medically Underserved Communities and Populations Act.
Appropriates $2 million from the state General Fund to UC
for outreach programs designed to increase the number of
underrepresented and/or disadvantaged students in UC health
professional schools.
d) SB 664 (Poochigian) Chapter 443, Statutes of 2001,
requires the California Postsecondary Education Commission
to study community college districts' admissions procedures
and attrition rates for two-year associate degree nursing
programs.
e) AB 394 (Kuehl) Chapter 945, Statutes of 1999, requires
the Department of Health Services to adopt regulations that
establish licensed nurse-to-patient ratios for all health
facilities, as specified, and limits the nursing-related
duties performed by unlicensed assistive personnel.
f) AB 655 (Scott) Chapter 954, Statutes of 1999, requires a
multi-system study of the need for trained nurses in
California.
9)SUPPORT . Supporters such as the California Hospital
Association (CHA) write that, while there has been increasing
attention and funds devoted to enhancing the nurse workforce,
California continues to rank last in the nation in the number
of RNs per capita. CHA contends that this bill addresses
enrollment expansion at CSUs for nursing degrees and the
funding for these programs. CHA also writes that this bill
creates a much needed clearinghouse that would establish a
central source of health care workforce and educational
pipeline data on which to base future funding for nursing and
health care occupations. The Latino Coalition for a Healthy
California writes that California is at a crossroad where
demographic shifts are already causing gaps between workforce
supply and demand and states that this bill will provide a
fuller picture of the state's health profession capacity so
that policymakers will have the data needed to make informed
decisions.
10)DOUBLE-REFERRAL . Should this bill pass out of this
committee, it will be referred to the Assembly Higher
Education Committee.
REGISTERED SUPPORT / OPPOSITION :
Support
American Nurses Association of California
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California Academy of Family Physicians
California Hospital Association
California Nurses Association
Latino Coalition for a Healthy California
San Jose Evergreen and Rio Hondo Community College Districts
Opposition
None on file. Analysis Prepared by : Rosielyn
Pulmano / HEALTH / (916) 319-2097