BILL ANALYSIS
SB 139
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Date of Hearing: July 3, 2007
ASSEMBLY COMMITTEE ON HIGHER EDUCATION
Anthony Portantino, Chair
SB 139 (Scott) - As Amended: May 2, 2007
SENATE VOTE : 34-2
SUBJECT : Nursing education
SUMMARY : Makes clarifying and technical changes to statutes
enacted last year (SB 1309, Scott, Chapter 837, Statutes of
2006) to increase California's nursing workforce and requires
the Office of Statewide Health Planning and Development (OSHPD)
to collect and annually report specified health professions
data. Specifically, this bill :
1)Allows a person who is currently employed as a Registered
Nurse (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 for nursing
faculty (SNAPLE) but not for the SNAPLE-SF, which provides
loan-assumption benefits for nurses employed in state-operated
facilities.
2)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 and prohibits
the California Student Aid Commission (CSAC) from making
further payments under the loan-assumption agreement until
specified employment requirements have been satisfied.
3)Prohibits a campus of the California State University (CSU)
and the California Community Colleges (CCC) that operates an
RN program from requiring a student who has been admitted to
an RN program and 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.
4)Amends statutory intent language to state that the University
of California (UC) and the CSU shall fund nursing enrollment
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expansions referenced in current law within the general
enrollment growth funding that is traditionally provided to
the segments in the annual Budget Act.
5)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.
6)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).
7)Allows any CCC district, regardless of whether it participates
in the NEGRP, to use any diagnostic assessment tool that is
commonly used in RN programs.
8)Authorizes a CCC district to use additional multi-criteria
screening measures if, after using an approved assessment
tool, a CCC district determines that the number of applicants
to its RN program exceeds its capacity.
9)Requires the Health Care Workforce Clearinghouse within OSHPD
to be responsible for the collection, analysis, and
distribution of information on the educational and employment
trends for health care occupations in the state and requires
these activities be funded by appropriations made from the
California Health and Data Planning Fund, as specified.
10)Requires OSHPD to collect and annually report to the
Legislature data, as specified, related to education and
employment trends in health care professions, current supply
and demand for health care workers in California, and policies
needed to address the issue of health care workforce shortages
and distribution.
11)Makes other minor, technical and clarifying changes.
EXISTING LAW :
1)Establishes the SNAPLE, administered by CSAC, under which any
person enrolled in an institution of postsecondary education
and participating in that loan assumption program is eligible
to receive a conditional warrant for loan assumption to be
redeemed upon becoming employed as a full-time nursing faculty
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member at a California college or university.
2)Establishes SNAPLE-SF, a loan-assumption program for employees
of specified state facilities within the SNAPLE program,
providing loan assumption benefits to persons who fulfill
agreements to work full time for four consecutive years as
clinical registered nurses in state-operated facilities, as
specified, that have a vacancy rate greater than 10% in
clinical registered nursing service.
3)Establishes OSHPD, which is charged with the administration of
health policy and planning.
4)Establishes the California Health Data and Planning Fund and
authorizes monies from that fund to be appropriated for
expenditure for health-related programs of OSHPD.
FISCAL EFFECT : According to the Senate Appropriations
Committee, $2.2 million in start-up costs for the health
workforce database and $1.5 million in ongoing costs to OSHPD to
operate the database.
COMMENTS : This bill was approved by the Assembly Health
Committee, 17-0, on June 26.
Background :
1)Need for healthcare workforce data: California has the
largest and most diverse population in the nation and is
facing a dramatic and pressing challenge related to the supply
and distribution of health care professionals in numerous
disciplines. A UC report titled, A Compelling Case for
Growth, projects that that California will face a shortage of
nearly 17,000 doctors by 2015 and recommended analysis,
forecasting, and reporting of workforce data.
2)Nursing shortage: California and the nation are experiencing
a severe nursing shortage. According to the state Employment
Development Department, California has an annual shortage of
9,900 RNs that 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
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RNs, a lack of educational capacity in nursing programs, and a
lack of qualified nursing instructors. Currently, California
ranks 50th among the states in the number of nurses per
capita.
California nursing programs: Approximately 70% of RNs in
California are prepared at the CCC 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 (BSN)
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 of Science in Nursing (MSN) 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.
Recent efforts to increase the number of nurses : SB 1309
enacted several 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 (SNAPLE-SF), 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 UC.
Need for this bill : The author states that this bill is a
combination of clean-up and follow-up to SB 1309 as follows:
1)Employees of state facilities: SB 1309 established a new
"Employees of State Facilities" program under SNAPLE to
provide up to $20,000 loan assumption grants ($5,000 per year
for four years) for RNs to work in 24-hour state facilities.
The author states that this new program was intended as a
recruitment tool for new employees by providing a "signing
bonus." The author states that when SB 1309 was signed, he
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committed to clarify in clean-up legislation that current RNs
at 24-hour state facilities are not eligible to enter into a
loan assumption agreement under this program.
2)Letter to the Journal regarding intent language: The author
submitted a letter of clarification to the Journal regarding
intent language contained in SB 1309. In his letter, the
author stated that, while not specifically referenced in the
measure, it was his intent that future state budgets fund
Baccalaureate of Science degree nursing student enrollment
growth at UC and CSU from within the general enrollment growth
funding that is traditionally provided to those institutions
as part of the annual budget process. This bill includes this
clarification in intent language.
3)Statewide health workforce database: The author states that
language to create this database was contained in SB 1309 but
was removed by the Assembly Appropriations Committee. The
author states that since that time, OSHPD has indicated their
support for the establishment of the database and has
suggested using the California Health Planning and Data Fund,
which funds OSHPD operations and is supported entirely by fees
paid by hospitals.
4)Technical clean-up: The author states that other provisions
of this bill are clarifying and consistent with the intent of
SB 1309.
Suggested amendments : Staff recommends the Committee adopt the
following amendments, which are technical and clarifying in
nature:
1)On page 10, line 3, clarify that "program development"
includes, but is not limited to partnerships or collaborations
between community colleges and four-year universities in order
to offer BSN, MSN, and ELM programs in nursing programs.
2)Page 10, line 10, delete: "developing and"
3)Page 10, line 33, delete: "validated" and insert: "recognized"
4)Page 10, line 35, insert: "community college"
5)Page 11, line 9, delete: "develop" and insert: "offer, or
identify"
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6)Page 11, line 10, after: "tutorials" insert: instructional
resources
7)Page 11, line 34, delete: "enroll in" and insert: "undertake"
8)Page 11, line 36, delete: "classes" and insert: "coursework"
9)Page 12 , Section 8:
a) Re-write/clarify subsection (b) (lines 27-30) to ensure
that all CCC nursing programs can use diagnostic assessment
tools; and
b) Add sub-section (c) to preclude CCC nursing programs
from excluding applicants based on district residency or
completion of prerequisite courses in that district.
10)Page 14, line 17, insert: baccalaureate degree
11)Page 14, around line 20, insert: sub-section (e) encouraging
CSU campuses to collaborate with CCC campuses in offering BSN
or ELM nursing programs.
12)Page 14, clarify that CSU may establish admission priorities
for BSN programs but may not exclude applicants who already
have earned a baccalaureate or higher degree.
13)Page15, line 7, insert: baccalaureate degree
Related legislation : AB 365 (Portantino), pending in the
Senate, would require the California Postsecondary Education
Commission to convene a task force of stakeholders to report to
the Legislature on California's future workforce needs and
actions necessary to meet those needs. SB 764 (Migden), pending
in the Assembly, would require OSHPD to report five-year
projections on the primary care physician workforce in the state
to the Legislature by June 1, 2009.
Previous legislation : SB 63 (Committee on Budget and Fiscal
Review), Chapter 73, Statues of 2005, established the SNAPLE
program, which was modeled after the existing teacher APLE
program, to encourage individuals to complete their graduate
education and serve as nursing faculty at an accredited
California college or university. AB 1241 (Parra), Chapter 396,
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Statutes of 2003, required 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. AB 652 (J. Horton), Chapter 459, Statutes of 2001,
established the Health Professions Education and Outreach for
Medically Underserved Communities and Populations Act and
appropriated $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. SB 664 (Poochigian), Chapter 443,
Statutes of 2001, required the California Postsecondary
Education Commission to study CCC districts' admissions
procedures and attrition rates for two-year associate degree
nursing
programs. AB 655 (Scott), Chapter 954, Statutes of 1999,
required a multi-system study of the need for trained nurses in
California.
REGISTERED SUPPORT / OPPOSITION :
Support
American Nurses Association of California
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 : Sandra Fried / HIGHER ED. / (916)
319-3960