California Board of Registered Nursing Annual School Report

Transcription

1 California Board of Registered Nursing Annual School Report Data Summary and Historical Trend Analysis Greater Sacramento April 9, 2015 Prepared by: Renae Waneka, MPH Timothy Bates, MPP Joanne Spetz, PhD University of California, San Francisco 3333 California Street, Suite 265 San Francisco, CA University of California, San Francisco 1

2 PREFACE Each year, the California Board of Registered Nursing (BRN) requires all pre-licensure registered nursing programs in California to complete a survey detailing statistics of their programs, students and faculty. The survey collects data from August 1 through July 31. Information gathered from these surveys is compiled into a database and used to analyze trends in nursing education. The BRN commissioned the University of California, San Francisco (UCSF) to develop the online survey instrument, administer the survey, and report data collected from the survey. This report presents ten years of historical data from the BRN Annual School Survey. Data analyses were conducted statewide and for nine economic regions 1 in California, with a separate report for each region. All reports are available on the BRN website ( This report presents data from the 6-county Greater Sacramento region. Counties in the region include El Dorado, Placer, Sacramento, Sutter, Yolo, and Yuba. All data are presented in aggregate form and describe overall trends in the areas and over the times specified and, therefore, may not be applicable to individual nursing education programs. Additional data from the past ten years of the BRN Annual School Survey are available in an interactive database on the BRN website. Beginning with the Annual School Survey, certain questions were revised to allow schools to report data separately for satellite campuses located in regions different from their home campus. This change was made to more accurately report student and faculty data by region, but it has the result that data which were previously reported in one region are now being reported in a different region. This is important because changes in regional totals that appear to signal either an increase or a decrease may in fact be the result of a program reporting satellite campus data in a different region. Data tables impacted by this change will be footnoted. In these instances, comparing data after to data from previous years is not recommended. When regional totals include satellite campus data from a program whose home campus is located in a different region, it will be listed in Appendix A. 1 The nine regions include: (1) Northern California, (2) Northern Sacramento Valley, (3) Greater Sacramento, (4) Bay Area, (5) San Joaquin Valley, (7) Central Coast, (8) Los Angeles Area (Los Angeles and Ventura counties), (9) Inland Empire (Orange, Riverside, and San Bernardino counties), and (10) Southern Border Region. Counties within each region are detailed in the corresponding regional report. The only data reported for the Central Sierra (Region 6) were for one satellite campus program. Therefore, data for that satellite campus program are grouped with that program s home campus region (Region 5, San Joaquin Valley). University of California, San Francisco 2

3 DATA SUMMARY AND HISTORICAL TREND ANALYSIS 2 This analysis presents pre-licensure program data from the BRN School Survey in comparison with data from previous years of the survey. Data items addressed include the number of nursing programs, enrollments, completions, retention rates, new graduate employment, student and faculty census data, the use of clinical simulation, availability of clinical space, and student clinical practice restrictions. Trends in Pre-Licensure Nursing Programs Number of Nursing Programs In, Greater Sacramento had a total of seven pre-licensure nursing programs; six ADN programs and one BSN program. Nearly three-quarters (71%) of pre-licensure nursing programs in the region are public, however, private programs have accounted for all new program growth in the past decade. Table 1. Number of Nursing Programs*, by Academic Year Total Nursing Programs ADN BSN ELM Public Private Total Number of Schools *Since some nursing schools admit students in more than one program, the number of nursing programs is greater than the number of nursing schools in the state. In, two pre-licensure programs (29%) in the region reported partnering with another school to offer a program leading to a higher nursing degree. Both of these nursing programs have formal collaborations with other programs. Table 2. Partnerships*, by Academic Year Programs that partner with another program that leads to a higher degree Formal collaboration 50.0% 100.0% Informal collaboration 50.0% 0.0% Total number of programs that reported *These data were collected for the first time in. Note: Blank cells indicate the information was not requested - 2 Starting in, data may be influenced by satellite campus data being reported and allocated to their proper region for the first time. Tables affected by this change are noted, and we caution the reader against comparing data collected before and after this change. University of California, San Francisco 3

4 Admission Spaces and New Student Enrollments Pre-licensure nursing programs in the Greater Sacramento region reported a total 577 spaces available for new students in. These spaces were filled with a total of 611 students, which represents the tenth consecutive year pre-licensure nursing programs in the region enrolled more students than they had spaces available. Table 3. Availability and Utilization of Admission Spaces, by Academic Year Spaces Available New Student Enrollments % Spaces Filled with New Student Enrollments 100.4% 104.2% 111.2% 107.9% 104.2% 104.2% 101.8% 103.7% 118.7% 105.9% Starting in, data may be influenced by the allocation of satellite campus data to their proper region. While Greater Sacramento nursing programs continue to receive more applications requesting entrance into their programs than can be accommodated, the number of qualified applications has declined from a high of 4,896 applications in to 1,930 applications in. Of the 1,930 qualified applications, 68% (n=1,319) did not enroll. Table 4. Student Admission Applications*, by Academic Year Qualified Applications 1,425 1,761 1,889 4,032 3,724 4,896 4,140 4,124 2,680 1,930 ADN 1,425 1,761 1,889 4,032 3,724 4,896 4,140 4,124 2,087 1,125 BSN ELM % Qualified Applications Not Enrolled 60.5% 62.4% 67.0% 82.1% 85.2% 88.5% 87.6% 83.6% 73.4% 68.3% *These data represent applications, not individuals. A change in the number of applications may not represent an equivalent change in the number of individuals applying to nursing school. Starting in, data may be influenced by the allocation of satellite campus data to their proper region. University of California, San Francisco 4

5 Pre-licensure nursing programs in the Greater Sacramento region enrolled 611 new students in, which is fewer students (14%, n=101) than in -. This decline was due to fewer new students in ADN programs. The distribution of new enrollments by program type was 58% ADN (n=354), 34% BSN (n=208), and 8% ELM (n=49). New student enrollment in the region s public programs accounted for 73% of total new student enrollment in the region in. Table 5. New Student Enrollment by Program Type, by Academic Year New Student Enrollment ADN BSN ELM Private Public Starting in, data may be influenced by the allocation of satellite campus data to their proper region. Student Census Data A total of 1,049 students were enrolled in a Greater Sacramento pre-licensure nursing program as of October 15,, which is a 9% (n=94) decline from the previous year across both ADN and BSN programs. The census of the region s programs indicates that 55.5% (n=582) of students were enrolled in ADN programs, 34.0% (n=357) in BSN programs, and 10.5% (n=110) in ELM programs. Table 6. Student Census Data*, by Year Program Type 2005 ADN BSN ELM Total Nursing Students 744 1,144 1,166 1,079 1, ,126 1,143 1,049 *Census data represent the number of students on October 15 th of the given year. Starting in, data may be influenced by the allocation of satellite campus data to their proper region. University of California, San Francisco 5

6 Student Completions Program completions at Greater Sacramento pre-licensure nursing programs totaled 533 in, which is slightly greater (3%, n=16) than the previous year and is mainly due to ADN programs. The distribution of completions by program type was 56% ADN (n=296), 37% BSN (n=196), and 8% ELM (n=41). Table 7. Student Completions, by Academic Year ADN BSN ELM Total Student Completions Starting in, data may be influenced by the allocation of satellite campus data to their proper region. - Retention and Attrition Rates Of the 516 students scheduled to complete a Greater Sacramento nursing program in the academic year, 84% (n=435) completed the program on-time, 5% (n=27) are still enrolled in the program, and 11% (n=54) dropped out or were disqualified from the program. Table 8. Student Retention and Attrition, by Academic Year Students Scheduled to Complete the Program Completed On Time Still Enrolled Attrition Completed Late Retention Rate* 77.5% 74.0% 68.0% 75.7% 81.2% 67.2% 79.2% 82.8% 87.0% 89.5% Attrition Rate** 17.8% 19.5% 22.5% 20.5% 11.5% 16.9% 17.5% 11.0% 6.0% 10.5% % Still Enrolled 4.7% 6.5% 9.5% 3.8% 7.3% 15.9% 3.2% 6.2% 7.0% 5.2% Data were collected for the first time in the survey. These completions are not included in the calculation of either retention or attrition rates. Starting in, data may be influenced by the allocation of satellite campus data to their proper region. *Retention rate = (students completing the program on-time) / (students scheduled to complete) **Attrition rate = (students dropped or disqualified who were scheduled to complete) / (students scheduled to complete the program) Note: Blank cells indicate the information was not requested University of California, San Francisco 6

7 Retention and Attrition Rates for Accelerated Programs The average retention rate for accelerated programs in the Greater Sacramento region was 80%. While retention rates in accelerated programs in the region have historically been higher than those of traditional programs, data show better retention rates in traditional programs for the second year in a row. The average attrition rate in accelerated programs was 20%, its highest since. Table 9. Student Retention and Attrition for Accelerated Programs*, by Academic Year - Students Scheduled to Complete the Program Completed On Time Still Enrolled Attrition Completed Late Retention Rate** 80.0% 81.5% 91.8% 89.9% 85.1% 79.8% Attrition Rate*** 20.0% 5.6% 6.8% 3.4% 11.7% 20.2% % Still Enrolled 0% 7.4% 1.4% 6.7% 3.2% 0% *These data were collected for the first time in. Starting in, data may be influenced by the allocation of satellite campus data to their proper region. Data were collected for the first time in the survey. These completions are not included in the calculation of either the retention or attrition rates. **Retention rate = (students who completed the program on-time) / (students scheduled to complete the program) ***Attrition rate = (students who dropped or were disqualified who were scheduled to complete) / (students scheduled to complete the program) Note: Blank cells indicated that the applicable information was not requested in the given year. NCLEX Pass Rates For the last eight years, NCLEX pass rates in the Greater Sacramento region have been higher for BSN graduates than for ADN program graduates. In, the highest average NCLEX pass rate was for BSN graduates. ADN programs had declines in their NCLEX pass rates in in comparison to the previous year, while the pass rates in BSN programs stayed about the same during that time period. The NCLEX passing standard was increased in April, which may have impacted NCLEX passing rates in - and. Table 10. First Time NCLEX Pass Rates* by Program Type, by Academic Year ADN 96.5% 95.4% 92.4% 91.3% 90.8% 91.2% 93.7% 95.1% 93.9% 89.0% BSN 87.2% 91.6% 95.0% 92.6% 95.5% 98.3% 97.2% 98.6% 97.7% 97.4% *NCLEX pass rates for students who took the exam for the first time in the given year. University of California, San Francisco 7

8 Employment of Recent Nursing Program Graduates 3 Hospitals represent the most frequently reported employment setting for recent graduates of prelicensure programs in the Greater Sacramento region. In, the region s programs reported that 57% of employed recent graduates were working in a hospital setting. Programs also reported that 16% of recent graduates had not found employment in nursing at the time of the survey, which is a significant decline (11%) from the previous year. The average regional share of new graduates employed in nursing in California was 59%, which has remained stable for the past three years. Table 11. Employment Location for Recent Nursing Program Graduates, by Academic Year Hospital 79.2% 49.2% 71.4% 73.4% 52.8% 53.0% 50.6% 50.9% 48.1% 56.7% Long-term care facilities 0.5% 0% 5.7% 16.4% 14.5% 13.3% 10.7% 4.2% 7.9% 6.5% Community/public health facilities - 0.0% 0% 0.7% 4.2% 6.7% 3.3% 3.3% 3.0% 2.7% 2.3% Other healthcare facilities 0.5% 0.8% 2.8% 4.0% 2.8% 7.8% 5.0% 2.8% 0.8% 9.5% Pursuing additional nursing education 13.1% 7.7% Other 18.9% 50.0% 12.7% 2.0% 0% 11.7% 2.0% 12.4% 0.7% 1.4% Unable to find employment* 27.8% 29.3% 26.7% 26.7% 15.9% Employed in California 64.8% 48.7% 97.4% 92.8% 57.0% 88.8% 72.5% 57.5% 59.4% 59.3% *This option was added to the survey in 10. Starting in, data may be influenced by the allocation of satellite campus data to their proper region. This option was added to the survey in -13. Note: Blank cells indicated that the applicable information was not requested in the given year. 3 Graduates whose employment setting was reported as unknown have been excluded from this table. In, on average, the employment setting was unknown for 9% of recent graduates. University of California, San Francisco 8

9 Clinical Simulation in Nursing Education Between 8/1/13 and 7/31/14, six Greater Sacramento nursing schools reported using clinical simulation 4. The remaining school plans to begin using clinical simulation during the academic year. The most frequently reported reasons for why schools in the region used a clinical simulation center in were to provide clinical experience not available in a clinical setting, to make up for clinical experiences, and to reinforce didactic and clinical training and clinical decision making. Of the six schools that used clinical simulation centers in, 67% (n=4) plan to expand the center. Table 12. Reasons for Using a Clinical Simulation Center*, by Academic Year To provide clinical experience not available in a clinical setting % 100% 100% 100% 100% 100% 100% To make up for clinical experiences 100% 66.7% 83.3% 83.3% 100% 100% 100% To reinforce didactic and clinical training and clinical decision making 100% To check clinical competencies 75.0% 100% 83.3% 66.7% 83.3% 100% 83.3% To provide interprofessional experiences 66.7% 83.3% To provide remediation 66.7% To standardize clinical experiences 75.0% 66.7% 100% 66.7% 66.7% 100% 50.0% To provide faculty development 33.3% 11.1% To increase capacity in your nursing program 25.0% 33.3% 16.7% 16.7% 16.7% 16.7% 11.1% To provide collaborative experiences between hospital staff and students 16.7% 11.1% Number of schools that use a clinical simulation *These t data were collected for the first time in. However, changes in these questions for the administration of the survey and lack of confidence in the reliability of the data prevent comparability of the data. Therefore, data prior to are not shown. Note: Blank cells indicate that those data were not requested in the given year. 4 Clinical simulation provides a simulated real-time nursing care experience using clinical scenarios and low to hi-fidelity mannequins, which allow students to integrate, apply, and refine specific skills and abilities that are based on theoretical concepts and scientific knowledge. It may include videotaping, de-briefing and dialogue as part of the learning process. University of California, San Francisco 9

10 Clinical Space & Clinical Practice Restrictions 5 Two pre-licensure nursing programs in the Greater Sacramento region reported being denied access to a clinical placement, unit or shift in, which is the highest number reporting in four years. The programs reported that they were offered an alternative by the site for the lost clinical unit and clinical shift but not the lost placement. The lack of access to clinical space resulted in the loss of seventy clinical placements, two clinical units, and one clinical shift, which affected 91 students. Table 13. RN Programs Denied Clinical Space, by Academic Year - Number of Programs Denied a Clinical Placement, Unit or Shift Programs Denied Clinical Placement Programs Offered Alternative by Site Placements Lost Number of programs that reported Programs Denied Clinical Unit Programs Offered Alternative by Site Units Lost Number of programs that reported Programs Denied Clinical Shift Programs Offered Alternative by Site Shifts Lost Number of programs that reported Total number of students affected Some of these data were collected for the first time in. However, changes in these questions for the administration of the survey prevent comparability of the data. Therefore, data prior to are not shown. University of California, San Francisco 10

11 Competition for clinical space due to more nursing students in the region, no longer accepting ADN students, a visit from an accrediting agency, staff nurse overload or insufficient qualified staff, displaced by another program, and a decrease in patient census were the most common reasons reported for clinical space being unavailable. Table 14. Reasons for Clinical Space Being Unavailable*, by Academic Year - Competition for clinical space due to increase in number of nursing students in region 50.0% 100% 50% 100% No longer accepting ADN students 25.0% 100% 50% 50% Visit from Joint Commission or other accrediting agency 50% 50% Staff nurse overload or insufficient qualified staff 50.0% 100% 0% 50% Displaced by another program 0% 100% 0% 50% Decrease in patient census 25.0% 0% 0% 50% Implementation of Electronic Health Records system 50% 0% Closure, or partial closure, of clinical facility 25.0% 100% 0% 0% Clinical facility seeking magnet status 0% 0% 0% 0% Change in facility ownership/management 25.0% 0% 0% 0% Nurse residency programs 0% 0% 0% 0% Other 50.0% 0% 0% 0% Number of programs that reported *Data were collected for the first time in the or survey. Note: Blank cells indicated that the applicable information was not requested in the given year. Programs that lost access to clinical space were asked to report on the strategies used to cover the lost placements, sites, or shifts. Both programs that reported these data added or replaced lost clinical space with space in a new site that was not previously used by the nursing program. Table 15. Strategies to Address the Loss of Clinical Space*, by Academic Year - Added/replaced lost space with new site 0% 50% 100% Replaced lost space at same clinical site 100% 0% 50% Replaced lost space at different site currently used by nursing program 100% 0% 50% Clinical simulation 100% 0% 50% Reduced student admissions 0% 0% 50% Other 0% 0% 0% Number of programs that reported *Data collected for the first time in 12. University of California, San Francisco 11

12 One nursing program in Greater Sacramento reported an increase in out-of-hospital clinical placements in, with surgery/ambulatory care centers, medical practices/clinics/physician offices, outpatient mental health sites, and urgent cares reported as the most frequently used alternative clinical placement sites overall. Table 16. Alternative Out-of-Hospital Clinical Sites* Used by RN Programs, by Academic Year - Surgery center/ambulatory care center 0.0% 66.7% 100.0% 100.0% Medical practice, clinic, physician office 33.3% 33.3% 0.0% 100.0% Outpatient mental health/substance abuse 0.0% 33.3% 0.0% 100.0% Urgent care, not hospital-based 0.0% 0.0% 0.0% 100.0% Public health or community health agency 33.3% 33.3% 100.0% 0.0% School health service (K-12 or college) 0.0% 33.3% 0.0% 0.0% Skilled nursing/rehabilitation facility 66.7% 100.0% 0.0% 0.0% Hospice 0.0% 0.0% 0.0% 0.0% Home health agency/home health service 0.0% 0.0% 0.0% 0.0% Renal dialysis unit 0.0% 0.0% 0.0% 0.0% Case management/disease management 0.0% 0.0% 0.0% 0.0% Occupational health or employee health service 0.0% 0.0% 0.0% 0.0% Correctional facility, prison or jail 0.0% 0.0% 0.0% 0.0% Other 0.0% 0.0% 0.0% 0.0% Number of programs that reported *These data were collected for the first time in. Note: Blank cells indicate that the applicable information was not requested in the given year. University of California, San Francisco 12

13 In, 71% (n=5) of Greater Sacramento schools reported that pre-licensure students in their programs had encountered restrictions to clinical practice imposed on them by clinical facilities. The most common types of restricted access students faced were to the clinical site itself, due to a visit from the Joint Commission or another accrediting agency, student health and safety requirements, glucometers, and some patients due to staff workload. Nursing schools reported that access to bar coding medication administration, automated medical supply cabinets, and alternative setting due to liability were more common in previous years than in. The five-year trend shows that restricted student access to IV medication administration and direct communication with a healthcare team have become uncommon. Table 17. Common Types of Restricted Access in the Clinical Setting for RN Students, by Academic Year - Clinical site due to visit from accrediting agency (Joint Commission) 83.3% 100% 80.0% 75.0% 60.0% Student health and safety requirements 80.0% 40.0% 25.0% 40.0% Glucometers 50.0% 20.0% 20.0% 25.0% 20.0% Some patients due to staff workload 40.0% 40.0% 25.0% 20.0% Bar coding medication administration 66.7% 80.0% 60.0% 100% 20.0% Electronic Medical Records 66.7% 60.0% 60.0% 75.0% 20.0% Automated medical supply cabinets 50.0% 20.0% 0% 50.0% 0% Alternative setting due to liability 33.3% 0% 0% 50.0% 0% IV medication administration 16.7% 20.0% 20.0% 0% 0% Direct communication with health team 33.3% 40.0% 0% 0% 0% Number of schools that reported Note: Blank cells indicated that the applicable information was not requested in the given year. The school reported restricted student access to electronic medical records was due to clinical site staff still learning the system (100%) and cost for training (100%). The school that reported students were restricted from using medication administration systems reported that it was due to staff still learning the system (100%), liability (100%), and cost for training (100%). Table 18. Share of Schools Reporting Reasons for Restricting Student Access to Electronic Medical Records and Medication Administration*, Electronic Medical Records Medication Administration Insufficient time to train students 0% 0% Staff still learning and unable to assure documentation standards are being met 100% 100% Liability 0% 100% Staff fatigue/burnout 0% 0% Cost for training 100% 100% Patient confidentiality 0% 0% Other 0% 0% Number of schools that reported** 1 1 *Data collected for the first time in. **Schools that reported EMR or MA as uncommon, common, or very common restrictions for students in clinical practice reported reasons why access was restricted. Schools that reported these restrictions as very uncommon or NA did not report these data. Note: Data collected for the first time in. University of California, San Francisco 13

14 The majority of nursing schools in the Greater Sacramento region compensate for training in areas of restricted student access by providing training in simulation lab (80%), ensuring that all students have access to sites that train them in the area of restricted access (60%), and training students in the classroom (60%). Table 19. How the Nursing Program Compensates for Training in Areas of Restricted Access % Schools Training students in the simulation lab 80% Ensuring all students have access to sites that train them in this area 60% Training students in the classroom 60% Purchase practice software, such as SIM Chart 20% Other 20% Number of schools that reported 5 Note: Data collected for the first time in. Faculty Census Data 6 On October 15,, there were 185 total nursing faculty 7 in Greater Sacramento, half (50%, n=92) of whom were full-time. The need for faculty continues to outpace the number of active faculty. On October 15,, there were 27 vacant faculty positions in the region, which represents a 12.7% faculty vacancy rate overall (4.2% for full-time faculty and 20.0% for part-time faculty). Table 20. Faculty Census Data, by Year * * * * Total Faculty Full-time Part-time Vacancy Rate** 3.8% 0.0% 2.3% 4.1% 4.9% 2.2% 2.0% 3.6% 17.6% 8.9% 12.7% Vacancies Starting in, data may be influenced by the allocation of satellite campus data to their proper region. *The sum of full- and part-time faculty did not equal the total faculty reported in these years. **Vacancy rate = number of vacancies/(total faculty + number of vacancies) In, three of the seven Greater Sacramento nursing schools (43%) reported that their faculty work overloaded schedules. All of these schools pay the faculty extra for the overloaded schedule. Table 21. Faculty with Overloaded Schedules*, by Academic Year - Schools with overloaded faculty Share of schools that pay faculty extra for the overload 80% 80% 100% 100% 100% 100% Total number of schools *These data were collected for the first time in Census data represent the number of faculty on October 15 th of the given year. 7 Since faculty may work at more than one school, the number of faculty reported may be greater than the actual number of individuals who serve as faculty in nursing schools in the region. University of California, San Francisco 14

15 Summary The number of pre-licensure nursing programs in the Greater Sacramento region has remained the same for the last three years. Two programs in the region reported that they partner with another school to offer a program leading to a higher nursing degree. Greater Sacramento programs reported a total of 577 spaces available for new students in, which were filled with a total of 611 new enrollments. This represents the tenth consecutive year pre-licensure nursing programs in the region enrolled more students than were spaces available. Of the 1,930 qualified applications to the region s programs in, 32% (n=611) enrolled. In, pre-licensure nursing programs in the region reported 533 student completions, which represent a 32% increase in the number of students completing ten years ago. However, if the current retention rate of 89.5% remains consistent and new student enrollments decline from their current level, the annual number of graduates from Greater Sacramento nursing programs is likely to decline in future years. The share of recent graduates unable to find employment in nursing has declined from a high of 29% in to 16% in, indicating that more nursing school graduates in the region are finding employment in their field. Six of the seven schools in the Greater Sacramento region are now using clinical simulation. It is seen by schools as an important tool for providing clinical experience not available in a clinical setting, to make up for clinical experiences, and to reinforce didactic and clinical training and clinical decision making. The majority (71%) of Greater Sacramento schools reported that pre-licensure students encountered some type of restriction to clinical practice. Expansion in RN education has required nursing programs to hire more faculty to teach the growing number of students. The number of nursing faculty in the region has increased in the past ten years to meet this demand, however, faculty hires have not kept pace with the growth in Greater Sacramento pre-licensure nursing programs. In, 27 faculty vacancies were reported, representing an overall faculty vacancy rate of 12.7% (4.2% for full-time faculty and 20.0% for parttime faculty). University of California, San Francisco 15

16 APPENDICES APPENDIX A Greater Sacramento Nursing Education Programs ADN Programs (5) American River College ITT Technical Institute Sacramento City College Sierra College Yuba College LVN to ADN Program Only (1) Carrington College (formerly Western Career College Sacramento) BSN Program (1) CSU Sacramento Satellite Campus (1) Samuel Merritt University BSN/ELM University of California, San Francisco 16

17 APPENDIX B BRN Education Issues Workgroup Members Members Loucine Huckabay, Chair Judee Berg Audrey Berman Brenda Fong Marilyn Herrmann Deloras Jones Stephanie Leach Judy Martin-Holland Vicky Maryatt Tammy Rice Paulina Van Ex-Officio Member Louise Bailey Project Manager Julie Campbell-Warnock Organization California State University, Long Beach California Institute for Nursing and Health Care Samuel Merritt University Community College Chancellor s Office Loma Linda University Independent Consultant, Former Executive Director of California Institute for Nursing and Health Care Kaiser Permanente National Patient Care Services University of California, San Francisco American River College Saddleback College California State University, East Bay California Board of Registered Nursing California Board of Registered Nursing University of California, San Francisco 17