California Board of Registered Nursing Annual School Report

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1 California Board of Registered Nursing - Annual School Report Data Summary and Historical Trend Analysis Central Coast June 17, 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 94118

2 - BRN Annual School Report 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 4-county Central Coast. Counties in the region include Monterey, San Benito, San Luis Obispo, and Santa Barbara. 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 - BRN Annual School Report 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 There are five pre-licensure nursing programs in the Central Coast region, all of which are public ADN programs. Table 1. Number of Nursing Programs, by Academic Year Total Nursing Programs ADN BSN ELM Public Private Total Number of Schools The share of pre-licensure nursing programs that partnered with another nursing school to offer a higher degree has shown an overall increase in the last nine years. Since, the majority of nursing programs in the region partner with other programs that offer a higher degree. Table 2. Partnerships*, by Academic Year Programs that partner with another program that leads to a higher degree Formal collaboration 25.0% 75.0% Informal collaboration 75.0% 25.0% Total number of programs that reported *These data were collected for the first time in. - 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 - BRN Annual School Report Admission Spaces and New Student Enrollments Pre-licensure nursing programs in the Central Coast region reported a total of 246 spaces available for new students in -, which were filled with a total of 242 students. This is about the same as what was reported in. Table 3. Availability and Utilization of Admission Spaces, by Academic Year - Spaces Available New Student Enrollments % Spaces Filled with New 95.8% 102.0% 101.2% 102.8% 95.2% 100.9% 100.9% 99.6% 98.4% Student Enrollments Starting in, data may be influenced by the allocation of satellite campus data to their proper region. While pre-licensure nursing programs in the Central Coast region continue to receive more applications requesting entrance into their programs than can be accommodated, there was a large decline in the number of qualified applications received over the last year. 53% (n=272) of the 514 qualified applications received in - did not enroll. Table 4. Student Admission Applications*, by Academic Year Qualified Applications ADN BSN % Qualified Applications Not Enrolled 55.9% 56.3% 38.7% 38.0% 54.1% 46.3% 59.6% 67.8% 66.3% 52.9% *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. The number of new students enrolling in both ADN and BSN programs in the region has remained about the same over the last three years. Table 5. New Student Enrollment by Program Type, by Academic Year New Student Enrollment ADN BSN Starting in, data may be influenced by the allocation of satellite campus data to their proper region. - University of California, San Francisco 4

5 - BRN Annual School Report Student Census Data A total of 405 students were enrolled in a Central Coast pre-licensure nursing program as of October 15,. The census of the region s programs indicates that almost all (89%, n=361) of students were enrolled in an ADN program. Table 6. Student Census Data by Program Type*, by Year 2005 ADN BSN Total Nursing Students *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. Student Completions The total number of students completing pre-licensure nursing programs in the Central Coast region has remained about the same over the past three years. In -, programs in the region reported a total of 199 completions, most of them from ADN programs (92%, n=184), with the rest being from the first cohort of BSN completions. Table 7. Student Completions by Program Type, by Academic Year ADN BSN 15 Total Student Completions Starting in, data may be influenced by the allocation of satellite campus data to their proper region. University of California, San Francisco 5

6 - BRN Annual School Report Retention and Attrition Rates Of the 216 students scheduled to complete a nursing program in the - academic year, 68.1% (n=147) completed the program on-time, 17.6% (n=38) are still enrolled in the program, and 14.4% (n=31) dropped out or were disqualified from the program. This marks a decline in the retention rate and a slight increase in the attrition rate compared to the previous year, along with a significant increase in the students who are still enrolled. 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* 58.0% 76.6% 68.0% 64.4% 66.4% 86.9% 79.8% 85.8% 84.3% 68.1% Attrition Rate** 33.6% 22.0% 24.2% 10.5% 13.0% 10.4% 15.6% 12.8% 13.3% 14.4% % Still Enrolled 8.4% 1.4% 7.8% 25.1% 20.6% 2.7% 4.6% 1.4% 2.4% 17.6% 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 - BRN Annual School Report Employment of Recent Nursing Program Graduates 3 As with other regions, hospitals are the most frequently reported work setting for recent graduates of a pre-licensure nursing program in the Central Coast region. Hospital- based employment has been declining in the region since its high of 85% in and was reported as almost 54% in -. The share of new graduates working as nurses in California has fluctuated in the last three years from 70% in, to 56% in, to 75% in -. Nursing programs in the region also reported that 7% of their - graduates had been unable to find employment by October, which marks a decrease compared to the 11% reported in the previous year. Table 9. Employment Location for Recent Nursing Program Graduates, by Academic Year Hospital 85.2% 72.6% 74.8% 80.4% 50.0% 54.2% 42.6% 47.6% 59.2% 53.7% Other healthcare facilities 4.7% 4.2% 4.3% 6.4% 6.7% 7.3% 9.5% 8.3% 12.5% 9.7% Long-term care facilities 4.0% 0.4% 2.5% 4.0% 22.3% 16.4% 12.4% 15.4% 9.1% 8.1% Community/public health facilities - 1.3% 2.8% 5.3% 5.8% 6.3% 0% 6.0% 5.4% 3.6% 5.7% Pursuing additional nursing education 3.6% 5.3% Other 1.3% 20.0% 1.0% 3.4% 0% 19.3% 2.3% 12.9% 1.0% 10.2% Unable to find employment* 15.0% 15.0% 10.3% 11.0% 7.2% Employed in California 76.6% 94.6% 73.4% 74.3% 78.8% 69.2% 70.4% 55.8% 74.5% *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 6% of recent graduates. University of California, San Francisco 7

8 - BRN Annual School Report Clinical Simulation in Nursing Education Between 8/1/13 and 7/31/14, all five Central Coast nursing schools reported using clinical simulation 4. The most frequently reported reasons for why schools in the region used a clinical simulation center in - were to standardize clinical experiences, 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. None of the schools in the region plans to expand their use of clinical simulation in Table 10. Reasons for Using a Clinical Simulation Center*, by Academic Year To standardize clinical experiences 100.0% 80.0% 100.0% 100.0% 100.0% 100.0% To provide clinical experience not available in a clinical setting 50.0% 60.0% 80.0% 60.0% 100.0% 80.0% To make up for clinical experiences 0.0% 80.0% 20.0% 20.0% 20.0% 80.0% To reinforce didactic and clinical training and clinical decision making % To check clinical competencies 100.0% 80.0% 40.0% 60.0% 60.0% 60.0% To provide interprofessional experiences 60.0% 60.0% To provide remediation 20.0% To provide collaborative experiences between hospital staff and students 20.0% 0.0% To increase capacity in your nursing program 0.0% 20.0% 40.0% 40.0% 0.0% 0.0% To provide faculty development 0.0% 0.0% 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 8

9 - BRN Annual School Report Clinical Space & Clinical Practice Restrictions 5 No nursing programs in the Central Coast region reported being denied access to a clinical placement, unit or shift in -. Table 11. 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 Table 12. Reasons for Clinical Space Being Unavailable*, by Academic Year - Displaced by another program 100% - 50% - Decrease in patient census 100% - 50% - Staff nurse overload or insufficient qualified staff 0% - 50% - Implementation of Electronic Health Records system 0% - 50% - Closure, or partial closure, of clinical facility 0% - 50% - Clinical facility seeking magnet status 0% - 50% - Competition for clinical space due to increase in number of nursing students in region 0% - 0% - Visit from Joint Commission or other accrediting agency 0% - 0% - No longer accepting ADN students 0% - 0% - Change in facility ownership/management 0% - 0% - Nurse residency programs 0% - 0% - Other 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. 5 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 is not shown. University of California, San Francisco 9

10 - BRN Annual School Report Table 13. Strategies to Address the Loss of Clinical Space*, by Academic Year - Replaced lost space at same clinical site - 0% - Replaced lost space at different site currently used by nursing program - 50% - Added/replaced lost space with new site - 50% - Clinical simulation - 0% - Reduced student admissions - 0% - Other - 0% - Number of programs that reported *Data collected for the first time in 12. Two pre-licensure nursing programs in the Central Coast region reported an increase in out-ofhospital clinical placements in -. This increase included home health agency/home health services, public health or community health agencies, school health services, case management/disease management, occupational health or employee health services, and others. Table 14. Alternative Out-of-Hospital Clinical Sites* Used by RN Programs, by Academic Year - Home health agency/home health service - 100% 100% 100% Public health or community health agency - 100% 0% 100% School health service (K-12 or college) - 0% 0% 50% Case management/disease management - 100% 0% 50% Occupational health or employee health service - 0% 0% 50% Skilled nursing/rehabilitation facility - 100% 100% 0% Hospice - 100% 100% 0% Surgery center/ambulatory care center - 100% 100% 0% Correctional facility, prison or jail - 0% 100% 0% Medical practice, clinic, physician office - 100% 0% 0% Outpatient mental health/substance abuse - 100% 0% 0% Renal dialysis unit - 0% 0% 0% Urgent care, not hospital-based - 0% 0% 0% Other 0% 0% 50% 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 10

11 - BRN Annual School Report Four of the five Central Coast schools reported that pre-licensure students in their programs had encountered restrictions to clinical practice imposed on them by clinical facilities in - (one more school than one year ago). The most frequently reported restrictions were access to bar coding medication administration and clinical sites due to visits from an accrediting agency. Table 15. Common Types of Restricted Access in the Clinical Setting for RN Students, by Academic Year - Bar coding medication administration % 66.7% 66.7% 75.0% Clinical site due to visit from accrediting agency (Joint Commission) % 33.3% 33.3% 50.0% Some patients due to staff workload 33.3% 33.3% 66.7% 25.0% Electronic Medical Records - 0.0% 0.0% 33.3% 25.0% Alternative setting due to liability - 0.0% 33.3% 33.3% 25.0% Student health and safety requirements 0.0% 0.0% 33.3% 25.0% Automated medical supply cabinets % 33.3% 66.7% 0.0% Direct communication with health team - 0.0% 66.7% 33.3% 0.0% IV medication administration - 0.0% 0.0% 0.0% 0.0% Glucometers - 0.0% 0.0% 0.0% 0.0% Number of schools that reported Note: Blank cells indicated that the applicable information was not requested in the given year. Schools reported that restricted student access to electronic medical records was due to clinical site staff still learning the system (67%) and liability (67%). Schools reported that students were restricted from using medication administration systems due to liability (100%). Table 16. Share of Schools Reporting Reasons for Restricting Student Access to Electronic Medical Records and Medication Administration, - Electronic Medical Records Medication Administration Staff still learning and unable to assure documentation standards are being met 66.7% 33.3% Liability 66.7% 100.0% Staff fatigue/burnout 33.3% 33.3% Insufficient time to train students 33.3% 0.0% Cost for training 0.0% 0.0% Patient confidentiality 0.0% 0.0% Other 33.3% 66.7% Number of schools that reported 3 3 Note: Data collected for the first time in -. University of California, San Francisco 11

12 - BRN Annual School Report Of the four nursing programs in the Central Coast with students that experience restricted access to clinical practice, half of them reported that they compensate for training in areas of restricted student access by providing training in simulation lab, ensuring all students have access to sites that train them in this area, training students in the classroom, and purchasing practice software. Table 17. How the Nursing Program Compensates for Training in Areas of Restricted Access % Schools Training students in the simulation lab 50.0% Ensuring all students have access to sites that train them in this area 50.0% Training students in the classroom 50.0% Purchase practice software, such as SIM Chart 50.0% Other 0% Number of schools that reported 4 Note: Data collected for the first time in -. Faculty Census Data 6 On October 15,, there were 72 nursing faculty 7 teaching at Central Coast nursing programs, 38% (n=27) of whom were full-time while 63% (n=45) were part-time. In addition, there were 12 vacant faculty positions. These vacancies represent a 14.3% faculty vacancy rate overall (12.9% for full-time faculty and 15.1% for part-time faculty), which is the highest reported since. Table 18. Faculty Census Data, by Year * * * Total Faculty Full-time Part-time Vacancy Rate** 16.3% 3.9% 11.1% 14.7% 2.8% 2.6% 2.5% 0% 9.1% 6.6% 14.3% 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 -, all five nursing schools in the Central Coast region reported that their faculty work overloaded schedules, and all of these schools pay the faculty extra for the overloaded schedule. Table 19. Faculty with Overloaded Schedules*, by Academic Year Schools with overloaded faculty Share of schools that pay faculty extra for the overload 100% 100% 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 12

13 - BRN Annual School Report Summary The number of pre-licensure nursing programs in the Central California region has remained consistent for the past decade. Total admission space and new student enrollments have fluctuated within a narrow range over the past three years, indicating stability in the region s capacity to train new nurses. Nursing programs in the region continued to receive more qualified applications than could be accommodated. In -, 47% (n=242) of the 514 qualified applications received enrolled. Programs in the region reported a total of 199 completions in -, which is 17% below the ten-year high reported in. While retention rates were lower in - than in each of the previous five years, the share of students still enrolled increased dramatically and the attrition rate showed a slight overall increase from 12.8% in to 14.4% in -. Hospitals remain the most frequently reported work setting for recent graduates of the region s programs. The share of recent graduates unable to find employment in nursing has declined since its high of 15% in to 7% of recent graduates in -. Approximately 75% of recent graduates employed in nursing reported employment based in California. In -, all of the schools in the Central Coast reported using clinical simulation, which is seen as a way to standardize clinical experiences, 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. Four schools reported that students in their programs had encountered restrictions to clinical practice imposed on them by clinical facilities, with the most common types of restriction being access to bar coding medication administration and clinical sites due to visits from the accrediting agency. Expansion in RN education has required nursing programs to hire more faculty to teach the growing number of students. Although the number of nursing faculty has increased by 76% in the past ten years, programs reported a continuing need to hire more faculty members. In twelve faculty vacancies were reported, representing a faculty vacancy rate of 14.3%, the highest reported since. University of California, San Francisco 13

14 - BRN Annual School Report APPENDICES APPENDIX A Central Coast RN Programs ADN Programs (4) Cuesta College Hartnell College Monterey Peninsula College Santa Barbara City College ADN to LVN Program Only (1) Allan Hancock College Satellite Campus (1) CSU Channel Islands BSN University of California, San Francisco 14

15 - BRN Annual School Report 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 15

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