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 Northern Sacramento Valley 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 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 5-county Northern Sacramento Valley region. Counties in the region include Butte, Colusa, Glenn, Shasta, and Tehama. 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 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, NCLEX pass 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 The number of pre-licensure nursing programs in the Northern Sacramento Valley has remained the same over the last four years. In -, the Northern Sacramento Valley had a total of four prelicensure nursing programs. Of these programs, two are ADN programs and two are BSN programs. The majority (75%) of pre-licensure nursing programs in the region are public. Table 1. Number of Nursing Programs, by Academic Year - Total Nursing Programs ADN BSN ELM Public Private Total Number of Schools For several years, none of the programs in the region had collaborations with another program that leads to a higher degree than offered at their own institution. However, one program began a collaboration in, followed by a second program in. Both of these programs had informal collaborations. In -, one of these programs no longer had this informal collaboration. Table 2. Partnerships*, by Academic Year - Programs that partner with another program that leads to a higher degree Formal collaboration 0% 0% Informal collaboration 50% 25% Total number of programs that reported *These data were collected for the first time in. Note: Blank cells indicate the information was not requested - University of California, San Francisco 3

4 - BRN Annual School Report Admission Spaces and New Student Enrollments After two years of declining availability of admission spaces for new students in Northern Sacramento Valley nursing programs, spaces available increased by 14% (n=32) over the last year, to 262 spaces in -. The 262 spaces available for new students in - were filled with a total of 260 students. Pre-licensure nursing programs in the region have enrolled more students than were spaces available in seven of the past ten years. Table 3. Availability and Utilization of Admission Spaces, by Academic Year - - Spaces Available New Student Enrollments % Spaces Filled with New Student Enrollments 100.0% 128.5% 116.0% 107.7% 112.9% 98.7% 103.4% 102.8% 116.1% 99.2% Northern Sacramento Valley nursing programs continue to receive more applications requesting entrance into their programs than can be accommodated. In -, programs in the region received 1,101 qualified applications for admission, which is a 20% (n=283) decline in applications compared to the previous year. Of the qualified applications received, 76% of them did not enroll in -. Table 4. Student Admission Applications*, by Academic Year - - Qualified Applications ,053 1,034 1,194 1,332 1,384 1,101 ADN ,016 1, BSN % Qualified Applications Not Enrolled 57.9% 58.0% 66.1% 61.2% 74.2% 78.4% 74.9% 80.7% 80.7% 76.4% *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. University of California, San Francisco 4

5 - BRN Annual School Report New student enrollments in the Northern Sacramento Valley have remained about the same over the past three years. In -, there were 260 new students in programs in the region, 57% (n=148) of these students enrolled in ADN programs while 43% enrolled in BSN programs. Table 5. New Student Enrollment by Program Type, by Academic Year - New Student Enrollment ADN BSN Private Public Student Census Data The total number of students enrolled in pre-licensure nursing programs in the region has fluctuated slightly over the last three years. On October 15,, there were a total of 525 students enrolled in programs in the region. Half of these students were in ADN programs and half in BSN programs. Table 6. Student Census Data* by Program Type, by Year ADN BSN Total Nursing Students *Census data represent the number of students on October 15 th of the given year. Student Completions The number of students that completed a nursing program in the region has been declining since the ten-year high of 267 students in. This decline was driven by ADN programs, which had a 28% (n=50) decline in the number of students completing their programs in the last four years. In -, 229 students completed programs in the region. Of these students, 56% (n=129) completed an ADN program and 44% (n=100) completed a BSN program. Table 7. Student Completions by Program Type, by Academic Year - ADN BSN Total Student Completions University of California, San Francisco 5

6 - BRN Annual School Report Retention and Attrition Rates Of the 252 students scheduled to complete a Northern Sacramento Valley nursing program in the - academic year, 88.1% (n=222) completed the program on-time, 1.2% (n=3) are still enrolled in the program, and 10.7% (n=27) dropped out or were disqualified from the program. The average retention rate in the region increased over the last year, while the average attrition rate decreased during the same time period. 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* 81.9% 89.4% 91.9% 83.3% 89.7% 87.9% 93.0% 88.7% 85.5% 88.1% Attrition Rate** 16.0% 8.8% 4.3% 14.8% 9.7% 10.0% 4.8% 8.2% 12.9% 10.7% % Still Enrolled 2.1% 1.8% 3.8% 1.9% 0.5% 2.2% 2.2% 3.0% 1.6% 1.2% Data were collected for the first time in the survey. These completions are not included in the calculation of either retention or attrition rates. *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 After three years of an increasing average attrition rate for ADN programs in the region, the average attrition rate for these programs declined to 13.2% in -. Average attrition rates for BSN programs decreased from 9.5% in to 7.4% a year later. - Table 9. Attrition Rates by Program Type*, by Academic Year - - ADN 23.3% 7.8% 4.5% 20.6% 14.3% 13.9% 4.8% 9.8% 15.3% 13.2% BSN 5.0% 5.1% 9.5% 7.4% *Changes to the survey that occurred between and may have affected the comparability of these data over time. NCLEX Pass Rates Over the last ten years, NCLEX pass rates in the Northern Sacramento Valley region have fluctuated for ADN and BSN program graduates. In -, the highest average NCLEX pass rate was for BSN graduates. 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 88.3% 80.3% 85.5% 82.1% 85.1% 82.8% 85.8% 87.9% 87.9% 80.4% BSN 85.5% 80.0% 95.3% 82.9% 84.4% 87.4% 92.8% 96.6% 88.7% 92.5% *NCLEX pass rates for students who took the exam for the first time in the given year. University of California, San Francisco 6

7 - BRN Annual School Report Employment of Recent Nursing Program Graduates 2 The largest share of RN program graduates work in hospitals. Although this share had been decreasing in recent years, from a high of 92.7% in - to a low of 61.3% in, it has been fluctuating over the past three years. In -, Northern Sacramento Valley programs reported that 76.9% of graduates were employed in hospitals. The share of recent graduates employed as nurses in California had been in decline since but has increased in each of the last three years. Northern Sacramento Valley nursing programs reported that 1.8% of recent graduates had been unable to find employment at the time of the survey, which is down from a high of 9.5% in. Table 11. Employment Location for Recent Nursing Program Graduates, by Academic Year - Hospital 74.5% 86.3% 92.7% 92.3% 80.0% 81.0% 61.3% 73.3% 88.1% 76.9% Long-term care facilities 0% 1.7% 2.5% 3.3% 5.0% 5.0% 6.7% 8.0% 3.7% 8.2% Community/public health facilities - 1.9% 10.0% 1.3% 1.7% 20.0% 15.0% 6.3% 3.3% 2.5% 5.2% Other healthcare facilities 1.9% 2.0% 4.3% 1.0% 7.5% 5.7% 5.0% 4.0% 2.0% 3.1% Pursuing additional nursing education 1.3% 3.3% Other 0.6% 0% 0% 1.7% 0% 0% 6.0% 5.7% 0.6% 3.7% Unable to find employment* 5.0% 9.5% 5.7% 1.8% 1.8% Employed in California 59.2% 96.7% 98.7% 96.0% 89.0% 92.7% 80.0% 85.0% 86.0% 91.5% *This option was added to the survey in 10. This option was added to the survey in 13. Note: Blank cells indicated that the applicable information was not requested in the given year. 2 Graduates whose employment setting was reported as unknown have been excluded from this table. In -, on average, the employment setting was unknown for 3.8% 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 four Northern Sacramento Valley nursing schools reported using clinical simulation 3. The most frequently reported reasons why schools in the region used a clinical simulation center were to check clinical competencies, to reinforce didactic and clinical training and clinical decision making, and to provide clinical experiences not available in a clinical setting. Three of the four schools that used clinical simulation centers in -, plan to expand the center. Table 12. Reasons for Using a Clinical Simulation Center*, by Academic Year - To check clinical competencies 100% 100% 100% 75% 75% 75% 100% To reinforce didactic and clinical training and clinical decision making 100% To provide clinical experience not available in a clinical setting 100% 100% 100% 75% 100% 75% 75% To standardize clinical experiences 100% 100% 100% 100% 100% 100% 50% To provide interprofessional experiences 50% 50% To provide remediation 50% To provide faculty development 50% 25% To provide collaborative experiences between hospital staff and students 25% 25% To increase capacity in your nursing program 50% 33.3% 0% 25% 25% 0% 25% To make up for clinical experiences 50% 33.3% 33.3% 75% 75% 0% 25% Number of schools that use a clinical simulation center *These 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. 3 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 4 The number of nursing programs in the Northern Sacramento Valley region that reported being denied access to a clinical placement, unit or shift has varied over the last four years. In -, three programs reported that they were denied clinical space. These programs reported being denied access to a clinical placement and to clinical units, which affected 126 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 9

10 - BRN Annual School Report Over the past five years, programs in the region reported that staff nurse overload, decrease in patient census, competition for clinical space due to increase in number of nursing students in the region, and displacement by another program are the most common reasons for clinical space being unavailable. In -, staff nurse overload, decrease in patient census, and competition for clinical space due to more nursing students in the region were the most frequently reported reasons for clinical space being unavailable. More BSN than ADN programs reported that a decrease in patient census as a barrier to securing clinical space for their students. Table 14. Reasons for Clinical Space Being Unavailable*, by Academic Year - Staff nurse overload or insufficient qualified staff 100% 33.3% 100% 100% 66.7% Decrease in patient census 100% 33.3% 50.0% 100% 66.7% Competition for clinical space due to increase in number of nursing students in region 100% 66.7% 100% 0% 66.7% Displaced by another program 100% 33.3% 50.0% 100% 33.3% Visit from Joint Commission or other accrediting agency 0% 33.3% No longer accepting ADN students 0% 33.3% 0% 100% 0% Implementation of Electronic Health Records system 0% 0% 0% 0% 0% Closure, or partial closure, of clinical facility 0% 100% 50.0% 0% 0% Clinical facility seeking magnet status 0% 0% 0% 0% 0% Change in facility ownership/management 0% 50.0% 0% 0% Nurse residency programs 0% 0% 0% 0% 0% The facility began charging a fee (or other RN program offered to pay a fee) for the placement and the RN 0% program would not pay Facility moving to a new location 0% Other 0% 33.3% 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. The programs that lost access to clinical space were asked to report on the strategies used to cover the lost placements, sites, or shifts. The strategies most commonly used by these programs were to cover the loss with clinical simulation and to replace lost space at the same site in which the placement was lost. Table 15. Strategies to Address the Loss of Clinical Space*, by Academic Year - Clinical simulation 50.0% 100% 66.7% Replaced lost space at same clinical site 100% 0% 66.7% Replaced lost space at different site currently used by nursing program 50.0% 100% 33.3% Added/replaced lost space with new site 50.0% 100% 33.3% Reduced student admissions 0% 0% 0% Other 0% 0% 0% Number of programs that reported *Data collected for the first time in 12. University of California, San Francisco 10

11 - BRN Annual School Report Two of the four nursing programs in the Northern Sacramento Valley reported an increase in out-ofhospital clinical placements in -. Outpatient mental health and substance abuse services were 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 - Outpatient mental health/substance abuse 50% 100% 100% 100% Surgery center/ambulatory care center 50% 0% 100% 50% Home health agency/home health service 50% 100% 100% 50% Public health or community health agency 50% 100% 0% 50% Skilled nursing/rehabilitation facility 50% 50% 0% 50% School health service (K-12 or college) 0% 0% 0% 0% Medical practice, clinic, physician office 0% 50% 0% 0% Hospice 0% 50% 0% 0% Renal dialysis unit 0% 0% 0% 0% Case management/disease management 0% 0% 0% 0% Occupational health or employee health service 0% 0% 0% 0% Urgent care, not hospital-based 0% 0% 0% 0% Correctional facility, prison or jail 0% 0% 0% 0% Other 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. Over the last five years, schools in the Northern Sacramento Valley consistently reported that students in their pre-licensure nursing programs commonly encountered restricted access to electronic medical records and bar coding medication administration imposed on them by clinical facilities. In -, half of the schools in the region reported that pre-licensure students in their programs had encountered restrictions to clinical practice. There has been a decline in the share of schools that reported restricted access to automated medical supply cabinets, glucometers, and some patients due to staff workload. Schools report that it is uncommon to have students face restrictions to alternative settings due to liability and to direct communication with health team. Table 17. Common Types of Restricted Access in the Clinical Setting for RN Students, by Academic Year - Electronic Medical Records 100% 100% 100% 100% 100% Bar coding medication administration 100% 100% 100% 100% 100% Clinical site due to visit from accrediting agency (Joint Commission) 66.7% 66.7% 100% 100% 50% Student health and safety requirements 33.3% 66.7% 0% 50% IV medication administration 33.3% 66.7% 33.3% 0% 50% Automated medical supply cabinets 33.3% 66.7% 66.7% 66.7% 0% Glucometers 66.7% 66.7% 66.7% 66.7% 0% Some patients due to staff workload 33.3% 66.7% 33.3% 0% Alternative setting due to liability 0% 0% 0% 0% 0% Direct communication with health team 33.3% 0% 33.3% 0% 0% Number of schools that reported Note: Blank cells indicated that the applicable information was not requested in the given year. University of California, San Francisco 11

12 - BRN Annual School Report Schools reported that restricted student access to electronic medical records was due to clinical site staff still learning the system (100%), insufficient time for clinical site staff to train students (100%), liability (100%), cost for training (100%), and patient confidentiality (100%). Schools reported that students were restricted from using medication administration systems due to staff still learning the system (50%), limited time for clinical staff to train students (50%), liability (50%), staff fatigue/burnout (50%), cost for training (50%), and patient confidentiality (50%). Table 18. 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 100% 50% Insufficient time to train students 100% 50% Liability 100% 50% Staff fatigue/burnout 0% 50% Cost for training 100% 50% Patient confidentiality 100% 50% Other 0% 0% Number of schools that reported 2 2 Note: Data collected for the first time in -. University of California, San Francisco 12

13 - BRN Annual School Report A majority of nursing schools in the region compensate for training in areas of restricted student access by providing student training in the simulation lab and classroom and using practice software (100%). Table 19. How the Nursing Program Compensates for Training in Areas of Restricted Access % Schools Training students in the simulation lab 100% Training students in the classroom 100% Purchase practice software, such as SIM Chart 100% Ensuring all students have access to sites that train them in this area 50% Other 0% Number of schools that reported 2 Note: Data collected for the first time in -. Faculty Census Data 5 The total number of nursing faculty in the region has been increasing for the last three years. On October 15,, there were 92 total nursing faculty 6 in the Northern Sacramento Valley. Of these faculty, 38% (n=35) were full-time and 62% (n=57) were part-time. The need for faculty continues to outpace the number of active faculty. On October 15,, there were 10 vacant faculty positions in the region. These vacancies represent an 9.8% faculty vacancy rate overall (14.6% for full-time faculty and 6.6% for part-time faculty), which is the highest rate in the past ten years. Table 20. Faculty Census Data, by Year * * Total Faculty Full-time Part-time Vacancy Rate** 0.0% 4.5% 6.7% 0.0% 3.5% 8.1% 4.8% 2.4% 8.8% 9.8% Vacancies Starting in, data may be influenced by the allocation of satellite campus data to another 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) For the past four years, three schools in the Northern Sacramento Valley reported that their faculty have overloaded schedules. All three schools reported paying 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 100% 50.0% 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. 6 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 the region s nursing schools. University of California, San Francisco 13

14 - BRN Annual School Report Summary The Northern Sacramento Valley region reported a total of four nursing programs in -, which has been consistent since. In -, one program in the region reported collaborating with another program that offers a higher degree than offered at their own institution. In -, there were more admission spaces available in Northern Sacramento Valley prelicensure nursing education programs than there were ten years ago. New students enrolling in these available spaces also increased during this time period. However, new student enrollments have remained relatively constant over the past three years. Programs in the region continue to receive more qualified applications than can be accommodated. In -, the region received 1,101 applications, 24% (n=260) of which enrolled. Nursing programs in the region graduated 46% (n=72) more students in - than ten years before. However, the number of students completing these programs has been declining over the past four years from 267 students in to 229 in -. The average retention rate in the region increased over the last year, while the average attrition rate decreased during the same time period. For the past three years, average attrition rates for BSN programs have been lower than for ADN programs. The share of new graduates working as nurses in California has been increasing since, to 91.5% of new graduates in -. At the time of the survey, 1.8% of new graduates in the region were unable to find employment in nursing, a decrease from the high of 9.5% in. All four programs in the Northern Sacramento Valley have been using clinical simulation since, and three of the programs plan to expand its use in the coming year. The number of nursing programs in the region that reported being denied access to a clinical placement, unit or shift has varied over the last four years, with three programs reporting that they were denied access in -. During the same year, two programs in the region reported an increase in out-of-hospital clinical placements. In addition, half of the schools in the region reported that their students had faced restrictions to specific types of clinical practice during the - academic year. Expansion in RN education has required nursing programs to hire more faculty to teach the growing number of students. The total number of nursing faculty in the region has been increasing for the last three years. In, there were 92 faculty and 10 faculty vacancies in the region, representing a vacancy rate of 9.8% overall (14.6% for full-time faculty and 6.6% for part-time faculty). University of California, San Francisco 14

15 - BRN Annual School Report APPENDICES APPENDIX A Northern Sacramento Valley Nursing Education Programs ADN Programs (2) Butte College Shasta College BSN Programs (2) CSU Chico Simpson University

16 - 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 16

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