California’s health care system is struggling with an acute shortage of nurses, so industry professionals were puzzled by the Jan. 10 vote of a little-known state committee to limit enrollments at one of the state’s most successful nursing schools.
The Board’s Education and Licensing Committee voted 2-1 to recommend that the Board of Registered Nursing cap enrollments at West Coast University. The board is expected to consider that recommendation during its next meeting, Feb. 13-14 in Redondo Beach.
The unusual action left health policy experts puzzled.
Attendees at the Jan. 10 meeting said the committee majority offered no public explanation for the vote. And while the meeting agenda listed seven members of the Education and Licensing Committee, the West Coast University recommendation passed without a quorum.
Neither Donna Gerber, vice president of the committee, nor member Michael Jackson responded to requests for comment on the meeting. The meeting was not recorded and received no media coverage. Minutes have not yet been posted.
But attendees say they were surprised and disappointed by the vote. For years, nurses have complained that medical facilities are understaffed, which means longer shifts, greater risk of injury, and burnout.
Board member Pilar De La Cruz-Reyes cast the lone vote against the cap. She said it was the wrong move at a time of critical need for nurses across the state – and particularly in the Central Valley where she lives. Barring new evidence, De La Cruz-Reyes said, she’ll will vote no again in February.
“I voiced what I felt and what I believe – that we need as many nurses as we can get,” she said. “West Coast University has had a good track record in the years I’ve been on this board.” Capping enrollments in the midst of a shortage because of a perceived reporting failure surprised her: “You don’t cut off your nose to spite your face.”
After West Coast officials met with the board for its latest BSN approval, the agency declared that the school had failed to get board approval for “substantive changes in its enrollment pattern and enrollment numbers.”
In an emailed statement, a West Coast University official said that while the BRN has no legal authority to limit enrollment at nursing schools, the school has annually updated the board about enrollment numbers since 2013, when the board approved the West Coast’s bachelor of science in nursing (BSN).
In the emailed statement, Scott Casanover, vice president of government affairs for West Coast, said the school regularly reported its enrollment figures in responses to the BRN’s annual surveys. In five years, the board took no note of the increasing enrollment figures, Casanover said.
West Coast officials say there’s another problem with the committee’s action: they say that nowhere in the board’s authorizing mandate and mission statement is there a requirement that schools get BRN approval for increases in enrollment. Instead, board approval is considered a “guideline.”
“WCU believes the BRN’s efforts to constrain the number of enrolled students in nursing programs is without justification, regulatory authority, and not in the best interests of healthcare and patient care for the state of California,” he said.
Attempts to meet with the board to get an explanation for its Jan. 10 action have so far been unsuccessful, Casanover said.
California is projected to have a shortage of 44,500 full time nursing positions by 2030. That’s nearly three times the shortfall in Texas, the state with the second most critical shortage. One study shows California has for the past decade been in the bottom five states in its ratio of nurses to the overall population.
In her most recent report, Joanne Spetz, associate director of research at University of California San Francisco’s Healthforce Center, says nursing shortages are most critical in the San Francisco Bay area, the Central Coast and the Central Valley.
The nursing shortage in Riverside County prompted hospital officials to approve pay raises to retain overworked nurses. At a time when medical-cost containment is a top policy concern, that increase alone is expected to add nearly $7 million to Riverside County’s annual payroll.
And the shortage may become more acute. De La Cruz-Reyes, who began her nursing career 50 years ago, said she is concerned state officials are underestimating the coming wave of retirements among nurses of her generation, men and women who worked longer because of the recession.
“We didn’t retire then because we couldn’t afford to,” she said. “They’re going to be retiring now. We’re tired. We want to retire.”
Judy Corless, a former member of the Board of Registered Nursing, says she has missed few meetings since 2009, and believes the real issue may be competition between successful private four-year universities like West Coast and the state’s community college system of two-year accredited RN (ADN) programs. Hospitals increasingly demand four-year Bachelors of Science in Nursing rather than two-year degress. Corless said current board members, all appointed by former Gov. Jerry Brown, are typically strong advocates for the beleaguered two-year programs.
This has sometimes come at the expense of four-year BSN programs like West Coast University’s, said Corless, president of the California Medical Association Alliance, said.
At the Jan. 10 meeting, it was clear the board intended to make an issue of West Coast’s enrollment increases, Corless said, although she couldn’t recall a time when the board punished a school over a disagreement over reporting. West Coast, she said, has provided the board with no reason to punish prospective nurses, some of whom wait years to get into a state nursing program.
“I support any expansion of any nursing school in the state if they are doing things the right way,” Corless said. “There is no more money for the state schools, no more money for their nursing departments. How are we expected to meet the need without the private schools like West Coast?”
Mary Anne Schultz, who was also at the meeting, called the board’s vote and its refusal to discuss it “heavy handed and capricious.”
Schultz, a nursing professor and former chair of the nursing program at California State University San Bernardino, said she believes the board is empowered to monitor enrollment numbers. But the punishment – of the public and of young men and women who want careers in nursing – was excessive, Schultz said.
“The reaction was way out of proportion to the circumstances,” Schultz said. “We need our private institutions. Schools should come and go as the public sees fit. The market is supposed to figure it out for us.”
Both women say they won’t miss the Feb. 13-14 meeting. “I think there are some people who are pretty angry about this,” Corless said.