That is the bottom line from this year's annual School Report from the Board of Registered Nursing. The school report is commissioned by the BRN's education advisory committee, then reported by the Center for the Health Professions at the University of California, San Francisco.
The report is filled with information on the numbers of new students enrolled (13,988 in 2008-09) in the number of available slots (12,812 for the same time period) and the number of students applying for slots (22,523). For 2008-09, a total of 25,285 students are enrolled in nursing schools; 29,691 are listed as pre-nursing students. For academic year 2008-09, more than 61 percent of applicants for nursing school in California did not get accepted. Joanne Spetz, PhD, investigator on the report, noted the number of applications is likely greater than the number of individuals applying for admission because potential students often apply to more than one program to better their chances for admission.
"The number of admission slots has risen every year since 2001," Spetz said. "Many programs are over-enrolled, and some schools have two or three admission cycles. Some programs may take a few extra students, or backfill empty slots, or could include LVN to RN students. The key thing is in early 2000, these programs were not operating at full capacity, and now they are. The number of qualified applicants still far outstrips the number of slots."
Because of the large number of recent nursing graduates unable to find work due to the effects of the economy on the nursing workforce, some of the "soft money" used to fund some slots in nursing schools is being pulled back. Spetz cautioned programs dependent on this "soft money" may begin to feel the pinch and may decrease enrollment to match funding. Many programs will be lucky to stay stable in the challenging budget environment.
"We expect more people will be looking at nursing," she said. "And we expect admission rates to be tight. Nearly a quarter of admission slots are based on grants. We know demand is going to go up despite the current economic conditions. There's a concern that legislators will see new graduates having trouble finding work, decree the shortage is over and pull the plug on funding."
The biggest increase was seen in entry level master's (ELM) degree programs, nearly doubling from nine in 2004-05 to 16 in 2008-09. In that time, the number of students admitted to ELM programs has more than doubled, going from 876 students admitted in 2004-05 to 2,184 in 2008-09. The greatest growth has come in private programs, which Spetz said tend to be a little more entrepreneurial and nimble.
"There are more people looking at nursing as a second career," Spetz said. "ELM programs draw people who want to be NPs, clinical nurse specialists or administrative supervisors.
By the Numbers
More than 10,500 students completed their nursing degree in 2008-09. There are still more than there times as many ADN graduates (7,119) as BSN graduates (2,788), although the gap is narrowing. Spetz noted the state needs to graduate between 10,000 and 12,000 nurses a year to meet the challenge of the nursing shortage.
While the retention rate (75.2 percent in 2008-09) has risen gradually over the past decade, the attrition rate had remained fairly constant. It decreased this year from 16 percent the past 3 years to 14.7 percent in the latest survey. Of 10,630 students expected to finish their programs in 2008-09, 7,990 actually graduated. An additional 1,078 are still enrolled, but 1,562 dropped out. Attrition rates are higher in ADN programs, running nearly twice the BSN rate and three times the ELM rate. Attrition is also higher in public schools than in private schools.
The use of simulation centers continues to increase. Nearly 90 percent (111) of nursing schools use simulation in some form for part of the clinical requirements for students; 85 of those plan to expand. An additional 11 schools planned to add simulation to the curriculum for 2009-10.
"The majority of schools that increased their simulation use did so because they received grants," Spetz said. "Most use sim centers to standardize clinical experiences, to check clinical competencies, to provide clinical experience not available in a clinical setting and to make up for clinicals no longer available in hospitals."
That lack of clinical sites is a big problem, Spetz added.
"The lack of pinch points, like pediatrics, is a big challenge," she said. "Schools can usually find med/surg placements, but specialty care is a problem."
Faculty is another issue.
"We still expect a number of faculty retirements," Spetz continued. "These programs all will not be able to maintain or expand enrollments without more faculty."
The report also breaks out information on a regional basis for nine of the 10 regions in the state. The nine regions include Northern California, the Northern Sacramento Valley, Greater Sacramento, the Bay Area, the San Joaquin Valley, the Central Coast, Southern California I (Los Angeles and Ventura counties), Southern California II (Orange, Riverside and San Bernardino counties) and the Southern Border Region. The Central Sierra does not have any nursing education programs and was not included in the analyses.
Southern California I and the 10-county Bay Area are home to 70 of the 125 schools of nursing in the state. Applications for these schools continue to be more than can be accommodated: 55 percent of those applying to the 40 schools in Southern California I are turned down, while 62 percent of those applying to the 30 schools in the Bay Area don't get in. More than 80 percent of the state's new nursing graduates come from these two regions: 2,319 in the Bay Area and 3,151 in Los Angeles/Ventura counties.
The complete school report plus regional breakdowns is available on the BRN website.