California’s Crisis: Hurting for new nurses

Chris Cadelago and Chris Cadelago

A full-time job earning $70,000 a year was waiting for her after graduation. But Kahea Kahui abandoned her plan to join the City College nursing program.

Had she put her name on the 331-student waiting list, she would not be guaranteed a seat until 2011.

“I just don’t know anybody in their right mind who would wait that long,” said Kahui, who came to Santa Barbara from Hawaii to study nursing. “It seems ridiculous to wait if there are other options, such as dental hygiene.”

Kahui is not the only one unwilling to wait.

The nationwide demand for nurses is being exacerbated by a crippling shortage of young students graduating credential programs combined with a quickly aging workforce. Only 10 percent of California’s nurses are younger than 30 years old, according to a University of California San Francisco study released in June.

California ranks No. 49 in the country in number of registered nurses per capita. But the problem is dire nationwide. The need for nurses across the country will reach 1 million by 2012, according to the U.S. Bureau of Labor Statistics.

City College officials are ready to launch a series of initiatives to address the problem. These include recruiting more hospital and classroom teachers, finding space for classrooms to expand, and aggressively pursuing private and public money – including a statewide ballot measure – to raise funds for new equipment and faculty.

“The problem is like baklava: it’s multilayered,” said Dr. Erika Endrijonas, dean of Educational Programs.

The UCSF nursing study predicts that the state will need another 122,000 nurses by 2030. Experts believe the solution to California’s nursing crisis rests in the hands of its community colleges.

“Half of the state’s nurses come from community colleges,” said Joanne Spetz, the study’s co-author and the associate director at UCSF’s Center for California Health Workforce Studies. “You would think [the governor’s office] would just start throwing money at schools.”

Recruiting Supervisors

City College issued a nationwide search for full-time nursing professors two years ago. A total of two applicants responded.

The college didn’t fare much better in the search for part-time instructors.

A big part of the logjam is the scarcity of clinical instructors who can legally supervise students working in the hospital. State laws require that a teacher with a clinical background supervise every student, and every nursing student must work two shifts per week at Cottage Hospital.

City College has only two clinical instructors, compared with Ventura College’s 20.

“Students need on-the-job support,” said Sheri Shields, acting director of the Associate Degree in Nursing program. “It’s difficult to find nurses who can combine theory-based lessons with clinical expertise.”

This type of real-world training is essential to the program’s curriculum, Shields added. Yet it’s challenging to hire clinical staff because the position requires a bachelor’s degree in nursing and offers no benefits.

“The bottom line is that we need more clinical staff,” said full-time Professor Evan McCabe, taking her lunch break while training students at Cottage Hospital. “We are looking at this from all angles and doing everything we can.”

Hiring Professors

It has been equally tricky to attract full-time classroom teachers, who must have a master’s degree in nursing. The City College program will lose half of its full-time professors to retirement in the coming years, Endrijonas said.

Likewise, half of all California’s nurses will retire in the next 15 years, added UCSF’s Spetz, who is also an associate professor of economics.

Shields and Endrijonas agree that teaching nursing is a labor-intensive job and is not for everybody.

“[The job] is something people have to prepare for,” Shields said. “But they do [it] because it’s a meaningful position.”

Finding Space

City College can’t begin to expand its nursing program without also expanding its space. In the next four years, officials expect to add an extra 44 student to the 115-student nursing program.

Nursing now shares a portion of the Administration Building with the School of Media Arts, or SoMA, and several other disciplines. Pending a future bond measure, City College is prepared to build a new SoMA building. Endrijonas, who oversees both programs, said she would like to see the nursing program take over SoMA’s classroom space in the Administration Building.

There have also been talks of moving the program off campus to the Wake or Schott centers. Endrijonas dismissed these ideas, claiming such a move would render the program second rate.

“I am not in favor of this move at all,” she said. “This would be detrimental to the students’ success.”

Funding Equipment

Nursing trainees need to learn on new equipment to keep up with the real-life classroom at Cottage Hospital, so the college is always searching for grants. Officials last year purchased a lifelike dummy that requires air from a tank to breathe. Fully equipped with vital organs, “Buddy” came with the sticker price of $45,000.

A new IV pump was also purchased for $3,000. The college now has one, compared with the hundreds at Cottage. Ideally, students said they’d like the college to upgrade all its equipment to match Cottage Hospital.

“The equipment is expensive, it takes lots of work to get things put in this lab,” said Lab Teaching Assistant Xenia Chimino, who traveled to Florida to attend a seminar on how to properly use Buddy as a teaching tool.

Offering Help

In partnership with Cottage, the college sends 30 of its 40 graduates every year to work in the hospital. Every graduate of the City College nursing program nails a nursing job there.

As part of a 10-year agreement with Cottage Hospital, Cottage Health Systems has agreed to pay for four full-time professors and one Allied Health Learning Laboratory staffer. The hospital also pays part of the department’s administrative assistant’s salary.

“Our relationship with [Cottage] goes both ways,” said Shields. Graduates balance out the staff at Cottage Hospital, which has had to contact with up to 150 traveling nurses in the last five years. The hospital often uses nurses from as far away as Los Angeles to meet state guidelines, which call for a 5-to-1 patient-to-nurse ratio.

Teaching Teachers

Cottage also offers registered nurses the opportunity to earn a degree while working at the hospital. A bachelor’s degree program being taught in Santa Barbara is offered through California State University Los Angeles.

California State University Fullerton offers a master’s degree in nursing through traveling programs as well.

Enrollment in nursing programs and the number of spaces available has increased in the last three years, Spetz said. She said the major reason is that more nurses are working with a four-year degree, meaning more are eligible to teach.

The program, called “RN to BSN,” or bachelor’s of science in nursing, has been successful, City College alumni said.

“Getting a BSN gives me the opportunity to travel as a nurse and also teach,” said Gerry Daniels. “It opens up doors for me later down the line.”

Marisa Almanza is a second-year nursing student who waited two years to enter the program.

She said she would consider taking a job at Cottage Hospital, but she doesn’t plan to enter the RN to BSN program. Schools offering degrees beyond nursing certificates must do a better job of retaining students.

“We need to encourage students to get their [master’s degrees],” said McCabe.

Some schools are t
aking the short road to recruit new faculty. Spetz said she has spoken with college nursing programs that pay their clinical instructors as “contractors,” which gives them the ability to offer medical benefits as bonuses.

“That way they avoid the unions, get higher pay, and can also receive benefits,” she said of the part-time clinical instructors.

Receiving Support

Many students said they don’t feel crowded, but they agreed that there’s no room to spare.

Students said they like Endrijonas’s plan to expand their classes in the Administration Building. The plan has also received early support from the college’s Board of Trustees.

Katherine Swihart, a second-year student who waited only three months to enter the program, said she couldn’t succeed without the Allied Health and Nursing Laboratory. With more space, college officials could add more student-based, hands-on labs like this one.

“This place is the basis of everything we will do in a hospital,” Swihart said. “The lab fosters confidence. It gives us a chance to mess up.”

In the lab, students practice medical procedures both during class and in their free time. Teachers use the lab to test students before sending them into the hospital. The lab has a computer lab, a library, and quiet rooms where students can study.

“It takes eight hours of prep time,” said Professor McCabe, for students to be ready to work their two 12-hour weekly hospital shifts.

Asking Voters

Funding for the nursing department is a crazy quilt of grants.

Three years ago, City College received a grant from the state’s Chancellor’s Office, which fluctuates depending on enrollment. The first two years, the college received $59,701 each year. This year, the college will get $49, 822. Next year, the college is expecting $58,823.

This fall, the college received part of a $3.9 million grant from the regional Workforce Investment Act, to be split among five South Coast colleges.

City College’s portion will be $405, 000 to boost enrollment and $100,000 to increase counseling hours and pay for more lab assistants. An extra $127,000 from the Chancellor’s Office will go to pay for new equipment.

An additional $10 million for nursing programs would be available through the proposed Community College Initiative. If approved by California’s voters, the ballot measure would allocate a windfall to nursing programs to raise enrollment.

Currently, City College college is funded based on its number of students. In this model, the college would receive differential funding, meaning it would get more funds for a nursing student than for a student taking general education courses.

The money City College receives will pay for hiring clinical staff in the nursing lab and Cottage Hospital.

Staffing Frontlines

Nursing student Katherine Swihart said she likes the saying that nurses are like soldiers and doctors are like generals.

While doctors issue orders, nurses staff the front lines. They check blood pressure, give medication and watch for side effects. They comfort the dying and fight for their patient’s lives, all while staring down the face of death.

“I don’t care what anybody says, you don’t do this for the money,” Swihart said. “When you sit down at the end of the day and your feet hurt, you will know you helped somebody.”

For more info see sidebar “Pre-nursing gets tougher.”