Figure 1
Nursing Program Students in California Must Complete Both Classroom and Clinical Units to Become RNs
Figure 1 is a graphic that depicts the elements of the process that nursing students in California must complete to become registered nurses. The first elements shows that accepted applicants enroll in a nursing program at a public or private school. Next, students must complete classroom and clinical units. For every one hour of class time, nursing program students must complete three hours of clinical time weekly. Clinical units must be completed in five content areas: medical/surgical, obstetrics, pediatrics, mental health/psychiatry, and geriatrics. Then, nursing program graduates must apply for licensure and pass the licensure exam. After passing the exam, registered nurses join the nursing workforce.
Figure 2
Some Regional Nursing Shortages Are Projected to Continue Within California
Figure 2, a graphic presenting two maps of California side-by-side that depict the regional nursing shortages that exist in 2018 and are projected to exist by 2035. The state is divided into eight regions: Northern California, Sacramento, San Francisco Bay Area, Central Valley, Central Coast, Los Angeles, Inland Empire, and Southern Border. The 2018 Map shows shortages in the following regions: Northern California (6.6 percent), Sacramento (15 percent), San Francisco Bay Area (6.4 percent), Central Valley (17.3 percent), Los Angeles (10.4 percent), Inland Empire (23.4 percent), and Southern Border (9.1 percent). The 2018 Map shows the Central Coast region as being in relative balance. The 2035 map shows shortages are projected to continue in the following regions: San Francisco Bay Area (10.9 percent), Central Valley (19.5 percent), and Central Coast (11.1 percent). The following regions are projected to have a surplus: Northern California (38.2 percent) and Los Angeles (17 percent). The following regions are projected to be in relative balance: Inland Empire and Southern Border.
Figure 3
BRN’s Lack of Guidance Results in Staff Presenting Inconsistent Information to the Governing Board
Figure 3, a graphic that presents the flow of information regarding clinical placements through three levels: from nursing programs to BRN nursing education staff and finally to BRN’s governing board. At the first level of nursing programs, the graphic shows that nursing programs must submit to BRN nursing education staff when requesting a new program or enrollment increase. Specifically, nursing programs must provide the following: a description of how the proposed enrollment increase will affect clinical facilities, facility and program verifications that no clinical displacement will occur, and the number of students in each nursing course and the facilities used for the associated clinical experience. The graphic shows that information flows to the second level, which is BRN nursing education staff. The graphic explains that BRN does not have policies that govern what education staff submit to the governing board. The graphic shows that information flows to the third level, which is the BRN governing board. However, the graphic notes that nursing education staff inconsistently presented information to the governing board. For 8 of the 15 decisions we reviewed, nursing education staff did not present the clinical placement information nursing programs must provide.
Figure 4
Summary of Survey Responses Related to Clinical Displacement
Figure 4, a graphic that presents a summary of survey responses related to clinical displacement. The graphic shows that 75 of 140 nursing programs reported clinical displacements during academic year 2017-18. It shows that more than 2,300 nursing students were affected. The graphic presents examples of reasons programs lost clinical placement. 37 programs reported that another program displaced them. 47 programs reported that facility staff work overload or insufficient qualified staff at facilities as the reason. 17 programs reported closure, or partial closure of clinical facilities as the reason. The graphic notes that nursing programs can report more than one reason for clinical displacement.
Figure 5
BRN Is Not Taking Full Advantage of Its Nursing Program Database
Figure 5, a graphic that presents actions that BRN is not taking to collect and use information regarding clinical placements. The graphic presents four columns of information. The first column explains that BRN does not use facility approval forms to gather key information: total number of clinical placement slots a clinical facility can accommodate annually, total number of slots each program needs annually. The next column explains that BRN does not ensure that its nursing program database is complete and accurate. The third column explains that BRN does not require nursing programs to submit updated facility approval forms for any changes to facility use after BRN has approved the use of a facility. The final column explains that BRN does not analyze and report key findings related to clinical placements to the governing board and stakeholders via its website.
Figure 6
Facilities Not Used by Nursing Programs for Clinical Placements Could Be a Source of Additional Placements
Figure 6, a chart the shows the number of clinical facilities, by type, that are used and unused by nursing programs in five bay area counties. The chart shows four types and their subtypes of facilities. The Home Health/Hospice type has two subtypes: Home Health agencies, which have three used and 168 unused facilities; and Hospice, which has five used and 64 unused facilities. The Clinic type has four subtypes: Other, which has none used and eight unused; Free, which has two used and 12 unused; Dialysis, which has three used and 64 unused; and Community, which has 21 used and 141 unused facilities. The Long-term Care Facility type has two subtypes: Other, which has one used and 11 unused facilities; and Skilled Nursing, which has 34 used and 107 unused facilities. The last type, Hospital, has three subtypes: Other, which has two used and one unused, Acute Psychiatric, which has four used and none unused; and Acute Care, which has 46 used and 11 unused facilities. The chart shows that the subtypes of facilities are used for various content areas. Home health agencies are used for medical/surgical and mental health/psychiatry content areas. Hospice are used for medical surgical, mental health/psychiatry, and geriatrics. Other clinics are not used. Free clinics are used for medical/surgical. Dialysis clinics are used for medical surgical. Community clinics are used for medical/surgical, obstetrics, and pediatrics. Other Long term care facilities are used for medical/surgical and pediatrics. Skilled nursing facilities are used for medical/surgical, obstetrics, pediatrics, mental health/psychiatry, and geriatrics. Other Hospitals are used for obstetrics. Acute psychiatric hospitals are used for medical/surgical, pediatrics, mental health/psychiatry, and geriatrics. Acute care hospitals are used for medical/surgical, obstetrics, pediatrics, mental health/psychiatry, and geriatrics content areas.