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Would-be nurses have to wait 

Nursing programs struggle under the weight of their own popularity

When Cuesta College announced that it wouldn't receive any more applications for the registered nursing program for the 2007-08 school year, a wave of disappointment and confusion spread through the campus.

click to enlarge LEARN BY DOING :  Julie Rushs end goal is to become a registered nurse, but first she had to complete Allan Hancock Colleges certified nurse assistant program. Now she works at Marian Medical Center, an experience that helps give context to what she is learning in her licensed vocational nurse program, the next step on the way to being an RN. - PHOTO BY SARAH E. THIEN
  • LEARN BY DOING : Julie Rushs end goal is to become a registered nurse, but first she had to complete Allan Hancock Colleges certified nurse assistant program. Now she works at Marian Medical Center, an experience that helps give context to what she is learning in her licensed vocational nurse program, the next step on the way to being an RN.

# Christine Kock remembers hearing the news right before walking into her physiology class to see other disappointed faces.

"I was devastated. I cried for two days just because this was my dream," she said. "I actually thought I was the only one that would get in the way of my dream. I never really thought that I'd get to the end, and then something like that would happen."

Once Kock earns what she expects to be an A in physiology, she will have fulfilled all of the prerequisites to be able to add her name onto the bottom of a list of 286 students waiting to be admitted into Cuesta's program.

The two-year RN program can accommodate 56 students in each class 10 more than a few years ago and admits a new class every year. The school also has a licensed vocational nursing program, which won't be affected by the application halt.

News may not be as bad as Kock and other pre-nursing students imagine, but her reaction points to the strain many aspiring nurses are already under due to the state of nursing education in the state and the Central Coast in particular.

The decision to halt the growth of the RN wait list for the moment doesn't necessarily extend the amount of time pre-nursing students must wait before they can start learning the trade, said Anna Davies, Cuesta's dean of student learning, sciences, mathematics, and nursing/allied health. The RN program is already filled to capacity through 2011.

What it does mean is that students who are admitted may face a different set of requirements to enter the program than their predecessors did.

Like other community colleges statewide, Cuesta College has faced a growing interest in the nursing profession at the same time that limited clinical spaces at health-care facilities for nursing students, a lack of qualified faculty, and funding issues have limited how much the program is able to accommodate interest.

"Even though [nursing] programs have been expanding, it's just not enough to meet the need. In fact, the situation is getting worse," said Joanne Spetz, an associate professor at UCSF who has written a number of research papers on the nursing shortage and nursing education.

Of the 28,400 applications submitted to nursing programs statewide in 2005, 17,400 were rejected, according to the state Registered Nursing Board Annual School Report.

In what Spetz said may be the first time a nursing program has put a moratorium on applications, Cuesta College announced its decision on April 16 as a way to take a step back and consider how to pursue new avenues of growth as well as whether to narrow the number of applicants who qualify for the program.

In addition to class prerequisites, in 2005 the school established a GPA cut-off of 2.5 for applicants to the RN program. Following a statewide trend, the school is now considering adopting an assessment test that would be used much as the SAT is used at four-year institutions, Davies said. Using the test would give the school access to new grant money from the state, though the decision must be made carefully because of community colleges' commitment to access, she said.

"This change in philosophy around nursing education is a huge shift within our system and is really the first time you've seen support on creating criteria that actually exclude students who won't be successful," Davies said.

Spetz said the No. 1 factor limiting schools' ability to grow is an insufficient number of clinical sites where nursing students can obtain the practice they need for graduation and licensing.

Right now, nursing students perform their clinicals at French Hospital, Sierra Vista Hospital, Twin Cities Community Hospital, and Arroyo Grande Community Hospital, where they share space with Allan Hancock College students. Because this rural area doesn't have as many health-care facilities as a city would, the school will now look as far north as King City for new sites, as well as form partnerships with more long-term care facilities, Davies said.

But with 20 vacancies for nurses open now and the nursing shortage hitting crisis proportions, French Hospital President/CEO Alan Iftiniuk said his facility would be more than happy to accommodate more nursing students, who would in turn become potential employees. They have room for 50 nursing students at a time, said hospital spokesperson Megan Maloney.

"We're so hungry for the product that they turn out that we'll do almost anything, so providing clinical space is not really an issue," Iftiniuk said.

Though the nursing shortage is a problem statewide, the situation on the Central Coast is especially pronounced, according to a report written by UCSF's Spetz, "Regional Forecasts of the Registered Nurse Workforce in California."

According to that report, Los Angeles faces the largest shortage of nurses 100,000 full-time equivalent RNs but it's the Central Coast region, from Monterey to Santa Barbara County, where nursing vacancies as a percentage of overall positions will be the greatest in the future as more nurses retire and an aging population needs more healthcare services.

Or as Spetz put it, "Basically when all those nurses retire and want their knee replacements, there's going to be no one to help them."

In response to this need, Cuesta and Hancock College have expanded their programs in recent years, with help from partnerships with local hospitals as well as state money.

In 2002, Hancock took a big jump from 30 to 60 students when it began enrolling students in its one-year RN program every year, instead of every two years, thanks to funding from Marian Medical Center. In 2005, the number of students in each class took a jump again to 40, said Linda Gabrielson, dean of academic affairs, which includes the nursing program.

But Hancock still has waiting lists for its LVN and RN programs, though the problem isn't as severe as at Cuesta. This may be partly because Hancock takes a ladder approach to nursing education LVN students must already be certified nurse assistants RN students must have passed the LVN program.

Julie Rush, an LVN student at Hancock, said she was hesitant about the school's stepped programs, but after she landed on Cuesta's wait list, she applied to Hancock and now appreciates the school's unique organization.

"I think being a CNA first it gets your feet wet and helps you see on a small scale what nursing really is," said Rush, who works at Marian. "I think it helps you see whether it's really what you want to do."

The school has 80 people on a two-year waiting list for the 12-month LVN program and less than 15 waiting for a spot in the RN program.

Increasing class sizes much more would be difficult not so much due to funding issues, but because of clinical space and also the struggle to find faculty who can afford to work on a community-college salary, Gabrielson said. To teach at a community college, nurses must have a master's-level education, but nurses with that level of training, already rare, could make much more money bed-side than in a classroom.

Holly Stromburg, the Hancock nursing program director, said that they must always weigh the quality of the program with the need to expand, and increasing student numbers without increasing faculty numbers would erode that quality.

"We're very aware that our students, when they go out to practice their profession, they're dealing with human lives. It's important that they know what they're doing," she said. "We don't want them to just be adequate we want them to be excellent."

Kirsten Flagg is editor of New Times' sister paper, the Santa Maria Sun. Send comments to


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