Ask CJN: Nursing school admission woes (2023)

Why is it so hard to get into nursing school in California?

Zuleika Dixon, a student at Rio Hondo College, asked the question in response to the CalMatters College Journalism Network’s call for questions about college in California.

Dixon hopes to transfer to another community college or a California State University next fall to earn an associate’s or bachelor’s degree in nursing — prerequisites to become a registered nurse. But after hearing stories of students applying to programs year after year with no success, Dixon said she’s worried about her prospects.

Dixon’s concerns aren’t unfounded. The waitlist for Ventura College’s nursing program sits at four-and-a-half years, according to Sandra Melton, the director of the school of nursing and allied health. The nursing school at Cal State Fullerton had to decide which of 8,000 applicants would take 100 available spots in its fall 2023 entering class, said its director, Penny Weismuller.

The scarcity of nursing program seats comes as California faces adire nursing shortage. A 2022studyfrom UCSF estimated the state would fall short by almost 19,000 full-time nurses by the end of the year, with the shortage continuing until 2029.

So why isn’t the state preparing more nursing students? Professors and program directors at Cal State and the California Community Colleges say there are two major forces limiting the capacity of nursing programs: poor pay for instructors and the COVID-19 pandemic.

Andrea Muir, president of the Sharp Professional Nurses Network, a San Diego-based nurses’ union, and a registered nurse at Sharp HealthCare in San Diego, knew she wanted to teach nursing from her first semester in nursing school. But when she became an adjunct instructor at the University of San Diego and National University, she said, she faced unreliable employment and received no benefits as a part-time employee. Muir said she needed to split her time between teaching and working as a full-time nurse to remain financially afloat.

“The only nurses that are teaching are typically working another full-time job,” Muir said.

“So just to be able to teach, you have to be able to work 50 to 60 hours a week. Is that who we want teaching our nurses, people who are burned out?”

Nurses may halve their pay when moving from a hospital to the classroom, said Monika Eckfield, chair of the nursing department at Cal State East Bay.

“People come and teach nursing because they love working with the students, they care about the profession and they really want to help develop the next generation of nurses,” she said. “They don’t come into nursing education for the money.”

Angela Vogel, the assistant director of nursing at San Bernardino Valley College, added that pay disparities may be especially pronounced in California because the state’s salary for bedside nurses isone of the highest in the nation.

At the same time, the pool of nurses who are qualified to become instructors is limited. At Ventura College, Melton said, nursing faculty must have at least a master’s of science in nursing. At Cal State Fullerton, the bar is even higher: Applicants must have a doctoral degree related to nursing, Weismuller said.

“That’s also another reason why it’s tough, because you might have student loan debt from your doctoral degree, and you’re going to make less money than you’re used to,” Weismuller said.

The COVID-19 pandemic exacerbated colleges’ struggle to teach more students as clinical sites closed across the state to protect patients and students.

Over the past three years, Ventura College has decreased its admissions by half, Melton said. As hospitals closed their doors to nursing students, she added, it became harder to provide students the clinical experience required by the California Board of Registered Nursing. At the same time, the college continued to face the primary challenge of filling faculty positions.

Some nursing schools were unable to graduate students on time during the pandemic, said Sandra Sanchez, the interim vice chancellor of workforce and economic development for the California Community Colleges, further creating a backlog that prevented campuses from expanding their programs. At the same time, she added, many nursing faculty members retired or left the field.

“It all layered on top of each other to create this perfect storm of, now we don’t have enough faculty, we don’t have enough clinical sites, and those who might have come into our system to teach just left the industry altogether,” Sanchez said.

These challenges come at a time when turnover in nursing ison the rise.

Benson Yeung, regional director for patient care services at Kaiser Permanente Northern California, said Kaiser’s hospitals regularly partner with Cal State and community college campuses to train and hire new nurses. Before the pandemic, Kaiser’s 21 Northern California hospitals typically hired up to 100 new graduates each year, said Ryan Fuller, the hospital chain’s regional director for workforce strategy. But that number has tripled since the pandemic in order to keep up with turnover and retirements.

While the pandemic exacerbated California’s demand for nurses, Yeung noted, more Californians have gained health insurance over the past 10 years, driving the need for healthcare workers overall. But California may be losing some of its future nurses to out-of-state schools, which tend to be less competitive than nursing admissions to California public universities and colleges, said Weismuller, the Cal State Fullerton nursing director.

Students locked out of public colleges can also more easily gain admission to for-profit nursing programs, but those come with a large price tag. While the cheapest community college program Dixon considered cost around $6,000, the private programs she looked at would have cost around $120,000, she said.

For Weismuller, costly programs and limited nursing school spots raise concerns about equity. She said that all students, regardless of their financial means, should have the opportunity to train and learn in their own communities. At the same time, patients should have access to a diversity of healthcare providers who understand cultural norms and local needs, she added.

“It is a social justice issue,” Weismuller said. “If we want to educate more diverse students, we need to be prepared to support people that are maybe first-generation in college or who see this as an important career that’s going to benefit their family, but also benefit society.”

Do you have a question about college in California? Use the form below to send it to the CalMatters College Journalism Network, and one of our student reporters might answer it in a future column.

Tagami is a fellow with theCalMatters College Journalism Network, a collaboration between CalMatters and student journalists from across California. This story and other higher education coverage are supported by the College Futures Foundation.