What’s at stake?
California community college bachelor’s degrees programs have been praised by some experts for making higher education more accessible to disadvantaged students. A local lawmaker is now hoping that expanding these bachelor’s degrees again could help solve staffing issues and severe shortages among registered nurses in the Central Valley – but not everyone’s on board.
For years, Fresno has been behind the curve on training local doctors, nurses, and other healthcare professionals.
Now, state lawmakers are weighing whether Fresno and the surrounding area can teach its way out of the crisis.
Assemblymember Esmeralda Soria, D-Fresno, is sponsoring a bill that would allow a handful of community colleges to start offering bachelor’s degrees in nursing.
Though community colleges have historically offered two-year associate’s degrees only, that’s changed in recent years as the state lawmakers embrace studies pointing to the benefits of community college bachelor’s degrees.
Assembly Bill 2104 would become the latest legislation expanding these bachelor’s degree programs if it passes.
“Times have changed,” Soria said in an interview with Fresnoland, “and we have to adapt to the realities of our communities.
“We have to provide avenues for communities and students that otherwise wouldn’t have the opportunity to go to a state university,” she added, “because of how far (it is), the lack of transportation, (and) how expensive it is.”
Not all are on board with the proposed legislation, however, including the California State University system.
The CSU Chancellor’s Office has registered its opposition to the bill, saying it would increase competition for clinical placements and qualified faculty for nursing programs across the board, “further complicating the problem that already exists.”
Others say the legislation has potential to alleviate staffing issues, but it’s a question of what healthcare providers more urgently need: more nurses with bachelor’s degrees, or more nurses period.
“Would our taxpayer, public money be better off expanding programs,” said Joanne Spetz, director of the Institute for Health Policy Studies at UC San Francisco, “rather than making the program longer?”
What does the bill do?
AB 2104 proposes a pilot of 10 community college districts around the state to offer a Bachelor of Science in Nursing degree.
Though California students only need an associate’s degree (and a passing score on the state licensing exam) to become a nurse, bachelor’s degrees are increasingly becoming the industry norm.
Some attribute that to a 2010 report from the Institute of Medicine, which recommended that the proportion of registered nurses with bachelor’s degrees rise to 80% within a decade.
Some credentialing organizations have echoed that call for 80% of the nursing workforce to have their bachelor’s, according to legislative documents.
“There was evidence to back up that recommendation,” Spetz of UCSF said. “As healthcare has become more and more complex, patients in the hospitals are more complexly ill.
“The additional upper level courses that you would take for the bachelor’s degree in nursing have value,” she added, “and would have increasing value.”
But access to institutions offering bachelor’s degrees is spotty across the San Joaquin Valley, especially for rural communities.
Students in more remote parts of Soria’s congressional district – like Huron or Coalinga – have a long commute ahead of them to Fresno State if they want a bachelor’s degree in nursing, she said.
That’s where legislation like AB 2104 comes in.
“I think about all these first generation kids or Dreamers that live in these small, rural communities,” Soria said, “that if they could just go a short distance to their community college and be able to get their education and their degree … how that’s going to change the access to care, the quality of care, which is much more reflective of the community that exists in those areas.”
Meanwhile a similar bill, Senate Bill 895, is also pending in the state legislature.
That bill, introduced by California Senators Richard Roth and Anna Caballero, proposes a pilot program of 15 community college districts to develop a bachelor’s degree in nursing. It likewise stresses that the pilot should give priority to community college districts in “underserved nursing areas,” according to the text of the bill.
Roth’s and Caballero’s offices declined to comment on deadline.
Fears of a nursing shortage
Soria said her bill also addresses a looming nursing shortage that researchers predict will be especially severe in the San Joaquin Valley.
Spetz of UCSF co-authored a 2018 study on California’s nursing workforce, which estimated the San Joaquin Valley would experience a shortage of between roughly 6,000 and 10,000 nurses by the year 2030.
Spetz told Fresnoland she’s working on an update to the study with more recent data – and is concerned the pandemic may have made matters worse.
“Statewide, the projections look pretty similar, except that we had a lot of people leave the nursing workforce – like, (they) retired earlier than would have been expected because of the pandemic,” she said. “So right now, any shortage is worse, but we still seem to be graduating enough nurses that we’re on a trajectory towards filling that hole.”
The 2018 study pointed to increasing the number of graduates from local educational institutions as the “primary policy solution” for filling said hole in the San Joaquin Valley. At the same time, the report noted the educational capacity in the Valley was lower than other larger urban areas in the state.
State Center Community College District Chancellor Carole Goldsmith, a supporter of AB 2104, told Fresnoland she thinks the potential legislation would help address this “unmet” need.
“Me being a longtime Central Valley person and watching hospitals close,” she said, alluding to the closure of the Madera Community Hospital and others through the years, “I think it’s important that the Valley has this program to be able to expand and be able to meet the workforce needs that we have.”
But the CSU system has taken issue with the bill’s approach to broadening nursing education.
In its opposition to the bill, the Chancellor’s Office wrote that the real issue with nursing education is that there aren’t enough clinical placements available for nursing students.
Adding more bachelor’s degree slots at community colleges would just increase competition for those placements as well as qualified faculty, the Chancellor’s Office said.
“The CSU believes the most appropriate and proven path forward to achieve an increase in the number of nursing students is through partnership and online programs,” the office added, saying it has existing partnerships with community colleges that allow rural students to complete coursework online.
Fresno State is among these universities that offer an online program for students seeking a bachelor’s degree in nursing, spokesperson Esra Hashem confirmed.
For hospital systems dealing with the brunt of the shortage, Spetz also wondered how helpful focusing just on expanding bachelor’s degrees in nursing would be.
“My bet is that your (Chief Nursing Officers) locally are going to say that they want more graduates, period,” she said, “and the bachelor’s degree thing is kind of icing on the cake, but not as important as more nurses. But I could be wrong.”
What Valley hospital administrators are saying about the bill
Fresnoland reached out to multiple Central Valley hospital administrators for their reactions to the bill.
Heather Von Housen is Patient Care Executive for the Central California Network at Adventist Health, which runs hospitals in rural communities like Tulare, Hanford and Selma. She said she personally supports the bill but sees it as “a piece of the puzzle” and “not the full solution.”
“It does open that up for rural communities that don’t have a university,” she said, referring to bachelor’s degree programs in nursing. “I’m very supportive of that, so that we keep people local for their education, which also means they’ll likely stay local for employment, which is a benefit to all of us.”
“But it doesn’t stop the shortage,” she added.
Von Housen said that partnerships between educational institutions and hospitals and clinics are vital to address the broader shortage.
“If there’s not enough instructors to train the new nurses, and if there’s not enough hospitals for them to practice in … the schools can do nothing about that,” she said. “We really have to partner.”
Valley Children’s Healthcare, which operates a children’s hospital in Madera and several clinics across the Central Valley, has formally registered its support for AB 2104.
“We strongly support Assemblywoman Esmeralda Soria and her introduction of this important legislation to create more nurses for the Central Valley and the children we serve,” Valley Children’s spokesperson Zara Arboleda said in an emailed statement to Fresnoland. “AB2104 is vital to improve healthcare.”
Karen Tellalian Cocagne, a spokesperson for Kaweah Health in Tulare County, said the potential legislation wouldn’t impact them much due to their existing partnership on a bachelor’s degree in nursing program between Fresno State and College of the Sequoias.
Community Health System – which operates downtown Fresno’s hospital as well as Clovis Community Center and the Fresno Heart & Surgical Hospital – said in a statement from its Chief Clinical and Operations Officer Daniel Davis that it “supports all efforts that create more opportunities to grow healthcare professionals to meet the health needs of this region.”
The hospital system declined to respond to a question asking if it supports AB 2104 specifically through spokesperson Mary Lisa Russell.
What’s next for Soria’s bill?
Despite some opposition from the CSU system and independent colleges, Soria said the pushback isn’t as strong as she anticipated and that the bill remains her “number one policy priority for the year.”
“I’ve been pleasantly surprised that people kind of understand that we’re in a crisis in our area,” she said, “and we’re soon to be there in other areas if we don’t think outside the box and figure out other avenues to increase the local workforce here in our state.”
If it were to pass, legislative documents said the cost for the California Community College Chancellor’s Office to “develop the application for the pilot program, issue guidance, and provide technical assistance” would be between $32,500 and $53,000.
The Chancellor’s Office would also be charged with selecting 10 districts to pilot the degree, based on criteria laid out in the bill.
The criteria to be considered for the pilot program require that at least two of the following apply:
- That the community college district demonstrates the need for more healthcare professionals, including by showing projected population growth of above 7% between 2025 and 2030
- That the district is located in “broadly recognized underserved nursing” area
- That the district is located in a community with “persistent poverty”
Though the Central Valley isn’t mentioned by name in the criteria, Soria thinks they guarantee local schools will be first in line.
“The goal of the bill is to make sure that the Central Valley is front and center,” she said.
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