Evaluation of CSU's Doctor of Nursing Practice Pilot Program

Evaluation of CSU’s Doctor of Nursing Practice Pilot Program MAC TAYLOR • L E G I S L A T I V E A N A L Y S T • JANUARY 2017 AN LAO REPORT 2 Legislative Analyst’s Office www.lao.ca.gov AN LAO REPORT TABLE OF CONTENTS Executive Summary ..................................................................................................5 Introduction ..............................................................................................................7 Background on Nursing Education Programs ........................................................7 The DNP at CSU .......................................................................................................11 Findings ...................................................................................................................15 LAO Assessment and Recommendation ...............................................................21 www.lao.ca.gov Legislative Analyst’s Office 3 AN LAO REPORT 4 Legislative Analyst’s Office www.lao.ca.gov AN LAO REPORT EXECUTIVE SUMMARY Background State Assigns Distinct Missions to Higher Education Segments. California’s Master Plan for Higher Education, dating back to 1960, and existing state law assign specific missions to each of the public higher education segments. The state generally gives the University of California (UC) responsibility for independent doctoral degrees but permits the segment to award joint doctoral degrees with the California State University (CSU). To Help State Address Nursing Shortage, Legislation Permits CSU to Offer Doctor of Nursing Practice (DNP) on Pilot Basis. In the late 1990s, California began experiencing a statewide shortage of registered nurses (RNs). Experts at the time forecasted that the shortage would continue to worsen absent an increase in the supply of RNs. To boost enrollment capacity in its nursing programs, CSU cited a need to increase the number of nursing faculty holding a doctoral degree, which is required for faculty seeking tenured and tenure-track university positions. To this end, CSU expressed interest in establishing its own DNP program, independent from UC. The state enacted Chapter 416 of 2010 (AB 867, Nava) to address the nursing workforce challenge. As a temporary exception to the Master Plan, Chapter 416 allowed CSU to offer an independent DNP on a pilot basis at up to three campuses. CSU’s Interest in DNP Program Also Linked With Anticipated Increase in Nursing Educational Requirements. In addition to addressing the nursing shortage, CSU sought DNP authorization to help the state meet an anticipated new educational requirement for higher-level nurse clinicians. Specifically, in 2004, a national organization of nursing schools endorsed a nonbinding statement that identified the DNP as the most appropriate entry-to-practice degree for advanced practice registered nurses (APRNs) and called for nursing master’s programs that train APRNs to transition to the DNP by 2015. Legislative Analyst’s Office to Evaluate Pilot. Chapter 324 of 2015 (SB 103, Committee on Budget and Fiscal Review) directed us to assess CSU’s DNP programs and make a recommendation on whether the pilot should be extended beyond its 2018 sunset date. This report fulfills that statutory requirement. Major Findings CSU Formed Two DNP Consortia Consisting of a Total of Five Campuses. In response to Chapter 416, CSU grouped five campuses into two consortia—the Northern California Consortium (consisting of the Fresno and San Jose campuses) and the Southern California Consortium (consisting of the Fullerton, Los Angeles, and Long Beach campuses). Both consortia operate programs five semesters long (spanning 21 months), with instruction—much of it online—occurring in fall, spring, and summer terms. About One-Third of CSU’s DNP Graduates Are Serving as Faculty but Few Graduates Are in Tenure/Tenure-Track Positions. The first DNP students began their studies in fall 2012 and graduated in spring 2014. Through the first three cohorts, CSU reports that 162 of a total 174 students (93 percent) www.lao.ca.gov Legislative Analyst’s Office 5 AN LAO REPORT have graduated with a DNP. Of the 162 graduates, 55 (34 percent) serve as faculty at CSU or other postsecondary institutions. Most of these graduates are in part-time or other faculty positions that do not require a doctorate. LAO Assessment and Recommendation State No Longer Facing Nursing Shortage. The Legislature authorized Chapter 416 at a time when it believed California faced a long-term mismatch between the supply of and demand for RNs. Yet, soon after the legislation was enacted, the state’s shortage eased considerably. Today, the Board of Registered Nursing and other experts report that overall the state’s RN labor market is in good balance and, assuming current graduation production continues, supply is sufficient to ensure an adequately sized RN workforce for decades to come. CSU Continues to Report Trouble With Attracting Doctorally Prepared Nursing Faculty . . . While CSU no longer needs to hire large numbers of new faculty to address an RN shortage, CSU still reports difficulty recruiting tenure-track nursing faculty to fill positions that become vacant due to retirement and turnover. For example, a Chancellor’s Office survey of three of the largest CSU nursing schools found that of eight tenure-track positions advertised in 2015-16, six were cancelled for lack of a sufficient pool of candidates. . . . But Only a Few DNP Graduates Helping CSU With Regular Hiring Needs. Despite CSU having open positions go unfilled, the pilot has produced only a few tenure-track faculty. To date, only 8 of 162 graduates (5 percent) have taken a tenure-track position at CSU. Increasing Compensation Levels for Nursing Faculty More Direct Way for CSU to Address Regular Recruitment Challenges. The primary reason CSU cites for its ongoing difficulty attracting tenure-track nursing faculty is the relatively low salaries that such faculty receive compared with nurse clinicians and administrators. A more direct way for CSU to address its recruiting challenges, thus, would be to offer more competitive salaries. CSU already has authority to pay differential salaries. For example, the average salary of entry-level, tenure-track nursing faculty currently is about $10,000 more than their history faculty peers and about $25,000 less than their business faculty peers. For the Most Part, Expectations About Higher Entry-to-Practice Requirements for APRNs Have Not Materialized. CSU also justified an independent DNP program based on an expectation at the time that the degree would become a requirement for APRNs by 2015. Yet, with one future exception (for nurse anesthetists), accreditors and licensing agencies continue to require APRNs to hold just a master’s degree. Other Options Available to Individuals Seeking a DNP. At the time the Legislature authorized Chapter 416, the number of DNP programs available to potential students was relatively small. Today, nearly 300 DNP programs—many of them online—are offered throughout the country. In addition, three UC campuses currently are seeking to offer DNP degrees by 2018. Recommend Legislature Allow Pilot to Sunset. Given that a nursing shortage no longer exists, CSU has more direct ways to attract tenure-track nursing faculty, the DNP has not become the required degree for APRNs, and an increasing number of other DNP programs are now available to students, we recommend the Legislature allow the CSU DNP pilot to sunset. 6 Legislative Analyst’s Office www.lao.ca.gov AN LAO REPORT INTRODUCTION State law generally gives the University of the pilot program and report to the Legislature by California (UC) sole authority to award doctoral January 1, 2017. This report fulfills that statutory degrees. As one of only a handful of exceptions requirement. The report has four main sections. to this rule, Chapter 416 of 2010 (AB 867, Nava) In the first section, we provide background on authorizes the California State University (CSU) nursing education programs. In the second section, to independently award a doctoral degree in we describe CSU’s two pilot DNP programs. In the nursing, the Doctor of Nursing Practice (DNP), third section, we present our findings on program on a pilot basis. Chapter 324 of 2015 (SB 103, implementation. In the final section, we assess the Committee on Budget and Fiscal Review) requires program and make a recommendation regarding the Legislative Analyst’s Office (LAO) to evaluate its extension. BACKGROUND ON NURSING EDUCATION PROGRAMS Below, we provide information on pre- and P re -L icensure P rograms post-licensure nursing programs as well as Each of the Three Types of Pre-Licensure registered nurses (RNs) and advanced practice Programs Involve Student Learning in Various registered nurses (APRNs). Settings. In California, three main types of Nursing Education Includes Pre-Licensure pre-licensure education programs are available to and Post-Licensure Programs. California’s more persons seeking to become an RN. The first two than 300,000 licensed nurses provide a variety of options are for students to enroll in either (1) an health care services in various settings, including associate degree in nursing program at a two-year hospitals, medical offices and clinics, extended college or (2) a four-year bachelor’s degree in care facilities, and labs. All RNs in the state must nursing program at a university. In addition, some have a license issued by the California Board of master’s degree nursing programs accept individuals Registered Nursing. To obtain a license, students who hold a bachelor’s degree in a non-nursing field. must graduate from an approved nursing program, Generally, students in such a master’s program pass a national licensing examination, and complete complete educational requirements for an RN certain other steps (such as undergoing a criminal license in about 18 months, then continue for background check). Nursing education consists another 18 months to obtain a master’s degree in of pre-licensure programs for individuals seeking nursing. (These master’s degree programs do not to become an RN and post-licensure programs for prepare individuals to work as APRNs.) All three RNs seeking to prepare for higher-level practice as types of pre-licensure programs combine classroom APRNs, administrative roles, or careers in teaching instruction, “hands on” training in a simulation lab, and research. As discussed below, California’s and clinical placement in a hospital or other health public higher education system plays a major role in facility. Graduates of these programs typically find providing both types of programs. nursing positions providing direct care to patients. www.lao.ca.gov Legislative Analyst’s Office 7 AN LAO REPORT California Community Colleges and CSU Are Master’s Degree in Nursing Key Providers of State’s Pre-Licensure Programs. Post-licensure master’s degree programs can Currently, 132 public and private colleges in prepare RNs for a variety of advanced roles and California offer a total of 138 pre-licensure specialty areas. These master’s degree programs programs. Figure 1 shows that the California typically take a student two years of full-time Community Colleges and CSU are two of the enrollment to complete. major educators of RNs, with community colleges Many Post-Licensure Master’s Degree offering 78 of the state’s 90 associate degree Programs Focus on Preparing APRNs. Most programs and CSU offering 17 of the state’s commonly, nursing students enroll in a master’s 36 bachelor degree programs and 2 of the state’s degree program to become an APRN. These 12 pre-licensure master’s programs. A total of programs have four tracks: (1) nurse practitioner, 11,119 students graduated from a pre-licensure (2) nurse anesthetist, (3) nurse midwife, and program in 2014-15—half with associate degrees (4) clinical nurse specialist. (We describe each of and the remaining half with bachelor’s or master’s these tracks in the next paragraph.) The APRN degrees. master’s degree curriculum typically includes P -L P foundational coursework such as nursing theory ost icensure rograms and research methods, as well as core clinical RNs have opportunities to pursue content such as physical health assessment, illness post-licensure degrees in nursing. These programs and disease management, and pharmacology. In include a master’s degree, Doctor of Philosophy addition to attending classes, nurses studying to (Ph.D.) in nursing, and DNP. become APRNs must spend considerable time in instructional (simulation) labs and clinical settings. Figure 1 Students completing a Nursing Pre-Licensure Programs in California post-licensure master’s Number of Programs Number of Graduates (2016-17) (2014-15) degree program in nursing must be certified by Associate’s Degree in Nursing California Community Colleges 78 4,844 the Board of Registered County of Los Angeles program 1 87 Nursing to work as an Private institutions 11 611 APRN in California, and Subtotals (90) (5,542) they may take national Bachelor’s Degree in Nursing CSU 17 1,628 examinations in their UC 2 97 respective nursing roles Private institutions 17 3,135 to receive national Subtotals (36) (4,860) certification. (Some Master’s Degree in Nursinga CSU 2 109 employers require their UC 2 144 nurses to have both state Private institutions 8 464 and national certifications.) Subtotals (12) (717) Totals 138 11,119 As discussed in the nearby a Reflects programs enrolling students who do not yet have a registered nursing license. box, APRNs work under Source: Board of Registered Nursing. physician supervision. 8 Legislative Analyst’s Office www.lao.ca.gov AN LAO REPORT Students Training to Become APRNs Enroll in population group (such as pediatrics or women’s a “Track.” Specifically, individuals may enroll in health). Universities typically offer a breadth of one of the following four educational tracks: such specialty options. Some Students in Master’s Programs Pursue a • Nurse Practitioner. Nurse practitioners, Non-APRN Track. Some master’s degree students the most common type of APRN, perform choose a non-APRN track, such as nursing health assessments, diagnose patients’ administration or nursing education. Students on conditions, and treat illnesses and injuries. the administration track often aspire to leadership • Nurse Anesthetist. Nurse anesthetists positions within health organizations, whereas the administer anesthesia to patients education track prepares nurses to teach in practice undergoing surgery in hospitals, dental settings (such as teaching diabetes management to offices, and other clinical settings. patients) or at educational institutions (such as at community colleges or nontenure-track positions at • Nurse Midwife. Nurse midwives have universities). training in prenatal care, assisting mothers CSU Is a Notable Provider of Master’s Degree with childbirth, and postpartum care. Programs. As Figure 2 (see next page) shows, • Clinical Nurse Specialist. Clinical nurse 35 public and private institutions in California specialists provide consultative services offer at least one post-licensure master’s degree to other health care staff and often devise program in nursing. In 2014-15, these institutions protocols for improving patient and granted 1,983 master’s degrees in nursing. CSU is hospital safety. For example, a clinical a notable provider of such programs—accounting nurse specialist may consult with nursing for 43 percent of institutions and 31 percent of staff to advise on the most effective wound graduates. care techniques for an elderly patient Ph.D. in Nursing recovering from surgery. Ph.D. in Nursing Is a Research-Oriented Within the nurse practitioner and clinical nurse Degree. Like the Ph.D. in various other disciplines, specialist tracks, APRNs further specialize by Advanced Practice Registered Nurses (APRNs) California Requires APRNs to Work Under Supervising Physicians. Pursuant to California law, an APRN must work under the supervision of a physician. (Other states permit APRNs to practice without supervision.) Generally, the level of supervision and specific services provided to patients are determined by an agreement laid out between an APRN and the supervising physician. While statute sets forth no requirements regarding the geographic proximity between a physician and an APRN, the physician is expected to be able to effectively supervise the APRN in fulfilling the service agreement. At a minimum, statute requires supervising physicians to be available by telephone at the time of a patient examination. Statute specifies that physicians may supervise up to four APRNs if the nurses are allowed to write drug prescriptions. Physicians have no limitations on the number of APRNs they may supervise if the nurses do not write drug prescriptions. www.lao.ca.gov Legislative Analyst’s Office 9 AN LAO REPORT the primary purpose of the nursing Ph.D. is Doctor of Nursing Practice to prepare students for careers in research and DNP Is Designed for Practitioners. The academia. Nursing students in Ph.D. programs DNP is a relatively new doctoral degree. The first generally are interested in advancing theory and DNP program began in 2001 (at the University discovering new knowledge about nursing science of Kentucky). In contrast to the Ph.D., the (on topics such as providing care to persons with DNP is designed for nurse professionals who chronic diseases, older adults, and vulnerable either provide direct care to patients or serve populations). Ph.D. programs focus heavily on in certain leadership positions (such as hospital coursework in theory development, research administration). Whereas the Ph.D. is concerned methodology, and data analysis, and students are primarily with scientific research, the DNP focuses required to complete an original research project on understanding research and applying it to (dissertation). After earning a master’s degree, practice. DNP programs typically include topics nursing students typically take about four years to such as reading and interpreting research studies, earn a Ph.D. using health care information systems to make UC Is the State’s Public Provider of Ph.D. more-informed clinical decisions, and policy Programs. As Figure 2 shows, the state currently advocacy. Rather than completing a dissertation, has seven universities that offer a Ph.D. in nursing, DNP students typically write a shorter “capstone” including four UC campuses. According to the paper that evaluates a health care program or federal Integrated Postsecondary Education Data identifies clinical strategies for improving quality System (IPEDS), 71 students received a Ph.D. in control and patient care. nursing in California in 2014-15, 42 percent of Two Routes to the DNP—Post-Master’s and which graduated from UC. Post-Bachelor’s. According to the American Association of Colleges Figure 2 of Nursing (AACN), Nursing Post-Licensure Graduate Programs in California 289 DNP programs operated in the United Number of Programs Number of Graduates (2016-17) (2014-15) States in 2015, enrolling Master’s Degree in Nursing nearly 22,000 students. CSU 15 606 According to a 2014 UC 4 304 study by the RAND Private institutions 16 1,073 Subtotals (35) (1,983) Corporation, most Doctor of Philosophy, Nursing DNP programs are UC 4 30 “post-master’s” programs, Private institutions 3 41 Subtotals (7) (71) meaning that RNs must Doctor of Nursing Pratice earn a master’s degree CSUa 2 53 before applying to and Private institutions 8 140 Subtotals (10) (193) enrolling in a DNP Totals 52 2,247 program. These DNP a Pilot programs. programs are relatively Source: Board of Registered Nursing (for master’s degree data) and Integrated Postsecondary Education Data System (for doctoral program data). short in length—typically entailing 18 months 10 Legislative Analyst’s Office www.lao.ca.gov AN LAO REPORT of full-time attendance. Some universities have just three DNP programs in the country serving “post-bachelor’s” DNP programs, which educate a total of 107 students), the master’s degree—not bachelor’s-prepared RNs to become APRNs at the the DNP—currently remains the entry-to-practice doctoral level. These post-bachelor’s programs requirement for APRNs. A future exception combine clinical instruction found in traditional will be for nurse anesthetists. The Council on master’s programs (such as patient assessment Accreditation of Nurse Anesthesia Educational and treatment) with additional coursework in Programs is requiring all nurse anesthetist health care technology, leadership, and other DNP programs to be at the doctoral level by 2022 and all subjects. Bachelor’s-to-DNP programs typically new candidates for certification to have a doctoral take students about three years of full-time study to degree by 2025. (In 2015, the National Association complete. of Clinical Nurse Specialists endorsed the DNP DNP Not Currently a Requirement for as the entry-to-practice degree for clinical nurse APRNs. In 2004, members of AACN endorsed a specialists by 2030. As of this writing, however, nonbinding statement that (1) identified the DNP none of the accreditors of clinical nurse specialist as the most appropriate degree for APRNs to programs has acted on that position statement.) enter clinical practice and (2) called for nursing CSU Offers Two of the State’s Ten DNP master’s programs that train APRNs to transition Programs. Currently, ten universities in California to the DNP by 2015. While the position statement offer the DNP. According to IPEDS, these programs helped to spur the development of DNP programs graduated a total of 193 students in 2014-15. The nationwide (at the time of the 2004 vote, there were following sections discuss CSU’s two DNP pilot programs. THE DNP AT CSU Below, we describe CSU’s rationale for wanting By contrast, lecturers typically are employed to operate independent DNP programs and identify on a part-time basis and have only teaching the statutory requirements the state established for responsibilities. Another difference between these programs. the two types of faculty are the educational requirements. Historically, tenured/tenure-track CSU’s Objective nursing faculty have been required to have a Ph.D. The CSU advocated an independent DNP (or other terminal degree, such as a Doctor of program to address a special set of circumstances, Education [Ed.D.]), whereas lecturers need only as explained below. have a master’s degree. Like tenured/tenure-track CSU Has Two Main Types of Faculty. As in faculty, nursing lecturers can teach and supervise other disciplines, CSU nursing programs employ students in various settings (including in the tenured/tenure-track faculty and lecturers. classroom for theory-based courses), though they Tenured/tenure-track faculty generally are are disproportionately assigned to supervise and employed on a full-time basis and are expected instruct students in simulation labs and at clinical to engage in teaching, research, and university sites. As of fall 2015, CSU campuses employed service (such as serving on campus committees). a total of 217 tenured/tenure-track nursing www.lao.ca.gov Legislative Analyst’s Office 11 AN LAO REPORT faculty and 675 part- and full-time lecturers. CSU Study Cites Several Advantages to As postsecondary accreditors do not set specific Offering Its Own DNP. In 2008, the advisory standards on the staffing mix, CSU nursing committee released a study concluding that programs vary on the ratio of tenured/tenure-track (1) more tenure-track faculty were needed to meet faculty and lecturers they employ. For example, in the current and projected demand for additional fall 2015, 24 percent of CSU, Fullerton’s nursing nurses in the state and (2) CSU had sufficient faculty were tenured/tenure-track, as compared institutional interest and capacity to prepare more with 14 percent at San Diego State University. faculty by establishing a doctoral program in In Response to Nursing Shortage, CSU Cites nursing. The CSU study acknowledged that, based Need for Additional Tenure-Track Faculty. As on survey results, its nursing directors would prefer we discussed in Ensuring an Adequate Nursing to offer a Ph.D. rather than a DNP. The committee Workforce: Improving State Nursing Programs recommended against pursuing a Ph.D., however, (May 2007), beginning in the late 1990s, the because (1) doing so would result in “significant state experienced a mismatch between employer competition” from the state’s Ph.D.-granting demand for RNs providing direct patient care programs (including UC’s schools of nursing) and and the size of the RN workforce. In response, (2) previous attempts to develop joint CSU/UC the state began expanding capacity by providing doctoral programs in nursing “were unsuccessful.” budget augmentations for pre-licensure nursing The committee also noted that launching a Ph.D. programs at CCC, CSU, and UC. Despite these program at CSU would require “significant efforts, the number of qualified applicants to growth” within nursing schools to boost research nursing schools in California continued to far productivity among current faculty members and exceed the number of available slots, and numerous secure external funding to support that research. studies throughout much of the 2000s forecasted a The DNP, by contrast, would not require as persistent and long-term nursing shortage absent extensive of a research program for current faculty, further enrollment expansions or other such would be shorter in length than the Ph.D., and strategies. In 2007, the CSU Chancellor’s Office likely would be attractive to nurse professionals formed an advisory committee and tasked it with seeking to advance their careers. exploring options for increasing nursing program CSU Also Cites DNP as Way to Help the capacity. The committee cited a lack of doctorally State Meet Higher Anticipated APRN Education prepared nursing faculty as an impediment to Requirements. In addition to producing future further expanding nursing programs. (At the nursing faculty to address the state’s nursing time, six universities in the state had nursing shortage, the CSU study pointed to AACN’s doctoral programs—five that offered a Ph.D. and 2004 vote to support increasing education one program, the privately operated University of requirements for APRNs to a DNP by 2015. As San Francisco, that offered a DNP.) The advisory the CSU study stated, “It is expected that by 2015, committee was further charged with studying the doctoral degree for advanced practice nurses whether it might be feasible for CSU to train will be required for licensure.” To prepare for future tenured/tenure-track nursing faculty by that anticipated new requirement, the CSU study establishing its own doctoral program. argued that the segment could give the state a head start on meeting that requirement. 12 Legislative Analyst’s Office www.lao.ca.gov AN LAO REPORT CSU Envisioned Having Two DNP Tracks— directors in other states, the study identified a Education and Advanced Practice. The CSU study possible consortium approach in which campuses acknowledged that, as a clinical degree, the DNP is share faculty, facilities, and support. To reduce not designed to prepare nurses for teaching careers. the need for physical space and provide better To reorient its proposed DNP toward preparing access to students (many of whom work full time nursing faculty, the study recommended creating and have family obligations), the CSU study also two tracks within the program—one specializing recommended that at least some courses be taught in nursing education (emphasizing competencies online. Finally, the study recommended that such as curriculum design and development), and CSU begin with DNP programs at two or three a second specializing in advanced clinical practice campuses, with initial cohorts of ten students per to prepare DNP-educated nurse practitioners and campus and future enrollments based on “shifts in other APRNs. demand and resources.” CSU Encouraged a Collaborative Approach Statutory Requirements to Operating Its DNP Programs. The CSU study identified potential ways for CSU campuses to Chapter 416 Authorized CSU DNP as an collaborate with each other on a DNP program so Exception to State’s Longstanding Master Plan for as to use physical and human resources efficiently. Higher Education. As described in more detail in Based on interviews with nursing program the nearby box, California’s Master Plan delineates Doctoral Education at UC and CSU Master Plan Assigned Doctoral Education to University of California (UC), With Allowance for California State University (CSU) to Offer Joint Degrees. In 1960, the Legislature adopted California’s Master Plan for Higher Education and incorporated many of its provisions into statute. Among these provisions is the assignment of specific missions to the state’s public higher education segments. CSU was given primary responsibility for undergraduate and graduate education in liberal arts and sciences through the master’s degree. UC was given responsibility for undergraduate and graduate education through the doctoral degree, but was permitted to award joint doctoral degrees with CSU. The inclusion of joint doctorates in the final plan was a compromise between the two systems. Over the following decades, CSU developed dozens of joint doctoral degrees with UC as well as a private university (Claremont Graduate University). Legislature Has Allowed CSU to Award a Few Independent Doctoral Degrees. Forty-five years after adoption of the Master Plan, the state authorized CSU to offer its first independent doctoral degree, the Doctor of Education Degree. Chapter 269 of 2005 (SB 724, Scott) was narrowly written as an exception to the Master Plan in recognition of the urgency of preparing more educational leaders. Since that time, the Legislature has approved three more independent CSU doctoral programs— each to address a specific issue. In 2010, the Legislature authorized CSU to offer a Doctor of Physical Therapy degree, which was in response to a 2009 decision by an accreditor to no longer accredit physical therapy programs at the master’s level. Also in 2010, the Legislature authorized CSU to offer the Doctor of Nursing Practice degree on a pilot basis. In September 2016, the Legislature authorized CSU to offer an independent Doctor of Audiology degree to address an identified shortage of audiologists in the state. www.lao.ca.gov Legislative Analyst’s Office 13 AN LAO REPORT the graduate-level functions of CSU and UC, with 2010—effectively disallowing CSU from converting CSU to offer master’s degrees and UC to offer both an existing master’s program in nursing to a DNP. master’s and doctoral degrees. Chapter 416 makes Furthermore, the legislation limits CSU to serving an exception to this delineation for a limited, no more than a total of 90 full-time equivalent targeted purpose—to address the nursing shortage (FTE) students across the three campuses. the state was experiencing. Specifically, Chapter 416 DNP Programs Not to Diminish found that (1) California “faces an ever-increasing Undergraduate Programs. Four requirements in nursing shortage that jeopardizes the health and the legislation aim to ensure that enrollment growth well-being of the state’s citizens,” (2) postsecondary in DNP programs do not come at the expense of institutions need to continue to expand nursing undergraduate programs. The requirements, which education programs to address that shortage, and resemble provisions in the legislation authorizing (3) the state needs to produce additional faculty to the Ed.D. and Doctor of Physical Therapy programs teach such programs. Accordingly, Chapter 416’s at CSU, are: (1) enrollment is to be funded from primary purpose was to empower CSU to address within CSU enrollment growth levels as agreed to the state’s nursing shortage by educating doctorally in the annual budget act; (2) state funding for each prepared, tenured/tenure-track nursing faculty. The FTE student is to be at the agreed-upon marginal legislative authorization was temporary—a pilot cost rate for CSU students; (3) DNP enrollments program with a specified sunset date—rather than may not alter CSU’s ratio of graduate instruction to a permanent authority. In authorizing CSU to offer total enrollment, nor diminish growth in university an independent DNP, Chapter 416 set out a number undergraduate programs; and (4) CSU must of specific requirements regarding the purpose provide initial funding from existing budgets, with and funding of the new program. The next few legislative intent that CSU seek private funding or paragraphs describe the main requirements. other nonstate funds for start-up costs. DNPs to Focus on Preparing Nursing Faculty. Tuition Rates Not Specified in Legislation. Chapter 416 requires the independent CSU Unlike the legislation authorizing CSU’s Ed.D. and programs to focus on preparing nurses to serve Doctor of Physical Therapy programs, Chapter 416 as faculty at colleges and universities. In addition does not include any requirements or limits on the to this primary focus, Chapter 416 permits the tuition or fees charged to DNP students. pilot programs to provide additional training for LAO Required to Evaluate Pilot Prior APRNs and nurse leadership. Regardless of the to Scheduled Sunset. Chapter 324 includes degree’s specific purpose, Chapter 416 requires a requirement for CSU to provide specified CSU to design an educational program that nursing information to the Legislature and Governor professionals can complete while working full time. by March 2016, including program enrollment, Campus, Program, and Enrollment Limits completions, and costs. In addition, Chapter 324 Placed on Pilot Programs. Chapter 416 authorizes requires CSU to report on whether its DNP CSU to establish a DNP program at up to three graduates are positively impacting the state’s campuses, which are to be chosen by the Board nursing shortage and the extent to which the pilot of Trustees. In addition, Chapter 416 prohibits programs are “fulfilling identified state needs for the three pilot programs from replacing or training doctorally prepared nurses.” Chapter 324 supplanting any CSU master’s degree nursing then requires our office to consider this and other programs that were offered as of January 1, information and make recommendations on the 14 Legislative Analyst’s Office www.lao.ca.gov AN LAO REPORT future of the pilot. Unless addressed by further enrolling any new students in the degree pilot legislation, Chapter 416 prohibits CSU from programs after July 1, 2018. FINDINGS Below, we present our findings regarding CSU’s Each Consortium Has a Lead Campus, Shares implementation of DNP programs and compliance Teaching Responsibilities. Each consortium has with the Chapter 416 requirements. an administrative lead—the Fresno campus for the northern consortium and the Fullerton campus for Programs the southern consortium. Students apply to one of Chancellor’s Office Specified Policies and the administrative lead campuses and, if accepted, Procedures for New Programs. Once Chapter 416 are an official student of that campus. Each was signed into law, CSU set out to implement consortium also has a committee made up of the the new DNP programs within 18 months. In nursing program directors and DNP coordinators November 2011, the CSU Chancellor issued from the member campuses. The committees meet an executive order outlining the policies and regularly to plan and make decisions on their procedures for the planned DNP programs. program. Under CSU’s consortium approach, The executive order and supporting documents courses are taught by faculty from each of the emphasized the statutory requirements for the member campuses and consortium members share new doctoral programs and established minimum responsibilities such as outreach, recruitment, and eligibility and graduation standards for students. application reviews. Student support services (such CSU Formed Two Consortia Programs as tutoring centers) generally are provided by the Consisting of a Total of Five Campuses. In fall lead campus. 2010, the CSU Chancellor’s Office issued a request Programs Operate Year-Round. While for proposals to CSU campuses that were interested Chapter 416 requires CSU to enable nurse in piloting the DNP. A total of six campuses professionals to earn a DNP while working full responded. The Chancellor’s Office grouped time, the legislation does not set expectations on five of the applicants into two consortia—the the duration of the program. The Chancellor’s Northern California Consortium (consisting of the Office’s November 2011 executive order specified Fresno and San Jose campuses) and the Southern that the program is not to be longer than three California Consortium (consisting of the Fullerton, calendar years in length. Both programs decided Los Angeles, and Long Beach campuses). The other on a five semester-long program (spanning campus (San Diego) subsequently withdrew its plan 21 months), with coursework extending throughout to implement the DNP. The Chancellor’s Office the summer. Students progress through these approved the two consortia and their member programs in cohorts. That is, all students entering campuses in January 2011. The first cohorts in a program in a given fall term take their courses each program began their classes in fall 2012. The together and are expected to complete the program Commission on Collegiate Nursing Education together. formally accredited the southern consortium in Program Use Online Technology to November 2013 and the northern consortium in Deliver Instruction. Both programs have an February 2014. online component. Instruction in the northern www.lao.ca.gov Legislative Analyst’s Office 15 AN LAO REPORT consortium is almost entirely online, with students California consortium has an elective on nursing meeting face to face with instructors and peers education, which adds two units to the degree for a few times per year. Instruction in the southern students who opt to take that course.) The Northern consortium is in-person (at the Fullerton campus) California consortium requires more courses but for the first three semesters. Courses in the final generally has fewer units per course. two semesters of the program are conducted Doctoral Projects a Central Feature of primarily online. Curriculum. Students’ doctoral projects are the centerpiece of the DNP curriculum. Students are Curriculum encouraged to identify a project topic as early as Curriculum Includes Nursing Education possible and approach each course in the context Coursework but No Education Specialization. of their project. For example, students taking Because the Commission on Collegiate Nursing biostatistics are instructed to use the course to Education determined that the DNP is to be a determine the appropriate statistical methods practice-oriented degree, CSU had to drop its for their project. In addition, each program has original plans to create an education specialization. independent study courses in which students are Instead, each CSU pilot program has one practice- expected to work directly with their faculty chair oriented track that includes some coursework in to develop and complete their doctoral project. curriculum development and teaching strategies. Because the DNP is considered a practice degree, Requirements for the Two Programs Largely the Commission on Collegiate Nursing Education the Same. Figure 3 shows the course requirements requires all DNP students to accrue at least 1,000 for the Northern and Southern California clinical hours. CSU’s “Practicum” course allows consortia programs. As the figure shows, course students to meet this requirement while earning requirements are similar and each degree totals units toward their degree by conducting research 36 units. (As the figure indicates, the Northern for their doctoral project at their workplace or Figure 3 Doctor of Nursing Practice Curriculum Similar for Two CSU Consortia Northern California Consortium Units Southern California Consortium Units Biostatistics 3 Biostatistics 3 Epidemiology and Clinical Prevention 3 Epidemiology and Clinical Prevention 3 Evidence-Based Research and Practice 6a Evidence-Based Research and Practice 3 Diversity 2 Health Care Information Systems and Technology 3 Health Care Information Systems and Technology 3 Health Care Policy 2 Health Care Policy and Advocacy 3 Leadership 2 Leadership, Management, and Finance 3 Finance 2 Nursing Education—Curriculum Development 3 Nursing Education—Curriculum Development 3 Nursing Education—Evaluation 3 Nursing Education—Instructional Design 3 Nursing Theories 2 Doctoral Project Development and Completion 2 Doctoral Project Development and Completion 9 Practicum—Clinical Setting 3 Practicum—Clinical Setting 3 Total Units Required 36b 36 a Taken as three separate classes of 2 units each. b On top of the 36 required units, students have the option of taking a 2-unit course in Nursing Education—Evidence-Based Teaching. 16 Legislative Analyst’s Office www.lao.ca.gov AN LAO REPORT other clinical setting. (CSU DNP students can of the two consortia programs. Overall, the two apply to their DNP up to 500 clinical hours that consortia admitted 88 percent of applicants for they accrued in their master’s program.) the first five cohorts, with admission rates for the cohorts ranging from 64 percent to 100 percent. Applications, Admissions, and Enrollment Of the students admitted, 80 percent enrolled. Applicants Must Meet Minimum Job and Enrollment rates for the cohorts ranged from Academic Requirements. To apply to a CSU DNP 68 percent to 89 percent. program, students must (1) have a current RN At Times CSU Has Exceeded the Statutory license; (2) hold a master’s degree in nursing or a Enrollment Limit. As discussed in the previous health-related field (such as public health or health section, Chapter 416 limits DNP “enrollment and administration); (3) meet minimum master’s degree maintenance” to no more than 90 FTE students grade point average (GPA) requirements (3.0 for across the pilot campuses. While CSU served a the northern consortium, 3.5 for the southern total of 45 FTE students in 2012-13 (the initial year consortium); (4) submit a specified number of the pilot) and 88 FTE students in 2015-16, CSU of letters of recommendation or professional exceeded the statutory limit in 2013-14 (112 FTE references; (5) write a statement of purpose; and students) and 2014-15 (99 FTE students). (The (6) complete an interview and writing sample, Chancellor’s Office maintains that it understood as requested. Applicants are scored and ranked Chapter 416’s enrollment limit to mean a combined based on their GPA and other factors. The average 90 FTE students per cohort per year.) master’s program GPA for enrolled students is Undergraduate Share of Enrollment Has 3.8 out of 4.0. Not Diminished. Because DNP enrollments are Most Qualified Applicants Accepted for so small (100 FTE students represent less than Admission. Figure 4 summarizes qualified three one-hundredths of 1 percent of total CSU applications, admissions, and enrollments for each enrollment), the new programs have had little Figure 4 Doctor of Nursing Practice Admission and Enrollment Rates Qualified Admission Enrollment Applicants Admitted Rate Enrolled Rate Northern California Consortium 2012 43 37 86% 33 89% 2013 30 30 100 26 87 2014 33 30 91 25 83 2015 36 32 89 24 75 2016 36 36 100 30 83 Average rate over period — — 93 — 84 Southern California Consortium 2012 64 41 64% 32 78% 2013 44 41 93 35 85 2014 34 34 100 23 68 2015 29 29 100 22 76 2016 54 45 83 35 78 Average rate over period — — 84 — 77 Totals 403 355 88% 285 80% www.lao.ca.gov Legislative Analyst’s Office 17 AN LAO REPORT effect on the undergraduate share of enrollment. In and current protocols in their workplace. Several 2011-12 (the year prior to commencement of DNP alumni remarked that the DNP gave them more programs), undergraduate and graduate enrollment confidence to assume a leadership role at work and accounted for 88.7 percent and 9.5 percent, that having a doctorate kept them at the “same respectively, of total enrollment. Since then, the level” as workplace colleagues who also had the undergraduate share has increased to 90 percent title of “doctor” (such as physicians, pharmacists, and the graduate share has dropped to 8.3 percent. and physical therapists). Finally, multiple students (Postbaccalaurate students in teaching-credential remarked they liked CSU’s education component. programs make up between 1 percent and 2 percent Even if they opted not to teach in a postsecondary of CSU enrollment.) institution after graduation, DNP students felt the nursing education courses helped them become Student Characteristics better teachers of health education to patients and Students Mostly Women Working Full Time. colleagues. Students enrolling in the CSU DNP programs Student Completion Rates typically are in their thirties or forties. Similar to the overall RN workforce, about 90 percent Graduation Rates Are High. To graduate with of students are women. Of the two programs’ a DNP degree, students must successfully complete five cohorts to date, 42 percent have been white, all coursework, write and orally defend a doctoral 26 percent Asian/Pacific Islander, 12 percent project, and—if they did not have it already— Latino, 9 percent African-American, and 11 percent obtain national certification in an APRN role (such Other/Decline to State. The vast majority of DNP as nurse practitioner) or non-APRN role (such as students work full time as nurse professionals while a nurse administrator). To date, three cohorts of enrolled in the program. DNP students have enrolled and graduated. Of the Students Motivated by Number of Factors. 174 students who enrolled in the fall 2012 through During our site visits to the two programs, students fall 2014 cohorts, 162 (93 percent) have graduated. and alumni expressed a number of reasons for The attrition rate for the first three cohorts is choosing to pursue a DNP. Since the DNP is not 7 percent (12 students out of 174). a requirement to practice, the decision to enroll Job Placement in a program generally was not employer-driven. Rather, a number of students cited personal reasons Some Graduates Teaching at Postsecondary and the opportunity to enhance leadership and Institutions—Though Largely in Nontenure-Track critical-thinking skills as prime motivators. Several Positions. As shown in Figure 5, of the 162 CSU students mentioned they sought the DNP to gain a DNP graduates to date, 37 (23 percent) serve as broader perspective on the nursing profession—to faculty at CSU. Most of these faculty (29) are in step back from day-to-day patient care and nontenure-track lecturer positions. Seventeen of acquire more of a systems and organizational these faculty were already lecturers at CSU when viewpoint. While all students had coursework they enrolled in the DNP program. The remaining in nursing theory and evidence-based practices eight faculty hires have tenure-track positions as part of their master’s degree, many stated that at CSU. Of these eight tenure-track hires, three the DNP offered opportunities to expand on this were already lecturers at CSU when they enrolled knowledge base and critically evaluate research in the DNP program. The other five hires had 18 Legislative Analyst’s Office www.lao.ca.gov AN LAO REPORT not previously worked at CSU. In addition to the began in 2012-13. This amount equals $14,340 for 37 CSU faculty hires, 18 DNP graduates have been the academic year and $35,850 for the five semester hired as faculty at other colleges and universities program. In addition to the systemwide tuition, in the state. Data indicate that no more than 7 of campuses set campus fees required of all students. these 18 DNP graduates are in faculty positions that Annual campus fees for DNP students total about require a doctorate. Thus, out of 162 DNP graduates $1,000 (or about $2,000 for the full program). Book to date, no more than 15 (9 percent) likely are in a and supply costs for DNP programs average about tenure-track position requiring a doctorate. $900 per year (or about $1,800 for the program). Most Clinicians and Administrators Stayed Altogether, total educational costs for a DNP degree With the Same Employer Upon Graduating. Based are about $40,000. on CSU surveys of the first two graduating cohorts, Loans and Grants Available. Unlike typical students generally have stayed in their same position CSU students, all DNP students have master’s and with their same employer upon earning their degrees and virtually all work full time. The two DNP degree. Several administrators who have primary sources of financial aid for DNP students maintained their same position, however, indicate are federal student loans and campus grants from that they have expanded responsibilities at work, a 20 percent set-aside from DNP tuition revenues. and a number of administrators and clinicians CSU reserves these campus grants for nursing report that they are now speaking nationally on students they define as financially needGy.r Ianp hic Sign Off their doctoral projects and other areas of expertise. addition, several scholarships and fellowships are Secretary available to offset students’ costs. In 2014-15, just Student Costs and Aid Analyst over 60 percent of DNP students received a federal MPA Students’ Educational Costs Total About loan, which averaged $17,760 per borrower that $40,000 for the Program. The CSU Board of year. Forty-four percent of students reDceeivpeud tay grant Trustees establishes systemwide tuition and fee or scholarship, with awards averaging $11,324. In levels for all programs. The systemwide tuition addition, since the inception of the DNP program, rate for the DNP program in 2016-17 is $7,170 per ten students have received education loans through semester—the same rate as when the program the Chancellor’s Doctoral Incentive Program. Figure 5 A Few CSU DNP Graduates Are Employed as Tenure-Track Faculty Graduates (162) Non-Faculty (107) Hired as Faculty by CSU (37) Part-Time Lecturers (18) Full-Time Hired as Faculty by Other Institutions (18) Lecturers (11) Tenure Track (8) Tenure Track Other (11) Requiring Doctorate (7) DNP = Doctor of Nursing Practice. www.lao.ca.gov Legislative Analyst’s Office 19 ARTWORK #130654 Template_LAOReport_large.ait AN LAO REPORT This program, which is funded with state lottery Costs and Per-Student Spending Varies monies, forgives loans of doctoral students studying by Program. Comparing costs between the at universities throughout the country who take two programs is difficult because of differing full-time teaching jobs at CSU upon earning their accounting practices. For example, library and degree. tutorial services are included in the Southern California consortium’s budget, whereas the Institutional Costs and Funding Northern California consortium covers these Programs Largely Supported by Tuition costs from within Fresno State’s overall university Revenue. Figure 6 shows program revenues and budget. Nevertheless, for both programs, salaries costs for 2014-15, as reported by the consortia to and benefits for DNP faculty and administrators the CSU Chancellor’s Office. Gross tuition revenues account for the largest expense. The second from DNP students totaled $943,000 at the largest costs are university grants, which subsidize Northern California consortium and $1.2 million financially needy DNP students’ tuition. Overall, at the Southern California consortium. Campus the Northern California consortium reports operating funds (comprising primarily a mix of program spending of $17,000 per FTE student state General Fund monies and redirected tuition in 2014-15, whereas the Southern California from non-DNP CSU students) were about $19,000 consortium reports program spending of about at the Northern California consortium and about $27,000 per FTE student. A variety of factors, $194,000 at the Southern California consortium. including differences in the sizes of student cohorts The CSU Chancellor’s Office notes that the total and faculty compensation levels, explain these amount of campus operating funds supporting differences in funding per student. these programs may be understated, however, Start-Up Costs Funded by CSU. Both programs because the amounts in Figure 6 generally do not reported having start-up costs. Start-up costs include campus funding for indirect activities (such included release time for faculty for program as back-office staff in human resources, accounting, and course development and costs for consortia and information technology). meetings, promotional materials, and supplies. Consortium members Figure 6 generally covered these Doctor of Nursing Practice Program Budgets start-up costs using 2014-15 general-purpose funds Northern California Southern California allocated by campus Consortium Consortium administration. The Funding Chancellor’s Office reports Gross tuition revenue $924,930 $1,025,310 Campus operating funds 19,005 194,449 that external sources, Totals $943,935 $1,219,759 such as foundation grants, Expenditures were not pursued due to Instructional faculty $624,973 $599,104 the rapid timeline CSU Administrative staff 181,884 190,642 followed to implement the Financial aid—grants and waivers 99,062 209,807 Other operating expenses 38,016 220,206 new programs. Totals $943,935 $1,219,759 Full-time equivalent (FTE) students 55.5 43.9 Program spending per FTE student $17,008 $27,785 20 Legislative Analyst’s Office www.lao.ca.gov AN LAO REPORT LAO ASSESSMENT AND RECOMMENDATION Below, we offer our assessment of the CSU UCSF currently report that overall the state’s DNP pilot and make a recommendation regarding nursing labor market is “fairly well balanced.” its extension. Moreover, the supply of RNs is forecasted to match State No Longer Facing Primary Problem demand reasonably well through 2035, assuming That CSU DNP Was Designed to Address. The the state continues to produce a stable supply of Legislature supported the pilot DNP program at new nursing graduates each year. As a result, the CSU to address the state’s nursing shortage. Shortly state does not need to rapidly expand the number after Chapter 416 was signed into law, however, the of nursing enrollments and hire large numbers of nursing shortage in the state eased considerably. new faculty as was assumed at the time Chapter 416 According to the Board of Registered Nursing and was enacted. University of California, San Francisco (UCSF) CSU Continues to Report Ongoing Difficulty labor experts, this is due mainly to the significant With Regular Nursing Faculty Recruitment . . . expansion of nursing enrollments and graduations Though the end of the state’s nursing shortage no that occurred between 2001 and 2010. (Please longer meant that CSU had to further build out see the nearby box for an explanation of how the nursing enrollments and hire large numbers of state closed the gap between nursing supply and new faculty, CSU still has vacant nursing faculty demand.) The Board of Registered Nursing and slots to fill each year, primarily due to retirements State Successfully Addressed the Nursing Shortage State Faced Nursing Shortage Throughout the 2000s. Beginning in the 1990s, health care employers indicated that the size of the nursing workforce was insufficient to adequately staff health care facilities—particularly hospitals, which are statutorily required to maintain minimum nurse- to-patient ratios. Despite paying higher wages and encouraging—and in some cases requiring— existing staff to work overtime, the state continued to experience a gap between supply of and demand for Registered Nurses (RNs) into the 2000s. State Responded to Shortage by Expanding Capacity in Nursing Programs. The Legislature responded to this nursing shortage in a number of ways, most notably by providing targeted funding to the state’s public higher education segments to expand pre-licensure nursing enrollments. As a result of these and other factors (including an increase in the number of private colleges launching nursing programs), the number of students graduating with an RN license more than doubled during the 2000s—from about 5,100 graduates in 2000-01 to 10,600 graduates by 2010-11. Nursing Labor Force in Good Shape Overall. According to the latest forecast from the Board of Registered Nursing and University of California, San Francisco, the large number of nursing graduations in the state (which has held reasonably stable at about 11,000 per year) likely is sufficient to ensure an adequate nursing workforce in the state for decades to come. Some hospital officials still report difficulty, however, with recruiting experienced RNs for certain specialized positions and attracting nurses to work in certain regions of the state (such as the Inland Empire and rural areas). www.lao.ca.gov Legislative Analyst’s Office 21 AN LAO REPORT and turnover. Even faced with these regular or bachelor’s degree was about $90,000 in 2014. hiring needs, CSU campuses report considerable Advanced practice clinicians such as nurse difficulties with recruiting tenure-track faculty. For practitioners earned an average of $105,000 in example, the Chancellor’s Office recently queried 2014 and senior nursing administrators averaged three CSU nursing programs concerning their more than $150,000. Like other educational ability to hire tenure-track faculty. In 2015-16, these entities in the state, CSU already has the power to programs advertised for a total of eight tenure- pay differential salaries based on discipline. For track positions, but had to cancel six of these example, the starting salary for CSU tenure-track searches for lack of a sufficient pool of candidates. faculty is more than $10,000 higher in nursing CSU notes, “The difficulties in hiring tenure- departments than in history departments (and track nursing faculty experienced by these three about $25,000 lower in nursing departments than campuses provides a snapshot of what typically in business departments). A more direct way for occurs in the other 16 nursing campuses.” CSU to confront its faculty recruitment problem . . . But Only a Small Number of DNP would be to pay more competitive salaries. CSU Graduates Helping CSU With Regular Hiring nursing programs also could mitigate their hiring Needs. As data from the previous section of this problems by modifying somewhat the proportion report show, the pilot DNP program has produced of overall faculty openings that are tenure-track. only a few CSU tenure-track nursing faculty. Most As mentioned earlier, campuses already have notably, even though CSU routinely has open discretion on the mix of the nursing faculty that positions go unfilled, to date only 8 of 162 DNP is tenured/tenure-track versus master’s-prepared graduates have accepted a tenure-track position lecturers. with CSU. CSU apparently is even having difficulty For the Most Part, Accreditation Expectations converting its “home grown” students into tenure- About APRN Training Have Not Come to track positions—of 20 DNP graduates that were Fruition. As noted earlier, CSU also justified CSU lecturers when they initially enrolled in the an independent DNP program based on its program, just 3 have taken tenure-track positions. expectation that the degree would soon become a (The other 17 DNP graduates have retained requirement for APRNs. With the future exception positions as CSU lecturers.) of nurse anesthetists, however, accreditors and Increasing Compensation Levels More licensing bodies continue to require APRNs to Direct Way for CSU to Address Ongoing Faculty have a master’s (rather than doctoral) degree in Recruitment Challenges. The primary reason nursing. Based on research, the master’s appears given by CSU for its ongoing difficulty attracting to be the appropriate entry-to-practice degree for tenure-track nursing faculty is the relatively low nurse practitioners and other APRNs. Numerous salaries that such faculty receive at CSU compared studies demonstrate that master’s-prepared APRNs with what nurse clinicians and administrators have historically functioned effectively in health earn. In 2014, the average starting salary for care settings and no evidence to date suggests entry-level, tenure-track nursing faculty positions that DNP-prepared APRNs deliver better patient was about $75,000. (In 2016, the average starting care and outcomes than their master’s-prepared salary is up to about $80,000.) By contrast, the counterparts. Board of Registered Nursing reports that the Other Viable DNP Options for Students. As average annual income for RNs with an associate noted earlier, the DNP is a relatively new degree 22 Legislative Analyst’s Office www.lao.ca.gov AN LAO REPORT that has grown rapidly across the country. Whereas segments. The assigning of distinct missions has only three DNP programs were operating in 2004, been widely regarded as one of the most important in 2015 the AACN identified nearly 300 such and valuable elements of the Master Plan—helping programs—many of them online—across 48 states. to: justify state support for two extensive public In California, the number of DNP programs has university systems, impede mission-creep among increased from one in 2006 (at the University institutions, contain growth in costs, and facilitate of San Francisco) to ten today (including the postsecondary access for all eligible students. To two CSU pilot consortia). In addition, three UC promote these key priorities, the Legislature’s campuses (San Francisco, Irvine, and Los Angeles) default has been to maintain CSU’s traditional role are seeking to offer DNP degrees by 2018. The unless compelling state workforce needs dictate UCSF and UC Irvine programs would be offered otherwise. Absent such special circumstances, primarily online (with some occasional face-to-face granting permanent authority to CSU to offer meetings) and be fully fee-supported. Whereas independent doctoral education weakens the state’s UCSF is planning a post-master’s program aimed pursuit of mission differentiation, coherence, and at currently practicing APRNs, UC Irvine is coordination. proposing to have two tracks. Track One would Recommend the Legislature Allow CSU Pilot be a post-bachelor’s program for RNs seeking to to Sunset. Chapter 416 was authorized during a become a DNP-prepared nurse practitioner. Track period when the state forecasted a growing shortage Two would be a post-master’s program along the of RNs and believed that additional faculty would lines of CSU’s current pilot. UCLA, meanwhile, be needed to significantly expand nursing program is planning a post-master’s, primarily face-to-face enrollments. The legislation also was authorized program that also would be fully fee-supported. at a time when CSU and others believed that the UCSF has formally approved the DNP proposal DNP would become a required degree for APRNs and is awaiting a decision by the UC system. UC by 2015. Given a nursing shortage no longer exists, Irvine’s and UCLA’s DNP proposals are undergoing the DNP has not become the required degree for campus review, with a goal to obtain system APRNs, an increasing number of DNP programs approval by spring 2017. In addition to these three (including UC programs) are available to students, proposals, UC Davis is considering offering a DNP and the Legislature has a strong and longstanding degree. preference for the delineation of functions as Granting Permanent Authority to Award laid out in the Master Plan, we recommend the Independent Doctoral Degree Undermines Legislature allow Chapter 416 to sunset. To the Master Plan and State’s Goals. In 1960, California extent CSU nursing programs continue to have adopted a framework intended to guide the state difficulty filling faculty vacancies, CSU already through the ensuing decades of intense demand has other, likely more effective, options at its for college education. Recognizing the potential disposal such as making nursing faculty salaries for what it called “unhealthy competition” among more competitive with the industry and changing the higher education segments, the Master Plan the mix of faculty positions that are tenure- and assigned distinct missions for each of the public nontenure-track (lecturers). www.lao.ca.gov Legislative Analyst’s Office 23 AN LAO REPORT LAO Publications This report was prepared by Paul Steenhausen and reviewed by Jennifer Kuhn. The Legislative Analyst’s Office (LAO) is a nonpartisan office that provides fiscal and policy information and advice to the Legislature. To request publications call (916) 445-4656. This report and others, as well as an e-mail subscription service, are available on the LAO’s website at www.lao.ca.gov. The LAO is located at 925 L Street, Suite 1000, Sacramento, CA 95814. 24 Legislative Analyst’s Office www.lao.ca.gov