Existing law provides funding for career technical education programs, including through, among others, the California Career Technical Education Incentive Grant Program and the Strong Workforce Program and a K12 component of the Strong Workforce Program, with the purpose of creating, maintaining, supporting, encouraging, strengthening, and expanding the delivery of career technical education programs in the state, as provided.

This bill would require the Superintendent of Public Instruction, subject to an appropriation of one-time funds for this purpose in the annual Budget Act or another statute, to allocate funding for the development of career pathways toward an associate degree in nursing at any of Californias community colleges at schoolsites that serve pupils in grades 9 to 12, inclusive, to be known as the Nursing Pathway Pilot Program. The bill would require the Superintendent to allocate these funds to pilot local educational agencies, as defined to include school districts, county offices of education, state special schools, and charter schools, on the basis of an equal amount per unit of average daily attendance, as those numbers were reported at the time of the first principal apportionment for the 202223 fiscal year. The bill would require the Superintendent to select those pilot local educational agencies through a competitive application process by no later than July 1, 2024, based on an applicants demonstrated ability with a community college to meet specified requirements. The bill would require the Superintendent to consult with the Board of Registered Nursing in the development of the competitive application process to ensure alignment with the Nursing Practice Act. The bill would require the selected pilot local educational agencies to expend allocated funds for, among other things, instructional materials aligned to the applicable science curriculum framework adopted by the State Board of Education and addressing the nursing profession. The bill would require the Superintendent to submit a report on the pilot program to the Legislature on or before January 1, 2028.

The bill would require that a pupil who enrolls in a pilot program pursuant to these provisions earn credits towards an associate degree in nursing program at any California community college, as provided, and that a pupil who successfully completes a pilot program gains preferential enrollment status toward an associate degree in nursing program at any California community college if certain conditions are met. The bill would require the Board of Governors of the California Community Colleges to adopt policies to implement provisions regarding community colleges. The bill would require the Board of Registered Nursing to review and approve any nursing course curriculum provided as a part of the pilot program to ensure alignment with the Nursing Practice Act. To the extent this bill imposes additional duties on community college districts, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Existing law provides funding for career technical education programs, including through, among others, the California Career Technical Education Incentive Grant Program and the Strong Workforce Program and a K12 component of the Strong Workforce Program, with the purpose of creating, maintaining, supporting, encouraging, strengthening, and expanding the delivery of career technical education programs in the state, as provided.

This bill would require the Superintendent of Public Instruction, subject to an appropriation of one-time funds for this purpose in the annual Budget Act or another statute, to allocate funding for the development of career pathways toward an associate degree in nursing at any of Californias community colleges at schoolsites that serve pupils in grades 9 to 12, inclusive, to be known as the Nursing Pathway Pilot Program. The bill would require the Superintendent to allocate these funds to pilot local educational agencies, as defined to include school districts, county offices of education, state special schools, and charter schools schools, on the basis of an equal amount per unit of average daily attendance, as those numbers were reported at the time of the first principal apportionment for the 202223 fiscal year. The bill would require the Superintendent to select those pilot local educational agencies through a competitive application process by no later than July 1, 2024, based on an applicants demonstrated ability with a community college to meet specified requirements. The bill would require those recipients the selected pilot local educational agencies to expend allocated funds for, among other things, instructional materials aligned to the applicable science curriculum framework adopted by the State Board of Education and addressing the nursing profession. The bill would require that the Superintendent to submit a report on the pilot program to the Legislature on or before January 1, 2028.

The bill would require that a pupil who enrolls in a pilot program pursuant to these provisions earn credits towards an associate degree in nursing program at any California community college, as provided, and that a pupil who successfully completes a pilot program gains preferential enrollment status toward an associate degree in nursing program at any California community college if certain conditions are met. The bill would require the Board of Governors of the California Community Colleges to adopt policies to implement provisions regarding community colleges. To the extent this bill imposes additional duties on community college districts, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Existing law establishes the California Career Technical Education Incentive Grant Program, administered by the State Department of Education, with the purpose of encouraging, maintaining, and strengthening the delivery of high-quality career technical education programs.

This bill would state the intent of the Legislature to enact future legislation relating to career technical education.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 1695

Author:(Gipson)

As Amended Ver:July 5, 2023

Majority vote

SUMMARY

Establishes the Nursing Pathway Pilot Program in high schools to create pathways toward associate degrees in nursing at California Community Colleges (CCCs), subject to an appropriation. Requires the Superintendent of Public Instruction (SPI) to select pilots no later than July 1, 2024, to allocate funding for the pilot to local educational agencies (LEAs) on the basis of average daily attendance (ADA), and requires that students completing the pathway earn community college credit and be given preferential admittance to nursing programs at Community Colleges.

Senate Amendments

1. Require the SPI to consult with the Board of Registered Nursing in the development of the competitive application process to ensure alignment with the Nursing Practice Act.
2. Require the Board of Registered Nursing to review and approve any nursing course curriculum provided as a part of the pilot program to ensure alignment with the Nursing Practice Act.

COMMENTS

California's nursing shortage may be abating. According to the United States (U.S.) Department of Labor, Bureau of Labor Statistics, health care spending is approximately 18% of the U.S. economy (GDP), and nursing is the single largest profession in the entire U.S. health care workforce with Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) making up the two largest occupations in this profession. Prior to the COVID-19 pandemic, according to a 2017 U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Health Workforce report, Supply and Demand Projections of the Nursing Workforce: 2014-2030, California is projected to have a shortage of RNs or LPNs by 2030, as shown in Table 1.

Table 1: Baseline and Projected Supply of and Demand for Registered Nurses by State: 2014 and 2030

Source: Supply and Demand Projections of the Nursing Workforce: 2014-2030, U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Health Workforce, 2017.

However, according to a 2022 California-specific research report from the University of California San Francisco, Forecasts of the Registered Nurse Workforce in California, over the last two years enrollments and graduations from RN education programs have declined, although numbers of applications continue to rise. RN education enrollments are projected to surpass pre-pandemic levels within the next two years, which is projected to lead to a closing of the shortage by 2029. In the last four years, many older RNs have left nursing, and a large proportion of older RNs intend to retire or quit within the next two years. Many RNs report that childcare and school closures have made it difficult to work, and that they feel that their employers do not care about their well-being or recognize their contributions.

Defining Career Technical Education. CTE prepares students for the world of work by introducing them to workplace competencies, and makes academic content accessible to students by providing it in a hands-on context. Along the way, students develop career-relevant, real-world 21st Century skills.

CTE is a program of study that involves a multiyear sequence of courses that integrates core academic knowledge with technical and occupational knowledge to provide students with a pathway to postsecondary education and careers. CTE programs in California are organized into 15 industry sectors, covering 58 pathways that identify the knowledge and skills students need. Partnerships are usually developed between high schools, businesses, and postsecondary schools, providing pathways to employment and associate, Bachelor's and advanced degrees.

CTE courses and pathways may be offered in comprehensive high schools with CTE programs, as well as through regional CTE programs or centers operated by JPAs or COEs. Some CTE programs are blended with academic programs in what is known as a "linked learning model." Community colleges and technical institutes also offer CTE at the postsecondary level.

Improved outcomes for CTE students. A wide body of research indicates that involvement in CTE coursework provides improved academic outcomes and other benefits to students with findings, such as the following:

1. Students with greater exposure to CTE are more likely to graduate from high school, enroll in a two-year college, be employed, and earn higher wages;
2. The average high school graduation rate for students concentrating in CTE programs is 93%, compared to an average national graduation rate of 80%;
3. Students taking more CTE classes are just as likely to pursue a four-year degree as their peers;
4. 91% of high school graduates who earned 2-3 CTE credits enrolled in college;
5. CTE provides the greatest boost to students who need it most – boys and students from low-income families; and
6. 80% of students taking a college preparatory academic curriculum with rigorous CTE met college and career readiness goals, compared to only 63% of students taking the same academic core who did not experience rigorous CTE.

Schools currently offer CTE courses in the health field. The California CTE Model Curriculum Standards apply to 15 industry sectors. Within the Health Science and Medical Technology sector, the standards represent the academic and technical skills and knowledge students need to pursue a full range of career opportunities in health science and medical technology, from entry level to management as well as technical and professional career specialties. The standards describe what workers need to know and be able to do to contribute to the delivery of safe and effective health care. The six career pathways are grouped into functions that have a common purpose and require similar attributes. The pathways are Biotechnology, Patient Care, Health Care Administrative Services, Health Care Operational Support Services, Public and Community Health, and Mental and Behavioral Health. Standards for each career path build on and continue the anchor standards with more complexity, rigor, and career specificity.

CDE data for the 2018-19 school year identifies 895 schools in California offering CTE classes in the Health Sciences and Medical Technology pathway. A total of 100,196 students were enrolled in these classes. Of these, 66% were female and 34% male students.

According to the Author

"California is facing a nursing shortage crisis, and we must address it at the root. This pilot program proposal is not a short-term band-aid, it is a long-term solution. We must train and retain more nurses here in California to help stop this ever-widening chasm of demand. This pilot program will be one tool in our belt to address this crisis, and it will empower our youth to fast-track their careers. Nurses are a vital part of the healthcare team, and healthcare systems fall apart without them, so it is crucial to shoring up our supply before this crisis reaches a critical tipping point."

Arguments in Support

The United Nurses Associations of California/Union of Health Care Professionals writes, "California faces a severe shortage of nurses, both now and in the future. If present trends continue, the shortage of nurses will only grow in the coming decades. With nursing programs impacted all over the state, it is imperative that we do whatever we can to speed up the training pipeline and get qualified nurses into patient care setting as soon as possible. AB 1695 accomplishes that by allowing high-school students to start earning the credits they need earlier than under current law, and enables them to complete the degree necessary to begin their career earlier. Currently, many potential nursing students are discouraged from entering the field simply because it will take years longer than it should for them to actually embark upon their professional career. Because it takes so long to get into nursing programs due to extended wait lists, this bill will remove some of the barriers facing students. This bill can make a real difference toward addressing the shortage of nurses, by enabling them to enter programs sooner and stay on track for the completion of the degree program. More nurses means more adequate staffing, which in turn leads to better patient outcomes and better health care access for all Californians."

Arguments in Opposition

None on file

FISCAL COMMENTS

According to the Senate Appropriations Committee:

1. While this bill's provisions would be subject to an appropriation, it could result in one-time Proposition 98 General Fund cost pressures in the millions of dollars to support the pilot program.
2. The Chancellor's Office estimates ongoing Proposition 98 General Fund costs to local community colleges for the duration of the pilot program related to cooperating with local educational agencies to ensure the pilot program adequately educates pupils on select areas of nursing to count toward community college nursing program credits. The extent of these costs would depend on the number of colleges participating in the pilot program, but could range from $8,068 to $20,899 per college, or $928,000 to $2.4 million statewide. In addition, the Chancellor’s Office indicates there could be a reduction in tuition due to the preferential enrollment of pilot program students.
3. The Chancellor's Office estimates General Fund costs of between $13,000 and $55,000 for the Board of Governors to adopt policies needed to implement the bill’s requirements.
4. The California Department of Education (CDE) indicates that any costs to administer the program would be minor and absorbable within existing resources.
5. The Board of Registered Nursing indicates that the bill would have a minor and absorbable fiscal impact, as reviewing and approving the nursing course curriculum would fall under the normal duties and responsibilities of existing staff.

VOTES:

ASM EDUCATION: 7-0-0

YES: Muratsuchi, Megan Dahle, Juan Carrillo, Hoover, Lee, McCarty, Quirk-Silva

ASM HIGHER EDUCATION: 12-0-0

YES: Mike Fong, Ta, Addis, Arambula, Gabriel, Irwin, Low, Ortega, Sanchez, Santiago, Wallis, Weber

ASM APPROPRIATIONS: 15-0-1

YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Lowenthal, Mathis, Papan, Pellerin, Sanchez, Weber, Ortega

ABS, ABST OR NV: Robert Rivas

ASSEMBLY FLOOR: 80-0-0

YES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones‑Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon

UPDATED

VERSION: July 5, 2023

CONSULTANT: Marguerite Ries / ED. / (916) 319-2087 FN: 0002277

 THIRD READING  

Bill No: AB 1695

Author: Gipson (D)

Amended: 7/5/23 in Senate

Vote: 21

SENATE EDUCATION COMMITTEE: 7-0, 6/28/23

AYES: Newman, Ochoa Bogh, Cortese, Glazer, McGuire, Smallwood-Cuevas, Wilk

SENATE APPROPRIATIONS COMMITTEE: 7-0, 9/1/23

AYES: Portantino, Jones, Ashby, Bradford, Seyarto, Wahab, Wiener

ASSEMBLY FLOOR: 80-0, 5/31/23 - See last page for vote

SUBJECT: Career technical education: Nursing Pathway Pilot Program

SOURCE: United Nurses Associations of California/Union of Health Care Professionals

DIGEST:

This bill establishes the Nursing Pathway Pilot Program in high schools to create pathways toward associate degrees in nursing at California Community Colleges (CCCs).

ANALYSIS:

Existing law:

1. Establishes the mission and function of the CCC, which, in part is to: (a) offer academic and vocational instruction at the lower division level for both younger and older students, including those persons returning to school; (b) authorizes the CCC to grant the associate in arts and the associate in science degrees; (c) requires the CCC to offer English as a Second Language instruction, adult noncredit instruction, and support services which help students succeed at the postsecondary level; and, (d) advance California’s economic growth and global competitiveness through education, training, and services that contribute to continuous workforce improvement. (Education Code (EC) Section 66010.4)
2. Establishes the CCC under the administration of the Board of Governors (BOG); and, specifies that the CCC consist of community college districts. (EC Section 70900)
3. Requires the CCC BOG to provide leadership and direction in the continuing development of the CCC as an integral and effective element in the structure of public higher education in the state. The work of the BOG must at all times be directed to maintaining and continuing, to the maximum degree permissible, local authority and control in the administration of the CCC. (EC Section 70901)
4. Stipulates, until January 1, 2025, that if a community college registered nursing program determines that the number of applicants to that program exceeds its capacity, the nursing program may admit students through specified methods.
5. Authorizes the K-12 component of the Strong Workforce Program (SWP) to create, support, or expand high-quality career technical education (CTE) programs at the K-12 level that are aligned with the workforce development efforts occurring through the SWP, and authorizes, commencing with the 2018-19 fiscal year, and subject to an annual appropriation, $150 million to be apportioned annually by the California Community Colleges Chancellor’s Office (CCCCO) to local consortia. (EC 88827)

This bill:

1. Establishes the Nursing Pathway Pilot Program until January 1, 2032.
2. Requires, subject to an appropriation, the Superintendent of Public Instruction (SPI) to allocate funding for the development of career pathways toward an associate degree in nursing at community college schoolsites, serving students in grades 9-12, subject to an appropriation of one-time funds for this purpose.
3. Requires the SPI to allocate funds to pilot local educational agencies (LEAs) on the basis of an equal amount per average daily attendance (ADA) based upon 2022-2023 figures, authorizes the funds to be encumbered through the 2026-2027 fiscal year, and requires funds to be subject to annual audits.
4. Requires the SPI to select the LEAs through a competitive application process by no later than July 1, 2024, based on an applicant’s demonstrated ability with a CCC to provide all of the following:
5. Professional development for teachers, administrators, and paraprofessional staff or other classified employees involved in the direct instruction of pupils in the nursing profession, the employment opportunities that a career in nursing offers, the educational requirements for various nursing degrees, and age-appropriate instruction on basic direct patient health care principles;
6. The ability for pupils to earn credits towards an associate degree in nursing program at any CCC; and,
7. The inclusion of a signed statement of support from a community college.
8. Authorizes a pilot LEA to use the funds received for any of the following:

a) Professional development for teachers, administrators, and paraprofessional staff or other classified employees involved in the direct instruction of pupils on the nursing profession, the employment opportunities that a career in nursing offers, the educational requirements for various nursing degrees, and age-appropriate instruction on basic direct patient health care principles;

b) Instructional materials aligned to the applicable science curriculum framework adopted by the State Board of Education (SBE) and addressing the nursing profession; and,

c) Age-appropriate hands-on instruction in hospitals, clinics, or other health care facilities.

6) Requires that a student enrolled in a pilot program earn credits toward an associate degree in nursing at any CCC. Credits are required to be applied upon the student’s successful admission to the nursing program.

7) Requires that a student who completes a pilot program be granted preferential enrollment status toward an associate degree in any CCC, subject to the establishment of additional capacity in community college nursing programs above and beyond the level in place for the 2024-2025 academic year (AY).

8) Requires the CCC BOG to adopt policies to implement the requirements of this section.

9) Requires the California Department of Education (CDE), by January 1, 2028, to submit a report on the pilot program to the Legislature.

Comments

1. Need for the bill. According to the author, “California is facing a nursing shortage crisis, and we must address it at the root. This pilot program proposal is not a short-term band-aid, it is a long-term solution. We must train and retain more nurses here in California to help stop this ever-widening chasm of demand.”

The author states that, “this pilot program will be one tool in our belt to address this crisis, and it will empower our youth to fast-track their careers. Nurses are a vital part of the healthcare team, and healthcare systems fall apart without them, so it is crucial to shoring up our supply before this crisis reaches a critical tipping point.”

1. The shortage of school nurses. By 2030, California is anticipated to have the most severe nursing shortage alongside Florida and Texas. It is estimated that for the 2018-2019 school year, there were about 2,700 school nurses employed and about 6.2 million students enrolled in California. This equates to about 2,300 students potentially needing care from each school nurse. Some rural counties reported no school nurses at all. The American Academy of Pediatrics recommends one school nurse to 750 students in a healthy population and one school nurse to 225 students when accounting for pupils who require daily professional health services.

These numbers are not new as it has been many years since every school in the state had a nurse of its own to conduct on-campus health screenings, review immunization records, tend to students’ minor medical needs and perform other duties intended to keep students healthy. The role of school nurses has become more critical due to the pandemic, with schools required to follow an extensive list of health and safety protocols.

In analyzing the potential causes of the school nurse shortage, it should be noted that the average salary for a nurse in California is $113,250. Meanwhile, the average salary for a school nurse in Los Angeles Unified was less than $80,000 in 2019, according to the district. In Fresno Unified, a school nurse is currently paid between $56,000 and $91,000 for 185 days of work, according to the district. School nurses often work fewer days than nurses working in hospitals and clinics, but they have to accept a lower annual salary and must take additional classes and pay more fees to get the job, which requires a School Nurse Services Credential.

1. Existing school nursing credential programs only offered at higher education institutions. Currently, there are four school nursing credential programs in California offered in the state: California State University at Fresno, California State University at Sacramento, California State University at Fullerton, and one private program offered at Azusa Pacific University located northeast of Los Angeles. The cost for these credential programs range from $4,392 to $19,552. The four school nursing credential programs provide classes such as Advanced Pediatric Health Assessment and Health Promotion, Adolescent Health Care, and Advanced Health Assessment: Ambulatory Pediatrics. The curriculum of these programs are specific to K-12 schools. Aspiring candidates enter the credential programs certified as registered nurses where they learn to work with children in a school environment, provide health and wellness services to a diverse student body, demonstrate professional management skills of data and recordkeeping, and study the formulation and evaluation of health policy.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes

According to the Senate Appropriations Committee:

• While this bill’s provisions would be subject to an appropriation, it could result in one-time Proposition 98 General Fund cost pressures in the millions of dollars to support the pilot program.
• The CCCCO estimates ongoing Proposition 98 General Fund costs to local community colleges for the duration of the pilot program related to cooperating with local educational agencies to ensure the pilot program adequately educates pupils on select areas of nursing to count toward community college nursing program credits. The extent of these costs would depend on the number of colleges participating in the pilot program, but could range from $8,068 to $20,899 per college, or $928,000 to $2.4 million statewide. In addition, the Chancellor’s Office indicates there could be a reduction in tuition due to the preferential enrollment of pilot program students.
• The CCCCO estimates General Fund costs of between $13,000 and $55,000 for the Board of Governors to adopt policies needed to implement this bill’s requirements.
• CDE indicates that any costs to administer the program would be minor and absorbable within existing resources.
• The Board of Registered Nursing indicates that this bill would have a minor and absorbable fiscal impact, as reviewing and approving the nursing course curriculum would fall under the normal duties and responsibilities of existing staff.

SUPPORT: (Verified 9/1/23)

United Nurses Associations of California/Union of Health Care Professionals (source)

American Federation of State, County, and Municipal Employees

Board of Registered Nursing

California Hospital Association

California School Nurses Organization

California Workforce Association

Los Angeles County Office of Education

OPPOSITION: (Verified 9/1/23)

None received

ASSEMBLY FLOOR: 80-0, 5/31/23

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon

Prepared by: Ian Johnson / ED. / (916) 651-4105

9/4/23 9:19:18

**** END ****

SENATE COMMITTEE ON

Senator Anthony Portantino, Chair

2023 - 2024 Regular Session

AB 1695 (Gipson) - Career technical education: Nursing Pathway Pilot Program

Bill Summary:

This bill establishes the Nursing Pathway Pilot Program in high schools to create pathways toward associate degrees in nursing at California Community Colleges (CCCs).

Fiscal Impact:

• While the bill’s provisions would be subject to an appropriation, it could result in one-time Proposition 98 General Fund cost pressures in the millions of dollars to support the pilot program.
• The Chancellor’s Office estimates ongoing Proposition 98 General Fund costs to local community colleges for the duration of the pilot program related to cooperating with local educational agencies to ensure the pilot program adequately educates pupils on select areas of nursing to count toward community college nursing program credits. The extent of these costs would depend on the number of colleges participating in the pilot program, but could range from $8,068 to $20,899 per college, or $928,000 to $2.4 million statewide. In addition, the Chancellor’s Office indicates there could be a reduction in tuition due to the preferential enrollment of pilot program students.
• The Chancellor’s Office estimates General Fund costs of between $13,000 and $55,000 for the Board of Governors to adopt policies needed to implement the bill’s requirements.
• The California Department of Education (CDE) indicates that any costs to administer the program would be minor and absorbable within existing resources.
• The Board of Registered Nursing indicates that the bill would have a minor and absorbable fiscal impact, as reviewing and approving the nursing course curriculum would fall under the normal duties and responsibilities of existing staff.

Background:

Existing law establishes the mission and function of the CCC, which, in part is to: 1) offer academic and vocational instruction at the lower division level for both younger and older students, including those persons returning to school; 2) authorizes the CCC to grant the associate in arts and the associate in science degrees; 3) requires the CCC to offer English as a Second Language instruction, adult noncredit instruction, and support services which help students succeed at the postsecondary level; and, 4) advance California’s economic growth and global competitiveness through education, training, and services that contribute to continuous workforce improvement.

The CCCs offer three different types of nursing programs: certifications as nursing assistants, licensed vocational nursing, and registered nursing degrees. For the 2017-18 academic year, there were 77 colleges that offered an associate’s degree in nursing and total enrollment of 12,960 full-time equivalent students in nursing programs systemwide.

Dual enrollment programs allow high school pupils to take college courses, and earn college credits while still attending high school. These programs, also referred to as concurrent enrollment, dual credit, or early college programs, are designed to increase college access and degree attainment, especially for students typically underrepresented in higher education.

Proposed Law:

This bill establishes the Nursing Pathway Pilot Program until January 1, 2032. It requires, subject to an appropriation, the Superintendent of Public Instruction (SPI) to allocate funding for the development of career pathways toward an associate degree in nursing at community college schoolsites, serving students in grades 9-12, subject to an appropriation of one-time funds for this purpose.

This bill requires the SPI to allocate funds to pilot local educational agencies (LEAs) on the basis of an equal amount per average daily attendance (ADA) based upon 2022-2023 figures, authorizes the funds to be encumbered through the 2026-2027 fiscal year, and requires funds to be subject to annual audits. The SPI shall select the LEAs through a competitive application process by no later than July 1, 2024, based on an applicant’s demonstrated ability with a CCC to provide all of the following:

1. Professional development for teachers, administrators, and paraprofessional staff or other classified employees involved in the direct instruction of pupils in the nursing profession, the employment opportunities that a career in nursing offers, the educational requirements for various nursing degrees, and age-appropriate instruction on basic direct patient health care principles;
2. The ability for pupils to earn credits towards an associate degree in nursing program at any CCC; and,
3. The inclusion of a signed statement of support from a community college.

This bill authorizes a pilot LEA to use the funds received for any of the following:

1. Professional development for teachers, administrators, and paraprofessional staff or other classified employees involved in the direct instruction of pupils on the nursing profession, the employment opportunities that a career in nursing offers, the educational requirements for various nursing degrees, and age-appropriate instruction on basic direct patient health care principles;
2. Instructional materials aligned to the applicable science curriculum framework adopted by the State Board of Education and addressing the nursing profession; and,
3. Age-appropriate hands-on instruction in hospitals, clinics, or other health care facilities.

This bill requires the SPI to consult with the California Board of Registered Nursing and require the California Board of Registered Nursing to approve any nursing course curriculum to ensure alignment with California’s Nursing Practice Act.

This bill requires that a student enrolled in a pilot program earn credits toward an associate degree in nursing at any CCC and credits are required to be applied upon the student’s successful admission to the nursing program.

This bill requires that a student who completes a pilot program be granted preferential enrollment status toward an associate degree in any CCC, subject to the establishment of additional capacity in community college nursing programs above and beyond the level in place for the 2024-2025 academic year (AY).

This bill requires the CCC Board of Governors to adopt policies to implement the requirements of this section, and for the CDE, by January 1, 2028, to submit a report on the pilot program to the Legislature.

Related Legislation:

SB 101 (Skinner, Chapter 12, Statutes of 2023), the Budget Act of 2023, includes $60 million in Proposition 98 General Fund per year, starting in 2024-25 for at least five years to grow, educate, and maintain the next generation of registered nurses through the community college system.

-- END --

SENATE COMMITTEE ON

Senator Anthony Portantino, Chair

2023 - 2024 Regular Session

AB 1695 (Gipson) - Career technical education: Nursing Pathway Pilot Program

Bill Summary:

This bill establishes the Nursing Pathway Pilot Program in high schools to create pathways toward associate degrees in nursing at California Community Colleges (CCCs).

Fiscal Impact:

• While the bill’s provisions would be subject to an appropriation, it could result in one-time Proposition 98 General Fund cost pressures in the millions of dollars to support the pilot program.
• The Chancellor’s Office estimates ongoing Proposition 98 General Fund costs to local community colleges for the duration of the pilot program related to cooperating with local educational agencies to ensure the pilot program adequately educates pupils on select areas of nursing to count toward community college nursing program credits. The extent of these costs would depend on the number of colleges participating in the pilot program, but could range from $8,068 to $20,899 per college, or $928,000 to $2.4 million statewide. In addition, the Chancellor’s Office indicates there could be a reduction in tuition due to the preferential enrollment of pilot program students.
• The Chancellor’s Office estimates General Fund costs of between $13,000 and $55,000 for the Board of Governors to adopt policies needed to implement the bill’s requirements.
• The California Department of Education (CDE) indicates that any costs to administer the program would be minor and absorbable within existing resources.
• The Board of Registered Nursing indicates that the bill would have a minor and absorbable fiscal impact, as reviewing and approving the nursing course curriculum would fall under the normal duties and responsibilities of existing staff.

Background:

Existing law establishes the mission and function of the CCC, which, in part is to: 1) offer academic and vocational instruction at the lower division level for both younger and older students, including those persons returning to school; 2) authorizes the CCC to grant the associate in arts and the associate in science degrees; 3) requires the CCC to offer English as a Second Language instruction, adult noncredit instruction, and support services which help students succeed at the postsecondary level; and, 4) advance California’s economic growth and global competitiveness through education, training, and services that contribute to continuous workforce improvement.

The CCCs offer three different types of nursing programs: certifications as nursing assistants, licensed vocational nursing, and registered nursing degrees. For the 2017-18 academic year, there were 77 colleges that offered an associate’s degree in nursing and total enrollment of 12,960 full-time equivalent students in nursing programs systemwide.

Dual enrollment programs allow high school pupils to take college courses, and earn college credits while still attending high school. These programs, also referred to as concurrent enrollment, dual credit, or early college programs, are designed to increase college access and degree attainment, especially for students typically underrepresented in higher education.

Proposed Law:

This bill establishes the Nursing Pathway Pilot Program until January 1, 2032. It requires, subject to an appropriation, the Superintendent of Public Instruction (SPI) to allocate funding for the development of career pathways toward an associate degree in nursing at community college schoolsites, serving students in grades 9-12, subject to an appropriation of one-time funds for this purpose.

This bill requires the SPI to allocate funds to pilot local educational agencies (LEAs) on the basis of an equal amount per average daily attendance (ADA) based upon 2022-2023 figures, authorizes the funds to be encumbered through the 2026-2027 fiscal year, and requires funds to be subject to annual audits. The SPI shall select the LEAs through a competitive application process by no later than July 1, 2024, based on an applicant’s demonstrated ability with a CCC to provide all of the following:

1. Professional development for teachers, administrators, and paraprofessional staff or other classified employees involved in the direct instruction of pupils in the nursing profession, the employment opportunities that a career in nursing offers, the educational requirements for various nursing degrees, and age-appropriate instruction on basic direct patient health care principles;
2. The ability for pupils to earn credits towards an associate degree in nursing program at any CCC; and,
3. The inclusion of a signed statement of support from a community college.

This bill authorizes a pilot LEA to use the funds received for any of the following:

1. Professional development for teachers, administrators, and paraprofessional staff or other classified employees involved in the direct instruction of pupils on the nursing profession, the employment opportunities that a career in nursing offers, the educational requirements for various nursing degrees, and age-appropriate instruction on basic direct patient health care principles;
2. Instructional materials aligned to the applicable science curriculum framework adopted by the State Board of Education and addressing the nursing profession; and,
3. Age-appropriate hands-on instruction in hospitals, clinics, or other health care facilities.

This bill requires the SPI to consult with the California Board of Registered Nursing and require the California Board of Registered Nursing to approve any nursing course curriculum to ensure alignment with California’s Nursing Practice Act.

This bill requires that a student enrolled in a pilot program earn credits toward an associate degree in nursing at any CCC and credits are required to be applied upon the student’s successful admission to the nursing program.

This bill requires that a student who completes a pilot program be granted preferential enrollment status toward an associate degree in any CCC, subject to the establishment of additional capacity in community college nursing programs above and beyond the level in place for the 2024-2025 academic year (AY).

This bill requires the CCC Board of Governors to adopt policies to implement the requirements of this section, and for the CDE, by January 1, 2028, to submit a report on the pilot program to the Legislature.

Related Legislation:

SB 101 (Skinner, Chapter 12, Statutes of 2023), the Budget Act of 2023, includes $60 million in Proposition 98 General Fund per year, starting in 2024-25 for at least five years to grow, educate, and maintain the next generation of registered nurses through the community college system.

-- END --

SENATE COMMITTEE ON EDUCATION

Senator Josh Newman, Chair

2023 - 2024 Regular

Bill No: AB 1695 Hearing Date: June 28, 2023

Subject: Career technical education: Nursing Pathway Pilot Program.

SUMMARY

This bill establishes the Nursing Pathway Pilot Program in high schools to create pathways toward associate degrees in nursing at California Community Colleges (CCCs).

BACKGROUND

Existing law:

1) Establishes the mission and function of the CCC, which, in part is to: 1) offer academic and vocational instruction at the lower division level for both younger and older students, including those persons returning to school; 2) authorizes the CCC to grant the associate in arts and the associate in science degrees; 3) requires the CCC to offer English as a Second Language instruction, adult noncredit instruction, and support services which help students succeed at the postsecondary level; and, 4) advance California’s economic growth and global competitiveness through education, training, and services that contribute to continuous workforce improvement. (Education Code (EC) Section 66010.4)

2) Establishes the CCC under the administration of the Board of Governors (BOG); and, specifies that the CCC consist of community college districts. (EC Section 70900)

3) Requires the CCC BOG to provide leadership and direction in the continuing development of the CCC as an integral and effective element in the structure of public higher education in the state. The work of the BOG must at all times be directed to maintaining and continuing, to the maximum degree permissible, local authority and control in the administration of the CCC. (EC Section 70901)

4) Stipulates, until January 1, 2025, that if a community college registered nursing program determines that the number of applicants to that program exceeds its capacity, the nursing program may admit students through specified methods.

5) Authorizes the K-12 component of the Strong Workforce Program (SWP) to create, support, or expand high-quality career technical education (CTE) programs at the K-12 level that are aligned with the workforce development efforts occurring through the SWP, and authorizes, commencing with the 2018-19 fiscal year, and subject to an annual appropriation, $150 million to be apportioned annually by the California Community Colleges Chancellor’s Office (CCCCO) to local consortia. (EC 88827)

ANALYSIS

This bill:

1. Establishes the Nursing Pathway Pilot Program until January 1, 2032.
2. Requires, subject to an appropriation, the Superintendent of Public Instruction (SPI) to allocate funding for the development of career pathways toward an associate degree in nursing at community college schoolsites, serving students in grades 9-12, subject to an appropriation of one-time funds for this purpose.
3. Requires the SPI to allocate funds to pilot local educational agencies (LEAs) on the basis of an equal amount per average daily attendance (ADA) based upon 2022-2023 figures, authorizes the funds to be encumbered through the 2026-2027 fiscal year, and requires funds to be subject to annual audits.
4. Requires the SPI to select the LEAs through a competitive application process by no later than July 1, 2024, based on an applicant’s demonstrated ability with a CCC to provide all of the following:
5. Professional development for teachers, administrators, and paraprofessional staff or other classified employees involved in the direct instruction of pupils in the nursing profession, the employment opportunities that a career in nursing offers, the educational requirements for various nursing degrees, and age-appropriate instruction on basic direct patient health care principles;
6. The ability for pupils to earn credits towards an associate degree in nursing program at any CCC; and,
7. The inclusion of a signed statement of support from a community college.
8. Authorizes a pilot LEA to use the funds received for any of the following:

a) Professional development for teachers, administrators, and paraprofessional staff or other classified employees involved in the direct instruction of pupils on the nursing profession, the employment opportunities that a career in nursing offers, the educational requirements for various nursing degrees, and age-appropriate instruction on basic direct patient health care principles;

b) Instructional materials aligned to the applicable science curriculum framework adopted by the State Board of Education (SBE) and addressing the nursing profession; and,

c) Age-appropriate hands-on instruction in hospitals, clinics, or other health care facilities.

6) Requires that a student enrolled in a pilot program earn credits toward an associate degree in nursing at any CCC. Credits are required to be applied upon the student’s successful admission to the nursing program.

7) Requires that a student who completes a pilot program be granted preferential enrollment status toward an associate degree in any CCC, subject to the establishment of additional capacity in community college nursing programs above and beyond the level in place for the 2024-2025 academic year (AY).

8) Requires the CCC BOG to adopt policies to implement the requirements of this section.

9) Requires the California Department of Education (CDE), by January 1, 2028, to submit a report on the pilot program to the Legislature.

STAFF COMMENTS

1. Need for the bill. According to the author, “California is facing a nursing shortage crisis, and we must address it at the root. This pilot program proposal is not a short-term band-aid, it is a long-term solution. We must train and retain more nurses here in California to help stop this ever-widening chasm of demand.”

The author states that, “this pilot program will be one tool in our belt to address this crisis, and it will empower our youth to fast-track their careers. Nurses are a vital part of the healthcare team, and healthcare systems fall apart without them, so it is crucial to shoring up our supply before this crisis reaches a critical tipping point.”

1. The shortage of school nurses. By 2030, California is anticipated to have the most severe nursing shortage alongside Florida and Texas. It is estimated that for the 2018-2019 school year, there were about 2,700 school nurses employed and about 6.2 million students enrolled in California. This equates to about 2,300 students potentially needing care from each school nurse. Some rural counties reported no school nurses at all. The American Academy of Pediatrics recommends one school nurse to 750 students in a healthy population and one school nurse to 225 students when accounting for pupils who require daily professional health services.

These numbers are not new as it has been many years since every school in the state had a nurse of its own to conduct on-campus health screenings, review immunization records, tend to students’ minor medical needs and perform other duties intended to keep students healthy. The role of school nurses has become more critical due to the pandemic, with schools required to follow an extensive list of health and safety protocols.

In analyzing the potential causes of the school nurse shortage, it should be noted that the average salary for a nurse in California is $113,250. Meanwhile, the average salary for a school nurse in Los Angeles Unified was less than $80,000 in 2019, according to the district. In Fresno Unified, a school nurse is currently paid between $56,000 and $91,000 for 185 days of work, according to the district. School nurses often work fewer days than nurses working in hospitals and clinics, but they have to accept a lower annual salary and must take additional classes and pay more fees to get the job, which requires a School Nurse Services Credential.

1. Existing school nursing credential programs only offered at higher education institutions. Currently, there are four school nursing credential programs in California offered in the state: California State University at Fresno, California State University at Sacramento, California State University at Fullerton, and one private program offered at Azusa Pacific University located northeast of Los Angeles. The cost for these credential programs range from $4,392 to $19,552. The four school nursing credential programs provide classes such as Advanced Pediatric Health Assessment and Health Promotion, Adolescent Health Care, and Advanced Health Assessment: Ambulatory Pediatrics. The curriculum of these programs are specific to K-12 schools. Aspiring candidates enter the credential programs certified as registered nurses where they learn to work with children in a school environment, provide health and wellness services to a diverse student body, demonstrate professional management skills of data and recordkeeping, and study the formulation and evaluation of health policy.
2. Arguments in support. The United Nurses Associations of California/Union of Health Care Professionals writes, "California faces a severe shortage of nurses, both now and in the future. If present trends continue, the shortage of nurses will only grow in the coming decades. With nursing programs impacted all over the state, it is imperative that we do whatever we can to speed up the training pipeline and get qualified nurses into patient care setting as soon as possible. AB 1695 accomplishes that by allowing high-school students to start earning the credits they need earlier than under current law, and enables them to complete the degree necessary to begin their career earlier. Currently, many potential nursing students are discouraged from entering the field simply because it will take years longer than it should for them to actually embark upon their professional career. Because it takes so long to get into nursing programs due to extended wait lists, this bill will remove some of the barriers facing students. This bill can make a real difference toward addressing the shortage of nurses, by enabling them to enter programs sooner and stay on track for the completion of the degree program. More nurses means more adequate staffing, which in turn leads to better patient outcomes and better health care access for all Californians."
3. Author amendments. The author has proposed, and staff concurs with, amending this bill to require the SPI to consult with the California Board of Registered Nursing and require the California Board of Registered Nursing to approve any nursing course curriculum to ensure alignment with California’s Nursing Practice Act.

SUPPORT

American Federation of State, County, and Municipal Employees
California Hospital Association
California School Nurses Organization
California Workforce Association
Los Angeles County Office of Education

OPPOSITION

None received

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 1695

Author:(Gipson)

As Amended Ver:April 18, 2023

Majority vote

SUMMARY

Establishes the Nursing Pathway Pilot Program in high schools to create pathways toward associate degrees in nursing at community colleges, subject to an appropriation. Requires the Superintendent of Public Instruction (SPI) to allocate funding for the pilot to local educational agencies (LEAs) on the basis of average daily attendance (ADA), and requires that students completing the pathway earn community college credit and be given preferential admittance to nursing programs at community colleges.

Major Provisions

1. Requires the SPI to select the pilot LEAs through a competitive application process by no later than July 1, 2024.
2. Authorizes LEAs to use the funds received for any of the following:
   1. Professional development for teachers, administrators, and paraprofessional staff or other classified employees involved in the direct instruction of pupils on the nursing profession, the employment opportunities that a career in nursing offers, the educational requirements for various nursing degrees, and age-appropriate instruction on basic direct patient health care principles;
   2. Instructional materials aligned to the applicable science curriculum framework adopted by the State Board of Education (SBE) and addressing the nursing profession; and
   3. Age-appropriate hands-on instruction in hospitals, clinics, or other health care facilities.
3. Requires that a student enrolled in a pilot program earn credits toward an associate degree in nursing at any California community college (CCC). Credits are required to be applied upon the student's successful admission to the nursing program.
4. Requires that a student who completes a pilot program be granted preferential enrollment status toward an associate degree in any California community college, subject to the establishment of additional capacity in community college nursing programs above and beyond the level in place for the 2023-24 academic year.

COMMENTS

Status of California's nursing shortage. According to the U.S. Department of Labor, Bureau of Labor Statistics, health care spending is approximately 18% of the United States (U.S.) economy (GDP), and nursing is the single largest profession in the entire U.S. health care workforce with Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) making up the two largest occupations in this profession. Prior to the COVID-19 pandemic, according to a 2017 U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Health Workforce report, Supply and Demand Projections of the Nursing Workforce: 2014-2030, California is projected to have a shortage of RNs or LPNs by 2030, as shown in Table 1.

Table 1: Baseline and Projected Supply of and Demand for Registered Nurses by State: 2014 and 2030

Source: Supply and Demand Projections of the Nursing Workforce: 2014-2030, U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Health Workforce, 2017.

However, according to a 2022 California-specific research report from the University of California San Francisco, Forecasts of the Registered Nurse Workforce in California, over the last two years enrollments and graduations from RN education programs have declined, although numbers of applications continue to rise. RN education enrollments are projected to surpass pre-pandemic levels within the next two years, which is projected to lead to a closing of the shortage by 2029. In the last four years, many older RNs have left nursing, and a large proportion of older RNs intend to retire or quit within the next two years. Many RNs report that childcare and school closures have made it difficult to work, and that they feel that their employers do not care about their well-being or recognize their contributions.

According to the Urban Institute's March 2022 report, titled, Growing and Supporting Diverse Nursing and Medical Workforce in California, although California is the most diverse state in the Union, the majority of its nurses are White. The report cites that statewide, Black and Latinx individuals account for 5.5% and 8% respectively of the nurses in the state.

The report made several recommendations in order for California to increase the diversity of the nursing field, including, but not limited to the following:

1. Develop and support an interdisciplinary, multisector working group on pathways to nursing specifically for Black and Latinx populations;
2. Work with nursing schools to develop a California-specific online compendium of pathway programs, financial, and career supports that can easily be accessed by Black and Latinx students interested in nursing;
3. Support the development and maintenance of nursing mentorship programming, including guidance, training, and compensation for mentors;
4. Work with the California Board of Registered Nursing and experts to map Black and Latinx practicing nurses to understand which geographic areas have the biggest gaps in diversity; using the information to inform workforce development strategies and to assess change over time; and,
5. Establish direct transfer agreements between local nursing associate's degree programs and bachelor of science nursing programs to facilitate admission into and completion of bachelor's degrees in nursing programs among students from economically disadvantaged backgrounds.

Current status of nursing programs at the CCC. The CCC offer three different types of nursing programs: Certifications as nursing assistants, Licensed vocational nursing (LVN), and Registered nursing (RN) degrees. According to the California Community Colleges Chancellor's Office (CCCCO) 2019 Nursing Report (the most recent report), based on data from the 2017-18 academic year, of the 115 brick and mortar CCC, 77 offered an associate's degree in nursing. The 2017-18 academic year, had a total enrollment of 12,960 full-time equivalent students in nursing programs. According to the CCCCO report, "colleges receiving nursing grants for enrollment growth had 12,960 nursing full-time equivalent students in 2017-18, a decrease of 7.4% from the previous fiscal year. Colleges awarded grants based on the additional capacity achieved by the additional enrollments." It is presently unclear why nursing student enrollments declined and if the nursing student enrollments have subsequently increased in more recent academic years.

According to the Author

"California is facing a nursing shortage crisis, and we must address it at the root. This pilot program proposal is not a short-term band-aid, it is a long-term solution. We must train and retain more nurses here in California to help stop this ever-widening chasm of demand. This pilot program will be one tool in our belt to address this crisis, and it will empower our youth to fast-track their careers. Nurses are a vital part of the healthcare team, and healthcare systems fall apart without them, so it is crucial to shoring up our supply before this crisis reaches a critical tipping point."

Arguments in Support

The United Nurses Associations of California/Union of Health Care Professionals writes, "California faces a severe shortage of nurses, both now and in the future. If present trends continue, the shortage of nurses will only grow in the coming decades. With nursing programs impacted all over the state, it is imperative that we do whatever we can to speed up the training pipeline and get qualified nurses into patient care setting as soon as possible. AB 1695 accomplishes that by allowing high-school students to start earning the credits they need earlier than under current law, and enables them to complete the degree necessary to begin their career earlier. Currently, many potential nursing students are discouraged from entering the field simply because it will take years longer than it should for them to actually embark upon their professional career. Because it takes so long to get into nursing programs due to extended wait lists, this bill will remove some of the barriers facing students. This bill can make a real difference toward addressing the shortage of nurses, by enabling them to enter programs sooner and stay on track for the completion of the degree program. More nurses means more adequate staffing, which in turn leads to better patient outcomes and better health care access for all Californians."

Arguments in Opposition

None on file

FISCAL COMMENTS

According to the Assembly Appropriations Committee,

1. "One-time Proposition 98 General Fund of an undefined amount, potentially in the millions of dollars, for a grant to support the pilot program created by this bill.
2. Minor General Fund costs to the SPI to administer the grant program, according to the SPI.
3. Ongoing Proposition 98 General Fund administrative costs to CCCs for the duration of the pilot program related to cooperating with the local educational agency to ensure the pilot program adequately educates pupils on select areas of nursing to count toward community college nursing program credits. Costs would depend on the number of colleges participating in the pilot program, and could range from $8,068 to $20,899 per college. In addition, potential costs to provide priority enrollment to these students, which could be a state mandate.

The state would need to reimburse these costs to CCC, if the Commission on State Mandates determines the bill's requirements to be a reimbursable state mandate."

VOTES

ASM EDUCATION: 7-0-0

YES: Muratsuchi, Megan Dahle, Juan Carrillo, Hoover, Lee, McCarty, Quirk-Silva

ASM HIGHER EDUCATION: 12-0-0

YES: Mike Fong, Ta, Addis, Arambula, Gabriel, Irwin, Low, Ortega, Sanchez, Santiago, Wallis, Weber

ASM APPROPRIATIONS: 15-0-1

YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Lowenthal, Mathis, Papan, Pellerin, Sanchez, Weber, Ortega

ABS, ABST OR NV: Robert Rivas

UPDATED

VERSION: April 18, 2023

CONSULTANT: Marguerite Ries / ED. / (916) 319-2087 FN: 0000826

Date of Hearing: May 10, 2023

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Chris Holden, Chair

ABPCA Bill Id:AB 1695

Author:(Gipson) – As Amended Ver:April 18, 2023

Urgency: No State Mandated Local Program: Yes Reimbursable: Yes

SUMMARY:

This bill, subject to a one-time appropriation, creates a pilot program for the development of dual enrollment programs at high schools leading to an associate degrees in nursing. In addition, the bill provides priority enrollment into an associate degree in a nursing program at any California Community College (CCC) to any student who completes the dual enrollment program created by this bill, subject to the establishment of additional capacity in community college nursing programs above and beyond the level in place for the 2024-25 academic year.

The program is to be administered by the Superintendent of Public Instruction (SPI). The bill requires the SPI, by January 1, 2028, to submit a report on the pilot program to the Legislature.

Specifically, the SPI is to select local educational agencies for a grant through a competitive application process by July 1, 2024. The funds are to be allocated to selected grantees based on a grantee’s student attendance. Funding may be used by grantees for professional development, instructional materials, and age-appropriate hands-on instruction at health care sites. The funding allocated by this bill is to be available for encumbrance through the 2026-27 fiscal year.

FISCAL EFFECT:

1. One-time Proposition 98 General Fund of an undefined amount, potentially in the millions of dollars, for a grant to support the pilot program created by this bill.
2. Minor General Fund costs to the SPI to administer the grant program, according to the SPI.
3. Ongoing Proposition 98 General Fund administrative costs to CCCs for the duration of the pilot program related to cooperating with the local educational agency to ensure the pilot program adequately educates pupils on select areas of nursing to count toward community college nursing program credits. Costs would depend on the number of colleges participating in the pilot program, and could range from $8,068 to $20,899 per college. In addition, potential costs to provide priority enrollment to these students, which could be a state mandate.

The state would need to reimburse these costs to CCC, if the Commission on State Mandates determines the bill’s requirements to be a reimbursable state mandate.

COMMENTS:

1. Purpose. According to American Federation of State, County and Municipal Employees, a supporter of this bill:

Unfortunately, nursing programs are impacted all over the state. According to a recent CalMatters article, “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”…AB 1695 will allow high-school students to start earning the credits they need earlier than under current law and enables them to complete the degree necessary to begin their career earlier. Currently, many potential nursing students are discouraged from entering the field simply because it will take years longer than it should for them to embark upon their professional careers. This pilot program proposal is not a short-term band-aid, it is a long-term solution.

1. Background. Dual enrollment provides students the opportunity to enroll in college courses and earn college credit while still enrolled in high school. According to the Public Policy Institute of California, more than 112,000 high school students graduating in the 2019-2020 school year participated in dual enrollment.

This bill creates a dual enrollment pilot program specifically in the nursing field.

Priority registration is the opportunity for certain students to enroll in courses and programs before the general public. Current law provides priority enrollment at any CCC campus to members, or former members of the United States Armed Forces, members, or former members of the State Guard, current, or former foster youth, current, or formerly homeless youth, students who identify as student-parents (beginning July 1, 2023), students who participate in Extended Opportunity Programs and Service programs, disabled students, and students who participate in the CalWORKs program.

This bill would also grant priority registration to students who complete the dual enrollment program created by this bill.

1. Related Legislation. AB 689 (Wendy Carrillo) of this legislative session requires a CCC, beginning in the 2024-2025 academic year, to set aside 15% of slots in its impacted courses and programs for incumbent health care employees. The bill also requires a CCC to provide priority registration to incumbent health care employees when enrolling in CCC courses and programs. The bill is pending in this committee.

Analysis Prepared by: Natasha Collins / APPR. / (916) 319-2081

Date of Hearing: April 25, 2023

ASSEMBLY COMMITTEE ON HIGHER EDUCATION

Mike Fong, Chair

ABPCA Bill Id:AB 1695 (

Author:Gipson) – As Amended Ver:April 18, 2023

SUBJECT: Career technical education: Nursing Pathway Pilot Program.

SUMMARY: Establishes the Nursing Pathway Pilot Program in high schools to create pathways toward associate degrees in nursing at California Community Colleges (CCC), subject to an appropriation. Specifically, this bill:

1. Establishes the Nursing Pathway Pilot Program.
2. Requires, subject to an appropriation of one-time funds for this purpose in the annual Budget Act or another statute, the Superintendent of Public Instruction (SPI) to allocate funding for the development of career pathways toward an associate degree in nursing at community college schoolsites, serving students in grades 9-12, subject to an appropriation of one-time funds for this purpose.
3. Requires the SPI to allocate funds to pilot local educational agencies (LEAs) on the basis of an equal amount per average daily attendance (ADA) based upon 2022-2023 figures, authorizes the funds to be encumbered through the 2026-2027 fiscal year, and requires funds to be subject to annual audits.
4. Requires the SPI to select the LEAs through a competitive application process by no later than July 1, 2024, based on an applicant’s demonstrated ability with a CCC to provide all of the following:
   1. Professional development for teachers, administrators, and paraprofessional staff or other classified employees involved in the direct instruction of pupils in the nursing profession, the employment opportunities that a career in nursing offers, the educational requirements for various nursing degrees, and age-appropriate instruction on basic direct patient health care principles;
   2. The ability for pupils to earn credits towards an associate degree in nursing program at any CCC; and,
   3. The inclusion of a signed statement of support from a community college.
5. Authorizes a pilot LEA to use the funds received for any of the following:
6. Professional development for teachers, administrators, and paraprofessional staff or other classified employees involved in the direct instruction of pupils on the nursing profession, the employment opportunities that a career in nursing offers, the educational requirements for various nursing degrees, and age-appropriate instruction on basic direct patient health care principles;
7. Instructional materials aligned to the applicable science curriculum framework adopted by the State Board of Education (SBE) and addressing the nursing profession; and,
8. Age-appropriate hands-on instruction in hospitals, clinics, or other health care facilities.
9. Requires that a student enrolled in a pilot program earn credits toward an associate degree in nursing at any CCC. Credits are required to be applied upon the student’s successful admission to the nursing program.
10. Requires that a student who completes a pilot program be granted preferential enrollment status toward an associate degree in any CCC, subject to the establishment of additional capacity in community college nursing programs above and beyond the level in place for the 2024-2025 academic year (AY).
11. Requires the CCC Board of Governors (BOG) to adopt policies to implement the requirements of this section.
12. Requires the California Department of Education (CDE), by January 1, 2028, to submit a report on the pilot program to the Legislature.
13. Sunsets the pilot on January 1, 2032.
14. Finds and declares the following intent of the Legislature:
    1. It is critical to public health and to the public health care workforce that California develops and encourages educational pathways for nursing degrees in California’s public school systems;
    2. It is necessary to encourage nursing education prior to postsecondary education; and,
    3. California pupils should have opportunities to explore nursing careers in grades 9 to 12, inclusive.

EXISTING LAW:

1. Establishes the mission and function of the CCC, which, in part is to: 1) offer academic and vocational instruction at the lower division level for both younger and older students, including those persons returning to school; 2) authorizes the CCC to grant the associate in arts and the associate in science degrees; 3) requires the CCC to offer English as a Second Language instruction, adult noncredit instruction, and support services which help students succeed at the postsecondary level; and, 4) advance California’s economic growth and global competitiveness through education, training, and services that contribute to continuous work force improvement (Education Code (EC) Section 66010.4)
2. Establishes the CCC, a postsecondary education system in this state, under the administration of the Board of Governors (BOG); and, specifies that the CCC consist of community college districts (EC Section 70900).
3. Requires the CCC BOG to provide leadership and direction in the continuing development of the California Community Colleges as an integral and effective element in the structure of public higher education in the state. The work of the BOG must at all times be directed to maintaining and continuing, to the maximum degree permissible, local authority and control in the administration of the CCC (EC Section 70901).
4. Stipulates, until January 1, 2025, that if a community college registered nursing program determines that the number of applicants to that program exceeds its capacity, the nursing program may admit students through the following methods:
   1. Administer a multicriteria screening process to evaluate applicants, applying evaluation measures with the following:
      1. The criteria applied in a multicriteria screening process will include, but is not limited to:
         1. Academic degrees or diplomas, held by an applicant;
         2. Grade-point average in relevant coursework;
         3. Any relevant work or volunteer experience;
         4. Life experiences or special circumstances of the applicants as defined; and,
         5. Proficiency in advance level coursework in languages other than English, as defined;
      2. Additional criteria such as a personal interview, a personal statement, a letter of recommendation, or a number of repetitions of prerequisite classes may be included but are not required; and,
      3. Additional criteria may include the use of a diagnostic test.
   2. A random selection process; and,
   3. A blend of a random selection process or a multicriteria screening process (EC Section 78261.5).
5. Authorizes the K-12 component of the Strong Workforce Program (SWP) to create, support, or expand high-quality CTE programs at the K-12 level that are aligned with the workforce development efforts occurring through the SWP, and authorizes, commencing with the 2018-19 fiscal year, and subject to an annual appropriation, $150 million to be apportioned annually by the California Community Colleges Chancellor’s Office (CCCCO) to local consortia (EC 88827).

FISCAL EFFECT: Unknown

COMMENTS: Double referral. This measure was heard in the Assembly Committee on Education, where it passed with a 7-0 vote on April 12, 2023. Issues germane to the Education Committee’s jurisdiction are referenced in that Committee’s analysis.

Purpose of the measure. According to the author, “California is facing a nursing shortage crisis, and we must address it at the root. This pilot program proposal is not a short-term band-aid, it is a long-term solution. We must train and retain more nurses here in California to help stop this ever-widening chasm of demand.”

The author states that, “this pilot program will be one tool in our belt to address this crisis, and it will empower our youth to fast-track their careers. Nurses are a vital part of the healthcare team, and healthcare systems fall apart without them, so it is crucial to shoring up our supply before this crisis reaches a critical tipping point.”

According to the Urban Institute’s March 2022 report, titled, Growing and Supporting Diverse Nursing and Medical Workforce in California, although California is the most diverse state in the Union, the majority of its nurses are White. The report cites that statewide, Black and Latinx individuals account for 5.5% and 8% respectively of the nurses in the state.

The report made several recommendations in order for California to increase the diversity of the nursing field, including, but not limited to the following:

1. Develop and support an interdisciplinary, multisector working group on pathways to nursing specifically for Black and Latinx populations;
2. Work with nursing schools to develop a California-specific online compendium of pathway programs, financial, and career supports that can easily be accessed by Black and Latinx students interested in nursing;
3. Support the development and maintenance of nursing mentorship programming, including guidance, training, and compensation for mentors;
4. Work with the California Board of Registered Nursing and experts to map Black and Latinx practicing nurses to understand which geographic areas have the biggest gaps in diversity; using the information to inform workforce development strategies and to assess change over time; and,
5. Establish direct transfer agreements between local nursing associate’s degree programs and bachelor of science nursing programs to facilitate admission into and completion of bachelor’s degree in nursing programs among students from economically disadvantaged backgrounds.

The author contends that, “this bill is working to develop and encourage educational pathways in public school systems for students who want to pursue nursing. The aim of this bill is to increase the number of nurses trained here in California to alleviate this nursing shortage.”

While this measure is not a direct response to the aforementioned report, it does appear to align, in part, with the recommendation of creating pathway programs that could assist in increasing the diversity of nurses in the state.

Current status of nursing programs at the CCC. The CCC offer three different types of nursing programs: Certifications as nursing assistants, Licensed vocational nursing (LVN), and Registered nursing (RN) degrees. According to the CCCCO’s 2019 Nursing Report (the most recent report), based on data from the 2017-2018 AY, of the 115 brick and mortar CCC, 77 offered an associate’s degree in nursing. The 2017-2018 AY, had a total enrollment of 12,960 full-time equivalent students in nursing programs.

According to the CCCCO report, “colleges receiving nursing grants for enrollment growth had 12,960 nursing full-time equivalent students in 2017-2018, a decrease of 7.4% from the previous fiscal year. Colleges awarded grants based on the additional capacity achieved by the additional enrollments.”

It is presently unclear why nursing student enrollments declined and if the nursing student enrollments have subsequently increased in more recent AYs.

Dual enrollment. According to the United States Department of Education's Institute of Education Sciences Transition to College, What Works Clearinghouse Report of February 2017, dual enrollment programs allow high school pupils to take college courses and earn college credits while still attending high school. Historically, dual enrollment targeted higher-achieving students through Advanced Placement (AP) exams or attending community college to take advanced courses after the student had exhausted courses offered at their high school campus. However, more recently, policymakers and educators have utilized dual enrollment as a strategy to help more students earn college credit and ease the transition to college.

Such programs, also referred to as concurrent enrollment, dual credit, or early college programs, are designed to increase college access and degree attainment, especially for students typically underrepresented in higher education.

In August 2019, the National Center for Education Statistics published findings from the High School Longitudinal Study of 2009. The data collected represented a cohort national study of the course taking behavior of high school students from 2009 to 2013. The study found that 89% of high schools in the nation offer dual enrollment programs, but only 11% of students participated in dual enrollment programs. Recent research from the UC Davis Wheelhouse in collaboration with the California Education Lab and Policy Analysis for California Education, found that California has not only exceeded the national average of dual enrolment participation, but has increased dual enrollment participation from 11.3% in 2015-2016 to 18.2% in 2018-19.

According to a 2021 policy brief from the Public Policy Institute of California (PPIC), Dual Enrollment in California, more than 112,000 California high school students graduating in the 2019–2020 school year participated in dual enrollment. That represented an increase of 56% from the 2015-2016 school year. The PPIC report attributed the growth, in part, to the authorization of College and Career Access Pathways Partnership (CCAPs) in 2016. After high school, students who participated in dual enrollment enroll at two- and four-year colleges at higher rates compared to all high school graduates.

This measure, the Nursing Pathway Pilot Program, in part, creates a dual enrollment program specifically for high school pupils choosing to enter into the nursing field.

Priority enrollment at the CCC. The CCC is the only open access public college system in California; the CCC accepts the top 100% of applicants and provides education to all students. The CCC also has limited enrollment or impaction in many programs of study. Nursing is one of the most impacted programs. The California Code of Regulations, Title 5, Section 58106, authorizes the CCC to limit enrollment utilizing the following methods:

1. Limiting enrollment to students who meet designated prerequisites and corequisites;
2. Limiting enrollment due to health and safety considerations, facility limitations, faculty workload, the availability of qualified instructors, funding limitations, constraints of regional planning, or legal requirements imposed by statutes, regulations, or contracts. When limiting enrollment for the above circumstances, the governing board of the community college may adopt policies that consist of one or more of the following:
   1. Limiting enrollment on a first-come, first-served basis;
   2. Limiting enrollment using a registration procedure that includes priority enrollment;
   3. Allocate available seats to students judged most qualified (this is limited to courses of intercollegiate competition, honors courses, or public performance courses); and,
   4. Limiting enrollment using any selection procedure expressly authorized by statute.

As noted in this Committee’s analysis of AB 689 (Carrillo) of 2023, according to the CCCCO, limited enrollment courses include Career Technical Education courses and nursing programs due to the nature of the course (limited lab placements) and the limitations in qualified faculty. When a course has limited enrollment or impactions, the result is a wait list, which can result in students waiting a semester or even up to an entire year before placement in the course.

Per the EC, a robust number of identified student groups already qualify for priority enrollment these groups include, but are not limited to: service members, or former service members of the United States Armed Forces and the State Guard, current and former foster youth, current and formerly homeless youth, disabled students, and students with dependents.

Additionally, community college districts are authorized to add additional groups of students who can receive priority registration; these student groups, in part, include: athletes and students in the California Promise program.

Committee comments. As currently drafted, this measure stipulates that pupils who successfully complete the pilot program will automatically gain preferential enrollment status toward an associate degree in a nursing program at any CCC, subject to the establishment of additional capacity in CCC nursing programs above and beyond the level in place for the 2024-2025 AY.

For several years, nursing courses at most CCC remain impacted and waitlists are long. Should more course offerings open in the 2024-2025 AY, college students who have been on the waitlists, more likely than not, would fill any new slots. However, as this this bill is drafted, high school pupils could potentially displace adults in these nursing courses.

Moving forward, the author may wish to work with the CCCCO and the CCC Statewide Academic Senate in order to address the potential of children displacing adults in much needed nursing programs at the CCC.

Additionally, this measure is subject to an appropriation of one-time funds in the annual Budget Act or another statute. Committee Staff understands that the United Nurses Associations of California/Union of Health Care Professionals (UNAC/UHCP) have submitted a 2023-2024 budget proposal to the Governor and the Legislature, which, in part, if approved, could potentially fund the provisions contained in this measure.

Arguments in support. According to the UNAC/UHCP, “California faces a severe shortage of nurses, both now and in the future. If present trends continue, the shortage of nurses will only grow in the coming decades. With nursing programs impacted all over the state, it is imperative that we do whatever we can to speed up the training pipeline and get qualified nurses into patient care setting as soon as possible.”

Further, UNAC/UHCP contends that, “AB 1695 accomplishes that by allowing high-school students to start earning the credits they need earlier than under current law, and enables them to complete the degree necessary to begin their career earlier. Currently, many potential nursing students are discouraged from entering the field simply because it will take years longer than it should for them to actually embark upon their professional career.”

Lastly, UNAC/UHCP states that, “because it takes so long to get into nursing programs due to extended wait lists, this bill will remove some of the barriers facing students. This bill can make a real difference toward addressing the shortage of nurses, by enabling them to enter programs sooner and stay on track for the completion of the degree program. More nurses means more adequate staffing, which in turn leads to better patient outcomes and better health care access for all Californians.”

Related legislation. AB 689 (Wendy Carrillo), which is scheduled to be heard by this Committee on April 25, 2023, in part, establishes a requirement beginning in the 2024-2025 AY, for limited enrollment course or programs and nursing programs offered at the CCC to reserve placements for incumbent health care workers and requires the CCC to provide priority registration for incumbent health care workers.

REGISTERED SUPPORT / OPPOSITION:

Support

United Nurses Associations of California/Union of Health Care Professionals

Opposition

None on file.

Analysis Prepared by: Jeanice Warden / HIGHER ED. / (916) 319-3960

Date of Hearing: April 12, 2023

ASSEMBLY COMMITTEE ON EDUCATION

Al Muratsuchi, Chair

ABPCA Bill Id:AB 1695 (

Author:Gipson) – As Amended Ver:March 23, 2023

[Note: This bill is double referred to the Assembly Higher Education Committee and will be heard by that Committee as it relates to issues under its jurisdiction.]

SUBJECT: Career technical education: Nursing Pathway Pilot Program

SUMMARY: Establishes the Nursing Pathway Pilot Program in high schools to create pathways toward associate degrees in nursing at community colleges, subject to an appropriation. Requires the Superintendent of Public Instruction (SPI) to allocate funding for the pilot to local educational agencies (LEAs) on the basis of average daily attendance (ADA), and requires that students completing the pathway earn community college credit and be given preferential admittance to nursing programs at community colleges. Specifically, this bill:

1. Establishes the Nursing Pathway Pilot Program.
2. Requires, subject to an appropriation of one-time funds for this purpose in the annual Budget Act or another statute, the SPI to allocate funding for the development of career pathways toward an associate degree in nursing at community college schoolsites, serving students in grades 9-12, subject to an appropriation of one-time funds for this purpose.
3. Requires the SPI to allocate funds to LEAs on the basis of an equal amount per ADA based upon 2022-23 figures, authorizes the funds to be encumbered through the 2026-27 fiscal year, and requires funds to be subject to annual audits.
4. Authorizes LEAs to use the funds received for any of the following:
5. Professional development for teachers, administrators, and paraprofessional staff or other classified employees involved in the direct instruction of pupils on the nursing profession, the employment opportunities that a career in nursing offers, the educational requirements for various nursing degrees, and age-appropriate instruction on basic direct patient health care principles;
6. Instructional materials aligned to the applicable science curriculum framework adopted by the State Board of Education (SBE) and addressing the nursing profession; and
7. Age-appropriate hands-on instruction in hospitals, clinics, or other health care facilities.
8. Requires that a student enrolled in a pilot program earn credits toward an associate degree in nursing at any California community college (CCC). Credits are required to be applied upon the student’s successful admission to the nursing program.
9. Requires that a student who completes a pilot program be granted preferential enrollment status toward an associate degree in any California community college, subject to the establishment of additional capacity in community college nursing programs above and beyond the level in place for the 2023-24 academic year.
10. Requires the Board of Governors of the California Community Colleges to adopt policies to implement the requirements of this section.

EXISTING LAW:

1. Authorizes the Career Technical Education Incentive Grant (CTEIG) Program as a state education, economic, and workforce development initiative with the goal of providing students in kindergarten through 12^th grade with the knowledge and skills necessary to transition to employment and postsecondary education. (Education Code (EC) 53070)
2. Identifies the purpose of the competitive CTEIG program as the encouragement and maintenance of the delivery of CTE programs by school districts and charter schools.
3. Appropriates funding for the CTEIG program as follows: $400 million for 2015-16; $300 million for 2016-17; $200 million for 2017-18; and $150 million per year for 2018-19 to 2020-21; and $300 million per year beginning in the 2021-22 fiscal year and every year thereafter.
4. Specifies the distribution of the funds appropriated by school size as follows: 4% to applicants with an ADA of 140 or less; 8% to applicants with ADA of 141 to 550; and 88% to applicants with ADA of more than 550.
5. Requires the California Department of Education (CDE) to annually submit the list of recommended new and renewal grant recipients to the SBE for review and approval prior to making annual grant awards. The CDE and the SBE, in determining proposed grant recipients, are required to give positive consideration and the greatest weight to those applicants who:
6. Serve unduplicated students or subgroups with higher than average dropout rates;
7. Are located in an area of the state with a high unemployment rate; and
8. Offer an existing high-quality regional-based CTE program as a joint powers authority (JPA) or county office of education (COE).
9. Authorizes the K-12 component of the Strong Workforce Program (SWP) to create, support, or expand high-quality CTE programs at the K-12 level that are aligned with the workforce development efforts occurring through the SWP, and authorizes, commencing with the 2018-19 fiscal year, and subject to an annual appropriation, $150 million to be apportioned annually by the California Community Colleges Chancellor’s Office (CCCCO) to local consortia. (EC 88827)
10. Establishes the California Golden State Pathways Program (GSPP) to provide LEAs with the resources to promote pathways in high-wage, high-skill, high-growth areas, including technology, health care, education, and climate-related fields that, among other things, allow students to advance seamlessly from high school to college and career and provide the workforce needed for economic growth. (EC 53020)
11. Federal law, the Strengthening Career and Technical Education for the 21st Century Act, reauthorizes the Carl D. Perkins Career and Technical Education Act of 2006 (Perkins) provides federal support for CTE programs and focuses on improving the academic and technical achievement of CTE students, strengthening the connections between secondary and postsecondary education and improving accountability.
12. Authorizes a student to undertake courses at a CCC if the governing board of a school district, upon recommendation of the principal of the student’s high school and with parental consent, determines a student would benefit from advanced or vocational coursework. The student may attend the CCC during any session or term as a special part-time or full-time student and take one or more courses of instruction offered at the CCC. Provides methods for parents to petition for students to attend community college courses and methods for appeals in case of a denial. Includes criteria for allocating attendance and funding for high school students who attend courses at the community college.
13. Authorizes, until January 1, 2027, the governing board of a CCC district to enter into a College and Career Access Pathways (CCAP) partnership with the governing board of a school district or the governing body of a charter school for the purpose of offering or expanding dual enrollment opportunities for pupils who may not already be college bound or who are underrepresented in higher education, with the goal of developing seamless pathways from high school to community college for career technical education (CTE) or preparation for transfer, improving high school graduation rates, or helping high school pupils achieve college and career readiness.
14. Requires that the CCAP partnership agreement be approved by the respective governing boards of the CCC district and the school district or governing body of the charter school. Requires the governing boards or bodies to:
    1. Consult with and consider the input of the appropriate local workforce development board in order to determine to what extent the career technical education pathways are aligned with regional and statewide employment needs; and
    2. Present, take comments from the public on, and approve or disapprove of the CCAP partnership agreement at an open public meeting of the governing board of the district or governing body of the charter school.

FISCAL EFFECT: Unknown

COMMENTS:

Need for the bill. According to the author, “California is facing a nursing shortage crisis, and we must address it at the root. This pilot program proposal is not a short-term band-aid, it is a long-term solution. We must train and retain more nurses here in California to help stop this ever-widening chasm of demand. This pilot program will be one tool in our belt to address this crisis, and it will empower our youth to fast-track their careers. Nurses are a vital part of the healthcare team, and healthcare systems fall apart without them, so it is crucial to shoring up our supply before this crisis reaches a critical tipping point.”

Subject to an appropriation for this purpose, this bill would require the SPI to allocate funding for the development of career pathways toward an associate degree in nursing at any of California’s community colleges at schoolsites that serve pupils in grades 9-12.

California’s nursing shortage may be abating. According to the U.S. Department of Labor, Bureau of Labor Statistics, health care spending is approximately 18% of the U.S. economy (GDP), and nursing is the single largest profession in the entire U.S. health care workforce with Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) making up the two largest occupations in this profession. Prior to the COVID-19 pandemic, according to a 2017 U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Health Workforce report, Supply and Demand Projections of the Nursing Workforce: 2014-2030, California is projected to have a shortage of RNs or LPNs by 2030, as shown in Table 1.

Table 1: Baseline and Projected Supply of and Demand for Registered Nurses by State: 2014 and 2030

Source: Supply and Demand Projections of the Nursing Workforce: 2014-2030, U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Health Workforce, 2017.

However, according to a 2022 California-specific research report from the University of California San Francisco, Forecasts of the Registered Nurse Workforce in California, over the last two years enrollments and graduations from RN education programs have declined, although numbers of applications continue to rise. RN education enrollments are projected to surpass pre-pandemic levels within the next two years, which is projected to lead to a closing of the shortage by 2029. In the last four years, many older RNs have left nursing, and a large proportion of older RNs intend to retire or quit within the next two years. Many RNs report that childcare and school closures have made it difficult to work, and that the feel that their employers do not care about their well-being or recognize their contributions.

Defining Career Technical Education. CTE prepares students for the world of work by introducing them to workplace competencies, and makes academic content accessible to students by providing it in a hands-on context. Along the way, students develop career-relevant, real-world 21^st Century skills.

CTE is a program of study that involves a multiyear sequence of courses that integrates core academic knowledge with technical and occupational knowledge to provide students with a pathway to postsecondary education and careers. CTE programs in California are organized into 15 industry sectors, covering 58 pathways that identify the knowledge and skills students need. Partnerships are usually developed between high schools, businesses, and postsecondary schools, providing pathways to employment and associate, Bachelor’s and advanced degrees.

CTE courses and pathways may be offered in comprehensive high schools with CTE programs, as well as through regional CTE programs or centers operated by JPAs or COEs. Some CTE programs are blended with academic programs in what is known as a “linked learning model.” Community colleges and technical institutes also offer CTE at the postsecondary level.

Improved outcomes for CTE students. A wide body of research indicates that involvement in CTE coursework provides improved academic outcomes and other benefits to students with findings, such as the following:

• Students with greater exposure to CTE are more likely to graduate from high school, enroll in a two-year college, be employed, and earn higher wages;
• The average high school graduation rate for students concentrating in CTE programs is 93%, compared to an average national graduation rate of 80%;
• Students taking more CTE classes are just as likely to pursue a four-year degree as their peers;
• 91% of high school graduates who earned 2-3 CTE credits enrolled in college;
• CTE provides the greatest boost to students who need it most – boys and students from low-income families; and
• 80% of students taking a college preparatory academic curriculum with rigorous CTE met college and career readiness goals, compared to only 63% of students taking the same academic core who did not experience rigorous CTE.

Current K-12 CTE and dual enrollment programs. There are a number of initiatives supporting K-12 CTE and dual enrollment programs supported by state and federal funds, including the following:

1. The Career Technical Education Incentive Grant (CTEIG) Program was originally established in 2015 as a one-time investment of $900 million to cover a three-year span, and acted as a bridge for LEAs to support CTE programs until the Local Control Funding Formula (LCFF) was fully funded. It was created as a state education, economic, and workforce development initiative to provide students in kindergarten through grade twelve with the knowledge and skills necessary to transition from secondary education to postsecondary education and living-wage employment. The purpose of the program is to encourage, maintain, and strengthen the delivery of high-quality CTE programs. The program is administered by the CDE. In 2018, ongoing funding of $150 million for CTEIG was appropriated. In 2021, the annual funding for CTEIG was increased to $300 million.

Prior to the adoption of the LCFF, the state provided funding for CTE through a number of categorical programs, including the Regional Occupational Centers/Programs (ROC/P), which was funded at $400 million at the time. This funding was folded into the LCFF, increasing the LCFF base rate for high schools by 2.6%.

Grants are awarded under the CTEIG program by CDE, in consultation with the SBE, in response to applications submitted by LEAs outlining the ways in which they meet the statutorily defined requirements, including a 2:1 match of local to state funding. For the 2022-23 fiscal year, the CDE received 383 applications from LEAs. A total of $266 million has been allocated to the 375 eligible applicants. A second round of funding allocated an additional $2.3 million to 5 eligible applicants.

1. The K-12 Strong Workforce Program (K-12 SWP) was established in 2018 as a component of the Community Colleges’ SWP to create, support, or expand high-quality CTE programs at the secondary level that are aligned with the workforce development efforts occurring through the SWP. As is the case for CTEIG, the K-12 SWP is meant to support the overall development of high-quality K-12 CTE programs, courses, course sequences, programs of study, and pathways. The program is administered by the CCCCO. The program is currently funded at $150 million per year.

Unlike the CTEIG program, which is administered at the state level, the CCCO allocates K-12 SWP grant funding to eight regional consortia according to a statutory formula. Each regional consortium is required to administer a competitive grant program it receives to LEAs in the region. Each consortium establishes a selection committee made up of individuals with expertise in K-12 CTE and workforce development, including teachers, administrators, community college faculty or administrators, and other K-12 education stakeholders. Employees of LEAs applying for grants under the program may serve as members of the selection committees. Each selection committee has exclusive authority under state law to determine the recipients of K-12 SWP grants in its region and the specific amount for each grant.

For the 2022-23 fiscal year, 224 individual pathways were funded for a total allocation of $143.7 million.

1. The California Golden State Pathways Program was established in 2022 to provide LEAs with the resources to promote pathways in high-wage, high-skill, high-growth areas, including technology, health care, education, and climate-related fields that, among other things, allow pupils to advance seamlessly from high school to college and career and provide the workforce needed for economic growth.

This program provides consortium development and planning grants, as well as implementation grants, to support collaborative planning between an LEA and their program partners in the development of high-quality college and career pathways.

1. The Dual Enrollment Funding Opportunity Program was established in 2022 as a competitive grant program aimed at increasing programs that provide high school students with access to college level courses. Of this amount, $100 million is available for LEAs to apply for one-time grants of up to $250,000 for planning and starting up middle and early college high schools on K-12 school sites. The remaining $100 million is available for one-time grants of up to $100,000 to establish CCAP agreements that allow students to take some community college courses at their high school. Priority will be given to LEAs with at least half of their student population consisting of English learner students, as well as those that have higher than the state average rates of high school dropouts, suspensions or expulsions, child homelessness, foster youth, or justice-involved youth.

Schools currently offer CTE courses in the health field. The California CTE Model Curriculum Standards apply to 15 industry sectors. Within the Health Science and Medical Technology sector, the standards represent the academic and technical skills and knowledge students need to pursue a full range of career opportunities in health science and medical technology, from entry level to management as well as technical and professional career specialties. The standards describe what workers need to know and be able to do to contribute to the delivery of safe and effective health care. The six career pathways are grouped into functions that have a common purpose and require similar attributes. The pathways are Biotechnology, Patient Care, Health Care Administrative Services, Health Care Operational Support Services, Public and Community Health, and Mental and Behavioral Health. Standards for each career path build on and continue the anchor standards with more complexity, rigor, and career specificity.

CDE data for the 2018-19 school year identifies 895 schools in California offering CTE classes in the Health Sciences and Medical Technology pathway. A total of 100,196 students were enrolled in these classes. Of these, 66% were female and 34% male students.

Dual Enrollment. According to the United States Department of Education's Institute of Education Sciences Transition to College, What Works Clearinghouse Report of February 2017, dual enrollment programs allow high school pupils to take college courses and earn college credits while still attending high school. Historically, dual enrollment targeted higher-achieving students through Advanced Placement exams or attending community college to take advanced courses after the student had exhausted courses offered at their high school campus. However, within the last decade, policymakers and educators have utilized dual enrollment as a strategy to help more students earn college credit and ease the transition to college.

Such programs, also referred to as concurrent enrollment, dual credit, or early college programs, are designed to increase college access and degree attainment, especially for students typically underrepresented in higher education. According to the report, dual enrollment programs support college credit accumulation and degree attainment via at least three mechanisms:

1. Allowing high school students to experience college-level courses helps them prepare for the social and academic requirements of college while having the additional supports available to them as high school pupils (this could reduce the need for developmental coursework).
2. Students who accumulate college credits early and consistently are more likely to attain a college degree.
3. Many dual enrollment programs offer discounted or free tuition, which reduces the overall cost of college and may increase the number of low socioeconomic status students who can attend and complete college.

In August 2019, the National Center for Education Statistics published findings from the High School Longitudinal Study of 2009. The data collected represented a cohort national study of the course taking behavior of high school students from 2009 to 2013. The study found that 89% of high schools in the nation offer dual enrollment programs, but only 11% of students participated in dual enrollment programs. Recent research from the UC Davis Wheelhouse in collaboration with the California Education Lab and Policy Analysis for California Education, found that California has not only exceeded the national average of dual enrolment participation, but has increased dual enrollment participation from 11.3% in 2015-2016 to 18.2% in 2018-19.

According to a 2021 policy brief from The Public Policy Institute of California, Dual Enrollment in California, more than 112,000 California high school students graduating in the 2019–20 school year participated in dual enrollment—an increase of 56% from 2015–16. The growth is attributed in part to the authorization of CCAPs in 2016 and higher Latino student participation. After high school, students who participated in dual enrollment enroll at two- and four-year colleges at higher rates compared to all high school graduates.

Figure 1: Participation in Dual Enrollment at Community Colleges has Been Growing

Source: PPIC

In California, high school students or their parents can petition their school board for permission to attend college courses on a college campus for dual credit via traditional dual enrollment or a CCAP partnership agreement. Figure 1 highlights the major difference between these two types of dual enrollment.

Table 1: Two Major Types of Dual Enrollment in California

Source: Legislative Analyst’s Office

College and Career Access Pathways partnerships. In an effort to expand the availability of dual enrollment programs to more students, AB 288 (Holden), Chapter 618, Statutes of 2015, created another category of special admit options, the CCAP. In order to establish a CCAP partnership, the governing board of a CCC district and the governing board of a school district (or governing body of a charter school) enter into a formal agreement. The intent of this new pathway is to serve lower achieving students in an effort to reduce remediation, increase degree completion, decrease time to earn a degree, and stimulate interest in higher education among high school students who may not already be college bound or who are underrepresented in higher education. According to information provided by the author's office, the program was structured to authorize a model more like the Long Beach Promise, which offers dual enrollment as a pathway, rather than a series of disconnected individual courses, and to provide greater flexibility in the delivery of courses at the high school campus.

The CCAP partnership authorization provides two incentives to form partnerships:

1. Colleges may receive apportionment for providing courses on a high school campus specifically for high school students and is otherwise closed to the public.
2. Students may take up to 15 units per semester. In non-CCAP dual enrollment, the maximum remains 11 units per semester.

In exchange for the greater flexibility, CCAP partners must meet a variety of requirements relative to instructors, job displacement, preserving access for adult students, and allowances and apportionments. While CCC districts may operate a dual enrollment partnership through an early college high school or middle college high school, they are prohibited from operating as a CCAP partnership unless they comply with the established provisions. Currently, there are 83 CCAP partnerships throughout the state.

CCAP Legislative Report. In 2021, the CCCCO released the legislative report required by AB 30 (Holden), Chapter 510, Statutes of 2019. Dual enrollment is growing overall and in terms of student participation; however, the number of community colleges participating in CCAP remains limited. The Chancellor’s Office estimates that 37.5% of students participating in dual enrollment as special admits were in CCAP partnerships.

Figure 2: CCAP Dual Enrollment

Source: CCCCO College and Career Access Pathways Legislative Report

The report includes several recommendations, including eliminating the sunset date for CCAP partnerships, as this bill proposes. The CCCCO believes that eliminating the sunset date will allow CCAP partnerships to continue and mature, as well as remove any worry that new partnerships will have to start from scratch in a few years.

Other dual enrollment programs. There are two additional dual enrollment programs available to high school students including, a Middle College High School (MCHS), and an Early College High School (ECHS).

A MCHS is a public high school located on a community college campus and represents a highly effective collaborative effort between local school districts and community colleges to provide an alternative learning environment to select at-promise high school students who are performing below their academic potential. Students enroll in a MCHS for 11^th and 12^th grades and graduate with a high school diploma and up to 44 units worth of college credits. Currently there are 14 MCHSs operating throughout the state.

Similar to a MCHS, an ECHS allows students to earn college credit while enrolled in high school; however, an ECHS is a partnership between a charter or non-charter public high school and a local community college, the CSU, or the UC which enables students to earn a high school diploma and two years of college credit in four years or less. Students enrolled in an ECHS are limited to enrolling in up to 11 college course units per semester. According to the CDE there are 20 ECHSs located throughout the state.

Outcomes for students participating in dual enrollment programs. According to a 2017 U.S. Department of Education Institute of Education Sciences review of analyses of dual enrollment programs, What Works Clearinghouse Intervention Report: Dual Enrollment Programs, dual enrollment programs have positive and significant effects on students’ college degree attainment, college access and enrollment, credit accumulation, completing high school, and general academic achievement in high school, with a medium to large extent of evidence.

A 2013 Educational Evaluation and Policy Analysis research article, The Impact of Dual Enrollment on College Degree Attainment: Do Low-SES Students Benefit?, used a nationally representative sample of students who began postsecondary education in 2003, and found that students who took dual enrollment courses were 10% more likely to complete a Bachelor’s degree than their peers who did not participate in dual enrollment. The benefits were even greater (12%) for students whose parents never attended college.

According to a 2021 Public Policy Institute report, Dual Enrollment in California: Promoting Equitable Student Access and Success, there are racial disparities in access to dual enrollment classes in California. Although there is an increasing number of students of all races participating in dual enrollment, the demographics of dual enrollment are not proportional to overall high school enrollments. Latino students account for 55% of high school enrollment in California but only 45% of students in dual enrollment are Latino. Black students are also underrepresented, while white and Asian students are overrepresented. Student academic outcomes are also disparate. Black and Latino students have a grade point average of 2.9, while white and Asian students have grade point averages of 3.2 and 3.4, respectively. On average, Black and Latino students also earn fewer units than their white and Asian peers.

Arguments in support. The United Nurses Associations of California/Union of Health Care Professionals writes, “California faces a severe shortage of nurses, both now and in the future. If present trends continue, the shortage of nurses will only grow in the coming decades. With nursing programs impacted all over the state, it is imperative that we do whatever we can to speed up the training pipeline and get qualified nurses into patient care setting as soon as possible. AB 1695 accomplishes that by allowing high-school students to start earning the credits they need earlier than under current law, and enables them to complete the degree necessary to begin their career earlier. Currently, many potential nursing students are discouraged from entering the field simply because it will take years longer than it should for them to actually embark upon their professional career. Because it takes so long to get into nursing programs due to extended wait lists, this bill will remove some of the barriers facing students. This bill can make a real difference toward addressing the shortage of nurses, by enabling them to enter programs sooner and stay on track for the completion of the degree program. More nurses means more adequate staffing, which in turn leads to better patient outcomes and better health care access for all Californians.”

Recommended Committee Amendments. Staff recommends that the bill be amended as follows:

• Require the SPI to select the pilot or pilots through a competitive application process no later than July 1, 2024, based on the potential pilots’ demonstrated ability with a community college to provide all of the following:
  • Provide professional development for teachers, administrators, and paraprofessional staff or other classified employees involved in the direct instruction of pupils on the nursing profession, the employment opportunities that a career in nursing offers, the educational requirements for various nursing degrees, and age-appropriate instruction on basic direct patient health care principles;
  • The ability for pupils to earn credits towards an associate degree in a nursing program at any California community college; and
  • The inclusion of a signed statement of support from a community college.
• Require the CDE to submit a report on the pilot program to the Legislature in compliance with Section 9795 of the Government Code by January 1, 2028.
• Move the proposed findings and declarations to an uncodified section.

Related legislation. AB 377 (Muratsuchi) of the 2023-24 Session would require the consolidation of specified K-12 CTE programs, increase ongoing funding for the CTEIG, administered by the CDE, to $450 million per year; requires specified CTE staffing at the state and regional level to support local CTE programs and pathways; and deletes authorization for the K-12 Strong Workforce Program (SWP) administered by the CCCCO.

AB 1189 (Gipson) of the 2023-24 Session requires school districts serving students in grades 9 to 12 to offer CTE courses.

AB 181 (Committee on Budget) Chapter 52, Statutes of 2022, appropriates $500 million in one-time Proposition 98 funding for the Golden State Pathways Program to support the development and implementation of college and career educational pathways in critically needed sectors of the economy. Authorizes the CDE to contract with up to 10 LEAs for the provision of technical assistance to LEAs, applicants, and grant recipients.

AB 1923 (Mathis) Chapter 114, Statutes of 2022, requires the SPI to prioritize proposals for new California Partnership Academies based on a school district’s enrollment of socioeconomically disadvantaged students, and for school districts located in a rural or economically disadvantaged area.

AB 130 (Committee on Budget) Chapter 44, Statutes of 2021, provides that, for the 2021–22 fiscal year and each fiscal year thereafter, $300 million would be made available to the CDE, upon appropriation for the CTEIG program. Also makes adjustments to program provisions relating to eligibility requirements for grant applicants, and for ensuring compliance with program requirements.

AB 102 (Holden), Chapter 902, Statutes of 2022, authorizes COEs to enter into CCAP partnerships with the governing board of CCC districts, and removes the sunset date for the CCAP partnerships.

AB 103 (Holden) of the 2021-22 Session would have required the CDE and the CCCCO, in consultation with experts in the field of CCAP partnerships, to identify best practices for CCAP partnerships and appropriate financial incentives for school districts and community college districts to participate in CCAP partnerships, and to distribute the best practices to school districts and community college districts on or before September 1, 2023. The bill also required, on or before September 1, 2023, the CDE and the CCCCO, in consultation with experts in the field of CCAP partnerships and other key stakeholders, to develop a statewide pupil- and parent-centered communication and marketing strategy that includes specified outreach and information, in order to increase the visibility of the CCAP partnerships for all secondary pupils in California. This bill was held in the Assembly Higher Education Committee.

AB 30 (Holden), Chapter 510, Statutes of 2019, streamlines the process for developing CCAPs, in part, by: changing the conditions of how CCAP partnership agreements may be adopted, authorizing high school pupils to complete only one community college application for the duration of their attendance, as specified, and, extending the sunset of the CCAP partnership from January 1, 2022, to January 1, 2027.

SB 586 (Roth), Chapter 529, Statutes of 2019, requires the governing board of a school and CCC district, as part of a career technical education CCAP partnership, to consult with the appropriate local workforce development board to determine the extent to which the pathway is aligned with regional and statewide employment needs.

AB 1808 (Committee on Budget) Chapter 32, Statutes of 2018, appropriates in the 2018–19 fiscal year and each fiscal year thereafter, $150 million to the CTEIG program administered through CDE. Also establishes a K–12 component of the SWP to create, support, or expand high-quality CTE programs at the K–12 level aligned with the workforce development efforts and, commencing with the 2018–19 fiscal year, requires the CCCCO to allocate $150 million for this program to regional CTE consortia.

AB 104 (Committee on Budget) Chapter 13, Statutes of 2015, establishes the CTEIG, a competitive grant program administered by the CDE, to provide support for career technical education in grades K-12, and provides $400 million in 2015-16, $300 million in 2016-17, and $200 million in 2017-18 for this program.

REGISTERED SUPPORT / OPPOSITION:

Support

United Nurses Associations of California/Union of Health Care Professionals

Opposition

None on file

Analysis Prepared by: Marguerite Ries / ED. / (916) 319-2087