California Nurses Association Scores Big for the Nursing Industry

• The California Nurses Association is helping to increase nursing school enrollment by expanding equitable access to clinical placement opportunities. 
• California nursing school enrollment is down due to lack of clinical placement opportunities for nursing students.  
• Competition between nursing schools to land contracts with clinical sites is a contributing factor. 

California has the largest percentage of licensed RNs in the nation. However, the state has struggled with nursing shortages for years, particularly in rural areas and in specialized fields like perioperative care, labor and delivery, intensive care, and emergency care. 

Nursing school enrollment is simply not meeting the state’s demand for more nurses. Research shows that California nursing school applications are on the rise, but enrollment remains low. Lack of clinical placement for students is a top contributing factor

But California is attempting to level the playing field for all prospective students.

The California Nurses Association (CNA) recently made great strides by sponsoring a new bill (S.B.1015) that would expand clinical placement opportunities for California nursing students. The bill was recently signed into law by California’s Gov. Gavin Newsom.

With this new law, California hopes to expand the nursing workforce for the future.

The Extent of the Problem 

In 2022, the No. 1 reason California nursing schools had low enrollment was because students who were accepted into programs chose not to enroll. While this isn’t necessarily a state or school problem, the second reason – inability for schools to secure clinical placements for students – is addressable.

The California Nursing Practice Act requires pre-licensure students to receive 500 hours of direct patient care clinical hours in board-approved clinical facilities. Without these hours, students can’t graduate or apply for state licensure. The problem is, California nursing schools are having a difficult time landing contracts with clinical sites – some 92 out of 152 nursing schools, according to one study.

Why are some schools denied contracts with clinical sites? For one, the facilities’ nurses are already overwhelmed. In recent years, “staff nurse overload” was cited as a primary reason for the letdown. Training nursing students can be overwhelming for many nurses who are already highly stressed by the demands of the field. Another reason cited was “insufficient qualified staff.” Hospitals that struggle with nurse retention, for example, may not be the most suitable choice for clinical placement of students.

Competition among nursing schools also plays a role. Public nursing schools have a harder time landing contracts than private schools, and 66% of all prospective students in 2022 applied to public schools.

To worsen matters, some schools pay clinical sites in exchange for clinical placements for their students – something prohibited by the California Nursing Practice Act, but poorly regulated.

This is where the CNA has made a difference. 

The New Law

Sen. Dave Cortese introduced S.B. 1015 in February and Newsom signed it in late September. Sponsored by CNA, the measure will help develop clinical placement standards for California nursing schools.

It requires the California Board of Registered Nursing to collect and annually report information on how board-approved schools arrange and coordinate clinical placements for students. This will require full transparency from nursing schools, potentially eliminating unethical practices like paying for clinical contracts.

“This commonsense reform will increase transparency around and equitable access to clinical education placements for nursing students across the state,” California Nurses Association President Michelle Gutierrez Vo, RN, said in a statement. “It is critical that all of California’s future nurses have clinical placement opportunities.”

By addressing the problems associated with nursing school enrollment, the new law aims to tackle the state’s nursing shortage. Cortese said it also “ensure we are on the right path” to meet nursing demands.

“As California’s population ages and becomes increasingly more diverse, we will need a qualified and experienced nursing workforce to meet the unique demands and varied needs of all patients,” Cortese said in a statement. “That is why we must have appropriate nurse staffing levels which have proven to reduce mortality rates, reduce hospital length of stays, and reduce the number of preventable events such as falls and infections.” 

The Bottom Line

Though enrollment numbers are bleak, California nursing schools are enrolling more students as the years progress. It’s just not enough to meet the current industry demand.

We often hear about the nursing shortage, its impact, and how it’s expected to worsen. But how often do we celebrate the wins of the many nursing organizations working tirelessly behind the scenes? This new law is among the many accomplishments aimed at increasing nursing school enrollment and alleviating the ever-present nursing shortage. To the California Nurses Association, thank you for making a difference!

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