Dropout, Failure Rates in Nursing Programs Soar

Community college nursing programs, straining to address a growing statewide nursing shortage, are facing a new difficulty: soaring dropout and failure rates that are shrinking California’s already inadequate nursing pipeline.

Faculty blame the increased attrition on the lowering of admission barriers, which has made it easier for students with poorer grades to gain entry.

The change was made to ensure that the limited number of slots be equally available to all California students, allowing A students and C students alike to have an equal chance at admission.

The aim was to avert discrimination complaints. But faculty say it has allowed under-prepared students to enter nursing programs, only to find they can’t handle the tough course work after they get there.

“It’s hard for the faculty, and it’s awful for the students,” said Mary Parker, head of nursing at Cuesta Community College in San Luis Obispo, where attrition has increased from 3% to 40%.

“I’ve had students who were suicidal in my office,” she said. “They were flunking out of nursing. . . . It’s the end of their dreams.”

The loss of students is an especially pressing problem given the severe lack of space in the two-year college nursing programs, suppliers of 70% of the state’s registered nurses.

Nursing programs have become an educational bottleneck even as California has sunk to 48th among the 50 states in the number of nurses per capita and “thousands of dollars in hiring bonuses are being offered all over” as hospitals compete for nurses, said Stephanie Ruh, vice president of patient care services at Bay Harbor Hospital.

So, even as hospitals are filling pages of classified ads seeking nurses, would-be nurses by the hundreds are being put on waiting lists or rejected outright by training programs.

State and college officials have been reluctant to invest in nursing programs because nursing is more expensive to offer than other academic courses. So most colleges haven’t expanded their nursing schools in years, and many turn away more students than they take in.

At the same time, changes in health industries have also placed limits on nursing programs. The downsizing of hospitals has reduced opportunities for nursing students to complete required training at the bedside.

Given the limits on programs, it’s not surprising that the question of how to select students for limited slots became a burning issue in the community colleges.

About four years ago, new state mandates were issued requiring nursing programs to adopt discrimination-proof admission systems based on lotteries, or first come, first served waiting lists.

They replace widely used systems that gave priority to students with the highest grades. By selecting randomly among students who meet minimum qualifications--usually completing prerequisite courses such as anatomy with a C grade or better--colleges can ensure that no qualified student is shut out.

That’s an important principle in the California community colleges. The system is built on the notion that anyone who can benefit from an education should be given a chance.

Even some nursing directors critical of the results praise the policy’s intent: “The mission of community colleges is open access to everyone,” said Parker. “I personally believe passionately in that.”

But nursing faculty fear they are inadvertently shutting out students with the best chance of completing degrees.

Nursing course work is demanding. Students are stretched to the limit learning all they need in two years; those who must hone basic skills as well simply run out of time, faculty say.

“It’s very difficult and very frustrating,” said Sharon Hall, head of the nursing program at Glendale Community College, where attrition has increased from about 6% to 20% since changing admission guidelines. “There has got to be a way to deal with this.”

Officials with the state Community College Chancellor’s Office said they don’t track nursing program attrition statewide.

But in interviews, nursing directors throughout the state cited increases in attrition rates ranging from 10% to 40% since the changes, and most said grades had dropped and the length of time students took to finish had lengthened.

A few said average scores on state board exams have also dropped--a trend reflected in average statewide pass rates, which have dropped from 92% in 1995 to 84% this year for associate degree nursing candidates.

“The students come to us less prepared, and we ask more of them,” said Wendy Hollis, director of nursing at Los Angeles Harbor College.

Students are being held back because their accents are too heavy to be understood by patients, or their reading skills too poor to comprehend college-level textbooks, or because they falter when asked to apply their knowledge to real-life situations, instructors say.

Several said their students were stumped by the single-variable algebra problem required to calculate medication dosages.

“They can’t read at a high school level . . . or they have undiagnosed learning disabilities,” said Sue Albert, interim dean of allied health at Antelope Valley College, ticking off some problems she has seen. She said the number of students who fail to finish in the standard two years has expanded from 10% to about 40%.

But despite problems, some nursing faculty stopped short of condemning the changed admission systems. A few said their programs have become more ethnically diverse as a result.

And the legal justification for easing admission standards--that grades don’t necessarily measure nursing talent--is often borne out.

“I know lots of really good nurses who were C students,” said Dixie Bullock, a former nursing program director who is now president of Saddleback Community College.

Take Miguel Martinez, a 22-year-old Pasadena City College nursing student who has wanted to be a nurse since childhood, ever since he saw a drive-by shooting in his neighborhood of El Sereno.

Martinez earned Bs and Cs in prerequisite classes, grades that a few years ago would not have made him a first pick for nursing. He soon began having problems in the nursing program, earning a low D on his second exam. “Oh, God. I felt like I was stupid,” he said. “I had studied so much.”

Yet Martinez is an example of why choosing nursing students on the basis of grades alone is problematic. For starters, he is male, Latino and a fluent Spanish speaker, attributes sorely in demand in the nursing field.

He also has an open, cheery bedside manner that seems to flow naturally from his personality--”one of the few students in the class who has the ability to be caring and compassionate on this level,” said one instructor. And he has worked earnestly to improve since his disastrous exam.

The question is not whether such students should be nurses, said Hall. “Their ability--this is not the issue,” she said. The problem is making sure they are prepared well enough to succeed, she said.

Concern over preparation reached such heights in October that a group of nursing directors met with state Community College Chancellor Thomas Nussbaum to discuss revising admission guidelines.

Nussbaum has agreed to assign a task force to try to develop more stringent nursing admission standards--perhaps an assessment test for incoming students.

“It’s a tough case,” Nussbaum said. “Colleges should be able to focus on students who show the most promise . . . but you have to allow a way for people to get into the mix even if they aren’t the best and brightest.”

Under current rules, admission standards can be set above minimum qualifications only if studies prove the standards are correlated with success. Such studies are difficult and time consuming, and only a few colleges have attempted them. The task force, though, may offer a chance to tackle the question on a statewide basis.

In the meantime, most nursing programs have been working on their own to boost student success, offering so-called nursing boot camps and additional tutoring.

Another option would be to invest more public funds in nursing programs to give additional students a chance.

William Pickens, executive director of the California Citizens Commission on Higher Education, supports more funding for nursing.

He said the state’s funding priorities have wrongly favored cheaper college programs at the expense of nursing, which offers exceptional social benefits and the promise of secure, well-paying jobs for thousands of aspiring Californians.

But community college advocates say that increasing funding for nursing programs is politically difficult, and that any efforts to do so are a way off.

So for now, variable abilities among students are requiring a cultural adjustment in many nursing programs.

Academic nursing programs tend to be run by PhD nurses who represent the best of their generation--women who entered the profession at a time when top-notch female students had few other career options.

Now these nurses are confronting a more heterogeneous pool of nursing students: single parents, nonnative English speakers, younger students from mediocre high schools.

Admission policies aside, nursing programs will have to adapt as a changing labor market forces California to broaden the field of potential nurses anyway, said Hall. “It is a different time,” she said.