Cal State Fullerton Responds to the National Nursing Crisis

By Valerie Orleans '80 / Images by Jeanine Hill

Student nurse Zachary Winkler checks the vital signs of a “patient” in the UnitedHealthcare Nursing Skills Lab.

Steven Huerta — married with three children — wants a master’s degree in nursing so badly that he works full-time as a registered nurse at Placentia-Linda Hospital while putting an additional 30-40 hours a week in classes and studying.

It’s a new career for Huerta, who has a bachelor’s degree in biology and worked in research at UC Irvine Medical Center for 10 years. “What I really enjoyed was interacting with patients,” he recalled. “I was trying to figure out how to combine both interests and then it hit me: nursing.”

Huerta was set to graduate in January from Cal State Fullerton’s three-year master’s degree in nursing program. (He received his RN certification after the first 18 months).

Similarly, Danielle Merchant, a pediatric ICU nurse at Children’s Hospital of Orange County whose undergraduate degree was in psychology/communicative disorders, works and studies long hours in pursuit of a master’s in nursing at Cal State Fullerton.

“People sometimes ask me why it’s important to have a master’s degree,” Merchant said. “I think there’s a tendency, industry-wide, to hire nurses with more advanced degrees. Medicine is becoming more complex and we have to acquire the critical thinking and technical skills to ensure that patients receive the best possible care.”

Steven Huerta is pursuing a master’s degree in nursing at Cal State Fullerton. As part of the solution to the state’s nursing shortage, students like Huerta play an increasingly important role.
Danielle Merchant believes a master’s degree in nursing will set her apart from other nurses.

Responding to the Nursing Crisis

Nursing is one of the CSUF Philanthropic Foundation’s top six fundraising initiatives, with $5.75 million being sought to supplement the cost of educating nursing students; fund scholarships; pay for administrative, faculty and development costs; and upgrade technology.

People like Huerta and Merchant are increasingly important on today’s health care scene. As baby boomers age and our nation’s capacity to provide more sophisticated care to those with medical issues increases, there is one certainty: America will need more nurses. A lot more nurses — especially those with advanced degrees.

The U.S. Department of Health and Human Services projects that California’s estimated shortage of 20,000 registered nurses will grow to a staggering 50,000 to 80,000 by 2015. That’s approximately 34 percent of the expected number of nurses required. Nationwide, the nursing shortage is estimated at 150,000 registered nurses, and the department projects that the shortage will grow dramatically to 800,000 nurses by 2020. California is ranked last in the nation for registered nurses per capita.

To compound the situation, there isn’t enough space in nursing schools to educate all those who would like to become nurses. In fact, it’s estimated that about 40 percent of those who apply to nursing schools are turned away because schools are already filled to capacity. At CSUF in fall 2009, 387 pre-nursing students applied for the entrylevel bachelor’s in nursing program and 33 were accepted. For the entry-level master’s in nursing program, of the 355 pre-nursing student applicants, 30 students were accepted.

“The cost of educating nurses is considerably greater than the cost of educating other, non-nursing students, due to heavy lab/clinical requirements and small class sizes,” said Roberta E. Rikli, dean of the College of Health and Human Development. “The ‘gap’ between the actual cost to educate nurses and the amount that the campus receives in state support and fee revenue can be as high as $5,000 per student, per year. To expand capacity, the university must raise external, supplemental funds to pay for expenses not covered by core state funding.”

So how do we alleviate the coming shortage? Supporting nursing schools through public funding, developing public-private partnerships, and generating private financial support for nursing programs like those at Cal State Fullerton. Nursing is one of the CSUF Philanthropic Foundation’s top six fundraising priorities over the next few years. Ultimately, more than $10 million will be sought to supplement the cost of educating nursing students; pay for administrative, faculty, and development costs; upgrade technology; and endow funds to help support scholarships, a professorship and chair.

Mary Wickman, left, director of pre-licensure programs, directs student nurse Sara Katie Barnes in the preparation of intravenous medications.
April Verkler, Whitney Dragon and Barnes work to resuscitate a simulated patient in the nursing skills lab.
Cindy Greenberg, chair and associate professor of nursing, helps student nurse Angelica Panova work on a pediatric “patient” in the nursing skills lab.

The Road to Becoming a Nurse

At Cal State Fullerton, a number of students take advantage of an “entry-level” master’s degree in nursing designed for students with non-nursing baccalaureate degrees. This program is one answer to the looming nursing shortage.

“These students are required to take prerequisite courses in anatomy, physiology, microbiology, chemistry, English, speech, statistics, psychology and sociology or cultural anthropology,” said Mary Wickman, director of pre-licensure programs. “Prerequisite and nursing curriculum provides students with a scientific, clinical and professional foundation upon which to build sound and safe individualized nursing care.”

Kaiser Permanente was one of the first community sponsors to offer assistance by awarding $300,000 to the Department of Nursing for the entry-level program.

More recently, the university received a $2-million grant from UnitedHealth Group that will allow Cal State Fullerton to admit an additional 120 nursing students to the entry-level, pre-licensure nursing program. (Students may choose to enter as freshmen or at the post-baccalaureate level).

“We push the students here and we want them to think critically and quickly.”

“It’s very difficult for students to be in a nursing program and work at the same time,” said Cindy Smith Greenberg, chair and associate professor of nursing. “The hours they must devote to their studies often mean that they must give up jobs or cut back significantly on work and family commitments.”

For that reason, scholarships are all the more important when our nation is trying to attract more students to consider nursing as a profession.

Recently, the Robert Wood Johnson Foundation awarded Cal State Fullerton $200,000 to offer 20 scholarships of $10,000 each to students in the accelerated entrylevel master’s nursing program.

Students from underrepresented groups are targeted for these scholarships because, according to the National Advisory Council on Nurse Education and Practice, diversifying the nursing profession is essential to meeting the health care needs of the nation and reducing health disparities that exist among many underserved populations.

For students who are nurses already, many classes are offered online as well, decreasing travel time and allowing students to access programs at times when it is more convenient for them. This allows them to pursue their studies while accommodating work schedules or other obligations.

Zachary Winkler works in the UnitedHealthcare Nursing Skills Lab
Russell Robinson is enrolled in CSUF’s nursing program

Cal State Fullerton's Nursing Programs

Included among the nursing programs currently offered at Cal State Fullerton are the following:

Bachelor of Science in Nursing (BSN)
Entry-level for those without RN licensure (usually enter as freshmen)
Associate degree (with RN) to bachelor’s degree (community college transfers)
Accelerated associate degree to master’s degree (ADN to MSN)
Entry-level pre-licensure to MSN (for those with bachelor’s degrees in other fields who want to enter nursing)
Master of Science in nursing degree with a concentration in:
- nurse anesthetist
- nursing leadership
- women’s health care (nurse midwifery or nurse practitioner)
- school nursing
- nurse educator

There are two pathways that lead directly to the Master’s of Science in Nursing. One is for those with an associate degree in nursing; the other is for those who have a bachelor’s degree in another field. The entry-level master’s program includes pre-licensure courses of basic nursing concepts, theories and skills, and culminates in the nursing leadership concentration.

All programs are accredited by the Commission on Collegiate Nursing Education and the pre-licensure programs, nurse anesthetist and women’s health care concentrations also are accredited by the California Board of Registered Nursing.

“The role of nursing has changed over the years,” Greenberg said. “Today’s nurses are often more highly educated and take on more professional responsibilities. In the hospital setting, patients are admitted for care that is prescribed by physicians but actually provided and monitored by nurses.”

According to a study in the Journal of the American Medical Association, hospitals that employed more nurses with bachelor’s, master’s or other advanced degrees had improved patient outcomes demonstrating lower patient mortality and failure-to-rescue rates nationwide.

CSU campuses, including Cal State Fullerton, will continue to offer advanced nursing degrees and plan to begin to offer a doctoral program in nursing, if approved, as well to meet the need for a highly educated nursing workforce.

Five of Cal State Fullerton’s nursing students pause from their work in the UnitedHealthcare Nursing Skills Lab: from left to right, April Verkler, Boudsakhone Sundara-Nunez, Zachary Winkler, Angelica Panova and Whitney Dragon.

Hands-On Education

As part of the nursing program, the university has a designated $1.6-million nursing simulation lab — a facility that replicates a hospital patient care unit. Recently named the UnitedHealthcare Nursing Skills Lab in appreciation of UnitedHealth Group’s generous gift, students can practice many of the skills and techniques they will need as nurses. Fitted with nearly $700,000 worth of equipment, including beds, wheelchairs, infant-care stations, patient mannequins and computer programs, the lab has a lobby; a 12-bed hospital wing with emergency, medical-surgical, obstetrical and pediatric rooms; a patient exam room; a 30-seat classroom; a six-seat study room; and a conference room.

“The lab is great for students because this is often the first time they get a chance to actually put into practice the skills they are learning in the classroom,” said Barbara Doyer, the lab’s coordinator.

Initially, students learn basic skills (with the help of the specially designed mannequins) such as taking vital signs, changing dressings, administering medications, inserting catheters, and learning the different ways to administer injections. Because some of the mannequins are computerbased, they can “talk back” to the students. (Actually one of the nursing staff is behind a two-way mirror and can respond to the student’s actions).

As baby boomers age and our nation’s capacity to provide more sophisticated care to those with medical issues increases, there is one certainty: America will need more nurses. A lot more nurses — especially those with advanced degrees.

As they progress in their studies, students will learn more advanced techniques: starting IV lines, recognizing signs of complications, learning labor and delivery techniques, and how to care for newborns. They may also be introduced to crisis situations — a patient goes into cardiac arrest, has a diabetic reaction, or develops sepsis (a lifethreatening bacterial infection).

“We push the students here and we want them to think critically and quickly,” said Doyer. “Most of them are nervous when they start working in the lab but after their first time, they love it. I let them know that this is where we want them to make mistakes.”

Doyer develops scenarios before the students arrive. In one instance, nursing students were required to defibrillate a patient who went into cardiac arrest. Doyer deliberately kept her hand on the patient’s bed. When the students applied the paddles to the patient (no, they weren’t charged), Doyer yelled and slumped to the floor because, if it were a real situation, she would have been shocked, too.

“Now the students had two patients to deal with — the mannequin and me,” she said. “However, I think before they ever defibrillate a patient, they’ll make sure everyone is clear of the bed.”

In another instance, Doyer saw a student about to give the wrong dosage of medicine to the mannequin. While she was willing to sit back and see how the student reacted to the error, the student’s nursing instructor raced forward, yelling, “No! Stop!”

“To me, that epitomizes the lab experience,” said Doyer. “Nothing bad was going to happen to a real person, but the mannequins become real to the folks working on them.”

Following what is usually a 20-25 minute session with the mannequins, a debriefing will follow. Students are taped while they are administering care and they review what worked and what didn’t.

“We also work with students on how they approach patients, family members, other staff members and doctors,” said Doyer. “We’ll tell some of the students to stop playing with their hair or waving their hands when they’re talking to the family. They’ll deny that they do it … and then they see the tape and those behaviors are on display. Of course, we get rid of the tape as soon as the lesson is over. This isn’t to embarrass the students but to point out how they might have approached a situation differently.”

The lab also is considering adding a new dimension to the simulation scenarios — end-of-life training.

“Sometimes, it’s appropriate to stop,” Doyer said. “We want students to be prepared for that and understand how to respond to family members and others who might be affected.”

The truth is, Doyer admits, the students are pushed harder in the simulation lab than they probably would be on the floor of the hospital where the additional 75 percent of their clinical training takes place. But the point is to prepare them for worst-case scenarios and allow them to make mistakes in the lab before they begin to actually treat living, breathing patients. end of story