California and Excelsior

Marie_LPN, RN, LPN, RN · Mar 18, 2006

To proclaim that they are dangerous or inadequately educated is simple ignorance.

I have to agree with this. Dangerous and inadequate education can come with any program, if a person doesn't take it seriously.

Marie_LPN, RN, LPN, RN · Mar 18, 2006

Insults add nothing to a discussion (i read the last closed thread on this subject, jeez). That's not to anyone in particular, but i've seen to many of these DL threads head south for STUPID reasons (one of those being pot-stirring).

RN34TX · Mar 20, 2006

California should simply accept the fact that excelsior isn't going away. I'm sure the law suits are not over. The fact remains that there are THOUSANDS of RN's in California that are Excelsior grads. To proclaim that they are dangerous or inadequately educated is simple ignorance. If they truely believe this they should suspend all of those people already licensed. Then the law suits will certainly start. I will be licensed in California and I never plan to work there. My only mission will be to write them a letter a month asking them to tell me why my fellow grads can't get licensed. If all of the excelsior grads in California did similar things and defend the education the NLN says is exceptional, California would have to change their mind.

I understand what you are saying, but I think that CA is making it quite clear that they don't "have to" do anything.

I'm not saying it's right, but I've read the court transcripts. It had nothing to do with "dangerous or inadequately educated" grads because they failed to introduce any such evidence and won nonetheless.

It was a matter of interpreting the legal requirements for RN licensure in the state and how EC did not meet those requirements in the eyes of the court.

In essence, a blind eye was turned to the 6000+ CA licensed EC grads who were presumed to still be working as RN's in the state. Whether or not some, if any, had competency problems, was irrelevent in this case.

I still would like to find out where you got that letter from. It was addressed to Excelsior students, faculty, and alumni.

I'm alumni, and I received no such letter.

Sheri257 · Mar 20, 2006

As the court states ...

The primary purpose of the Board is to protect the public. "Protection of the public shall be the highest priority for the Board of Registered Nursing in exercising its licensing, regulatory, and disciplinary functions. Whenever the protection of the public is inconsistent with other interests sought to be promoted, the protection of the public shall be paramount."

In August 2001, the Board received correspondence from the statewide organization of Public Health Nursing Directors expressing concern about the skill level of new graduates from some nursing schools. The Board's subsequent inquiry revealed that the nursing education provided by Excelsior College did not meet minimum education requirements for California registered nursing licensure because it lacked sufficient supervised clinical practice.

Excelsior's supervised clinical practice consisted of students taking and passing its Clinical Performance Nursing Examination (CPNE). The CPNE is a weekend course, administered over two and one-half days, with a limited number of patients involving only two areas of nursing. As opposed to California's 810 hours of supervised clinical practice in a variety of settings with various patients, Excelsior's students simply take the weekend CPNE. (Excelsior reports that 35% of students fail {Slip Opn. Page 7} the CPNE.) This differed substantially from the minimum 810 hours of supervised clinical practice required under California Code of Regulations, title 16, section 1426.

The CPNE, in the Board's opinion, is not equivalent to the minimum education requirements for clinical practice under California licensure law.

http://fsnews.findlaw.com/cases/ca/caapp4th/slip/2006/c047824.html

:typing

fergus51 · Mar 20, 2006

Every state has the right to set its own educational standards. EC may produce some fabulous nurses, but that doesn't mean California has to liscence them. Have you seen all the posts about UK newly trained nurses trying to get liscenced? Some of them are more skilled that their American counterparts (for instance, midwives there have more responsibilities than L&D RNs in the US), but no nursing board in the US is going to give them a liscence unless they do coursework in the specialties they lack. It doesn't matter that they could be great nurses.

Trauma Columnist · Mar 20, 2006

This is a very interesting subject. However, it can also explode into a fractious mess if we let it. So...let's stay on the topic. Thanks.

Home Health Columnist / Guide · Mar 21, 2006

from california board of registered nursing:

board prevails in excelsior college court decision

i fully expected ca board of nursing to prevail in this issue. the ability to grant licensure to an individual is a states right, not a federal one. that is why we have individual state licenses for marriage, driving and occupational licensure ---no national licensure. each state determines the laws to govern and protect it's citizens.

prior to the development of national council of state boards of nursing about 25 yrs ago, nursing education standards + licensure were very individualized by state. a nurse living in one state applying for reciprocity one another state (with several years experience even), would need to obtain additional education hours + supervised practicum in say psych or maternity nursing prior to obtaining licensure: her state only required 150 hours, but next state required 180 hours. due to a national licensing exam, this rarely occurs.

the issue here is that the ca born has the right to determine educational requirements.

1426. required curriculum; prior approval

(a) the curriculum of a nursing program shall be that set forth in this section. a program's curriculum shall not be implemented or revised until it has been approved by the board.
(b) the curriculum shall reflect a unifying theme, which includes the nursing process as defined by the faculty, and shall be designed so that a nurse who completes the program will have the knowledge and skills necessary to function in accordance with the minimum standards for competency set forth in section 1443.5.
© the curriculum shall consist of not less than fifty?eight (58) semester units, or eighty?seven (87) quarter units, which shall include at least the following number of units in the specified course areas: (1) art and science of nursing, thirty?six (36) semester units or fifty?four (54) quarter units, of which eighteen (18) semester or twenty?seven (27) quarter units will be in theory and eighteen (18) semester or twenty?seven (27) quarter units will be in clinical practice.
(2) communication skills, six (6) semester or nine (9) quarter units. communication skills shall include principles of verbal, written and group communication.
(3) related natural, behavioral, and social sciences, sixteen (16) semester or twenty?four (24) quarter units.
(d) theory and clinical practice shall be concurrent in the following nursing areas: medical?surgical, maternal/child, mental health, psychiatric nursing and geriatrics

(f) the course of instruction shall be presented in semester or quarter units under the following formula: (1) one (1) hour of instruction in theory each week throughout a semester or quarter equals one (1) unit. (2) three (3) hours of clinical practice each week throughout a semester or quarter equals one (1) unit.

because excelsior did not meet the requirement of concurrent clinical practice, the board was in their right to deny approval of the program.

this is not to say that excelsior is not a good program...it must conform to california regs to be approved in that state. i've read about 25 state nursing practice acts to assist bb members here. it surprises me how some states have minimal nursing practice act language: hawaii and texas come to mind, in comparison to ca, pa and mass.

i fully expect a solution to be worked out between these institutions in the coming years since the suit is now settled. either students will obtain their own preceptors or excelsior will develop preceptor program for that state---too many potential students to loose coming from that area of country.

RN34TX · Mar 21, 2006

It surprises me how some states have minimal Nursing Practice Act language: Hawaii and Texas come to mind, in comparison to CA, PA and Mass.

I asked Texas about this when I first moved here. I was surprised that there was no LVN practice act, only a title act. (This is currently in the process of change as the two boards have merged.)

The answer I got was that they felt that it would become too restrictive and have less flexibility if a more specific practice act were to be written.

Having lived in PA, one of the states you listed, the long laundry list of LPN "do's" and "don'ts" that exists in PA is exactly what TX is trying to avoid.

The plus side of this is that LVN's can enjoy a significantly broader scope of practice than in a state like PA and LVN's can be used in a wider variety of areas in TX than in PA.

The downside of this, IMHO, is the confusion that can be created and inconsistency between facilities. The facilities are often left to make up their own policies with minimal help from BNE guidelines and rules.

In the case of CA, it looked to me, reading the transcripts, that the rules were quite specific and clear even in 1979, the date that CA acknowledged allowing full unrestricted licensure of EC grads and this continued through most of 2003. (I did note that CA did in fact delay their final decision at EC's request prior to the final Dec. 2003 ruling).

It remains a mystery to me how this was overlooked for that many years, literally sitting dormant for so long, but has grown into such a hot political issue that it has become today in such a relatively short period of time.

RN34TX · Mar 21, 2006

The ability to grant licensure to an individual is a STATES right, not a federal one. That is why we have individual state licenses for marriage, driving and occupational licensure ---no national licensure. Each state determines the laws to govern and protect it's citizens.

I understand your point here. It is the states right to make these determinations.

States are outlawing gay marriage left and right, it is within the right of the state to do this.

Does that just automatically make it ok to do so?

Are states outlawing gay marriage only to protect the public and are doing so purely out of concern over what's best for it's citizens?

No self-serving agendas or peoples religeous beliefs clouding their judgement involved here?

My point here is that if one is going to compare CA's ruling regarding EC to a state having the right to govern drivers licenses and marriage, then the difference that needs to be pointed out here is that a straight married couple who both hold valid drivers licenses in any of the other 49 states will have no trouble getting either their drivers licenses or their marriage recognized in CA should they choose to move there.

However, if they both happen to be EC grads after the cutoff date, getting an RN license there is another story.

It's not the same.

BBFRN, BSN, PhD · Mar 21, 2006

My point here is that if one is going to compare CA's ruling regarding EC to a state having the right to govern drivers licenses and marriage, then the difference that needs to be pointed out here is that a straight married couple who both hold valid drivers licenses in any of the other 49 states will have no trouble getting either their drivers licenses or their marriage recognized in CA should they choose to move there.
However, if they both happen to be EC grads after the cutoff date, getting an RN license there is another story.
It's not the same.

LOL...Good point.

Sheri257 · Mar 21, 2006

In the case of CA, it looked to me, reading the transcripts, that the rules were quite specific and clear even in 1979, the date that CA acknowledged allowing full unrestricted licensure of EC grads and this continued through most of 2003. (I did note that CA did in fact delay their final decision at EC's request prior to the final Dec. 2003 ruling).
It remains a mystery to me how this was overlooked for that many years, literally sitting dormant for so long, but has grown into such a hot political issue that it has become today in such a relatively short period of time.

I think there are some clues in the court decision. To wit:

In August 2001, the Board received correspondence from the statewide organization of Public Health Nursing Directors expressing concern about the skill level of new graduates from some nursing schools.

This, apparently, is what prompted the board to look at the program again after all those years.

From what I read in the court decision, apparently the EC program never did comply with the statute when the board allowed it back in 1979. When they looked at it again in 2001, apparently the board determined they had made an error in their previous interpretation of the statute. As the court states:

This guideline, however, does not prevent the agency, itself, from correcting its own erroneous interpretation of a statute ... An agency is not bound by its prior statutory interpretation if it determines that prior interpretation was in fact erroneous.

As for why it may have become a political issue, there may be some clues in this statement from the court:

Meanwhile, Excelsior contacted members of the California Legislature conveying concerns that the Board was unfairly evaluating Excelsior's nursing program.

Maybe this antagonized the board or, maybe not but ... whatever the case may be ... the program didn't comply with the law. That was the bottom line.

:typing