California and Excelsior

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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.

Dustin

Specializes in Emergency, Family Practice, Occ. Health.

The bottom line is ignorance by the CA BORN.

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

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Specializes in Emergency, Family Practice, Occ. Health.

Where is the proof that this decision protects anyone?

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

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The bottom line is ignorance by the CA BORN.

Maybe but ... EC lost and the board won. I guess the courts didn't think the board was that ignorant.

Where is the proof that this decision protects anyone?

Maybe there is no proof. I just think the court looked at a two and a half day exam versus two years of nursing school clinicals and said ... no way that protects the public. No matter how you slice it, and no matter how much the pro-Excelsior arguments may have merit, it would have taken a miracle to convince a judge that a two day exam provides the same protection as hundreds of supervised clinical hours.

Maybe it's a perception versus reality problem. But even if you're totally right, and the perception is totally wrong ... two and a half days just wasn't going to cut it ... no matter how much you try to argue otherwise. That's pretty much all the board had to say to win this thing, and it's probably the reason the court prominently mentioned the comparison in their ruling.

:typing

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Specializes in Emergency, Family Practice, Occ. Health.

Everyone listen very carefully now:

The CPNE is not clinical rotations; it is an exam to prove beginning level graduate registered nursing competency. It is not a weekend course or a class. No one shows anyone anything except for where the bathroom is. The people who currently graduate from Excelsior College have years of experience in a licensed care provider role; they aren't coming into the program with a GED and mechanics certificate. They are licensed health professionals with years of clinical experience. To compare the CPNE to traditional school clinical rotations is ignorance. They are not even close to the same one is instructional and the other is the exam to prove that the instructional needs have been met. This would be like a traditional programs final clinical exam, unlike that which any traditional nursing student has ever seen.

Now hopefully there won't be any further confusion (ie ignorance) on this issue.

DUSTIN

As a side note:

If you disagree with any of this i would hope you would provide facts and sources rather than unfounded opinions and propaganda.

Maybe but ... EC lost and the board won. I guess the courts didn't think the board was that ignorant.

Maybe there is no proof. I just think the court looked at a two and a half day exam versus two years of nursing school clinicals and said ... no way that protects the public. No matter how you slice it, and no matter how much the pro-Excelsior arguments may have merit, it would have taken a miracle to convince a judge that a two day exam provides the same protection as hundreds of supervised clinical hours.

Maybe it's a perception versus reality problem. But even if you're totally right, and the perception is totally wrong ... two and a half days just wasn't going to cut it ... no matter how much you try to argue otherwise. That's pretty much all the board had to say to win this thing, and it's probably the reason the court prominently mentioned the comparison in their ruling.

:typing

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Specializes in Peds stepdown ICU.

Medic you are correct in your definition of the CPNE. The CPNE is a criteria based competency exam. There is absolutely no teaching involved. You come prepared to be evaluated against the actions and clinical competence of new grad RN. The CPNE can't be paralleled with a traditional clinical. Irregardless of traditional school claims by people, the truth is all schools graduate sub-standard nurses. I have never seen so many failed NCLEX students until I moved here to Cali. Our unit secretary failed, the guy next to me at orientation failed 5 times, a nurse on our floor failed twice....below competence abounds everywhere. With that said, I just had my 90 day evaluation--nothing but positives and praises...the traditional student I started with was put on probation again for not being up to par. California has the right to make it's own decisions on what they will accept to be licensed but the bottom line remains--all schools put out nurses who are not meeting standards.

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
If you disagree with any of this i would hope you would provide facts and sources rather than unfounded opinions and propaganda.

:yeahthat:

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Maybe there is no proof. I just think the court looked at a two and a half day exam versus two years of nursing school clinicals and said ... no way that protects the public. No matter how you slice it, and no matter how much the pro-Excelsior arguments may have merit, it would have taken a miracle to convince a judge that a two day exam provides the same protection as hundreds of supervised clinical hours. :typing

True. It would take a miracle to convince a judge, particularly when the CPNE wasn't even acknowledged as an exam, but rather a "weekend course."

I definitely believe that to be a gross misrepresentation of the CPNE, as stated in EC's letter.

The CPNE was equated with clinical students functioning under the direction of an instructor.

If a court believed that one school held only one "weekend course" while all of CA's schools required hundreds of clinical hours, it's no wonder EC lost.

There's a big difference between a clinical exam and a clinical experience, and I think that the difference between the two somehow got lost during the case, and the two were blurred as undifferentiated except in terms of hours.

But again, that doesn't even touch on the fact that the CA BNE was merely exercising their right to make, change, or enforce requirements for RN licensure.

If someone is going to challenge the BNE's decision, then as long as the CPNE is going to be referred to nothing more than a "weekend course," and 2 1/2 days of an exam is looked at as the same as 2 1/2 days of supervised clinical instruction, then there really isn't any room to work toward any sort of common ground or agreement on either side.

I'm still wondering what kinds of proposals EC made or was willing to do to meet CA requirements and what they weren't willing to do so that no agreement was possible between the two.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

many are missing the point: california nursing program regulations (as well as illinois) require that students spend specific # hours in concurrent course and clinical work covering several nursing subjects: medical surgical nursing, maternity, pediatrics, geriatrics and psych nursing.

per excelsior:

the nursing performance examinations are skill-based assessments designed to measure a student's ability to demonstrate the expected behaviors and skills of a beginning-level associate- or baccalaureate-prepared nurse. the performance examinations offered by excelsior college include the clinical performance in nursing examination (cpnesm), and the health assessment and promotion examination (hape)....

although each performance examination focuses on a different set of clinical skills, the examinations are similar in that they all provide the following:

  • 1:1 evaluation by a master's- or doctorally prepared clinical examiner who was trained to administer the examination
  • actual or simulated clinical situations that serve as the basis for the examination
  • a carefully controlled and monitored examination experience that allows for a fair and objective assessment of your knowledge and skill no matter where or when you choose to complete the examination

for each examination, a comprehensive study guide is provided that describes the examination requirements in detail. excelsior college also offers workshops to help you prepare for the cpnesm and hape.

students enrolled in the excelsior college associate degree nursing program must complete one performance examination: the cpnesm. the hape is required for all excelsior college bs in nursing students.

https://www.excelsior.edu/portal/page?_pageid=57,58528&_dad=portal&_schema=portal

because of the lack of concurrent clinical experience and per ca born, low pass rates of some ca excelsior graduates, the board of nursing chose to no longer accept excelsior as an approved nursing program. nursing is more than mastering clinical skills and textbook material. learning how to effectively nurse and advocate for our patients comes from the human experience of supervised nurse, patient, physician, and healthcare worker interaction found in various clinical settings. this program is missing out on this vital part of basic nursing education. for those lpn, paramedic, military medics and rt excelsior students working within a hospital setting, they are exposed to registered nurses who demonstrate daily professional practice. those persons working in other areas, may not have exposure to rn's who can help answer questions, be mentors, offer clinical support.

california is upholding its obligation to safeguard nursing education within their state by requiring supervised clinical experience. they have made this decision to review schools adherence with educational program standards after receiving complaints in 2001 from public health nursing directors expressing concern about the skill level of new graduates from some nursing schools. excelsior is not the only school that was reviewed. bon tried to resolve this issue with excelsior to include supervised practice but it's attempts to resolve issue unsuccessful. court ruling has uphold the board's right to set nursing education standards and require nursing programs to meet those standards.

illinois regulations are similar requiring supervised clinical practice.

section 1300.20 application for examination or licensure

pursuant to section 10‑35 of the act, when an applicant has completed a nonapproved program that is a correspondence course or a program of nursing that does not require coordinated or concurrent theory and clinical practice, the department may grant a license to an applicant who has applied in accordance with subsection (a) and who has received an advanced graduate degree in nursing from an approved program with concurrent theory and clinical practice or who is currently licensed in another state and has been actively practicing in clinical nursing for a minimum of 2 years. clinical practice for purposes of this section means nursing practice that involves direct physical (psychomotor and psychosocial) patient (client) care with an acute care facility.

http://www.idfpr.com/dpr/who/ar/rn.asp

registered nurse applicants and practical nurse applicants may participate in an individual self‑study plan developed by an approved nursing education program in illinois that includes theory and coordinated clinical practice components.

1) the theory component shall have the following minimum components:

a) assessment of theory learning needs through use of published tests measuring knowledge in medical/surgical nursing, growth and development across the life span and pharmacology;

b) specification by a nursing education program of units of content, objectives and unit plans for study

c) documented hours equivalent to at least 48 contact hours of theory for registered nurse applicants and 32 contact hours of theory for licensed practical nurse applicants

d) use of a medical/surgical nursing text currently used in basic nursing education programs

e) a means for demonstrating achievement of objectives.

2) the clinical practice component shall be sponsored by a nursing education program. the clinical practice experience shall include the following minimum components

a) assessment of skill learning needs, arranged by the applicant with the nursing education program prior to assignment to a unit of the institution

b) mastery of the registered nurse or practical nurse minimal skills set forth in appendix a and c of this part

c) clinical practice component of at least 96 contact hours for registered nurse applicants and 64 contact hours for licensed practice nurse applicants that includes the clinical practice experience set forth in appendix b and d of this part; and

d) identification of a faculty member or registered nurse preceptor

e) registered nurse or licensed practical nurse applicants, taking a self-study course approved by another state board, shall have the course approved by the department in order for the course to be accepted. the clinical practice component of the course must be provided by an illinois health care delivery institution and must incorporate the department's minimal requirements for the clinical practice component. the nurse taking the course must make arrangements with the health care delivery institution for the clinical practice component and identification of a registered nurse preceptor.

e) individuals may request a review, by the board of nursing, of any other pertinent documents or training that are not set forth in this section for approval as meeting these requirements.

all boards of nursing have an obligation to safe guard the public by making sure nursing education programs it approves meet state guidelines. most bon require periodic reviews of programs it has approved. state nursing practice acts also are periodically reviewed by bon then sent to state legislature for approval. healthcare is rapidly changing these days. "routine practices" language found it many regs now is being strengthened to include specific language regarding minimal education standards. "concurrent theory education and clinical practice" has always been considered "routine education practice". many states have had falling nclex pass rates in 2000-2004 (my state pa is one) indicative of need to more closely look at education standards as the exam structure had not changed during this period. adding this type language to state's practice act is a way to ensure this vital part of basic educational preparation is not abandoned with the advent of internet technology.

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If you disagree with any of this i would hope you would provide facts and sources rather than unfounded opinions and propaganda.

You misunderstood the context of the post, which I tried to carefully explain but ... let me try again.

My point was ... you're likely to have a perception problem when the clinical component only consists of a two and a half day exam. There's always the possibility that people will perceive that's all there is to it, even if there's a lot more to it than that.

There's a big difference between a clinical exam and a clinical experience, and I think that the difference between the two somehow got lost during the case, and the two were blurred as undifferentiated except in terms of hours.

This was my point exactly, except you stated it better than I did. Thank you. As soon as you say it's only two days ... and, technically, this portion of the program is only two days ... you have a perception problem. There's a real danger of all of the other arguments and explanations about previous clinical experience, etc. falling on deaf ears.

And you're right. I think the fact that the court called it a weekend course, rather than an exam ... demonstrates the potential perception problem here.

:typing

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They are not even close to the same one is instructional and the other is the exam to prove that the instructional needs have been met.

I understand your point. But I've got to disagree with you here.

As NRSKarenRN pointed out ... the board requires clinicals in Med Surg, Maternity, Pediatrics, Geriatrics, Psych, and Critical Care (among others).

The CPNE does test in some of these areas, but not all of them (I believe the court decision said only two clinical areas are tested). So you really can't say the instructional needs have been met because ... a lot of what is covered in all of those traditional clinical hours isn't tested with the CPNE exam.

And, with no testing in those areas ... there was no assurance that EC students had competency in all of the clinical areas required by the board.

I know the board had a big problem with this and, I'm sure, the court did as well.

:typing

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Specializes in Peds stepdown ICU.
I understand your point. But I've got to disagree with you here.

As NRSKarenRN pointed out ... the board requires clinicals in Med Surg, Maternity, Pediatrics, Geriatrics, Psych, and Critical Care (among others).

The CPNE does test in some of these areas, but not all of them (I believe the court decision said only two clinical areas are tested). So you really can't say the instructional needs have been met because ... a lot of what is covered in all of those traditional clinical hours isn't tested with the CPNE exam.

And, with no testing in those areas ... there was no assurance that EC students had competency in all of the clinical areas required by the board.

I know the board had a big problem with this and, I'm sure, the court did as well.

:typing

This point is valid. The CPNE covers adult med-surg and pediatrics. Often times if there is not peds available they will sub an adult. I think Excelsior needs to reorganize their entire clinical componet--this could be via preceptorships along with theory or they may need to contract with hospitals and provide this directed supervision.

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Many are missing the point: California nursing program regulations (as well as Illinois) require that students spend specific # hours in concurrent course and clinical work covering several nursing subjects: Medical Surgical nursing, Maternity, Pediatrics, Geriatrics and Psych nursing.

CA and IL are not the same.

They may both require the same # of clinical hours, but IL recognizes the experienced RN and allows licensure without expecting an experienced RN to go through clinicals in OB-GYN, psych, or whatever a particular BNE decides that they want from an experienced RN applicant.

I work in MICU, SICU, Burn ICU, and PACU, and I would think that it would be ridiculous for Texas to say no to an experienced RN for licensure because they didn't complete enough clinical hours in L&D, psych, or whatever.

With all of the incompetence out there these days, when are people going to figure out that stomping out EC grads isn't going to solve the problem?

San Diego City College and El Centro in Dallas both have put out incompetent and dangerous grads who somehow passed NCLEX.

Should they be shut down as a result?

I realize what this thread is about, but I ask all of you as one example:

Is asking schools of nursing in any state to put students through more clinical rotations going to produce better nurses?

We can all parrot the phrase of how it is the state's perogative to decide whether or not someone meets licensure requirements, but does that state's decision suddenly become ok simply because they made a decision?

Are we thinking for ourselves or merely taking comfort that the CA BNE is going to decide what's best for all of us?

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