Concurrency and Deficiency - What do these entail exactly?

ceridwyn · Aug 10, 2013

Hang on, before blaming assessors for acting illegally, by picking and nurses from the Phillipines and not assessing their degrees well, there are nurses from other countries that are declined as well. Perhaps nurses from the UK and Australia who believe their nursing degrees are pretty spiffy as well.

Nearly all other countries have independent courses /units for obstetrics, in Australia and the UK it is a totally separate profession, though many still do a few weeks in Mid/obs and some do the mid subject, does not qualify them as it is not deemed sufficient.

If the CA BOn does not have a nursing shortage they therefore cannot spend hours and hours decifering something that just is not there and they have no way of knowing just how many theory or prac has been done in 'altogether' 2 semester subjects.

They can only work on what is presented to them,they still have no proof you have attended those hours in that subject, in comparison to the CA curriculum then it is their responsiblity to decline.

This is not a racial issue, but an issue that the Phillipine nursing curriculum most often does not satisfy the assessors at the CA Board of NUrsing in camparison to the rules and regulations of that Nurses Board.

mpgj83 · Aug 10, 2013

I haven't categorically accused CA BRN of being haphazard in their evaluations of our applications. I've only implied that it is possible that evaluators could easily overlook certain aspects of it, especially considering how many applicants with similar backgrounds they may have to go through in a given day.

Sure, there's no way to "prove" theory or clinical hours to anyone. The only way this could be done is if the evaluators themselves were physically present during every single lecture and every single clinical duty shift. Of course, this is impossible. But this is beside the point, because we are assuming that the applicant is submitting true documents averring such. CA BRN has the prerogative to define what constitutes proof, and this would presumably be embedded in its application process.

I'm not asking CA BRN to "decipher" anything, but only a chance to help make their job easier. So on the one hand, if I knew their precise criteria for meeting certain requirements, I myself can make a letter, or have my dean or some official make a letter, showing them where in our curriculum this might be satisfied. BSN programs in the Philippines are required to follow a curriculum mandated by the government, and these requirements are viewable online for any nursing board to see. It is, however, a 129-page document, and certainly not every single CA BRN evaluator has the time to scrutinize it. On the other hand, if I see clearly that I really am deficient in terms of a certain requirement, then I will gracefully acknowledge this and understand why I have been declined, if it will turn out this way.

I am not trying to be argumentative, but I don't want to be fatalistic as well; I am only trying to improve my chances. Ultimately, I seek only transparency. Yes, rules and regulations say that you need to have concurrent didactics and clinicals, and that you are required to satisfy a minimum number of hours of each. But how does CA BRN operationally define concurrent, and what precisely are these minimum hours?

mpgj83 · Aug 10, 2013

So I've just reviewed Title 16 California Code of Regulations, Article 3 Schools of Nursing, Section 1426 Required Curriculum. (Board of Registered Nursing - Title 16, California Code of Regulations) Unfortunately, it doesn't state precise hour requirements. Does anyone know where these hours can be found?

In addition, letter (d) of the same section does indeed say that "theory and clinical practice shall be concurrent..." But in any given semester, our theories and duties are concurrent. We just don't always accomplish cases in the same semester. But we do indeed still go to duty wherein we interact with patients, perform nursing care, and many times even at least observe deliveries and operations being performed. So what does "clinical practice" really mean here in the first place? I am told that many times CA nursing students also just observe such procedures.

steppybay · Aug 10, 2013

Here's my take on what you are discussing above and many points well taken. There are many references made in going thru this forum and it's a lot of reading but then again, I got started much earlier than you.

You need to have your dean of school explain to you in writing if at all possible so that information is not lost in the translation.

-- Why are the PH curriculums unable to successfully be able to meet the CA BRN minimum educational standards? Remember that it's not only CA with the concurrency requirements, but in several other states and these regulations have been in their policy book for over 20 years. There was a letter from the NV BON from someone's denial letter, showing the requirement was in effect since 1952.

-- I don't think anyone here has reviewed or gotten a copy of the CA BRN actual policy information, but like you said with the 129 page document, it may work fine with the PH nursing world, but then again the CHED only cares what's right for the Phils and don't care if the 33% of PH grads go back to the States with CA as the number 1 choice (this is from CHED's own saying). They along with the PRC and PNA do what's okay to maintain the standards in the Phils, as that's their primary goal, not for the USA market.

-- In light of my above statement, one poster mentioned that one of her batchmate's family friend is a CA lawyer who was from the PH and inquired with the CA BRN for months and came back with his professional opinion that the CA BRN is correct in their findings and that we as applicants "don't have a legal leg to stand on".

-- It was mentioned by another poster who stated that he knows the CHED and the other two agencies came to the CA BRN in Dec. 2012 and Feb. 2013 to discuss these same exact matters that's affecting the PH grads and nurses here. I'm sure that if such meetings did take place, that you should inquire directly with the proper people at all these agencies to see if that really happened, if so, what was the outcome? You must, of course, take anything these agencies say with a pound of salt, as we all know how they "operate", I mean, don't hide any of the facts, don't give little white lies, say if it really happened are you now looking with eggs in the face, etc.

-- With regards to the clinical practice, from what I know from my US educated nursing friends and gainfully employed at two top CA hospitals, yea, it's really COOL that we in the Phils get to do these neat cord dressings, baby deliveries etc, but it's NOT a requirement in CA or the other states (for one good reason, it's a hugh liability problem should a nursing student do harm to a newborn, plus probable multi-dollar lawsuit against the hospital).

-- To follow the thought process of the above statement, the clinical practice is done one-on-one between an experienced nurse and the new nursing student, BUT, the nurse is constantly evaluating the student with not only the "simple questions" of the task at hand, but asked "what if this, what if we don't, what about this, what's the issue if we do it this way, why are we doing this, etc", it's a long list of questions that must be answered not only correctly, but you must give your answer right then and there, they want an immediate answer and it better be close to correct as possible. There are students in their classes that can FAIL the clinical part of their schooling. It's not possible in the Phils with 20 plus students asking the poor patient the same old questions and no one to make us to the more "critical thinking" which is one of the primary reasons why the NCLEX-RN passing rate of foreign students is so low compared to US educated ones.

Look at the recent 2013 NCLEX-RN passing rate for first timers between US and international (and I'm sure the Phils is a high amount of takers): https://www.ncsbn.org/Table_of_Pass_Rates_2013.pdf

-- It's not just a matter of taking care of 10-20-30 patients, but why we are doing this and all the previous things I mentioned above, yes, CARE is one thing, but to understand it is another. So yes, the US students do "observe" but they are always constantly on their toes from the time they check-in with their preceptor to the time they go home, I have always been told they are "joined at the hips" except for lunch and restroom breaks. The student nurses even have to go on holidays, if that's the only time their preceptor are on staff that day! If that nurse has to work a day or night shift or on-call at the last minute, that student must show up! No excuses, there are some instances where it might not be possible, but the make-up time is even tougher since they too MUST complete their clinical hours in time before the semester ends or FAIL.

-- So that's why the USA educational requirements say it MUST be taught concurrently, not months or a year or so later. It goes like this: this semester in your theory class you're learning about this, okay, now the preceptor is going to GRILL you for the entire time you're there with different patients with different scenarios and then they also go back to your previous theory and how is that all related or are they? You better have a good precise reply in nursing terms, knowing the preceptor is noting all your every moves and answers, you have a minute or two. Then the next questions gets fired at you. What's your answer? Most nurses love going to clinicals but dread the actual time there with the 8 hours of on the hot seat. You're always being judged as well, to see if one day, you're the RIGHT fit for their hospital, come job application time.

-- I don't know if anyone here ever got the actual requirements that's mentioned the Section 1426, but I'm sure it has to be mentioned in their policy somewhere. With regards to the evaluators, I'm sure they only get their instructions from the higher-ups but those that I know of that actually filed an appeal with the CA BON people, still were denied.

-- Again, this is where you should ask your dean of school to PROVE his case/argument to you in providing you why your school is concurrent along with the CA BRN policy documentation. The proof of burden in this case is that you and the dean must show that the CA BRN is incorrect, not the other way around. CA BRN can simply say "you're not concurrent", you're done. You and the dean must provide that proof, you paid good money and put in 4 long hard years, they at least should do that in return. If it's that hard to prove, then the CA BRN wins.

-- While I know you're still to actually place your application for evaluation, I would enclose this letter from your dean with the solid proof of why you're concurrent, just to stay ahead of the game. In fact, I would ask for a copy of the letter and documented proof and have another set that's completely "sealed" with your school's stamp on it to show it was not tampered with.

-- With regards to the "proof" of the theory and clinical hours etc, is why they depend only on the documents submitted, that's why it's also requested to see if they match with the "sealed documents" sent from the school's transcripts. Any slight difference is subject to a quick denial. It's either black or white, nothing in between. I think also it's possible that some PH schools may be on a "list" of suspected false reportings or "adjusted" documentation. There's been a few PH posters who also know their own friends switched or adjusted their schedules so they can be "concurrent", that's also partly why I think now, of how can someone from the exact same batch, same college, same courses, same graduation month and year, but granted the ATT but they didn't. All these false and altered paperwork is enough for the CA BRN evaluator to look at the PH grads and nurses with a microscope and I DON'T buy into any racial references at all. That's why I've said several times in these forums, If I know of anyone playing these games, I have absolutely no problems with giving the CA BRN (or any other states BON) Enforcement Div., their names. While they are innocent, until proven guilty, I hope they are found guilty as charged and lose their nursing licenses forever. Really, everyone here should do the same so that we can bring the standards up and show to the CA BRN that we don't stand for this and will want justice done to them so that we can proceed in the future as the more honest and hard working people we deserve to be. It only takes a few bad apples to spoil the sauce. But don't give me their names via PM, go to the CA BRN Enforcement Div. section and do it yourself, since I can't claim the possible suspect and would not be fair to the accused. You don't have to give them your name.

-- One of the funny but interesting thing that my US nursing friends say that they think partly the PH's educational system allows for FREE nursing care at the expense of the PH students to watch over the PH patients. Then I tell them, in the Phils, we have to PAY for our training! Yes, we can work in a PH hospital but many require a FEE of some sort to be there. Of course, they say that's all WRONG! But it is what is in the Phils.

-- The one US educated nursing friend of mine, a Filipina, who received her BSN from a very good SF college and now works at Stanford hospital, making $50 an hour minimum as a new grad (2012) and more on certain times. Yes, I've seen her paychecks in passing at dinner and in a nice way, I posted this in another thread about that. She's my mentor, lol.

mpgj83 · Aug 11, 2013

Thank you for your very thoughtful input, steppybay! You're very well informed about these issues and I really appreciate your time in replying to me. =)

My original queries still stand, however. None of the posts on here are able to answer them directly; they seem to get into tangents that are entirely different issues in and of themselves. So let me dissect my questions and thought process plainly:

1.) How does CA BRN precisely define "concurrent?" Embedded in question is the following line of reasoning:

-Precisely what is supposed to be concurrent? [theory and clinicals?]

-Precisely what do you mean by clinicals? [duties that occur within the same semester as its corresponding didactics?]

-If so, then my theories and clinicals are indeed concurrent, and I satisfy this particular requirement to be issued an ATT.

But the issue continues, as I illustrate in the following hypothetical exchange between CA BRN and me:

-CA BRN: But you completed your delivery room and essential newborn care cases only after the semester finished!

-Me: I still had duties, took care of patients, and observed deliveries and newborn care being performed if I couldn't directly assist with them myself. These occurred within the same semesters as my maternal and child nursing classes.

-CA BRN: But you need to have performed your cases during the same semester as your didactics.

-Me: Do you require nursing students in California to perform such cases during the same semester?

-CA BRN: No. But they do have their clinicals, take care of patients, and observe these procedures within the same semester.

-Me: So did I. I just happen to have additional duty beyond minimum clinical hour requirements to fulfill case requirements.

2. How does CA BRN precisely define "deficient" in terms of a particular area of training (e.g. OB/MS)?

-Does it depend on a certain number of hours that need to be satisfied?

-If so, how many hours do we need in each?

-If it also depends on what the student applicant experienced personally during didactics and clinicals, precisely what are these things? Tell us so that we may document our required experiences to your satisfaction.

Now I'd just like to respond to some of your input, in turn.

-- Why are the PH curriculums unable to successfully be able to meet the CA BRN minimum educational standards? Remember that it's not only CA with the concurrency requirements, but in several other states and these regulations have been in their policy book for over 20 years. There was a letter from the NV BON from someone's denial letter, showing the requirement was in effect since 1952.

I'm not arguing against the law. It does make sense to me that theory and clinicals should occur in the same timeframe, and I think it's good that more US states are enforcing this. All of them should. Theories and clinicals will complement one another and make learning more effective, producing more competent nurses. This is still what is occurring in the Philippines. But why does CA BRN enforce the case requirement on Philippine grads when this requirement does not even exist for CA grads? In other words, the issue does not seem to be one of concurrency between theory and clinicals (i.e. duties occurring within the same semester as didactics), but between theory and a particular component of Philippine clinicals (i.e. cases). CA BRN does not require CA grads to complete "cases" (i.e. actual, hands-on assistance of deliveries, newborn care, and major surgical operations), in the way that they seem to require Philippine grads to complete them.

-- I don't think anyone here has reviewed or gotten a copy of the CA BRN actual policy information, but like you said with the 129 page document, it may work fine with the PH nursing world, but then again the CHED only cares what's right for the Phils and don't care if the 33% of PH grads go back to the States with CA as the number 1 choice (this is from CHED's own saying). They along with the PRC and PNA do what's okay to maintain the standards in the Phils, as that's their primary goal, not for the USA market.

That policy information is exactly what needs to be made transparent so that foreign grad hopefuls can evaluate their educations against CA BRN standards and establish whether or not they meet specific requirements. If not, maybe they'd decide not to apply anymore, saving them their time and money.

-- In light of my above statement, one poster mentioned that one of her batchmate's family friend is a CA lawyer who was from the PH and inquired with the CA BRN for months and came back with his professional opinion that the CA BRN is correct in their findings and that we as applicants "don't have a legal leg to stand on".

I realize she is a lawyer but it would still be nice if we could evaluate this ourselves. We don't even know what the issue at hand was here.

-- It was mentioned by another poster who stated that he knows the CHED and the other two agencies came to the CA BRN in Dec. 2012 and Feb. 2013 to discuss these same exact matters that's affecting the PH grads and nurses here. I'm sure that if such meetings did take place, that you should inquire directly with the proper people at all these agencies to see if that really happened, if so, what was the outcome? You must, of course, take anything these agencies say with a pound of salt, as we all know how they "operate", I mean, don't hide any of the facts, don't give little white lies, say if it really happened are you now looking with eggs in the face, etc.

I'll just try to contact CA BRN to pose these questions myself. It's best to just tap into the source. I've sent a couple e-mail inquiries about the application process a couple weeks ago, but I never got a response. (I still don't even know if my fingerprint cards are coming!) And so considering the unresponsiveness from those e-mails, I thought I'd read through posts and just ask people on this forum, but it seems like nobody really knows either. Somehow, I doubt these meetings took place because if they did I think I would have encountered them in newspapers, online articles, or whatnot.

-- With regards to the clinical practice, from what I know from my US educated nursing friends and gainfully employed at two top CA hospitals, yea, it's really COOL that we in the Phils get to do these neat cord dressings, baby deliveries etc, but it's NOT a requirement in CA or the other states (for one good reason, it's a hugh liability problem should a nursing student do harm to a newborn, plus probable multi-dollar lawsuit against the hospital).

I understand the rationale why CA nursing students don't have these "case" requirements. But the question is why CA BRN is requiring that Philippine grads complete them within in the same semester, especially when CA nursing students have no such requirements of their own.

-- To follow the thought process of the above statement, the clinical practice is done one-on-one between an experienced nurse and the new nursing student, BUT, the nurse is constantly evaluating the student with not only the "simple questions" of the task at hand, but asked "what if this, what if we don't, what about this, what's the issue if we do it this way, why are we doing this, etc", it's a long list of questions that must be answered not only correctly, but you must give your answer right then and there, they want an immediate answer and it better be close to correct as possible. There are students in their classes that can FAIL the clinical part of their schooling. It's not possible in the Phils with 20 plus students asking the poor patient the same old questions and no one to make us to the more "critical thinking" which is one of the primary reasons why the NCLEX-RN passing rate of foreign students is so low compared to US educated ones.

Look at the recent 2013 NCLEX-RN passing rate for first timers between US and international (and I'm sure the Phils is a high amount of takers): https://www.ncsbn.org/Table_of_Pass_Rates_2013.pdf

-- It's not just a matter of taking care of 10-20-30 patients, but why we are doing this and all the previous things I mentioned above, yes, CARE is one thing, but to understand it is another. So yes, the US students do "observe" but they are always constantly on their toes from the time they check-in with their preceptor to the time they go home, I have always been told they are "joined at the hips" except for lunch and restroom breaks. The student nurses even have to go on holidays, if that's the only time their preceptor are on staff that day! If that nurse has to work a day or night shift or on-call at the last minute, that student must show up! No excuses, there are some instances where it might not be possible, but the make-up time is even tougher since they too MUST complete their clinical hours in time before the semester ends or FAIL.

-- So that's why the USA educational requirements say it MUST be taught concurrently, not months or a year or so later. It goes like this: this semester in your theory class you're learning about this, okay, now the preceptor is going to GRILL you for the entire time you're there with different patients with different scenarios and then they also go back to your previous theory and how is that all related or are they? You better have a good precise reply in nursing terms, knowing the preceptor is noting all your every moves and answers, you have a minute or two. Then the next questions gets fired at you. What's your answer? Most nurses love going to clinicals but dread the actual time there with the 8 hours of on the hot seat. You're always being judged as well, to see if one day, you're the RIGHT fit for their hospital, come job application time.

I think this is now an entirely different issue here. CA BRN has stipulated that theory and clinicals be concurrent. If you fulfill this requirement (and others), you may receive an ATT as a chance to prove your competence on the NCLEX. Regardless of whether or not students had to exercise more independence in their duties because of staffing shortages and the large number of patients, or whether or not students were "joined at the hip" of their respective preceptors who constantly grilled them, the NCLEX would presumably weed out incompetent applicants. Yes, international applicants have lower passing rates on the NCLEX. But this doesn't mean it should be made more difficult for them to even just attempt it. There should be a level playing field. The original issue is about being approved to take the NCLEX, and not being approved to become an RN right away.

Again, yes, educational requirements must be concurrent, like you say. In the Philippines, in terms of didactics and clinical exposure, they are. In terms of didactics and case requirements, they can't always be.

Incidentally, just as an aside, I cannot speak for all Philippine-educated nursing grads, but my experience as a nursing student was also that I got grilled frequently, by clinical instructors, staff nurses, and sometimes even doctors alike. I may not have had a preceptor to shadow constantly, but I was supervised and I carried out my duties within my scope of practice. Yes, I imagine always having a preceptor around would make for a highly enriching learning environment, but I don't think it's the only way to learn. Philippine nursing education forces students to be highly independent and flexible. Only give the applicant a chance to prove his or her competence through the NCLEX.

But again, the issue is not about what style of instruction must be implemented in order to qualify to sit in for the NCLEX. If it really were mandated that we had to have a preceptor, then CA BRN should say so. But so far, the issues are about concurrency and deficiency and CA BRN needs to be clear exactly what it means.

-- Again, this is where you should ask your dean of school to PROVE his case/argument to you in providing you why your school is concurrent along with the CA BRN policy documentation. The proof of burden in this case is that you and the dean must show that the CA BRN is incorrect, not the other way around. CA BRN can simply say "you're not concurrent", you're done. You and the dean must provide that proof, you paid good money and put in 4 long hard years, they at least should do that in return. If it's that hard to prove, then the CA BRN wins.

It's hard to prove something if we don't know what they're looking for us to prove. Again, what are these concurrency and deficiency issues really about? Clinical exposure or cases? If cases, why cases when CA nursing students have none of their own? Is it about hours? How many do we need? If it's not about hours, then what?

-- With regards to the "proof" of the theory and clinical hours etc, is why they depend only on the documents submitted, that's why it's also requested to see if they match with the "sealed documents" sent from the school's transcripts. Any slight difference is subject to a quick denial. It's either black or white, nothing in between. I think also it's possible that some PH schools may be on a "list" of suspected false reportings or "adjusted" documentation. There's been a few PH posters who also know their own friends switched or adjusted their schedules so they can be "concurrent", that's also partly why I think now, of how can someone from the exact same batch, same college, same courses, same graduation month and year, but granted the ATT but they didn't. All these false and altered paperwork is enough for the CA BRN evaluator to look at the PH grads and nurses with a microscope and I DON'T buy into any racial references at all. That's why I've said several times in these forums, If I know of anyone playing these games, I have absolutely no problems with giving the CA BRN (or any other states BON) Enforcement Div., their names. While they are innocent, until proven guilty, I hope they are found guilty as charged and lose their nursing licenses forever. Really, everyone here should do the same so that we can bring the standards up and show to the CA BRN that we don't stand for this and will want justice done to them so that we can proceed in the future as the more honest and hard working people we deserve to be. It only takes a few bad apples to spoil the sauce. But don't give me their names via PM, go to the CA BRN Enforcement Div. section and do it yourself, since I can't claim the possible suspect and would not be fair to the accused. You don't have to give them your name.

I don't know who those posters are but I agree completely that those who falsify documents should be reported. But for those of us who have honestly paid their dues with blood, sweat and tears in nursing school should be given a fair chance to prove themselves to be competent with the NCLEX.

steppybay · Aug 11, 2013

In a nutshell, again, the dean of your school or any PH college should know exactly what's required by the CA BRN requirements and that's why they (deans) should assist in that letter of explanation addressed to the CA BRN evaluators. The admin's of each school should have the exact CA BRN's policy manual or if not, then, the CHED office should, but I don't think the CHED will offer to write that letter of explanation. I would go directly to the CHED office and ask them for the CA BRN policy manual or documentation, but then again, they may not have it just as the CA BRN probably doesn't have the one from the Phils side. But the CA BRN doesn't need one to see, as they are only concerned with the courses being conducted and shown in the transcripts.

That's why I said to have your dean look into this and in fact, he might already be using one as a copy for the other students that have already been denied. If he has, hopefully, it was good enough for the CA BRN to reconsider their position and grant the ATT. The dean should have what's needed to prove the concurrency since we don't know the exact requirements. If the dean doesn't know, then, it's just going to crash into a concrete wall.

However, there are other posters here who after were denied the first time, they did have their deans explain their situation in a letter, to have claimed the school was in compliance with the concurrency rules and but still were denied by their evaluators again. You may certainly try, but I think until you're officially "denied", the letter of explanation may or may not help in the first stage of the application process.

Yes, I agree with you on giving us PH students a chance to take the NCLX-RN but like with anyone else, from any other US states or foreign country, we must all adhere to that state's minimum requirements. Applicants from the UK and AU are also being denied the ATT to take the NCLEX as they are most likely to be deficient in certain courses.

I myself do not know the exact qualified terms as defined by the CA BRN as for the "concurrency" and "deficiency" items of concern.

I do agree with the on-going thought processes out there, that the concurrency issue is more of a technicality problem. Yes, the Philippines curriculum requires that the clinical and theory are concurrent except for the L&D, OR and the Nursery completion cases. However, these completion cases are not a requirement in the US, only in the Philipines. The CHED reduced the cases in order to make it more likely to accommodate the PH students load, but it's still not working. What needs to happen is for the CHED and PH govt. and all those involved to DROP the baby delivery and cord dressings completely. But that's not likely to happen either, as who else is going to assist for free in these cases.

I think the above technicality is what is causing the appearance of the non-compliance with the old CA nursing laws. You can't be asking why the CA BRN doesn't require these same cases completion from the US (or CA) nursing students, when it's not even on the CA nursing curriculum as it appears on the PH courses. CA BRN sees that the timing difference is not happening in the same semester and many are done after the completion of the course, but in the Phils, we're allowed to still do so at least before the graduation date.

The CA BRN doesn't see it that way.

You do bring up some excellent points, I would use that in your discussions with the dean to structuring your letter of explanation. I know one of my batchmate's friend tried to appeal her declination with the Board but still got denied even with her dean's letter.

I hope that you will get an e-mail return reply by the CA BRN, but I don't know if they will explain it any details until you give them your case file or application information, but if they do, please post up here. I would think there would be some delays as many of the CA schools have been just graduating many of their students in the past couple of months and probably concentrating their efforts into those applications. Then there's probably a small but still numerous applicants coming from the out of state students.

steppybay · Aug 11, 2013

Below is from the CA BRN the same link you provided above, there is some sort of breakdown in terms of the hours and units and the formula they use:

1426. Required Curriculum

(a) The curriculum of a nursing program shall be that set forth in this section, and shall be approved by the board. Any revised curriculum shall be approved by the board prior to its implementation.

(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 student who completes the program will have the knowledge, skills, and abilities necessary to function in accordance with the registered nurse scope of practice as defined in code section 2725, and to meet minimum competency standards of a registered nurse.

© 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 oral, written, and group communication.

(3) Related natural sciences (anatomy, physiology, and microbiology courses with labs), 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: geriatrics, medical-surgical, mental health/psychiatric nursing, obstetrics, and pediatrics. Instructional outcomes will focus on delivering safe, therapeutic, effective, patient-centered care; practicing evidence-based practice; working as part of interdisciplinary teams; focusing on quality improvement; and using information technology. Instructional content shall include, but is not limited to, the following: critical thinking, personal hygiene, patient protection and safety, pain management, human sexuality, client abuse, cultural diversity, nutrition (including therapeutic aspects), pharmacology, patient advocacy, legal, social and ethical aspects of nursing, and nursing leadership and management.

(e) The following shall be integrated throughout the entire nursing curriculum:

(1) The nursing process;

(2) Basic intervention skills in preventive, remedial, supportive, and rehabilitative nursing;

(3) Physical, behavioral, and social aspects of human development from birth through all age levels;

(4) Knowledge and skills required to develop collegial relationships with health care providers from other disciplines;

(5) Communication skills including principles of oral, written, and group communications;

(6) Natural science, including human anatomy, physiology, and microbiology; and

(7) Related behavioral and social sciences with emphasis on societal and cultural patterns, human development, and behavior relevant to health-illness.

(f) The program shall have tools to evaluate a student's academic progress, performance, and clinical learning experiences that are directly related to course objectives.

(g) The course of instruction shall be presented in semester or quarter units or the equivalent 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. With the exception of an initial nursing course that teaches basic nursing skills in a skills lab, 75% of clinical hours in a course must be in direct patient care in an area specified in section 1426(d) in a board-approved clinical setting.

mpgj83 · Aug 11, 2013

I think the above technicality is what is causing the appearance of the non-compliance with the old CA nursing laws. You can't be asking why the CA BRN doesn't require these same cases completion from the US (or CA) nursing students, when it's not even on the CA nursing curriculum as it appears on the PH courses. CA BRN sees that the timing difference is not happening in the same semester and many are done after the completion of the course, but in the Phils, we're allowed to still do so at least before the graduation date.
The CA BRN doesn't see it that way.

Yes! My biggest hunch is that when an applicant submits documentation of oncall duty, CA BRN thinks we have theory in one semester, and then duties in between semesters or during the following one. That is far from the case, as you are well aware. Our theories and clinicals are assuredly concurrent within the same semester. Some students just happen to have to extend clinicals beyond the semester, but in no way does this imply that they were grossly incompetent or failed either didactics or clinicals for that particular area of nursing.

I hope that you will get an e-mail return reply by the CA BRN, but I don't know if they will explain it any details until you give them your case file or application information, but if they do, please post up here. I would think there would be some delays as many of the CA schools have been just graduating many of their students in the past couple of months and probably concentrating their efforts into those applications. Then there's probably a small but still numerous applicants coming from the out of state students.

The last e-mails I sent to CA BRN ([email protected] , from their website) were on July 24 and July 31. No responses yet. Would graduating CA schools warrant this kind of delay? Yes, maybe they are busy, but a confirmation e-mail saying they received my e-mails would be nice. I also sent in request for fingerprint cards, but I have no confirmation for that either. It’s funny that I sent in requests to the CA Commission on Teacher Credentialing for fingerprint cards, and they replied within a couple days and said they would send me some. My only concern is…will this be the same card as the one I’d have to send to CA BRN??! Lol.

Anyway, if and when I send them CA BRN another e-mail, I intend to state plainly that I had oncall duty to complete my handling and newborn care cases, but that I still had L/D clinical duty during the same semester as my maternal and child nursing semesters. Then I will ask if my application will still be denied. If they will say outright yes, then…well, I’m not yet sure what I’ll do. Maybe try to reason some more and insist, or maybe just save my time and money and no longer apply.

I’ve noticed so many people on here every week complain that CA BRN denied them. I truly empathize with their feelings of being lost, surprised, frustrated, depressed, demotivated. With the number of so many foreign applicants being denied, one would think that CA BRN would update, clarify, and/or revise their requirements so that applicants will know if they have a chance to be accepted in the first place. It would save them a lot of time, heartache, and money.

mpgj83 · Aug 11, 2013

Yeah I tallied those units and hours earlier, and correct me if I am wrong but it seems like per every area of nursing they are required 18 hours of theory and 54 hours of duty. We exceed that in the BSN curriculum here in the Philippines.

Current Philippine BSN curriculum: Theory hours/Clinical "RLE" hours. (This list covers professional courses that have clinical components only, but there are many other courses in the curriculum.)

Fundamentals: 54/102

Health Assessment: 36/51

Community Health Nursing: 54/102

Healthy Maternal/Child/Family: 72/204

Maternal/Child/Family at risk or with problems: 90/306

MS 1: 144/306

MS 2: 90/204

MS 3: 108/255

Psychiatric Mental Health Nursing: 72/102

Leadership and Management: 72/153

Intensive Practicum: 0/408

steppybay · Aug 12, 2013

Yes, the hours you calculated seems to be right on the numbers. It exceeds the minimum required, but in FL, one can get their applicaton denied if it's "excessive", don't ask why, but that's their policy.

Recognize that as far as we know, the concurrency issue may be a technicality, however, it's enough to cause a rejection of the application. I'm not sure, but it remains to be seen if the CA BRN lawyers are aware of this in terms of a Phils applicant who may have gone that distance and was either granted the ATT or simply denied. From my other batchmates who are on some FB's, there's been not one person who knew if someone got lucky recently.

Yes, there's over 10,000-11,000 applicants filing their applications into CA with the bulk coming in from the CA schools, you can see by the earlier above link of the numbers (of those passing the NCLEX the first time) and there was some mention last year of the high numbers. Realize that the CA schools and their students can usually receive their ATT's in 2-3 months if their schools submitted their transcripts in a timely manner, then they probably have ones that don't make it due to some issue somewhere. CA schools just released their current student population in May-June and still processing those.

I think there's a section in the CA BRN that handles the international applications, but with the overloads, maybe they are asked to help out with the locals, as they know that's their priority and many of the CA grads prefers to take their NCLEX-RN as soon as possible as some have job offers pending or they need to start the job search as soon as possible. The international applications just takes longer due to having to sift thru them, plus don't forget now that the CA BRN is on "high alert" to look for falsified documents.

Here's just 6 Phils nurses getting caught, there was a memo in the CA BRN minutes last year of a suspected 137 plus Phils students or nurses that are under investigation and really, I think that's just the tip of the iceberg.

From the CA BRN website:

Press Release - California Department of Consumer Affairs

With the current high unemployment rate of CA new grads approaching the 50% level (per CA BRN survey), with the low supply of available new grad residency programs, the cancelling of even some of the new grad programs (even top rated UCLA cancelled the summer cohort of some of their depts., other hospitals as well (some cancelling entire programs or just some sections), even the VA, it's all there on the CA nursing forum) there's no pressing incentive for the CA BRN to speed up the foreign application process.

The hiring priority are 99% going to the CA grads and local US educated students, to those that did their clinicals in their hospitals or had very impressive school records, high GPA grades, very active outside life that's related to the nursing profession or could be unrelated but still pretty good activities, very good to excellent letter of recommendations from professors (maybe an alumni) or other high level preceptors.

The low passing rate (35%) of the NCLEX-RN for international first-timers as stated above doesn't help the Phils application, yes, we all need be given the chance, but we must all pass the minimum standards.

I think you have to look at it from the CA BRN's eyes of how to stem the flow. There's more than enough CA grads (now and future) to take over the nursing positions if they were available and I say this as reading over the CA nursing forum, many have to leave the state of CA to find their first nursing jobs. Many of the CA and those of other states actually prefer not to work in the sub-acute, nursing homes, LTC and SNF's and the likes, as those jobs do not give the right amount of needed experience if their primary goal is to work in a hospital. I know and personally met several older CA Filipino nurses who wants to work in a hospital, but after years in the mentioned facilities, they find themselves stuck and no chance to move on, which I think one day, if the CA market opens up, the majority will be in the nursing homes, etc. Yes, there's always going to be a few that gets lucky to move on to a hospital, but when compared to the local CA or out of state USC, the numbers don't look good for the PH nurses.

Canada has recently stated that they no longer consider "nurses" as a needed skilled worker and thus, closed the doors. I don't think CA will say this out loud like Canada did in their official press release, CA is more discreet. So yes, it's a gamble of your time and money to apply into CA, of which once the process starts, there's no refund, approved or denied.

All the above (and there's more) I think that's led to the flat out rejection of the majority of the PH applicants looking into CA as their first and last job stop and why the CA BRN is doing this.

mpgj83 · Aug 13, 2013

Yeah I've read through those articles and they're pretty depressing for those of us foreign grads with legitimate credentials. About 5 years ago I had a cousin with a Philippine BSN and who had applied for CA licensure by examination, and it took only 2 months to get his ATT. Then he took his NCLEX and began working as a nurse shortly thereafter. Sigh, how the times have changed.

So at the advice of my aunt, who is a nurse in CA, I shouldn't send that letter to CA BRN because it's may come off as argumentative or inflammatory in some way, possibly causing me to become profiled. So when I get my Philippine RN license in a couple weeks, I'm just going to send my application in the usual way.

I'm hoping to get some advice as to how I should go about doing this...

A. Should I just go the traditional route and send in the bare minimum for the initial application? (And then wait for CA BRN's response and request for follow-up materials, and then send those in at a later time?)

or

B. To save time, send in everything that CA BRN seems to have been requesting from Philippine grads as supplementary material after their initial application? This means I would also just send in: photocopies of US passport, SSN card, academic calendars, clinical rotation log, case forms, etc (hmmm...am I missing anything?) I would also probably send in a letter from my dean (if she will write one for me) explaining clearly that while I have had to do oncall duty to complete my case requirements, theory and clinical practice components per each given semester were indeed nevertheless still concurrent--that clinicals and case-completion duties are not the same.