Pros and Cons of Excelsior Program

Sheri257 · May 13, 2006

lizz, why don't you tell us why an rn who has been working in another state for 2 years, with years of experience as an lpn would be less qualified than a new grad who has never worked a day?
because it's the decision of a bunch of control freaks who ignore the obvious reality of the situation?

I don't think they're less qualified. I just think the problem is more complicated than what you're describing. If you suspend the requirements for certain groups then you render the requirements meaningless. Maybe the requirements should be changed but if they are changed, they should apply to everyone. If you have a bunch of loopholes then, before you know it you've got major problems like MA's with little training or experience getting RN licenses. That's what started this whole thing in the first place.

As for the legal arguments, my question is this: If the board had total discretion and authority, why did Excelsior bother to sue in the first place? And why did they appeal? Are their lawyers totally incompetent?

Obviously EC hoped the courts would interpret the statutes the way they did. But the case still came down to the law, not the board's discretion. If the board had total discretion EC wouldn't have bothered to sue in the first place.

:typing

ChesterRN · May 13, 2006

Liz, I would completely agree with you if you weren't so wrong.

Section 2736, subdivision (a)(2) provides that a nursing applicant seeking licensure in California must have either successfully completed required courses of instruction in an accredited in-state program or "successfully completed courses of instruction in a school of nursing outside of this state which, in the opinion of the board at the time the application is filed with the Board of Registered Nursing, are equivalent to the minimum requirements of the board for licensure established for an accredited program in this state."

"Previously, the Board recognized Excelsior's program as equivalent to the minimum requirements of accredited programs in California, thus enabling Excelsior graduates to apply for licensure in California. The Board, however, recently concluded it has no authority to evaluate out of- state programs prospectively -- that is, before a nursing program graduate applies for licensure."

So what major event took place to reverse the BRN's decision that EC grads were acceptable and now, that they are not, if safety was not considered an issue? Isn't that what the BRN is charged to do?

Perhaps it was related to this in the Courts opinion:

"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."

Hmmm. "Some schools?" Could they mean EC? Why not list them by name? Wouldn't that strike at the crux of the BRN's assertion? Perhaps because they didn't have that little known thing to back it up, like er huh EVIDENCE!

Then, they dance around the issue, while hoping, Liz, that those who are less than astute observers of detail and fact would not notice in the following assertion,

"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."

Now that clears it up completely, The BRN evaluated EC as meeting the standard before they determined they didn't. Kind of like my boy John Kerry, the millionaires wife, voting for the funding before he voted against it. Only in Massachusetts and California can this logic fly.

Of course, at least the Court got the characterization of the CPNE right,

"The CPNE is a weekend course, administered over two and one-half days..."

I'm going out on a limb here, Liz, but I'm guessing you never successfully negotiated the CPNE process as traumadude and I have? In case you did, as you know, it's really not a course or just an exam...it's an adventure! And for those of you that are EC grads, are you really surprised that the BRN mischaracterized the CPNE in such an egregious way? Isn't it telling of the Courts' bias when they adopted the same language in the dicta of the brief? Also, do you often wonder, like I do, how many BRN folks as well as non EC grads could actually pull it off, that is passing the CPNE? But hey, it's just a weekend seminar, right?

At least the BRN wasn't being arbitrary in its decision to cut off EC grads:

"Excelsior College graduates, like other out-of-state graduates,....This eligibility requirement applies to students who enrolled at Excelsior on or after December 6, 2003."

I suppose EC started adding something different to the applicant's water supply after December 6, 2003 to make them less of a worthy candidate for RN licensure. If indeed EC grads do pose a threat to consumers of California, it's a good thing the BRN is looking out for folks by letting some EC grads stay licensed, like the 6,000 plus who are working in California.

Fortunately for the BRN, and perhaps unfortunately for the school that is in the process of approval, the BRN can change it's position at anytime:

"An agency is not bound by its prior statutory interpretation if it determines that prior interpretation was in fact erroneous."

You see, I was wrong, the BRN isn't malicious, their just incompetent (excuse me "erroneous") I only hope the faculty of the school in which you speak are all knowledgeable on how to kiss rings. Just tell them it's all in the pucker.

I am very happy for your school that they will have an unfair advantage over EC. As fair minded indivduals, I'm sure they are delighted, of course unless the BRN decides to turn on them. The architect of this decision will also be pleased. Your school must be very pleased, especially since they don't have to pay the overhead (because the hospitals who are so short on nurses are picking up the tab), and if it's a state sponsored school, they can really rake in the FTE moneys at what-$250+ dollars per FTE unit?...all ancillary profits. It's good to be on the State's payroll.

As far as University of Phoenix, I find it very telling that you would include them in the mix. Perhaps you may want to read some comments posted by some happy students and graduates of UoP at ripoffreport.com/. Just type in "uop" and take note of the 52 pages of kind comments related to UoP. Perhaps the school you speak of is in there, too. You will be happy to know that EC, is listed twice, only for not printing a diploma correctly and its association with the College Netweork, though. Too bad, huh. There's no accounting for good taste and high quality.

Anyway Liz, I'm always appreciative to hear the other side of things. If it wasn't for your logic and reasoning, I wouldn't have any reason to scratch my head. Keep up the good work, and as I said before, it takes all kinds.

Sheri257 · May 13, 2006

If you're saying the board screwed up with it's original interpretation of the statute then, yeah, I would agree with you.

The board hadn't looked at the EC program in 14 years. They probably should have looked at it sooner, but they didn't. They got a complaint from the Public Health Nurses Association (which, from what I can tell, doesn't have an ax to grind) which they had to investigate, and realized that the original interpretation of the statute was wrong and that the program was out of compliance.

And the problem with that is what? This is ... afterall ... the reason why this went to court. Four judges looked at this. The law says what it says. And from a practical standpoint: how can you tell 100 schools in the state you have to follow this set of rules but, nevermind about this other program -- we're going to suspend the rules for them. C'mon. Do you really expect any agency or regulatory body to continue to make exceptions just for one school? Once the problem was brought to their attention, they had to correct it. What do you expect?

As for the CPNE, I agree that the court's language does mischaracterize the nature of the exam. But the problems with CPNE went much deeper than that. If the CPNE tested for all of the required clinical areas then I would be more inclined to agree with you. But it doesn't. There's no clinical testing for many of the skills required in ADN programs such as OB, psych, ICU, advanced meg surg, telemetry, ER, geriatrics, etc. The board had major problems with this, and I don't blame them.

As for the claims that the college is going to make money with this new weekend-night program ... this is pretty funny. First, you guys complain that the board and traditional schools aren't doing enough to make flexible programs available for working adults. Now that they are ... you're complaining that it's a profit scam.

The hospitals are going to pay $33,000 per student on this deal. That's exactly how much a private non-profit nursing education would cost you without state subsidies.

You may have noticed that the state of California has a huge budget deficit. This is the only way they can get more students into the pipeline. Even if the school somehow makes money off of the 20 students who go through this program (which I seriously doubt), that won't begin to cover the loss that's incurred with the 160 students who are receiving state subsidized education. There's no way the school, or the state, makes money on this deal.

:typing

pedinurse05 · May 13, 2006

I don't think you're understanding the legal issue. The actual statute states that out-of-state grads have to attend schools with the same cirriculum requirements as California schools. The board can't change that statute, only the legislature can. What the board can do is change the cirriculum requirements, but that means they'd have to throw out all of the clinical requirements for the 100 or so programs in the state and, obviously, it makes no sense do that.
The evidence is posted right here on this board on another thread. To wit:
If you don't think that policy comes from evidence of problems with the program then, ok, but it's not the first time that people have posted similar stories on this board.
:typing

curriculum

traumahawk99 · May 13, 2006

I don't think they're less qualified. I just think the problem is more complicated than what you're describing. If you suspend the requirements for certain groups then you render the requirements meaningless. Maybe the requirements should be changed but if they are changed, they should apply to everyone. If you have a bunch of loopholes then, before you know it you've got major problems like MA's with little training or experience getting RN licenses. That's what started this whole thing in the first place.
As for the legal arguments, my question is this: If the board had total discretion and authority, why did Excelsior bother to sue in the first place? And why did they appeal? Are their lawyers totally incompetent?
Obviously EC hoped the courts would interpret the statutes the way they did. But the case still came down to the law, not the board's discretion. If the board had total discretion EC wouldn't have bothered to sue in the first place.
:typing

i'd have sued. as a practical matter, excelsior didn't have much of a chance to win, but that's not a reason to just roll over. and yes, the board does have discretion, else it would have been obvious from reading the state statutes. the statute is interpreted by the board. who says that interpretation can't be challenged?

so now you feel that excelsior lpn's are qualified? it would be simple enough to pass a provision exempting them. others have done it. why hasn't the california board of nursing done it? because it's just too complicated (maybe for their pea-sized brains, it is)? doh! is it a better answer to deny qualified nurses licensure? these excelsior graduates are vastly MORE qualifed than a new rn grad. how could this be anything other than an anal, knee jerk, politically driven decision?

um, i'd have to say my man chester appears to be a bit more articulate regarding the law than you. however, he's just an incompetent excelsior grad, like me. alas, if only we'd gone to real nursing schools! then we'd know what high standards are!

nothing demonstrates the complete ignorance and rock-hard-headedness of the board of nursing better than calling the cpne a "weekend course". that speaks for itself.

what size garbage bags should i send? tall kitchen, or 50 gallon?

Sheri257 · May 13, 2006

so now you feel that excelsior lpn's are qualified?

It would be helpful it you stuck with the original content of the discussion. You said:

lizz, why don't you tell us why an rn who has been working in another state for 2 years, with years of experience as an lpn would be less qualified than a new grad who has never worked a day?

That was the context of my reply: RN's with two years experience, not LPN's.

Anyway ... it really doesn't matter what Chester or I think of the law. The ruling is what it is.

:typing

traumahawk99 · May 13, 2006

the point is, why can't they set a standard for obviously qualified grads? ok.. let's assume we're talking 2 years experience. those nurses still wouldn't be licensed. why not?

Sheri257 · May 13, 2006

the point is, why can't they set a standard for obviously qualified grads? ok.. let's assume we're talking 2 years experience. those nurses still wouldn't be licensed. why not?

Actually, I wouldn't be opposed to a more comprehensive CPNE type exam, so to speak. If it tests for all the clinical skills required and experienced EC RN's pass it then, I think that would be a good compromise. The RN's wouldn't have to go back to school and, as long as they demonstrate competency in all the required areas then, I think they should be licensed. The law would have to be changed, and I don't know who would pay for the test or administer it but ... maybe that would be a solution.

:typing

ChesterRN · May 13, 2006

If the CPNE tested for all of the required clinical areas then I would be more inclined to agree with you. But it doesn't. There's no clinical testing for many of the skills required in ADN programs such as OB, psych, ICU, advanced meg surg, telemetry, ER, geriatrics, etc. The board had major problems with this, and I don't blame them.

Ok, now I think I see your point. You would be OK with the CPNE and EC if the above areas were tested. Is that about right?

Here's what I think. Any generalist generic RN program is not worth it's salt unless students are exposed to at least 789 hours within a neuro intensive care environment and possesses skills consistent with that of a safe staff neuro nurse within a Level I trauma center. How much credibility would I have if I truly possessed this system of beliefs?

The point I think you may be missing is that the overall goal of any generic (pre-licensure) program is to produce beginner clinicians who are safe and effect nurse generalists. It is true that EC doesn't test competency in the advanced areas that you have mentioned, insofar as psychometric domain, but let me tell you, all areas are covered within the cognitive exams, which are required of all NLAN accredited nursing schools.

Again, the areas that you have mentioned fall well outside of the parameters of what beginning nurses do, or what they should be doing without more training in the form of an intensive orientation or skills workshop. Either way this is training that is considered "post licensure." It is crazy to think with the minimal exposure that any traditional nursing student receives in intensive care would provide for sufficient knowledge to function in that environment as a beginner RN.

Again, safe, beginning nurse generalist is the overall goal of any program. This is what NLAN looks at before they put their endorsement on any program.

But then again, perhaps you and the BRN know more about programmatic curriculum design and evaluation than national authorities who have actually procured Ph.D. scholarly degrees in curriculum design. Perhaps the BRN knows more than the scholars who possess advanced degrees in psychometrics who guide line item construction for NCLEX. Perhaps the BRN is right and the vast majority of BON's in the country are not when it comes to public safety.

Maybe one day the California BRN will share its logic with us all, so us simpletons, the scholars, The NLAN, The NCLEX and the rest of the country's BON's can all learn.

Sheri257 · May 13, 2006

The point I think you may be missing is that the overall goal of any generic (pre-licensure) program is to produce beginner clinicians who are safe and effect nurse generalists. It is true that EC doesn't test competency in the advanced areas that you have mentioned, insofar as psychometric domain, but let me tell you, all areas are covered within the cognitive exams, which are required of all NLAN accredited nursing schools.
Again, the areas that you have mentioned fall well outside of the parameters of what beginning nurses do, or what they should be doing without more training in the form of an intensive orientation or skills workshop. Either way this is training that is considered "post licensure." It is crazy to think with the minimal exposure that any traditional nursing student receives in intensive care would provide for sufficient knowledge to function in that environment as a beginner RN.
Again, safe, beginning nurse generalist is the overall goal of any program.

I agree. I'm not saying that someone who goes through ICU clinicals is going to be a competent ICU nurse from the start. That would be ridiculous. But having some ICU clinicals before you graduate is still lot better than having no ICU clinicals when you graduate. And taking those clinicals concurrent with theory does make the theory a lot more meaningful ... especially for a beginner nurse.

While the board is hardcore on the concurrent with theory requirement, and I agree with this for beginner nurses who aren't RN's, I don't think this requirement is absolutely necessary for EC RN's who may have two years experience elsewhere. That's why I wouldn't be opposed to a more comprehensive clinical exam as a compromise, as I mentioned in the above post.

:typing

ChesterRN · May 14, 2006

I agree. I'm not saying that someone who goes through ICU clinicals is going to be a competent ICU nurse from the start. That would be ridiculous. But having some ICU clinicals before you graduate is still lot better than having no ICU clinicals when you graduate. And taking those clinicals concurrent with theory does make the theory a lot more meaningful ... especially for a beginner nurse.
While the board is hardcore on the concurrent with theory requirement, and I agree with this for beginner nurses who aren't RN's, I don't think this requirement is absolutely necessary for EC RN's who may have two years experience elsewhere. That's why I wouldn't be opposed to a more comprehensive clinical exam as a compromise, as I mentioned in the above post.
:typing

Ok, I think were on the same sheet of music now. We both agree that the terminal end goal for any graduate RN is to be a safe clinician. I'm sure you would also agree that exercising safe clinical behavior does not cross a continuum such as health. For example, with death, there is no continuum; you are either dead or not. Just like being safe, RN's are either safe clinicians or they are not. If you can, try and follow this logic in the form of my questions.

Do you think that the NLAN would provide programmatic accreditation to EC without reservation if the program produced unsafe graduates, or in anyway was not able to demonstrate that EC grads possessed knowledge and skills consistent with their standards?

Also, do you think that all of the other BON's that accept EC grads are placing the consumers of nursing care across the country in jeopardy by allowing EC graduates to practice?

Also, do you think the architects and administrators of NCLEX in any way would make the exam process available to program graduates who were unsafe?

Also, do you think the Masters and Doctoral prepared nurses who actually administer the CPNE who are deans, associate deans and professors of traditional nursing schools would jeopardize their credibility in affirming safe and competent status on an unsafe nurse candidates of EC?

Also, have you ever seen anything in writing from the California BRN which provides any documentation that EC grads have had more problems in the clinical setting than traditional grads--not slimy innuendos, I mean actually by name-EC? If not, why not? Do you think the reasoning for this is that the BRN, although delusional, may indeed be able to appreciate such terms as "slander", "libel", "defamation" ect.?

These are some things to think about when you start to feel yourself gravitate towards the delusional extreme on the continuum of the BRN's way of thinking about EC.

traumahawk99 · May 14, 2006

lizz, don't you think an ec rn with two years of experience.. (heck, let's say 6 months of med surge experience) would be VASTLY more qualified than you when you graduate, fresh from nursing school? if nursing schools are so great and produce anything other than rank beginners, why do hospitals have such extensive training programs for them? one of the hospitals i talked to said "nurses are made on the floor, not in a school". that's an employer who has already offered me a position. yes, a paramedic/ec nurse.

i've got to believe that the phd's at the nln know a heap more about educating nurses than the board of california, which has secret information it won't share. the nln is different than the board of california in that they operate in the light of day.

i'm damn proud of my ec education, and of passing the cpne. if you attempted to take that exam, i think you'd be humbled by the difficulty.

out of curiosity, you sure seem to have invested a lot of energy in learning about ec and the cpne. is there a particular reason, or is it just a hobby?