July 7, 2020
The Governor of California
President pro Tempore of the Senate
Speaker of the Assembly
Sacramento, California 95814
Dear Governor and Legislative Leaders:
As directed by the Joint Legislative Audit Committee, my office conducted an audit of the Board of Registered Nursing (BRN) to assess its oversight of prelicensure nursing programs (nursing programs). The following report details our determination that BRN has failed to use sufficient information when considering the number of students new and existing nursing programs propose to enroll.
BRN’s governing board (governing board) both approves new nursing programs in the State and makes decisions about the number of students that existing nursing programs are allowed to enroll (enrollment decisions). Two of the key factors that should influence BRN’s enrollment decisions are the forecasted supply of nurses that the State will need to fulfill demand and the available number of clinical placement slots—placements at a health care facility for students to gain required clinical experience. BRN’s 2017 forecast of the State’s future nursing workforce indicated that the statewide nursing supply would meet demand; however, it failed to identify regional nursing shortages that California is currently experiencing and is expected to encounter in the future.
BRN’s governing board also lacks critical information about clinical placement slots when making enrollment decisions, which hampers its ability to prevent nursing students from being displaced because other nursing programs took their clinical spots. BRN does not gather and share with the governing board information about the total number of placement slots that a clinical facility can accommodate annually or how many slots the programs that use the facility will need each year. Without this key information, BRN cannot properly gauge the risk of such student displacement—reported to have affected 2,300 students in academic year 2017–18—when its governing board makes enrollment decisions.
Finally, we found that some of BRN’s requirements for nursing programs overlap with standards imposed by national nursing program accreditors (accreditors). As part of the Legislature’s 2021 review of BRN, it could consider the appropriateness of restructuring BRN’s oversight to leverage portions of the accreditors’ review in order to reduce duplication and more efficiently use state resources.
ELAINE M. HOWLE, CPA
California State Auditor