[Editor's note: This story originally was published by Real Clear Health.]
By Robert Goldberg
Real Clear Health
Recently, RealClearHealth ran an article describing the vital role nurses from other countries play in filling nursing jobs in the United States. However, as the article made clear, these applicants barely make a dent in a persistent shortage of nurses facing this country. Much like other shortages we have endured during and after COVID-19 ranging from N95 masks to infant formula, the dearth of nurses is a result of regulatory coziness designed to protect a shrinking group of producers.
According to the U.S. Bureau of Labor Statistics (BLS), the United States is short 194,500 registered nurses a year. It is no surprise then that the epicenter of our nation’s nursing shortage is California, a state which excels in turning every regulatory body into a source of crony capitalism.
California has the highest nursing salaries globally at an average of $120,000 a year. So, if you thought the state would have no problem attracting nurses, you would be only half right.
Despite this high compensation, California has a shortage of 45,000 nurses, a need that existed even before the pandemic. Indeed, in 2020, California nursing schools received 54,823 qualified applications but could only accept 15,002. In other words, each year, 39,000 eligible nursing students are denied access to nursing education in California every year. Nationally, 80,000 nursing applicants were turned away, making California the biggest single contributor to our national nursing deficit.
Greed and self-dealing are the source of the shortage in California and, therefore, nationwide. The California Board of Registered Nursing (BRN), a state agency stacked with California Nurses Association (CNA) members and executives, deserves full credit for creating this nursing desert. The BRN controls the licensing of registered nurses and accrediting nursing schools in California. It has interpreted its authority to regulate the number of nursing students that any school can enroll. The BRN opposes substantially increasing nursing school enrollment, claiming it will lead to inadequate education and a shortage of clinical placements required for graduation and licensure.
The BRN claims that shortages are due to a limited number of qualified instructors to manage student nurses who must complete a clinical rotation to graduate and be licensed. It should know because the BRN is causing the shortage in faculty hiring and clinical opportunities. How is this possible? First, the BRN must approve the hiring of every nursing instructor in California – even though every nursing program is already required to meet national accreditation standards. This redundancy in oversight results in delays and the loss of potential faculty.
Next, the California BRN discourages the use of non-acute facilities for practical training. According to the California Department of Health Care Access, the licensed sixteen nursing programs in the state were using only 121 of the 708 facilities (or 17%). It also turns out that many of these facilities are in medically underserved communities, which have the worst nursing shortages in the state.
What have other states done to address their nursing shortages? Indiana passed the “Nursing Indiana Back to Health Act,” allowing private and public nursing schools to accept additional students. Like Maryland and other states, the Indiana law also addresses the need for additional faculty by allowing nursing programs to hire qualified instructors who are not full-time employees.
These are sensible solutions to a solvable problem that the BRN has opposed. A broad alliance of California health institutions has urged both – all of which have been proposed and opposed by the BRN and the CNA.
BRN policies are deepening health disparities. Indeed, the $1 billion California paid for traveling nurses during the first COVID-19 surge went to nursing working in the wealthiest communities. That money could have been used to hire nursing faculty and pay the tuition of the nursing students – most of whom are Black and Hispanic – who could eliminate the 45,000-nursing shortage. In February, the CNA said state legislators refused to vote on a bill to establish a single-payer health system. The CNA Association and BRN should know turning a shortage of patient care into a cash cow sets a gold standard for the politics of greed.
Robert Goldberg is Vice President at the Center for Medicine in the Public Interest (CMPI).
[Editor's note: This story originally was published by Real Clear Health.]
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