California Institute for Nursing and Healthcare (CINHC)
Report submitted for the February 4, 2012 ORNCC Meeting
Submitted by Judy Dahle
1.
Grant Updates

A few new grants have come in. We received a small grant – $25,000 – from The Doctor's Company
Foundation to support Magic in Teaching; we also received $45,000 for an expansion of Transition to
Practice Programs (TPP) in community clinics and school nursing from the Metta Foundation,
matched by $90,000 for TPP in home health from Kaiser Permanente Health Education Fund through
the East Bay Community Foundation to USF, in partnership with CINHC. Glide Health Services
received a HRSA grant for NP residencies; I was written into the grant as a consultant based on our
TPP. Also, we recently received a $300,000 2-year grant to support the Southern California
simulation alliance.

Pending grants are still out for collaborative model of nursing education, to include one with
UniHealth Foundation in partnership with CSU Fullerton and four community colleges in Orange and
Riverside Counties, and with KP Southern California Community Benefit for technical assistance for
collaborative model. An evaluation of CINHC’s clinical faculty development program was submitted
to RWJF as a response to their call for proposals regarding evaluation of new programs for nursing
education.

We are also continuing to be alert for other grants that may support both CINHC and CAAC program
work. Priscilla is focusing on seeking grant funding for the diversity program. She and I recently
met with a program officer from The California Endowment. Priscilla is also planning a meeting with
The California Wellness Foundation in early 2012. Bob has a small grant proposal out to redo the
Men in Nursing video. After listening to the webinar discussing the CMS Innovation Program, there
are some real possibilities of seeking funding that support new practice models.
New Partnerships – over the last few months, several opportunities for partnership have become available
to CINHC. All are based on the work that CINHC has done over the last 8 years and some are requesting
that we work with them to increase their capacity to hire RNs and add them to their staffing models. All
of these potential partnerships would contribute to the IOM Recommendations, and relate to CINHC’s
new focus, as well as help to define the leadership needed in the new executive director. This is also
consistent with direction from the Board following the 2011 Retreat, which was to seek opportunities for
new partnerships, with a focus in out of hospital health care settings. Potential new partnerships include:




California Primary Care Association
California Rural Health Association
Pacific Clinics (a behavioral health organization with 80 clinics in the greater LA area) to develop a
new staffing model that includes RNs and integrates primary care with behavior health
Masonic Foundation, which wants to increase the number of nurses interested in long term care and
prepared to care for patients with memory loss. Discussions are actively underway to determine the
potential for a partnership with CINHC.
Additionally, other potential partnership discussions have included:






2.
Glide Health Services – how CINHC can help facilitate replication of their model of nurse-run clinics
as we are continuing our work with the California Health Workforce Alliance to develop models to
increase access to primary care.
Mount St. Mary's College – interested in developing a new collaborative model of nursing education
for AD nurses to obtain the BSN with a focus on care of our aging population.
Western University of Health Science, in partnership with community colleges' Health Workforce
Initiative, to provide a QSEN faculty institute for Southern California nursing school faculty.
Department of Education – Cindy Beck from the department discussed with Priscilla about having
CINHC facilitating the development of a “boot camp” for high school students interested in nursing
as a career, as a diversity initiative.
Services for the Aging in California – met with Joanne Handy, and there is interest in collaborating
on many fronts, to include: TTP for new grads in home health and LTC, the potential partnership
with the Masonic Foundation, and, in partnership with ACNL, offering the Leadership Development
Program as part of a planned leadership institute for the nursing directors in their organization’s
facilities.
Jewish Vocational Service and SEIU Education Fund – interested in TPP for particular populations of
nurses. Nikki involved in ongoing discussions.
Results of 2010 Report Card for RN jobs/100,000 population
The 2010 national average number of RN jobs per 100,000 was 860 (compared to 787 in 2004) –
grade C. California received a D with an RN job ratio of 644 (compared to 622 in 2004). All
California P/MSAs fell below the national average with the exception of the San Francisco and
Redding P/MSAs, with ratios of 960 and 857.7 RN jobs respectively. Four P/MSAs received Fs,
indicating a ratio less than 462 RN jobs per capita (compared to 320 in 2004) RN jobs per capita.
The most common grade received in California is a D, received by 10 P/MSAs. Most P/MSAs
retained the same grade, although five P/MSAs improved their grades and five dropped their
grades from the 2004 ratio.
The District of Columbia and forty states received a C or above, representing 761 jobs per capita
or better. Eighteen states and DC received C+ or greater, representing 960 jobs per capita. Only
three other states received Ds: Arizona, Nevada, and Utah.
3.
Simulation Alliance
This past year they have held 10 simulation classes around the state, training over 200 faculty.
Our 2012 calendar of courses has been confirmed and they are continuing to use C-Vent for
registration and are pleased with the system. Courses have been offered for a reasonable fee and
our breakeven point was high; moving into 2012 with our increased fees, they feel they will
bring in additional revenue without affecting the number of registrants, as CSA subscribers will
benefit from discounted fees. We continue to work with the seven regions to conduct train-thetrainer training.
Southern California Simulation Collaborative (SCSC)
CINHC is providing two years of leadership and coordination to support the development of the Southern
California Simulation Collaborative. Funding from Kaiser Permanente Southern California Community
Benefits provides for part-time CINHC personnel including: KT Waxman, Project Director (0.1 FTE),
Carolyn Orlowski, Regional Coordinator (0.4 FTE), and Tianda McKoy (0.20), Project Coordinator
through June 2013.
4.
RN Transition to Practice Programs for New Graduate Nurses
(LA, Ventura, Orange and Riverside Counties)
Supporting the replication of the initial (4) Bay Area RN Transition Programs in other regions of the state
was one of the deliverables in the Bay Area Evaluation Grant funded by Kaiser Permanente National.
Meetings with schools, employers, and workforce investment boards in LA, Ventura, Riverside, and
Orange Counties provided information, resources and tools used initially in the (4) Bay Area RN
Transition programs to encourage and support the development of additional programs in Southern
California. Inclusion of the QSEN-based evaluation tools developed by CINHC and the Casey -Fink
Confidence Tool supports the adoption of a standard set of core competencies and measures across
programs while positioning for the analysis of evaluation and outcome data across the state.
RN Transition Programs in the Region:
 Pre-existing and ongoing programs developed in 2010 (2) include: Mount Saint Mary’s College
and CSU Fullerton; both self-funded through registration fees paid by the participants.
 Western University conducted a pilot program in spring 2011 with their internal RN to MSN new
graduate students. Six Community Colleges each completed a summer pilot course: Golden West
College, Saddleback College, Chaffee College, Riverside Community College, Rio Hondo
College, and LA Pierce College.
 Funding was provided by HWI at Golden West College ($10,000 per school) to support initial
programs at 4 Community Colleges in the Orange County/Riverside areas. Rio Hondo College
received partial funding from statewide HWI funds as an affiliate for LA County, and LA Pierce
College had access to pre-existing internal grant funding.
 Participants from each of the 9 programs in the region paid standard school registration fees that
varied across schools based on the typical cost per unit in each of the private programs, at CSUF,
and for the community college courses as work study programs.
 Clinical partners were closely involved in developing candidate selection criteria, and participated
in the selection process, program planning and/or curriculum design. Some hospitals provided a
portion of the didactic content, or included participants in existing hospital training programs
such as hospital orientation.




Sustainability and expansion of Community College-based programs is uncertain related to
established capacity limits and insufficient internal funding of work study programs. Community
College programs have indicated the need for outside or additional funding of between $8,000$10,000/course to conduct each program. HWI is currently funding an additional 2 fall cohorts at
Golden West College and Saddleback College.
Thus far 9 school-based RN Transition Programs have provided one or more programs in the
Southern California region with approximately 30 clinical partners. CSU Channel Islands,
Ventura College, and Moorpark College are planning to implement programs in January 2012
supported by funding received from a 2-year grant ($100,000) from the Ventura Community
Foundation.
A regional Webinar was conducted September for these Southern California programs to provide
updates and share their experiences.
Thus far, a total of 227 nurses have participated in these 9 programs in 2011. The 4 Community
Colleges funded by HWI report 63% of those attending their summer programs have been hired.
Forecast of the Registered Nurse Workforce in California
Policy Implications
The 2005 forecast report advised that “The only plausible solution to the RN shortage,
based on our preliminary analyses, appears to be continued efforts to increase the numbers of
graduates from California nursing programs.” This recommendation was acted upon by state
leaders. Significant increases in state funding for expanded educational capacity of nursing
programs, increased funding for equipment, use of updated instructional technologies, and other
needed educational resources have had a favorable impact on addressing the RN shortage in
California. Between 2004-2005 and 2009-2010, nursing graduations increased 72 percent,
reaching over 11,500 new RN graduates per year. The new forecasts indicate that this number of
graduations per year appears more than sufficient to meet future RN demand.
Policymakers should be cautioned that the 2011 BRN forecasts represent long-term
forecasts and are not intended to reflect rapidly changing economic and labor market conditions.
They also are based on the most currently available data; the factors that affect RN supply and
demand are unlikely to remain static. The most important possible changes include: (1) the
number of graduations from RN education programs; (2) inter-state migration; and (3)
employment rates of older RNs. These factors and any other potential influences on California’s
nursing shortage, such as the limited pool of faculty, limited availability of clinical education
placements, and faculty salaries that are not competitive with clinical practice positions, should
be monitored continuously.
California leaders should observe closely the employment paths of recent nursing
graduates who are entering a difficult job market and may choose to leave the nursing profession
or leave California. Moreover, they should watch new enrollments in nursing programs, which
could drop as state colleges and universities face tight budgets and as potential students hear
there might not be enough nursing jobs. California will likely need to maintain the present
number of nursing graduates in order to meet long-term health care needs.