BILL ANALYSIS
SENATE COMMITTEE ON EDUCATION
Gloria Romero, Chair
2009-2010 Regular Session
BILL NO: SB 155
AUTHOR: Wright
INTRODUCED: February 12, 2009
FISCAL COMM: Yes HEARING DATE: March 18, 2009
URGENCY: No CONSULTANT:Beth Graybill
SUBJECT : Assumption Program of Loans for Education: School
Nurses
SUMMARY:
This bill expands eligibility for the Assumption Program of
Loans for Education (APLE) program to individuals completing
training to be a school nurse and who agree to work as a
school nurse in a qualifying school or school district.
BACKGROUND
Current law requires a school nurse to have a valid
Registered Nurse (RN) license and complete additional
requirements for and possesses a School Nurse Services
Credential issued by the Commission on Teacher Credentialing
(CTC).
The Assumption Program of Loans for Education (APLE),
administered by the California Student Aid Commission (CSAC),
was established in 1983 to provide loan assumption benefits
to credentialed teachers. The program is designed to
increase the number of teachers in disadvantaged schools or
high-priority subject areas. The program "forgives" up to
$11,000 of college loan debt for a person who teaches for
four consecutive years in a qualifying school or subject area
(paying $2,000 for the first year of teaching service and
$3,000 for each of the next three years of teaching).
Qualifying schools include those in the lowest two deciles of
the Academic Performance Index, schools with high proportions
of students from low-income families, a high percentage of
emergency permit type teachers, and those located in rural
areas. The subject area shortages are determined annually by
the Superintendent of Public Instruction and may vary from
year to year; math, science and special education have been
listed consistently for many years.
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Current law (SB 63, Budget and Fiscal Review Committee,
Chapter 73, Statutes of 2005) establishes the State Nurse
Assumption Program for Education Loans (SNAPLE), administered
by the CSAC, that provides up to $25,000 in loan assumption
warrants to encourage RNs to complete graduate education and
serve as nursing faculty in a nursing program at a California
college or university. An additional program, the State
Facilities Assumption Program for Education Loans (SF-APLE)
expands the SNAPLE program to RNs who agree to work full-time
in a 24-hour state facility (e.g. prison, state veteran's
home, state hospital) that has an RN vacancy rate of greater
than ten percent.
ANALYSIS
This bill :
1) Expands the APLE program to provide for the
assumption of student loans for students completing
training or coursework necessary to be employed as a
school nurse and seek employment as a school nurse in
schools serving a large population of pupils from
low-income families, schools with a large percentage of
teachers holding emergency-type permits, or schools
ranked in the lowest two deciles on the Academic
Performance Index.
2) Requires program applicants to meet the following
eligibility criteria and continue to meet the criteria,
as appropriate, during the payment periods.
Specifically, the bill requires applicants to:
a. Enroll in a program to complete training or
coursework in order to be employed as a school
nurse and agree to work as a school nurse in an
eligible school.
b. Be currently enrolled in or have been
admitted to a program in which he or she will be
enrolled on at least a half-time basis, and agree
to maintain satisfactory academic progress as
defined by the institution.
c. Be judged by his or her postsecondary
institution to have outstanding ability based on
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specified criteria.
d. Have received or be approved to receive a loan
through the Federal
Family Education Loan Program or any loan program
approved by CSAC.
3) Requires applicants to agree to be employed full-time
for at least four consecutive academic years after
obtaining the appropriate nursing credential in 1) a
public elementary or secondary school or school district
that at the time the school nurse is hired, is an
eligible school, or 2) a public elementary or secondary
school district that has at least one school in the
nurse's service territory that, at the time the nurse is
hired, is an eligible school.
4) Requires CSAC to commence loan assumption payments
upon verification that an applicant has met requirements
of the agreement and all other pertinent conditions and
completed all of the following:
a. The applicant has received a California
preliminary or professional clear credential or an
equivalent credential from another state
authorizing service for kindergarten or any grades
1 to 12 inclusive.
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b. The applicant has provided full-time
classroom instruction or employment as a school
nurse, or the equivalent on a part-time basis, in a
public elementary or secondary school for the
equivalent of one school year.
5) Provides for loan assumption payments up to $11,000
to be paid as follows:
a. $2,000 after the completion of one school
year of employment as a school nurse.
b. $3,000 after the completion of two school
years of employment as a school nurse.
c. $3,000 after the completion of three school
years of employment as a school nurse.
d. $3,000 after the completion of four school
years of employment as a school nurse.
6) Specifies that participants who do not fulfill the
minimum service requirement assume liability for all
remaining student loan obligations and provides for the
deferral of loan liability for participants who due to
serious illness, pregnancy, or other natural causes are
unable to complete school nurse education.
STAFF COMMENTS
1) School Nurse Services Credentials . In addition to
the direct medical services authorized by the Registered
Nurse license, holders of School Nurse Services
Credentials are authorized to provide specialized health
services including conducting immunization programs,
assessing and evaluating the health and developmental
status of pupils, designing and implementing individual
student health maintenance plans, developing and
implementing health education curriculum, and
interpreting medical and nursing findings appropriate to
a student's individualized education program. CTC
issued 274 preliminary and 47 clear school nurse
services credentials in 2007-08.
a. The Preliminary School Nurse Services
Credential requires a valid California RN license,
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a bachelor's degree or higher, and a clear criminal
history background check. Candidates do not need
to complete training to be a school nurse prior to
earning this credential. This credential is valid
for five years and is non-renewable.
b. The Clear School Nurse Services Credential
requires a valid Preliminary School Nurse Services
Credential, a valid California RN license, the
completion of two years of successful work
experience as a school nurse, and completion of a
CTC-approved school nurse credential program. The
Clear School Nurse Services Credential is valid for
five years and is renewable.
School nurse credential programs are typically one year
long. Candidates admitted to these programs have an RN
license and a bachelor's degree, typically a Bachelor of
Science in Nursing (BSN), and hold a preliminary school
nurse services credential.
2) Need for the bill . According to the California
Department of Education, there were 2,829 credentialed
school nurses working in public schools in 2007-08. The
statewide school nurse - student ratio that year was
1:2,218, slightly under the average statewide ratio of
1:2,255 that has existed over the past decade. The
sponsor of the bill contends that this ratio indicates a
shortage of school nurses and notes that the ratio
exceeds the American School Nurses Association
recommendations of one nurse for every 750 students.
Although school districts also employ Licensed Vocational
Nurses (LVNs) to provide some medical services to
students, these nurses are not authorized to provide the
specialized services a credentialed school nurse
provides. Moreover, the sponsor argues that schools
need more credentialed school nurses because of the
number of students who have special needs and/or chronic
and acute health problems, and the growing number of
students who take prescription medication during the
school day. By enabling registered nurses to qualify
for a loan assumption award through the APLE program,
the author hopes SB 155 will encourage more nurses to
complete requirements for the Clear School Nurse
Services Credential and commit to serving in a
qualifying public school for at least four years.
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3) School nurse shortage . There may be several reasons
why there are relatively few credentialed nurses in
public schools, including the overall nursing shortage,
compensation disparities, district staffing priorities
and employment uncertainty. Salaries for school nurses
tend to be lower than salaries for nurses who work in
clinical settings. For example, San Rafael City Schools
recently posted an opening for an experienced school
nurse with an annual salary range from $43,823 to
$66,846, while nursing jobs at nearby Marin General
Hospital have a salary range of $95,000 to $120,000.
While this wage disparity makes it difficult for some
districts to hire and retain credentialed nurses, other
districts, especially those with budget constraints, may
choose to hire LVNs to provide basic medical services.
In addition, many veteran nurses are discouraged from
making a mid-career change to become a school nurse due
to current federal law which reduces Social Security
benefits of workers who also have pension benefits from
employment not covered by Social Security (i.e. the
State's retirement system for schools, the State
Teachers Retirement System). Finally, recent evidence
suggests that school nurses are generally more
vulnerable to layoffs than classroom teachers when
districts face budget reductions. More than 100 school
nurses received layoff notices in March 2008. Given
these factors, it is unclear whether this bill will
address the need for more school nurses.
4) Is APLE the right strategy ? Assuming some of the
unmet need could be addressed through recruitment
strategies, there may be non-general fund alternatives
to the APLE. The Health Professions Education
Foundation, funded through a $10 surcharge on each RN
license renewal, provides direct scholarships or loan
repayment to nurses who work in medically underserved or
rural areas. Could this program be expanded to address
the need for more school nurses?
The APLE is a competitive teacher incentive program
designed to address certain teacher shortages by
encouraging students, district interns, and out-of-state
teachers to teach in subject areas where a critical
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teacher shortage has been identified or in designated
schools meeting specific criteria. By expanding the
eligibility pool for APLE, could this bill have the
effect of reducing the number of APLE awards available
for teacher candidates?
The SNAPLE program addresses the critical shortage of
nurses who serve as faculty in nursing programs or serve
in an eligible position as a registered nurse in a
state-operated facility. Since SNAPLE is designed to
address the nursing shortage, would it be more
appropriate to expand eligibility for SNAPLE to include
school nurses? As an added benefit, loan assumption
awards could be shifted from the undersubscribed SNAPLE
state facilities program to the school nurse program
without reducing the number of APLE awards available for
teacher candidates. If the Committee chooses to so
amend the bill, staff recommends the following
amendments:
a. Move the content of the bill to Chapter 3
of Part 42 of the Education Code.
b. Specify the repayment schedule utilized in
APLE in order to maintain consistency with loan
assumptions for teachers.
c. Add an evaluation requirement and sunset
date to enable the Legislature to determine the
efficacy of the program as a tool for increasing
the number of school nurses.
5) Prior legislation . SB 155 is similar to SB 1521
(Cedillo, 2008), which was heard by this committee and
would have created a specific APLE program for school
nurses. SB 1521 failed passage in committee on a 3-4
vote with reconsideration granted.
6) Technical amendments . The author's office indicates
the bill is intended to assist registered nurses who are
enrolling in or have enrolled in a Clear School Nurse
Credential program. Staff recommends amending the bill
to so clarify. In addition, staff recommends amendments
that would change "assume" to "retain" on page 6, line
32 and change the word "teaching" to "service" on page 7
line 4.
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SUPPORT
American Federation of State, County and Municipal Employees,
AFL-CIO
California School Nurses Organization (Sponsor)
Union of Health Care Professionals
United Nurses Associations of California
OPPOSITION
None received.