In Sacramento’s competitive health care industry, finding employees and retaining them is consistently on the minds of managers at local hospitals, clinics and other facilities.
The industry's worker shortage has given rise to a new pipeline for workers entering the Sacramento area labor force: For-profit nursing schools.
Nurses represent the bulk of Sacramento’s health care workforce, from registered nurses and licensed vocational nurses at the region’s hospitals and clinics, to certified nursing assistants that provide care in nursing homes and rehabilitation facilities.
But with a lack of schools and training facilities, California is projected to have a shortage of 140,000 nurses by 2030, according to a 2017 report published by the American Journal of Medical Quality. At the same time, California nursing jobs, from nursing assistants to registered nurses, are anticipated to grow by 15% to 17% by 2026, outpacing the national growth rates for those professions, according to figures from the U.S. Department of Labor.
The Sacramento region is now home to at least 11 for-profit nursing schools that seek to provide more workers for the region's growing health care industry. As demand for graduates grows, these schools are poised to expand.
For-Profit Nursing Schools in the Sacramento Region
A red number indicates a cluster of schools. Click on number for details.
Influx of schools, students
For-profit programs often focus on niches in certified nursing assistants or home health. Programs that focus on nursing assistants or licensed vocational nurse training are often seen as stepping stones to higher-paying careers in health care, such as nurse practitioners or registered nursing.
“Enrollment is at an all-time high,” said Wayne Williams, CEO and owner of Curam College of Nursing in South Sacramento. “It started in 2008 and it hasn’t let up.”
Williams founded the for-profit nursing school in 2009. He said it's more independent compared to corporate-run private nursing schools like Unitek College or Carrington College. When the school was first founded, demand was driven by truck drivers and service industry workers who were looking for a more stable career during the Great Recession, Williams said. Lately, demand has continued to rise due in part to the health needs of aging baby boomers and growing demand from long-term care facilities and home health agencies.
Curam typically has space for about 240 students per year, though with increasing demand for students, the school could double in size. Williams said he is currently exploring Title IV classification by the U.S. Department of Education, which would give the school more federal recognition and allow students to apply for financial aid.
“We cater to a different type of student,” Williams said, adding that many of his students are immigrants from Southeast Asia or may not have strong English skills. “I believe that the system is somewhat discriminatory against people who don’t do well on entrance exams.”
Carrington College's Sacramento campus is one of the college's 19 campuses across the state, with nursing as one of its most popular programs. While Carrington typically only has space for about 24 registered nurses and 30 licensed vocational nurses at a time, the number of applications that those programs received rose about 25% from last winter's application period to the summer application period in August, said John Andersen, campus director at Carrington College in Sacramento.
“The greater Sacramento area is ripe for health care jobs,” he said.
Careway Health Institute, another program that centers on nursing assistant training, expanded from the Bay Area into Sacramento last year, and schools like Carrington College have expanded their offerings.
Rapidly expanding California Northstate University has also voiced interest in pursing a school of nursing. Officials from the Elk Grove-based, for-profit university have declined to comment on what kind of program it would be or when it might launch.
The influx of for-profit colleges is making it more competitive for nonprofit and public schools to find applicants and spots for their students to practice their skills in a clinical setting, said Nancy James, associate dean of nursing and allied health at Sierra College.
“At the end of the day we’re all fighting for clinical spots," she said.
The recent increase in for-profit school enrollment has seen the number of clinical spots become “tapped out,” James said. The region appears to have reached a plateau for nursing student demand, she said, though that's part of a normal "wax and wane" in demand for new nursing graduates, while demand for more experienced nurses remains high.
About three years ago, the Sacramento region saw a rise in the number of older nurses entering retirement, James said. Now, with the average age of a nurse landing at around 50, those individuals might not be ready for retirement yet, but a new wave is coming, she said.
Sierra College saw about 150 applications this year for about 40 student spots, which was down from years previous that saw 300 applications. The drop was due to a recent tightening of its entrance requirements for the nursing program, James said.
Employers seek their own slice
In the past, it was the community clinics and senior care facilities that struggled to fill nursing positions. In recent years, however, more of the larger hospitals and health systems have needed help recruiting health workers as well, said Preet Kuar, CEO of Pacific Staffing, which focuses on medical and administrative staffing for the health industry.
The crunch for workers has larger players more likely to hire from a for-profit college than they might have been in the past.
“It’s better than keeping that position vacant,” Kuar said.
Health systems are also beginning to court for-profit schools to build a pipeline of potential employees, she said.
"Larger employers are all over the place partnering with these schools, doing externships and waiting in line to be on the advisory board," Kuar said.
Employers are increasingly offering mock interviews and information sessions for students at for-profit schools as well, she said.
Locally, Kuar has seen Unitek College and Chamberlain College work closely with several health care companies, though she declined to say which ones.
Kaiser Permanente launched a partnership with Unitek College in 2018 to send more of its students through Kaiser locations in Northern California for clinical rotations.
Worker shortages have led BrightStar Care in Roseville to get more hands-on with education programs as well. The for-profit home health agency deals with staff shortages on a regular basis with both nursing assistants and caregivers, which is partly due to a lack of professionals who specialize in home-based care, CEO Ignacio Céspedes said.
Céspedes' Brightstar franchise has seen recent success with a "surge" of graduates from Kash Career College, a nursing assistant and home health aid program with locations in Sacramento and Auburn. Representatives from Kash Career College did not respond to requests for comment.
"While they don’t have the work experience that we require — we ask for one year of professional experience — they are good candidates after going through those programs," Céspedes said in an email.
To ready graduates from nursing assistant programs like Kash Career College for employment, Brightstar recently launched its own training program to give students more experience working in the field. After they complete the training, the students can apply to Brightstar or another local company, Céspedes said.
“It has really helped boost our pipeline of candidates," he said.
State dollars on the horizon
With a looming gap in health care workers, a California task force recommended that the state pump $3 billion into nursing education and prioritize training nurse practitioners. The designation requires a master's degree.
The California Future Health Workforce Commission is pushing to increase the state's health professions training programs by 25%. That could see the number of home care workers increase, to prevent an anticipated shortfall of 600,000 across the state by 2030. Another $462 million has been recommended to increase the role of nurse practitioners. The commission, which is lead by Dignity Health CEO Lloyd Dean and University of California President Janet Napolitano, is seeking support from legislators and Gov. Gavin Newsom for its next steps.
Implementing some of those changes, however, has been difficult. Multiple iterations of a state bill to increase nurse practitioners' scope of practice have faltered, predominately because of pushback from the California Medical Association.
Assemblyman Jim Wood (D-Santa Rosa) introduced Assembly Bill 890 earlier this year, which would have allowed nurse practitioners to offer care without the supervision of a primary care doctor. The bill was tabled in the Assembly Appropriations Committee this spring. Wood plans to reintroduce the legislation as a two-year bill in 2020, he told the Business Journal.
"The reality is that there simply isn't enough nurses," Wood said. "We’re still falling behind."