This Date in UCSF History: Nursing Undergrad Program Nixed


Originally published on October 4, 1979. Despite a shortage of nurses, fierce competition for admission to the UCSF undergraduate nursing program and the program’s high academic rating — this fall’s class of 139 students will be the program’s last.

The generic baccalaureate program is being phased out from the UCSF School of Nursing in favor of an all graduate curriculum.

The UCSF School of Nursing has decided it should provide graduate training for nurses, leaving undergraduate training to other institutions.

Presently, RN degrees are granted to graduates of two year Associate Degree (AD) programs, three-year hospital based Diploma programs, and four-year university based baccalaureate degree programs.

Opponents of the phase-out claim that this action will diminish the already insufficient number of RN’s available for patient care; and will not serve the overall interest of either nurses or the community.

Background UCSF began offering a Bachelor of Science in Nursing (BSN) degree in 1917.

The current BSN program design, begun in 1973, offers a unique, two-year course for students with “advanced college standing,” who often have previous college degrees or extensive work experience in other fields.

The School of Nursing also currently offers the graduate degrees of Masters of Science in Nursing (MS) and the Doctorate of Science in Nursing (DNS) degree, which was first offered at UC in 1964.

UCSF is the only school of nursing in California to award a doctorate in nursing. The new “AD to MS” program will begin in Fall, 1980. The curriculum will, in three years, lead AD and Diploma trained RNs through a BSN directly to a MS in nursing.

While the program will be welcomed by RNs wishing to “upgrade” their skills, the program will not be accessible to LVNs except through AD programs.

Most nurses with masters degrees assume roles such as teachers, administrators, researchers, consultants, clinical specialists, and nurse practitioners.

Nurses with doctoral degrees generally prepare for careers in academics or research.

“The role, responsibilities, and scope of practice of the technically prepared nurse are supposed to be different from those of the professional nurse,” said Dr. Holly Wilson, Associate Dean of Academic Programs.

“What we’re attempting to do is to build into the program an opportunity to be socialized into that expanded scope of practice.”

Mandate Wilson stated that the faculty developed plans for the move by the School of Nursing in accordance with a 10-year Plan for Higher Education in the state of California.

“In that mandate,” she said, “it’s the junior and community colleges’ responsibility for the two-year AD programs.

The state colleges are mandated to put their resources toward the baccalaureate level, and the university system is mandated, when choices have to be made in the face of limited resources, to shape and focus their resources toward graduate education.”

According to Wilson, development of the graduate program necessitated the discontinuance of the generic baccalaureate program.

Resources are limited, she said, and UC’s educational plans approved by the Regents “have certain numbers attached to enrollments.”

Describing UCSF’s move as a “mission,” Wilson said that the decision to discontinue the baccalaureate program was “a really hard choice.”

“It was important for UCSF to move into a position of leadership in relation to some important curriculum issues in the country,” she continued, “to tackle something that was difficult and controversial, so that UC’s history and expertise in innovative curriculum development and evaluation would be able to serve the profession in some way.”

However, she added, “many feel a loss about the baccalaureate program.”

High demand

The demand for the baccalaureate program was evident in the number of applicants to the program.

Seven-hundred-eighteen applied for the 139 places in this year’s class, compared with 380 applicants for 192 spaces in the masters program and 47 applicants for 34 DNS openings this year.

There are 19 accredited institutions statewide offering a baccalaureate degree in nursing.

Two programs exist locally — San Francisco State University and the private University of San Francisco — both of which require the full four year attendance.

Tuition for the USF program is $3500 a year.

“UCSF’s nursing program was the only program in the state that admitted people from other fields,” said one former School of Nursing faculty member. “That option needed to be kept open.”

One second year nursing student noted that, “While the AD to MS program will benefit many RNs living in the area who wish to further their careers and skills through the pursuit of a higher degree, there will no longer be any BSRN program accessible to individuals with more than two years of college.”

The present program, she said, invited “individuals with a greater variety of training and outlook into the profession.”

“I am not convinced that the switch to the new program serves the overall interests of nurses or the community,” the same nursing student continued.

In addition to the advantages the present program offers to students, she noted that the current program “also served to increase the total number of RNs.

The AD to MS program does not do this and, as is apparent in any hospital, there is a current shortage of nurses which has a definite negative effect on the quality of both patient care and work satisfaction.”

Shortage April’s American Journal of Nursing cites American Hospital Association figures that 17 per cent of California’s budgeted RN positions are unfilled, with a 21 per cent vacancy in Los Angeles, and acute shortages in rural areas.

The article reports that the shortages are most acute in hospitals, where many nurses find the traditional role delineations the most confining, and the working conditions the hardest to endure.

UCSF currently has 53 openings for RN’s out of its full staffing of 580 FTE’s, according-to Thais Hawkins of the Nursing Office. There were 96 openings in May, 16.5 per cent of full staffing.

A former faculty member stated, “I voted against the change in the program because I think we need highly trained people at the bedside with patients. Hospital patients these days need highly complex care that requires the depth of knowledge the baccalaureate program allows.”

“I think that one of the hopes, expectations, and opportunities that the students prepared with advanced degrees have is to explore their practice out of the confines of bureaucracies where they work for institutions instead of working for their clients,” said Associate Dean Wilson.

“Nurse clinicians and nurse practitioners do go into other work structures, like private practice and group practice, and are able to be a little more autonomous.”

“Or else they’ll plunge back into nursing service,” she continued, “and make a stab at changing the structure of nursing in an acute care setting so that there can be excellence in practice and a decent quality of life for the practitioner, with some sort of authority and power in patient care decisions.”

“Up” and “out” Some, however, think that the way “up” in nursing constitutes a way “out” of nursing, as it is experienced by most nurses on the basic level of practice.

Another second year nursing student remarked: “The graduate program will be able to sidestep the problems that exist for most nurses in favor of increasing the power, prestige, and influence of a small minority of nurses. Even if it is a good program, it’s going to leave the interests of a lot of nurses and other health workers behind.”

When a head nurse on a busy floor in Moffitt Hospital was asked what she thought of the changes in UCSF’s nursing program, she stated flatly, “I think it stinks. It is important to develop new directions in nursing,” she continued earnestly, “but what I’d like to know is who the hell is going to do bedside care? Do you think someone with a masters degree will want to hold a bedpan in her hand?”