Grossmont College’s Single Subject Pilot Project - Helping Internationally-Trained Nurses to Succeed in CA

Internationally-trained nurses face a difficult barrier to obtaining their license to practice in California. Many nursing courses are comprised of both classroom instruction and clinical practice in a healthcare setting. The California Board of Registered Nursing requires that both components take place concurrently. In some nursing schools overseas, they are offered in consecutive semesters, which is deemed a "deficiency" and makes the applicant ineligible to take the NCLEX-RN (National Council Licensure Examination), a national exam one must pass in order to receive a state nursing license.

Often, these nurses need to take only one or two courses to satisfy the requirement, but with impacted nursing schools, finding a spot in just one course is difficult. A pilot project at Grossmont College aims to assist these internationally-trained healthcare professionals by offering courses to Single Subject Students. This summer, five students were chosen from over 75 highly qualified applicants to be in the first Single Subject Course offered, an Obstetrics and Pediatrics course.  Medical-Surgical, Geriatrics and Psychiatric-Mental Health are the other courses included in the state requirement, which internationally-trained nurses might have to pass before being authorized to take the NCLEX.

“Until now, what people have done is call every nursing school they can find,” said Ann Durham, Director of the San Diego Welcome Back Center and the San Diego/Imperial Health Workforce Initiative Deputy Sector Navigator. “Unless a student fails or withdraws from the class, there is no room for an internationally-trained nurse to take just that one subject that they need.  Class sizes are limited based on several factors:  there are a finite number of clinical placements available in the region, a hospital unit might only allow a certain number of students at a time, and there are regulations in place limiting the number of students per clinical instructor.”

International nurses have gone to great lengths to qualify for the California NCLEX-RN. Some have traveled to other states, which don’t have this specific requirement, and obtained their license thinking that it is transferrable to California, but it’s not.

Durham spoke to one nurse who contemplated taking one course at a for-profit institution in San Francisco. It would have cost $15,000. He was so desperate, he considered taking out a loan, then living out of his car and showering at a gym (because housing is too expensive) for the duration of the coursework. The cost of the course and requirements to take it through the Single Subject Pilot at Grossmont College was under $500 for in-state students.

The Obstetrics portion of this summer’s pilot was taught by Dr. Gabi Aliyev, a full-time faculty member of Grossmont College’s nursing school. “It’s a really great and very strong program to be in and to graduate from in general and I think it was helpful for them in terms of getting ready for the NCLEX.” Aliyev also has experience as an international healthcare professional.  She was a physician in the former Soviet Union and graduated from the Welcome Back Center's MD-to-RN program at Grossmont College.  That was a grant-funded program which had approximately 120 graduates over the course of several years.  She initially attended Grossmont College to learn English, then entered the nursing program.  Since then she has continued her nursing education at the master's and doctoral level, and is contributing to the profession by educating the future workforce.

“I would like to thank you from the bottom of my heart for all the hard work/struggles of all the people that worked to enable this program,” wrote Charmaine Miralles, one of the five pilot students. She received her BSN in the Philippines and has lived in the US for three years. She took and passed the NCLEX in Texas, but still didn’t qualify for a California license because of the concurrency requirement. Miralles had tried for a year to access an OB course before finding the Single Subject course at Grossmont this summer. Now that she has successfully completed the course, she is on track to become a licensed RN in California. “This is truly life-changing for all of us.”

Most of the internationally-trained nurses who immigrate to the US must work in lower paid and lower skilled jobs until they get their license, sometimes outside of the healthcare field. Obtaining their license allows them to move from a job that may not provide a living wage to a profession with a solid middle-class and above income.

Grossmont College’s Single Subject Pilot Project is a project of the California Community College Chancellor’s Office’s California Healthcare Workforce Academy and funded by the Strong Workforce Program Statewide Coordination Fiscal Omnibus Grant. The Health Workforce Initiative and the San Diego Welcome Back Center, which helps internationally trained health professionals get licensed to work in California, are integral partners in the project.

Although Durham and others have been trying to find a solution to this structural barrier for years, pilot project funding was only secured this spring. On short notice, she and the team at Grossmont College and the Welcome Back Center were able to secure the clinical spots and implement the project.  ”Everyone involved in the project, from participants to faculty to administrators, are grateful to our industry partners for providing clinical placements for the students.  These valued organizations include Sharp, Scripps, Rady Children's Physician Management Services, and the Grossmont College Child Development Center.  Without the clinical placements, and an incredible number of other variables falling into place, we never would have been able to run the class this summer."

Over the course of the next year, Durham plans to continue working on developing processes, policies and procedures for Single Subject Courses, in collaboration with Dr. Domenica (Dee) Oliveri, Interim Senior Dean of Allied Health and Nursing at Grossmont College.  "Dee has been a true champion of this program, and it never would have happened without her passion and dedication.  I am so grateful for her efforts and those of her incredible team, including Lisa Maloy, who was responsible for securing the clinical placements, and Gabi Aliyev and Michelle Harrison, who taught the course," said Durham. "As part of the pilot project, we will document lessons learned, so that this concept can be replicated and institutionalized at other community colleges.  The need is great, and the benefit is tremendous! If more of these health care professionals can work at a level that matches their education and expertise, it not only benefits the communities where they work and the patients they serve, it benefits society and it benefits them as individuals and their families as well. It’s just such a win-win-win!”