SACRAMENTO, CA - If you enter a hospital, do you want to be attended by a nurse who was admitted to a nursing program based on merit or on a random lottery system? Most Californians would naturally say merit. It would, therefore, shock people to learn that many nursing programs in California ignore the qualifications of applicants in favor of a luck-of-the-draw lottery.

The programs in question are the Associate Degree Nursing (ADN) programs based at community colleges. Because such schools are supposed to provide the widest access possible to higher education, admission into the ADN programs has been based on a lottery system that ignores applicants' grades and other academic merit factors. Turning a blind eye to quality indicators, however, has had disturbing consequences.

Not surprisingly, using a lottery to choose nursing students results in the admission of many students with low-level qualifications and increased dropout rates because such students can't handle the tough coursework. Sue Albert, the dean of health programs at the College of the Canyons in Southern California, says that her school's nursing program has a 27-percent attrition rate. This startling dropout rate occurs despite the provision of remedial assistance including tutoring centers, counseling, and a skills lab coordinator. Other colleges see similar dropout numbers.

Allowing weak students to enter nursing programs only to have them drop out afterwards not only exacerbates the state's nursing shortage but also costs taxpayers a lot of money. Instructors paid to teach a full class are still paid even if dropouts result in a class that is only 75 percent of capacity. To put a monetary value on the dropout problem, every empty seat in an ADN nursing program results in a loss to the school of about $1,800. Thus, if 40 students are admitted to a nursing program and a quarter - 10 students - drop out, the result is a loss of $18,000.

Such a loss is just for one semester at one school. Multiply that figure over time and for many schools and it is easy to see that attrition is very costly. Cost, however, is not the only problem with the lottery admission system.

According to Dean Albert, "Qualified students that are forced to wait on long waiting lists will go on to other careers.'' Of the 300 students currently on her waiting list, some have only the minimal math and English requirements and a 2.5 grade point average, while others have completed science courses plus core subjects and boast 3.0-4.0 averages. Yet, says Albert: "It is first come, first serve. It is not based on qualifications. No longer are the best and brightest rewarded for choosing nursing as a career. They just get in line like
everyone else. Why should they stay in line when other professions will reward them for their efforts?''

By ignoring qualifications, the result is a decrease in the quality of nurses at people's bedsides. While prospective nurses must pass a test to enter the nursing profession, the lottery system ensures that many nurses are merely adequate rather than superior. Patients and their families who want the very best care possible end up being the losers.

Ignoring merit qualifications for nursing program applicants results in waste, inefficiency, and lower quality care. Some healthy reform is vitally needed.

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Lance Izumi is a senior fellow in California Studies at the Pacific Research Institute. He can be reached via email at lizumi@pacificresearch.org.