The nation is experiencing a nursing shortage; however, it will hit California harder.

California has the second-lowest RN-to-population ratio among the 50 states. But California also has the highest projected population growth in the nation, resulting in a projected 21% increase in RN jobs by 2006.

Nurses are not going to come out of "retirement" as in past nursing shortages. About 85% of the RNs in California are in the workforce, and 11% of the RNs registered in California live outside the state.

The supply of nurses is limited in California by educational access. More than 50% of new RN licensees received their nursing education outside the state. More than 95% of the pre-licensure educational programs in California are fully enrolled, according to 1998 data. Pre-licensure programs include both the baccalaureate and associate degree programs. Specific demands for RNs, prepared at the baccalaureate level to care for patients in hospitals, is especially crucial. In California, 70% of the RNs graduate from associate degree programs in contrast to 30% nationally. Only about 17% of associate degree graduates continue their education in California.

Most baccalaureate graduates are prepared within the California State University system. The 22 departments of nursing within the CSU system are 98% fully enrolled, and many have waiting lists, some as long as three years. Some community colleges are admitting students into nursing by lottery, resulting in a high attrition rate and a high failure rate of the state board licensure exams. Even transferring nursing credits from the community colleges to CSU or UC is not smooth, although efforts are being made to address this.

The reasons for the nursing shortage are different for the rest of the nation. In contrast to California, nursing education programs nationwide are under-enrolled. There has been a 19.2% decrease in enrollment of entry-level baccalaureate programs in the last five years. RNs under age 30 dropped 41% between 1983 and 1998. By 2010, 40% of all RNs will be over 50 years old. nursing education faculty are the "oldest" of employed nurses, resulting in a shortage of nursing faculty. Thus, most of the remedies for the nursing shortage outside California focus on making nursing a more attractive career choice.

Here is what needs to happen in California: Preparation of nurses at the pre-licensure baccalaureate level needs to expand within the CSU system and needs to begin probably at four to five UC campuses. The schools of Nursing at UCLA and UCSF do not offer entry-level baccalaureate programs. Given the economic environment of the state, funding for expanded or new programs will not be a priority for at least the next three to four years. As with other health sciences, nursing education has a high-end cost structure.

How many RNs do we need to educate? Assuming the existing RN-to-population ratio, approximately 61,000 additional RNs will be required by 2020. If the current trends continue in the California educational system, there will only be 36,000 nurses -- a shortfall of 25,000.

Cowan is dean of the School of Nursing.