This time, tears of joy: Aspen University may keep teaching nursing students under stricter oversight, board says

Phoenix-based Aspen University is allowed to continue teaching the remaining students in its embattled nursing program, but with stepped-up oversight, the state nursing board decided Thursday.

A last-minute legal challenge by leaders with the private, for-profit university and subsequent court intervention meant the Arizona State Board of Nursing was not allowed to shut down Aspen's nursing program, which previously had been an option and an unusual one.

There's no recent history of an Arizona bachelor of science in nursing program losing program approval by revocation or surrender, board documents show.

"This is very serious," board president Carolyn Jo McCormies said before the board's unanimous vote to support an amended settlement with the school that includes using an ombudsman to oversee students' clinical hours, and a process for handling any future problems with the program. As part of the agreement, Aspen is dropping its legal action against the nursing board.

The board has voiced numerous concerns over inadequate education at Aspen, which they've said could harm students and put future patients at risk.

The board on Thursday afternoon went into an executive session for about an hour before returning with a vote in favor of the agreement with Aspen. After the vote, several students who attended the meeting wearing scrubs clapped, hugged and wiped away tears.

"I am very grateful to be able continue on this journey and to show the community that safety is what we are all about," said Aspen student Louise DeBusk, who attended the meeting and is scheduled to graduate in October.

"It's amazing. It is what all of us deserve," said Aspen student Sarah Adler, who also attended and is scheduled to graduate in October. She wants to become an emergency department nurse. "I have put in almost three years. I started in 2020 with pre-requisites. ... I have student loans."

Aspen's nursing program is no longer admitting students and was scheduled to end anyway, but under an agreement with the state nursing board, the school has been allowed to continue instructing students as part of a "teach out" to allow those already enrolled to graduate.

'We're going to fight it':Aspen University nursing students push to finish their degrees

Aspen University officials say that 338 Arizona students plus 75 out-of-state students located in Florida, Tennessee and Texas would have been affected and not able to graduate as planned if the teach out had ended prematurely. The number of students still enrolled has decreased as some students have left the program, possibly because of the program's ongoing struggles.

Aspen University on Monday filed a court action asking for a temporary restraining order against the board's scheduled final vote on its nursing program's fate, which had been set for Thursday's meeting. During a hearing on Tuesday, Maricopa County Superior Court Senior Commissioner John Rea indicated he was going to issue a temporary restraining order, which prevented the nursing board from closing down the Aspen program on Thursday.

The court document filed by Aspen says that closing the program immediately without allowing several hundred nursing students to graduate as planned "would lead to catastrophic financial consequences for Aspen University" and jeopardize the students' career aspirations.

In a unanimous Feb. 23 vote following an emotional and nearly three-hour meeting, the nursing board gave a minimum 10-day notice of an intent to immediately shut down Aspen University's nursing program, which would prematurely end the teach out. The vote was a reaction to Aspen's "failure to provide minimum instruction and learning opportunities, including clinical opportunities, to meet basic standards of educational practice and legal requirements," the nursing board said at the time. Several students wept as the board members cast their votes.

At that meeting, board members cited various criticisms about Aspen's nursing program quality, including the fact that students were able to count time worked in paid health care jobs such as patient care technicians as clinical hours towards their nursing degree, which board members said was a violation of the Arizona Administrative Code.

The board found other problems at Aspen, including falling scores on Aspen students' nurse licensing exams, a failure to adequately proctor exams, and a lack of improvements overall at a school that already had been scrutinized over quality issues.

Students mobilized to save their program

Aspen officials and students have pushed back on the board's assessment of their National Council Licensure Examination scores, a test developed by the National Council of State Boards of Nursing that's often known as the NCLEX, and noted that other schools have had issues meeting the 80% pass rate threshold required by the state's administrative code. They also said they'd made improvements with enhanced instruction that would ensure an improvement to future pass rates.

The nursing board has said that it was not just the NCLEX scores that informed their decision, but other quality issues as well, though the NCLEX score pass rates at Aspen have been consistently low and had been falling, board members said. The most recently posted NCLEX exam results show the pass rate for Aspen graduates was 69.6% in the second quarter of 2022, 59.1% for the third quarter and 56.6% for the fourth quarter.

In a statement after Tuesday's court hearing, the nursing board said that because of the legal challenge they would only be permitted to either continue an ongoing investigation into the education at Aspen or consider additional terms in order for Aspen to continue the teach out.

"About half of the students graduating from Aspen are unable to pass the national mandatory exam to be able to become nurses. This concerns the board because that means that all of those graduates cannot become nurses, in spite of all of their hard work and money spent on tuition," the statement said.

"The board has concerns that Aspen has not been properly testing its students or providing clinicals that meet minimum standards. These types of failures harm students and place the public, including future patients, at risk," the statement says.

Adler, the Aspen University student, said the board's concerns with patient safety felt personal and the students are determined to prove them wrong. Adler was among the Aspen students who mobilized following the Feb. 23 vote, contacting the governor's office, elected officials and "anyone who would listen," Adler said. The students balanced their advocacy with studies, clinical rotations, families, and in many cases, other jobs.

Among those advocating for the students was Rep. Steve Montenegro, R-Litchfield Park, who is chair of the Arizona House Health and Human Services Committee, who wrote in a March 17 email to The Arizona Republic that he'd made it clear to the state board that it would be "an institutional failure" if the students are not allowed to complete their studies.

"The board has an urgent responsibility to address this in a satisfactory way," he wrote.

Aspen began admitting nursing students in 2018

Aspen University began admitting students to its nursing program in 2018 and a cascade of problems followed.

In August 2019 the school agreed to a stipulated agreement with the Arizona State Board for Private Postsecondary Education related to financial concerns. In January 2021, Aspen received a non-disciplinary letter of concern from the nursing board over a failure to adequately supervise student clinical experiences.

In May 2021, Aspen withdrew its request for full program approval after its NCLEX scores for the first quarter of 2021 were 70.8%.

During the spring of 2022, the board put Aspen's nursing program on probation for at least three years until the school increased its nursing licensure exam pass rates and implemented other improvements. Aspen had to pay a $4,000 civil penalty related to the board’s claim that Aspen provided inaccurate information to regulators, according to a consent agreement signed by a university official and the nursing board director and approved by the nursing board in March 2022.

The consent agreement included findings that Aspen failed to provide adequate education, including infrastructure, learning opportunities, and program resources to support student learning and successful outcomes.

In September 2022, Aspen agreed to voluntarily surrender its program approval. The voluntary surrender required the program to close down within two years after a teach out, with minimum standards required for the teach out.

"Everyone's goal here is the same: to have safe, competent registered nurses. And we do want more nurses in the state of Arizona," McCormies said during Thursday's meeting. "It is really important and I don't think anyone involved has taken it lightly."

Reach health care reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes.