Access to health care is not evenly distributed throughout California, and large areas of the state have too few medical providers.
This graduation season, 660 people are heading out into the health care workforce with degrees from the University of California’s four schools of nursing. Some new grads are getting ready to start their first nursing jobs, while others have worked in the field for years and came to UC to deepen their expertise and grow their leadership through master’s or doctorate degrees.
Whatever their background, nurses graduate from UC with the skills and training needed to take on one of the biggest challenges facing our state: A shortage of clinicians that makes it too hard for too many people to get the medical care they need. Today nearly 40% of Californians — or 15 million of us — live in federally designated primary care shortage areas, and about a third of Californians live in places with too few mental health providers.
Nurses graduating from UC this spring are ready to be part of the solution. Meet four inspiring California nurses who are dedicating their careers to improving and expanding access to health care for those who need it most.
Closing gaps in primary care in California’s Central Valley
Nobody ever chose a career in nursing because they thought it was going to be easy. But neither did anybody ever think nursing would be as hard as it was in the fall of 2020. As the country sank deeper into the COVID-19 pandemic, nurses faced impossible demands on their time and unprecedented threats to their health. Nearly 100,000 nurses quit the profession in the first two years of the pandemic, and those who’d been in the field for less than ten years were likeliest to leave it.
Into this historic upheaval stepped Cheyenne Matyac. In September 2020, she began her first job as a nurse on a transplant unit in a Los Angeles hospital. She was 22 years old and fresh out of school.
“As a new nurse, going to work on a transplant unit is already a very big learning curve, and COVID made that especially scary,” Matyac says. “Sometimes we were taking care of really sick patients that should have been in the ICU, but the ICUs were at capacity with COVID patients.” Many of her coworkers quit, citing COVID as a source of their burnout.
Matyac was a recent grad, but she’d already put in years toward her goal of eventually becoming a nurse practitioner. Nurse practitioners can either work independently or alongside physicians and are licensed and trained to oversee patients’ treatment and prescribe medications. She set her mind on the job in elementary school, when her mom started taking prerequisites to begin her own second career in nursing. “I’d watch my mom go off to class, and then she’d come home and study with me or practice her assessments on me,” Matyac said.
So even though she was walking into the field in 2020 just as so many experienced nurses were walking out of it, Matyac stayed. It helped that her first year in the workforce was spent in a new graduate residency program, designed to flatten the daunting learning curve. She worked closely with designated, more experienced nurses on her floor, who supervised her learning and gradually introduced her to more complicated cases as her skills and confidence grew.
Such residency programs are getting more common in California as health care leaders look for ways to retain more of the nurses the state so desperately needs. Nearly a quarter of new registered nurses quit within their first year in the field, but studies find that residency programs can help keep these new professionals on the job.
After a year working at patients’ bedsides, Matyac felt confident enough to take the next step in her career, applying to master’s programs that would prepare her to work as a nurse practitioner. In 2022 she started work on a doctor of nursing practice degree at the UC Irvine School of Nursing with a focus on becoming a family nurse practitioner, and she’s on track to graduate in June. Her first job after graduation? A nurse practitioner residency program in primary care with UC Davis Health.
At her new clinic, a federally qualified health center that provides primary care to low-income patients in California’s Central Valley, she’ll work closely with experienced providers to practice and gain confidence with the kinds of decisions and situations she’ll face as a nurse practitioner. It’s a setting she can see herself staying in for a long time.
“It would be great to be able to continue to grow with UC Davis Health. My passion has always been to work in primary care, since there’s still such a big gap in access to primary care, especially in underserved areas,” Matyac says. “And the clinic isn’t too far from where I grew up, so I’m excited that I’ll have a chance to give back to my community.”
Providing specialized care for patients experiencing mental illness
More than half of Californians with mental illness say they aren’t getting the psychiatric care they need — a reality that Chris Hall confronts on a daily basis. As a registered nurse in the emergency room in a Sacramento hospital, Hall often treats people experiencing mental health emergencies. He helps stabilize and keep them safe until the crisis has passed. “But a lot of times, it’s hard for patients who come in with a psych emergency to navigate the medical system and find a therapist and a psychiatrist,” says Hall, a nurse since 2018. “And once they do, the wait times for just an initial outpatient visit can be three to four months.” While they wait, Hall adds, their conditions can worsen, and they often end up back in the ER.
To break this cycle, Hall enrolled in the UC Psychiatric Mental Health Nurse Practitioner Certificate Program at the Betty Irene Moore School of Nursing at UC Davis. The one-year program is offered across all four UC schools of nursing, and it gives nurse practitioners who already have master’s degrees the tools and training to independently manage and guide psychiatric patients’ care. UC created the program in 2020 in direct response to California’s need for more behavioral health care clinicians.
Hall says he’s had a beast of a year furthering his education at UC Davis while working full-time in the ER, but he knows the long hours are worth it. He’s graduating with a better understanding of the science behind medications, talk therapy and other forms of treatment for mental illness, and with a wider view of how California’s system of psychiatric care works (or doesn’t).
“Now I think I can just better meet patients where they’re at and do more to advocate for them and help them navigate to spaces where they can get the help they need,” he says.
Meeting people where they’re at is already a strength that Hall brings to his work as a nurse. “I understand the dark spaces and some of the depression and obstacles that my patients face, because I’ve been through some of that too,” he says. Fifteen years ago, he was taking classes to apply for medical school when he was hospitalized following a severe allergic reaction. He was intubated. Doctors put two tubes in his chest. Then his kidneys failed.
“It was a huge, huge change,” Hall says. He spent the next two years on dialysis, much of that time at UC Davis Health facilities, until a kidney transplant in 2011 helped him get his career and his life back on track. Except now, the track pointed in a new direction.
“When you’re on dialysis, you have nurses around you all the time, so I got to see what they do,” Hall says. “I had a great doctor at UC Davis, but it was the nurses I had a more personal relationship with.” So he shelved his medical school plan and decided to become a nurse instead. He earned his master’s degree in 2020, credentials that have allowed him to work both as a bedside nurse and as a nurse practitioner.
Hall is not sure where his journey will take him next. That’s in part because the certification opens doors to so many jobs — in hospitals or outpatient settings, or working for the county as a street medicine provider, or in a substance use disorder clinic — and in part because the needs are so great everywhere he looks. “Wherever I go, I know I’ll be able to have an impact, and that’s all I’m really trying to do,” he says. “Because of my life experiences and what I’ve been through, I’ll be able to be that voice patients might need to hear saying, ‘Hey, it’s okay. Things can get better after this. They will get better after this.’”
Changing the way hospitals run to better serve patients
Alexander Kim knows that a dementia diagnosis can be overwhelming, both for patients who receive the news and for their loved ones who care for them. But too often, caregivers’ needs are left out of the health care conversation: “Primary care providers often have tightly packed schedules with numerous patients each day, which can result in missed opportunities to address the many questions family members have about managing the challenging situations they face daily,” says Kim.
Kim has worked as nurse practitioner in geriatric medicine in a downtown Los Angeles hospital for a decade, and he’s often seen how that lack of information and support makes a heartbreaking diagnosis even more devastating for families. So Kim designed a pilot program among his patients, offering one-on-one coaching and group sessions where participants watched a series of videos from UCLA Health that help dementia caregivers navigate common challenges. But he found that as one practitioner in a big hospital within an even bigger health care system, launching even a fairly simple, low-cost program like that one wasn’t easy.
“Initially, it was a challenge to speak about this idea to stakeholders in my organization,” Kim says. “They were a little bit skeptical, like, ‘Why are you trying to make this change if it won’t bring any financial benefit to the hospital?’”
Kim knew he had good answers to those questions. But he had little educational or professional background in how to get that information to decision-makers, or how to affect structural change. “Nurse practitioners get master’s degrees, which is just a two-year program where we’re focused on gaining clinical skills and experience,” Kim says. “It’s not enough time to focus on leadership, research, or how to run a quality improvement project.” So he went back to school to earn his doctorate in nursing practice from the UCLA School of Nursing, a program focused on training nurse leaders.
Kim has used his first two years in the UCLA program to launch, test and report on his pilot project to provide more support to dementia caregivers among Spanish-speaking immigrant families in downtown L.A. The first 15 participants reported improved confidence and a greater sense of self-advocacy. Using skills and strategies he learned during his doctorate program, Kim is sharing these results, and a structured plan to expand the program, to his hospital’s leadership team.
“Now I’m starting to get attention to this project and persuade people that this change will make our patients’ lives better,” Kim says. “Leaders from across the hospital are coming to me saying, ‘This is great work, and I want to work with you to get this protocol out to more of our caregivers and patients.”
Teaching the next generation of nurses
America doesn’t just need more nurses. It also needs more people to teach them. Nationwide, nursing schools turned away over 65,000 qualified applicants in 2023, and most cited faculty shortages as the top reason. UC is an important part of the solution to this problem for California. Our four schools of nursing collectively produce hundreds of graduates with advanced degrees that qualify them to teach nursing each year.
This year’s graduating class includes Bridget Gramkowski, who will earn a doctorate in nursing practice from UC San Francisco. “I love teaching nursing. It's a great honor and privilege, and really fun, to have taught so many students who then go out and serve as nurses and change lives,” says Gramkowski, who’s taught nursing at UC San Francisco since 2017.
A mother of four, she taught middle and high school before embarking on a second career in nursing two decades ago. In addition to training future nurses at UC San Franciso, she’s worked as a pediatric nurse practitioner in schools, private clinics, hospitals and public health care settings.
Gramkowski decided to pursue her doctorate because she wanted to continue to teach at UC San Francisco, which is aligning with the national shift to doctoral-level training as the standard for nursing faculty. To help experienced, passionate faculty like Gramkowski make the shift, the federal government offers a loan repayment program for doctoral nursing students who plan to stay on and teach.
Still, Gramkowski says she was initially reluctant to undertake the considerable work of earning her doctorate: “I’ve been a clinician for over 20 years, on the ground, in a variety of settings. I’ve been a faculty member,” she says. “Going into this program, I thought, you know, I'll learn some things, but it won't shift my whole lens on the profession.”
Happily, she was wrong about that. “Before, I could tell you all kinds of problems I saw in our health care system, but I just thought they were hard and frustrating and didn’t know how to approach them,” Gramkowski says. “This program trained me to identify problems, find evidence for solving those problems, and then put that evidence into a pilot project.”
Not only did the experience “change the way I think about health care, but it transformed the way I think about teaching,” she says. “Now I have such a better understanding of the complexities and difficulties within our healthcare system, and that will inform both how I treat patients going forward, and also the kind of preparation I’m able to give students.”
