For-Profit Virginia Nursing School Shuts Doors Abruptly

For-profit nursing schools often market their programs to people working in low-level jobs, people looking to improve their life circumstances. Many promise a flexible, expedited education and a supportive environment, in which anyone who works hard can succeed.

But too often the schools fail to deliver on those promises. When that happens, students stand to lose tens of thousands of dollars in federal loans, the chance to sit for their nursing licensure exam, and a career many say they felt called to since childhood.

This is the second story in our series on for-profit nursing programs. As part of our investigation, MedPage Today spoke with more than a dozen nursing students, as well as academics, nursing professors, and regulators.

Lizette Scupal, a single mother working in retail, chose Stratford University in Woodbridge, Virginia, because it offered an accelerated bachelor of science in nursing (BSN) program she was told she could complete in 18 months, without quitting her job.

Tuition ran around $6,300 per term over an 18-month period, with around five terms per year -- roughly $48,000, excluding lab fees and clinical course fees. To apply, students had to submit their high school transcripts or General Educational Development (GED) test scores, pass an admissions test, and write an essay. Scupal applied in February 2021 and was accepted a month later.

Scupal had completed her prerequisites and was 2 weeks into the core nursing program in June 2021 when she joined a Zoom call with the Virginia Board of Nursing (BON) organized in response to student complaints. It was then that she began to notice warning signs.

Students shared stories of how hard it was to find clinical placements. "One girl literally said to find a clinical spot is 'like The Hunger Games,'" she said. When students couldn't secure a clinical spot, they typically had to also drop the lecture class paired with that rotation until the next term, which could delay their timeline to complete the program.

Stratford did not have a "bad reputation," Scupal said, but in hindsight, she wished she had paid attention to the program's pass rates for the National Council Licensure Examination for Registered Nurses (NCLEX-RN). Everyone from potential students to regulators to employers looks at the share of students who pass the NCLEX out of the total number of test-takers, as a reflection of the strength of a program. In 2020, Stratford's Woodbridge campus had an average pass rate of 69.7%, and the school's Falls Church campus had a 51.9% pass rate -- nearly 30 percentage points lower than that campus's 80% pass rate in 2019.

For-profit schools tend to have lower pass rates than their public and private nonprofit counterparts, and Stratford was no exception. From 2020 to 2022, Stratford held the unfortunate distinction of having the lowest NCLEX pass rate in the entire state. One 2019 study in the Journal of Nursing Regulation found even "after controlling for school-, program-, and county-level covariates, for-profit ownership is still a significant predictor of lower first-time NCLEX pass rates."

Scupal said that during the Zoom call, BON staff glossed over the sharp drop in Stratford's pass rates, characterizing them as to be expected, given restrictions on clinical rotations at the start of the pandemic. NCLEX pass rates fell nationally during the pandemic, but Stratford's pass rates sank lower than most.

Clinicals in Chaos

Stratford's admissions packet boasts "clinical experiences at a wide variety of Northern Virginia, Central Virginia, Southern Virginia, and Washington, D.C. hospitals and community agencies." But Scupal said three of her four rotations were in nursing homes. Like so many students before her, she was forced to drop a class when she couldn't find a pediatrics clinical rotation, which, combined with other curriculum changes, pushed her expected graduation date from December 2022 to March 2023.

Amethyst Whitaker, another student in Stratford's accelerated BSN program, was notified on a Friday of a clinical rotation the following Monday. But when she arrived at Manor Care, a nursing home in North Arlington, Virginia, no one seemed to be expecting students. The instructor was 1.5 hours late, and complained that she hadn't been paid yet. "They were scrambling to keep up the illusion that things were okay," Whitaker said.

Destiny Facemire, a Stratford student on the traditional BSN track who works as a medical assistant in an urgent care facility, said her clinical experience was more of a glorified study hall. The only thing students were allowed to do was take vitals.

Broken Dummies, Grade Inflation

Stratford, like many nursing schools, used training mannequins to teach students about care through simulations. In theory, students should have been able to listen to the mannequin's hearts, lungs, and stomach, to hear, for example, what an arrhythmia sounds like. But, in Whitaker's class, only one of the mannequins worked. When students complained, Whitaker said they were told to "just pretend."

Another problem was grade inflation, which was common, according to Whitaker. If a large number of students failed a test, teachers would curve the scores to make it look as though everyone passed, she said. For one pharmacology exam, Scupal said not more than three students in a class of about 30 passed. The class retook the exam at home, open-book. The professor averaged the grades of the initial exam and the retake, according to emails from the professor provided to MedPage Today.

At some point in the core nursing program the grading system changed, recalled Lesly Polanco, another student. If students didn't average 80% on their tests, they weren't allowed to pass the course, regardless of what their class grade was.

Then, from the spring of 2022 into early September, students started to notice changes that in retrospect, they said, should have been red flags. Wifi was disabled for a few weeks at one campus, forcing students back onto Zoom. Janitors were fired or quit abruptly and students were told to clean up after themselves. Financial service staff were suddenly unreachable, the library closed, and a software license for student exams was allowed to lapse. Perhaps most worrying of all, teachers were leaving "back to back to back," Polanco said.

In hindsight, the warning signs were everywhere, Whitaker said, but because she was so focused on graduating and taking the NCLEX, she brushed them aside.

A Sinking Ship

On Aug. 25, 2022, Stratford's Dean of Nursing Marie Mirna Lexima, PhD, MSN, RN, emailed students acknowledging that Stratford's nursing program's NCLEX pass rates collectively had not reached the nursing board's minimum threshold of 80% or above.

The school would begin requiring most students to take an in-person NCLEX preparatory course. But in brighter news, Lexima shared that second quarter 2022 NCLEX pass rates for the Woodbridge campus had risen to 84.6%. However, she failed to mention that the Accrediting Council for Independent Colleges and Schools (ACICS), Stratford University's accreditor, had been stripped of its recognition a few days earlier.

Under most BON rules, a nursing program must have accreditation at the level of its parent institution -- in this case Stratford University -- or accreditation at the program level, so-called specialized accreditation. Stratford had both. But without a federally recognized accreditor, the university stood to lose access to an important tranche of federal financial aid: Title IV funding.

Stratford nearly lost its ACICS accreditation in 2020 for reportedly operating an unapproved program in Erbil, Iraq, according to NBC4 Washington. ACICS called for Stratford to stop all new enrollments. Stratford sued, but the two parties later dropped the lawsuit, according to Higher Ed Dive.

Likewise, ACICS lost its authority to accredit universities in 2016, but 2 years later, it was reinstated under then-Education Secretary Betsy DeVos. With the change in administration in 2021, ACICS came under scrutiny again and the Department of Education stripped it of its status once more, due to its "long-standing inability to come into compliance with the minimum standards expected of accreditation agencies," according to Under Secretary of Education James Kvaal. Among other lapses, ACICS famously accredited a sham college, Reagan National University in Sioux Falls, South Dakota, which had neither students nor faculty, a USA Today network investigation found in 2020.

When to Stay, When to Leave

It's unclear whether Stratford ever formally acknowledged losing its accreditation from the now-defunct ACICS, or if students heard the news through other channels, but students also had other reasons to be concerned.

On Sept. 12, 2022, Barbara Harrison, RN, MSN, a Stratford professor sent an email to her students stating that she and 38 other people had been terminated due to budget cuts.

The affected staff members were invited to a Zoom call on a Friday afternoon and -- once everyone was online -- told they were "terminated effective immediately," she said.

Harrison, who taught three classes, earned a higher salary than many of her colleagues, she told MedPage Today. Other faculty were similarly highly paid, which suggested to Harrison that the school's actions were budget and not performance-related. Concerned for her students, she offered to teach for free.

Harrison had "inklings" that the program was in trouble. Payroll had been late 6 months earlier and in the weeks before she was terminated, the cleaning staff was let go, leaving one of the directors to take up the task of replacing the bathroom toilet paper.

"It was sad," she said. But, academically, things had been looking up. In addition to investing in an NCLEX preparatory course, which Harrison was helping to integrate into the classroom, Stratford hired a more competent manager to oversee clinical rotations, and Lexima, the "new dean," as of August 2022, was working 7 days a week to help get Stratford back on track, Harrison said.

NCLEX scores were improving, students were more engaged, and faculty were working as a team, she said. "It was working. We saw a difference, and then everything was just cut out from under us."

The same day that Harrison and her colleagues were let go, Myra Lynette Lucas, the school's student council president, posted a message to a student WhatsApp group stating that she had spoken with Lexima, "and she advised me that THE SCHOOL IS NOT CLOSING ... I will update any new information I get as soon as I get it." In another WhatsApp message, Lucas did, however, suggest that students with more than two terms left to complete "seek another institution." (Multiple requests to Lexima and Lucas for comment did not receive a response.)

But on Sept. 23, 2022, at 11:08 a.m., students received a very different message from Richard Shurtz, PhD, Stratford University's president and CEO. Stratford had been given 18 months to find a new accreditor. However, the Department of Education had thrown it a curve ball, he said, by prohibiting it from enrolling any new students. Without new students, Stratford could not afford to continue to operate. "The Stratford family has been privileged to serve our students for over 45 years," Shurtz wrote. "After all those years of delivering quality education, I must announce with a heavy heart that Stratford will cease operations at the end of this term."

The words "cease operations" made Scupal angry. She had just started planning for her pinning ceremony. She was trying to find a way to bring her sister over from Dominica to see her graduate. For more than a year, she had spent her nights stacking shelves, and her days studying or in clinicals.

But what bothered her most were the lies, Scupal said. Students had asked "many times" whether Stratford was losing its accreditation, whether it was closing, and whether it would do a "teach out" -- halt enrollments but allow current students to graduate. "And every time," she said, "They told us, 'No and no and no.'"

Accreditation and Oversight

Data on the Virginia BON's website shows that Stratford's pass rates at its Falls Church campus had missed the 80% minimum mark for four consecutive years -- from 2013 to 2016 -- and that it had failed to "publish and distribute" its pass rates for 5 years; it also was called to a "formal hearing" in May 2018. Stratford's performance recovered in 2018 and it was granted full approval in 2020, having been on "conditional approval" since 2015. Then its pass rates fell once more.

Because of the marked decline in NCLEX pass rates beginning in 2020, the BON conducted site visits at the Woodbridge campus in 2021 and the Falls Church campus in 2022, and required the Alexandria campus (opened in 2020) to submit "an NCLEX plan of correction" in 2022, a spokesperson for the BON told MedPage Today in an email. Students at the Falls Church campus were transitioned to the Alexandria campus in September 2022, after the Falls Church campus closed.

During a July 21, 2022 "informal conference," the BON unanimously voted to place Stratford's Woodbridge campus back on "conditional approval" -- essentially probation -- contingent upon the school's NCLEX pass rates "meeting or exceeding 80%" and other conditions.

While a full "teach out" was not offered to all students, a representative for the BON indicated that Stratford did not officially close until Dec. 18, 2022, during which time students expected to graduate in 2022 were given the chance to complete their coursework.

In addition to oversight by the BON and the university's recently defunct accreditor, ACICS, Stratford's nursing program also had programmatic accreditation from the Commission on Collegiate Nursing Education (CCNE), but how closely such specialized accreditors monitor programs like Stratford's is unclear.

Accredited programs are required to submit annual reports to CCNE as well as "substantive change notifications" if student performance, faculty composition, or the fiscal health of the organization changes significantly, Benjamin Murray, MPA, CCNE's deputy executive director, told MedPage Today. But whether Stratford submitted any such notification to CCNE or whether anyone else alerted the accreditor to Stratford's problems is unknown. That information is confidential, Murray said. Stratford remained CCNE-accredited until it closed.

What Happens Now

In October 2022, nearby Chamberlain University, also a for-profit institution, announced a transition agreement with Stratford University for nursing students, noting that 350 had been impacted by the closure. Chamberlain has not responded to multiple requests for information regarding how many former Stratford students it has enrolled.

Polanco looked into Chamberlain and learned she would have to pay to repeat prerequisite courses, which were even more expensive than at Stratford. She chose a local community college instead, and will start in January 2024.

Facemire, who had 1 year left to complete, has enrolled at Germanna Community College, where she plans to first get her associate's degree, and then transition to a bridge program at a public university to obtain her BSN.

Polanco had $48,000 in loans discharged. Facemire submitted a request for loan forgiveness for her $36,000 in loans three times and has been denied each time. Whitaker has twice applied for her $60,000 in student loans to be forgiven; she has been denied once and is awaiting the outcome of her second application.

Scupal, who had only two terms left to complete, is transferring to a public nursing program in the area, and therefore has not requested loan reimbursement or forgiveness.

Stratford University officially ceased operation on Dec. 18, 2022, according to the Virginia BON. In February of 2023, the university declared bankruptcy.

Whitaker had a job lined up as an operating room nurse, but that offer is void now. "I have all this knowledge, all this experience, all these clinical hours and essentially, it all meant nothing. It was a waste," she said. Still, "I definitely want to finish my nursing degree ... Who knows when or how, but I will," she added.

But she'll never go to a private for-profit university again.

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