In 1999, with a long-feared nursing shortage having hit Cheyenne, Wyo., and with regional hospitals competing for the same limited pool of employees, Shirley Harris, vice president of nursing at 195-bed United Medical Center, set her sights on constructing a reliable pipeline of workers.
It wasn't going to be easy. Hospitals such as United have to shore themselves up against a perfect storm created by two clashing frontal systems: a rise in the demand for bedside nurses and a fall in the number of faculty qualified to train them. The national nursing shortage is exacerbated by the fact that U.S. nursing schools turned away 15,944 qualified applicants to entry-level baccalaureate nursing programs for the 2003-2004 school year because of a dearth of faculty, clinical sites, classroom space, clinical preceptors and budget constraints, according to data from the American Association of Colleges of Nursing, or the AACN.
The tempest, which shows no signs of abating, has sparked a renewed commitment to the education of nurses and allied health workers. Hospital administrators like Harris are learning to think outside the box.
Harris quickly struck out when she spoke to the local community college-which had an established two-year program for RNs-about partnering with the hospital to bump up enrollment or even create a fast-track licensed practical nurse program that could at least help supplement her staffing, she says. College officials told her that they had found their niche with the two-year program and were comfortable sticking with it.
Harris' search for a partner continued until the end of 2000, when she discovered T.H. Pickens Technical Center, 120 miles away in Aurora, Colo. Pickens agreed to allow Harris to send eight students per semester-a total of 16 a year-into its one-year LPN program.
The hospital buses the students 240 miles per day from Cheyenne to Aurora, pays their tuition and books as well as an hourly wage, and in return receives from the students a two-year commitment to work at the hospital. The program's total cost is $300,000 per year, including transportation. To date, more than 50 students have graduated from the program. The hospital now is setting up a teleconferencing center, so that the students can take all of their classes remotely in Cheyenne.
With that program launched in January 2001, Harris revisited the local community college and persuaded officials to increase enrollment, guaranteeing her 16 additional RNs every two years in exchange for a clinical instructor from the hospital. United pays for tuition and books or, alternatively, a stipend, on the promise of a two-year commitment from the students.
"Either we sit here as an organization and say there is nothing we can do or we make it happen in any way we can," Harris says. "It really has made a difference for us. The pipeline is so very important because in January I know I'm going to get at least eight students and then in June again and then every two years RNs come out, so there is something out there that is working for you all the time."
The program was a ticket out of shipping and receiving for Louis Williams, 34, who worked at the hospital six years, starting out in the laundry. Williams, who is now working as an LPN in the oncology unit, says with four daughters and a girlfriend to support at home, he could never have afforded to go to school on his own.
Dustin Weinberger, 34, who graduated in the same class, was working for a credit union and taking a course at United to be a certified nursing assistant when he heard about the program at Pickens. He was paid a nursing aide's salary while attending school and, like the other students in the program, worked at the hospital during the summer and on holidays.
"I never missed a paycheck and got health benefits throughout the entire program. I was able to just concentrate," he says. When his two-year commitment is complete, Weinberger says he "will probably come down and talk to Ms. Harris about continuing my education."
Hospitals are seeing a resurgence in the number of people choosing to go into nursing, but the shortage continues "because we don't have school capacity," says Lillee Gelinas, vice president and chief nursing officer for hospital cooperative VHA. Hospital-based, three-year diploma programs, once the gold standard for training RNs, have fallen by the wayside because of the nursing shortage and the increasingly high-intensity demands on bedside nurses. There are 88 hospital-based diploma programs in the U.S. compared with 885 associate degree programs and 673 baccalaureate nursing programs, according to the AACN.
Reports of up to a two-year waiting list for nursing school programs in rural Pennsylvania spurred two-hospital Geisinger Health System in Danville to partner with Thomas Jefferson University in Philadelphia to offer an associate/RN degree. The program will launch in the fall and has slots for 40 students. Classes will be held in the nursing education building at Geisinger that once housed the system's three-year diploma program.
"Mainly what's in it for us is being part of the solution to the community nurse shortage," says Susan Hallick, chief administrative officer for 320-bed Geisinger Medical Center and chief nursing officer for the health system. "We believe bringing a quality program to the area will keep students here."
Such fast-track programs, which are increasingly prevalent, have created their own problems as new nurses are arriving for their new jobs short on clinical training. Like many other hospitals, Geisinger has developed an orientation program to compensate for the limited clinical experience new graduates are getting in school. Some of the orientation programs could be as long as six months, Hallick says. At United, Harris installed a "skills lab" equipped with interactive mannequins.
The renewed commitment to solving the workforce shortage also is seen in the plethora of hospitals that are joining with their communities to seek solutions, Gelinas of VHA says.
The example was set more than a generation ago when, seeking to prepare more underrepresented students for careers in healthcare, Houston educators and the Texas Medical Center partnered to open a magnet school on the campus of the medical center in 1972. The Michael E. DeBakey High School for Health Professions has since moved to its own building with 750 students in grades 9 through 12-with 68% of the student body from minority populations.
Beginning in the first year, students are given an overview of all the professions in healthcare, and by the third year, they are rotating through medical lab technology, patient-care science and dental science. Seniors also do a preceptor class in which they shadow professionals in whatever career they think they might want to pursue, says Charlesetta Deason, the school's principal.
The school considers roughly 2,000 applications each year, accepting less than 10%; 98% of the graduating seniors go on to college and generate as much as $12 million per year in scholarships for students, she adds. The school has served as a model for similar high schools throughout the country. A study looking at graduates from 1975 to 1990 found about 15% of the alumni are practicing physicians, and others had gone into a variety of health-related areas, Deason says. An updated longitudinal study is in progress.
Recruiting and training workers for the allied health professions demands creativity as well though the need in number terms is somewhat less than it is for nurses. Nevertheless, the healthcare industry is expected to add nearly 3.5 million new jobs between 2002 and 2012, according to the U.S. Bureau of Labor Statistics. To meet the demand the U.S. Department of Labor in March announced a $24.4 million initiative to help workers train for jobs in the healthcare sector.
The grants cut across the industry in acute care, long-term care, allied health professions and rural healthcare; among other things, they are supporting outreach recruitment efforts, retention and advancement programs, and expansion of faculty and capacity at educational institutions.
As with nursing programs, hospitals are going at it alone when they have to, luring students to allied health professions with enticing programs. University of Pittsburgh Medical Center offers a two-year tuition-free radiology technician program in exchange for a two-year work commitment, says Mark Saltrelli, UPMC's manager of system recruitment.
The in-house program accepts about 40 students each year, and this year in response to requests from students, an evening program is available. Since it is a teaching hospital, educational programs are more global in focus but a lot of people who train at UPMC wind up working there, he adds.