TRAINING AND RADING FUND

PHILADELPHIA HOSPITAL AN H CARE-DISTRICT 11 9 9 C

TRAINING AND

RADING FUND

1 3 1 9 LOCUST STREET, PHILADELPHIA, PA 191 07 TELEPHONE: (21 5) 735-5555 * FAX: (21 5) 735-791 0

James T. Ryan Director I f f icers Henry Nicholas Chairman Timothy Fehrle >o-Chairman Phyllis Kemmerling Secretary Marguerite Morrison Treasurer Inion Trustees Maureen Bendig Shelia Bennett Barbara Bohannan Craig Ford Donna Ford Vivian Gioia Peter Gould Gary McCormick Marguerite Morrison Henry Nicholas Charlene Royal David Shahade Employer Trustees Theresa Angelone

It-. Robert Bass Jr. ,rian Bowie Sylvia Chandler larry T. Collier rian DuVall Timothy M. Ferhle ay Graham Phyllis Kemmerling laria Scenna David Smiley, Sr. Walt Swoeble Labor Day, 2001

Dear Concerned Healthcare Advocate:

Twenty seven years ago, the major hospitals in Philadelphia and the National Union of Hospital & Healthcare Employees were inspired by a unique vision. They created a joint educational enterprise to serve both groups. The Training & Upgrading Fund would provide a path out of dead end jobs for workers. And the Fund would address the workforce

shortages of the employers. This joint effort was quickly expanded beyond the union membership to the entire Philadelphia area community.

The history of the Training Fund has also been unique. To serve the different goals of the two partners, the governance structure required the hospitals and the union to agree on how to proceed. There has never been an impasse, demonstrating a mutual commitment to the workers and to the industry.

Now the healthcare industry and the economic development of the region face an old problem which has become systemic and exponential-the shortage of nurses. The shortage threatens not just the hospitals, but every sector in which healthcare is delivered. The Training & Upgrading Fund now proposes a solution which is innovative and comprehensive. In the report we outline a plan which we believe will have a significant impact on the shortage of nurses.

We ask your consideration in reading this document and we would appreciate your reactions and suggestions.

A non-profit educational trust fund, jointly administered by District 1 l99C and the Contributing Hospitals:

ARA Q Hospital of the University of PA 0 ARA Q Presbyterian 0 Baptist Home 0 Benefit Fund 0 Brandywine Hall 0 Burlington Woods Conv. 0 Cadbury Nursing Center 0 Chestnut Hill Rehab. Hospital o Cooper River Conv. Ctr. East 0 Cooper River Conv. Ctr. West 0 Covenant House Inc. 0 Crestview Conv. Ctr. 0 Crozer Chester Medical Center 0 District 1199C Staff 0 Dresher Hill Nursing Center 0 Elmira Jeffries Memorial Home 0 Episcopal Hospital 0 Elkins Crest 0 Fairview Care Center-Bethlehem 0 Fairview Care Center-Papermill 0 Graduate Hospital (Tenet) 0 Green Acres Nursing Home 0 Greenbriar East Nursing Home 0 Greenbriar of Woodbury 0 Greenbriar of Hammonton 0 Greenwich CLA & Services 0 Hahnemann University Hospital Healthcare Management Alternatives 0 IHS @ Broomall 0 IHS @ Chestnut Hill 0 lnglis House 0 JFK Corn. Center Prof. & Service 0 KenCCid 0 Kresson View o Lakewood of Voorhees 0 Legal Fund 0 Maplewood Manor o Marriott @ Graduate (Tenet) 0 Medical College of PA (Tenet) 0 Medical College of FA (EPPI) o Mercy Douglas Stephen Smith Home 0 Methodist Hospital Nursing 0 Morrison-Crothall Support Services 0 National Union Staff 0 New Jersey Academic Aquatic Science 0 North Phila. Health System Pension Fund Staff 0 Silver Court Nursing Center 0 Silver Court-Health Care Service Group 0 Simpson House 0 Stenton Hall Nursing Home 0 The Association for Independent Growth 0 Temple Children’s Hospital 0 Temple Continuing Care Center 0 Temple University Hospital 0 Thomas Jefferson Hospital 0 Training & Upgrading Fund 0 Voorhees Pediatric 0 West Philadelphia Consortium

The Solution to the Nursing Shortage

0

0

0 Moving to Scale 0

Analysis of the Nursing Shortage

Testing the Analysis- A Demonstration Project

Analysis

The Solution to the Nursing Shortage

Healthcare management is valiantly attempting to confront the shortage of nurses with a fatally flawed strategy. Essentially they are engaged in a bidding war over a finite and limited number of nurses. One local hospital is offering a signing package of $13,000. Another is offering $5,000 to any employee who recruits a nurse. Mail Line Health is offering bonuses of $23,000 to $25,000 for nurses who will commit to stay for three years. Many institutions have hired recruiters to spend their money on bonuses and advertising. The problem with this strategy is that all this expense does not add a single nurse to the pool.

Another fundamental failure of industry solutions is that they are self centered. Even when industry groups agree to act, they generally represent one healthcare sector such as hospitals. But the nursing shortage touches every segment of the healthcare industry and the problems are interrelated.

The Training Fund is constantly promoting to members the message that, “There is no shortcut.” Many healthcare gurus need to realize that this is true of the nursing shortage. The only solution to the nursing shortage is a three-fold approach.

First, the pool of eligible candidates has to be increased whereas it is currently

decreasing. Women now have a variety of more attractive careers to pursue and they are doing so. The lack of applicants has led to the closure of nursing schools. We must extend our vision to populations traditionally ignored. Who will these new nurses be? The nursing candidates from non-traditional sources should be from three major groups:

0 Current Healthcare Workers in Entry Level Positions

0 Minority Populations

0 Immigrant Groups

Thousands within these groups would leap at the opportunity to become nurses and would make excellent candidates.

The second essential element of a successful strategy is that the flight of current nurses out of healthcare must be halted. Some of the healthcare administrators lament that the poor image of healthcare as a place to work discourages new nursing admissions. The wholesale desertions of nurses should indicate that the image may be poor but it is very accurate. We have to change the reality and the image will catch up. Nurses are treated as if administrators wanted them to leave.

The third element is the need to involve the broader community in the nursing issue. The shortage does not simply affect the institutions trying to meet staffing requirements. The health industry is a vital segment of the Philadelphia economy. The Healthcare Council is attempting to recruit patients from around the world. But what is the point if we do not have a reliable supply of qualified healthcare workers to staff the floors?

If there were to be a comprehensive effort to recruit non-traditional nursing students, the healthcare industry would have to change. Professional training programs traditionally have presumed their students would attend full time. Most of these programs have entrance requirements and rejected candidates are simply sent away. Any successful strategy to recruit new groups will have to meet these students where they are.

Many of the applicants in these new populations are not ready for professional training. A massive effort to prepare these students is required. These efforts include GED, high school refresher classes, English as a Second Language, Pre-nursing courses and various support services. The District 1 199C Training & Upgrading Fund currently provides these services. Unfortunately, we have no competition.

As we also tell our students, “There is no quick fix.” The strategy outlined above will not produce a registered nurse in two years. It will take four or five years. Are agencies besides ourselves willing to make that commitment? The approach will be expensive but it will probably be less expensive than the current industry strategies. Money is certainly important to a successful effort. But even more essential is the commitment.

Despite our criticism of the competitive bidding war, it is impossible to overstress the retention crisis. The nursing workforce is hemorrhaging. Despite the already horrific departure of nurses, the Federation of Nurses and Health reports that one out of every five nurses expects to leave the profession within 5 years because they are frustrated by

working conditions. Not only does the healthcare industry have a bad image, the reality is worse.

We realize this proposal flies in the face of traditional expectations of what a nurse looks like. But we believe current expectations are unrealistic and cannot be achieved. Given the changing world and face of healthcare, we believe it is imperative to recognize the crisis we are facing and be willing to examine new solutions.

Testing the Analysis A Demonstration Project

The District 1 199C Training & Upgrading Fund was one of nine national projects to receive Round I funding from the U.S. Department of Labor under the HI-B program. With the grant received from DOL, the Training Fund designed a demonstration project that addresses the need for more trained high skilled nurses resulting from the nursing shortage that is impacting the nation and the Philadelphia area.

The model targets entry-level health care workers for upgrading into skilled nursing positions. The project provides practical and registered nursing students, attending a variety of nursing schools in the Philadelphia area, with tuition support, assistance for books, uniforms, and fees as well as tutoring and educational support services.

Another important aspect of the project is the training provided for unemployed and entry-level, low-income workers so that they may qualify to advance on the nursing career ladder to become professional nurses. The Training Fund provides the opportunity to both union members and community residents to become trained as nurse’s aides, pass the state certification test, and obtain employment in the long term care industry. Once trained as a nurse’s aide, a variety of preparatory classes are offered to obtain the GED, receive a high school diploma, and/or boost basic reading, writing, and mathematics skills so that aides may qualify for admission into nursing school.

Targeting entry-level health care workers for upgrading addresses the nursing shortage by creating a new pool of potential nurses with workers who are already familiar with the health care system and motivated to improve their skills. The majority of these workers are minorities, who traditionally have not had access to positions as high skilled nurses. The grant strategy creates new opportunities for individuals who might not otherwise have the financial means to attend nursing school. In succeeding, these workers qualify to upgrade as professional nurses and obtain high paying jobs that enable them to better provide for their families. At the same time, the strategy increases the pool of new nurses with populations traditionally prevented from entering high skilled jobs due to

educational and financial barriers.

.

The results of the demonstration project are impressive. A little more than halfway through the project, the Training Fund has exceeded enrollment goals. The entire project established the enrollment goal at 80 high skilled nurses during the two-year grant period. To date, 93 licensed practical and registered nurses have been enrolled and the Fund is targeting 200 additional high skilled nursing enrollments by the end of the grant period. 192 nurse aides have been trained in a one-year period, and at least 100 more will be trained by the end of the two-year project. Hundreds of other candidates would like to participate, and could do so if funding was available.

The success of the project derives from the Training Fund’s uniqueness as a union based organization, its strong linkages with health care employers, its ties to the community, and the time and resources that it has committed to developing an educational continuum of academic preparatory programs. Over a twenty-five year period, the Training Fund has built a reputation with the members of its parent union, District 1 199C, and the

community as a quality educational institution that assists workers to achieve their career goals.

Students who come to the Training Fund’s Learning Center quickly learn that everyone who comes motivated to work hard is welcome no matter where they may be starting out educationally. The Fund’s success in helping students to progress academically and succeed in attaining career goals while maintaining high educational standards has resulted in an extensive word of mouth network that provides a constant pool of students who want to achieve similar results. This is supported by the union leadership which has placed a great emphasis on education, and created the expectation that union members take advantage of generous educational benefits available through the Training Fund. A history of providing quality training opportunities to members and the community for many years has resulted in relationships with hundreds of community organizations and a reputation that attracts new students on a continuous basis.

Similarly, the Training Fund has built strong relationships with health care employers. Employers that contribute to the Training Fund as a result of their collective bargaining agreements have come to depend on the Fund as a provider of quality educational services for their employees. Employers have assisted the Fund in the development of joint programs and in recruitment of workers to Fund-employer initiatives. In turn, the

Fund has helped leverage additional financial resources that assist employers by increasing the breadth of services that can be brought to bear in addressing their employment needs.

The H1-B grant received by the Fund to address the nursing shortage is an example of how the Fund works with employers to increase needed resources. The grant has enabled the Fund to widen the net of eligible candidates for nursing scholarships, beyond the members who qualify for Fund training benefits, to a much wider population. Employers then have the ability to provide matching funds to nursing students in return for a

commitment of service, thus widening their pool of future staff nurses. Employers have the option of supporting their current entry-level health care workers in achieving their upgrading goals and/or providing financing to nursing students who have not previously worked for them. In both cases, the Fund and partnering employers have succeeded in working together to successfully invest in increasing the pool of nurses.

Another key ingredient to the model’s success is the extensive array of preparatory classes available to members and the community free of charge. Students can attend part time classes from morning to night, including the weekends. Classes are provided at different levels, from basic skills remediation through intensive pre-nursing classes designed to prepare students for difficult admissions testing and challenging nursing course work. Students can start at any point in the continuum and work up to the level

needed to qualify for nursing school. Students work at their own pace, taking as long as they need to accomplish their goal. Because the Fund’s model targets non-traditional populations to fill nursing openings, these preparatory classes are a critical component of the support services that help students succeed in attaining admission and successfully completing nursing programs.

The H1-B grant has provided the resources to help the Training Fund put into place the components of a successful model that addresses the nursing shortage. The demonstration project entailed training 200 nurse’s aides and 80 high skilled licensed and registered nurses at 17 different schools of nursing. Matching funds were provided by three employers in addition to the employer funds contributed to the Training & Upgrading Fund. Now that the model has proven that it can work, these numbers must be increased significantly to impact the nursing shortage.

With the success of this demonstration project, the Fund is ready to take the project to scale by increasing the number of participants served in all of the essential project components as well as expanding the parameters of the model. In bringing this model to scale the Fund proposes to track students in preparatory classes and add another

component that is essential to the preparation of registered nurses, prerequisite college course work. The new model will provide a ladder of educational levels that students can access at any point in the continuum, as follows: nurse’s aide training, GED/Adult Diploma classes, Nursing Prep classes, Pre-Nursing classes, college prerequisite courses, and finally practical nursing and registered nursing programs. Each level will train increased numbers of students, culminating in 1200 high tech nurses that will be trained over a two year period. 800 nurses aides will be trained, 500 students will attend

GED/Adult Diploma classes, 500 students will attend preparatory classes, and 300 will attend college prerequisite classes. The number of employers who will provide matching funds, beyond the amount required by collective bargaining agreements in return for a commitment of service will increase to ten.

Bringing the program to scale will involve a comprehensive effort with a larger funding base than currently exists.

A

Career Ladder

for

High Skilled Nursing

New

Faces

I

I

Moving to Scale

The District 1199C Training Fund model enrolling over 300 nursing students will far exceed the targets of the Department of Labor grant. With the Analysis of the shortage and the proposed solution verified, the needs of the industry and the city dictate a move to a much larger scale and a substantial funding base.

Goal

Based on the successful model in place, it is realistic to propose that the number of nurses who would normally enter the field should be increased by 1200 within the next two

years. Who

In order to create a large scale nurse training effort, an organization should have capabilities in glace:

Permanent structure vs. ad hoc committee

Represent all sectors of the healthcare community Have an Accountability structure in place

Access to nursing candidates

Experience training the target groups

We believe that the most logical entity to conduct a full scale program is the District 1999C Training & Upgrading Fund.

Like every potential operator, the Training Fund runs the risk that it will serve its own agenda. However, the structure of the Fund as a union-management trust provides a unique oversight mechanism which guarantees openness and accountability. The Fund has a long history of involvement in a wide range of activities with employers in all

sectors of the healthcare industry. Perhaps, most noteworthy is the Fund's work with the schools districts of Philadelphia and Delaware Counties, founding Health Academies. How

The Training Fund has several services which create a large flow of candidates:

The Fund is the only center based site for Commonwealth certification testing for nurses aides in the Philadelphia region

.

The Fund is one of two organizations offering the Adult Diploma Program leading to a high school diploma from the School District of Philadelphia

The Fund is one of 3 test sites in the city for the GED test. In terms of the target groups proposed:

a Current Healthcare workers

Healthcare workers to be targeted are working in three main sectors:

+

+

+

The Training & Upgrading Fund has access to the employees of 100 employers with union contracts. The Fund has had successful outreach to other interested employers

a Minority candidates

The Fund is widely known and respected in the minority community because its history is largely integrated with the civil rights movement in Philadelphia.

0 Immigrants

Although District 1199C has many immigrant members, a major new outreach is planned. The local home care workforce has a large immigrant segment and the Training Fund is about to initiate a home care worker upgrade program with the assistance of the Philadelphia Workforce Development Corporation which will create a career ladder for these workers.

Premises of Moving to Scale There is no short cut

The target population will require more time to become nurses The career ladder concept offers the best model

A successful large scale program must be comprehensive Essential elements of the Effort

Outreach Screening

0 Remedial and Prep Training

Tracking

0 Linkages to employers 0 Student Services

Outreach

As a result of the H1B funding linkages have been made with most of the nursing schools. In an expanded program, outreach would be made to:

The Public School System Healthcare Programs The Archdiocesan High Schools

The Political Leadership of the City Immigrant Advocacy Groups

Nursing Schools to recruit rejected candidates into remedial programs Screening

The Fund has 20 years experience in screening and assessing training applicants. Currently the Fund is working with consultants from the University of Pennsylvania School of Social Work to codify our practices so that we can accommodate a greater number of applicants.

Remedial and Prep Training

Existing Programs will be expanded ABE, GED

English as a Second Language $re-Nursing New Programs Foundation Skills Accelerated GED Accelerated ADP Mathematics Clinics

Home Health Care Upgrading Program Tracking

Tracking of candidates from application to graduation is a most essential element of the proposed strategy. In most nursing programs tracking is generally lacking. Students who do not initially qualify for nursing school must be given alternatives. and it must be confirmed that the next link is made. There must be a system in place so that

periodically, the status is verified and action taken if the student is off track. This case management approach is staff intensive but the Fund has found it to be most effective in terms of the projected target groups.

Licensed Practical Nursing and Registered Nurse Training

There must be an increase in number of Practical Nursing seats. The number of LPN seats in the city is relatively fixed with the Fund having by far the largest number (86) in fall, 2001. In order to expand capacity, the Training Fund will add a full time day program to its program. This will create an additional 50 slots.

While the proposed project would be funded largely by grants from public agencies, the financial base of the Training Fund is guaranteed by collective bargaining agreements. linkages to employers

The Linkages to employers would be expanded from 60 to 100 employers.

Student Services

Academic Counseling Financial Aid Services

A new Financial Aid position would be established to coordinate the various income streams and to expedite PELL and PHEA funding. Tutoring

Summary

The nursing workforce is critically inadequate and traditional remedies are proving unsuccessful. The solution is to expand the eligible pool of candidates by including populations which have been excluded. The elements of a large scale program to do just that are in place. What is required is a community wide commitment to launch such an effort.

Possible Contributions by Various Groups

In order to make a real difference in increasing the number of nurses, the effort must be cooperative and broad based. Many groups will have to share the commitment and be willing to take practical steps. A few examples are indicated below.

Training & Upgrading Fund

The Fund is in the process of reorganizing its Adult Education Program to accommodate new populations and dramatically increase the number of adults receiving high school diplomas.

The Fund must aggressively seek new sources of funding to prepare candidates and train nurses.

The Fund will continue its outreach efforts to employers who are contributing to nursing education in return for commitments of service.

U.S. Department of Labor

The Fund will seek a renewal and expansion of H1B grant City Council

Councilman James Kenney’s initiative encouraging immigrants leads logically to a potential source of nursing candidates.

PA Department of Welfare

Nursing should be recognized as a permanent high demand employment and the necessary investment should be made to make these careers accessible to welfare recipients.

Pa Department of Labor & Industry

The Department is currently cooperating with a U.S. Department of Labor grant to retrain laid off hospital workers. Training candidates in nursing for the long term care industry is a transition to the demand positions.

Pa Department of Education

The Department has resources to bring to bear to fill the gap for nursing aspirants who lack the prerequisites to enter nursing schools.

The Mayor

The shortage of nurses must be recognized as a threat to the economic health of

the city and the physical health of the city’s residents. There are not enough nurses to meet the current demand.

It is not in the best interest of the city to continue the practice of importing third world countries’ nurses while Philadelphians are unemployed.

Under the leadership of the Mayor, the Workforce Investment Board currently serves as a conduit for Department of Labor funding to the Training Fund for training nurses. It is proposed that this effort be greatly expanded.

Chamber of Commerce

The Chamber can recognize that the shortage of nurses is chronic and threatens the economic health of the region and the importation of foreign workers is not a long term solution.

Philadelphia Workforce Development Corporation

P WDC currently assists eligible candidates to obtain practical nurse training. We propose to expand this effort.

Delaware Valley Healthcare Council

The Council perhaps could help alleviate the nursing shortage by promoting among its constituency the need for employers to make nursing employment more humane so that the hemorrhaging of existing nurses is stopped.

If nurses believe it is in their best interest to unionize, they should not be opposed or intimidated.

Healthcare Employers

Employers need to brace themselves against anti-union prejudice and examine the nursing shortage realistically, thinking outside the box, and thinking beyond your own institutional self interest.

Employers must recognize that most of their recruitment efforts simply increase a competitive bidding war without adding any nurses to the workforce.

Employers should examine their need for LPNs in light of the fact that the Training Fund has more than double the LPN enrollments than any other school in the city.

Employers will have to be cooperative in scheduling work for workers who wish to become nurses and want to study part time.

Nursing schools

Schools should examine cooperative agreements with other agencies particularly in regard to referring unqualified candidates to remedial training.

Schools should reduce the number of nursing dropouts by being more realistic in acceptances and provide the case management needed as support for the students.

School District of Philadelphia

The Training Fund would be pleased to work with the District to provide enhanced career counseling focusing on healthcare careers in high demand and have accurate information so that graduates can negotiate a career ladder.

District nursing assistant programs could assure that students interested in nursing opportunities become certified as nursing assistants and find employment before they graduate.

Students need to see that the position of nursing assistant need not be a final goal but can be a viable step in a career ladder.

Obviously many other groups and individuals can play a role in turning the nursing shortage into an opportunity. The District 1 199C Training & Upgrading Fund offers this document as a proposal which we believe has real promise. We welcome other thoughts and criticisms as we forge new partnerships. You can contact the Fund through the Director: James T. Ryan, Ph.D. 13 19 Locust St. Philadelphia, PA 19 107 Jryan@HSLC.org .org 215-735-5555