Boston Private Industry Council. Nursing Career Ladders Program PROJECT BACKGROUND

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1 Boston Private Industry Council Nursing Career Ladders Program PROJECT BACKGROUND In June 2002, the Commonwealth Corporation received a $2.9 million dollar grant from the U.S. Department of Labor to fund a two year Nursing Career Ladder Initiative (NCLI) in Massachusetts. The Commonwealth Corporation is a quasi-public organization that administers and delivers a broad range of workforce development initiatives and services in Massachusetts. The state-wide career ladders grant seeks to incorporate a number of existing systems and stakeholders to strategically address the nursing shortage beyond what a single workforce investment board, community-based organization, educational institution or state agency could accomplish on its own. The Commonwealth Corporation proposed a combination of resources and creative collaborations. The primary goal of the grant is to create an infrastructure to recruit and retain nurses and to keep the pipeline to this profession flowing with new and existing talent. The Massachusetts health care industry is the leading sector of the state s economy, second only to the government. It accounts for 10% of the state s employment and 15% of Boston s workforce. And it continues to rise. By the 2008, there will be just over 404,000 active health care positions within the Commonwealth. Inside of this sector, registered nurses account for 18% of all existing positions. In addition, a significant number of Licensed Practical Nurses and Certified Nurses Aides serve as patient care professionals in long-term care facilities and home care agencies. The nursing crisis was brought on by a number of converging factors. The demand for more nurses has increased as the population ages and new technologies and medications keep people alive longer. The supply of nurses has decreased as dissatisfaction in the field grows due to the increasing difficulty of providing care in an environment of pressure to reduce costs and document and justify procedures. Women of a generation who were raised to believe that the most stable professions were nursing and teaching now have a wide-range of challenging and financially rewarding professions open to them - - most on a schedule that doesn t include mandatory weekends and holidays and none with the pressure of balancing quality patient care with onerous administrative requirements during any given shift. The overarching model for Nursing Career Ladder Initiative is one that educates and draws the most appropriate people into the field (recruitment and assessment), assists them with entry into nursing programs (education), and provides guidance and support services so that they can successfully work as nurses (coaching and mentoring). The structure brings together employers within the health care sector, nursing education providers, and labor and workforce development organizations. The target audience for the grant includes those currently working in the health care field who want to advance or change careers, those new to the workforce graduating from high school, and dislocated workers in search of a growing field with sustainable wages. The first rung of the career Boston Private Industry Council Nursing Career Ladder Program 1

2 ladder begins at the CNA level and/or entry level patient care and advances to a Bachelor s prepared Registered Nurse position with many steps in-between. The broad outcomes of the initiative are to increase the enrollment and stability of nursing programs and to assist individuals interested in pursuing a nursing career. This pipeline approach was designed to lead to more qualified nurses entering the hiring pool of health care institutions. PROJECT OVERVIEW The Boston Private Industry Council has a strong track record of creating innovative employer partnerships in critical regional industries. Its original relationships with health care employers were developed in the early 90s in the context of the PIC s School-to- Career program (ProTech) in which hospitals partnered with Boston high schools to provide paid internships and structured learning opportunities for high school students. In 1999 the PIC was awarded an incumbent health care worker demonstration grant to develop skills training programs for entry-level workers at four Boston healthcare facilities for 400 entry level workers. The PIC collaborated with employers, community colleges, a union and other stakeholders to coordinate career planning and education activities for health care workers. Components under this grant included: a career ladder program for Certified Nursing Assistants, a Medical Coding certificate program, a 3-day training program for entry-level Practice Support Secretaries and ESOL classes. In addition to these health care programs, the PIC administered a health care technology skills shortages training grant to develop recruitment, training, and retraining strategies for technical positions within the health care industry. The grant targeted Radiologic Technologists, Pharmacy Technician and Surgical Technician positions. The PIC s extensive experience in health care provided a solid grounding for the NCLI project. The PIC was selected by the Commonwealth Corporation to serve as one of four implementation teams funded through NCLI to launch this pipeline program. The PIC works in partnership with the Metro North Regional Employment Board and receives guidance and industry expertise through a Regional Advisory Committee. The Committee helps staff to identify service priorities and to develop and test pilot programs. The Commonwealth s goals for the Nursing Career Ladder Initiative are to establish a permanent, dynamic, sustainable infrastructure that will 1) increase the number of individuals who enroll in nursing programs 2) increase the retention of nursing students in their academic programs, and 3) improve the retention rate of practicing nurses. The Boston PIC responded to this initiative by creating three distinct program components: career coaching for adults at participating health care institutions and high school students at participating high schools, a forgivable loan program for employees of community health centers who want to obtain their nursing degree, and Boston Private Industry Council Nursing Career Ladder Program 2

3 academic and career support for immigrants who have been trained as health care workers in their native country but need assistance in taking the next steps to obtain employment in nursing (either by obtaining recognition of their education or by completing an accredited nursing education program in the U.S.). The PIC s focus on career coaching services is designed to address the lack of a comprehensive map for those interested in a career in nursing. There are very few existing services or systems to respond to the need for information on nursing programs, financing a nursing education, and carefully thinking through the resources necessary to make the right choices in developing a nursing career. This is true particularly for adult career changers or those working in health care looking to advance within the field. While the nursing shortage is a stark reality in hospitals, the lack of skilled nurses is even more acutely felt in Massachusetts community health centers where average salaries for nurses are lower than those in neighboring hospitals, thus making retention of nurses an even more critical issue. The forgivable loan fund is designed to test the idea that individuals who already know and thrive within the culture of community health centers are more likely to remain in this sub-sector when they become nurses. Finally, the PIC s approach to the gap in nursing staff recognizes the valuable, yet untapped resource of immigrants coming to the U.S. with a nursing or patient care background who find it difficult to obtain licensure in the U.S. to practice as nurses. If these workers become licensed nurses, they will also help to expand the cultural competence of Boston s health care providers. The PIC s approach is three-pronged: coaching, providing scholarship support for employees of community health centers and capitalizing on the untapped resources of immigrant health care workers. The goal of this approach is to test strategies for building a pipeline of future health care professionals, thereby addressing the nursing shortage in Massachusetts. The table below outlines program components inside of the Nursing Career Ladders Program, the elements of the component and their defined goals. Program Elements COMPONENT PROGRAM ELEMENTS PROGRAM GOALS Career coaching - Provide coaching services Enrollment:100 adults (assessment, resources, Boston Private Industry Council Nursing Career Ladder Program 3

4 advocacy) for adults interested in the nursing field working within selected health care institutions Completion of career plan: 85 Enrollment in pre-requisite classes: 50 Career coaching high school students Loan forgiveness community health centers Immigrant nurses Provide exploration in nursing curriculum and provide coaching for high school students interested in nursing at selected high schools Establish loans to enable employees of community health centers to attend nursing programs while working Provide assessment and case management services for immigrant health care workers interested in obtaining their RN license or entry into an RN program Enrollment in pipeline program (CNA/LPN): 20 Enrollment in RN program: 10 Enrollment: 100 Completion of college plan: 70 enrolled in developmental classes: 20 enrollment in pipeline program (CNA/LPN): 10 enrollment in RN program: 10 Enrollment: 10 4 complete ADN program and become licensed RNs 6 complete first year of ADN or BSN program 1. Enrollment 10 (goal of RN credential recognition) 3 gain RN credential 5 achieve TOEFL scores of 550 and in process of gaining credential 2. Enrollment 30 (goal of entry into post-secondary nursing) 25 enroll in vocational ESOL and complete career plan 10 attain language proficiency required for matriculation 15 enrolled in pre-requisite 5 enrolled in pipeline (CNA /LPN) program 3 enrolled in RN program NURSING CAREER COACHING SERVICES FOR INCUMBENT HEALTH CARE WORKERS Application for pilot sites Boston Private Industry Council Nursing Career Ladder Program 4

5 The PIC and the Metro Boston NCLI Regional Advisory Committee developed an application process by which any health care institution interested in preparing their employees for careers in nursing could apply to serve as a pilot facility for on-site nursing career coaching services. The PIC was seeking to develop partnership agreements with health care institutions that had a demonstrated track record in supporting employees interested in advancing their careers and the ability and commitment to sustain coaching services beyond the pilot phase. All applications required sign off at the highest levels of administration (CEO/COO), in addition to the Director of Nursing, Director of Human Resources, Nursing Education or the Staff Development Director. Where applicable, the PIC also required evidence that union representatives had been consulted and were supportive of the application. Ten health care institutions applied for the program; the PIC chose five facilities to participate in the program. The partners are: The Massachusetts General Hospital and Brigham and Women s Hospital, two large Boston teaching hospitals; The Lahey Clinic, a multidisciplinary group practice healthcare facility; The Cambridge Health Alliance, an integrated health care system of public health, clinic care, academics and research; and Sherrill House, an extended care facility. The selected grant sites include diversity in types of institution (acute care, community health centers, and long term care) and geographic areas within the Boston and Metro North regions. The health care institutions participating in the program cited a commitment to building a long-term and sustainable approach to addressing the nursing shortage within their own organization as the primary reason for taking part in the project. All of the institutions have existing workforce development and/or professional education programs [see pilot site application.] Recruitment of participants Career coach liaisons and other staff (most often from the Human Resources Department) at each employer site work closely with the PIC s nursing career coach. Each pilot site shares a common recruiting model, though they are rolling out the program and implementing it differently within each facility. Some sites have adopted a broad outreach strategy in which large and multiple orientation sessions are held to draw high numbers of attendees with a wide range of interest. This approach ensures a full complement of participants but requires a significant amount of staff time to assess and screen appropriate applicants. Other institutions have chosen to conduct a very targeted recruitment strategy and select only those people who present themselves as having all of their paperwork in order and ready to take next steps as one Human Resources representative explains it. This institution acknowledges that they were fortunate enough to receive a positive response to the program so that they didn t have to work through the tedious process of screening hundreds of potential applicants. Had the program not been so attractive, they would have reverted to plan B, a less streamlined process which would have strained their staff resources. Still other employers recruited participants from existing workforce development programs with similar goals to provide participants the benefits of additional resources and information that the NCLI program provides. Orientation sessions often include a brief presentation by the NCLI career coach about the services that are provided under the grant, information about the field of nursing, and Boston Private Industry Council Nursing Career Ladder Program 5

6 educational programs and ways to finance it. A Human Resources representative discusses specific services that each institution offers to support participation in the program. The goal of these sessions is to provide a general overview with enough information to whet the appetite of those interested in a nursing career. In addition to a more general orientation on nursing, the career coach and four experts from the field of nursing and education designed a Getting Started workshop. The objectives of the workshop are to educate participants about the skills required for a career in nursing, teach participants how to assess one s own interests, values and aptitude for the profession and help them determine whether the skills required are compatible enough to further pursue a career in nursing. The workshop, Looking for a Lifetime Career with a Good Salary? also provides information on the varied career opportunities available in nursing, job outlook, salary information and strategies for developing short and long term career plans useful for entering the field [see NCLI workshop outline.] The role of the career coach The nucleus of this nursing career ladders program is the career coaching service. Employer partners may support the coaching with other workplace benefits such as tuition remission, scholarships, release time, job shadowing and mentoring. The primary function of the coach is to work with employees of the pilot sites one-on-one and in a group setting to assist them in 1) determining the suitability of a nursing career 2) investigating nursing programs, how to apply for a program and finance it, and 3) working with their employer to increase their ability to obtain a nursing degree while successfully staying on the job. The PIC hired a career coach at the start of the project (June 2003.) The coach is supervised by the Program Manager at the PIC and uses the PIC as a home base. However, the nature of the job requires that the career coach be out in the field at the five pilot sites, visiting nursing programs and doing the legwork necessary to recruit and retain the participants. According to the career coach, participants need to have access to her at any given time to answer questions, provide guidance or assist in the follow-up necessary to take the next steps in the program application process. This is not a job for someone who just wants to sit at a desk all day. The career coach is managing a caseload of people in various stages of their career development process at any given time. The format of coaching activities is as follows: Initial one-hour meeting with the employee on release time (often following an on-site employer orientation) Introduction of the NCLI program (if needed) Review and completion of program forms including the enrollment form, a release of information form and a grievance form [see intake form] Assessment of employee profile Boston Private Industry Council Nursing Career Ladder Program 6

7 o are there financial barriers to attending a nursing program? o will the employee work full or part-time? o what are the geographic constraints (in the commuting triangle of workschool-home) and what is a realistic commuting scenario? Navigating the system the first steps once a school(s) have been identified o Attend an open house or obtain school-specific information o Pass the college placement test (score is valid for one year only in addition, a nursing program admissions test may be required) o Determine the course sequence appropriate for the employee o Identify all pre-requisites for the course and how to take them before the course begins (with the understanding that some programs may have a wait list up to a year before entry to a program) o Learn about the timeframe for application to school and make note of deadlines and next steps for follow-up Within two months of the initial meeting, approximately half of the employees who attend the first meeting will schedule a second meeting to review steps taken. The majority of employees will have contact with the career coach by phone to follow up on action items and check in while undergoing the research and application process. The career coach reaches out to students and also initiates contact where necessary. On average, the career coach will have 4-6 exchanges with each employee for the first 2-3 months after the initial meeting. Like any case management model, there are those employees who require more attention after the initial meeting than others. While the primary function of this position is coaching (assisting employees to map out their strategy for a nursing career, providing information, offering encouragement and assistance with next steps) there is also a significant advocacy role for the career coach. In some instances, the coach advocates on behalf of the employee in situations that need attention or pushes on a policy or procedure that might otherwise stall a school application for an employee. For example, an employee was told by a school that she was not eligible for federal financial aid due to a default on a former school loan. It was only through further investigation by the coach that the employee learned that enrollment in a credit repair program and consistent payments over a short period of time would once again make her eligible for financial aid. This information enabled the student to enroll in a nursing program. [see financial aid planning sheet] Credibility within the field is an important characteristic of a successful coach. The person hired into this position is a former nurse with a strong background in human resources and administration. When she talks to health care providers about the challenges and rewards of the nursing profession, she does so with a realistic understanding of what they may be facing in preparing for this new career. Employees appreciate her willingness to share her own experiences in nursing with them. Credibility among supervisors, managers and other nursing staff is enhanced by the coach s knowledge of industry language and standards. According to this coach, a nursing background is key to the position. You are taken more seriously because you understand Boston Private Industry Council Nursing Career Ladder Program 7

8 the culture, environment and politics of the field. You also have a better ability to read people and get a sense of whether they have what it takes to succeed in school and on the job. The position requires an eclectic mix of skills and qualifications. The ability to incorporate many different types of skills sets is among the most important. The coach must feel comfortable in one-on-one situations as well as speaking to large groups. The person must have an eye for detail in order to record participant demographic data and yet have an understanding of the big picture when it comes to the politics and culture of large hospital environment. The position calls for someone who can work as a member of a team, but also operates independently within the five coaching sites [see career coach job description.] Other program collaborators The coach works closely with human resource staff from the employer pilot sites, admissions and nursing staff from the nursing programs where employees enroll, in addition to other partners within the collaboration. One such partner is the Higher Education Information Center (HEIC.) HEIC is a division of TERI, a national non-profit organization offering educational loans with a goal of increasing the chances for people from varied backgrounds to successfully complete higher education. HEIC provides financial aid counseling to individuals and educational awareness programs to communities [click here for a link to the HEIC website.] The staff from HEIC and the PIC career coach deliver presentations together on the mechanics of financing a nursing education. In addition to employer-wide presentations, the team provides in-depth workshops and individual sessions covering such topics as the FAFSA, credit repair, loans, scholarships and grants and strategies for managing household finances while in school. The PIC commissioned the development of a financial aid guide specifically for those considering nursing within the NCLI program. The guide lists private, corporate and government resources as well as tools for researching these sources of funding [see nursing financial aid guide.] One Stop Career Centers are also partners in the NCLI program. The PIC oversees three career centers in Boston - - a natural link between those searching for jobs and exploring careers and the nursing career ladder program. The primary focus of the grant is on incumbent workers employed by participating health care institutions. Yet, the career centers have the potential to draw from a pool of people who may be interested in changing their career choice to health care. The career centers offer the opportunity for PIC and career center staff to work together in educating the unemployed, those in search of a career change and other career center customers about the nursing profession. Career centers provide an obvious pool from which to recruit new talent into the nursing field. Yet, experience has shown that this channel brings fewer recruits into the program than anticipated. There are situational barriers for a category of people actively working with career centers. Many customers who use the services of the centers are collecting unemployment benefits and may not be in a financial situation to enroll in a two-year Boston Private Industry Council Nursing Career Ladder Program 8

9 nursing program. They are often interested in shorter-term training. Furthermore, those who may be in a position to attend a long-term program may have financial barriers to attendance. Those coming to the centers under grant funded programs (through TAFDC or government funded skills training programs) are often entering health care at the CNA level and other beginning levels of patient care, and are therefore not ready to enroll in a degree program. Employer sustainability The sustainability of the program is a major focus of the PIC s approach. From the application process to its implementation, there is an expectation that each participating organization will institutionalize coaching services by training their own more experienced staff to become coaches to those enrolled in the program. Each pilot site is looking into ways to effectively manage the transition of moving career coaching services out from under the umbrella of the PIC administered grant and into their own workforce development and professional education departments. This transition is not without complications. For example, the career coach acknowledges that while meeting with an employee it is common for that employee to disclose personal and financial information. The employee may be candid about that fact that she or he would be very reluctant or refuse to share this same information with a career coach working for the same institution, regardless of an agreement around confidentiality. This withholding of pertinent financial information may well have an impact on the effectiveness of assessment and next step strategies. This reality is one that every collaborating institution faces when planning for the next phase of the program. Another challenge to sustainability lies in the perception that a partner organization like the PIC is free from the internal politics and bureaucracy of the health care institution and can therefore work more effectively. By transitioning the work of the career coach, the program may take a back seat to other priorities and preferences of the institution. Unless it has a strong champion or advocates with decision making power within the institution, it could become less effective or phased out altogether. Institutions will be bought in as the program realizes concrete and attainable outcomes and becomes better known throughout the pilot sites. Snapshot of program participants As of June 30, 2004, the career coach had enrolled 129 participants across the five pilot institutions. The coach documented the following measures of progress among coaching participants: Enrolled in CNA programs: 2 Completed CNA programs: 2 Applied to LPN programs: 2 Accepted to LPN programs: 1 Enrolled in LPN programs: 1 Boston Private Industry Council Nursing Career Ladder Program 9

10 Applied to ADN programs: 15 Accepted to ADN programs: 12 Enrolled in ADN programs: 2 Applied to BSN programs: 5 Accepted to BSN programs: 3 Enrolled in BSN programs: 2 Applied to Nurse Practitioner Programs: 4 Accepted to Nurse Practitioner Programs: 4 Enrolled in Nurse Practitioner Programs: 2 CAREER COACHING SERVICES FOR HIGH SCHOOL STUDENTS The outcomes for career coaching at the high school level is similar to those for adult coaching - - to work with designated institutions (in this case high schools or health care exploration programs) to educate, support, and guide those interested in pursing nursing as a career. The design of the program differs in that participation in a health care career exploration class is an equally important component to the career coaching itself. Students work with a career coach to explore a future career in nursing as part of a cohort of other students experiencing the same career exploration curriculum. The high schools and programs participating in the NCLI program were chosen based on their existing relationships with the Boston PIC (through their School-To-Career program), their interest in the program and the existence of some health careers curriculum or component. Participating schools and programs include East Boston High School Health Career Pathway, The Health Careers Academy and the Boston Area Health Education Center. [see Memorandum Of Understanding for youth sites.] The PIC hired a career coach with youth experience to work with school and youth program staff to design and implement an appropriate curriculum for each setting. The coach is also responsible for connecting individually with high school students to make them aware of the program and set aside regular times each week to work with them on career exploration in nursing. The PIC initially conceived of the position as focusing solely on nursing career exploration but subsequently redesigned the coach position to work toward a longer-term objective of providing health care career awareness both to students and to the PIC s career specialists. [see Health Care Career Coach job description.] The PIC made this change to ensure that the model they were developing would be sustainable over the long term and would integrate within the PIC s overall health care business development strategy. LOAN FORGIVENESS PILOT PROGRAM Boston Private Industry Council Nursing Career Ladder Program 10

11 The Nursing Loan Pool is another component of the Nursing Career Ladder Program. It is designed specifically to support community health center staff while they complete their nursing education and training with a goal toward meeting the current and anticipated demand for professional nursing staff within the community health center system. The loan pool is administered centrally through the office of The Massachusetts League of Community Health Centers. The League spearheads numerous workforce development initiatives and continuing education programs for staff for the 50 community health centers located in Massachusetts. It acts as the clearinghouse for recruitment and retention efforts throughout the system. Community Health Centers face a unique challenge to the retention of clinical staff. Unlike large hospitals and medical care groups, community health centers have a smaller staff structure, and as such have fewer opportunities for advancement within their institution (and across health centers.) These health care facilities do not have the same resources and budgets of hospitals, which is reflected in an on-average lower pay scale. In addition, fewer resources and smaller staffing increase the pressure on the existing staff. Lower wages coupled with limited opportunities for advancement make turnover of clinical staff at community health centers an important issue, both on a strategic and operations level. The loan forgiveness program was adapted from the Radiologic Technologist model created under a separate Department of Labor skills shortage grant. The goals of the loan forgiveness programs are similar. They provide financial support to incumbent health care workers interested in developing a career in recognized skills shortage areas. The loan covers tuition, fees, books and other expenses incurred while enrolled in an accredited associate degree or bachelor degree nursing program. The maximum loan amount is $3,000 per year based on successful completion of course work per semester. Participants of the loan program are selected based on their status as a community health center employee, academic performance, clinical performance and aptitude, professional demeanor and interpersonal skills, supervisor recommendations and financial need. According to the written policy for the Massachusetts League of Community Health Centers, for the loan to be completely forgiven the participant must be employed at a community health center for successive periods of six months equal to the number of semesters during with the loans were received. [see scholarship application] The loan forgiveness program began as a pilot targeting the 22 community health centers located within the Greater Boston area. Due to a slow response to the project during the initial launch (5 participants out of 10 proposed), the geographic locations were expanded outside of Boston. To date, the League s Steering Committee has approved $16,500 in loans to 8 employees. Four recipients are currently LPNs; three are Medical Assistants and one is a Nutritionist. Five are in ADN programs and three are in BSN programs. Two of the participants work in centers outside of Boston (Central and Southeastern Massachusetts) and 3 participants have received the full scholarship amount allowable under the program ($3,000.) Boston Private Industry Council Nursing Career Ladder Program 11

12 IMMIGRANT HEALTH CARE WORKERS PILOT PROGRAM The PIC s third strategy for addressing the nursing shortage is to tap into the growing pool of immigrants who are making their new homes in Massachusetts. According to a 1999 Mass Inc. report, foreign immigrants account for 82% of the net growth in the state s labor force. They estimate that 1/3 of these immigrants coming to the state since 1990 have a bachelor s degree or more advanced education. As a part of this immigration increase, there are significant numbers of immigrants entering Massachusetts who have a background in health care or who have worked in the health care field. While language and cultural differences may create challenges for immigrants seeking employment in the Massachusetts health care sector, one of the most daunting barriers for health care professionals from other countries is becoming licensed. This is especially true for nurses. Licensed nurses in Massachusetts who are United States-educated are required to have an Associates Degree in Nursing (ADN) or a Baccalaureate Degree in Nursing (BSN) from an approved nursing program, and to pass the National Council Licensure Examination (RNs.) At that point, they can apply for licensure with the Massachusetts Board of Registration in Nursing. Foreign educated nurses must take additional steps to become licensed. In order to sit for the exam, they must first obtain certification by the Commission on Graduates of Foreign Nursing Schools (CGFNS). CGFNS reviews the applicant s education credentials and certifies that they meet U.S. standards. If the applicant s nursing education was not conducted in English he/she must demonstrate English-language proficiency by securing a minimum score of 550 on the TOEFL Exam (Test of English as a Foreign Language) or by achieving an acceptable score on another approved exam. The target populations for the immigrant nursing pilot program under the Nursing Career Ladder Initiative fall into two tracks. One track targets immigrants who were educated in their native countries in a nursing program that is comparable to the U.S. and want to work toward credential recognition in the U.S. The other track is for immigrants who participated in post-secondary level training as health care workers in their native countries and want to enroll in a nursing education program in the U.S. The project outcome for the first track is licensing and employment. The outcome for the second track is matriculation into an approved school of nursing. The PIC s program design contains case management services for both tracks of the pilot program. Case management services will be provided by a contracted vendor. Case management includes: recruitment and intake (candidates from the five participating NCLI coaching sites will be prioritized), as well as assessment of English, health care experience/interest, and personal circumstances. The program design incorporates an ongoing support system for all program participants including: coaching students through exams, school applications and licensing process and identification and resolution of personal issues that may stand in the way of successful program completion. The primary goals of certification and matriculation through tracks one and two require that the Boston Private Industry Council Nursing Career Ladder Program 12

13 contracted vendor provide an integrated continuum of services [see immigrant nursing pilot RFP.] PRELIMINARY PROJECT RESULTS Placeholder for RL and KS summary level data project milestones and progress-to-date LESSSONS LEARNED Career coaching component: Adult Services Employers should be aware that the coaching component is only as successful as the staff that supports it. This career ladder program takes time and effort on the part of internal staff to organize and implement. Overwhelmingly, all five pilot sites involved in the program report that a significant amount of time is required from the human resources and other staff to introduce and sell the idea to those working within their institution - - both potential participants of the program, as well as the managers and supervisors of the participants. As one Human Resource staff person said, It would have been useful if someone had told me about how much time it was going to take so that I could have prepared. If others are considering taking on a project of this scale, they should be warned. Allow the maximum amount of lead time to educate the staff about the program before it begins. Educate through a wide variety of different types of messaging including internal and external newsletters, staff meetings, s messages, print material in the cafeteria and in the human resources offices, and word of mouth. Staff time is not the only resource needed for success. The issue of adequate and consistent space in which coaching meetings can take place is significant. Employees express their frustration when the time that they have allocated to spend in a coaching session is taken up by trying to find private space to meet. It is the role of the staff at each employer site to arrange for appropriate and consistent meeting space. At many health care facilities, space is at a premium. Taking the time to reserve space for coaching sends the message that it is valued by the institution. The career coach and human resource staff are aware of the initial concerns of employees who are considering enrollment in a nursing program. They revolve around 3 areas: Boston Private Industry Council Nursing Career Ladder Program 13

14 paying for nursing school, beginning the process of going back to school, and mentoring or other support from their employer while in school. A staggering amount of information on financial aid exists for prospective students. However, it is not presented in a user-friendly format or in an integrated fashion. The process of researching financial assistance can be overwhelming and confusing. Identify the most relevant information and package it into manageable categories for employees. Presenting scholarships specific to nursing and health care makes it easier for program participants to follow-up on locating resources to fund their education. Targeted scholarships can be found on the websites of professional nursing associations and the school to which the employee is applying. Don t overlook workplace resources. You would be surprised at how many employees don t know what kinds of tuition benefits that their employer offers, observed the career coach. Make sure that they are familiar with any possible in-house resource. In addition, personal financial management workshops are also useful to help students plan wisely. Work with students to develop a timeline with specific tasks and associated deadlines. The career coach has found that some potential students need assistance in mapping out even the most detailed steps involved in going back to school. Short and long term goals for completing nursing school should be articulated and understood. In addition to creating a plan for the future, the coach works with them on current challenges such as restructuring their work schedule and to accommodate competing needs of work, study and other responsibilities. The relationship between the employee and the institution does not end with coaching activities. Students who have ongoing mentoring and individual attention while in school are more likely to stay in school when challenges arise. Recruiting students into the career ladders program is a business decision based on how employers want to spend their staff time. Institutions take a broad range of approaches to the recruitment process. While some employers cast a wide net to attract as many interested people as possible for assessment, others use a selective outreach approach to screen participants into the program. A good assessment process is time consuming, but will result in higher program retention and quality. A strategic approach to developing an internal advisory board will save time and lead to effective decision making when tough issues need to be resolved. Boston Private Industry Council Nursing Career Ladder Program 14

15 The configuration of the right people at the table goes a long way toward creating strategic connections across departments and institutionalizing the program. Certain hospital-wide policies can have significant implications for a career ladders program housed within a human resource department or continuing education department. For example, a schedule of reduced work hours made it possible for one staff member to attend classes while working, but that reduction also affected eligibility for tuition reimbursement. The advisory committee was able to resolve this issue within the group itself because a member of the workforce development department and a member of human resources were presented with the situation at the same time and able to resolve it together in a timely way. Staff not meeting the eligibility guidelines for this grant will need encouragement and alternative resources to stay interested in advancement. Not everyone interested in a career ladders program will be eligible or appropriate. In some institutions, the program will meet its capacity. Staff needs to know about other resources and how to access them so that they can educate interested employees about how to pursue other avenues of education and training. It is not unusual for staff to be stumped when asked about their own employee benefits. Coaches should be aware of the benefits provided at each institution and be able to guide the employee through the definitions and guidelines of those benefits. They should be knowledgeable about all employer sponsored resources available to them such as tuition remission/reimbursement, as well as outside educational and financial aid information and support services. Projects with multiple partners can be confusing to everyone - - even staff who are implementing the program. Present a clear and focused explanation of the program from the beginning so that employees administering the program as well as employees participating in the program know who is responsible for what and the roles that everyone plays. In an initial meeting between the career coach and the participant, there are many questions about the role of the coach and why she is doing what she does. The coach makes it clear that she does not work for the participant s employer but for the Boston Private Industry Council which is funded by a grant from the Department of Labor. She also describes that she works closely with the staff of the participant s employer and reviews the reasons that the employer became Boston Private Industry Council Nursing Career Ladder Program 15

16 involved in the project. It is useful that participants know their employer is supportive of this program and wants to see them succeed. Career coaching by a person outside of the participating institution has benefits and liabilities. The model of a career coach coming to an institution to coach employees works well because it allows the coach direct access to employees without the concern of an employer learning all about their business as described by one participant. Employees are more inclined to provide relevant personal and financial information and share more about their professional hopes and aspirations - - key to successful coaching. At the same time, coaches have a limited understanding of the internal structure, environment, culture, and politics of the organization. The coach is not always privy to issues affecting employees the way that someone on the inside is. Once the organization transitions the model from grant-funded career coaching to a model operated by the institution, great care must be taken to develop trust and boundaries for coaches working with participants. Career coaching: Youth Services Walk into the school with a workable health care careers curriculum in hand so that the appropriate school staff can have something tangible to consider. Writing the curriculum from the ground up may maximize the amount of input from school staff and it would allow for everyone s ideas to be surfaced. However, it may well substantially delay the actual start date of program by creating the opportunity for too much process and disagreement over details. Have a curriculum outline prepared for staff to react to rather than starting from scratch. The career coach must take a lead role in laying out the expectations for staff and students of the program from the moment that the initial contact is made. This lesson is as true in a high school environment as it is at an employer site. The career coach must roll out the program clearly and cohesively in a manner that staff and students understand. It is likely that the staff and the students may want to know different things about the program (staff may be more focused on administrative and programmatic concerns and students will want to know how the program will directly benefit them.) It is the job of the coach to get the right kind of information to each audience in a way that is customized but consistent. Boston Private Industry Council Nursing Career Ladder Program 16

17 Students need consistency and regularity for meeting times. Considerable follow-up is required to keep students focused and ontrack. RL and KS example from the field? The career coach needs to understand the hierarchy and culture of the public high school environment. RL and KS need some information to flesh this out. Loan forgiveness program Match your intuition about what you think your employee s needs are to the reality. Conduct research in the design phase of the program. We never conducted a formal needs analysis to get a real sense of how the program would be received. Had we done focus groups, surveys and interviews, we would have had more useful information about the needs of our employees, said a representative of the Mass League of Community Health Centers. Management staff members are often excited with programs that assist employees in professional growth and development. Check it out with employees to understand their level of interest in a new program. This will help gauge the amount of participation expected and will help staff plan accordingly. In order for the program to be successful, it has to be structurally embedded in a department within the institution - - either in workforce development or training. Every program needs to be housed somewhere within the organization so that specific people can act as champions and advocates for the program. It also gives the program a sense of identity and importance which will help staff through the organization, recognize it and support it. Internal marketing of a program is time consuming. Implementing a new program successfully takes time - - and lots of it. Staff must have a solid understanding the reasons behind the program, be able to clearly articulate why it will benefit employees, and know who is responsible for its implementation. Publicize the message often and in different formats. Written materials, staff presentations and s about the program should be delivered to the staff on a consistent and regular basis for several months before the program begins. Initially, there was a lot of excitement about the program, but we needed more lead time to do internal marketing so that everyone could understand the benefits and potential long term effects. said one Mass League representative. 17 Boston Private Industry Council Nursing Career Ladder Program

18 The loan forgiveness program had a slow start. It was not until news of the program began to spread by word-of-mouth that employees began to apply in significant numbers. The distribution of written materials and s laid the groundwork for the program, but it took off when colleagues started to talk to each other about it. While the loan forgiveness piece was attractive, more people would have been drawn into the program with a more comprehensive set of financial resources from which to draw. The reality is that nursing school is expensive. While a loan forgiveness program will help defray the cost of an education, the associated expenses of going back to school for any working adult can be daunting. Supplement scholarship information with other realistic resources that will help the participant piece together a comprehensive financial plan that works for them. Full scholarships are rare to non-existent for adults going back to school. Students need to be encouraged that a degree can be affordable by tapping into the many resources that are available to them. PROJECT DOCUMENTS Pilot site application NCLI workshop outline NCLI Intake form NCLI Financial Planning Sheet Adult areer coach job description Nursing education financial aid guide financial aid guide scholarships Memorandum Of Understanding, youth sites Youth Career coach job description Community Health Centers scholarship application Immigrant Nursing Pilot RFP Boston Private Industry Council Nursing Career Ladder Program 18

19 Revised 4/1/03 PILOT SITE APPLICATION PACKAGE Nursing Career Coaching Services What is the Nursing Career Coaching Pilot Program? In June, 2002, the US Department of Labor awarded the Commonwealth Corporation a $2.9 million 2-year grant to develop a statewide infrastructure and test strategies for increasing the Commonwealth s ability to recruit, train and retain nurses. The goals of the Commonwealth s Nursing Career Ladder Initiative are to: 1) increase the number of individuals who enroll in nursing programs; 2) increase the retention of nursing students in their academic programs; 3) improve the retention rate of current nurses. The Commonwealth Corporation selected the Boston Private Industry Council to convene a Nursing Career Ladder Initiative (NCLI) Regional Advisory Committee and manage the implementation of demonstration projects within the MetroBoston region. With guidance from the MetroBoston NCLI Regional Advisory Committee, the Boston Private Industry Council (PIC) will be using a portion of the region s grant funds to pilot strategies for providing career coaching services to adults who are interested in pursuing a career in nursing. The Boston PIC plans to offer these Career Coaching services in partnership with health care institutions that want to support their employees in exploring and preparing for a career in nursing. With the assistance of a subcommittee of the Regional Advisory Committee, the Boston PIC will select health care institutions to serve as pilot sites for the Nursing Career Coaching services. The Nursing Career Coaching services will initially be provided by a coach who will be hired by the Boston PIC with grant funds. The coach will also work with staff from the selected institutions to identify strategies to create coaching services for their employees that will be sustained after the grant period has ended. Coaching services will include: career assessment, career exploration, academic planning, and financial aid coaching. The outcomes of this federal grant are focused on enrollment in post secondary Nursing programs. Our timeline for this project is 16 months. Therefore, the Career Coach will need to work with individuals who will have a reasonable expectation of preparing for enrollment in a nursing program within the year. The Coach will work with employees with a minimum of a High School diploma or GED and who have moderate to high levels of English proficiency. What will Selected Pilot Sites Receive? Selected pilot sites will receive the following: On-site nursing career coaching for employees. (We estimate each site will receive an average of 20 hours/month of coaching services). Created by the Boston Private Industry Council,

20 Nursing career exploration workshop curriculum and materials. Financial aid counseling for employees pursuing nursing careers. Information about financial aid resources for nursing students. Information about the region s nurse education programs. Assistance with forming partnerships with local community colleges and other educational institutions and community based organizations to facilitate employee training and education. Staff training in providing career coaching to employees. Timeframe The Boston Private Industry Council must receive all application materials no later than 5:00 p.m. on Friday, April 25, Pilot sites will be announced by May 15, Services will begin by June 1, The initial grant runs through June 2004, during which time participating pilot sites will be required to submit updates and evaluations of their progress. Facilities may keep all materials received through their participation as a pilot site. Application Guidelines Complete the attached application form (copy as needed) and deliver to Karen Shack at the Boston Private Industry Council (2 Oliver Street, 7 th floor, Boston, MA 02109) no later than 5:00 p.m. Friday, April 25, While pilot facilities must designate one person as the lead contact for the program, it is imperative that all relevant personnel - administrators, supervisors, facility ownership, human resource personnel, organized labor (if targeted employees are represented by a collective bargaining agreement) and employees who might participate in career coaching services - are committed to the goals of the nurse career coach pilot project. To that end, please note that the application must include the signatures of the CEO, COO or Administrator of the facility, the Director of Nursing, the Director of Human Resources, the Director of Nursing Education or Staff Development Director, and the relevant Union Representative(s)* (if applicable); in addition to the facility s designated Lead Contact for the pilot site grant application. *See Section 2 Question 4 Selection Criteria All applications will be reviewed by staff of the Boston Private Industry Council, the Metro North Regional Employment Board, and a subcommittee of the Metro Boston Regional Advisory Group. We hope to select a range of institutions to include: Different types of healthcare institutions (including acute care, community health centers, long term care, home care). Institutions that have established a track record in providing support to their employees interested in advancing their careers. Institutions representing the entire geographical region covered by this grant. Institutions that demonstrate commitment and capacity to sustain these services for their employees. Finalists may be asked to participate in an interview. Created by the Boston Private Industry Council,

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