PASSAGE TO NURSING. I. Laying the Foundation

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1 PASSAGE TO NURSING A case study by: Karen Nemeth Project Director Partnership Facilities: The Boston Home, The German Centre, Sherrill House September 30, 2005

2 PASSAGE TO NURSING This case study examines the efforts of three facilities, The Boston Home, Sherrill House and The German Centre, to partner on a program that aims to assist CNAs in their pursuit of nursing studies. The primary intervention consists of a 45-hour centralized training course teaching literacy and study skills in the context of introductory nursing material. Facility based follow-up, assistance and career counseling is available through site coordinators. Of the 14 students who completed the first 30 weeks of the course, three have thus far been admitted to nursing programs. Optimism exists for additional students to be accepted for enrollment after completion of the course in December, I. Laying the Foundation The Boston Home is a 96 bed skilled nursing facility in the Dorchester area of Boston that serves individuals severely disabled by multiple sclerosis and other neurological diseases. In 2002, The Boston Home applied for and was fortunate to receive Round I ECCLI funding. The next two years saw the development and implementation of an intensive Career Ladder initiative one that was extremely well received, invigorating and thought provoking. The Boston Home was successful in meeting most of its objectives, a notable accomplishment given the fact that the facility was also in the midst of a major renovation and expansion project. By the end of 2003, 11 C.N.As earned career advancement through ECCLI training with wage increases ranging from $.50 to $2.00 an hour, and an additional 10 aides were in the process of completing requirements for senior aide training. Progress was more difficult when looking for career advancement to professional levels such as nursing school. Participants functioned well in their jobs and were conversationally fluent in English, their second language. They consistently struggled however to understand material when presented in paragraph or chapter form, often missing the main topic of a paragraph or subtle meaning of a sentence. Through its participation in Paradigm, a corporation formed by three not for profit organizations in Boston, The Boston Home had an existing venue to discuss their experience. Individually, each member of Paradigm had participated in and benefited from prior ECCLI projects; The Boston Home from Round I, The German Centre with a Round III grant and Sherrill House (along with ACCT - a corporation with Mt. Pleasant, Rogerson House and Spring House) from a Round I & II. With ECCLI funding, each developed career planning interventions, basic language and life skill training, and clinical career advancement programs unique to their site. 2

3 The German Centre and Sherrill House had successes and difficulties similar to The Boston Home. The ECCLI Career Advancement program was most successful at advancing aides within clinical rungs still at the C.N.A. level such as restorative aides, CNA mentors and dementia care specialists, Over 40 CNAs at the two organizations were promoted to higher paying positions along the CNA career ladder. At the level of college prep or actual nursing training there were some successes (most notably with aides who spoke English as their first language) but literacy and learning barriers were apparent for most. Once again, examples of employees being conversationally adept but with reading, comprehension, writing composition and other literacy deficiencies were evident. The Boston Home, Sherrill House and The German Centre sought to partner on the ECCLI VI grant in an effort to develop creative solutions to a shared problem. Partnering allowed The Boston Home to broaden its approach while maintaining greater efficiencies and better chances for sustainability once grant funding ends. Project Goals Even for employees who function well in senior nurse aide positions, literacy and learning skills strong enough to allow success with college level courses are often lacking. Language and basic skill classes alone are not always attractive to participants, and maintaining interest and motivation over the long-term can be a challenge. The goal of this ECCLI grant was to develop and provide an interesting and motivating course that combines literacy and basic skills with nursing fundamentals, with the objective of improving the chances for admission to, and success in a nursing program. In partnering we also hope to develop an effective and cost effective model upon which to build future shared workforce development activities. Project Model, Start-up and Implementation Structure One of the early structural decisions the partnership faced, even before applying for the ECCLI grant, was whether or not to expand the partnership to others. As word of ECCLI VI spread and interest increased, additional health care providers ranging from housing and home care organizations, to other nursing homes, expressed interest in joining as partners with the Paradigm facilities for the ECCLI grant. There was much discussion on this topic, as there were compelling arguments both for and against broader participation. On the plus side of the discussion for partner expansion was the realization that such expansion could provide an opportunity to expand the knowledge and experience base as other partners came to the table with different expertise and experience. In addition, the common thought was that a larger coalition would enhance the groups positioning for 3

4 actually being awarded the grant. The proposal guidelines called for partnerships, and with limited funding available there was concern that competing applications within a city would not be viewed as highly as one larger partnership. Concerns with expansion of the partnership focused on the practicality of administering a grant for a broader constituency. Experience with Paradigm and initial planning meetings for ECCLI VI gave the partners a level of comfort with the fact that they had similar needs, an agreement as to an approach, and compatible styles. There was, in other words, already a good thing in Paradigm, the benefits of which the partnership wanted to maintain. Addressing the different needs and styles of additional organizations was viewed with caution. The final decision in terms of structure of the partnership sought to combine the best elements of both approaches. The core partnership for the grant, and the voting membership for grant activities, consisted of the three Paradigm nursing facilities with The Boston Home as the lead applicant. The group committed to offering enrollment to employees of other interested organizations as space permitted, and to participate in meetings for the sharing of ideas and approaches. Memoranda of understanding to this effect were drawn up with the other organizations who expressed interest at this level. Governance, vendor selection, program identification and other direct grant decisions however would rest solely with the Boston Home, Sherrill House and The German Centre. Project Management From the start, the Paradigm partnership saw the model of management for ECCLI VI as an important area to concentrate on one that is sometimes given a back seat to programming yet is an essential feature of an effective intervention. A few common observations emerged when the partners reflected on what to consider in plans for a management structure for ECCLI VI. Common thoughts among the partners included the following: Collaborative arrangements, while positive in terms of shared experiences and knowledge, can be time consuming on an administrative and management level as groups seek to find time for centralized meetings and decision making; Strong centralized direction is necessary to keep all the players on the same page, identify problems and solutions, and move the process along; Even with centralized direction, buy-in and coordination at the facility level is imperative; and creating a time and cost efficient form of management is important for sustainability. 4

5 With this in mind, the partners sought to develop a project management model that was efficient at the centralized level while also responsive and sensitive to organizational differences at each facility. The planned model consisted of three main components: Centralized project direction: A project director on a limited consulting basis was planned to provide overall executive direction and leadership for grant activities. The Project Director was expected to work closely with facility-based program coordinators and outside contractors to negotiate contracts, define the scope of work, establish goals, launch the program, monitor progress and provide ongoing problem solving as needed. Facility-based coordination: The partnering facilities agreed that each would designate a facility-based site coordinator to organize and oversee facility-level grant activities, provide tutoring and follow-up on a weekly basis and coordinate career counseling or referral as needed. Subject specific coordination: In addition to facility level responsibilities, the model called for each site to assume a lead role in developing specific program components that would then be shared with the entire group. There was general optimism regarding the model, as it seemed to provide the foundation to build on skills and knowledge at the facility level, while allowing for focused, but limited, central management. Shortly after receiving the ECCLI grant, a consultant, well known to all three organizations and with prior nursing home and workforce development experience, was retained to: Provide overall direction for the ECCLI VI grant; Set up means for communicating between all site coordinators, executive directors and other key players; Establish and monitor budget; Convene partner meetings, develop agenda; chair meetings and address major issues; Negotiate consultant contracts; Develop billing tool for sites to use for reporting to The Boston Home; Develop mechanism for compliance with Commonwealth Corporation requirements; Develop a career counseling tracking form for use by all sites; Offer ongoing advise on program structure; Each facility also appointed a site coordinator to organize and direct their activities under this grant. Site coordinators were assigned primary responsibility as follows: The Boston Home intensive Passage course and ECCLI financial reporting; The German Centre career counseling; Sherrill House the VOCAL mentor program. Feedback and input 5

6 from all partners were expected, but site coordinators were charged in defined areas to use their expertise to provide leadership in their assigned programmatic area. Prior familiarity with the organizations and their ECCLI activities by the Project Director and the site coordinators allowed for relatively efficient start-up. After an initial kick-off meeting attended by the project director, executive directors, nurse managers, site coordinators and select educational contractors, subsequent communications most often took the form of phone conferences and s. Site coordinators converged weekly for the course and used the opportunity to review concerns and share information. There was frequent communication with the project director and site coordinators on common issues as well as ones specific to the particular organization. Site coordinators kept executive directors and nurse managers informed at their facility and solicited input on a regular basis. Additional venues for input existed during the partnership conference calls and by direct contact with the project director. Eligibility and Recruitment The partners, site coordinators and instructors all agreed that criteria for enrollment would be more selective than was the case for the career ladder courses within the C.N.A. role. Candidates were considered if they had tenure for at least one year; acceptable performance reviews including attendance, attitude and skills; a GED or high school diploma; and a working knowledge of conversational English to the point where English ability did not regularly hinder current job performance. Other employees with an interest in a nursing career who were not at this level were offered career counseling advice but encouraged to participate in ESL, GED or other appropriate training first. Recruitment took place in a number of ways. Sherrill House took the lead in developing a brochure that was adapted for each facility (Appendix A ). These were posted in various locations, included in paychecks and handed out to managers and supervisors to make them aware of the program. Announcements were made at staff meetings and site coordinators also met with various groups. One to one outreach took place as site coordinators and managers knew of the career goals of some individuals because of prior workforce initiatives. Outreach and brochure sharing also occurred with two non-nursing home groups that were a part of alliance activities with Sherrill House on prior ECCLI grants and had expressed interest in our activities Rogerson Communities and Mount Pleasant Rest Home. Marketing was done in an enthusiastic way, but with a dose of realism this was a focused course for preparation towards nursing studies. Whereas much of prior ECCLI career ladder courses were offered during scheduled shift time, employees knew they were being asked to split the hours between paid release time and their own. Completing the course would not lead to a direct increase in pay, only a better chance of successful testing and performance for nursing school. The partners knew what dedication would be 6

7 required to succeed should employees be accepted into nursing school. This was a supportive test as to the level of commitment that existed. We had hoped for twenty-four employees to enroll in Passages. We exceeded this by having thirty-two employees from five different organizations meet the initial criteria and proceed to testing. Passages planning Central to our intervention was the development of a course to help participants prepare for entrance into nursing programs, and enhance their chances of success once they were there. We did not have extensive testing data when Passages was being planned, but prior ECCLI projects had given each organization a sense of their employees needs, and ongoing conversations with them continued to provide information. Discussions also occurred with other educators at community and local colleges and with our lead instructor, Dr. Dorothy Brissenden, a professor at Laboure College s nursing program with years of experience in nursing education. We tried to address a few important points as we moved forward: Although baseline testing was not complete, we expected concerns around literacy skills to be evident, especially in the area of reading comprehension. We had seen such issues arise in prior trainings and they were shared by others in the field. Study and time management skills were seen as a need, especially for those students who had not been enrolled in any program since high school. Educators spoke of the need to develop critical thinking skills for prospective nursing students. Nursing directors underscored the importance of this as for success on the job as well. Students had limited experience in test taking and had considerable stress around such requirements. Maintaining interest in literacy and study skill type of courses is a challenge. Some employees had been taking ESOL and related courses for a number of years. Taking a nursing course was seen as important for confidence and motivation. We could have offered separate courses by various workforce partners in such topics as Writing and Composition 98, Critical Thinking 100 and Effective Communication 99 similar to what is done at community colleges for pre-credit courses. Although this may have addressed some of the skill-based issues, we were concerned that such an approach with a number of different teachers and discrete course goals would feel like a 7

8 fragmented journey for our employees. We wanted a different and more cohesive solution. The Boston Home had already been looking into creative interventions for nursing preparation with Dr. Brissenden, and suggested adaptation of a foundational nursing course she taught at the college level. The course aimed at assisting students in skill development around study habits, time management, organization, critical thinking and testing, all in the context of medical language and nurse competencies. The approach of integrating these skills with nursing related material was of much interest to the partnership and we agreed to offer this type of course during ECCLI VI. Passages was planned to consist of one, two-hour class a week, over three 15-week semesters, with two week breaks in between. Homework assignments were to be given weekly. The course would rotate every 15 weeks to one of the three partner organizations. Our training model also called for homework assistance and review to be available at each facility during the week, led by the respective site coordinators. Each coordinator was expected to attend a percentage of the Passage classes, both to assist the lead instructor as well as to become more familiar with the training material and specific teaching techniques used. Coordinators not attending a specific class would be apprised by the lead instructor of the topics actually covered, areas of emphasis, assignments, and suggested follow-up lessons and materials. Each site coordinator was given the flexibility to work with facility administration and management to organize its specific approach for the weekly follow-up, taking into account participants input and the particular resources and operational factors of each organization. We anticipated a combination of small groups, drop-in times and individual counseling. Baseline Testing An important part of our model was the use of standardized testing. Whereas earlier ECCLI interventions looked at advancement along an internal career ladder according to criteria established by each organization, our goal for ECCLI VI was to advance employees to training outside of the facility at educational institutions where standardized testing would be required. The partners agreed that objective baseline and follow-up college preparatory testing should therefore be integrated into this level of ECCLI intervention - to provide objective data as well as an opportunity for practice by our students. A local college had generously offered free computer-based testing using their Accuplacer college placement tool, and we planned to take advantage of this offer for baseline and follow-up testing. Unfortunately, our recruitment occurred during the summer, and we were not ready for testing until August of 2004 around the same time 8

9 they needed to have full access to their testing computers to accommodate a larger than usual number of prospective students. We remained hopeful that openings would occur, but it became clear that an alternative was needed. The Passages instructor suggested use of the Stanford test focusing on literacy skills. The test offered a few advantages for early testing: it was pencil and paper versus computer and could remove the bias of potential computer difficulty for our students not comfortable with computers; sub-score test analysis was available; site coordinators could be trained by a qualified trainer and the testing could occur on a timely basis at each facility. We had originally set a level of 9 th grade performance on the Stanford for admission into Passages. Less than half of the students tested at this level. We were concerned that some of the low scores were due to problems test taking problems and nervousness. To give as many students as possible a chance, we lowered the criteria for participation into the program and selected 30 for the program, suspecting there would be attrition after the first semester. One of the 30 students was already an LPN but was interested in the course for RN studies. She was empowered by her success in the baseline testing and took entrance test for an Associates Degree program. She was accepted and therefore did not continue with ECCLI. Passages revised We originally planned for the full 45 weeks of Passages to be taught by Dr. Brissenden. As we were able to evaluate the actual pool of participants and obtain baseline testing results, it became clear that a more focused initial intervention on literacy skills would be needed for the first 15 week semester. We were fortunate to have a dynamic instructor who had been working on ESL courses with The Boston Home available for this purpose. The format would stay the same as originally planned for Passages, but the curriculum during this period would pay more attention to broader non-medical vocabulary, sentence structure, comprehension and writing. Although we knew all students were not up to this level, the course was geared to 8 th and 9 th grade literacy so as to be of use to those best positioned to move on to nursing studies. If this level proved too aggressive for certain students, even with facility-based help, they would be referred to other ESL classes within their organization or elsewhere. The revised first semester of Passages began in September Attendance throughout the 15 weeks of literacy training was excellent as was feedback about the teacher, content and the tough but caring teaching style. Many students felt the course to be challenging, but worked with mentors and site coordinators during the week between classes to master the material. Dr. Brissenden also attended some of the classes to get to know the students, provide continuity with her part of the course which was to begin in January, and reinforce that these first 15 weeks were integral to preparation for nursing studies. 9

10 Although feedback was good, the course proved difficult for those with low baseline testing scores. By the end of the first semester, four students dropped the course because of difficulty. Another two finished the semester but did not want to continue due to personal situations that could not be remedied even after meetings with the site coordinators. Another six students were advised to continue with more basic literacy classes instead of proceeding with Passages. The second semester of the course was a more selective group of 17 individuals. The content was expanded to the nursing fundamentals portion taught by Dr. Brissenden (refer for Appendix B for syllabus). From the beginning, students were excited about the nursing and health components they were reviewing. Attendance continued to be good and students appeared motivated. Written, anonymous course evaluations at the end of the semester showed that students were very pleased with the course and were looking forward to more this despite the hard work that most needed to put into the course to succeed. Almost all of the respondents reported needing to spend more than five hours a week reviewing, studying and completing homework. But the intensity of the course seemed to motivate the students, as reflected in one of the written comments: You can never absorb enough knowledge. Everyday I learn something new and it empowers the mind to yearn for more. This course was great. So was the instructor. And from another: I thank all of the people who helped put this course together, especially the teacher Mrs. B. and I wish we could go on until we all got licensed. God bless you all. As enthusiastic as the majority of students were, there was the shared opinion with the instructor and site coordinators that a break was needed for the summer. Site coordinators used the time to work with another area of literacy use of a computer. A consultant worked on a very limited basis to design simple interventions for the site coordinators so as to introduce students with no or limited familiarity with computer usage to word processing and internet techniques. This summer intervention served as a way to keep students in touch with the program and learn a new skill, while taking a rest from the rigors of the main Passages program. Students are now three weeks into the past semester of Passages which began in September Added to the subject matter this semester are topics concerning mathematics in nursing, along with a continuation and reinforcement of the skills and material covered in the spring semester. Career Counseling 10

11 In prior ECCLI grants, all three facilities contracted with a workforce development firm, WorkSource, for assistance in career planning and counseling. WorkSource provided a range of activities ranging from employee and management seminars, teambuilding, and individualized career counseling. Much had been gained from WorkSource s input, and the groundwork for ongoing career counseling had been laid. With ECCLI VI the partnership felt ready to move to a more sustainable model where career planning was done in-house, versus with outside consultants. Of particular help was the fact that facility-based coordinators were all involved in prior ECCLI grants, and had gained a certain amount of expertise as a result of workforce development activities at their organizations. After discussion with the executive directors and site coordinators, agreement on the following approach was reached: Career counseling for those enrolled in ECCLI VI would be the responsibility of the site coordinators; Because of interest and expertise on the part of the site coordinator at The German Centre, this facility would take the lead in career counseling, data collection and related activities for the partnership; WorkSource would be retained for consultation to the site coordinators if special areas of interest or need arose, as well as for employee select employee seminars. A common form for documenting individual career goals and interventions was developed by the Project Director for use by all three facilities (Appendix C). Site coordinators meet with each employee on a separate basis to ascertain and document past education and training, demographic information, career goals, strengths and concerns. As additional interventions or career changes occur, the career plan is updated. VOCAL Mentoring - Volunteers for Career Advancement & Literacy Two of the organizations in the partnership had positive experiences in training and using employee mentors, and there was interest in extending this concept to the Passages program. The partnership thought it could leverage its not for profit status by calling on community members, staff, families and existing volunteers to launch an innovative mentoring program, VOCAL - Volunteers for Career Advancement & Literacy. With the VOCAL program we hoped to recruit and train volunteers to partner with us in our campaign for literacy and advancement. While our VOCAL intervention seemed to be unique in the nursing home setting, using volunteers for literacy and educational interventions had precedence. We partnered with an organization that had a long history of providing such services. Literacy Volunteers of Massachusetts (LVM) is a Boston-based not for profit group with more than 20 years experience in their field. LVM agreed to assist us in providing guidelines for screening 11

12 and assessment of volunteers for the VOCAL program, and conduct an 18-hour training for selected volunteers. We expected that following training, volunteers would make a commitment of at least one hour per week performing a variety of activities ranging from practicing phone skills, reading newspaper articles or discussing issues of the day with employee match. The site coordinators were expected to work with the volunteers to keep them abreast of students coursework so that practice areas would be relevant. Difficulties came early with our VOCAL program. First was the timing of our recruitment efforts July and August. Outreach during these months was ineffective, and trying to schedule training was close to impossible. We delayed the training until the Fall to give more time for recruitment and attendance at training sessions. A flyer (Appendix D) and recruitment guidelines were developed by Sherrill House, the lead facility for this aspect of the grant and September and October were used for recruitment efforts. We also had problems with the 18-hour length of the training for VOCAL mentors, and difficulty in agreeing on a location and time where the majority of the volunteers from the three sites could meet that also coincided with the availability of the instructor from LVM. We attempted to contract for additional training times to increase flexibility but instructors were not available. We asked for LVM s assistance in changing the training from 18 to 9 hours, changing the focus to a training of trainers where site coordinators were trained to then train the volunteers their organization was able to recruit. By October 2004, mentors had been recruited for all Passage participants requesting one, (the majority did), and training of the site coordinators and other facility representatives began that month. The training by LVM was very well received with strong praise for the content as well as for the instructor s skills. The site coordinators then used their knowledge to assist mentor volunteers in their endeavors. Mentors were assigned to students by November and at first the program appeared to be working well. Students and mentors reported regular meetings and work on vocabulary and writing homework for the first semester of Passages. Mentors reported that they were also challenged the new vocabulary words and writing assignments were not easy! There was early success with VOCAL, but as time went on the program lost strength. In two cases, employee mentors were no longer employed by the organization and the students were not interested in a new match. In other cases, there were difficulties finding times to meet. By the middle of the spring semester, few of the VOCAL mentor relationships continued. As we reflected on our experience, we realized that an unexpected outcome of our program model indirectly contributed to difficulties with maintaining excitement for VOCAL. Our site coordinators were all directly trained by Literacy Volunteers and left the training excited and knowledgeable. With the way our program model was structured, the site coordinators were able to work closely with Passages participants without being in 12

13 the situation of directly marking and evaluating them in the courses. The site coordinators had easy access to the students, direct mentor training from LVM and a good foundation from which to build student trust. Each site coordinator reported that participants said they were able to get assistance with course work from them at the facility level,and many students felt the extra time with a mentor was not needed. As a result of working closely with the students, the site coordinators had an opportunity to get to know their participants well, and with the pressure off because they were not the instructor, offering support, encouragement and personal follow-up. Being a mentor became a natural extension of their position. IV. Outcomes, Lessons Learned and Recommendations Successes Governance and Management Model Overall, the partnership was very pleased with the governance and management model it had chosen, and believes it can be adapted for other partnerships going forward. s and phone conferences often took the place of face to face meetings. With the pressures that are on nursing home managers and the difficulties of finding a time that could accommodate all and be accessible. Our method of electronic and phone assembly, was well suited to our needs. Agendas and materials were circulated ahead of time for review and conferences typically took place before 9am. Dividing ownership of different portions of the grant was also effective as sites did not need to become expert in everything. The approach does take work and a building of trust, but allows more efficient use of site coordinator time and leverages the benefit of multiple facilities partnering. It is necessary to appoint a person centrally for overall grant activities. However, provided that the partnering facilities are able to carry out their lead responsibilities for the grant, this position can be effective with relatively minimal consulting hours. Our project was far more cost effective than we had planned, and we believe the design contributed in part to this outcome. Passages and enrollment in nursing schools This report is being written with another semester 15 weeks remaining for completion of Passages. We are pleased however to report that three of the 14 students who completed the spring semester of Passages were accepted to nursing schools and enrolled 13

14 for the September 2005 academic year. Two students are in LPN programs, and one is enrolled in an Associate Degree RN program. The importance of Passages is exemplified by the following vignette for one of these students. Berthilde is a twenty-nine year old woman who emigrated from Haiti in She has always wanted a career in nursing and had taken many courses in pursuit of this goal. She has been a valued employee of The German Centre for Extended Care since She had attempted to enroll in nursing schools in the past but had not been successful in passing the entrance exams. Berthilde participated in 30 weeks of Passages training, career counseling and facility based follow-up. Following these two Passages semesters, Berthilde applied for and passed the nursing entrance exam, with credentials high enough to be admitted to school at Greater Lowell Regional Technical School. According to Berthilde, the emphasis on English grammar along with nursing language gave her the confidence to once again take, and this time pass, the entrance exam for nursing school. She has been in school for a few weeks and is confident that she will have success. When asked if ECCLI has helped her achieve her goals of becoming a nurse, she responded, Oh yes, the courses I took made me feel like I could pass this test and gave me confidence in my English. Since I took these classes, I got into a nursing school. We look forward to other stories of success when Passages is completed in December. Combining literacy training and learning skills with nursing based material Marketing this course as a nursing preparatory course, and teaching skills and techniques for comprehension, word use, writing, math, test taking and time management in a nursing context adds to the appeal of such training. From our experience, it is easy for students to loose interest in basic courses. Put in the context of clinical training, the material is more meaningful and motivating. Career Counseling and Support Site coordinators were able to get to know Passages participants well and work with them on their career goals. Prior ECCLI interventions helped to build experience and expertise at the facility level so these activities could occur in a sustainable way inhouse. There were, however a number of complicated cases that required special expertise, especially pertaining to the validity and usefulness of credentials from foreign countries. Having a lead site coordinator for career counseling with interest, knowledge and practical experience to assist the other site coordinators was very helpful and sets the base 14

15 for a sustainable partnership model. In the absence of such a person at one of the partner facilities, we recommend contracting with an outside group such as Workforce for this expertise, but with the bulk of activities occurring with facility-based personnel. An unexpected outcome of our intervention was the bonding that took place between the site coordinators and the participants. Having a facility based point person who was knowledgeable about the classes and available to students during the week, yet not responsible as the lead instructor was a positive aspect of the model. Although it is a simple tool, the site coordinators felt that the career plan was helpful for documentation and plan on using it for the future. Cautions Volunteer Mentor Program Successful volunteer mentoring programs take more time, expertise and nurturing than we had anticipated and this must be carefully built in to a program. The need for such an intervention should be accessed in light of other supports available to participants such as access to site coordinators on a regular basis. Need and interest may decrease as other supports are enhanced. Choosing Site Coordinators Good people are in high demand. The facilities chose talented and dedicated individuals for the site coordinator positions. Discipline must be exercised by management to allow such individuals to give full priority for workforce training activities. The sharing of responsibilities among site coordinators means that the model is not overly dependent on any one individual, but there is vulnerability if pressures at the facility level temporarily place workforce activities on the side. No magic bullets For the majority of our CNAs, the road to licensure in nursing is a long one. There is no simple solution to advancement when employees have language barriers, literacy issues, personal constraints and other significant barriers and advancement is not realistic for all. It is the rare situation where a 45-hour course alone will ready a CNA for nursing school. We have had success with Passages, but this success is built on a history of workforce activities at the workplace, and ongoing efforts by the individual employees and their organizations. Appendix A: Recruitment Brochure 15

16 Appendix B: Career Counseling Documentation Appendix C: Vocal 16

17 Dreams of becoming a nurse? Let us help to make your dream come true. This fall we are offering an innovative program to prepare CNAs for entry into the nursing profession. Eligibility: CNA in good standing with 2+ years (or hours) CNA experience. High school diploma or GED. Score 50 or above on the College Board Accuplacer Exam (available free of charge ) Cost to student: Program is funded through a grant from the Commonwealth of Massachusetts for career development. Start date: Pretesting: During August 2004 Classes: Start in Sept 2004 and continue until August 2005 Time commitment: 4-6 hours per week. 50% of this is employer sponsored as part of regular work time. Course Includes: 15 weeks of advanced English grammar 30 weeks of strategies for nursing success with math, medical terminology, critical thinking, test taking Private and group tutors For More Information

18 CAREER ADVANCEMENT PLAN: INTAKE FORM Background Information Date: Name: SS# Home Address: Last First MI Street Phone Native language Country of Origin Town Home Zip Code (required) Work Date of arrival Work Information Date of Hire Current Position Hourly Wage Usual Shift Hours per week Education & Certifications: Highest Grade Completed Date Completed GED? HS Diploma? No or Yes If Yes Date Completed No or Yes If Yes Date Completed List Certifications, other training, ESOL courses etc. Type of Course From what organization Date use back if necessary

19 CAREER LADDER PLAN Long-Term Career Goal(s) Positive factors for Obtaining Goal Barriers to Obtaining Goal Keyword & number 1. Steps to goal attainment Date Identified Date Targeted Date Reached

20 PROGRESS NOTES Keyword of Step Date Notes

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22 Dear Friend: As autumn approaches, Sherrill House is preparing to launch a brand new initiative funded under a recently awarded, competitive grant from the Extended Care Career Ladder Initiative, a program of the Commonwealth Corporation. With a comprehensive program of counseling, coursework and tutoring, our goal is to provide interested frontline employees the opportunity to enter nursing school. Sherrill House has been honored over the years to receive other workforce grants that have assisted us in creating a career ladder for certified nurses aides, where specialized training and advancement within the nurse aide position is made available. The success of these initiatives has given us the impetus in this new grant to do more to help our employees reach levels that alone they may view as unachievable namely, becoming a licensed nurse. As motivated as we and our employees may be, our prior experience in workforce development has shown us that we are not yet ready to send a cadre of employees to nursing schools. With English being a second language to many of our aides, we have seen even our most motivated and successful staff struggle with the subtleties of language and literacy at the college level. We intend to use this new grant to change this scenario by giving our employees who are interested in advancement to professional fields a better foundation from which to proceed. The opportunity to create a culture of literacy at Sherrill House is an exciting one, and we d like to invite you to join us. Through our VOCAL Program (Volunteers for Career Advancement and Literacy), we are actively recruiting individuals to provide basic one to one tutoring and support to prepare staff to meet the many challenges of nursing training. If you, your family members or friends would like to be a part of this initiative, please call me at , ext or me at ksoorian@sherrillhouse.org. Training will be conducted by Literacy Volunteers of America, beginning in October. We, and our partners on this grant, The Boston Home, The German Centre, Rogerson Communities, Mount Pleasant Home and Springhouse, are excited about this new opportunity and the critical role volunteers can have in making a difference. A flyer for the VOCAL program is enclosed. If you would like additional information, please don t hesitate to contact me. Sincerely, Karen Soorian Director of Community Relations