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TOCICO 2009 ConferenceDealing with theNursing Shortage:An overview of how the Rio Grande Valleysuccessfully employed the concepts of TOCto increase the throughput of locally trainednurses and allied health professionalsPresented By: Dominique HalabyHalaby, DD.P.A.,P A UTSADate: June 66--9, 2009 2009 TOCICO. All rights reserved.1

RIO GRANDE VALLEY ALLIED HEALTH TRAINING ALLIANCEU.S. DEPARTMENT OF LABOR HIGH GROWTH JOB INITIATIVETOCICO 2009 ConferenceAlliance MembersBACKGROUNDThe RioThRi GrandeGd ValleyV ll AlliedAlli dHealth Training Alliance wasorganized to 1) identify twotraining needs in Allied Health inthe Rio Grande Valley and 2)develop a strategic plan to meetemployer’s workforce needs.Dolly VinsantMemorial HospitalV ll InterfaithValleyI t f ithMember Southwest IAF NetworkThe goal of the Alliance is simplyto enable area hospitals to meettheir need for nurses and alliedhealth practitioners with localresidents.2 2009 TOCICO. All rights reserved.

RIO GRANDE VALLEY ALLIED HEALTH TRAINING ALLIANCEU.S. DEPARTMENT OF LABOR HIGH GROWTH JOB INITIATIVETOCICO 2009 ConferenceAlliance was established to:gnursingg and allied health labor Seek collaborative solutions to the region’sshortages based on sound workforce development principles and upholdprofessional standards in education and on-the-job quality service delivery. Develop a regional funding strategy to address the nursing and allied healthlabor shortage Provide the organizational structure and regional voice necessary to addressthe potential political obstacles in addressing the issues surrounding thenursing and allied health labor shortages. Lead a campaign in community awareness on the allied health labor shortage Develop a forum for nursing and allied health students and healthcareprofessionals to address the challenges and opportunities in their professionaldevelopment and ensure student recruitment and retention in the area. Study the allied health shortage through research, focus groups and interviewsto identify potential barriers and possible solutions. Collaboratively implement the strategies agreed upon by members to addressthe shortage.3 2009 TOCICO. All rights reserved.

RIO GRANDE VALLEY ALLIED HEALTH TRAINING ALLIANCETIMELINETOCICO 2009 ConferenceTWC grants 350,607to AHTACity of McAllen grants 350,000 over twoyears to VIDA todevelop plan toaddress allied healthshortage2001Group of Valleybusiness leadersttravell tot GermanyGanddIreland to researchapprenticeshipconcept200220032004AHTA receives 313,000 grant from WorkFORCESolutions2005Hospital CEO’s,Workforce boarddirectors and collegedeans meet todiscuss the region’sstrategy for ‘GrowingOur Own’Houston Endowmentgrants 200,000 toVIDA to address alliedhealth shortageDOL H1-BH1 B granttapproved. VIDA andUTB/TSC begin workon allied healthfeasibilityU.S. Senator John Cornynand Congressmen RubenHinojosa and Solomon Ortizon hand to announce DOL 4 million grantRio Grande ValleyAllied Health TraininggAlliance officiallyformed4 2009 TOCICO. All rights reserved.AHTA begins lookinginto the developmentof career pathwaysand adoption of Kthrough Lifeeducation/ trainingcontinuumAHTA winner of TWC2004 TransitionalWorkforce Award

RIO GRANDE VALLEYTOCICO 2009 Conference The Rio Grande Valley comprises the four southernmost counties in Texasbordering the Republic of Mexico. According to latest Census figures, the Rio Grande Valley's population isestimated at one million residents. As a result of its proximity to Mexico, the area is comprised of nearly 85 percentHispanics.Hispanics The population is also very young. The median age of the Rio Grande Valley is29RGV TOP FASTEST GROWING OCCUPATIONSLicensed Vocational NursingRegistered NursingRadiologic TechnicianSonographerMRT TechnicianCT TechnicianNuclear TechnicianSurgical TechnicianPharmacy TechnicianMedical Lab TechnicianRespiratory TherapistEmergency MedicalTechniciansThe per capita incomeamong the lowest inU.S.SHidalgo County 9,899Starr County 7,069U.S. CensusBioMedical EquipmentTechnician5 2009 TOCICO. All rights reserved.

RIO GRANDE VALLEYTOCICO 2009 Conference Unemployment figures for November 2004indicate that 10.7 percent of the McAllen areag g populationp pand 9 percentpofworking-agethose in Brownsville were without jobs,ranking the unemployment figures of Valleycitiesiti theth highesthi h t ini theth state.t t6 2009 TOCICO. All rights reserved.

RIO GRANDE VALLEY HOSPITALSTOCICO 2009 Conference Hospitalspfind themselves recruitingg from outside the state andas far away as Canada and the Philippines for qualified nursesand allied health practitionersg Foundation,, if states were ranked byy the number Texas Nursingof Registered Nurses per 100,000 population, Texas would rankamong the bottom 10 percent or 45 out of 50. What is perhapsmore striking is that the need for nurses along the border withMexico is greater than the rest of the statestate.7 2009 TOCICO. All rights reserved.

RIO GRANDE VALLEY ALLIED HEALTH TRAINING ALLIANCETOCICO 2009 Conference The issue of a shortage of trained nurses has gottenth attentionthett ti off theth area CEO'sCEO' becausebthisthi hashcaused us to close beds in our hospitals. Closingbeds means a reduction in income. The CEO's have also found it to be in their bestinterest to work together to attempt to help resolvethis problem because united we have a larger voiceand can influence change.8 2009 TOCICO. All rights reserved.

THE ROLE OF THE CHIEF EXECUTIVE OFFICERSTOCICO 2009 Conference The CEO's must communicate with the schools andth legislatorsthel i l ttot encourage changehandd tot "think"thi koutside the box". There is no competition between CEOCEO'ss regardingthis issue, we know that individually we will not starta leap frog effort in increasing salary rates to movenurses between the hospitals because no one winsthat war. We all loose by starting that process.9 2009 TOCICO. All rights reserved.

RIO GRANDE VALLEY ALLIED HEALTH TRAINING ALLIANCECAREER EDUCATION SUPPORT MODELTOCICO 2009 ConferenceRGV ALLIANCE TARGET OCCUPATIONS(Feasibility Study Results)Traditional Health Occupations CareerProgramsLicensed Vocational NursingCERT Vocational NursingRegistered NursingAAS -LVN-RN TransitionAAS-Associate Degree Nursing (ADN)BS-Bachelor in Nursing (BSN)Radiologic Technician CT TECHNICIAN MRI TECHNICIANAAS-Radiologic TechnologySONOGRAPHERAAS SONOGRAPHYNUCLEAR TECHNICIANAAS NUCLEAR MEDICINE TEHNOLOGY *SURGICAL TECHNICIANCERT/AAS SURGICAL TECHNOLOGYPHARMACY TECHNICIANCERT/AAS PHARMACY TECHNOLOGYMEDICAL LAB TECHNICIANAAS MEDICAL LAB TECHNOLOGYBS CLINICAL LAB SCIENCERESPIRATORY THERAPISTAAS RESPIRATORY THERAPYEMERGENCY MEDICAL TECHNICIANSCERT/AAS EMERGENCY MEDICALTECHNICIAN (BASIC INTERMEDIATEPARAMEDICS)BIO MEDICAL EQUIPMENT TECHNICIANBS/MS BIOMEDICAL TEHNOLOGY10 2009 TOCICO. All rights reserved.Career Education Support Ladder ModelProgramsNursing Specialty Certification Critical Core/Intensive Care Perioperative Nursing Emergency Nursing Obstetrical Nursing (Labor/Delivery) Neonatal Intensive CareImaging Services: Computerized Tomography Magnetic Resonance Imaging MammographyFirst Assistant (OR)Advanced certification in trauma (ACLS,PALS, ATLS)EMS Instructor Certification

NURSING AND ALLIED HEALTH SUPPLY CHAINTOCICO 2009 otationScreeningSpecialtyTrainingState ExamJobPlacementForeignRecruitmentRecruitment Performed bycollege May require thatstudents attendadvisement Word of mouth Collegemarketingdepartment H.S. articulationagreements anddual enrollmentprogramsScreening Performed bycollege Application Highg Schooltranscript or GED ACT test scores College GPA Transcripts Letters ofrecommendation Completion ofprerequisitecoursework Mastery ofcollege readinessmeasuresCoursework Provided bycollege Traditional track((Biology,gy, Math,,Anatomy &Physiology,Nursing, etc.) Advancedplacement track(Transitioncoursework)Clinical Rotation Performed bycollege inconjunction withhospitalp Provided inconjunction withcoursework Preceptorships Student ratiomandated by stateboards andexternalaccreditingorganizationsState Exam Administered bystate board Review coursesfor licensureexams Operates asquality control toensure programgraduates meetminimumstandards Upon successfulcompletionconferred statenursing and alliedhealthprofessionallicense orcertificationtifi ti11 2009 TOCICO. All rights reserved.Job Placement Performed byhospital BonusesSpecialty Training Performed byhospital Three to ninemonths ofadditional skillstraining Neonatal Obstetrics Pediatrics Critical care Preoperative Emergency care

CONSTRAINTSTOCICO 2009 Conference Hospital (clinical) related barriers Number of available clinical locations Number of available shifts for each clinical procedure Number of qualified and available hospital staff tooperate as preceptors Hospital sponsored post-licensure training drainsresources Policy limitations12 2009 TOCICO. All rights reserved.

POLICY CONSTRAINTSTOCICO 2009 Conference Texas Higher Education Coordinating Board/Texas Department of Health Reportgtitled Texas-Mexico Border Health Education Needsto the 77th State Legislaturethe “supply of nurses is affected principally by a shortage of nursing faculty,noncompetitive faculty salaries, changes in career preferences for women, andthe aging of the nursing population.” “sets for the requirements for the ratio of faculty to students in clinical learningexperiences for basic nursing education programs (diploma, associate degree,baccalaureate degree, or entry-level master’s degree) and post-licensurebaccalaureate nursing education programsprograms” Requires that master degree nurses operate as clinical teaching assistants forno more than 10 students Rule 215.10 (g) (1) enables baccalaureate nurses to serve in conjunction with amaster degree nurse and be permitted to serve an additional 5 students or 2:1513 2009 TOCICO. All rights reserved.

2004 HOSPITAL STAFFING AND STUDENT CLINICAL PATTERNSTOCICO 2009 Conference14 2009 TOCICO. All rights reserved.

PREVIOUS RESPONSETOCICO 2009 Conference Hospital-sponsored financial aid programs Faculty sharing Employment bonuses Foreign recruitment Mexican nurses15 2009 TOCICO. All rights reserved.

COLLEGES/UNIVERSITIESTOCICO 2009 Conference The “Career EducationL dd ” isLadder”i an existingi tistructure that allowsstudents/workers toprogress frombeginning to higherlevels within theirprofessionsM.S.N.Certified RNSpecialistRegisteredNurseVocationalNurseC.N.A.16 2009 TOCICO. All rights reserved.

RIO GRANDE VALLEY ALLIED HEALTH TRAINING ALLIANCEU.S. DEPARTMENT OF LABOR HIGH GROWTH JOB INITIATIVETOCICO 2009 Conference Traditionallyy students/workershave tried to climb the CareerEducation Ladder on their own.Some make it by balancingwork, school and family.Others are less fortunate.17 2009 TOCICO. All rights reserved.

RIO GRANDE VALLEY ALLIED HEALTH TRAINING ALLIANCEU.S. DEPARTMENT OF LABOR HIGH GROWTH JOB INITIATIVETOCICO 2009 Conference With the critical shortage ofy, we needhealthcare workers today,more people on the careereducation ladder. We cannot afford to lose capableworker/students.18 2009 TOCICO. All rights reserved.

THE CAREER EDUCATION SUPPORT LADDERTOCICO 2009 Conference The workplaceprovides supportpppthrough clinicalresources andeducation programsupport initiatives.Educationaltil EdInstitutionsprovide moresteps throughcareer ladderprogram options,flexible coursescheduling,student successinitiatives, anddistance learningdelivery models. The Department of WorkplaceLabor providessupport throughtargetedinvestments titutionWith support more can climb and faster!19 2009 TOCICO. All rights reserved.

RIO GRANDE VALLEY ALLIED HEALTH TRAINING ALLIANCEALTERNATIVE PROFESSIONAL MODELTOCICO 2009 Conference Adjustment of policies regarding clinical/studentratiosti andd preceptort qualificationslifi ti Regional student/clinical scheduling system Hospital support system for staff participation aspreceptors Retention servicesser ices Formalized specialty instruction for post-licensuretraining20 2009 TOCICO. All rights reserved.