For the last several months, a team of UNC graduate students from the Department of City and Regional Planning have been working with Professor Nichola Lowe and healthcare employers in Lenoir County to analyze labor market data and begin building Lenoir County Health Care Career Maps for local employers (including RHA Howell, the primary partner for UNC’s research).
On Monday, August 16th, the Community-Campus Partnership hosted a meeting of healthcare employers and supporting organizations in Lenoir County. The meeting was the capstone event for a project described in previous posts here and here. Graduate students from UNC presented data and facilitated a discussion of workforce challenges, opportunities for collaboration and potential barriers to collaboration.Common challenges for healthcare employers in Lenoir County include retention of entry level workers, recruiting in a rural area, and new employee’s lack of exposure to workplaces. Participants also discussed training gaps. A representative from Lenoir County Community College mentioned that while the community college has had maximum enrollment for the past four years, they have problems with retention as students are unprepared for the coursework and often must juggle jobs, family and school. A representative from RHA Howell mentioned the lack of standardized training for direct support professionals, which has proven to be a barrier their efforts to provide promotional opportunities for direct support workers.
Multiple organizations in Lenoir County are working to address these barriers and training gaps. The RHA Howell Workforce Investment Network and the Lenoir Memorial Hospital Grow Your Own programs were specifically mentioned, both of which provide financial support for employees returning to school for additional training in a health care field. These programs were both formed to increase retention and improve the incomes of entry level workers. The Eastern AHEC (Area Health Education Center) is working to address retention issues at the community college, working with local high schools to ensure students are taking the right courses should they be interested in a healthcare career. The community college has also worked to address this issue through a job skills assessment program (Workkeys) and identifying transferable skills. RHA Howell is also working on standardizing training for direct support workers, working with the internet-based College of Direct Support.
While subsets of employers have different challenges and are addressing the issues in different ways, many at the meeting agreed that there was room for collaboration. Partnerships have already formed between some of the participants, as Lenoir Memorial Hospital acts as a clinical rotation site for community college students, and has participated in some AHEC programs. There was some consensus around the idea of networks and relationships, which could provide efficiency as employees or applicants find that a specific work environment will not meet their needs. Other examples were mentioned, such as the Regional Skills Partnership in the Turning Point Workforce Development Board and the Baltimore Alliance, which could provide ideas for further collaboration in Lenoir County or the Eastern Carolina region. One participant mentioned that addressing common problems in their entry level workforce may be a starting point for collaboration. A potential barrier to this collaboration was discussed, however. Different employers require different skill sets at levels above entry level, a potential hurdle to a multi-employer career ladder.
Conclusions and Recommendations
(adapted from Healthcare Career Ladders in Lenoir Co)
The goal of this project was to identify the causes of staffing difficulties, as well as potential targets for a career ladder initiative. We found that gaps in training, difficulty recruiting licensed professionals, as well as high turnover in entry level positions have led to common staffing challenges. Additionally, lower regional and county wages may make recruitment difficult, particularly for higher level positions. Many of these issues can be addressed through a career ladder program, much like the Workforce Investment Network established at RHA Howell or the Grow Our Own program at Lenoir Memorial Hospital.
A multi-employer initiative could brand the Lenoir County or Eastern Carolina regional health care employers, aiding in recruitment of both high level professionals and entry level employees. For entry level positions, having career advancement options can attract and retain employees who may otherwise seek less difficult occupations. Knowledge of career advancement opportunities can encourage high school students, or even displaced workers, to take the prerequisite courses for health care training programs. At higher levels, having a brand recognized as a high quality employer may allow Lenoir County health care providers to better compete with urban employers.
Additionally, a regional cooperation could address another training gap by utilizing standardized training for currently non-certified direct care givers within the region. Working within the existing state and national standards, adopting common training standards can allow employees to more easily move between employers. Standardized training will create a wider range of advancement opportunities for entry level direct support workers.
A career ladder initiative will be more effective if services are targeted to meet regional employment needs. Based on both the above quantitative analysis and interviews with local employers, we recommend the following:
- Target nursing positions. The nursing workforce accounts for the largest segment of the health care workforce (Broome, 2010). All employers interviewed for this study indicated an established career pathway for the nursing staff, with additional education allowing nursing assistants to become Licensed Practical Nurses, and allowing LPNs to become Registered Nurses. There exist intermediate supervisory and leadership positions at many employers. LPN positions and RN positions both provide above median annual wages, and significant increases over certified nurse aides and direct support professionals. This occupational group has the largest overlap among the employer’s interviews for this study, making it a strong candidate for a structured career ladder program. A significant obstacle may be specialized skill needs, as the health care providers in the county often work to meet very diverse client needs.
- Target high growth technical and therapy positions. The majority of technical and therapy positions identified in this study requires a one to two year diploma or associate’s degree, and provide a significant improvement in annual wages. The nature of the technical positions targeted through a career ladder program should be determined based on the health care providers included in the initiative. Among the fastest growing, however, are medical assistants, dental assistants, emergency medical technicians and paramedics, dental hygienists, diagnostic medical sonographers, medical records and health information technicians, and surgical technologists. Occupational therapy assistants, physical therapy assistants and respiratory therapists are also areas of opportunity. The short amount of training required, income potential and regional need for individuals trained in these areas makes these occupations potential fields in which entry level workers can achieve advancement.
- Provide intermediate steps. The proposed career ladder for direct support professionals, put forth by RHA Howell, provides a good example of creating intermediate steps for entry level workers. As discussed at the stakeholder’s meetings, one of the main barriers to retention in community college programs is financial barriers. Creating intermediate steps, particularly in the nursing assistant and direct support professional fields, based on additional training and on-the-job experience can ease these financial barriers and provide incentives for workers to continue with their training. Even though many of these training programs are only two year programs, meeting prerequisites and working full time may increase the completion time significantly. Furthermore, providing higher level positions for nursing assistants and direct support professionals provides opportunities and rewards to those who are unable to complete an associate’s degree or chose to stay in these occupations. Leadership and advancement opportunities will create a true career ladder with smaller, more manageable, steps.
While these this initial analysis produced these recommendations, establishing clear goals for a collaborative initiative will require continued conversation among health care employers and institutions in the region, much like the meeting described above. It is our hope that this report may provide some common ground for further discussion as these partnerships form.
Will Lambe authored the NC Rural Center report, Small Towns, Big Ideas, and he served as Director of the Community and Economic Development Program at the School of Government from 2009 to 2014.