Research at the University of Southern Maine

Pathways to Higher Education - Health Care Professions In Lewiston

by Steve McFarland, Director, Pathways to Higher Education - USM

Funder: Maine Health Access Foundation (MeHAF)

On behalf of the Lewiston/Auburn Health Care Action Team (HCAT), the Pathways to Higher Education program in the Division of Community and Professional Education at the University of Southern Maine received a planning grant to partially fund HCAT’s planning process that will result in a comprehensive strategy to address the shortage of health care professionals – particularly registered nurses – in the Lewiston/Auburn area.

Background/Need

The three largest health care employers in the Lewiston-Auburn area are Sisters of Charity Health System, Central Maine Medical Center, and Androscoggin Home Care and Hospice. The providers of professional health care education in the area are Central Maine Medical Center School of Nursing, USM College of Nursing and Health Professions, and Central Maine Community College. As part of the USM Corporate Partners' program, these organizations have banded together as the Health Care Action Team to address the ever-increasing need for qualified health care professionals in the Lewiston/Auburn area. Successes of HCAT have included:

Several major employers of nurses have entered into an agreement with Lewiston-Auburn College to jointly advertise for nursing students;
Establishment of an “Earn and Learn” program for current employees of member organizations; and
Establishment of a “Coaches for Nursing Students” program.

There is a need for more nurses and members of other health professions in Lewiston/Auburn. Androscoggin County is designated as a primary medical care and mental health shortage area¹ and as a medically underserved area/medically underserved population.² Since 1999, registered nurse jobs in Maine moved up from second place in highest demand among the 40 occupations with the largest projected net growth in Maine by 2005, to first place with the largest net growth between 1998 and 2008.³ By 2008, the number of registered nurse jobs added in Maine is projected to be 2,676.

Maine’s nursing education programs are unable to produce enough nurses to meet the high demand. Although there are many complex factors that influence this capacity shortage, the majority of the state’s nursing education programs have reported difficulties hiring part-time faculty. Reasons cited for this difficulty include (a) finding qualified people with the Master’s in Nursing credential, and (b) lower than market salaries for master’s-prepared nurses.⁴ Said one HCAT member regarding her organization’s educational program, “There are hundreds of applicants, but only dozens accepted.”

Maine and particularly Androscoggin County have large numbers of people who are educationally or economically disadvantaged. Maine is a leader in getting students through high school, but unfortunately that doesn’t translate into high rates of postsecondary attainment. According to the National Center for Public Policy and Higher Education⁵, in Maine 92% of 18 to 24 year-olds have a high school credential, 4th in the nation. Yet, Maine lags behind the rest of the country in higher education attainment, 37th among the 50 states. According to the 2000 Census, only 22.9% of Maine’s residents aged 25 or older had a four-year college degree or higher compared to 24.4% nationally. In Androscoggin County, the situation is even worse, where only 14.4% of those 25 or older have at least a four-year degree. For young adults, those 25 to 34 years of age, the gap was even wider – 27.5% of U.S. residents in this age group have college degrees compared to 22.9% of Maine residents and 15.5% of residents of Androscoggin County. These undereducated individuals represent a large potential pool of health care workers.

Goals of the Planning Process:

The program partners will respond to these needs by developing strategies to:

Create a career development program that will support and encourage entry-level and paraprofessional employees of health care organizations to achieve higher skill levels through increased access to college-level education. We plan to establish a “Pathways to Higher Education” program at the worksites so that employees will start on a path to health care related degrees by taking college preparatory and entry-level college courses at their employer’s worksite and finish their degree at CMCC, USM L/A or CMMC.
Evaluate options and develop programs to increase the capacity of nursing education programs, including developing strategies to increase the number of adjunct faculty in nursing programs by increasing the number of Master’s level nurses, and by creating strategies that allow health care employers to make qualified nurses available to teach in nursing education programs.
Collaborate with area high schools to establish programs that will create awareness among high school students about health care careers and the postsecondary educational opportunities available in Androscoggin County. Potentially, early college experiences will be made available to students with interest and aptitude for health care careers. One particular population we hope to reach are those who have interest and potential to succeed in college, but never actually attend, estimated to be about 30% of all high school freshman.⁶

Activities to be accomplished include:

Analyze and interpret the results of a survey distributed by the HCAT. The survey was designed to determine the educational attainment, aptitudes and educational aspirations of employees of the three largest health care organizations in the Lewiston-Auburn area, as well as barriers preventing them from participating. 1290 surveys have been returned, representing approximately 30% of the total workforce of the three organizations. The survey results will lead to a series of program design considerations, many of which will be incorporated, ensuring a successful program.
Conduct six focus groups (two at each employer) of employees who express interest in achieving further education in order to gain deeper insights into the perceived and actual barriers and to plan for their removal.
Create Career Pathways models for multiple health care professions. These models will include credit and non-credit educational opportunities, certifications, tests, and other benchmarks that a participant will need to achieve as their career progresses. These models will be made available via brochures and other print media to HR professionals at local health care organizations, health care degree granting programs, adult education programs, career development organizations, and high school guidance counselors.
Review career ladder programs at each organization, recommend enhancements and improvements, and create mechanisms to provide educational counseling, planning, and supportive services to employees who wish to move up the career ladder within the health professions.
Review current articulation agreements between all local health care education programs and recommend actions to improve and promote the transition/transfer of credits between the programs.
Research successful national programs addressing the Nursing faculty shortage and prepare to implement those with the most promise/benefit for our local needs.

Longer Term Outcomes:

Increasing the skill level and educational attainment of the current and future workforce is an investment in the future of high quality health care. Increasing the number of registered nurses and other health care professionals can have no more important impact than increasing access to health care and reducing its cost. Increasing the capacity of nursing education programs and reducing the waiting lists of applicants is a critical piece of the puzzle.

Similar “Pathways to Higher Education” programs at other southern Maine employers have realized approximately 10% of an organization’s workforce completing at least one college credit class, and approximately 5% of employees having the full intention of completing a two- or four-year degree. If results are similar here, this program could result in an additional 200 health care degree holders in Androscoggin county in the short-term (4-6 years), and when fully sustainable, hundreds more over the long-term (10+ years). We plan to closely monitor these expected results, as well as measure the capacity issues of local programs.

Special Considerations:

The Health Care Action Team collaboration is strong, the comprehensive educational needs and barriers survey has been completed, and each organization has committed staff to ensure, as the group’s name implies, action. We’re ready to go.

The strategies contained herein have promise and merit. The “Pathways to Higher Education” program recently received FAME’s (Finance Authority of Maine) first annual Business and Education at Work Award for its excellence in providing greater access to and success in higher education.

Endnotes----------

¹ U.S. Department of Health and Human Services Bureau of Health Professions. Health Professional Shortage Areas Ad-Hoc Database Query Selection HPSA Data Extract as of 11/11/2003; Primary Medical Care and Mental Health. http://bphc.hrsa.gov/databases/mewhpsa/hpsa.cfm.

² U.S. Department of Health and Human Services Bureau of Health Professions. Bureau of Primary Health Care Search Results MUA/MUP as of 11/11/2003. http://bphc.hrsa.gov/databases/mewmua/Results.cfm.

³ Evans, D. (July 2000). Maine’s Employment outlook 1998 to 2008: Industrial and occupational employment projections. Augusta, ME: State of Maine, Department of Labor, Division of Labor Market Information Services, Economic and Demographic Group. Maine Department of Labor. (1999) Maine’s employment outlook, 1994-2005. Augusta, ME. Author

⁴ OMNE Task Force, May 2002, 2002 Overview of Maine’s Nursing and Health Care Workforce, passim

⁵ National Center for Public Policy and Higher Education (2000). Measuring up 2000: The state-by state report card for higher education – Maine, http://measuringup.highereducation.org/2000/reporthome.htm

⁶ Compact for Higher Education (2004). Action Plan. (working draft, final document to be released 4/29/04.)