CRISISOPPORTUNITY

or

H E A L T H C A R E P E R S O N N E L S H O R T A G E :

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A Report of theHealth Care Personnel

Shortage Task ForceDecember 2002

Health Care Personnel Shortage Task Force Members

Brian Ebersole, Chair, President of Bates Technical College

Bill Gray, Vice-Chair, Dean of Washington State University – Spokane

Dana Duzan, Allied Health Professionals

Joan Garner, Washington State Nurses Association

Marc Gaspard, Higher Education Coordinating Board

Earl Hale, State Board for Community and Technical Colleges

Troy Hutson, Washington State Hospital Association

Brian Jeffries, Office of Superintendent of Public Instruction

Linda Lake, State Board of Health

Brian McAlpin, Washington Medical Association

Jeff Mero, Association of Washington Public Hospital Districts

John Nagelmann, Group Health Cooperative

Rick Ouhl, Washington State Dental Association

Gloria Rodriguez, Community and Migrant Health Centers

Ellen O’Brien Saunders, Workforce Training and Education Coordinating Board

Mary Selecky, Washington State Department of Health

Diane Sosne, Service Employees International Union

Evelyn Torkeleson, Washington Rural Health Association

Karen Tynes, Washington Association of Housing and Services for the Aging

Diane Zahn, United Food and Commercial Workers Union

For Meeting Notes and Presentations see the Health Care Personnel Shortage Task

Force Web Page: http://www.wtb.wa.gov/HEALTHCARETASKFORCE.HTM

For additional copies of this report, please go to www.wtb.wa.gov/publications

December 31, 2002

Governor Locke and Members of the Legislature:

Washington State is facing a severe shortage of health care workers in all areas of thestate and in nearly all health professions. These shortages are affecting the quality ofhealth care, and adding to the cost of health care services. Hospitals that cannot findenough staff to fill vacancies are turning away patients from emergency rooms andpostponing or canceling scheduled procedures. Because the health care industry is oneof the main economic drivers in the state, the shortages are also affecting the state’sfinancial stability. As we look to the future, we see the demand for health care workerswill increase because of our aging population and the numbers of health care workersreaching retirement.

In 2002, at the behest of four leaders in the House of Representatives, the WorkforceTraining and Education Coordinating Board convened the Health Care PersonnelShortage Task Force comprising key stakeholders from industry, education and labor. TheTask Force met between July and November to learn from efforts to increase the numberof health care professionals already under way in Washington and in other states, andto devise recommendations for the state. This report is a state strategic plan to addressthe critical shortages of health care personnel.

Increasing our state's health education and training capacity is the top priority. Whenwe consider that Washington’s unemployment rate is hovering around 7 percent, and wehave a health care industry that offers high wage jobs and is clamoring for workers, itmakes sense to train more high school graduates, dislocated workers, unemployed people,and others for health care professions. However, nearly all of the state’s health careeducation and training programs report that they are turning away qualified students dueto lack of capacity.

The Task Force meetings have provided increased visibility to this critical issue,matured the level of debate, and stimulated partnerships among state and local stakeholders.If the legislature and stakeholders implement the recommendations contained withinthis report, we believe we will make immediate and significant progress. We will reversethe current trend and alleviate this critical problem.

Thank you in advance for your attention to this critical issue,

Sincerely,

Brian Ebersole Dr. Bill GrayTask Force Chair Task Force Vice Chair(President Bates Technical College) (Dean, Washington State University-Spokane)

Table of Contents

Executive Summary ......................................................................................page 1

1: Overview.......................................................................................................page 6

2: The Demand for Health Care Personnel......................................................page 9

The Shortage of Health Care Personnel in Washington..................................................page 9

The Consequences ............................................................................................................page 12

3: Challenges and Opportunities for Addressing the ShortageThe Aging Population Intensifies the Shortage ..............................................................page 13

The Necessity of Recruiting Diverse Populations ............................................................page 14

Educational Capacity is Inadequate to Fulfill Demand ...................................................page 15

Recruiting and Preparing Students for the Health Workforce ........................................page 20

Retention and the Workplace Environment ...................................................................page 24

Information for Future Planning ......................................................................................page 24

Empowering Local Communities .....................................................................................page 26

Providing Leadership to Oversee the Plan .......................................................................page 26

4: Recommendations and Outcome Measures .................................................page 28

Goal 1: Increase Educational Capacity ...........................................................................page 29

Goal 2: Recruit and Prepare Diverse Individuals for Health Care Occupations ............page 32

Goal 3: Develop a Data System to Assess Supply and Demand .....................................page 35

Goal 4: Retain Current Health Care Workers ................................................................page 36

Goal 5: Empower Local Communities to Address Shortages .........................................page 37

Goal 6: Track Progress, Create Accountability and Plan for Future Needs ...................page 37

Outcome Measures to Track Progress................................................................................page 38

AppendicesAppendix A: Retention of Health Care Personnel ........................................................page I

Appendix B: Initiatives to Alleviate Health Care Personnel Shortages in Other States.....page VII

Appendix C: Local Health Skills Panels ........................................................................page XI

Appendix D: K-12 Schools Offering Health Careers .....................................................page XVII

Appendix E: Task Force Committee Membership and Presenters ..............page XIX

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Executive Summary

Washington’s health care personnel shortageis at a crisis level. It threatens the quality andaccessibility of health care, the financialstability of the health services industry, andthe financial stability of the state. Thisshortage is structural and different to previousshortages because of demograhpic changes:more health care workers will retire at a timewhen the state's aging population requiresincreased health care services.

As 2003 commences, health care facilitiesacross the state are operating with criticalstaff shortages even though Washingtonreports one of the highest unemploymentrates in the country, at more than sevenpercent. Occupations with critical shortagesinclude nurses, medical aides, dentalhygienists, laboratory personnel, pharmacists,physicians, radiology technologists, billersand coders, among others.

The shortage is so severe, industry hasresorted to importing workers from othercountries, and utilizing temporaryemployment agencies for regular staffingneeds, despite exorbitant costs. These short-term activities have not been adequate tofill the gap between supply and demand,leading to undesirable outcomes. Theseoutcomes include turning patients away from

emergency rooms and delaying scheduledprocedures.

While health care employers search for staff,a large number of Washington’s health caretraining programs report they are turningaway qualified students because the programslack the capacity, faculty and clinical sites totrain them. Fifty-six programs offering nursingand allied health training reported waitinglists in 2001. For example, Washington StateUniversity's School of Nursing turned awaytwo-thirds of its undergraduate applicants.Across the state, health care training programshave reached capacity. However, the numberof people graduating from these programsdoes not meet our immediate or future needs.Increasing educational capacity should be apriority if the severe shortage is to beremedied.

In addition, the diversity of the health careworkforce does not meet current or futurehealth care access and workforce needs. Over5,000 more minority licensed physicians,physician assistants, nurse practitioners andnurses are needed to reflect the diversity ofWashington’s residents. Racial and ethnicminority populations and people withdisabilities are under-utilized labor pools.

HEALTH CARE PERSONNEL SHORTAGE OVERVIEW

A TASK FORCE IS CREATED

In response to these concerns,Representatives Phyllis Gutierrez Kenney(Chair, House Higher EducationCommittee), Eileen Cody (Chair, HouseHealth Care Committee), Steve Conway(Chair, House Commerce and Labor

Committee), and Shay Schual-Berke(Vice-Chair House Health CareCommittee) requested the WorkforceTraining and Education CoordinatingBoard convene a task force, comprisingkey health personnel stakeholders. Upon

"The health care personnelshortage has some very seriousconsequences for all of us inhealth care delivery. We haveto spend more money hiringstaff from temporary agencies,paying very large amounts ofovertime pay and when wehave staff calling in sick, we'rein a real bind. Though we havenot had to divert patients manyof our peer hospitals have...there is just not enough staffto meet all our collectiveneeds."

Terry J. Brennan,PeaceHealth -St. Joseph Hospital

“I tried to get into the RNprogram at TacomaCommunity College but thereare so many people applyingyou don’t know whether you’regoing to get in or not.”

David Ryhal,Dislocated Worker

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this request, the Health Care PersonnelShortage Task Force was established. Thelegislators charged the Task Force:

…to identify ways to increase the capacity ofhealth professions in all areas, especially in thehigh demand areas, review training programs,which have well-designed career ladders, lookat ways to improve recruitment and retentionof students, ways to increase the diversity ofhealth professions and to engage familiestransitioning from welfare to work, methods toencourage unemployed workers to seekemployment in the health care field, and identifyways that state regulations, requirements, andstatutes can be modified in a positive fashion toaddress the health care labor shortage.

In order to fulfill the charge, the Task Forceheld meetings from July to December during2002, learning from a wide range of stateand local efforts, and the experience ofother states. The Task Force formedcommittees on educational capacity, andrecruitment and retention, allowing theparticipation of a larger group ofstakeholders. The committees incorporatedrecommendations from the HealthWorkforce Diversity Network to preventduplication of efforts regarding diversityissues. Following recommendations fromthe committees, the Task Force developedthis state strategic plan to increase thesupply of health care personnel to meetcurrent and future demand.

STRATEGIC GOALS

Goal 1: Increase educational capacity and efficiency in health care training programs to enable morepeople to gain qualifications to work in health care occupations.

Goal 2: Recruit more individuals, especially targeted populations,1 into health care occupations andpromote adequate preparation prior to entry.

Goal 3: Develop a data collection and analysis system to assess health workforce supply and demand.

Goal 4: Retain current health care workers.

Goal 5: Enable local communities to implement strategies to alleviate the health care personnel shortagein their areas.

Goal 6: Develop a mechanism to ensure continued collaboration among stakeholders, track progress,create accountability for fulfilling this plan, and to plan for future health workforce needs.

1 Targeted populations includes underserved populations such as rural communities; racially and ethnicallydiverse youth and adults; men and women; disabled, new immigrants, dislocated and incumbent workers; and military personnel.

The recommended strategies developed by the Task Force address six goals:

WHAT YOU WILL FIND IN THIS PLANTo accomplish these goals this planoutlines 40 strategies and identifies entitiesresponsible for accomplishing each strategy.The Legislature, state agencies, educationalinstitutions, and other public and privatepartners such as community-based

organizations are among the responsibleentities. The complete recommendationsare followed by 16 outcome measures totrack progress. A complete list ofrecommendations and outcome measuresbegins on page 28.

PRIORITY RECOMMENDATIONS

• Provide funds to health care education and training

programs in order to expand capacity and allow for

the higher costs of providing these programs.

Education and training providers report turning away

qualified students. This is due to a lack of funding

and facilities for key programs and services.

Education and training programs must have more

state general funds that account for the high costs

of providing health care education and training

programs. Funding programs located in underserved

and rural communities is essential for training and

educating health care providers who are more likely

to practice in those communities.

• Provide compensation to health program faculty

that competes with wages earned outside teaching.

A major barrier to expanding health care education

programs is the lack of qualified faculty. In some

local areas, employers and education institutions

have been able to share employees. Education

institutions working with the Legislature, labor and

employers should identify ways to increase flexibility

in faculty salary structures to compensate faculty

competitively with wages earned outside teaching.

• Expand clinical training capacity. While most health care

education and training programs include a clinical training

component, educational institutions report severe

shortages of clinical sites and faculty to supervise clinical

placements. Employers and educators are working

together to overcome these barriers. Local health skills

panels are developing coordinated clinical training

placements among educational institutions and employers.

These must be expanded to all health occupations and

areas of the state experiencing clinical site shortages.

• Empower local communities to address the shortage in

their areas. As of December 2002 health skills panels have

been established in eight of Washington’s 12 workforce

development areas. These skills panels are collaborations

of health employers; labor and education providers; and

community-based organizations in local areas. They

implement strategies to alleviate critical shortages. Funding

should be provided to establish health skills panels in the

four remaining workforce development areas, and to

continue support for the existing health skills panels. There

must also be coordination among local panels to enable

them to learn from one another and for the state to continue

to learn from them.

The Task Force recommends four priority strategies that require immediate action toalleviate Washington’s severe shortage of health care personnel:

2 The federal Workforce Investment Act of 1998 required that each state establish local workforce investment boards, known inWashington as workforce development councils. Washington has 12 workforce development councils that are each comprised ofa majority of business representatives, with education, and labor representatives. These councils fulfill the state strategic goalsfor workforce development at the local level.

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Local Health Skills Panels

Health skills panels arecomprised of local healthemployers, educators, andlabor representatives.They meet to develop andimplement local solutionsfor health care personnelshortages. Since 2000, theWorkforce Training andEducation CoordinatingBoard has issued SKILLS(Securing Key IndustryLeaders for Learning Skills)grants to workforcedevelopment councils2 forthe purpose of supportingskills panels in industriesthat are significant for theeconomic development ofthe area. Eight workforcedevelopment councilshave established healthskills panels with thecharge of identifying healthpersonnel shortages intheir areas, designingstrategies to remedy theshortages, andimplementing thesestrategies.(See Appendix C.)

OUTCOME MEASURES

1. Number and diversity of students enrolled in healthcare education and training programs.

2. Number and diversity of students completing healthcare education and training programs.

3. Number and diversity of students training to becomefaculty in health care education and training.

4. Amount of additional funds allocated to increaseeducational capacity in health care education andtraining programs.

5. Establishment of an ongoing statewide system for datacollection and analysis.

6. Establishment of a campaign to market health carecareers.

7. Establishment of a Web site to provide health caretraining/career mapping and financial aid information.

8. Numbers of workforce development councils that haveestablished health care Skills panels.

9. Turnover rates for health care personnel.

10. Level at which health workforce diversity reflects thediversity of the populations served.

11. Numbers of incumbent health care workers receivingtraining to move up a career ladder.

12. Number of high schools offering health scienceprograms, and the number of these that lead tocertification.

13. Proximity of supply to demand of health care personnel.

14. Number of strategies in this plan that are successfullyimplemented.

15. Creation of a formal mechanism that oversees theimplementation of Task Force recommendations, andholds responsible entities accountable.

16. Commitment by the Governor and legislature to targethealth professions education at the true cost.

To ensure accountability for accomplishing the goals in this plan, the Task Forcedeveloped the following outcome measures:

The Task Force decided to exclude twosignificant issues from the discussion toensure progress within a limited timeframe. The two issues are reimbursementrates and scope of practice issues. TheTask Force acknowledges that Medicare,Medicaid and private insurancereimbursement rates are serious issues thatimpact physician supply, the industry’sability to fund workforce development,and the entire health system. The stateshould examine reimbursement issues.However, the membership and time framewere inadequate to address these concerns.The Task Force also removed scope ofpractice issues from the discussion because

associated controversies could preventprogress on immediate, high priority issues.

While not outlined specifically in thecharge provided by the legislators, TaskForce members recognize another issuethat is also very important: retainingcurrent health care workers. This isdiscussed in Appendix A.

Health care personnel shortages areimpacting all areas of the state, thestability of the health care industry, andthe state’s economy. All Task Forcemembers agreed that the priority foralleviating the health care personnel

EXCEPTIONS

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5

shortage is increasing educationalcapacity. With increased capacity inhealth care education and trainingprograms, this crisis could develop into

an opportunity to prepare many of thestate’s dislocated and unemployed workersfor high-wage jobs in health care, andboost the economy.

Overview

Health care employers statewide reportsevere shortages across all healthprofessions and all types of health carefacilities. The shortages are not onlythreatening the quality of Washington'shealth care system and access to healthcare services, but the stability ofWashington’s economy. In 2001,Washington’s acute care hospitals, thelargest employer of nurses, reported ashortage of approximately 2,000 staffregistered nurses (RNs). (This figureunder-est imates the shortage ofregistered nurses because the study didnot include private clinics, federal,rehabilitation psychiatric hospitals, andother settings where registered nursesare employed.)1 Washington’s nursinghomes reported a vacancy rate of nearly20 percent for staff RNs and nearly 15percent for licensed practical nurses.2

Shortages of this magnitude endangerpatients and increase health care costs.

In 2001, 55 percent of emergencydepartments turned away patientsbecause they did not have enoughnurses .3 According to the JointCommission on Accreditation of HealthOrganizations (JCAHO), the primaryaccrediting body of hospitals andcommunity health centers, staffing levelshave been a contributing factor in 24percent of the reported unanticipatedevents occurring that resulted in death,injury or permanent loss of function.4

In understaffed facilities, health care

workers must work longer shifts, moreovertime and be responsible for morepatients. Studies of nurse satisfactionrates report that a high percentage ofnurses are thinking of leaving their jobs.5

W h e n d e s c r i b i n g s o u r c e s o fdissatis faction, health personnelconsistently describe the workplace ashighly pressured and difficult.6 Turnoverrates for nursing staff working in nursinghomes are as high as 95 percent fornursing assistants and 69 percent forstaff RNs per year.7 Washington’shospitals are reporting a turnover rateof about 17 percent for their staff RNs.8

As a result of the shortage, health carefacilities have watched operating costsincrease astronomically. In 1995,contract nursing expenses for hospitalsin Washington were just over $11million, or about $120,000 for anaverage hospital. Four years later, in1999, the figure had grown to over $40million, or an average of over $400,000per hospital.9 Short-term solutions, suchas sign-on bonuses, hiring nurses fromother countries, and more use oftemporary help to fill vacancies are veryexpensive and part of the reason thatcosts have increased at health carefacilities. Because facilities must paythese higher costs, they put fewerresources into developing long-termstrategies for filling vacancies andretaining staf f , such as of fer ingeducational opportunities and workredesign.10

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“In surgery we have a higherratio of nurses to patients.When a co-worker has a dayoff and then one or two otherscalls in sick, it is extremelydifficult to find staff. Even thetemporary staffing agencies areshort – there is just not enoughqualified staff out there.”

Ken Cameron,RN, Group Health

Health care is one of the largest industriesin Washington. Given this, the shortage ofhealth care personnel could have seriousimplications for the economic vitality of thestate. Over 207,000 people are employed inhealth services representing eight percentof the state’s workforce.11 The health careindustry provides over $6.2 billion in wageseach year. This is almost twice as much asthe agriculture, forestry, and fishing industriescombined. Between 2002 and 2008 therewill be over 6,600 job openings in healthcare each year.12 The National Rural HealthAssociation estimates that 20-30 percent ofa rural community’s economy depends onits health care system because it is usuallyeither the major or the second majoremployer in the community.13

The shortage is threatening Washington'scompetitiveness as a desirable place to liveand work. Businesses want to locate incommunities with a high quality of life.Access to health care is a fundamentalcomponent in determining a region's qualityof life.

To address this crisis, four legislative leadersin the State House of Representativesrequested that the state’s Workforce Trainingand Education Coordinating Board convenea task force to address the health carepersonnel shortage in Washington. Thelegislators requested that the task forceinclude key labor, business, education andhealth care leaders and directed the taskforce to identify ways to increase the numberof workers in health professions. The

legislators asked the task force toexamine educa t iona l c apac i t y ;recruitment and retention, includingrecruitment of diverse populations; andchanges to regulations for licensing andaccreditation.

The Task Force reviewed initiatives andrecommendations of previous efforts,inc luding those o f pro fes s ionalassociations; national, state and localhealth care entities; and the experienceof other states. The Task Force formedtwo committees to develop strategiesf o r e d u c a t i o n a l c a p a c i t y, a n drecruitment and retention. Committeemembership was expanded beyond TaskForce members to encompass a wideportion of stakeholders from industry,labor and education (see Appendix E forlist of committee members.) Committeesexamined a wide range of strategies,and determined they addressed:

• Rural and urban Washington

• Increasing the diversity of the workforce

• All types of health care facilities

• All health care occupations (or occupational specific)

• Impact on quality of health care, and cost v. benefit

The Task Force asked the HealthWorkforce Diversity Network to makerecommendations to the EducationalCapac i ty and Recru i tment andRetention Committees on increasingthe diversity of the health careworkforce.14

“The health care sector is animportant economic driver dueto its size, projected growth,average wages andconcentration. Health care isnot only an important economicdriver in each region, but alsofor the state as a whole.”

Dr. Paul Sommers,Deena Heg,Occupational Demand andSupply by Industry Clusterand Region

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Task Force members narrowed the rangeof topics open for discussion to ensureprogress could be made on key issues. Forexample, Medicare, Medicaid, privateinsurance reimbursement costs, and scopeof practice issues can impact the supply ofhealth care personnel but the Task Forcepurposefully did not address these. WhileTask Force members acknowledge theseare important issues that the state shouldexamine, they were beyond the charge ofthe Task Force. The Task Force prioritizededucational capacity and recruitmentissues.

The members of the Task Force agree thatthe priority for alleviating the shortage isincreasing educational capacity. Educationand training institutions must be giventhe funding to expand their programs,

secure state-of-the-art facilities, train alarger number of qualified applicants, andprepare for a large number of students tobe served by health care programs. Inorder to have sufficient capacity, healthcare education and training faculty mustbe compensated at a level that competeswith industry wages. In addition, localeducation institutions, employers andlabor must receive assistance to enablethem to craft solutions that address theirspecific needs.

This report discusses key issues andchallenges Washington faces in workingthrough this shortage and recommendsstrategies for the Legislature to pursue. Italso serves as a strategic plan for stateagencies, educators, labor, employers andworkers to take immediate action.

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The Demand for Health Care Personnel

Washington is experiencing a severeshortage of health personnel in all areasof the state. Health occupations that facecritical shortages include nurses, medicalaides, dental hygienists, billers and coders,laboratory personnel, pharmacists,physicians and radiology technologists,among others. In 2001 the Center for

Health Workforce Studies at theUniversity of Washington and theWashington State Hospital Associationconducted a survey of the 83 acute-carehospitals in Washington.15 Results shownby workforce development area, provideevidence of the statewide problem(see Figure 1.)

THE SHORTAGE OF HEALTH CARE PERSONNEL IN WASHINGTON

Fig. 1: Difficulty of Recruitment in Washington Hospitals: Workforce Development Area (See map in Appendix C)

(1)Olympic

(2)Pacific

Mountain

(3)Northwest

(4)Snohomish

(5)King

(6)Pierce

(7)Southwest

(8)North

Central

(9)TriCounty

(10)Eastern

Washington

(11)BentonFranklin

(12)Spokane

Newly Trained RNs

Experienced RNs

Licensed Practical Nurses

Nursing Aides

Medical Technologists / CLS

Medical Lab Technicians / CLT

Radiology Technologists

Ultra Sound Technologists

Nuclear Med. Technologists

Radiation Ther. Technologists

Medical Records Technologists

Medical Records Coders

Licensed Pharmacists

Pharmacy Technologists

Physician Assistants

Dieticians

Physical Therapists

Occupation Therapists

Respiratory Therapists

(1) Clallam, Jefferson, Kitsap (2) Grays Harbor, Lewis, Mason, Pacific, Thurston (3) Island, San Juan, Skagit, Whatcom (7) Clark, Cowlitz, Skamania, Wahkiakum(8) Adams, Chelan, Douglas, Grant, Okanogan (9) Kittitas, Klickitat, Yakima (10) Asotin, Columbia, Ferry, Garfield, Lincoln, Pend Oreille, Stevens, Walla Walla, WhitmanSource: Washington State Hospital Association and Center for Health Workforce Studies, University of Washington , 2001 Survey of Acute-Care Hospitals in Washington.

KEY: Percent of hospitals reporting “very difficult” to recruit: 0% 1% to 49% 50% to 100%

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Data on supply and demand of registerednurses demonstrates the severity of theshortage. In 1999, there were 52,497licensed registered nurses in Washington.16

According to a 2002 report by the U.S.Department of Health and Human Services,Health Resources and ServicesAdministration, if the demand for nursescontinues to outstrip supply at its currentrate, Washington is forecast to experiencea shortage of 25,451 full-time equivalentregistered nurses by 2020.17 Registerednurses and licensed practical nurses comprisealmost a quarter of the occupationsemployed in health services.18 Whencombined with nursing aides, orderlies andattendants, this figure rises to about a thirdof the health care workforce.

The survey of acute-care hospitalsestimated a shortage of 1,987 staff nursesneeded to fill 1,401 vacant full-timeequivalent positions in 2001. Hospitalregistered nurse vacancy rates were 9.2percent statewide, with rural hospitalsreporting vacancy rates of 8.9 percent, andurban reporting vacancy rates of 9.6percent.19 When asked to identify theprimary reason for nurse vacancies, morethan 80 percent of hospitals said therewere either not enough applicants or alack of qualified applicants.20

Hospitals reported difficulty recruitingboth newly trained and experienced nurses.More than 74 percent of hospitals reporteddifficulty in recruiting newly trainedregistered nurses and 97 percent reported

difficulty recruiting experienced registerednurses. More rural hospitals than urbanhospitals reported it was “very difficult”to recruit newly-trained nurses (38 percentrural, 12 percent urban.)21 Hospitalsindicated that the most difficult registerednurse specialties to recruit were intensivecare unit/critical care unit, anesthesia,emergency, operating room/recovery, andlabor and delivery.

High rates of burnout contribute to thecritical workforce shortages. In 2000 and2001, the average nursing staff turnoverrate in Washington’s rural and urbanhospitals was 16.6 percent per year. Whilea high proportion of hospitals reportedusing a wide range of recruitment andretention incentives such as supplementalpay, tuition reimbursement, and flexiblehours, fewer hospitals reported that thesewere effective. In Washington’s nursinghomes the annual average turnover ratefor registered nurses was 69 percent. Fornursing assistants the turnover rate was 95percent (see Appendix A for a discussion onretention issues.)22

Projected retirements imply the shortagewill become more severe unless supply isincreased. The average age of registerednurses in Washington is 47 compared tothe national average age of 45. Sixty-ninepercent of registered nurses employed inhospitals in Washington are 40 or older.

The results of the 2001 survey of the state’sacute-care hospitals describe only part of

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the picture. More than 40 percent of healthpersonnel work in non-hospital settings(see Figure 2.)23 Fifty-four percent ofregistered nurses work in non-hospitalsettings, while about 77 percent of licensedpractical nurses work in non-hospitalsettings (39.5 percent in long-term care).

The health care personnelshortage in Washington is

not limited to nurses.Other occupations are

experiencing severeshortages as well. Asurvey of dentistsconducted jointlyby the WashingtonS t a t e D e n t a l

Association and theU n i v e r s i t y o f

Washington’s Center forHealth Workforce Studies,

demonstrates that shortages ofdentists, dental assistants, and particularlydental hygienists are spread throughoutthe state.24

Half of urban dentists reported theyplanned to retire by 2013. Thirty-threepercent of general dentists anticipateallowing no increase in patient volume,citing lack of available dental hygienists,and dental assistants among the reasons.On average there are 41 dental hygienistvacancies per 100 general dentists. Thestudy reports greater shortages of dentistsand dental hygienists in rural areascompared to the general population with

57 percent of rural dentists indicating theyplanned to retire by 2013.

Washington’s dental hygienist vacancyrate was 24.5 percent with the highestvacancy rates in rural areas (29 percent)and along the Puget Sound I-5 corridor.The study estimates that Washington willrequire about 360 dental hygienists toenter practice each year through 2010 toeliminate vacancies, 210 more thancurrently supplied by college programs.

As Washington’s population ages there isa growing demand for pharmaceuticalservices, and the roles for pharmacists areexpanding to long-term care facilities,community health centers, managed careorganizations and hospital settings.25 The2001 hospital survey shows that hospitalsin all areas of the state report shortages ofpharmacists.26 A study by the NationalAssociation of Chain Drugstores reportsthat chain and community practices inBonney Lake, Chehalis, EasternWashington, Moses Lake, Olympia,Seattle, Spokane, Southwest Washington,Sunnyside, Tacoma, Tri-cities area, Yakima,and Walla Walla are experiencing severeshortages.27 Each year the two schools ofpharmacy at the University of Washingtonand Washington State University produceabout 140 graduates. At the same timeabout 100 pharmacists are retiring eachyear.28 The reported shortages in hospitals,chain drugstores and community practicesuggest that 40 additional pharmacistseach year are not enough to meet demand.

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Fig. 2: Health ServicesEmployment by Placeof Work: Washington

Source: The Bureau of Labor Statistics, 2001

Hospitals38%

Officesand Clinics

34%

Nursing andPersonal Care

Facilities16%

Other7%

Medical andDental Labs

2%Home Health

3%

Health care personnel shortages have madeit extremely difficult for health care facilitiesto maintain adequate staffing levels. Thisthreatens the quality of care given topatients; negatively affects the safety andwell being of existing staff; and significantlyincreases health care facilities’ cost ofproviding care. Hospitals and other healthcare facilities’ operating costs areskyrocketing, as they must contract forexpensive temporary help throughtemporary employment agencies. Majorconsequences of health care personnelshor tage s a re emergency roomovercrowding, diverting patients to otherhospitals, discontinuation of services,delaying elective surgeries, reducedavailability of hospital beds, waiting listsfor appointments, and increased workerburnout and turnover rates.

In 2001, 66 percent of urban hospitals, and46 percent of rural hospitals went on “divertstatus,” turning away emergency departmentpatients because they did not have enoughnurses.29 As a result, emergency patientshad to travel further and emergencytreatment was delayed. Low staffing levelshave caused Washington hospitals to cutback and/or postpone scheduled procedures.In 2001, a large regional hospital in Seattlehad to cut back its surgery schedule by 50pe rcent because o f a l ack o fanesthesiologists.30 Delaying electivesurgeries may mean prolonging a patient’sdiscomfort and increasing the risk ofcomplications.31

Recent surveys of Washington’s hospitalsand nursing homes reveal high turnoverand vacancy rates of essential personnel,which lead to higher patient-to-nurse ratios.According to a study recently published inthe Journal of the American MedicalAssociation, surgical patients withconditions that require high nurse-to-patient ratios are at higher risk of dyingfrom complications because nursing staff isnot available to respond quickly enough.32

Low staffing levels have also been linkedto job dissatisfaction and burnout. Higheremotional exhaustion and greater jobdissatisfaction in nurses were strongly andsignificantly associated with high patient-to-nurse ratios in a recent survey. In thesame survey, 43 percent of nurses whoreported high burnout and were dissatisfiedwith their job intend to leave their currentjob within the next 12 months.33

Hospitals’ operating costs have increaseddramatically as nursing and other essentialstaff vacancies become harder to fill. Inorder to keep staffing levels acceptable,administrators must contract for temporarystaff at a much higher cost to the facility.These expensive short-term solutions arenecessary to ensure that patient care is notcompromised. Because facilities are payinghigher recruiting costs, they are less ableto put resources into developing long-termstrategies for filling vacancies and retainingstaff, such as work redesign and offeringstaff educational opportunities.34

CONSEQUENCES

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THE AGING POPULATION INTENSIFIES THE SHORTAGE

Challenges and Opportunities for Addressing the Shortage

Alleviating the shortage of Washington’shealth care personnel will requireovercoming significant challenges. Thestate’s population is aging and becomingincreasingly diverse. In order to meetthese challenges, we must expandcapacity in health care education andtraining programs.

Washington had the second highestunemployment rate in the nation (7.4pe rcent a s o f Octobe r 2002) .Unemployed workers could be recruitedinto health care professions. Individualsreceiving Temporary Assistance to NeedyFamilies (TANF), served through thestate’s WorkFirst program, are also inneed of career opportunities. The jobvacancies in health care can provide the

types of career opportunities thatunemployed workers and TANFr e c i p i e n t s n e e d . A n d b e c a u s eWashington’s unemployment rate ishigh, Washington is receiving increasedfederal funding though the federalWorkforce Investment Act (WIA) thatcan be utilized to support and expandprograms to prepare workers for healthcare occupations.

The following section outlines the majorchallenges and opportunities foralleviating the shortage of health carepersonnel and examples of initiativesalready underway in the state. The TaskForce examined these initiatives withthe intention of building a state planbased on previous successes.

The current shortage of health carepersonnel is different from previouscycl ical shortages because i t i ss t ruc tu ra l . Wash ing ton ’s ag ingpopulation will dramatically increasethe demand for health care. The agingpopulation includes health carepersonnel who will retire just at thetime when more health care workersare needed.

In 2000, Washington’s population overage 65 was 662,000. By 2020, there willbe more than 1.22 million people overage 65.35 The impact of this increaseon our health care system will be

immense. Older adults use 23 percentof ambulatory care visits, 48 percent ofhospital days, and 69 percent of homehealth services, and they represent 83percent of the residents in nursingfacilities.

Many health care workers are alsonearing retirement age. The averageage of registered nurses in Washingtonis 47, two years above the nationalaverage . Forty-e ight percent o fpharmacists are 45 or older, and abouthalf of Washington’s dentists reportthey plan to retire by 2013.

“I am 55 years old, and outof work from the shutdown ofthe Reynolds Metals Company(Longview Aluminum LLC.)I have taken all of theprerequisites for the nursingprogram, but have not beenaccepted as of yet. I have beenapplying for two quarters in arow, without success.”

Bob Callos,Dislocated Worker

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THE NECESSITY OF RECRUITING DIVERSE POPULATIONS INTO THE HEALTH WORKFORCEIt will be necessary to recruit more racialand ethnic minorities, people withdisabilities, and men into nursing andother health professions. Non-white andHispanic people represent the fastestgrowing segment of Washington'spopulation. People with disabilitiescomprise a substantial under-utilized laborpool. Of the 557,000 working-age adultswith disabilities in Washington, only abouthalf are employed, and about a third ofthose employed report they are under-

employed.36 In order to benefit from theavailability of racial and ethnic minoritiesand people with disabilities, it will also benecessary to provide both sufficientpreparation in math, science, and basicskills courses, as well as role models forthese populations.

Currently, the racial and ethniccomposition of Washington’s healthworkforce does not reflect Washington’sracial and ethnic diversity (see figure 3.)37

Fig. 3: Percent of Racial and Ethnic Minority Populationsin Health Workforce for Selected Occupation

Percent ofState Population

MedicalDoctors (%)

PhysicianAssistants (%)

NursePractitioners (%) Dentists (%) Dental

Hygienists (%)

African American

American Indian / AK Native

Hispanic

Race / Ethnicity

3.2

1.6

7.5

1.0

0.5

2.0

2.4

1.2

4.5

1.1

0.6

1.6

0.9

0.7

0.7

0.5

1.1

1.7

Source: 2000 Census and Center for Health Workforce Studies, University of Washington, Data Snapshots

Registered nurses make up the largest singlehealth profession, representing nearly 20percent of all the health care workers.Historically women have chosen nursingas a career. Ninety-two percent ofWashington’s RNs are female.38

Important strategies include encouragingdiverse health care professionals to mentorstudents and offer job-shadowingopportunities. Health training programscan reduce potential cultural and languagebarriers by integrating English as a SecondLanguage into the core health care training

curriculum. Two ongoing efforts to improveeducational outcomes of minorities are theState Board for Community and TechnicalCollege’s (SBCTC) strategy for increasingcollege completion rates of its minoritystudents and the Office of Superintendentof Public Instruction’s recent emphasis onimproving methods of assessing Englishlanguage proficiency.

Recruiting from these diverse populationswill build a workforce that more closelyreflects the increasing diversity of our statewith the added benefit of improving health

“Solving the current healthworkforce shortage involvesdeveloping and recruiting fromnew pools of candidates.Racial and ethnic minoritiesconstitute the fastest growingpopulations in the state. Agrowing body of researchshows that when the diversityof the health workforce isreflective of the populationserved, access and healthoutcomes for racial and ethnicminorities improves.”

Vickie YbarraState Board of HealthMember and YakimaMigrant CommunityCenter

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outcomes of underserved and minoritypopulat ions . Racia l and ethnicminor i t ies in our s tate carry adisproportionate burden of disease,disability, and premature death whencompared to the general population. Agrowing body of research shows that adiverse health care workforce canimprove the health status of racial and

ethnic minorities because minorityhealth professionals are more likely toprovide health care to poor andunderserved patients, and practice inunderserved areas. In addition, studiesdemonstrate that a common languageand/or ethnic background shared byprovider and patient improves qualityof care and health outcomes.39

EDUCATIONAL CAPACITY IS INADEQUATE TO FULFILL DEMANDExpanding educational capacity in healthcare education and training programs is thekey to eliminating the shortage of healthcare personnel. Currently, two- and four-year higher education institutions do nothave the capacity to train all qualifiedapplicants and are turning away manystudents. In addition, demand for highereducation and training is projected toincrease. Forecasted growth in the industrywill require increased capacity beyond currentdemand, and there are likely to be additionalstudents from the ranks of dislocated workers,TANF recipients, workers in low-incomeoccupations, racial and ethnic minorities,and a growing number of students graduatingfrom high school.

Educational capacity includes five elements:

(1) Funding to support student enrollments,

(2) Availability of qualified faculty,

(3) Clinical Training capacity that includes sites at theworkplace, clinical supervision faculty and clinicalsupervision staff at the workplace,

(4) Equipment, and

(5) Facilities for classrooms and laboratories.

Postsecondary institutions cite all theseas limitations for expanding health careprograms.

A large number of schools and collegesreport turning away qualified studentsbecause they lack capacity in their healthcare education and training programs.Fifty-six separate nursing and alliedhealth programs at community andtechnical colleges reported waiting listsin 2001(see Figure 4, following page.) Forexample, Washington State University’sSchool of Nursing turned away two-thirds of undergraduate applicants andSeattle University’s Nursing programreceived 120 applications for 20 slots.Many programs report waiting lists. Forexample, students who want to enter theMedical Laboratory Technician Programat Clover Park Technical College inTacoma are on a waiting list for twoyears. Only 12 students can be admittedeach year because of lack of on-siteclinical training opportunities and theneed for additional equipment.

“The problems for allied healthprofessions are similar to thosefor nursing. We need morecapacity in our education andtraining programs and we needto find ways of attractingqualified faculty.”

Diane Zahn,UFCW

Health care education and trainingprograms are more expensive than mostother programs due mainly to faculty,equipment and facilities costs. Low student-to-faculty ratios are required in class and atclinical training sites for programaccreditation and to ensure patient safety.Program costs include salaries for labassistants and faculty with appropriategraduate degrees. Most health care programsrequire specialized equipment that can beextremely costly, such as x-ray machineryand instructional materials. At communityand technical colleges the average cost ofhealth care programs is about $10,000 perfull-time equivalent student, while otherprograms average between $5,000-$6,000. At the University of Washington, the costfor courses taken per full-time equivalentstudent per year is $29,000 for a Bachelorsin nursing (upper division) and $41,000for courses taken in the Masters in Nursingprogram.40

Health care education and trainingprograms have difficulty attracting qualifiedfaculty because many health care

professionals are able to earn more workingin the industry than as faculty. For example,according to the American Association ofColleges of Nursing, a nurse practitioner inprivate practice earns $78,217 whilesimilarly prepared nursing faculty earn anaverage of $54,980. At community andtechnical colleges the average faculty salaryis $46,271.41

The increase in the number of facultyqualifications waivers the WashingtonNursing Commission has granted in recentyears is one indication of the shortage ofqualified faculty. These waivers allow facultyto teach programs even if they have notyet attained a masters in nursing, as requiredfor accreditation of programs. In 2002, mostof the 17 nursing programs requestingwaivers to employ faculty with Bachelorsin Nursing rather than a Masters in Nursingwere approved.

Another imminent concern is the averageage of health program faculty. The averageage of professors in four-year nursingprograms nationwide is 56.3 years. Associate

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Fig. 4: Barriers to Expanding Health Care Programs at Community and Technical Colleges

60

50

40

30

20

10

0

Source: State Board of Community and Technical Colleges, Survey of Selected Allied Health Programs, December 2001

Number ofHealth Programs

Waiting List Shortage ofFaculty

Shortage ofClinical Sites

Cost ofEquipment

Class andLab Space

Prerequisites

56

44

57

32

53

15

professors are 53.8 years and assistantprofessors are 50.4 years.42 This suggeststhat the demand for qualified health carefaculty will also increase.

The lack of clinical training sites is amajor barrier to expanding health careeducation programs across many healthprofessions. In some programs, therequired ratio of student to clinicalsupervisor is very low. For example,radiology technology is one-to-one.Accrediting bodies also require specificsupervision from faculty and staff on-site.Staff on-site must have certainqualifications, and often students haveto take exams using on-site equipment.

In order to identify barriers to expandingcapacity, SBCTC conducted a survey ofall health care programs. Thirty-oneschools responded and all indicated aneed to expand their health careprograms.43 The survey found that a largenumber of programs were over-enrolled,had students on waiting lists, reporteddifficulty recruiting qualified staff, lackedclinical training capacity, and had highequipment costs. A smaller numberreported that they did not have enoughspace for teaching classes, and that therewas a lack of pre-requisites available inthe school such as English as a SecondLanguage, basic skills, math and science.

In 2002, SBCTC directed $2.1 millionin grants for health care programexpansion or creation for 12 separate

projects. SBCTC received requests thatfar outnumbered the available funds,demonstrating the readiness of healthprogram administrators to expandprograms if funds become available.44

The grants expand capacity in a varietyof ways. Tacoma Community Collegereceived a grant to hire a clinical sitecoordinator. The college is examiningthe model implemented by MaricopaCounty Community Colleges, Arizona.This program provides one point ofcontact for health care employersproviding clinical sites, assures a fairdistribution of students, and increasescapacity.

Tacoma Community College, inpartnership with eight regional nursingprograms and the Pierce County HealthServices Careers Council, received twogrants to support hiring a clinical sitecoordinator. The coordinator willcentralize and maximize clinical trainingopportunities, including development ofa Web-based planning system, such as isused in Maricopa County, Arizona.

Without compromising quality, greaterefficiency in health care education andtraining can help expand capacity. Forexample, in Arizona, MaricopaCommunity Colleges transformed sixseparate nursing curricula into onecurriculum. The allied health programsdevised a common-core curriculum thatcovered subjects all students must

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take, such as medical terminology, anatomyand physiology. These actions have helpedincrease efficiency among the schools byfreeing up faculty time and other schoolresources without compromising quality.In Washington, some institutions arebeginning to develop a core programapproach. For example, in 2002 SpokaneCommunity College received a grant tocreate seven basic online programs thatprovide a core curricula for allied healthprograms.

There are 55 health professions regulatedby the Department of Health, eitherthrough the Secretary or the 16professional boards and commissions.These entities approve education andtraining programs (working with nationalaccreditation boards), hear complaints,and examine a variety of rules andregulations related to gaining andmaintaining credentials. The Departmentof Health has been working with the boardsand commissions to review professionalregulations and identify barriers to entryinto professions.

Another way to increase the efficiency isto improve articulation betweeninstitutions and programs, and increaserecognition of competencies learned in avariety of settings including the work site.Increased points of entry and credit forcompetencies already achieved promotetimely achievement of qualifications. Oneproject in eastern Washington thatreceived a grant from SBCTC aims to

develop articulated agreements in alliedhealth between five community collegesin rural Washington.

Ensuring students are well prepared beforethey enter health care programs would alsohelp increase retention and efficiency. Atcommunity and technical colleges wherethere is a policy of open enrollment,students must still take placement tests. Ifstudents are not sufficiently prepared, theymust take basic skills or pre-requisiteclasses. Some colleges do not have enoughcapacity in pre-requisites such asphysiology, or basic skills such as reading,writing, math or English languageproficiency.45

In response to studies that found thatfaculty diversity improves retention ofdiverse populations, SBCTC implementeda policy to increase the diversity of faculty.In addition, SBCTC conducted focusgroups with faculty and students to identifycauses for the high rate of attrition amongracial and ethnic minorities in post-secondary education. The study led to thedevelopment and incorporation ofcurricula that is appropriate to diversecultures.

Besides additional state funding forincreasing capacity at two and four-yearcolleges and universities, there are otheravenues for expanding capacity.Apprenticeship is one such avenue in somefields. The Apprenticeship TrainingCouncil of the Department of Labor and

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“Doing the HealthOccupations Program I hadthe opportunity to work withpatients in a nursing home andjob shadow doctors and othersin the hospital. Thisencouraged me a lot and helpedme determine that this is theright field for me and that Ireally want to become amedical doctor.“

Mynoc Son,Premed Student, UW,Former Health OccupationsStudent, SammammishHigh School

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Industries has been working with theDepartment of Health and the DispensingOpt i c i an Boa rd to c r ea t e anApprenticeship for Dispensing Opticians.Three students have completed theprogram with another 38 in progress. Oneof the barriers to expanding apprenticeshipsin health care is the misconception thatall the training is done at the work site.Apprenticeship programs always includea significant classroom component. Usuallya participant will work on-site during theday and attend classes at night. The healthskills panel in Pierce County, of the PierceCounty Health Services Careers Council,is planning to pilot an apprenticeshipprogram for health unit coordinators.

Many examples exist of public/privatepartnerships that have resulted in increasedcapacity of health care education andtraining programs. When Kelso SchoolDistrict had difficulty finding qualifiedfaculty to teach their health science coursesin nursing, they approached St. JohnHospital. The hospital agreed to enablefour qualified registered nurses to teach atthe high school. The teachers receive anhourly rate that is equivalent to an industrysalary, but at reduced hours depending onthe funds the school has available. Thehospital pays benefits. Two of the teacherswork almost full-time at the school, whilethe other two work 50 percent or less atthe school and pick up hours working atthe hospital. The arrangement enablesstudents at the high school to take healthscience with a nursing specialty, and the

hospital is seeing the benefits of theirinvestment having hired at least 40employees that went through the programat Kelso High School.

Other examples of faculty sharingarrangements exist within the state. Somehospitals provide full or partial salary and/orbenefits for faculty that may also workpart-time in the hospital. Ideas forincreasing faculty availability include jointappointments among educationalinstitutions, faculty chair endowments,and the use of distance technology toenable remote faculty to teach classes.With limited state funding for facultysalaries, all colleges and universities needassistance in finding ways of attracting andretaining faculty.

Currently the Washington State HealthProfessions Scholarship and LoanRepayment Program devotes a portion offunds to aid students who intend to becomenursing faculty. Additional funding for thisprogram and the creation of similarprograms funded privately, or thoughpublic/private partnerships, would helprecruit faculty to serve in schools that areexperiencing shortages of health carefaculty.

Post-education and training employmentoutcomes demonstrate that jobs are readilyavailable upon completion of theirprograms. In 2001, 88 percent ofWashington’s Medicine ResidencyGraduates secured a position within one

RECRUITING AND PREPARING STUDENTS FOR OPPORTUNITIES IN THE HEALTH WORKFORCE

A career in health care can be anattractive option because of the directrewards of patient care and high salariescompared to other occupations. Becominga health care professional requires a goodfoundation in math and science,postsecondary, clinical training, and inmany professions, passing a certificationor licensing exam.

Many high school graduates find they arenot adequately prepared to enter healthcare education and training because theyhave not taken the necessary math andscience pre-requisites. Some of thesestudents choose other areas of study;others must spend their first year ofpostsecondary education completing pre-requisites they could have taken in highschool. Dislocated workers or peopletransitioning from welfare to work, whomay be interested in a health care career,find the training may take longer thanwhat their program allows or what theycan afford.

The Task Force recognizes there are manyways for people to enter into a health carecareer. Ideally, no matter which path onechooses, it should be as direct of a pathas possible.

Washington’s K-12 system has a HealthOccupations Program, offered in highschools and skills centers around the state,that prepares high school students forentering into postsecondary education ordirectly into a health care career (seeAppendix D). Students enrolled in aHealth Occupations Program mustcomplete academic and technicalinstruction, which is generally a 360-hourprogram. Academic instruction includesmath, science, and medical terminology.Technical instruction includes practicalapplication and clinical training and leadsdirectly to certification.

The Health Occupations Programs offerthe most direct path to entry-level healthcare careers from high school by providingjob training to students ages 16 through

“The Health OccupationsProgram benefited me becauseI got to take medical classesand learn about being a nurse,which is what I really want todo--I want to be a nurse. I gotmy Nursing AssistantCertificate, which enabled meto get a job. I am only 18 andnow have advantages that alot of adults don’t have due tothe Health OccupationsProgram.“

Bethany Dietrich,Certified Nursing Assistant,Former Health OccupationsStudent, Port AngelesHigh School

20

month post residency.46 Other health careeducation and training programs are at thetop of the list with the highest employmentrates (in the third quarter followingcompletion) when compared to otheremployment and training programs. Awide range of allied health programs haveemployment rates of around 80 percentwith dental hygienists at 96 percentemployment and medical x-ray

occupations between 92 and 94 percentemployment. It should be noted that thisdata does not include those students whogain employment outside the PacificNorthwest, or those who take time offbefore seeking employment.47 These highemployment rates following programcompletions correlate with other datasources showing shortages across a widerange of health care occupations.

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21 or in grades 11 or 12. They learnthe technical knowledge and skills toeither gain advanced placement inapprenticeships, private career schools,two- and four-year colleges anduniversities, or go directly to entry-level employment in the health careindustry. All of the entry-level healthcare careers offered through the HealthOccupations or Health Sciences CareersPrograms are considered the first rungof a career ladder.

Students enro l led in a Heal thOccupations Program must take corehealth courses including anatomy andphysiology, medical terminology, andinfection control. Students also learnabout the legal and ethical issues ofproviding health care and takecommunication and leadership courses.

Comprehensive programs such as aHealth Occupations offer many of theimportant elements that attract andretain students, as demonstrated by thehigh number of students that continuetheir education at four-year collegesand universities or two-year communityand technical colleges (see AppendixD).

All students, but especially academicallyat-risk students, have a better chanceof succeeding in school if they haveaccess to mentoring, counseling,outreach and other supportive services.The Health Occupations Programs

a l ready provide many o f thesecomponents. The programs are smalland taught by a core set of teachers.The average class size runs between 15and 25 students. The curriculumprepares students academically forhigher education, and the internshipsprovide students with mentors in thecommunity and a sense of pride andaccomplishment.

Schools that are not affiliated with aSkills Center or do not offer a HealthOccupations Program can still offerstudents guidance toward a health carecareer and work-based opportunities byproviding a health-component of theHealth and Human Services CareerPathway. Ideally every high schoolstudent in Washington should haveaccess to this type of program orpathway. Currently, there are HealthOccupations Programs in about half ofthe high school districts.

Collaborating with schools to providestudents with a Health and HumanServices Career Pathway can be anexcellent way for local employers, labor,community-based organizations, andhigher education institutions to developthe health workforce of the future.Health care providers can provide jobshadowing,internships, and mentoring ofstudents. Health skills panels can beimportant mechanisms to advance suchcollaboration.

Educational Pathways

Since 1993, all Washingtonschools must offer their studentseducational pathways. Althoughthe schools must offer pathways,the students are not required tochoose one. For example, theRenton School District has sixpathways: Arts andCommunication; BusinessOrganization and Management;Engineering and Technology;Health and Human Services;Marketing and Entrepreneurship;and Science and NaturalResources. The District hasdeveloped materials to introduceall grade levels to future careeroptions. Schools within thedistrict can order a color andactivity book with skin colorcrayons for the younger gradesand a pathway-planning book formiddle and high schools studentsand their families. The bookbegins with a quiz to assessinterests and then links intereststo appropriate pathways,careers and courses. It thenguides the students to plan theirrequired and electivecoursework for graduation andoffers options for after highschool.

In Pierce CountyMultiCare Health Systemhas partnered withWorkSource to fund an on-site career specialist toassist employees withprogressing up careerladders. By August 2002over 50 employees hadstarted health careeducation and trainingprograms. WorkSourcecareer specialists are alsoon-site at Franciscan HealthSystem, Good SamaritanCommunity Healthcare, andMadigan Army MedicalCenter.

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To recruit enough people to fill all of thehealth care vacancies requires reachingout to a wide variety of individuals. Theseinclude, but are not limited to, recentlyunemployed or dislocated workers,incumbent workers, individuals with priortraining in other states or countries butnot licensed in Washington, and militarypersonnel and their spouses preparing totransition into the civilian workforce.

The state’s service for individuals seekingnew or better jobs is WorkSource.WorkSource, administered by theEmployment Security Department at thestate level and overseen by 12 localworkforce development councils, providesone-stop shopping for employment-relatedservices. Assistance includes informationabout job openings; instruction in how tolook for work; career counseling; andassessments of skills, abilities, and interests.The federal WIA is the main source offunding. Services are available tounemployed workers, TANF recipients,incumbent workers who want a better job,and anyone else who wants employmentassistance.

Some workforce development councilshave already focused the attention of theirWorkSource centers on jobs in healthcare. For example, the Northwest HealthAlliance, which is addressing the healthcare worker shortage in Whatcom, Skagit,Island, and San Juan counties, has prepareda PowerPoint presentation that provides

occupation information such as jobopenings current and forecasted, wages,and educational requirements. Thepresentation plays continuously in theWhatcom County WorkSource office (SeeAppendix C on local health skills panels).

More people move into Washingtonthan leave here for other states. Someare coming here as military personnelstationed at one of several basesrepresenting all branches of our military.Some may have worked in a health carejob in another state or country beforemoving here. In some cases, the trainingrequired in a different country, state, orbranch of our military may not meetWashington’s licensing requirements.The Department of Health, division ofHealth Services Quality Assurance hasalready begun to address these issues byworking with the professional boardsand commissions to review existingl icensure requi rements fo r anyunnecessary barriers that might hinderrecruiting efforts.

Instituting career ladders and trainingopportunities within health careorganizations can help recruit individualsinto entry-level positions and improveretention of existing personnel byproviding them with career advancementopportunities, such as going from a CNAto a LPN to an RN. A career ladderidentifies what an entry-level employeemust do to move up a ‘rung of the ladder’

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to a higher credential and higher payingposition. In most cases, the employersalso provide support in the form offinancial aid and/or allowing a portionof the training to occur on-site.

Many health care employees havefinancial, family, or other responsibilitiesthat prevent them from pursuingadditional training. These individualsare more likely to attend education andtraining programs that are offered eitherat the work place or at the school inshort modules, and at times that aresuitable for working health carepersonnel. Modular education andtraining allows employees to climb upthe career ladder by taking intermediatesteps towards the next rung with thesupport and recognition of theiraccomplishments by the employer.Career maps have been developed tohelp health care workers identify howto move within a career, or to move toa parallel career, such as going fromlicensed practical nurse to ultrasoundtechnologist.

The success of efforts to create careerladders and expand educational capacityin K-12 and higher education dependsupon increas ing the number ofindividuals who want to pursue or returnto health careers. While there arewaiting lists now to get into manyeducation and training programs, in thelong-run success requires enticing evenmore people to want a job in health care.

Some local and national public awarenesscampaigns have begun to get the messageacross that there are many great jobopportunities in health care. Examplesinclude local efforts such as KIRO's'Nursing: Making a Difference Every Day,'KOMO's 'Nursing – A Career for Life,'and national efforts such as the Johnsonand Johnson’s 'Discover Nursing'campaign. The public needs to knowabout available jobs, educationalopportunities, financial aid, and careerladders. The Web can be a valuable toolto reach a wide audience. Given theincreasing diversity of our state,information needs to be available in avariety of languages. We need to reachout with messages that resonate withyouth, adults of racial and ethnicallydiverse populations, new immigrants,people with disabilities, unemployedworkers, and other under-utilizedpopulations. Currently, however, there isno statewide coordinated effort to increasepublic awareness of the shortage of healthcare workers and the opportunities theshortage creates.

For some individuals, taking advantageof opportunities in health care dependson financial aid for education andtraining. Washington has a HealthProfessions Scholarship and LoanRepayment Program operated jointly bythe Higher Education Coordinating Boardand the Department of Health. Itadministers state funds and funds federal

“I had 16 students at the labas part of a middle schoolprogram to provide exposureto career options. After thevisit eight students wrote to mesaying the experience inspiredthem to consider going intohealth care and four of thosesaid they wanted to becomelab techs or histologists!”

Patty Wood,Medical Lab TechnicianPort Angeles, WA

RETENTION AND THE WORKPLACE ENVIRONMENTEfforts to increase the number of peopleentering into health care careers must becomplemented by efforts to ensure thatpeople employed in health care remainthere throughout their professional lives.Consequently, efforts to recruit more

individuals into the workforce must alsoaddress retention.

Workplace retention issues are furtherdiscussed in the paper on retention (seeAppendix A).

INFORMATION FOR FUTURE PLANNINGAlthough the Task Force has collectedample evidence to document the shortageof health care workers, it is only a snapshotat a point in time. The absence of a statehealth workforce information systemthreatens to hamper efforts to measure ourprogress and address future shortages. A

permanent, coordinated informationsystem could collect health workforce dataand statistics from various sources and fillgaps in data collection and analysis, whileensuring appropriate access and use.Currently, no comprehensive healthworkforce data system exists for the state.

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Health Resources and ServicesAdministration (HRSA) funds to studentstraining to work in a health care profession.A committee convenes prior to each newfunding cycle to determine which healthprofessions should get priority funding basedon shortages.

However, the program has been unable toserve current student demand. Between1998 and 2002, the Health ProfessionsScholarship and Loan Repayment Programreceived 276 applications for scholarshipsand awarded 74. It received 193 applicationsfor loan repayment and awarded 92.48 Inreturn for a scholarship or loan repaymentgraduates must agree to practice for at leastthree years in a federally designatedunderserved community.

In rural areas, local public hospitaldistricts would like to provide educationand training opportunities to recruithealth care personnel . Withouteducation and training opportunitiesprovided by local hospital districts, manypotential rural health care workers willnot have the resources needed to obtaintraining. Currently state statute isunclear about the ability of publichospital districts to pay for training as arecruitment and retention strategy.Examples include paying for tuitionexpenses of a student in exchange forthe student agreeing to work at thehospital upon graduation for a certainperiod of time, or paying recruitmentrelated expenses for the family of aprospective new employee.

Providence St PeterHospital (Olympia) isoffering registered nursesattractive opportunities inan effort to improverecruitment and retention.These include schedulingoptions:

• RN's who work 12 weeksof pre-determined nightshifts receive four weeks offwith pay.

• RN's who work two 12-hour or three eight hourweekend shifts will be paidfor 30 hours.

Providence St PeterAugust 02 Newsletter

1. Number and type of health care personnel, by geographic location and employment setting;

2. Statistics on immigration and out-migration of the health workforce;

3. Number of students enrolled and completing health care education and training programs;

4. Employer demand for health personnel as measured by job openings, vacancy rates and difficultyrecruiting workers.

A basic system for health workforce supply and demand information

requires four major categories of data:

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In addition to information on healthworkforce supply and demand, the Statealso needs information concerningavailability of health care professionals toassure people have access to the types ofcare they need. For example, are obstetricsand gynecology services available in ruralcommunities or are patients required totravel great distances? Are dentists workingfull time? Are registered nurses providingdirect patient care or are they working asadministrators? Do people covered byMedicare have access to providers whoaccept Medicare patients?

Data on students and health care personnel’srace and ethnicity, gender, and otherdemographics will be needed to evaluatethe effectiveness of efforts to address goalsand objectives discussed in this report, andto measure outcomes listed on page 38.

The questions about whether health careemployers can find enough qualified jobapplicants to fill their openings and whetherthe types of nurses, physicians and otherhealth personnel are available to provide

care are different, although there is someoverlap. The State needs to examineoptions to determine whether, or to whatextent ongoing data collection and analysisefforts should be created that answer bothaccess and labor market questions, andwhether there should be a common database. This examination requires acomprehensive cross-agency assessment ofdata needs and existing data collectionefforts.

Pending recommendations regarding thebest options for ongoing data collectionand analysis, there are steps that can betaken now to update information about thehealth care labor market. Surveys can beconducted on health care personnel toobtain information on the current supplyof health care workers. Surveys can also beconducted of health care employers toanswer questions about demand. Educationdata can be examined to better identify thecapacity of health care programs. Theseefforts can get underway now as the stateexamines the best options for an ongoingdata system.

EMPOWERING LOCAL COMMUNITIESOften, the best solutions for addressingthe shortage of health personnel aredevised and implemented at the locallevel. While policy-makers in Olympiacan make certain actions happen, suchas meeting the need to increase fundingfor higher education enrollments, thereare other actions that local communitiesare better able to provide.

Beginning in 2000, the state WorkforceTraining and Education CoordinatingBoard has provided federal funding,authorized by the Workforce InvestmentAct (WIA), to Washington’s 12 localworkforce development councils toestablish health skills panels. Healthskills panels are partnerships of employers,labor, and education and trainingproviders formed to address skill shortagesin a particular industry or occupationalcluster. Eight of Washington’s 12 workforce development areas have healthskills panels.

Health skills panels have been analyzingthe labor supply gaps in their local areasand designing plans for addressing these

shortages. They have also begun toimplement action steps and haveleveraged funds from other sources forimplementation. Health skills panelshave used WIA funding provided by theEmployment Security Department toprovide customized training to incumbentworkers to move up career ladders. Panelshave used state funds provided tocommunity and technical colleges tocreate new health care programs.

Health skills panels that have beenoperating for over a year in NorthwestWashington, Pierce County, PacificMountain, Benton-Franklin, andOlympic workforce development areashave already implemented a wide numberof initiatives that have positively affectedthe health personnel shortage in theirareas. Newer panels in Seattle-KingCounty, Snohomish County, andSouthwest Washington have begunmeetings of stakeholders and conductedsurveys to identify priority skill shortages(see Appendix C for additional informationon local health skills panels).

PROVIDING LEADERSHIP TO OVERSEE THE PLANThe critical shortage of health carepersonnel requires the plan presented inthis report be carefully monitored forseveral years to ensure responsible entitiesare held accountable for accomplishingtheir assignments. The 2002 Task Forcecould be instructed to meet several times

each year beginning in 2003 to performt h i s r o l e a n d m a k e f u r t h e rrecommendations as changes incircumstances demand. Alternatively, thestate could explore more formalmechanisms to monitor and supportprogress.

The Olympic Health CareAlliance, one of eight localhealth skills panels inWashington, identified dentalassisting as one of its topthree shortage areas. Aftermeeting with health scienceinstructors at the Port Angelesschool district and dentalhealth professionals, theAlliance decided it wasfeasible to support dentalassisting and dental hygieneprograms at the new NorthOlympic Skills Center. As thefocus of the program hasexpanded to addresscommunity access, so hascommunity interest. Recentlythe Lower Elwha S'KlallamTribe and Local CommunityAction joined the Alliance. TheAlliance is currentlydetermining startup costs,developing a timeline, andlooking at a variety of fundingopportunities for these healthcare education and trainingprograms at the Skills Center.

26

27

While the Task Force process in 2002spurred changes among various state andlocal entities, and created a state planfor addressing the shortage, it is possiblethat advances could end here unlessthere is some formal mechanism to takeresponsibility for progress in the future.The continuation of a formal entity,such as the current Task Force, would

help reassure Washington citizens andbusinesses that the state will continueto address the health care personnelshortage and implement workforcedevelopment strategies to preventshortages in the future. This is theminimum oversight recommended. TheTask Force favors a more formalmonitoring structure.

Recommendations and Outcome Measures

TASK FORCE RECOMMENDATIONSTask Force members reached consensus onthe following goals and strategies that forma plan to alleviate Washington’s health carepersonnel shortage and build the workforcefor the future. The plan requires coordinated

efforts among health care stakeholders.Strategies that require immediate actionare highlighted “priority.” The plan noteswhere state general funds (GF-S) andlegislation (L) are required.

GLOSSARY• Responsible Entities are listed after each strategy. These include Legislature, state agencies, local

health skills panels, and/or public and private partners that are responsible for continuing efforts toaccomplish the strategy.

• High Demand refers to occupations where employer demand exceeds labor supply.

• Underserved refers to federal health professional shortage area designations known as MedicallyUnderserved Areas (MUA’s), or Medically Underserved Populations (MUP’s).

• Skills Panels are health skills panels. As of December 2002 eight have been established in 12 localworkforce development areas. The panels are comprised of health care employers, education andtraining providers, and labor. Their purpose is to identify shortages in their local areas and devisesolutions (see Appendix C).

• Professional Boards and Commissions refer to the 55 health professions regulated by the Departmentof Health either through the Secretary or the 16 professional boards and commissions. They are amongthe responsible entities named for reviewing regulations related to program accreditation, facultyqualifications, clinical training, articulation of programs, apprenticeships, among other issues.

• Articulation refers to the recognition by educational institutions of prior education and training thatstudents receive at other educational institutions or on-the-job, and allow these to count as creditstowards a certificate, diploma or degree.

• HECB is the Higher Education Coordinating Board.

• SBCTC is the State Board for Community and Technical Colleges.

• OSPI is the Office of Superintendent of Public Instruction.

• AHECS are Area Health Education Centers. They exist across the United States and receive both federaland state funding. Washington has AHEC centers in western and eastern Washington. Their missionincludes providing linkages between health care delivery systems and educational resources inunderserved communities.

28

GOAL 1. Increase educational capacity and efficiency in health care training programsto enable more people to gain qualifications to work in health care occupations.

Increase current funding and support new funding initiativesthat increase the capacity of high demand health care programs,taking into account the higher costs of these programs. Givepriority to programs situated in medically underserved areas.(GF-S)

Legislature, SBCTC, HECB, four-year colleges and universities.

Develop apprenticeship opportunities in health care.

Department of Labor and Industries, labor, employers,Department of Health, professional boards and commissions.

OBJECTIVE 1.1: Increase funding and continue to reallocate resources to provide more capacityin new and current health care education and training programs.

PRIORITY STRATEGY 1.1.1:

STRATEGY 1.1.2:

RESPONSIBLE ENTITIES:

RESPONSIBLE ENTITIES:

Increase the flexibility of faculty salary schedules or allocationsto provide health program faculty with compensation that iscompetitive with industry wages. (GF-S.)

Legislature, SBCTC, HECB, four-year colleges, universities,labor and employers.

Provide additional financial support, such as scholarships andloan repayments for students who intend to become healthcare faculty for high demand health care programs experiencingfaculty shortages. (GF-S.)

The Legislature, SBCTC, HECB, Department of Health, four-year colleges and universities, private partners or foundations.

OBJECTIVE 1.2: Increase the availability, diversity and retention of health care faculty in highdemand health care programs that have difficulty recruiting faculty.

PRIORITY STRATEGY 1.2.1:

PRIORITY STRATEGY 1.2.2:

RESPONSIBLE ENTITIES:

RESPONSIBLE ENTITIES:

29

Implement faculty sharing arrangements among educationproviders, or among industry and education providers.

Health skills panels working with employers, labor and educationinstitutions.

Develop alternate pathways to gain teaching qualifications fornursing faculty and other health program faculty.

Professional boards and commissions, Department of Health,SBCTC, colleges and universities.

Provide financial and other incentives to employers or self-employed professionals for providing faculty resources, e.g. taxincentives and increased reimbursement rates. (L) (GF-S)

Legislature.

PRIORITY STRATEGY 1.2.3:

STRATEGY 1.2.4:

RESPONSIBLE ENTITIES:

RESPONSIBLE ENTITIES:

STRATEGY 1.2.5:

RESPONSIBLE ENTITIES:

Coordinate clinical training sites for nursing and allied healthprofessions.

Health skills panels working with employers, labor and educationproviders, AHECs.

Provide financial and other incentives to employers or self-employed professionals for providing clinical training resources:sites and faculty supervision. (L) (GF-S)

Legislature.

OBJECTIVE 1.3: Increase clinical training capacity.

PRIORITY STRATEGY 1.3.1:

STRATEGY 1.3.2:

RESPONSIBLE ENTITIES:

RESPONSIBLE ENTITIES:

30

Identify and eliminate barriers to expanding clinical capacity,and to expand opportunities for training, testing, andcertification through multiple delivery modes such as distancelearning, and at multiple sites (e.g., the workplace), and makerecommendations to state and national accreditation bodies.

Professional boards and commissions, Department of Health,education institutions, AHECs.

STRATEGY 1.3.3:

RESPONSIBLE ENTITIES:

Develop and implement “common core” health care curricula.

SBCTC, HECB, colleges and universities, OSPI, Departmentof Health and professional boards and commissions.

Expand articulation among health care programs based oncompetencies learned in a variety of education and trainingsettings, including on-the-job and in the military. (See Goal 4for education and training modules strategy that leads to promotionwithin the workplace.)

Health skills panels, SBCTC, HECB, OSPI, colleges anduniversities, Department of Health.

Improve program completion rates by blending basic skillsincluding English as a Second Language, and occupationalskills, adjusting instructional methods, incorporating culturalawareness, and improving support services.

SBCTC, colleges and universities, community-basedorganizations.

OBJECTIVE 1.4: Increase efficiency and maintain quality of health care education and trainingprograms to enable students to complete programs in a shorter time span and to reduce programcosts.

STRATEGY 1.4.1:

STRATEGY 1.4.2:

RESPONSIBLE ENTITIES:

RESPONSIBLE ENTITIES:

STRATEGY 1.4.3:

RESPONSIBLE ENTITIES:

31

GOAL 2. Recruit more individuals, especially targeted populations* into health careoccupations, and promote adequate preparation prior to entry.

Expand and/or leverage financial aid for individuals pursuinghealth care training, and disseminate information on availablefinancial assistance.

Legislature (GF-S) and/or private companies, HECB, employers,foundations, local health skills panels.

Support proposed changes to regulations that allow moreindividuals to enter or re-enter health care, and identify refreshercourses and/or alternative opportunities that recognize priortraining and experience for obtaining licensure.

Department of Health working with health professional boardsand commissions.

Allow regulated health care entities flexibility in developingrecruitment and retention programs that are effective for theircommunities.

Legislature, Department of Health working with Associationof Washington Public Hospital Districts.

OBJECTIVE 2.1: Provide more opportunities for people to enter health care careers.

STRATEGY 2.1.1:

STRATEGY 2.1.2:

RESPONSIBLE ENTITIES:

RESPONSIBLE ENTITIES:

Establish career ladder opportunities in health care throughcollaboration among employers, labor, and education.

Local health skills panels, Department of Health, professionalboards and commissions, professional associations.

OBJECTIVE 2.2: Raise awareness of opportunities in health care careers, and provide informationon technical and financial resources available for training.

STRATEGY 2.2.1:

RESPONSIBLE ENTITIES:

*The following recommendations focus on underserved populations such as rural communities;racially and ethnically diverse youth and adults; men and women; disabled, new immigrants,dislocated and incumbent workers; and military personnel:

32

STRATEGY 2.1.3:

RESPONSIBLE ENTITIES:

Train frontline WorkSource staff to inform unemployed workersor transitioning individuals (e.g., military) of opportunities inhealth care careers, including providing information on requiredcourses, referrals to appropriate programs and available resources.

Employment Security Department and local workforcedevelopment councils.

Create smooth transitions for military trained personnel toenter the civilian workforce.

Local health skills panels working with the military andeducation providers.

Develop a statewide healthcare marketing plan to raise awarenessof the wide range of career opportunities. Communicate theplan in a variety of languages and ways.

Private foundations and associations, community-basedorganizations.

Create and promote a web site that demonstrates different jobsin healthcare, the coursework required for each job, schoolsthat provide that education, and sources of possible financialaid. Career mapping templates should identify multiple pointsof entry and advancement, including places along a path thatallow crossover to other health professions.

Private foundations and associations.

STRATEGY 2.2.2:

STRATEGY 2.2.3:

RESPONSIBLE ENTITIES:

RESPONSIBLE ENTITIES:

STRATEGY 2.2.4:

RESPONSIBLE ENTITIES:

STRATEGY 2.2.5:

RESPONSIBLE ENTITIES:

33

Support local school districts and communities in strengtheningprimary and middle school students' math and science skillsand in building health science career programs in high schools,including increasing the number of work-based learningopportunities for students, creating health care-focusedmentoring programs, increasing the number of core healthscience and math programs, and increasing the number ofprograms that lead to industry certification and employmentin health care careers.

OSPI working with local school districts and boards, highereducation, community based organizations, local camps, healthcare employers, local workforce development councils, localyouth development councils, the AHECs, and labororganizations.

Support efforts of local school districts, communities and highereducation institutions to raise student achievement in mathand science to assure students are prepared for post-secondarystudies in health sciences programs.

OSPI working with local school districts and boards, highereducation, community based organizations, local camps, healthcare employers, local workforce development councils, localyouth development councils, the AHECs, and labororganizations.

Identify and maximize opportunities to provide students andtheir families, equitable access to academic assistance andresources needed to pursue a career in health care.

OSPI working with local school districts and boards, highereducation, community based organizations, local camps, healthcare employers, local workforce development councils, localyouth development councils, the AHECs, and labororganizations.

OBJECTIVE 2.3: Promote K-12 programs that provide opportunities to explore a variety of healthcare careers and prepare students academically so they can complete postsecondary healthsciences programs.

STRATEGY 2.3.1:

STRATEGY 2.3.2:

RESPONSIBLE ENTITIES:

RESPONSIBLE ENTITIES:

The following recommendations target K-12 students and their families:

STRATEGY 2.3.3:

RESPONSIBLE ENTITIES:

34

GOAL 3. Develop a data collection and analysis system to assess health workforcesupply and demand.

Conduct a comprehensive cross-agency assessment of dataneeds, existing data collection efforts and opportunities forcollaboration and reduction of duplication.

Department of Health and Workforce Board working withhealth stakeholders.

Analyze the options for creating and maintaining an ongoingcentralized coordinated data system for information on bothaccess to health care professionals, and labor market demandand supply for health care personnel.

Department of Health and Workforce Board working withhealth stakeholders.

Collect workforce supply information through methods suchas surveys of licensed professionals.

Department of Health and Workforce Board working withhealth stakeholders.

Collect workforce supply information for non-credentialedhealth personnel.

Workforce Board working with Department of Health andhealth stakeholders.

Collect data on students, enrolled and completing health careprograms at high school, two-year and four-year public colleges,private career schools, and programs based at hospitals andlong-term care facilities.

Workforce Board working with Department of Health, four-year colleges and universities, SBCTC, OSPI.

STRATEGY 3.1.1:

STRATEGY 3.1.2:

RESPONSIBLE ENTITIES:

RESPONSIBLE ENTITIES:

STRATEGY 3.1.3:

RESPONSIBLE ENTITIES:

STRATEGY 3.1.4:

RESPONSIBLE ENTITIES:

STRATEGY 3.1.5:

RESPONSIBLE ENTITIES:

35

Collect demand data by surveying health care employers.

Workforce Board working with Department of Health andhealth stakeholders.

Analyze workforce supply and demand information for healthprofessionals.

Workforce Board and Department of Health working withresearch universities.

STRATEGY 3.1.6:

STRATEGY 3.1.7:

RESPONSIBLE ENTITIES:

RESPONSIBLE ENTITIES:

GOAL 4. Retain current health care workers.

Expand customized training opportunities for incumbent workersthat enable them to move up a career ladder or move to otherhigh demand health occupations.

The Governor and the Employment Security Department.

Develop education and training modules that allow health carepersonnel to complete training in incremental steps, leadingto recognized promotions and increases in wages.

Health skills panels, SBCTC, HECB, OSPI, colleges anduniversities, Department of Health.

Develop other career mobility strategies within health careorganizations, maximizing training opportunities and leveragingfunds within regions and among employers and educators forthis purpose.

Health industry, education and training providers.

Reduce paperwork where possible by changing state regulations,department and agency directives, and implementing newtechnology.

DSHS, Department of Health, health industry.

STRATEGY 4.1.1:

STRATEGY 4.1.2:

RESPONSIBLE ENTITIES:

RESPONSIBLE ENTITIES:

STRATEGY 4.1.3:

RESPONSIBLE ENTITIES:

36

STRATEGY 4.1.4:

RESPONSIBLE ENTITIES:

GOAL 5. Enable local communities to implement strategies to alleviate the health carepersonnel shortage in their areas.

Implement strategies to enhance the workplace environment.(See Appendix A.)

Health employers and labor.

STRATEGY 4.1.5:

RESPONSIBLE ENTITIES:

Provide continuing support to current Health Skills panels andexpand the formation of Health SKILLS panels to cover all 12workforce development regions.

Workforce Board.

Facilitate communication among local Health Skills panels toenable coordination of efforts, and to communicate with stateentities and the legislature.

Workforce Board.

PRIORITY STRATEGY 5.1.1:

STRATEGY 5.1.2:

RESPONSIBLE ENTITIES:

RESPONSIBLE ENTITIES:

GOAL 6. Develop a mechanism to ensure continued collaboration among stakeholders,track progress, create accountability for fulfilling this plan, and to plan for future healthworkforce needs.

Reconvene the Task Force twice a year to establish an ongoingmechanism comprised of key stakeholders to oversee the TaskForce recommendations, and hold responsible entitiesaccountable. (L)

Workforce Board.

Explore more formal mechanisms to monitor and supportprogress in acheiving the goals in this plan. (L)

Legislature.

PRIORITY STRATEGY 6.1.1:

RESPONSIBLE ENTITIES:

37

STRATEGY 6.1.2:

RESPONSIBLE ENTITIES:

OUTCOME MEASURES TO TRACK PROGRESS

In order to evaluate the success of thesestrategies it is necessary to track ourprogress. The Task Force formulatedoutcome measures that provide a meansfor tracking progress and for holdingresponsible entities accountable. Eachoutcome measure may apply to one orseveral of the goals and strategies. The

most obvious measure for trackingprogress is the number of studentscompleting health care programs. Bytracking this and other measures overtime, it will be possible to assess progressand alter goals and strategies to beresponsive to future health workforceneeds.

1. Number and diversity of students enrolled in healthcare education and training programs.

2. Number and diversity of students completing healthcare education and training programs.

3. Number and diversity of students training to becomefaculty in health care education and training.

4. Amount of additional funds allocated to increaseeducational capacity in health care education andtraining programs.

5. Establishment of an ongoing system for data collectionand analysis.

6. Establishment of a campaign to market health carecareers.

7. Establishment of a Web site to provide health caretraining/career mapping and financial aid information.

8. Numbers of Workforce Development Councils thathave established health care Skills panels.

9. Turnover rates for health care personnel.

10. Level at which health workforce diversity reflects thediversity of the populations served.

11. Numbers of incumbent health care workers receivingtraining to move up a career ladder.

12. Number of high schools offering health scienceprograms, and the number of these that lead tocertification.

13. Proximity of supply to demand of health care personnel.

14. Number of strategies in this plan that are successfullyimplemented.

15. Creation of a formal mechanism that oversees theimplementation of Task Force recommendations, andholds responsible entities accountable.

16. Commitment by the Governor and Legislature to targethealth professions education at the true cost.

Outcome measures:

38

1 Susan M. Skillman, Troy Hutson, C. Holly A. Andrilla, Bobbie Berkowitz, Gary L. Hart, How are Washington State Hospitals Affectedby the Nursing Shortage? Results of a 2001 Survey. Working Paper #68. Center for Health Workforce Studies, University of Washington,Seattle, WA, 2001.2 Health Services Research and Evaluation, American Health Care Association, Results of the 2001 AHCA Nursing Position Vacancyand Turnover Survey, February 7, 2002.3 Ibid 1. 54% of all hospitals were on “divert” over a total of 6 days.4 Linda H. Aiken PhD, RN , Sean P. Clarke PhD, RN, Douglas M. Sloane, PhD, Julie Sochalski, PhD, RN, Jeffrey H. Silber, MD, PhD,“Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction,” Journal of American Medical Association,Vol 288, October 23/30, 2002; Joint Commission on Accreditation of Healthcare Organizations, Health Care at the Crossroads,Strategies for addressing the evolving nursing crisis. August 2002.5 Janet M. Coffman, Jean Ann Seago, Joanne Spetz, "Minimum Nurse-to-Patient Ratios in Acute Care Hospitals in California," HealthAffairs Vol 21 No 5, September / October 2002: Julie Sochalski, "Nursing Shortage Redux: Turning the Corner on an Enduring Problem",Health Affairs Vol 21 No 5, September / October 2002.6 American Nurses Association Health and Safety Survey, September 2001, NursingWorld.org; The Shortage of Care, A Study by theService Employees International Union Nurse Alliance, May 2001; Peter D. Hart Research Associates "The nurse shortage: Perspectivesfrom current direct care nurses and former direct care nurses," Study for the Federation of Nurses and Health Professionals, April2001, page 20.7 Health Services Research and Evaluation, American Health Care Association, Results of the 2002 AHCA Nursing Position Vacancyand Turnover Survey, February 7, 2002.8 Ibid 1.9 Troy Huston, Taya Briley, Who Will Care for You?: Washington’s Hospitals Face a Personnel Crisis, Washington State HospitalAssociation and the Association of Washington Public Hospital Districts, 2002, page 12.10 Ibid, page 11.11 U.S Department of Health and Human Services, Bureau of Health Professions, Health Resources and Services Administration,HRSA State Health Workforce Profiles: Washington, page 4.12 Workforce Education and Training Coordinating Board, Washington’s Economy, January 2002.13 Email communication with Robyn Henderson, Vice President, Program Services, National Rural Health Association, April 2002.14 The Diversity Network began meeting in March 2002 to follow up on the State Board of Health’s Committee on Health DisparitiesFinal Report recommendations on reducing health disparities by improving health workforce diversity. The Network is chaired byJudy Huntington of the Washington State Nurses Association and Dr. Charles Weatherby of the Washington State Medical Association,and is made up of representatives from organizations, agencies, foundations and associations interested in diversifying the healthworkforce. See http://www.doh.wa.gov/sboh/Priorities/disparities/disparities.htm for more information and the State Board ofHealth’s Final Report on Health Disparities.15 Acute-care hospitals are state hospitals (not federal hospitals) that provide a full range of health services.16 Center for Health Workforce Studies, University of Washington, Data Snapshots available athttp://www.fammed.washington.edu/CHWS17 U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions,National Center For Health Workforce Analysis, Projected Supply, Demand, and Shortages of Registered Nurses: 2000-2020, July2002, page 18.18 Ibid 11.19 Ibid 1.20 Ibid 1.21 This problem is significantly compounded by the fact that most rural hospitals in Washington State are public hospital districtsand as such are presently limited (due to a recent statutory interpretation by certain state agencies) in their ability to engage ineven the most common recruitment practices found at private hospitals. Email Communication with Taya Briley, Association ofWashington Public Hospital Districts, December 2, 2002.22 Ibid 2.23 Data collected in local areas does not always correspond with the hospital survey because local surveys usually encompass arange of health employers, not just hospitals. For example, in Northwest Washington figure 1 shows that 0 percent of hospitals inthat region reported it was “very difficult” to recruit licensed practical nurses while the local Health Skills panel, the NorthwestAlliance for Health Care Skills, identified licensed practical nurses as one of the area’s most severe shortage occupations amongall health care employers in that region.24 Gary Hart, Findings from the 2001 Washington State Dental Association Survey of Dentists, Center for Health Workforce Studies,University of Washington, September 2002, Pages 9-11.

REFERENCES

39

40

25 William E. Fassett, Ph.D, Dean Washington State University College of Pharmacy, Sidney D. Nelson, Jr., Ph.D., Dean, Universityof Washington School of Pharmacy.26 Ibid 1.27 National Association of Chain Drugstores Chain Pharmacy Employment Survey Results, July 2002. Approximately 60 percent ofgraduating pharmacists go into chain and community practice.28 Email communication with Dr. Bill Fassett, Washington State University School of Pharmacy October, 200229 Ibid 1.30 Elective surgeries are not optional, they are scheduled, non-emergency surgeries.31 Ibid 9, page 11.32 Linda H. Aiken PhD, RN , Sean P. Clarke PhD, RN, Douglas M. Sloane, PhD, Julie Sochalski, PhD, RN, Jeffrey H. Silber, MD, PhD,“Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction,” Journal of American Medical Association,Vol 288, October 23/30, 2002.33 Ibid 32.34 Ibid 9, page11.35 Workforce Training and Education Coordinating Board, Our Changing Labor Force, 2001. According the 2000 Census there are557,000 working-age adults in disabilities in Washington. The ratio of active to retired workers in 1998 was 3.4 workers for everyretiree and this is predicted to fall to 2.4 workers for every retiree in 2020; Christine Tassen Kovner, Mathy Mezey, and CharlesHarrington, “Who Cares for Older Adults? Workforce Implications of an Aging Society,” Journal of American Medical Association,vol 288, October 23/30, 2002. In 1999 people over 65 used 2,257 days per 1000 population, in nonfederal short-stay hospitals comparedto the age group 55 to 64, who used 795 days per 1,000 population.36 Workforce Training and Education Coordinating Board, “Our Changing Labor Force,” 2001.37 Center for Health Workforce Studies, Data Snapshots: http://www.fammed.washington.edu/CHWS. For example, only 0.5 percentof Dental Hygienists, 1 percent of physicians, 1.1 percent nurse practitioners are Black/African American compared to 3.2 percentBlack/African American population in Washington. Only 1.7 percent of Dental Hygienists, 2 percent of Physicians, and 1.6 percentof Nurse Practitioners are Hispanic compared to 6 percent Hispanic population in Washington.38 Ibid 16.39 See studies cited in State Board of Health report, Joe Finkbonner, R. Ph., M.H.A., the Honorable Margaret Pageler, J.D., VickieYbarra, R.N., M.P.H., Final Report State Board of Health Priority: Health Disparities, Committee on Health Disparities, May 2001http://www.doh.wa.gov/sboh/Priorities/disparities/2001_HD_Report.pdf. See also The Key Ingredient of the National PreventionAgenda: Workforce Development, U.S.D.H.H.S., HRSA, 2001; “The Case for Diversity in the Health Care Workforce,” Health Affairs,Vol. 21, 5, Sept/Oct 2002; Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans,Commonwealth Fund, March 2002; Room for Improvement: Patients Report on the Quality of their Health Care, Commonwealth Fund,April 2002, http://www.cmwf.org/; Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, Institute of Medicine,March 2002, http://www4.nationalacademies.org/news.nsf/(ByDocID)/019EBFFF2620394885256B820053A338?OpenDocument40 Email communication with David Asher, University of Washington, December 2, 2002.41 Email communication with Jim Boesenberg State Board for Community and Technical Colleges, November 12, 2002.42 Nancy Frugate Woods. Presentation to Washington Nursing Leadership Council, July 2002.43 Programs included in analysis: Associate Degree Nursing, Practical Nursing, Nursing Assistant, Medical Radiology Technology,Diagnostic Medical Sonography, Medical Records Technology, Phlebotomy, Medical Laboratory Technology, Pharmacy Technician.44 No similar grant program is available to baccalaureate institutions.45 Students who participate in programs that combine basic skills with occupational skills have better wage and employmentoutcomes post course completion. Workforce Board, Workforce Training Results, 2002.46 Susan Skillman, Deputy Director Center for Health Workforce Studies, presentation to the Health Care Personnel Shortage TaskForce, September 4, 2002.47 Workforce Training and Education Coordinating Board, Job Training Results Data aggregated for health care employment rates.In 1998-2000 employment rates in the third quarter after program completion demonstrated health education and training programshad employment rates that were consistently higher than for most other programs. It should be noted that this does not includeemployment outside the Pacific Northwest, and does not include baccalaureate programs. The highest employment rates were forDental Hygienists – 96 percent, Diagnostic Medical Sonography –94 percent, Nuclear Medical Technology — 92 percent, RadiationTherapy Technology – 92 percent, Radiology Technology-91 percent, Dispensing Optician – 90 percent, Histologic Technology – 88percent, Surgical/Operating Room Technician – 87 percent, Physical Therapy Assistant – 87 percent, Associate Degree Nursing –86 percent, Biological Laboratory Technician – 84 percent, Cardiac Invasive Technician – 84 percent, Practical Nursing – 84 percent,Medical Laboratory Technician – 83 percent, Pharmacy Technician/Assistant – 83 percent, Dental Assistant – 83 percent.48 Email communication with Kathy McVay, Washington State Department of Health, Office of Community and Rural Health, October 2002.

Washington's nursing homes are thehardest hit when it comes to retainingnurses. According to a national survey,Washington nurs ing homes areexperiencing turnover rates ranging from38 to 95 percent for essential nursing staff1

(see Table 1). Washington’s hospitalsrecently reported a turnover rate of about17 percent for staff registered nurses. Ofthe Washington hospitals surveyed, nearly54 percent of urban hospitals reportedincreased turnover in the past year.2 Tomake matters worse, a national survey ofnurses found that one in three nurses underthe age of 30 plans to leave the professionwithin a year.3

A survey of Washington clinicallaboratories found that the reason technicalemployees (MT/CLS, MLT/CLT,cytotechnologist, and histotechnologist)leave their jobs is "for better pay. "Themajority of laboratories surveyed require

overtime to cover vacant positions untilnew personnel can be hired--usually athree month process. The main reasonpositions remain vacant for more than onemonth is an “insufficient applicant pool.”

National health care-related associationsand organizations such as the AmericanHospital Association (AHA), theAmerican Nursing Association (ANA),the Joint Commission on Accreditation

APPENDIX A: RETENTION OF HEALTH CARE PERSONNEL

Efforts to increase the number of peopleentering into health care careers must becomplemented by efforts to addressworkplace retention issues. Some of theprofessions experiencing the greatestshortages are also the ones experiencingdifficulty in retaining workers. Manystudies and surveys document the nursingshortage and identify an array of complexfactors contributing to the shortage,including the workplace. Unfortunately,there has not been the same effort to

document and explain the shortages inallied health and the other healthprofessions. However, there are strongsimilarities between nursing and alliedhealth, especially when describing thework environment. Health care workersconsistently describe the workplace ashighly pressured and difficult, many arethinking of leaving their jobs .Consequently, any efforts to recruit moreindividuals into the workforce must alsoaddress retention.

WORKER TURNOVER

TABLE 1: Turnover Rates of Nursing Personnelin Washington State Nursing Homes

Annualized Turnover RatesNursing Personnel

Directors of Nursing

Administrative RNs

Staff RNs

Licensed Practical Nurses

Certified Nursing Assistants

Source: Health Services Research and Evaluation, American Health Care Association,Results of the 2001 AHCA Nursing Position Vacancy and Turnover Survey, February 7, 2002.

49.6%

38.0%

69.3%

54.2%

95.1%

I

of Healthcare Organizations (JCAHO),and the Service Employees InternationalUnion (SEIU) have recently releasedreports addressing worker retention. Inaddition, state and local health careprofessional organizations such as theWashington State Hospital Association(WSHA), Washington Nurs ingLeadership Council, Washington Health

Foundation, and Washington StateClinical Laboratories Advisory Councilhave also begun addressing the health careworker shortage and workplace retentionissues. Along with recruiting more peopleinto health care, these professionalorganizations recommend improving theworkplace environment so that, oncehired, they stay.

CONTRIBUTING FACTORS

Several national nursing surveys,conducted in recent years, point to agrowing sense of job dissatisfaction amonghospital nurses. Many of the same issuesreported in the nursing surveys areapplicable to the non-nursing health careworkforce as well. A study conducted byPeter D. Hart Research Associates foundthe top reason why nurses leave, besidesretirement, is to seek a job that is lessstressful and less physically demanding.Additional reasons are more regular hours,more money, and better advancementopportunities. When practicing nurseswere asked to identify the biggest problemwith nursing, respondents citedunderstaffing (39 percent) and the stressand physical demands of the job (38p e r c e n t ) . 4 T h i s s a m e g r o u poverwhelmingly reported that the mostenjoyable aspect of nursing is helpingpatients and their families. The majorityof nurses (74 percent) said they would stayat their jobs if the work environmentimproved. Increased staffing, lesspaperwork and fewer administrative dutieswere identified as the top three changes

they would like to see made.5

According to the 2000 National SampleSurveys of Registered Nurses, employedin hospitals, are the least satisfied amongall nursing positions. Across all settings(hospitals, nursing homes and publichealth), one of every three reported thatthey were dissatisfied with their currentjob in 2000.6 Staff nurses bear much ofthe responsibility for coordination andcontinuity of care, yet they reported havinglittle control over or support for manyaspects of their jobs.7

These findings have motivated severalhospitals across the country to adopt theMagnet Hospital Program, whichencourages participation of staff at alllevels. The program offers competitivesalaries and benefits and promotes apositive image of its staff as professionalswho provide quality care and are involvedwith their communities as providers ofhealth care and as teachers.8 TheAmerican Nurses Credentialing Center(ANCC) magnet hospital program,

II

inspired by the original magnet hospitals,established the Magnet ServicesRecognition Program to recognizehospitals that had achieved excellencein providing nursing services.9 Thecharacteristics of ANCC magnet hospitalsinclude high nurse-to-patient ratios,substantial nurse autonomy and controlover the practice setting, positive nurseand physician relationships, nurseparticipation in organizational policy

decisions, and strong nursing leadership.10

The nurses working in these hospitalsreport increased satisfaction, increasedperception of giving higher quality ofcare, and an increased perception ofproductivity. The hospitals reportincreased RN retention rates, increasedability to attract and retain nurses, andlower rates of nurse burnout.11 To date,the ANCC program has certified over 50hospitals in the United States.

PAPER INSTEAD OF PATIENTS

The amount of paperwork required foreach patient is overwhelming. A studycommissioned by the American HospitalAssociation found that for every hour ofpatient care, 30-60 minutes were spenton required paperwork12 (see Table 2).

According to the AHA report, althoughsome of this paperwork is directlyassociated with clinical care, there hasbeen a significant increase in paperworkneeded to document regulatorycompliance. This administrative burden,driven by complex rules and regulations,shifts the focus from patient care topaperwork and affects all who providehealth care or services. To put this in

perspective, more than 100 federalregulations affecting health care havebeen adopted since 1997.13 On top ofthese new federal regulations the stategovernment has also passed a multitudeof new regulations and agency directives,some of which conflict with the federalregulations.

TABLE 2: The Paperwork Burden

Every Hour of PatientCare Requires:Care Setting

Emergency Room

Surgery & Inpatient Acute Care

Skilled Nursing Care

Home Health Care

PricewaterhouseCoopers survey of hospitals and health systems

1 Hour of Paperwork

36 Minutes of Paperwork

30 Minutes of Paperwork

48 Minutes of Paperwork

THE STAFFING CHALLENGEThe health care personnel shortage hasmade it extremely difficult for medical andclinical facility directors to adequately stafftheir facilities. Inadequate staffing in healthcare facilities has a ripple effect throughout

the health care system. When nursinghomes are inadequately staffed and cannotaccept new patients, hospitals frequentlymust keep patients who would usually bedischarged to nursing homes.14 This in

III

turn results in fewer resources (beds andstaff) for new patients. Depending on thereason for their hospitalization, these newpatients might be diverted to anotherhospital or be put on a waiting list untilstaff or a bed is available. A shortage ofradiology or laboratory technologists canlead to delays in diagnosing illnesses. In astudy commissioned by the American

Hospital Association, respondents reportedthat the nursing shortage has causedemergency department overcrowding intheir hospitals (38 percent); diversion ofemergency patients (25 percent); reducednumber of staffed beds (23 percent);discontinuation of programs and services(17 percent); and cancellation of electivesurgeries (10 percent).15

HEALTH AND SAFETY ON THE JOB

Health and safety have always been aparticular concern for health care workers.A recent study by the American NursesAssociation found that more than 70percent of nurses indicated thatcontinuing severe stress and overworkwere among their top health-relatedconcerns. Forty percent of nurses reportedhaving been injured on the job; 17

percent experienced physical assaultswhile working and 75 percent of thenurses surveyed stated that unsafe workingconditions interfere with their ability toprovide quality care. Nearly 90 percentof the nurses indicated that health andsafety concerns influence the type ofnursing work they do and their likelihoodto continue to practice.16

NATIONAL EFFORTS

As bad as it is, this problem is notunsolvable. Nurses and other health careproviders want to do the jobs they weretrained to do. They want the focus of theirjob to be caring for patients and supportingfamilies, which is what they do best. Theywant to have the time to provide qualitycare and they want to work in a safeenvironment. There are many professionalorganizations and industry leadersrecommending ways to improve workplaceretention.

Recently Congress passed the NurseReinvestment Act, which recognizes

retention as a critical component in solvingthe nursing shortage. Two provisionscontained in the Act specifically addressworkplace retention: A provision thatprovides grants to health care facilities toimplement the American NursesCredentialing Center Magnet RecognitionProgram; and a provision that providesgrants to hospitals to establish career ladderprograms. There is no comparable federallegislation for allied health professions.

The Joint Commission on Accreditationof Organizations (JCAHO), well knownfor its large volume of paperwork required

IV

OTHER STATE EFFORTS

To date, five states have reported thatthey have initiatives on job redesign forhealth workers, including nurses andcertified aides. These include support fordemonstrations and evaluations, and/orbest practices conferences.18 In addition,several states have passed legislationprohibiting or limiting mandatoryovertime and one state (California) haspassed legislation mandating minimumnurse staff ratios in hospitals and nursinghomes.19

The Texas Board of Health revised itshospital nurse staffing rules based onrecommendations put forward by the TexasNurses Association and the Texas HospitalAssociation. The rule now requires thathospitals implement a staffing plan.20

Other state efforts to improve retentioninclude wage pass-throughs; rate increases;shift differentials; bonuses and otherassistance (e.g., insurance, childcare); staffingstandards; and recognition programs.21

WASHINGTON STATEWashington State has made importantprogress in improving the workplaceenvironment for health care personnel.In May 2000, Washington implementedthe "Ergonomics Rule" that will beginwith nursing homes. The guidelines werereleased in April 2002. This past springthe state passed legislation regardingmandatory overtime for nurses.

The Washington Health Foundation hasreceived a $1 million federal grant fornursing retention. With this funding theFoundation plans to conduct a survey onnursing retention of 20,000 RNs fromhospitals and skilled nursing facilities,which will be done through a partnershipwith the WSHA. The results of the surveyare expected to lead to additional projectsincluding a program on mentoring at

of hospitals to prove compliance with itsstandards, recently launched an in depthreview of its hospital standards andrequirements for demonstrat ingcompliance with those standards. As aresult of this work, JCAHO has developednew standards to help health careorganizations assess their staffingeffectiveness. The tool provides facilitieswith an objective and evidence-basedapproach to assessing the number,

competency and skill mix of their staff bylinking staffing effectiveness to clinicaloutcomes. The standards are effective forhospitals beginning July 1, 2002. Similarstandards are being developed for longterm care, assisted living, home care,ambulatory, behavioral health care, andlaboratory settings. The JCAHO has alsopromised to take major steps in reducingthe documentation burden of theiraccreditation process.17

V

THERE IS MUCH WORK TO BE DONE

There are additional opportunities to helpemployers retain their health care workers.Washington State agencies can beginreviewing state regulations and agency

directives and removing any that lead toduplicative or unnecessary paperwork.Additionally, some employers have begunto form retention committees.

Affiliated Health Services and providing 32 scholarships to attend a leadership institutefor mid-level nurse managers.

REFERENCES1 Health Services Research and Evaluation, American Health Care Association, Results of the 2001 AHCA Nursing PositionVacancy and Turnover Survey, February 7, 2002.2 Susan M. Skillman, Troy Hutson, C. Holly A. Andrilla, Bobbie Berkowitz, Gary L. Hart, How are Washington State HospitalsAffected by the Nursing Shortage? Results of a 2001 Survey. Working Paper #68. Center for Health Workforce Studies, Universityof Washington, Seattle, WA, 2001.3 Aiken, L.A., Clarke, S.P., Sloan, D.M., et al, "Nurses' reports of hospital quality of care and working conditions in fivecountries," Health Affairs, 20 (3): 43-53, 2001.4 Peter D. Hart Research Associates study for The Federation of Nurses and Health Professionals, "The nurse shortage:Perspectives from current direct care nurses and former direct care nurses," April 2001:20.5 Ibid.6 Sochalski, Julie, "Nursing Shortage Redux: Turning the Corner on an Enduring Problem," Health Affairs, Volume 21,Number 5, pp. 157-164.7 Ibid.8 American Hospital Association Commission on Workforce for Hospitals and Health Systems, "In Our Hands, How HospitalLeaders can Build a Thriving Workforce," April 2002.9 Aiken, Linda, "Superior Outcomes for Magnet Hospitals: The Evidence Base," January 2002.10 Joint Commission on Accreditation of Healthcare Organizations, Health Care at the Corssroads, Strategies for addressing theevolving nursing crisis. August 2002.11 "The Attraction of Magnet Nursing Services," Texas Nurses Association, November-December 2001.12 American Hospital Association and PricewaterhouseCoopers, "Patients or Paperwork? The Regulatory Burden FacingAmerica's Hospitals," May 1, 2001.13 Ibid.14 Washington State Hospital Association and Association of Washington Public Hospital Districts, "Who Will Care ForYou?" Washington Hospitals Face a Personnel Crisis, page 26.15 First Consulting Group study for the American Hospital Association, January 2002.16 American Nurses Association, Health and Safety Survey, September 2001.17 Joint Commission on Accreditation of Healthcare Organizations, Facts about staffing effectiveness standards, 6/02.18 University at Albany, SUNY, School of Public Health, The Center for Health Workforce Studies, "How Are StatesResponding to Health Worker Shortages?" An Interim Report, July, 2002.19 Ibid.20 Texas Nurses Association Website: www.texasnurses.org21 Ibid 18.

VI

TASK FORCES & COMMISSIONS

Forty-seven states have convened taskforces, committees or commissions(includes Washington). In a few states,commissions led to more permanent

responses to address workforce shortagesor state law and policy changes. Most statesare still deliberating and policy responsesare in the formatives stages.

APPENDIX B: HOW ARE OTHER STATES RESPONDING TOTHE HEALTH PERSONNEL SHORTAGE?

The health personnel shortage is a nationalproblem. According to an interim reportby the Center for Health Workforce Studiesat the University of Albany other statesare engaging in a variety of response to the

shortage, such as forming task forces andcommissions, increasing scholarship andloan repayment programs, and providingincentives to increase workplace retention.1

SCHOLARSHIP AND LOAN REPAYMENT INCENTIVES FOR EDUCATION AND TRAINING

Forty-two states reported renewedattention to scholarship and loanrepayment programs. Twenty-five statestargeted a broad array of healthprofessionals (dentists, dental hygienists,and pharmacists), 29 states specificallytargeted registered nurses, and 27 statestargeted physicians. Other strategies toexpand the pipeline include increasingeducation and training capacity;expanding scholarship and loan

repayment programs; developing careerl a d d e r s ; i m p l e m e n t i n g f a c u l t yimprovements; conducting out ofstate/foreign recruitment; and launchingmedia and Web-based career campaigns.Ten states have training and educationinitiatives that utilize H1-B Visa grantsand the Workforce Investment Act(includes Washington). Several stateshave tapped Temporary Assistance toNeedy Families (TANF) funding.

WORKFORCE DATA COLLECTION

Thirty-one states collect health workforcedata. Most states survey their healthprofessionals at the time of licensure orrenewal, although some states regularlyconduct provider needs assessments andcollect data via surveys. State agencies are

the entities primarily responsible forcollecting health professional data but insome states data is collected by task forces,research centers, Area Health EducationCenters (AHECs), or professionalassociations.

1 National Academy for State Health Policy, Presentations at the session on health workforce shortages, August 4, 2002. The Centerfor Workforce Studies at the University of Albany reviewed state responses to health workforce shortages. The Center surveyedkey state organizations, governors’ offices as well as health, workforce development, labor, and education departments in all 50states, the District of Columbia and Puerto Rico. In addition, staff reviewed state web sites and did follow-up interviews with stateofficials for information on efforts to address health workforce shortages. This comprehensive study resulted in an interim report,“State Responses to Health Workforce Shortages.”

VII

HEALTH CAREER MARKETING

Twenty-seven states have initiatives to market health careers; 11 states indicated AHECsadministered many of the initiatives, especially those targeting youth.

CAREER LADDERS AND WORKFORCE RETENTION

Twelve states and Washington, D.C. havedeveloped or are developing career ladderprograms targeting nursing. Other activitiesare improving workplace retention throughwage pass-throughs; rate increases; shiftdifferentials; bonuses and other assistance(insurance, childcare, etc) workforceredesign; minimum staffing ratios/staffingstandards; and recognition programs. Fivestates have job redesign initiatives for

health workers, including nurses andCNAs. These initiatives include supportfor demonstrations, evaluations and bestpractice conferences.

Several states have passed legislationprohibiting or limiting mandatory overtimeand one state (CA) has passed legislationmandating nurse ratios in hospitals andnursing homes.

OTHER INITIATIVES

Some states are implementing initiativesto improve productivity such as reducingpaperwork. In an attempt to reduce theneed for health care, some states arefocusing on prevention and promotinghealthy behaviors. Other system changes

include conducting analysis and evaluationof programs and initiatives; and mandatingcollaboration and coordination amongdepartments of labor, education, health,human resources, and welfare to workprograms.

STATE HIGHLIGHTS

Minnesota: Continuation of Efforts -Minnesota's Health Professions WorkforcePartnership added local partners from 11communities in 2001 to develop solutionsto the health shortage. The state increasedthe number of individuals receivingfinancial assistance and loan forgivenessprograms, and the amounts available. Thispertains to the Medical Education andResearch Costs program and the GraduateMedical Program. The state created ahealth career information Web site for

both educational and employmentopportunities and developed a corecurriculum for a health career ladderprogram. Minnesota began collectinghealth workforce data coordinated withlicensing in the 1990’s. Ongoing datareports help the state to measure progressand inform planning for health workforceneeds. New initiatives include a university-sponsored Health Workforce 2013 redesignproject, an H1-B grant for training

VIII

Georgia: System Changes - Georgiaestablished a short-term workforcecommittee in late 2001. The committeereport, Code Blue, led to legislation thatcreated an ongoing health workforceshortage committee with subcommitteeson education, data and forecasting, workenvironment and productivity, andrecruitment and marketing. Committeeaccomplishments include increasing thehealth careers loan program; funding aresearch project that evaluates educationalcapacity and innovation; increasing the

nursing faculty loan program; developinga bridge from certified nursing assistant tolicensed practical nurse to registered nurse;and creating private sector scholarships.They also created a Data Consortium tooversee a data research center, and fundedregional forums and a workforceenvironment and productivity report.Recruitment and marketing initiativesinclude the Teach Academy, health caresummer camps and youth training, a healthworkforce Web site, and a health carecareers media campaign and manual.

California: Nurses & Direct Care - In 2001California launched the Long-Term CareCouncil, the Aging with Dignity Initiative,and two Caregiver Training Initiatives andprovided additional funds in 2002. A five-year grant of state and local funds supportsthe Los Angeles Health Care WorkforceDevelopment Program. The Nurse

Workforce Initiative received a three-yeargrant for training, education capacity,media, and prerequisite standardization.In addition, the state established linkagesamong the Office of Statewide HealthPlanning and Development, theEmployment Development Departmentand the Employment Training Panel.

New York: Healthcare Workforce Recruit-ment and Retention Act - In 2002, the NewYork State legislature allocated $1.85billion to ensure an adequate supply ofhealth care workers. The funds supportedMedicaid rate add-ons and grant programsfor disadvantaged hospitals, nursing homes,home health care services and clinics. Thestate share is $774 million; federal andlocal funds total $1.1 billion. Resources

to fund the initiative include a cigarettetax increase, a covered lives assessment,increases in federal upper payment limits,and Medicaid match and funds from aBlue Cross/Blue Shield conversion to afor-profit company. Anticipated savingsinclude $694 in state funds from a shift inpublic health costs. to fund the initiativeinclude a cigarette tax increase, a coveredlives assessment, increases in federal upper

incumbent workers and data collectionchanges that will improve regional

planning and emergency preparedness.

IX

Texas: Nursing Shortage Solutions - A riderin the 2002 appropriations bill includedmonies for a Nursing Growth carve-out.Five million dollars a year was allocatedfor community colleges, $5.6 million foruniversities, and $723.7 thousand forpublic nursing programs in healthscience centers. More than $4 millionin Tobacco Settlement funds were

allocated for recruitment and retentionand increasing pay for faculty overloadsfor both private and public nursingp r o g r a m s . T h e Te x a s M e d i c a lAssociat ion, the Texas Nurs ingAssociation, and the Texas HospitalAssociation Coalition on WorkplaceIssues created a “Zero Tolerance” policyon physician abuse of RNs.

Maryland: Nursing Legislation - Marylandincreased its nursing scholarship awardand allowed nurses to receive morethan one state scholarship and becharged in-county tuition for out ofcounty programs. In addition the state

increased its Medicaid budget by $25million to increase long-term carenursing staff salaries. A NursingSupport Program provides $6 millionto hospitals for nursing recruitmentand retention.

ADVICE FROM OTHER STATES

The current shortage is not a short-termproblem. Policy makers should expectshortages to be on state agendas for manyyears to come. It is important to considerthe whole system. Accurate workforcedata is important for appropriateplanning, monitoring progress, andevaluating ongoing efforts. Workforceinitiatives should include increasing

diversity, bioterrorism and emergencypreparedness. Workforce and workplaceissues are inter-related. However,retention and productivity issues arepolitically difficult and scope of practicei s sues can dera i l other e f fort s .Collaboration and coordination amongplayers is key; one agency or organizationmust lead the effort.

payment limits, and Medicaid match andfunds from a Blue Cross/Blue Shieldconversion to a for-profit company.

Anticipated savings include $694 in statefunds from a shift in public health costs.

X

ALLEVIATING THE HEALTH CARE PERSONNEL SHORTAGE IN LOCAL AREAS

Collaboration between the health industryand educators is vital for solving the healthcare personnel shortage. Skills panels inhealth provide an effective avenue forimplementing change at the local level.Since 2000, the Workforce Training andEducation Coordinating Board has issuedSKILLS (Securing Key Industry Leadersfor Learning Skills) grants to workforcedevelopment councils1 for the purpose ofsupporting skills panels that are working

partnerships between industry andeducation. Each skills panel addresses skillsgaps for a particular industry cluster suchas health, technology or food processing.In Washington, eight workforcedevelopment councils have establishedskills panels in health with the mainpurpose of identifying health personnelshortages in their areas, designing strategiesto remedy the shortages and implementingthese strategies.

XI

APPENDIX C: LOCAL HEALTH SKILLS PANELS

EIGHT HEALTH SKILLS PANELS IN WASHINGTON

Benton-Franklin Benton-Franklin Community Health Alliance(Benton and Franklin)

Northwest Washington Northwest Alliance for Health Care Skills(Whatcom, San Juan, Skagit and Island)

Olympic Olympic Health Care Alliance(Clallam, Jefferson and Kitsap)

Pacific Mountain Pacific Mountain Health Care Partnership(Grays Harbor, Lewis, Mason, Pacific, Thurston)

Tacoma-Piece County Pierce County Health Services Careers Council (PCHSCC)(Pierce)

Seattle-King Healthcare Industry Panel(King)

Snohomish Snohomish County Health Care Industry Skills Panel(Snohomish)

Southwest Washington Southwest Washington Allied Health Care Skills Panel(Clark, Cowlitz, Skamania, Wahkiakum)

Note: As of December 2002, health skills panels were not established in the Tri-Counties, Spokane, North Central or Eastern Washington workforce development areas.

Workforce Development Area (Counties)(See map, page C5)

Health Skills Panel

1 The federal Workforce Investment Act of 1998 required that each state establish local workforce investment boards, known inWashington as workforce development councils. Washington has 12 workforce development councils that are each comprised ofa majority of business representatives, with education, and labor representatives. These councils fulfill the state strategic goalsfor workforce development at the local level.

FUNDING SOURCES

Apart from the initial SKILLS grants from the Workforce Education and TrainingCoordinating Board, health skills panels have received funding from other sources:

• The State Board for Community and Technical Colleges: To expand or establishhealth care education and training programs.

• The Employment Security Department: To train incumbent workers in health careoccupations.

• The U.S Department of Labor: To train incumbent workers in health care occupations.

• Local Workforce Development Councils: To expand capacity in local health careeducation and training programs.

• Local Industry: To support various initiatives

• The Governor’s Office: To establish or expand programs that prepare students forhealth care occupations.

See Table 3, page 51 for information on skills panel, State Board for Community andTechnical College and Employment Security grants.

HEALTH SKILLS PANELS INITIATIVES

Recently established health skillspanels in Seattle-King, Snohomish,and Southwest are at the beginningstages of identifying occupations withthe most severe shortages by assessinglocal labor market information and

conducting local employer surveys.Health skills panels in Tacoma-Pierce,Northwest, Olympic, Pacific Mountainand Benton-Franklin have begunimplementing initiatives that haveprimarily focused on:

• Increasing educational capacity of nursing and allied health programs;

• Increasing clinical training capacity;

• Creating career mobility by providing training opportunities for incumbent workers to move upthe career ladder; and

• Developing recruitment strategies to encourage more students to enter health care educationand training.

XII

INCREASING EDUCATIONAL CAPACITY: EXAMPLES

In 2002, the Tacoma-Pierce CountyWorkforce Development Councildedicated a total of $1.3 million federalWorkforce Investment Act fundingallocations to support the expansion oflocal health care training programs. Thelocal health care industry has committed$700,000 in cash and equipment todevelop, sustain, and increase high demandtraining and health care employers havepaid for staff time to teach in trainingprograms. For example, MultiCare hasemployed a clinical coordinator tosupervise LPN students from BatesTechnical College during their on-sitetraining at Tacoma General Hospital.

The health skills panel in Pacific Mountainreceived $850,000 from EmploymentSecurity to expand education and trainingprograms in health care at South PugetSound, Grays Harbor, Centralia andOlympic Colleges.

In 2002, Tri-Tech Skills Center receiveda $200,000 discretionary grant from theGovernor’s office to expand its pre-healthprofessional programs thus creating moreopportunities for students to take thecourse offerings. The Benton-FranklinHealth Skills Panel supported theapplication.

The Northwest Washington health skillspanel research on employer demand forimaging specialists supported a successfulproposal by the Bellingham TechnicalCollege for a grant to develop a radiologictechnologists program. BellinghamTechnical College is leading thedevelopment of a community andtechnical college consortium ofrepresentatives from Skagit ValleyCommunity College, Everett CommunityCollege, Edmonds Community Collegeand Whatcom Community College toimplement the program.

INCREASING CLINICAL TRAINING CAPACITY: EXAMPLE

Tacoma Community College, inpartnership with eight regional nursingprograms and the health skills panel inPierce County is developing a system forcentralized clinical site coordination to

maximize clinical training opportunities.The system will include Web-basedplanning, similar to the model developedby in Maricopa County CommunityColleges in Arizona.

CREATING CAREER MOBILITY: EXAMPLES

The Pacific Mountain Health Skills Panelis utilizing an Employment Security grantto train 25 incumbent workers from

Providence St. Peter Hospital. Elevencertified nursing assistants will becomelicensed practical nurses by 2003, and 14

XIII

licensed practical nurses will becomeregistered nurses within by 2004. Thesetraining funds have the additional benefitof enabling South Puget SoundCommunity College to open another classwith space to train 12 more non-grantstudents in the registered nursing class.

Health employers and members of thehealth skills panel in Pierce County,partnered with WorkSource to provide

a WorkSource career specialist who isco- located at Good Samari tan,Franciscan and Multicare Health System,to provide incumbent workers withcareer development information:identifying career aptitudes and goals,appropriate training, and opportunitiesfor financial assistance. Since 2001,over 500 workers have been assisted,and more than 50 are now in health carecareers training.

RECRUITING INDIVIDUALS INTO HEALTH CARE OCCUPATIONS: EXAMPLES

Seattle-King, Snohomish, and Tacoma-Pierce Health Skills Panels coordinatedwith KIRO TV, and several large healthcare employers to develop a marketingcampaign aimed at increasing communityawareness, especially among youth andethnic groups, about the opportunitiesavailable in health care. The initialcampaign includes TV commercials andthe development of a Web site, and isfocused on nursing and the nursingspecialties. Future campaigns plan toaddress other health care occupationsshortages.

In 2002, the health skills panel inNorthwest Washington created a financialassistance program to encourage workersinto further education and training inorder move up a career ladder. The skillspanel will match employer scholarshipfunds; advance the money for tuition if

the employer's policy is to reimburse afterclass completion; provide coaches andtutors as career counselors or to assist withspecific education needs, and providefunding for childcare and transportation.

As part of local marketing campaigns,Tacoma-Pierce, Olympic, and Benton-Franklin Health Skills Panels havedeveloped Web sites that aim to recruitindividuals into health care occupations.They provide information about localemployment opportunities, career paths,education and training programs andfinancial aid.

Pierce County:http://healthjobsforyou.com

Benton Franklin: http://www.healthcareworx.org

Olympic:http://www.practiceinparadise.org

XIV

XV

WORKFORCE DEVELOPMENT COUNCILS/AREAS IN WASHINGTON

San Juan

Island

Kitsap

Clallam

Jefferson

Grays HarborMason

Thurston

Lewis

CowlitzWahkiakum

Pacific

Pierce

King

Snohomish

Skagit

Whatcom

Okanogan

FerryPend

OreilleStevens

Lincoln Spokane

Whitman

Garfield

Columbia

Walla Walla Asotin

Adams

Douglas

Chelan

Kittitas

Yakima

Grant

Franklin

Benton

Klickitat

Skamania

Clark

EASTERNWASHINGTONPARTNERSHIP

SPOKANE AREA

BENTON-FRANKLIN

NORTH CENTRAL WASHINGTON /COLUMBIA BASIN

TRI-COUNTY

TACOMA-PIERCE

SEATTLE-KING

SNOHOMISH COUNTY

NORTHWEST

SOUTHWEST WASHINGTON

PACIFIC MOUNTAIN

OLYMPIC CONSORTIUM

EASTERNWASHINGTONPARTNERSHIP

XVI

OUTCOMES AT A GLANCE

Table 3: Workforce Training and Education Coordinating Board HEALTH CARE SKILLS PROJECTS 2000-2003

Northwest Olympic Seattle/King

Tacoma/Pierce

PacificMountain

Benton/Franklin Snohomish Southwest

Total WTECB Funding

Create skills panel

Analyze/validate regionallabor market data

Identify specificoccupations/skill gaps

Develop job ladders/wage progression

Recommend/revise curricula

Catalyze development or expansionof college training program

Streamline process foridentifying clinical sites

Create articulation agreements

Integrate withexisting partnership

Develop marketingand recruitment tools

Sustainability plan

Identify issues requiringlegislative action

State Board for Community &Technical Colleges Grants mainly

for Expanding Educational Capacity

Employment Security Grantsfor Customized Training for Incumbent Workers

* Other State Board for Community and Technical College Grants: Spokane Community College received $150,00 for an articulated LPN-RN program, and with Spokane Falls $95,746 forexpanding education via distance learning. Yakima Valley received $95,746 to expand nursing careers programs.

** Colleges located in three workforce development areas in Eastern Washington partnered (see Benton-Franklin above) to receive $537,518 to expand allied health program capacity.

Workforce Development Council

$46,000 $71,375 $135,000 $135,000 $102,000 $68,000 $85,000 $71,347

X X X X X X X X

X X X X X X X

X X X X X X X X

X X X

X X X X

X X X X X X

X X X X

X X

X X X X X

X X X X X X X

X X X X X X X X

X X X X X X X

$79,000$191,492

$262,038$179,524$187,662

$82,389$92,029 $95,746 $537,518**

$127,995 $175,000 $150,000 $175,000$150,000 $199,700

$191,492

X

X

There are 248 high school districts andnine Skills Centers in Washington. Ofthose, 124 (50 percent) have access toHealth Occupations Programs either atthe high schools or through affiliationwith a Skills Center. Health OccupationsPrograms include Health OccupationsBasic Core, Nursing Assistant, DentalAssisting, and Medical Assisting. TheSkills Centers also offer an EmergencyMedical Technologist (EMT) program.During the 2000/2001 school year, 3,22911th and 12th graders were enrolled in aHealth Occupations Program.

Students enrol led in a Heal thOccupations Program are required to takecore health science classes in addition tothe requisite math and science courses.These include medical terminology,anatomy and physiology, asepsis andAIDS education, vital signs, CPR/FirstAid, growth and development: physicaland emotional, communication, careerawareness, safety practices, and studentleadership. The students must also meetthe core skill standards for health sciencesestablished by the U.S. Department ofEducation Office of Vocational and AdultEducation.

High school Health Occupations Programsprovide students with excellent preparationfor post-secondary health sciencesprograms. Many of these students take astate exam upon graduation and receivecertification that enables them toimmediately enter the health careworkforce as a nursing assistant, dentalassistant, emergency medical technician,or medical assistant. Some school districtsand Skills Centers are considering addingprograms that would train students asphlebotomists, pharmacy technologistsand medical laboratory technicians. Thesestudents graduate high school with morecareer options than many adults who havebeen working for a number of years.

There are 124 high school districts whosestudents do not have access to theopportunities offered through the HealthOccupations Programs. There are 40 SportsMedicine programs already in districts,however, which could be broadened toinclude the Health Occupations core areasof study. A one-time investment in theremaining schools not currently set up tooffer Health Occupations Programs couldallow them access to program coursesthrough a variety of methods.

APPENDIX D: K-12 SCHOOLS OFFERINGHEALTH OCCUPATIONS

XVII

XVIII

Table 4: Schools Districts Offering Health Occupations Programs

Health Occupationsand Nursing Assistant

Health Occupationsand Dental Assistant

Health Occupationsand Medical Assistant

EmergencyMedical Services

Note: 40 school districts offer Sports Medicine but this does not generally include a health occupations component with additional health sciences.

Health Occupations Only

Battle Ground

Lake Chelan

Kelso

Kent

Bellevue

Oak Harbor

Tacoma

Arlington

Bellingham

Bethel

Cape Flatery

Central Kitsap

Centralia

Chehalis

Franklin Pierce

Lynden

Tacoma

Vancouver

Kennewick

Evergreen

Grand Coulee

Chewalah

Northshore

Mukilteo

Battle Ground

Bellevue

Kelso

Kent

Lake Chelan

Port Angeles

Spokane

Sunnyside

Tumwater

Wenatchee

Bainbridge

Yakima

Bremerton

Edmonds

North Kitsap

Oak Harbor

Peninsula

Stanwood

Tacoma

Tonasket

Walla Walla

Vancouver

Kennewick

Evergreen

Mukilteo

Spokane

Yakima

Vancouver

Highline

Goldendale

Seattle

Highline

Goldendale

Kennewick

Tumwater

Troy Hutson (Committee Chair), Washington State Hospital Association, BobbieBerkowitz, University of Washington - School of Nursing, Monet Craton, Pierce CountyHealth Services Careers Council, Dorothy Detlor, WSU - College of Nursing, DanaDuzan, Sacred Heart Medical Center, Maura Egan, Department of Health, William E.Fassett, College of Pharmacy, John Fricke, Higher Education Coordinating Board, JoanGarner, Washington State Nurses Association, Brian Jeffries, Office of Superintendentof Public Instruction, Pamela Lee, Tacoma Community College, Carol Mizumor, PimaMedical Institute, Jim Crabbe, State Board for Community and Technical Colleges,Sidney Nelson, School of Pharmacy, UW, Nick Parisi, Yakima Valley CommunityCollege, Lisa Pletcher, Pierce County Careers Consortium, Michael Ratko and PamelaDoss, Washington State Department of Labor and Industries, Susan Shoblom, Departmentof Health, Sue Skillman, Center for Health Workforce Studies, UW, Jody Smith,MultiCare Health System

APPENDIX E: TASK FORCE COMMITTEEMEMBERSHIP AND PRESENTERS

TASK FORCE EDUCATIONAL CAPACITY COMMITTEE

Gloria Rodriguez (Committee Chair), Association of Community and Migrant HealthCenters, Elizabeth Floershim, Washington Health Foundation, Lee J. Forshey, WorkSourceNorth Seattle, Patty Hayes, Department of Health, Mary Lampe, University ofWashington, Brian McAlpin, Rockwood Clinic, Steve Meltzer, Area Health EducationCenter, Spokane, Jeff Mero, Association of Washington Public Hospital Districts, JohnNagelmann, Group Health Cooperative, Linda Nguyen, Tacoma-Pierce CountyWorkforce Development Council, Jody Palmer, Western Washington Area Health CareEducation Center, Anne Tan Piazza, Washington State Nurses Association, Lisa EdwardsPletcher, Pierce County Careers Consortium, Ellen O’Brien Saunders, WorkforceTraining, and Education Coordinating Board, Susan Shoblom, Department of Health,Sue Skillman, Center for Health Workforce Studies, UW, Diane Sosne, SEIU/1199NW,Teresa Stone, Office of Superintendent of Public Instruction, Terry Takto, WesternWashington Area Health Care, Evelyn Torkeleson, WA Rural Health Association,Karen Tynes, WA Association of Housing and Services for the Aging, Suzanne Wall,SEIU/1199NW, Audrey Woodin, WA State Residential Care Council, Diane Zahn,United Food and Commercial Workers Union

TASK FORCE RECRUITMENT AND RETENTION COMMITTEE

XIX

XX

Linda Nguyen, Pierce County Health Services Careers Council, Karen Hasse-Herrick,Northwest Organization of Nurse Executives—Washington Nursing Leadership Council,Mary Selecky, Secretary of Health, Pam Hayes, Kris Sparks, Department of Health, SueSkillman, Center for Health Workforce Studies, UW, Ross Wiggins, EmploymentSecurity Department, Jim Crabbe, Kathy Cooper, State Board for Community andTechnical Colleges and two High Demand Grant Managers from Columbia BasinCollege, Alex Kosmides and Larry Thompson, NW Alliance for Health Care Skills,Vickie Ybarra, State Board of Health Board Member—Diversity Network

PRESENTERS AT TASK FORCE MEETINGS

Bryan Wilson, Madeleine Thompson, Donna Russell, Barbara Mix, Workforce Trainingand Education Coordinating Board; Thanks to Pam Hayes, Department of Health, whoprovided assistance for Appendix B; Marianne Seifert, staff for the Health WorkforceDiversity Network.

WORKFORCE TRAINING AND EDUCATION COORDINATING BOARD AND TASK FORCE STAFF

Workforce Training and Education Coordinating Board128 10th Avenue SW, 6th FloorPO Box 43105Olympia, Washington 98504-3105

(360) 753-5660(fax) (360) 586-5862www.wtb.wa.gov/HEALTHCARETASKFORCE.HTM

http://www.wtb.wa.govEmail: wtecb@wtb.wa.gov