Expanding the Health Care Workforce through Partnerships by HC11120112143

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									                                     DRAFT


                         PARTNERSHIP DEVELOPMENT


                                       For



                   CALIFORNIA COMMUNITY COLLEGE
                   HEALTH OCCUPATIONS PROGRAMS


                                       By


                          The Center for Student Success

                                 September 2005


                               With Support From


                         THE HEALTH CARE INITIATIVE
                  CALIFORNIA COMMUNITY COLLEGES




Senior Researcher & Author: Lisel Blash, MS, MPA
Senior Researcher: Eva Schiorring, MPP

Director
Robert Gabriner, Ph.D.




                                                           1
Expanding the Health Care Workforce through Partnerships............................................. 3
1. Types of Collaborations and How They Work ........................................................... 3
  Creating New Programs that Reflect Community Needs ............................................... 4
  Expansion of Existing Programs ..................................................................................... 5
  Career Ladder and Step-Up Programs ............................................................................ 7
  Streamlining the Curriculum to Enhance ADN to BSN Transition ................................ 8
  2. Seeking Resources for Implementing Partnerships .............................................. 10
  3. Making Partnerships Work: Advice from Successful Program Directors ............ 15
4. Case Studies .............................................................................................................. 21
  A. Yuba College Rad Techy Program with Satellite Site in Sacramento .................. 21
  B. Fresno City College Radiologic Technology Program with Satellite Site at West
  Hills College in Lemoore .............................................................................................. 24
  C. Cabrillo Community College Limited Permit X-Ray Technician Program ......... 27
  D. Santa Barbara Nursing Program Expansion ......................................................... 32
  E. American River College Nursing Program Expansion ......................................... 35
  F. Sacramento City College Nursing Program Expansion—Sutter Center for Health
  Professions .................................................................................................................... 39
  H. Shasta Community College Dental Hygiene Program.......................................... 43
  I. Antelope Valley College Distance Learning Satellite .......................................... 43
  J. San Francisco City College’s Nursing Program Expansion ................................. 49
References: ........................................................................................................................ 53




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Expanding the Health Care Workforce
through Partnerships
This brief documents and examines different types of partnerships community college
health occupations programs have entered with hospitals, clinics and other community
and academic partners.
The featured partnerships have generated a wide range of benefits for all parties
involved and have in many cases increased community colleges’ ability to respond to the
demand that they produce more job-ready health care workers at a time when resources
are extremely scarce. At the same time, the partnerships have increased health care
providers’ ability to recruit more workers and communities’ ability to provide local
residents with access to adequate health care services.
The colleges, health care providers and other stakeholders that have already engaged in
designing and expanding these partnerships possess a wealth of information that other
programs and stakeholders can benefit from considering as they begin to seek out
community partners and develop collaborative programs. In addition, since no two
collaborations are identical, even those with years of experience in partnership design
and development may get new ideas from learning how others are structuring and
managing their joint ventures.
The purpose of the brief is thus to document and examine promising practices in the
field of partnership development and to create a forum where practitioners and would-be
practitioners of partnership development can gather to exchange information.
The report comprises four sections:
                 1   An overview of different types of partnerships and their
                     purpose;
                 2   A discussion of resources successful partnerships have used
                     to fund and expand their joint ventures;
                 3   Suggestions from practitioners on how to design and develop
                     partnerships.
                 4   An appendix featuring case studies of California community
                     college health occupations programs involved in partnerships with
                     other organizations. Each case study includes contact information
                     for key administrators.

1.     Types of Collaborations and How They Work
This brief explores health care partnerships aimed at:
      Creating new programs to address a community need, including:
           Initiation of new programs, both permanent degree and certificate
              programs and ―as needed‖ short-term specialty programs
           Distance learning satellite programs
      Expanding existing programs to enroll more students via:
           Employer support of additional faculty and facilities.



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          Contract education and step up or career ladder programs, faculty
            positions and facilities.
     Streamlining curriculum to enhance ADN to BSN transition.
Many of these strategies overlap as programs innovate to work with local resources and
challenges.

Creating New Programs that Reflect Community Needs
Initiation of New Programs: Degree, Certificate and Short-Term
Specialty Programs
Community college allied health occupations departments, along with Regional Health
Occupational Resource Centers (RHORCs), have been innovative in identifying and
addressing community health care needs. In many instances, this has meant starting a
whole new degree or certificate program. For instance, Shasta College worked with
local dentists, the local community dental clinic, and the Northern California Dental
Society to address the local workforce shortage in the dental hygienists. The partners’
response was to start a local dental hygienist training program which, although it attracts
students from all over the state, enrolls many local residents who stay and practice in the
area after completing their training. The new program is particularly innovative because
it shares facilities with the local community dental clinic. This physical partnership
provides students with the opportunity to get clinical experience in their own backyard,
while it simultaneously helps staff a facility that provides critically needed dental services
to low-income residents. (See pg. 43 for the corresponding case study.)
The limited permit x-ray technician program offered by the Santa Cruz Workforce
Investment Board and Cabrillo College cross-trains health care employees who are
already working in local clinics to provide basic x-ray services. As a result, the value and
earnings potential of the employees increase and patients no longer have to travel far to,
for example, have a simple x-ray taken of an injured foot. The program, which is the
first of its kind in a California community college, was designed by a partnership that
included local clinics, the Workforce Investment Board, and adult education providers,
including Cabrillo College. By working together, these stakeholders successfully
conceptualized the program and obtained Workforce Investment Act funding to pilot the
new initiative. (See pg. 27 for the corresponding case study.)
Finally, a new program developed by the South Coast RHORC responds to local health
care needs by instituting a semester-long certificate course in phlebotomy at Santa
Barbara Community College (SBCC). In addition to the RHORC and SBCC, the
partners include the Sansum/Santa Barbara Medical Foundation which will provide a
lecturer/clinical director for the program and clinical placements for students. (See pg.
31 for the corresponding case study.)

Distance Learning Satellite Programs
Distance learning has provided health care training organizations and health care
providers in remote places or across scattered sites with new opportunities to
collaborate effectively. One of the more successful strategies has been the institution of
various distance learning programs which utilize video-broadcasting technology to
transmit courses to satellite facilities in other, sometimes rural areas. This strategy often
involves collaboration between many different stakeholders, as multiple training



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providers may work together to provide the lecture material, while hospitals and clinics
may provide funds and facilities for the program and/or clinical sites for students.
A large number of community colleges across the state have distance learning
programs; many of them are part of a collaborative effort with employers, other
community colleges, and sometimes other training providers and community
organizations. Examples include:
      Fresno City College, West Hills Community College and a consortium of local
       hospitals in a collaborative radiologic technology distance learning program;
      Butte College’s collaboration with a consortium of local hospitals to provide an
       expanded radiologic technology program in Sacramento and Marysville;
      Antelope Valley College and Owens Valley Development Corporation’s distance-
       learning LVN program;
In Central California, the West Hills Community College Rad Tech program works with
Fresno City College (33 miles away) and with a consortium of local hospitals that pay for
the cost of the program and provide clinical sites. The purpose of this program is to offer
training to local students in a relatively isolated agricultural area with the aim of retaining
rad tech staff in local hospitals. (See pg. 24 for the corresponding case study.)
Likewise, Yuba’s Rad Tech satellite program enables a community in the Sacramento
aret that previously did not have a rad tech program to offer training in this high demand
occupational area. The local hospitals, which urgently need to hire more radiologic
technologists, pay for the costs of running the satellite program. However, unlike the
case with FCC and West Hills—there is only one community college involved, and the
hospital partners provide only one facility for clinical training. (See pg. 21 for the
corresponding case study).
In the case of the partnership between Antelope Valley College and the Owens Valley
Development Corporation (OVDC), students in the Eastern Sierra town of Bishop
receive lectures that are broadcast from Lancaster, almost 200 miles away. Hospitals at
both sites provide clinical slots, and the OVDC and Inyo Mono Paiute Shoshone Indian
Nation provide the equipment and facilities for the classroom segment in Bishop. This
program is unusual in that the Bishop facility is located in a different community college
district than that in which Antelope Valley is situated. This partnership is also different in
that the partnering organization is another adult education program rather than an
employer. (See pg. 43 for the corresponding case study).

Expansion of Existing Programs
Expansion of existing programs onsite, or nearby to the community college campus,
generally takes two forms—one a general expansion open to all students, including
those new to health care; the other, an expansion targeting existing health care workers.

General Expansion Through Provision of Additional Faculty and
Facilities
Community college health occupations programs all over the state are under pressure to
―produce‖ more job ready health care workers. To meet this challenge, many have
attempted to expand the number of slots available to entering students. This, however,
can only be done through a corresponding increase in faculty and through the
identification of additional clinical training slots. Expansions may also require more


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classroom space, a dilemma that can be met by physical expansion, creative
scheduling, or both.
Nonetheless, some programs have managed to nearly double enrollment, including:
      American River College Nursing Program in conjunction with the Healthy
       Community Forum through a Workforce Investment Act grant;
      Sacramento City College Nursing Program in conjunction with Sutter Health
       through funding provided by Sutter Health;
      Santa Barbara City College Nursing Program in conjunction with Cottage Health
       through funding provided by Cottage Health;
      San Francisco City College Nursing Program in conjunction with California
       Pacific Medical Center and St. Luke’s Hospital through funding from the Moore
       Foundation;
One key way that hospitals and community colleges have collaborated is through finding
creative ways to fund faculty positions. One strategy is to recruit adjunct faculty from
amongst practicing nurses or other staff at partner hospitals or clinics. For instance,
employers can provide paid release time to existing qualified staff to serve as
instructors/lecturers for community college programs. This means that the instructor is
retained as hospital staff at a practitioner’s salary, but with teaching duties.
As an example, the American River College (ARC)Nursing Program has integrated a
large number of clinical adjunct faculty (26-27) from its hospital partners. The WIA grant
has also allowed the program to reimburse existing faculty for training and mentoring the
new clinical faculty and has provided some additional support (counseling,
administrative) to alleviate the increased workload incurred by ARC faculty as a result of
the expansion. The hospitals contribute release time to participating nurses in the form
of 24 hours per week plus benefits for their staff to work as clinical faculty for 18 weeks
per year. (See pg. 35 for the corresponding case study).
Sacramento City College (SCC) is also taking on a large number of new clinical adjunct
faculty provided by Sutter Health. The hospital partner contributes paid release time for
staff to serve as part-time clinical faculty, and SCC faculty will train the new adjuncts to
take on the duties of clinical instructors. Sutter has contributed $16 million to develop
the new Sutter Center for Health Professions, an extended campus facility that will
support training and graduation of 500 new nursing students over a 6-7 year period.
Sutter is paying the tuition for all new students during the first few years of
implementation. (See pg. 39 for the corresponding case study).
Another model is for the hospital to pay for the cost of the salary of a tenured faculty
member. This may work better for some programs because the faculty member in this
case is a community college employee who can dedicate him/herself fully to teaching.
Santa Barbara’s nursing program employs four faculty through this model, with full-time
salaries provided by Cottage Hospital. Should the need for faculty ever decrease, the
partners have agreed to shed teaching positions via attrition. (See pg. 32 for the
corresponding case study).
Finally, the San Francisco City College RN Program in collaboration with California
Pacific Medical Center and St. Luke’s, applied for and was awarded a $4.2 million 5-year
grant from the Gordon & Betty Moore Foundation to support an expansion that will
increase by one-third the annual enrollment of RN students. The expansion will be
implemented through the addition to the regular day-time RN program of an afternoon-


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evening section. The grant pays for staff time for program development, coordination,
instruction and other direct services to students. Grant support also contributes to
faculty training, research & evaluation and student counseling/case management
services (See pg. 49 for the corresponding case study).

Career Ladder and Step-Up Programs
Career Ladder and Step-Up Programs are a special kind of expansion that train and
prepare incumbent health care workers to move to a higher level on the health care
career ladder.
The strategy offers a wide range of benefits and incentives to key stakeholders. The
promise of advancement opportunities is a great recruitment and retention tool for
hospitals. Career ladder and Step-Up Programs also help health care providers
advance existing staff into positions for which there is a shortage. In addition, the
strategy provides community colleges with the opportunity to expand through the
enrollment of highly committed students with prior health-care experience. Finally, the
opportunity to work while moving up the career ladder is an important option for students
who cannot afford to stay in full-time education for extended and unbroken periods.
A large number of community colleges across the state have been involved in these kind
of programs, including:
      The Paradigm Program, a partnership between Fresno City College and five
       Fresno and Madera area hospitals to train and advance CNAs and other hospital
       staff into RN positions;
      Santa Ana College’s program with St. Joseph’s Hospital to train existing
       employees to become RNs;
      Riverside Community College Caregiver Training Initiative Grant program with a
       local nursing home to train CNAs and others to become LVNs;
      American River College and four Sacramento area hospital’s partnership to
       educate hospital employees (and some additional students) to receive ADN
       degrees;
      Cabrillo College’s limited license radiologic technician program, where hospital
       staff and other students are trained into entry level technician programs, with the
       option of eventually receiving further education to step up to radiologic
       technologist;
These programs may be used in conjunction with distance learning programs and other
strategies to provide training to existing staff on-site, or staff may travel to classes.
Many colleges have instituted special programs utilizing weekend/evening scheduling
and some allow staff from participating provider organizations to forgo lengthy
enrollment waiting lists. In exchange, provider organizations may support the training
organizations with funding for faculty salaries, onsite or offsite learning facilities and
equipment for their staff, etc. Some providers use 20/40 programs to pay staff full-time
while they take part in educational activities half-time, while others provide tuition
reimbursement, time off, travel reimbursement and scholarships. In return, students are
often required to commit to staying with the hospital or clinic for a certain amount of time.
A 2004 report on helping low-skilled adults enter and succeed in college and careers
provides a list of preconditions that pave the way for successful collaborations in these
endeavors:


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    1. Strong employer need for skilled workers trained to a certain recognized or
       credentialed level;
    2. Skills shortages in occupations with well-defined career ladders that link acquired
       skills with advancement and pay increases for workers;
    3. The existence of large employers and/or intermediary organizations;
    4. Good existing relationships between community colleges and businesses;
    5. State or local policies and political support that provide flexibility in using adult
       education and workforce development funds, promote interagency collaboration
       and integrated funding streams, and allow for the development of basic skills
       programs that integrate academic and occupational skills; and
    6. A level of integration within community colleges, or between community colleges
       and other education partners that allow for a coordinated continuum of education
       and training1.
The report outlines a number of case studies, all of them in the health care field, in which
community colleges and employer organizations worked together to provide career
ladder programs. As the short list of programs offered above illustrates, many California
Community College health occupation programs have developed programs similar to
those implemented in other parts of the country. Most of the examples listed involve
nursing, an occupational area that is experiencing serious workforce shortages, has a
very clearly defined career ladder, large employers, and situations in which large
numbers of workers are needed at each employer site. Some of these programs work
with hospital staff who have entry level skills to train them to step up to the first rungs of
the nursing ladder (CNA, LVN), while others take staff already trained to these initial
levels and work to promote them to higher rungs that are in high demand (ADN trained
RN)2.
Radiologic technologists and other allied health care workers are also very much in
demand, but the number of them at each site is relatively few, making it difficult to
replicate the nursing approach and its use of onsite classes or of large training programs
that serve specific hospitals. Instead, ―step-up‖ programs for other allied health workers
are often handled on an individualized basis through employer-sponsored tuition
reimbursement, release time, and scholarship programs. However, Cabrillo’s limited
radiologic technician program addresses the shortage of x-ray technicians by instituting
another rung in the career ladder for this profession. Students, many of them practicing
medical assistants, will be cross-trained to perform some of the rudimentary tasks
involved in x-ray technology for placement at clinics and other sites where a full-fledged
radiologic technologist may not be necessary due to the low volume and basic nature of
the tasks. With curriculum integration, these trainees may be eligible to ―step-up‖ further
if they wish and enter an accelerated track towards becoming a higher paid, higher
skilled radiologic technologist.

Streamlining the Curriculum to Enhance ADN to BSN Transition
ADN to BSN programs are a special type of step-up program. Most ADN to BSN
programs are instituted directly between hospitals and 4-year institutions. However,

1
 Jobs for the Future, 2004, pg. 20.
2
 Programs meant to move ADNs up to the next level, BSN, are discussed in the section on seamless ADN-
BSN programs.


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these collaborations are important to community colleges in that 70% of practicing
nurses in California received their ADN from a community college. Many students who
graduate with an ADN, may for financial and other reasons wish to work soon after
receiving their degree. The ADN to BSN option gives them the opportunity to start
making a living while taking advantage of employer-based tuition reimbursement or other
incentives to eventually pursue the BSN at a 4-year institution. For employers, these
programs help boost retention and gain better-educated employees able to move into
positions where the need is greatest.
While these collaborations do not directly benefit the community colleges, at least one
community college Regional Health Occupation Center has moved to convene a
consortium of health care agencies to choose a provider of BSN education for the
region. South Coast RHORC and provider organizations recognized that there was no
generic program in baccalaureate nursing in their region, meaning that students (a) had
to leave the area to get the degree and (b) had to spend a long time finishing both
degrees with a lot of repetitive coursework. The consortium assessed a number of
different programs and chose CSU Fullerton to provide video-teleconferenced didactic
instruction at Cottage Hospital for both working ADNs and inactive ADNs wishing to
obtain the BSN degree. Participating hospitals and agencies may provide employees
with incentives like tuition reimbursement, flexible hours, advancement opportunities, or
support of preceptors.
In several instances, California community colleges and CSUs are collaborating to
provide a new type of accelerated ADN to BSN program, sometimes called ―seamless‖
ADN to BSN programs. In these collaborative programs, students take degree
requirements concurrently at the community college and at the CSU.
Eventually the student transfers to the CSU to become a full-time upper division student.
This type of collaboration requires extensive coordination of curriculum, financial
arrangements, and staffing. For instance, the community college can lose significant
funding if the AS degree is not awarded. However, the AS requirements may end up
creating units that cannot be applied to the BSN degree depending on how many
transferable units the BSN-granting institution allows.
Seamless ADN to BSN programs work to more fully utilize the existing (and limited)
nursing education resources to address the state’s need for more baccalaureate-
prepared nurses. Both colleges are able to expand their degree programs as a result,
share nursing faculty, and possibly increase the pool of nurses qualified to eventually
serve as nursing faculty.
Approximately 18 California community colleges across the state have moved to
implement special ADN-BSN programs in conjunction with CSUs, including:
      Sacramento City College and CSU Sacramento (seamless);
      Saddleback College and CSU Fullerton (seamless);
      Glendale Community College, Rio Hondo College, Los Angeles Trade-Tech
       College, Mt. San Antonio College and CSU Los Angeles (seamless);
      CSU Bakersfield and three local community colleges;
      San Joaquin Delta College, Merced College, Modesto Junior College and CSU
       Stanislaus (seamless);
      Riverside Community College and CSU Fullerton via distance learning;


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        College of the Canyons and CSU Northridge
In the future, this type of collaboration should become easier as a result of projects like
the Intersegmental Major Preparation Articulated Curriculum (IMPAC), a faculty-initiated
and run project that is designed to coordinate the transfer of students from community
colleges to UCs and CSUs. The IMPAC Project is an initiative of the Intersegmental
Committee of Academic Senates (ICAS) representing the faculty of the University of
California, California State University, and California Community Colleges, through their
respective Academic Senates. IMPAC works to standardize and coordinate admissions
requirements, the process used to determine equivalency for pre-licensure coursework
for the ADN to BSN students, and other processes within community colleges and
CSUs, and across levels.

2.       Seeking Resources for Implementing Partnerships
The following section examines funding strategies and sources that partnerships
presented in this report have developed and pursued. For a nuts and bolts review of
how to fund health care programs, expansions, and partnerships, please refer to Fund
Raising Tools for Community College Health Care Training Programs and Projects, the
companion report to this brief.
Many programs forge their own partnerships with employers, but some partnerships are
initiated or assisted by intermediary organizations such as the Regional Health
Occupation Resource Centers (described below). In addition to working with employer
partners, other colleges and universities, and intermediary organizations, many
successful partnerships also include working with local government, Workforce
Investment Boards (WIBs), private funders, professional organizations and other groups
to seek funding for expansion or improvement. The following table summarizes the
nature of several partnerships outlined in this report and their funding sources:




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Table 1 Partnership Formats and Funding
Note: the programs marked with a * are featured in the case study section of this report
College          Program          Partners                Funding           Format
Yuba*            Radiologic       RHORC and 3 local       Hospital          distance learning
                 Technology       hospitals               partners          satellite
Fresno           Radiologic       West Hills College      Hospital          distance learning
                 Technology       and 6 local hospitals   partners          satellite
Cabrillo*        Limited Permit   Workforce               Workforce         Start-up of a short-
                 X-Ray            Investment Board, 3     investment        term certificate
                 Technician       local clinics           grant with        program primarily
                                                          some in-kind      for existing
                                                          support from      employees
                                                          clinic partners
American River   Nursing          Workforce               Workforce         Program expansion
College*         program (ADN)    Investment Board, 3     investment        with step-up or
                                  local hospitals         grant;            career ladder
                                                          eventually        component utilizing
                                                          support from      clinical adjuncts
                                                          hospital
                                                          partners
Sacramento       Nursing          Local hospital          Hospital          Program expansion
City College*    program (ADN)    network                 partner           utilizing clinical
                                                                            adjuncts
Shasta           Dental           Local community         Professional      Start-up of dental
Community        Hygiene          dental clinic,          association       hygiene program,
College*         Program          professional            (main),           co-location with
                                  association             California        local dental clinic,
                                  (Northern California    Endowment         shared director
                                  Dental Society)         grant
Santa Barbara*   Nursing          Local Hospital          Hospital          Program expansion
                 Program                                  partner           via provision of
                 (ADN)                                                      salaries for new
                                                                            faculty
Santa Barbara    Phlebotomy       RHORC, local            Clinic partner    Start-up of a
                 program          clinics                                   phlebotomy
                                                                            certificate program
Antelope         Nursing          Development             Community         distance learning
Valley*          Program (LVN)    Corporation/Indian      partner—with      satellite
                                  Nation                  some funding
                                                          from WIA,
                                                          VATEA, Title V
                                                          and Statewide
                                                          Tech
Riverside        Nursing          Workforce               Workforce         Career ladder
College          Program (LVN)    Investment Board,       investment        program/extended
                                  local nursing home      grant             campus
                                  chain                   (Caregivers
                                                          Training


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                                                      Initiative) with
                                                      some in-kind
                                                      support from
                                                      nursing home
                                                      partners
Riverside         Nursing        Riverside Economic   H1-B Tech          Expansion of
College           Programs       Development          Skills Training    nursing programs at
                                 Agency and 6 local   Grant (DOL)        four levels: CNA,
                                 health care          through local      LVN, RN, BSN
                                 employers            WIB
Fresno City       Nursing        6 local hospitals    Hospital           Career ladder
College           Program                             Partners &         program/extended
                  (Paradigm)                          Workforce          campus
                  (LVN)                               Investment
                                                      grant
Victor Valley     Nursing        1 local hospital     Workforce          Career ladder
College           Program        through RHORC        investment         program/LVN to RN
                                 and WIB              grant with in-     program
                                                      kind donation
                                                      of student
                                                      support from
                                                      hospital
City College of   Nursing        2 local hospitals    Private            Addition of new RN
San Francisco*    Program                             foundation         afternoon-evening
                                                      funding with in-   section, expansion
                                                      kind support       of student support
                                                      from hospital      and other key
                                                                         training activities.

As many interviewees noted, the key to forging successful partnerships is for programs
to be active in the community and to make connections with many different types of
stakeholders such as professional organizations, employers, other educational
organizations, policy makers and economic and employment development groups. Also
key is the support of the community college administration and/or district in forging and
maintaining these partnerships.

Regional Health Occupations Resource Centers
http://www.healthoccupations.org/rhorc/
The California Community Colleges has established eight Regional Health Occupations
Resource Centers (RHORC) that coordinate programs for health care training and
workforce development. The role of the RHORCs is to promote partnerships between
public and private sector health care employers, local government agencies, community
colleges and veteran health workers. RHORCs provide a wide range of services that
include:
       Developing health occupations models and customized curricula to meet industry
        training needs;
       Developing and analyzing needs assessments for new training programs;
       Improving student access and success in health occupations programs;




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      Facilitating partnerships between the health care industry and community
       colleges to leverage resources;
      Providing job analysis for industry and education through the DACUM process;
      Serving as test sites for certification and competency testing of health
       professionals;
      Providing in-service education programs for health care professionals, educators,
       counselors, and the industry.

RHORCs can be an important resource for program directors who wish to develop
partnerships with local health care providers and other institutions.

Workforce Investment Boards
The Workforce Investment Act of 1998 mandated state and local area Workforce
Investment Boards (WIBs) to assist in the administration of federal job training funds.
These bodies are composed of a group of representatives drawn from labor, business,
colleges and other educational institutions, legislative bodies, economic development
agencies, and community-based organizations. The chief elected official in a local area,
often a mayor or county executive, is authorized to appoint the members of the local
boards, whereas the state WIB’s members are appointed by the governor. A key feature
of the WIA is the requirement that a wide range of state programs, including employment
services, unemployment insurance, vocational rehabilitation, adult education, welfare-to-
work, and postsecondary vocational education be brought together into a one-stop
system.
Many large-scale community college health occupation program expansions have
received funding through partnerships with local Workforce Investment Boards (WIBs).
For instance, when American River College was approached by the Healthy Community
Forum with the idea of expanding the nursing program, the partnership involved the
Sacramento Employment and Training Agency (SETA), a WIB. The initial phases of the
expansion were funded through a Nursing Workforce Initiative (NWI) Grant from the
California Employment Development Department and the California Health and Human
Services Agency. To be competitive for this funding, proposals were required to include
collaborations between representatives from each of four stakeholder groups: Local
Workforce Investment Boards, Health-care Industry Employers, Health-care Labor and
Professional Organizations, and Educators. While the initiative started out with NWI
funding, the hospitals were required to pay for additional activities beyond the grant.
Other collaborations involving step-up or ―grow-your-own‖ programs such as Riverside
Community College’s program training up hospital employees in a local nursing home
chain to become LVNs were funded through the earlier Caregiver’s Training Initiative.
This grant program was created by the Governor’s Office and provided $25 million to
twelve regional organizations throughout the state of California from 2001 through 2002
to address caregiver workforce shortages and to enhance wages for caregivers. These
collaborative projects also involved working with multiple stakeholders and local
Workforce Investment Boards.
Riverside also made use of the H1-B Technical Skills Training Grant (2002-2003 )
awarded by the Department of Labor to support development of local training programs
in high-skill technology areas that face labor shortages. Again, colleges had to apply
through their local WIB's for support. In 2002, Riverside Community College District
collaborated with the Riverside Economic Development Agency and six local health care
employers to request a $2.1 million grant to address the nursing shortage in the region.


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The partnership proposed to do so by collaborating to prepare and add to the region’s
health care workforce 60 CNAs, 30 acute care Nursing Assistants, 24 LVNs, 30 RNs and
30 BSNs. Riverside proposed to use the two-year grant for developing career ladders
from entry level through the bachelor nursing degree. Specifically, the grant focused on
―recruitment of all levels of nurses, remediation and support services aimed at helping
the enrolled students complete the programs, retention and job satisfaction of employed
nurses in the community.‖3
Most recently, community college nursing programs were able to compete for WIA funds
through the California Nurse Education Initiatives (CNEI), a partnership between the
California Community Colleges Chancellor’s Office and the California Labor & Workforce
Development Agency. The competition for approximately $30 million in grant funding
over five year required a 2-1 cash or in-kind match from community colleges, their health
care partners, and/or other stakeholders. The premise of the CNEI was that the nursing
shortage can only be effectively addressed if educational institutions, health care
providers, other workforce development entities, foundations and community
organizations collaborate to expand the capacity of Associate Degree Nursing program
and to make these programs more effective. In addition to increasing the number of job-
ready nursing graduates the California Community Colleges produce each year, the
purpose of the CNEI was thus also to encourage the development of partnerships
between community college nursing programs, the health care industry and other key
stakeholders.
Not surprisingly, programs that already had in place strong partnerships enjoyed a
distinct advantage in the grant competition. During the next several years, as
implementation of the newly funded expansions begin, it will be interesting to see what
the CNEI partnerships learn and are able to jointly achieve. Although it is beyond the
scope of this brief to review and compare the partnerships that supported each winning
application, the Center for Student Success hopes that an evaluation of the
effectiveness of the $30 million investment will consider not merely individual programs,
but also the sum total of all that will have been learned.
http://www.edd.ca.gov/wiarep/wiaspind.htm#Current%20Solicitations

Private Funders & Professional Associations
As another way to raise funds, some colleges have successfully worked with employers
to apply for grant funding from private donors to assist in program expansion.
For instance, the Betty Irene Moore Nursing Initiative in the Bay Area funded City
College of San Francisco’s nursing program expansion to add an afternoon/evening
program. The local hospitals needed more nurses, and the community college needed
more faculty to educate more nursing students, so the partners collaborated to jointly
apply for a grant. The $4.2 million grant supports staff time for all three partners (CCSF,
California Pacific Medical Center, and St. Luke’s Hospital) for program development,
coordination, instruction and other direct services to students as well as funding for
faculty training, and research and evaluation.
The Shasta-Tehama-Trinity Joint Community College District applied to the California
Endowment for a two year grant for a Dental Hygiene Training and Clinic Program to
increase the number of dental hygienists in rural Northern California and to increase

3
 From “Healthcare Education and Workforce Preparation Partnership H-1B Grant,” Riverside Economic
Development Agency, Riverside Community College District, and Health care Partners, Fact Sheet


                                                                                                14
access to affordable dental care through a local start-up professional training program.
They received the bulk of their funding, however, from the Northern California Dental
Society, a professional organization.

3.     Making Partnerships Work: Advice from Successful
       Program Directors
Developing the Partnership
In nearly every case, partnerships emerged when employer organizations or local
economic development agencies approached health occupations programs with a
funding opportunity. However, the connection was generally the result of years of prior
collaboration.
While many programs made their own connections with employers, two interviewees
strongly advised that allied health deans or program directors talk to their local RHORCs
about partnership and funding opportunities for program expansion. One suggested
working with the RHORC to identify the executive director of the local Hospital Council
and the local Private Industry Council (PIC) and/or Workforce Investment Board (WIB) –
the three major players in workforce development, and work with the RHORC to find
ways to partner with industry. She noted that the Executive Director of the Hospital
Council works with the CEOs of all the county’s hospitals and could either identify whom
to talk with or make the introductory call for the college representative. She also noted
that since so much workforce development money flows through the WIBs and PICs,
and because many state grants require partnering with them, it is a good idea to get to
know them.
Two program directors who were successful in obtaining large amounts of funding for
partnerships via state grants noted that having a good connection with the campus
grants and contracts office was invaluable in getting outside funding. As one noted, a
busy program director does not have time to be scanning all available sources for
notifications of funding—and that it is therefore highly advantageous to be connected
with a good grants person who ―knows your needs and can notify you if anything
promising shows up.‖ At one college, the nursing program was highly successful in
attracting outside funding because they a) worked with the campus research office to
establish need and document program outcomes, b) received grant development
assistance from the campus grants and contracts office, and/or c) because they received
substantial support from the higher levels of their administration, including the president.
Nearly all interviewees noted that establishing long-term relationships with local industry
and other organizations was extremely important for the ability of a program to access
outside support. Directors were likely to say that they ―sat on the board of everything”.
Identifying and documenting the need for a new program or expansion of an existing
program was key to getting administrators and others to support the initiative, and
identifying what each partner received as a result of the partnership was key to gaining
consensus. Finally, one interviewee suggested reaching out beyond the local
community to other colleges for good models and advice on how to implement
successful partnerships. Another had also actively implemented such a ―best practices‖
scan and incorporated information from other program into her plans for a new
expansion.




                                                                                         15
Getting Faculty Onboard
Perhaps the biggest challenge reported by nearly all interviewees was getting faculty
onboard with the new program or way of doing things. It is vitally important to think
through how the suggested changes might impact faculty. This question has legal as
well as morale ramifications. If you are thinking of implementing a program that calls for
a major expansion in the number of students enrolled or a substantial change to the way
the program provides instruction, you should think about how you will involve faculty and
how you can work with them to facilitate the change in a way that will invite buy-in
First, many of the partnerships listed involve enrollment expansion, which increases
faculty, staff and administrator workload. In many cases, faculty reportedly felt left out of
the planning process, and the changes sparked considerable tension within the program.
They disliked the change in their relationship with students, which generally involved
less individualized contact due either to an increase in the number of students and/or the
involvement of distance learning technologies. First year nursing instructors in particular
might be overwhelmed with the new influx of students. At the same time that health
occupations faculty have identified problems with a less prepared student pool requiring
more individualized assistance to make it through their programs, they are being asked
to take on more students than ever before. There may also be issues with union or
contractual issues involved in asking faculty to take on more work.
Faculty are also often being asked to put in additional time working with new clinical
faculty and coordinating instruction with people who may never have taught before in
their lives. This often means that they are working side by side with, and training,
people who earn clinical salaries higher than their own academic salaries.
Finally, faculty may be asked to work with new technologies that change the way they
lecture, change their relationship with students, and which may introduce discipline
problems and increase attrition.
While bringing faculty into the process early may seem like a good idea, many
interviewees reported difficulty in bringing staff into the planning process, often because
an opportunity presented itself with a short timeline for application, or because the
application process took place during the summer, or because the opportunity was at the
behest of a president or other high level administrator outside the program.
Nonetheless, interviewees identified a few important strategies for working with this
issue:

   1.      Build in funding for faculty time required to mentor new teachers and
           administer the program. Some colleges may provide stipends for distance
           learning or other technological innovations.
   2.      Work with faculty around change in general and, from the outset, invite and
           encourage them to become involved in the planning process.
   3.      Focus the process on the overall goals of the profession and the needs of the
           community rather than on individual agendas.
   4.      Focus on and work with those willing to give the innovation a chance. Reward
           creativity and get faculty excited about the innovation to set the tone for the
           others as opinion leaders.
   5.      Establish guidelines for faculty on how the new program will work and what
           the expectations are in terms of changes in the way things are done.




                                                                                          16
   6.      Highlight the value of the ―applied experience‖ that adjunct faculty bring to the
           program—it is different from years of teaching experience, but may still be
           very valuable.

As many interviewees noted—demand exceeds supply not just nurses, rad techs and
dental hygienists, but also for educators in these fields. A major reason is that for all
these positions the earnings of the professional in the field greatly exceeds that of the
professional in the classroom. As a result, the recruitment and retention of health care
faculty have become major challenges that programs need to address, especially if they
are planning to expand enrollment. While this study identified some promising practices
programs have developed to respond to this challenge, (see recruitment strategies)
faculty recruitment and retention remains a priority area that is in need of much
additional attention.

Bridging Different Organizational Realities
Another major issue identified by interviewees concerns differences in organizational
cultures and realities, particularly between academic institutions and hospital employers.
Good communication between partners can go a long way in meeting this challenge,
and interviewees repeatedly mentioned the importance of building long-term
relationships before entering a large-scale collaboration.
There is a great deal of interest in how colleges can better serve the health care industry
in terms of producing new staff—but industry may not understand what makes good
educational sense, how the academic schedule works, and what legal and regulatory
issues colleges face in educating students adequately. For instance, one interviewee
found that an employer representative seemed surprised that a clinical adjunct could not
reasonably take on more than 8-12 students at a time
One interviewee questioned whether hospital partners truly recognized the deadline
pressures of large educational bureaucracies. She noted that employer organizations
may not realize that there isn’t much ―wiggle room‖ around deadlines for making
changes to the curriculum or initiating new programs—if it isn’t in front of the right board
or committee by a certain deadline, it may not be reviewed and approved in time for
implementation. Hospitals and colleges run on different schedules, and hospital
partners may forget that there may be fewer people around during the summer and
breaks, or that instructors cannot schedule meetings during the hours when they are
teaching.
In several instances, college administrators expressed concerns about the ―bottom line‖
overtaking concerns about sound educational practices and quality of life issues for
current and former students. For instance, one administrator felt that if employer
organizations were going to push community colleges to generate more health care
staff, they should also work to make a good working environment to retain their existing
staff rather than churning through new grads who rapidly become dissatisfied and move
on, increasing the pressure on the college to produce even more grads more rapidly.
The number of employer organizations involved in any collaboration is also an issue.
More partners introduce greater complexity, but this situation may have advantages. In
the case of the Fresno/West Hills Rad Tech program, the students rotate through
different hospitals for clinicals, but are not required to work for any one hospital upon
graduation. Since the hospitals are funding the program as a group, this encourages
them to provide a pleasant clinical experience for the students because they are


                                                                                          17
competing against one another and the outside world for these students as employees
once they graduate. On the other hand, single sponsorship may enhance the
employer’s sense of investment in a program, although community college programs
may need to think through how much ―branding‖ they are comfortable with in these
situations.

Recruiting Instructors
To educate more students, colleges usually need more faculty. However, many
professionals who have the qualifications to teach may prefer to work in the field rather
than teach. Further, with employers offering substantial salaries to students graduating
from two-year degrees, many may never progress to obtain a degree that would make
them eligible to teach.
According to an American Association of Colleges of Nursing (AACN) white paper4 on
faculty shortages, nurse educators tend to be older (the percent of doctorally-prepared
faculty over the age of 50 has grown from about 50% to 70% since 1993, while the
percent of master’s-prepared faculty over the age of 50 has increased from 33% to 47%
in the same time period). The percent of younger faculty has declined, and this may be
due to younger faculty seeking the higher pay available in clinical practice.
In some instances, programs recruit and train existing hospital staff as adjuncts. This
means that the new instructors remain hospital employees and retain their clinical
salaries, which are generally much higher than those of tenured faculty. The advantage
of this approach is that the adjuncts maintain the high pay of those working in the field
and that the hospital can deploy them to the program on an as-needed basis. However,
before the adjuncts even approach the classroom, they must be trained and oriented by
existing tenured faculty who in some instances may deplore their lack of experience and
high pay. This situation is aggravated when employer partners don’t fully grasp the skills
and time that go into teaching and therefore are unsympathetic to educators’ request
that the adjuncts need hours of release time to learn how to teach and how to coordinate
their classroom activities with those of their colleagues.
Another important factor to consider is how adjunct faculty who remain the employees of
participating hospitals adjust to the academic workload. This may mean transitioning
from the hourly mentality of working nurses to the faculty mentality, where, regardless of
the number of hours required, you work until you get the job done. Again, those who
must continue their clinical practice may find it difficult to integrate these two worlds, and
full-time release from clinical duties may be ideal. A number of administrators noted that
even with the employer’s backing, locating and recruiting qualified staff from amongst
existing clinical staff is a challenge.
Another route is for hospital partners to contribute to pay the salaries of tenured faculty
who become community college employees. This ensures that the faculty are 100%
invested in teaching, but with the shortage in health care workers, it may still be difficult
to locate instructors due to the relatively lower wages for teaching.


4
 Faculty Shortages in Baccalaureate and Graduate Nursing Programs: Scope of the Problem
and Strategies for Expanding the Supply, White Paper, American Association of Colleges of
Nursing, May 2003. http://www.aacn.nche.edu/Publications/WhitePapers/FacultyShortages.htm




                                                                                            18
Nonetheless, educators working with part-time clinical adjuncts report that some
hospital-employed instructors develop an interest in teaching and come to see the hours
and working conditions as preferable to clinical practice. As one nurse educator said,
―It’s great to have my summers and also to work with people who are not burned out all
the time.‖
On their part, community college administrators strive to create a situation that without
creating dissatisfaction amongst existing faculty makes teaching attractive to new
faculty. For instance, long-term faculty may be given more desirable teaching times (not
evenings and weekends) and facilities. Unfortunately, if a program expands rapidly and
new instructors cannot be found to fill all slots, existing faculty may end up filling in by
taking on more responsibilities. One administrator advised starting recruitment of faculty
well before the start of the program rather than attempting it during implementation.
Finally, some programs such as the seamless ADN to BSN programs take a long-range
approach by facilitating the movement of students into higher education where their
training will qualify them to teach down the road.

Locating Clinical Placements
A major challenge for many programs has been locating enough clinical placements to
accommodate the new students they hope to take on. In response, some programs
have moved to alternative hours to schedule placements. As one interviewee put it:
―The non-traditional schedule is part and parcel of the expansion.‖ Other programs have
had to seek placements relatively far from the site of instruction—in at least two
instances, this meant outside the county in which the program was located. One
generally highly successful program found it difficult to meet its ambitious schedule for
graduating students, largely due to this barrier. Hospital partners and colleges need to
communicate early (prior to implementation) about the requirements for clinical
placements, and think ahead about where students will be placed prior to making any
commitments about producing graduates over a given time period. If programs move to
alternative scheduling, they need to anticipate the impact this will have on students,
faculty and hospital staff who need to work these alternate hours. While some may
prefer this scheduling, it may be a detriment to others.

Planning for Infrastructure Enhancement
Even if colleges could find additional faculty, they are often limited by space
considerations—they simply lack the teaching space and facilities to take on additional
students and the funding to expand that space. Many interviewees mentioned at some
point realizing that they had not anticipated some necessary changes in infrastructure
that resulted from expanding the size of a program. For instance, if the hospital partner
is paying for a new facility, who is paying for things like trash cans for the classrooms? If
the college promises to provide you with additional classroom space if you expand your
program, how can you be sure they will follow through? Even if a program does not
require a new facility, an expansion may generate significant new needs. For instance, if
you double the amount of students, do you have funding built into the department
budget to copy twice the number of syllabi? Do you need additional administrative staff
to handle the increase in students and faculty?
Many directors spoke of finding their workloads dramatically expanded without additional
compensation. How will the expansion impact those teaching pre-requisite classes?
What about counseling? One interviewee advised that anyone planning an expansion



                                                                                          19
notify everyone who might be impacted well in advance so that they can decide how to
proceed. One director noted that you need to ―get everything in writing‖, whether the
promise comes from the college or an industry partner, or you may be left making do
without a critical resource that didn’t come through.



SUGGESTED QUESTIONS TO START PLANNING FOR A COLLABORATION

Describe in as much detail as possible what you want to do?

    Why do you think the project is needed?

    What evidence do you have to support that it is needed?

    What provider organizations are located in your area and what is your/the
     college’s prior relationship with these organizations?

    What reasons do the provider organizations and other potential partners
     have to think the project is needed? What would be their short-term and
     long-term incentives for working with you?

    What are the employment and training needs of local provider
     organizations and your community?

    What could your program offer to meet those needs?

    What do you need in terms of resources a provider organization could
     offer?

    Will you be able to get enough resources from all parties (faculty,
     classroom space, administrative support, funding for materials and
     equipment, and clinical placements) to actually support taking on more
     students?

    What other resources exist to help you expand your program? (i.e. what
     is your relationship with your grants and contracts office, with your local
     RHORC, with the Workforce Investment Board, with the Hospital Council,
     with labor organizations?)

    How will the expansion or institution of a new program impact faculty, staff
     and students?

    How will you inform and include faculty and other key college staff in the
     program design process?




                                                                                    20
4.     Case Studies
A.     Yuba College Radiologic Technology Program with
       Satellite Site in Sacramento
Contact
Contact Person:      Angela Willson
Title:               Program Director
Email:               awillson@yccd.edu
Phone:               530-741-6960

Address:             Yuba Community College District
                     2088 North Beale Road
                     Marysville, CA 95901

Web Site:            http://www.yccd.edu/radtech/

Partners
RHORC Butte College, Yuba Community College, Catholic Healthcare
West/Mercy Hospitals, Sutter Health and UC Davis Medical Center

Type of Partnership
Distance Learning; facilities and faculty time paid for by hospital partners

Reason for Partnership
There is a great need for radiologic technologists in the Sacramento area, but no
radiologic technology programs. However, relatively nearby Yuba College does
have a radiologic technology program. The local RHORC director at Butte
College was working with hospital managers in Sacramento area and helped
bring together a number of community college people in the northern area to talk
about how they could address the shortage and better publicize the Yuba
program. Eventually, the hospital representatives called a meeting with the
community colleges and other stakeholders to brainstorm how they could
address the tech shortage. The distance learning program grew out of this
meeting.
The hospital collaborators agreed to fund all operational costs required to expand
the Yuba program. This included development of a learning facility in a
Sacramento-based office that receives video-teleconferenced lectures and live
lectures and also hosts a lab for the Sacramento students. The partners started
discussing and planning the program in 2002. The first cohort of students started
in the 2003-2004 school year.




                                                                               21
Program Description
Yuba College is a part of the Yuba Community College District. The Sacramento
Center is still considered part of Yuba College, but is located in an office building
the hospital consortium has leased through an agreement with the Los Rios
Community College District, which encompasses Sacramento.
This program involves a program director, who also teaches, and two other
instructors. The program director rotates between the two campuses. For
instance, she is in Marysville on Monday, in Sacramento on Wednesday, and on
Tuesdays she rotates between the two (one week Marysville, the next,
Sacramento, and so on). Where she is at, she lectures live; simultaneously,
where she is not, she video conferences. One of the other instructors is based in
Sacramento, while the other is based in Marysville. They share the lectures;
whoever is teaching the lecture also has it video-telecast. After the lecture, the
instructors conduct the lab with their respective students. Once a semester, the
instructors switch for a day and the Marysville instructor goes to Sacramento and
the Sacramento instructor goes to Marysville. The program director noted that
the students will never get to know the instructor from the other campus very
well, but it seems important that students get to know them all. The students are
regular community college students, some of whom are sponsored by local
hospitals. They use a Tandberg system to do live video conferencing.

What does each of the partners provide and receive?
The Sacramento hospital consortium contributes salaries for the Marysville and
one of the Sacramento faculty members. It also supports rent and equipment.
On the down side, the director’s workload has doubled without additional
compensation. They also do not get additional funding for the expanded
enrollment because their college is at capacity (once that cap is reached, there is
no more funding.) Despite all this, the professional satisfaction the director and
her staff get from serving a need in the community makes the additional workload
worthwhile. In some ways, the satellite expansion has probably also helped the
college retain the original Yuba College program. If another local area
community college started its own rad-tech program, especially in a more
populated area like Sacramento, the Yuba College program might lose a
significant portion of its funding for faculty positions, which was paid for by
Sacramento-area hospitals even prior to the distance learning program. If the
decision had been to open the program at another college, it would have taken a
long time to set it up and the preparation of new graduates would have taken
longer. From this perspective, this has been a win-win arrangement for all
involved parties.

What are the hallmarks of a successful partnership?
What has amazed the program director is the hospital partners’ ability to
collaborate. This is especially the case since the three hospital groups are
competitors in a medium size market—nevertheless, they were willing to come
together to address this important need.


                                                                                   22
Challenges
The hardest challenge to overcome is the fact that private industry does not
understand the community college system. As an example, employers often fail
to fully understand that a commitment to deliver something by a certain date (for
instance, that you need to get it to your board by a certain date) is really a ―drop-
dead‖ deadline and not negotiable. Employers and colleges also have conflicting
notions about schedules; college faculty and staff are very much driven by their
teaching schedules in a way that the industry may not understand. They may not
understand, for instance, that there are fewer instructors in the summer and one
instructor may be responsible for twice the number of students and hence less
available rather than more available.

Advice for others thinking of implementing a similar program
Health occupations programs should consider the basic nuts and bolts details
that might not be evident to those working within an established program and
facility. For instance, you need to plan and budget for little things like office
supplies, trash cans, and DSL lines.
The distance learning format introduces its own special dynamic because some
students thrive on it and some do not. One of the pros is that technology
provides new opportunities for expansion. The con is lack of connection; you
need to be prepared to reach those who do not learn well. An instructor cannot
look into the eyes of the students via video-teleconference and see whether or
not they are ―getting it‖.

Indicators of Success
The decision was made to increase the existing class from 25 to 50 students.
About 16 students graduated from the Sacramento program in 2004, 19 in 2005,
and 21 more are expected to graduate in 2006. Thus far, the program has been
able to maintain its high pass rates, despite the change of mode.




                                                                                    23
B.     Fresno City College Radiologic Technology Program with
       Satellite Site at West Hills College in Lemoore
Contact
Dave Bolt at 559 925 3222
Dean of Educational Services
West Hills College
Email: davebolt@sesthills.com
Phone:559-925-3222

Paul N. Gonzales, M.S., C.R.T., A.R.R.T.
Director, Radiologic Technology Program
Fresno City College
Health Sciences Division
1101 East University Avenue
Fresno, CA 93741
Email: paul.gonzales@scccd.com
Phone:559-244-2652

Partners
Fresno City College, West Hill College, and Adventist Health/Central Valley
General Hospital (Hanford), Kaweah Delta Hospital (Visalia), Alta District
Hospital (Dinuba), Corcoran District Hospital, Tulare District Hospital and Sierra
View District Hospital(Porterville)

Type of Partnership
Distance Learning; facilities and faculty time paid for by hospital partners

Reason for Partnership
In 2003, six hospitals in the Central California region formed a consortium to
grow local radiographers. The consortium members had a long history of
competing with each other, but recognized that they needed to collaborate to
address a common problem: they were all investing considerable resources in
recruiting and training radiographers from outside of the area only to see them
leave again after a short time on the job. The answer to the problem, the hospital
leaders realized, was to recruit and train local residents who had family and other
ties in the area to become radiographers. To do so, the hospitals also realized,
they would have to collaborate with one another and with a local training
institution. They contacted Fresno City College (FCC), which had a well-
established and successful rad tech program, but did not have enough space to
take on more students to meet the need. They also identified West Hills College,
which, although nearby, did not have a radiologic technology training program.
Working with the two colleges, the partners initiated a distance learning program



                                                                                 24
where Fresno City College broadcast via teleconferencing to a satellite program
at the West Hills campus.

Program Description
Working together, the hospital-community college partnership established a
distance learning training program that broadcasts FCC’s successful and
established Radiologic Technology (RT) Training program to students at West
Hills College. West Hills receives the lecture and then assigns students to area
hospitals to do their clinical rotations. The hospitals, which are responsible for
the clinical training, rotate students through all of the participating sites. However,
the students do not have to agree to work for the hospitals for any length of time.
This, a program representative suggested, serves as an incentive for the
hospitals to do a very good job recruiting the new graduates.

What does each of the partners provide and receive?
The parties developed and signed a Memorandum of Understanding stipulating
that the hospitals would pay the costs of running the program. Specifically, the
employers would pay approximately $150,000/year to support 1.5 RT instructors
and the administrative cost of running and coordinating the program, including
outfitting the video center. The faculty are not tenured as they are supported on
soft money. The hospitals get trained radiographers from the local community
that are more likely to stay in the local area.

What are the hallmarks of a successful partnership?
The foundation of this partnership is the competitors’ willingness to work together
to increase the pool of radiographers in this agricultural area. Another key
ingredient of success was the hospital consortium partners’ willingness to pay the
entire cost, including start up and operating expenses. The initial investment
included the video set up and the time that went into testing and later fine-tuning
the linkages. The operational expenses, as pointed out above, run about
$150,000 per year. The current capacity of the satellite program is 32 students.

Challenges
The program first group of 16 West Hills students graduated in June 05. The first
year had a steep learning curve and involved a number of adjustments both at
the Fresno City College site and at the (West Hills) satellite site. Students who
are used to live classroom instruction may have difficulty adjusting to distance
learning. However, this problem is phased out as students become used to the
technology.
There were also challenges in fine-tuning the technology, including a lag time in
the video telecast to Visalia. However, the program has had many more
applicants than it can accept and it has the potential to address an important
community need.




                                                                                    25
The success of the program may also be one of its greatest challenges in that
some of the partners now believe that the demand for rad-techs in the local area
has been met and that it is time to focus on other aspects of the health care
shortage, such as the demand for nurses. The group may thus join the local
Workforce Investment Board and other community partners to apply for
Workforce Investment Act Funding through the Governor’s Nursing Initiative.
In response to this challenge, West Hills has applied for a grant to partner with
Fresno City College to bring an LVN to RN satellite nursing program to West Hills
Lemoore.

Advice for others thinking of implementing a similar program
It took a lot of time to work out the logistics for this program, and other programs
considering adding a distance education satellite may think about launching at
least one other health occupations program to spread out the cost of the
associated administrative and clerical time.




                                                                                   26
C.     Cabrillo Community College Limited Permit X-Ray
       Technician Program
Contact
Tom McKay, R.N., Ph. D.
Director of Allied Health
Cabrillo Community College
Email: tomckay@cabrillo.edu
Phone: 831-479-6280

Partners
Santa Cruz Workforce Investment Board, the Santa Cruz Medical Foundation,
Doctors On Duty, Santa Cruz County Health Services Agency, Cabrillo College.

Type of Partnership
Development of a new (pilot) program to meet community needs (limited permit
x-ray technician).

Reason for Partnership
While Cabrillo has an established radiologic technology program serving
community needs for rad techs in local hospitals, many local clinics need people
qualified to take x-rays on an as-needed basis in conjunction with other duties.
These clinics cannot afford and do not need full time rad-techs because the x-ray
work they have is relatively less skilled and more sporadic than what takes place
in hospitals. The idea behind this program was to cross-train and certify
individuals with other medical office skills, such as certified medical assistants, to
run this equipment and upgrade their job skills.
In 2004, Cabrillo and the industry partners had been discussing a possible limited
permit program. However, in its current incarnation, the program was the result
of an RFP from the Governor’s Discretionary Fund for WIA funding that went out
to the 10 Bay Area counties as part of the Bay Area Health Care Collaborative.
There was about $2 million available, and the local Workforce Investment Board
(WIB) invited local health care employers, Cabrillo College representatives, and
other community stakeholders to the table to discuss the possibility. The WIB
group did some research using local workforce and economic data to brainstorm
and develop three concept papers of programs that might address community
health care needs. The WIB facilitated the process of building consensus
amongst the different partners, and they submitted the three papers in hopes of
receiving funding for at least one. They were also interested in a CNA program
through the local Adult Schools, and in extending the Medical Assisting program
at Cabrillo. They were invited to submit a proposal for the Limited Permit X-Ray
Technician program and applied for a grant of almost $500K to educate two
cohorts of students. They received $273K, which was enough to fund one cohort
of students.


                                                                                    27
Program Description
This is a pilot program which started June 6, 2005. The program will move about
22 students through a series of classes and a clinical component to graduate in
January of 2006. The program trains in three categories (Chest, Extremities, and
Torsoskeletal) and each student trains in all three. The student must pass the
California State Examination to work as an X-ray Technician.
There had previously not been much of a career ladder in this field as there is in
nursing and the dental professions. This program should allow those already
working as certified medical assistants (CMAs) to move up and gain more skills
and receive higher wages. Cabrillo is also working on building some bridge
classes between this program and the rad tech program so that those who wish
to move up to the full rad-tech degree can transition. There is no other such
program at a community college in California although some private colleges
such as Bryman in Southern California have them.
While the target for this program was students already working in the field, some
participants are new students. The mix is 12 employer-based students, and 8
―general population‖ students. Amongst the new students, many were taking
pre-requisite courses to get into the rad-tech program. With the Limited Permit
X-Ray Tech program, they can get the permit and work while waiting to get into
the RT program. The targeted employers were multi-site clinics, although single-
site clinics and other offices might be an area for further exploration.

What does each of the partners provide and receive?
The clinic partners receive cross-trained professionals who can operate x-ray
equipment as needed in conjunction with other duties. This allows them to retain
existing staff and gain needed skills at a reasonable cost. Most of the clinics’
investment is in-kind. They provide clinical placements and on-the-job training to
fill the positions that upgraded employees vacate. They also identify and refer a
large number of the students taking part in these classes.
The community college benefits by serving a community need. Another benefit
may be the experience of learning how to move quickly on a funding opportunity.
Further, as a WIB subcontractor and as an active participant in the grant
development process, Cabrillo received support to hire a program director for the
classroom component of this program (starting in August of 2004).
The job of the WIB is to provide training and job placement to the local workforce,
and coordinate development of the local workforce with the needs of local
employers, so this initiative fits within their mission. The WIB coordinated the
application process and convened the partners. The WIB is responsible for
managing the grant and built into the request support for an analyst/program
manager (a .6 FTE position5). This position is responsible for a major array of
responsibilities the WIB could not adequately manage with existing staff,
including outreach to employers, capacity building, tracking of results, an

5
    The grant allows for about 10% in administrative costs.


                                                                                 28
evaluation component and weekly coordination meetings including meetings with
businesses and state representatives. The analyst/program manager will also
review sustainability and assess whether the one-time program has the capacity
to meet the existing need.

What are the hallmarks of a successful partnership?
This program has an evaluation component and staff to manage and track
outcomes. Indicators of success will include graduation of students, pass rates
on the state boards, and subsequent employment in the field. For the
community, meeting the needs and alleviating the shortage in local clinics will be
another indicator of success. Additional indicators might be extension of the
existing program and/or replication by other community colleges and local
employer partnerships.
While not directly an indicator of a successful partnership, program
administrators found that there was a huge demand for this program amongst
potential students. They held three pre-orientations and had at least 50 people
at the first session.

Challenges
The major challenge has been identifying clinical sites for participating students.
The project director on the college side worked to develop curriculum and to
inform clinical sites about the specifications they need to meet to take on
students. These include having on staff an employee that holds a CA state
supervisor-operator certificate. Unfortunately, there are not that many clinics with
the right qualifications. In a few cases, therefore, they have had to go outside the
county for clinical placements.
Another challenge has been to provide training to people with varying levels of
educational preparation in the field. For instance, students thinking of entering
radiology are required to take certain pre-requisite classes such as medical
terminology and pass them with a minimum GPA. However, the program has no
control over the educational preparation of existing staff working at clinics. While
many of the ―new‖ students have taken anatomy & physiology prerequisite
because they want to get into the rad tech program, many of the current
employees trained as Medical Assistants.
The instructor explains that the combination of backgrounds and experience
among students actually has made the class richer as it has enabled different
groups of students to learn from each other. However, others working with
programs that attract student groups with different backgrounds and with varying
levels of academic as well as clinical preparation, need to make sure that
instructors know how to teach to different levels of knowledge.

Advice for others thinking of implementing a similar program
The WIB Director noted that for this type of initiative to be effective, there needs
to be a pre-existing partnership between the players that is not just about seeking


                                                                                  29
funding. The partners need to work out the relationships and develop and clarify
roles prior to taking on large-scale initiatives. For instance, WIB representatives
are on community college committees and community college representatives
are on the WIB. One thing that can be an advantage in a relatively small
community like the Santa Cruz area is that there is a limited number of partners
available, which may make partnership development easier. For instance, there
is only one community college in the area.
Another suggestion is to include anybody that might be affected by the project in
the early meetings. This could help a fledgling program avoid many problems. It
is also important to offer an ―escape hatch‖ for those who wish to remove
themselves from the initiative before relationships are compromised. At the
college level, you need to get anyone working in counseling or referral and
curriculum involved, the bookstore—any group that will be affected by the
introduction of the new program.

Another important lesson learned was that a community college program can get
exempted from regulations that don’t make sense. As Tom McKay explains
―Speaking in person with regulatory agencies can build relationships and trust.‖
In this case, the X-Ray Technician Program was compromised by the regulatory
body of the Department of Health Services Radiology Health Branch’s
requirement that while a rad tech student can be supervised by a rad tech, an X-
Ray technician student must be supervised by an MD. The requirement would
have made it virtually impossible for the X-Ray technician students to get clinical
training and it went against the whole purpose of the new program which was to
provide clinics that can only afford a small staff and that are located in rural and
remote areas to take X-Rays. These clinics, needless to say, don’t have doctors
to spare to supervise the clinical training of X-Ray technicians. Instead of giving
up when they ran into the regulation, Cabrillo scheduled a meeting with the
Director of the regulatory body and effectively presented its case. The result was
that the program obtained an exemption to the MD training requirement and that
Cabrillo thus could move forward.

Another important lesson learned was that a community college program can get
exempted from regulations that don’t make sense. As Tom McKay explains
―Speaking in person with regulatory agencies can build relationships and trust.‖
In this case, the X-Ray Technician Program was compromised by the regulatory
body of the Department of Health Services Radiology Health Branch’s
requirement that while a rad tech student can be supervised by a rad tech, an X-
Ray technician student must be supervised by an MD. The requirement would
have made it virtually impossible for the X-Ray technician students to get clinical
training and it went against the whole purpose of the new program which was to
provide clinics that can only afford a small staff and that are located in rural and
remote areas to take X-Rays. These clinics, needless to say, don’t have doctors
to spare to supervise the clinical training of X-Ray technicians. Instead of giving
up when they ran into the regulation, Cabrillo scheduled a meeting with the
Director of the regulatory body and effectively presented its case. The result was


                                                                                  30
that the program obtained an exemption to the MD training requirement and that
Cabrillo thus could move forward.
It might also be important to make clear that limited permit x-ray technicians will
not really be competing for radiologist jobs and therefore not undercutting people
in the higher-skilled, higher-paid profession. This has reportedly not been an
issue for this program, but might come up in some other instances. The State of
California has very clear licensing laws around this that make it clear what people
with this degree can and cannot do.
A Cabrillo College administrator for this program suggested that other colleges
interested in replicating such a program learn from their example and speak to
them about their experiences.




                                                                                  31
D.     Santa Barbara Nursing Program Expansion
Contact
Jan Anderson, Santa Barbara Nursing, June 10, 2005, 11:30 am.

Partners
Santa Barbara City College, Cottage Health System.

Type of Partnership
Employer sponsorship of tenured faculty positions at community college

Reason for Partnership
As other parts of the country, Santa Barbara faces an acute nursing shortage.
Because of this, the community also faces a shortage of nursing faculty, and any
attempt to address the former must take into account the latter. In response, the
Santa Barbara City College Nursing Program has been able to expand by
working out an agreement with a local employer to fund several tenured faculty
positions.

Program Description
The SBCC program was approached in the past by local hospitals with a
proposal for a partnership, but the program director had concerns about letting
industry gain too much influence over the program. When a new director took
over, the hospitals again approached the program with a proposal for a
partnership, and this time the answer was positive.
The partnership was developed directly between the College and the local
hospitals. In the beginning, three hospitals participated, including Goleta Valley,
St. Francis & Cottage Health System. The CEO of Cottage Hospital and the
President of SBCC were both involved in the initiation of this partnership and it
was agreed that each health care provider would fund one temporary full-time
faculty. When Cottage Hospital later bought out the two other hospital partners,
the CEO made a commitment to support four full-time faculty.
The nursing program at SBCC is a self-paced program. Consequently, each
faculty member serves as an advisor to a certain number of students. Faculty
teach both clinical and didactic courses.

The expansion, by adding 48 students, almost doubled the size of the nursing
program and faculty increased from 7 to 11 full time instructors with the 4 new
positions supported by Cottage Hospital. At the behest of the director, the
program has maintained its original faculty-to-student ratio. However, the entire
program, including the curriculum, needed to be changed dramatically to
accommodate the change in scale. The bigger program is more complicated to


                                                                                  32
run and requires more administrative and office support. The program also had
to increase the evening clinical rotations and add a weekend clinical rotation to
accommodate more students.
One issue that needed to be considered was what would happen if the demand
for nurses decreased and the program no longer needed the added capacity.
With the faculty tenured, a layoff would not be possible. The partners addressed
the situation by agreeing to downsize through attrition until the program was back
to its original seven full-time faculty.

What does each of the partners provide and receive?
The college receives four tenured faculty positions paid for by the hospital
partner and is able to graduate many more nursing students. As the director
noted, the program gets much satisfaction from contributing to meeting urgent
community needs because: ―We all know that someone in our family or in our
community is going to need a nurse some day.‖ The nursing program is
responsible for tracking the increased number of students and for training and
managing the expanded faculty. This, not surprisingly, means considerable
more work.
The hospitals eventually gain access to more local nurses. They also get the
free labor of students during their clinicals, although the director noted that
training new students places additional stress on hospital staff.

What are the hallmarks of a successful partnership?
The partnership has been able to almost double the size of the nursing program,
and they have retained a high completion rate (about 80%).

Challenges
The director noted that the three things that compromise expansion for most
community college nursing program is lack of faculty, classroom space, and
clinical spaces. The Santa Barbara program secured additional faculty, but the
college was not able to come up with more classroom space, and finding clinical
space has been a challenge. Since the expansion, the college has had to
increase the evening shift rotations and added Friday/Saturday slots, but it is
difficult to find faculty to cover those times, and some students do not like the
alternative scheduling. New faculty was hired with the expectation that they
would take on the Friday/Saturday shifts whereas existing faculty was promised
that they would not have to take on these less desirable time slots. Because the
existing faculty have put in extra work to make the expansion work, this measure
may help to keep them satisfied. On the other hand, the schedule may serve as
something of a detriment to the recruitment of new faculty. While some students
may like the alternative scheduling, some end up in these slots because they are
the only time periods left, and the non-stop nature of the program may be difficult
for some hospital staff since they have students on shift every day and night too.




                                                                                  33
Despite the fact that they have received full funding for full-time, tenured
positions, it has still been difficult to recruit and retain enough qualified faculty to
fill these positions. It thus took five years to fill these four positions even with
hospital funding because the college had to compete against the high wages
offered nurses by hospitals. Good faculty orientation is crucial to getting new
instructors up to speed, but it still takes a new instructor at least a year to settle in
and 3-5 years to become really competent.
Some issues could obviously be alleviated if it were possible to pay community
college nursing faculty more, and if there were more flexibility around the use and
compensation of part-timer faculty (they cannot work more than 60% time and
they do not receive benefits). A ―hard to hire‖ policy such as they use in the four-
year system to pay faculty what the private sector pays would help, but failing
that the director is exploring how to get additional stipends for faculty.

Advice for others thinking of implementing a similar program
The director of this program believes that it is important to create full-time,
tenured positions rather than part-time and/or temporary positions because the
disparity in nursing salaries versus faculty salaries is so great, you need to
provide some sort of incentive for people to take the job and stay. She advises
formalizing agreements by getting everything in writing from both the college and
industry partners to make sure that all parties carry through with agreements, but
to really ―go for the gold‖ since it is possible to set high standards for partnership
agreements.




                                                                                      34
E.     American River College Nursing Program Expansion
Contact
Contact Person:      Victoria Maryatt, R.N., M.S.N.
Title:               Program Director
Email:               Maryatv@arc.losrios.edu
Phone                916-484-8254

Address:             American River College
                     Health & Education/Nursing
                     4700 College Oak Drive
                     Sacramento, CA 95841

Web Site:            http://www.arc.losrios.edu/~edhealth/index.html

Partners
Sutter Health, Catholic Health care West, U.C. Davis Medical Center, Kaiser
Permanente (all part of the Healthy Communities Forum), Sacramento
Employment and Training Agency (SETA)

Type of Partnership
Hospital employee step-up program, with outside (new-to-nursing) students
involved (where partners unable to fill slots with qualified employees); partnership
with several local hospitals

Reason for Partnership
This program was developed at the initiative of the Sacramento Healthy
Community Forum, a group that is made up of representatives of local hospitals.
The Forum has long been concerned about the health care system in
Sacramento County and contracted with American River College (ARC) to help
meet the local nursing shortage.

Program Description
The purpose of this program is to expand American River College’s Nursing
program. The strategy is to recruit and train staff from the four participating
hospitals to serve as clinical adjunct faculty with the ARC nursing program. The
students the new faculty will train wil include incumbent hospital workers who
want to become RNs and other students who can help fill nursing positions in
local hospitals. The goal from the outset was to nearly double the number of
ARC nursing graduates.
The first two cohorts of the Healthy Community Forum Program included hospital
employees from all kinds of job classifications including unit secretaries, transport
people, CNAS, phlebotomists, and lab technicians. The third cohort is an LVN to



                                                                                  35
RN program. The Health Community Forum program students complete the
didactic training with the ―regular‖ ARC students. Their clinical training is
provided by the new adjunct nursing faculty (qualified RN’s from partner
hospitals), and all clinical rotations are within one partner hospital system (e.g.
Kaiser employees complete all clinical at Kaiser facilities. Some of the clinical
rotations take place on evenings and weekends.
The first cohort, which was about 65% hospital employees, graduated in spring
2005 (4th semester). The cohort achieved lower attrition rates and higher
average theory grades than other ARC nursing students. This may be because
the new students are already in the health care system, know the system, and
know the culture.
ARC’s second cohort, which started in Fall 2004, also exhibited lower attrition
rates and higher theory grades. The percentage of hospital employees is higher
in this cohort; about 90% compared to 65% in the first group. The director
attributes this increase to the fact that word about the program is spreading and
people are taking work with the hospitals with the intent of getting into the
program.
The third cohort comprised of LVN-RN Career Mobility students began
coursework in spring 2005. Attrition rates have been very low (and only due to
life issues); theory grades match those of the generic students. This is a typical
pattern for LVN-RN Career Mobility students.
Clinical faculty, many of whom have never taught before, are doing well and
some have expressed the desire to get their Master’s in order to be able to
pursue teaching careers. Some 4-5 out of 26-27 adjunct faculty are considering
becoming nurse educators.

What does each of the partners provide and receive?
The Sacramento Employment and Training Agency (SETA), American River
College and the Healthy Community Forum worked together to apply for a
Nursing Workforce Initiative grant. The grant paid didactic staff for time spent in
weekly team meetings with new clinical instructors, and in mentoring the new
staff (for the first cohort of students, who started in fall 2003). The hospitals
contributed 24 hours of release time per week plus benefits for their staff to work
as clinical faculty for 18 weeks. The SETA grant also paid the ARC program
director for time to coordinate and administer the new program. Program staff,
concerned about the challenges of taking on many more students while
attempting to maintain high quality and individualized contact with students,
negotiated funding for additional counseling and instructional assistance to take
some pressure off of faculty. The college agreed to remodel the onsite
classroom space, which is shared with other programs, to accommodate the new
large class size. The SETA funding paid to provide tuition-free education for the
first cohort of 40 students. The additional two cohorts will be funded by the
Healthy Community Forum partners; the budget distribution remains the same.




                                                                                      36
Some of the hospitals have offered one day off per week for their participating
employees, or paid for their books.
The hospitals are upgrading existing employees and getting new nursing
employees as a result of the program. The partnership has also been good for
ARC because the program is bringing in more students and this has boosted
productivity and enrollment in all prerequisite nursing classes. In response to the
additional demand for these courses, the Science Department got a new portable
unit that was partially supported by the SETA grant.

What are the hallmarks of a successful partnership?
The fact that competing hospitals are willing to work together to improve the
health of the people of the Sacramento area is really important. Previously, they
had only seen collaborations between single employers and health occupations
programs. The Healthy Community Forum has worked because the participating
stakeholders looked beyond their own immediate self-interest to focus on the
objective of improving the health of the residents of the Sacramento area.

Challenges
Integration or lack of integration between the new program and the existing
program is an important issue for the students. For instance, the Healthy
Community students are moved through the new program as a unit with
employees from the same hospital. By contrast, the regular students are
randomly assigned to clinical sites and thus they end up at different sites with
different people. While moving through the program and clinicals as a unit from
the same hospital may foster group cohesion, it could potentially be a problem if
the group does not get along. The students in the Healthy Community cohort
don’t get to know other students in the program as well, and they do not get the
exposure to other hospital environments that their peers enjoy. Finally, the
nursing program has more control over the scheduling of rotations for the generic
group. For the Healthy Community cohort, the hospitals are responsible for
providing faculty and clinical rotations, so the director might not know until the
last minute where and when these will be held.
Expansion in the number of students also increases the program’s day-to-day
costs of supplies and materials. For instance, they did not anticipate how much
more their printing costs would be for the number of syllabi; fortunately, these
unexpected expenses—when discovered—have been covered by the Healthy
Community Forum.

Advice for others thinking of implementing a similar program
Educational and employer institutions need to adjust to each other’s respective
cultures. Hospitals need to understand nursing education better, and community
colleges need to understand the industry better.
Many of the new faculty has never taught before, and they and their employer
institutions need to learn to work within the academic framework of nursing


                                                                                  37
education. Potential new clinical faculty and their employers need to understand
that teaching, in addition to instructional activities, requires a great deal of
paperwork, grading, and documentation beyond the time spent supervising the
students. To address these training needs, the new faculty completes a one day
orientation with the director. They also take part in online instruction, complete a
CD-ROM program produced by RHORC, and shadow experienced instructors.
They meet with their specialty instructors and are assigned a faculty mentor.
Each one of the ARC faculty has mentored one of the clinical instructors. The
clinical instructors are also evaluated by the ARC faculty and students. This
feedback is summarized and reviewed with each clinical adjunct faculty.
Programs also need to consider how to work with existing faculty and how to
compensate them for extra time. The Healthy Community Forum pays existing
faculty for the extra time put into mentoring the new adjunct faculty. The
compensation for the extra time is helpful, but learning to work with
inexperienced teachers may take a lot of adjustment on the part of long-term
faculty and require additional outreach by administrators. Faculty also has to
adjust to working with more than twice the number of students in a field that has
traditionally depended upon intensive contact between faculty and students to
foster success.




                                                                                  38
F.    Sacramento City College Nursing Program Expansion—
      Sutter Center for Health Professions
Contact
Contact Person:     Mary Turner
Title:              Dean
Email:              TurnerM@scc.losrios.edu
Phone               916-558-2271

Address:            Division of Science & Allied Health
                    Sacramento City College

Web Site:           http://www.scc.losrios.edu/programs/nursingadn.pdf


Partners
Sutter Health and Sacramento City College

Type of Partnership
Multi-dimensional program expansion

Reason for Partnership
The Dean of The Sacramento City College of Science and Allied Health noted
that partnerships tend to emerge in response to community needs. All
communities face nursing shortages, but community colleges lack the resources
required to expand their RN programs.
The Sutter Health and Sacramento City College partnership is the culmination of
dialogues between the district and chief executives of the hospital organizations.
At one point, the Chancellor and the Dean talked to the CEOs of the local
hospitals about how to address the community need. The discussions, which
included the Healthy Community Forum, focused on expanding the nursing
program at ARC (See the American River College Nursing Program Expansion
Case Study above). However, following the discussions, Sutter Health
approached the district with a proposal that the two parties collaborate to expand
SCC’s nursing program. SCC had previously worked with Sutter health for
clinical placements for nursing students, but they had had no prior relationships
with employers like this one.

Program Description
Sutter Health Sacramento/Sierra Region endowed the Los Rios Community
College District to expand the ADN Program at Sacramento City College. Sutter
is contributing some $16 million to create the Sutter Center for Health
Professions, an extended campus, which will initially offer tuition-free nursing
education to the greater Sacramento community. The program does not require


                                                                                39
that students be existing hospital staff (although many were initially recruited
from existing staff), nor does it require that they work for the hospital after
graduation, although the hope is that graduates will stay and work in the
Sacramento area.
Sutter pays for new faculty positions, scholarships and classrooms to help
Sacramento City College triple the number of nurses it graduates. The program
adds to the existing nursing instructional staff a large number of adjunct faculty
from the hospital.
The program offers the didactic and clinical training at the extended campus and
at Sutter Hospital sites. Courses are delivered as16 week offerings, as opposed
to the normal 18 week semester. Otherwise, the accelerated program runs
parallel to the regular nursing program at SCC.
The program was formalized by a legal contract between the CEOs of both
organizations. There is no outside grant funding involved in this collaboration;
the hospital partner (Sutter Health) is funding the expenses.

What does each of the partners provide?
The community college gets new clinical facilities and equipment and
theoretically, increased recruitment of nursing faculty. The latter hasn’t
necessarily worked out easily. The vast majority of clinical and theory instructors
have been recruited out of Sutter Health. SCC helps to recruit them and provide
training. The educational courses cause the existing faculty more work because
they need to mentor new faculty. In some instances, if adjunct faculty cannot be
found, existing faculty has to take on more students until an adjunct can be
found.
The hospitals eventually get more nurses—most of the graduating class has
been placed in Sutter Health Facilities.

What are the hallmarks of a successful partnership?
The program started in 2003, and the first cohort of students graduated from the
extended campus on February 11, 2005. The program was intended to add 80
students per semester in an accelerated 16-week semester program and to
graduate an additional 120 nursing students per year. Interest in the new
program was tremendous and the initial announcement of the new, tuition-free
program inspired some 2,000 phone inquiries about enrolling.
Since the program’s inception, the percent of students who are existing hospital
workers has decreased and the proportion is now about 20%. All members of
the first graduating class have been offered jobs, the vast majority within Sutter
Health facilities.
An additional plus is that many of new adjuncts would like to go on to become
nursing faculty.




                                                                                     40
Challenges
The program was originally intended to graduate 80 new nurses per semester,
but has had to settle for about 50 per semester. The long-term goal is to
graduate 485 new nurses. However, SCC has extended the timeline to 2010 and
expanded from $13 to $16 million the amount of funding for the program.
 The main reasons for the adjustment include:
   1) adjunct faculty recruited to teach in the program needed more release
      time to work with the program; and
   2) hospitals could not accommodate all the clinical placements necessitated
      by the influx of new students.
At the initiation of the program, administrators identified as a major challenge
coordination and standardization of training to incorporate the new adjunct faculty
into the existing program. In response, the Nursing Director at Sacramento City
College developed a training program that introduces new adjunct faculty to the
philosophy of the nursing program and to its curriculum. The training program
also challenges participants to examine and analyze different educational
theories, classroom techniques, evaluations, etc. In addition to this1-2 week
training, regular faculty mentors the new adjuncts who receive a stipend from the
hospital for taking part in the required training.
While this has generally worked well, the adjunct faculty remains employees of
the Sutter Health System. It is sometimes difficult for faculty working in clinical
practice to adjust from the hourly mentality of working nurses to the faculty
mentality, where, regardless of the number of hours required, an instructor must
continue to put in hours until the work is done. While administrators have found
that full-time release works the best, this has not always been possible. It can be
hard to facilitate communication between existing and adjunct faculty when the
adjuncts are torn between clinical and academic responsibilities.

Advice for others thinking of implementing a similar program
Extended campuses can be a challenge, so administrators should carefully
consider how they will integrate the two programs. Further, they should recall
that running programs that are not in synch is an extreme challenge.
Prior to making any plans or commitments, programs wishing to add a second
program or to otherwise expand should research the capacity of the participating
hospital systems to provide clinical placements. They should also begin early to
recruit faculty for the expanded program.
It is also important to have adequate administrative support for the program(s).
For the extended campus, the hospitals have an onsite person that helps with the
scheduling and recruitment of faculty at the site. The Dean recommends thinking
about getting additional administrative support for running such a program; in
retrospect, she sees that SCC could probably use an assistant director for the
program.



                                                                                 41
Finally, administrators should communicate with the existing faculty throughout
the process and be aware in advance of union and contractual issues that may
emerge from the expansion. Further, administrators should anticipate situations
that have the potential to cause tension such as faculty members working side-
by-side with (and mentoring) clinical adjuncts who have much less teaching
experience, but who receive much higher pay.




                                                                              42
H. Shasta Community College Dental Hygiene
Program
Contact
Contact Person:      Vickie J. Kimbrough, RDH, MBA
Title:               Program Director
Email:               vkimbrough@shastacollege.edu
Phone                1-530-245-7335

Address:             Dental Hygiene Program
                     Center for Human Development
                     Shasta College
                     11555 Old Oregon Trail
                     Redding, CA 96049


Web Site:            www3.shastacollege.edu/dental/


Partners
Shasta Community College, Shasta Community Dental Health Clinic, Northern
California Dental Society

Type of Partnership
Development of a new program to meet community needs (dental hygiene); co-
location with local dental clinic.

Reason for Partnership
Until the inception of the Shasta Community Dental Health Clinic, there was no
dental hygiene program in nine Northern California counties located near Shasta.
As a result, local dentists had a very difficult time finding dental hygienists willing
to live in a rural area with no large urban centers nearby.
The local dentists approached the community college with the problem and for
the next two years the Shasta Community College Center for Human
Development, the Northern California Dental Society and the local Shasta
Community Dental Health Clinic worked together to start a new dental hygiene
program. As a first step the partners had to prove that there was a patient base
and present the evidence to the American Dental Association which authorizes
all new dental hygienist training programs. They were able to do this and to
establish that the need was particularly urgent amongst low-income households.
To support the new program, the Shasta-Tehama-Trinity Joint Community
College District applied to the California Endowment for a two year grant (around
$250,000) for a ―Dental Hygiene Training and Clinic Program to increase the
number of dental hygienists in rural Northern California and to increase access to


                                                                                    43
affordable dental care through a local start-up professional training program.‖
However, the main source of funding for the start-up of this program was the
Northern California Dental Society, which gave the program $600,000 in start-up
funding. Local dentists also fundraised for the program. The program, which
started in 1999, is now funded through the community colleges.

Program Description
The school and Shasta Community Health Center’s main dental clinic in Redding
share a floor of a commercial building where education and oral health services
are provided. SCHC also provides clinical work experiences for the dental
hygiene school. When there are acute situations that the dental hygiene
students on the training side of the building cannot handle, patients are referred
to the clinic side.
Unless they have unfilled openings, the program only accepts students from
Northern California. They are allowed to do so because their endowment from
the Northern California Dental Society specifies that they are funded to provide
education to locals who are more likely to stay in the underserved area. The
program graduates about 14 students per year and most of these new graduates
find work in the local area.

What does each of the partners provide and receive?
The local dentists, represented by the Northern California Dental Society, wanted
more dental hygienists. The local clinic wanted more help, but could not find
appropriate applicants in the local community. The community college wanted to
launch new program, but could not afford the start up costs. The partnership
addressed all these needs.
The Northern California Dental Society provided the bulk of the funding for the
start-up. Shasta Community College hired the staff and developed the
curriculum and the facility.

What are the hallmarks of a successful partnership?
The initiative, which has become a flagship program for Shasta Community
College, has been operational since 2000. The first graduating class scored 8th
in nation out of some 267 dental hygiene programs, and they have remained in
the top 10 ever since. They have graduated over 80 dental hygienists and most
have stayed in the local area.
Another measure of success is the fact that other colleges vie them as a model
and come to them for advice on how to start similar programs.
Finally, as an indication of the commitment and support the dental clinic enjoys,
the college recently had a bond measure passed that will provide $11 million for
a new health sciences building in Redding. With this new funding, they plan to
move the clinic(s) from their current location to a more central location in 2007.




                                                                                  44
Challenges
The main challenge was finding adequate models and consulting help to develop
the program. Despite an extensive search, they were unable to find examples of
similar programs. As a result, they had to develop the curriculum from scratch.
To do so, they worked with the American Dental Association to find a good
consultant who assisted the development process. Next, they hired a director.

Advice for others thinking of implementing a similar program
 Health occupation programs in the community colleges need to share
information with one another about how to do this sort of thing, and how to do it
right; otherwise they will end up spending a lot of money on expensive
consultants. The dean visited a number of schools to learn how to implement a
complex new program and also put in years of planning with community partners
so that all the details were in place by the time they were ready to hire a director.
She suggests that those planning similar initiatives go to successful schools and
see what they are doing and ask for their assistance because that is the best way
to learn what works. She also suggests that programs share with others
because this is the only way our communities are going to be able to address the
health care crisis.




                                                                                  45
I.  Antelope Valley College Distance Learning Satellite
Program with Owens Valley Development Corporation
Contact
Dr. Karen Cowell
Dean of Allied Health
Antelope Valley College
3041 West Avenue K
Lancaster, California 93536
(661) 722-6402
kcowell@avc.edu

Dee Odell,
Vocational Education Director
Owens Valley Career Development Corporation
http://www.ovcdc.com/Index.htm
c/o 760-873-5107

(See also: http://www.heydaybooks.com/news/issues/articles/15.2.GraniteRim.html)

Partners
Antelope Valley College (AVC) and the Owens Valley Development Corporation of the
Inyo Mono Paiute Shoshone Indian Nation (OVDC) with Lancaster and Northridge
hospitals providing clinical training facilities for the program.

Type of Partnership
LVN distance learning program

Reason for Partnership
Located in Kern County District, Bishop has two health care facilities, a 23 bed hospital
and a 99 bed long term care facility. Due to shortages in available LVNs, however, the
area was up until recently only able to keep 50 beds open. The partnership, which was
launched to address this situation, uses distance learning to ―grow your own LVN.‖

Program Description
In Spring 2003, Antelope Valley College (AVC) and the Owens Valley Development
Corporation of the Inyo Mono Paiute Shoshone Indian Nation (OVDC) launched a
collaborative project to bring LVN training opportunities to the Bishop community. At that
time, the nearest LVN training program was Ridgecrest, three hours away, and Reno or
AVC, four hours away. Having identified a need for LVNs in the local community, and
building on the success of other employment training programs, OVDC approached the
nursing program at AVC with the idea of starting a distance learning program.
AVC and OVDC combined their resources to enroll 15 Bishop students in AVC’s LVN
Program and delivered the didactic part of the training to the class by broadcasting



                                                                                        46
locally AVC’s LVN courses. AVC also expanded its own onsite program in Lancaster by
incorporating the broadcasting technology to open up an overflow classroom while
lectures took place in a nearby auditorium. The clinical part of the Bishop program
training was delivered first at the Northern Inyo Hospital and then, when this facility
temporarily closed, at Lancaster and Northridge hospitals. OVDC took care of
transportation issues by busing students to their clinical training sites.

The OVDC has its own state-of-the-art video teleconferencing lab, and access to
technical consulting staff through their tribal affiliation. They hired a classroom monitor
in Bishop to attend all session to safeguard against technical problems. They also
located a former community college instructor living in Bishop who agreed to work at the
convalescent care site for the clinicals. The program director stresses the importance of
support staff (career counselors) in making sure that students’ needs are met so that
they can concentrate on the very demanding program. They have Workforce Investment
Act funding for their program, and Pell Grants for their students.

What does each of the partners provide and receive?
AVC and OVDC have the satisfaction of contributing to meet the community’s need for
LVNs. OVDC has created the opportunity for local residents to be trained in a high-
demand occupational area that offers plenty of opportunities for advancement. AVC has
extended the benefits of an existing program to a new, remote community and piloted an
innovative distance learning model.

What are the hallmarks of a successful partnership?
All but one of the eight graduates from the first LVN class plan to stay and work in the
area after they graduate. An additional and very significant benefit is that the project is
growing a nursing workforce that looks much more like the local community and includes
a number of Native American women, as well as white women and a Hispanic man6.
The OVDC already runs a successful CNA program, and is considering an RN program.

Challenges
They started this program with 45 students in Lancaster (where Antelope Valley College
is located) and 15 in Bishop, almost 200 miles away. During the first semester, they lost
many students, a pattern not uncommon for distance learning in general. Some
students in the classroom receiving the live broadcast in Lancaster felt alienated by the
lack of live instruction. AVC has decided to move back to a somewhat smaller program
that is more manageable. The nursing program was the first at Antelope Valley College
to make use of the video-broadcasting facility, and now they are considering having a
rad tech program broadcast to AVC from Moorpark College.

The Bishop program, which is considered a success, graduated 8 students this summer.
In Bishop, the Vocation Education Director noted that students face many challenges
and OVDC does whatever it takes to bolster students’ self-esteem and take care of their
daily needs so they can focus on learning because ―these are students who might not
have been used to expecting success.‖ They need to get the idea that ―I can make it
come alive; I don’t have to settle for what is available‖.

6
 While the program is proud that it has inspired many Native American students to succeed, the program
director stresses that they are an inclusive program serving the employment development needs of the
entire Bishop community.


                                                                                                     47
Advice for others thinking of implementing a similar program
AVC’s teleconferencing equipment was supported by VATEA, Title V, and statewide
Technology money given to the college and not specifically to Health Sciences. In terms
of the team that made the program possible, the AVC lead faculty person participated in
the discussions from the beginning and ―made it happen.‖ Dean Cowell emphasizes that
a motivated faculty is a requirement for this kind of initiative.
One issue that had to be addressed on both sides was the compatibility of the networks
institutions have access to—just having the technology doesn’t mean that ―your
equipment can talk to their equipment.‖




                                                                                     48
J. San Francisco City College’s Nursing Program
Expansion
Contact Person:      Linda Squires Grohe
Title:               Dean, School of Health and Physical Education
Email:               lgrohe@ccsf.edu
Phone                415-561-1908

Address:             Associate Degree Nursing Programs
                     City College of San Francisco
                     50 Phelan Avenue, C306
                     San Francisco, CA 94112

Web Site:            http://www.ccsf.cc.ca.us/Departments/ed_programs.htm

Partners
California Pacific Medical Center and St. Luke’s Hospital, both Sutter Health
Affiliates with Jewish Vocational Services

Type of Partnership
This grant-supported partnership will, through the addition of an afternoon-
evening section, almost double the capacity of City College of San Francisco’s
RN program. The new section is open to all interested applicants. California
Pacific Medical Center and St. Luke’s Hospital, as the hospital partners, will help
recruit clinical adjunct faculty and will serve as the main clinical training site for
the afternoon-evening students.

Jewish Vocational Services, a community-based organization and a partner in
many previous CCSF’s health care initiatives, will provide counseling/case-
management services to participating students.

Reason for Partnership
The San Francisco/Bay Area has been very hard hit by the nursing shortage. A
survey conducted by the Hospital Council of Northern and Central California in
2001 found a 15.8% vacancy rate for non-surgical RNs in San Francisco
hospitals. The situation is aggravated by the fact that San Francisco’s 17,150
nursing population is aging with only 4% under the age of 30 and 29% over 50
years of age. As a result of these demographics and of dissatisfaction over
stressful working conditions, a San Francisco Department of Public Health
study found that almost one third of San Francisco’s nurses plan to leave their
jobs over the next five years.




                                                                                    49
In 2004, CPMC and City College of San Francisco joined forces to respond to
this situation. The impetus that brought the two partners together was an
announcement by the Gordon & Betty Moore Foundation of a major grant
competition for funds to improve the quality of nursing-related patient care in five
counties of the San Francisco Bay Area.

The partners succeeded in developing a winning proposal that was funded with a
$4.2 million grant that over a five-year period will increase enrollment in CCSF’s
RN Program by 33% from 96 to 128 students per year.

Program Description

The grant covers staff time for program development, coordination, instruction
and other direct services to students. All three key partners, CPMC, St. Luke’s
and CCSF, partake in this funding. Grant monies also contribute to faculty
training, research and evaluation, and student counseling/case management
services.

Once the funding had been secured, the partners collaborated to plan the
implementation. As part of this effort, the CPMC Moore Grant Coordinator joined
the CCSF Hiring Committee that recruited and interviewed candidates for the
new faculty positions. They also worked with an outside evaluator to conduct
four focus group sessions that asked current students, program graduates,
faculty and nursing managers working with CCSF nursing graduates to examine
the strengths and areas in need of improvement in the existing RN program. The
findings were used both to plan the expansion and to support the development of
CCSF’s request for WIA funding from the State Chancellor’s Office.

Improvements will focus on reducing the program’s attrition rate and on
increasing students’ preparation for the workplace, especially in the area of
critical thinking. The expanded program will thus have an early alert system that
identifies and quickly responds to students showing the first signs of difficulty and
case management services that will help students with life management issues.

To coordinate and execute the daily operational components of the program, the
partnership hired from among the CCSF Nursing Faculty a Program Coordinator.
On the hospital side, the Chief Nursing Officer, Director of Profession Nurse
Development, and Director of Nurse Recruitment will be responsible for
developing and implementing strategies and processes to successfully
accommodate the new program.

What does each of the partners provide and receive?
CPMC and St. Luke’s, by contributing to the design of the expanded program
and by serving as the clinical training site for the afternoon-evening students, will
be able to recruit students whose training reflect hospital input and priorities.




                                                                                   50
CCSF has increased its ability to serve the local community in an area that is of
rising concern. The college has also gained prestige from collaborating with one
of the area’s largest health care providers.

Both partners recognized, as CCSF parlayed the Moore award and the CPMC
partnership into an additional grant opportunity from WIA, that funders like to
support well-defined collaborations between educators and health care providers.

What are the hallmarks of a successful partnership?

The hallmarks of success have yet to be generated—as the first group of
students started classes in Fall 05—but will include:

    Increased effectiveness in CCSF’s nursing program resulting from
     reduced attrition and increased pass rates on the NCLEX

    Further increases in efficiency as CCSF’s nursing graduates enter the
     workplace highly prepared and ready to fully assume the responsibility of
     nursing

    Increased diversity in the local nursing population resulting from the fact
     that CCSF is a highly diverse institution and its students far more diverse
     than San Francisco’s current nursing workforce

Challenges
In its application to the Moore Foundation, the program identified two major
challenges it anticipated encountering:

         CPMC and St. Luke’s staff nurses participating as adjunct faculty will
          require assistance in fully understanding the scope and responsibilities
          of their new role. To reduce the learning curve and ensure that
          expectations are realistic and comprehensive, the partnership
          proposed to create and provide a 32-hour training for all new faculty.
          The curriculum for this training was developed by the CCSF faculty.

         Mentoring the new adjunct faculty as well as defining the role of the
          actual CCSF mentor may present challenges.

While these two tasks required considerable attention, the main challenge that
emerged during the planning phase was the struggle to get faculty buy-in. Since
the Moore grant opportunity came about during the summer, faculty returned in
the fall uncertain about the impact the expansion would have on them and
concerned about the fact that they had not been fully involved in the grant
development process. The problem was one of timing. To compete for the
grant, the CCSF development office (Research, Planning & Grants) had to
move forward with input from the limited number of RN faculty members who
were able and interested in becoming involved in the grant development effort


                                                                                  51
during the summer break. In a subsequent proposal development process,
when the program applied for a WIA Grant, there was much more involvement
from the RN program and from faculty that had been appointed to represent the
program with the development office.

Aside from faculty buy-in, the second major obstacle in moving forward was the
difficulty of recruiting and hiring additional full-time instructors. Industry wages
are simply too tempting and, even for the handful of individuals who applied, the
teaching experience requirement for full-time faculty disqualified several
candidates.

Advice for others thinking of implementing a similar program
The program director advises that faculty be involved in the planning process as
early as possible and that all efforts be made to address their concerns about
changes the expansion will have on their work-load, relationship with students,
and responsibilities for training new instructors.

Further, begin as early as possible to recruit the new faculty and recognize that
the shortage in nursing faculty is at least as the related shortage in nurses. After
months of recruitment efforts only a handful of applicants have emerged. The
program is now preparing to spend more funds on advertising the positions in the
area’s largest newspapers.

Make sure that the expansion budget includes funds for faculty to train new
adjunct faculty members who have no teaching experience. Also include funds
for professional development and planning.

Research what other programs have done to plan and implement their
expansions. In addition to proving helpful for planning an effective program and
for anticipating problems, knowledge of other programs is also useful when it
comes to writing good grant applications.

Design and implement a formative evaluation component that can help drive
program implementation.




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References:
American Association of Colleges of Nursing. May 2003. Faculty Shortages in Baccalaureate
   and Graduate Nursing Programs: Scope of the Problem and Strategies for Expanding the
   Supply, White Paper,
   http://www.aacn.nche.edu/Publications/WhitePapers/FacultyShortages.htm
American Association of Colleges of Nursing. October 2002. Using Strategic Partnerships to
   Expand Nursing Education Programs. (Profiles of successful partnerships nationwide).
   http://www.aacn.nche.edu/Publications/issues/Oct02.htm
California Community College System, VTEA State Leadership Best Practices Website. A
    searchable online database of best practices, including in partnership development and
    career ladders. http://vteabp.org/partnership_devel.htm
California Community Colleges Economic and Workforce Development Program. December
    2003. Getting It Done With the Health Care Initiative. Volume 1, Number 8.
    http://www.cccco.edu/divisions/esed/esed/ed_svc_newsbriefs/rhorc_gettingitdone_vol1-8.pdf
Employment Development Department, Labor Market Information Division, Information Services
   Group, Occupational Research Group. May 2003. Careers Under Construction: Models for
   Developing Career Ladders.
   http://www.calmis.ca.gov/file/occmisc/CareerLaddersConstruction.pdf
Jobs for the Future, 2004. Breaking Through: Helping Low-Skilled Adults Enter and Succeed in
   College and Careers. A report produced with fuding from the Charles Stewart Mott
   Foundation, with the assistance of the National Council for Workforce Education.
   http://www.jff.org/jff/kc
Spann, Jerl and Larkin, Michelle. Addressing the Nursing Shortage: Partnerships Amongst
   Governments, Schools and Employers are Getting Results. January 2005. A Publication of
   the Robert Wood Johnson Foundation and part of the Charting Nursings’ Future series.
   http://www.rwjf.org/files/publications/other/nursing_issue1_final2%20(2).pdf
Workforce Excellence Network (WEN). Promising Practices: Resources for the Workforce
   System. (A website with a searchable database of promising practices in workforce
   development funded by the Employment and Training Administration, U.S. Department of
   Labor.) http://www.promising-practices.org/kc/main/kc_frame.asp?kc_ident=kc0001




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