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Sustainable, Scalable Upskilling in Specialty Nursing

The Hospital Workforce Collaborative used the Talent Pipeline Management® (TPM) framework to identify and work with education providers to create an efficient, sustainable model for hiring, upskilling, and retaining nurses in six specialty practice areas critical to the healthcare business community in Arizona.

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The identification and simplicity of clear and common objectives from the collaborative assisted the colleges in building an equally collaborative solution.


spent on each nurse hired

The Challenge

The nursing workforce in Arizona, as in most states, is aging quickly and there are no longer enough trained specialty nurses to meet the growing need for their expertise. This hiring difficulty is compounded by the ongoing challenges of turnover among nurses at all levels of experience in most U.S. states.

Arizona is expected to experience a 23% growth in demand for specialized nursing, with 20,508 new openings projected by 2025. As a result of this demand, hospitals must hire expensive traveling nurses and pay extensive overtime in what is a very costly support model. Recruitment for new talent can cost up to $10,000 per nurse, and though these numbers vary by location and facility, when you add costs incurred through orientation, education, and inactive working hours for a nurse preceptor, hospitals can spend around $170,000 on each new nurse they hire.

The Solution

The healthcare system in the region needed a more efficient way to upskill candidates from entry level to specialty nursing roles, so the Hospital Workforce Collaborative was organized by the Greater Phoenix Chamber Foundation to address ongoing critical skill shortages. These nine hospitals in the Phoenix area used the Talent Pipeline Management (TPM) model to identify their greatest pain points – developing and retaining nurses in six specialty practice areas – and develop a plan to address them.

The collaborative of employers established a partnership with the Maricopa County Community College District (MCCCD) to inform the curriculum of applicable nursing and healthcare programs within the district’s ten community colleges to meet the needs of the growing healthcare business community. The state of Arizona approved a $5.8 million budget request to expand nursing programs at the community colleges, specifically focused on upskilling existing employees. This unique approach to upskilling talent will deliver the workforce that the local economy needs.

Background Research

After getting organized as a collaborative (TPM’s Strategy 1), the next step was to engage in demand planning and better understand the landscape of the skills gap challenge faced in Arizona as well as the future education needs of the healthcare business community (TPM Strategies 2 and 3).

MCCCD engaged in market research with the major healthcare providers in the region. The Hospital Workforce Collaborative identified a significant shortage of specialty nursing talent in the region’s six critical areas of specialty nursing.

Following this research, the collaborative confirmed that need with labor market data and aggregated job market posting data from the last few years.

The Cost of Vacancies

The costs of RN vacancies and turnover are found in the expense of recruiting new nurses, hiring agency or traveling nurses to fill vacancies, engaging in excessive overtime, or suffering the operational costs created by a shortage of qualified nurses. The American Organization of Nurse Executives reports “a conservative estimate” is $10,000 per turnover. On average, a facility with 400 RNs must be prepared to recruit and train up to 80 new RNs per year, representing direct costs of $800,000 per year.

300 students

are projected to graduate through this new talent pipeline by 2021

936 specialty nurses

are projected by major healthcare providers in the region to need upskilling in the next year across six practice areas

$5.8 million

has been committed by the state to support the community colleges

Overcoming Communications Gaps

The 10 community colleges in Maricopa County are organized under one district. But all 10 schools are individually accredited and operated with varying employer relationships from one college to the next. Without a strong link to the employers, the schools had a limited understanding of how to meet their incumbent worker needs.

“They weren’t looking at specialty nurses as their area of focus because hospitals are all looking to hire nurses with four year degrees. But the collaborative wanted a four-year bachelor’s degree in nursing and one year of work experience who could be upskilled. While the four-year degree is the responsibility of universities, the upskilling certificate falls within the mission of community colleges.” — Jennifer Mellor, chief innovation officer for the Greater Phoenix Chamber

Once community colleges understood the magnitude of the need for incumbent workers (TPM’s Strategy 4) and had access to a collborative of employers that would help determine the related requirements, they immediately responded. The collaborative provided a mechanism for colleges to respond more quickly to market and employer demands rather than continue a model that shifts continuously over time. The collborative began to refine the curriculum, as well as the right facilities and partnerships to deliver it (TPM’s Strategy 5).

The Key to Unlocking the Support you Need

During this process, MCCCD identified a need for funding to create additional simulation facilities and labs to support these new programs. MCCCD was able to secure an appropriation of $5.8 million, in part due to the support of the collaborative and the business community. Working together, the need for expanded facilities and coordination across the region was clear.

The process to date has highlighted the need for employers to reflect on how they’re upskilling talent and whether or not there are better ways of doing it. The workforce collaborative looked at who should be training specialty nurses, and employers recognized that education providers are better suited for the task.

Though this is only phase one of this initiative for the Arizona collaborative, the keys to their success so far have been organization, a strategic approach, and a true partnership with the education system.

Standardizing the Curriculum

It wouldn’t be practical to work with each community college independently, so the collaborative worked with the head of workforce development for the entire community college district who helped them focus on the community colleges most involved with the healthcare practice, specifically nursing.

For example, the Critical Care certificate program already existed so the collaborative reviewed and informed the curriculum to ensure it aligned with each hospital’s needs and expectations. This February 2020, the community college will pilot the Critical Care stackable credential program to upskill existing nurses before they transfer into the Intensive Care Unit.

After measured success, the collaborative will complete the same process in other specialty areas to launch additional programs. The order of the program launches will be: Telemetry, Emergency Room, Operating Room, Oncology, and Home Health. To supplement these educational efforts, the collaborative is exploring the possibility of completing the stackable credentials with an apprenticeship program.

Plans for the Future

MCCCD is working to create a state of the art learning environment, leveraging existing assets and facilities to meet market demand. The financial support from the state will ensure sustainable equipment and supplies for the participating community colleges to expand current nursing and healthcare programs and create new programs and workforce pathways based on community need, including specialty simulation centers.

With the potential for up to 300 graduating students through this program by 2021, doubling the current number of nursing students in the region, and the increase in a minimum of five new programs and multiple tracts for upskilling incumbent working nurses, the potential for increasing the healthcare workforce in Arizona is extraordinary.

Phase II of their plans includes an expansion of these new programs and simulation opportunities to other schools and nursing programs throughout the community college district.

A Repeatable Model

The TPM initiative is a framework that makes it possible for a community, region, or state to achieve the same kinds of results that this collaborative has seen and develop a reliable pipeline of talent across any industry.

TPM is an outgrowth of the supply chain management business model where communities build regional leadership coalitions among business, education, and workforce to identify partnerships that produce sustainable talent pipelines. Employers are in the driver’s seat of these partnerships so that the resulting workforce solutions are truly driven by demand. Get started today.

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