By Mike Foster

September 19, 2002

 

Introduction

Good morning. Mister Chair and Members of the Board, for the record I am Mike Foster, Senior Director of Advocacy for the Sisters of Charity Health System, which sponsors affiliate Montana hospitals St. Vincent Healthcare in Billings, St. James Healthcare here in Butte, and Holy Rosary Healthcare in Miles City.

Joining me this morning is our Regional Vice President of Human Resources Harold Anderson, who is also headquartered in Billings. We appreciate the opportunity this morning to briefly address an issue of critical importance to our health care system and to all hospitals in Montana -- the current shortage of health care workers. In particular we will comment on the nursing shortage, which Mr. Anderson will portray to you what he believes is a crisis that requires immediate and well-coordinated action by both the public and the private sectors.

Due to the seriousness of this issue, we hope to continue having a dialogue with you and, depending on circumstances. may request some time on your agenda during a future meeting.

Body of Comments

A very interesting source of information is the latest draft version of the report from the Governor's Blue Ribbon Task Force on Health Care Workforce Shortage, of which Deputy Commissioner Joyce Scott has been a member. Several times the report illustrates the magnitude of the problem in ways that are consistent with our Montana operations. It describes the matter as "an acute shortage of health care workers," a "crippling shortage," and even "a national problem." One comment succinctly states, "Montana is experiencing an unacceptable shortage of qualified health care workers." Since, according to the report, "nurses represent 34 percent of Montana's health care workforce," the problem is especially critical in that field and extends into the future. Registered Nurses represent the largest group of health care providers, and most RN's are nearing retirement age with an average age of 45.5 years old. The report states, "In 2000, 70% were over 40 while only 9.1 % were under 30 years old."

Several of the task force's recommendations address potential actions of the Board of Regents and Commissioner of Higher Education. For instance, the report proposes that the OCHE should establish an integrated, single point of contact Distance Learning and Continuing Education program for health professionals to accommodate ongoing education in our rural state, such as a nursing refresher course modeled after the University of North Carolina. Another proposal urges the OCHE to explore ways to retain health care graduates in Montana through incentives such as loan reductions and payments, conditional scholarships, tax credits, and child care. The task force also decided that the OCHE should assess and report on the program capacity of our higher education system to meet health care workforce needs.

That leads us to the reports prepared by Deputy Commissioner Joyce Scott. We are well aware and greatly appreciative of the Montana University System's proud tradition in providing nursing students with a high quality education. Both the health care industry and the consumers of health care services are extremely grateful for the excellent training our MUS nurses have received over the decades.

Deputy Commissioner Scott's reports indicate the quality of the programs and the dedicated pride the program overseers have for the programs. It is noteworthy that the reports show available capacity in some programs at various locations. It is very significant that the reports indicate a continuum of education opportunities for nurses so that they can increase their educational experience through the MUS and thus maintain or upgrade their license status even as they practice their profession.

Deputy Commissioner Scott's reports seem to reflect the reality that the market situation has changed dramatically over the past decade. No longer does St. Vincent Healthcare, for instance, have great flexibility in selecting nursing professionals. As demand for health care services rises and the pool of nursing applicants dwindles, our standards for attainment of certain education levels of job-seekers has been forced to retreat. Our hospital will eagerly hire a qualified candidate with a bachelor's degree in nursing, but we have also become quite appreciative of applicants with an associate degree in nursing. Quite frankly, we desperately depend on the two-year programs in the University System to be responsive to our needs.

The dynamics of the job market have changed, and we are asking for your help in addressing this crisis. Mr. Anderson will be able to provide you with specific examples.

Conclusion

Members of the Board, we want to continue our dialogue with you because the Sisters of Charity Health System believes that the current healthcare workforce shortage must be addressed by all stakeholders. We in the private sector can provide scholarship money, instructors, clinical sites for training, and of course jobs.

The Office of Public Instruction can work cooperatively in developing and implementing on-the-job nursing and other health care training curriculums in our high schools.

Local, state, and federal government can play a critical role in providing adequate program funding, training money, matching dollars for scholarships, and market data, while also acting as an intermediary for communication between the private and public sectors.

The Board of Nursing can help by examining policies on licensing reciprocity and educational requirements. A balance must be struck so that qualified nurses from outside our state are allowed to practice in Montana without sacrificing our high level of professional standards. Educational requirements should allow nurses to increase their licensing attainment with a minimum of redundancy.

The Montana University System can help by being flexible in meeting the educational needs of Montana's health care industry, including the importance of two-year degrees, by maintaining a close working relationship with the private sector as the market continues to shift, and by serving as a great resource of information and data so that sound policy decisions can be based on accurate facts.

Thank you for your time and I would now like to turn the podium over to Harold Anderson, Vice President of Human Resources.

COMMENTS TO BOARD OF REGENTS

By Hal Anderson

September 19, 2002

Madame Chair and members of the Board, I am Harold Anderson, Vice President of Human Resources for the Montana Region of the Sisters of Charity Health System

Healthcare in Billings.

Like Mr. Foster, I am headquartered at St. Vincent.

I have been in Healthcare for the past 18 years. I started my career in the Human Resource Division of Valley Health System in Southern California. In 1985, 1 experienced the ramifications of what then was considered nationally as a severe nursing shortage.

Arguably the worst problem associated with a shortage is that sometimes high risk, undesirable candidates can slip through the cracks in the selection process. The most notable in California was the hiring of the Angel of Death who killed nearly 30 hospital patients by administering lethal doses of lidocane. I know that he was hired because of the Nursing shortage and that he was under investigation at the time he was hired. The pressure from Physicians and Directors to hire any nurse walking through the door was incredible.

Thus, a terrible ramification of a shortage situation is the risk associated with compromising hiring processes in order to fill immediate needs. At that time, health care professionals collectively let that shortage creep up on them without forecasting appropriately and planning accordingly.

Now some 17 years later the media and Healthcare professionals are stating the nation is facing another shortage. This time the difference is being announced as far more severe. After the memory and learning experience I had as a new Human Resource Professional in Healthcare, I began taking note of this current problem some time ago. As a result, The Directors of Human Resources for the affiliates I represent at St. Vincent in Billings, St. James in Butte, and Holy Rosary in Miles City began a planning process to deal with forecasted shortages. We implemented terms of employment proposed by experts forecasting what to do in order to hire and retain Nurses. These terms included, Flexible Scheduling, Creative Wage Differentials, and an Aggressive Compensation Philosophy aimed at positioning ourselves to be the market leader. We also implemented a Professional Practices Committee comprised of Physicians, Nurses, Senior leaders and other staff members. (Tell purpose of the committee.)

One and a half years ago, 17 out of 19 Graduating Nurses from MSU-B chose to leave the state. We hope the changes we have implemented and other ideas we are developing will convince future graduates to stay here in Montana. Our challenge is to strike a balance between providing competitive compensation packages and not driving up the cost of healthcare for Montanans.

For the last 13 years II have been with the SCLHS in Montana. For 11 of these 13 years we had a file of applications of Nurses that we hired from and in most cases we could pick and choose the best of the best. Prior to the last two years, that file contained as many as 30 resumes or applications at SVH. Now the file is empty. It's been a long time since we used the expression, "We'll keep your application on file."

Specifically, SHV currently has 40 openings for RN's. SJH has 16 openings and HRH has 2 openings. HRH would have perhaps as many as 10 openings had nurses from recently closed services not been re-deployed. We don't have the applications to fill these positions which have now been open for nearly a year.

In a perfect world. I could focus on candidates with bachelor's degrees in nursing, but that's not the world in which I am currently operating. Candidates with two-year Associate degrees in nursing are very appealing to me right now, and I agree with Mr. Foster that we should all take a team approach in addressing this shortage because the Montana University System is a huge factor in this difficult equation.

For instance, when any unit of the University System is unable to accept applicants into its nursing program due to enrollment limitations, there should be a mechanism to allow both the private sector and the University System to focus immediately on how to resolve the problem jointly. By establishing this type of communication system, the integrity and viability of the programs will be maintained while the students' needs and health care industry's concerns will also be met. Especially during a time of shortage, potential members of the health care workforce should not be turned away at the door of education.

Thank you for your efforts and for taking the time to listen to us today. We have come here today to respectfully express our perspective and to open the door of communication, not to complain about anything. We appreciate and support the Montana University System very much. I will gladly answer any questions and hope that you will be open to future discussions as well.