Kathleen Wessel (Host): In the face of ongoing nursing shortages, healthcare leaders must think outside the box by realigning the nursing staff pipeline, utilizing key metrics, evaluating training and investments, and engaging in smarter recruitment strategies. Welcome

to a HA Associates Bringing Value, a podcast from the American Hospital Association. In these series of podcasts, we speak with a HA associate program, business partners check in on their efforts and learn how they support a HA hospital and health system members. I'm Kathleen Wessel, vice President of Business Management and Operations at the a HA, and today I'm happy to share an interview with Tom McNamara.

Tom serves as Chief Transformation Officer at UN Tech Learning, And in today's discussion, we will address a critical challenge facing many hospitals and health systems by taking a data-driven approach to the nursing shortage. Starting by identifying key workforce metrics, collaborating with HR and measuring the ROI of training programs.

Tom, welcome to the podcast.

Tom McNamara: Thanks so much, Kathleen. Delighted to be here with you today to discuss this really important topic,

Kathleen Wessel (Host): critically important to members across the country. And as you know, uh, core mission of hospitals and healthcare systems is taking care of people to fulfill that mission. Hospitals and health systems need compassionate, skilled, trained, and dedicated professionals. Can you help set the stage for the discussion? What are some of the current challenges schools are facing that lead to fewer nursing graduates, And what are some of the approaches that we have to address those?

Tom McNamara: That's a great question. Thank you, Kathleen. The reality of it is the world that we live in, especially when it comes to nursing education, has become really difficult over the last few years. It is a combination of a whole bunch of things. Pandemic obviously played into it like it did with delivering quality healthcare across the country, but for nursing schools in particular, being able to align with hospitals to provide key clinical rotations and being able to secure clinical faculty and faculty in general has become a big, big challenge.

But when you look at it holistically, the reality of it is a lot of nursing schools have not moved with the needs of the hospitals that have been so critical And so supportive of them over the years. And what I mean by That is you have lots of nurses graduating, especially from flagship universities, that will have availed of wonderful clinical experiences, potentially have worked after graduation in local hospitals, And then ultimately leave very quickly after they've gotten their search of initial onboarding in search of that transition to practice.

That is so, so important. From a unitec learning perspective as one of the largest nursing schools in the country, we believe that the solution to the nursing shortage that we as a country are dealing with at the moment is by leaning more into the relationships of your members, of, of hospitals across the country to truly understand what it is they need.

What we hear time and time again is they want confident, competent clinicians. Who are ready to go as quickly as possible. And what I mean by That is that the nursing schools understand the value of transition to practice And that they're not just dropping off a graduate after four years of education that a hospital has to retrain, whether it's their technologies, the electronic health records, their care model.

Just the basics of interacting with patient's and their families. And so we have developed a very, very innovative program that works directly with hospitals to craft a nursing program that fits their specific needs and their community. And so working very, very closely with our hospital partners, we develop a curriculum that delivers as close to a practice ready nurse as you could possibly want or need very, very soon after graduation.

So feathering in elements of of transition to practice. Feathering in the electronic health records, the charting that a particular hospital would use the care model, making sure that the clinical rotations that are so key to helping a nurse develop as a confident and competent clinician that they are done in conjunction with the hospital partner, so that at the end of the day, not only does the hospital have a pathway for their healthcare workers to become nurses.

They also have a pathway to become a practice ready nurse. Very, very close to licensure, which we see as adding huge value with regards, managing the critically important nurse pipelines that every hospital in the country is endeavoring to do at the moment.

Kathleen Wessel (Host): I think practice ready is, is the key term there. Thank you for that. Before we dig any deeper, can you share with listeners more about your healthcare experience, your expertise, and how Unitech learning supports a HA member hospitals.

Tom McNamara: I've worked for over 25 years in higher education with most of that being in, um, health sciences, specifically growing, building, running large nursing schools. And for the last five years I've been associated with UN tech learning first as a board member, and, uh, more recently, since March as a Chief transformation officer.

We are one of the largest nursing schools in the country. We educate close on 10,000 nursing students a year, And we partner with some of the largest healthcare systems specifically to set our model to support their needs. Not only do we believe it is important to graduate confident and competent nurses that are capable of passing nclex, but that it is vitally important.

That we also graduate nurses that are aligned with the needs of the hospitals that pay such a critical role in supporting the education of every nurse that graduates and passes NCLEX and becomes licensed in the country. In addition to that, as one of the largest nursing schools in the country, that focuses on the adult learner population, we are singularly focused on nursing.

The way that we partner with our hospitals and our local communities is we put a Pathways program on front of an entry-level healthcare worker. We graduate students at really, really high levels because we have all of the wraparound services that you need or should demand as an adult learner.

And so we work closely with our students. We work closely with our hospital partners. We have phenomenal graduation rates. Our students pass CLE at really high levels, well above state averages. They all get jobs with our hospital partners. And so when you look at a return on investment from a student perspective, it is exceptional.

And that's not just us saying it. We were recently ranked by Georgetown University's ranking of all educational programs in the entire country. We were ranked second with programs at California Institute of Technology in the number one spot. Our two nursing programs were ranked second and third. Fourth was Massachusetts Institute of Technology.

And that was looking at the investment a student makes in a program that takes into account the completion and graduation rates And what a student is expected to wear. And upon graduation, and because our students have such clear line of sight into a high paying job. Not only do we have wonderful outcomes, which we're very, very proud of.

Our programs help elevate all of the communities that we serve. And so being recognized by Georgetown was phenomenal. But it's all of the hard work from all of our faculty, all of our healthcare, our hospital partners, and our wonderful students working together to make sure that we provide access to the nursing profession for people from rural, from urban communities that most educational institutions have passed by.

So we're very, very proud of it. We're very, very proud of the partners that we work with, the hospital systems across the country. And when you put it all together by putting in place a Pathways program for these wonderful, wonderful adult learners, great things can happen. And so we're very excited by the work that we do.

Kathleen Wessel (Host): That is quite a testament, and congratulations on that standing.

Tom McNamara: Thank you.

Kathleen Wessel (Host): Members are in kind of this perpetual state of planning when it comes to labor needs. So from your vantage point as an educator, can you share with us kind of, you know, whether it's a pipeline concern, a capacity issue, a misalignment between education and workforce needs? What are you seeing and how would you characterize the issues?

Tom McNamara: There's been a significant misalignment between the needs of hospitals and healthcare systems across the country with what I would call traditional nursing schools. And what I mean by That is, you know, as a hospital you want to participate in the education of training of a nurse. Right, and you would hope that at the end of their training that they would come and work for you.

Unfortunately, one of the biggest issues that we deal in nursing education today is that you have hospitals that invest so much time, effort, resources in educating and helping support rather, the educational nursing students through their partnerships with flagship national universities. Local community colleges And in many cases, in return, they don't get to hire.

Or more importantly, if they do hire them, retain those nurses throughout their careers, especially with flagship universities. You, what you find is you have students coming in from all over the country, they get a wonderful, wonderful education, become great nurses. Working with the local hospitals to help train those nurses.

But as soon as they become licensed and get some experience, invariably they typically go back to the states that they came from. And This is a particular problem. And with rural healthcare rural hospitals where they have decades long partnerships with some of the national flagship nursing schools, they provide such a key part of the educational process.

And then at the end of the day, after educating, these wonderful nurses are left with holes in their pipeline. And so what we do here at Unitech Learning, we don't advocate that you stop doing that. We very, very clearly encourage hospitals to continue to lean in and support the local nursing schools that they've supported for many years.

But our plan, our model, has been crafted in collaboration with some of your members to very specifically open up access to nursing for your frontline workers, your entry level healthcare workers. Almost all of them. 80, 90% of them in survey after survey want to become nurses. But because of life, because they cannot step out of working, they have to provide for their families.

They're not in a position to be able to go to a four year school, despite the fact that they would make great nurses. And so what we do here at Unit. We partner with local hospitals. We partner with the leadership across the board and embed a nursing program specifically for, for entry-level healthcare workers within a hospital.

Essentially bringing control of pipeline back to the hospital. That typically has played such a huge role in educating nurses that typically go back to where they came from. There's an opportunity to retain them in the communities where the hospitals are.

Kathleen Wessel (Host): No, I like that. Leveraging kind of the local kind of aspects of that. That makes a lot of sense for so many different reasons. You've kind of started down this path in that last set of comments, but clinical rotations are critical for nursing graduates and everything that goes into making sure students are kind of up, ready to hit the ground running.

Once they actually do graduate for host organizations, it takes a ton of time and effort, uh, and deep commitments from their existing workforce to make sure nurses are brought up to speed. You know, where does that investment for clinical training end up, You know? And if organizations aren't able to hire or are prevented from hiring for one reason or another, who does?

What is the status that.

Tom McNamara: Yeah, and you've literally hit the nail on the head with regards the problem that has manifested itself over the last 10 to 20 years. You have hospitals that are putting in all of the investment, then unfortunately not reaping the benefits. So, as I mentioned, a lot of flagship universities, students who come to get educated, they typically leave, go to the large cities or go to the states that they came from.

But in particular, what we advocate And what we believe all hospitals should look at as a sort of. Way of evaluating what their ultimate return on investment is, is to keep score. If you've been supporting a nursing school or a series of nursing schools over the last, you know, 10, 20, 30 years, every nurse leader, um, chief people officer should ask the question of the hundreds of clinical rotations that we have supported.

How many of your students have actually come to work with us And then ultimately have retained with us? Now we have hospital partners that not only ask that question, but keep track of that information themselves so that they have their own scorecard. So there's a search of a self-reporting, And then there's the ultimate search of scorecard.

Again, we wanna be very clear. We do not want hospitals to not support the schools that have supported them over the years. We just ask that hospitals look at additional partnerships so that we leverage to help educate their team members to become nurses knowing that they will retain.

Kathleen Wessel (Host): So retention is a critical component here. Can you touch a little bit more on, on what the implications are here and how your position to.

Tom McNamara: It's a topic that comes up time and time and time again. And so, you know, obviously we, we talked a wee bit about how retention of nurses is really important. A key element of That is making sure that the hospital and ourselves, that we work really, really closely together to ensure that there is transition to practice elements throughout the curriculum that we launch.

One interesting statistic that your members, I'm sure will know quite well that the only attrition or retention issue That is bigger than nursing is that for entry level and frontline workers. It is a difficult job, whether it's a medical assistant, a patient care tech, a cook, security, whatever the, the job function, the turnover rates in those areas are horrendous in almost every hospital that we visit with.

And when you can put a Pathways program, as I mentioned earlier, we know that almost nine in 10 frontline workers want to become nurses, which is wonderful from a societal perspective that there are so many potential great nurses out there. But by working with us. Not only can a hospital have clear line of sight into retaining those critically important frontline workers and entry level healthcare workers, but you build a pathway to not only retain them while they're in the program, but then you get to retain them as they become new, confident, competent nurses.

So you have a six to seven-year, preferably career long insight into a pipeline that starts with a medical assistant that retains with you all the way through their nursing program. They graduate, they commit to work for two to three years afterwards. And then, as I mentioned earlier, if you believe in people, which we do, you have clear line of sight into a career long nurse that has the potential to add huge, huge value to your member institutions.

That's in a nutshell, what we really, really focus in on is making sure that we are aligned with our hospital partners, that we bring the nursing school to them and to their employees, and working really, really closely together. We deliver confident, competent nurses that are vested in their community, that are loyal to their employer because the employer has been loyal to them.

And that over time we build up the local community, we build up the hospital's nursing organization. Ultimately, our goal is to eliminate the nursing shortage.

Kathleen Wessel (Host): That really is a wonderful model That is just so beneficial for the community overall. I really like that. Wonderful advice. When you think about lessons learned or what you can share with listeners that might be looking to realign their nursing staff strategies, what advice could you provide for them?

Tom McNamara: The solution to your nursing shortage, the solution to having a robust pipeline, a multi-year view into your pipeline is look to your own frontline workers. Right? We have surveyed at this point with the partners we work with across the country. We have completed survey after survey. The lowest survey response that we've got for frontline entry level healthcare workers was 78%.

The highest was 94. So somewhere between eight and 10 entry level frontline workers want to become nurses. That is an amazing statistic that when we started surveying employees as part of our business development process, we were somewhat stunned by, until you actually look deeper and you look at the reasons why these wonderful people weren't able to become nurses.

They have to provide for their families. They don't have the money to be able to stop out from work and go to college. They have to maintain benefits. And so what we here at Unitec Learning do is we essentially put a ladder on front of them, a pathway that allows any frontline worker, And we have security guards, we have recruiters, we have cooks, we have medical assistants, patient care techs, CNAs, the entire spectrum of frontline workers.

They are enrolled in our programs. In partnership with our hospital partners, they continue to work. They continue to provide value to the hospital That is supporting them, And so you have line of sight into retention of your frontline workers, And then as they're going through the program and they commit for a period of time after graduation, you have direct line of sight into your nursing pipeline.

So you essentially have a four to five or six year view of your future workforce. That is very, very key as you look ahead to the future where understanding not just the demand for healthcare, which we know is going to increase, but being able to match that with the critical, critical supply of future nurses.

And so my advice is the answer to the problem actually rests within the community that you serve. We bring the nursing school to your employees and with you, the hospital as the key, the hero in all of this. Being able to provide the critical elements of the program working with us, we're able to grow nurses from within your organization.

And so if you're looking to rebuild culture after the difficulties And the challenges of the pandemic and you're looking to elevate the community that you serve, we all know the benefits of of having a healthcare team that reflects the community that it serves. If you fundamentally believe in that, the answer to the problem is working with partners like us.

To put a pathway in front of your frontline workers. They all want to be nurses. They just haven't been able to find a program that will work for them. And if you can help put that pathway on front of them, if you believe in people, which we absolutely do, then the solution to the problem rests within the four walls of your hospital.

Kathleen Wessel (Host): I love that because just the loyalty That is bred by really focusing on your own staff and providing the real clear demonstration to all your workers that you know, you believe in your workforce base. You are committed, you are investing, you are kind of doing all of the right things that they need to see.

Breeds commitment, I. Tom, I wanna thank you so much for joining me on this podcast today and sharing your takeaways with a HA members. For listeners, if you'd like to learn more about unitech Learning And the a HA Associate Program, please visit us@sponsor.aha.org. This has been an A HA Associates Bringing Value Podcast, brought to you by the American Hospital Association.

Thanks for listening.