Facing the Highest Shortage of Registered Nurses in the United States, Georgia Establishes a Nursing Careers Program
From 1993 through mid-1997, Georgia Ladders in Nursing Careers (L.I.N.C.) enrolled 146 students from 48 institutions, with minority participation close to 50 percent.
L.I.N.C., a national program of the Robert Wood Johnson Foundation (RWJF), provided financial and other resources to low-income and minority, entry- and mid-level hospital and nursing home employees to help them become licensed practical nurse (L.P.N.) and registered nurse (R.N.) positions.
Under the program, Georgia L.I.N.C.:
- Standardized the requirements for entry into R.N. programs.
- Standardized the educational path for R.N.s seeking a B.S.N. or other further professional nursing education.
- Provided an avenue for welfare recipients to obtain education and employment.
- Recruited individuals for advanced practice nursing programs (e.g., nurse practitioners, nurse midwives, nurse anesthetists) to increase the number of nurse practitioners in the state practicing in rural and medically underserved areas.
RWJF provided $544,807 in funding from February 1993 to June 1997 to support the project.
Despite efforts by the Georgia Hospital Association in collaboration with other agencies and organizations to support hospitals' recruitment and retention programs, Georgia had high vacancy rates for nurses. From 1986 through 1990, the R.N. vacancy rate in Georgia was significantly higher than the national rate. For example, in 1990, Georgia's R.N. vacancy rate stood at almost 16 percent, while the national average was 11 percent. The state's largest hospitals experienced the greatest difficulties in filling R.N. positions; their vacancy rate averaged nearly 22 percent.
Licensed practical nurses (L.P.N.s) were also in short supply in the state. Georgia reported approximately 470 L.P.N. vacancies statewide in 1991. In a state where L.P.N.s are used by hospitals to a greater extent than in other states, this deficit was keenly felt. Moreover, in a 1989 survey of working L.P.N.s in Georgia, 90 percent reported that they wanted to return to school for an advanced degree but faced barriers such as lack of money, time, family support, employer support, and child care. The state needed support services to facilitate the upward mobility of L.P.N.s to R.N. status.
Georgia's vacancy rates for other allied health professions such as physical and occupational therapists also were higher than the national rates. For example, Georgia's vacancy rate for occupational therapists was 18 percent in 1989 while the US average was just under 14 percent.
At the same time, US Census Bureau report ranked Georgia 11th among the states in growth of the 65 and older population. Because of the growing number of elderly who are more likely to require care for chronic health conditions and a significant AIDS population, the insufficient numbers of nurses and other health care professionals were a concern.
The issue of minority representation in the health care professions was also directly relevant to Georgia. According to the 1992 Georgia County Guide, the state's citizen population was 6.6 million, 27 percent of whom were African American. Approximate figures from the Georgia Board of Nursing in 1991 estimated the state's working R.N. population at 40,000, with only 9.7 percent African American. High attrition rates in nursing schools among minorities resulted in fewer minority professionals who could serve as role models and mentors for professional students. This, in turn, perpetuated racial and cultural inequities and contributed to a lack of racial and cultural identification between clients and caregivers. With its shortage of nursing personnel overall and a shortage of minority nurses, Georgia was a doubly appropriate choice for a L.I.N.C. site.
Georgia Project L.I.N.C. was housed in the Georgia Hospital Research and Education Foundation of the Georgia Hospital Association. Project staff worked in partnership with the state Board of Nursing, the Georgia Board of Regents, the Georgia Student Finance Commission, 30 of the state's nursing schools, and the Georgia Division of Public Health. Georgia L.I.N.C.'s objectives were to:
- Establish a career ladder program for disadvantaged (low-income, minority, and/or rural) individuals in the state.
- Provide a workable strategy to meet immediate and long-term hospital personnel needs.
Three key strategies that made it possible for Georgia L.I.N.C. to meet these objectives were:
- Creation of a broad-based steering committee composed of individuals from hospitals, nursing schools, the board of nursing, public health, the Georgia State University System, professional nursing organizations, minority groups, and state agencies.
- Development of a deep network of participating health care organizations and schools of nursing. Eventually Georgia L.I.N.C. opened the program up to every hospital in the state increasing the pool of potential student applicants and worked with 30 schools of nursing.
- Partnership with the Georgia Student Finance Commission to assure a steady stream of educational dollars for participants. The Commission provided nearly $730,000 in funding over four years (199498) in the form of service-cancelable loans of $2,500 per student per year.
Georgia L.I.N.C. exceeded student enrollment requirements of 100 students during the program's lifetime. It enrolled 146 students from 48 institutions in the program with minority participation close to 50 percent. Georgia L.I.N.C. also shaped the program to fit the changing health care environment. As demand for advanced practice nurses increased in response to changes in the state's Medicaid program, and the state Department of Public Health took on the role of primary care provider for the Medicaid program, Project L.I.N.C. increased its recruitment efforts with this population. As nurse vacancy rates dropped, Project L.I.N.C. focused on recruiting students for allied health professions for which there was a shortage, as well as advanced practice nurses to practice in medically underserved rural areas. As the geographic distribution of L.I.N.C. students throughout the state shifted, Project L.I.N.C. redistributed educational counselors accordingly and used conference calls and group lunch meetings to keep in touch.
Georgia L.I.N.C. also played an active role in the state's effort to establish a nursing articulation model. Such a model allows student to transition smoothly from Registered Nurse (R.N.) status to the B.S.N. (Bachelor's of Science in Nursing) level and from there to the M.S.N. (Master's of Science in Nursing) level. Previously, students faced significant hurdles transferring credits among programs and institutions. Georgia L.I.N.C. co-sponsored a conference with the Georgia Nursing Association, Georgia Organization of Nurse Executives, Georgia Board of Nursing, and the Georgia R.N.-B.S.N. Articulation Committee to help explore and resolve this issue.
Project L.I.N.C. produced a brochure, a newsletter and a video. It held a conference, "Windows of Opportunity for Nursing: Education, Practice, and Regulation," during its implementation grant, and published an article, "Eliminating Educational Barriers: Project L.I.N.C.," in Georgia Nursing.
AFTER THE GRANT
Georgia has institutionalized Project L.I.N.C. The educational counselor role was taken on by counselors within the Minority Advisory Program (MAP) within educational institutions in the state's University System. The program planned to continue to support 40 enrolled students through graduation with $2,500 in funding per year from the Georgia Student Finance Commission and the Georgia Hospital Association Scholarship Fund. L.I.N.C. students will be able to repay loans through service to the students' employers. Future applicants to Project L.I.N.C. will be reviewed on a case-by-case basis, with admission to the program based on the individual's financial needs and the participating health care organization's human resource needs and ability to sponsor the applicant. Georgia L.I.N.C. also planned to:
- Continue to solicit funding from local and state sources and maintain the partnerships it has built with nursing service, education, and professional organizations throughout the state.
- Work closely with the Georgia Healthcare Personnel Planning Commission to assure that there are adequate numbers of health care personnel in the state.
- Continue its collaboration with the Georgia Organization of Nurse Executives to develop a nurse leadership training program for L.I.N.C. graduates.
- Work with the state Department of Public Health on a project to develop minority nurse leaders in public health.
GRANT DETAILS & CONTACT INFORMATION
Georgia Project L.I.N.C.
Georgia Hospital Association Research and Education Foundation (Marietta, GA)
Dates: February 1993 to December 1993
Dates: January 1994 to June 1997
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Newsome GG. "Eliminating Educational Barriers: Project L.I.N.C.," Georgia Nursing, 54(July/August): 20, 1994.
Brochures and Fact Sheets
Project L.I.N.C. brochure, "Georgia L.I.N.C.: Ladders in Nursing Careers," 1994.
Project L.I.N.C. newsletter, "Georgia L.I.N.C. Newsletter," 1996.
"Windows of Opportunity for Nursing: Education, Practice, and Regulation."
Audio-Visuals and Computer Software
Project L.I.N.C. video, "Georgia L.I.N.C. Project," 1997.
Report prepared by: Karin Gillespie
Reviewed by: Patricia Patrizi
Reviewed by: Molly McKaughan
Original Program Officer: Polly M. Seitz
Current Program Officer: Rosemary Gibson