Maryland Goes Back to Basics to Prepare Students for Nursing Careers
From 1993 through 1997, Maryland Project L.I.N.C. (previously, Project L.I.N.C.) enrolled 75 students in the program. More than 50 percent of these participants were minorities.
Project L.I.N.C. was a national career advancement program that provided financial resources and support services to qualified low income and minority, entry- and mid-level hospital and nursing home employees to help them advance into licensed practical nurse (L.P.N.) and registered nurse (R.N.) positions.
The project was part of the Robert Wood Johnson Foundation (RWJF) Ladders in Nursing Careers Program national program.
- Project L.I.N.C. developed a pre-L.I.N.C. remedial program, which provided basic education in math, reading, and English to students entering a nursing or allied health program.
- Maryland L.I.N.C. partnered with the Maryland Hospital Skills Enhancement Program, which provided students with the lowest test scores with a more intensive basic skills curriculum.
- Maryland L.I.N.C. worked with Essex Community College to establish adult literacy programs within hospitals.
- Maryland L.I.N.C. also enrolled students in allied health programs based on the employment needs of hospitals in the state.
RWJF provided $542,482 in funding from February 1993 to August 1997 to support the project.
Nursing and allied health vacancies created staffing challenges for Maryland hospitals. In 1991, the statewide R.N. vacancy rate was 7.1 percent, meaning that more than 900 full-time nursing positions were unfilled. Physical therapists, respiratory therapists, and radiology technicians were also in short supply. State regulatory changes that required a master's degree for physical therapists and certification for respiratory therapists and radiology technicians exacerbated the problem.
Maryland has also had difficulty recruiting minorities into nursing and allied health positions. In 1993, African Americans made up 23 percent of Maryland's population but represented less than 7 percent of the state's health care professionals. Instead, they were overrepresented within the lowest paying positions in hospitals.
These shortages were partly the result of the poor performance of a number of Maryland's urban public school systems: in 1997 the state took over their control. This poor performance left many of the state's high schools students minority students in particular without the skills and grades to enter nursing programs. Because the state has so few college nursing programs, competition for slots was keen, only adding to the problem.
Maryland Project L.I.N.C. was housed in the Maryland Hospital Association (MHA) under its Center for Nursing and Allied Health Careers. (In 1997, in response to changing member needs, MHA closed the center.)
Maryland L.I.N.C.'s objectives for its program were to:
- Implement the project statewide with all MHA member institutions eligible to participate.
- Enroll a minimum of 100 students in the program over three years.
Maryland was able to achieve the former (although western hospitals opted not to participate because they had their own initiative) but not the latter. Failure to meet enrollment requirements was largely the result of inadequacies in public school systems in the state, resulting in significant remedial needs among high school graduates employed in Maryland's health care institutions.
More than 50 percent of Maryland Project L.I.N.C. applicants were unable to score at or above the 40th percentile on the NLN exam and therefore were ineligible for the program. To open up the L.I.N.C. pipeline, Maryland L.I.N.C. developed a pre-L.I.N.C. remedial program, which provided basic education in math, reading, and English, emphasizing skills the students needed to build prior to entering a nursing or allied health program.
To provide remediation for applicants who scored at the lowest levels, Maryland L.I.N.C. partnered with the Maryland Hospital Skills Enhancement Program (a program jointly administered by the MHA and local colleges and other education providers), which provided students with a lengthier and more intensive basic skills curriculum. In this way, Maryland L.I.N.C. built a bridge for students from basic skills enhancement to professional development and career enhancement. Educational institutions in the state have adopted Maryland Project L.I.N.C.'s remedial efforts as a model for developmental learning courses offered to students during the summer prior to their entry into college.
Maryland L.I.N.C. also worked with Essex Community College and MHA member hospitals as part of a grant program funded by the US Departments of Education and Labor to establish adult literacy programs within hospitals. This partnership created another pipeline for Project L.I.N.C. Several students completed their GED through these programs and were subsequently accepted into Project L.I.N.C.
Maryland Project L.I.N.C. was able to enroll only 75 students in the program during the grant period. By October 1997, 35 students had graduated, and 40 remained in professional nursing and allied health educational programs. More than 50 percent of these participants were minorities.
Hospitals from all regions in the state except western Maryland, which had developed its own career advancement program were involved in the program. During the course of the program, however, hospitals became increasingly reluctant to sponsor Project L.I.N.C. students. To understand why, Maryland Project L.I.N.C. convened a focus group of hospital human resource and nurse executives in 1995, and simultaneously conducted a survey among all MHA member hospitals.
The findings showed that hospitals wanted training in non-degree programs for nursing assistants and surgical technologists; classes in supervision, management, and delegation for nurses and other professionals; and training for multi-functional workers. The design of the national program and funding guidelines, however, did not include these types of non-degree educational programs. Nevertheless, Maryland Project L.I.N.C. wanted to accommodate such students. Because of the limited number of programs in some allied health areas and lengthy waiting lists for entry at others, Maryland L.I.N.C. reached across the Maryland state boundaries to identify allied health programs for students in contiguous states. Some Maryland L.I.N.C. students attended schools in Delaware, Virginia, and Washington, D.C.
In response to Maryland L.I.N.C.'s effort to obtain additional funding for participating students, the Maryland Health Services Review Commission (the body that regulates hospital costs in the state) provided an $800,000 grant to the program to cover student tuition and related educational expenses. In addition, Maryland L.I.N.C. collaborated with the United Way, allowing individuals to designate that donations be used for Project L.I.N.C. activities. Maryland L.I.N.C. also successfully recruited students under a fee-for-service model that required participating health care organizations to contribute $2,300 per participant per academic year.
Maryland Project L.I.N.C. published a brochure, an informational paper for applicants, two orientation manuals, a liaison information packet for schools, and a newsletter. It also issued an annual student directory and published a Special Report. See the Bibliography for details.
AFTER THE GRANT
Using monies from the Maryland Health Services Cost Review Commission and fees paid by participating hospitals, Maryland L.I.N.C. planned to support the 40 students remaining in nursing and allied health programs through graduation in June 1998. MHA rearranged the financial obligation of the health care facilities supporting students. The facilities paid MHA for technical support and assistance on a fee-for-service basis, which they did not do during national L.I.N.C. Project L.I.N.C. is continuing to work with MHA member hospitals on workplace literacy programs, seeking additional funding sources for these initiatives.
MHA may use the Project L.I.N.C. model to address specific training needs in the future, focusing on one discipline at a time (e.g., surgical technicians, nurse practitioners, physician assistants).
GRANT DETAILS & CONTACT INFORMATION
Maryland Project L.I.N.C.
Maryland Hospital Education and Research Foundation (Lutherville, MD)
Dates: February 1993 to January 1994
Dates: February 1994 to August 1997
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Books and Reports
Project L.I.N.C. Special Report. Lutherville, Md.: The Association of Maryland Hospitals & Health Systems, October 1996.
Project L.I.N.C. in Maryland Student Directory. Lutherville, Md.: The Association of Maryland Hospitals & Health Systems, 1993 (revised 1994, 1995, 1996, 1997).
Survey of Maryland Hospital Association Member Hospitals on Personnel Training Needs, 1995.
Focus Group with Human Resource Staff and Nurse Executives on Hospitals Personnel Training Needs, 1995.
Brochures and Fact Sheets
Project L.I.N.C. in Maryland (informational paper for applicants). Lutherville, Md.: The Association of Maryland Hospitals & Health Systems, 1993.
Project L.I.N.C. (brochure). Lutherville, MD: The Association of Maryland Hospitals & Health Systems, 1993.
Project L.I.N.C. Hospital Orientation Manual. Lutherville, Md.: The Association of Maryland Hospitals & Health Systems, 1993 (revised 1994, 1995).
Project L.I.N.C. Student Orientation Manual. Lutherville, Md.: The Association of Maryland Hospitals & Health Systems, 1994 (revised 1995, 1996, 1997).
Project L.I.N.C. School Liaison Information Packet (a collection of materials describing all aspects of Project L.I.N.C.). Lutherville, Md.: The Association of Maryland Hospitals & Health Systems, 1994, 1995.
Project L.I.N.C. Bulletin Board (newsletter). Lutherville, Md.: The Association of Maryland Hospitals & Health Systems, JanuaryFebruary 1995, OctoberNovember 1995, Spring 1996, Fall 1996.
Report prepared by: Karin Gillespie
Reviewed by: Patricia Patrizi
Reviewed by: Molly McKaughan
Original Program Officer: Polly M. Seitz
Current Program Officer: Rosemary Gibson