How UVA Health is Helping to Build a Nursing Workforce

00:00:00:28 - 00:00:34:07
Tom Haederle
Making connections between the Charlottesville community and University of Virginia Health was a priority as the health system explored how to recruit and retain its nursing workforce. So UVA Health quickly engaged schools, youth organizations and other community groups to provide opportunities for entry into their programs.

00:00:34:09 - 00:01:03:24
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. In today's episode, Elisa Arespacochaga, AHA's vice president of Clinical Affairs and Workforce, sits down with Wendy Horton, chief executive officer, University of Virginia Health; and Beth Mehring, program manager of Earn While You Learn, University of Virginia Health; to discuss their approach to building and sustaining a nursing workforce for the future.

00:01:03:27 - 00:01:23:20
Elisa Arespacochaga
Hi, I'm Elisa Arespacochaga and today I'm really pleased to be joined by Wendy Horton, chief executive officer, and Beth Mehring, program Manager for Earn While You Learn at the University of Virginia Health. Today we're going to talk about the evolution of their work to really build the health care workforce for the future. So to get us started, Wendy, I'm going to start with you.

00:01:23:22 - 00:01:27:12
Elisa Arespacochaga
Can you just tell me a little bit about yourself and your organization?

00:01:27:15 - 00:01:44:03
Wendy Horton
Sure. I'm Wendy Horton. I'm the CEO of the UVA Medical Center here in Charlottesville, Virginia. We're about a 700 bed academic medical center, really busy every single day in and out. And I've been here just three years, right at the beginning of the pandemic.

00:01:44:05 - 00:01:48:06
Elisa Arespacochaga
Wow, What a time to start a new job. And Beth, how about you?

00:01:48:09 - 00:02:07:07
Beth Mehring
So I'm Beth Merhing. I'm the program manager for the Earn What You Learn Program, a program that's just getting ready to celebrate its first year anniversary. I've been employed at UVA for about 37 years as a registered nurse and have been a lifelong resident of the communities. Those things, I think, have been helpful as we work through the evolution of our Earn While

00:02:07:07 - 00:02:08:14
Beth Mehring
You Learn program.

00:02:08:16 - 00:02:28:28
Elisa Arespacochaga
Wonderful. I'm really excited to hear about it. So, Wendy, let me start with you. You started this job at the beginning of the pandemic and can you tell us a little bit about how the coincidence of that, along with the nursing shortage that we knew was coming along, really impacted your organization and was probably one of your first leadership challenges?

00:02:29:01 - 00:02:53:15
Wendy Horton
Absolutely. And I think like most academic medical centers across the nation, you know, we were just plagued really by a lot of staffing shortages. So in the beginning, I remember in COVID, people were working really hard and we were caring for the patients and, you know, we worked really well through that. There were different spikes, different time periods through the pandemic.

00:02:53:18 - 00:03:22:04
Wendy Horton
And then we came out on the other side and, you know, I remember the day where we kind of looked at each other as a senior leadership team. And although COVID patients had subsided, our work force had been quite obliterated. Just, you know, people were exhausted, they were tired, burnt out, some people leaving the profession altogether. But almost more importantly, we also didn't have the support teams that we needed to to help our nurses.

00:03:22:06 - 00:03:38:17
Wendy Horton
And so it was at that moment where we were sitting down really critically thinking about how we were caring for patients in the here and now that, you know, I think all of us across the nation really had to be very creative in how we were staffing.

00:03:38:20 - 00:03:55:02
Elisa Arespacochaga
Absolutely. And Beth, I know you said it's been a year, just about, that you're celebrating for the Earn While You Learn. Can you tell me a little bit about sort of where the program came from and some of the adjustments I know you've already made in just the short year that you've been working on this?

00:03:55:05 - 00:04:22:02
Beth Mehring
Well, one thing's for sure, the program has been an evolution. It has been from a starting point. It's taken a great deal of collaboration between our senior leadership as well as departmental leadership, educational systems, both internal and external. It has been an ongoing assessment of not only our initial needs but reassessing as we do in health care for the ongoing changes within our system so that we can be agile and adapt to those.

00:04:22:05 - 00:04:51:18
Beth Mehring
A couple of examples of the agility we've had to have have included: we've adjusted course sizes to meet demands. We've adjusted our HR process to focus on three hiring times per year to gain efficiencies. And one of the biggest things we've looked at our vacancy rates so that we could set priorities. So for example, our nursing assistant program has been one of our greater priorities. And then trying to use some innovation and how we might work other programs such as our EMT to aid in that area.

00:04:51:24 - 00:04:56:01
Beth Mehring
So it has been an ongoing process since day one.

00:04:56:03 - 00:05:11:00
Elisa Arespacochaga
Absolutely. So, Wendy, tell me a little bit, as the CEO of the organization, how did you sort of start the development of this program? And then, Beth, I'm going to ask you to also chime in on on getting it off the ground.

00:05:11:03 - 00:05:36:18
Wendy Horton
Sure. And I would say every step of the way, it's been a team effort. No one person, you know, it's taken all of us pitching in all the time, then, you know, throughout the different phases of the growing pains and then more of the sustainability. And seeing the one year milestone has really been amazing. You know, living in Charlottesville, it's more of a rural community.

00:05:36:25 - 00:06:03:24
Wendy Horton
And we had the epiphany that we needed to really train our own, to inspire the next generation to go into health care and these were really important tenents. We also came to the conclusion that it would be really important as a large employer to really help our communities and have our employees represent the communities that we serve. So those were some of the foundational principles that we were thinking about.

00:06:03:27 - 00:06:26:24
Wendy Horton
I'm a pharmacist by training. One of the very first programs that we looked at was the pharmacy technician program, where we had individuals coming in off the street and we had them job-shadowing. And then for half the day and more of a didactic program. And I would say that this was one of the foundational programs that really inspired Learn While You Learn.

00:06:26:24 - 00:06:55:21
Wendy Horton
And then we quickly took off and into many other programs, including CNA, medical assistant, phlebotomist, sterile processing. So now we have several different tracks that people are able to go in there on. The other piece that I would just mention is really extending and having a vision towards a pipeline. So we also know that individuals that are able to make it into our institution that have a job, we're able to give them a career.

00:06:55:24 - 00:07:15:25
Wendy Horton
We have a pipelines within these various tracks and then we have tuition reimbursement. And that enables individuals to go on and further their career if they so choose. So we view this as the starting spot, maybe a home for most. And then for those that want to go on in their career, an opportunity for them as well.

00:07:15:27 - 00:07:50:22
Wendy Horton
I would say that we also have seen evolution. As Beth mentioned earlier, the university at UVA has to have also developed a pipelines and pathways program through our HR department and this and ensures that individuals are workforce ready and including helping with transportation and child care, life skills to really have individuals ready. So now we are partnering together the pipelines and pathways is helping us recruit, and our program continues to evolve and just get stronger each and every day.

00:07:50:22 - 00:07:58:14
Wendy Horton
And so grateful for, for all the partnerships, including our HR teams and this Pipelines and Pathways program as well.

00:07:58:16 - 00:08:12:07
Elisa Arespacochaga
Beth, as someone who's coming from this field, a registered nurse with 30 plus years of experience, can you tell me a little bit about sort of your thoughts in terms of developing this program and really getting it off the ground?

00:08:12:09 - 00:08:36:02
Beth Mehring
Well, I think one of the biggest things is we aren't always as aware of the fact as we should be that it takes every role within our institution to to ensure our operations. So there certainly was a learning curve as I was having conversations with laboratory services and pharmacy services. But those communications are essential. Learning that the staffing shortages expanded beyond nursing

00:08:36:02 - 00:08:56:21
Beth Mehring
I mean, obviously that that seems like it should be a no-brainer, but really fully understanding that and understanding how to best represent and meet the needs. I think we're integral. Sort of to build off of what Wendy said. The three components that I think have been essential for this program has been our communication, transparency and building trust.

00:08:56:29 - 00:09:11:19
Beth Mehring
And so not just building trust within the institution that that we're going to do what we say we're going to do, but also within our community. And so I think with with those elements, it has been very helpful keeping that in the center focus as we have built our program.

00:09:11:21 - 00:09:26:21
Elisa Arespacochaga
And Beth let me expand on that a little bit. What are some of the challenges that as you started a year, as you think back now a year? What were some of the challenges to get the program off the ground and to get beyond the pharmacy tech one, which sounds like it was a great way to start?

00:09:26:23 - 00:09:52:05
Beth Mehring
Well, I think that everything has its own set of logistics that you don't always fully anticipate. So as an example, we were finding that not all of our classes were full to capacity because our window for onboarding is fairly short. So we had to very quickly adjust our target numbers for how many we were going to make offers to by about 20 to 25% to try to hit those target numbers.

00:09:52:07 - 00:10:20:23
Beth Mehring
Additionally, we found that we have administrative managers who oversee those various programs, and with each of those programs, there's a different set of recruiters. And so any time you have different managers and different recruiters, you can have variability in process. So just this with the June hires that we have, we are streamlining our HR efforts with a single team. So that the the process is ongoing on how we can refine and better serve and ensure the long term sustainability of the program.

00:10:20:25 - 00:10:41:20
Elisa Arespacochaga
Wonderful. And Wendy, as you look at this now, you've got a year under your belt. What are you thinking about to sustain it, to keep going, to be able to, you know, come back and say, now we've got ten, 15 years of this work being done. And it is the way UVA makes sure that we have a workforce for the future.

00:10:41:22 - 00:11:07:23
Wendy Horton
Yeah, I think it's a great question. I think we're embarking on some of those early sustainability efforts, I think of how do you hardwire? I think as as we had touched on a little bit, this Pipelines and Pathways program is really important. We want to make sure that every individual coming in to the Earn While You Learn program is workforce ready and to really have those wraparound services and the support that they need.

00:11:07:29 - 00:11:30:10
Wendy Horton
We envision that this was really, really important. We learned this early on that there are really talented individuals in our community that may need additional help and support. For example, refugees that are coming in that may need support, English as a second language. And so we've been trying and piloting some programs for English as a second language class.

00:11:30:18 - 00:11:56:10
Wendy Horton
And how do we think about kind of our community, the individuals within our community, and how can we help each and every person be successful? So those are some of the things that come to mind that we're continuing to think about. How do people have the resources? Do they need a laptop or an iPad? Do they need more child care support and really to make this sustainable?

00:11:56:12 - 00:12:18:05
Wendy Horton
I also see so many people now that the program's been in place a year, to see them working on the floors and our clinics and on the inpatient unit, they have a career for the very first time. And I think that word of mouth is really getting out into our community. It's a new day in that regard and so exciting to see.

00:12:18:08 - 00:12:52:06
Wendy Horton
And then as they're here, they're motivated, inspired to continue on in their career. And it's just been so wonderful to see. So now we're thinking about moving from certificate programs to what that may look like for second year - two  year degree programs, associate degree programs and other roles that may be advanced. Beth is working on a project for nursing and our community college right now, and so we're continuously looking to see how we may be able to expand the program moving forward.

00:12:52:08 - 00:13:07:25
Elisa Arespacochaga
I love that idea. I mean, health care really is a calling for those who enter it. But to be able to give that opportunity to many more people by really showing them the path and helping them along the way, because not everyone has all of the opportunities to do that.

00:13:07:27 - 00:13:32:29
Wendy Horton
What else has been really, really amazing is, you know, I think there's so many roles in health care that as we grow up, you know, we may know about a physician or a nurse, but there's there's so many really, really fun and exciting roles that, you know, thinking about high school and middle school and individuals in our community that they just may not know that are real options.

00:13:33:01 - 00:13:43:00
Wendy Horton
And so we're trying to just expand options for people and to expose them and to inspire them for real important careers in health care.

00:13:43:03 - 00:14:03:19
Elisa Arespacochaga
Oh, absolutely. I've actually just heard of a new position that I had not seen before, which was a technology technologist. So someone who helps troubleshoot new technologies on the floor with the nursing and the care team, that's that's at the patient bedside. So I think there's always new roles that are going to evolve in health care.

00:14:03:21 - 00:14:26:16
Beth Mehring
And if I could just add maybe one little thing to that. We have been surprised at how many within the community have reached out to us. So from day one, we were getting, again, individuals to have resettled in our communities, but also our local high schools, the Boys and Girls Club. So people are really seeing this as an opportunity to help build the futures of a lot of the young people.

00:14:26:21 - 00:14:41:03
Beth Mehring
And that's exactly we talk about the pipeline. The pipeline starts before these young people even get out of there, their high schools. Let's help with their planning. Let's extend the opportunity to their families. And that's pretty much been our experience.

00:14:41:05 - 00:14:57:08
Elisa Arespacochaga
Right. Beth, let me ask you to close this out. What advice would you give to others who are saying, you know, we need to do something like this, obviously our own version, but you have a couple of words of advice that you'd share with someone who's thinking about a similar program.

00:14:57:10 - 00:15:22:10
Beth Mehring
So I think that one of the most rewarding things has been individuals from our community who have said, I've always wanted to be in health care, but I didn't know how to start. I didn't know where to enter the program. And so with that as a motivation, it's most important. And I would add that you've got to be patient, flexible and agile, because as we've mentioned multiple times, this program has been a constant state of evolution.

00:15:22:12 - 00:15:42:28
Beth Mehring
They're looking for career opportunities and career progression. So that's essential. I would say to start a step at a time, not to look at the whole project and not wait until you have all of the planning in place. But just start with a program. And most importantly, I would say don't let perfect be the enemy of good. You know, there are times that we've just stepped forward.

00:15:42:28 - 00:16:02:00
Beth Mehring
We knew that it wasn't the perfect plan, but that we were going to learn from it. And with good communication and transparency and trust, we've been able to have all of our team. We've been very pleased with how open and receptive all of the team members have been to this effort. So I think that has been a big help.

00:16:02:03 - 00:16:10:18
Elisa Arespacochaga
Wonderful. Well Wendy, Beth, thank you so much for your time today for sharing your program and best of luck with continuing it forward.