Recruiting, Training More Health Care Workers

[LESH]

Tuesday, August 17, 2010

Recruiting, Training More Health Care Workers

 

by David Gorn

 

There is a dearth of health care providers in California, and the demand for more highly skilled health workers will only increase when national health care reform goes into effect. That's the word from Tom Riley, legislative advocate for the California Academy of Family Physicians, speaking at a Senate Health Committee hearing last week.

"We think the time has come for this to be front and center in the health care debate, the workforce issue," Riley said. "This is a terribly important thing for us to be addressing."

The proposed law, AB 2551 by Assembly member Ed Hernandez (D-West Covina), would establish the Health Workforce Development Council, a task force charged with tackling how to recruit and train a new segment of the health care workforce.

To make this year's legislative deadline at the end of August, it will need to move quickly. The Senate Health Committee passed it and sent it to the appropriations committee. If it can pass appropriations, it will need a two-thirds vote on the Senate floor, because it's an urgency measure -- meaning that if the Legislature approves it and the governor signs it, it would become law immediately.

According to bill author Hernandez, it couldn't happen soon enough. As a physician himself, Hernandez said he has seen the world of medicine change rapidly, and he'd like the state to keep up.

"California has not been able to respond to these changes," Hernandez said, "and we are ill-equipped to handle the new pressures on the health care system."

The governor vetoed a similar bill at the end of the last legislative session. "But that was obviously before the national health care reform act passed," Hernandez said. The difference now, he said, is that federal funds are available to start on health care workplace projects. That's why Hernandez listed it as an urgent item.

"Now there will be federal dollars available in regard to workforce," he said. "With passage of federal health care reform, the need for a coordinated health workforce development plan is essential to the success of overall health care reform in the state."

 

 

 

Read more: Recruiting, Training More Health Care Workers - Capitol Desk - California Healthline

[dharmaPA]

HI LESH,

It would be great if CA legislators really got how PAs could fill a big gap in CA medical care.

This is what I read on AB 2551:

_____________________

STATE OF CALIFORNIA

CALIFORNIA COMMUNITY COLLEGES CHANCELLOR’S OFFICE

1102 Q STREET | SACRAMENTO, CA | 95811-6549 | (916) 445-4434 | http://HTTP://WWW.CCCCO.EDU

AB 2551 (Hernandez) Pharmacy Technicians: Scholarship and Loan Repayment Program

Analysis/Summary: This bill would establish the California Pharmacy Technician Scholarship and Loan Repayment Program, to be administered by the Health Professions Education Foundation. This program is designed to pay for educational expenses of Pharmacy Technician (PT) students and to repay qualifying educational loans of PTs who agree to serve in areas of the state where unmet priority needs exist. PTs are the second largest field within Allied Health and there is no comprehensive statewide

public or private financial aid program to meet the needs of PTs. PT programs require an AA degree in pharmacy technology, completion of a 240-hour training course accredited by the American Society of Health-System Pharmacists, or graduation from a school of pharmacy accredited by the American Council on Pharmaceutical Education. Registration or tuition fees, and lab costs range from $1,664 at community colleges and $23,306 at a career or vocational colleges.

Location: This bill was placed on the Assembly Appropriations Committee’s suspense file.

[Timon]

I would love to chime in on this discussion and ask a question.

 

I found it near impossible to gain employment as a new graduate without experience. Especially in the Inland Empire. For example, I went to UCI Medical Center and got my CPT1 license (ASCP) and coudln't even get an interview to any hospital or lab. My feedback was because I didn't have experience and didn't care about the 350 venipunctures completed in my clinical training.

 

Next I got a license as an EKG Technician, same story...

It wasn't until I got my EMT license and got some help from people I've met over the years that I finally got my big break into a hospital.

 

The interesting thing is that I know a number of people who are in the same position with other certifications such as ultrasound, RN, CNA, LVN, RT and other technical degrees.

 

I'm not sure if the big problem is that vocational schools are pumping out certifications but no one wants to hire someone without experience because they do not trust the quality of instruction despite taking national exams? And let's face it, it's difficult to get into a traditional school when classes have either had their sizes reduced, limited acceptance, or just are not even accepting students period.

 

I really would value your input regarding this practice of not hiring new grads. I see a slipperly slope forming in California as a recent PA School applicant I've noticed a number of schools are raising the bar now requiring paid hands on clinical work which is near impossible to achieve (at least in Southern California) due to this practice.

[Seijou]

Timon - I wrote a long response to your post but lost it with a page refresh and so I'll just summarize it...

 

You are not alone in thinking this, but it's reflective of the job market and the economy. The experience working in a clinical or hospital setting is extremely valuable, more so than you may think. The cost of training a new hire can be tremendous to the hospital (just ask any new hire RNs). So you have to consider these things - regardless of how many certifications you have, you have not proved that you can work with people on a day-to-day basis in a clinical environment while others who have the credentials with experience have.

 

Certifications are just certifications - they do not mean you will find a job nor do they mean that you deserve a job. I know EMT-Bs who have been working 5 years and still aren't fully confident in what they do. And I know that what you learn in a classroom setting (to pass the national registry) is just a glimpse of what you will actually need to know to be able to perform your job. These skills are generally learned and perfected in the real world.

 

I kept getting turned away by hospitals and ambulance companies regardless of being a competitive academic candidate and always having high marks in everything I did in a previous life. I was persistent and got my foot in the door where I could, and now I'm working to prove to them that I deserve to be here.

 

It's a lot easier in other places of the country... Some people can land surgical tech or OR tech jobs even without certifications or with limited experience. Depending on how saturated the market is (we pump out lots of certifications every few months here... like clockwork) and the demand for the skills, it may predetermine how difficult it may be for you to get a job.

 

Just keep trying.

[Timon]

Hi Seijou,

 

Thank you so much for your response and insight as well as your words of encouragement. I am currently working as a ER Tech but that was because I called some family members who were physicians that setup opportunities to interview directly within their hospital. Once interviewed I had no problems reassuring the hiring manager of my capabilities and understanding of healthcare being that I had close to 500 hours of shadowing, was a CPR instructor for 3 years, and had all my science pre-req's completed along with my alphabet certifications.

 

Yes I understand that training does cost money, but in reality we're talking about the lowest levels of healthcare providers being EMT, phlebotomist, and 12 lead technician gaining experience for more advanced roles such as RN, PA, MD/DO etc... The only new items that are really being trained are administrative tasks/duties and the hospitals internal operation system. Anything outside of that will be beyond the scope of practice within that field. My ER Tech new hire training consisted of shadowing / working along side another ER tech for 5 shifts. This would have been the same regardless if I had been a previous ER Tech for 5 years at another hospital or a new grad from what I was told during my hiring.

 

The notion that people in these fields need x many years of experience reflects on the hiring managers lack of knowledge or lack of confidence of national licensure exams such as the NREMT, ASCP, and NCCT. As someone that has recently taken these exams and observed people who have been in these roles for 10+ years I can say that most of them were completely out of date on their training and were performing practices that had an adverse effect on tests results and techniques that could harm the patient.

 

During my phlebotomy training I shadowed a phlebotomist doing rounds on inpatients and observed her probing at a deep angle for the basilic vein which is right next to a nerve and the patient began to yelp in pain. I observed another phlebotomist not using aseptic techniques for blood culture samples in addition to not doing 3 way patient identification checks on any of her patients. There was another situation where a different phlebotomist saw a grieving family outside and asked them to let her pass into their family relatives room. After she placed a tourniquet on the patient and performed a venipuncture she noticed no blood was coming into the evacuated tube. Later she found out the patient had expired hours ago and that the test was never removed from her sheet.

 

When I did my ride-along for EMT-B I observed the IFT EMTs not performing a full primary and secondary assessment. The EMTs only performed BP's / pulses on this one patient and neglected the other vital signs as well has not taking a medical history. I asked the patient if they had diabetes after I noticed they were having kussmaul repirations I reported this along with a full set of vitals to one of the EMT's and we ended up having to make a visit to the ER and was later thanked for taking a complete primary and secondary assessment. They had been in the field 3-5+ years.

 

I guess the underlying question is these careers are gateway careers and should have a high turnover just in the general nature of the position. I belive anyone that is in healthcare should want career progression. IMO EMT-B's should become paramedics, firemen or advance in another healthcare career. Phlebotomist should become CLS or move into more advanced roles such as nursing. When I was in my EMT class it was explained to me that because of the NREMT and the fact a lot of people couldn't pass it that there was going to be a crisis for not having enough EMS personnel. It's a double edged sword really.. there's a whole bunch of new grads looking for work, no one wants to hire a new grad yet there isn't enough people staffed in healthcare and a lot of people who have been in the field need to undergo training as if they were a new grad.

 

In my current position I was offered fulltime employment and was told I would work a minimum of 36 hours a week. I asked what if I wanted to work 4 or 5 shifts in a week to which they replied a lot of us do that especially for the overtime. From a hospital perspective, why do I want to pay someone 1.5x or double time when I can hire additional personnel and avoid that situation? There are many ways of beating the additional costs through offering part-time, on-call, or per diem positions (which I would have happily accepted).

 

The economics should never justify paying an individual overtime apart of a pre-planned schedule because of the cost of training a new hire low level provider. I would understand if it was a specialty field that wasn't saturated with people that had that credential, we're talking about EMT-Basic and Phlebotomy.

 

The end result is that regardless if you're a new grad or have been in the field for 10+ years, training must be constant and you're always going to have people who are good and bad. The idea that a person must have X years experience as a safety net for hiring managers to hiring "qualified personnel" is a poor excuse based on my direct observations of those who have been in the field for a number of years.

[Seijou]

 

The end result is that regardless if you're a new grad or have been in the field for 10+ years, training must be constant and you're always going to have people who are good and bad.

 

If you understand this than I think you should understand my perspective.

 

 

I wanted to touch on some of the things you said. I fully understand that the way you feel is reflective of the experiences you've had; the way I feel is also reflective of the experience that I've had.

 

 

I had a "What does it take to get a dang phone call back?" kind of attitude for a while. But I've realize that I don't deserve a job just for getting my certification and showing up to the interview. I had successful interviews with private ambulance companies and I felt like I did a great job. I had multiple companies tell me they'd give me a call next week and schedule for a FTO to spend some time with me and never did. I was persistent and kept bugging them and eventually found out that they hired other people instead.

 

What happened there, as I figured out, was that they didn't care for my academic achievement or prior (non-clinical) experiences. I'm a Master's student who also has to work on a thesis and so my schedule was limited to Friday, Saturday & Sundays as well as overnight shifts. They much rather have someone who is available full-time, anytime. A lot of their current employees had my same schedule (because they were going back to school and they also wanted those same shifts).

 

This is reflective of my situation and of my area. I'm not sure why your NREMT pass rates are low, but at my school they're above 85% and very proud of it (and the majority of these students are young and right out of high school). Turnover rate is high, but at the same time we have people here commuting 30 minutes in traffic to get to work because they simply will take anything they can get (check out EMTLIFE.com forums). We also have people waiting upwards of 6 months just to hear back about their applications (this can also be confirmed at EMTLIFE).

 

BLS companies know that the job is relatively simple and it doesn't matter if you hire Mr. Smarty pants or Mr. Average Joe - as long as the job can be done. In fact, one of the interviewers actually said she could teach a monkey to do the job (working on an IFT BLS rig). So there is no benefit to hiring me, even if my compassion towards others and my desire to be a patient advocate goes far beyond their expectations.

 

 

I picked up a job at a local hospital that only required a BLS certification, I've lost scope of practice of my EMT-B. But even in this job I feel an overwhelming sense of responsibility. When you are new at something, you have to get worst before you can get better. Training me took 3 shifts, primiarly because I'm at one of the largest hospitals in the city. But I haven't stopped learning how to do my job better and more efficiently, and I don't expect to.

 

On another note, you might have had some bad experiences during your ambulance ride-a-longs. I had some really great ones that I'd like to share. I was on an ALS rig with 1x Paramedic and 1x EMT for Rural Metro (who runs all of the 911 calls for my area). It was something magical to see that paramedic sitting in the back of a terribly shaky rig, waiting for just the right moment, and inserting a peripheral IV line on the first try. It was an art, to me.

 

Maybe you've run across some really crappy clinicians and I think that it's great that you notice things - remember that and be critical of yourself as a practicing healthcare provider.

 

I think that's more or less what I have to say. I certainly see your point of view, but if I were the hospital and I had to pick between myself (ie. fresh meat) and an experienced candidate... I would pick the safe choice.

 

Regardless of how you feel about the way things are (and it can be terribly frustrating, I know...), try to stay positive in regards to what you do every day. I don't approach my days feeling like things are stupid or wrong anymore, I try to look at what I can do in the role that I'm at to make a positive impact and I think it's definitely been helpful in changing my perspective (because these last few months have been rough on me).

 

Cheers

 

P.S. I personally feel that the EMT role (and what it requires to be 'competent') can very vague.

 

I know EMTs on IFT BLS rigs, EMTs who work on ALS rigs and run emergent calls, and EMT-P who are just freaking good at what they do. But it's very hard for me to compare them, they're on completely different playing fields in my mind and people don't seem to acknowledge that.

 

I certainly feel that your position as an ER Tech is also different, after all, you're practicing under the nurse and you are no longer delivering pre-hospital care. I think the coolest thing I've seen so far from an ER Tech was the application of a split (if you mess up the molding process then you've gotta do it over!)... aside form that they didn't really seem to impress me too much, at least not to the degree of the guys on the ALS rig. Again, just my impression based on the experiences I've had, not meant to offend anyone.

 

Personally, I just like to know when I'm comparing apples and oranges.

[marilynpac]

I would love to chime in on this discussion and ask a question.

 

I found it near impossible to gain employment as a new graduate without experience. Especially in the Inland Empire. For example, I went to UCI Medical Center and got my CPT1 license (ASCP) and coudln't even get an interview to any hospital or lab. My feedback was because I didn't have experience and didn't care about the 350 venipunctures completed in my clinical training.

 

Next I got a license as an EKG Technician, same story...

It wasn't until I got my EMT license and got some help from people I've met over the years that I finally got my big break into a hospital.

 

The interesting thing is that I know a number of people who are in the same position with other certifications such as ultrasound, RN, CNA, LVN, RT and other technical degrees.

 

I'm not sure if the big problem is that vocational schools are pumping out certifications but no one wants to hire someone without experience because they do not trust the quality of instruction despite taking national exams? And let's face it, it's difficult to get into a traditional school when classes have either had their sizes reduced, limited acceptance, or just are not even accepting students period.

 

I really would value your input regarding this practice of not hiring new grads. I see a slipperly slope forming in California as a recent PA School applicant I've noticed a number of schools are raising the bar now requiring paid hands on clinical work which is near impossible to achieve (at least in Southern California) due to this practice.

 

 

Another example of not what you know or what you can do but who you know or who you are............