|
Nobody mentioned research. Surprised? We were not. Ask almost any faculty member what they think about research and, most likely, they will tell you that they barely have time to collect all the data that is required. The thinking here is that data is something that needs to be gathered for somebody else so that researchers can figure out what happened last semester, the previous semester, etc. Research, according to this interpretation, is a tool we use to assess what HAS BEEN: how many students enrolled, how many succeeded, and how well this semester's students performed compared to previous groups. But research-especially when it is directed and implemented through a partnership that includes both faculty and researchers-can be a powerful tool that guides our vision of what COULD BE and helps us make decisions that improve the way we run our programs and thereby the success of our students.
Using Research to Promote Student Success in Health Care Programs
The purpose of this paper is to draw the connection between research and student success and to encourage faculty, administrators and staff to talk about what research might be able to do to for them and their students. The case in point is a series of research projects that were designed to identify promising and replicable practices that health occupations programs have developed to:
- increase student recruitment and retention
- increase diversity in their student populations and the retention of under-represented students
- identify strategies for how rural community college health occupations programs can contribute to the development of a rural health care workforce
Why health care? The first and several subsequent projects were initiated by The California Community College Health Care Initiative, an ED>Net-conceived entity that connects the approximately 250 health care programs at work in California's community colleges with each other and with health care employers and other stakeholders. The Health Care Initiative (HCI) is implemented through eight Regional Health Occupations Resource Centers (RHORC) located across the state.
The HCI felt that the best way to improve student success in health occupations programs was to look around the colleges and find out what is already working. Which programs have in place pre-entry activities and courses that help students build critical thinking, math, time management and other skills needed in demanding health care programs? Which programs have a strong track-record for recruiting and retaining under-represented student populations? And what kind of strategies are working for increasing retention? The HCI asked the Center for Student Success to find examples of such promising practices, to investigate the strategies they have developed, and to document their outcomes.
Established in 2000 as part of the Research & Planning Group of the California Community Colleges, the CSS mission is to conduct research and evaluation that address issues that are high priority across the state's 109 community colleges. CSS does not have a permanent research team, but instead brings together the best possible team for every new project. All CSS researchers and evaluators are either recruited directly from the Research & Planning Group or they are researchers who have worked with or in the community college system in the past.
A specialty area of the CSS is to identify, document, and disseminate promising practices, and to connect practitioners statewide in discussions about what works, why it works, what it costs and who needs to be on board to make it work. CSS's goal is thus to generate research that faculty, administrators and staff can use to make decisions, to learn about what others are doing that works, to replicate promising strategies, and to lobby for additional support and resources inside and outside of their colleges by saying "here is evidence that this strategy works and that it is increasing retention among nursing students in College X ......now help us find the funds to do the same here."
The next section presents three research projects CSS conducted for the Health Care Initiative, the California Wellness Foundation (CWF) and the HCI in partnership with the California State Rural Health Association.
Case Studies
Research Project I: Identifying Promising Practices for Recruiting and Retaining Students in California Community College Health Care Programs
Project Initiator: The California Health Care Initiative (HCI).
Purpose: The HCI wanted to identify, document and disseminate promising practices California community college health care programs have developed to recruit and retain students. The HCI was particularly interested in identifying pre-program courses and activities that providers have developed to increase students' readiness to participate successfully in demanding health care programs.
Approach: The CSS team surveyed all 250 health care programs at work in the California community college system asking program directors for information about their recruitment and retention strategies, and their completion rate. With responses from about half the programs, the CSS team identified programs that indicated they had developed effective strategies for recruitment and retention and that also had high retention rates. The next step was to conduct initial interviews with the program director from each program. Based on the findings from some 28 initial exploratory calls, the CSS team selected 17 programs for in-depth research. For 13 programs, this involved multi-stakeholder phone interviews with faculty, students, and health care partners. The remaining four programs hosted site visits by the CSS research team.
Findings: The CSS team identified, reviewed and documented promising practices in the following areas:
- * Development and delivery of introductory courses
- * Intensive orientations
- * Early outreach and recruitment
- * Support services and supplementary courses
- * Experimentation with prerequisites
- * Collaboration with employers
For example, CSS found that an increasing number of programs are recommending and a few requiring that students enroll in introductory courses prior to entering health occupations programs. The specific purpose of these courses varies depending on whether they are designed to address basic skills deficiencies, to help students develop a realistic sense of what will be required, and/or to help them identify the health care career that is most likely to be a good match for their skills, ability to commit, and personality.
Many introductory courses are continuously updated by motivated faculty members who identify new needs and deficiencies among incoming groups of students. The research team found a general enthusiasm in the field about these courses and many faculty noted that they feel they have contributed to reduce attrition and in some instances improve student achievement in the first semester.
Case Study: An example, and one of the case studies included in CSS's promising practices, is the Los Angeles Harbor College Associate Degree Nursing Program. In order to respond to a high attrition rate, Nursing Director Wendy Hollis explains "we began to conduct exit interviews with students who were leaving the program to understand why they had not succeeded." We found that lack of preparation was one major reason for failure. Another reason was related to students' problems with money and family responsibilities, but it was not quite as simple as that. While some students are able to cope with multiple and conflicting demands in the academic, personal and work-life without much support, others cannot. If students who belong to this latter category don't get the support they need, they tend to give up and fail."
The program used the findings to develop a series of interventions, including several that respond to students' lack of preparation. These include development of courses students can take while they are waiting to get into the nursing program. "Nursing Math" and "Nursing Pharmacology"-both 3-unit courses developed by the nursing faculty-help students develop fundamental skills they will need to be successful in the nursing program. In addition, the program developed three one-unit "Introduction to Nursing" courses. The first of these is required for all students applying to the nursing program and recommended for all those who "lean toward nursing." The course introduces students to the roles and responsibilities of nurses and explains skills they need to complete the program. The other two courses, still not required, cover critical thinking, nursing study skills, communications and test-taking strategies.
Enrollment in all three Introduction to Nursing courses are increasing and the first and required course has already contributed to reduce attrition as it has helped some students screen themselves out before entering the program and others develop the foundation skills and life management skills they need to succeed.
To address the other success inhibitor-unmet need for support-Director Hollis hosts monthly group counseling sessions for students who are interested in entering the program. For those already in the program, she is trying to increase tutoring services.
Three years after Director Hollis and her faculty members launched their campaign to increase student success, the attrition rate has dropped from 40% to 25%. Director Hollis is pleased with this accomplishment, but wants to continue to take action to get the attrition rate down even further.
The research team also found that several programs have worked strategically to offer orientations that contribute to student success and retention. Highly replicable because of their affordability, the case studies that are documented, reviewed, and presented on the CSS web site include Fresno City College's Radiologic Technology Program's orientation which is conducted in the summer two months prior to the start of the program. Students are required to bring along their significant others so their family will understand the impact the student's enrollment in the program will have on them. At the session, students are briefed on what will be expected of them over the next two years.
The orientation also addresses students' financial preparedness and the adjustments they will have to make in their personal lives to succeed in the program. The orientation program includes a session with counselor who answers students' questions. Second-year students come in and address the group about their experiences in the program. The instructors are very honest about the fact that the program will be extremely demanding and that they will not make exceptions for students who cannot meet their standards. Some potential students drop out before classes start as a result of the orientation. These are the students who would have dropped out early in the program and the orientation is helping the college save precious and expensive training space for students who are more likely to complete the demanding program.
Research Project II: Identifying Promising Practices for Increasing Diversity Among Students in California Community College Health Care Programs
Project Initiator: The CSS-based on input from the field where programs are struggling to recruit and retain students from underrepresented groups.
Purpose: The project responds to health care programs' need for strategies they can use to increase success among students from underrepresented groups, a challenge that begins with recruitment and then centers on retention. The project also responds to the health care industry's urgent need to increase the diversity of the existing workforce and to the fact that California's 109 community colleges, with their annual "yield" of a remarkably diverse group of 11,000 health care graduates, are in a key position to increase the supply of job-ready health care workers who come from underrepresented populations. The project is supported by the California Wellness Foundation.
Approach: In this instance, the CSS started out by identifying among the ten health care programs that have the greatest enrollment of students statewide 50-60 programs that achieved significant increases in the diversity of their student population during the past 7-8 years. The criterion used to control for demographic changes in the surrounding community was that the increase in diversity among students in the health care program had to be considerably greater than the increase in the participation of non-majority students college-wide during the period under study. CSS got the data from the State Chancellor's Office. As of this writing, CSS has completed preliminary interviews with representatives from 47 health care programs and the research team is presently identifying candidates for the second and multi-stakeholder round of interviews and site visits. The top candidates are initiatives that appear to have taken deliberate and replicable action to increase their diversity and that have the data to prove the impact of their interventions.
Findings: This is a two-year project and final findings and promising practices will be available in workshops and on the CSS Website in January 2006. Preliminary findings identified the following cluster of promising practices among programs that have achieved increases in diversity:
- assignment of effective and preferably bi-cultural and bi-lingual persons to conduct outreach to underrepresented groups
- initiatives that help non-majority and low-income students get onto the first tier of the health care career ladder (for example, Certified Nursing Assistant (CNA), Home Health Aide)
- initiatives that help non-majority and low-income students get from the first to the next step of the health care career ladder (for example, Certified Nursing Assistant to Licensed Vocational Nurse (LVN) and Psychiatric Technician Assistant to Psychiatric Technician)
- initiatives that provide low-income individuals with the assistance and support they need to go back to school (for example, programs that provide students with opportunities to work part-time in their health care field of choice, but to get paid for a full-time workload)
- distance-learning programs that provide non-majority and low-income individuals from isolated areas of the state with opportunities to participate in training programs
- use of diverse outreach teams and participation of underrepresented students in outreach activities
- diversification of faculty
- outreach that emphasizes the vocational nature of the programs and the fact that with nursing, for example, you can start by enrolling in a CNA program and gradually work your way up to the LVN and Registered Nursing programs
- rules that allow students who have family or other problems to drop out for a semester and then come back
- programs that steer ESL students on health care program waiting lists to strengthen their English before they enter the program
Case Study: As an example, Porterville's LVN and Psych Tech programs decided some years ago to launch a major effort to increase the diversity of their student populations. They wrote a grant proposal and received funding to hire a recruiter who would conduct outreach to underrepresented students. They initially looked for somebody with health care experience, but could not find anybody who fit this description. Instead, they hired a Hispanic man who has a background in recruiting, is bilingual, and very good at making people feel comfortable. Since this person began to conduct outreach and to help prospective students get through the enrollment programs, the number of applicants and the diversity of the student population has continued to increase. From having trouble recruiting 15 students per semester for the Psych Tech program, they now have 70-80 applicants per semester for 45 slots. Similarly, the LVN program had 107 candidates applying for 15 slots during the Fall 04 semester. Further, while students from underrepresented groups comprised only 11% of all LVN and Psych Tech students four years ago, they now represent about 50% of all students.
Research Project III: Identifying Promising Practices that Rural Health Care Providers can use to Recruit and Retain a Diverse Workforce
Project Initiator: The project was commissioned by the California Rural Health Association and the California Community Colleges' Regional Health Occupations Resource Center (RHORC). The project is funded by the California Wellness Foundation.
Purpose: The purpose of this project was to identify effective strategies rural health care providers have developed to recruit and retain health care workers, particularly individuals from underrepresented groups.
Approach: The CSS Research Team facilitated focus groups with rural health care stakeholders in three parts of the state. The Research Team also conducted 30 interviews with rural health care training and service providers. The findings have been compiled in a Promising Practice Resource Guide, a how-to-manual that provides rural health care stakeholders with tangible examples of how their colleagues from around the state have responded to the challenge of recruiting and retaining a health care workforce. The case studies of best practices will be posted on the CSS website in Summer 05 and disseminated statewide through a comprehensive promotional campaign.
Findings: Rural health care providers face tremendous challenges. At a time when health care providers all over the country are out-bidding each other to recruit and retain health care workers, they confront the additional challenge of having to persuade professionals who are in high demand everywhere to move to the countryside and practice for what is probably less money than they can earn in the city. In conducting interviews to assess how rural providers have responded to these challenges, the research team found much innovation. Promising practices included grow-your-own strategies where rural providers support efforts to recruit and prepare local residents for health care jobs. The other strategy is to recruit from outside and the research team identified a wide range of strategies that promote this goal. The team also found that most providers use a combination of the grow-your-own and recruit from outside strategies. Specific strategies used to accelerate the "grow-your-own" include:
- K-12 outreach efforts that increase young residents' awareness of health care career opportunities
- Community outreach and recruitment programs that encourage and provide opportunities for local residents to work in the health care sector
- Popular health care training programs that give local residents an edge in the application process
- Distance learning programs that enable residents who live far away from training institutions to enroll in high demand health care training programs that are delivered locally
- Career ladder programs that enable health care workers to step into or advance on a career path
The Recruit From Outside case studies demonstrate how providers have recruited health care workers from other countries and from other parts of the state or country.
- Working with academic institutions to provide internships, clinical rotations and residencies in rural facilities to train and recruit potential staff
- Working through government programs like the National Health Services Corps to recruit new physicians, nurses, nurse-midwives, physician's assistants, dentists, and dental hygienists, amongst others through government-sponsored scholarship and loan repayment programs
- Recruiting doctors from other countries through the J-1 Visa program, recruiting nurses from other countries via recruitment agencies; and recruiting foreign-trained health care workers through "Welcome Back" centers
- Using perks and benefits, marketing the local environment/quality of life, and improving the practice environment to recruit and retain staff
Case Study: As an example of how community colleges can help local communities and providers grow a local health care industry, Bakersfield Community College recently launched a multi-site RN distance-education program that has enabled 30 individuals from remote, and often lower-income areas to enroll in the college's coveted RN program.
Another grow-your-own example that is based on collaboration between a health care provider and a community college involves the Enloe Medical Center (EMC) in Chico and College of the Siskiyous. The EMC, very interested in "growing" local health care workers, partnered with the College to design and implement a major campaign aimed at "marketing" health care careers to local residents. The two partners jointly participated in career fairs and got the local media on board so that every week there was a new story about opportunities for medical assistants, CNAs, LVNs and other health care workers.
The partners also collaborated on a survey that was designed to determine why locals were not pursuing health care careers in a community plagued by high unemployment rates. The findings suggest that major obstacles include lacking awareness of job opportunities and concern about the cost of health care training programs. To address these barriers, the hospital opened its doors to residents interested in health care careers, providing them with a $7.50/hour incentive to job shadow incumbent health care workers for two days. In addition, EMC partnered with the College to offer a work-study program that is available to students enrolled in college health care programs and to those taking classes required to enter these programs.
When the outreach activities began, the College was struggling to recruit enough students to its CNA and LVN programs. At this time, a few semesters after the recruitment initiative began, applications are way up and the College has remodeled its nursing classroom to accommodate the new and large influx of students.
How to Use the Research to Support Program Improvement and Increase Student Success
So what is a practitioner to do with these findings and case studies? For example, imagine a Radiologic Technology Director (RT Director) who wants to know more about the orientation at Fresno City College (see research project I, case study section) and who would like to learn about other orientation sessions used in health care occupational programs?
This is where the CSS website comes into the picture. On the website, http://css.rpgroup.org, under the health care training tab, the RT Director will be asked to choose what kind of promising practices category he is interested in reviewing. His options will include recruitment, retention, partnerships and rural health care. He will probably choose the recruitment option and can then scroll down to review short introductions to ten different case studies. When he finds the Fresno example and clicks on it, he will find a brief description of all the orientation sessions FCC's health sciences programs offer, a section on why FCC thinks the orientation sessions are effective, and a list of FCC faculty members he can call for more information. One of the people listed here will be an individual who can speak directly to the FCC RT orientation. Before the CSS listed this person as a contact, we asked him if he would be willing to serve as liaison to the project and talk to colleagues interested in replicating the orientation practice. Each of the 27 best-practice projects featured on the website has such a contact person-an individual who is not just willing but in many cases eager to share with colleagues from around the state the story about his or her program.
The CSS's goal is to have the RT Director make the call to the contact person or email him or her and to thereby connect two practitioners around a promising practice. This way, we contribute not just to disseminating what works, but also to building a network of practitioners who want to learn with and from each other.
Conclusion
Research at the State Level: This article has already explained how practitioners can use the promising practices write ups to identify promising practices that are relevant to what they are doing or hoping to do, and to connect with colleagues from around the state who have already implemented a practice or approach they may be interested in replicating partially or fully.
The promising practices serve several other purposes. First they enable individual practitioners to consider the large picture of their training field. What is going on in different parts of the state and how does their local approach compare to what others are doing?
Additionally, the best practices can serve as a fund-raising tool. A practitioner who has identified and researched a practice that seems suitable to increase student success at his/her college can approach a funder to explore if there might be funds available to replicate the project. The approach would be "this is working in program X where it has helped increase student retention by an estimated 15% two years after start up. The cost is $50,000. The expected benefits are that retention will likely increase to 85% in our program from its current rate of 75%.
The examples that illustrate partnership development can be used by practitioners, after careful research into each relevant practice, to develop a strategy for how to best approach a potential health care provider partner. An approach may be "this is what hospital X is doing with community college Y." The hospital is paying for two faculty and this has enabled Y to increase enrollment by 40% while maintaining a retention rate of more than 85%.
In short, there are many ways a program can use the kind of data CSS generates to promote student success, including:
- identification of promising practices at work in other programs
- comparison of one's own practices with others
- connection with those who developed and are implementing these promising practices
- use of findings to lobby for support to replicate promising practices
- use of findings to approach hospitals and other health care partners
- use of findings to request internal or external support to replicate local adaption of best practices
Research at the Program-Level: But this is only one side of the picture-using research to promote student success is a strategy that should start at the program level. Time and again, the CSS researchers hear about interventions that practitioners "just know are working." When we ask: "Do you have any data that shows that it works?" the response is much too often that "We are so busy and everybody is working over-time as it is. Also, there are so many variables that could have influenced the increase, although we know that strategy A played a key role."
The point here is certainly not to blame the program staff for not being able to carry out one additional task, but rather to draw attention to the importance of collecting and analyzing the data-in this case to determine the likely impact of strategy A-and to suggest that at many colleges the research office might be able to help the program staff set up a data-collection system that is easy to implement. The data generated could then be analyzed by the researchers and discussed by the program team. It may not be possible to quantify the precise impact of strategy A because there are many variables, but it will almost certainly be possible to determine whether retention-promoting strategy A is helping at all, helping a lot, or helping a little. With this information, the program team would be in a position to determine whether strategy A is a good investment for increasing retention - and, if it is, to document the impact to funders who with the evidence will be much more likely to reinvest in strategy A-or whether other approaches should be prioritized. In either case, the data will help the program team make a good decision about where to allocate resources that can help increase student success.
Case Study-Program Level Use of Research to Advance Student Success: While promoting the research-program collaboration on a macro-level across the colleges, the CSS is seeing some collaborations emerging at the program level. An example is Riverside Community College (RCC) where the Associate Degree Nursing (ADN) Program is working closely with their Institutional Research Office to improve student success. "We just asked Institutional Research to take a second look at our entry requirements," says Interim Dean/Director Sandra Baker. "Our attrition rate at this time is 9%. This is very low compared to the state average of 23-26%, but it still means that 5-6 nursing students in a class of 60 drop out. So we want to continue to reduce attrition and give the scarce and expensive training slots to students who, according to our data analysis, are most likely to successfully complete the program." The state-wide study of predictors for student success in nursing programs (conducted by the Center for Student Success, adopted and recommended by the State Chancellor's Office, and available on the CSS Web Site) found that a major predictor for successful completion is the number of time a candidate has taken prerequisite classes like biology and anatomy. "I'm not quite sure this holds true for our students," Sandra Baker says, "so I've asked our Institutional Research Department to see if they can validate this relationship for our students."
Dean Baker and the RCC ADN Program are also using data analysis to support continuous curriculum improvement. This time, the provider of the data is not the RCC Institutional Research Office, but Pearson Educational Measurement, a private research corporation that for a fee conducts a detailed review of Riverside's National Council Licensure Examination for Registered Nurses (NCLEX) results. The findings identify areas of strength and weakness in the curriculum and include a comparison of how the program did in different areas of the test compared to other local programs and to programs across the nation.
The Pearson findings from two semesters ago found that the RCC NCLEX candidates were not doing as well as they could in the management section of the exam. Additionally, the percentage of management questions on the NCLEX was slated to increase. RCC's instructors immediately went to work and strengthened the management part of their curriculum. The result has been increased NCLEX pass rates, up from 85% in Fall 2003 to 93% in Fall 2004.
The way that RCC and many other health care and other programs use data to drive continuous program improvements and thereby improved student outcomes is exemplary and hopefully a model that many other programs - health related and otherwise - will consider replicating. With the research-program collaboration in place at the local level, the program can then look toward the CSS for state-wide research findings. With both in hand, program directors and faculty will be in a very good position to make program improvements, to learn from and possibly replicate what is working in other parts of the state, to connect with colleagues from successful programs, and thereby - to form successful partnerships and attract program investments from multiple internal as well as external sources.
|
