BRIEFING PAPER: INCREASING ETHNIC DIVERSITY IN THE ORANGE COUNTY HEALTH CARE WORK FORCE

Partners for Health Funding Deadline: November 6, 2006

NOTE: This briefing paper, developed for the Foundation's internal use, is being shared to encourage nonprofit hospitals in Orange County and their community partners to apply for Foundation "Partners for Health" funding by November 6, 2000. Inquiries regarding this initiative should be directed to: Susan G. Zepeda, Executive Director, The HealthCare Foundation for Orange County (714) 245-1650 or szepeda@hfoc.org. The Partners for Health Application may be downloaded from the Foundation website at www.hfoc.org.

Background

The HealthCare Foundation for Orange County is committed to increasing access to health care services for low income families in central Orange County. Lack of health insurance, and inability to pay out-of-pocket for needed health services, are a major barrier to receiving health care for the County's 400,000 uninsured residents. However, other barriers to care have been identified as:

Time-related. Operating hours of low-cost clinics and physician offices often coincide with the working hours of low income patients and parents; the "opportunity costs" of taking time off during working hours for an hourly wage earner or day laborer are far greater than for a salaried employee.
Geographic. It is difficult and time consuming to travel by public transportation in Orange County; the primary wage earner in a low income family may use the family's automobile - if they have one - for work purposes, making it unavailable for patient transport.
Linguistic/cultural. The ethnic diversity of central Orange County includes many recent immigrants whose English-language skills limit their ability to explain medical problems in English to a care provider, or to understand verbal and written explanations and instructions given in English.

Our interest in the ethnic diversity of Orange County's health care workforce stems from our concern for these linguistic and cultural barriers to care. Added benefits to assisting motivated and able ethnic minorities to pursue careers in health come from providing entry to careers more likely to provide living wages, health and other benefits, and opportunity for upward mobility.

The decade just begun provides a unique "confluence of interests" which offers new opportunity to increase work force diversity:

Federal and state efforts to move low income families from welfare to work have increased resources available for training, child care and other services whose absence has been a barrier in the past.
An aging health care work force and dwindling numbers of nursing graduates in California have created a nursing shortage, motivating local hospitals to work with community colleges, four-year colleges and others, seeking innovative ways to increase the pool of trained workers.
The HealthCare Foundation is not alone in identifying this issue and opportunity - offering possibilities for partnered solutions, in concert with other local and Statewide foundations.

As noted, an aging nursing work force and changing County demographics present challenges and opportunities for Orange County's health care providers. At an August 10 meeting on the local nursing shortage, convened by the Heathcare Association of Southern California (HASC) - Orange County, Mark Meyer (CEO, Garden Grove Hospital) noted that there are currently 1000 - 1500 nursing vacancies at Orange County hospitals, and there is a waiting list of 800 - 1000 interested persons, seeking admission to community college registered nurse (RN ) training programs.

A recent (6/14/00) article in the Journal of the American Medical Association (JAMA), projects that, within the next ten years, 40% of the RN workforce will be over 50 years of age. When coupled with a decline in younger people choosing nursing as a career over the last two decades, the total number of full-time equivalent working RNs is expected to peak in the year 2007, and decline steadily thereafter, as large cohorts of practicing nurses retire.

A decision of the governing board of California's community colleges may have contributed to local shortages. A few years ago, the community college system went to a "lottery" approach to applicant entry into much sought-after nursing programs statewide. This has left many qualified interested students on growing waiting lists, while the attrition rate of those admitted has reportedly increased. While some of this attrition may be due to a mismatch of student skills/aptitudes and demands of the curriculum and the profession, and inadequate K - 12 preparation, observers also suggest that efforts to reduce nurse:patient ratios in hospital settings have added to the stresses of an already challenging career option, and less stressful, better-paying options have attracted students away.

Educators note the high cost of educating nurses, as an added challenge to financially strapped institutions: The clinical component currently requires 1:12 teacher-student ratios for required clinical classes, compared to a 1:60 ratio permitted in other programs of study. To increase availability of teachers for these courses, the colleges have only limited recourse to use working nurses as part-time instructors, as all prelicensure programs require that no more than 50% of faculty can be part-time.

Even if faculty and laboratory resource expansion could increase the ranks of two-year RN graduates, today's high-tech medical environment calls for added specialty training, to make a new nurse ready for duty.

In addition to increasing the numbers of new nurses graduating from local schools, there may be opportunities in assisting persons who received health-related training elsewhere (for example, military paramedics and medical assistants; persons with medical or nursing degrees from other nations, whose training is insufficient for California licensure) to qualify for licensure and current practice.

HASC in Orange County has accumulated examples of models used elsewhere in the state or nation, to increase numbers of work-ready nurses. Some of these show promise, also for increasing diversity in the workforce. A summary of these models is Attachment A to this report.

The Health Care Council of Orange County has recently received a grant of $200,000 from the California Wellness Foundation, to work with local colleges and community clinics, to increase the ethnic diversity of the local health work force, enhancing educational opportunities and providing a "career ladder" for competent health care providers at every level. A summary of this project is Attachment B.

Assemblymembers Lou Correa and Ken Maddox, Congresswoman Loretta Sanchez, along with Bill Campbell are local representatives who have expressed an interest in the nursing shortage issue. In the state legislature, no effort to address this concern passed out of committee; however, they did pass a $50 million "community clinic investment act," which may assist community clinics in hiring and retaining added culturally competent staff.

Next Steps

It is recommended that:

The HealthCare Foundation seek out and encourage parties interested in pursuing the goal of increased cultural diversity of the Orange County health workforce
Viable local strategies be identified, and willing qualified nonprofit hospital partners
The majority of the Foundation's 2000-2001 "Partners for Health" funding (November 6, 2000 due date) be dedicated to strategies to increase cultural competence/cultural diversity of the local health work force.