Q&A with Roxanne Fulcher, Director of Health Professions Policy and the Health Professions Education Center at the American Association of Community Colleges

Millions of students attend community colleges every year. A large percentage of those students go into health care professions. Compared to those attending four-year institutions, students in community colleges are more likely to be the first in their family to attend college, more likely to come from a minority background, and more likely to work while they are in school. Health Workforce News had the opportunity to interview Roxanne Fulcher from the American Association of Community Colleges (AACC) about the role of community colleges in addressing the nation’s health workforce needs and the upcoming launch of the Healthcare Virtual Career Platform, a project funded by the Employment and Training Administration.

What do you see as the role of community colleges in educating the health workforce?

The nation depends on two-year colleges for the majority of its registered nurses (RNs), licensed practical nurses (LPNs), and allied health professionals, and the numbers of students choosing community colleges for their health professions education is increasing. In fact, demand for health professions program enrollment at community colleges is often greater than capacity, as is demonstrated in nursing where in the 2009–2010 academic year, associate degree in nursing programs rejected 46% of qualified applications.

Overall community college enrollments continue to grow as traditional (recent high-school graduates) college-bound students, incumbent workers, and the unemployed increasingly become aware of the quality education available at community colleges where an array of affordable, efficient educational models are utilized to support both academic progression and career advancement. With employment projections and health care reform implementation signaling increased job availability in our health care system as well as the shared health professions roles among many practitioners educated in associate- and bachelor’s-degree programs, demand for enrollment in and graduation from community college health professions programs is likely to continue to grow.

What are the particular strengths of community colleges?

Community colleges are particularly strong in their capacity to meet health professions workforce needs, which also happens to align with the community college mission—to provide access to higher education and to workforce training to support economic development and sustainability of the local community. Developed through decades of experience addressing health professions workforce challenges at the local and state levels, community colleges create and adjust programs that meet the unique needs of both their students and communities and provide employers with quality professionals with the competencies and skills necessary for successful licensure attainment and practice.

To what extent is the student makeup of community colleges different from four-year universities and how can that help address the need for a diverse health workforce?

Federal data demonstrate that community colleges enroll larger percentages of nontraditional, low-income, and minority students than four-year colleges and universities. For example, federal data demonstrates the following about community college students:

Age:
45%	Aged 22-39
15%	40 or older

 

Percent of Minority Undergraduates Attending Community Colleges:
55%	Native Americans
52%	Hispanic
45%	Asian/Pacific Islander
44%	Black

 

Employment Status:
21%	Full-time students employed full time
59%	Full-time students employed part time
40%	Part-time students employed full time
47%	Part-time students employed part time

 

Other Characteristics:
42%	First generation to attend college
13%	Single parents
6%	Non-U.S. citizens

Tapping the talent of the diverse community college student enrollment can strengthen national goals targeted at increasing health care workforce diversity. Data demonstrate that community colleges have provided America its greatest nursing workforce diversity:

Minority RNs Educated at Community Colleges:
65.9%	American Indian/Alaska Native, Non-Hispanic
55.4%	Multiracial, Non-Hispanic
55.3%	Hispanic, all races
52.6%	Black, Non-Hispanic
46.3%	Native Hawaiian/Pacific Islander, Non-Hispanic

 

A March 2011 policy brief from the American Association of Community Colleges written by you and Christopher M. Mullin looks at the role of community colleges in educating registered nurses. In our May 2011 Q&A with Susan Hassmiller, we heard some of her thoughts on a recently released Institute of Medicine report which advocates that 80% of the nursing workforce have a baccalaureate degree by 2020. Could you speak to the role of associate-degree programs in preparing RNs to meet our nation’s health workforce needs?

Associate degree nursing (ADN) programs, predominantly at community colleges, offer the most affordable and efficient access to the nursing profession and provide the nation its largest numbers of RNs, minority nurses, and nurses practicing in the states where they attained their degrees as well as in rural America. Additionally, ADN programs provide unparalleled and flexible pipeline opportunities, allowing students with adult responsibilities and other disadvantages to directly earn the RN credential or to achieve the LPN and advance to the RN level. The nation will continue to rely on these community college pathways to provide graduates to assume an array of nursing roles and responsibilities.

In response to recent calls for a more educated nursing workforce, community colleges are ensuring that nursing program content continues to educate quality RNs prepared for practice in the nation’s evolving healthcare system, including in interdisciplinary teams and in non-hospital settings. With strong interest in expanding the nursing workforce prepared at the graduate-level, community colleges are working to raise awareness among ADN-prepared RNs of opportunities to achieve, without first attaining a nursing degree from a four-year program, the Master’s in the Science of Nursing (MSN) at the nation’s existing 173 RN to MSN programs where competencies are delivered for graduate-level nursing practice. In addition to community colleges, both the Institute of Medicine and Carnegie Foundation have recognized the extraordinary opportunity RN to MSN programs represent in achieving goals related to a more educated nursing workforce especially since a recent study reported that the majority of RNs will achieve only a single additional degree after completing their nursing degree.

In 2010, AACC was awarded funding from the Employment and Training Administration to build a Healthcare Virtual Career Platform. What will the platform do and when do you expect its launch?

AACC anticipates a late fall launch of the nation’s Virtual Career Network – Healthcare (VCN), which will recruit a wide range of people to nearly 100 healthcare professions as well as enable current health-care workers to progress academically and within their careers. From career exploration to skills assessment, training, and job placement tools, the VCN will facilitate moving both those currently employed in health professions occupations and new entrants to the workplace, into roles in healthcare that offer family-supporting wages. The VCN will demonstrate career pathways leading to employment following short duration training as well as progression and growth allowing for advancement and academic progression. Visitors will follow a structured step-by-step online process designed to assist them to accomplish the following: select a healthcare profession; identify educational requirements and an institution to become educated for the selected profession; and find jobs available within the profession.

How is community college education for health careers changing? In particular, how are community college programs adapting to address the changing practice environment and to help graduates meet needs such as a greater focus on non-hospital based care and more reliance on technology?

One of the greatest community college strengths is the ability to rapidly respond to demands for change and for new types of workers. While over time practice boards and licensure exam content drive change in community college health professions programs, close ties between colleges and both hospital and non-hospital employers facilitate more immediate change. Colleges respond to employer needs and workplace settings by adjusting programs to ensure graduates are prepared for current practice demands, such as utilization of new technologies and practice in evolving delivery models.

The limited availability of hospital clinical placements in many community college locations as well as the commitment to practice within the community have advantaged students in preparing them for practice in non-hospital settings. Community college students’ clinical experiences include long-term care facilities, schools, public health, Head Start, senior living centers, and other settings. Federal data demonstrate public health employers rely on approximately the same percentages of ADN- and BSN-prepared RNs while non-hospital (long-term care) providers are more dependent on community colleges for their nursing workforce.

In addition to adjusting programs to ensure graduates are prepared for current practice, community colleges create new educational delivery models and programs to meet both employer needs and when at its best, student needs. An example of a new model meeting those needs is the stackable certificate, which delivers education in academic certificates that provide new competencies required for specific health care workforce roles, and that when stacked, move students toward career advancement and college graduation. Stackable certificates provide, in short timeframes, competent health care workers who are following academic and career advancement pathways that support national health care goals. These goals include a more educated workforce, improving continuity of patient care, and ensuring availability of health care practitioners in rural America.

Most recently, community colleges have responded to U.S. Dept. of Labor calls to create programs to deliver content to prepare a Health Information Technology workforce to support the nation’s shift to electronic health records and to provide a Health Career Virtual Platform to recruit people for the health care professions and to enable current health care workers to progress both academically and within their careers. Healthy People 2020 includes an objective to increase the proportion of 2-year colleges offering public health or related associate degrees and/or certificates. In addition, health care reform emphasizes the need for health professionals capable of providing wellness and preventive care and caring for patients in community and public settings. To meet these high priority needs, community colleges are working to build partnerships to leverage the community college infrastructure and experience to create new academic progression and career pathways in public health.

What types of data do community colleges consider when making decisions about degree and course offerings, and to what extent is the needed research available to support their decision making?

The data community colleges use in making decisions about course and degree offerings varies from state to state and includes a variety of sources. For example, one state considers a variety of data that includes but is not limited to the following:

• Advisory Committee Recommendations
• Employment Needs Data; including information from the state Employment Security Commission
• Prospective Student Interest Data
• Professional Association Endorsement
• Program Duplication
• Funding Source (first year of funding is not provided)

For health programs, colleges often partner with organizations such as the State Hospital Association, State Health Care Association (long-term care), and others. Partnering organizations often assist with first year funding, especially for equipment.

Is there anything else you would like to add to this conversation?

The American Association of Community Colleges has created a Health Professions Education Center to provide a forum to join community colleges with health providers, businesses, and workforce leaders interested in leveraging resources to address America’s health care challenges through collaboration with community colleges. HPEC welcomes the interest of others in those efforts. In addition, two organizations—the National Network of Health Career Programs in Two-Year Colleges and the National Organization for Associate Degree Nursing—provide forums that focus specifically on health professions education at community colleges.

Roxanne Fulcher can be reached at RFulcher@aacc.nche.edu or 202-728-0200, ext. 274.

Please note that the views expressed in this article are the opinions of the interviewee and do not reflect the official policies, positions, or opinions of the Health Workforce Information Center or its funder.