Amanda Wilde (Host): It's concerning. All around the U.S., there is a growing shortage of medical staff. In the San Joaquin Valley, while the number of registered nurses is declining, the demand for registered nurses is increasing, and it will increase by more than 35% in the next decade. There's a program called HOPE that addresses the nursing shortage by helping students overcome barriers in order to pursue careers in healthcare. We'll get the details next with Dr. Anitra Williams, Vice President and Chief Nurse Executive, St. Joseph's Medical Center.

Welcome to Hello Healthy, a Dignity Health podcast. Thanks for joining us. I'm Amanda Wilde. And Dr. Williams, thank you for being here.

Dr. Anitra Williams: Thank you, Amanda, for having me.

Host: Now the HOPE program is one of a kind. How was it created? Where did the idea come from?

Dr Anitra Williams: So, the idea came from HealthForce Partners. HealthForce Partners is regional partnership where they lean on members of industry and academia, and they basically serve as a convening body to bring all these great minds together. And our focus has been on preparing pathways that will allow individuals to elevate in the community, get them into jobs that will allow them to have at least a comfortable living wage.

And one of the shortages that we've been focused on includes the nursing shortage. And so, you did a great job sharing some of those statistics. So, I live in the Central Valley area, and we are definitely projected to have a significant nursing shortage. So, myself, along with the dean and the director of San Joaquin Delta College's Nursing Program, we basically met and started talking about ways that we could mitigate the shortage that we were expected to see here in our Valley, and me representing the industry side, being in in an acute care hospital, I have been frustrated for more than a decade with my local junior college, which is San Joaquin Delta College, because I know that the majority of their nursing students live outside of our county. So, more than 80% of students that they accept come from outside of the county. I am also one of the only hospitals in this community that hires new graduates. And so, what had been happening for the past decade plus is we hire new graduates, they stay with us for six months or so, and then they leave our hospital to go back to the communities that they come from. And that just really has a huge impact on morale. And we find ourselves with this revolving door, and it's just really hard.

What we also started to notice in the industry side is that positions in our emergency department or our labor and delivery area, in our neonatal intensive care unit, we were losing those nurses, and those are specialty areas. So without the proper skilled nurse in those departments, patient care can be at risk. And so, I leapt at this opportunity to just really challenge our local community college to see how they could help us on the industry side. And within two hours, this group, we developed a pathway that would allow high school students to be dually enrolled at San Joaquin Delta College while in high school, preparing themselves for the registered nurse program.

So, as part of their high school curriculum, we would embed the nursing prerequisites. And by the time they would graduate high school, they would have two more classes to take that would allow them to then transition into the associate degree nursing program. So, we were extremely proud about our success with this pathway.

We went to a local high school, it's called Health Careers Academy where the majority of those students, they come from impoverished backgrounds. Their family's median income is around $20,000 a year. So, it's definitely a community and a group of students that we really felt compelled to be able to put on the track to just changing the trajectory of their family's lives. So, it was during a meeting with the parents and students that we introduced this pathway that we would be allowing 10th graders to enter. And one of the moms came up to me at the end of our session and she was in tears. She shared with me that she's 30 years old, her daughter was 15, and she wanted to know that this was for real. She shared that she works two jobs, a single parent, and she couldn't believe that before her daughter was 21 years old, she would actually be a registered nurse making six figures. And she just was blown away and so excited, and she hugged me. And when I went home that evening, I couldn't shake the image because the room was filled with such joy and such excitement that I wanted to do something with the word hope. And so, from that meeting, the HOPE program was born. And that word hope stands for Helping Our People Elevate. Because I firmly believe that if we invest in people who are rooted in the community they live, they will continue to serve that community. So, that was the first part of our HOPE Program.

The second part is once the word got out and socialized around St. Joseph's Medical Center where I'm a current employee, I've been here for 25 years, an individual approached me from our emergency department. Her name is Jennifer Garcia and she was an ED tech at the time, so an emergency department technician, a mom working two jobs, been with the hospital for 17 years. And she said, "Dr. A," that's what they call me here, she says, "I hear what you did for the kids across the street, Health Careers Academy. And I think that's great. But what are you going to do for people like me?" And I said, "Jennifer, tell me more. What do you mean?" She said, "I have applied to nursing programs five times and I've been denied. I'm giving up. I'm losing hope. And I know that I will make an excellent nurse. But just because my GPA is 3.0, I'll never be able to get into any nursing program, because you need to have a nearly 4.0 GPA. And I just don't think that's right." And I said, "Are you serious? You have a 3.0 GPA, you've taken all of your prerequisites?" and she says, "Yes. And I've applied to Delta's program three times, Modesto Junior College two times, and I just can't get in." And so I said, "Well, are there other people that are in the same situation that you're in?" She said, "I know 20 people off the top of my head who work here in dietary that work as an EDS worker and several unit clerks, and they're ready for the nursing program, and they've passed their prerequisites, but there's just no hope for us." And she literally used that word hope. And so, I said, "Well, Jennifer, prove to me that you've done those things. I want you to email me your transcripts, and I want you to talk to those other 20 people that you're telling me about and have them do the same thing. I'm going to give you 48 hours and I want to receive that information." In 24 hours, I had more than 20 individuals email me with their transcripts, and all of these individuals had a GPA of greater than 2.5.

I then took that information to the dean of the college and the director. And I said, "We have to do something for our incumbent workers. At my hospital alone, I've got over 20 people that are qualified for the nursing program that will never have a shot at getting into an affordable nursing program unless they pay a hundred plus thousand dollars for some sort of private school. We have to be able to do something."

And at first I was told, "No, I don't think it's possible because there's a lot of rules with junior colleges." And I said, "No, please try to figure it out." And those ladies went back and they figured it out. They came back to me and said, "We absolutely can create a program and a pathway for your incumbent workers. The only catch is the hospital has to be willing to provide the clinical instructor. If you all provide the clinical instructor, you'll be able to select the students that you want to put in the program, and the college will cover the theoretical components."

And that's how our HOPE incumbent program was birthed. And so, I'm really excited about that because It allows us to invest in our employees that have been loyal to the organization, that are rooted here in the community. And so, I know once they graduate from the nursing program, their intent will still be to continue serving in this organization. And I know you're going to ask me more questions, but I will say that Jennifer Garcia, she was a student that I awarded an invitation to enter our first cohort. And that first cohort started in January of 2020. She graduated in May of 2021. She's now a registered nurse working in our emergency department. She's still working there nearly three years later. And she purchased her first home. And so, she has undoubtedly changed the trajectory of her family's life.

Host: And that's just an example of how HOPE, the program, really benefits the community, gives job paths to students, and obviously some stability we're lacking in the past as far as retaining employees at the hospital.

Dr Anitra Williams: Absolutely.

Host: And you mentioned the program started in 2020, and that was a great follow through on one story. Has HOPE, the program, also grown throughout those years?

Dr Anitra Williams: It has grown. So to date, we are on our fifth cohort. And so, what happens is San Joaquin Delta College, every year, they allocate 30 seats for HOPE. So, every year we start in January, the students graduate in May. And so, to date, we're on our fifth cohort. We're actually in the process of selecting our sixth cohort. So, I should be done with selections the end of August, and we'll notify those individuals in September, and they will start in January of 2025.

So, currently, when you look at cohorts one through five, we have accepted 132 individuals into the HOPE Accelerated Track Program. And so far, cohorts one through four have graduated. And our graduation rates, 98%; the state boards that they have to take, it's an exam, we're at a 97% pass rate. And that is aligned with the other traditional track programs. So, I don't want people to think that these are individuals that have a lower GPA, so they're not going to be successful in the program. The program is not watered down. It is the exact same nursing program that your 4.0 plus student would attend. There's no change. The only change is that we're recognizing that the majority of individuals who have lower GPAs, that there are often socioeconomic things that are tied to that, that maybe they are single parents or they live below that healthy living wage. And because of those competing priorities, they're unable to study as a full time job and make those perfect grades.

But these students are extremely intelligent. And with pathways like this and with support from their employers, they're able to be successful and engaged just as any other student would and be successful. So, we're really proud, 132 individuals through the program. The fifth cohort will be graduating soon, and I'm sure we'll have 132 new nurses in our county within the next couple of months.

Host: Who is eligible to apply? How does one do that?

Dr Anitra Williams: So, one of the ways is you have to be working at a sponsoring organization. So, as I said, HealthForce Partners was the collaborative that convened, the academic minds along with myself. And I represent St. Joseph's Medical Center. There is Adventist Lodi, that's a sponsoring organization, as well as San Joaquin General Hospital. So, if you are an employee that if you work in an ancillary role and you've completed all of your nursing prerequisites, you are then eligible to apply to the HOPE Program.

And for me, as a co-founder of this program, I actually accept two individuals who live or who may have other jobs, maybe they work at Wendy's or Walmart, as long as they live in San Joaquin County, I, every year, have accepted two individuals from the community because my goal is to help our people elevate. And, by our people, I define that as people that are rooted here in the San Joaquin County. And so, they are more than welcome to contact me directly or reach out to the facility that I work at, and would be more than happy to review their applications. And if they're in our area here in San Joaquin County, I'd love to meet with them and possibly offer them an opportunity to participate.

Host: And I'll give your contact information, too, at the end of our interview. And if our listeners wanted to support the HOPE program, other people from the community who want to be partners in this, is that a possibility?

Dr Anitra Williams: Absolutely, and we welcome it. Because as I said, these are active employees, so they have a job and, in order to be successful in this fast-paced nursing program, they have to use their PTO time or just work with their supervisors so that they can take additional time off. So, what we've also done is we've offered scholarships. So, we're very generous here at my facility. And there are several scholarships that are set up for the HOPE program, as well as any of our employees that are going back to school to further their education.

And so, one of the funds that I would invite your listeners to to donate to would be our Nurses Society. So, the Nurses Society is a fund where our HOPE students have the privilege of tapping into, and we award them with scholarships to offset tuition as well as help with their living expenses. And then, another fund that I'll share with you all is the Eliza Tanner Memorial Fund. And so, that's a fund that I established in honor of my mother, who was a nurse for more than 30 years before she passed away.

Host: Oh, my goodness. And I was just going to ask you, maybe you can channel your mom too, what advice would you give to an aspiring nurse?

Dr Anitra Williams: Anyone that's aspiring to become a nurse, I would first tell them that the road is not going to be easy. And the second thing that I would say is never give up, because the science courses, they can be difficult for some, very challenging. Many students struggle with physiology and or anatomy. And what I would tell that individual is to believe in themselves because there are people out here in the world who believe in them. And if they are struggling in their science courses, the moment that they get a grade that's unsatisfactory, they need to reach out to their professor and start getting tutored so that they can get at least a B grade in their science course. And if a B grade is not going to be possible because perhaps they failed their exam, then they would want to withdraw from that class, because what we're seeing is that individuals will try to stick it out and they'll end up with possibly a D. And most colleges consider a D a passing grade. And with the D, you are not going to be eligible for the HOPE Program nor will you be eligible for most nursing programs.

So, that would be my advice is they've got to believe in themselves. They've got to know that there's people out there that believe in them and want to support them and that we need a diverse workforce. So, culturally congruent care is so, so very important. And, for anyone that's struggling, if they've got the heart and they're struggling, they need to link up with tutors and reach out to individuals who can mentor them and assist them so that they can be successful. But I don't want anyone that's listening on the call. If there's someone that's working in environmental services or dietary, I want them to know that science doesn't have to be scary, and there are so many individuals that can assist with tutoring. And most colleges also have financial support for things of that nature.

Host: So, the road's not easy, but you can do it, and there are resources to help. And with the resource that you're offering, the HOPE program, that now since 2020 has had proven success year after year, are you looking at trying to use the HOPE Program as a model to start other programs around the country?

Dr Anitra Williams: We are. People are starting to find out about this program throughout the state of California. And so, I had the privilege of accompanying the president of San Joaquin Delta College. We went to a meeting in Sacramento, California, where we went talk to the chancellors and presented this program, and they actually want to use it as a model and replicate it throughout the state of California. And so, there are a couple of colleges within the state that are interested in modeling this. And so, I'm really happy to have the chancellor's blessing. There's also a gentleman by the name of Dr. Garrett Chan. And he leads Health Impact. He's also very interested in the work that we're doing and wanting us to start working with colleges that are in the Southern California area so that we can also give those individuals the opportunity to elevate, because the need is there. There are so many Jennifer Garcias that are working in facilities just hoping that they can get a chance.

Host: This is very uplifting. Thank you, Dr. A, for this detailed description of how HOPE works, for helping nurses overcome these financial, employment, and education barriers. And wishing you continued success.

Dr Anitra Williams: Thank you so much, Amanda, for the opportunity to share.

Host: That was Dr. Anitra Williams. For more information, please visit dignityhealth.org/stockton. You can also email Dr. Williams directly at anitra.williams@commonspirit.org. If you found this podcast helpful, please share it on your social media. Thanks for listening to Hello Healthy, a Dignity Health podcast.