On-site training for tomorrow's LPNs.

The prophesied nursing shortage--at all levels--is here, or at least high on the horizon. But rather than accepting this gloomy situation, Good Shepherd Lutheran Home in Sauk Rapids, Minnesota, has taken the offensive. Partnering with St. Cloud Technical College (SCTC), Good Shepherd offers Long Term Care Connections, a training program that prepares CNAs and other caregivers to become LPNs.

According to Good Shepherd CEO and Administrator Bruce Glanzer, this 30-acre senior living campus has experience functioning as a teaching organization: "Instead of just being a long-term care campus, we've added a little twist. Because we believe that people grow and systems advance through education, physicians from the Mayo Clinic in Rochester, Minnesota, do a geriatric rotation at Good Shepherd as part of their residencies."

"In addition, students from the College of St. Benedict/St. John's University are here year-round gaining practical, hands-on experience with the elderly," adds Nancy Kollmann, RN, DON, director of resident care services. "We also host a geriatric program for non-nursing students from these schools, as well as St. Cloud State and St. Cloud Technical College."

The new program, though, brings continuing education directly to the frontline staff. When Glanzer and Kollmann began at Good Shepherd, 40% of its staff were agency personnel. They recognized that this presented an immediate cost concern that had to be resolved. To stem escalating agency costs and address staff concerns about Good Shepherd's lack of career opportunities, Kollmann created Long Term Care Connections, an on-site, three-year program that prepares its students for LPN licensing upon completion.

Mary Leyk, health programs manager for continuing education at SCTC, hired the faculty for the program. Most instructors are adjunct faculty from SCTC. "As we begin the clinical portion of the curriculum this year, there are others with LTC experience that have expressed an interest in teaching, but they must meet SCTC's teaching requirements to qualify as instructors," she explains.

Instituting the program was one thing, but funding it turned out to be easier than expected. "In an attempt to encourage nursing as a profession," says Glanzer, "the Minnesota legislature awards 25 cents per patient-day as a starting point for staff education and training in long-term care." The caveat is that if those 25 cents aren't used by the end of the year, the state takes them back. Glanzer quickly points out that the 25-cent allowance is an arbitrary number and not a cap: "In reality, the state matches dollar for dollar of educational spending. In fact, Good Shepherd spent $1.52 per patient-day on education last year and is now being reimbursed."

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There is absolutely no cost to students. Good Shepherd pays for everything--tuition, books, and fees. Because almost everything is computer-driven these days, including nursing, each student is provided with a laptop, which the state considered a reimbursable expense. The laptops were important because Kollmann, SCTC's Past Director of Nursing Jan Hooper, and Kathy Gilbride, who was the director of SCTC's Center for Customized Training and Development when the program started, decided that Long Term Care Connections would be supplemented with additional Web-based training materials. Daycare expenses incurred during class time and mileage for students from outlying areas were also reimbursable the first year.

Specific requirements must be fulfilled before an applicant is accepted into Long Term Care Connections. Leyk explains that, to qualify, a candidate must be a nursing assistant in a long-term care environment or have equivalent caregiving experience and be able to test out at a nursing assistant level. Each candidate also needs three letters of recommendation--one from his or her DON and two others, such as clergy, unit managers, or clients. To round out their profiles, applicants must write goal statements on what they hope to get from the program and what their facilities will gain by their participation.

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With funding, qualifications, and course content in place, 25 LTC administrators and DONs in Central Minnesota were invited to hear about the program in May 2002 and were encouraged to offer this educational opportunity to eligible employees. Sixty prospective students then showed up for a general information meeting. "From that meeting," says Leyk, "we had 35 applicants. Twenty-eight students from seven facilities were accepted into the first class that began in September 2002."

Because classes were to be held on the Good Shepherd campus, the facility converted a large storage area into a "smart" classroom equipped with the latest computer hookups, projectors, DVDs, VCRs, surround sound, and 33 Internet-connected stations. The classroom is located on a pathway between the long-term care facility and the assisted living/independent living apartments. Although this classroom's first priority is Long Term Care Connections, it is used for other meetings when available. Leyk recalls a recent exchange in which one resident told another, "That's where they learn to be nurses."

To accommodate employees' work and personal schedules, classes are held twice a week. "Classes are held on Tuesdays and Thursdays from 4 to 8 p.m., which gives these nontraditional students enough time to commute to Good Shepherd and still be home in time to put their children to bed," says Leyk. Students take only one subject at a time, which is called block scheduling. By limiting subject matter, students can focus more time and attention on one subject so that learning is enhanced.

"Because the laptops are essential to the program, the first four weeks were spent teaching Microsoft programs so that the students could use them for research and writing assignments," says Leyk. She continues: "Instructors are also challenged to incorporate long-term care principles into the curriculum. After first learning computer basics, students took an eight-week analytical writing course. Then the instructor assigned a paper, for example, on eldercare. Students' papers were on elder abuse, Medicare, prescription drug legislation, and so forth, and students had to research their topics and give them a long-term care application. The laptops were indispensable to them because they could do their research and writing at home."

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Many of these students have been away from a learning environment for many years. Their ages range from 21 to 58, with an average age of 34. Leyk recalls one student, a single parent in her 30s, who has been a nurse aide for 12 years. She didn't do well in high school and felt she had nowhere to go. This pessimistic outlook was compounded by her insecurity. "She didn't pass the college math placement test and had to take an additional math course. Almost daily she would come to me and say, 'Okay, Mary, if I fail this course, I'm out of the program, right?' Although she passed the course, her negativity continued. Later, as she began to recognize her capabilities, her confidence grew. She is now a secure woman who is supportive of students who, too, feel overwhelmed by the challenges they face," says Leyk.

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And these students continue to excel. Last year, 10 students received Presidential Awards from SCTC for a perfect GPA (4.0) and four were on the dean's list (GPA 3.5 to 3.99). Kollmann reflects on the progress made since the first day of class when they began their journey in a state of high anxiety and energy. "Today, midway through the program, I see students with confidence, self-esteem, self-worth, and faces that are eager to learn," she says.

Good Shepherd Administrator Glanzer notes that this pilot project is the first of its kind in Minnesota--and it's getting attention. He says, "After we won the Minnesota Health and Housing Alliance Innovation of the Year award, we welcomed a visit from faculty at Riverland College in southern Minnesota, who wanted to see Long Term Care Connections firsthand. They asked us for advice in setting up a similar program at a long-term care facility near the college."

As word of Long Term Care Connections spreads, Kollmann hopes that more facilities will adopt in-house education as not just a means for securing nurses for the sponsoring facility, but as a resource to place and keep qualified staff in long-term care environments wherever they're needed.

A collaboration of the American Association of Homes and Services for the Aging and Nursing Homes/Long Term Care Management Not-for-Profit Report, appearing in every issue of Nursing Homes magazine, addresses issues of particular interest to long-term care's not-for-profit sector. It provides nonprofit aging service providers with an additional information resource. Topics have been identified in collaboration with the American Association of Homes and Services for the Aging. Nursing Homes welcomes comments and suggestions for future coverage.

For more information, contact Good Shepherd Lutheran Home at [phone]. Send e-mail to Bruce Glanzer at [e-mail] or Nancy Kollmann, RN, DON, at [e-mail]. To comment on this article, please send e-mail to [e-mail].

BY SANDRA HOBAN, MANAGING EDITOR