 I'm very yes. Thank you. Mr. Chair just reporting out that this morning the board hosted our General Advisory Committee meeting from 10 to 12 in this room. I Really felt like it was a really productive meeting. We're we're actually looking at reimagining the general advisory Group and we received really helpful and meaningful feedback from the members who attended today So just wanted to report that out to the public you all board were there, so you know what happened That's all I have to report. Thanks. Okay, great The next item on the agenda are the minutes of Wednesday September 26th. Is there a motion so moved? It's been moved and seconded to approve the minutes of Wednesday September 26th without any additions deletions or corrections Is there any discussion? Seeing none all those in favor signify by saying aye aye any opposed So let the record show was a four zero one vote with Maureen abstaining because she was away So with that we're going to Move on to What I found to be a truly fascinating presentation that Tom and I were able to See at the workforce summit at Castleton and Just to reiterate a few points That I tried to make down there if you take a look at Vermont demographics. It's it's not a great Store to tell when we had Twice as many People in the state that were under 18 as over 65 Just a couple of decades ago. We're now at the point where we have equal numbers And we were also at the point where we've lost 20,000 of the working-age Vermonters. So We are a very old state in an old country in a young world and workforce issues are hitting all areas of Vermont's Structure whether you're in the construction business or you're running a hospital and The point that I would like to make is that in health care We hear repeatedly from Jeff's members. How many travelers are employed at different hospitals whether they be doing nursing or Medical work or tech or even as a tech in that each time When we ask how much they cost they cost twice as much as What it would cost to employ in a Vermonter and it just seems like We've got two stories going forward and the one story is that People have to leave Vermont in order to be successful in a career And the reality is is they don't have to leave Vermont that there are very good rewarding jobs That are left open in Vermont that have good benefits Could pay and you can retire with dignity and so That summit was the start of reaching out to our partners in higher ed and elsewhere to see what could be done and Some of the interesting takeaways before I turn it over to Mary Ann that we heard at that summit is it's four different institutions of higher education in the nursing field were represented at the summit and I'm pretty sure that at least three of the four said that they could Have additional capacity in their programs if they had the clinical placements for the students so this is something that We all have to work together on solving and Deb just walked in and Deb I'm I'm giving a quick recap of the summit and What I was talking about is the fact that If We all want to solve this then everybody has to be working together whether it's higher education providers themselves If you take a look at what happened with the College of St. Joseph It wasn't just money that stopped them from getting the PA program through it was also problems trying to find the placements for their students in the clinical settings and The good news is from people that were at the summit like Jill Olson from the V&A's Even though they don't have money to invest in things They are willing to step forward and provide the opportunities for students and I know talking to a few heads of our community action programs and also our mental health programs that they're also willing to Step up and provide those settings so Candy I had at the full capital just kicked in I'm not sure what was in it but Anyways Long story short, there's more that all of us can do to try to solve this problem and My favorite quote whenever I talk about workforce issues comes from The head of the visiting nurses and hospice for the Southwest region And he would always tell those of us in the legislature that sooner or later He was going to have to take care of our sorry old butts in that we better take care of them. So One of the things that happened at the summit was a fascinating presentation with a lot of new Data that we hadn't seen before and I know that when Tom and I walked out of the summit We we talked about how we almost had hoped that Marianne had been the first person presenting at the summit Because it was all new information to us and we started wondering well If it's new information to us have others heard the presentation And that's why we reached out and we're very very fortunate that Marianne had a Change in her schedule that is allowing this to occur. So With that I'm going to turn it over to you and and I hope that the audience Finds it as fascinating as what Tom and I found it at the summit Thank You Kevin As Kevin said my name is Marianne Sheehan and I work for the Vermont business roundtable The Vermont business roundtable First I'm going to just mention three people in this room have already heard this presentation. So I Typically like to make it interactive, but I understand that we have a Moment at the end like well or 15 minutes or so that we can actually have an open dialogue about it The Vermont business roundtable has been around for over 30 years It's an organization that's made up of a membership and to be a member of it You have to be either a CEO or a president which sounds very exclusive, but the Vermont talent pipeline is a Work we're part of the Vermont business roundtable research and education foundation and we Are inclusive of every every organization that's out there. So when we Do our work we work in a sector strategy with a particular industry and the industries that we've been in so far our construction health care and manufacturing but we invite every Member of the business community to participate It's an employer-led Strategy meaning we work with employers to identify their most critical jobs and what the requirements of those jobs are And also to forecast the number of them so that we can translate that information and give it to the education community We didn't develop this Program by ourselves it's going through the United States in a national rollout and it was it's basically a set of strategies and some tools that The US Chamber of Commerce Foundation developed So the folks in our state who have been through the training for it are in different parts of the state Some regional partners. We have somebody in Brattleboro somebody in St. Albans and then Some statewide partners and I consider myself a statewide neutral convener of Employers so that's just sort of the framework that we work within So the model that we use is called collective impact So I'm not sure how many folks are familiar with collective impact, but the idea behind it is that you You get people together who have an interest in the same subject in this case It's in talent. So when you think about health care and talent, we have a number of people who are Organizations out there who are looking for talent in order to be Be able to do their job or to grow in the industry. So I'm just going to point out that the employer is the center of this. I have to stand The employer is the center of this world so In this case, we've invited all of the hospitals and a number of visiting nurses and home health agencies and Also rehab centers and some Retirement communities to participate in this I'm not saying that we were successful at getting everyone because we weren't we got 34 employers who were interested in participating But the employer is the center of our world here So this is just one perspective that exists and it happens to be the employer perspective So the idea behind this is we are Vermont town pipeline management. That's what that little logo up in the right represents and These are the folks who are involved in the work that goes on in terms of developing talent So we have regional workforce partners in every part of the state I mentioned that we have somebody who went through the training from Braga or another person from St. Alvin's we've actually done in-house training in the state of Vermont for all the regions including Rutland, Middlebury St. John's Berry Chittenden County Bennington Central Vermont, so we try to cover most of the state with with Regional regional partners who are neutral convening partners now that means that they're not an employer and they're not an educator There people are relationships with businesses throughout the state the whole idea behind this is we're engaging businesses in the conversation and the dialogue So industry associations were invited to the table Policy makers educators government agencies. We couldn't do any of this work without partners. I'm also going to mention Myself I my background is I'm a project management professional So I am not an industry expert and I'm not an educator My my job here is to facilitate consensus among a number of diverse employers. So That's the work that we're doing So when we say what is Vermont talent pipeline talent pipeline management is actually the generic term used across the United States and Vermont actually has a statewide rollout. We're the first state to actually implement it in the state model We have other states who have who are starting to do this as well I went to Michigan to help them roll it out In August we have Kentucky who's going through it right now and Tennessee is going to follow after them so It's a set of strategies and also a set of web tools which allow us to do some survey design Based on employer input. So these are the strategies. There's six of them. I'm just going to point out that these three here On the left side are all employer only so we don't engage any Additional folks that you just saw in the collective impact thing Anywhere in this part we do a full Facilitation of what are the most critical jobs? What's the demand for those jobs? What are the skill requirements for it before we share anything here? This is where we are in Advanced manufacturing right now This is where we are in construction This is where we are in healthcare. So we're in different stages of all these different pieces at any given time We couldn't do this work again without our partners So it would mean nothing if we didn't share it collective impact is Incredibly inclusive and there's no point in doing the work unless we're sharing the data with it with the community So I'm just going to point out we have a website and all of our reports are available I'm trying to make them interesting to read. They're not just data So if you wanted to read about healthcare you could So we have these six strategies three of them are clear only and then this side is where the Education and training community comes in One of the most obvious questions here is We have supply and demand model Okay, so this side is really here's the demand that we have and over here we have here's the supply of Education and training It's a little bit different than what we've seen in the past So in the past we used to take people who are coming out of programs and try to plug them into jobs Now what we're doing is we're saying here's the jobs we have can you create a training program? That will work for us So Sometimes and we know that the state of Vermont has it has a changing demographic We're talking about youth You know, and we're talking about how do we engage youth? But in the case of Vermont our biggest opportunity is in the adult population people who have actually graduated from high school and did not get any Post-secondary degree or credential. So those are people who are now more interested and looking for careers and This becomes much more applicable to that group of folks I Don't know how many people in here have ever heard of we owe a funding. We owe a funding is federal funding. That's available and Typically what they're looking for in order to fund programs from from the federal government is a Sector strategy that's data-driven that uses employers as its base. So I This is just my guess I'm thinking that the US Chamber of Commerce Foundation took the we owe a funding model and said let's build a program That actually works this way. And so that's what we're coming with. We're at we're actually at this point building the pipeline with educators That can take a serious amount of time depending on what level of training we're talking about so And continuously improving is just getting better and better Making the making the capacity broader the time to completion shorter or the quality better So those are the things that we're looking at dying Okay, so our first First step is we invite employers to come together and we do this by inviting the CEOs of the presidents of these organizations We typically ask an industry champion to do this for us in the case of health care We asked John Bromstead and he is our industry champion. So he invited all the hospitals and Home health and you know visiting nurses and rehab centers and folks to come together In a dialogue and decide whether or not they wanted to be part of this group We actually have 34 employers who came to the table including all 15 hospitals in the state We didn't get Dartmouth Hitchcock to come to our first Discussion because we didn't think outside of the box there. We were thinking that that was not a Vermont Organization we did end up including them in our work So I just wanted to put that in perspective But the reason that they came together was basically to forecast New and replacement hires for the most critical jobs and define the competency and credential requirements The value to them is that they're able now to provide clear hiring signals on what they're looking for In a way, that's really collective. So for instance, if you were to say we want to hire a health care assistant What does that mean? It might be different people different things to different people it might be You know Personal care aid it might be an LNA so we work on coming together in a Model where we are speaking the same language and That's part of the work that we're doing Okay Okay, so when we develop a survey we asked them to identify what their most valued employee the characteristics of their most valuable employee and Hospitals we do paired interviews. So we're using something called the appreciative inquiry in this case Where we're appreciating the people who are really good who work for us and they talk about what the qualities of those people You know, they have excellent employability skills. They really know how to work with people they Have all their licensing requirements. They know how to communicate up and downward, you know, they might give Information like that and then what we asked them each Member who's there each employer What are the top five jobs that you're looking to hire for? So what comes out of that is a list and you might get you know, we had we need physicians We need physical therapists. We need occupational therapists. We need registered nurses. We need LPNs LNAs We heard everything. Okay, but everyone could say here's my top five They put it on a note card and then they sort it so remember I am not an industry expert I'm facilitating a discussion here They come to consensus on what the top typically we say five roles are in this case What rises to the top? All of the jobs Those are the most critical jobs in health care right now. So Now we've identified this We need to place a value on it. Okay, so I'm just going to say this is what the survey looks like We asked them what are the most critical jobs and they tell us and these are this is the list personal period licensed nurse assistant licensed practical nurse Registered nurse nurse educator clinical nurse manager Advanced practice mental health nurse. This is I call that a red herring. I'll explain that in a minute and nurse practitioner so typically advanced practice mental health nurse is a Primary care role This was identified several times But it also fell into the category of registered nurse because a lot of places said they wanted a mental health nurse Who was a registered nurse? It didn't have to be an advanced practice level nurse So that was something that we learned more about when we asked questions So we asked how many new and how many replacement positions and if you can see this far I'm just going to say if it doesn't apply to your organization. You just check that box This is what our survey is they tell us what they need and we ask them how many they need that there are Follow-on pages that say What are the competencies? What are the credential requirements? What is the education level that you're looking for and they can evaluate what's important to them? So but this is really the the meat of it is right here. So I'll just say this is this is tricky for you guys to read but I'm going to find out This is what our forecast looks like for nursing. So we asked them what period of time they want to They want to look at we said we did this survey in April So we said we're going to look at a two-year forecast. How are we going to do that? We're going to look over the last two years and we're going to get a number that we feel You know we hire for each of these positions We're going to consider how many retirements. We think we're going to have we're going to talk about our attrition rate And then we're going to also talk about growth So I'll just say blue means new positions and orange means replacement positions If you look at this graph What you see the most though is registered nurse And LNA right I'll just say a few things just for my general observations here look how much orange we have there That means that if you if you really are looking at data This graph is really Basically tells you everything you need to know We have a 75% turnover rate in nursing careers in two years time That's that's big. Why do we have that? So I'll say for licensed nurse assistant I think our number is actually artificially low because we really only had about seven Nursing homes who were involved in this so we Suspect that number is much much higher knowing that we have over a hundred nursing homes in our state Personal care aid How much to add on that one The licensed practical nurse seems to be a role that also is in nursing homes. That's where like we use a heck data on where these jobs are Every time someone gets re-licensed in nursing they actually capture some data through a heck and they are able to show our supply of nurses is Mostly in what career fields LNAs are typically LNAs and licensed practical nurse the majority of those jobs tend to be in nursing home environments, so That's that's the interesting point here so Just as a glass 74% of the jobs in nursing are Replacement jobs due to attrition and retirements They're expecting that perhaps 30% so a national average for retirements is about 7% with baby boomers right now So they think that they have in the nursing career field potentially 30% retirements When we asked why they said well, there's a number of reasons why but we have an aging workforce We also have some challenges Workforce challenges which have to do with the lack of workforce in every career and the nurse being the front line so there's Much much deeper explanations for this if you were to read, you know the summary, but I'll just say There's a lot of reasons why there's turnover in this and I think we can make a dent in that So Well big questions that came out of this how can nurse education partners increase increased capacity or Decrease time to completion so when we share this information out with the education community the Folks who are in education looked at this and said well, they're not complaining about our quality the quality I think there are nurses are typically licensed so 53% of the jobs that were referring to our RNs So how can we increase the capacity for this we identify what some of the bottlenecks are we talked about legislation and Regulation amendments, there's a whole bunch of things that can be done But we need to have collective impact to do it Educators together can come up with some of these ideas and they have so Then we another question that we have is how can employers increase retention? Yeah, but that is a good question And then how can we eliminate the bottleneck of clinical educators clinical placements and clinical managers, so I'm going to just go back on side here If you look here clinical nurse managers and clinical nurse educators are really small numbers That's the forecast, right? They also happen to be the bottleneck to all of these other jobs, so if we don't have them We don't have these other jobs, so those are really really important pieces One of the things that really jumped on at me to the summit Conversation overhaul little people that are actually teaching our new nurses are ranking comparisons What their students make when they actually enter the field exactly It's kind of alarming. Well, so what we heard from the educators was Nurse educators are Technically trained and they're also they also have to have the addition of educational training They have these two incredible qualities yet. They're paid lower than some educators And not at the level of a nurse So there's a disconnect there That's you know, one of our first items that we identified So this here is a list of recommendations that the educators came on with and We we organized in these work groups to say, okay We have a list of recommendations that we've come up with We've prioritized them into these groups and if we work on them together, I think we can move this Now I'm just going to point out When we started with this discussion, we were talking educator to educator But there's a certain level where as you as you get deeper in this You realize that we can't do this without the employer So educators can only do so much without the help of employers But some of the things that they want to do are increased awareness and preparation for nursing careers So some of this will start in Um middle school other parts will happen at the Secondary level in general education in high school or in tech centers in high school And then it once they're able to learn about those careers. How did they get in? right a lot of people think okay If you've missed the boat at uvm. I was just used that as our Our vermont model for Nursing if you miss the boat at uvm You can't transfer in there's no transfers there. They don't have capacity to take extra people If you um, there are programs in our state though that offer Preparation I'll just say ccb has a number of preparation courses That allow people to enter at a second second years to Say at norwich or at castleson. So there are ways to get into it that um, Don't appear Obvious to people who are just starting out in school So one of the biggies says we need to develop an approved nurse educator training because What we what we've been seeing is one day you're a nurse and the next day you're a nurse educator. So You know, it not all nurse educators are created equally. They They need some better understanding for what the education process is how to assess people and how to motivate them to Stay in their field so There are a whole bunch of Regulation barriers that we talked about that we know about that we can probably Effect if we work together at them. So I'll just mention a couple of them One is that all of our neighboring states Massachusetts New York and new hampshire Have a regulation that says you can't come here to do a clinical placement unless you pay us You have to register with us And then and that's like a five-year registration cost About $18,000 and then each placement is going to cost you about $4,000 a year so That makes it really hard for us to send people to our neighboring states Vermont doesn't have any of those regulations So if you want to come to do a clinical placement in Vermont Call the hospital You might get one You know, if you're from some other state, we don't have those same Problems, you know of it's it's easy access and I'm not saying that this is the right thing but Should we put some guidelines around that? Somebody who's smarter than me would have to answer that question. I'll just say it's something that needs to be investigated How can we be part of this? System this that's going on in other states And still have placements for our own students So we still need to improve our clinical placement strategies and we heard from a great model that vtc has where they said They had a relationship with north country hospital Where vtc actually had a person who was Paid for by the hospital who who worked? For vtc and did clinical placements at north country hospital So they they actually named it after the woman who Came up with the idea and i'm gonna not try to remember her name, but um That uh They actually have a really good strategy for how to how to make clinical placements work for them And it's a relationship that exists between educators and employers Working together. So that's a model. I think we can replicate in other places And then the last one is um employer sponsored hiring solutions So we need employers to get more actively engaged in Um the development of these students all along the way For instance, I'll just say we we have a number of um Ways that students are able to have clinical experiences They don't all have to have clinical experiences in acute care Settings they could potentially have clinical experiences in settings that are Um Say none of you. I mean like nursing home experiences that give them a more well-rounded Training and you know More hours and more ability to Develop into a decent employee for an employer And the employers can have more input into that in developing internships and Work-based learning opportunities. So that's where we see it going So these are the ideas of the education community What we what we plan to do is bring it back to the ed to the employers and then Say here's what we need from you and this is like the next step in our dialogue Nursing is it's an industry that's uh, it's well regulated. It's licensed. It's you know The folks in it have really great skills But how do we get more? That's our question. So that's where we're going with this work I'd like to open this up to your comments and questions because I'm only giving you one perspective, which is really the employer perspective I've touched a little bit on the education community We haven't talked at all about labor market. Where is the labor market the three dimensional model? So That's where we need more Let's hear from you guys. What do you what do you think about this? Okay board members one of the things that fascinated me just sitting in my little round table at castleton was the The insight that you had about Which schools offer employers opportunity? And there was a discussion as you would call about UVM being a great school But they also have a lot of out of state Students there that tend to come get trained and leave As opposed I think was for my technical college for certain of those nursing careers and norwich For other other of those careers. So maybe if you could talk a little bit about that that You know, there are pathways out there that You know that this system your approach revealed But to the person seeking that pathway it might not be readily Clear to them that that's the way to go So What tom's referring to is the talent flow analysis So, um, I I didn't really talk about that but that's what we just completed in the health care world So we asked people to look back over Um, they're quality employers Sorry, sorry quality employees in each of the categories of nursing We said go back and find all of the people who are still working for you. They'll work for you for at least two years meaning They're they are in the 25% category. You're um, these are people who have been with you more than two years and um Um What we want to hear is where did they come from? What did where did they get their education? Who was their previous employer and what was the recruiting source? So we asked everyone of the employers to upload their data on those specific people Knowing that this is only one quality indicator. Okay, so retention is just one of many quality indicators you could have You know any kind of Organizational performance reviews things like that, but this is one that's standard across all of the industry retention, so what we found was that Vermont tech had more people than Say UVM, Cassitin or Norwich Who were retained in Vermont hospitals and health care environments? So If you ask me to Describe why I would just say There's probably a lot of reasons why but some of them might be who goes to Vermont tech Vermonters who goes to UVM? Yeah, it's like 80 out of state nursing happens to be the hardest program to get into at UVM, so I'll just say Um, they have limited capacity there So they're able to take the cream of the crop Many of those are out of state students We do have a fair number and I don't know the actual number for the college of nursing. I'll just say In general, UVM has 80 percent out of state students and 20 percent in state Yeah, yeah, I was going to add that too part of that was DTC right now is the only school in the state that had cellophores and associate graders in the department two years Exactly and they also get a lot of non traditional students People going back to school. Yeah, maybe you can't leave you out going back to school for four years Two years is doable and these are people that are already living here in less than a year staying right and great description I mean, they're You guys could probably come up with many more ideas like that, but that's a great one. Yeah um I actually think that The way vtc has their program structured. It's a one plus one plus two Meaning stackable credentials their first year you get the lp of lpn And then lpn is not always a college program but vtc has credit Giving credit to that program if you were to continue at vtc For a second year you get your associate's degree now an associate's degree Will still get you an rm just like a bachelor's degree But now hospitals are looking for folks with bachelor's degree to improve The quality of their nursing so i'm just going to say quality Is measured in a variety of different ways if retention is one of them Having a bachelor's degree may or may not be the quality indicator that they need Um One of the reasons that employers are saying this is because There's some and about it. I'm going to look to you for help on this Is because there's some pressure associated with um being a quality hospital that says your nurses should be bachelor's degree Credentials so if you get a job as a registered nurse um If you get a job as a registered nurse You can do this with a two-year degree Um, and you can uh be working while you're getting your bachelor's degree That's what a lot of folks are doing Southern Vermont college has identified that um They want to become uh, you know, they want all their nurses to become bachelor's degree All of their registered nurses to become bsn's Bachelor of science in nursing And they have agreed to pay for The folks who are our ends to get their bsn from southern vermont college online or in person which is right there in their community And in return what they're asking people to do is to sign a commitment that they'll stay with the employer This is the kind of model that's an incentive that Builds better communities. It's you know a model that we'd like to see replicating other parts of the state so That's just one example I love what you're doing in southern Vermont Other questions Yeah, I had a question actually on this chart one of the things that surprised me was Kind of the consistency of the replacement positions across, you know, those the first like the four largest there and um Understanding 30 may go to retirement. You know, I wonder are some of them Shifting between other hospitals or some of them you know Just are totally shifting to a different profession. I mean that just seemed really high Especially when you would go across and say some of the education requirements are more than others So some of them if they're entry level from a high school You you may see them shift to other positions But if you've earned your rn either with the bachelors or the two-year degree to actually have so much in replacement Just seems like a big challenge Well, and I heard a variety of different things from uh, so I'll just say maribel plomo is um A colleague that I rely on for every every move that I make as I am not an industry expert So I go to maribel and I say why why do you think this and she said things like, you know when the economy is good A lot of nurses don't want to work full-time And you know when uh spouses get laid off and jobs are uncertain They want to go back so there's a variety of reasons why that um You know we can posture about but I I know that the turnover rate Has a lot of different economic influences not just I'm not happy with my work environment Sometimes it's you know, I can work days I'm not nice, you know or And those things are not really reflected in these numbers, but They are important, you know when you consider work environment The number one thing that we heard was that nurses are on the front line And they're picking up the slack for all of the workforce shortage that's occurring at the hospital, you know And it's because they're on the front line. There's nobody else to do it So they may be changing that they may be serving meals. They may be showering people They may be doing things that all those other jobs Typically would would do but nobody's there to do it. So everybody's working Okay, thanks sure Other questions So this seems like a really helpful demand side analysis of what is the Forecast to demand for nursing and I'm wondering if there's also been a supply side analysis looking at for example So you there's 3,900 vacancies roughly and we can expect How many nurses in all the various categories are currently in the pipeline that will be expected to Graduate in two years. What is the potential for enticing? Former nurses who have you know left the field to to recertify and come back in minutes or any Supply side analysis of how we're going with the gaff is actually going to be in terms of the pipeline versus Yeah, I I actually So when I sat down with maren dal from a heck She said we are we have our finger on the pulse of the supply side We can tell you here's how many people are in programs throughout the state I don't have all that data, but we could put it together I know there's someone here saying I'm just going to ask Do you have any of that anecdotally that you know of That seems like really important right so Yeah, is it 3 000 that we have in the pipeline of the You know We have five nursing programs in our state each one of them reported out at our summit, right? So, um, the largest one was about 120. Yeah, so we're so um, and that's In a year And like the majority of them i'm going to say in our chip like maybe 40. Yeah Castleton had maybe 15 it's about Two years ago. It was about like 300 came out of the line of school. So The north close So most of these nursing positions are going to have to be dropped to me there people in the state who may be up But largely it's going to be out of state Well, remember those are people who are going through the bsm program, right? um, and some of them are going through the Lpn at the therapy on tech These others these can be developed in other places. I I actually had this question. I'm like so we have a We need Some of these right license practical nurses Could this be developed at the center level It's a one-year program Um, they say, you know because you have to be 18 to do a clinical So i'm like Is that a regulation we can change? You don't have to be 18 to do this Why would you I I don't I just you know poking questions at some of the stuff that we have What if you were able to do this in high school And then you could do one year Vermont tech To get your registered nurse and then your hospital would pay for you to get the bsm That'd be good um, so there's a lot of different ways these things could happen that you could make You know get more people through the pipeline but We really have to come together and make decisions that are that lift all votes, you know So when we talk about this we talk about, you know the Employer getting something out of it and they're going to have to give something too And the educator who are getting something out of it because they're able to put You know more nurses through their program and have better outcomes for their students but really The labor market is the one who gets the most out of it because there's such a need out there and They are good jobs, but in many cases it looks like we have to reevaluate How we value time so i'm going to say in particular these two roles Need employer observation on how to do this better if we spent If we talk to them about nothing else those two things would Be a huge opening of a bottleneck Any other questions I guess we'll open it up to the audience Jill And I really appreciated your presentation at just the structure that you're sort of putting around this This issue my question that I was reflecting on after I left Was whether you're only focusing on nursing or if you're focusing on health care workforce in general It looks like you have PCAs on your list who are not you're not really it's not really a nursing position But it's certainly one that's really important in long-term care In particular and then also ptot and some of those other disciplines So, um, well we did our first one of the most critical jobs You can see here with eight, right? Um We we took the top 10 And so positions were in that And then we had another grouping that we called rehab services, which were occupational speech and physical parents Um, I let them do all of this sort. So here's where we see these in order to be effective in state of curve halfway The decision was made that we're going to focus on nursing and we called these jobs Yeah, I know we called we called these jobs health care assistants. Yeah, okay. Yeah They were on your list. That's why they're on that number. Exactly. Yeah, so, um It was really hard to eliminate because there were so many important ones and so much So so many of them Repeated over and over like duplications of them that we were like, okay Can we cut out so we call it we created four categories of nursing and we said, uh Nurse practitioner and advanced practice mental health nurse were going in one category because the training was relatively similar Nurse educator and clinical nurse manager was in a category called nurse manager and then Skilled nurse included registered nurse and lpn even though we know the training is not the same They're still administering and doing a lot of similar type of work And then we said lma's and personal care was like more like a health care assistant So when people answered it they answered it by job category But when we look to like training providers, we are sort of thinking, okay, you might have a similar level of education for these folks There might be some different Types of classes that you would create to make them good at what they do, you know, if you're upscaling existing nurses I agree, I agree. So I'll just say, um, I'm speaking on behalf of not myself On a group of other people, so that's the decision that they made so Every time we get them together we involve them in some sort of a workshop Where we're developing consensus and we're generating ideas and things like that. There's nobody standing up here like I am right now Blah blah blah blah You know, we're they're active members and that's why they're engaged So like when we do a survey, um, we typically get a hundred percent engagement in a survey because they're they're all there because they need to be there because they need Forks, so if they've chosen to become part of the employer collaborative They're there because they chose to be there We're not dragging anybody along Um, thank you right here Yes, thank you I had a somewhat related question to jills I think uh, but even stepping back a little further about how you define the health care industry or the employers you invited To participate it sounds like it was largely sort of hospitals and the continuation of sort of post-hospital care I'm wondering if you also included say The designated agencies or physician practices or more what I see is ambulatory outpatient employers Well, we could um, yeah, so these are just numbers that are representative of the subset of the workforce so We could include anybody at any point You know the idea behind this is we're building something that benefits the entire industry so You know That's right So we went to our regional firms and said invite all the health care Employers in your region and that's who came, you know, so I didn't create a list either. I just sent the invitation from John Bromsted to say, um You know, we're having this problem and we're we'd like to get together and share this collective impact model with you and then people said That's our problem too. Yes. I would like to do that um, so And at any point we welcome like I just added someone from DNA and several a lot. Yeah, so, um Because they asked can can I be part of this and I said, yeah, sure, of course um, let me share some of this with you and so we went through the model and and what the employers had You know already come up with and I said just do you think this is suitable for you? How does this work with your business? Do you you know, and I asked her a lot of questions and So now they're part of it too so honestly, um Being being a member of the collaborative is It's not a high bar. It's like, you know You have to say you you want to you know support it and if the contribution that you make is You will respond to any kind of survey that we put out And develop it in order to respond to it. So, um, you know, it's We try to be as organic as possible But also inclusive of anybody who who feels like this is part of their mission Yeah, thank you Thanks for the presentation Marianne. I'm Jeff teaming with the hospital association. I'm just curious Both demand and supply can be affected by factors within vermont and factors outside of vermont So the example I'm thinking of right now is the proposed mandatory nurse staffing ratios in massachusetts which would Create a huge demand for new nurses in that state and then would have You know an impact on our both supply and demand side of the equation So i'm just curious how and I know this is a piece of it But um, how your sort of assessment and analysis would would factor in those kind of developments um, so I haven't heard that before but like remember we're developing a list of like amendments that need to be reviewed and potentially that's a regulation thing that We want them to know about and also to be able to respond to in a way that you know Is appropriate. I I don't I don't have the answer to that one and I never heard that before But now I feel like I have to write that down Is that important? Yeah Good question though. Yeah I'm Ken Loverton and I've been a mental health advocate for many years And I I I I couldn't help but think when I looked at some of the projections on nursing That it's a very optimistic portrayal of the future if you compare it to what the mental health feel The substance that you feel might look like if you did the same study Think I think conditions would be much less rosy Than what you're projecting here One of the things that I react to though is the fact that I think it's important to begin to lay out this information, but I'm always Troubled by the fact that when employers And round-to-round table type people get together There they they got the world of the experts I think that you could really have a more full understanding If for example, uh, you would sit down in this case with groups of nurses And they could tell you I think pretty simply Why We're looking at a very concerning future In this part of the healthcare field again. I think this is a much more optimistic. So You know I I have to say that in my experience There are probably three or four things that you know, you would hear Oh, yeah, absolutely And you know, I hope you know, it's not the only the employer The reason that you know, I think that we have Appendement crisis is one we don't have necessarily Adequate payment for salaries for work done Now it's you know, there are big differences UVM medical Is in a separate category compared to The nursing home in your area. Yes, I mean totally different reality But uh, one of the reasons there's such an enormous turnover Particularly in the nursing home and auxiliary kind of thing is the treatment And the lack of real regulation, even though the regulation is not Useful. Yeah. Anyway, that's one. The other is that Uh, in many of these fields, uh It's really not very Wise to go into them because the cost of an education is so great That that you look at your potential You know wages Uh, you're not so so, you know, second part of this is I think, you know, somebody should look at the question Is there a way of modeling with some of these Business leaders in the round table to say we we have parts of our health care system that need help It should be help to reduce or pay back Um educational expenses And you know, and then the third is started the problem I think if you hear from people working in the field, there's certainly some tendency to be Overworked and underpaid and the overwork part. There's something that You can hear more about if you went into, you know, if you heard from people who are there right now Doing the work Nursing education, I, uh, very thank you Well, so I, I, I didn't mean to kick you off your mark I'm like, I wanted, I wanted to just say the people who were responding to the survey Were not with CEOs and presidents They were the chief nursing officers And uh folks in HR So we get sponsorship from the top level when we begin Yes, our organization commits to this And then there's a hand on so our first demand planning session We asked for the hiring managers So the people who are responsible Who really know what the needs of the industry are So I think we have, um, the correct people answering the questions on the survey But I'll just say, um, and developing the survey But, um, I, I have to agree with you on the, um, the cost of education and the salaries Well, what I hope to see come out of this is what we're seeing in other industries, which is a low barrier entry point That once you're hired by the employer, there's some kind of payment that, um, Is associated with upscaling to the next level So there are career pathways that are developed by employers That they'll stand behind, like the one at Southern Vermont College So, like, if, if, like, and this is just in my, you know, pipe dream here If you were able to graduate from high school or a technical center with, um, The, uh, licensed packet donors If, if that were the case Or say you were, um, that's a post high school program, a one-year thing that's No cost to a student Then you would have the ability to start working And get your associate's degree while you're working And the employer could pay for that And then the employer will, you know, potentially, uh, be able to help you get your BSN over a period of time So those are retention strategies that would, I think, work well with them But all these things have to come together, you know, so We don't have all that yet So, my name is Susan Blan, I'm an HR director at Washington County Mental Health And this all sounds great, but I want to think back on what Ken said We don't have the money to pay for people to continue their education Or to be competitive with the hospitals Or to sit on somebody's round table So it's, it's, it's a real challenge to hear about this And I think this is a much rosier picture in the private sector, in the health care, in the hospitals Than what we're seeing is, doesn't make any sense to my question for the group is, is their funding available? They help those employers, other grants, other, programs, and internships And you sit on these councils and get some traction So, is there a part of the labor, like I said, those real funds at the beginning Those are, um, Workforce Investment Opportunity Acts So the way that that funding works is, you have to show that there's a demand Because employers say that they need it And if you do that, there can be a funding stream for training that goes along with that From the Department of Labor So we work really closely with labor to make sure that these things are laid out properly Um, in the past, the Department of Labor has distributed BOA funds in a different way They actually asked, um, people who were doing training to, uh, get themselves on this list Of approved training providers And if you were on that list and someone came and said, I'm eligible for real funds, oh, let's see Good, we'll give you some money That's how they did it in the Department of Labor Well, I think if you're getting much more knowledgeable about, okay, we have data that supports this We can put on an entire program that lasts a year We can do an apprenticeship program We can do, you know, there are lots of different ways that they can do it And apprenticeships are one of the things that are coming up From the TV show The Apprentice Apprenticeships actually are receiving a lot of federal funds So I think that that's going to be one possible route You know, I haven't put all these pieces together totally, but you can see that there are connections Um, and it's a matter of us, uh, having some real down-home communication between all the parties to make it work And that's how collective impact will benefit, you know, this entire industry You know, we can't have, um, Helps over here doing one thing and over here saying another Without, you know, actually having a dialogue But I actually thought that meeting at Castleton was really helpful because you got to hear A variety of different viewpoints And it was really just a dialogue. It was like a starting point for, um, all these folks who are You know, from different, uh Parts of that sector, you know, where the educators, where the employers, where the, um Where the stakeholders, where the board members from Green Mountain Care were, you know, and and It was a really good dialogue to continue that happening You know, the the point of having meetings In my opinion is not to hear someone share their stuff It's more of a, um, let's hear from you. And so that's why, like I really I find that this dialogue that I'm having with you guys Is a tremendous value to me So, yeah To just be creative think outside the box about how do we attract nurses to this state? I mean salary is an issue. We are ranked 47th Um for nursing pay adjusted for cost of living Um, obviously we're not going to make great strides in that in the next two years So what else can we be doing and I heard him mentioned like the massachusetts initiative I'm not 100 sure I agree with everything in their initiative But stuff like safe staffing ratios stuff like no lifting policies That attracts people because they know they're going to be safe in their assignment And they're not going to break their backs to their next lifting patients So there's other things that can be done to make this an attractive state for nurses to come to I'll be even heard things like, you know, shift Changes that would attract people who are studying while they're While they're working and then also shift opportunities for people who are in their senior years Because a lot of those folks feel that they can't do a 12 hour shift anymore But does that mean that they can't work in nursing? No So there's a lot of more creative and innovative ideas that are coming from these folks And I think that, you know conversations like this You know instead of complaining about them, we need to put them out there and say Here's here's the way we could improve How can you help us? We need these things, you know, and I think that it will I Can't say it's all going to work out. But you know, I think it's going to improve. I mean, that's That's a positive Yeah, thank you Thank you Is there any Old business to come before the board? Is there any new business to come before the board? Same none. Is there a motion to adjourn? I move to adjourn Is there a motion to adjourn? I'll hold some favor signify by saying aye