President’s Podcast: Answering the state’s nursing crisis

ACC President/CEO Dr. Richard M. Rhodes discusses a solution to the state’s nursing crisis in a President’s Podcast featuring guests Megan Snay, a May graduate of ACC’s nursing program, and Greg Hartman, chief of external and academic affairs with the Seton Healthcare Family. The three examine the impact of Senate Bill 2118, signed into law by Texas Governor Greg Abbott on Monday, June 12.


JESSICA VESS: Welcome to the President’s Podcast at ACC. I am Jessica Vess, and I’m joined by ACC President/CEO Dr. Richard Rhodes. Today, we are talking about solving the state’s nursing crisis.

RHODES: It’s a need. It’s a critical workforce need in Central Texas, but not just in Central Texas, for the state of Texas.

JESSICA: And we also have a couple of guests with us today. I’d like to let them introduce themselves. 

MEGAN: My name is Megan Snay. I am a recent graduate of the ACC ADN program as of May 10th, and I’m happy to be here.

GREG: And I’m Greg Hartman. I’m the President of Academic and External Affairs for the Seton Healthcare Family.

JESSICA: Well, nice to have you all with us. We’re here talking about solving the state’s nursing crisis or helping to do so, and that’s really done through a special program at ACC.

RHODES: What we have here in Central Texas, we’ve got about 7,500 nurses who are working in hospitals, doctor’s offices, clinics, and so forth, who have an ADN, or they’re licensed nurses. They’re registered nurses, and they’re practicing. They’re working right here in Central Texas. By 2020, 80% of the nursing workforce in the hospitals are supposed to have Bachelor’s degrees, but they need a good accessible, affordable pathway to go from the RN to BsN. And we just—we believe that it’s critical as a part of—you know, our name is “community”—that that’s our mission, is to provide that affordable, accessible pathway. For those RNs who’re working here, they stay in Central Texas, and they work here, to have that pathway and get their BsN.

JESSICA: Absolutely, and Megan, you’re facing that right now yourself as a recent graduate of the ADN program. That’s the Associate’s degree in nursing. You recognize fully the need to get your Bachelor’s in Science in Nursing.

MEGAN: Absolutely. When you graduate from ACC, you almost always go directly into the workforce. We have awesome rates. It’s the exception for nurses in our program to not be immediately employed, which is wonderful and part of what drew me to ACC in the first place, that you hit the ground running. Nurses in Central Texas who’re graduating as Associate’s degree nurses, for us, we know that this is just the first step. We’re just getting started. What’s wonderful is you get this entry into the workforce. Most people who’re going to community college are already non-traditional students. You do it because you need a career. You want to move into something that has room for growth, and the best way to do that is to enter the workforce as quickly as possible so that you can support your family, pay your bills, keep yourself sustained as a human being while still continuing your education. And so for me, the biggest thing now is: Where do I go for that higher level of education? What are they going to offer me in terms of support? And cost. And so for ACC to be able to offer this Bachelor’s degree program essentially answers all of my needs and allows me to maintain my commitment to staying in the community that has provided me this education. Part of living in Austin and being a student in ACC has been this symbiosis of… I get a wonderful education, and I get to go and be a part of the workforce in the community that made that possible. My next steps personally are, you know, integrating my professional development with continuing my education, which, like I said, it’s not an if, it’s a when. This is an inevitability. This is something that I know I need and want personally moving forward in the workforce. I think it’s important that the audience understands that the differentiation between a BsN-educated nurse and an ADN-educated nurse is no different in terms of licensure. We pass the same exam. We study the same curriculum. What ACC has offered is essentially a fast track to get you started in the workforce. But what the workforce sees why we have the 80-20 rule you’re talking about, where 80% of nurses need to be Bachelor’s degree educated by 2020, is that—and this is every nurse’s goal—better patient outcome. We want better healthcare outcomes, and you achieve that through higher education. So for us, to be able to reach that goal more affordably, more locally, is a benefit not only to the nurses in this community, but every person in this community who is a healthcare consumer, which is hopefully most of this community, you know?

RHODES: Right.

MEGAN: This touches beyond the scope of healthcare. This touches the community as a whole, and so I think it’s a really exciting step, and I’m really looking forward to seeing where it will take us.

RHODES: You know, and we know that there’s some online, purely online-delivered programs, and they’re good programs, but you know, one of the things I always think about is a lot of the responsibility of a nurse is social interaction with patients, and one of the things we want to do at ACC is make sure that those last two years, that there is the social interaction between the nurse and teachers so that a hybrid program to where you get some online and you get some face-to-face. That’s what I hear from nurses out in the field, that they would like to see—that they would prefer to have some face-to-face time in that last two years.

GREG: And I can say from the hospital’s perspective, from Seton’s perspective, that’s really important, too. What we’re really finding is when there are mistakes, when there are problems, it’s that communication issue. GREG: And you can have someone who’s really smart, and the communication with the doctor and the nurse, or the nurse and the nurse, or the nurse and the therapist, or the patient and the nurse isn’t effective. That’s a real problem, so I think that’s right. We really appreciate, from our perspective, having those programs. Online’s great, but you got to have that social interaction. You got to have that ability to know how to communicate with different types of professionals and what their priorities are and those kind of things as well, too.

RHODES: And that’s kind of a focus of those last two years, to get that type of relationship. Supervisory, managerial type of experiences and that’s communication, exchange in dialogue and, you know, having those conversations. You know, one thing I would just like to make sure everybody knows, too, because I’m so proud of our nursing program here at ACC, is, you know, if you take a look at the past rate on the NCLEX— and I know you’re going to pass, have no fear—that the past rate over the past five years has averaged 95%, and that’s pretty much unheard of. And so, a past rate going through a two-year program, 95% of the nurses pass it directly into the workforce. And most universities would die to have a 95% pass rate for their nurses after four years, and so our faculty, our staff, our students are just fantastic.

MEGAN: I’m glad you both touched on two points that I think are really, really important here and worth mentioning. One, we have an incredible pass rate, and now that I’m transitioning into a graduate nurse role in the workforce, you know ,when I check in to pick up my newly-embroidered scrubs or get my schedule and everyone says, “When do you sit for the Boards? When are you sitting for the Boards?” “June 19th.” “Where’d you go to school again?” “ACC.” “Oh! You’ll be fine. You’re going to be fine.” Our institution is recognized for its success. The nurses that ACC produces are top-notch, undisputed with the healthcare providers in this community. And that’s just such a wonderful, comforting thing as somebody who’s about to face essentially the largest test of their lives is that the confidence the community has in our program is so outspoken and so wonderful that for us to be able to take it to the next level is only the next natural step. And something else that ACC has provided us aside from our awesome NCLEX pass rate, which is phenomenal: We have one of the highest hours required in our clinical programs. We spend more time with our patients in the facilities in this community, who are gracious enough to have us, than most other institutions. There are minimal standards in terms of those hours that need to be met for accreditation, and ACC exceeds them. We go much, much closer to the maximum. And I don’t have the exact numbers, but I know that we are very much on the high end of that face-to-face interaction with our patients and that high number of clinical hours. And that, I think, is what sets this foundation in terms of that communication you’re talking about. A big component of nursing in my very humble and short experience is that in order to be effective in your job, yes, you need to be able to safely administer medications, and yes, you need to be adept and practiced in your skills, but above all else, you need to be a good communicator. And so to take that communication to the next level, which is what the Bachelor degree offers us in terms of the higher-level management curriculum is going to have people who have a really wonderful foundation in their profession and their practice alone, because nursing is about communication, and saying, “We’re going to help you to further hone this so that you can be the most effective nurse possible,” while still meeting all of these requirements and demands that the current sort of environment and culture that we’re in in nursing, which is—I mean, some refer to as a crisis. We’re facing a shortage. This just really changes the tone of the conversation, so it’s less about being a crisis and more about being as effective as possible.

GREG: And I’d like to add to that because that’s a really good point. There really is a crisis. We’ve averaged close to 500 nursing opportunities openings at any one time for the last couple of years, and in Central Texas, I think the number’s, like, 2,000 openings right now, so there’s a—you’d call a shortage. And that’s even with the work we’ve done with ACC to add to the program and create the clinical education center and some of those kind of things. We still have the shortage, and so this really is critical. That’s one reason for Seton. This is one of our highest legislative priorities during last session, and that’s even with all of the other things going on in healthcare. I mean, healthcare is in a time of transition now with all the Medicaid changes and all those kind of things, too. This was still one of our highest priorities. Part of it is to fix that pipeline because we need more nurses, but part of it, too, I’ll also endorse what you said about ACC nurses. We love ACC nurses. You all are great nurses. You hit the ground running. It’s just a great program. And then also, when someone comes from a community college program, they’re more likely to stay in the community, and that’s a huge thing because there’s a nursing shortage not only in Central Texas, but all over Texas and frankly, big parts of the nation. There’s lots of folks coming in and, you know, wanting to pull our people out and take them to Houston or to Los Angeles or whatever, but community college-trained nurses, not only are they great nurses, but they often are real connected to the community. They have families. They’ve been around. That’s why the ACC experience was so good for them, and it’s just a wonderful investment for us to have those kind of nurses to be able to hire.

RHODES: And I just want to say thank you to Seton and thank you, Greg, because every time we needed testimony—and you really put into practice your support, and every time we needed testimony, somebody from Seton was there to testify for—whether it was a House Higher Ed Committee or the Senate Higher Ed Committee, but you were always there and critical to see the support from the business community, the hospitals, there to say, “This is important. This is a critical workforce need for Central Texas to allow ACC then to provide this opportunity.” So I just want to say thank you—

GREG: You’re very welcome.

RHODES: —for the support.

GREG: It was easy for us. When the bill was passing, you know, that last weekend, there was probably as many texts going on [inaudible] because there was so much excitement for you, they do have it bad. We love being a partner with you guys.

RHODES: The other part that made a really good impact to legislators is to hear the voice of the students, and so we had student testimonies during that time. Incredible. Incredible. And I think that’s why it made it through the legislature this year. Soundly. I mean, the vote was not even close. And so it took a lot of hard work, but well justified.

GREG: And that’s a big deal in a session where there were very few things that were unanimous in this legislature session, so the fact that this passed with the sort of support it did actually says something about it because most of the time, they had a hard time deciding, you know, whether it was daytime or nighttime, you know, but the support behind this bill was pretty positive from all sides of the aisle and from all different parts—

RHODES: It was.

GREG: —of the political spectrum.

RHODES: And Megan, I just—you know, you had touched upon clinicals, and basically, you’ve done all of your clinical necessary to sit for the NCLEX in those two years, and so, you know, some concern had been raised, “Well, it’s going to take additional clinical space away from, you know, if we allow ACC to offer for a four-year BsN,” and it really doesn’t because clinicals, for the most part, have already been done, which is why we hear testimonies. And I’ve got to give you one quick short story that, you know, was just, I think, a couple of years ago. I went to my dermatologist, and she didn’t know who I was, and so after she was done burning the spots—because I was a bad boy, I didn’t put sunscreen on—so when she got done burning all the spots on my forehead and face, she said, “So where do you work?” And I said, “Austin Community College.” And she said, “So what do you do there?” And I said, “Well, most days, I’m the President.” Occasionally, I don’t claim that, but she immediately got this big smile on her face, and she jumped up, and she ran over. She closed the door, she came back, and she says, “I just have to tell you, you have the best nursing graduates. I spend no time trying to train them once I hire them. They are ready to go, and I can’t say that about some of the other institutions.” So, you’re ready. 

JESSICA: It’s fine, you’re there.

RHODES: You’re ready.

MEGAN: It’s so wonderful to hear that. I wish I could articulate more effectively the warm and fuzzy feeling I get talking about being—this might be the first time I’ve said it out loud—an ACC alum. It means so much to know how much our community supports us because nursing is hard. I know that the obstacles in front of me in terms of the career that I’ve chosen will be innumerable, but to know that the institutions that have provided us the clinical hours that we’ve had to now—which I have to take a moment and thank Seton for that because I’ve spent a good amount of time, especially at Dell Children’s, which was wonderful—to know that we’re going into this workforce with this community support behind us is just one less thing to worry about from the perspective of somebody who’s, you know, going into essentially personally-uncharted territory. Many have come before me, and many will come after me, but my personal journey in a community that has been so supportive is just such an important thing. I can’t drive that home enough how much that means to me. From the moment I began taking classes at ACC, there was always somebody there to help me get to the next step. And it’s not just the nursing program, and it wasn’t just the nursing faculty. The administration, the advisors, the financial aid department, this school in its entirety has really dialed in what it takes to give students all of the resources that they need to be successful, and that’s something that I just—I was not expecting that. You know, when I started, I thought, “Well, you know, here goes.” And often, for students, the biggest part of navigating higher education is managing the administrative side of things. How do I get registered? What do i do to get my student ID? Where do I go for this? How do I coordinate my financial aid? And from the get-go, ACC hit the ground running so that I could do the same, and now I move forward into this career where I’ve got all of this support behind me and I can hit the ground running in the same way, and I hope that I can give back to this community that has given me so much, and that’s a big thing with this Bachelor’s program for me personally. I don’t want to give my money to someone else. I want my investment to stay in this community. I want my education to be centered in this community, and I want my career to stay here. I feel personally indebted to a place that has given me so much, and for me to be able to continue my career here and give back for an extended period of time and to know that my financial resources will be allocated back to that institution is something that I take very seriously, and I want other people to know that that is a place of political and social power that you have as a student, and ACC, doing all of this work to allow this Bachelor’s degree program, is going to allow all the nurses in this community to do the same. And to turn around and say, “Hey, community college, Central Texas, you supported us through this degree plan. I want to turn around and start to give back. And I want to take it further,” and this allows us to do that, you know? I’m just getting started in my nursing career. I’m so excited. And to be able to get affordably into a Bachelor’s degree program has started turning gears in my head for things like, “Oh, maybe I can teach some day. Maybe I can really give back, you know?” If you had asked me five years ago what I thought I’d be doing with my life, I never in a million years would’ve thought that I would be sitting at this table right now discussing something as monumental as this.

GREG: You know, I think it’d be a mistake if we didn’t point out, too, that so inspirational what you’re talking about there, too. We’ve talked about how good a job ACC does and folks like you. You know, this is a unique time in Austin, too, that we have to recognize, and ACC’s role in that is significant. My role in Seton, I get to work with the new medical school quite a bit, and that’s not only a big thing, but it’s bringing—I mean, you’ve heard about recently the Merck pharmaceutical company coming into town, and there’s all sorts of new start-up entrepreneurs coming into town, but there’s a lot happening in that whole Innovation Zone area, which I know ACC is involved in that as well, too. So the future of Central Texas is—we have a shortage now. Frankly, it’s going to get probably worse even in some time because we’re going to have so much healthcare moving into those community. And not only just traditional healthcare, but healthcare that really is redefining what healthcare is and what it looks like in this country. Because of that, that medical school and the medical school I know in UT were supportive of what you guys were doing here, and it was a great—you know, I think everybody knew this was a really good thing to do, and I think that’s not only a maturity on everyone’s part, but also just a recognition of this community. We’re about to write something big here, and if we don’t have the right nurses to do it, all this other stuff doesn’t work. And so, it’s just a big moment here, and so ACC being such a critical part of it, that probably had something to do with the overwhelming support you guys had for this, but it really isn’t—This community, I think, people realize there’s about to be something big, and ACC’s right at the front of the line.

RHODES: You know, I mentioned the business community has been strongly supportive. The Austin Chamber of Commerce had people testify on our behalf during the session also. But I also—you know, for your benefit, Megan, you just need to know that you have support from legislators from right here in Central Texas, and you know, I’ll point out a couple specifically who really carried the water for us strongly. In the Senate, we had Senator Kirk Watson who just went above and beyond, I think, anybody’s expectation to make sure that this happened. He worked really hard. And then in the House side, Donna Howard who, you might know, she’s a nurse—

MEGAN: Also a nurse—

GREG: She’s a nurse.

RHODES: Also a nurse.

MEGAN: Sure is.

RHODES: —who worked the House very aggressively to help make this happen. So they see it. The legislators here in Central Texas, our delegation sees it as a strong need and a critical need for the workforce here and for all the reasons Greg talked about. I mean, this is going to be an explosion. I had the opportunity to go with Geronimo last week to Boston specifically to look at how they’re coordinating health care. Health care education, health care delivery and service, and the collaboration among different institutions, whether it’s education or hospital. One of the things they brought up in out visit there is 20% of the workforce in Boston is in health care. 15% of the workforce in Boston work for hospitals. And I think, you know, as we see the four-year medical school and as we see the pharmaceutical companies, we’re going to see the same thing begin to happen in Austin.

GREG: Yeah, you can see it already.

RHODES: And I just have to tell you, too, I have a real spot in my heart because my mother was a nurse. Actually, Senator Watson’s mother was a nurse also and so one of the reasons why he’s a strong advocate. But I have a strong passion, too, because my mother was a Navy nurse and physically at Pearl Harbor the day it was bombed—

GREG: Wow.

RHODES: —in the operating room. So, you know… Knowing what nursing meant to her over my life has made a big difference. This will probably get edited out of the tape, but, you know, when she went through nursing school, she went through nursing school in Chicago, but then she entered the Navy and… But the training then… I swear, when I was growing up, it didn’t matter what I had—a cold or whatever, the flu or whatever—her way to get rid of it was to hang up this enema bottle on the back of the bathroom door, and she said, “If you get sick, here’s the solution.”

GREG: Probably worked for you damn well, too, didn’t it?

RHODES: Yeah, well, I never got sick.

MEGAN: Wise woman. That’s very clever.

RHODES: And I got to tell you, too. So during the legislation session, one of the things that made a great impact is to have the student voice, have the student testimonies, and our students just did an outstanding job of that, of giving their story because, you know, I can supply all the data necessary to prove a critical workforce need, but legislators need to put the data with the face of the student and to hear the voice of the student. There’s one student that I remember specifically that talked about, she graduated from ACC, went to work for a local hospital, needed to go back and get her BsN, had to do it on an online program, and the end of her testimony, she said, “I made it through, but I have debt of $23,000.”

MEGAN: I think that’s another really important thing to consider in talking about student loan debt. In community colleges one of the things that ACC’s worked very hard to include in this legislation and the Bachelor’s degree program is that this offers the potential for a Bachelor’s degree program for $10,000. Not $10,000 to bridge from your ADN to your BsN, which is about average for the going rate, I’m currently shopping around, I know pretty well, but to start and finish for a sum total of $10,000 vs. the $23,000, you know, which is pretty average for most students. And I think student loan debt is averaging a little bit higher than that overall. The ability to have a hybrid program, which is what ACC is hoping to accomplish, gives students that face-to-face connection that ties back into that communication and that support, that allows us to do more than just make it, you know? It opens those doors to other bigger, better things, and you know, with our nursing shortages in this community, we don’t need just bedside nurses. We’re going to need nurse leaders. We’re going to need nurse managers. We’re going to need nurses who are willing to go into roles above and beyond the bedside, and to do that, we need higher education. We need more education, and we need a good education so that we can do that effectively, you know? And the nursing workforce is the majority of the workforce in most healthcare institutions. I can’t say that factually, I don’t know what those numbers are, but we all know that—

GREG: It is.

RHODES: It is.

MEGAN: That is the bulk of the workforce.

RHODES: It is an overwhelming majority.

MEGAN: And so, for them, to be trained effectively and to bring in better and more effective nurses, you have to set precedent with the best training possible. I think, moving forward with this, we are doing absolutely everything within our power to make that happen, and that, as a future nurse, makes me very happy.

RHODES: And one other thing I’ll have to tell you is that we just recruited Greg to be a member our Foundation Board to help us raise money for nursing scholarships, and so we want to make sure not only do you have the access, that it is affordable, but we want to make sure that we also provide some assistance through scholarships to help our nurses get through.

MEGAN: Wonderful. Well, thank you.

GREG: It was an easy improvement. I think I even paid for lunch. Well, you know, part of it is I really believe in community college. I think they’re just so critical. I attended community college myself, too. I also believe in ACC programs, too. And also, not only are nurses the majority of the workforce, good healthcare is built on the back of nurses. I mean, the reality is there’s lots of people who make nurses, who make healthcare work, including physicians obviously, but if you don’t have a great nursing workforce, you don’t have a healthcare system, and so all the change we’re about to go through is just going to emphasize that even more because it’s becoming more and more about care at the bedside, care at home, you know, avoiding people getting really sick, and that’s all about nurses doing their job, so good nursing is critical to the success of healthcare.

MEGAN: I think that’s a really interesting and very valid point you’re making about the general population in terms of healthcare and that we’re looking, and you know, Seton has this wonderful human care, which I thought was really clever the first time I heard that because what nursing is is, it’s about caring for a person holistically. We’re looking at them in their entirety, and as medicine evolves and changes and healthcare evolves and changes, we as a people are looking at medicine more preventatively and proactively than we are reactively. And with that, we’ll be an evolution in nursing. You know, there are things… We already have home care nursing, and telenursing and telemedicine are really taking off as a way to allow people to be more proactive about taking initiative with their health and taking it to the next level and allowing them to intervene before things become chronic conditions or crises or emergencies. And if we can keep our nursing workforce here and at the edge of that and always one step ahead and looking to the future, we’re going to allow our community overall to flourish in a way that if we didn’t have these resources, I don’t—I don’t think would be as possible.

[murmurs of agreement]

JESSICA: Well, it’s an evolution in healthcare as you mentioned, and this is definitely something that would be an evolution in education, in higher education.

RHODES: Right.

JESSICA: Now, RN-to-BSN program at ACC can help solve the state’s nursing crisis.

RHODES: And I want to thank Megan. Thank you for taking the time to be with us. Greg, thank you for being with us today.

GREG: Thanks for inviting me.

DR. RHODES: And thank you all for joining the President’s Podcast.

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