LACONIA — Eight people.
It was a slim turnout to a Lakes Region Community College recruiting event geared to easing the region’s health care staffing shortages — but sincere interest is better than none in a landscape still reeling from COVID and trying urgently to fill vacancies, according to workforce advocates.
Over the next 10 days, training program coordinators at Laconia’s community college are hoping to boost enrollment in fast-track courses that begin early next month and lead to becoming licensed as a nursing assistant or medical assistant — two positions in demand statewide as outpatient medical practices, nursing homes and hospitals jockey for staff with skills.
“I like working with people,” said Joe Sawyer, 22, of Gilford, who came to LRCC’s health care open house Tuesday. Sawyer took courses at Plymouth State University and hoped to become a social worker before deciding nursing aide would be a better fit. Since fall of 2019, he’s been grappling with what to do, volunteering in the community and for Easter Seals. “I think I’ll get satisfaction out of helping people. It’s always what I wanted,” Sawyer said. “I think I’d like to work in a nursing home. That sounds just about right for me.”
Health care instructors and local employers are counting on more to answer the call.
“There’s been a steady increase in demand. The health care sector continues to expand. It’s a huge employer in New Hampshire” as well as in the Lakes Region, said Andrew Duncan, workforce development manager at LRCC, who makes connections between employers and workforce needs and training programs at the local two-year college.
Marty Pasquali, RN, the department chair for nursing, said that although interest in nursing has held steady for decades, there’s been a lull in enrollment in the last few years in the college’s licensed nursing assistant program, and inquiries into the medical assistant program are also lagging.
“I don't know the public is aware that there’s a demand for medical assistants, or really knows what a medical assistant does,” Pasquali said. Medical assistants escort patients to rooms and take their temperature and blood pressure, usually handle billing and insurance, and often give inoculations and wound care, and assist doctors in minor outpatient surgery. They’re the go-to person in an outpatient office — a career that is expected to grow by 18 percent, according to federal labor department.
Right now, throughout the Lakes Region, it’s all hands on deck and Pasquali is worried about the lingering effect of COVID on the mindset of job seekers. “There’s still an interest in nursing, but COVID has brought to the forefront the workload and how nurses are exposed. The info out there now is how hard nursing is” — which has always been true, but the demands intensified during the pandemic. “People are having a moment when they hear, ‘This is a hard job. We love you and you’re heroes.’ Every day is hard work, so you’ve got to love it,” said Pasquali, who’s been a nurse for 40 years, and hopes people of all ages will catch the health caregiving bug.
Another hurdle has been retaining nursing and nursing assistant students. In recent years the average demographic has dropped from people in their 30s to late 20s, including many single moms overwhelmed by juggling school, work and child care. Nursing school itself is hard and time-consuming, with the level of difficulty increasing with each semester, Pasquali said. “When life interferes, they jump.”
“We need RNs everywhere because of the acute needs of patients across the board,” whether they’re 25 and recovering from surgery or 90 and in long-term care. People are sicker and living longer — which leads to a building demand for all medical personnel, including LNAs, who provide direct patient care, and medical assistants who assist doctors with routine checkups, office visits and front line care.
It’s unknown just how many health care workers are needed now or in the future — statewide or in the Lakes Region. But a September survey of eight health care providers in the North Country may provide a snapshot. Two out of six nursing homes and three out of four hospitals responded, and showed staggering vacancy rates, which are being addressed by low-cost, local training. The eight responding facilities and providers reported a 44 percent vacancy rate for LNAs, 25 percent for licensed practical nurses, a 33 percent vacancy rate among physicians assistants, a 38 percent vacancy rate for lab technicians, and a 40 percent vacancy rate for mental health substance abuse social workers — compared to full staffing levels, said Lynn Carpenter, director of NH Needs Caregivers, a workforce development non-profit that connects students to subsidized learning opportunities.
Her hope is to expand programs statewide, especially in areas with strategic need.
When combined with online and phone registration, three candidates who came Tuesday to LRCC’s health care house will make just enough to run one, eight-week course starting in early October that leads to expedited licensing as a nursing assistant — a physically demanding role that requires a caregiver’s heart.
It’s half the interest in nursing assistant programs LRCC witnessed 10 years ago, when 16 students were enough to hold two classes, said Cathy Weigel, coordinator of the school’s LNA training program, which has been in existence for 24 years. COVID and remote learning temporarily dampened participation in college courses, including those that lead to technical certification or two- and four-year degrees, Weigel said. Last year clinical training became a tense hybrid of on-site practical experience, and medical procedural learning through dummies and online teaching modules — an LNA program approved by the New Hampshire Board of Nursing.
Weigel finds encouragement in the personality and motivation of current LNA applicants. The ideal prospect is “somebody with compassion who can build a trusting relationship. LNAs get to know people and need to understand that person as a whole,” their physical, mental and social attributes. They need to have good observational skills, and be a team player. “LNAs take care of people, sometimes for years” — becoming friends as well as emotional stand-ins for absent family members, she said.
Hannah Barnett, 23, has worked as an LNA at Merrimack County Nursing Home for four years, and now hopes that concentrated training at LRCC will fit her schedule and enable her to work as a medical assistant, perhaps in an outpatient primary or specialty medical practice. “I do like helping people, and making an impact,” Barnett said. “I think I’ll be content as an MA. It’s the right amount of education for me. I’ll be comfortable with that level,” and not tempted to go on to become a registered or licensed practical nurse.
For five years, Jazmyn Coulter, 24, of Laconia, has worked for the home care agency No Place Like Home. Her role consists of helping older and often physically frail and medically compromised adults with the activities of daily living, such as meal preparation, housework, grocery shopping, and getting in and out of the shower. She came to LRCC’s open house, hoping that becoming a licensed nursing assistant will open doors.
“I love helping people in their home,” Coulter said. “Nursing homes aren’t always an option for people, and they don’t work out well for some people. It’s always better to have people comfortable in their own home” when that can be safely done. “LNAs can do wound care and that helps people be more independent longer.”
Coulter said her mother and grandmothers on both sides are LNAs, and 17 members of her extended family are in the nursing field. Coulter is not sure if she will advance to become an RN or LPN. “I know I like home care, but it would also be nice to see the hospital and nursing home point of view.” Becoming a home health worker or an LNA is akin to becoming an adjunct family member, she said.
The decision to enter direct care is something nursing educators hope more students will make, especially in one of the state’s oldest counties, along with Carroll and Coos. In the past decade, participation in the LNA program has dropped, said Weigel. “We used to have double classes. I don’t know what happened. I think some of it is pay. Other jobs paid more and nursing homes paid less.”
But steadily increasing demand for LNAs that spiked during COVID has ironically led to more opportunities. Many facilities now offer signing bonuses, tuition reimbursement, and better pay and benefits to attract and retain newcomers who might be tempted by other careers — or by higher-paying entry work without potential to move up a ladder.
Mandy Hopkins of Northfield has been a medical assistant for 15 years, and now teaches the clinical section of the MA 12-week course at LRCC. She believes the job is underestimated and often misunderstood. “The diversity I’ve had has led me to other settings, from primary and specialty care to nursing homes and home care,” she said.
Along the way Hopkins acquired a bachelor’s degree in psychology and a master’s degree in human growth and development, and now works as east coast account manager for Utah-based Orriant Wellness Company, promoting well-being in the workplace.
She describes working as a medical assistant: “Everyday was something different. I had one-on-one interaction helping people jump over little milestones. My patients were like my extended family. We’d build relationships, rapport and trust. I was that first line before the doctor. If you have the desire to work with people and feel good about what you’ve done each day, this is the field for you,” she said. “If you like holding people’s hands and helping them through their problems, this is definitely the right career. You have to be a people person, someone who listens. The thing we all have in common is we all want to help.” Unlike many entry jobs in health care, this one is typically Monday through Friday, 8 to 5 p.m., compared to LNAs, who typically works nights and weekends to start.
“We’re in desperate need of medical assistants in this area,” said Donna Morgan, coordinator of the LRCC MA program. A career developed in the 1940s to support doctors in private practice who couldn’t afford to hire full-time nurses, the medical assistant position has taken off and now involves a gamut of responsibilities from medical coding to drawing blood and administering EKGs. One obstacle to becoming a medical assistant is likely the cost of training: LRCC’s 12 week course that begins Oct. 11 costs $4,985, down from roughly $6,200 in previous years. The LNA course is roughly $1,402, which is reimbursed 100 percent by Medicaid if the student works in a nursing home. For people who are unemployed or underemployed, funds through Workforce Innovation Opportunity Act can pay part or all of the MA training bill.
When it comes to registered nurses, “staffing is so short right now, they’re hiring directly from school into the emergency room and obstetrics,” said Pasquali, adding that Colby-Sawyer College, Southern New Hampshire University, the University of New Hampshire and the state colleges will accept LRCC credits toward a RN-BSN degree.
According to 2018 statistics from the New Hampshire Economic and Labor Market Information Bureaus, average salaries in New Hampshire ranged from $26,042 for starting LNAs to $35,173 for those with experience, but those numbers have likely risen.
In comparison, 2020 average salaries for medical assistants in New Hampshire run from $33,280 for entry-level MAs to $41,496 for experienced MAs. Registered nurses in New Hampshire start at $57,137 on average, but earn up to $84,552. The cost of LRCC’s two-year RN program is roughly $15,000.
By starting at LRCC, which includes experience at local job sites such as the New Hampshire Veterans Home in Tilton and Concord Hospital-Laconia in Franklin, “You’ll get confidence going in and confidence is huge,” Pasquali said. “You have to not get discouraged and keep at it. There’s a lot of hard work (in nursing), but it’s worth it in the end. Quickly get yourself up and running as an LNA or MA.”