Tom Hefner, acting for chairman Mike Lewis, opened the meeting.  On motion (Hutchinson/Atkins), the minutes of the May 14th meeting were approved on motion (Ferrari/Nemitz).

Nursing Shortage Study Commission

Dr. Patsy Haslam, chair of the Commission, reported that:

  Nursing shortages are not a new phenomenon.  There were shortages in the early part of the 20th century, which led to the development of hospital training programs with at least one RN as a teacher. Visiting nurses associations were organized to provide care to an influx of immigrants. During WW II, there was a shortage, so a National Cadet Student Nurses Program was begun.

Nursing has always been sensitive to economic cycles. Today's shortage is somewhat different.  There's been a steady downhill trend because women have more career options.  We could be facing a more critical shortage if nurses in Reserve Corps are called up.

In 2001, the Legislature created the Nursing Shortage Study Commission in the nurse licensing board.  Their report is due February 1, 2002. There are 11 members: two from the licensing board; one from a school of nursing; two employed as hospital RNs, two RNs from long-term care; one hospital administrator; 1 doctoral-level researcher, and two public representatives.

The Commission has three subcommittees: (1) data analysis; (2) recruitment of students; and (3) retention of nurses. The Commission has monthly meetings, which are open to the public. They have looked at data on shortages and heard presentations from experts at the WV Hospital Association and the WV Bureau of Employment Programs.  They've also reviewed Catherine Nolan's data.

The Commission is organizing public forums through October to identify issues from working nurses.  Also, nurses are encouraged to write to the board.

Retention is a problem because we aren't replacing nurses or nursing faculty.  Salaries aren't keeping pace.  Staff nurses aren't speaking well of the profession, which discourages students.

 In response to questions, Dr. Haslam said that West Virginia graduates 500 to 600 RNs a year.  Only 10 to 15 percent go out of state.  About 6 percent are male.  Increasing associate degree enrollment is not the total answer, because they can't be put in some nursing positions.  Scholarships could help, but workplace incentives are just as important. In the late 1980s, hospitals provided financial incentives.  There are a huge number of LPNs interested in RN and bachelor degree programs.  A very promising strategy is to articulate LPNs in vocational schools to RN programs.  Betsy Degges said that the Bluefield State satellite in Lewisburg is working cooperatively with a community college in Clifton Forge on an associate degree nursing program.

 Staff Report

Alicia reported that the HSSP application was revised, based on recommendations of a subcommittee (Shannon Bell, Chuck Conner, Linda Atkins, Jill Hutchinson, and Imogene Foster).  The purpose was to improve the selection process by asking better questions of applicants and developing a standard recommendation form.

Alicia presented the case of Dr. Conni Anderson, a HSSP participant from WVSOM, who asked for a reconsideration of her request to serve her obligation in Lewisburg. Her original request was turned down by staff because Lewisburg is not designated as a HPSA or MUA. Dr. Anderson was advised that exceptions, such as Dr. Michael Richmond's case last year, would be considered on a case-by-case basis, and that input from the Committee would be sought. Although her office location is in Lewisburg, Dr. Anderson spends one day a week in Rainelle, a HPSA, providing care to nursing home patients.

Dr. Anderson provided data showing that 65% of the patients served by Greenbrier Physicians were Medicare or Medicaid, and 5% no pay.  Although this indicates care to the underserved, several Committee members said that it was probably typical for many West Virginia providers. After considerable discussion, the Committee voted to deny Dr. Anderson's request.

HSSP Awards Subcommittee

Jennifer Plymale reported that the group is tasked to make recommendations to the Vice Chancellor regarding awards to medical students and how to make the process more effective. This could include making higher awards because of their indebtedness.  Some things may require a statutory change, while others may be changed administratively. The group will review the financial incentives study report being written by Jodie Jackson and a survey of other state programs and bring recommendations to the November 26th meeting.

Dr. Ferrari said that the state's malpractice crisis was discouraging medical students. No one at WVU has asked for a HSSP application. The state is getting bad publicity nationally, which will hinder recruitment. Bill Shires said that Greenbrier Valley Medical Center's new CEO is recruiting all kinds of physicians, but not being successful. Their residency program is having trouble filling slots.
 
Hilda said that, as in the past, there's too much finger-pointing in the malpractice crisis. It's impacting patient care in rural areas, and patients need to get involved. Additional discussion covered ongoing issues facing providers and concerns that recruitment and retention of providers in rural areas have become more difficult. Discussion reverted to Dr. Anderson's request for site approval, and it was suggested that, given the current medical climate and the struggles we face retaining providers, a process be developed to address specific areas in which exceptions be made for approval of HSSP obligations.  The HSSP Awards subcommittee was asked to address issues regarding site approval and develop criteria if exceptions are to be made in the future. A specific time frame was not established.

Update on Rural Health Access -- Phase II Implementation Proposal

Jim Nemitz reported on plans re. three recruitment and retention initiatives: (1) Coordinated Placement; (2) Recruitable Communities; and (3) Financial Incentives Study. Coordinated placement involves funding placement coordinators at each medical school to serve as points of contact on recruitment for medical students and residents.  A web page of practice opportunities is being created so that residents and communities can have direct access to information.  The application is due in late November or early December.  Phase II will start in April 2002.

Update: Division of Recruitment
 
Linda Atkins reported that, as of July 31, the National Health Service Corps Division of Scholarships and Loan Repayment and the Division of Shortage Area Designation have been transferred from the
Bureau for Primary Health Care to the Bureau for Health Professions.  She also said that Martha Endres is serving on a team to review the new federal HPSA methodology. States are estimating the effects of the new methodology using data from the Cecil Sheps Center in North Carolina. West Virginia may lose 10 HPSAs because of the loss of population and new doctors in some counties. The new process will be implemented over four years, and regulations will be out before the end of the year.  Hilda asked that this process be coordinated with RHEP, and Linda will follow up on this.

Linda also provided a handout of the Ideal Recruitment Process developed in Oregon.
 
The meeting was adjourned.