COTTONWOOD, Ariz. — Out in Arizona's wide-open spaces, dozens of rural school districts are struggling to serve their communities and often are challenged just to keep the doors open.
A recent report by The Rural School and Community Trust found rural schools in Arizona and across the country struggle with inadequate funding, changes to the communities they serve and providing educational opportunities for all of their students.
The report found Arizona's rural school graduation rates are among the lowest in the country. Wes Brownfield, executive director of the Arizona Rural Schools Association, said the biggest struggle for many districts is to fund and maintain school facilities.
"If I've got a high school with 80 kids in it, first of all, I have to provide the same services as if I had 800 kids," Brownfield said. "When a school building is built, there's money to build the building, but there's never money included in preventive maintenance.”
He said other recurring problems include low teacher and staff salaries, transportation costs, and the "hollowing out" of living standards for middle-class rural families.
The report said about 50,000 of Arizona's 1.1 million public- and charter-school students attend rural schools. Outside of the state's three main cities, rural schools are found in Arizona's pine forests, arid deserts and vast reservation lands.
Brownfield said the expansive distances can wreak havoc on school bus systems.
"Out here in the Rocky Mountain West, we also have rural and remote. And it's those remote school districts who have to provide transportation to their students, more often than not, with a bus fleet that is old and suffers from a lack of preventive maintenance,” he said.
Brownfield said rural school administrators need to do a better job convincing local communities and state education officials of how valuable rural schools are to the state.
"Rural schools have to do a better job of communicating how vitally important the rural school is to a rural community,” Brownfield said. “It's more than just the place where kids are educated. It's often the cultural and emotional and social center of the community."
The report found 23% of Arizona's rural students live in poverty, compared with about 16% nationally. The graduation rate for Arizona's rural students did improve to about 82% over the past five years, but is still below the national average of 89%.
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By Laura Aka for Working Nation.
Broadcast version by Danielle Smith for Tennessee News Service reporting for the WorkingNation-Public News Service Collaboration
We all witnessed the significant impact the pandemic had on frontline health care workers. One in five health care workers has left their job since 2020, according to one industry report. And the exodus is not over.
"Research suggests that up to 47% of health care workers plan to leave their positions by 2025. The U.S. is suffering from a significant health care worker shortage, and the data shows that this is going to have near-term and long-term effects on both patient care and hospital and physician performance," says Definitive Healthcare.
Nashville, considered a major health care hub, has not been immune to worker shortages. To address its talent pipeline needs, Vanderbilt University Medical Center (VUMC) is collaborating with local education institutions - including high schools, community colleges, and state colleges - to create learning opportunities and fill open jobs.
Where the Shortages Are
Peggy Valentine, Ed.D., vice president of allied health education at VUMC, was brought on in 2021 to help address the organization's need for allied health workers. She says, "There were a lot of positions that were in high demand. You can't really run a hospital without these positions.
"I came on poring through these reports in terms of where the vacancies were located. We found that there were a number of professions where there were over a hundred vacancies, such as medical assistant, EMT/paramedics, pharmacy techs, medical laboratory scientists."
Valentine notes, "When you think of allied health, there are over 200 distinct disciplines, maybe more because it keeps growing. You combine them all together, it represents about 60% of the health care workforce.
"They include the technologists, people who work in the laboratory, people who work in x-ray, people who support the work of nurses, support the work of physicians.
"It may be in the operating room where you're a surgical assistant. It may be doing the CAT scan or the person who runs the machine for ultrasonography - just a very large group of professionals to support this important work," she explains.
Partnerships with local postsecondary institutions are instrumental to VUMC's efforts to grow its talent pipeline. "They already had these programs up and running. There's no need for us to reinvent the wheel."
Nashville State Community College
The first collaboration - launched in 2022 - was with Nashville State Community College (NSCC) with a focus on medical assistant training. The opportunity to learn central sterile processing through NSCC was added later.
"The first cohort of medical assistants was people who worked here at the medical center. Maybe they worked in dietary, delivering food trays, or they worked in environmental cleaning. We had people who worked in various positions who always wanted to go back to school but never had the resources to do so," says Valentine.
VUMC pays for their employees' tuition, books, uniforms, and supplies while they maintain their salaries and benefits, explains Valentine.
After the completion of the first cohort, she says the workforce opportunity was extended beyond employees of the medical center to the wider community, partnering with organizations like Grace Place Ministry and UpRise Nashville. Students from the community are given stipends to help offset the costs of expenses like transportation and childcare. As Valentine says, "Those kinds of things that people worry about."
Nashville is a good representation of what's happening in health care, nationwide, says Donna Whitehouse, dean of the School of Health Sciences at NSCC.
"The reason for the health care shortages - we have the baby boomer retiree exodus. We have the leftovers of COVID burnout that came along with the intensity of, not just the caseload, but just the depth of what caring meant at that point in time with the great loss of people."
Whitehouse says, "We are hearing from our alumni that the billable productivity requirements for rehabilitation professionals such as occupational and physical therapists have significantly increased over time.
"Productivity requirements, especially on our rehab side of things, used to be 80% to 85% of your work time was considered time with patients and then you had some time to do some paperwork. Now they're looking at 90% to 95% of that time to be billable and that's a quick pace in order to be able to get things completed."
She adds that other challenges include the cost and geographic location of educational opportunities, the need for more flexibility around work schedules, and having enough educators to teach the training.
"We have to really credit Vanderbilt with their open-mindedness and their creativity in addressing this workforce shortage," says Whitehouse.
"[VUMC is] also fronting scholarships for our surgical technology students [which requires a degree in order to earn the necessary credential]. Once those students have been accepted into our program, [VUMC is] helping fund any additional costs that they have so they can continue their education," she notes.
Whitehouse continues, "In this case, Tennessee residents who qualify for programs like Tennessee Promise or Tennessee Reconnect can attend school tuition-free. But we know that there are more costs to attend than just tuition, so Vanderbilt has stepped in.
"Vanderbilt has made, not just an investment in getting people on those ground-level positions and getting in those short-term training programs, but they are also investing in their long-term career towards a credential that requires a little bit more extra time and a little bit more extra education through an accredited program."
Whitehouse points out, "We've had over a hundred students who have completed the Vanderbilt-Nashville State MA program. Our first-time MA certification rates are well over 80%. That's the first-time test takers. We have a 100% certification rate, overall. Sometimes it takes more than one time, but we get it.
"Here's the kicker, of those people in that program, 90% have seen it all the way through. You're not going to see those numbers in a whole lot of places. Close to 95% of the people who have gone through the program and then gone to work are still at Vanderbilt."
Tennessee State University
"After COVID, there was a national shortage of respiratory therapists, and there still is," says Brenda K. Batts, D.H.A., director of the cardio-respiratory program, Tennessee State University (TSU).
She continues, "With that, Vanderbilt started a new initiative to recruit respiratory therapists. They started a scholarship program with Tennessee State University's cardio-respiratory program. Within that scholarship program, if [students] accept the scholarship, they have to commit to a time period to work at Vanderbilt for a year or more."
Batts says, sometimes, students have to leave the program, "One of the things we do know is that in the last year, many students at Tennessee State have financial hardships.
"When you have a scholarship that can help lift that heavy burden and help you complete that journey, it's so rewarding. We had 10 that applied to that scholarship program, and they accepted 10. All of them are ecstatic about working at Vanderbilt. Many of them wanted to work there anyway."
According to the Bureau of Labor Statistics, "Employment of respiratory therapists is projected to grow 13% from 2022 to 2032, much faster than the average for all occupations. About 8,600 openings for respiratory therapists are projected each year, on average, over the decade."
Batts says it is crucial to create awareness about the role of the respiratory therapist. "Some respiratory programs have a problem with recruiting people.
"I think people are misinformed because they think, 'Oh, you have to have go to school forever.' No ma'am. We need to identify the two ways that you can enter our profession.
"There's a two-year program that feeds into the four-year program. You can have a two-year degree, but Vanderbilt will invest in you to go back and get the four-year degree."
In addition to the Vanderbilt collaboration, Batts says outreach in the community is important, including afterschool programs. She says, "The Martha O'Bryan Center is one of the largest nonprofit organizations in the middle Tennessee area. We take our respiratory therapy students, who have to do a total of 80 hours of service work over two semesters.
"The respiratory therapy students become teachers of those young people. We showcase our profession, and we take all the tools with us - the mannequins, the intubation of procedures."
Pearl-Cohn High School
Similar to Batts, Tyler Welch, academy coach of the Academy of Health Science and Personal Care at Pearl-Cohn High School, says, "It comes down to exposure. Young people have a hard time, I think, seeing where they fit in the big picture."
"It's actually from their life experiences," says Welch. "When they go to the emergency room or when they go to the doctor's office, everyone they interact with has scrubs on.
"I started realizing they were generalizing - a nurse. When you start looking at, 'Well, I want to become a nurse,' the pathway to be a nurse can be more difficult than some of the [alternative] pathways to become a nurse. I started realizing these certification stacks are what actually can lead to, ultimately, being a nurse. When we say medical assistant certification, they don't really know what that is. But we say, 'Hey, it's a path to nurse.'"
Welch notes that Vanderbilt has visited the high school giving students the opportunity to explore different jobs including - the already-mentioned medical assistant, HR positions, nurse practitioner, traveling nurse, and surgery techs.
By the time students complete high school, they have OSHA and CPR certifications. Additionally, when they finish the medical assisting coursework and an appropriate clinical internship, students may sit for the Certified Clinical Medical Assistant (CCMA) exam. Welch says the Academy has recently implemented a program to teach professional and employability skills.
He offers an observation, "I feel like it's really hard to go from high school to the job. I feel like that's a big jump. I could be wrong, but that's what I feel like. We need to get that postsecondary piece. We have to find a model that really keeps them into it."
Welch says, "To hear what Vanderbilt is doing with Nashville State - if we could learn to build that bridge, 'Hey, prefer our students if they're prepared and ready.' Let's build that bridge where it is.
Changing Family Trees
Welch notes, "We all see that there's a problem and we have to figure out a way to solve that. In the medical field, there's some postsecondary schooling, skills work and it's a long game. Nowadays everything is a sprint, instant gratification so there has to be some other teaching going on than just this is the skeletal system. We have to do our part to prepare the kids so then they can be in that environment to take hold of the opportunities that are there.
"I just feel like that pathway is ready to really explode and do what it's supposed to do."
Tennessee State University's Batts says about the stakeholder collaboration, "It's a partnership within a community - coming together to address the needs of our community."
She continues, "I try to make a difference in my community and that's what drove me to do the different aspects of [my own] education. I wanted to learn more about how to fix a problem that kept me up at times - kids with asthma, people down from COPD, and health disparities.
"A lot of the students come from those same communities. So, they're already vested in it."
Nashville State Community College's Whitehouse says, "If we take advantage of these opportunities to ladder up, it's endless what we can do. And it's just a matter of making the connection.
"I want to talk about helping people connect to these opportunities because we need them. We have seats available. We need people to come in to provide health care services in a variety of different ways. We can get you connected and into a program that is going to put you on that path for success," says Whitehouse. "Not only put you on a path for success, but we know connecting workers to high-wage jobs then changes family trees, right?"
She adds, "Think about times in your own life when people have invested in you and the fact that when someone invested in you, they thought you mattered. That feeling of mattering to someone else is motivation to continue to move forward. And that's exactly what this opportunity is."
Lastly, VUMC's Valentine notes not everyone can go to college right now, "It has been very important to reach young people to let them know that if you don't go to college, there are other options - short-term training programs until you figure out what you want to do.
"Sometimes the work experience you gain at one level can help you at your next level. And courses you take may transfer into that next level. With high school students, it's very important to let them know, 'If you don't go to college, it's not the end of the world. You can go later, but there's some things you can do short-term when you can still earn a decent income until you figure out the path forward.'"
Valentine continues, "They may be the first one in their family to reach this level. It opens up the doors of opportunities for them and generations to come because the children will look at their parents and say, 'Wow, if mommy could do this then I can go back to school and do this too.' It also moves the needle in terms of having a more diverse workforce. We're moving the needle in terms of ridding our communities of health disparities.
"We're setting the examples for the next generation that's coming behind us. And to me, it's the most important work that we can do for our communities."
Laura Aka wrote this article for WorkingNation.
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