A healthcare crisis was looming: these local colleges made sure that would not happen

Julie Benson knew trouble could be coming.

As Tacoma Community College’s associate dean of nursing, she was concerned about the state’s nursing assistants certified — workers responsible for many caretaker responsibilities at hospitals and nursing homes. Last April, the Centers for Medicaid & Medicare Services (CMS), the governing body of most medical facilities, announced it would be ending a pandemic-related pause on skills testing requirements.

Benson and others understood what the legislation implied: At the beginning of October, up to 5,000 practicing nursing assistants throughout Washington State might not be allowed to work. When the announcement was made, Benson’s students told her the soonest the state health department could schedule their tests was March 2023.

“That means places like Life Care [Centers for America] have employees that they could lose if they don’t get them tested in a short amount of time,” Benson said.

Benson and other TCC administrators have joined the state health department’s plan to avert that fate: a mass NAC testing operation hosted by colleges throughout Washington. Having started their efforts earlier in August, both TCC and and Bates Technical College will continue to test as many nursing assistants as possible before their ability to practice expires.

As much as the plan is designed to help future NACs, it also aims to aid the patients nursing aides care for.

“If you think about patients that are in long-term care, they may have been there for many many months,” Benson said. “Now, all of a sudden, to not have that caregiver there? That is traumatic for patients, especially people who are not in their baseline setting.”

Combating a time crunch

The NAC backlog, like the COVID pandemic that caused it to arise, was a crisis waiting for an opportunity.

When the coronavirus dominated every aspect of daily life in March of 2020, two opposing needs created a tension: Health care workers who could reduce the virus’s damage were at a premium, but in-person activities like skills testing were minimized.

As a consequence, CMS relaxed the testing requirements for nursing assistants; instead of being forced to take their skills tests within four months of starting work, those who had completed NAC training could work in hospitals or long-term care facilities indefinitely. Governor Jay Inslee affirmed the legislation locally, and workers would operate under the term “registered nursing assistant” until tested.

CMS’ pandemic-time decision enabled thousands of workers across Washington to care for people more vulnerable to severe COVID than the general population. However, when in April 2022 the government organization announced it would soon remove the universal waivers, it put both nursing assistants and their employers in a difficult spot come October.

“They would have to stop working,” said Bill Swaren, Bates’s NAC director. “That would put an even worse situation in place for all of the extended care facilities and nursing homes and other places that use NACs. Because right now, they’re short on to begin with.”

According to Benson, Credentia, the company responsible for NAC exams, did not have the capacity to meet the testing demands in the state. Thankfully, from their NAC degree programs, colleges like TCC already had the equipment necessary to administer the evaluations.

“Things like beds, bedside tables, overbed tables, towels, washcloths,” Benson said. “All those things that a lot of programs don’t have, we have.”

Soon after CMS’ April announcement, the state health department reached out to TCC; it helped the school prepare its new exam location and formally credentialed it as a test center.

Now, as one component of Washington’s mass testing effort, TCC is reducing the 5,000-person backlog by 8 registered nursing assistants a day.

“I think this solution will fix [the backlog],” Benson said. “I mean, we’re going to test probably 150 students alone in our short period of time, 6 weeks.”

A crucial arm of healthcare

The responsibilities of an NAC are both numerous and wide ranging.

“An NAC does all the things that you and I take for granted,” Benson said. “They help people eat, bathe, walk, dress ... what we call the activities of daily living.”

But it is not a lucrative career; by Benson’s estimate most people who enter the profession earn between $15 and $20 and hour.

To Swaren, the entry-level pay does not reflect importance of nursing assistants in the health-care workforce.

“They are providing a service that would make it a lot harder on the nurses if they weren’t around,” he said. “NACs really come in and help out with the care of the clients that [nurses] are taking care of.”

The job can also endanger and threaten those who work in it. One study that measured how New York City NACs managed throughout the pandemic noted that between September and November 2020, 80% of participants were exposed to at least one person with suspected or confirmed COVID; another academic paper found that, at long-term care facilities, workplace violence from treated patients was almost an expectation among nursing assistants.

Benson said that while the job can be demanding, it may also be the first step in pursuing other health profession opportunities.

“If they can get become an NAC, then they can work to get their LPN [Licensed Practical Nursing degree] or their RN [registered nursing degree],” Benson said. “Whatever they want to advance to.”

Future opportunities

While TCC and Bates currently are focused on averting an early October crisis, both colleges are excited about the future. Each expects to continue examining students now that they are each credentialed testing centers.

“We’ll be able to get more people into the pipeline and into working,” Swaren said.

To Olga Ingerbritson, dean of TCC’s Gig Harbor campus, TCC’s role in this effort not only helps to avert a public health hazard but also highlights the school’s five-week NAC training program. She believes it’s a great way for people who might be intimidated by higher education to start a health-centered career.

“It’s a great pathway to get your feet wet,” Ingerbriston said. “A certificate program like this not only gives you the opportunity to realize that you can go back to school, but also get into a job. And that can lead to a growing health career.”