Public housing residents in Richmond, Virginia, who are unemployed, underemployed, or making the transition from welfare to work are being trained as certified nurse aides (CNAs) through an innovative program called Hope for Health Care.

"We're helping to increase the city's supply of nurses while enabling public housing residents to achieve self-sufficiency," says Joan Seldon, program manager for special programs within the Richmond Redevelopment and Housing Authority's (RRHA's) HOPE VI program.

As the average age of the nation's population continues to rise, the number of nurses continues to decrease, creating a severe nursing shortage. Enrollment at nursing colleges and universities is at a 6-year low, and experts express concern that if the supply of nurses does not increase in the coming decade, the shortage will worsen. Hope for Health Care was started by Deborah Johnston, CEO of Care Advantage, a healthcare staffing agency in Richmond, in collaboration with Seldon of RRHA's HOPE VI program, to respond to the critical shortage of nursing professionals. Johnston worked with RRHA and the Richmond YMCA to develop the CNA program, which benefits both residents and employers.

HOPE for Health Care's 6-week training program includes 120 hours of classroom and clinical training. RRHA funding covers the cost of students' testing fees, books, uniforms, and transportation. After graduation, residents receive monthly job-retention coaching.

The first class of CNAs graduated in August 2001. As of February 2002, 57 women have graduated from the HOPE for Health Care program, and all are employed. Many graduates are working at hospitals, nursing homes, and assisted-living and long-term care facilities. Thirteen residents are enrolled in the latest 6-week training session, and 85 others are on the waiting list for future training. On March 13 graduates started a 15-month licensed practical nurse (LPN) training program at the Richmond School of Health and Technology. RRHA helped residents acquire the financial aid they need for this long-term program. "We're not training people just to be CNAs," says Seldon. "It's just the beginning step to getting that LPN or RN [registered nurse] degree and building a career. And that's what we emphasize to our residents."

After interested residents complete an application, they meet with Hope for Health Care program staff to learn about the CNA program, the duties and responsibilities of a CNA, and careers in nursing. They also complete job-readiness and literacy assessments.

The next step in the process is orientation. During this time, applicants provide proof of education, complete a criminal background check and drug screening, and undergo a tuberculosis test. Those who fail the initial screening can remain on the waiting list while they complete the requirements. Counselors work with residents to develop career goals and assess their need for supportive services, such as childcare or transportation assistance. After graduation, residents receive additional case management services to address any barriers to success and help them retain jobs. Monthly job-retention coaching is an important part of the program, according to Seldon.

All residents attend a weeklong professional development course before the actual CNA training begins. This course includes information on accepting supervision, handling conflict on the job, getting along with coworkers and supervisors, time management, writing a resume, and completing a job application. Residents also complete a basic computer literacy course to increase their marketability in today's technology-driven workplace.

Residents involved in the CNA training are also encouraged to participate in RRHA's Family Self-Sufficiency program. This program allows residents to take advantage of one of two options. In the first, rents are frozen at their current level for 18 months to allow residents to put money into savings accounts for education, homeownership, or other needs. The second option charges residents higher rents based on their income; the difference between the old and new rents is placed into an escrow account. Once residents complete their educational or career goals, the money is returned to them with interest.

RRHA is developing new partnerships to expand the CNA training. University Park, a long-term care facility with more than 156 patients in Richmond's far West End, has a severe nursing shortage and plans to hire at least 50 public housing authority (PHA) residents as nurse aides once they complete training. University Park has reactivated its former nurse aide training school and is providing CNA training to program participants. It pays residents a stipend of $6 an hour and helps with transportation costs. Once training is complete, the residents become employees of University Park, which has very good benefits, according to Seldon.

Because University Park is located in West End Richmond, beyond the reach of public transportation, RRHA plans to help a PHA resident start a transportation service to help bring the nurse aides to their jobs. "The resident will enroll in a small-business training course," says Seldon. "Then the housing authority will lease him a van to begin operations. Residents will pay a nominal fee for the transportation service, and we expect the demand will be so great that the service will need to expand almost immediately."

Seldon says the housing authority hopes to subsidize childcare for a short time after graduation. It is seeking grant opportunities to provide this service. RRHA is currently negotiating with several childcare facilities to offer slightly lower costs per child in exchange for a guaranteed number of children in the 3 p.m. to 11 p.m. and 11 p.m. to 7 a.m. slots, when many of their mothers work. Because many childcare facilities in the Richmond area are hoping to expand their hours of operation, Seldon feels that this arrangement will benefit all involved.

RRHA originally targeted older heads of households for the initial CNA classes. Now, Seldon is targeting a new audience-younger people in public housing households who have graduated from high school, are not in college, and are perhaps working at fast-food restaurants or other low-paying jobs. The housing authority recently distributed 2,000 letters to residents ages 18 to 26 inviting them to attend a career fair at which the CNA program will have an exhibit.

"I will emphasize to this group that they can complete the CNA training and start work at a job that pays $9 to $10 an hour, plus overtime and weekend work," Seldon said. "For those who want to move on to an LPN program, we can help make that happen. Financial aid is available."

"This is an opportunity for these young people to break the cycle of dependency-get a good-paying job, move out of public housing, and make a life for themselves," Seldon stresses. "They can buy a home. Things that their parents were unable to do."

When asked about the challenges she and her staff have encountered in the Hope for Health Care program, Seldon replies, "Our biggest challenge has been developing the work ethic and getting people to go to work every day. We keep motivating them and provide positive reinforcement."

RRHA formed the Hope for Health Care Alumni Association to help graduates continue to grow professionally. Future plans for meetings include guest speakers who will discuss budgeting, credit repair, investment strategies, understanding withholding and job benefits, health and nutrition, parenting skills, and homeownership. Sponsors and volunteers are invited to the association's meetings to provide information on scholarships, career opportunities, and networking and to mentor the graduates. Mentors can help graduates continue to set and achieve goals. The association is developing a community volunteer project in which CNAs will check on elderly neighborhood residents and teach young parents how to check their children's body temperature and vital signs.

For communities that would like to start a program like this, Seldon has this advice: "Funding and partners will not be your biggest problem. Recruiting residents to participate is key. Give them as much upfront training as possible so that they are truly prepared for the work they will be doing and so they can succeed."

Seldon indicates that keeping a hands-on approach and motivating residents is very important. "Emphasize that it's a career, not a job," she adds.

For more information, contact: Joan Seldon, Program Manager for Special Programs, HOPE VI, Richmond Redevelopment and Housing Authority, 901 Chamberlayne Parkway, Richmond, VA 23220, (804) 780-8812.