Roxbury nursing program plagued by high turnover, lack of qualified personnel
With mannequins that can simulate labor and delivery and test equipment designed to mimic a hospital setting, Roxbury Community College’s nursing laboratory opened in 2017 with plenty of fanfare and a keynote speech from Governor Charlie Baker.
But two years later, the sophisticated simulation lab, part of a $13 million state investment in the community college’s health sciences building, still has no coordinator and only part-time technicians to help students gain the clinical training they need to become nurses.
During that same time, directors of the nursing program have come and gone, some lasting just a few months. Turnover has been so common that the staff giving orientations would often no longer be there by the time students started their classes.
The lack of qualified and dedicated personnel to run the simulation lab and the staff turnover were among several problems the state’s nursing regulatory board cited last month when it pulled the Roxbury program’s accreditation. The move effectively halts the program, which educates mostly minority and predominantly low-income Boston-area nursing students, at the end of this year.
Roxbury had the high-tech equipment for a competitive nursing program but didn’t invest the resources to support the staff and students and ensure they succeeded, said JoAnn Mulready-Shick, president of the Massachusetts-Rhode Island League for Nursing and a clinical nursing professor who was a dean at Roxbury more than 13 years ago.
“Creating it is one thing, sustaining it another,” Mulready-Shick said. “If this is the wake-up call that the upper administration needed, then so be it.”
Roxbury college officials said that they have been providing appropriate resources for staff and students and that Boston’s job market has made it difficult to fill positions.
“Health care in Boston is a very competitive market, and it sometimes takes time to fill vacancies in the area,” said Jordan Smock, a spokeswoman for the college.
Roxbury, which enrolls 92 students in its two-year nursing degree program, is trying to regain state approval, Smock said.
In the meantime, 55 students will be able to finish their studies by December and take the national exams. College officials are contacting other schools to find places for the remaining 37 students, but the options have been limited so far, and many of them have been left scrambling.
“I’m kind of at a loss,” said Krystle Callender, a 35-year-old single mother from Brockton, who worked as a medical assistant during the day and attended classes at Roxbury in the evening. Since the program lost its state approval, Callender said she’s been researching alternatives, but many of the area nursing programs are already full for the fall, few offer evening classes, and some don’t accept transfer credits from Roxbury because the requirements are different or the classes don’t match up. “Right now, I’m trying to figure out my life. I’ve had to talk myself into not giving up.”
Callender said she didn’t realize how dire the situation was at Roxbury until news reports surfaced last month that the state had revoked approval of its nursing education program. But the problems at the college have been building for several years.
Roxbury, which enrolls 1,900 students campuswide, has been mired in infighting, leadership shuffles, and financial mismanagement for years.
Valerie Roberson, Roxbury’s current president, arrived in 2013 to help turn around the troubled campus. But Roberson has also experienced her share of controversies and clashed with administrators and faculty over budget cuts and her management of contracts and other issues.
The college, with an operating budget of about $28 million, has become more financially stable in recent years, but it remains under heightened financial oversight by the US Department of Education.
Nursing has been one of Roxbury’s prized academic tracks, with nearly 20 percent of Roxbury’s graduates in 2018 receiving nursing degrees. But it has struggled over the years, with students passing the national exams at much lower rates than the state average. In 2018, the pass rate for Roxbury students was 78 percent, below the 89 percent state average. Roxbury’s pass rate was as low as 43 percent in 2015.
The chaos in the nursing program seems to have increased in recent years. In February 2017, the state nursing board placed the school on warning. Then in November, the board blocked the school from admitting new students. According to state officials, Roxbury’s nursing program has been in some sort of warning status longer than any other school in the past five years.
“The length of the warning, and its outcome, is fully dependent on the school’s ability to correct the state deficiencies,” said Omar Cabrera, a Massachusetts Department of Public Health spokesman, in an e-mail response to questions.
In the fall of 2017, as the school celebrated the completion of its $72.5 million campuswide renovation project, which included the new health sciences building with the simulation center, Roxbury also hired a new nursing director. But in mid-October, state nursing regulators informed Roxbury that the hire, Kristin Lundsten, did not have the required qualifications for the job, including three years of nursing education experience.
Roberson instead promoted Lundsten to become the dean of health and human services at Roxbury, overseeing the nursing program. By that December, several top administrators of Roxbury’s nursing program had resigned.
The nursing program would go through five leaders in three years. Its most recent director, Dorothy Chase, lasted less than six months. In an early May meeting with state nursing regulators, two weeks before she left the job, Chase said that she had communicated with upper administrators about the need to fill positions quickly, but the approval process for applicants was still taking a long time.
While Chase was supposed to help pull the program out of warning status, she said she felt overwhelmed by the day-to-day work.
“I’ve been stuck in the weeds,” Chase told the Board of Registration in Nursing, according to recordings of the meeting. “I haven’t had enough support, and time, and energy.”
After Chase left, Roxbury officials told regulators that Lundsten would step in and serve as the nursing program administrator. But Lundsten resigned from the school in late June. The school promoted a newly hired assistant director, Simona Hankins, to the director’s job.
Lundsten said she did get certified to be a nursing director a few months after arriving at Roxbury in 2017, but resigned from the college in June because she was expected to take on multiple roles.
“We didn’t have enough hands on deck,” Lundsten said. “Turnover was rampant because of upper management lack of support.”
The lack of stable leadership has meant that the nursing program was sometimes disorganized, current and former students said.
E-mails to faculty and administrators would go unanswered for days, students said. Earlier this year, some students were sent home and unable to start their clinical training because it wasn’t clear whether their necessary immunizations were up to date, said Linda Pascal, 47, of Braintree, who has been attending Roxbury since last fall.
“I feel like they could have done more,” said Pascal, who started taking nursing courses after she found out her job as a medical coder at Massachusetts General Hospital was going to be outsourced.
Roberson declined to comment for this story. But last month, she acknowledged in a meeting with state regulators that the recent transition in the program’s leadership was rocky, while insisting that Roxbury remained committed to educating students to become nurses.
“The history of the college certainly has not been perfect,” Roberson told the state board, according to a recording of the meeting. “We certainly understand that the student population that we serve and the community that we serve, this is one of the poorest areas of Boston. . . . We have made significant investments in terms of resources that are necessary for the program. I couldn’t be any more committed to the success of the students.”
Roberson continues to enjoy support from Roxbury’s board of trustees. Mark Culliton, the founder of College Bound Dorchester, which helps at-risk youth graduate from college, and a trustee, said Roberson has been trying to rebuild the college.
“Our community deserves the college she, her team, and our students are building in the heart of Roxbury,” Culliton said.
Ultimately, operating a nursing program requires heavy investment in equipment and training for staff and faculty, said Mulready-Shick, the president of the nursing league.
These programs are important, particularly at the community college level, as economic ladders for lower-income students, she said. Many residents in the Boston area may not be able to afford a private nursing school or to take classes full time, she said.
The league plans to reach out to the college to see if it can help it regain state approval, Mulready-Shick said.
“The Commonwealth absolutely needs this program,” she said. “To me, this is like a time-out.”