July 1999

Grant Results

National Program

Ladders in Nursing Careers Program


From 1993 to 1997, South Carolina Hospital Research and Education Foundation, West Columbia, S.C., developed and delivered three new nursing degree programs to rural areas.

Known as South Carolina Project L.I.N.C., the project focused its efforts in three areas:

  • Distance learning.
  • Building partnerships.
  • Work force retraining.

The project was part of the Robert Wood Johnson Foundation's (RWJF) national program Ladders in Nursing Careers Program.

Key Results

  • Working with the technical colleges in the state, South Carolina Project L.I.N.C. developed and delivered three new degree programs to rural areas.
  • Because of its partnership with South Carolina Educational TV and the state's Area Health Education Centers (AHEC) program that provides education to health care students and members of the health care work force, Project L.I.N.C. was able to facilitate the delivery of educational programs to rural hospitals and link students with AHEC libraries via telephone and modem.
  • South Carolina L.I.N.C. worked with Spartanburg Regional Medical Center to develop a training and basic skills programs.
  • L.I.N.C. was asked to help other health care organizations across the state with their re-engineering efforts.
  • By September 1997, South Carolina Project L.I.N.C. had enrolled 227 students; 75 had graduated. Each year of the grant, at least 32 percent of enrolled students were minority, mirroring the state's overall minority population. In 1997, 45 percent of enrolled students were minority.

RWJF supported the project with two grants totaling $542,395 between February 1993 and July 1997.

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South Carolina had two very high need areas in the state: the Low Country and the Pee Dee Region in the southern part of the state.

These regions had the highest numbers of rural hospitals in the state with significant nursing and allied health vacancies; the highest numbers of persons living in poverty; the highest concentrations of minority citizens; the greatest high school drop out rates; and the lowest SAT scores in the state. Hospitals in these regions faced significant difficulties recruiting individuals from outside the community to their nursing staffs.

Therefore, the "grow-your-own" potential of Project L.I.N.C. — coupled with the strong financial and academic support available to L.I.N.C. students — was very appealing. In addition, the numbers of minority health care workers in South Carolina lagged behind the overall minority population in the state. Only 8 percent of RNs were minority and 3 percent of physical therapists, when the minority population stood at 33 percent.

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South Carolina Project L.I.N.C. initially targeted its program to the Low Country and the Pee Dee Region in the southern part of the state, and attracted a large number of applicants. In 1996, South Carolina Project L.I.N.C. moved into the upper part of the state — adding a rural hospital and a large tertiary medical center as participants — making L.I.N.C. a statewide project.

The primary goal of South Carolina Project L.I.N.C. was to develop a strategy for the hospital association to help its members meet their short- and long-term work force needs. The project's four objectives were:

  • To assist hospitals in "growing" their own work force by providing new career advancement opportunities in the areas of nursing and allied health for current entry-level hospital employees, and thereby reduce vacancies.
  • To increase minority involvement in the work force.
  • To retrain workers and enhance staff development efforts.
  • To reduce the recruiting costs for needed staff.

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By September 1997, South Carolina Project L.I.N.C. had enrolled 227 students; 75 had graduated. All went back to their sponsoring institutions, and began working in their new roles. They advanced professionally and personally and received substantial salary increases. Each year of the grant, at least 32 percent of enrolled students were minority, mirroring the state's overall minority population. In 1997, 45 percent of enrolled students were minority.

Despite the state's small size, access to education from poorer, rural areas was a problem. South Carolina Project L.I.N.C. worked with Trident Technical College in Charleston and Midlands Technical College in Columbia to deliver three degree programs — diagnostic medical sonography, pharmacy technician, and medical records — to rural hospitals and other rural sites via satellite.

Students completed the clinical portion of the course at their sponsoring health care facility or another facility in their hometown. Student course work was done using a combination of computer-assisted instruction, e-mail, and the Internet. To bring satellite services to rural hospitals at a low cost, South Carolina Educational Television agreed to donate "left-over" funds from a state grant that had been provided to bring South Carolina's schools on-line via satellite.

South Carolina Project L.I.N.C. created nine completely mobile learning centers across the state to provide L.I.N.C. students with access to computers, software (including word processing, spreadsheets, database programs, and typing tutors), and other educational resources.

All of the learning centers were located in hospitals with the exception of one that was housed in the state's Recruitment and Retention Center, but because the centers are mobile, they can be moved to where they are needed most. Course work on medical terminology, microbiology, psychiatric nursing, and medications mathematics (mathematics related to drug dosage) was made available through computer-aided instruction. In addition, some computers provided Internet access for those students who needed it for their nursing programs.

South Carolina Project L.I.N.C. partnered with the state's Area Health Education Centers (AHECs) that serve health care students and members of the health care work force. As a result, L.I.N.C. students were able to access the AHEC libraries in person, by telephone, and by computer to request literature searches and copies of articles. L.I.N.C. students could also take review courses for their licensure exam through the AHECs if they were unable to attend the course offered by their hospital.

South Carolina's hospitals began re-engineering efforts during South Carolina Project L.I.N.C., and as a result they embraced the concept of multi-skilled patient-care technicians who can provide an array of patient care services. Because of Project L.I.N.C.'s reputation across the state, L.I.N.C. representatives were asked to participate in the planning and implementation of basic skills preparation and enhancement efforts.

In these spin-off projects, L.I.N.C. emphasized the concepts of Project L.I.N.C. — academic preparation, academic assistance and support, and career laddering for minority and disadvantaged employees — so these important facets of L.I.N.C. were included as core elements of new programs.

Specifically, Project L.I.N.C. worked with Spartanburg Regional Medical Center to implement a certificate program for patient care associates (PCAs) cross-trained in phlebotomy, aspects of respiratory care, and performing electrocardiograms (EKGs). Program participants were required to take a skills assessment exam that allowed program staff to predict future performance and to design any necessary remediation.

Spartanburg and Project L.I.N.C. found extensive remediation needs among candidates and developed a comprehensive basic-skills program with training in math, reading, and English. The PCA program also included computer-aided instruction using tailored software and traditional classroom instruction. By mid-1997, 33 students had graduated. Many of the graduates subsequently approached L.I.N.C. representatives to explore continuing their nursing education by working toward a nursing degree through the L.I.N.C. program.

South Carolina L.I.N.C. was able to obtain significant funding from the Duke Endowment ($200,000 annually) and the Fullerton Foundation (about $74,000 annually).

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With anticipated continued funding from both the Duke Endowment and the Fullerton Foundation, as well as fees paid for service by participating health care facilities, the South Carolina Hospital Association planned to continue to recruit students into Project L.I.N.C. The final report to RWJF states that "The South Carolina Hospital Association will remain committed because Project L.I.N.C. represents a vehicle for an association to provide assistance to its members."

South Carolina Project L.I.N.C. also initiated discussions with both state and federal Departments of Education and Labor about expanding. As L.I.N.C. evolved, it planned to continue to target high-need regions and professions, and wanted to address work force literacy. South Carolina L.I.N.C. also intended to focus on the following areas:

  • Development of new courses for distance education.
  • Recruitment of new hospitals involved in work restructuring.
  • Expansion of computer-assisted learning modules.
  • Evaluation and development of multi-skilled curriculum in additional technical colleges.
  • Development of courses.

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South Carolina Project L.I.N.C.


South Carolina Hospital Research and Education Foundation (West Columbia,  SC)

  • Amount: $ 42,728
    Dates: February 1993 to January 1994
    ID#:  021763

  • Amount: $ 499,667
    Dates: February 1994 to July 1997
    ID#:  023383


James Walker
(803) 796-3080

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Report prepared by: Karin Gillespie
Reviewed by: Patricia Patrizi
Reviewed by: Molly McKaughan
Original Program Officer: Polly M. Seitz
Current Program Officer: Rosemary Gibson

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