Presentation on theme: "Wisconsins Statewide Clinical Placement Summit: Meeting the Challenge of Expanding Clinical Nursing Opportunities Roberta Gassman, Secretary Department."— Presentation transcript:
Wisconsins Statewide Clinical Placement Summit: Meeting the Challenge of Expanding Clinical Nursing Opportunities Roberta Gassman, Secretary Department of Workforce Development
April 11, 20072 Wisconsins Economy
April 11, 20073 Wisconsins Economy Fiscal house in order and economy on track Jobs up, unemployment down -Gained 187,400 jobs & 9,000 employers since Jan 03 Natl Honor Roll twice - 1 of 6 states Corp for Enterprise Dev. Exports up 60% since 2003
April 11, 20074 Governors Opportunity Budget for Working Families Fiscally Responsible Invests in Shared Priorities Creates Opportunities Tax Relief for Middle Class Families -Health Insurance, Child Care, Tuition, Social Security Create Jobs Save Taxpayers $1.7B in 4 yrs Helps Communities and Businesses
April 11, 20075 Governors Opportunity Budget for Working Families Education Tripling School Breakfast Quality Child Care Funding 2/3 of K-12 Special Ed increase by $54M 4 yr old K & SAGE 3 rd year Math & Science Wisconsin Covenant Tech College/Worker Training increased x 4 Doubling Youth Apprenticeship
April 11, 20076 Governors Opportunity Budget for Youth Apprenticeship 30% in Health Care Careers Youth Apprenticeship Funding Doubled
April 11, 20077 Governors Opportunity Budget for Higher Education To increase nurse capacity $225 M to UW System –Covenant Office –Financial aid increased by $44M –Limited tuition increase to 4% –$21M UW Growth Initiative –Funding for emerging and essential occupations: nurses, teachers, scientists, engineers
April 11, 20078 Governors Opportunity Budget for Working Families Affordable Health Care Expand BadgerCare Plus -all children -low wage adults, pregnant women Catastrophic coverage Anti-smoking
April 11, 20079 DWD Efforts 2 nd Annual WI Health Care Workforce Report This document represents our yearly checkup Defines challenges Provides updates Copies available on-line at: dwd.wisconsin.gov/healthcare
April 11, 200710 Health Care Occupations in High Demand Nationally - 30.3% growth and 4.7 million new jobs by 2014, 3 of every 10 jobs will be in health care Wisconsin – Specifically for nursing, we will need RNs to fill 1,600 new jobs and 1,010 replacements every year to 2014
April 11, 200711 Top jobs in new job growth –Health Diagnosing and Treating Practitioners, Registered Nurses, Health Technologists and Technicians, Nursing/Psychiatric/Home Health Aides, Home Health Aides, Other Healthcare Support Occupations Top jobs in % growth –Physician Assistants, Registered Nurses, Respiratory Therapists, Dental Hygienists, Diagnostic Medical Sonographers, Surgical Technologists, Medical Records and Health Information Technicians, Home Health Aides, Dental Assistants, Medical Assistants Top job growth in overall #s –Health Diagnosing and Treating Practitioners, Registered Nurses, Health Technologists and Technicians, Nursing/Psychiatric/Home Health Aides, Home Health Aides, Other Healthcare Support Occupations The Top Jobs by 2014
April 11, 200712 Collaboration Health Care stakeholders must work together to avoid potential shortages of nurses and other health care workers Working together, we can make the health care sector more attractive by building career ladders and bridges to family supporting jobs
April 11, 200713 Summit Resolution Let us reaffirm our commitment to finding solutions to the challenges facing the health care sector Please join with me in the signing of this Resolution
April 11, 200714 DWD Efforts Select Committee on Health Care Workforce Development formed in 2003-key stakeholders: Health Care Organizations & Advocacy Groups- home health, nursing homes, & long-term care Labor Education Other government agencies
April 11, 200715 DWD Efforts Workplace Issues - Developing best practices to improve retention rates. Stronger Data for Planning – To improve projections of health care occupations in demand. Clinical Site Capacity and potentially developing an on-line product to assist with placement and reservation.
April 11, 200716 DWD Efforts Bureau of Labor statistics-6 of top 10 occupations at highest risk for back injuries are in health care Employees from Gunderson Lutheran Hospital, La Crosse, demonstrate a safe lifting device to Secretary Gassman Governor Doyles Safe Lifting Initiative $325,000 WIA funds-18 projects around the state 7,500 nurses & other health care workers recd training in proper lifting
April 11, 200717 Working together keeps our Health Care Workforce #1
April 11, 200718 Senator Herb Kohls Health Care Agenda JoAnne Anton State Director Senator Kohls Office
April 11, 200719 Overview of Clinical Placement Issue Nancy Sugden, Director Wisconsin Area Health Education Centers
April 11, 200720 Health Workforce Concerns Changing healthcare needs of the population Current and projected shortages in the healthcare workforce Chronic maldistribution of the workforce - number of rural and urban underserved areas (HPSAs) Limited access of students from minority and rural backgrounds to health professions careers
April 11, 200721 Initial Statewide Efforts April 2000 - Formation of Health Care Workforce Coalition joint project of WHA, AHEC and many other partners April 2002 - WTCS organized conference: Taking Action! Creating Healthcare Workforce Solutions Spring 2003 - Formation of Governors Select Committee for HealthCare Workforce Development
April 11, 200722 Initial Statewide Efforts Health Care Workforce Coalition early conversations about actions needed to address anticipated shortages initial focus on health careers recruitment/pipeline, career ladders, apprenticeship programs and longterm care needs quickly found major roadblock - limited capacity of training programs to expand, in part due to need for clinical placements WTCS activities standardization of health professions curricula and pre-requisites across campuses, transferability of courses, development of on-line options, expansion of facilities and use of sophisticated patient simulators
April 11, 200723 Academic Program Initiatives support for health careers activities and pipeline programs in underserved areas and populations several grant-funded projects focused on increasing the number of masters-prepared nurses available to teach in the health professions programs, especially nursing –NET –SWIFT –LEAP Other grant-funded initiatives to develop capacity of community-based sites and providers - to provide learning opportunities for health professions students
April 11, 200724 Regional Efforts Development of regional collaborations under leadership of several different groups –Regional AHECs and academic partners: health careers continued effort to develop new community-based training sites –Local Workforce Boards giving increasing attention to health workforce issues –Fox Valley Health Care Alliance –La Crosse Health Science Consortium
April 11, 200725 Current Status Diminishing federal grant resources available to academic programs to address healthcare workforce issues (Title VII Health Professions funding) Increasing appreciation of the challenge posed by current and impending health workforce shortages the need for a collaborative, regionally-focused approach with broad external statewide support to get the job done Must expand capacity for clinical placement
April 11, 200726 Clinical Placement What are clinical placements? Coursework involving hands-on, direct care or service experience and evaluation of the students skills, variously referred to as: Clinical Clinical rotation Clerkship Fieldwork experience Community placement Practicum Internship
April 11, 200727 Clinical Placement Why are clinical placements so important? Couldnt we fill the need through expanded use of manikins, clinical simulators and standardized patients? Students need experiences outside the formal classroom, in community and patient care settings under the supervision of skilled practitioners, to develop their critical thinking and clinical judgment skills and learn to use those skills in a dynamic work environment.
April 11, 200728 Clinical Placement What kind of students? Technical college associate degree and technical training programs Undergraduate health professions degree programs Advanced degree programs What fields? Medicine Dentistry Nursing Physician Assistant Pharmacy Respiratory Therapy Radiologic Technology Nutrition Social Work Physical Therapy Mental Health -and many others-
April 11, 200729 Clinical Placement What kind of facilities? direct patient care (inpatient or ambulatory) technical and support services such as: pharmacy radiology dietetics social work long-term care facilities mental health facilities hospice home health other community agencies schools and public health agencies
April 11, 200730 Clinical Placement How scheduled? Time blocks of 2 hours to a full day A few days a week, integrated into a general education curriculum and a regular campus course schedule or A full-time block of several weeks when students may be engaged in the field experience full time
April 11, 200731 Clinical Placement Who teaches and supervises the students? faculty from the academic program who accompany students to the site or staff at the clinical site in consultation with a faculty clerkship director who makes occasional site visits On-site staff are often called preceptors, mentors or community faculty and may have volunteer appointments with the academic program.
April 11, 200732 Clinical Placement What are the expectations of the student? The student may be merely observing, or may be participating directly in patient care or service delivery. The independence expected of the student in carrying out assigned tasks evolves as the students training progresses. Sites and preceptors must be prepared to evaluate the students progress and permit increasing responsibility appropriate to the students level of development.
April 11, 200733 Focus on Nursing Summer of 2006 survey of health professions programs indicated a need for more clinical placements in many disciplines. Why initial focus on nursing? nursing shortage affects so many different care settings and agencies training site requirements so varied within just one discipline expectation that lessons learned and regional collaborations developed will speed efforts for other disciplines.
April 11, 200734 Nursing Curriculum Diverse curricula, but in general: ADN and BSN students need 4-5 clinical placements - at least one every semester (except BSN sophomore entry programs). One clinical placement may involve scheduling experience for the student on more than one service within a facility. Students spend from 12-24 hours per week at the clinical site, in 2-6 hour blocks of time. PN, first year ADN and junior year BSN students are taught in groups of 8, usually by a faculty member who travels with the students to the site. Second year ADN and most senior year BSN programs use preceptors on site for one of the clinicals. The transition or practicum experiences provide a 1:1 relationship of student to preceptor, and an opportunity for the student to exercise more independence.
April 11, 200735 Nursing Clinical Placements Needed Core clinical skills Hospitals Long term care facilities Community health and service learning Public health Community agencies Other School health clinics Mental health facilities
April 11, 200736 Challenges for Nursing Programs in Arranging Clinical Placements Will the patient or client mix at the site meet the needs of the specific component of the training program for which a training site is needed? Is the site able to provide space for students to meet as a group? Will students be able to access computers and on-line information resources at the site if needed? Are there staff at the site qualified to teach/precept/supervise students? Can they get release-time for preceptor development activities? Is housing available on-site if students will be there full time and must travel a distance to the site? Does the site understand the role of the student as learner, not as an extension of the workforce? Does the site understand its obligation to provide emergency care for students who become ill or are injured? What are the requirements of the partnership agencies regarding documenting students, affiliation agreements, and risk management, liability and malpractice issues?
April 11, 200737 Challenges for Healthcare Organizations and Providers Meeting the needs of different occupations, educational programs and levels of student. Assuring that the patient to student ratio is acceptable and that patients are agreeable to student-delivered/observed care. Establishing and verifying both school and facility expectations regarding staff role with students. Coping with the lack of standardization in record keeping processes and expectations among the educational programs. Providing clinical time around academic program schedules. Clarifying risk management/liability and all other variables relating to the relationship. Educating managers and staff regarding their own responsibilities, school expectations and student abilities. Small or specialty units and facilities far removed from the school location may have additional special issues to address.
April 11, 200738 Barriers lack of trained community preceptors with time to teach barriers of time and distance for students and faculty limited scheduling flexibility lack of classroom space and equipment for students at smaller facilities administrative burden on smaller facilities without an education coordinator some academic programs are proprietary about sites unwillingness to change from the way we have always done things
April 11, 200739 Opportunity to explore these challenges in our regional discussions over lunch
April 11, 200740 Update on Nursing Shortage: 2007 Ann Cook, RN, PhD Board Member, Wisconsin Center for Nursing Professor, Columbia College of Nursing
April 11, 200741
April 11, 200742 Nursing Workforce: National Picture Overall Trends Shortage easing somewhat? –Latest projection is 340,000 (vs. 1 million) shortfall by 2020 Health Affairs, Jan/Feb 2007: Auerbach, Buerhaus, Staiger –Age of entry into profession has increased Vacancy rate 8.5% (Down from 13%) Demand continues to increase Salary increases have slowed Aging workforce Looming PMD shortage = Demand for NPs
April 11, 200743 Current RN Workforce National Sample Survey of RNs: 2004 2.9 million registered nurses Increase of 7.9% from 2000 2.4 million (83.2%) employed in nursing Increase of 10% from 2000 58% employed full-time 25% employed part-time 16.8% not employed in nursing 56% employed in hospitals Decrease of 3% from 2000 11.5% employed in ambulatory care Increase of 2% from 2000
Source: 2004 RN NSSS Aging Workforce: National Picture Average age of RNs is 46.8 years –26.6% under age of 40 –16.6% under age of 35 2000: 31.7% under age of 40 1980: 40.5% under age of 35 –25.5% over age of 54 2000: 24.3% over age 54 1980: 17.2% over age 54 –Largest age cohort in 2004 is 45-49
Source: National Sample Survey of Registered Nurses: 2004 Age Distribution of RNs in U.S.
April 11, 200746 Nursing Workforce: Wisconsin 73,073 licensed RNs (As of Sept. 2006: Dept of Regulation and Licensing) Estimate 60,000 in workforce (based on National Sample Survey figure of 83%) 41% of RNs work part-time (2004 RN National Sample Survey) 54% of RNs work in hospitals (2001 WI RN survey) Average age of RNs is 47.6 years 27% of RNs are under 40 years of age 44% of RNs are 50 years or older Average age of nurse educators is 50.3 years
Source: WI DWD, Bureau of Workforce Information: 2006
April 11, 200748 Will there be enough RNs in 2015 and 2020 to care for you and your family? Aging Population and Aging RN Workforce Increased demand in outpatient, home health, long term care, hospice settings Impact of technology –Could make nurses more efficient and able to manage more patients –Could also increase demand
April 11, 200749 Employment Projections Office of Economic Advisors, WI DWD, July 2006 RN is one of top 5 occupations with most openings RN is one of top 30 fastest growing occupations RNs are the top occupation with most new jobs –From 2004-2014: 26,100 jobs (2,610/year) 16,000 new jobs 10,000 replacements Many new jobs are in Ambulatory Health Care Services
April 11, 200750 Current State Demand: RN Jobs Based on quick web site search – 3/26/07 –Approximately 1000 RN openings Many openings required advanced education or specialty area experience: –Nurse Practitioner –Clinical Nurse Specialist –Critical Care or ER –Hospice and home care –Surgery services –Behavioral health –Floating or PRN pool –Management –Long term care
April 11, 200751 Contributing Factors: Supply Increasing supply now School enrollments increased after 2000 Partnerships between clinical settings and nursing schools Increasing options for students to enter profession Johnson & Johnson campaign Decreasing supply in future Aging nursing school faculty Increased average age of nurses Increased number of RNs retiring in next ten years
April 11, 200752 Contributing Factors: Demand Increasing elderly population Outpatient services Long term care and home-based services Physician office practices Nurse Practitioners: Acute care and Community Clinics Specialty areas: Surgery, Oncology Management Faculty
April 11, 200753 Wisconsin Residents 1 in 8 residents over age 65 in 2005 1 in 6 in 2020, 1 in 5 in 2030 Age group 55-64 grew by 27% from 2000-2005 Those 64 in 2005 will be 79 in 2020 Many nurses in this group Age group 85+ grew by 22% from 2000-2005 Fastest growing age group (Health Care Wisconsin: Report from the Governor's Health Care Workforce Shortage Committee, 2005; Wisconsin Department of Health & Family Services)
April 11, 200754 Faculty Shortages: National Vacancy rate of 7.9% in BSN and graduate programs – most positions required a PhD ( AACN, 2006) Vacancy rate of 5.6% in associate degree programs (NLN, 2006) Nursing schools turned away > 41,000 qualified applicants for baccalaureate and graduate programs (AACN, 2006) Insufficient faculty, clinical sites, classroom space, clinical preceptors and budget constraints Troubling Trends: (NLN, 2006) Increase in part-time faculty Aging of faculty Decrease in doctorally prepared faculty
April 11, 200755 Faculty Shortage: WI Vacancy Rate as of October 2006: 6% –BSN and graduate programs: 9% –Associate degree: 2.4% Projected Retirement in next 5 years –Administrative positions: 23% –Faculty positions: 18% Source: Survey conducted by Wisconsin Center for Nursing, 2006
April 11, 200756 Nursing Schools Have Responded 2001-2005 – National (AACN, 2006) –Enrollment increased by 57% in generic entry level BSN programs –Graduation increased by 37.7% 2001-2005 – Wisconsin –NCLEX first time pass rate increase by 45% Associate degree increase 49% BSN increase by 39% –UW Schools by 37%
April 11, 200757 Nursing School Strategies Clinical simulations Collaborative learning environments Distance education Sharing of resources Academic-service partnerships More part time, temporary, & adjunct faculty, faculty overload
April 11, 200758 Question for WI: Will Supply=Demand? WI does not have coordinated, systematic method of collecting nurse workforce data –Supply –Demand Without this information - cannot develop a plan to meet the needs of the citizens of WI Healthcare marketplace is slow to respond to needs –Marketplace creates surpluses and shortages that do not meet needs of population Specialty areas Geographical areas
April 11, 200759 WI: Prepare for the Future Need to answer these questions: –Is the supply of nurses adequate to meet the health needs of the citizens of WI? –Does the nurse workforce have the right skills and education to provide quality care in the right locations and specialties? –Does the nurse workforce reflect the cultural and racial make-up of the state? WI must have basic nurse workforce data –Supply: Demographics, Work settings, Education, Hours of work –Demand: Across all settings: available positions and requirements, turnover and vacancy rates, projected needs
April 11, 200760 Break Please be back in 10 minutes
April 11, 200761 Fox Valley Healthcare Alliance (FVHCA) Retirement and Departure Intention Survey Data & Clinical Placement Efforts Presenters: Cheryl Welch and Norma Tirado
April 11, 200762 FVHCA Partners: Affinity Health System Ripon Medical Center Agnesian HealthCare UW-Fond du Lac Aurora Health Care UW-Fox Valley BrightStar Health Care UW-Oshkosh Circle of Care Co-op Winnebago County Health Department Community Health Network: Wisconsin Center for Nursing Berlin Fox Valley Technical College Fox Valley Workforce Dev. Board Marian College Moraine Park Technical College Northeast WI AHEC Park View Health Center
April 11, 200763 Clinical Placement Efforts of the FVHCA
April 11, 200764 From an October 2006 FVHCA Clinical Placement Summit, the three top issues surrounding clinical placements, were identified by attendees. They centered around the areas of: 1) Preceptors 2)Uniformity/Standardization 3) The vast number of clinical placement requests (most wanting the same time/place)
April 11, 200765 Three workgroups were formed for each issue and brainstorming started immediately! During the next 6-9 months, the Preceptor Committee (#1) will focus their efforts on: –Preceptor education (What is a preceptor? What qualities/skills should someone have? How do we promote/market being a preceptor?) –Uniform evaluation (of preceptors and of the entire experience, so preceptors have a voice) –Recognition (reward system, what would a preceptor appreciate as a token of thanks? Luncheon? Preceptor of the year? Pin for nametag? Gift certificates?)
April 11, 200766 Uniformity/Standardization committees (#2) areas of concentration: A Universal/Uniform orientation across area facilities Development of a Skills Checklist (For precepted experiences, will help everyone know what a student can really do) Consistency in what area facilities require from students (paperwork, healthcare requirements, etc.) Development of a concise, collaborative process of how to submit and request a clinical.
April 11, 200767 And finally, the Clinical Placement subcommittee (#3) will work on: Researching innovative clinical placement models that promote thinking outside the box. Data gathering: (Need to know what schools and healthcare facilities want/need/already do/can do to identify matches and mismatches) Securing funding for possible projects: –Simulation center for all to share –On-line clinical placement system
April 11, 200768 Each workgroup meets 1-2 times before each full FVHCA meeting and reports on its progress, while also asking for input/ suggestions from all members. A Partial List of Successes to date: * Development of FVHCA website: www.fvhca.org * Job shadow requirements/paperwork has been standardized with major healthcare systems involved. * Healthcare requirements have been standardized. * Criminal background check group has been formed as a resource for schools.
April 11, 200769 Retirement and Departure Intentions Survey Our goal was to gather relevant data to identify the specific healthcare workforce needs (in all areas, not just nursing) for the seven county region of the Fox Valley WDA: Calumet, Fond du Lac, Green Lake, Outagamie, Waupaca, Waushara, and Winnebago Counties.
April 11, 200770 Update/Results: Survey of nearly 7,800 Fox Valley healthcare employees. Six healthcare organizations represented in initial data. Averaged 60% response rate. Margin of error +/- 0.5% (finite population calculation)
April 11, 200771 Respondent Demographics 70% full-time employees Occupational setting: –22% Registered Nurses – 6% Nursing Aide/Assistant/Attendant – 5% Licensed Practical/Vocational Nurse – 4% Medical Transcription/Coder – 3% Medical Records/Health Information Technician Employment Setting: –47% work in hospitals –29% work in clinical outpatient – 7% long-term care. Years of healthcare employment –25% - 5 years or less –45% - 6 to 20 years –30% - more than 20 years
April 11, 200772 Retirement Intentions ALLRNsLPNsCNAs < 1 year1%.6%.5%.7% 1-5 years10%8%13%7% 6-10 years15%14.5%22%11% 11-15 years17%20%19%14% Within 10 years26%23%36%19% Within 15 years43% 55%33%
April 11, 200773 Major factors in retirement decision Of respondents 5 years or less from retirement –Financial security at time of retirement (59%) –Reaching appropriate retirement age (41%) –Reaching eligible retirement age (40%) –Desire to pursue leisure activities (36%) –Job stress/pressure (34%)
April 11, 200774 Departure Intentions Just under 4% plan to leave within 24 months. –2% of RNs –2.9% of LPNs –5.9% of CNAs Major reasons in departure decision: –45% insufficient salary and benefits –42.5% desire for a career change –39% job stress / pressure –31% emotional demands of the job
April 11, 200775 These surveys will: Assess current number of positions staffed and the age ranges of employees at each facility. Assess anticipated staffing level changes over the next 5 years. A total of 7 occupational clusters and a miscellaneous cluster. These surveys are completed by individual HR departments. Healthcare Staffing Assessment~ still working on it!
April 11, 200776 Any Questions? For more information, please contact: Cheryl Welch or Jen Meyer at the Fox Valley Workforce Development Board (920) 720-5600 or firstname.lastname@example.org
April 11, 200777 Western Wisconsin Clinical Placement La Crosse Medical Health Science Consortium Mary Lu Gerke, RN, PhD
April 11, 200778 Bring the Stakeholders to the Table –Schools of Nursing Western Technical College UW- Western Campus Viterbo University Winona State University –Representatives of Clinical Sites Franciscan Skemp Gundersen Lutheran Tomah Memorial VA Medical Center Onalaska Care Center Mile Bluff Medical Center Vernon Memorial Hospital –Professional Organization Wisconsin Hospital Association Shortage of Clinical Sites
April 11, 200779 Create the Vision – Set the Target Expand the number of clinical sites in the regional areas To better facilitate nursing clinical site scheduling To increase the amount of nursing faculty available
April 11, 200780 Whats the Process Assess/Analyze Capacity – Demand Ratio Assure Competent Preceptors Develop a Memorandum of Agreement with Academic and Service Facilities –Standardize Contracts –Create Software Data House Develop a Clinical Placement Center
April 11, 200781 Assess the Capacity - Demand Created a data base with all hospitals, nursing homes, community health agencies, any potential clinical site in 20 counties Total = 202 potential sites Created a Survey regarding Clinical Site and Preceptor Availability (See handout) Mailed out survey – 50 completed – mail out reminders after two weeks 65 to date response
April 11, 200782 On Line Preceptor Training Telehealth grant dollars from the LMHSC 30 students for the Winona online preceptor program 30 students for the UW-Madison online preceptor program.
April 11, 200783 Create an Agreement Sign by partners – academia – service To continue to the next steps Human resources to work on development Seeking funding for a Clinical Placement Center
April 11, 200784 Development of a Clinical Placement Website Contract with Web Master – Ken Graetz Estimate Cost – $16,000 – $20,000 initial build and start up Need to Determine On-going structure & cost
April 11, 200785 Status of Software Programming Ken Graetz E-Learning Director Winona State University-Minnesota
April 11, 200786 Supporting Online Collaboration Easy collaboration and coordination are the keys to supporting clinical placement The challenge is not as much technical as it is human What is needed –Flexible online tools that allow partners to collaborate and coordinate efforts themselves –Build capacity to collaborate at a distance
April 11, 200787 Online Community Pilot 12 partners Tools –Microsoft SharePoint –Adobe Acrobat Connect Professional (Breeze) Use tools to –Allow partners to build the solution that best meets their needs –Allow partners to support the process themselves without hefty license fees or a lot of maintenance –Provide a framework and capacity for further collaboration
April 11, 200788 An Online Communispace
April 11, 200789 Collaborative Documents
April 11, 200790 Meeting at a Distance
April 11, 200791 Clinical Placement On-line Software Elizabeth Biel Program Planning and Development Director Healthcare Education-Industry Partnership-Minnesota
April 11, 200792 Box Lunches Please be back in 25 minutes
April 11, 200793 Small Group Discussion
April 11, 200794 Group Report Outs
April 11, 200795 Next Steps
April 11, 200796 Resolution Signing
April 11, 200797 Thank you for your Participation