CODE BLUE: Working together solves shortage problems

No hoarding of ideas among North Carolina facilities

This isn’t a story about how to attract high school and college students into nursing or other medical professions — at least not directly. This is a story about how competing health systems have come together in North Carolina to share resources and ideas on how to solve the critical shortage problems facing health care.

Two years into the Code Blue program, it’s working like gangbusters, increasing the number of applicants in most medical career areas, and beginning to address the specific shortages that individual hospitals are facing in several areas. And none of the four systems involved feel like they are giving away the store by participating in a program with their competitors in the medical marketplace.

Code Blue originated in the 1980s when there was a nursing shortage in North Carolina, but once that problem was solved, the program was shelved. When nursing was again impacted by shortage — and several other health care professions started to show signs of low or dipping enrollments — it was resurrected by the four systems that operate in a 12-county area of North Carolina: High Point Regional Health System, Moses Cone Health System, Novant Health System, and Baptist Health.

"The problem was too big for one health system to solve alone," explains Marty Cooper, president of Marty Cooper & Company, the organization that designed and runs the program. Human resources and recruiting executives from the four systems joined Cooper to brainstorm and come up with budgets. They then returned to their organizations to get funding approval. Perhaps most surprising was that they did get it.

It wasn’t even much of a hard sell, says Diane Everhart, Director of Corporate Recruiting at Moses Cone Health System in Greensboro. "There wasn’t really opposition when it was discussed," she says. "I think everyone realized that if there are more health care workers in our market period, we can all hire more, and we may not lose our people to other facilities recruiting them away."

The Code Blue program includes several elements, says Cooper, including:

Classroom and community presentations — This is the most important element of the program, she notes. A coordinator is available to visit schools and community centers to talk about health careers. The coordinator is also available for college nights, job expos, and career fairs.

Resource Notebook – To be distributed to all guidance counselors, health occupations, science, and life study teachers, as well as to school and public libraries, to adult employment locations and colleges. The notebook gives information about a variety of health careers including salaries, where programs are taught, scholarship/ tuition programs, and what course prerequisites are required.

The Code Blue Web site — Located at

Poster Series — Series of fun posters with cartoon illustrations to entice interest. The posters have been distributed to all middle and senior high schools in the 12 counties, as well as to libraries and other adult employment and education areas.

Brochure — six-panel, four-color brochure for mass distribution.

T-shirts and other specialty items — To be given away at classroom presentations and at career nights.

Mass media advertising campaign — The program is advertised in high school and college publications such as newspapers and yearbooks. Radio/TV and/or billboards also are under consideration.

Code Blue Scholarships — The program awarded 16 scholarships of $500 to $1,000 last year to students currently enrolled in a health care program as well as those newly enrolling in a field of study related to health care.

Newsletter and news releases — Newsletters with employment profiles and needs are mailed to all of the above-mentioned groups.

So far, so great

Cooper says that preliminary enrollment data reflects a significant increase in applications to health care educational programs in the 12 counties Code Blue covers. For example, Forsyth Technical Community College in Winston-Salem was having difficulty recruiting qualified applicants for their RN and LPN programs prior to the program’s onset. In 2001, the school had 564 applicants to the RN program, 206 of which were qualified; in 2002 Forsyth had 793 applicants to the RN program, of which 406 were qualified. The school can admit 60 new RN students annually. Although Cooper says the program cannot claim credit for all of the increase in applications to Forsyth’s nursing program, "we feel we have greatly contributed. Our toll-free hotline receives no less than 5 calls daily and as many as 30 daily after a job or career fair."

In some respects, the program is working too well, notes Lynn Boggs, Vice President of Human Resources for Novant Health in Winston-Salem. "It’s working so well that we have a sizable backlog of qualified applicants trying to get into schools without success," says Boggs. "State restrictions on class size and state funding problems have exacerbated the problem. It’s a good problem, but a problem none the less."

The hospitals and health systems involved in the program are starting to see some direct positive impacts from the program, though. Combined with some of the other scholarship and recruitment programs offered in North Carolina and by individual organizations, Everhart says that her system is starting to see an easing of some of the critical shortages they experienced as recently as a year ago. "We are just at the point where we are starting to feel more supply in the marketplace," says Everhart. "It was definitely worse a couple years ago."

While acknowledging that working with competition can sometimes be a hard thing to do, Robert Katana, RN, FACHE, FACMPE, the CEO of the Triad Health Alliance that oversees Code Blue, says it’s important to overcome that hurdle. "You have to do this collaboratively because it is not an individual system problem. It is a community, regional, and national issue," he says. "Working together we can combine and share the cost." That cost is about $250,000 per year right now — in part because of up front development costs. It should be lower in future years.

Not that the individual facility is lost in the collaboration process, he adds. "Even though we are working together on the overall program, each hospital can still do its own thing with recruitment and retention, scholarship programs, or other ways to address the problem."

Everhart says hospitals afraid of working with their competition should get over that fear, and do it quickly. "This is a simple issue of market supply and demand," she notes. "If there are more health professionals out there for all of us to get, it’s better for all of us. And since we are all chipping in together, we can all reap the benefits of not having to cover the costs in whole individually."

Currently, Code Blue is doing well enough that it is likely to be licensed to other facilities in North Carolina to use, and Katana thinks it may go national. Indeed, he is happy to share information with any health care organization that is interested in the materials.


• Robert F. Katana, RN, FACHE, FACMPE, CEO, Triad Health Alliance, 4380 Federal Drive, Suite 100, Greensboro, NC 27410. Telephone: (336) 632-1177.

• Marty Cooper, President, Marty Cooper & Company, Inc., 2670 Merry Oaks Trail, Winston-Salem, NC 27103. Telephone: (336) 765-2225.

• Lynn Boggs, Vice President of Human Resources, Forsyth Memorial Hospital/ Novant Health, 3333 Silas Creek Parkway, Winston-Salem, NC 27103. Telephone: (336) 718-2034.

• Diane Everhart, Director of Corporate Recruitment, Moses Cone Health System, 1200 N. Elm St., Greensboro, NC 27401. Telephone: (336) 832-7578.