An essential strategy for ensuring that inside-up initiatives lead to career advancement is to ensure that tuition assistance is accessible to entry-level employees. Some health systems have policies whereby only degree-granting programs are eligible for tuition assistance and short-term technical certificates are not eligible. The term “certification” may cause confusion, as short-term technical training programs that ensure a person has the necessary skills to perform a job, such as a pharmacy technician or phlebotomist, use the term certification in a different way than professional enhancement certifications such as a Lean certification, a program management certification, or a Human Resource SHRM certification. Being able to explain the difference to internal leaders who create tuition assistance policy will be important to affecting change.

Writing policies regarding tuition assistance eligibility without the full understanding of the word “certificate” may have the unintended consequence of eliminating the pursuit of important technical certificates by those who would most likely engage in this training—entry-level employees—even though these employees may gain the most from financial support.64 Therefore, tuition assistance should be made available for certification programs that include occupations such as medical coding, patient care, surgery technician, and phlebotomy. Other courses that could be considered for tuition assistance eligibility that would benefit entry-level employees include English for Speakers of Other Languages (ESOL), literacy and numeracy, college preparation, and paths to citizenship.

It is crucial that institutions communicate clearly to entry-level workers about the availability of education and training opportunities. One strategy employed by Baystate Health is to host in-person “opportunity fairs” where employees, especially those with limited access to computers, can learn about the benefits and programs available to them that can help to build financial security, including financial assistance for education.65 In addition, it is important that employees become eligible for internal training programs within a reasonable timeframe. Workforce planners can also help connect new employees to tuition support opportunities. Even if employees are not yet eligible for tuition assistance until after three months of employment, for example, they can begin working with a workforce planner early on, who can help them assess their skills and identify trainings they might be interested in for when they do reach the tenure requirement to qualify for this benefit.

Since the upfront cost of college degrees or technical training programs can be a barrier to participation for entry-level workers, as many cost hundreds or even thousands of dollars, tuition advancement and direct payment for education help make these programs more accessible. Hospitals that provide tuition advancement often ask employees to sign agreements stating that they will work at the institution for a designated period of time after completing the training, and that they will complete the degree program. These accountability measures allow institutions to more clearly trace the impact of what are often costly tuition programs. Other measures include requiring back payments if the employee does not finish or pass the program. With agreements such as these, it is critical that job coaching and academic support be provided to troubleshoot problems as they arise in order to improve completion rates.

Ascension has taken this approach, providing debt-free education to employees who seek to pursue certain clinical pathways. Through the health system’s Vocare program, tuition is paid directly to the partnering education institutions so that employees face no out-of-pocket costs. “The Vocare Program has granted me the freedom to pursue a career I am passionate about without the financial burden,” reflected Renata, an employee studying to become a surgical technologist. “I am grateful it has created an opportunity for learning and growth within a space that recognizes my unique needs as a full-time employee and student.”66 

The Johns Hopkins University and Health System works with their vendor Guild to help employees fund degree programs as well as access tuition-free learning opportunities with the myTuition education benefit program.

An example of adapting tuition payment to help facilitate participation can be found at University of Vermont Health (UVM Health), which enables employees to earn wages and benefits while pursuing advanced studies to further their career—often with full tuition support. Facing a shortage of nurses in its rural setting, the health system developed a nurse education pathway program to remove barriers for individuals seeking to enter or advance in the nursing field, with grant support for tuition advancement from the Vermont Agency of Human Services. Launched in 2023, the program covers the tuition, fees, and books for 25 individuals pursuing a master’s in nursing education. “We [previously] had traditional tuition reimbursement, which is limited,” explains Betsy Hassan, director of nursing education and professional development. “The finances of going back for a graduate degree are hard for many.”67 

In order to access tuition advancement, individuals are asked to commit to a two-year, dual work-service agreement that includes working with UVM Health and teaching with a partnering college of nursing. “The candidates who came forward [for the nurse education pathway program] were people who already wanted this career and were thinking about doing it at some point,” says Hassan. With tuition advancement, they can meet their career goals, while UVM Health is able to prepare additional employees to progress into nursing roles. For example, individuals with little to no prior experience can go through a Licensed Nursing Assistant (LNA) earn-and-learn program, and at a later point, participate in an LNA-to-RN Pathway Program with tuition advancement.

Xi Chen, a newcomer to Vermont with limited English proficiency, started at UVM Health as a hospital cleaner and participated in an English language training program, leading to a LNA certification. She has since obtained her practical nursing certificate and is now training to become a registered nurse through a local university partnership. Xi is receiving tuition support through an employer-funded loan program called the Workforce Opportunity Loan Program (WOLP). UVM Medical Center and UVM Health provide the funds and repay the loan payments as Xi continues through the program and the first three years of employment as a registered nurse, fully funding her education. Xi has stated that she has “a strong desire and a calling to be a caregiver, [and] I’m able to do that and provide for myself because of the support I get from our leaders and my coworkers.”68

While tuition assistance might make training programs financially accessible, there can still be major barriers for participation, especially for low-income workers. Individuals might have multiple jobs or may not have access to reliable transportation. Providing on-site training opportunities can help facilitate participation by reducing commute time and making it easier for employees to attend. Moreover, if the training has a clinical component, employees become familiar with institution-specific equipment and facilities.

The University of Utah Health’s on-site Workforce Development Center connects residents with resources and tools for job searching, resume building, and interview preparation, and provides internal career development services such as internal career fairs and career development courses for employees. Resources are available online through an enhanced website, which includes tools to support career advancement, job searching, and resume development. A workforce development counselor is available for one-on-one consultations to support career advancement, providing overviews of career pathways and guidance on the requirements for each role. Internal programs include pharmacy technician, medical assisting for radiology specialties, nurse residency, critical care, and operating room internships. In addition, the workforce development counselor acts as a liaison between the university and partner organizations that support career pathway programs for roles in surgical technology, sterile processing, and radiation therapy. By being located on-site, the Workforce Development Center is better positioned to deliver on its goals of increasing job growth, investing in employees, improving retention, and enhancing employee satisfaction. 68c 

Another way to facilitate participation in training programs is to provide release time for employees so that they can complete training during work hours and thus maintain their full-time wage and benefits. In this case, the employee’s department may cover the wages, especially when the employee is being trained to move into a high-need position within that department. Other models include having wages covered by the department where the newly trained employee will work once their training is complete, or utilizing grant funds that pay wages.