Ready to Lead: An Innovative Microcredentials Leadership Program for Frontline Healthcare Workers in Continuing Care

Abstract

With an ageing population and the highest disability rate in Canada, Nova Scotia continues to see demand for continuing care services grow. While focus has been placed on addressing persistent frontline staffing challenges, less attention has been paid to the ongoing need for new leaders. The many Continuing Care Assistants (CCAs) and Licensed Practical Nurses (LPNs) working in continuing care are a diverse, educated, and experienced workforce bringing new ideas and perspectives into healthcare leadership. Mount Saint Vincent University’s Ready to Lead (R2L) program is a microcredential series designed to prepare CCAs and LPNs to progress into continuing care leadership roles. R2L can also serve as a unique recruitment and retention tool attracting individuals seeking career paths including continuing care leadership opportunities. This article details R2L’s design, development, and outcomes from the inaugural R2L program offering insights for health leaders wanting to identify effective training and retention strategies.

Introduction

Nova Scotia, like much of Canada, is rapidly moving towards an overall older population. It is estimated that in less than 5 years, more than 25% of all Nova Scotians will be 65 years of age or older.^1,2 This presents a two-fold challenge for healthcare in Nova Scotia with more leaders reaching retirement age and an increase in older adults requiring more resources for care on average. ³ Much of this support will be provided through Nova Scotia’s continuing care system, which supports tens of thousands of demographically diverse individuals at home, in community, and in formal care spaces such as nursing homes, with a focus on supporting older adults. ⁴

Over 10,000 Frontline Continuing Care Professionals (FCCPs), including Continuing Care Assistants (CCAs) and Licensed Practical Nurses (LPNs), provide many of the direct care services offered across Nova Scotia. While continuing education opportunities have been developed for Registered Nurses (RNs) in clinical settings,^5,6 and well-established programs exist for continuing care administrators in Nova Scotia, ⁷ FCCPs have fewer extension programs focused on their practice. Current opportunities come primarily through bursaries and scholarships for further education that encourage FCCPs to pursue other fields or advanced qualifications,^8,9 such as an RN designation, leading to an opportunity vacuum for individuals who wish to remain in their current role and/or context while progressing their careers. This also creates challenges for organizations seeking to support their staff in professional development when available opportunities implicitly, if unintentionally, undermine efforts to professionalize or maintain attachment to many FCCP roles. The Ready to Lead (R2L) program was developed as a response to various challenges in continuing care, preparing experienced FCCPs for formal leadership roles through a unique learning opportunity designed for individuals working on the frontline of continuing care in Nova Scotia.

Ready to Lead Program Overview

R2L is a competency-based series of non-credit continuing education modules (“microcredentials”) delivered in a blended on-line format designed to support the development of emerging frontline leaders working in continuing care settings. ¹⁰ Within the program, competencies are defined as actionable skills, knowledge, attitudes, and behaviours that can be applied in specific contexts.^6,11,12 Much of the program centres competencies related to leading teams, communications, relationship building, ethical decision-making, and reflective practice in line with the interpersonal nature of continuing care. ¹³ Systems thinking is also key to the learning, with R2L participants exploring the Canadian and provincial healthcare landscapes while identifying challenges and formulating solutions to issues impacting frontline professionals and the people they support. ¹⁴

Design and Development

The R2L program was designed with a learner-centred approach, exploring demographics and individual considerations to better understand and support prospective learners. ¹⁵ Universal Design for Learning (UDL) principles were applied throughout development and delivery to support quality programming while expanding equity, inclusion, and accessibility within the program.^16,17 Program designers also aligned each module with the Nova Scotia Microcredentials Framework to confirm programming would be relevant and credentials recognized across the province. ¹⁸ Prior to development, key sector partners were identified to further expand the validity and recognition of participants’ accomplishments while supporting the identification of key insights into the continuing care context. ¹⁹

The Prospective Learner

Prior to formal program design, the MSVU team started by reviewing available information on individuals working in frontline continuing care positions, intentionally centring the learner first. At the outset of development, there were around 11,650 people working in CCA and CCA-adjacent roles and an estimated 3,100 LPNs across Nova Scotia.^20,21 Around 85% of LPNs and 56% of CCAs had completed a certificate or diploma program beyond high school. Significantly, around 27% of individuals in CCA and adjacent roles had not completed a formally recognized education program beyond high school. As of 2024, 5.3% of employed LPNs had graduated from nursing programs outside of Canada. ²² In 2023, 45% of CCAs across Nova Scotia were identified as having been born outside of Canada. ²³

Other available demographic data indicated that in Nova Scotia 94% of LPNs and 88% of CCAs and similar FCCPs identified as women.^20,21 The most recent census data for Nova Scotia indicated around 7.5% of people living in the province in 2021 immigrated to Canada from abroad. ²⁴ These data also showed that 9.8% of Nova Scotians self-identified as part of a visible minority group. Further conversations with industry representatives and others helped fill gaps in affirming the likelihood of a diverse group of applicants for the program.

Through analysis of these combined data sources, the R2L team identified various characteristics that influenced the creation of seven learner personas for diverse participants. Learner personas helped guide decisions throughout the curriculum design process, centring the learners’ perspectives while allowing developers to connect with these hypothetical learners. ²⁵ This process also supported aligning the program with the university’s mission, vision, values, and strategic goals as an institution that has and continues to champion the advancement of women through education and development opportunities. ²⁶

Program Alignment

The R2L program was developed as a series of microcredentials aligned with the Nova Scotia Microcredentials Framework. This framework, developed with input from educators, policy-makers, and others, created a strong foundation upon which to structure the program. In line with the framework, the R2L team documented several core considerations for the program, including how it supported access, equity, inclusion, and more. ¹⁸ By formally articulating the approach prior to development, the team could readily communicate to government and sector partners how participants would be supported, programming would meet accessibility guidelines for on-line learning, and the design would align with UDL principles.

Achieving support for new programs often requires the ability to clearly communicate its potential value, impact, and direction. ²⁷ Before development, the team identified an ongoing high demand for qualified FCCPs within Nova Scotia due in part to turnover, churn, and burnout, which have led to notable recent challenges for employers within the continuing care sector.^20,28,29 The R2L program aimed to address these challenges and others by supporting FCCPs in developing their skills, efficacy, understanding of, and connection to the continuing care profession while expanding capacity for frontline leadership in the sector. In a sector with limited professional development opportunities, programs like R2L support professionalizing the work of continuing care, bringing positive attention and a sense of recognition to individuals in the program.

Partner Engagement

For programs like R2L, the team recognized the importance of having key members of the sector engaged as partners. To this end, the team sought and received support from two of the largest employers in continuing care within Nova Scotia.

Partner engagement began by internally networking to identify points of contact at several target organizations. This gave university leaders a clearer perspective on the proposed approach while limiting potential conflicts related to extant partnerships. The team focused on engaging with prospective partner’s executive leadership from the outset allowing for immediate organizational support and expediting partnership discussions. Following initial conversations, the R2L team collaborated with prospective partners to outline partnership expectations prior to formalizing the agreement, an approach that limited confusion and incorporated partner feedback, increasing buy in.

The development team determined the best partnership approach for this pilot to be a direct development partnership. R2L partner representatives attended regular development meetings, identified prospective participants for the pilot, and offered specific insights from industry relevant to the delivery of the program. In turn, the program reserved a specific number of seats in the pilot delivery to each partner organization, identified the organizations as partners in promotions and communications, and shared anonymized program feedback with partners. This partnership approach offered several notable benefits.

The R2L team gained access to vital practical information, such as scheduling considerations, through partner liaisons allowing for a more impactful and inclusive delivery. During curriculum review, partners supported categorizing the priority and structure of topics creating a more streamlined and relevant program. With partners involved at every stage of program development, those organizations felt confident validating the R2L program as meeting the criteria outlined in the curriculum, thus imparting industry recognition on the credentials earned by successful R2L participants. Having access to key industry partners also helped significantly with the identification and recruitment of qualified participants for the program within a relatively short time.

Andragogical Approach

At the core of R2L’s design is UDL, a framework designed to support inclusion, equity, and access in education. ¹⁶ In considering the participants in the program, the development team recognized several specific challenges that could be readily addressed by applying a UDL lens with an andragogical approach throughout program design. During development and delivery, the team addressed challenges related to engaging with materials, learning in an on-line context, language ability, cultivating psychological safety, and more.

Considering the available demographic data on FCCPs, it seemed plausible that participants would have limited or no experience of formal learning in an on-line context. MSVU offers all on-line programming using Moodle, a Learning Management System (LMS) designed with built-in accessibility features. ³⁰ However, to support learners inexperienced in navigating an LMS, there is a need to address the basics of navigating a digital learning environment while offering continuous support. ¹⁵ To meet this expectation, the team offered two on-line orientation sessions for all registered participants, with a recording of one session made available throughout the program. Orientation sessions provided secondary benefits by creating a welcoming virtual space for participants to meet support staff prior to program commencement, which can encourage reaching out for support as needed rather than struggling in silence. ³¹ Dedicated support staff and the program facilitator were available for individual consultation throughout the program by request.

To mitigate requirements for paid software, the team developed all materials as keyboard-navigable PDFs accessible with any free PDF reader software. The team also followed WCAG and UDL guidelines by exclusively using accessible sans serif fonts, high contrast colour combinations to distinguish between text and background, appropriate line spacing, and a consistent design for all materials and presentations.^16,32 Slides for live discussions were shared in advance as PDFs with only specific in-session activity slides removed offering participants opportunities to review discussion topics in advance and maintain continuous access to references cited in the program without undermining spontaneous engagement during live sessions.

While the team recognizes that offering programming in multiple languages has the potential for expanding access and equity, available resources and context limited the R2L program to individuals with at least an intermediate English level. However, recognizing program outcomes centred developing leadership skills relevant to a continuing care context, the team made two significant choices. First, program assessments were designed to be practical, flexible, and focused on content and ideas rather than grammar and structure. This was clearly outlined in assessment rubrics available to participants alongside assessment instructions. Second, language for the program was aimed at a Canadian Language Benchmarks standard of CLB-7, ³³ allowing for a wide range of vocabulary while limiting challenges for participants not fully fluent in English. Language above CLB-7 was occasionally included to allow for professional language necessary to leading in and understanding the continuing care context.

Participant Recruitment

Participant recruitment was conducted in two stages for the program’s two distinct cohorts. The first stage involved the identification by partner organizations of individuals who met all program requirements and who organizational leaders identified as prospective leaders. A total of 20 partner-identified participants were recruited into the first R2L cohort.

The second recruitment stage required a modest marketing and communications campaign to connect with prospective independent applicants. Several posts were made with information on the program via LinkedIn and other relevant social media platforms. The R2L team simultaneously contacted leaders at continuing and similar care-focused organizations via email to share information about the program and application process. A total of 55 individuals applied for 20 available seats in the second cohort. All selected participants met or exceeded all entry criteria for the program.

Evaluation of Pilot

R2L participants benefited through professional development, recognition, and validation of their achievements by government, employers, and the university. Skills developed through the program apply directly to leadership roles in a continuing care context. However, many of the skills and competencies developed and recognized through the program are highly transferrable to a variety of leadership contexts.

Although 19 (47.5%) of the original 40 R2L participants successfully completed all six modules, only two (5%) were unsuccessful due to inability to meet the success criteria requirements for one or more modules; of those two, one arranged to participate in the appropriate respective modules for the 2026 delivery of R2L. The other 19 participants who voluntarily disengaged from the program indicated personal reasons, scheduling challenges (in some cases unanticipated permanent changes to work schedule), or similar with one participant leaving R2L to pursue an advanced professional designation.

Anonymous program feedback was overall positive. Each module received an overall evaluation of 4.73 or higher out of 5, with 1 identified as Poor and 5 as Excellent. Program elements that participants identified as highly impactful included one-to-one sessions with the R2L facilitator at various program milestones, panel discussions with senior leaders in continuing care, and case studies reflecting the complex realities of frontline continuing care roles. R2L participants provided detailed descriptions of how the knowledge and skills they acquired in the program had a positive impact in their current work and in some cases, their home life.

Discussion

Quality care requires effective dedicated leadership.^5,6 R2L shows promise in identifying and supporting frontline leaders in continuing care and similar contexts. Programs like R2L may support continued attachment to the sector, limit uncertainty and miscommunication in the workplace, and infuse leadership skills while expanding leadership capacity across various frontline workplaces.^5,34 Although there is widespread agreement leadership development in care settings is important, more research is required to determine the impact it has on individuals and organizations. ³⁵ As this program review did not constitute research into human subjects and all information was fully anonymized, formal ethical review was not required. In future, it is hoped R2L will provide meaningful opportunities for research into participant outcomes and organizational impact.

For R2L, specific challenges were identified and addressed prior to and during delivery. Key challenges presented during delivery included limited engagement with programming outside of scheduled live sessions, continuous technology challenges, and significant levels of attrition early in the program. To address these issues, the team recommended incorporating more of the required asynchronous programming into the live sessions, limiting the steps required to access live on-line sessions and other program elements, and offering a more flexible schedule, ideally with multiple live sessions at different days or times covering the same materials.

Conclusion

Individuals working in continuing care serve vital roles in our communities, though their contributions are not always recognized. Through programs like Ready to Lead, CCAs, LPNs, and others working in frontline continuing care can find that recognition along with a community of likeminded professionals to share in their passion and dedication for this work and the people they support. As more leaders retire and demand for services grow, programs like Ready to Lead are preparing the next generation of leaders in Nova Scotia’s continuing care system.