Healthcare organizations nationwide are experiencing workforce shortages which are projected to continue over the coming decade.¹ In the face of this challenge, community health centers are finding creative solutions to continue providing quality healthcare for Tennesseans. Dayspring Health, Inc. first opened in 1952 as a small community clinic in rural Appalachia² and is now a federally-funded health center serving more than 8,000 patients across three counties.³ In 2024, Dayspring received the Charles Darling Organization of Excellence Award from the Tennessee Primary Care Association for a first-of-its-kind initiative to address their nursing shortage, led by Bonnie McNabb, LPN, Director of Nursing, and Cheri Lewis, LPN, Assistant Director of Nursing.
Bonnie and Cheri pioneered the creation of a Certified Clinical Medical Assistant (CCMA) training program after seeing a need to grow their team of skilled medical staff and improve their ability to serve patients. Bonnie tells me that CCMAs, who can assist with a lot of patient care, are not common in their area. They initially hired Clinical Nursing Assistants (CNAs) to help carry out more basic care, but over time, it became difficult to maintain daily functions. “These were excellent employees who had really dedicated their time and effort to the position they were in, and there wasn't even a question of laying them off so we could bring in new staff,” Bonnie explains to me. “But we asked ourselves, ‘How do we advance their skill level?’”
And so, the work began to put together a rigorous four-month program to turn their CNAs into CCMAs. “We sent out an e-mail to staff, and you know, to be quite honest, I only expected probably four [CNAs] that would want to do it,” Bonnie says, nodding. “But all of them—all the original eight that we had hired to get us through COVID—said, ‘Hey, I want to do it. I want to stay with you guys. I like my job. Sign me up!’”
When I ask about challenges they encountered during the program, Bonnie and Cheri tell me that they had to come off the clinic floor a couple hours each week to get through the program material. “We had a lot [of content] to fit in,” Bonnie explains, remembering the process. She emphasizes that their entire department pitching in to help was an important part of their success. “[The nurses] wanted to see these ladies succeed because we needed them, and, you know, over the time of their employment with Dayspring, they became a part of us,” she says meaningfully. “We had an, ‘If one fails, we all fail,’ kind of attitude.”
When the time came for the CNAs to take their certification exam, Bonnie and Cheri could hardly wait for the results. “We're sitting there in hesitation. It seems like forever,” says Bonnie, a smile on her face. “We got down to the very last person and everyone was just standing around. I don't know how she passed.” Both Bonnie and Cheri laugh recalling how excited they were. “We had one-hundred percent pass. You would’ve thought we were at a football game!”
Hearing Bonnie and Cheri speak about their students, it’s easy to see how much they care for them not just as employees, but also as people. “Giving women in our community who would normally not have an opportunity to obtain that certification the opportunity to do it [meant a lot],” Bonnie tells me when I ask how it felt to see them succeed. “We cried with them. We laughed with them,” Cheri says, agreeing.
One, perhaps unexpected, effect of the program has been that other organizations in the area—Campbell, Claiborne, and Whitley County—are realizing they can follow Dayspring’s lead by opening up CCMA positions. Bonnie says, “I think people in the community may have seen what we were doing and thought, ‘Well, if they're doing it, we can do it, too.’” This development in staffing could be crucial to advancing patient care in their community long-term.
Bonnie and Cheri’s advice to other healthcare organizations looking to develop a similar training program is, “Help the ones that you have inside grow to their fullest potential first, then search outside. I guess it’s that old saying, ‘Anything worth having is worth working hard for.’”
This interview was edited for brevity and clarity.
¹Health Workforce Projections (HRSA, 2024). https://bhw.hrsa.gov/data-research/projecting-health-workforce-supply-demand.
²About Us (Dayspring Health, Inc.). https://dayspringhealth.org/about-us/.
³2025 Site Guide (TPCA). https://www.flipsnack.com/tnpca/tpca-s-tn-community-health-center-site-guide/full-view.html.
#Feature