Durham, NC - Trenton Emmert positioned the plastic tube between the mannequin's lips to measure lung capacity and recited post-operative instructions.
"This is to get you breathing deeper," said Emmert as a nursing instructor observed.
"To prevent what?" the instructor asked.
There was a close guess, a brief pause and then Emmert remembered and offered the correct answer: "To prevent post-operative pneumonia."
A Duke anesthesia technician, Emmert practices patient simulations like this as part of his nursing studies at North Carolina Central University. He's one of slightly more than 1,000 Duke employees who currently combine full-time work with additional schooling, a feat made possible in part because of Duke's Employee Tuition Assistance Program.
Last year, Duke reimbursed employees about $2.56 million for tuition expenses at a time when many institutions cut the benefit. According to the Society for Human Resource Management, U.S. businesses offering tuition assistance dropped from 68 percent in 2007 to 58 percent in 2011. But at Duke, the program is growing. Participation has more than doubled in five years - from 432 employees in 2007 to 1,006 in 2011.
"Tuition reimbursement and other professional development opportunities at Duke signal our desire to make Duke an institution of learning not just for students, but for staff as well," said Kyle Cavanaugh, vice president for administration at Duke. "This investment translates into a skilled workforce and more opportunity for employees to advance within Duke as they expand their skills."
The tuition benefit is available to staff and faculty who work at least 30 hours each week and have atleast two years of continuous service. An eligible employee can receive as much as $5,250 per year for up to nine courses at North Carolina accredited schools. The courses must be approved as part of a professional development plan. Employees who use the benefit must commit to remaining at Duke for two years after receiving reimbursement.
Seizing educational opportunities
Jameca Dupree followed her husband and two young sons into Frankie's Fun Park in Raleigh and slid a laptop and two accounting books on the table. While her husband negotiated pizza toppings with her sons, she powered up the laptop.
She studied before the pizza arrived and joined her family for one round of go-karts before returning to her books while the rest of the family played.
"Studying is important," she said, "but so is family time."
In her 11 years at Duke, Dupree has artfully balanced home, work and school as she seized educational opportunities to help advance her career from a part-time Duke food service employee with a high school diploma to a full-time financial analyst with a bachelor's degree in business administration.
"I don't know of any other place where I could have worked and achieved so much in such a short time," she said.
Dupree began charting her path with Duke's Professional Development Institute, known as PDI. In 2004, she graduated from PDI's Office Staff Development Program, where she learned Duke's financial and record-keeping systems, business writing and other administrative skills.
Soon after she finished that 44-week program, Dupree moved into a coordinator position in the Cardiac MRI department. Ten months later, she moved to a staff assistant position in Perkins Library.
"PDI helped get my career on track," Dupree said. "But I knew I needed a college degree to move farther."
She enrolled in North Carolina Wesleyan College in 2007 with her heart set on a bachelor's degree in business administration. Over three years, Duke's tuition benefit reimbursed her about $15,000 for the degree.
She recalls those years as a whirlwind of activity. Many days, she would rush home after work, review her sons' homework, give her husband a quick hug, then drive 20 minutes to the Morrisville campus for a three-hour class. On weekends, she sat in bleachers at her sons' basketball games and studied accounting practices and organizational behavior.
"It was tough, but my family understood how important it was to me," she said.
While Dupree was in college, Ann Elsner, director of administrative services at Perkins Library, increasingly involved Dupree in budget discussions and assigned tasks such as budget trend analysis. A few months after Dupree graduated in 2010, Elsner was able to promote Dupree to a financial analyst position at Perkins Library.
"I wouldn't have been eligible for this last promotion without the degree," Dupree said. "But I'm not finished learning. I want to go on now and get my masters in business."
Help finding her voice
Three years ago, Aliki Martin watched as her son anxiously checked email each day, awaiting news of acceptance into college.
She could empathize.
She, too, had applied for college.
A senior auditor for Duke's School of Medicine, Martin joined the second class of Duke's new doctorate in nursing practice in 2009. Her classes in evidence-based practice and applied statistics started days after she dropped her son off at the Rochester Institute of Technology.
"Immersing myself in school work helped me cope with having an empty nest," said Martin, who joined Duke 30 years ago as a pediatric nurse.
She's most recently been working on her capstone project: a pilot study to see if routinely screening breast and lung cancer patients at Duke for clinical trials will increase the numbers of women, minorities and underserved populations enrolled in clinical trials for new treatments.
Her studies have given her an appreciation for just what it takes to make subtle changes in healthcare practices that could have major impacts on outcomes and research. She expects to earn the doctorate in August.
"This work has helped me find my voice as a patient advocate," Martin said. "No matter where my career takes me next, that will be helpful, and I'm grateful to Duke for supporting this growth."
Long days paying off
Trenton Emmert, the anesthesia technician studying at NCCU, settled into a favorite study nook in NCCU's new Nursing Building. He pulled out a three-inch thick surgical nursing textbook from his backpack and underlined phrases with a blue highlighter.
It had been a long day already. He arrived at school at 8 a.m., a few hours after finishing a 10-hour shift at Duke University Hospital.
"It's a hard schedule, but it's for a good purpose," he said.
"I'm excited about becoming a nurse."
Emmert already has one bachelor's degree that helped him get a job as a surgical technician at Durham Regional Hospital. But, during his work there helping position patients on operating tables and wheeling in trays of equipment for sedating patients, he grew fascinated by the role of a nurse anesthetist.
"It was something I could easily imagine myself doing, having responsibility for a patient throughout the operation," he said. "But I needed that second degree."
He investigated nursing school but discovered he was ineligible for most federal financial aid for a second bachelor's degree. Before his second anniversary at Duke, a co-worker told him about the tuition benefit. He enrolled at NCCU and transferred to weekend night shifts at Duke Hospital to make time for day classes.
When he earns his nursing degree next May, he hopes to gain direct experience at Duke for a few years then return to school to gain accreditation as a nurse anesthetist.
"Right now I have zero social life on the weekends, but thanks to the tuition benefit and the flexibility of being able to transfer to night shifts, I'm working toward the degree that I really want," Emmert said. "I'm just really thankful to be working at an institution that makes this all possible."