18—and Already a Nurse

At 18 years old, Holli Hamby graduated from high school in rural Tahlequah, Okla., with the goal of becoming a registered nurse. Unlike many aspiring nurses, however, Hamby didn’t head off to college or settle for an entry-level job to start. She spent two more semesters at the career tech center she had just graduated from, and at the end of it, she was a licensed practical nurse.

“I can’t tell you how invaluable having that LPN certification almost immediately out of high school was for me,” Hamby says. “My first job was in a nursing home. I worked the 3-11 shift, and I was the most senior person in the building. I was the grown-up.”

Now 31, Hamby is a registered nurse. She’s also back in school finishing a master’s degree to become a nurse practitioner. Hamby’s full-time job as an LPN financed her education to become an RN and also gave her more on-the-job experience than most students her age training to become nurses.

Hamby’s story is part of growing efforts to expand nursing education to the high school level amid a nationwide shortage of nurses. High schools that specialize in career and technical education offer students the opportunity to kickstart their careers, usually for far less money than they’d pay if they started in college. And while some employers have been hesitant to hire teenagers into licensed roles in hospitals, partnerships with high schools allow them to create their own pipelines to combat worker shortages. 

High school career and technical education historically focused on the trades, but in recent years there’s been a growth of programs in other industries, too. 

“We’ve seen quite a bit of expansion in the funding that’s available for the healthcare sector,” says Dan Hinderliter, associate director of state policy at Advance CTE, a nonprofit membership association. That’s been especially true after COVID, he says.

While Oklahoma has long been ahead of the curve on healthcare career and technical education at the high school level, the state has increased its investment with funds from the American Rescue Plan Act in 2021. Other states have responded similarly since the pandemic. North Carolina launched a youth pre-apprenticeship in pre-nursing to allow students to get paid on-the-job training and mentoring. Florida passed a bill requiring career tech schools to develop programs to accelerate students’ entry into postsecondary healthcare programs. And some states, including Colorado, are opening new healthcare high schools, partnering with community colleges.

Last year, Bloomberg Philanthropies made a $250M investment in early education in nursing and other fields, funding the creation of 10 healthcare high schools across the United States that work closely with their local hospitals and community colleges. Community colleges also are expanding their reach into K-12 outside of the early college model, focusing on career exploration and hands-on experience in healthcare for high schoolers. 

Not all programs get students into positions like licensed practical nursing as quickly as Hamby’s program at Indian Capital Technology Center—which has since cut the additional two semesters after graduation down to one. But many of the more robust programs graduate students with some type of dual enrollment credit and certification, like certified nursing assistant or phlebotomy, so they can start working immediately. They also emphasize career planning, advising students on the different ways they can continue their education to get into higher-paying roles, often on their future employers’ dime. 

The idea is to prevent students, especially those from lower-income families, from getting stuck on the pathway from entry-level healthcare jobs to higher-paid roles in nursing. Most certified nursing assistants don’t move up to become registered nurses, even when they want to. Getting on track earlier, before young adults are living on their own and life gets more complicated, gives students a better chance at advancing in their careers.

Hamby was able to take certified nursing assistant and phlebotomy training in high school for free. The last year of her LPN training was covered by a scholarship since she enrolled immediately after graduation. She also received advance credit for nursing school, so she wouldn’t have to repeat—and pay for—courses like anatomy and physiology when she studied to be a registered nurse. All of this helped her get through school faster and for less money, while working full-time.

“I always knew I wanted to go to nursing school, but I don’t know that I could have because of the money,” Hamby says. “Nursing school is very expensive.”

Showing What’s Possible 

Creating healthcare programs for high school students that quickly lead to well-paid jobs isn’t easy. Nursing roles above licensed practical nursing all require some kind of postsecondary degree, from an associate all the way to a master’s. And employers can be reluctant to let teenagers do the kind of patient care that is required for clinicals. 

Career and technical education proponents, however, argue that healthcare programs in high school better prepare students for college later, mostly through early exposure to different pathways within the field, as well as hands-on experience. 

“The biggest thing for high school learners is not necessarily that we’re preparing them for a specific career after they graduate high school,” Hinderliter says. “It’s more that we’re exposing them to the entire body of the world of work in their given sector.” The goal, he says, is to give them the experience and skills necessary to choose what’s next.

Many healthcare-focused high schools, like those funded by Bloomberg, take this approach. Several of them regularly hold career fairs as early as freshman year and bring in professionals to talk about their work. As students get older, they shadow hospital employees and take part in paid internships. Like Hamby, many start working as CNAs before they even graduate. 

Students also learn about the pathways they could take next. The recently opened Durham Early College of Health Sciences in North Carolina—a partnership between Duke Health, Durham Technical Community College, and Durham Public Schools—was one of the Bloomberg grant recipients. Oluwunmi Ariyo, Durham Tech’s director of college recruitment and high school partnerships, says one of the new school’s goals is to help its students, who typically come from low-income backgrounds, build generational wealth. This includes wraparound support and career guidance. 

“Every pathway is valuable, and every pathway is going to lead them to a job,” Ariyo says. “Let’s say we have a student who isn’t making A’s in anatomy and physiology. They can still become a medical assistant, which is tremendously needed at Duke Health. They have the opportunity to do an internship or apprenticeship and build off that. And down the road, they may be ready to go into nursing school, for free if they work at Duke Health.”

The Bloomberg-funded healthcare high schools are built on partnerships with employers, which often guide decisions around curriculum and the career pathways that are offered. Those kinds of employer partnerships are new territory for most high schools. In fact, a lot of the hospitals Bloomberg is working with had never even spoken with their local school district before the project started. 

Dana Chandler, deputy director of international competitive events at HOSA-Future Health Professionals who also started the LPN program at Indian Capital Technology Center, says that’s starting to change as the shortages in nursing and other professions have reached crisis levels. 

“There’s been more of an openness, not just on the education side, but also on the provider side within hospitals,” Chandler says. “They’ve had to be open to having younger students who are doing clinicals at 17.”

Baylor Scott & White Health in Dallas, another of the Bloomberg grant recipients, previously partnered with the local charter school Uplift Education to create a medical assistant pathway where students could begin working right out of high school. The grant has allowed them to expand to four distinct pathways at two schools: nursing, healthcare operations, diagnostic and therapeutic medicine, and biomedical science. Nursing is the most popular pathway, and it addresses a vital need at the hospitals, says Phil Kendzior, vice president of workforce development programs at the health system.

At Uplift, all students have the opportunity to earn a patient care technician certificate by the time they graduate, with other optional certificates like phlebotomy, pharmacy technician, or EKG technician. The school and health system also are building out a radiology certificate. Kendzior says they purposefully designed the curriculum to offer students three options upon graduation: going to college full-time, going directly into the workforce, or doing a combination of both.

In Boston, the Edward M. Kennedy Academy for Health Careers, in partnership with the city’s public school district and Mass General Brigham, has used its Bloomberg grant money to transform into a fully career-oriented healthcare school. Before the grant, students could choose to take healthcare classes if they wanted, but now every student will be on one of five pathways in the field, with paid work opportunities before they graduate.

Heather Kay (H. Kay) Howard, director of health careers training at Mass General Brigham, says it’s been logistically challenging coordinating with the high school and teens’ schedules, which can include extracurricular activities, as well as all the traditional classes students need to take to graduate. But she anticipates a big payoff. 

“This is fundamentally a workforce development strategy for Mass General Brigham,” Howard says. “Some roles are really hard to fill, or take a long time to fill. We’re hoping that getting students in early will help us to reduce those vacancy rates. We also think it will drive deeper retention among those early employees. They’re going to stick to us if we are really committed to supporting them.”

Community Colleges as a Bridge

In the many places that don’t have high schools focused on healthcare, some community colleges have started to reach out to younger students about healthcare careers, with the hope that they’ll find their way to nursing school when the time comes. 

Through its work with Achieving the Dream and a grant from the Brave of Heart Fund, Lorain County Community College in Ohio has created a program to accelerate and diversify nursing pathways. Mary Grady, nursing programs administrator at the college, says part of the college’s strategy has been to make their nursing programs more visible in high schools. They even hired a nurse part-time to regularly talk to students about what nursing is and let them know their options before they are ready for college. The college also hosts workshops and career fairs for high schoolers, bringing them into the nursing lab and facilitating a summer program at University Hospitals in Cleveland. 

“We have to promote our profession and make it a viable option for people,” Grady says. “In our area, a lot of our students are the first in their families to go to college. For some of them, they don’t even know what nursing is or how the pathway works, or even how to get into college, because they didn’t have those resources at home to help guide them.”

An obvious area for partnership between high schools and community colleges is dual credit, though historically career and technical education haven’t been a focus of those programs. 

One limitation is transfer policies. While general education classes are likely to transfer, colleges are less willing to accept nursing-specific classes taken elsewhere, says Nancy Allen, executive director of the National Consortium for Health Science Education. She’s seen pockets of dual enrollment for nursing classes, but it isn’t yet widespread. 

Employers are one of the challenges, she says. Many worry about students’ emotional maturity and their ability to handle the stress and interpersonal demands of patient care. Allen says that this can be a major obstacle getting students access to the required clinicals and then to a job after graduation. But, she says, if districts get employers into the schools and involved in the curriculum, it can make a big difference. 

“Many people don’t know what goes on at the high school level,” Allen says. “They just don’t know the rigor and the relevance of these programs. These students aren’t just coming out of an English class. They can do vital signs, they’ve got medical anatomy and physiology.”

For the students themselves, the responsibility can also be a lot to handle while still in their teen years. When Hamby began her licensed practical nursing job at the nursing home at age 18, she cried in the bathroom during her first three shifts. 

“There was no administration there when I was there because it was the evening shift,” Hamby says. “I had 25 patients I was taking care of with some CNAs who were helping me. It can get very heavy and overwhelming. That is probably the only downside.” 

Madyson Snow, 33, who graduated from Indian Capital Technology Center around the same time as Hamby agreed. When she started working as an LPN at 19 years old, she initially got a lot of flak from her coworkers, many of whom were much older than her but working in more junior roles. She says her high school teachers warned her about that, which helped her to brush it off and keep going.

Snow is now a nurse practitioner and has worked alongside a lot of students doing their clinicals, including Hamby. She sees a difference between those who started their healthcare education in high school at career and technical education centers and those who didn’t start until college. The career tech students are usually more prepared for the job—not just in terms of nursing skills, but also general job readiness, like knowing how to dress and present themselves at work. This is all part of the curriculum.

Previously, Snow thought she’d begin her career in college, too, but she’s grateful she found an option to get on track sooner. 

“It’s almost like a step up and an instant push into life,” Snow says. “Having that extra certification behind your name in high school, whether it’s CNA or phlebotomy, and then getting the LPN, it just puts you that much further ahead in life.”

Editor’s note: This story is the final one in a three-part series looking at how to become a nurse, in particular pathways for certified nursing assistants to move up into nursing. Read the other two stories here and here.