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What The Different Paths Into Nursing Careers Say About Inequality In High School Education

Elle Moxley
KCUR 89.3
Students in the nursing program at Summit Technology Academy inflate a healthy pig lung to use in a demonstration on the dangers of smoking. The students have access to the state-of-the-art skills lab at the Missouri Innovation Campus.

It’s a common refrain in career and technical education: school must prepare students for jobs that haven’t been invented yet.

To do that, vocational training centers are undergoing high-tech transformations, and nowhere is that more apparent than in Lee’s Summit. The gleaming, $64 million Missouri Innovation Campus that opened last fall has been hailed as a game changer for accelerating the time it takes for a four-year degree after high school.

The idea is that students will save big on college tuition, even more than they would if they took dual college enrollment classes at their high school, because the programs are aligned with degrees from the University of Central-Missouri. The university is partnering with the Lee’s Summit R-7 School District.

Credit Elle Moxley / KCUR 89.3
KCUR 89.3
Students from other metro-area school districts can take classes at the Missouri Innovation Campus, but the sending district has to pay tuition to Lee’s Summit R-7.

But building the innovation campus took a big upfront local investment. And school districts with fewer resources than affluent districts like Lee’s Summit struggle to keep up.

Consider nursing education

Traditionally, a lot of nurses got their start as certified nursing assistants. They worked at hospitals or long-term care facilities under the supervision of licensed nurses while studying for boards. It’s an entry-level job: CNAs provide basic, hands on care, such as taking vital signs or helping patients bathe. 

Most vocational nursing programs at the high school level prepared students to sit the CNA exam, but that’s no longer the case at Summit Technology Academy, Lee’s Summit’s career and tech ed center.

“We’re not a typical CNA program,” instructor Tracy Colon says. “There are CNA programs in the area students have access to, but we’ve always been focused on preparing them for a professional program of study.”

Colon and her co-instructor, Peggy Chandler, decided that with the move into new, state-of-the-art facilities at MIC, it was time to update their curriculum. In Lee’s Summit, where more than 80 percent of graduate go on to college, the emphasis is now on professional nursing.

“We through the last several years learned the value of not only helping students get into nursing school, but staying in nursing school,” Chandler says.

That’s because hospitals want to hire more nurses with four-year degrees. In 2010, the Institute of Medicine (now the National Academy of Medicine) recommended that 80 percent of the nursing workforce have a bachelor of science in nursing or higher degree by 2020.

Interest in sitting the CNA exam had been declining at Summit Tech even before Chandler and Colon decided to drop preparing for the exam from the curriculum. It used to be 30 percent of students would take the exam and complete the requisite clinical hours. Last fall, it dipped to 17 percent, and this spring, none of the students in Chandler and Colon’s class were interested, in part because they were already getting college credit.

Elle Moxley
KCUR 89.3
Lee’s Summit North senior Samantha Simpson practices palpations in the nursing skills lab at the Missouri Innovation Campus. She’ll be a semester ahead when she arrives at the University of Central Missouri this fall.

Samantha Simpson, a senior at Lee’s Summit North, has spent a lot of time this spring in the nursing skills lab. During a recent class, she got to listen for bowel sounds on a high-tech dummy.

“You’d make sure there’s a pillow under their head and between their knees,” Simpson says, draping her patient’s hospital gown for modesty, “and then I would begin palpations, so I would just push on the different areas to make sure there was no firmness.”

A lot of high school students would be grossed out, but not Simpson. She’s enjoyed learning medical terminology and basic nursing skills at Summit Tech. Taking this class reinforced her decision to major in nursing when she starts college at UCM in the fall – and she’ll be a semester ahead.

No need to take the CNA exam.

The CNA track

But elsewhere in the metro passing the CNA exam is still the goal.

Credit Elle Moxley / KCUR 89.3
KCUR 89.3
Paw Hser, a student at Northeast High School in the Kansas City Public Schools, wants to be a nurse so she can help others. She spent this semester at Manual Career and Technical Center preparing to take her certified nursing assistant exam, which will allow her to work in hospitals while pursuing a two-year degree.

Paw Hser is a senior at Northeast High School. She spends half her day at Manual Career and Technical Center, part of the Kansas City Public Schools. Nearly all of the students here are students of color. Many speak languages other than English at home. A lot of them will be the first in their family to go to college.

“My career goal is to become a nurse so I can take care of others,” Hser says.

Hser is planning to continue her education after high school, but she knows she’ll have to work to pay for her associate’s degree.

“I was planning to get a job at Children’s Mercy or North Kansas City Hospital because they say I can apply for it if I have a CNA degree,” Hser says.

Credit Elle Moxley / KCUR 89.3
KCUR 89.3
Edith Radillo is headed to the University of Missouri after she graduates from East High School. Even though she plans to get her bachelor of science in nursing, she still wanted to take the certified nursing assistant exam so she can work with sick kids in the hospital as an undergrad.

Like the students in Lee’s Summit, Hser’s classmate Edith Radillo is planning to pursue a four-year nursing degree. She’s headed to the University of Missouri after she graduates from East High School. But unlike the students in Lee’s Summit, she expects to work as a CNA in college.

“I really want to work with kids in the hospital because I just love working with kids,” Radillo says. “I feel like being a CNA already, I’ll be more advanced.”

Mary Sharbell, the nursing instructor at Manual, was surprised to hear other districts are moving away from the CNA curriculum because she also sees it as so foundational to the spectrum of care nurses provide.

“You just don’t have one type of person you’re taking care of,” she says. “We have to look at the whole person in a holistic view. Their race, their culture, their religion, their spirituality, what gifts do they bring? And then we’re learning from each other.”

Sharbell says her job is more fulfilling because her students overcome the challenges they bring to the classroom. The pass rate for Manual students who sit the CNA exam is high – better than 90 percent. And Kansas City Public Schools got full marks from the state last year for exceeding college- and career-readiness goals ahead of schedule.

Most graduates of Manual’s nursing program plan to work as a CNA while pursuing a two- or four-year degree. But sometimes the CNA ends up being the terminus, which means a much lower lifetime earnings potential.

The push for nurses with degrees

If anyone knew how many CNAs go on to take and pass licensing exams, it would be Sue Hassmiller, senior advisor for nursing at the Robert Wood Johnson Foundation. She directed the 2010 study that called for more nurses with four-year degrees.

But Hassmiller says no one’s really keeping those statistics, which makes it hard to know exactly how nurses are moving through the alphabet soup of licensure. There are nurses with two-year degrees and nurses with four-year degrees. There are nurse practitioners with advanced degrees and nursing assistants who never advance beyond CNA.

Not that there’s anything wrong with that, Hassmiller hastens to add. She got her start as a CNA, and she’s extremely grateful to the CNA who helps care for her mother. In fact, Hassmiller says, there’s a critical shortage of home nursing personnel right now.

“Some people can’t just jump into a college education,” Hassmiller says. “They need to go to community college. Community college is more affordable.

“But you also want to make sure that you’re not holding people back, especially underrepresented minorities. You shouldn’t say, ‘Oh, community college is good enough.’ If we know by evidence that we’d like everyone or nearly everyone to move on to baccalaureate, we have to find ways of equitably helping everyone get there.”

The research shows safety and quality improve when nurses continue their education. So it’s hard for Hassmiller not to like Lee’s Summit’s approach. After all, the whole point of releasing that report was to drive the kind of policy change that improves the health care system.

Equity challenge

Back in Lee’s Summit, opportunities seem limitless.

Late last year, the Board of Education approved another option for students to get started on a college degree while still in high school. Students in the Innovation Track can take classes on nearby college campuses for part of the day.

It was really important to Superintendent Dennis Carpenter that all students be able to participate, regardless of whether they could pay.

Credit Elle Moxley / KCUR 89.3
KCUR 89.3
Lee’s Summit Superintendent Dennis Carpenter, right, and University of Central Missouri President Charles Ambrose talk about the Missouri Innovation Campus at a meeting of the South Kansas City Alliance on Oct. 9, 2017. A partnership between the school district and the university lets students do their last two years of high school and their first two years of college simultaneously.

Equity is a priority for Carpenter, which is why so many people were stunned when he took the top job in one of the state’s wealthiest school districts. Before, he was the superintendent in Hickman Mills, where he advocated fiercely for students of color whose families faced the dire circumstances of poverty.

Carpenter asked the Lee’s Summit Board of Education to set aside $396,000 for students who wouldn’t otherwise be able to afford to take college classes. That works out to about one-sixth of one percent of the district’s overall operating budget.

“How do we become that suburban district that becomes the model for our country? We have to have access for all students to obtain those quality programs,” Carpenter said at a school board meeting in December.

He ultimately convinced the board that the district should be paying course fees for students who quality for free or reduced lunch, but not before coming up against real resistance.

In the same community where there’s been enthusiastic support for the Missouri Innovation Campus, there were people who didn’t want their tax dollars being used for post-secondary education for low-income kids.

Elle Moxley covers education for KCUR. You can reach her on Twitter @ellemoxley.

Elle Moxley covered education for KCUR.
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