Espanola Healthcare Career Pathways Project

Submitted to Espanola Valley Healthcare and Nursing Careers Pathways Program Partners

By: Theresa A López MSN, RNC CHW

Background

Española Valley High School (EVHS), Española School District (District), Northern New Mexico College (NNMC), Presbyterian Española Hospital (Presbyterian) and the LANL (Los Alamos National Lab) Foundation (Foundation) desire to explore the possibility of meeting the local health care workforce needs by providing easier and affordable access to health care education through establishment of an Espanola Valley Healthcare and Nursing Careers Pathway Program among the partner institutions. A particular focus of the program would be creation of a pathways program for individuals to become Licensed Practical Nurses (LPNs).

Over the past few years, the partners have discussed establishment of such a program. However, a formal needs assessment or plan had not been developed to guide this effort. It was posited by the partners that if potential healthcare workers are to fill the many current and future positions in the health care workforce, they need to be able to access a range of education and training programs that not only provides them with an education but also provides them with the additional socio-economic resources necessary to be successful. If a major goal is to enable these workers/students to obtain employment that offers a life/family- sustaining wage as well as maximize their potential contributions as workers, continued education and training needs to be available to them after they enter the health care workforce.

To achieve this goal, it was proposed, and agreed upon by stakeholders, that educational healthcare career pathways, with multiple entry and exit points, would address this need. In September 2020, in a meeting convened by the LANL Foundation, the partner organizations met and confirmed their interest in pursuing this project. It was then determined that a formal assessment and implementation plan would be helpful to advance this effort and ensure its sustainability.

The partners moved forward with support of the creation of the proposed Espanola Valley Healthcare and Nursing Careers Pathway Program by employing a consultant to conduct a needs assessment and develop an implementation plan to establish a health care career pathways program among partner institutions. At this time, an advisory council was formed. A representative from each partner institution was selected to sit on this council and provide input into strategy, policies, and future direction of the project. It was also agreed that the proposed project would occur in two phases with associated timelines. The resultant plan would be brought to the partners for review and approval at determined times

At the initial meeting of the consultant and partners it was decided that the LPN focus would be postponed. Instead, the focus of the work would be redirected to the creation of three healthcare support occupations career pathways, as selected by the partners, with high school dual credit students and the adult community being identified as the target population.

This report provides a summary of the work completed for the project. It describes the rationale for creating a health and nursing careers pathway program and documents local and regional employment demand and economic need. Specific challenges and supports needed by student and faculty participants are identified. Three options for the establishment of a health and nursing careers pathway program among the partner organizations are described, and information regarding dual credit programs is presented. Information regarding accreditation, needed resources, benefits and drawbacks, and curricula for each option is included.

Rationale

(RFP Objective # 1)

It is clear to many that numerous and diverse approaches are required to address the critical shortage of health care workers nationally and in the Española Valley community. Absence of a qualified health care workforce threatens the availability of affordable quality medical care for the citizens of the Española Valley community. Policy initiatives, innovative health care workforce education programs, and funding aimed at attracting, educating, and retaining health care workers and expanding the capacity of healthcare education are necessary to alleviate the shortage.

The Espanola Valley Healthcare and Nursing Careers Pathways Program is a comprehensive initiative and partnership project that integrates coordinated academic and social support services aimed at supporting entrance and progression through healthcare career ladders for local high school youth and adult community members. The target population for this program includes high school dual credit students, incumbent health care workers, and the adult community at large.

The Espanola Health and Nursing Careers Pathways Program is designed to address two key concerns in the community:

1. Employers lack qualified workers to fill the growing vacancies in the healthcare field. As employers in the community struggle to address this issue, the Department of Labor (DOL) projects that there will be rapid and significant increase in the need for healthcare workers over the next ten years. (Health Care Occupations: Occupational Outlook Handbook, 2021).
2. Incumbent workers struggle to obtain jobs that provide a good living wage and to advance in their careers. Workers too often experience insurmountable barriers without options to help them move forward.

Local and Regional Employment Demand and Economic Need

National Health Care Workforce Needs

The U.S. will face significant healthcare worker shortages in the coming decade. By 2025 there will be a shortage of more than 400,000 home health aides, 95,000 nursing assistants, and 29,400 nurse practitioners (Mercer Report, 2019). Healthcare occupations are one of the fastest growing employment sectors in the nation. The U.S. Bureau of Labor Statistics (Employment Summary 2019-29) reports that “the healthcare occupational groups in which employment is projected to grow markedly faster than average, include healthcare support occupations…” Healthcare support occupations such as medical assistants, personal care attendants, home health aides, nurse aides, and phlebotomists are projected by the Bureau of Labor Statistics (2019) to have a “bright outlook” status, meaning they are projected to display “Rapid Growth” (an employment increase of 10% or more), and /or “Numerous Job Openings” (100,000 or more job openings during the time period of 2019-2026). In the next decade, the rate of job growth in health care support occupations is projected to be three times as great as the rate of job growth in the remainder of the economy (U.S. Bureau of Labor Statistics, Employment Summary 2019-2029).

Healthcare support occupations include Home Health Aides and Personal care Assistants, Nurse Aides and Orderlies, Psychiatric Aides, Occupational Therapy Assistants, Occupational Therapy Aides, Respiratory Therapist Aides, Physical Therapist Aides, Massage Therapists, Dental Assistants, Medical Assistants, Medical Equipment Preparers, Medical Transcriptionists, Pharmacy Aides, Veterinary Assistants and Laboratory Animal Caretakers, and Phlebotomists (U.S. Bureau of Labor Statistics, May 2020).

Health care support occupations offer a wide range of employment opportunities from jobs requiring only short-term training, such as home health aides and personal care attendants, to those requiring Associate Degrees such as physical and respiratory therapist assistants.

New Mexico Health Care Workforce Needs

New Mexico is undergoing an historic increase in healthcare occupations vacancies. The New Mexico Department of Workforce Solutions Occupations Bulletin (April 2018) projects that registered nurses will have the most annual job openings between 2014 and 2024 and 660 jobs a year are anticipated to be in demand by employers. Licensed practical and licensed vocational nurses are projected to have 80 job openings per year. It is anticipated that employment growth in healthcare support occupations, at 21.2 percent, is expected to be the second fastest growing occupation in the state, with jobs increasing by 5,790 over the next decade (New Mexico Department of Workforce Solutions 2016-2026 Occupational Employment Projections).

An aging adult population and the greater number of insurable people (due to the Affordable Care Act) are the primary drivers for this accelerated need.

Health care support occupations provide employment opportunities for individuals with varying levels of education and training. Two-fifths of direct care workers—nursing assistants, home health aides, and personal and home care aides have no more than a high school diploma or GED certificate. In New Mexico, workers can enter the health care field with even less education (Casau, 2014).

While many of these entry-level positions pay only a minimum wage and turnover is high, career pathways can make it possible for entry-level workers to get jobs with higher wages by incrementally increasing their job responsibilities and educational attainment. The local and statewide environment has created a wealth of opportunities for future workers who have the desire to enter the healthcare field but who do not have the educational or financial resources to pursue a college degree.

As a group, healthcare support occupations number approximately 26,560 workers in New Mexico and this number is expected to grow exponentially over the next decade (U.S. Bureau of Labor Statistics, May 2020). New Mexican healthcare support occupations workers receive an annual median wage of $29,020, which ranks them as among the top wage earners in positions which do not require a college degree (New Mexico’s Occupational Outlook). However, despite the possibility of getting an entry-level position without formal education, most health care employers in New Mexico prefer to hire those who have some degree of training and certification.

Espanola Valley Healthcare Care Workforce Needs

As part of identifying local healthcare workforce needs, interviews were conducted with several local stakeholders and other individuals with relevant experience. Interviews focused on healthcare work force needs in the community and familiarity with career pathways programs. Local healthcare institution participants were asked to respond to two concerns: 1) healthcare workforce occupations with the most vacancies in their institutions, and 2) obstacles faced by students and/or workers who desire to have a career in health care. Educators were asked to provide expertise on career pathways programs, curriculums, and costs.

The need for Registered Nurses was, by far, the occupation with most vacancies in each institution. Because there is an associate degree in nursing program at Northern New Mexico College in Española that meets the educational need for registered nurses, participants were asked to list three other healthcare occupations their institutions were having difficulty filling.

• Ms. Lore Pease, Chief Executive Officer (CEO) of El Centro Family Health, reported that Licensed Practical Nurses (LPNs) were in high demand at the El Centro clinics. However, medical assistants (MAs) were doing many of the jobs of the LPNs, putting the medical assistant positions in a place of high demand. Per Ms. Pease, El Centro Family Health would entertain the idea of hiring additional medical assistants if the MA role could be expanded through additional training.
• Ms. Brandi Darby, Chief Operations Officer (COO) of Las Clinicas del Norte, voiced a dire need for nurse aides and medical assistants. She stated that Las Clinicas del Norte has multiple facilities in rural areas of New Mexico. Due to the rural nature of the clinics, it is difficult to find job applicants who have a background or training in health care. Most of the medical assistants and nurse aides receive on the job training which places an added burden on the institution to teach competencies that, she believes, should be part of a training program. She voiced strong support of a healthcare careers pathway program that would prepare future employees to be job ready upon hire.
• Ms. Brenda Romero and Dr. Theresa Valerio, Chief Executive Officer (CEO) and Chief Nursing Officer (CNO) respectively, of Presbyterian Española Hospital reported the need for LPNs in the Presbyterian Medical Group Clinics. They stated, however, that medical assistants were being used interchangeably with LPNs, and medical assistants were earning salaries comparable to those of an LPN. At the present time, Presbyterian Hospitals do not allow medical assistants to administer medications. However, if medical assistants received the proper training in medication administration, Presbyterian could potentially reconsider and expand the role of the medical assistant to include medication administration. In the hospital setting, both Ms. Romero and Ms. Valerio confirmed that nurse technician positions have continual vacancies which are getting increasingly difficult to fill due to employee’s reluctance to do shift work and work weekends and holidays.
• Mr. Ricardo Briones, Laboratory Technical Supervisor at TriCore Reference Laboratories reported continual vacancies in phlebotomy positions.
• Ms. Geraldine Torres (Ambercare Hospice), Ms. Tamara Rodriguez, (Del Corazon Hospice), and Ms. Leslie Van Pelt (Comfort Keepers) all agreed that the need for personal care assistants and home health aides was at an all-time high. They reported that with health care delivery shifting from hospitals to the community, the increasing need for health care support occupations that provide care for the elderly, disabled, and those on hospice care are in constant demand.
• Ms. Shirley Lia, Director of the Colorado Early College program provided a significant amount of information on resources regarding career pathways programs. Among those resources are the National Health Career Association (NHCA), and Health Occupations Students of America (HOSA). She shared curriculums for a variety of pathways and discussed her experiences managing career pathways programs. Suggestions for ways to integrate dual credit student cohorts with adult student cohorts was also part of the information sharing.
• Ms. Terri Tewart, Director of Santa Fe Community College (SFCC) Nursing Program, discussed SFCC’s high-school based LPN program and their careers pathways program. She shared information regarding the Santa Fe Capitol High LPN program. Creation of this program was a lengthy process (2 years or more) and much of its success was because potential students were identified in their freshman year of high school thus creating a cohort of like-minded students in a Health Care Careers Group. She provided resources relevant to the health care careers program offered at SFCC and access to the respective curricula. She also volunteered to be a local source of support as the career pathways programs at NNMC are developed.

The information obtained from interviewees align with national and New Mexico data on healthcare support occupations with the most vacancies and with educational best practices. Healthcare support occupations such as medical assistants, personal care attendants, home health aides, nurse aides, and phlebotomists are projected to have a “bright outlook” status, meaning they are projected to display “Rapid Growth” i.e.an employment increase of 10% or more (Bright Outlook Occupations, 2019).

Challenges and Needs: Student and Faculty Support

Interviews with Española stakeholders also substantiated findings in the literature regarding personal challenges often being the most difficult obstacles for incumbent or potential health care workers to overcome. It is not uncommon for this population to have a variety of life challenges affecting their ability to participate in health care training programs. Most need to work, sometimes two jobs, resulting in limited time to attend classes. They often have family responsibilities, including childcare and elder care, and may lack transportation or the funds to participate in available assistance programs. They struggle to manage competing priorities in their work and family lives and do not have the necessary resources to take classes to advance their careers.

• Ms. Brenda Romero, Presbyterian Española Hospital CEO, noted that “often times hospital workers such as nurse technicians have commented that hospital work is not conducive with family life and that the idea of being upwardly mobile and pursuing educational opportunities is next to impossible with the multitude of family commitments they have.”
• Ms. Ellen Trabka, Chair of the NNMC Department of Nursing and Health Sciences, agreed that family responsibilities often get in the way of potential healthcare student success and, by extension, are obstacles to local community members working in the healthcare workforce. “In this area, students have many social and cultural family commitments. Family is their first [sic] priority. For example, I might have a student say that they can’t get to class on time because they have to get their grandmother to her doctor’s appointment.”
• As suggested by Ms. Pease, CEO of El Centro Family Health, oftentimes students interested in health care, and workers already in the field, have little prior education and English may be a second language. Complicating this situation is the fact that having little prior education and/or a lack of English language proficiency affects skills levels in both math and English, thus making entry into a health care employment setting or school environment intimidating or impossible.

Structural and environmental challenges present obstacles to success for many potential students as well. Stakeholders identified several structural/environmental challenges faced by students.

• Inaccessible education and training were identified as major structural/environmental challenges by all interviewees. Because most workers already employed in the healthcare sector are working, classes that are held during the week and during work hours often make it impossible for students to participate.
• All interviewees agreed that for many students and incumbent workers, particularly those in positions of less skill and responsibility, the cost of education is prohibitive and adds another layer to the challenges potential students face. Most potential and incumbent health care workers must work. Often, they earn a minimum wage or a fraction above, and although they might recognize the value that education will have on future earnings, their present financial circumstances present a significant barrier to this pursuit. Out of pocket expenses for classes, particularly if the educational institution is charging typical four-year college tuition fees, is not feasible.
• Interviewees cited lack of coordinated support services as a major structural/environmental challenge. They mentioned that the absence of career coaches to serve as guides through the complicated educational system is sorely lacking. They also reported that employees who hope to return to school experience extreme difficulty navigating the complex world of support services such as childcare, transportation, financial aid, mentoring, and counseling. While most of these services were available somewhere in the community, the difficulties involved in coordinating and accessing these resources are major obstacles.
• Lack of knowledge about education, certificate and/ or training programs is also a primary barrier. When there is no clearly defined direction or career path potential students often give up out of frustration. Dr. Valerio, Presbyterian Española Hospital CNO, stated “I don’t think people know what the process is. Having someone to help kids in school and already employed healthcare workers chart the waters would be very helpful.”
• Ms. Lia of Colorado Early Colleges Program stated the lack of knowledge about, or access to financial aid, can be a barrier. Oftentimes students may also face systemic barriers such as the fact that financial aid often is not available for students who can only attend class part time or the fact that certificate programs may not qualify for financial aid.

Possible solutions to these issues as proposed by the interviewees include the following:

• Create career coach positions. Career coaches would assist students to navigate the educational system and help them access resources to manage family commitments while also attending school.
• Offer classes on professionalism to assist students to understand the expectations for healthcare employees. Examples include classes on communication, ethics, and time management. Make classes available at no or minimum cost to assist students to develop the English, math, and science skills needed for job and career success. Offer classes on computer skills needed for completion of class requirements. These support classes, combined with academic and career coaching, could help students gain confidence needed to remain in school and to succeed.
• Make the pathways program part of the community college segment of NNMC. This would lower tuition costs for pathways students.
• Explore funding to provide tuition reimbursements for all or selected pathways program participants.
• Explore the possibility of scholarships to defray education costs.
• Place college counselors at work sites to provide information about academic programs and support services.

Health and Nursing Careers Pathway Program Options

(RFP Objective # 2)

Career Pathways Definition

As noted previously in this report, many potential students and incumbent workers face barriers to pursuing an education and/or career advancement in the healthcare sector. These student/workers are a diverse group in terms of their age, prior education, ability to access resources, and basic life skills. A large percentage lack English, math, and other rudimentary skills, which often leads to unemployment or employment in low-wage positions. Incremental educational steps would assist career advancement. Offering stackable certificates within a career pathway program is a means toward meeting this goal (Career Pathways Catalog of Tool Kits, 2019).

Career pathways are defined as a “series of connected education and training programs and support services enabling individuals to secure employment within a specific industry or occupational sector and to advance over time to successively higher positions through advanced education and employment in that sector. Each step on a career pathway prepares an individual for the next level of employment and education. Several metaphors have been used to describe career pathways: an interstate highway where individuals enter and exit at different points and advance according to their resources and desires; a ladder with steps leading from one level to another; or a pipeline (U.S. Department of Education, Career Pathways).

The Career Pathways Tool Kit: A Guide for System Development (LINCS,2021) was designed by the US Department of Labor, Employment, and Training Administration to help guide teams through the essential components necessary for developing a comprehensive career pathways system. In 2012, the U.S. Departments of Education, Health and Human Services, and Labor released a letter endorsing the concept of “Career Pathways” as a promising approach to address the country’s challenge of how to prepare workers of all types and skill levels to

participate fully in the country’s economic future (Career Pathways Catalog of Tool Kits, 2019). The Departments defined Career Pathways as a “series of connected education and training strategies and support services that enable individuals to secure industry relevant certification and obtain employment within an occupational area and to advance to higher levels of future education and employment in that area.” The graphic below illustrates the six elements identified as essential in the creation of career pathways.

Stakeholder Roles

The Career Pathways Catalog of Tool Kits (2019) further defined the roles for each stakeholder in the career pathways process. “The education community takes a lead on providing classroom-based learning, and then partners with business and workforce development professionals to create workplace-based learning opportunities. These connections help businesses meet staffing needs and grow a next generation of skilled employees. At the same time, the human services field supports workers in balancing their educational, professional, and family responsibilities while they make this investment in their future. What makes these activities a true Career Pathways initiative is the commitment to cross agency partnerships that identifies the strengths and needs of each partner and uses that expertise to build the pathway” (Career Pathways Catalog of Tool Kits, 2019).

Basic Pathways for Healthcare Careers

According to the National Institute for Literacy report, HealthCare CareerPathways andAdult English Language Learners (Crandall, Wrigley, & Spence, 2011), healthcare careers programs generally follow three basic pathways: Patient Care, Allied Health, and Medical Administration. Each pathway is described below.

Patient care pathways typically begin with entry at the Personal Care Assistant, Home Health Aide, or Certified Nurse Aide (CNA) level. Requirements for these certifications is generally a high-school diploma or GED. The next tier of occupations is licensed practical nurse (LPN) or emergency medical technician (EMT). After that is the registered nurse (RN) tier which requires an associate of nursing degree. A bachelor’s degree in nursing (BSN tier) follows. Above the bachelor’s degree tier, career pathways advance to graduate degrees in nursing, health care administration, and other patient care specialties.

Allied health workers include technicians, technologists, therapist assistants, and phlebotomists who support physicians, nurses, and therapists (e.g., physical, respiratory, occupational, or speech therapy) in providing patient care. Requirements for these certifications include a high school diploma or GED (General Equivalency Diploma). At the associate degree level, careers such as respiratory therapist, registered nurse, or radiology technician are found. At the

bachelor’s degree level students can progress to laboratory technologist or a bachelor’s degree in nursing.

The Medical Administration pathway typically begins with a certificate-awarding medical assistant program. Requirements for entry into these programs are either a high-school diploma or GED. The next tier would be an associate’s degree. A bachelor’s and then a graduate degree in health care administration follows.

Table A provides a graphic representation of each of the above healthcare program pathways and the accompanying tiers with salaries associated with each pathway.

Table A

The institutional partners utilized the results of the local stakeholder needs interviews to select the three pathways for this project. They include a career selection from one of each the pathways: Patient Care Pathway, personal care assistant/home health aide, nurse aide; and Medical Administration Pathway, medical assistant. Because NNMC has a well-developed Nurse Aide program, a pathway to a career in Allied Health, phlebotomy, was included as the third pathway program.

Pathways Options

According to the Premier Nursing Academy web page Healthcare Career and Education Pathways(2021), three potential tracks exist for health care career programs of study: Traditional, Non-Traditional, and Accelerated. Employer Partnerships provide additional options.

Traditional track. The traditional track for acquiring a healthcare degree/certificate usually starts at a 2-year community college. Classes are usually offered several days a week and offer fewer options for evening or weekend classes. Students must meet college entrance exam requirements to qualify for these programs. If the entrance requirements are not met, basic math and English college requirements must be completed. This could include multiple remedial classes before the student can enter the college level classes that our part of the training program. Additionally, if a student requires remedial classes the classes often do not qualify for financial aid. Plans of study for this track also include prerequisite courses (typically science based), acceptance into a specific program, and completion of program-specific classes and clinical hours. Often, a national certification exam or licensure exam must be completed at the end of the program to acquire a license and begin working. This option might work for students looking for a traditional campus experience or students without full-time jobs or other commitments they need to balance with schoolwork. This traditional option provides a direct path to a career rather than progressing along a career pathway. This type of program requires a prolonged time commitment and is less flexible for students who must balance school and numerous other responsibilities.

Non-traditional track. The non-traditional track typically includes completing several separate steps or programs and advancing the degree over time before finally reaching the desired or highest degree. These programs typically include completion of pre-requisite basic science courses as well as the basic math and English pre-requisites. Students then move directly into degree-specific courses. This tract can be ideal for incumbent workers seeking career advancement. Schedules are often consolidated to have back-to-back classes on just one day of the week so students can continue working their regular jobs. Employers often incentivize or reward employees who further their degrees and continue to work for the same company.

Accelerated track. The accelerated track is an option for those students who need or desire to start working and quickly earning money. It is also an option for those who don’t have the time or resources to dedicate to a two-or four-year degree. Approaching education in stages and working to gain experience in the field while earning money can work for many students. Some Certified Nursing Assistant (CNA), Personal Care Assistant, Home Health Aide, Certified Medical Assistant (CMA) programs can be completed in as little as 4-12 weeks. These

accelerated programs are quick, flexible, and less expensive than pursuing a more advanced degree right from the start. They are also attractive to students who need to earn a paycheck as quickly as possible to support themselves and/or their family. There are generally no science pre-requisites for this track and oftentimes basic math and English courses are not required.

Employer partnerships. Though not as widely known, there is a unique and promising option for entering the healthcare field that not only eliminates the cost of entry-level schooling, but also guarantees students a job upon completion of the program. Free entry level health care career programs change up the traditional model of healthcare education by partnering with potential employers who are willing to pay the tuition of entry-level health care programs in exchange for a reliable supply of dedicated and well-trained individuals. Students are paired with potential employers beforeentering the classroom. Once a match is found, the candidate enters a training program (paid for by the employer) and can begin working right away upon degree completion. In exchange for the paid tuition, the new employee exhibits loyalty to the employer by staying with them for an agreed upon amount of time. Often companies who are this invested in their employees will offer incentives and tuition reimbursements for further education, essentially shaping and growing their own group of dedicated and high-quality professionals. This track is generally for quick career options such as home health aide and personal care assistant. There are no prerequisites for this option. This option could potentially work for dual credit high school students and adult community members as well.

At this juncture, it seems clear that the partners need to select a track or tracks that would meet the goals and needs of each sector. Whatever the decision may be, there are a multitude of sample health care support occupations curricula available for each type of program.

Dual Credit Programs

According to the New Mexico Department of Higher Education Policy and Procedures Manual for Dual Credit (2018) “Dual Credit Programs are a starting point to pathways that lead to credentials and/or degrees that provide entry-level job skills, thereby offering New Mexico high school students an accelerated path to success in college or a career. “

As part of the need’s assessment, an interview was conducted with Ms. Stephanie Garduño and Ms. Evelyn Martinez, Espanola Valley High School (EVHS) student career and dual credit counselors. The following is a summary of the discussion:

1. There is a need for a health care careers pathways program at EVHS. According to Ms. Garduño, when students are queried about career paths in the yearly “Interest Inventory”, at least 50% of students express an interest in pursuing a career in healthcare. At present, the only dual credit courses available at NNMC are Introduction to Health Care Professions, CPR, and Medical Terminology. The lack of any additional health care career courses frustrates students, which often causes them to lose interest in pursuing additional college courses. Both Ms. Martinez and Ms. Garduño believe that a group of additional health care dual credit courses is a way to keep students interested and focused. In addition to the Introduction to Health Care Professions and Medical Terminology courses they suggest that an Anatomy and Physiology introductory course and a course in Medical Ethics is needed. These could be either 1, 2, or 3 credit hour courses as dual credit courses are no longer mandated to be 3 credit hours or greater.
2. There is a need to be able to determine which students are prepared for the rigor of a healthcare careers pathways program. In the past, dual credit students were required to meet the NNMC Accuplacer admission requirements for entry into college level course work. Currently, high school transcripts can be used in place of Accuplacer scores as an assessment of college academic readiness. Per Ms. Garduño and Ms. Martinez, transcripts oftentimes are not a true assessment of the student’s academic aptitude. When considering forming a cohort of students for the healthcare careers pathways program, an application and selection process would need to be in place that would include a more accurate evaluation of the student’s chance for success in college courses than just transcripts.
3. Dual credit health care careers pathways classes need to be offered for the freshman and sophomore cohort after high school hours. This cohort is not allowed to leave campus during school hours. The ideal time for these classes is 3:30 to 4:00 pm. This could be an issue with transportation as the school buses are needed for student transport home. The option of a contract with city transportation (RDI) is a possibility.
4. Both counselors expressed the desire that dual credit health care careers classes be in a face-to-face format once Covid-19 restriction are lifted. They stated that the students want to be on a college campus and experience college life.
5. Suggestions for the start-up of health care careers pathways program at EVHS:
   1. Recruit a cohort of 15 students in the fall semester of the Freshman year to join a Health Care Careers organization. Per the counselors, Freshman are not ready for dual credit courses, but membership in a health care careers organization can create a sense of academic direction. These students would maintain membership in this organization for their four years of high school. Some activities of this organization could include seminars, community events, shadowing experiences with healthcare professionals, and formal or informal mentorships by healthcare professionals.
   2. In the spring semester of their Freshman year, students would enroll in the dual credit course IntroductiontoHealthProfessions. In the fall semester of their sophomore year, students would enroll in MedicalTerminology.The spring semester of their sophomore year, students would take a medical ethics and a CPR class.
   3. In the fall semester of their junior year, students would take the Accuplacer exam. If the student achieves a score that allows them to take college level courses, they could then begin the Medical Assistant pathway or Certified Home Health Aide pathway. The students who do not achieve the desired Accuplacer score would then be directed to the Personal Care Assistant/ Home Health Aide or Certified Phlebotomy Technician Pathway.
   4. At the time of graduation, students will have completed a pathways course and receive a certificate of completion from NNMC. Those in the Medical Assistant, Certified Phlebotomy Technician, and Certified Home Health Aide pathway will be eligible to sit for the certification exam once they are 18 years of age.

Curricula for Pathways Programs

Exploration of community college heath care occupations websites shows a commonality in course offerings and sequence of courses for each pathway. These curricula would work for students in the accelerated pathway, but it must be kept in mind that basic English and math skills, as well as a high school diploma or GED, are requirements for entry into these kinds of programs. Each pathway’s informational sheet (Appendices A, B, and C) contains suggestions for pathways courses and course sequences following the community college model.

Additional curricula available for public use mostly follow the accelerated path framework, and often there are not previous educational requirements for entry into these programs. Samples of these types of curricula are the following:

• The California Community Colleges Health Workforce Initiative, a program of the Workforce and Economic Division of the California Community Colleges Chancellors Office’s website contains a wealth of information for students and educators interested in the healthcare workforce initiative. A complete curriculum for medical assistant, patient care assistant, certified nursing assistant, home health aide, and phlebotomy pathways, among many others, are provided. The curriculum materials are free to be used if copyright credit is provided. https://ca- hwi.org/curriculum/access-curriculum/
• Curriculum course sharing is also part of the Integrated Basic Education and Skills (I- Best) Initiative. The I-BEST healthcare career pathways bridge program curriculum is available for view at six college websites in New Mexico (Santa Fe Community College, Central New Mexico Community College, Mesalands Community College, Eastern New Mexico Roswell & Ruidoso, University of New Mexico Gallup, Valencia & Taos, and San Juan Community College). I-Best programs of study vary across the community colleges and are matched to Department of Workforce Solutions (DWS) job projections. The I-BEST bridge programs in New Mexico are showing great promise with 84 percent of participants either having completed their programs, earned certificates, or still in progress, and less than 16 percent having dropped out or temporarily stopped. (Casau, 2014). https://www.nmvoices.org/wp- content/uploads/2014/08/Career-Pathways-rpt-web.pdf
• The Health Occupations Students of America (HOSA) is an organization of future health care professionals. This organization provides a few sample curriculums, and has “on demand” pre-recorded videos for advisors/health science instructors to supplement classroom instruction in pathways programs ((Stauffer, What Is Hosa?)

There are also ready- to-use curricula available for purchase from a variety of agencies. These curricula are available in a digital format and are created to meet the requirements of certification agencies. A sample of these products include curricula from organizations such as “Health Center 21” and “Reality Works”. Ms. Lia, Director of the Colorado Early College Program, states these digital programs can be useful at the start of careers pathways programs because creation of a curriculum can be overwhelming and time consuming. Oftentimes available faculty do not have the expertise in curriculum development to create a program from the ground-up. These programs can be costly, but the fee for certification exams is often included in the total price. This selection could work with an accelerated pathway and/or the debt-free pathway.

Appendices A, B, and C provide detailed descriptions of each of the three pathways program options.

Suggested Next Steps

To achieve the goal of establishing the Espanola Valley Healthcare and Nursing Careers Pathway Program the following suggestions are offered for consideration by the partner institutions.

1. The following is a recommended list of organizations that should collaborate to create a local partnership: Educators: Northern New Mexico College and Espanola Public Schools; Hospital Systems and local clinics: Presbyterian Espanola Hospital, Presbyterian Home Health, and El Centro Family Health; Workforce Development Systems; and social services providers. All organizations partnering in this project would submit letters of support.
2. Create an advisory council of local stakeholders/partners. All partners, in their role as Advisory Council members, will monitor the progress of the programs, evaluate the results, make recommendations for program changes, and strategize next steps.
3. A range of support services are needed to help potential students move through health careers pathways. These support services should include academic guidance and counseling, career counseling, assistance with job placement, case management, academic support, and financial aid or free tuition, childcare, and transportation services. Collaboration among community organizations is essential for the success of this project.
4. A career coach is essential to the success of the pathways program. Too frequently, students end or interrupt their studies due to a lack of supportive services. While many services exist, students encounter barriers to accessing these supports.
   1. The role of the career coach would be to meet with potential candidates and refer them to any academic, career, or support services they may need. This would apply to dual credit students, incumbent health care workers, and adults in the community.
   2. The career coach would also assist candidates as they move through the career pathway program, ensuring access to relevant services and limiting barriers to program completion and success.
   3. The career coach would work closely with employers and pathway candidates to identify and assess needs and create plans for attaining their goals. The coach would maintain relations with employers and advisory council members and ensure coordination of program activities.
   4. The Advisory Council could also work with the career coach to identify and address any concerns that would improve retainment of participants.
5. The use of academic assessment tools is critical to ensure that participants in the career pathway programs are prepared to undertake appropriate academic programs. COMPASS testing or ACCUPLACER should be administered.
   1. During the initial intake process, the career coach would administer these exams and depending on the results, assess the pathway participant’s needs and make a referral to the appropriate educational partner to insure coordination of services. When assessment indicates that a pathway participant is not prepared to advance academically, they would be directed to a remediation program to build the necessary skills that will prepare them for their career field.
   2. There are remediation programs available at Northern New Mexico College that are currently in place. In addition to these courses, partners should consider creating a series of noncredit courses, such as professionalism and communication, tailored to prepare individuals for health care occupations.
6. If high school dual credit students are to join the healthcare career pathways programs, additional dual credit courses need to be made available. At present, only Medical Terminologyand IntroductiontoHealthCareProfessionsare the allied health courses available at NNMC.
7. High school dual credit students need to be recruited into a cohort of students interested in pursuing a career in healthcare at the start of the freshman year. An important part of creating this cohort would be procuring membership in the HOSA- Future Healthcare Professionals Organization.
   1. HOSA is not a club, but rather, “HOSA is a powerful instructional tool that works best when it is integrated into the health science related curriculum and classroom.” Those who join the HSE-HOSA Partnership recognize the importance of providing students with training far beyond the basic technical skills needed for entry into the health care field.
   2. The rapidly changing health care system needs workers who, in addition to their technical skills, are people-oriented and capable of playing a leadership or followership role as a member of a health care team. Membership in HOSA assists students to “develop effective leadership qualities and skill; build self- confidence, motivation and enthusiasm; strengthen their academic and technical skills; create new friendships and social networks; participate in community service activities; set realistic career and educational goals; expand communication and teamwork skills; develop workplace readiness skills; and understand current healthcare issues.”
   3. HOSA members have opportunities to apply for scholarships; travel to regional, state, and national conferences, and serve as local, regional, state, and national officers.
   4. To qualify for membership in HOSA the educational institution must have a Career Technical Education (CTE) health science pathway, or health science sequence of courses, or health science academy, or a course or courses that meet the CTE course requirement; an advisor or co-advisor that has a CTE health science and medical technology credential; five (5) students and one advisor to start the organization; and school administration and district supportive of the chapter.
   5. Student membership in HOSA is $30.00/year.
8. Outreach, Recruitment, and Publicity for the programs is essential to success. Many potential students lack knowledge of both the availability of education and training programs and financial aid that can help them to participate. Publicity campaigns focusing on information about health care career pathways programs should be initiated.
9. Policies should be created for the integration of high school dual credit students with an adult population. There are samples of policies available for review and use.
10. In addition to the remediation courses mentioned previously, the literature supports the development a series of noncredit courses to better prepare people who are not working in healthcare. These courses would also be offered to existing healthcare workers so that they may refine their skills and advance in the healthcare field. Some suggestions include the following: CareerPlanning,BecomingEmployedin theHealth CareWorkforce,MakingACommitmenttoyourJob,WorkingwithOthers, Communication Skills and the Professional, and Personal Traits of the Healthcare Professional. Courses such as these can be found on the HOSA website and are available to members. This suggestion aligns with local stakeholder’s request for methods of teaching professionalism to potential students.
11. The pathway model should become a permanent, self-sustaining model. It is suggested that partners should work with employers to increase cash contributions to sustain the project and reduce reliance on possible philanthropic funding. Partners should work to explore the funding available for tuition reimbursement for program candidates perhaps using the “debt free” track or model. Additionally, partners should continue to work with area and national foundations to secure funds for equipment and program expansion.
12. Recruitment and retention of faculty to teach and oversee the programs is critical. Accreditation agencies such as the New Mexico Society of Medical Assistants (NMSMA), have specific criteria for those who teach and oversee Medical Assistant Programs. Incumbent NNMC nursing faculty could potentially meet some needs, but they are sorely needed to teach in the nursing program. An intense faculty recruitment campaign would be necessary before the pathways program could begin.
13. A retention plan to maintain candidates in the pathway program is key to program success. This plan could include monthly support groups with pathway participants to review progress, issues, or concerns. Student participants could be assigned a mentor (mentors could be hospital employees working at the tier level the participant wants to advance into). Monthly email updates and reports to participants could also be part of the plan. These emails could include success stories, articles on relevant topics such as stress management, dress for success, and resource management.
14. An evaluation plan should be developed before the program begins. It should include identification of evaluation criteria and strategies for collecting, analyzing, and reporting data. It should include an annual and/or end-of-semester survey distributed to students.