The Pipeline Development section of The What, When, Where, Why & How Guide contains numerous examples of successful tactics that are attracting young people to health careers. These young people also are flirting with — and being courted by — other industries and work life choices. Your recruitment strategies will be more effective if you understand the direct and indirect influences that shape students' early career interests, as well as the strengths, weaknesses, resources and tactics of industries competing against health care for the best and brightest among America's youth.

Parents often are the most influential sources of career guidance. The opinions of teachers, close relatives, family friends and peers' family members also rank high. Any among this group who speak passionately about their own career choices — either positively or negatively — can determine what goes on a teenager's hot, maybe and definitely not lists.

The quality and consistency of career guidance varies from district to district, school to school and grade to grade. So does the role of the school guidance counselor, whose limited resources and wide-ranging responsibilities for other student concerns often impose unavoidable constraints on developing this important function. Some schools, however, have extensive, multi-year career exploration activities that include advisor consultations, presentations by adult professional role models, field trips, career fairs, cross-disciplinary teaching modules and individual student projects.

Career exploration programs for youth abound, fueled by state and federal regulations and grant-funded incentive programs. In 1994, Tennessee began to require eighth graders and their parents to submit a four-year plan of "focused and purposeful study," designed to link graduation requirements and elective courses with career goals. Students express preliminary interest in a career within one of the following seven clusters:

• Arts and communication
• Business and marketing
• Health care
• Hospitality and tourism
• Manufacturing, construction and transportation
• Human services
• Science and Technology

Based on the academic preparation required for their targeted careers, eighth graders choose one of three academic tracks: technical path, university path or dual path. Each path includes certain required courses and electives leading to a high school diploma and prepares students for their next step.

Technical path careers can be entry level (training provided in high school facilitates employment following graduation) or skilled level (technical training begins in high school and continues in a community college, vocational/technical school or apprenticeship program).

University path students plan to enter a two-year or four-year college after high school and complete a four-year degree program or higher. Graduation requirements under the university path include foreign language and fine arts credits, which are optional in the technical path.

Dual path is recommended for most students interested in health careers. The requirements are the same as the university path but also include technical training in high school related to the career choice.

Tech Prep and the Education Edge (School to Career) initiative are federally funded programs designed to improve students' education and employment outcomes. Tech Prep is funded by the Carl D. Perkins Vocational-Technical Act of 1998, which prepares students for both post-secondary education and employment. The program combines classroom instruction with active learning such as on the job training or job shadowing.

Tech Prep students develop six-year study plans that lead to an associate degree from a community college or professional certification in a specific technical field. Examples include engineering technology, business and information technology, graphics design and manufacturing technology. Tech Prep is operated in Tennessee through 13 consortia. These partnerships bring together representatives from business and industry, local school districts and post-secondary institutions to coordinate Tech Prep planning, programming and funding within each service area.

For more information about Tech Prep click here, or click here to see which schools in your area participate.

Education Edge is similar to Tech Prep, but is more focused on work-based learning that leads to employability right after high school. Education Edge aims to provide all students (particularly those in special populations) "comprehensive career guidance activities beginning in kindergarten and continuing throughout life," according to the Tennessee State Board of Education.

Tech Prep programs stress articulation agreements that enable high school students to earn free post-secondary credit through high school technical courses. Articulation saves students time and money by eliminating duplicative training. It aligns curricula between high school and post-secondary institutions and attempts to ensure program graduates have the specific competencies employers require.

Many programs can be articulated, from accounting to electronics to welding. Articulation agreements are in place between a number of Tennessee's secondary schools and post-secondary institutions. Health science classes are structured to meet articulation standards but in the process, Tennessee has met with some setbacks, including resistance from the Tennessee Board of Nursing. For more information on this issue, contact Bill Jolley at THA, bjolley@tha.com, 615-256-8240.

Today's emphasis on early career exploration means youth are exposed to many more work life choices than were previous generations, and at younger ages. Ambitious elementary and middle schoolers will find numerous career-focused web sites designed just for them. Many of these effectively employ "kid-approved" design, navigation and interactive tools such as games, puzzles, animation, music and interviews to tell their stories. Some of the best, including Air Force Link, Jr. and Be a Habitat Hero, are listed on FirstGov for Kids. WhatDoTheyDo.com describes 65 occupations from custodian to volcanologist. As children are introduced to more and more options, the competition among industry and professional groups hoping to recruit them intensifies.

High school students enrolled in career and technical education courses are strongly encouraged to join the student leadership organizations that correspond to their expressed interests. These clubs develop occupational knowledge, familiarity, skills and teamwork. Members may compete in skill contests and serve in elected offices at local, state and national levels. The seven organizations most active in Tennessee's public schools are:

• DECA – An Association of Marketing
• FFA – Future Farmers of America
• FCCLA – Family, Career and Community Leaders of America
• FBLA – Future Business Leaders of America
• TSA – Technology Students of America
• SkillsUSA-VICA (formerly Vocational-Industrial Clubs of America)
• HOSA - Health Occupations Students of America

These national organizations play a significant role in the guidance and nurture of youth aspiring to careers in that industry or work life choice. DECA, for example, boasts 180,000 members in over 6,000 local chapters. DECA awards over $250,000 in student and teacher scholarships annually, and more than $40,000 in cash to international competitive event winners. Large national employers and professional groups are actively engaged in the strategic planning and funding of these organizations. They typically hold seats on boards and advisory councils and sponsor skill competitions, scholarships and worksite learning opportunities that build bonds with prospective future employees.

Unfortunately, health care is the exception to this rule. Health Occupations Students of America (HOSA) receives little financial support from major corporations and national employers. While hospitals and healthcare systems often support local HOSA chapters, the lack of organized industry support for health career development programs puts health care at a serious competitive disadvantage in "growing our own." For more information about HOSA in Tennessee, read Growing a Local Garden of Healthcare Heroes elsewhere in this section of the guide.

High school students who have not committed themselves to a specific career may make a selection based on other forms of targeted recruitment such as:

• Career fairs, where local employers and professionals spotlight job and career opportunities.
• College fairs, where colleges vie to recruit high school students directly into tracks that prepare them for specific career and professional areas.
• Summer job and internship opportunities provided by local employers.

Since 1999, Junior Achievement (JA) has conducted four Interprise Polls™ profiling teenagers' career interests. The November 2002 survey collected opinions from 1,183 students ages 13-18+, primarily members of 127 JA chapters in the U.S. These programs instill and reward initiative, high achievement and entrepreneurial skills. While Interprise Poll results do not reflect a statistically valid sample of American teenagers, they are useful in identifying interests and trends among goal-directed youth. The 2002 respondent profile approximated the national distribution of the U.S. population by ethnic origin and race.

In the preceding three years, teens named "doctor" as their ideal career choice. In 2002, however, "businessperson" topped the list by a narrow margin, chosen by 10.4 percent of the participating youth. Doctor (10%), teacher (6.5%), lawyer (6.5%), entertainer (6.2%) and athlete (6%) followed. No health careers made the top ten, but nurse came in at #13, chosen by 2.2 percent of the respondents. Psychologist, veterinarian and physical therapist were among the top 24 choices, but each received fewer than 2 percent of the votes cast.

Career ideals differ according to gender, race and ethnic background. Doctor was the top choice for girls (11.5%), followed by teacher (9.5%), businessperson (8.2%) and lawyer (7.9%). Black, Asian and Hispanic students also named doctor as an ideal career most often, which came in third place (after teacher) for white students. Over 30 percent of Asian teens selected either doctor (16.4%) or businessperson (14.9%). Hispanics showed the highest preference for the legal profession compared to other racial or ethnic groups (13.1%), although they selected doctor most frequently (13.7%).

America's Career InfoNet is a treasure trove of information on careers choices, industry and labor market trends, job openings and training opportunities. These free services include over 5,500 external links, making it "the most extensive set of career resources available on the Internet," according to the award-winning site. Its Career OneStop suite of tools offers online videos of 360 occupations, including many health careers. This site is a one-stop shopping experience for teens and adults who are researching career opportunities, projections and current openings.

According to the Bureau of Labor Statistics and America's Career InfoNet, the fastest growing occupations are those requiring associate degrees or training below the bachelor's degree level for entry. Over half of the top ten are health-related careers. (Click here to view chart.)

The list is headed by computer support specialists, with an expected growth rate of 97 percent over the period 2000-2010. Medical records and health information technicians rank third (behind desktop publishers), with a growth rate of 49 percent. Physical therapist assistants (45%), fitness trainers and aerobics instructors (40%), occupational therapist assistants (39%), dental hygienists (37%), cardiovascular technologists and technicians (35%), and respiratory therapists (35%) complete the top 10 fastest growing occupations in this category.

Computer-related occupations dominate the list of fastest growing occupations requiring a bachelor's degree, holding eight of the top 10 positions. Two health careers round out the list: physician assistants at #7 (53% growth rate) and audiologists in ninth position (45% growth).

Registered nurses top the list of occupations with the most openings projected. Over 100,000 job openings are anticipated each year between 2000-2010 due to health care's net growth and replacement needs. Other occupations requiring post-secondary education or training below a bachelor's degree include:

Four health careers are included in the top 10 highest paying occupations reported by acinet. The list includes:

Physicians and surgeons, including dentists and psychiatrists, hold nine of the top 10 highest paying occupations requiring a bachelor's degree or higher. Chief executives on this list rank #9 at median wages of $120,500 in 2001.

Health care is not the only industry purposefully engaged in long-range recruitment strategies. Here are several examples of what other fields are doing to ensure their share of America's best and brightest students.

Retail. Restaurants, retail, hospitality and other service sector industries have long histories of workforce instability. Many candidates applying for these jobs, the majority of which do not requiring extensive training or education, consider them to be transitional or short-term positions. These new entrants' long-term career goals and interests often lie somewhere else. They may casually change employers to snag a higher paying, more convenient or more desirable position.

The impact of frequent turnover is enormously costly to employers. When inadequate training and inconsistent performance compromise customer service, customer confidence falls, followed by revenues, market shares and stock prices.

Savvy employers in unstable industries are beginning to use a strategic hiring approach, according to consultants Roger Herman and Joyce Gioia of The Herman Group. They are departing from traditional recruiting techniques and targeting individuals who are looking for "more than just a job." The recruitment focus is on long-term career paths. The goal for employers is a more experienced, engaged and loyal workforce. Ads and recruiters promise flexibility, training and development opportunities, and career ladders. Internet sites seek to create external online communities of preferred candidates for high turnover positions. Incumbent workers also are being nurtured and gathered into informal communities of promotion candidates by their employers.

Retailology.com, sponsored by Federated Department Stores, includes a fun, interactive section for college student recruitment. Its slogan acknowledges retail's popularity as a place to work before (but not after) obtaining a college degree:

Retailology's college recruitment section uses animation, sound and interactive features to provide an engaging online experience. The site is content-rich, containing career information, interview tips and job search guidance; interviews with young, upwardly mobile employees (including announcements of promotions); internship opportunities; campus recruiting events; topic-generated chat (presented as a "think tank"); and listings of open positions at Federated stores across the country, including alluring vignettes of lifestyles and locales. And — but of course! — clicks to online shopping on every page.

Engineering. The American Society for Engineering Education (ASEE) is one of "hundreds of organizations . . . working to attract more of the best U.S. schoolchildren to engineering and other technical fields." According to ASEE, engineering degrees have fallen by nearly 25 percent in the last 15 years, from 80,000 a year to the low 60,000's. Increasingly, these degrees are awarded to international students who frequently settle in their home countries after graduation.

ASEE's web site includes an appealing section aimed at bright, imaginative, high achieving teens who want to make a difference in the world. It includes inspiring stories of great engineering feats, as well as games and competitions designed to stimulate the imagination. Other engaging sites include Engineer Girl, sponsored by the National Academy of Engineering; and Discover Engineering.org, a site aimed at younger students.

Teaching. Teacher shortages have reached crisis proportions in some areas. The factors creating these shortages are similar to those shaping the nursing shortage: an aging/retiring workforce, low relative wage rates, workplace problems and diminished interest among the traditional, primary source of recruits (Caucasian females). The National Education Association ended its oversight and support of Future Teachers of America clubs in 1969. Phi Delta Kappa, a professional association of educators, is organizing chapters under a new banner called Future Educators of America.

The lack of a national infrastructure has impeded teacher recruitment efforts at the local level. As in health care, there is a dearth of major national corporations providing financial support to ease worker shortages. (Johnson & Johnson's extraordinary Campaign for Nursing's Future is a noteworthy exception.) Innovative and ambitious local initiatives to recruit youth into teaching are cropping up, however, like the one in Dallas, TX (see sidebar below).

Benchmark Practice: Building Local Pipelines of Teachers A local initiative in Dallas County, Texas is a benchmark practice for collaboration and big picture thinking. Tomorrow's Teachers comprises local independent school districts, the Dallas County Community College District and area four-year universities. Its overarching objective is to "transform Dallas-area students into Dallas-area public school teachers." Organizers believe the best answer to their local teacher shortage is to build a pipeline directly from local classrooms. These students "speak the language, know the neighborhoods and understand the culture. . .We must shift our focus to developing these valuable assets." The program's innovative components include: Inventing teaching opportunities for elementary school students. Introducing immigrant parents to the concept of financial aid. Developing a seamless (articulated) education curriculum among high schools, area community colleges and universities. Providing mentors within each educational system to support and encourage students, especially first-generation college students, to "make sure no one falls through the cracks." Special scholarships and funding programs, including the opportunity for all Dallas County high school graduates to attend their first two years of college free at a Dallas County community college. Guaranteed employment following college graduation in the Dallas Independent School District. Bilingual graduates receive an annual stipend that boosts starting salaries by $3,000-4,000. The project's exemplary support system includes mentoring new graduates through their critical first year of classroom teaching. Tomorrow's Teachers members are lobbying Dallas-area community and business leaders to contribute by sponsoring a series of special student events that "spotlight achievement and reward initiative."

Armed Forces. America's military forces are legendary recruiters (self-described as "the best trained salespersons on earth"). Their teen-focused web site at MyFuture.com lists four career areas under its Hot Jobs section: health services, computer/technical, social services and other services (currently featuring desktop publishing and paralegal careers). It also contains advice on life after high school, including money matters and job interview tips.

Links go to web sites for all five military services, career information on many of the 4,100 jobs available in the service, and the ASVAB career exploration program developed by the U.S. Department of Defense. The strategy employed in this and other web sites devoted to recruiting for America's armed forces is to build trust, rapport and familiarity with potential recruits. The sites contain practical information pertinent to young people just embarking on adult life, and showcase the military's unique benefits.

Todaysmilitary.com features Real Life Stories, video interviews with celebrity veterans, like former Dallas Cowboys tackle and Air Force Reservist Chad Hennings.

How can health care compete against other industries for each generation's best and brightest? By fulfilling the inherent potential to become Industry of Choice.

In almost every case, the recommended strategy when recruiting youth is to appeal to their desire to make a difference in the world, to be engaged in meaningful work. Employees of all ages also want to be part of a spirited, capable, collegial and recognized team. They want to be members of a community of colleagues who share and practice common values, such as mutual respect and service to others. They want job stability, attractive benefits and schedule flexibility that enables them to manage their responsibilities for both work and family. They want fair wages and opportunities for advanced learning that will allow them to grow personally and professionally. They want fair treatment and good management.

All of these things are found in benchmark hospitals. When healthcare facilities are at their best, they are employers of choice. Hospitals recently dominated AARP's list of Best Employers for Workers Over 50. Hospitals also make strong showings in Working Mother magazine's annual Top 100 Companies for Working Mothers as well as numerous state and regional best workplace competitions.

Even hospitals that have achieved magnet status or top workplace recognition, however, can struggle with workforce shortages and pipeline development. Here are a few critical issues and challenges that need to be addressed collectively:

• Expand and improve student clinical experiences
• Build seamless (articulated) educational ladders
• Overcome negative perceptions
• Learn to speak the language of youth
• Establish support systems for students and new entrants at each level
• Create national infrastructure for a health careers pipeline
• Expand local, state and national support for HOSA

Expand and improve student clinical experiences.Less than one-half of Tennessee hospitals provide clinical sites for HOSA students. When hospitals say no, where do they go? To nursing homes, primarily, according to Tennessee Department of Education specialist Laurene McLemore. When we turn them away, we risk their losing interest in hospital-based careers, and miss opportunities to establish workplace loyalties with future stars.

The inconsistent quality of clinical experiences is an even greater problem. High school and college advisors report that many students lose interest in health careers following disappointing clinical rotations. Supervising students requires extra work for nurses and others who are already giving their all. Sometimes, students report, they feel unwelcome, resented and mistreated. If we offer clinical experiences that work the way they should, we will build a steady supply of future workers — for the industry and for our individual hospitals.

Build seamless (articulated) educational ladders. Tech Prep is working in Tennessee, but not as effectively as it should in the health sciences sector. Other states have done a much more effective job of streamlining education and training for health professionals. We must achieve similar outcomes in Tennessee.

Overcome negative perceptions. Negative perceptions and misperceptions from many sources work against health careers recruitment efforts. In many schools, students, teachers and guidance counselors perceive technical path degree programs as inappropriate for college-bound students interested in professional level careers. The old associations with vocational education and blue-collar workers remain, especially when vocational-technical classes are held in a separate building.

What can help? Honors-level classes in health sciences is one solution, according to Teresa Williamson, HOSA advisor at Richland High School in Giles County. Another is educating the educators. Programs that update teachers and guidance counselors on health careers can make a big difference in how they influence their students. (Read about Baptist College of Health Sciences' grant-funded Summer Institute for Teachers .)

Negative stories in the media about health workforce shortages also limit our effectiveness. It may be appealing to know there are so many opportunities available in hospitals, but if current workers are leaving because they are angry and burned out, why should young people be interested in taking their places?

We cannot make the shortage and its newsworthiness disappear. What we can and must do is rid our individual workplaces of problems that drive discontent: inadequate staffing, unhealthy cultures, ineffective managers, disaffected workers and unenlightened leadership.

Learn to speak the language of youth. The better we communicate with our target audience, the more effective our recruitment efforts will be. It is no cinch to break through the clutter of marketing pitches aimed at teenagers on a 24/7 basis. When we create recruitment messages and materials, it is not enough to merely inform. We must earn and sustain the interest of a sophisticated consumer audience. Effective marketing requires understanding our target market. We must communicate efficiently and persuasively how our product fits their needs and desires.

Establish support systems for students and new entrants at each level. Students and aspiring health careerists need help along the way. We must create support structures that leave no worthy candidate behind, including tutoring, mentoring and financial aid for students; flexible scheduling, extended orientations, preceptors for new hires, career and educational ladders, employee assistance services, career mapping and work/life benefit programs.

Create national infrastructure for health careers pipeline. Expand local, state and national support for HOSA. With its Campaign for Nursing's Future, Johnson & Johnson has taken a leadership role in crafting solutions for the workforce crisis that plagues its healthcare customers. We need more such initiatives, aided by financial support from the health care industry's many friends and vendors. Health care is woefully behind other high-shortage industries and professions in workforce development. State-level initiatives are making progress. Real relief, however, requires a nationwide health careers recruitment pipeline. Organizations like HOSA can be enormously effective components of this pipeline, with a strong commitment at local, national and state levels.

For more information on how your hospital can help THA meet these challenges, contact Bill Jolley, bjolley@tha.com, 615-256-8240.