Cassie Valera knew early on that she wanted to be a nurse. “I was the kid that always had a Band-Aid ready for friends that got hurt,” recalls the 31-year-old Allen resident.

But the fear of unwieldy student loan debt led her down a different path.

For 11 years, she worked as an emergency medical technician. In 2013, the mother of two took an administrative job at Medical City Plano, helping to coordinate the transfer of patients from the hospital to other facilities.

Becoming a nurse seemed like “light at the end of a very long tunnel,” Valera said. She needed to work full time to support her family while in school, and figured she could probably realize her dream in another decade or so.

She didn’t have to wait that long.

About 10 years ago, Medical City Healthcare began piloting a program at one of its North Texas hospitals that paid for full- and part-time staffers to go to nursing school for free.

The goal of the Two-Step Nursing Pathway program is to address a shortage of nurses that many say is critical and only projected to get worse. Medical City expanded the program to include all 10 of its North Texas hospitals in 2008.

Cassie Valera (second from the left) poses for a portrait with other nursing graduates before a pinning ceremony at Medical City Dallas on Friday, May 19, 2017. The nurses graduated from Medical City's 2-Step Nursing Pathway program. (Terry Cockerham of Light & Bytes, Inc.)

Valera is one of 13 students in the latest class that graduated in May. This month, she begins interning as a paid registered nurse in the neuro progressive care unit at Medical City Plano.

The U.S. has experienced nursing shortages for decades, and the demand is expected to rise as baby boomers age. Texas is short about 16,000 nurses already. And that number is expected to grow to 60,000 by 2030, according to the Texas Nursing Association.

Nurse vacancies and turnover are key measures in assessing the nursing labor market. High vacancies can result in too few nurses managing too many patients and staff burnout, which can ultimately have a negative impact on the quality of patient care.

Texas has higher nurse vacancy and turnover rates than other states with comparable populations, according to a 2016 report from the Texas Department of State Health Services.

Of 51,744 full-time registered nursing positions available statewide, 5,637 (or about 11 percent) were vacant. By 2030, the demand for nurses is expected to grow 53.8 percent, but the supply is only expected to grow 35.4 percent.

The need for registered nurses is particularly stark, the department concluded. For example, while 98,613 RNs will be needed in North Texas in 2030, the projected supply is 15,689 short.

“I don’t know that there is anywhere that is untouched by the nursing shortage,” said Tricia Scott, Medical City Healthcare’s director for workforce development. She helped to launch the system’s nursing education program in 2007.

The first set of students graduated in 2010. To date, about 350 have completed the program, which has accepted an array of employees, from kitchen staff to secretaries and lab workers to telephone operators. Financially, many of the students would not have been able to do it on their own, Scott said.

“There’s a lot of need. So, you have to be more diligent in your recruiting, and come up with programs that attract people,” Scott said.

Around 84 percent of Medical City’s graduates remain in the hospital system's network, she said.

Health systems throughout the state are finding ways to fill the void in nurses, said Kat Hinson, director of communications for the Texas Nursing Association. Several have developed intense training programs; others have partnered with nursing schools and have students commit to working at the hospital after graduation, she said.

For example, Cook Children's in Fort Worth offers a 12-month residency program that puts qualified nurses through an intense training that accelerates their transition into specialty practice. That program has led to a substantial reduction in one- and three-year turnover rates, according to the Texas Nursing Association, which has been tracking the trend.

“It’s not just a shortage in general. It’s also a shortage of experience,” Hinson said. Even when systems send students to school, it can take a while for the knowledge to pay off in the clinical setting. Health care systems are introducing innovative programs to address both needs, she said.

Medical City's two-year associate degree nursing program is fully covered for staff. The hospital partners with Collin College in McKinney and El Centro College in Dallas, where students who qualify for the program take classes.

Medical City Healthcare pays upfront for tuition, fees, books and uniforms, and admitted students must make a two-year commitment to work full time as a registered nurse.

The health system declined to say how much it has spent to send staff to school. But Scott says it’s less expensive than the process of recruiting nurses externally, which can range between $60,000 and $90,000 when the costs of advertising jobs, paying salaried interim employees and training new hires is considered.