Spotlight on Registered Nursing Apprenticeships -- published by American Institutes for Research® August 2023
On July 19, 2023, the Department added an important new occupation to the list of occupations we recognize as apprenticeable: registered nurse (RN). Apprenticeship creates a new pathway to a career as an RN for people who might not be able to stop working to go to college — one that will also help hospitals and other healthcare providers train the nursing workforce they need so desperately. Several SAA states, including North Carolina, have already put Registered Apprenticeship Programs in place, while many OA states, including North Dakota, have developed programs and were just awaiting Departmental recognition of the occupation. What can we learn from them?
Wake Forest Baptist Health launched North Carolina’s first registered nurse Registered Apprenticeship Program, followed closely by Northern Regional Hospital (NRH), which established the state’s first youth RN apprenticeship. Led by NRH’s Vice President of Human Resources (who came out of the manufacturing sector and brought an appreciation for the Registered Apprenticeship model), NRH partnered with area high schools so that students can take part in a pre-apprenticeship program leading to CNA certification, followed by the chance to apply for an RN Registered Apprenticeship. RN Apprentices work part time at Northern Regional Hospital as CNAs while earning an associate’s degree in nursing from Surry Community College. (State legislation offers a community college tuition waiver for all students who sign on as apprentices before graduating from high school.) RN Registered Apprenticeship Programs have spread around the state to other hospitals, assisted living facilities, and home healthcare agencies. Tiffany Jacobs, a Regional Coordinator for ApprenticeshipNC, notes that, as the model has expanded, many community colleges are aware of the benefits of apprenticeship training, but dedicating an apprentice slot in limited-entry programs can be a challenge. Nursing programs are full, so some community colleges are willing to designate seats for Registered Apprentices while others are not, which can cause delays for an apprentice. Educating nursing department leaders on the benefits is critical, says Jacobs; these include good outcomes for the students and colleges and strong relationships with the healthcare providers who are employing their (apprentice) students. Partnering a healthcare provider with an experienced peer is particularly helpful.
North Dakota launched its RN apprenticeship program in fall 2022 as a pilot led by Lake Region State College (LRSC) in partnership with three employer partners. It’s the capstone of a nursing Registered Apprenticeship pathway that progresses from certified nursing assistant (CNA) in year 1 to licensed practical nurse (LPN) in year 2 to RN in year 3 (with opportunity for students to enter at any point along the way). LRSC staff began the process by researching apprenticeship models used in other states, then brought the research and some initial ideas to the North Dakota State Board of Nursing to ask for their help in creating a high-quality apprenticeship program that would work in the State and ensure the professional integrity of the RN license. LRSC Apprenticeship Coordinator Melana Howe stresses the importance of early involvement and buy-in from the Board of Nursing, as well as anticipating and speaking to the Board’s concerns, e.g., quality and public safety. (Howe is a former RN with decades of nursing experience, so she brings an understanding of the players, potential roadblocks, and complexities of the state licensing process.) Howe also says that it was helpful to build on existing, approved training components: they used standard RN coursework offered through LRSC, incorporated existing clinical practicum requirements (but with registered apprentices getting paid for practicum hours and 8 to 16 additional hours of work under a mentor per week), and leveraged available “rules of delegation” that permit nurses to delegate certain tasks to a CNA or LPN who has mastered the task (which allows the apprentices to progressively learn, practice, and demonstrate competencies on the job). LRSC assesses each student for financial aid, and then employers pay any remaining costs for tuition and books so that apprentices obtain their associate’s degree and RN license at no cost to the student. Getting employer buy-in to the apprenticeship model as a way to grow their workforce was an “easy sell,” says Howe, due to the extraordinarily high costs hospitals are paying for traveling nurses when they can’t fill positions.
For more information on developing an RN Registered Apprenticeship Program, check out the work process schedules and related instruction outlines available in OA Bulletin No. 2023-111 and the Urban Institute’s Registered Apprenticeship Standards Library. For ideas and resources to grow Registered Apprenticeship Programs in the healthcare sector more broadly, check out the Apprenticeship in Healthcare resource page. For information on all newly approved occupations, you can watch for OA bulletins posted on Apprenticeship.gov. And for help with developing any kind of new program standards, see the Department’s Standards Builder, Urban Institute’s Registered Apprenticeship Standards Library, the Developing Apprenticeship Standards and Work Processes resource page, and the Registered Apprenticeship Program Development Peer Resources page.