Growing the Local Nursing Workforce through Apprenticeship in North Carolina

North Carolina needs more nurses. A decade from now, North Carolina is projected to have a 22 percent shortage of registered nurses—the most severe in any state. Nursing shortages lead to medical mistakes, nursing burn-out, and delays in needed care.

The question, then, is how to train more nurses in the communities that need them.

Nursing is unusual, in that aspiring nurses can take multiple educational pathways to become a Registered Nurse. About one third of registered nurses first entered the profession with an associate degree and about half with a bachelor’s degree.

Other nursing occupations, like a certified nursing assistant (CNA) or a licensed practical nurse, require less education, but also come with lower pay. In theory, aspiring nurses can become a CNA in six weeks, then an LPN with about 10 months of training, before becoming an RN through an associate’s degree or bachelor’s degree.

Although the CNA and LPN roles can be seen as gateways to the nursing profession, they often become the endpoint. A study in California found that only about 20 percent of CNAs went on to get a higher level educational credential, and only around 10 percent became registered nurses within six years. Financial costs, time constraints, and limited clinical spots prevent many otherwise qualified individuals from moving up the nursing career ladder through higher education.

Enter nursing apprenticeships. Traditionally associated with trades like HVAC and manufacturing, apprenticeship is an educational model that combines structured, on-the-job learning with academic coursework designed to prepare an individual for a particular occupation. Nursing apprenticeships offer students pay for clinical hours worked and often provide discounted or free tuition.

In North Carolina, Surry Community College has partnered with two local hospitals, Northern Regional Hospital and Hugh Chatham Health, through a community-based apprenticeship program called Surry-Yadkin Works. Nursing apprentices earn free tuition for their associate degree in nursing while also working at one of the hospitals.

Crystal Folger-Hawks, Executive Director of Surry-Yadkins Works, explains how the program can impact entire families: “When you’re sitting there at graduation and you see their family members, you can visually see the generational change you just made. [You can see] the amount of pride and how excited these family members are, who have never had anybody even get a high-school diploma. To have an associate degree and immediately make $70,000 a year in a community with a median income of $40,000—it’s just huge.”

A key reason the Surry program has worked is that the community college found healthcare partners who were willing to be flexible for students. Although traditional nursing shifts last 12 hours, usually from 7:00 am to 7:00 pm or vice versa, Surry’s nursing apprentices needed shorter three-hour shifts that could accommodate their class schedules.

But that flexibility comes with benefits for employers, too, who may reduce costs on travel nurses and recruitment. Folger-Hawks noted, “At one point, one of our local hospitals spent millions of dollars on travel nurses—they usually employed about 40 or so travel nurses at a time. We are at zero now.” Nurse apprentices become ingrained in the hospital community, building relationships that translate to full-time jobs after graduation.

Folger-Hawks explained how the apprenticeship helps aspiring nurses see the value of living and working in the community, rather than pursuing career opportunities in nearby cities. In rural communities, where bright students often feel the need to leave home to find a good job in the healthcare industry, nurse apprenticeships train local talent and build economic opportunities in the region.

For community colleges considering starting a program like Surry’s, Folger-Hawks emphasized the importance of partnership and choosing a hospital or another health care facility willing to start small and experiment. “Being slow and being thoughtful about the process. Serving businesses and serving the students.”

Meeting the challenges of current and projected nursing shortages—in North Carolina and around the country—requires a willingness to experiment with new ways of learning that serve students, schools, and communities.

Across the country, community colleges and health systems are meeting that challenge with nursing apprenticeships, while also opening doors for students who can’t stop working altogether to pursue their education.