Apprenticeship and Opportunity in Nursing Today

Though Alexis Barba enjoyed her work as a licensed vocational nurse in Stockton, California, she dreamed of becoming a registered nurse. Alexis applied to associate degree programs in nursing a few times to reach that goal, but due to limited clinical sites, she wasn’t able to get in. It’s not just her: schools of nursing turned away 75,000 qualified undergraduate and graduate applicants in 2018 alone, partly due to capacity constraints. Besides that, pursuing further education isn’t cheap and takes time away from other competing demands, such as family responsibilities and work.

Alexis crossed her fingers that she’d get into an associate degree program, trying not to think about how impossible it would be to pay for school and make ends meet if she did get accepted and had to reduce work hours. When it looked like her goal of becoming an RN was just out of reach, another opportunity arose. Her union, SEIU Local 1000, was recruiting applicants for a new LVN-RN apprenticeship. More than help with tuition for an associate degree, the apprenticeship would give her paid experience in a variety of patient care settings, expanding her skills and knowledge with every new challenge. Space was tight. The first cohort of apprentices would be small. It would be tough to get in, but Alexis applied with her fingers crossed.

The acceptance letter changed her life.

Two years later, as a graduate of the apprenticeship and thriving RN, Alexis joined the Healthcare Career Advancement Program (H-CAP) and CESNA’s Apprenticeship in Nursing Today convening on June 17 in New York City to share her experience. “If it were not for this apprenticeship, I would not be an RN today,” she told an audience of nursing faculty, workforce development leaders, and representatives of nursing associations and labor-management partnerships.

Following CESNA’s 2018 Apprenticeship and the Future of Nursing report, H-CAP and CESNA hosted the convening to discuss whether and how apprenticeship can confront significant challenges in meeting health care demand and to support the career and academic progression of talented nurses like Alexis.

The nursing profession faces a number of significant workforce challenges. Both the nursing workforce and US population are aging, leading to a wave of nurse retirements and a simultaneous increase in need for health care, especially in long-term care settings. Furthermore, the nursing workforce we currently have does not mirror the racial and ethnic diversity of the population. For example, Black nurses are overrepresented among LPN/LVNs, but continue to be underrepresented among registered nurses, a disparity that widens at higher education levels. Latinx nurses, on the other hand, are underrepresented in the LPN/LVN and RN workforce and at every education level. Entry-level programs and academic progression opportunities need to work better for current and aspiring Black and Latinx nurses and accelerate training and promotion of new nurses to meet demand for care as experienced nurses retire.

With the challenges in the workforce and promise of apprenticeship in mind, on the day of the New York convening, Michael Prebil and I released a short guide on why and how apprenticeship could diversify the nursing workforce and increase academic and career progression for nurses. While apprenticeship may not be a silver bullet for workforce challenges, the model can lower financial and logistical barriers to entry and progression for folks that may have felt such a career was out of reach.

Apprenticeship integrates both classroom-based learning and paid opportunities to hone technical skills on the job, which can benefit new and experienced nurses. And it’s not meant to replace traditional nursing education. Instead, apprenticeships in nursing work within existing frameworks of licensure and credential attainment. Yet compared to traditional programs, apprenticeship can provide nurses an enhanced educational experience through structured mentorship in the workplace, continual assessment against required competencies, and low to no cost for the apprentice.

In addition to Alexis’s LVN-RN bridge program, apprenticeships have also emerged to train entry-level practical/vocational nurses, or to help associate degree RNs to get their BSN. Other “transition to practice” apprenticeships are aimed at newly-licensed nurses.

Alexis may have achieved her dream of becoming an RN, but she’s far from finished. She’s already progressing through a bachelor’s degree program and has her eyes on the next prize: graduate school and a role as a nurse practitioner. She believes none of this would be possible without the opportunities that apprenticeship opened for her. “I believe in this program,” she says. “It is now my passion and part of my happiness to see others get the chance that I have been able to experience.” As more employers and colleges offer nursing apprenticeships, they will tap into the immense talent and dedication of nurses just like Alexis, all by offering them the chance and resources to climb higher.

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