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    Nursing Apprenticeships: How to Get Paid to Go to Nursing School

    By: Kathleen Gaines BSN, BA, RN, CBC

    There are plenty of paths that students can take to becoming a licensed Registered Nurse. Some students begin their nursing career by earning their LPN at a local community college before moving onto advanced degrees. Others enroll in a Bachelor of Nursing Program that will provide them with a four-year degree and prepare them to take the NCLEX exam, which they must pass in order to practice as a licensed nurse.

    However, federal and local governments, along with educational institutions and healthcare facilities, are looking to create yet another path. These different groups are joining forces to provide nursing apprenticeships that allow students to gain hands-on experience and earn money while attending school.

    Apprenticeships are increasingly being seen as an effective method for individuals to achieve their career goals. Commonly utilized for careers such as electricians or plumbers, nursing apprenticeships are becoming more and more popular.

    The United States is taking steps to join other countries, including England, to provide nursing apprenticeship programs, in part, to help address the projected nursing shortage. England started utilizing nursing apprenticeship programs in September 2017 after investing £4.5 million to universities to develop new courses. Nurse apprenticeships are offered at,

    • Universities of Derby
    • Gloucestershire
    • Greenwich
    • Sunderland

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    The Current U.S. Nursing Shortage

    According to The Bureau of Labor Statistics’ 2016-2026 employment projections, nursing continues to be among the top occupations with steady projected job growth through 2026. The workforce is anticipated to grow from approximately 2.95 million nurses in 2016 to 3.39 million in 2026. Furthermore, the Bureau expects a 15% change in employment from 2016 to 2026 which is almost double than other occupations.

    While there may be a nursing shortage, U.S. News & World Report states that nursing programs remain one of the most competitive programs in terms of gaining entry. Nursing apprenticeship programs help to alleviate the burden and allow students another avenue to becoming a nurse.

    By allowing students to learn on the job and get paid while they are obtaining their education, the programs hope to attract more students and make nursing degrees accessible to those who wouldn’t otherwise be able to afford the cost of tuition. 

    While there has been some disagreement about the severity of the projected nursing shortage, the numbers have been unsettling enough for the government to act and seek new ways to develop qualified nurses to fill positions. The disagreement is mostly seen amongst rural hospitals and in more remote areas of the country. Larger city hospitals don’t often have as many vacancies that are being accurately reported.

    Apprenticeship Opportunities are Poised to Increase

    The development of nursing apprenticeship programs is reflective of larger labor trends in the United States. 

    As the cost of education continues to rise and new graduates are saddled with tens of thousands of dollars of debt before even landing their first job, apprenticeship programs are emerging as a viable solution across a wide variety of industries. 

    While their existing nursing apprenticeship programs are scattered across the country and don’t necessarily represent a consistent approach, it is safe to assume that lessons learned from these early programs will be used to inform accreditation policies on a national scale.

    If you have been considering a career in nursing, but have been wary of applying because the cost of tuition seems prohibitive, then a nursing apprenticeship may be the best solution. 

    These programs may not yet be available across the country, certain states do offer options that will allow you to work towards becoming an RN while also being paid. It is an option worth researching, especially since there are numerous programs currently in development. There may be a program opening up near you!

    Where are Nursing Apprenticeships Available?

    Outside the US, apprenticeship programs provide total on-the-job training without requiring participants to attend university. As students acquire new skills, the move up a structured set of education tiers.

    Initial versions of nursing apprenticeships in the U.S. follow a different model. These models have students first spend time in the classroom and then move on to the hands-on hospital training.

    The Council for Adult and Experiential Learning (CAEL) has been developing apprenticeship training models that also incorporate online learning for a hybrid model that offers accelerated learning and allows students to become an RN is less than two years.

    The CAEL is using an award from the U.S. Department of Labor to implement pilot programs in Illinois, Maryland, Texas, South Dakota, and Washington.

    The state of Nevada has also taken steps to implement an apprentice nursing program that has been designed by the state’s board of nursing. Their program allows students to practice the skills they are learning in the classroom in a healthcare environment and be compensated for their time and work. 

    The Nevada State Board of Nursing’s website has a comprehensive list indicating what skills an Apprentice Nurse can perform. The Nevada Apprentice Nurse Program offers students the opportunity to practice their clinical skills and to acclimate to their new role as a bedside nurse.

    Skill Apprentice RN
    Advanced Directives Documentation and teaching
    AM Care/Activities of Daily living Includes shaving
    Ambulation of Patients Performs
    Admission and ongoing assessment Contributes to data collection, reports information and records objective and subjective data
    Back Rubs Performs
    Bathing patients Bed, assist, sponge, tub, shower, whirlpool
    Bathroom Assist with commode, bedpans, urinals
    Bed making Performs
    Bili-lights Assist RN with the care of infants under light
    Breastfeeding Reinforcement education
    Bowel and bladder Assist with retraining
    Call lights Answer
    Cast care Routine cast care with RN assist
    Care Planning Contributes to the plan of care established for a patient by recording and reporting to the appropriate person his or her observations by conducting a focused assessment.
    Catheters, Foley Insertion, site care, care of patient with, emptying drainage bag, discontinuation, retention
    Catheters, intermittent Insertion, site care, care of patient
    Catheters, suprapubic Site care, care of patient, empty drainage bag
    Charting, flow sheets Graphic/vital signs record, profile, admission database, I&O, outpatient, pre-op
    Circulation, movement, sensation assessment Performs
    Code As appropriate with basic BLS and AED
    Croup tent Care of patient in
    Discharge of patients Performs
    Douche Administration
    Dressing and undressing Performs
    Dressing changes (sterile and non sterile) Surgical, simple (uncomplicated), moist, non sterile, wet to dry
    Education, patient Reinforcement of established written teaching plan
    EKG, 12-lead Task only, no interpretation
    Enema Fleets, Harris Flush, oil retention, soap suds
    Errands as directed Supplies and equipment
    Elastic stockings Measuring and application
    HS and PM care Performs
    Haircare Shampoo, brush, and comb
    I&O Adult/pediatric
    Impaired mobility management Positioning and transferring. Use of transfer equipment
    Intravenous Therapy Start and remove peripheral line or peripheral access device, administer IV fluids w/o additives or medications, peripheral and central venous IV site care, flush lock
    Isolation Technique following guidelines (Standard Precautions, Body Substance Isolation)
    Jejunostomy Gavage of existing tube
    K-pad Administration and monitoring
    Linen Emptying
    Medications With Immediate Preceptor, supervision may:  Administer oral, intramuscular, subcutaneous, otic, ophthalmic, nasal, tube, or vaginal medications
    Medications not allowed IV medications (PCA, push, piggyback, additives) epidural or chemotherapy meds (PO or IV)
    Nutrition Appropriate for age and diagnosis, feed patient, verifying diet, feed with regular or thumb-controlled syringe, assist with menus, pass trays
    Nutrition, GT/PEG feeding Care of patient, administer tube feeding
    Nutrition, nasogastric tube Care of patient, insertion, gavage with existing tube, gastric suctioning,
    Observe condition or change in condition Performs
    Oral hygiene (conscious and unconscious patient) Brush, floss, denture care
    Orthopedic devices Care of patient with knee immobilizer, cervical collar, sling, crutches, CPM
    Ostomy Change bag and skincare
    Orientation of patients to room/unit Performs
    Oxygen therapy Care of patient and application of mask, nasal cannula, hood, blow-by
    Perineal care Performs
    Positioning patient in bed Performs
    Post-mortem care Assist with care, consent forms, required request
    Pre-procedure shave/skin prep Performs
    Pulse oximetry Performs
    Range of Motion exercises Simple
    Rectal digital stimulation (not on new paraplegics or quadriplegics) Performs
    Restraints/safety devices Apply, release, care of patient
    Safety Fall prevention, care of patient, patient education and documentation, reporting
    Seizure care Precautions and management
    Sequential compression stocking Application and care of patient
    Skincare Pressure ulcer prevention, turning, collecting skincare related data
    Specialty beds Care of patient
    Specimen collection and handling (non-manipulated) Respiratory secretions and sputum, throat, rectal, stool, urine, diaper
    Specimen collection and handling (manipulated) Wound drainage, indwelling catheter
    Staples/suture Removal only
    Steri-strips Application and removal
    Suctioning and care of patient Tracheal, oral, and nasal
    Suctioning, bulb (infants) Only with OB/RN instruction
    Surgical drains Care of Jackson Pratt, J-Vac, JT-tube
    Tracheotomy Care and suctioning
    Traction equipment Set up (trapeze only), assist RN/LPN/PT with initial application and care of patient, may reapply traction
    Transportation of patients and equipment Performs
    Transcription of orders May NOT accept telephone and/or verbal orders. May process/transcribe provider orders. RN to reconcile and note all orders
    Vaporizer–cool mist Performs
    Valuables Appropriate care and documentation
    Vital signs Perform
    Weights/heights May measure and weigh patient (standing/chair/bed, scale/sling)

    As students learn new skills in the classroom, they are able to assume more responsibilities at work and progress through a predetermined set of skills. Once they graduate, they are awarded an Interim Permit, which allows them to practice nursing.  

    While there are clear benefits for students who participate in apprenticeship programs, hospitals and healthcare facilities also reap rewards. For facilities that are understaffed and have high nurse to patient ratios, apprentices can help fill the gaps and provide vital manpower that is required to monitor and treat patients. 

    Apprenticeships also provide the opportunity to cultivate future employees and expedite the hiring process since other nursing staff and managers will already be familiar with new graduates.

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    Funding Announcement

    The American Association of Community Colleges, in April 2019 announced a partnership with the U.S. Department of Labor, to add 16,000 new nurse apprenticeships over the next three years. Furthermore, the Department of Labor announced a contribution of $183.8 million to support the expansion of apprenticeship programs. While it is not entirely clear how much of the funding will go towards starting nursing apprenticeships, it is evident that new apprenticeship programs will be developed.

    Current Nurse Apprenticeship Programs

    Currently, there is only one health system in the United States offering apprenticeships for nursing students.

    Norton Healthcare in Louisville, Kentucky

    Created in 2017, Norton Healthcare in Kentucky is credited with creating the first state-accredited nursing apprenticeship in the United States. The program was developed in direct response to the ongoing nursing shortage that is quite profound in Kentucky. Currently, with one of the largest number of vacant nursing positions, the apprenticeship helps fill the void.

    Nursing students who are in their junior year of college or working towards an Associate’s Degree can apply to the program. Participants shadow nurses and learn skills while also earning competitive wages.

    According to the website in order to apply for the program, students must submit the following:

    • Transcript from an accredited nursing program
    • Resume
    • American Heart Association Basic Life Support provider card
    • Two letters of recommendation from nursing faculty members. If currently employed in a health care setting, one letter must be from the employer.
    • Personal statement: Why did you choose nursing as a profession? What are your goals for graduation? How does enrolling in the apprenticeship program assist you in accomplishing those goals?

    The program lasts 12 –18 months and focuses on "reinforcing nursing education and patient safety, awareness of the professional nurse role, and an appreciation of organization structures and operations with a leading health care setting.”

    The program utilizes three tiers of progression in order to meet the state’s requirements.

    In the first stage, nurses will focus on learning about Norton Healthcare’s culture of safety. The second will focus on building hands-on experience in a hospital setting. The third step focuses on building the apprentices' confidence in their desired nursing specialty.

    Fairview Health System in Minnesota

    The program designed by Fairview Health System, while considered a nursing apprenticeship program there is very little information available regarding its structure and application process. It is clear that individuals in these apprenticeship programs had already graduated from a nursing program and were working as Registered Nurses.

    According to the website, Fairview was awarded a grant from the U.S. Department of Labor to fund apprenticeships, on-the-job training, and tuition support for nurses. RNs pursuing a four-year degree can apply for this assistance to advance their nursing careers. 

    Fairview limited eligibility for the apprenticeship to nurses who were already enrolled in RN-BSN programs. By 2018, Fairview had 122 nurse apprentices enrolled, making it one of the largest single-employer apprenticeship programs in the country.

    The Future of Nurse Apprenticeships

    There is still a great deal of work that needs to be done for nurse apprenticeships to become a reality in the United States. Through federal funding, state support, and an increasing need for qualified beside nurses, apprenticeships will soon become more prevalent in the nursing education conversation. Unfortunately, there is only one fully functioning program at this time but it has been working and hopefully will set an example for other healthcare systems to follow.

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