Can Texas Apprenticeships Put a Dent in the Nursing Shortage?

South Texas College is set to offer the first federally-approved registered nurse apprenticeship program, which aims to boost healthcare and economic opportunities for residents.

It’s no secret that the U.S. is in dire need of nurses. Since the COVID-19 pandemic, approximately 100K registered nurses nationwide have left the workforce due to unprecedented workloads, burnout, and stress. In Texas alone, officials are predicting a deficit of more than 57K nurses by 2032.

In response to this vast and growing need, the Texas Workforce Commission is investing heavily in apprenticeships, hoping to make entering the field more affordable and to attract more students to—and keep them in—nursing even if they need to work to support families.

The commission announced a $15M initiative two years ago focused on hiring and training new staff in nursing and other healthcare fields through apprenticeships. Through February, Texas employers could apply for grants of up to $1M to defray costs for curriculum development, training supplies, and instructors.

The big idea: While apprenticeships in some healthcare specialities are well-established in the United States, those in nursing are relatively new and evolving—though they are a common entryway to the nursing profession in European countries. 

In the 2023 fiscal year, the U.S. only served about 6.2K registered apprentices in nursing, and almost half of them were in Texas, where more are on the way. 

The growth is being buoyed by the U.S. Department of Labor’s approval last year of a new registered apprenticeship for registered nurses. Before that, registered apprenticeships were mostly offered for licensed practical nurses or for registered nurse residents who had already completed degrees. Those occupations still make up the bulk of nurse apprentices, but that’s changing.

The new registered nurse apprenticeships, spearheaded by places like South Texas College, are embedded in degree programs—an approach that is growing in popularity

The apprenticeships aim to bring more people into the profession by allowing them to earn a wage and gain clinical experience in hospitals and other healthcare settings as they pursue their degrees, making nursing a more feasible option for those who otherwise could not afford tuition or time off from work.

“We should see the demographics and makeup of nurses begin to look a lot different than it does today.”

—Kenyatta Lovett, former managing director at Educate Texas

The employer demand is strong. The TWC projects that jobs in healthcare will grow 18.4% by 2028, which will account for more than 11% of the overall anticipated job growth in Texas. But for that to happen, there have to be qualified people to fill those roles. The need for bilingual nurses, doctors, and other healthcare workers is especially acute in a state with 7.5M residents who primarily speak Spanish.

“Full-time employment combined with classroom training is a way for many individuals to gain employment or progress to highly-skilled and high-paid healthcare careers,” says Catherine McKee, a TWC spokesperson.

A Boost for First-Generation Students

On the ground: The five campuses of South Texas College are located along a southeastern stretch of the Rio Grande, where more than 75% of the predominantly Latino population is first-generation students. It’s a region where the demand for nurses is great, as well as the need for economic opportunities among residents. The college is the top producer of nurses among Texas’s public community colleges, graduating 326 nurses in the 2023 academic year.

Jayson Valerio, dean of South Texas College’s Division of Nursing and Allied Health, has been deeply invested in bringing apprenticeships to the region. For 17 months, the college worked to receive approval of the nation’s first registered apprenticeship program for registered nurses from the U.S. Department of Labor, which STC announced in July.

The effort to achieve that designation came from a consortium of leaders in the Texas healthcare industry, community colleges, elected officials, and the TWC. 

“We were invited to that meeting and basically [the TWC] flat-out told us that we need to do something to take care of the nursing staffing issue and that’s how the apprenticeship came about,” Valerio says. “It took 17 months to approve this because there’s no blueprint in the nation for nursing apprenticeship.”

Students in nursing and allied health at South Texas College. (Photo courtesy of STC)

STC is set to enroll the first 20 students in the apprenticeships in the fall, pending the final approval of the Texas Board of Nursing, which Valerio is hoping will happen this month. In order to receive the federal registration, the college needed an employer to sign on to the partnership, which it found in DHR Health and its 500-bed acute care hospital in Edinburg, Texas.

The first cohort of students pursuing their associate degrees in nursing will fulfill their clinical rotations in the hospital and receive a minimum $14-per-hour stipend, with opportunities for wage increases after the first year, as well as tuition grants and other cost-of-living funds. The degree curriculum will remain the same—no changes were needed—but the difference is that students will “earn as they learn” and also have the chance to put all the theoretical lessons garnered in the classroom into real-world practice

Under the supervision of college faculty and hospital staff, students will be paired with mentors in the hospital who will guide them through the kinds of tasks and responsibilities they will take on as registered nurses. 

Diversifying the pool: Kenyatta Lovett, principal at Education Strategy Group and former managing director for higher education and workforce at Educate Texas, sees the nursing apprenticeship as a way to alleviate some of the pressure to find other jobs while students are working on their degrees and credentials, which expands the access to the career path to more people while expediting the time it takes to graduate.

“We should see the demographics and makeup of nurses begin to look a lot different than it does today,” he says. “We’ll see a long-term expansion of opportunities for students to not have to go through residencies or work-based learning experiences where they don’t get paid. The standard will be that they get paid for spending that time to deepen their career experience.”

The challenges: The apprenticeship model may help more students stick with nursing, but it only goes so far in addressing other challenges with nursing programs. The shortage of nursing educators and mentors is chief among them. Programs can only admit as many students as staff-to-student ratios allow.

Valerio, for example, says in the past year STC had to turn away 350 qualified students for its nursing programs because it has struggled to replace the 12 faculty members it lost during the pandemic—mostly to traveling nurse positions that paid them far more (up to $100 per hour).

“We’ve been able to replace seven of the positions,” Valerio says. “It’s not an isolated issue; it’s nationwide—there’s a big salary gap for the master’s degree of science in nursing going into academia versus going into the clinical world.”

Lovett agrees that the lack of capacity for more students is a problem.

“It’s a longstanding challenge that may be around for quite some time,” he says. “Obviously you want those students to have the ability to earn a wage while going through work-based learning experiences, but still those slots are very limited because they’re dependent on what the hospitals can provide in terms of access and opportunities.”

An Optimistic Outlook

Photo courtesy of STC

The good news? The Department of Labor data shows that 91% of apprentices retain employment after they finish their programs, with about 90% reporting that they stay with the same employer. Playing the long game, those kinds of statistics could be a saving grace for an ailing profession like nursing, especially in regions that also want to increase employment opportunities for their residents. 

The employer view: Mariam Hammad, chief nursing officer at DHR, sees nothing but upside for the hospital, as well as the incoming apprentices. Before they graduate, they’ll already know the people that they’ll work with, the facility, and the operation. The on-boarding time is reduced, as well as the cost to bring in new staff members. According to Valerio, employers invest $52K to on-board one new nurse only to have about 27% leave the job within one year. 

“These nurses will be more comfortable and more familiar with the area and the leaders,” Hammad says. “If I am a new person to a facility, I need a good two to three weeks to learn the unit on top of learning new skills. Now they will learn those skills during their clinical hours.”

TWC says it will measure the success of the healthcare apprenticeships it has helped fund by tracking their completion of the U.S. Department of Labor registration process and the number of apprentices that commit to each program. For STC and Valerio, the measure of success will be retention—more students able to complete their degrees and less turnover of nursing staff at DHR.

“I firmly believe that this nursing apprenticeship will address that retention,” Valerio says. “It’ll address the burnout, especially among newly hired nurses.”

As one of the pioneers of registered nurse apprenticeship programs, Valerio is also hearing interest spreading across the country. He’s fielded calls and queries from leaders of nursing programs in Minnesota, Rhode Island, New York, and Mississippi, he says. He’s eager to share what he’s learned and, in time, the benchmarks that show progress.

“So I’m hoping that this will be a success and we’re going to be the blueprint for other schools to follow,” Valerio says.

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