Out Today: Apprenticeship and the Future of Nursing

In 2010, the Institute of Medicine (IOM) published a landmark report calling for a dramatic increase in the share of nurses who hold a bachelor’s degree (BSN), from around half of registered nurses at the time to 80 percent by 2020. The IOM’s recommendation was based on research showing that hospitals with a higher share of bachelor-degreed nurses generate better patient outcomes. Today, with less than two years to go, about two-thirds of registered nurses have a bachelor’s degree – a significant increase since 2010, but still well short of the goal.

Registered nursing is the fifth largest occupation in the United States, employing nearly 3 million Americans. All of us, at some point or another, have benefited from the care, knowledge, and skills of a nurse. Nursing is also unusual among healthcare professions because it allows people to enter the field through a variety of pathways including a bachelor’s degree, an associate degree, or a diploma program. The associate degree continues to be the primary entry point into the profession. With the push toward requiring a bachelor’s degree, however, associate degree nurses increasingly have to figure out a way to go back to school. In fact, a growing number of employers require all nurse managers to hold at least a BSN, and graduate programs that prepare nurses for advanced practice roles and/or faculty positions require a BSN. So, why aren’t more nurses pursuing the degree?

For one, even in the best cases, BSNs are expensive. Registered nurses without a BSN can enroll in a “bridge” program (also called “RN-BSN” programs) to help them earn a bachelor’s degree in two years or less, but they are usually responsible for at least part of the significant cost of the program. Tuition may be especially difficult to meet for registered nurses in underrepresented groups, such as Black and Latinx nurses, due to substantial racial wealth gaps. And a BSN may or may not come with a wage bump to offset the cost of the degree.

Beside the financial cost of pursuing a BSN, working nurses may already have to juggle personal and family responsibilities, leaving little time for the lectures, reading, and homework involved in a BSN program.

The nursing profession needs more equitable strategies for supporting BSN attainment that address the time and cost barriers for nurses who might not otherwise pursue the degree, opening doors of further opportunity to a diverse cohort of nurses. In Apprenticeship and the Future of Nursing, we highlight an innovative strategy that Fairview Health Systems of Minnesota is using to meet these challenges: an RN-BSN Registered Apprenticeship.

Registered Apprenticeship consists of related technical instruction and on-the-job training with the support of an experienced mentor. Fairview’s program is unique among nursing apprenticeships in the country because it culminates in a degree. Leveraging apprenticeship to support employees’ skill growth made so much sense to Fairview that they now offer apprenticeship opportunities for surgical technicians and medical assistants in addition to their BSN apprenticeship for registered nurses.

While Registered Apprenticeship may still be uncommon in nursing, the model offers much to working nurses who aim to pursue a BSN. First, apprentices are rarely responsible for the cost of their tuition, reducing or removing the financial barriers to the BSN. Second, on-the-job mentorship and training enhance the leadership skills and theoretical knowledge nurses are cultivating in their degree programs. A third benefit of an RN-BSN apprenticeship is that nurses’ work schedules and class schedules would be considered holistically, with nurses granted release time from work to attend classes. That means RN-BSN apprentices won’t be logging on to complete late-night homework on top of a series of long shifts, like nurses juggling an RN-BSN program and full-time work might do.

By reducing time and cost burdens through Registered Apprenticeship, earning a BSN becomes possible for a broader cohort of nurses. And by using apprenticeship as a strategy to increase BSN attainment for underrepresented nurses, employers stand to improve patient care by better mirroring the population demographics. To cultivate future academic and administrative leaders that match the diversity of the country, bolstering equitable access to the BSN will be critical. By leveraging Registered Apprenticeship to meet dual education attainment and leadership development goals as Fairview has done, the future of nursing can look even brighter.