Advancing Degree Apprenticeships in Health Care

Combining nursing and allied health degree programs with Registered Apprenticeship is a promising strategy to strengthen preparation for these demanding jobs. Apprentices earn the credential they need for licensure or certification while building skills and confidence through hundreds of hours of paid, mentored work-based learning. 

In Degree Apprenticeship: A Remedy for the Health Care Talent Crisis, we explore the value proposition of degree apprenticeship for educators, employers, and aspiring health care professionals. The model promises to increase the efficiency of the health care workforce development system by improving completion rates and reducing the attrition of early-career professionals. It also creates a pathway for people who are locked out of these professions because they cannot study full-time and complete clinical training hours without compensation.

So why isn’t the model more prevalent in health care? 

In our research and interviews, professional associations, program accreditors, and state licensure boards or other state regulatory authorities were commonly cited as the chief obstacles. Educators often assumed reflexively that these entities would oppose degree apprenticeship and hesitated to ask for their support. We found several examples, however, where these gatekeepers supported degree apprenticeship. What’s important is how they got there.

When Michigan employers wanted to create apprenticeships in respiratory therapy—an occupation that requires at least an associate degree for professional certification and state licensure—Jan Karazim, program manager for Michigan’s employer-led Health Careers Alliance, went to work. She first convened community college faculty and respiratory therapists to get up to speed on the specifics of the profession and to prepare to engage professional associations. She then contacted national respiratory therapy organizations to discuss the possibility of apprenticeship and appeal for their help. Taking time to answer questions from these organizations and build trust paid off, and all three signed off on a letter to the Office of Apprenticeship in the U.S. Department of Labor (DOL) recommending that it designate respiratory therapy as an apprenticeable occupation. DOL approved the occupation as apprenticeable in January. New accreditation standards for respiratory therapy programs that will take effect in 2027 acknowledge the place of apprenticeship in entry to the respiratory therapy profession. 

Registered Apprenticeship requires that apprentices be paid for their mentored on-the-job learning hours. Yet, students in nursing and other allied health care degree programs are often required to engage in clinical learning experiences that are unpaid. Seeking to launch a registered nursing apprenticeship program that would pay students for their clinical experience, South Texas College approached the Texas Nursing Board with its proposal collaboratively, explaining how the model could effectively prepare students for the profession while maintaining standards for safety and academic rigor. It won the board’s support. The board then joined the college in persuading the Texas Higher Education Coordinating Board to remove the prohibition against compensation for clinical experience. South Texas College graduated its first cohort of nursing apprentices this year, with 90 percent of them passing the NCLEX state licensure exam on their first attempt.

Jayson Valerio, regional healthcare liaison at South Texas College, noted that the school’s interaction with state regulatory authorities was successful because it was not approached as a battle of wills: 

Degree apprenticeship will not thrive in health care without the explicit support of professional associations, accreditors, and state regulators. But just because these bodies serve as gatekeepers does not make them adversaries. Each party is attempting to do its part to foster safety and quality. Recognizing these shared goals when approaching accreditors and regulators with an innovative education strategy, like degree apprenticeship, is essential. The Michigan and Texas cases show that they can become partners and allies when engaged with patience, humility, and a willingness to collaborate. 

Degree apprenticeship will not thrive in health care without the explicit support of professional associations, accreditors, and state regulators. But just because these bodies serve as gatekeepers does not make them adversaries. Each party is attempting to do its part to foster safety and quality. Recognizing these shared goals when approaching accreditors and regulators with an innovative education strategy, like degree apprenticeship, is essential. The Michigan and Texas cases show that they can become partners and allies when engaged with patience, humility, and a willingness to collaborate.