Introduction

Laura Beeth, Vice President of Talent Acquisition at Fairview Health Services of Minnesota, spends a good part of every week thinking about how to get nurses to go back to school and earn a bachelor’s degree. She knows it is a lot to ask of people who are working full-time and have countless other personal and financial responsibilities. But studies have shown that hospitals with more bachelor-degreed nurses generate better patient outcomes, ¹ so Fairview has charged Beeth with raising their share to more than 80 percent. The strategies Beeth develops are critical to helping Fairview secure “Magnet” status,² a prestigious designation awarded to just 475 hospitals across the country that exemplify best practices in nursing leadership, patient care, and education attainment.

Increasing the share of registered nurses with a bachelor of science in nursing (BSN) is a top priority for Fairview and many other health care systems around the country that are responding to the growing body of evidence connecting the presence of bachelor-degreed nurses to better patient outcomes. Beeth is keeping close tabs on Fairview’s nursing workforce, ensuring at least 80 percent of new hires per week already have a bachelor’s degree. “I have to report weekly on those ratios that end up going to the chief medical officer and chief nursing officer…I have to say what the solutions are [for getting more BSN nurses]. ³

Increasing the share of registered nurses with a bachelor of science in nursing (BSN) is a top priority for Fairview and many other health care systems around the country.

She has a few strategies for getting that percentage up, but each one comes with some drawbacks. For example, she can limit any new hires to those that already have bachelor’s degrees, but that cuts Fairview off from the pool of talent from local associate degree programs, many of which are very good. Even more importantly, restricting new hires to nurses with a BSN could leave Fairview with a much less diverse nursing workforce than it currently has or wants.⁴

She can encourage the 30 percent of registered nurses working at Fairview who lack bachelor’s degrees to take advantage of the health system’s tuition assistance program, which provides $3,000 a year to all employees. The financial assistance has helped Fairview make strides toward the 80 percent BSN goal, but not at the rate Beeth needs. To entice more nurses to enroll, she needs something that will make earning the degree more affordable and easier to integrate with current nurses’ day-to-day work at Fairview while also opening the door for upward career mobility and leadership opportunities.

She may have found it. Fairview Health Services has partnered with the Minnesota Department of Labor and Industry (DLI) to set up a Registered Apprenticeship program for nurses in need of bachelor’s degrees. Apprenticeship is an educational model that combines structured, on-the-job learning with academic coursework designed to prepare an individual for a particular occupation. The on-the-job learning is overseen by a qualified mentor. The classroom portion is delivered by a qualified instructor, and apprentices generally not responsible for paying tuition. The apprentice is employed throughout the program, earns a progressively higher wage, and is granted release time from work to attend classes.

Nurses are not those who come to mind when most people think of apprenticeship. Nor do bachelor’s degrees. But apprenticeship is spreading into parts of our economy where it has had little presence historically: financial services, cybersecurity, early education, and health care.⁵ And it is increasingly being used as a path to a job and a college degree, not in lieu of a degree.⁶ For Fairview’s registered nurses who only have an associate degree, the apprenticeship program provides an opportunity to earn the degree with almost no out-of-pocket costs, continue working full-time, and connect classroom learning to daily on-the-job experience. The program has enrolled 122 apprentices, making it the largest program of its kind and one of just a handful of Registered Apprenticeship programs nationwide that culminate in a bachelor’s degree.

Fairview’s apprenticeship program is an experiment well worth watching. Registered nursing is the fifth largest occupation in the United States, with nearly three million workers.⁷ Changes in the educational requirements to enter and advance in the field are felt in every community in America. Today, one-third of registered nurses do not have a bachelor’s degree, and the associate degree is still the primary point of entry into the profession.⁸ Nursing apprenticeships have the potential to open a pathway to the bachelor’s degree that is more effective, and more equitable, than just providing financial aid to nurses to go back to school on their own time. Understanding whether and how apprenticeship can help build the nursing workforce we need is critical to ensuring the profession continues to be a source of quality care for patients and economic security and mobility for millions of Americans.