Recommendations

The relative ease with which Fairview incorporated apprenticeship into its existing professional development strategies demonstrates that it is already a close fit. It also shows that apprenticeship can be a valuable tool for helping the field reach its goal of increasing the share of bachelor-degreed nurses to 80 percent. But expanding the use of apprenticeship in nursing and realizing its full potential as an education and training model will require support from a broad range of stakeholders across the public and private sectors—state and federal policymakers, philanthropy, advocacy groups and professional bodies, and health care employers. Below are steps each group can take to broaden access to high-quality nursing apprenticeships.

The Role of Federal and State Government: Federal and state policymakers have an important role to play in expanding the use of apprenticeship in the health care sector and should:

• Convene key stakeholders to discuss Registered Apprenticeship: Leaders can bring together key stakeholders in the nursing sector—employers, state boards of nursing, researchers, unions, institutions of higher education—to explore the value of apprenticeship and identify opportunities and barriers to expansion. Significantly expanding the use of Registered Apprenticeship in nursing will required coordinated policymaking. Governors and federal agencies are well positioned to host these conversations.
• Create targeted grant programs: Fairview’s experiment with Registered Apprenticeship was made possible by a federal grant program, the American Apprenticeship Initiative (AAI). Grants funds covered one of the biggest barriers to apprenticeship expansion, the cost of developing a new program. Congress and the Executive Branch should consider a targeted discretionary grant program to help more employers set up apprenticeship programs in the health care sector, including for registered nurses. Funding should also support the role of workforce intermediaries who can work with groups of employers and help scale up high-quality programs. The U.S. Department of Labor’s Office of Apprenticeship and the Health Resources and Services Administration at the Department of Health and Human Services could jointly administer the program.
  Similarly, governors and state legislatures should identify opportunities to seed the development of apprenticeship programs as part of their efforts to meet the 80 percent goal. New York recently passed the country’s first law mandating that registered nurses obtain a bachelor’s degree within 10 years of being licensed. Similar “BSN-in-10” legislation is under consideration in other states. States that choose to legislate degree requirements should consider Registered Apprenticeship as an equity-based strategy for increasing their share of BSN nurses.
• Support research and evaluation: The IOM’s study of the impact of bachelor-degreed nursing on patient outcomes has been transformative. But little is known about the effectiveness of different models to support BSN attainment. Any additional investments in health care apprenticeship should include a robust evaluation of its effectiveness as a teaching and learning model, particularly in comparison to other strategies, including the fully online RN-BSN and the entry BSN.

The Role of Philanthropy, Nursing Associations, and Advocacy Groups: The healthcare policy community is broad and includes many influential health care stakeholders beyond government and employers. These groups can play an essential role in building support within the public and private sectors for apprenticeship in nursing and should:

• Raise awareness of apprenticeship: The Campaign for Action, funded by the Robert Wood Johnson and AARP Foundations, has played an essential role in raising awareness among employers and practitioners of the IOM’s goal and strategies for reaching it. These groups could play a similar role in raising awareness of apprenticeship as an educational strategy to move associate-degreed nurses up to the bachelor’s degree.
• Fund pilots and evaluation: National and local philanthropic organizations can provide funding for pilot programs and evaluations to further understand how apprenticeship can be of value to the nursing sector.
• Recognize apprenticeship as compatible with “Magnet” status: The Magnet status designation awarded by the American Nurses Credentialing Center (ANCC) sends an important signal regarding high-quality professionalization strategies for nurses. ANCC should explore the value of Registered Apprenticeship as a credentialing strategy and consider including it in its list of activities that contribute to Magnet status.

The Role of Employers: Health care employers should explore how Registered Apprenticeship could advance their workforce development goals, particularly increasing BSN attainment levels. An apprenticeship program with a robust on-the-job learning component may well provide more return on investment than traditional tuition reimbursement programs. As apprenticeship sponsors, employers can have more influence over the curriculum and the instructors than in a traditional degree program. And the convenience of learning-on-the-job may entice more of their associate-degreed nurses to enroll in the program. Employers interested in apprenticeship should:

• Partner with health care workforce intermediaries to develop apprenticeship programs: Hospitals and other health care employers are already spending a lot of money on professional development for their staff, but they likely have little familiarity with Registered Apprenticeship. There are organizations that specialize in the design and development of apprenticeship programs—nonprofits like the Healthcare Career Advancement Program and government agencies such as local workforce development boards or state departments of labor—that can help.
• Partner more selectively with institutions of higher education to ensure quality and drive down tuition: Apprentices at Fairview are enrolled in RN-BSN programs all over the country, paying varying rates of tuition for a similar set of courses. Because high-quality apprenticeship programs require strong connections between on-the-job and classroom-based learning, they are best supported by a single educational partner that has helped develop both components of the program. An additional advantage of working closely with one educational partner is the opportunity to negotiate better deals on tuition.