Nursing Apprenticeship in Alabama

Coastal Alabama is another great example of the ways that an employer champion is necessary to propel apprenticeship programs forward. Alabama, like many places, acutely feels the critical need for more nurses. Nursing is one of the most in-demand positions in the state, with more than 4,500 openings every year.¹ According to data from the Bureau of Labor Statistics, Alabama has fewer than 10 nurses per 1,000 people, and one of the worst general labor shortages in the nation.² High rates of turnover that plagued the health care field for years reached a crisis point during the COVID-19 pandemic, motivating great interest in accelerated nursing programs. And a study released by the Alabama Board of Nursing in October of 2023 surveying 84,779 experienced nurses in Alabama found that over 45 percent of them (nearly 39,000 nurses) intend to leave the profession within the next five years, making the need to build the pipeline of new nurses even more urgent.³ This makes health care a challenging, but attractive, option for colleges in the state considering apprenticeship programs.

As a sector, health care is heavily regulated, for necessary and obvious reasons, and these regulations make it difficult for students to get practical experience before they are licensed.

For years, the leadership at Coastal Alabama Community College, employers like the Alabama Nursing Home Association, and the governor’s office had been advocating for new legislation that would allow students to apply to the Board of Nursing for a permit to participate in clinicals rounds and on-the-job training alongside a journeyworker ahead of their official licensure. The Board of Nursing, a critical stakeholder in the process, was eager to cooperate. In early 2020, the new legislation was at the top of the docket in the Alabama state legislature.

Then COVID-19 hit. The legislative and administrative processes required to make the change didn’t pick back up until March 2021, and it took another year after that before the new rules were implemented. When the new rules took effect in March 2022, Coastal Alabama Community College wasted no time in assembling its first cohort of nursing apprentices in the summer of that same year. It now runs a Practical Nursing Apprenticeship, which is three semesters, and the Associate Degree Nursing Apprenticeship, which is five semesters. Tiffany Scarborough, the dean of Nursing and Allied Health at Coastal Alabama Community College, noted her gratitude for the support of the governor and of Coastal Alabama’s leadership in advocating for the changes.

Meredith Smith, assistant director of the Alabama Office of Apprenticeship, noted that while she was also grateful for that support, “the loudest voice in the room was really the employer's voice. The Alabama Nursing Home Association was really struggling with recruitment and retention; [they said] what we’re doing isn’t working, we’re interested in trying something different, and we’re interested in apprenticeship.”

Based on this interest, the college was brought into the conversation, and the nursing apprenticeship program was born shortly thereafter. In the first semester of the program, Coastal Alabama worked with just one employer, but the program quickly grew. Now in its second program year, Coastal Alabama has signed over 30 employer acceptance agreements. Smith said that finding partners wasn’t a challenge. “We know that 90 percent of apprentices stay with the same employer two years after they finish an apprenticeship nationally,” she said, “so we communicate that to our employers. Health care retention is substantially lower than that, so if we can move the needle that is great.” Coastal Alabama hopes to help minimize the nursing shortage in its state not just by creating more nurses, but by creating more nurses who will stay in the profession long term.

But before taking on retention in the health care field, it had to tackle retention within the nursing program itself. When the program started, Coastal Alabama saw a lot of students leave after the first semester. Scarborough attributed this to a variety of causes, and said that many students are shocked by the difference in instruction between general education courses and nursing classes. They also have misconceptions about the time commitment. Scarborough noted that between classes, studying outside of class, and 12-hour clinical shifts, the program is really like a “mini med school.”

In order to make things less overwhelming for students, and to prevent relationship damage with employer partners, the college decided to onboard students into the apprenticeship program during the first semester of nursing school and allow students to begin working as apprentices during their second semester. This means students don’t have to juggle new classes and being oriented with their employer during the first semester. It also works better logistically, as onboarding is a lengthy process. Scarborough said that she has found that students who persist to the second semester are more likely to persist through the entire program. Stronger relationships with employer partners are built this way, since they are paired with students who are more likely to complete.

Scarborough said she recognized that academic challenges are not the only thing keeping students from completing their programs. Even before its apprenticeship program, Coastal Alabama was aware of many students dropping out due to financial difficulties. In fact, part of the reason that Coastal Alabama was interested in starting the program was to support a population that it saw had interest in the program—students like Matthew Dempesy who were entering their second or third careers, many of whom had families and were facing economic strain.

To alleviate this obstacle to program completion, the state of Alabama ensures that the program is no cost for nursing apprentices. The state has a last-dollar scholarship policy, so any costs remaining after Pell grants and other aid is charged to the employer, not the student. This is a resource that a college can leverage as a sponsor or intermediary eligible for state and federal financial aid. The state of Alabama is leveraging a public resource, in cooperation with the private sector, to build talent. The college has seen that employers are happy to participate, as they find the cost is often minimal, and they see value in the recruitment potential.

Legislative changes and employer champions got the program started, and Scarborough attributes its success to continued support from employers as well as a few other factors. Employers continue to be strong partners by offering flexibility for students, building their clinical hours in a way that allows them to also complete their RTI. This flexibility has helped students, and the program, to be successful.

Coastal Alabama also hired a nursing apprenticeship and clinical coordinator to act as a liaison between the institution and the employer, to oversee onboarding, and to ensure journeyworkers are trained appropriately. Having one sole point of contact at the college helps employers more easily navigate processes and keeps the program streamlined. The flexibility, thought, and care demonstrated by both Coastal Alabama and its employer partners were recognized at the end of 2022, with the award of the Governor’s Seal of Excellence for Work-Based Learning. Additionally, Alabama Works! recently announced the program as winner of an Innovator Award.