What Makes Health Care Degree Apprenticeships Work?

From our research and interviews, we found that five strategies make degree apprenticeship successful for health care careers: (1) collaborating with accreditors and state regulatory bodies; (2) delivering online asynchronous related technical instruction for flexible learning; (3) compensating apprentices for clinical experience; (4) creatively relieving clinical capacity constraints; and (5) recruiting apprentices who are familiar with the health care environment.

One instructive example of the power of working collaboratively with accrediting and regulatory organizations is respiratory therapy. This occupation was deemed apprenticeable by the U.S. Department of Labor (DOL) in January 2026, though some states with state apprenticeship agencies⁴⁸ have had respiratory therapy apprenticeships in place for some time. A degree is required to work as a respiratory therapist, so apprenticeships in respiratory therapy will, by default, be degree apprenticeships. We heard from several interviewees that employers had been expressing interest in respiratory therapy apprenticeships. However, the paid on-the-job learning essential to Registered Apprenticeship was prohibited by the Commission on Accreditation for Respiratory Care, or CoARC, the national professional body that accredits respiratory therapy programs. CoARC’s 2022 standards, as amended in March 2024, read, “Students must not receive any form of remuneration in exchange for patient care they provide during programmatic clinical coursework.”⁴⁹ Without occupational consensus and support, there could be no apprentice designation for respiratory therapy.

With this holdup at the federal level, Wisconsin was home to an early degree apprenticeship in respiratory therapy, launched in 2024. This program benefited from an employer and sponsor—UW Health—with apprenticeship experience, sufficient preceptors for apprentices’ clinicals, and a good relationship with Madison College, the technical instruction provider. The three-year program is structured so that apprentices work as respiratory therapy assistants during the first year and then as student respiratory therapists for the next two years. The Wisconsin Department of Workforce Development now has a model for a respiratory therapy apprenticeship available for employers to tailor as needed.⁵⁰ The program’s related instruction is aligned with associate degree programs within the Wisconsin Technical College System. 

Meanwhile, Michigan employers were asking for a respiratory therapy apprenticeship and expressed that to Jan Karazim, program manager for the Health Careers Alliance. She let these employers know that, as an Office of Apprenticeship (OA) state, there was currently a roadblock to apprenticeship because the occupation had not yet been deemed apprenticeable by the DOL. Another group in Michigan had tried unsuccessfully to move the occupation forward, and Karazim decided to try again. 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 that had expressed some hesitation around apprenticeship. She then contacted national respiratory therapy organizations to discuss the possibility of apprenticeship and, she emphasized, to inform them that respiratory therapy apprenticeships were already being developed in states with their own apprenticeship agencies. “It’s already happening,” she told them, “and I’ve got this group of employers in Michigan that want to do it. We really need your help. We want you to help us get this occupation approved and be part of it.” Taking time to answer questions from these organizations and build trust paid off, and all three signed off on a letter supporting the apprenticeability of respiratory therapy. 

New CoARC accreditation standards taking effect in 2027 acknowledge the place of apprenticeship in entry to the respiratory therapy profession. Regulations continue to emphasize that apprentices cannot take the place of professionals or stand in as backup for regular staff.⁵¹ The framing of this clarification makes clear the goal of protecting students from exploitation and makes space for the many ways that apprenticeship is a viable and acknowledged path into a profession, where student-apprentices can have extended on-the-job training while being well-supported and engaged in a rigorous degree program. 

As with respiratory therapy, registered nursing degree apprenticeships started in states with State Apprenticeship Agencies (SAAs). Alabama’s student nurse apprentice permit is rightly cited as a successful model of nursing apprenticeship, allowing nursing student-apprentices to be paid wages while completing clinical hours and on-the-job training over the course of their degree program.⁵² The apprentice permit was facilitated by the Alabama Office of Apprenticeship and close collaboration among a variety of stakeholders, including the Alabama Board of Nursing.⁵³ However, those in OA states only became able to develop prelicensure registered nursing apprenticeships in 2025. 

South Texas College faced several barriers to launching an associate degree nursing apprenticeship, but it is now moving forward, with wisdom to share with others. Challenges in its service region drove the college’s interest in apprenticeship: a nursing shortage, a nursing faculty shortage, and a worrying 37 percent of newly licensed nurses leaving their first job. However, it quickly realized that the DOL did not recognize registered nursing as apprenticeable, even though some SAA states had already launched degree apprenticeships in nursing. In other words, there was no federally approved registered nursing apprenticeship that could provide a blueprint for Texas to adopt. Because apprenticeship represented a new approach, the Texas Board of Nursing sought additional information regarding its structure, educational safeguards, clinical requirements, employer responsibilities, and alignment with nursing education regulations. With conversations around the mechanics of apprenticeship, the importance of pay for clinicals, and the promise of meeting crucial workforce needs through apprenticeship, state nursing, higher education, and workforce stakeholders came to an agreement to move forward with an application for apprenticeability, which was approved in 2025. 

With registered nurse named as an apprenticeable occupation, the door is wide open for more nursing apprenticeships in OA and SAA states alike. However, there are still some state-specific policies to attend to. The National Council of State Boards of Nursing recommends that state nursing boards set standards for prelicensure nursing educational programs and clinical learning experiences and establish procedures to approve these programs, but states vary in the degree of specificity of their program regulations.⁵⁴ For example, North Dakota, among other states, has a provision in the state administrative code for the Board of Nursing allowing innovation in nursing education.⁵⁵ Schools of nursing may apply to implement a change or pilot a program in nursing education that would enhance students’ experiences or learning outcomes. Lake Region State College successfully proposed nursing apprenticeships to the state board of nursing as just that: an innovative practice. 

We asked interviewees how they successfully engaged accreditors and regulatory bodies, understanding that they might have had some concerns about Registered Apprenticeship. Several themes emerged clearly around dispelling myths about apprenticeship, working to build trusting relationships with these bodies, and coalescing around the urgency to prepare more people for nursing and allied health professions. 

David Polk, director of the Bureau of Apprenticeship Standards at the Wisconsin Department of Workforce Development, shared the importance of engaging with regulatory bodies and considering the expertise each party brings. “I’m not a subject matter expert for the [respiratory therapy] occupation at all,” he said. “I’m a subject matter expert for the Registered Apprenticeship structure. But you all that have been in coordination with these certifying bodies for a very long time, they know you, they know your voice, they know your expertise. You go and advocate for any leeway that we may need in the certification to make this thing an apprenticeship.” The health care degree apprenticeships in Wisconsin suggest this strategy is working. 

Other interviewees strongly concurred that those with subject-matter expertise and experience in allied health professions make the best liaisons with state and professional regulatory and accrediting organizations. Melana Howe leads apprenticeship programs at Lake Region State College in North Dakota and has been a registered nurse for 50 years. She said, “We come with credibility, and we come knowing what the scope of nursing is. I recommend you approach the licensing Board [about] becoming a partner in the initiative. The chances of success are always much higher if you don’t go in with a new concept and tell highly educated professionals what to do. Working in partnership with the Board from the start strengthens the concept and builds the shared support needed for successful implementation.” 

Across interviews, we heard repeatedly that trusting relationships with licensing boards can prove essential in the face of seemingly fundamentally conflicting requirements between the way things are and the way things could be done in apprenticeship. Jayson Valerio, regional health care liaison at South Texas College, felt that approaching the Texas Board of Nursing with the idea of a registered nursing apprenticeship as an innovative practice was helped along by the fact that the college had previously worked with the board on another innovation in nursing education: a dual credit associate degree for high school students. Building credibility and willingly addressing concerns are not steps one can skip in conversations with accreditors and regulators. Jan Karazim knows this well and shared how jumping directly to seeking support for apprenticeship can derail progress. “You’ve got to engage people so that they understand what [apprenticeship] is,” she said. “I wouldn’t sign a letter of support unless I truly understood what was going on. Especially with Registered Apprenticeship and health care people, because there’s been such long-term assumptions made about what Registered Apprenticeship is.”

Even when there is hesitation around the degree apprenticeship model for nursing and allied health education, numbers do not lie. Accrediting and regulatory bodies are aware of an aging populace and workforce, workforce shortages, and a dearth of clinical placements and faculty. Bringing up the urgency of preparing new professionals well—and expanding pathways into nursing and allied health occupations—may create space for conversation about innovative education and training strategies, to include degree apprenticeship. In the face of workforce shortages, a number of employers approached the National Board of Surgical Technology and Surgical Assisting (NBSTSA) about new strategies. Employers’ enthusiasm for apprenticeship influenced NBSTSA to adapt their rules to make space for this model and for clinicals to count as on-the-job training hours. 

Degree apprenticeship can reduce some barriers to earning a degree and entering nursing or an allied health profession through traditional pathways. Some traditional certificate and degree programs require students to attend full time, which is simply untenable for learners who need to continue earning wages while pursuing additional education. We encountered several leaders who employ creative strategies to deploy related technical instruction (RTI) encompassing a full degree in a way that maximizes accessibility for apprentices. 

Program leaders can express hesitation around online learning in prelicensure programs, but Amy Lee, president of MWTEC, says the results speak for themselves. “You’ll get a lot of people that say, ‘Well, you can’t really do hybrid or online in these health care programs. It doesn’t work.’ But,” she says, “we have a 90 percent completion rate across all of our programs. Depending on the program, 85 to 90 percent pass their boards on their very first attempt. So that tells you that the model actually works.” 

Online and asynchronous RTI can open up time for apprentices to engage in on-site learning, where it is essential to work in person. In Michigan, Lee says delivering RTI in this way allows apprentices to be available to work with mentors for skill assessment and support on the hospital floor during daytime hours, when traditional students might be in class. The College of New Jersey’s clinical mental health counseling master’s degree apprenticeship delivers some classroom instruction asynchronously and then convenes apprentices in class synchronously to practice and apply what they learned. The college accommodates the diverse work schedules of students by offering classes in the morning, at noon, and in the evening. Once established, their class schedule remains the same for the duration of the program so they do not have to rearrange their work hours each semester. Apprentices practice their skills weekly with the support of a workplace mentor outside of class before submitting skills demonstration videos for faculty feedback, creating a structured and responsive feedback loop. Sandy Gibson, chair of the Department of Online Counselor Education, reports that apprentices are demonstrating notably stronger clinical skills in their video submissions than non-apprentice students in comparable programs, suggesting that the integration of online learning with paid workplace practice and the support of a mentor deepens clinical competency in ways that traditional programs do not.

A full day of in-person classes on a college campus is not likely to work well for degree apprentices or employers. Creative approaches like online instruction can reduce commute time, provide access to a simulated learning space, and allow for a work-first schedule integrated with classroom learning at a time that works best for apprentices.

Expanding clinical placement sites is paramount in nursing and allied health, for traditional programs and degree apprenticeships alike. In fact, the issue becomes more challenging in health care, because Registered Apprenticeship requires trained worksite mentors to support on-the-job learning, and health care degrees also require clinical supervisors. However, several of the degree apprenticeship programs we encountered were creative in increasing clinical capacity.    

In Wisconsin, employer leadership broke the logjam to create the state’s first registered nursing associate degree program at Madison College. After Madison rebuffed University of Wisconsin Health’s proposal for a nursing apprenticeship because of its capacity constraints, Bridgett Willey, then UW Health’s director of Allied Health Education and Career Pathways, invested in increasing the college’s clinical capacity. She hired four registered nurses who were trained and appointed by the college as clinical preceptors at no cost to Madison. UW Health also built a new simulation center and provided classroom space on its premises, working with the college to obtain its accreditor’s approval of them as satellite instructional sites. With the capacity issues resolved, Madison agreed to launch the apprenticeship that UW Health designed and sponsored. The program is currently serving 64 nursing apprentices. 

UW Health’s internal research indicated that a registered nursing apprenticeship had the potential to generate savings that might exceed the costs of the capacity enhancements by reducing attrition. A 2025 survey of hospitals found that the average cost of turnover for each hospital nurse was $60,090 in 2025, and estimated that reducing nurse attrition by just one percentage point could save the average hospital $295,000 annually.⁵⁶ Two health care organizations also told the Government Accountability Office that they had implemented nursing apprenticeship programs partly because they cost less to develop than to hire traveling nurses,⁵⁷ whose median hourly wages can be more than 50 percent higher than those paid to regular employees.⁵⁸ UW Health WorkForward, the organization that Willey now leads, is focused on helping other employers activate the savings possible through apprenticeships.  

MWTEC solved the capacity challenge in another way. As a nonprofit consortium of Michigan community colleges and health care employers that work together to deliver online and hybrid degree programs in nursing and allied health occupations—some of which are degree apprenticeships, including magnetic resonance imaging (MRI) technologist, registered nursing, surgical technology, and respiratory therapy—its model allows small and rural colleges to offer highly specialized programs that would be financially unsustainable if they tried to operate them alone. MWTEC designs programs so that students complete their general education coursework at their home institutions while taking coursework in their health discipline online. Student-apprentices complete their hands-on clinical hours and on-the-job learning at hospitals and health systems located near their home communities, unlocking clinical training capacity at smaller and rural facilities that would otherwise go untapped. Through this strategy, MWTEC has dramatically expanded allied health enrollment across Michigan and recently extended its reach to employers in multiple states who cannot find programs willing to train their workforce using an apprenticeship model.

Texas is one state where state higher education regulations proscribed payment for clinical experience for registered nursing students. Here, the collaborative relationship that South Texas College has established with the state nursing board proved vital. The college coordinated with the nursing board in approaching the Texas Higher Education Coordinating Board about removing the prohibition. These discussions contributed to a shared understanding of how the apprenticeship model could move forward while maintaining compliance with nursing education and higher education requirements, and the prohibition on paid clinicals was repealed.

Where apprenticeship proponents have encountered resistance to compensating students for clinical experience, some have turned to offering students stipends, rather than wages, to ensure the program is financially viable for learners. In the emerging registered nursing apprenticeship model in Massachusetts, for example, apprentices will receive stipends for their clinical experiences and regular wages for the on-the-job learning hours of the apprenticeship, which will occur in parallel to their associate degree studies.⁵⁹ Apprentices in Heartland Community College’s registered nursing associate degree program in Illinois also receive a stipend for their clinical experience. Employers recognized that paying the stipend was critical to keeping students on track to completion.

While degree apprenticeship addresses some important factors that contribute to lower rates of degree completion and early-career attrition in health care occupations, by, for example, providing support from a trained mentor and paying wages for learning, degree apprenticeships in health care remain a challenging pathway. For that reason, the successful programs we encountered were careful in recruitment of apprentices who were already familiar with the health care environment and what it entails. 

One North Carolina community college, for example, uses a structured, multistep process to recruit and screen nursing apprentices from current students. Staff visit classrooms to introduce the apprenticeship concept, waiting until the second semester to avoid recruiting students who may drop out in the first semester. Interested students then complete a student interest form, meet with a career navigator for a deeper conversation, and build a résumé before becoming eligible for a hiring event where employer partners select from the pool. South Texas College uses a similar strategy.   

For degree apprenticeships, UW Health recruits exclusively from its own workforce, in part because multiyear programs require levels of commitment and familiarity that UW Health has learned are less likely to be found among external hires. External hires, however, are recruited for nondegree apprenticeships. In this way, a degree apprenticeship becomes a powerful upskilling strategy. Bridget Willey, executive director and chief operating officer of UW Health WorkForward, explains, “When you talk with these apprentices and you hear why they’ve applied for these programs, you learn they have wanted to step into these roles forever, and they just have not been able to have that opportunity.” 

One of the reasons that employers and several of the colleges in California’s Launch Apprenticeship Network started nursing apprenticeships was because they wanted to strengthen pathways to nursing for incumbent workers who were certified nursing assistants (CNAs) and licensed vocational nurses. That’s also a chief reason that Jay Prosser, executive director of the Massachusetts Nursing Council on Workforce Sustainability, advocates for nursing apprenticeship. He’s looking for funding to develop English literacy bridge programs to strengthen the pathway to nursing for CNAs whose first language is not English. “We offer the Massachusetts CNA examination in four languages—English, Spanish, Chinese, and Haitian Creole—to try to encourage non-native English speakers, [saying] ‘Hey, get into health care.’ The problem is that that’s all we do for them. We do not give them a pathway forward.” For people who are new to the field, Prosser recommends creating pre-apprenticeship programs that are lower cost and lower risk for employers and offer an orientation to careers in health care.

Note: On August 17, 2026, the authors updated David Polk’s title.