Learning on the job is transforming nursing education

^{Anoka-Ramsey Community College (ARCC) students share their experiences being nurse apprentices with the Department of Employment and Economic Development (DEED), which is funding the pilot. From left, front row, Paige Pool, Asia Greer, Kylee Sisell and Sydney Wahnschaffe. From left, back row, Robert Willis (DEED), Jennifer Eccles (CNEE), Jeff Pearson (ARCC), Peterson Austin, Emma Heckman, Desiree Jennings and Kimberly Johnson (PNAM).}

As a nursing student, Karen Dear remembers the nerves she felt the first time she provided care for a patient with a tracheostomy.

“My preceptor walked me through it and I was able to do all the noon medications and all the cares,” says Dear, who is a student at Minnesota North College and a nurse apprentice at the Essentia Health hospital in Virginia, Minnesota. “She definitely made me feel a lot more confident.”

Dear is one of the first students in the Pre-Licensure Nursing Apprenticeship Model pilot program. The Center for Nursing Equity and Excellence, which was launched through a partnership between the University of Minnesota and Minnesota State, was awarded a grant from the Department of Employment and Economic Development to roll out the pilot program in the fall of 2024.

Senior nursing students from the University of Minnesota, Anoka-Ramsey Community College and Minnesota North College apply to become nurse apprentices at Allina Health or Essentia Health. The students are employees of the health system, earning a wage and receiving full employee benefits while they learn. They serve two shifts weekly as nurse apprentices, which often count toward their clinical education requirements, and receive paid release time to attend school.

“Students are reporting extraordinarily strong clinical education experiences with the Pre-Licensure Nursing Apprenticeship Model, including exceptional skills education, critical thinking and clinical reasoning development, and the ability to work as an embedded team member on the unit,” says Julie Anderson, PhD, RN, project director. 

For Dear, being a nurse apprentice makes being a student financially feasible. “It helped a lot with daycare, the financial burden of it,” says Dear, who is a mom of two and lives just down the road from the hospital in Virginia.

She also appreciates that she has the ability to apply for a position at Essentia Health if she successfully completes the apprenticeship and passes the NCLEX-RN exam. “It’s a great program. You get so much more hands-on experience,” she says.

A key feature of the Pre-Licensure Nursing Apprenticeship Model is the more immersive experience it provides. Apprentices feel that they get more varied and extensive hands-on opportunities with patients.

“The Pre-Licensure Nursing Apprenticeship Model empowers aspiring nurses by providing hands-on experience, fostering confidence, and bridging the gap between theoretical knowledge and practical application, ultimately enhancing patient care and health care outcomes,” says Carolyn Hughes, DNP, RN, NE-BC, NPD-BC, the system senior nursing director at Essentia Health. “It also plays a crucial role in strengthening rural health care by training local talent who are more likely to remain and serve in their communities.”

Lynette How, MSN, PHN, RN, director of Practical and Associate Degree Nursing Programs at Minnesota North College, also sees the program as a vital component in strengthening rural health care.

“The appeal and hope of a program like this is strengthening the nursing workforce in our region,” says How. “We’re excited to try new things to see if it will be a better fit for some students because it’s not one-size-fits-all anymore.”

Bridging the long-standing academic-practice gap 

The pilot also launched in the metro area, with Allina Health, the University of Minnesota and Anoka-Ramsey Community College.

April Prunty, PhD, RN, NPD-BC, Allina Health system director of Nursing Professional Development, sees the nurse apprenticeship model as an innovative approach to recruitment and a way to bridge the long-standing academic-practice gap in nursing. Traditional models of integrating students into the workforce often have low student-to-hire conversion rates. This program offers an alternative, providing a more immersive entry into the profession.

What sets this program apart, Prunty says, is its ability to embed students in the clinical environment in a more longitudinal and integrated way, offering a deeper understanding of workplace culture and expectations.

She likened the experience to buying a home — touring multiple options before choosing one, but not fully appreciating its nuances until actually living in it. Traditional clinical models often provide limited exposure to a variety of settings, whereas this apprenticeship allows students to become truly immersed. 

“I can’t emphasize enough the importance of thinking differently about how we transition folks from the student environment into the professional environment,” says Prunty. “This is the way of the future. I’m excited to see what’s next.”

A Lee Xiong, a nurse apprentice at United Hospital in St. Paul and a senior in the Bachelor of Science in Nursing program at the University of Minnesota, sees the apprenticeship program as a valuable opportunity to gain hands-on experience in an area of nursing that aligns with his career aspirations.

One of the most impactful aspects of the apprenticeship for Xiong is the mentorship and support he received from his preceptor. It not only strengthened his clinical skills but also helped him build confidence in his abilities. “I really like the aspect that everyone is so helpful and resourceful and being a mentor to one another,” he says. “It shows that they care about you as a person.”

The immersive nature of the program has also contributed to his overall growth as a nursing student. The consistent exposure to real-world clinical settings helped him develop critical thinking and decision-making skills, which are essential for nursing practice. “The program really developed my nursing frontal cortex,” he says. “I’m able to be confident now, which allows me to develop more of my nurse intuition.”