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Nursing Apprenticeship Gives State Health Care Workers A Career Boost

A man in a white uniform, bends over a hospital bed and examines a mannequin's arm. A woman stands next to the bed with her back to the camera. Her white uniform has the letters "RCC" on it.
Students enrolled in the registered nurse apprenticeship program administer care in Riverside City College's simulation lab. The mannequin they work with reacts in real-time to their care with realistic life signs.
(Alborz Kamalizad
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A week after becoming a registered nurse, at age 54, Denise Myers already had her official nursing license number memorized.

"It's a huge deal, huge deal," Myers said of achieving her longtime dream. She didn't get her RN title through a typical 2- to 4-year nursing program, but rather through an apprenticeship that helps licensed vocational nurses (LVNs) working in rural state prisons rocket from some of the lowest-paying jobs to some of the highest.

Apprenticeship Helped This State Worker Finally Become A Nurse

The state government has embraced apprenticeship in recent years — particularly in health care and information technology — as a way to fill vacancies left by an aging workforce, professionalize their operations and provide advancement opportunities for incumbent workers. Apprenticeships allow workers to earn money while learning on the job and in the classroom.

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Myers has been working as an LVN for California Correctional Health Care Services for 13 years. She was recruited straight out of Riverside City College, where she initially hoped to enroll in the nursing program, but couldn't afford to keep trying after an initial rejection.

"I needed to really get out into the workforce and earn an income," said Myers, who, at the time, was recently divorced with three kids to care for.

Like many nursing programs in California, Riverside City College's program is very competitive, only accepting about one-fourth of its annual applicant pool. (California State University Long Beach accepted less than 7% for its Fall 2021 cohort).

The nursing logjam has only been exacerbated by the COVID-19 pandemic — despite high demand for nurses — as schools were forced to limit in-person classes and many hospitals cancelled clinical rotations for students.

Myers always hoped to go back to nursing school, but the nearest campus was two hours away from the small desert town she settled in for her job at the nearby prison. Plus, she couldn't afford to stop working and take on student loans.

"I all but gave up on that hope," she said.

Then, in late 2019, she and the other LVNs at her workplace were asked to submit a letter of interest to join an apprenticeship program that would allow them to keep their jobs and salaries, while spending half of their work hours studying to become a registered nurse.

The year-long program would put them up in a hotel while they did their clinical hours in a Riverside hospital — all for free.

She couldn't believe it when she got accepted.

"Everything fell into place, and it was a miracle, really," Myers said.

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Four women sit at a conference table, all wearing masks. Three of the women turn to look at the one at the end of the table as she speaks. A large TV in the background displays the word "SIMstation."
“Sometimes we have to also recognize that despite our best efforts, we also aren’t God and even when we’ve done everything we may not be able to save.” Instructor Dr. Amy Vermillion prepares RCC students for the emotional strain of nursing along with medical, technical, and procedural duties.
(Alborz Kamalizad

A Solution To Mandatory Overtime?

The LVN to RN apprenticeship program is a collaboration between Riverside City College, California Correctional Health Care Services and SEIU Local 1000, the union that represents state employees. The program came about, in part, as one way to remedy the prison health care system's long-time use of overtime, including mandatory overtime to fill shortages in its nursing staff.

The nursing logjam has only been exacerbated by the COVID-19 pandemic — despite high demand for nurses — as schools were forced to limit in-person classes and many hospitals cancelled clinical rotations for students. This happened at the same time that nurses were needed the most, as COVID-19 ripped through the prison system.

"There is a large body of licensed vocational nurses from which we [can] draw to upskill and help fill some of these many vacancies," said Ken Anyanwu, one of SEIU's apprenticeship success coordinators.

The program also helps incumbent state employees move into better-paying jobs — especially those, like Myers, who can't afford to take time off for training. Registered nurses get paid nearly twice as much as licensed vocational nurses.

"Apprenticeship is designed for those who may not have the education or experience, but [do have] the aptitude and interest."
— Ken Anyanwu, SEIU Local 1000

Plus, apprentices get support from Anyanwu and the other success coordinators, whose job is to act as a liaison between apprentices and their employers. They help apprentices overcome hurdles that, in other circumstances, can easily derail a student's studies, like a new baby or a sick parent.

"One comment that we hear frequently from those who are ultimately accepted into the program is that, 'I didn't think this sort of thing was possible for me,'" Anyanwu said. "'I didn't think that getting to go back to school was going to be an option for me.'"

'When You Think Of Apprenticeship, You Think Of The Labor Trades, Right?'

Barbara Barney-Knox, who oversees the approximately 7,000 nursing staff members who work for California Correctional Health Care Services, said when the union first came to her with the idea of an LVN to RN apprenticeship, she didn't get it.

"Initially, I was dead set against it," she said. "And that's because, like many people, when you think of apprenticeship, you think of the labor trades, right?" But once she understood how it worked "and that it didn't lessen the education for nursing," she saw the benefits.

These benefits, she said, include better attendance, and a more professional, up-to-date workforce.

"Historically, health care in a prison is about five to 10 years behind the community," Barney-Knox said. Because apprentices do their clinical rotations outside of the prison health care system, they can bring back what they learn to help improve care for incarcerated people.

"You have students who are getting cutting edge information in real time, and then being able to come back to the institution and put that into practice … and to inform their peers about a better way to do things," Barney-Knox said. "What we gain is a higher level of an employee."

Ultimately, she said, that means better health outcomes for patients.

A man in a white uniform, bends over a hospital bed and holds a stethoscope to the chest of a mannequin.
Students enrolled in Riverside City College’s registered nurse apprenticeship program administer care in a medical simulation based on a real-life emergency room case. The mannequin they work with reacts in real-time to their care with realistic life signs.
(Alborz Kamalizad

Expanding Apprenticeship For State Workers — And Future Workers?

Besides nursing, apprenticeships are now available for state workers in various IT fields, including help desk, mainframe computing, and most recently, cybersecurity. Applications for some of these programs are open to employees who may not have any formal background in IT, including, for example, entry-level office assistants.

"Apprenticeship is designed for those who may not have the education or experience, but [do have] the aptitude and interest," Anyanwu said. "Usually it's folks who [employers] don't even consider for these opportunities, because on paper, they don't meet the minimum qualifications."

Kelly Mackey, Regional Director of Strategic Partnerships for the Office of Apprenticeship and Workforce Innovation, said the state is now launching pre-apprenticeship programs to help potential apprentices learn so-called "soft skills," like communication and time management, and as a vetting opportunity for both employers and potential apprentices.

"If I'm an individual and I'm thinking maybe I want to get into cloud computing and there's a pre-apprenticeship program tied to the registered apprenticeship program, this gives me an opportunity to vet whether or not I have a particular acuity for this type of work," Mackey said.

Mackey said the goal is to eventually open up apprenticeship opportunities in state government to people who aren't already state employees, "to create a mechanism whereby somebody can apply to the state of California and instead of applying for a job where they need to meet the minimum qualifications, they would apply for an apprenticeship program … and then upon successful completion, secure permanent state civil service appointment."

Mackey said this could help scale some apprenticeship programs for state jobs that are currently fairly small.

Thus far, some 40 people have graduated from California's three nursing apprenticeships for correctional nurses — including Denise Myers. She started her new job as a registered nurse in October.

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