By Jane Ehrhardt
In the past ten years, renewal of licensure data in Alabama found that 5,000 to 7,000 nurses lapse annually at the first of the year. By April, many would normally have reinstated their licenses. But according to the latest Alabama Nursing Workforce Study released this year by the Alabama Board of Nursing (ABN), licensure reinstatements decreased to around 1,800 over those years.
Several reasons arise. For example, compact nurses, who hold licensure in other states, now no longer need an Alabama license to practice here. ABN has no way to pinpoint the cause of the drop, but the statewide study of 84,779 licensed nurses did reveal that 38,727 experienced nurses intend to leave nursing in the next five years.
“We know nursing is a difficult job. Nurses can physically burn out,” says Honor Ingels with the ABN. “It’s also a supply chain issue. We see thousands of qualified potential nursing students denied entry to our programs because there are not enough slots available. The problem lies with a lack of teachers.”
However, the ABN has succeeded in convincing the state legislature to pass, though they have not yet funded, a loan repayment program for nurses pursuing graduate degrees to become instructors. The nurses will receive a $15,000 loan that will be forgiven in exchange for working in a public college or university for two years.
Though historically around 5,000 new graduates will apply for licensure each year, the ABN estimates that RN and LPN vacancies in Alabama could potentially grow to 13,000 or 14,000 in the next four years. With the average age of nurses dropping from 54 to 46, a large exodus of experienced nurses have already left the workforce in the last few years.
With the nursing workforce decline spread nationwide, Alabama has turned to cultivating potential graduates through innovative programs. In September, the state legislature approved a $500,000 contract for a feasibility study to be completed by the end of January on the construction of a statewide health-science high school. This will be the first STEM school in Alabama targeted at healthcare.
Whitfield Regional Hospital, in Demopolis—a rural township of 7,000–has already been working with local high schools and are the proponents behind the project. “It’s amazing to watch what happens to a young person when they get to observe an orthopedic surgery or see a state-of-the-art treatment center treat a level three or four wound,” says Douglas Brewer, the CEO of Whitfield Regional.
Brewer envisions students in their 11th and 12th grades being dual enrolled in nursing programs as well, graduating high school pretty much with an RN and able to go right to work. “It’s going to give young people, who believe that healthcare is the place for them, a place to go to accelerate their training time,” he says.
In Centreville, another rural hospital reached out to their nearby community college to make a change. Two years ago, Bibb Medical Center (BMC) approached Shelton Community College asking how they could help remove barriers for starting a practical nursing program together.
The BMC program offered up the classroom space, lab facilities, and staff to build a three-semester program, that included classes in math, biology, and English. They also became an accredited campus of the college. “We asked what they needed and gave it to them,” says Joseph M. Marchant, CEO of BMC.
Some students even received scholarships. Books, tuition, school fees, and access to practice testing networks, were all provided. “These are people who are working full or part time at a regular job while going to class,” Marchant says. The LPN certification had seemed out of reach, but would mean a significant economic rise from working at the local gym or Walmart.
“Life can get in the way,” Marchant says. “Our goal is to help them. And for them to want to be here for the long haul.” Each graduate of the program receives a job offer from BMC if they commit to working there for two years.
In August, the first cohort of nine practical nursing students graduated. This fall, 14 more students enrolled. This class also has the opportunity to participate in the state’s new apprenticeship program, which means the they receive a salary for the work they do as they learn at the hospital while still being in school.
The new nursing apprenticeship option came about when the state passed new rules in March 2022 to allow Alabama healthcare employers to enter into apprenticeship agreements with nursing programs. Administered through the Alabama Office of Apprenticeship, students accepted as nurse apprentices work alongside an experienced nurse, all the while earning a salary as an employee of the healthcare facility.
Statewide in the past year, an estimated 400 nursing apprentices from 17 colleges have served at more than 60 healthcare facilities. Coastal Alabama and Gadsden State community colleges were the first to offer apprenticeships. During that initial phase, 30 apprentices filled nursing vacancies in four facilities.
Alabama is the first state in the country to implement an apprenticeship program at this level. “This has broken through the wall,” Honor Ingels says. “Alabama is now the national model.”
Because of their clinical training and one-on-one mentorships, newly graduated apprentices are ready to stand on their own within a few days versus the usual six weeks. “That’s a tremendous savings for the facilities and benefit to the patients,” Ingels says. “Imagine that spread over our state with 400 nurses. That’s an amazing achievement.”