How a South Texas community college embraced apprenticeships to ease a growing nursing shortage

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McALLEN — Every Wednesday, the students from South Texas College clock into their shift at the largest hospital in town. Donning light blue scrubs and compression socks, they practice checking vitals on a mannequin.

The worried family members, the medical codes on the machines — it all feels new to many of the students. But when they’re ready to take the vitals of real patients, veteran nurses will be in the room, guiding them.

The 18 students are getting hands-on training at one of the first nursing apprenticeship programs in the country. Many of them will be the first in their family to graduate from college.

Apprenticeships make it possible for Texas nursing students to make money right away instead of waiting years until they complete a degree. That could be appealing to adults who are impatient to start earning and wary of taking on loan debt.

In their two years at South Texas College, apprentices will have to complete 2,000 clinical hours on top of their classroom work. They’ll squeeze in time during Christmas and Thanksgiving. The hospital, DHR Health, pays apprentices $14 an hour for their clinicals.

Traditional nursing students spend a fraction of their time in a hospital and are not paid for their clinical hours. Both tracks take about 2 years to complete.

The Rio Grande Valley — where these students live, work and learn — is projected to have the largest nursing shortage in the state, with more than 6,000 open positions by 2032. And already, patients in the area see long wait times at local hospitals. The need to get more nurses trained, and soon, was the impetus for South Texas College to start up the apprenticeship program.

“Our students, many of them, have to prioritize work. And so work oftentimes interferes with their ability to have time to study,” Margo Vargas-Ayala, the dean of nursing at the college, said. “The opportunity to be able to earn while they learn … they won't have to come to their classes, do clinical and then work.”

Adrian Villarreal, 23, is part of the college’s first group of nursing apprentices. He jumped at the chance to join the program.

“To be more in the hospital, but not just be there learning, but you also are getting paid,” Villarreal said. “I'm going to get some money, not a lot, but enough to where it'll pay for my gas, my groceries.”

Villarreal started his clinicals in January in the hospital’s behavioral health unit. When he and the other apprentices in his class graduate with an associate's degree in nursing next year, they’ll be able to work as a registered nurse.

An apprenticeship boom

Apprenticeships have long been key to training workers for many blue collar jobs. A 2020 Texas Workforce Commission report said construction and manufacturing together make up more than 75% of registered apprenticeships in the state.

That’s in large part because of state regulations and the influence of unions. In fields like plumbing and electrical work, state agencies require workers to have on-the-job experience before they can obtain a license. And unions, which emerged out of the industrial sector, routinely sponsor apprenticeships for their workers.

Political momentum is building nationally around this type of work-based learning.

“There's an unusual degree of just full-throated support by policymakers, government officials at the local, state and federal level,” said Joe Ross, the president of Reach University, a California-based institution that offers apprenticeships across the country and helps other schools start up their own. “Partisans across the spectrum want there to be more apprenticeships.”

President Trump encouraged apprenticeships in his first term and will likely continue that effort in his second term. Gov. Greg Abbott has also named career training as an emergency item this legislative session, but it's not clear what that will look like.

Other states have passed legislation subsidizing apprenticeship wages and interest has been growing in Texas: Since 2014, the number of apprentices in Texas has nearly tripled. Workforce leaders are seeing the earn-while-you-learn model as a way to solve critical Texas-sized shortages in nursing and education. About 28% of education and health services jobs can be learned through an apprenticeship, an analysis from the Department of Labor found.

That’s because students looking to enter these fields are already getting exposure to the workplace, Ross said.

“Schools are used to having people come in for clinical experiences. That's an asset. We've got that in place,” Ross said. “What's different with apprenticeships is the assumption that that clinical experience is part of a paid job.”

“We want this to be the blueprint”

It took pushing through a lot of regulatory red tape to get the apprenticeship underway at South Texas College.

“There was no blueprint,” said Jayson Valerio, the school’s regional health care liaison. “We want this to be the blueprint, not just for Texas, but for the nation.”

The school had to find a hospital willing to take a risk of paying students who would be learning on the job. They had to get the Texas Board of Nursing to agree to nursing students getting paid for clinicals — going against the grain of typical nursing education.

And getting the U.S. Department of Labor to certify the program — a key signal to employers that students went through a rigorous curriculum — was a two-year process, Valerio said.

“We knew we had to be more innovative, more disruptive,” said Solis, the school’s president. “The long line of paperwork was insurmountable. That’s why very few people do it.”

Cracks in the Valley’s health care infrastructure had been appearing even before the Covid-19 pandemic. High rates of diabetes and kidney disease meant more patients needed help. Local hospitals added beds to their facilities, but they needed more nurses to staff them, Valerio said.

Then, in the bleak days of 2020, nurses at the local hospitals quit in droves as COVID-19 hammered the area. South Texas College lost 12 nursing faculty members in 2021, too, putting a limit on the number of students the school could admit and get ready for the workforce.

“Seasoned RNs became traveling nurses” during the pandemic, Valerio said. “We could not compete with the pay.”

Mary Von Ohlen is one of the general nurse educators at DHR Health who trains the apprentices in vital signs, IVs and CPR. She said the idea is to get apprentices accustomed to the culture of the hospital so they’ll be inclined to stay for a full time job after they graduate.

“You figure if they get to all of this, they should be able to function as a qualified nurse,” said Von Ohlen, who sees the program as a worthy investment since it costs more than $50,000 to onboard a new nurse. “And if you retain them for three years, they will stick around.”

The Texas Tribune partners with Open Campus on higher education coverage.

Disclosure: DHR Health has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.