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Virginia nursing schools are working steadily to address the statewide nursing shortage by focusing on recruiting and skills development. One proposed method is the Earn While You Learn program, a clinical education model that allows nurses in training to gain first-hand clinical experience, build their critical thinking skills, and get paid as they finish their nursing program.

Following a successful pilot test with Marymount University and VHC Health, Earn While You Learn demonstrates the potential to transform Virginia’s nursing pipeline.

Read on to discover how the Earn While You Learn Program can benefit your healthcare facility, or contact VHHA to become an Earn While You Learn Partner.

What Is the Earn While You Learn Clinical Education Model?

The Earn While You Learn Clinical Education Model (EWL CEM) is an innovative clinical education model for registered nurses (RNs). The program produces practice-ready RNs while providing immediate workforce relief to healthcare organizations.

EWL CEM is based on an apprenticeship model that leverages existing (and new) academic and clinical partnerships. The program immerses nursing students in 12-hour clinical rotations, connecting them with experienced RN mentors. Students earn a stipend for their work, which goes toward educational costs.

The goals of EWL CEM are to:


• Better prepare nursing students to enter the Virginia workforce


• Make nursing education more accessible through paid incentives


• Address hospitals’ need for nursing aids


• Create hiring pipelines for hospitals


• Train RNs in Virginia, encouraging them to stay in Virginia


Phase I employs students through a clinical partner to build student confidence in a clinical setting and tackle hospital staffing needs. Phase II connects students with RN mentors who can contextualize the students’ learning objectives and provide one-on-one mentorship to consolidate learning.

EWL CEM was developed by Eileen L. Dohmann MBA, BSN, RN, and Patti Lisk DACCE, BSN, RN. They pilot-tested the program at Marymount University with Terri Gaffney, PhD, MPA, RN, CNE (Assistant Professor), and VHC Health with Lisa Steeves, MSN, BS, RN (System AVP of Staff Development). The Virginia Hospital & Healthcare Association has published its toolkit to expand the program across Virginia.

Building Clinical Judgment and Critical Thinking Skills in Nursing Students

EWL CEM directly addresses the gap in clinical experience for recent RN graduates. In a 2017 study by Kavanagh and Szweda, recent RN graduates and their nursing mentors noted that only 23% of newly graduated nurses demonstrated entry-level competencies and clinical practice readiness.

Graduates struggled with clinical reasoning, professional confidence, and critical thinking skills. As a result, they were less effective in clinical environments, feeling paralyzed while trying to identify next steps in care delivery.

Dohmann and Lisk’s study demonstrates that implementing an EWL CEM program can help nursing schools and hiring hospitals substantially increase nursing students’ clinical judgment and confidence before formally entering the workforce. RN mentors retain responsibility for patient care. This allows students to practice what they’ve learned on the job while positively impacting the patient.

Ann McGowan, PhD, RN, (Professor of Nursing, Germanna Community College) attests to the positive impact, noting:

“Since its inception, the Earn While You Learn Program has provided students with an opportunity to immerse themselves into the culture of healthcare while earning supplemental income. The value of collaborating with healthcare partners to provide students with individualized clinical experiences has many rewards. Students learn the value of time management, how to care for multiple complex patient assignments, teamwork, delegation, and prioritization of care; all of which can be a challenging transition for a newly graduated nurse.

Additionally, the designated preceptorships provide the students with an opportunity to learn the organizational policies and culture, from experienced personnel, thus making their transition from graduate nurse to RN less difficult. Finally, the bonus of providing students with supplemental income while participating in the program supports the student’s need to earn an income while decreasing barriers to educational success.”

Benefits of Earn While You Learn Program in Healthcare

EWL CEM is a cost-effective and efficient program that benefits nursing schools, students, and healthcare facilities. Lisk describes the program as a “win-win” for all parties amid the critical workforce shortage. She comments:

“Amid critical workforce shortages, facilities “win” as they receive immediate relief from nursing workforce needs through the employment of nursing students.

Nursing students “win” as they participate in immersive clinical learning experiences that enhance their competence, confidence, and comfort, making them more practice-ready at graduation.

They receive financial compensation for both employment and their involvement in the EWL program. This much-needed compensation enables students to meet basic needs, to enroll in, and complete their nursing education.”

Nursing Student Benefits


EWL programs seek to educate nursing students in Virginia and encourage them to stay in Virginia. The most notable benefits include:


• Nursing students can earn a stipend while gaining first-hand experience under a seasoned mentor.


• Students can directly apply their training in a practical setting to reinforce their studies.


• Nursing graduates are more practice-ready, demonstrating enhanced confidence, clinical judgment, and skill acquisition.


• Participants have a higher NCLEX (RN licensure examination) pass rate, with many passing on their first try.


In the pilot program, Gaffney found that EWL participants saw notable clinical confidence and performance, which extended beyond the program’s first year. Gaffney notes:

“The Earn While You Learn participants report a higher confidence level at the time of hire than indicated in a larger national study. Further, their self-reported confidence level continues to increase through the first year of practice.

EWL participants who complete the program are familiar with the practice environment in which they are employed, having (1) received immersive and guided clinical experience and (2) experienced a working role (part-time) in the same setting.”

Healthcare Facility Benefits


EWL CEM equally benefits healthcare facilities by addressing serious healthcare staff shortages.


• Employing nursing students helps address the critically low healthcare and nursing workforce shortages.


• Healthcare facilities employing nursing students gain immediate staffing relief.


• Patients receive greater care with nursing mentors and nursing aids.


• Newly graduated RNs acclimate faster to clinical environments and pick up skills quickly, reducing orientation time and costs.


• Healthcare facilities gain a nursing pipeline from schools, with participating clinical partners demonstrating a 50% increase in RN retention upon graduation.


Dohmann and Lisk’s survey found that about 93% of graduating RNs accepted employment with their clinical partners, indicating a positive trend in retention. Participating RN mentors were more engaged when investing in EWL students. Dohmann shares:

“Nurses participating in EWL, as mentors, were better prepared, eager, and engaged in educating the student nurses. Students verbalized learning more from these RN mentors than from previous mentors.

Nurses who work with EWL students describe them as “the best students we have ever worked with.” Patients receiving care from EWL students described them as “skilled, caring, and the best I’ve had.”

Earn While You Learn Student Testimonials

Students who completed the EWL program saw substantial benefits during and after the program. Read this first-hand account from a program graduate:

“During my time in nursing school, I learned about becoming a nursing assistant as part of the Earn While You Learn Program for MWH, a local hospital in the area. The position seemed like a pretty good prospect as it promised a job that was both flexible with my school hours and designed with it in mind.

Working as a nursing assistant through this program was an amazing opportunity for me as it enabled me to gain real-world experience that I could directly relate to my coursework in nursing school. Consequently, I could also apply what I was learning in class directly to my encounters with patients as a nursing assistant.

The Earn While You Learn program also provided me with a head start in my career. This head start helped me form relationships with current healthcare workers, put my name out there, and gain practical skills that directly flowed into my job as a new grad RN.

Once I started working as a new grad nurse, I noticed I had an advantage over my peers who had not worked in healthcare until becoming nurses.

My fellow staff members would comment on how fast I grew my knowledge of the facilities, equipment, and procedures in place. This head start can be directly attributed to the experiences that I was able to have as a nursing assistant.

There were some difficulties, as there will always be in healthcare. But if I could choose whether or not to participate in the Earn While You Learn Nursing Assistant Program with MWH, I would definitely do it again and encourage any current nursing student to consider taking the time to make the most of an opportunity like it.”

Developing an EWL program that accounts for the nursing student’s curriculum and the healthcare facility’s staffing needs can create a mutually beneficial relationship. Newly graduated RNs have demonstrated superior clinical skills and acclimation to work environments.

Addressing Healthcare Workforce Shortages With Earn While You Learn

EWL CEM presents clear advantages to healthcare facilities and nursing students alike. Initial pilot tests at Marymount University with VHC Health showed promising results for nursing programs. Steeves argues:

“Funding for Earn While You Learn is essential to create further innovation in healthcare education. The pilot project with VHC Health and Marymount University has created a greater awareness of the learning objectives each student group is expected to achieve, allowing for enhanced learning for all students.

It has also allowed us to find innovative ways to expand student clinical placements. These models are essential to meet the ever-growing demands of healthcare shortage.”

EWL CEM is flexible and applicable to all clinical and academic institutions across the Commonwealth of Virginia. To become an EWL CEM partner, visit VHHA’s EWL CEM toolkit for more information.