The country’s third-largest nonprofit health system, Charlotte, N.C.-based Advocate Health, is rebuilding nursing degree programs to close a gap chief nursing officers know all too well: new graduates who tested well in school, but stall at the bedside.
Advocate wants its newest nurses working a hospital unit before they graduate, not after. To do just that, the system is launching a program in collaboration with Chamberlain University, the nation’s largest nursing school, and its parent company, Covista.
The centerpiece is a specialized Acute and Progressive Care bachelor of science in nursing pathway that puts students in Advocate’s own hospitals throughout their education. It also embeds them on the exact unit where they will work for the final 12 weeks of school. Recruiting begins this month, and the first cohort starts in September.
The problem Advocate is trying to solve is one that has worsened over time, according to Betty Jo Rocchio, DNP, RN, executive vice president and chief nurse executive.
“Nurses were coming out not ready to practice nursing,” Dr. Rocchio told Becker’s. “They might have some things up here to pass a test, [but] they had some deficits — definitely some deficits in how they thought through the nursing process. They were struggling.”
Acuity and new technology only raise the stakes, she said, “My worry was they’re going to be less ready than they’ve ever been.”
That readiness gap is why systems have leaned on nurse residencies, which are typically 12 weeks of on-unit learning after a new nurse passes the National Council Licensure Examination.
To Dr. Rocchio, that timing never made sense. “That seems crazy. We just paid how much money to go to nursing school,” she said. “So I said, ‘How can we back that up and make people ready for practice?'”
Moving the residency inside school
Under the new model designed by Advocate and Chamberlain, the last semester of the BSN doubles as orientation. Students spend their senior practicum on a “home” unit inside Advocate, working alongside the nurses, patient loads and technology they will inherit after licensure.
“They are literally going to be practicing beside a nurse for 12 weeks,” Dr. Rocchio said. “I think [that is] even better than the way our residencies scale today. There’s a thing about still being a student that gives you permission to learn and ask questions. When you’re out [of school], there’s that pressure that you should already know this.”
The new program “gives them permission to ask questions, be inquisitive, and learn at their own pace, even in that last 12 weeks,” she said. “They’re doing it within the constraints of what they’re going to have to do when they get out. That’s really powerful.”
Stephanie Zidek, PhD, RN, vice president of nursing education and professional development at Advocate, said the unit placement will be deliberate. Nursing students will be allocated to units where they already have exposure and interest.
Because every clinical rotation in the program happens within Advocate, Dr. Zidek said students are “born and bred” in the system’s culture before day one.
Dr. Rocchio expects that to show up in one of the numbers the system cares about most: first-year turnover of nursing staff. The national turnover rate is 17%: a statistic that has barely budged despite years of efforts to retain nurses.
“Done correctly, this should impact first-year turnover,” she said. “When you ask nurses why they stay, [they say] they love the people they work with and they love the patients. They’re going to know both before they even get out of school.”
Advocate is starting from a strong baseline. Its retention rates run more than 20% above the national average, according to the system. Within its New Grad Nurse Residency program, first-year retention holds steady above 90%, compared with 72% to 77% nationally, and second-year retention exceeds 85%, versus 57% to 60% nationally, Advocate said.
Widening the front door
The clinical redesign sits inside a broader strategy Advocate calls People Forward, Practice Ready. The “people forward” half is about who gets in.
“We want everybody [who] wants to be a nurse and has a passion for nursing, we want to give them a pathway,” Dr. Rocchio said, pointing to a surge of second-career nurses and students who enter as certified nursing assistants or licensed practical nurses. “You don’t want the barrier to entry to be that they can’t figure out how to live their life and then get into nursing. That’s crazy.”
Chamberlain University serves roughly 40,000 students. Advocate chose the university in part because it already specializes in nontraditional and working-adult learners and because it operates in every one of Advocate’s markets. The system runs 69 hospitals and more than 1,000 care locations across eight states.
“If you talk about the scale of Advocate, you need a partnership with a school that has that kind of scale,” Dr. Rocchio said.
The two organizations already share a pipeline: of the roughly 2,500 nurses who enter Advocate’s New Grad Nurse Residency each year, about 10% are Chamberlain graduates.
Dr. Zidek said the system is committed to staying with nurses well past hire. “We really see our one Advocate nurse as a life cycle, and it starts as a student,” she said.
Financial support and mapped advancement, from LPN to RN to leadership, are built into the model. Advocate’s Education Assistance benefit, which includes loan support, is available to employees on their first day of employment, with no waiting period.
That structure sets Advocate apart from other systems racing to build their own pipelines. Morgantown, W.Va.-based WVU Medicine gives aspiring nurses up to $25,000 in cash, mentorship and clinical rounding sites — but in exchange for a three-year work agreement. St. Louis-based SSM Health, which also partners with Chamberlain, does not have a work agreement, yet still ties full loan repayment to four years of employment after graduation. Advocate attaches no such condition: its benefit starts on an employee’s first day, with no minimum service requirement.
The BSN pathway is also compressed. Working with Chamberlain, Advocate cut the traditional four-year degree to three years of continuous fall, spring and summer terms.
Future associate degree and LPN tracks are planned at under two years and about one year, respectively. These are designed, Dr. Zidek said, for the flexibility adult learners need.
A med-surg bet, and a national one
The first pathway targets acute and progressive care, which is essentially medical-surgical nursing, an area that Dr. Rocchio and Dr. Zidek said is chronically understaffed and rarely a new graduate’s first choice.
“If you can master med-surg, you can master anywhere,” Dr. Zidek said. “Anything you see in the ICU and ED is going to have those med-surg acute care foundations.”
The curriculum, built with input from the American Association of Critical-Care Nurses, also bakes in the technology reshaping the bedside — including virtual nursing and ambient AI documentation — so students learn the nuances of these tools long before they are expected to master them.
Advocate is starting the program in Wisconsin and Georgia, where its rural hospitals and acute care vacancies are concentrated, with a target of roughly 100 students in the first academic year and growth from there. The system already touches close to 30,000 nursing students annually, Dr. Zidek said.
Both leaders framed the collaboration as a template other systems could copy. Success will be tracked through NCLEX pass rates, first- and second-year retention, student-to-employee conversion, and the Casey-Fink transition-to-practice survey.
Existing Advocate nurses will help teach through the system’s clinical instructor partner model, giving current staff a new way to precept and mentor.
Neither leader is promising a quick return. Dr. Zidek called it “a far strategy,” as the first cohort will not graduate until 2029.
Dr. Rocchio said the hardest and most important ingredient is the academic partner itself.
“You have to have the right partner. The right academic partner is key … you have to be able to build flexibility into their academic program. That sounds easy. It is not easy,” she said. “We’re starting with Chamberlain, but if we have proof of concept, we’re happy to partner with other nursing schools, too.”
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