Nursing shortages make headlines across Virginia and the nation. Virginia Western Community College has a new tool to address those shortages and make nursing school more accessible — the Earn to Learn Nursing Education Acceleration Program.
Virginia Western’s Associate of Applied Science Nursing Program, a pre-licensure RN program, and Carilion Clinic have partnered to implement Earn to Learn in the Roanoke Valley, aiming to transform nurse clinical education and ensure nurses are practice-ready when they graduate.
“The way I describe it is I feel like I’m being trained as a nurse instead of as a student,” said Danielle Ledbetter, one of 22 Virginia Western nursing students who took part in the 2025-26 Earn to Learn cohort.
Five students participated in a pilot program last year after the Virginia Department of Health (VDH) awarded more than $4 million statewide in 2024 to a range of institutions. Those five all became Carilion employees.
The program reaches third-semester nursing students to enhance their clinical experiences, explained Dr. Kelley Pennell, Professor and Coordinator/Administrative Officer of Nursing for Virginia Western’s AAS (prelicensure-RN) Nursing Program.
“Working with these students and seeing the progression from entry-level student to becoming a practice-ready nurse is extremely rewarding,” Pennell said. “Knowing this program will contribute to better-prepared nurses that can provide evidence-based care to promote patient safety and positive patient outcomes is a game changer for associate degree nursing programs.”
One-on-one benefits
ETL students are paired with a nurse mentor for one-on-one preceptorship instead of taking part in the customary groups of eight to 10 students in clinical rotations.
“Having that one-on-one time with a mentor versus having to vie for attention in a group of clinical students for one instructor — I’ve learned a lot more than I think I would have in a clinical group,” said nursing student Cody Shelton.
Meanwhile, nurse mentors note that Earn to Learn students are demonstrating increased knowledge and critical thinking skills, said Brittany Ashwell, Clinical Coordinator at Carilion.
Earn to Learn students complete 104 clinical hours in third semester. They are paid two ways: through an academic role and work role. For the academic role, most perform one 12-hour shift per week.
“You walk a day in a nurse’s shoes because you’re one-on-one with a nurse,” said nursing student Teresa Jamison. “I think it really has taught me time management, and what it’s going to look like to actually work a shift on the floor. When she’s charting, I’m sitting down and charting with her. And when she’s assessing, I know I need to be doing my assessments at certain times.”
Students also fulfill a work role as a Nurse Extern on the same unit with the same mentor. Nurse Externs are nursing students who work in a role similar to a patient care technician but with additional training to perform advanced patient care skills while completing their nursing education. Four hours a week are required, but students may schedule up to 24 hours per week in this role.
This facet of the program boosts patient care and provides more paid clinical experiences, but students also see more than financial benefits.
“In order to be a good nurse, you need to understand what everybody’s roles are in the collaborative care team,” said nursing student Kim Young. “So I really appreciated being trained as a patient care tech, and understanding that once we are nurses, we cannot function without them, because there are so many things that need to happen, and we cannot be in multiple places at once. We also need to be willing to give them respect and be willing to help them. So being cross-trained is very valuable.”
When the semester’s clinical hours are complete, ETL students receive a $2,288 stipend for the academic role, which is enough to pay for tuition the following semester. Meanwhile, students are paid for their work role, which has the added benefit of flexibility in scheduling.
“I had a job all last school year and over the summer, and I didn’t quit, but I stepped out of that role and have only been working my Earn to Learn position,” Jamison said. “That in itself is a huge blessing, because it’s just made my life so much less stressful not having to coordinate another job on top of school and this position.”
‘A powerful bridge’
Carilion sees great benefit in reducing stress for potential employees, said Kristin Crouse, Transition to Practice Director at Carilion Clinic.
“Earn to Learn creates a powerful bridge between education and practice, helping us prepare confident, practice-ready students familiar with our tools, policies, and procedures here at Carilion,” said Crouse. “Thus the program is enhancing a smooth transition to Nurse Resident with reduced stress and ready to deliver exceptional care from day one.”
Earn to Learn mentorships also help nursing students gain a different style of experience in some of the foundational places in nursing. The five students who participated in spring 2025 all were retained at Carilion in hard-to-fill areas, Ashwell said.
Students gain insights from their nurse mentors about a wide range of medical-surgical areas that take in a combination of patients, helping them visualize opportunities these areas offer. This also gives the students a broader range of experiences they can speak to when interviewing for jobs, Ashwell and Crouse said.
Nurse mentors see the benefits. “Taking a full patient load, charting multiple patients, and performing skills, medications, and tasks rapidly improves their confidence, time management, and abilities,” said Micah Borgia, a Progressive Care Unit nurse at Carilion Roanoke Memorial Hospital who has mentored several students in the Earn to Learn Program. “It is also extremely rewarding for the nursing mentor as it provides them opportunities to instill current best practice standards, give back to the nursing profession, and ensure the next generation of nurses are prepared for an ever-changing medical landscape.”
This year’s cohort were able to choose whether to continue with Earn to Learn this spring in their fourth semester before graduation. Whereas third semester focuses on medical-surgical clinical experiences, fourth semester includes required hours in specialties including pediatrics, psychiatric, labor and delivery, and community-based care.
Students see this as a strong selling point. “I was worried that continuing in Earn to Learn would mean that I wouldn’t get to get the preceptor placement that I wanted, but this semester they’ve opened it up to a ton of different specialty fields, so we’re going to get a more diverse clinical experience and still have the one on one, which is really vital,” Jamison said.
A cycle of mentorship
The mentoring relationship remains the program’s core. “I think the money’s just a plus at this point. It’s not something to do it for anymore. And my nurse, it’s so wonderful, because it’s not a nurse you’re seeing one time,” said Ledbetter. “When I come back, she’ll be like, ‘Oh, by the way, when you turned in this assessment, you just forgot this small thing. So we just want to make sure for next time that we fix it.’ So it’s good to get feedback continuously.”
Borgia said he would like every nursing student to have a one-to-one nurse mentor in their final year. “This would help reduce the cost of on-boarding future nurses by shortening new graduate nurse orientation for new hires, immediately prepare nurse graduates for the real-world nursing environment, and lead to longer nurse retention.”
The mentor role is vital. “Mentors must meet certain eligibility requirements, and we work hard to match students with their prospective units based on strength of student and the needs we have identified the student has to become practice ready upon graduation,” said Pennell.
“To see some our Virginia Western Nursing graduates from the past apply to mentor current Earn to Learn Students highlights a rewarding opportunity to give back to the nursing community. We currently have two RN mentors that graduated from the Virginia Western Nursing Program in recent years,” said Pennell.
This year’s cohort praised the selection process. “I feel like my mentor is a match made in heaven for me,” Shelton said about his mentor in the fall.
Young, who previously worked in clinical research for 13 years, said her mentor graduated from Virginia Western’s Nursing Program in 2020. “When she started nursing school, she was my age, so later-in-life change of career,” Young said. “We have a lot in common, and I feel like that’s given us a better rapport as well.”
These Virginia Western students’ experiences mirror goals that the state health department outlined at the program’s outset: “The Earn to Learn model is based on a growing body of evidence that suggests better workforce program outcomes come from programs that incorporate hands-on, work-based trainings alongside academic engagement and include access to one-on-one career navigation assistance and other wraparound services.”
This spring, Virginia Western was awarded Virginia Department of Health funding for the 2026-27 Earn to Learn cohort. This continuation funding, which runs through June 2027, will allow additional students to participate and add HCA Healthcare as a clinical partner.
“When we invest in nursing students, we invest in the future of healthcare,” said Pennell. “Their curiosity, resilience and commitment to service are already shaping stronger, safer patient outcomes. The Earn to Learn program is a perfect example of investing in our nursing students.”
