Ashlee Dunn knew from an early age she wanted to be a nurse, and thought she wanted to work in pediatrics. But once she tried the specialty, she discovered it was not the path for her.
“I figured out actually orthopedics was what I call ‘my true love of nursing’,” Dunn said. "But it was partly because of the nurse apprenticeship program that I got to participate in as a student nurse that helped me figure out where I wanted to be, because, as a first-generation nurse, I didn't really have anybody to lean on for that experience.”
"Once they graduate, truly we believe they're going to be more prepared to make that transition from student nurse to graduate nurse."Ashlee Dunn, Director of Clinical Education at Poplar Bluff Regional Medical Center
Now, she leads a nurse extern program at Poplar Bluff Regional Medical Center in southeast Missouri — a type of apprenticeship that helps young student nurses discover their own paths while staying close to home.
Dunn is from Patton, an unincorporated area in rural Bollinger County, and graduated in a class of 36 people. She said she had to travel to the nearest large city, Cape Girardeau, to get her Bachelor of Science in Nursing.
Which is why she’s excited to now be able to run a program that offers nursing education paired with hands-on experience closer to home for those who live in and around the Bootheel.
“Students already have such a commitment to their nursing program, to travel a distance to go to an apprenticeship program — is it's a weight, it really is,” Dunn said. “Nursing school is... probably one of the hardest things I've done in my life. It takes true dedication, so we appreciate that we can provide that convenience to those nursing students that are here local and in the community.”
The Poplar Bluff externship is a partnership between Poplar Bluff Regional Medical Center, Three Rivers Community College, the Poplar Bluff Technical Career Center [PBTCC], and Heartland Forward — a regional think tank focused on economic growth and opportunity in the middle of the country.
Angie Cooper, the President of Heartland Forward, said it's important to invest in nursing pathways because economic growth can’t take place in a community if there isn’t stable access to health care.
“What we see all across the heartland is if you have access to quality health care and education, you are really going to have the kind of tip of the sphere of growing your community,” Cooper said. “And if the access is there and the delivery is there, people then are more likely to come to the community. That's a quality of life issue that we see when we're talking to economic development directors that are trying to recruit new talent or recruit new businesses.”
'We think if you're going to accelerate economic growth, you have to help healthy communities, but you have to have the workforce to have healthy communities."Angie Cooper, President of Heartland Forward
She says this is why their partnerships begin with high schoolers at PBTCC. She said the students can work toward their Certified Nursing Assistant (CNA) license while in high school.
They can then decide if they want to apply to Three Rivers Community College to obtain either their one-year Licensed Practical Nurse (LPN) license or a two-year associate’s degree in nursing (ADN), which would allow a student to work as a Registered Nurse (RN).
Once enrolled in the two-year program, student nurses can apply to be a part of the Poplar Bluff Regional extern program, which includes one-on-one mentorship and hands-on experiences.
A little more than two and a half years ago, the partners were able to secure $1.5 million in Workforce Opportunities for Rural Communities grant funding from the U.S. Department of Labor.
They worked alongside Community Funding Accelerator (CFA), a national group that helps communities win and implement public funding.
“[It’s] important to build these pathways in rural communities or within communities, and not just outside of them,” Mara Eala said. She’s a project leader for CFA. “[Poplar Bluff] stands at the edge of a healthcare desert, and so, trying to build pathways where we can place folks and nurses in health care systems where there is that need — because there isn't much beyond that to serve the community — I think is also critical, and not just nice to have.”
Carla Rider, the Chief Nursing Officer at Poplar Bluff Regional, was brought on at the hospital in early 2024 to implement the program.
She said she wanted to create an environment in Poplar Bluff that attracts and trains new nursing talent while also providing existing nurses with enough opportunities and incentives to stay in the area.
Rider said the goal is stability – where nurses want to stay in the community and the healthcare system overall benefits from the experience of those nurses.
During the pandemic, she said there were times that Poplar Bluff Regional had as much as 75% of their nursing staff filled by temporary and travel nurses.
“We had government entities that stepped in and was paying $100 an hour,” Rider said. “When nurses just jump from one community to the next, really not having that buy-in. So, we're having to really reset the playing field and really look at explaining and pulling out the ‘Why’ somebody went into healthcare.”
"Tenured nurse brings that stability, and then they're able to train newer nurses coming in, and you just keep improving and improving."Carla Rider, Chief Nursing Officer at Poplar Bluff Regional
Which is where the student extern program comes in. Students in the two-year associate registered nurse (RN) program at Three Rivers apply for the externship, and, once admitted, they commit to working a certain number of hours in the hospital each month where they benefit from a “pay-as-you-learn” model.
“We started out paying $15 an hour to the nurse externs, but then to incentivize them as they increase their knowledge base. I made it to where if they got their CNA, they got another dollar. If they became telemetry tech, they got another dollar. So they could go all the way up to $19 an hour while they were through school,” Rider said.
She said the program works with students to schedule their hours around things such as tests. Plus the students become more comfortable working in the hospital setting with real patients.
Dunn said hands-on experience is incredibly valuable to a student nurse, and she’s worked with the staff at Three Rivers to make sure the externship experiences aligns with what is being taught in the classroom.
“For example, they have their mental health course in their second semester of the nursing program, and so we have the nurse externs here do additional training in the behavioral health unit clinical environment at that same time,” Dunn said. “So that they can identify and see rhythms happening in real time, and they can get that just reinforcement of what they're learning in the classroom.”
Dunn said the extern model allows student nurses to try out different specialties before committing to working in them — just like she did — and they get first pick upon graduation of what department they want to work in.
But one of the largest benefits, she said, is that the externship is local and paired with a two-year ADN, which opens the door to more non-traditional students.
“Some individuals who don't want to go far for further education – maybe they want to stay close for family purposes, or just because it's home, and maybe they are passionate about nursing care because they want to serve their community,” Dunn said. “We get a lot of… non-traditional students as well. I've had a few nurse externs who've gotten married during the program, some of them had their first child during the program, some of them come back and they already have started their family, so it just gives more opportunity to grow their career, advance their knowledge, while they're right here at home.”
Jill Williams, the Vice President of Workforce Development for the Missouri Hospital Association (MHA), said she has seen a huge growth in this type of apprenticeship or extern program in the last five or so years.
She said MHA has been collecting data about healthcare worker vacancies and retention for many years, and while the statewide vacancy rate for RNs has gone down considerably since the COVID-19 pandemic, the rate of turnover has actually increased.
Since 2023, the rate of RN turnover has increased from 15.6% to 18.9% — meaning hospitals are hiring nurses to fill positions but are struggling to keep them.
“One of the things that we're really seeing from the nursing workforce is that they are wanting more out of their job, like, leadership development. They want to be heard, they want their opinions to matter, they want flexibility,” Williams said. “We're hearing from the nursing staff that they want us a job that they feel supported, they feel psychologically safe, they feel physically safe.”
She said she believes it’s important for hospitals to come up with different pathways for staff — like the Poplar Bluff nursing externship — because once people have their foot in the door, they’re more likely to stay in the area where they received their training.
Williams added that as the current nursing workforce continues to age and retire — these programs are also a great way to attract students who are just out of high school, as well as those who may be interested in changing careers or have to balance receiving an education with working and raising a family.
“It's like a win-win for everybody all the way around,” Williams said.
Back in Poplar Bluff, Program Director Ashlee Dunn said they have already graduated nine nurses with two-year ADNs, and 13 more are expected to graduate in May 2027.
Each of these RNs is contracted to work in the hospital for at least 18 months post-graduation, but she hopes they stay on.
She said she’s excited, as a born and bred resident of southeast Missouri, that more nurses are getting the opportunity to train in the community.
“Once they graduate, truly we believe they're going to be more prepared to make that transition from student nurse to graduate nurse, and that is the greatest benefit for not just Poplar Bluff Regional, but our community as well,” Dunn said. “We're producing more, more prepared nurses with stronger critical thinking skills, clinical judgment, and truly a good foundation in compassionate care, as well.”
In the future, Dunn said there are plans to expand both the size of each cohort and to work with more community colleges in the region.
