Registered Nurse Refreshers and Pandemic Healthcare

Updated on September 16, 2023

Alex Lehtonen (a pseudonym to protect someone currently in the process) wants to be a Registered Nurse in North Carolina. Alex was a nurse for around 15 years and as a graduate nurse went directly into a surgical/trauma ICU. 

North Carolina needs Alex today, as does practically every other state in the country. Since Alex hasn’t worked as a nurse for a while, Alex has been following all of the re-licensure protocols in North Carolina, which are set forth by the states Board of Nursing. 

“The pace is sclerotic,” Alex told me. “I have $3,000 in sunk costs, and need to be working right now. I want to help – to be there for patients and for the North Carolina healthcare system – but I might have to drop out, as many others have. Who wants to wait around in the abyss?”

Alex wouldn’t be alone. The current refresher programs have a completion rate of less than 50% as currently structured. This is on par with many prisoner reentry programs. 

Last year, the North Carolina legislature said nurses could get through the relicensing program in three months. But at the same time, the Board of Nursing decreased clinical slots to four per county at one time, which, according to Alex, has left at least 65 people bottlenecked at the clinical phase of re-licensure. These requisite clinical rotations – 160 hours in North Carolina – are a huge part of the problem where access to clinicals is so limited. 

Isn’t there a better way of getting nurses back into the field in a global pandemic? With re-licensure candidates such as Alex waiting three weeks to five months to complete their clinicals, the entire process is slower and far more opaque than it needs to be. 

North Carolina isn’t alone. While the re-licensure process is uneven across 50 states, complaints exist across the board. The system doesn’t do what it at least should have been designed to do in a pandemic – get more nurses quickly and efficiently into the field. 

Alex observes that the program is designed in practice to have candidates move slower than is necessary. “While refresher programs seem different between states, the online class I did I could have easily completed in 3 weeks. But I was told it would not look good and I would be flagged as a clinical rotation potential problem. So I took 6 weeks.”

John Lawlor, a Fort Lauderdale lawyer, argues that legislators and courts should make it as expedient as possible for RNs to complete refresher courses and enter the labor market:

“In almost every jurisdiction in the nation, there is a need for additional skilled and experienced healthcare professionals. It’s ultimately up to licensing boards, lawmakers, and, where needed, the courts, to ensure that in these truly exceptional times, healthcare professional licensing rules are as streamlined as possible.”

So how can this be fixed? One option is a nursing preceptorship. Preceptorship is a formal process of providing guidance and support to another. The relationship is led by an experienced and competent nurse who facilitates the learning and development of the learner. Here, with experienced learners seeking to re-enter the profession, the learning could actually be a two-way street. 

This would have worked well for Alex. “Just get me familiar with equipment and protocols, but do that by immersion. I passed all of my coursework with high 90’s test scores. I need to get to work and the hospitals need me today.”

Especially in these exceptionally trying times, candidates who have a relatively short financial runway to make a career change back to nursing will be dissuaded by the uncertain timelines. Only someone with the luxury of savings will be able to fully focus on nursing recertification. What a terrible waste of needed talent if even one nurse won’t re-enter the profession in a pandemic because of a broken system.

Hospital systems also need to rethink their role in this process. Hospital systems in North Carolina and throughout the nation are dialed into political power. If the hospital systems found the will to make nursing recertification better, they could quickly make it happen. 

Alex suggests a compelling practical fix for hospital systems. “instead of offering nurses $15K signing bonus, these hospitals should reward people who complete a preceptorship with $10K. Cover credentialing and hire them for three months for acclimation and clinicals. This would smooth out the transition to context and provide much-needed cash flow – I can certainly attest to that.”

While the experience has’t left Alex less enthusiastic than at the outset, a desire to improve the process is a daily occurrence:

“To me, it’s kind of remarkable that while I struggle to become a nurse again, hospitals in my state are offering $7K per week to traveling nurses. I know of nurses offering to travel in their hometown. Maybe this isn’t the best use of resources in our system.”

About Aron Solomon

Aron Solomon, JD, is the Head of Strategy and Chief Legal Analyst forEsquire Digital. He has taught entrepreneurship at McGill University and the University of Pennsylvania, and was elected to Fastcase 50, recognizing the top 50 legal innovators in the world. Aron has been featured in CBS News,TechCrunchThe HillBuzzFeed,FortuneVenture BeatThe IndependentYahoo!, ABA Journal,,The Boston Globe, and many other leading publications. 

Aron Solomon
Aron Solomon

A Pulitzer Prize-nominated writer, Aron Solomon, JD, is the chief legal analyst for Esquire Digital and Today’s Esquire. He has taught entrepreneurship at McGill University and the University of Pennsylvania, and was elected to Fastcase 50, recognizing the top 50 legal innovators in the world. Aron has been featured in Fast Company, Fortune, Forbes, CBS News, CNBC, USA Today, ESPN, Today’s Esquire, TechCrunch, The Hill, BuzzFeed, Venture Beat, The Independent, Fortune China, Yahoo!, ABA Journal,, The Boston Globe, and many other leading publications across the globe.