The goal of the NC AHEC Program is to meet the primary health care needs of the state by improving the supply, distribution, and quality of health care professionals. Since 1974, all of the state’s nine regional AHECs have employed nurse educators who work to expose North Carolina’s nursing workforce to emerging technological changes as well as innovative methods that are intended to improve the quality of nursing care. All NC AHEC nursing activities aim to increase and enhance the nursing workforce in North Carolina through education, training, and consultation.

In the 1980s, the North Carolina General Assembly created the Legislative Study Commission on Nursing. The Commission carried out an exhaustive examination of nursing workforce shortages in the state and considered suggestions from a number of stakeholders, including NC AHEC. Based on those findings, the 1989 General Assembly allocated funding to support the most promising of the initiatives. The NC AHEC Program was identified as a key player with responsibility for developing activities that support those legislative intents. (See The Role of AHEC and Legislative History)

Legislative funding over the past 22 years has enabled NC AHEC and many North Carolina nursing schools to create innovative programs that provide advanced education to registered nurses and that prepare more students for careers in nursing. Three initiatives that are vital to nurse workforce development are nurse refresher programs, educational mobility for working nurses, and clinical site development to support enrollment in the state’s nursing schools. The report discusses each of these projects.


The NC AHEC RN Refresher Program provides registered nurses who have been out of the workforce with an opportunity to update their clinical knowledge and skills and return to clinical practice. It also allows those nurses who have been working in non-clinical nursing roles to update their clinical skills and return to direct patient care. From 1990-2012, over $1,300,000 was allocated to the nine regional AHECs to support the non-personnel expenses of nurse refresher courses.

Between 1990 and 2012, over 3,400 nurses enrolled in the RN Refresher Program offered through each of the nine regional AHECs and in collaboration with The University of North Carolina Chapel Hill. Almost 2,500 of those enrollees completed the didactic portion of the program, and 1,650 also completed the clinical component. More than 67% of nurses who completed the full program over the past five years returned to work in nursing in North Carolina, an important measure of Program outcome.

RN Refresher Program coordinators in each of the nine AHECs and at the UNC Chapel Hill School of Nursing arrange clinical experiences for students. The regional AHECs currently have agreements with 56 health care organizations that are willing to precept students who are enrolled in the clinical portion of the RN Refresher course. Students are placed at these sites based on where they live and, when possible, their preferred practice settings. New and alternative sites are regularly developed as regional needs demand.

Over the past five years, three program enhancements have improved the refresher experience for registered nurses. The didactic portion of the Program is now offered in both correspondence and on-line formats. Clinical opportunities for all students now include both training in clinical laboratories and in simulated clinical settings where human patient simulators are generally available. Finally, structured faculty and clinical experiences for groups of eight students are offered as needed in locations with large numbers of students.

(More Information on the RN Refresher Program)


The NC AHEC Program designs and supports off-campus educational mobility programs that provide educational opportunities for working RNs and other non-traditional nursing students. The NC AHEC Program allocates funds for these programs to the schools of nursing within the constituent institutions of The University of North Carolina and Duke University School of Nursing. NC AHEC nurse faculty collaborate with schools of nursing to develop and operate off-campus RN to BSN, MSN, and Family Nurse Practitioner programs in areas of the state that lack resources. These flexible educational formats allow nurses to advance their nursing preparation while continuing to work in their own communities.

Between 1977 and 2012, educational mobility programs supported over 1,500 graduates from nine different schools of nursing. Special psychiatric-mental health funding supported over 70 nurses who earned their certification as Psychiatric-Mental Health Nurse Practitioners.

The nine regional AHECs provide the schools and students with logistical support, classroom space, computer support, and library support. In addition, they help identify appropriate clinical sites and develop preceptors.  From 1990-2012 the NC AHEC Program allocated almost $6,750,000 for educational mobility program support.

The NC AHEC Program continues to work closely with UNC General Administration and with the UNC nursing programs to determine how to best support off-campus RN to BSN and MSN programs. As the nature of higher education has changed and on-line nursing programs became more available, NC AHEC has continued to explore innovative ways by which it can encourage and support nurses as they work to continue their educations. One collaborative effort in which NC AHEC is engaged is the Foundation for Nursing Excellence’s Regionally Increasing Baccalaureate Nurses (RIBN) Project; a dual enrollment effort that speeds student nurses’ progress through paired associate degree and baccalaureate nursing programs.


In 1989, the NC legislature allocated funds to the NC AHEC Program with the specific goal of exposing the greatest number of nursing students for the maximum time possible to new clinical training sites in rural, long-term care, and critical care settings. As a result, the NC AHEC Program established a grants program, which continues to allocate funds among the schools of nursing within the NC Community College System and UNC constituent institutions.

AHEC nurses work with the NC community colleges nursing programs and UNC system schools of nursing to identify and develop new clinical sites. These nurses also assist with grant preparation and offer consultation on areas related to student use of the clinical sites.

Since 1990, 490 sites and 59 schools have received clinical site development funds. Consistent with the initial legislative intent, 84 percent of the sites have provided training experiences in the identified areas of greatest need.

Since 1990, over $2,840,000 has been distributed across the state for clinical site development.


While we celebrate the many significant outcomes of the NC AHEC Nursing Initiatives over the past 22 years, it is imperative that the efforts to expand the nursing workforce at all levels continue unabated. In the year 2012 , nursing workforce shortages as described in the North Carolina Institute of Medicine Taskforce on the Nursing Workforce report continue. According to the North Carolina Center for Nursing, “The state is unlikely to avoid the next nursing shortage, but we can affect its severity if we aggressively work to recruit and retain nurses – in both education and practice – right now.” The North Carolina AHEC Program is working energetically to do just that. The RN Refresher Program was updated in 2010 and, in conjunction with that effort, was placed on-line increasing both its availability and interactivity. The NC AHEC Program now offers both correspondence and on-line versions in an attempt to meet the needs of all North Carolina nurses. Enrollments in the program are growing and the majority of program completers are working in nursing in North Carolina. The NC AHEC Program also contributes to efforts to increase the cultural diversity of the nursing workforce and all other health care professions by facilitating the retention and recruitment of people representing all ethnic and socioeconomic backgrounds into health professions.

North Carolina continues to need more nurses prepared at the baccalaureate level and above. In addition to strong clinical skills, nurses need expertise in decision making, critical thinking, delegation, teaching, and working effectively on interdisciplinary teams. The NC AHEC Program sponsored off-campus degree programs provide flexible options for working nurses who wish to advance from RN to BSN and beyond. The state’s need for nursing faculty prepared at the Master’s level requires flexible educational options that allow working nurses who are interested in the faculty role to be prepared to teach. In addition to formal educational pathways, the role of Clinical Teaching Associate can give nurses who are employed in clinical agencies (primarily hospitals) the opportunity to act as clinical instructors for nursing programs on a part-time basis while retaining a regular clinical position. Three regional AHECs have developed clinical teaching associate educational programs and have supported the efforts of nursing programs and clinical agencies to work together to implement the CTA process.

The NC AHEC Program clinical site development grant program continues to place priority on rural and underserved communities but has expanded its focus to cover other areas of significant clinical need.  In addition, alternative clinical options have been examined and human patient simulation, simulated cases and precepted learning opportunities have all been supported.  The future promises to bring with it a variety of additional virtual clinical experiences and, when appropriate, they too may be supported.

The NC AHEC Program is committed to giving nursing workforce issues priority attention in the coming years through continued collaboration with our academic partners, and community practitioners and institutions.  In the process, NC AHEC Program nursing will meet its historic mission: to enhance nursing practice in North Carolina through education, training and consultation in order to meet the health care needs of the citizens of North Carolina.


The NC AHEC Program wishes to acknowledge the many contributions of Gail O. Mazzocco, EdD, RN, Clinical Associate Professor at the School of Nursing of The University of North Carolina at Chapel Hill and Statewide AHEC Nursing Liaison (retired 2012).

The NC AHEC Program also wishes to acknowledge all members of the nursing staff and faculty at all North Carolina Area Health Education Centers.
NC AHEC Program Office Contact:

Karen D. Stallings, RN, MEd, FAAN
Associate Director
North Carolina Area Health Education Centers Program
145 N. Medical Drive, CB# 7165
516 NC AHEC Building
The University of North Carolina
Chapel Hill, NC 27599-7165
Telephone: 919-966-0807
Fax: 919-966-5830
Web site: