Building the workforce continuum: UTC nursing prepares graduates at every level

A nursing skills drill with nursing students practicing their skills on a mannikin

UTC nursing students practice clinical skills using a mannequin during a simulation exercise in the School of Nursing. Photo by Angela Foster.

The nursing shortage in Tennessee and across the Southeast is not new—and it is not going away.

Hospitals, clinics and rural health providers continue to feel the strain of too few nurses to meet patient needs. For the University of Tennessee at Chattanooga School of Nursing, that shortage is both a challenge and a calling.

UTC has built its nursing programs to prepare practice-ready graduates across the workforce continuum. From undergraduates pursuing a Bachelor of Science in Nursing to graduate students focusing in the areas of adult gerontology acute care, psychiatric mental health and family nurse practitioners, nursing administration and highly specialized nurse anesthetists, UTC’s mission is to educate and graduate nurses who are ready to step into the workforce and fill critical gaps in care.

“We see a tremendous gap in care, not only in our area but across the nation. With that in mind, the UTC School of Nursing is planning to expand our enrollment significantly over the next three to five years,” said Dr. Chris Smith, director of the School of Nursing and chief health affairs officer for the Division of Enrollment Management and Student Affairs. “But note, the quality of our graduates will not be impacted by larger cohorts entering the program.”

Among the School of Nursing’s active grants are three from the Health Resources and Services Administration (HRSA), each focused on a different level of nursing education, that together highlight how UTC builds a pipeline of nurses serving Tennessee and the region.

“These grants are proof points,” said Dr. Brooke Epperson, associate director of the School of Nursing and undergraduate program coordinator. “But if you peel back the layers, all of them are really about reaching the community and letting people know they have a resource with UTC.”

Nursing shortages have long been part of the health care landscape, but the demand is particularly acute in Tennessee and neighboring states. Rural communities are especially hard-hit. The School of Nursing has deliberately positioned itself to address that gap by structuring its programs around the workforce continuum.

“We don’t just want our students to graduate,” Epperson said. “We want them to be ready to serve.”

That readiness requires curriculum enhancements, clinical partnerships and financial support that allow students to complete rigorous programs and enter the workforce prepared. That is where the HRSA awards come in.

A DNP student practices his craft by talking to an actor simulating a patient

UTC nurse practioner students work with patient actors during a simulation lab.

Epperson leads the AHEAD-RN project, a three-year, $1.4 million award focused on preparing undergraduate nurses to work with vulnerable populations.

“Our grant is primarily focused on making sure that our graduates are practice-ready in three specific patient care areas or patient populations: homeless, mental health and the aging populations,” Epperson said. “Using simulated patient actors—trained individuals who portray patients in real-life scenarios—students gain experience navigating difficult conversations, unconscious bias and end-of-life care.”

That simulation focus is shaping the way undergraduates learn, she explained. Instead of relying only on high-tech mannequins, students also interact with simulated patient actors, providing more realistic practice in communication and care.

“The mannequins are amazing and the technology with the mannequins is amazing,” Epperson said, “but there’s something to be said for having a real-life person portraying a certain patient in a certain scenario—and with it comes the real feedback and interaction with a real person versus a mannequin.”

The grant also pushes faculty to address difficult topics. Beyond clinical skills, students are challenged to reflect on their own responses, confront unconscious bias and build the confidence needed to support patients and families in complex situations.

“I always joke that our goal is to get you residency-ready,” Epperson said. “Practice-ready is insinuating that you’re going to be ready to hit the ground and you don’t need any additional support or guidance once you graduate.”

Epperson said by giving undergraduates these experiences early, UTC is building a stronger pipeline of nurses prepared to meet the needs of diverse patient populations.

“At the core, it’s all about reaching the community and how we can serve the community better,” she said. “Even though our grants have different deliverables, at the foundational level, that’s what all of our grants in the School of Nursing are working toward—having that presence and letting the communities know that they have a resource with UTC.”

Nursing students practice taking vitals on each other, including blood pressure checks

UTC nursing students practice taking vitals.

At the graduate level, Dr. Amber Roaché, associate professor and coordinator of the nurse practitioner concentration, leads UTC’s Advanced Nursing Education Workforce (ANEW) project.

Now in its third year, ANEW is supported by a $2.6 million grant over four years. The project builds on an earlier Clinical-Academic Network for Developing Leaders (CANDL) award, which gave faculty the opportunity to reassess the curriculum as the program transitioned from a master’s to a doctoral degree.

“Our first grant really allowed us to look at our program and see things like the social determinants of health—the barriers patients face outside the clinical setting,” Roaché said. “How do people get access to health care? What resources do they have for food, for paying for rent, paying for a car, transportation, the ability to buy medications?”

That perspective reshaped the curriculum. Instead of labeling patients as “non-compliant,” faculty teach students to recognize barriers—lack of transportation, unaffordable deductibles, cultural traditions—and respond with practical solutions.

“With the grant, we literally went course by course and looked at where we plug in these factors,” Roaché explained. “Where do we plug in talking about socioeconomic factors? Where do we look at talking about abuse or risk of being trafficked? All these different things.

“Students are trained to recognize challenges and adapt their approach, and they are prepared to meet patients where they are. That makes a difference for families across this region.”

The result is a program that prepares students for the realities of practice. Graduates complete more than 1,050 clinical hours—well above the 750 required by the National Task Force on Quality Nurse Practitioner Education, a collaboration between the American Association of Colleges of Nursing and the National Organization of Nurse Practitioner Faculties—and work in rural and underserved settings throughout the region.

“They are getting those clinical hours between virtual, real simulation, the curriculum, the clinicals and the site placements,” Roaché said. “All of that is really well integrated to prepare our students to be practice-ready when they graduate.”

The project also emphasizes community partnership, from Chattanooga’s major hospitals to private practices and clinics across Southeast Tennessee.

Roaché sees the MobileMOC medical outreach clinic as the next opportunity to reach more patients.

“I really see tying in that mobile unit,” she said. “Going to those senior centers, going to the churches. I see that as our next step—being able to take that mobile unit into some of these rural areas, these underserved areas, and truly being able to have people walk up to where we are and be seen.”

Nurse anesthesist training with nurses practicing their skills during an airways workshop

Certified Registered Nurse Anesthetist students work with faculty on airway techniques.

At the most specialized end of the continuum, Dr. Linda Hill, professor and coordinator of the nurse anesthesia concentration, leads UTC’s Nurse Anesthetist Traineeship program. Supported by HRSA for “at least the 20 years I have been here,” she said, the traineeship helps graduate students defray the cost of tuition and fees.

UTC’s Nurse Anesthesia program has been preparing Certified Registered Nurse Anesthetists for more than 50 years.

“This program has been in existence since 1972, first through Erlanger Medical Center as a certificate-based program,” Hill said. “We have a strong history here in this community of educating CRNAs—and we have a national reputation.”

That reputation is built on results. Hill said program graduates consistently exceed the required anesthesia case experiences and clinical practice hours. As an example, the most recent graduating cohort had an average of 1,040 anesthesia cases and 3,198 clinical hours.

“The registered nurses in our DNP Nurse Anesthesia program play a critical role in our clinical partners’ patient care enterprise,” she said. “Between January 1, 2024, and January 1, 2025, the nurse anesthesia students provided 36,300 supervised patient care hours and administered anesthesia under clinical preceptor supervision to 23,000 surgical and obstetrical patients.”

The program attracts more than 400 applicants each year for 33 available seats.

“Our students all have jobs when they graduate. We have a 100% employment rate,” she said. “Our students go out as graduates and are our best ambassadors.”

Many of those graduates remain in Tennessee and the surrounding region, helping address persistent workforce needs in both metropolitan hospitals and rural community clinics.

In addition to the big three Chattanooga-area hospitals, students rotate through rural sites such as the Rhea Medical Center in Dayton, Highpoint Health – Ascension Saint Thomas in Winchester, and Ascension St. Thomas Riverpark Hospital in McMinnville gaining hands-on experience in shortage areas.

The program’s reputation is national.

“I get recruitment requests from companies, from physicians’ groups, from hospitals literally all over the country,” she said. “They will tell me, ‘We have someone who graduated from your program. This person is really an outstanding CRNA. Do you have somebody else that you could send us?’”

To keep the pipeline strong, Hill and her colleagues continue to innovate. They are planning an obstetric anesthesia fellowship and recently hosted a free workshop in peripheral regional anesthesia for local CRNAs on Oct. 18-19.

“By promoting that to the CRNAs,” she said, “we are giving them skills that they can take back into their clinical settings and use, and then also help those same skills reach our students.”

For Hill, the program’s impact is measured not just in years but in generations of graduates who have carried UTC’s name into operating rooms across the country.

“We are just a jewel sitting in Chattanooga, Tennessee,” she said, “and we have a strong reputation for our outcomes.”