Centralizing Nurse Refresher Program Data in North Carolina

A Statewide Change Model to Strengthen Workforce Planning and Program Impact

Abstract

North Carolina faces a projected shortage of nearly 12,500 registered nurses by 2033, highlighting the critical need to strengthen workforce participation among licensed nurses, including those who exited practice. The NC AHEC Registered Nurse (RN) Refresher Program, historically decentralized across nine regions, provides didactic and clinical components to support nurses re-entering the workforce. While the program consistently achieved high completion rates, participant satisfaction, and licensure activation, limited centralized data hindered timely evaluation, longitudinal tracking, and strategic workforce planning. In 2024, a change in partnership prompted a systematic modernization of data infrastructure. Guided by Kotter’s 8-Step Process for Leading Change, the intervention development phase included establishing urgency, forming a guiding coalition, and creating a vision for a unified, data-rich system that balances centralized oversight with regional expertise. A staged implementation strategy utilized existing software to centralize applications, standardize outcome reporting, and maintain regional-led student support, clinical placements, and employer engagement. Implementation emphasized peer-to-peer learning, iterative feedback, and preservation of regional coordination while introducing centralized workflows, automated reporting, and standardized evaluation tools across didactic, clinical, and follow-up phases. Early outcomes demonstrate improved data quality, operational efficiency, and the ability to generate real-time statewide insights while retaining local responsiveness. The centralized infrastructure enables longitudinal assessment of program outcomes, including workforce entry, licensure reactivation, and satisfaction. Future evaluation will explore workforce retention, participant characteristics, practice settings, and strategies to enhance engagement of nurses returning to the workforce, offering a model for scalable, data-informed return-to-practice programs beyond North Carolina.