Closing the Clinical Readiness Gap

Mandating a Transition-to-Practice Program for 68C Soldiers in Support of LSCO

By CPT Katlyn Stinnett

July 9, 2026 | Pulse of Army Medicine, 2026 E-Edition

Read Time: < 7 mins

The Army Health System (AHS) relies heavily on the Practical Nursing Specialist (68C) to deliver highly reliable patient care in both Military Treatment Facilities (MTFs) and operational environments. The Army created this military occupational specialty (MOS) to bridge the gap between a 68W combat medic and a 66H registered nurse (RN). With the operational environment transitioning to Large-Scale Combat Operations (LSCO), the Army will require all medical personnel to perform at the top of their scope of practice and, if necessary, beyond. However, the Army is leaving its youngest, least experienced nurses vulnerable to “transition shock” while still in garrison. The Army provides newly commissioned RNs who have already earned a four-year bachelor’s degree with a highly structured, six-month Clinical Nurse Transition Program (CNTP). While this has proven highly effective in bridging the gap for newly commissioned registered nurses (RNs), there is no equivalent currently mandated for 68Cs whose nursing education is limited to one year. This lack of standardization results in inconsistent clinical competency. To ensure patient safety, increase retention, and prepare 68Cs for increased responsibilities in contested environments, the Army must implement a structured LPN Transition to Practice program to mirror the CNTP currently mandated for RNs.

BACKGROUND AND CURRENT PRACTICE

Currently, 68Cs graduate from their one-year nursing school, also known as Advanced Individual Training (AIT), and are assigned to their first duty station. Alarmingly, the Army assigns a portion of these Soldiers directly to operational units where they may not treat live patients for up to three years. According to CSM (ret) Laragione in the NCO Journal, he had experiences with “staff sergeants with six years of service who never had an actual patient encounter.” This results in significantly atrophied clinical skills before even getting a chance to practice them. For Soldiers initially assigned to MTFs, leadership often passes them between multiple rotating preceptors without a dedicated program director to track their progress or document their competence. Additionally, unlike CNTP, MTFs do not require preceptors to hold any formalized certification to demonstrate additional training as a preceptor. These new LPNs must balance their fragmented 12-week orientation with completing unit taskings, and once the 12 weeks are complete, leadership releases them to independent practice.

Due to the lack of structure and protected time, newly graduated LPNs are less of a force multiplier for RNs, sometimes resulting in leadership placing them back on orientation. On the ward, clinical leaders expect LPNs to perform many of the same duties as RNs. However, a 24-year-old RN with four years of collegiate education receives a formalized, highly structured transition program. In contrast, a 19-year-old with 52 weeks of schooling is expected to hit the ground running with minimal oversight. The first few months on the ward represent a critical and opportune time to solidify a strong clinical foundation. The current lack of structure creates an unnecessary risk that an existing Army solution can easily fix.

LARGE-SCALE COMBAT OPERATIONS IMPLICATIONS

Not only do the 68Cs need the capacity to operate independently within a hospital setting, but they must also prepare for prolonged casualty care during LSCO. When operating in a contested environment with limited resources, an LPN’s scope of practice will inevitably expand, forcing them to perform advanced skills typically reserved for registered nurses in garrison. The Army will rely on these junior Soldiers to make critical, life-saving decisions based entirely on their clinical experience and knowledge. Before the Army can expect them to think and perform at this level, they must first support their clinical foundation. Unfortunately, leadership only discovers a critical knowledge gap after a new nurse makes an error, which could have negative outcomes for real patients. Instead of rushing new LPNs through an unorganized orientation, a structured transition program would provide them with the ability to develop vital muscle memory in a safe, controlled setting.

RETENTION AND MORALE

The Army invests significant time and financial resources into licensing these Soldiers. By forcing them to transition into practice without structured support, the Army risks losing its return on investment to a preventable cause that the officer corps has already solved. An additional benefit of CNTP is that it protects nurses from unit manning rosters during their training phase. Because enlisted personnel make up the majority of manning rosters, protecting new nurses is difficult but necessary. In an MOS that directly impacts Soldier medical readiness, 68Cs deserve the protected time required to become clinically competent before units burden them with additional Soldier taskings. By investing a few additional months of protected, structured training into a 68C, the Army can save hundreds of thousands of dollars per Soldier in lost recruiting, AIT, and replacement costs due to burnout or failure to meet the standard.

CLINICAL NURSE TRANSITION PROGRAM

The CNTP is a 24-week structured program that relies on a phased “Scaffolding Model” to gradually build a nurse’s confidence and capabilities. The first few weeks of the program begin with basic shadowing and observation. From there, the new nurse and their preceptor gradually begin to share a patient load. Based on the nurse’s observed progress, the nurse will begin to take total responsibility for the patients independently, with the preceptor stepping back to serve solely as a safety net and resource. Easing into autonomy like this naturally builds a strong foundation of confidence. Ultimately, nurses graduate from CNTP because they have demonstrated true competence, not just because the unit is short-staffed. The biggest difference about this program versus current practice is the engagement of the director who adjusts the progression of the program to the individual and provides documented feedback weekly with new goals established for the next week.

Implementing a CNTP-style program for LPNs would provide a structured, monitored environment to ensure each LPN meets the standard of safe patient care before acting as an independent nurse. In an operational environment, units must focus on training tactical tasks rather than basic clinical competencies. A structured transition program directly protects the lives of Service Members and beneficiaries within the MTF by ensuring dedicated mentors catch “near misses” and utilize them as teaching moments.

MAXIMIZING THE 68C MOS

The Army already has a proven method to transition RNs to the bedside after formalized education. By establishing a transition to practice program for LPNs as well, the Army is maximizing the 68C MOS, which will be required to increase chances of survival in LSCO. When an Army nurse has a reliable clinical baseline, they are a genuine force multiplier. Neglecting to formalize this transition during peacetime adds unnecessary risk that could make the difference in adapting when the mission requires it during LSCO.

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