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Dive Brief:
A bipartisan group of lawmakers is advocating for the U.S. Department of Education to classify graduate nursing degrees as “professional degrees” in response to potential regulatory language that would place a lower limit on how much advanced nursing students could borrow.
Under a proposed framework, advanced nursing programs would be classified as “graduate degrees” rather than “professional degrees,” which would cap student loans for new nursing borrowers at $100,000 total, rather than the higher limit of $200,000 that will be in place for professional programs.
In a letter sent to Education Under Secretary Nicholas Kent on Friday, lawmakers said the framework could exacerbate an existing worker shortage in the industry. “At a time when our nation is facing a health care shortage, especially in primary care, now is not the time to cut off the student pipeline to these programs,” the letter said.
Dive Insight:
This summer, Republicans passed a massive spending package that will cap graduate student loans to $100,000 for most programs but $200,000 for professional degrees. The Education Department recently brought higher education stakeholders for a process known as negotiated rulemaking to determine which programs would qualify as professional degrees, and they reached consensus on regulatory language that would exclude nursing.
The letter, signed by over 100 lawmakers and led by Sens. Jeff Merkley, D-Ore., and Roger Wicker, R-Miss., and Reps. Jen Kiggans, R-Va., and Suzanne Bonamici, D-Ore., argues the proposed changes would undermine the “largest health care workforce in the United States.”
Under the changes, students would receive higher borrowing limits — $50,000 annually — for pursuing degrees like Doctors of Pharmacy, Dentistry, Medicine and Clinical Psychology that are deemed professional.
Students pursuing other advanced nursing degrees like Masters of Science in Nursing, Doctors of Nursing Practice and Doctors of Philosophy in Nursing would be subject to lower aid borrowing limits of $20,500 annually or $100,000 in total.
The Education Department argued the reforms — which also include eliminating other federal aid programs and sunsetting some student loan repayment plans — place “commonsense limits and guardrails” on student loan borrowing and simplify repayments.
However, lawmakers say the lower aid caps will force new students to take out additional student loans and make it more difficult for nurses to join the healthcare workforce, which is already suffering from shortages exacerbated by burnout during the coronavirus pandemic.
For example, the loan caps wouldn’t meet most Certified Registered Nurse Anesthetist programs, which can cost over $200,000.
“CRNA programs have shown to be a critical return on investment, with default rates near zero percent, and a workforce that overwhelmingly provides anesthesia to rural and underserved communities where higher cost physicians do not practice,” the letter says.
Jeopardizing advanced nursing degrees could also impact primary care, according to the letter. Over half of Medicare beneficiaries received primary care from a nurse practitioner or physician associate, according to research cited by the lawmakers. In rural communities, over 60% of Medicare patients receive those services from a nurse practitioner or physician associate.
“Nurses and nurse faculty make up the backbone of our health system,” the lawmakers said. “As such, post-baccalaureate nursing degrees should be treated equally to other accredited post-baccalaureate health profession degrees.”
Editor’s note: Natalie Schwartz contributed to this article.
This story was produced in partnership with Work Shift and reprinted with permission.
MOBILE, Ala. — Three or four times a week, LaTyra Malone starts her day at Mobile Infirmary hospital at 6:30 a.m. For the next 12 hours, she makes her rounds and visits with patients — asking if they’re in pain, checking vitals, administering fluids. To an outside observer, she appears to be a nurse.
But Malone, 37, is a registered nurse apprentice. Everything she has learned how to do in her nursing classes at Coastal Alabama Community College, she can do at the hospital under the supervision of registered nurse Ondrea Berry, her journeyworker — a term typically used in the skilled trades. Unlike most nursing students who complete their required clinical hours in groups for no pay, Malone gets paid as an employee with benefits. She also gets much more personalized, hands-on learning time.
“It’s like having a little kid attached to your leg all day,” Berry joked.
For Malone, the partnership is invaluable.
“I learn so much more one-on-one,” Malone said. “I might know the basics of disease processes or why we’re giving a certain medicine, but hearing her break it down to me helps a lot.”
The pair work largely as a team, alternating duties to allow Malone a chance to observe and practice. By now, Malone knows the ropes pretty well: In addition to her apprenticeship training and classes, she has 16 years of experience as a certified nursing assistant and a medical assistant. And Berry, who is 25, says she benefits from the working relationship too. “There are teaching moments for both of us,” she said.
Degreed nursing apprenticeships, like the one in Alabama, have emerged nationally as a potential solution to a thorny problem. The national nursing shortage is creeping toward crisis levels, with the demand for RNs like Berry and licensed practical nurses, or LPNs, projected to outstrip the supply for at least the next decade. At the same time, tens of thousands of people like Malone are already working in patient care in hospitals. Many aspire to be nurses — in fact, many certified nursing assistant programs sell the idea that you can start there, quickly land a job and then continue on to become a nurse.
But in reality, that’s a huge leap that requires an entirely different admissions process and English, math and science prerequisites that many nursing assistants don’t have. It also assumes that someone working an eight- or 12-hour shift for $18 an hour can find the time and the money for more education.
“The sort of ‘we are excellent’ ethos in nursing might be self-defeating in that it is weeding out a lot of people who would be amazing nurses,” said Iris Palmer, director for community colleges with the education policy program at New America.
Ondrea Berry, left, dispenses medication at Mobile Infirmary hospital while LaTyra Malone looks on. As an apprentice, Malone must be supervised by Berry at all times. Credit: Mike Kittrell for Work Shift
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Several states, including Texas, North Carolina and Wisconsin, have begun growing registered apprenticeships in nursing — which have approval from the U.S. Department of Labor — to help address this problem. But no state has done quite as much as Alabama in scaling the model.
In 2021, the Alabama Board of Nursing worked with the state legislature to create a nursing apprenticeship license. Normally, nursing students are not licensed until after they graduate and pass a national licensure exam, and therefore they can’t be paid for their supervised clinical hours. The new apprenticeship license allows them to earn while they learn, making nursing school much more accessible for students like Malone and helping to fill critical staffing needs in hospitals.
Since the law passed, 80 employers and 28 colleges and universities in Alabama have jointly created LPN and RN apprenticeship programs for those who are still working toward a degree. Nearly 450 apprentices — the great majority RNs — have completed the program and passed their exam, with more than 500 currently apprenticing. It’s too soon to say whether apprenticeships will solve the nursing shortage in the state, but early data shows benefits for employers and aspiring nurses alike.
Mobile Infirmary has had over 90 nursing apprentices since the hospital’s program began in 2022, first with the LPN apprenticeship and soon after with the RN one. Graduates are required to stay at the hospital for one year after the apprenticeship ends, but most are staying beyond that. Only five have left so far, according to Stefanie Willis-Turner, the director of nursing school partnership and programs at Mobile Infirmary.
The hospital, like many others, already offered tuition reimbursement for employees who wanted to go back to college and move into nursing or another higher-level position. But such programs have notoriously low uptake, in part because most low-income employees can’t front the cost of tuition and also because many don’t know what steps to take.
“It amazed me the number of people that wanted to go back to school but didn’t really know where to get started,” Willis-Turner said. “Having a person to help guide them has really been our trigger, and that’s how we run this program.”
LaTyra Malone is a two-time apprentice at Mobile Infirmary hospital. Last year, she worked with Ondrea Berry as a licensed practical nurse apprentice while she earned the certification. This year, she is a registered nurse apprentice. Credit: Mike Kittrell for Work Shift
Willis-Turner played a crucial role in recruiting Malone for the apprenticeship. Malone has wanted to be a nurse since she was a teenager when she was president of her high school’s chapter of HOSA-Future Health Professionals, a global student-led organization that promotes careers in health care. But her plans to become a registered nurse were delayed when she became a mother. The financial burden plus the rigid schedules of nursing school made it difficult to make room for parenting, working and studying.
With the apprenticeship, Malone doesn’t have to worry about paying for college, and she can provide for her family while improving her nursing skills. Her path stands in stark contrast to that of Berry, who worked at Dairy Queen throughout nursing school to pay for tuition and health insurance. Berry didn’t have kids to take care of, but she also didn’t have financial support from anyone else in her family. Her only on-the-job training in nursing school was the clinical hours, where she joined a group of students who took turns practicing new skills with just one nurse. Berry says she only attempted two IVs in that time. Malone has done so many she can’t count.
About 75 percent of the apprentices at Mobile Infirmary over the last three years were already working at the hospital. The rest came from surrounding medical facilities. Some even quit their jobs to transfer to Mobile Infirmary for a better chance at getting into the apprenticeship program. In addition to paying students for their work, Mobile Infirmary pays for any tuition that isn’t covered by scholarships or grants. The hospital also provides two uniforms free of charge. And students know they have a guaranteed job after they graduate and pass the nursing exam.
This kind of targeted support is what makes the best apprenticeships successful in boosting individual economic mobility, its advocates say. Another key factor is the type of job an apprenticeship prepares people for. Most health care apprenticeships are for entry-level roles like CNAs, patient care technicians and medical assistants — jobs that, on average, pay $18-$20 an hour.
About half of states offer apprenticeships for LPNs, who make about 50 percent more than that, and half do so for RNs, whose median salaries are close to six figures, according to data from the U.S. Department of Labor. But far fewer apprentices are in those LPN and RN programs — and the majority of RN apprenticeships are for nurses who already have degrees, not for those who are still learning. That means aspiring nurses must still get all the way through the financial and logistical obstacles of nursing school before they can start to work.
Josh Laney helped set up the different model in Alabama when he was director of the state’s Office of Apprenticeship. For a long time, he said, he bought into the “urban legend” that training more people to be certified nursing assistants, especially when they’re young, would get people onto the path to becoming nurses.
“The pitch was, ‘We get you the certificate and then you’re going to work at a hospital because it’s a very high-demand occupation. From there you can go on and move into nursing or whatever else you want to do,’” Laney said. “But there was no specified plan for how to do that — just a low-wage, very stressful and strenuous job.”
The data backs that up. A 2018 study of federal Health Profession Opportunity Grants for CNA training showed that only 3 percent of those who completed the training went on to pursue further education to become an LPN or RN. Only 1 percent obtained an associate degree or above. A study in California showed slightly better odds: 22 percent of people who completed certificate programs at community colleges to become CNAs went on to get a higher-level credential in health care, but only 13 percent became registered nurses within six years.
Because of these outcomes, Laney refused to pursue apprenticeships for CNAs in Alabama. One reason apprenticeships for CNAs and medical assistants are common, however, is that they are jobs that don’t require degrees and have fewer regulations when it comes to training. Setting up a registered apprenticeship for nurses who don’t already have a bachelor’s degree is complex and requires the work of many entities — the nursing board, colleges and employers.
When he went to the state board of nursing to propose LPN and RN apprenticeships, Laney was initially shut down.
“To their credit, they said, ‘Go away, bureaucrat! You’re not industry, you’re not the employer. You don’t really have anything to do with this,’” he recalled. “What I learned there, and what I’ve recommended to every other state who’s tried this, is let the employers carry your water. If they want it, they’ll get it done.”
Laney then talked to the Alabama Hospital Association and Alabama Nursing Home Association, to reach employers. Given the shortages they had been experiencing, they bought into the idea and approached the nursing board themselves. Next, Laney’s team got community colleges on board, then universities. With the assurance that apprenticeships wouldn’t cut down on any of the required classes and clinical hours, the nursing board agreed to create the new license, following legislative approval.
Other states embarking on nursing apprenticeships have faced similar challenges.
Apprenticeships aren’t a panacea. They hold promise for creating upward mobility, diversifying the profession and improving the odds a student makes it through to graduation, but they can’t solve all the knotty challenges of the nursing shortage. A lack of instructors in nursing schools — and therefore a lack of available seats for qualified students — is still one of the biggest factors. And in the apprenticeship model, every student needs one-on-one mentorship, meaning hospitals must have enough staff available and willing to work in a mentoring role for up to a year.
Jay Prosser, executive director of the Massachusetts Nursing Council on Workforce Sustainability, knows all that. But he thinks apprenticeships will bring in more “practice-ready” nurses who are more likely to stay in the field long-term, especially those who were already working in patient care in the United States or other countries. Massachusetts is on the cusp of starting a licensed practical nurse apprenticeship with one employer and one academic partner, after working with the state nursing board and colleges for the past year. Unlike in Alabama, the nursing board didn’t need to create a new license, but rather the board judges whether educational programs meet regulations or not.
The Massachusetts Nursing Council on Workforce Sustainability is also creating a nursing apprenticeship network in the state, to make it easier for different institutions and programs to exchange ideas.
Prosser said one of the biggest barriers was making sure that the scope of practice for apprentices was clearly defined. He worked with local colleges to make sure of this. Prosser had previously worked as an assistant chief nursing officer in Birmingham, Alabama, and moved to Massachusetts in 2021 with the idea of apprenticeships already in mind.
Several other states have also created nursing apprenticeships for students who don’t already have a degree, but they’re limited to single institutions. In 2023, Texas began offering nursing apprenticeships for students who hadn’t already earned a degree in a collaboration between South Texas College and the Texas Workforce Commission.
The University of Wisconsin Health system has created a portfolio of nine registered apprenticeship programs, including an RN program launched in 2023 and a handful of other apprenticeship-style programs. Bridgett Willey, director of allied health education and career pathways, said the hospital started with entry-level apprenticeships, like medical assistants, before proposing degreed programs.
“There’s still kind of a myth that the colleges are going to do all this on their own,” Willey said. “Well, that’s not true. Employers have to sponsor, because we’re the ones hiring the apprentices and often supporting tuition costs, as well.”
The outcomes from the entry-level apprentice programs helped convince the health system that it was worth investing more. A three-year study showed that staff retention rates for those who participated in the hospital’s apprenticeships were 22% higher than for those who didn’t. In the two-year-old RN program, attrition is less than 10% so far — significantly lower than the attrition rate the hospital has seen with traditional students who participate in clinicals at the hospital.
UW Health supports efforts to scale their apprenticeship model across the state, but so far they haven’t panned out. Willey said employers are interested, but conversations often stall when questions arise about how to create more clinical capacity and find funding sources to support apprentices.
Even so, Eric Dunker, founding executive director of the National Center for the Apprenticeship Degree, which is affiliated with Reach University, predicts that nursing apprenticeships are about to see major growth, as teaching apprenticeships did five years ago. Earlier this year, Reach University received a $1 million grant to expand apprenticeships in behavioral health, and is planning for nursing ones. The strict licensing regulations for nursing make it more complicated than scaling up teaching apprenticeships, but Dunker sees the possibility of expanding them if nursing boards, colleges and employers all come to the table, as they did in Alabama.
“There’s a lot of entry-level health care apprenticeships,” Dunker said. “But the key is upward mobility, which is nursing and nurse practitioners. There’s typically been a bottleneck in stacking these pathways, but that’s where you’re starting to see more states and systems become a little more creative.”
Tyler Sturdivant, Coastal Alabama Community College’s associate dean of nursing, knows what that looks like. Figuring out the logistics of setting up an apprenticeship program was a challenge, he said, and required hiring an additional staff member to liaise between the college and hospital partners. But three years into the apprenticeship program for LPNs and RNs, the school is seeing higher completion rates than for traditional students.
This means they’re producing more licensed nurses to fill positions and someday mentor, or even teach, other apprentices.
On a typical Friday morning in September at Mobile Infirmary, Malone and Berry visited a 70-year-old man who came in for a urinary tract infection that then weakened him. That day, the apprentice and journeyworker switched out his bed for one lower to the ground to reduce the fall risk, taught him how to raise the bed so he could sit upright, updated him on a plan for physical therapy and adjusted his socks for him.
Malone appeared comfortable and confident, taking the lead in the patient’s care while Berry assisted her. Malone says the many hours of practice she’s had through the apprenticeship has made her feel prepared for the job and ready to continue to follow her dreams. One day, she wants to become a nurse practitioner specializing in mental health.
“I won’t feel complete until I actually become a nurse,” Malone says. “I thought I was going to be one sooner, but bumps in the road happened and I ended up having a child. If it wasn’t for the apprenticeship, I probably wouldn’t be here now.”
Contact editor Lawrie Mifflin at 212-678-4078 or on email at [email protected].
This story was produced in partnership with Work Shift and reprinted with permission.
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The next generation of nurses will need to master not only clinical skills, but also technology, compassion, and cultural awareness.
Across the country, the nursing profession stands at a pivotal moment. Hospitals and communities are grappling with workforce shortages, an aging population, and rapid technological advances that are redefining how healthcare is delivered. The nurses of tomorrow must be clinically skilled, culturally aware, and technologically fluent — ready to care for patients with both competence and compassion.
To meet this demand, nursing education is undergoing a transformation. Programs and nursing educators nationwide must reimagine how students learn, practice, and collaborate, weaving innovation and inclusion into every aspect of training. Simulation labs, artificial intelligence, and virtual reality are no longer optional enhancements — they are essential tools that prepare nurses to deliver safe, effective, and equitable care in an increasingly complex health system.
Leading the way
One school helping lead this transformation is Purdue University’s School of Nursing, where innovation is shaping what it means to prepare tomorrow’s healthcare professionals. With the new Nursing and Pharmacy Education Building scheduled to open in spring 2027, Purdue will unite students, faculty, and research under one roof. The four-story facility is designed for collaboration and connection, featuring modern classrooms, study spaces, and simulation environments that replicate real-world medical situations.
Libby Richards, Ph.D.
Interim Head and Professor, Purdue University School of Nursing
“Our goal is to create a space that feels like an academic home — comfortable, collaborative, and equipped for the future of healthcare,” said Libby Richards, interim head of the School of Nursing.
Technology is central to this vision. The building will include advanced simulation systems and immersive virtual and augmented-reality labs, allowing students to practice complex procedures and develop clinical judgment in a safe, hands-on environment. Through programs like The Heart Through Virtual Reality, nursing students can explore the inner workings of the human heart — watching chambers contract and valves open in real time to deepen understanding of cardiac care.
Representation matters
Julian Gallegos, Ph.D.
Assistant Head for Graduate Programs and Assistant Professor, Purdue University School of Nursing
Purdue’s innovation also extends to representation within the profession. Faculty member Julian Gallegos leads initiatives to recruit and support men in nursing, encouraging representation and mentorship through Purdue’s chapter of the American Association for Men in Nursing and his research focus on men’s health. “We need to ensure that all students see themselves reflected in this profession,” Gallegos said.
Tyson Magee
Doctor of Nursing Practice Student, Purdue University School of Nursing
Research within Purdue’s School of Nursing reflects this same forward momentum. Doctor of Nursing Practice student Tyson Magee is studying how AI-generated exercise plans can improve patient engagement and outcomes. “AI won’t replace the nurse,” Magee said. “But nurses who understand it will deliver more individualized care.”
When the new building opens, Purdue Nursing expects to expand enrollment to help address critical workforce needs across Indiana and beyond. The investment underscores a lasting commitment to preparing healthcare professionals who merge innovation with empathy — defining not only the future of nursing education, but the future of care itself.
Bringing more men into nursing goes beyond addressing shortages; it represents a critical step toward a more balanced and equitable healthcare system.
Beverly Malone, Ph.D., RN, FAAN
President and CEO, National League for Nursing (NLN)
While nobody alive today can recall this, throughout its early history, men dominated the field of nursing. All that changed when men went off to fight the Civil War, and women trained as nurses stepped in to take their places in hospitals on the battlefield and on the home front.
After that, the scarcity of men in nursing has persisted for 165 years and counting. In 1970, when men in nursing hit an all-time low, only 2.7% of the nursing workforce was male, according to the American Nurses Association.
With increased attention to this imbalance, the number of men choosing to enter nursing has been inching upward, with the greatest jumps posted since the dawn of the 21st century. The Bureau of Labor Statistics (BLS) reported that in 2002, men accounted for 7% of RNs, LPNs, and NPs. Now, over 20 years later, BLS statistics show about 12% of nurses are male.
The National League of Nursing’s Annual Survey of Schools of Nursing, which represents nursing programs across the spectrum of higher education, confirmsthis promising trend, with increasing male enrollment in basic RN programs. In 2022-23, the latest survey data available, just over 14% of nursing students identified as men, an uptick from the prior year.
Most recently, men have even broken barriers in nursing leadership. The American Nurses Association elected its first male president, Dr. Ernest Grant, in 2018. Just recently, the National League for Nursing (NLN) membership elected Dr. Paul Smith, dean of the Linfield-Good Samaritan School of Nursing at Linfield University, as the League’s first male NLN Chair-Elect, breaking new ground in nursing education history.
Building a more balanced workforce
All that said, it may be asked, “Why is it even important to attract more men to nursing?” In the current nursing shortage, our nation cannot afford to ignore a potentially enormous job applicant pool. Nearly half of the U.S. adult population — 49% according to the 2020 Census — is male.
Beyond sheer numbers, men of all racial and ethnic backgrounds bring to the profession different life experiences and perspectives. Research indicates that patients tend to be more open and responsive to health professionals who share physical, psycho-social, and cultural characteristics with them. So, with the need for greater diversity in nursing, how can we move the needle even more quickly?
Public service campaigns targeted specifically to men that promote the career pathways, benefits, and rewards of nursing can be effective and should be amplified across both traditional and social media. This will require sustained, coordinated efforts and financial investment by all stakeholders, including health and hospital systems, schools of nursing, professional associations, federal and state agencies, public health foundations, and industry partners.
Another key to making the nursing workforce more diverse and inclusive is to diversify nursing faculty and leadership in nursing education. As matters stand, men are vastly underrepresented among nurse educators, comprising only 8% of full-time faculty. But opportunities abound, with more than 800 vacant positions budgeted and 86% of programs that participated in the NLN survey pursuing new hires.
Male nursing graduates of the future need mentors and support to inspire, affirm, and nurture them, and to guide them to achieve their full potential to make a real difference in the health of the nation and the global community.
With the dawn of a new year ahead, anyone looking for new opportunities can find one in nursing, with a wealth of job openings currently available.
Beverly Malone, Ph.D., RN, FAAN
President and CEO, National League for Nursing
A persistent shortage of registered nurses (RNs) and licensed practical nurses (LPNs) is at the root of nursing jobs going unfilled, caused by:
An aging nursing workforce, prompting a wave of retirements accelerated by the COVID-19 pandemic
The increased demand for healthcare by the aging Baby Boomer generation
Job stress and burnout precipitating workforce exits, particularly by nurses with less than two years of experience
A shortage of nurse educators, limiting the capacity of nursing programs to admit more qualified applicants
Among the additional effects of too few nurses are higher levels of medication, safety, and other clinical errors, and potential hospital closures in regions with the lowest ratio of nurses to patients. For example, in June 2023, there were nearly 300 rural hospitals at risk of immediate closure. Texas and Kansas led this trend, with 29 of their hospitals facing imminent shutdown.
Both states’ widely dispersed populations meant that the loss of vital healthcare infrastructure would have a devastating ripple effect on local economies, in addition to threatening healthcare access for some of society’s most vulnerable. So, how to address these multiple challenges?
Encouraging more nurse educators
One obvious approach to expand the nursing workforce is to hire more nurse educators to prepare a greater number of nurses for practice. While this goal may sound simple, in reality, it is hard to achieve, given budget constraints and the lack of state, federal, and local funding to support clinical nurses desiring to transition into education.
Still, there are so many rewards that come with a career in nursing or nursing education — or both. Yes, it’s more than possible to combine the daily satisfactions of clinical practice with the long-term fulfillment inherent in teaching, mentoring, and preparing outstanding practice-ready practitioners. That remains true whether you become an instructor in academia exclusively or a clinical nurse educator, supplementing your own nursing practice in an academic medical center.
Nursing itself has become a multi-dimensional field with a number of career pathways, including advanced practice roles. Specialties like nurse-anesthetist or doctor of nursing practice (D.N.P.) often come with welcome higher paychecks and professional status.
Plus, with nurses now providing more of the frontline preventative care and chronic disease management in community clinics and through non-traditional healthcare settings, a variety of job opportunities may provide scheduling flexibility that’s compatible with family responsibilities.
Nursing education offers an incredible opportunity to engage in research that has the potential to transform the educational landscape for generations. Nurse educators, with their scholarly expertise, are also often at the forefront of nursing and community leadership, tapped to consult in the highest circles of government, public policy, nonprofits, and industry.
The sky is the limit. Consider exploring the possibilities of nursing and nursing education, while helping resolve one of today’s most urgent crises: too few healers to provide the healing.
Nursing has long been romanticized as both a “calling” and a profession—an occupation where devotion to patients is assumed to be limitless. Nursing schools, hospitals, and media narratives often reinforce this ideal, framing the nurse as a tireless caregiver who sacrifices for the greater good. But behind the cultural image is a system that normalizes exhaustion, accepts overwork, and relies on the quiet suffering of an increasingly strained workforce.
The cultural expectation that nurses should sacrifice their own well-being has deep historical roots. Florence Nightingale’s legacy in the mid-19th century portrayed nursing as a noble vocation, tied as much to moral virtue as to medical skill. During World War I and World War II, nurses were celebrated as patriotic servants, enduring brutal conditions without complaint. By the late 20th century, popular culture reinforced the idea of the nurse as both saintly and stoic—expected to carry on through fatigue, trauma, and loss. This framing has carried into the 21st century. During the COVID-19 pandemic, nurses were lauded as “heroes” in speeches, advertisements, and nightly news coverage. But the rhetoric of heroism masked a harsher reality: nurses were sent into hospitals without adequate protective equipment, with overwhelming patient loads, and with little institutional support. The language of devotion was used as a shield against criticism, even as nurses themselves broke down from exhaustion.
The problem begins in nursing education. Students are taught the technical skills of patient care, but they are also socialized into a culture that emphasizes resilience, self-sacrifice, and “doing whatever it takes.” Clinical rotations often expose nursing students to chronic understaffing and unsafe patient loads, but instead of treating this as structural failure, students are told it is simply “the reality of nursing.” In effect, they are trained to adapt to dysfunction rather than challenge it.
Once in the workforce, the pressures intensify. Hospitals and clinics operate under tight staffing budgets, pushing nurses to manage far more patients than recommended. Shifts stretch from 12 to 16 hours, and mandatory overtime is not uncommon. Documentation demands, electronic medical record systems, and administrative oversight add layers of clerical work that take time away from direct patient care. The emotional toll of constantly navigating life-and-death decisions, combined with lack of rest, creates a perfect storm of burnout. The grand irony is that the profession celebrates devotion while neglecting the well-being of the devoted. Nurses are praised as “heroes” during crises, but when they ask for better staffing ratios, safer conditions, or mental health support, they are often dismissed as “not team players.” In non-unionized hospitals, the risks are magnified: nurses have little leverage to negotiate schedules, resist unsafe assignments, or push back against retaliation. Instead, they are expected to remain loyal, even as stress erodes their health and shortens their careers.
Recent years have shown that nurses are increasingly unwilling to accept this reality. In Oregon in 2025, nearly 5,000 unionized nurses, physicians, and midwives staged the largest health care worker strike in the state’s history, demanding higher wages, better staffing levels, and workload adjustments that reflect patient severity rather than just patient numbers. After six weeks, they secured a contract with substantial pay raises, penalty pay for missed breaks, and staffing reforms. In New Orleans, nurses at University Medical Center have launched repeated strikes as negotiations stall, citing unsafe staffing that puts both their health and their patients at risk. These actions are not isolated. In 2022, approximately 15,000 Minnesota nurses launched the largest private-sector nurses’ strike in U.S. history, and since 2020 the number of nurse strikes nationwide has more than tripled.
Alongside strikes, nurses are pushing for legislative solutions. At the federal level, the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act has been introduced, which would mandate minimum nurse-to-patient ratios and provide whistleblower protections. In New York, the Safe Staffing for Hospital Care Act seeks to set legally enforceable staffing levels and ban most mandatory overtime. Even California, long considered a leader in nurse staffing ratios, has faced crises in psychiatric hospitals so severe that Governor Gavin Newsom introduced emergency rules to address chronic understaffing linked to patient harm. Enforcement remains uneven, however. At Albany Medical Center in New York, chronic understaffing violations led to hundreds of thousands of dollars in fines, a reminder that without strong oversight, even well-crafted laws can be ignored.
The United States’ piecemeal and adversarial approach contrasts sharply with other countries. In Canada, provinces like British Columbia have legislated nurse-to-patient ratios similar to those in California, and in Quebec, unions won agreements that legally cap workloads for certain units. In the United Kingdom, the National Health Service has long recognized safe staffing as a matter of public accountability, and while austerity policies have strained the system, England, Wales, and Scotland all employ government-set nurse-to-patient standards to protect both patients and staff. Nordic countries go further, with Sweden and Norway integrating nurse well-being into health policy; short shifts, strong union protections, and publicly funded healthcare systems reduce the risk of burnout by design. While no system is perfect, these models show that burnout is not inevitable—it is a political and policy choice.
Union presence consistently makes a difference. Studies show that unionized nurses are more successful at securing safe staffing ratios, resisting exploitative scheduling, and advocating for patient safety. But unionization rates in nursing remain uneven, and in many states nurses are discouraged or even legally restricted from organizing. Without collective power, individual nurses are forced to rely on personal endurance, which is precisely what the system counts on.
The outcome is devastating not only for nurses but for patients. Burnout leads to higher turnover, staffing shortages, and medical errors—all while nursing schools continue to churn out new graduates to replace those driven from the profession. It is a cycle sustained by institutional denial and the myth of infinite devotion.
If U.S. higher education is serious about preparing nurses for the future, nursing programs must move beyond the rhetoric of sacrifice. They need to teach students not only how to care for patients but also how to advocate for themselves and their colleagues. They need to expose the structural causes of burnout and prepare nurses to demand better conditions, not simply endure them. Until then, the irony remains: a profession that celebrates care while sacrificing its caregivers.
Sources
American Nurses Association (ANA). “Workplace Stress & Burnout.” ANA Enterprise, 2023.
National Nurses United. Nursing Staffing Crisis in the United States, 2022.
Bae, S. “Nurse Staffing and Patient Outcomes: A Literature Review.” Nursing Outlook, Vol. 64, No. 3 (2016): 322-333.
Bureau of Labor Statistics. “Union Members Summary.” U.S. Department of Labor, 2024.
Shah, M.K., Gandrakota, N., Cimiotti, J.P., Ghose, N., Moore, M., Ali, M.K. “Prevalence of and Factors Associated With Nurse Burnout in the US.” JAMA Network Open, Vol. 4, No. 2 (2021): e2036469.
Nelson, Sioban. Say Little, Do Much: Nursing, Nuns, and Hospitals in the Nineteenth Century. University of Pennsylvania Press, 2001.
Kalisch, Philip A. & Kalisch, Beatrice J. The Advance of American Nursing. Little, Brown, 1986.
Oregon Capital Chronicle, “Governor Kotek Criticizes Providence Over Largest Strike of Health Care Workers in State History,” January 2025.
Associated Press, “Oregon Health Care Strike Ends After Six Weeks,” February 2025.
National Nurses United, “New Orleans Nurses Deliver Notice for Third Strike at UMC,” 2025.
NurseTogether, “Nurse Strikes: An Increasing Trend in the U.S.,” 2024.
New York State Senate Bill S4003, “Safe Staffing for Hospital Care Act,” 2025.
San Francisco Chronicle, “Newsom Imposes Emergency Staffing Rules at State Psychiatric Hospitals,” 2025.
Times Union, “Editorial: Hospital’s Staffing Violations Show Need for Enforcement,” 2025.
Oulton, J.A. “The Global Nursing Shortage: An Overview of Issues and Actions.” Policy, Politics, & Nursing Practice, Vol. 7, No. 3 (2006): 34S–39S.
Rafferty, Anne Marie et al. “Outcomes of Variation in Hospital Nurse Staffing in English Hospitals.” BMJ Quality & Safety, 2007.
Aiken, Linda H. et al. “Nurse Staffing and Education and Hospital Mortality in Nine European Countries.” The Lancet, Vol. 383, No. 9931 (2014): 1824–1830.
Where hands-on learning meets visionary research in healthcare
The University of New Hampshire is home to the School of Nursing, where students can help shape the future of healthcare through real-world clinical experience and innovative research opportunities.
UNH’s status as an R1 research institution and its proximity to some of the nation’s premier medical centers provide you with unmatched clinical learning and nursing research opportunities—empowering you to make an impact in healthcare from day one.
Building on 60 years of nursing education excellence at UNH, the newly launched School of Nursing offers programs from pre-licensure through clinical doctorate, both in-person on the Durham campus and online, creating flexible pathways that meet you where you are in your journey toward meaningful impact in healthcare.
Explore different paths in nursing
At UNH’s School of Nursing, you’ll find your perfect fit among bachelor’s, master’s, and doctoral degree options designed to match your goals and aspirations.
Charles Adler discovered his passion through UNH’s hands-on approach. After earning his bachelor’s in nursing and a master’s as a clinical nurse leader, he’s now enrolled in the Family Nurse Practitioner (FNP) program, which offers the flexibility he needs.
“I love the clinical environment, whether it’s a pediatrician’s office or a primary care or hospital setting—that’s where things started to click for me,” Adler said.
The real-world experience that defines UNH’s approach has shaped his entire career trajectory. His senior practicum led directly to a job in an ICU, which opened doors to experience as a travel nurse, clinical nurse leader, and finally to his current role as an FNP.
“I wouldn’t have been able to have the experiences I’ve had if it weren’t for UNH nursing,” Adler reflects.
Where knowledge meets practice
At UNH, you don’t have to choose between rigorous academic learning and real-world practical skills; you get both. Our commitment to hands-on learning means you’ll graduate not just with depth of knowledge and a degree, but with the practical skills and forward-thinking approach that healthcare needs.
Ready to pursue meaningful impact in healthcare? If you’re drawn to a field where you can make a real difference, UNH’s one-of-a-kind School of Nursing offers clinical learning to propel you to exceptional career opportunities that make an impact.
Reality TV star Ciara Miller, also a traveling ICU nurse, discusses how honest communication, supportive colleagues, and personal routines can help nurses manage burnout.
What does the word “strength” mean to you when you think of nurses?
Strength, to me, is the quiet resilience nurses carry every day. It’s not just physical — being on your feet for 12+ hours — it’s emotional. It’s being there for people on their hardest days and still showing up with empathy. That kind of strength is deep. It’s unspoken, but it’s so powerful.
What message would you share with nurses who may be feeling burnt out or unseen, especially when mental health isn’t openly talked about?
I’ve been there. Honestly, burnout is real, and it’s okay to say you’re not okay. You’re not weak for feeling exhausted; you’re human. I’d say to find your support system, whether that’s therapy, a trusted friend, or just a coworker who gets it. You deserve care, too. You can’t pour from an empty cup, and it’s not selfish to protect your peace.
Can you share a personal experience where communication, with either a patient or a coworker, made a real difference in your day?
I remember a shift where everything was chaotic — understaffed, high acuity. One of my coworkers pulled me aside and just said, “I’ve got your back. What do you need?” That moment changed the tone of my entire day. It reminded me I wasn’t alone, and we were in it together. That one check-in made a huge difference.
What are some small things that help you feel good and stay comfortable, even on tough days?
Skincare after a shift is my ritual. It sounds small, but it’s grounding for me. Music on the drive home, comfy clothes, and a moment of silence before bed. Also, I try to remind myself that I did the best I could that day. That mindset — grace over perfection — keeps me sane.
What role do you think communication plays in building strong, supportive teams in healthcare settings?
It’s everything. Honest, respectful communication creates trust. When people feel heard, they feel valued. That’s how you build a team that supports each other, where it’s okay to speak up, ask for help, or say, “I’m not okay today.” It’s what makes the difference between surviving and thriving at work.
Actress and ER nurse Jennifer Stone shares how small acts of care, teamwork, and personal routines help nurses stay grounded and effective.
Can you share a moment from your career that reminded you why you chose nursing?
I had a doctor once tell me, “If you can really touch one person a shift, it’s been very successful, and that’s a good shift.” As a nurse, you’re always rushing around; it’s very fast-paced, especially in the ER, so it’s about the moments of stillness with somebody who just needs comfort or somebody to care for them. Whether it’s an older person who doesn’t have anybody and just wants to talk, or if it’s somebody who’s really scared, you can just try to make time, stop a little, and be like, “Hey, you’re okay. You’re in the best possible place, and we’ve got you.” It’s those moments of being a sense of certainty for someone in a time of uncertainty that remind me why I do what I do.
What’s one piece of technology or equipment that’s made your work as a nurse more efficient or effective?
That’s a great question. A great piece of technology that has made nursing more effective is, I hate to say, the PureWick. We have a lot of non-ambulatory patients, so the PureWick, a condom catheter, helps patients stay more comfortable without using something like a bedpan, which can feel kind of demeaning or uncomfortable or cause bedsores. Also, things like ultrasound machines for hard-stick IVs. Those are game changers. Also, updated charting systems. Having good shorthand to be able to chart efficiently and get back to one-on-one patient care is great.
Has there been a time when strong communication, with either a patient or teammate, made a big difference in your day?
I didn’t anticipate that there would be so many parallels between acting and nursing, but one of my favorite things about both is the collaboration.
Whenever I have a nurse that’s in my team — whether they jump in when I’m stuck in another room with a patient or I do the same for them — it’s that shorthand of seeing that a nurse has a need and collaborating. We’re all on the same team. We’re all trying to accomplish the same thing — better patient outcomes. When I have a nurse who, without me even asking, will jump in and help me with the patient, that makes me feel like we’re all collaborating on this together for a common goal. That’s something that just means the world to me — when nurses will help each other out.
What advice would you give to a nurse who’s feeling overwhelmed or underappreciated right now?
Focus on what you can control. I’ll be very honest. For me, I know sometimes, especially in the earlier years, I would get very angry at things that were very out of my control. Whether it was issues with the healthcare system, or the way the system was set up and falling short, I would find myself getting very angry and discouraged. What’s helped me is to focus on the things that I can control. Yes, they may be on a smaller scale, but I can control how I respond to negativity at work or positivity at work. I can control how I talk to patients. I can control what I let in and what I don’t. Especially in an ER environment, or any healthcare bedside environment, there can be a lot of negativity, unfortunately, and it’s within your control what you let in.
I’ll be honest: Some days I win, and some days I lose and allow things in, for sure. There are shifts I ended where I was like, “Alright, this shift beat me.” But I try to make it so I am in control of how I respond to the healthcare industry, and to know that it’s all a choice. Although some days it’s harder than others.
What daily habits or small routines help you stay grounded and feel good during long or stressful shifts?
Getting outside, to be honest. Time stands still when you’re on a 12-hour shift, so I carve out time if I can — and not every shift allows for it — but when I can, I carve out time to just get outside, get some vitamin D, and look at some nature. It’s something to remind you that the entire world isn’t those fluorescent lights. It’s just sort of reconnecting with life outside of the hospital.
I had the privilege of attending a nursing conference at Creighton University. From the moment the first keynote speaker began to share, I felt deeply inspired. Her words focused on the foundational role nursing theorists and their frameworks play in shaping our professional identity. As someone with more than 30 years in this field, her reflections stirred something meaningful in me. It reminded me that the journey to becoming a strong nurse—and an enthusiastic, confident educator—is never a solo effort. We are shaped and supported by those around us: our families, mentors, peers, administrators, and communities.
Our mentors model excellence and cheer us on, encouraging us to aim higher and trust our abilities. Our peers walk beside us, offering camaraderie, support, and shared wisdom. A strong administration gives us the resources, trust, and space to innovate—to build thoughtful curricula and design meaningful assessments. Together, they help us grow in ways we may not always recognize in the moment but deeply appreciate in hindsight.
Be an Advocate
One of my earliest mentors showed me that being an educator is about more than teaching content—it’s about showing up and being a reliable advocate. She was the first to model what it means to truly be there for students, during both their triumphs and their hardest moments. Her open-door policy wasn’t just a phrase—it was a way of life. Through her, I learned that advocacy means listening, guiding, and supporting with consistency and compassion. It’s a daily practice of presence and empathy, and it’s where true impact begins.
Set the Bar High
“Set the bar high, and students will strive to reach it.” Those words, shared with me by a mentor years ago, continue to guide my philosophy. She believed in the boundless potential of every student and taught me that high expectations, paired with strong support, yield incredible growth. I have seen this in action countless times. When we show students that we believe in their capabilities, they rise—not just to meet the challenge, but often to surpass it.
Be a Cheerleader
One of the most joyful lessons I learned from a mentor was to bring genuine enthusiasm into the classroom. A smile can shift the energy in a room. She encouraged me to use affirmations and call-and-response interactions to build confidence and connection. Small moments, like telling students, “You are capable, confident, and ready,” go a long way. With her influence, I learned to energize a room and help students believe in themselves through positivity and encouragement.
Be Innovative
I was lucky to be mentored by educators who challenged me to move beyond traditional teaching methods. They encouraged me to embrace active learning, to create space where students become participants rather than passive listeners. These mentors inspired me to design experiences that reflect the real world our students will step into—fast-paced, complex, and collaborative. They also reminded me to have fun, to bring my full self into the classroom, and to enjoy the creativity and spontaneity that comes with teaching.
Find Your Theme
One mentor encouraged me to find my scholarly “theme”—an area that aligned with my passion and values. She emphasized that impactful scholarship isn’t just about output; it’s about focus, authenticity, and purpose. Through her mentorship, I found my academic voice. She pushed me to take chances, refine my work, and stay aligned with what truly matters to me. Because of her, I continue to approach writing and research with purpose and pride.
Step Outside Your Comfort Zone
Growth often begins with discomfort, and one mentor was instrumental in helping me embrace that truth. She encouraged me to try new teaching strategies and take risks, even when they felt uncertain. Her example helped me see failure not as defeat, but as an essential part of learning. She taught me to model resilience and curiosity—traits I now pass along to my students.
Be Confident
Confidence as an educator doesn’t come overnight, and for me, a peer played a key role in building that. She guided me in designing exam questions that challenge critical thinking and reflect real-world application. Her belief in my abilities helped me believe in myself. Thanks to her, I now approach assessments as a vital, thoughtful part of the learning process.
Meaningful Connections
Over the years, I’ve formed lasting connections with peers who have become dear friends. Even while teaching at different institutions, our collaboration has remained strong. We share resources, brainstorm, and support each other. These partnerships are more than professional—they’re deeply personal, and they remind me how important it is to foster connection in our work.
Work-Life Balance
Recently, a peer helped me realize the value of setting boundaries and honoring my well-being. She taught me that time for rest, family, and joy is essential—not a luxury. Her example helped me reframe self-care as a necessity for sustained excellence. Today, I prioritize balance, and it’s made me a more effective, fulfilled educator.
Spirituality and Compassion
A mentor once reminded me that spirituality is an essential part of holistic nursing. She taught me that kindness, compassion, and a joyful heart—especially one filled with color (purple, in her case!)—are just as important as clinical skills. Her teachings helped me understand that healing involves the whole person, and that our energy, presence, and spirit deeply affect those we serve.
Joy and Motivation
One of my greatest sources of daily encouragement is my son. His love, his kind words, and his constant support fuel my motivation and joy. He reminds me to live fully, to stay grateful, and to appreciate each moment. Knowing he’s proud of me pushes me to be my best, every single day.
Without Limitation
A dear friend once told me that I deserve all the good things life has to offer—and that I should never doubt my worth. Her belief in me helped me overcome self-imposed limits. Because of her, I’ve stepped into new opportunities with courage, knowing I am capable and deserving.
Cultural Respect and Humility
One of the most impactful lessons I’ve learned came from a mentor who emphasized cultural humility. She taught me to approach every person as a unique individual, with their own story, values, and needs. In both education and care, respect and humility create space for genuine connection and better outcomes. I strive to carry this mindset into every classroom and clinical setting.
My Foundation
At the start of my journey, a mentor believed in me when I struggled to believe in myself. She urged me to pursue my graduate degree and never let me settle for less than my full potential. Her faith in me laid the foundation for the educator I’ve become. I carry her lessons with me daily and hope I’ve made her proud.
An Honor to Witness
Every day, I learn from my students. Their empathy, dedication, and curiosity inspire me. They cheer each other on, advocate for others, and bring fresh perspectives into the classroom. It’s an honor to witness their growth and to be part of their journey. They are already showing the compassion and leadership that will define their futures in nursing.
Future Leaders
The students I mentor often think I’m guiding them—but the truth is, they inspire me. Their passion and eagerness to become nurse educators push me to reflect, evolve, and reach higher. They remind me why I chose this path: to make a difference and help others do the same. They are the future of nursing education, and I’m proud to be a part of their development.
The Sigma conference was more than an event—it was a heartfelt reminder that growth in nursing and education is a shared journey. The keynote speaker’s message brought me back to the many people who have walked with me these past three decades. I am who I am today because of their mentorship, encouragement, and belief in me. As we move forward in our profession, may we all strive to lift others as we have been lifted—to teach, lead, and advocate with purpose, passion, and heart.
Dr. Maureen Hermann earned her BSN (1995), MSN (2011), and DNP (2016), with an emphasis in leadership, from Saint Francis Medical Center College of Nursing in Peoria, IL. Dr. Maureen Hermann is an Associate Professor at Creighton University, Omaha, Nebraska.
