Walter Cronkite critiqued America’s health care system as “neither healthy, caring, nor a system” in 1993. Thirty-two years later, the U.S. health care system continues to flail. In clinical settings across the country, especially those in rural and other underserved communities, shortages of registered nurses hamper the quality-of-care patients and families receive.
About 30,000 new advanced practice nurses — those prepared in master’s and doctoral programs — will be needed each year through 2032 to meet the challenges of people living longer with increasingly complex health and social needs.
Remarkably, it is at this moment in time that the current administration decides that advanced practice nursing is not a profession. The Department of Education has proposed to remove advanced nursing degrees from its list of professional degree programs, which would significantly limit the amount of federally subsidized loans students are able to obtain.
The move is shortsighted, with little appreciation of its negative downstream effects: It will make it more difficult for nurses with bachelor’s-level training to seek further specialized training in critical areas, such as primary and acute care, oncology, pediatrics, gerontology, and anesthesia, by pursuing a master’s of science in nursing, nurse practitioner, doctor of nursing practice, or doctor of philosophy degrees.
In the short-term, this decision will make it more difficult for nurses with an undergraduate degree to obtain the federal financial aid essential to obtain more specialized training in critical areas as previously noted. Given the cost of education today, limiting federal support to $20,000 annually and $100,000 over a lifetime will make the pursuit of advanced degrees cost-prohibitive for a large segment of bachelor’s-prepared nurses.
The ailing U.S. health care system needs these highly trained nurses to meet the challenges of caring for an aging population or for children living longer with increasingly complex health conditions who require tailored, multifaceted treatments.
More than 18 million people (5.4% of the U.S. population) are living with cancer. They require treatments, testing and monitoring, and ongoing support. More than 29 million Americans have at least one major chronic disease, and many have more than one. We also have a mental health crisis, with 4.5 million adolescents reporting a major depressive episode and 20% who have seriously considered suicide.
These realities forecast the need for more highly trained registered nurses, who not only deliver expert care but also lead the research that drives innovative treatments.
Is the administration unaware that nursing has matured into a highly skilled profession helping to heal the complex ills of modern society and addressing the need for primary and acute care in light of a shrinking physician workforce? Approximately one-fifth of primary care services in the U.S. are provided by nurse practitioners and increasingly, hospitalized patients are managed by acute care NPs.
The nursing workforce also plays a vital role in the delivery of preventative health services, with a considerable body of evidence that supports the quality of care that NPs provide with positive and cost-effective health-related outcomes. These advanced practice clinicians collaborate with their physician counterparts, but they are also autonomous and exercise independent judgement in clinical care.
More than 460,000 advanced practice nurses fill the void as primary care specialists for many rural and underserved communities and marginalized populations.
At a time of exponential growth in demand and workforce shortages, why make it harder for nurses to obtain advanced training?
Decreasing access to federal funding for graduate nursing education will further exacerbate the overall nursing shortage by creating a crisis in the availability of faculty with advanced degrees. Many who aspire to the profession of nursing are turned away from both undergraduate and graduate programs because of the ongoing shortage of nursing faculty. In fact, in 2023 nursing schools turned away over 65,000 applicants to baccalaureate and graduate nursing programs, primarily due to an insufficient number of faculty. This decision will severely impede the preparation of nurse researchers, whose scientific contributions have enhanced the lives and well-being of all Americans, to discover new evidence-based treatments and approaches to care.
In the longer term, a large reduction in the advanced practice nurse workforce poses a serious threat to the public’s health. When access to education is restricted and the health care workforce shrinks, the human costs are severe. Fewer advanced practice nurses will result in higher rates of preventable illness and death, increased rates of health care deserts, and communities without care providers and incalculable suffering. Nurse practitioners who work in underserved communities may be forced to shift to higher paying jobs elsewhere.
In the context of a system of healing that has instead become a web of suffering, where individuals and families struggle to navigate endless barriers, why are we questioning whether nursing is a profession, whether nurses who have consistently applied critical knowledge and skills to enable the people they serve are indeed professionals?
Nursing is a profession. Nurses are professionals. In fact, nursing (and advanced practice nursing) clearly meets and exceeds the 1965 federal definition, which states that a professional degree “signifies both completion of the academic requirements for beginning practice in a given profession and a level of professional skill beyond that normally required for a bachelor’s degree.” The current Department of Education proposal is in direct conflict with the 1965 definition, is ill advised, and will imperil the nursing workforce.
Nurses must be recognized and redesignated as a profession by the Department of Education. To deny this reality, to demean nurses and undermine their professional contributions, is simply uninformed and dangerous. To limit the resources needed to train the next generation of nurse educators, leaders, and scientists, stifles nursing science-based care, further erodes patient trust, and jeopardizes patients’ lives.
Nurses have always filled the gap in our health care system and are the glue that holds health care together. Amid her struggle with leukemia, Tatiana Kennedy Schlossberg wrote: “I have never encountered a group of people who are more competent, more full of grace and empathy, more willing to serve others than nurses. Nurses should take over.”
It is time to reverse course, correct this wrong, and affirm nursing’s rightful place as a profession to ensure that nurses have the resources they need to prepare themselves to deliver the best care possible that all Americans expect. When patients enter hospitals, primary care offices, long-term care residences, and research settings, they rely on registered nurses to deliver expert and humanistic care, uphold their dignity, and allay their fears.
If nursing is not a profession, what is?
Connie M. Ulrich, Ph.D., R.N., is the Lillian S. Brunner endowed chair in medical and surgical nursing, and professor of nursing and medical ethics and health policy, at the University of Pennsylvania School of Nursing and Perelman School of Medicine. Mary Naylor, Ph.D., R.N., is the Marian S. Ware professor in gerontology and professor of nursing at the University of Pennsylvania School of Nursing. Martha A.Q. Curley, Ph.D., R.N., is the Ruth M. Colket endowed chair in pediatric nursing at the Children’s Hospital of Philadelphia and professor of nursing at the University of Pennsylvania School of Nursing.
