The shortage of nurses is straining our hospitals and increasing health-care costs—and yet there are also big barriers in place for students interested in entering the profession where they are sorely needed. But with some creative collaboration, a scalable solution that addresses the needs of all stakeholders—students, schools, and hospitals—may now be in sight.
The clinical staffing shortage isn’t a small problem.
In 2024, nearly half of hospitals had nursing vacancy rates higher than 10 percent, with the average time to fill a Registered Nurse (RN) position taking anywhere from 59 to 109 days. Nationwide the shortage of RNs is roughly 350,000. States like California had a shortage of over 100,000 nurses and Georgia had over 34,000.
Our country’s inability to solve this crisis has led not just to a shortage of trained professionals to the detriment of patient care—but also a steadily increasing set of costs in the form of rural hospital closings, signing bonuses, poaching, contract labor, and expensive internationally educated nurses.
The challenge is threefold: not enough individuals completing nursing school; not enough capacity in existing nursing schools; and the friction associated with traditional tuition assistance programs.
What these three challenges have in common is a desire to avoid risk.
Prospective students can be reticent to take on the high cost of education—an average yearly cost of $30,884 for a Bachelor of Science in Nursing according to the National Center for Education Statistics. That cost comes on top of the opportunity cost from not working and lack of security that students will find jobs at the local employers where they want to work.
There’s also the risk of failure. Yes, many programs boast high graduation and licensure pass rates. And given the shortage of nurses, most graduates can then find a job. But the education to employment path has bumps—which means that at least four out of ten students are likely to fall through one of these cracks at some point in their journey.
Most nursing schools are also trying to minimize risk.
Although affordable, online programs do operate at scale, most students still enroll in local colleges. And those schools are cautious about over-expanding and having to slash costs once the nursing shortage passes, as it has done in past—albeit more short-lived—episodes. What’s more, nursing programs often have difficulty finding sufficient faculty and are dependent on hospitals for clinical slots as part of students’ hands-on practicum requirement. Together, that has created limited nursing school capacity. In 2021, nursing schools turned away over 91,000 qualified applicants.
Even though hospitals could alleviate some of the shortage by funding the cost of a nurse’s education to solve their challenge, they have been understandably reticent to take on the cost and risk of training people who might simply pick up and leave for a better salary at a different hospital.
There’s good news on the horizon. New, scalable programs are emerging to help students enter the nursing field with less debt and more job security—and to help health systems retain new nurses.
The idea behind one such program is that students commit to earning their degree and working for three years in local hospitals. Hospitals in turn commit to repay a significant portion students’ loan debt through a scholarship fund that it draws down over three years. This eliminates some risk for the student—as they know they can pay for the education and they’ll have a job on the other side.
By way of example, UNC Health Wayne, a nonprofit hospital affiliate of the UNC Health System and one of the largest private employers in Wayne County, expects to invest in its workforce through the program while recognizing cost savings. If a nurse leaves the hospital for another health system before three years, then the hospital isn’t responsible for any more payments—so their risk is also minimized. And the cost of repaying student loans is less than paying for contract labor, signing bonuses and the like.
“Nurses are a vital part of our healthcare system, especially in rural communities like ours,” said Dr. Jessie Tucker, CEO of UNC Health Wayne. “The UNC Health Wayne Nursing Scholars Program is a powerful tool to help us attract and retain top talent. Through our partnership with Noodle’s Scholars Network, we’re investing directly in students while building a more stable, sustainable healthcare workforce for our region.”
Different states are working to bring schools together with hospitals to reduce risk for everyone. Another bright spot is in New England, where the Scholars Network is working with Providence College to lead a consortium of nursing schools to address the problem and increase capacity.
For nursing schools, they get valuable clinical rotation spots in hospitals that they need to expand—with a guarantee for graduating students that they’ll have a job, which improves their value proposition. The schools can then bolster capacity without a big investment in infrastructure so they don’t create excess capacity. Prior to employment, many Providence College nursing students will complete work through the PC Summer Nursing Academy and have opportunities to work with their potential future employers early in their degree program.
Providence College has used this as an opportunity to lead an emerging consortium of healthcare and higher education leaders in Rhode Island to address the shortage.
Dr. Kyle McInnis, the founding dean of the School of Nursing and Health Sciences at Providence College said that leveraging partnerships is critical. “Resolving the nursing workforce crisis requires bold cooperation across sectors,” McInnis said. “At Providence College, the Scholars Network is supporting creative ways we partner with hospitals—expanding clinical experience opportunities and creating pathways towards exciting career opportunities. The inclusion of tuition incentives makes it a win for students and healthcare systems who recruit the next generation of nurse leaders.”
In other regions, the state is also playing a role in advancing this approach. In Pennsylvania, the state helped bring the parties together by funding up to one-third of the reimbursement for the students—and now Gov. Josh Shapiro is including the commitment in the state budget to the tune of just $5 million.
This approach is not just relevant to nursing. Solving the shortage in many allied health professions, for example, can happen more quickly and less expensively. Similar high-quality approaches are starting to address shortages in other fields as well, such as teaching.
In each of these areas of national need, this model is a small, smart investment that can make a dent in nursing shortages, lower health-care costs, and improve care.