In California, America’s most trusted profession is in deep trouble | Opinion
Nursing, the nation’s largest health care profession, is in critical condition. The U.S. faces a shortfall of more than 78,000 full-time registered nurses this year alone, and California’s projected nursing workforce gap is among the largest. Nurses are fleeing the profession for familiar reasons: an aging workforce, high turnover and burnout that began long before the COVID pandemic and only deepened after it. But an overlooked cause of this crisis isn’t at the bedside — it’s in the classroom.
We don’t have enough educators to train new nurses, and Washington’s recent funding cuts will make that shortage even worse — especially here in California.
While Gov. Gavin Newsom and state lawmakers have taken steps to support nursing education, recent federal actions have weakened this progress. Congress dealt the first blow to nurse educators by slashing $46.8 million from Nursing Workforce Development Programs. That cut eliminated both the Nurse Faculty Loan Repayment Program and the Nursing Workforce Diversity Program.
Soon after, the Department of Education struck by excluding nursing from professions eligible for higher federal financial loan assistance. The timing is deeply ironic: While the federal government promotes its “Make America Healthy Again” plan, it’s eliminating funding for the professionals who make that vision possible.
U.S. nursing schools turned away 65,766 qualified applicants in 2023, so it’s clear that plenty of people want to become nurses. Nearly a quarter of California nursing schools reported enrolling fewer students that same year because they lack sufficient faculty, according to the state’s Board of Registered Nursing. This bottleneck has nothing to do with student interest and everything to do with economics.
Nursing educators often take significant pay cuts to leave clinical practice for the classroom; in California, this pay cut averages about $30,000. I’ve approached several promising students to consider returning to teach. Their honest reply is always the same: “Geez, Professor Nguyen, I wish I could, but I can’t afford too.”
We cannot train enough nurses because we can’t afford to pay the people qualified to teach them.
Nursing schools are not the problem. They are operating under mounting challenges including budget cuts, hiring freezes and a significant number of nurse faculty retirements. Those who remain will take on higher workloads. Not only do we teach in classrooms, but we also scramble to secure training sites for our students and plead with busy clinicians to supervise them during hands-on training in clinical settings. This challenge is particularly severe for California nursing schools, where limited access to clinical placements remains the top obstacle to expanding enrollment.
At the same time, the pathway into nursing education is shrinking. Earning a doctoral degree to teach nursing is expensive. My doctoral nursing students juggle full-time jobs, families and coursework. New caps on federal student loans and the elimination of the Nurse Faculty Loan Repayment Program will pile extra financial burdens on doctoral students.
In 2023, enrollment in undergraduate nursing programs grew by 0.3%, but enrollment in PhD nursing programs declined by 3.1%. The math does not add up. Future nurse educators will have to go into more debt or leave academia altogether.
The nursing shortage has many causes: Unsafe working conditions, high patient-to-nurse ratios and moral distress drive nurses out of the profession. But we can’t overlook the pathway into nursing. Even if we could retain every existing nurse, we have to invest in those who train the new ones we need. Doing so isn’t just good for health care, it’s good for the economy.
Nurses make up America’s fifth-largest occupation, and 1 in 10 of the country’s nurses live in California, according to the California Health Care Foundation. We need to reinstate meaningful funding for nurse educators.
The recently-killed Nurse Faculty Loan Repayment program cancels up to 85% of educational loans for those who commit to teach for four years. I know firsthand how vital this program is — it’s the only reason I can afford to teach and live in California.
Congress can pass legislation like the Nursing Workforce Reauthorization Act of 2025, which would maintain funding for nursing education at current levels. This bill has bipartisan support. The Department of Education must recognize nurses as a profession that qualifies for more federal student loans, particularly in states where the cost of living makes academic careers financially precarious.
For every nurse who’s held your hand, helped you deliver a baby or cared for a loved one, there was a nurse educator who taught them how. It’s time for us to show America’s most trusted profession how much we value them.
My Hanh (Theresa) Nguyen, PhD, is a board certified psychiatric-mental health nurse practitioner and an associate professor in the Hahn School of Nursing and Health Science at the University of San Diego as well as a recent alumna of UCLA’s National Clinician Scholars Program.