Friese Warns Graduate Loan Caps Threaten Nursing Pipeline

University of Michigan

Proposed federal borrowing limits on graduate degrees will deter nurses from pursuing advanced education and faculty roles, exacerbating critical shortages in patient care.

AI-assisted summary of When nurses cannot afford to advance — original source. Check the original for full context.

Source published: 2026-09-11

Key ideas

Proposed federal regulations capping graduate borrowing at $20,500 annually and $100,000 aggregate threaten to deter registered nurses from advancing into specialized clinical and faculty roles. (8:17)
Data from the Michigan Nurses Study reveals that roughly one-third of registered nurses already carry significant debt, and one-third of indebted advanced practice nurses hold balances exceeding the proposed $50,000 graduate threshold. (8:17)
Educational debt directly drives nurse turnover, making indebted clinicians far more likely to leave positions or seek new employment over compensation concerns and household financial stress. (10:46)
A bipartisan group of 100 federal lawmakers has urged the Department of Education to classify nursing as a professional degree, while states and health systems explore localized loan repayment models to alleviate debt burdens. (20:18)

Detailed notes

## Background Published on YouTube by the University of Michigan on September 11, 2026, this episode of the Michigan Minds podcast features Christopher Friese, a professor of nursing and of health management and policy. According to the show description, Friese draws on findings from the Michigan Nurses Study to explain how proposed federal caps on graduate student loans could deter nurses from pursuing advanced degrees, highlight the financial strain of high student debt on the nursing workforce, and jeopardize patient care as well as the future supply of nurse practitioners, midwives, anesthetists, and nursing faculty.

## TL;DR Dr. Christopher Friese reframes the U.S. nursing crisis not as a raw shortage of licensed personnel, but as a 'leaky bucket' retention problem driven by unsafe clinical environments, inadequate leadership support, and heavy student debt that pushes nurses to switch employers for higher pay. He warns that proposed Department of Education rules capping graduate nursing loans at $20,500 annually ($100,000 lifetime) rest on flawed assumptions, pointing to his team's rapid 57-day re-analysis of the Michigan Nurses Study which proved that one-third of nurses carry substantial debt and one-third of indebted advanced practice nurses borrowed over $50,000 for graduate school. Because mandated low student-to-faculty ratios and a chronic shortage of educators—who earn significantly more in clinical practice than in academia—prevent universities from simply lowering tuition or safely shortening programs, these borrowing limits threaten to cut off the pipeline of advanced clinicians and future faculty. Rather than restricting access to education, Friese advocates for hospital sponsorships, state and philanthropic loan repayment initiatives, and active constituent outreach to federal lawmakers.

## Atmosphere & style The episode pairs urgent, data-driven policy analysis with a warm, conversational rapport between host Juan Ochoa and Dr. Friese. Although the subject matter is weighty—spanning workplace violence, household financial strain, and higher education hiring freezes—the discussion feels grounded and relatable, punctuated by Ochoa sharing his family member's struggle to find a clinical teaching post and Friese recounting his own six-month stretch of unemployment after graduating in 1997. The emotional arc moves from clear-eyed concern over short-sighted regulatory barriers to a reassuring sense of long-term resilience, ending on Friese's steady optimism that the nursing profession, like a cat, will ultimately land on its feet.

## Bulletin - [08:17](https://www.youtube.com/watch?v=ligHrH084hA&t=497s) Proposed federal regulations capping graduate borrowing at $20,500 annually and $100,000 aggregate threaten to deter registered nurses from advancing into specialized clinical and faculty roles. - [08:17](https://www.youtube.com/watch?v=ligHrH084hA&t=497s) Data from the Michigan Nurses Study reveals that roughly one-third of registered nurses already carry significant debt, and one-third of indebted advanced practice nurses hold balances exceeding the proposed $50,000 graduate threshold. - [10:46](https://www.youtube.com/watch?v=ligHrH084hA&t=646s) Educational debt directly drives nurse turnover, making indebted clinicians far more likely to leave positions or seek new employment over compensation concerns and household financial stress. - [20:18](https://www.youtube.com/watch?v=ligHrH084hA&t=1218s) A bipartisan group of 100 federal lawmakers has urged the Department of Education to classify nursing as a professional degree, while states and health systems explore localized loan repayment models to alleviate debt burdens.

## Key takeaways - [00:00](https://www.youtube.com/watch?v=ligHrH084hA&t=0s) The U.S. nursing crisis is primarily a retention breakdown driven by unsupportive management and workplace violence rather than an absolute shortage of licensed RNs. - [00:00](https://www.youtube.com/watch?v=ligHrH084hA&t=0s) Pouring new graduates into unsupportive clinical environments creates a 'leaky bucket' dynamic, where newly licensed nurses exit active practice the quickest. - [03:43](https://www.youtube.com/watch?v=ligHrH084hA&t=223s) Proposed federal graduate student loan caps risk choking off the educational pipeline for nurse practitioners, certified nurse-midwives, CRNAs, and academic faculty. - [06:22](https://www.youtube.com/watch?v=ligHrH084hA&t=382s) Clinical nursing programs cannot easily lower tuition because accreditation standards mandate low student-to-faculty ratios and highly qualified instructors. - [06:22](https://www.youtube.com/watch?v=ligHrH084hA&t=382s) Innovative financing models, including federal loan repayment programs and hospital-sponsored tuition agreements with retention commitments, are essential to offset training costs. - [08:17](https://www.youtube.com/watch?v=ligHrH084hA&t=497s) Michigan Nurses Study findings refuted federal assumptions by demonstrating that heavy borrowing is already a standard reality for a large share of advanced practice nurses. - [10:46](https://www.youtube.com/watch?v=ligHrH084hA&t=646s) Educational debt directly correlates with job turnover, prompting nurses to switch employers primarily to seek better pay and benefits to stabilize household finances. - [12:21](https://www.youtube.com/watch?v=ligHrH084hA&t=741s) Departing nurses follow three main pathways: moving laterally to another nursing employer for higher pay, permanently leaving the profession, or stepping away temporarily for family caregiving before returning. - [12:21](https://www.youtube.com/watch?v=ligHrH084hA&t=741s) High nurse mobility creates an economic conundrum for health systems, which invest heavily in clinical onboarding and on-the-job training that cannot be recouped when staff depart. - [14:19](https://www.youtube.com/watch?v=ligHrH084hA&t=859s) A persistent shortage of nursing faculty is driven by a stark pay gap between academic salaries and higher-reimbursed clinical practice as advanced practice registered nurses. - [14:19](https://www.youtube.com/watch?v=ligHrH084hA&t=859s) Friese proposes creating targeted incentives that allow advanced practice clinicians to allocate part of their time toward academic teaching without taking a punitive pay cut. - [16:07](https://www.youtube.com/watch?v=ligHrH084hA&t=967s) Current hiring freezes and faculty placement difficulties reflect broader higher education instability in 2026, though long-term career resilience in nursing remains robust. - [18:21](https://www.youtube.com/watch?v=ligHrH084hA&t=1101s) Proposals to shorten nursing degree curricula to rush graduates into hospitals risk undermining clinical competence and patient safety without solving the underlying retention leak. - [20:18](https://www.youtube.com/watch?v=ligHrH084hA&t=1218s) Advocacy against Department of Education loan caps includes protests outside the White House and a bipartisan letter signed by 100 lawmakers pushing for nursing's professional degree designation. - [21:29](https://www.youtube.com/watch?v=ligHrH084hA&t=1289s) State-level loan repayment programs, hospital-sponsored debt relief, and targeted philanthropic donations are emerging as vital localized buffers against federal borrowing limits.

## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=ligHrH084hA&t=0s) Re-evaluating the "Shortage": A Leaky Bucket in the Nursing Workforce

Host Juan Ochoa introduces Christopher Friese, professor of nursing and health management and policy at the University of Michigan School of Public Health, framing nursing as one of the country's most trusted professions yet facing a growing mismatch between supply and demand. Friese challenges the conventional framing of a nationwide nurse shortage. Looking at national data, the United States has an ample number of individuals who hold an RN license relative to the population—unlike many other nations. Rather than a pure numbers deficiency, Friese argues the primary crisis is a lack of supportive work environments that retain practitioners.

Surveys and studies reveal that registered nurses leave active practice or cut back hours due to feeling unsupported by leadership and management, as well as an alarming, increasingly frequent sense that their workplace is unsafe due to unaddressed workplace violence. When challenged by Ochoa on why an exodus shouldn’t simply be labeled a shortage, Friese points out that the newest entrants into the profession are departing the quickest. Pouring more graduates into clinical settings without fixing the underlying culture and safety issues creates a classic "leaky bucket" dilemma: the priority must be plugging the hole rather than endlessly replenishing lost personnel, even while acknowledging the system still needs built-in "slack" to absorb shocks like COVID-19.

```mermaid flowchart LR accTitle: The Leaky Bucket Dynamic in Nursing Retention accDescr: Diagram illustrating how incoming registered nurses enter practice but exit rapidly due to adverse workplace conditions rather than a true initial supply deficit. subgraph Supply["Workforce Inflow"] A["New RN Graduates & Licensed Nurses"] end subgraph Retention["Practice Environment"] B["Clinical Practice Environment"] C["Workplace Violence & Safety Risks"] D["Lack of Management Support"] end subgraph Outflow["Attrition (The Leak)"] E["Reduced Hours"] F["Complete Departure from Nursing"] end

A --> B B -.-> C B -.-> D C --> E C --> F D --> E D --> F ```

[03:43](https://www.youtube.com/watch?v=ligHrH084hA&t=223s) The Risk of Proposed Graduate Loan Caps

The discussion shifts toward the Department of Education's proposed regulations designed to place federal borrowing caps on graduate students across medicine, dentistry, social work, occupational therapy, and nursing. While ostensibly aimed at curbing tuition inflation and student debt burdens, Friese explains why applying these constraints indiscriminately to graduate nursing degrees poses a unique danger. Data from the Michigan Nurses Study reveals that roughly one-third of registered nurses carry significant debt from their undergraduate or pre-licensure training alone. Confronting an even steeper debt load to advance their education presents an insurmountable psychological and financial hurdle.

Unlike high-earning professions such as corporate law, specialized medicine, or dentistry, the post-graduation return on investment in nursing takes significantly longer to materialize. Friese warns that the borrowing caps will stop potential candidates from even exploring graduate degree options—deterring them before they ever submit an application, consult a university financial aid office, or investigate employer assistance programs. This threatens to choke off the training pipeline for roles critical to clinical care delivery and institutional training:

- Nurse practitioners delivering primary and specialized care - Certified nurse-midwives providing maternal and reproductive care - Certified registered nurse anesthetists (CRNAs) - Future nursing faculty required to educate and train the next generation of nurses

[06:22](https://www.youtube.com/watch?v=ligHrH084hA&t=382s) Specialized Costs and Alternative Financing in Nursing Academics

When asked why universities cannot simply lower graduate nursing tuition to balance the new loan limits, Friese explains the rigid structural realities of clinical nursing education. Because of the direct clinical responsibilities and high-stakes nature of the work, training advanced practice nurses demands low student-to-faculty ratios and legally mandated instructor qualifications. These faculty positions cannot simply be replaced by non-clinical instructors or cheaper alternatives, leaving almost no room for aggressive cost containment without compromising safety or accreditation standards.

Instead of expecting schools to dramatically slash tuition rates, Friese advocates for innovative, collaborative financing structures that directly alleviate student out-of-pocket expenses. Potential mechanisms include federal loan repayment initiatives and health system sponsorships, where hospitals commit to subsidizing tuition for registered nurses who agree to continue working during school and commit to a retention agreement post-graduation. Without expanding these models, the proposed borrowing restrictions will place prospective applicants into a deep financial squeeze.

[08:17](https://www.youtube.com/watch?v=ligHrH084hA&t=497s) Michigan Study Findings on Debt Limits and Nurse Career Decisions

Friese outlines the specific regulatory mechanics: the Department of Education's rulemaking—introduced in late winter and advancing in early 2026—proposes removing graduate nurses from access to the highest-tier federal loan brackets, capping them instead at $20,500 annually and a $100,000 aggregate lifetime limit. Seeking to test assumptions by proponents who claimed the caps would affect only a negligible fraction of students, Friese's research team mobilized an urgent re-analysis of the Michigan Nurses Study data, completing the project from research design to publication in an unprecedented 57 days between late November and late January.

The empirical data directly refuted the policy's underlying assumptions. Examining self-reported debt levels gathered in 2022 among both RNs and advanced practice nurses, the study established that: - Approximately one-third of the overall nursing cohort carried significant educational debt. - Among practicing advanced practice registered nurses who carried debt, roughly one-third held loan balances exceeding the proposed $50,000 threshold for graduate studies, demonstrating that large borrowing burdens were already a standard reality of advanced nursing credentials.

[10:46](https://www.youtube.com/watch?v=ligHrH084hA&t=646s) How Student Debt Fuels Nursing Turnover and Household Financial Stress

Continuing his analysis of the Michigan Nurses Study, Christopher Friese explains how student loan burdens directly shape job retention and career mobility. When researchers examined whether nurses had recently left a position or were actively looking for another job, they discovered that nurses carrying student debt were far more likely to have recently departed their roles or to be searching for new employment specifically because of pay and benefits. High levels of debt push nurses to make different career decisions, directly feeding into what Friese describes as the profession's "leaky bucket"—a cycle where health systems invest heavily to prepare a nurse who is already working in their clinical setting, only for that nurse to leave in search of better compensation elsewhere to stabilize their personal finances.

Beyond workplace turnover, the personal weight of this debt is substantial. Survey respondents holding student debt were far more likely to report that household finances were a top concern for their families. While the general public often assumes that nurses are well-compensated—which Friese acknowledges is true relative to average wages across the entire United States—the reality on the ground is much more strained. Nursing is demanding, exhausting work, and those carrying heavy educational debt feel that financial pressure acutely at home. For Friese, these findings underscore a clear policy takeaway: "this is not the time to put caps on what nurses can borrow if they want to pursue graduate education, if they want to advance in their profession. And in fact, the opposite is true. We want to open opportunities. We don't want to cut people off."

[12:21](https://www.youtube.com/watch?v=ligHrH084hA&t=741s) Where Departing Nurses Go and the Economic Conundrum of Turnover

When the host asks where nurses actually go when they leave their positions, Friese breaks the departures down into three distinct pathways, drawing on findings from a recent study published in 2026:

```mermaid flowchart TD accTitle: Pathways of Departing Nurses and Employer Impact accDescr: Diagram showing how indebted or departing nurses split into three career pathways, creating an economic conundrum for health systems that lose their training investments.

subgraph Origin["Workforce Departure"] A["Experienced Nurse Leaves Role"] end

subgraph Pathways["Three Departure Pathways"] B["Moves to Another Nursing Employer<br/>(Driven by debt & better pay)"] C["Leaves Nursing Profession Entirely<br/>(Permanent exit)"] D["Steps Out for Family Caregiving<br/>(Re-enters & retrains later)"] end

subgraph Impact["Health System Conundrum"] E["Lost On-the-Job Training Investment<br/>& High Replacement Costs"] end

A --> B A --> C A --> D B --> E C --> E D --> E ```

The most common trajectory is lateral movement within the field: nurses leave their current employer to take a job with another nursing employer, seeking better economic opportunities. The 2026 study demonstrated that nurses holding debt are significantly more likely to belong to this mobile group. A second group leaves the nursing profession altogether and never returns. A third group—which is not well studied in the academic literature but is observed year after year in practice—consists of nurses who step away from the workforce temporarily to raise a family or attend to caregiving responsibilities, only to re-enter the profession later once their children are older or in school and caregiving demands have eased.

Friese views this third pathway as "one of our secret weapons": the inherent flexibility of a nursing career allows professionals to work in one clinical area, step out for a period, return, retrain, and re-enter either in their original specialty or a completely new one. However, while that mobility is great news for individual nurses, it puts hospitals and health systems in a severe bind. As Friese notes, it creates "a bit of a conundrum for the economists in the room": while labor markets function best when employees can move freely as they wish, healthcare employers pour substantial financial investments into on-the-job preparation and training that they cannot recoup when a nurse departs, making it very expensive to replace an experienced clinician.

[14:19](https://www.youtube.com/watch?v=ligHrH084hA&t=859s) The Chronic Shortage of Nursing Faculty and Misaligned Incentives

The conversation turns to a bottleneck that much of the public overlooks: the persistent shortage of nursing educators, compounded by state regulations that strictly cap how many students a single instructor can supervise during clinical rotations. Friese explains that because of the complexity of modern patient care, the nursing profession has established best practices requiring expert nurses—typically those holding a master's degree or higher—to lead classroom instruction and clinical supervision. Research consistently proves that higher investment in nursing education is a "win-win," yielding both better health outcomes for patients and superior educational outcomes for students.

However, maintaining that standard comes at a steep cost, and nursing schools have been chronically short of credentialed faculty for years. "We've been really strapping this together," Friese admits, noting that most nursing programs are actively recruiting faculty almost every single year. The core issue is a structural misalignment of financial incentives:

- **Credential overlap:** Most nurses who hold the advanced degrees required to teach in a nursing school are also qualified to practice clinically as advanced practice registered nurses (APRNs), such as nurse practitioners and nurse midwives. - **Compensation gap:** Clinical practice as an advanced practice nurse is reimbursed at a much higher rate, offering a substantially better salary than academic teaching roles. - **Policy proposal:** To bridge this gap without forcing clinicians into a full-time pay cut, Friese and his colleagues have proposed creating targeted incentives for advanced practice nurses to spend at least a portion of their time teaching.

[16:07](https://www.youtube.com/watch?v=ligHrH084hA&t=967s) Navigating Higher Education Instability and Career Flexibility in 2026

Bringing the issue down to a personal level, the host shares that a family member who previously taught nursing clinicals has been unemployed for about two months and is struggling to find a new teaching position despite wanting to be in the classroom. Friese empathizes, pointing out that this frustrating paradox reflects the acute instability and mismatch currently gripping higher education in 2026. Schools of nursing, along with universities more broadly, are navigating a turbulent environment. Faced with high uncertainty about where the landscape is heading, administrators become cautious: they freeze or reduce new job postings, rely on existing staff to cover needs, and wait to see if conditions stabilize.

To encourage educators and clinicians caught in this hiring freeze, Friese points to the adaptability that has defined his own career. Having served as a professor at the University of Michigan School of Nursing for 18 years, he also maintained an active clinical practice for nearly that entire span until very recently, allowing him to pivot and apply his knowledge across different settings. He also shares a personal anecdote he frequently tells his students to put temporary market downturns into perspective:

- **1997 market freeze:** When Friese graduated with his Bachelor of Science in Nursing (BSN)—the entry-level professional degree—in 1997, he could not find a job as a staff nurse for six months. - **Long-term resilience:** Even though everyone assumes healthcare is perpetually booming, the industry periodically experiences pockets of acute uncertainty. Despite the anxiety of the current moment in 2026, Friese insists that nursing remains a strong long-term investment: "In the long run, like a cat, we will land on our feet."

[18:21](https://www.youtube.com/watch?v=ligHrH084hA&t=1101s) Why Shortening Nursing Programs Won't Fix the "Leaky Bucket"

When asked what happens to the future healthcare workforce if high educational costs lock nurses out of becoming faculty, Friese says that very scenario—alongside a broader underinvestment in professional nursing—is what worries him most. He views the proposed federal cap on graduate student loans as a structural policy barrier that deliberately makes career advancement harder at the exact moment cuando expertise is needed most.

At the same time, he warns against a dangerous counter-trend emerging from colliding pressures in the healthcare sector. Because demand for healthcare services is rising and hospitals need to hire nurses quickly, there is a growing movement to shorten nursing degree programs and push students through the pipeline faster by cutting educational requirements. Friese urges extreme caution against taking such shortcuts:

> "Again, we're pouring more folks in the bucket. We haven't stopped the leak, right? We've got to make sure that not only are we supporting nurses in their workforce, but the people that we're bringing in are competent, qualified, and prepared to work in those settings. And that doesn't come with shortcuts."

He emphasizes that nursing education programs in the United States serve as an international model for other countries, and making hasty cuts to speed up graduation times risks inflicting long-term damage on the quality of nursing education and patient safety.

[20:18](https://www.youtube.com/watch?v=ligHrH084hA&t=1218s) Grassroots Advocacy and Legislative Pushback Against Department of Education Rules

The host notes that opposition to the proposed Department of Education (DOE) loan rules has already sparked visible action: nurses have protested outside the White House, and a bipartisan coalition of 100 federal lawmakers sent a signed letter to the Department of Education urging that nursing be included in the department's definition of a "professional degree." Asked how everyday citizens and nurses can register their opposition now that the formal public comment period has closed, Friese outlines practical steps for civic engagement:

- **Contact federal lawmakers:** Constituents should reach out directly to their elected representatives to ensure lawmakers hear firsthand that nursing workforce issues matter to voters. - **Thank existing allies:** Rather than focusing exclusively on persuading undecided legislators, advocates should make a point of thanking the 100 lawmakers who already signed the bipartisan letter—letting them know, "we saw that you supported provision X. So we thank you for that."

As the nursing community waits to see how the Department of Education ultimately rules, Friese notes that the current policy environment is fluid, characterized by numerous federal proposals being issued and subsequently revisited.

[21:29](https://www.youtube.com/watch?v=ligHrH084hA&t=1289s) Legislative Advocacy and Emerging State and Hospital Debt-Relief Strategies

Continuing his thoughts on how current policies might eventually be retracted or changed after this current period, Dr. Christopher Friese emphasizes the importance of civic engagement, encouraging listeners to let legislators know that these matters are of concern to them. Beyond federal policy, he points out that alternative, localized strategies are beginning to emerge to help alleviate the financial pressure on nurses. States are increasingly exploring whether they can reduce the debt burden through their own state-level loan repayment programs, and individual hospitals are beginning to follow suit.

To illustrate how healthcare institutions and private philanthropy are stepping in, Dr. Friese highlights a recent real-world example from the news: just a few weeks prior, *The Philadelphia Inquirer* ran a story about a donor who contributed funds directly to a hospital specifically to pay off the student loan debt of its nurses. He notes that these developments make for "an interesting time" and that observers will have to watch closely to see how these varied approaches play out.

- **Legislative outreach:** Contacting lawmakers to voice concern and push for policy changes or retractions after the current period. - **State-level initiatives:** States developing their own loan repayment programs to reduce nurses' debt burdens. - **Hospital and philanthropic programs:** Healthcare systems and donors directly funding debt relief, such as the recent case reported in *The Philadelphia Inquirer* where a donor paid off student loan debt for a hospital's nursing staff.

[22:04](https://www.youtube.com/watch?v=ligHrH084hA&t=1324s) Closing Reflections and Optimism for the Nursing Profession

As the podcast reaches its conclusion, the host invites Dr. Friese to share any final thoughts. Acknowledging that their conversation covered some "tough issues," Dr. Friese strikes a hopeful and encouraging tone for the future. "What I would say is despite these tough issues, I'm optimistic for nursing in the long run," he shares, describing nursing as a "great profession." He expresses confidence that these financial and policy challenges will ultimately get resolved, adding, "I always count on nurses to do the right thing and be in the right position for patients."

The host warmly agrees, expressing hope that things will change as well and candidly remarking, "I feel like I trust nurses more than I do doctors at times." After the host thanks him for joining the show and Dr. Friese replies that it was a pleasure, the episode wraps up with a closing credit thanking listeners for tuning in to *Michigan Minds*, produced by Michigan News, a division of the University of Michigan's Office of the Vice President for Communications.

## Notable quotes > [10:46](https://www.youtube.com/watch?v=ligHrH084hA&t=646s) this is not the time to put caps on what nurses can borrow if they want to pursue graduate education, if they want to advance in their profession. And in fact, the opposite is true. We want to open opportunities. We don't want to cut people off. — Christopher Friese

> [12:21](https://www.youtube.com/watch?v=ligHrH084hA&t=741s) one of our secret weapons — Christopher Friese

> [12:21](https://www.youtube.com/watch?v=ligHrH084hA&t=741s) a bit of a conundrum for the economists in the room — Christopher Friese

> [14:19](https://www.youtube.com/watch?v=ligHrH084hA&t=859s) We've been really strapping this together — Christopher Friese

> [16:07](https://www.youtube.com/watch?v=ligHrH084hA&t=967s) In the long run, like a cat, we will land on our feet. — Christopher Friese

> [18:21](https://www.youtube.com/watch?v=ligHrH084hA&t=1101s) Again, we're pouring more folks in the bucket. We haven't stopped the leak, right? We've got to make sure that not only are we supporting nurses in their workforce, but the people that we're bringing in are competent, qualified, and prepared to work in those settings. And that doesn't come with shortcuts. — Christopher Friese

> [20:18](https://www.youtube.com/watch?v=ligHrH084hA&t=1218s) we saw that you supported provision X. So we thank you for that. — Christopher Friese

> [22:04](https://www.youtube.com/watch?v=ligHrH084hA&t=1324s) What I would say is despite these tough issues, I'm optimistic for nursing in the long run — Christopher Friese

> [22:04](https://www.youtube.com/watch?v=ligHrH084hA&t=1324s) I always count on nurses to do the right thing and be in the right position for patients. — Christopher Friese

> [22:04](https://www.youtube.com/watch?v=ligHrH084hA&t=1324s) I feel like I trust nurses more than I do doctors at times. — Juan Ochoa

## Mentioned Christopher Friese, Juan Ochoa, Greta Guest, Jeremy Marble, Hans Anderson, University of Michigan, University of Michigan School of Nursing, University of Michigan School of Public Health, Michigan Minds, Michigan News, Michigan Nurses Study, U.S. Department of Education, The Philadelphia Inquirer, White House

## Video description Christopher Friese, a University of Michigan professor of nursing and of health management and policy, is a national authority on health care quality, nursing work environments and workforce policy.

Friese joins the Michigan Minds podcast to explain how proposed federal caps on graduate student loans could shape nurses’ education and career decisions, what high student debt is revealing about the nursing workforce, and why these policies may have ripple effects for patient care and the future supply of nurse practitioners, midwives, anesthetists and nursing faculty.

What makes loan caps on borrowing for graduate nursing degrees different?

We are worried about caps on loans for graduate nurses for a couple of reasons. Our study, the Michigan Nurses Study, identified that about a third of registered nurses have substantial levels of debt to begin with. If you already are carrying a lot of debt, imagine trying to advance your career in nursing—that usually means you have to go back for a graduate degree—and then you’re facing an even higher bill.

What we are worried about is that these proposed caps will deter people from even thinking about graduate school. They will just decide, 'I'm not going to pursue graduate school.' And that is bad for the country, because advanced practice nurses and the future faculty that train nursing students do a tremendous amount for our health care system. If we cut off this supply route for graduate nurses, we are worried about health care outcomes and the future of nursing education.

Michigan Minds is produced by Greta Guest and hosted by Michigan News staff. Jeremy Marble is the audio engineer and Hans Anderson provides social media animations.

[Source](https://www.youtube.com/watch?v=ligHrH084hA)

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Friese警告：研究生贷款上限将威胁护理人才输送渠道拟议的联邦研究生借款限额将阻碍护士接受高等教育和担任教职，从而加剧患者护理领域的严重短缺。 Christopher Friese博士将美国的护理危机重新定性为并非持证人员的绝对短缺，而是一个“漏水桶”式的留任问题，其诱因是不安全的临床环境、管理层支持不足，以及沉重的学生债务迫使护士为寻求更高薪酬而跳槽。他警告称，美国教育部拟将护理研究生贷款上限设为每年20,500美元（终身100,000美元）的规定基于错误的假设；他指出其团队在57天内对密歇根护士研究（Michigan Nurses Study）进行的快速重新分析表明，三分之一的护士背负大额债务，而在负债的高级实践护士中，有三分之一为读研借贷超过50,000美元。由于法定的低师生比以及师资的长期匮乏（教育工作者在临床实践中的收入远高于学术界），大学无法简单地降低学费或在确保安全的前提下缩短学制，因此这些借款限制可能会切断高级临床医生和未来师资的人才来源。Friese主张推行医院赞助、州政府和慈善贷款偿还计划，并积极向联邦议员反映诉求，而不是限制接受教育的机会。拟议的联邦法规将研究生借款上限设为每年20,500美元、累计100,000美元，这可能阻碍注册护士晋升至专业临床和教职岗位。 (8:17) 密歇根护士研究的数据显示，大约三分之一的注册护士已背负巨额债务，且负债的高级实践护士中有三分之一的欠款超过了拟议的50,000美元研究生门槛。 (8:17) 教育债务直接导致护士流失，使负债的临床医护人员极有可能因薪酬考量和家庭财务压力而离职或另谋高就。 (10:46) 由100名联邦议员组成的两党团体已敦促教育部将护理学列为专业学位，同时各州和卫生系统也在探索本土化的贷款偿还模式以减轻债务负担。 (20:18)

Reading summary

Christopher Friese, professor at the University of Michigan School of Public Health, argues that the United States faces a nursing retention crisis driven by unsupportive workplaces and educational debt rather than an absolute shortage of licensed nurses. He warns that proposed federal graduate borrowing caps will sever advanced practice and faculty pipelines at a moment when health systems are already struggling to retain clinicians. The Retention Crisis and the 'Leaky Bucket' (0:00) Friese challenges the conventional narrative that the United States lacks a sufficient pool of registered nurses, noting that per-capita licensing counts compare favorably to other nations. Instead, he characterizes the workforce crisis as a 'leaky bucket' dynamic, where poor workplace culture, unaddressed workplace violence, and perceived absence of leadership support drive nurses to scale back hours or leave clinical practice altogether. Crucially, the newest entrants exit at the highest rates. According to Friese, focusing solely on increasing nursing school graduation rates fails to address this systemic outflow. Healthcare institutions must prioritize plugging structural attrition hazards rather than treating continuous replenishment as a sustainable solution, while still maintaining sufficient operational slack to withstand shocks like the COVID-19 pandemic. Graduate Loan Caps vs. Empirical Debt Realities (3:43) A key barrier to workforce sustainability is a Department of Education rulemaking proposal advancing in early 2026 that seeks to exclude graduate nursing degrees from top-tier professional loan access, imposing an annual borrowing ceiling of $20,500 and a lifetime cap of $100,000. While designed to curb tuition inflation, Friese contends this restriction disproportionately harms nurses because advanced practice degrees—such as nurse practitioners, nurse-midwives, and nurse anesthetists—take far longer to yield a return on investment than fields like corporate law or dentistry. To evaluate claims that caps would touch only an insignificant share of students, Friese's team analyzed 2022 data from the Michigan Nurses Study within a 57-day window. The findings revealed that roughly one-third of registered nurses already carry significant debt from pre-licensure training alone, and approximately one-third of debt-holding advanced practice registered nurses carry balances exceeding $50,000 for graduate studies, demonstrating that the proposed caps directly collide with current educational costs. Debt-Driven Turnover and the Faculty Bottleneck (10:46) The Michigan data indicates that nurses burdened by student loans are significantly more likely to leave their positions or search for new jobs specifically to secure higher pay and benefits, reporting substantial household financial strain. When experienced nurses leave, they typically pursue lateral moves to better-paying employers or step away for caregiving. This mobility creates an economic dilemma for health systems, which lose significant on-the-job training investments and face substantial replacement costs. This debt cycle directly aggravates a chronic shortage of nursing faculty. State regulations enforce strict student-to-faculty ratios in clinical rotations, requiring instructors with master's or doctoral degrees. However, credentialed nurses earn substantially higher compensation in clinical advanced practice than in academic instruction. This pay disparity leaves nursing schools constantly recruiting, a situation worsened in 2026 by broader university hiring freezes and economic uncertainty. Dangers of Program Shortcuts and Alternative Solutions (18:21) In response to staffing shortages, some industry voices advocate shortening nursing curricula to accelerate workforce entry. Friese cautions strongly against cutting clinical requirements, arguing that shortcuts dilute educational quality, undermine international training standards, and introduce unprepared staff into clinical settings without resolving the underlying retention leak. Rather than forcing tuition cuts that would compromise clinical safety standards, Friese points toward emerging financial models. A bipartisan group of 100 federal lawmakers petitioned the Department of Education to classify nursing as a professional degree exempt from lower caps, while state-level repayment programs, hospital tuition sponsorships, and private philanthropy—such as a donor paying off nursing staff debt at a hospital reported by The Philadelphia Inquirer—offer targeted relief mechanisms. While Friese remains optimistic about the long-term resilience of the nursing profession, the immediate trajectory hinges on whether federal policymakers abandon graduate borrowing limits and whether health systems address the workplace safety and compensation structures that currently accelerate nurse departures.

Source quotes

[10:46] Christopher Friese: this is not the time to put caps on what nurses can borrow if they want to pursue graduate education, if they want to advance in their profession. And in fact, the opposite is true. We want to open opportunities. We don't want to cut people off. [12:21] Christopher Friese: one of our secret weapons [12:21] Christopher Friese: a bit of a conundrum for the economists in the room [14:19] Christopher Friese: We've been really strapping this together [16:07] Christopher Friese: In the long run, like a cat, we will land on our feet. [18:21] Christopher Friese: Again, we're pouring more folks in the bucket. We haven't stopped the leak, right? We've got to make sure that not only are we supporting nurses in their workforce, but the people that we're bringing in are competent, qualified, and prepared to work in those settings. And that doesn't come with shortcuts. [20:18] Christopher Friese: we saw that you supported provision X. So we thank you for that. [22:04] Christopher Friese: What I would say is despite these tough issues, I'm optimistic for nursing in the long run [22:04] Christopher Friese: I always count on nurses to do the right thing and be in the right position for patients. [22:04] Juan Ochoa: I feel like I trust nurses more than I do doctors at times.

Original transcript

[0:00] [music] [0:03] Welcome to the Michigan Minds podcast [0:05] where we explore the wealth of knowledge [0:07] from faculty experts at the [music] [0:08] University of Michigan. I am Juan Choa, [0:11] international public relations [0:12] representative for the Michigan news [0:14] office. With me is Christopher Fes, [0:16] professor of nursing and of health [0:18] management and [music] policy at the [0:19] school of public health. Professor Fes [0:22] is a national authority on the equality [0:24] of care delivery and nursing work [0:26] environments. [0:26] >> [music] [0:27] >> His research focuses on health policy, [0:29] nursing student debt, and the staffing [0:31] crisis currently impacting the US [0:33] [music] healthcare system. Welcome to [0:35] the podcast, Professor Freeze. [0:36] >> It's great to be with you. [0:38] >> We know that nursing is one of the most [0:40] trusted professions and that the US [0:43] health care system heavily relies on [0:45] nurses and yet the gap between the [0:47] number of nurses available and the [0:48] number needed continues to rise. What [0:51] are some of the issues at play here and [0:53] how could that affect the care we all [0:56] receive? [0:57] >> So, one of the things that's really [0:58] great about our health care system is [1:01] we've identified that registered nurses [1:03] are the glue that keep our US healthcare [1:06] system going and we've heavily invested [1:09] in the registered nursing workforce. And [1:12] in fact, I often say to folks, it's not [1:14] really a shortage of nurses. It's really [1:17] a shortage of workplaces that support [1:19] them, that keep them in their setting. [1:22] We actually have plenty of individuals [1:24] in the US who hold an RN license. What [1:27] we don't have is sufficient numbers who [1:29] are actively working in practice. And [1:31] when we ask nurses, our studies, and [1:34] others, what we often hear is that the [1:36] workplaces are not supportive. We often [1:39] hear more recently that they don't feel [1:42] safe in their workplace, that they're uh [1:45] facing violent situations that are not [1:47] being addressed. And then we also hear [1:50] that um they don't have the support of [1:53] their leadership and their management. [1:56] So those are often the things that are [1:58] leading nurses to say either I don't [2:01] want to work in this setting any longer [2:04] or they reduce their hours or they leave [2:09] nursing entirely. [2:11] Now the good news is all of those things [2:13] can be addressed and fixed. [2:15] >> But if a there's a lot of nurses leaving [2:18] then why can't we call it a shortage? [2:21] What we what we have is um when we look [2:24] at national data of country to country, [2:29] we have a sufficient number of [2:31] individuals in the US who hold an RN [2:33] license for our population. Other [2:36] countries are not in that same spot. We [2:38] are preparing plenty of nurses. What [2:41] we're not doing is keeping them in the [2:43] workplace. What our recent study showed [2:46] is that the group that is most likely to [2:49] leave are the newest entrance. So some [2:52] of us have called this sort of a leaky [2:53] bucket problem. You keep bringing people [2:56] into the workforce and they're the [2:57] fastest to leave. So what we really need [2:59] to do is instead of just pouring more [3:02] people into the bucket, we need to plug [3:04] the hole. So if we can focus on [3:06] improving the working conditions, we [3:09] have an ability to kind of stem this [3:11] tide. Now you're right that we we [3:15] certainly I and others have argued that [3:17] we need we do need more nurses. We need [3:19] some slack in the system we call it [3:22] because we have to handle these [3:23] unanticipated issues like COVID or or or [3:27] other things but we really do have a [3:30] sufficient number in the country. It's [3:32] the question of are we committed to [3:34] keeping them in the workplace? [3:36] >> In our study and the work of others [3:38] would suggest that's where the [3:40] investment really needs to happen. [3:43] >> It seems like with the recent Department [3:46] of Education changing the rules, uh it [3:48] might even be a little bit more [3:50] difficult. Um, on that point, the rules [3:54] go into effect this summer and set new [3:56] caps on how much graduate students can [3:58] borrow from the government to finance [4:00] their education. These limits, which the [4:03] department says are meant to curb the [4:05] cost of programs, and resulting debts [4:08] for students apply to doctors, nurses, [4:10] social workers, dentists, occupational [4:12] therapists, and others. What makes caps [4:14] on borrowing for graduate nursing [4:15] degrees different? [4:16] >> So, we're worried about caps on loans [4:19] for graduate nurses for a couple of [4:20] reasons. Number one, our study, the [4:22] Michigan Nurses Study, identified that a [4:25] substantial number of existing nurses, [4:28] not even nurses who are in grad school [4:29] yet, but registered nurses who have yet [4:31] to go to grad school, just about a third [4:33] of them have pretty substantial levels [4:35] of debt to begin with. So, if you [4:38] already are carrying a lot of debt, [4:40] imagine trying to advance your career. [4:42] And in nursing, that usually means you [4:44] have to go back for a graduate degree. [4:46] And then you're facing yet an even [4:49] higher bill. while you have debt. So, [4:53] what we know is that um when nurses go [4:56] back for graduate school, it does pay [4:58] off eventually. It doesn't pay off as [5:01] quickly as some of these other higher [5:03] paying professions like law, medicine, [5:06] dentistry, etc. So, we want to make sure [5:10] that nurses don't see the affordability [5:12] of graduate school as the barrier for [5:15] them to enter. What we're worried about [5:17] is that these new proposed caps will [5:20] deter people from even thinking about [5:22] graduate school. They won't even think [5:25] about applying. They won't have a [5:27] conversation with the university about [5:29] financial aid or loan payment or loan [5:32] programs or some kind of novel program [5:36] for health systems to support them. [5:37] They'll just decide, I'm not going to [5:39] pursue graduate school. And that's bad [5:42] for the country because it's really [5:44] clear that advanced practice nurses, [5:46] nurses with a graduate degree do a [5:49] tremendous amount for our health care [5:50] system. These are folks like nurse [5:52] practitioners, nurse midwives, nurse [5:55] anesthetists, and the future faculty [5:58] that train nursing students. Right? So, [6:00] if we cut off this supply route for [6:05] graduate nurses, we're really worried [6:07] about healthcare outcomes. We're worried [6:10] about the future of nursing education [6:13] and we think that these proposed caps [6:16] are likely going to reduce interest [6:18] overall in graduate education for nurses [6:20] and that's a shame. [6:22] >> You know, I I think back when I was [6:24] applying for schools, the first thing I [6:26] would do is look at costs. Can't the [6:28] universities just reduce the cost of [6:31] tuition and hopefully get more students [6:33] to apply that way? I think that nursing [6:35] schools are looking for these [6:37] opportunities to try to make graduate [6:39] nursing education more affordable. But [6:42] this is highly specialized training, [6:45] right? This is not education that can be [6:48] substituted with other experts. We have [6:50] pretty strict rules as to who can teach [6:53] graduate nurses, the the proportion of [6:56] faculty members to students because of [6:58] the intensity of the work they do. So [7:00] this is unfortunately graduate nursing [7:03] education is not a space where we have a [7:06] ton of opportunity for cost containment [7:08] which would lower tuition. In fact, we [7:11] continue to want advanced practice [7:12] nurses to do more and more. So there are [7:16] some opportunities there, but I think [7:18] what we really need are more flexible [7:20] models and partnerships that help reduce [7:25] what I will call the out-ofpocket cost [7:27] for a graduate student in nursing. So [7:30] that might mean and we have some federal [7:33] programs for loan repayment. We have [7:35] some health systems that are stepping up [7:38] and saying if you agree to work with us [7:40] as an RN while you get your graduate [7:43] degree and you stay with us, we'll [7:45] offset your tuition. I think those are [7:47] promising models and we need more of [7:51] those. We can look for ways to bring [7:53] down the cost of graduate nursing [7:55] education, but we're but this proposal [7:59] puts applicants, potential applicants in [8:02] a bind. And I think that's what we're [8:04] worried about in the moment. So, I think [8:08] there will be some innovation here. I [8:10] just don't know how much we can squeeze [8:13] >> to really bring cost down in a [8:15] demonstrable way that students will [8:17] feel. [8:17] >> Right. Right. What are the Department of [8:20] Education's proposed changes to nursing [8:22] graduate loans? [8:24] >> So, the proposal from the Department of [8:25] Education issued in late winter and then [8:28] went through rulemaking in early 2026 [8:31] would take graduate nurses out of the [8:34] pool for the highest level of available [8:36] loan amounts and instead they would be [8:38] capped for $20,000 [8:42] $20,500 [8:43] for one year and a total lifetime amount [8:46] of $100,000. [8:48] So that would put constraints on how [8:49] much nurses could borrow towards [8:51] graduate education. [8:53] >> The Department of Education rule [8:55] proposal inspired your recent research [8:57] on what impact that had on nurses career [9:00] decisionmaking in Michigan. What are [9:02] your key findings in that? [9:04] >> Well, first I'm really proud of this [9:06] team. So, we came up with this need to [9:11] reanalyze our study data right before [9:14] Thanksgiving and our results were [9:16] published in the end of January, 57 days [9:20] from the original research question to [9:23] publication. And in my career over 27 [9:26] years, I've never had that experience. [9:28] So, I'm first of all grateful to our [9:29] team and our publisher um and all that [9:33] goes into that to make that happen. So, [9:36] we really wanted to put the numbers out [9:38] there. We were hearing individuals who [9:41] were talking about this proposal that [9:44] that putting these caps on graduate [9:46] nursing education wouldn't affect a [9:48] large number of nurses. And we didn't [9:52] believe that at face value. And so, we [9:54] wanted to go back into our data from the [9:56] Michigan Nurses Study. We had [9:58] fortunately asked this question in 2022. [10:02] what what are the levels of student debt [10:04] that you're holding um of individuals [10:07] who are both registered nurses and [10:09] individuals who had completed graduate [10:11] school in nursing. And again, about a [10:13] third of our s of our entire sample had [10:17] uh substantial debt. And just about a [10:20] third of the advanced practice nurses, [10:22] these are folks who have already gone [10:23] through graduate school, about a third [10:26] of that group that had debt had debt [10:29] levels that exceeded that $50,000 cap, [10:32] right, that's being proposed. So in [10:35] 2022, we were already seeing these high [10:37] levels of debt. [10:39] >> The next thing we did is we said if you [10:42] we wanted to ask about their career [10:44] plans. So did they plan to stay in their [10:46] job? Were they looking for another job? [10:48] And what we found is far higher numbers [10:51] of nurses who had debt had either [10:54] recently left their job or were more [10:57] likely to look for a new job because of [10:59] pay and benefits. So the point is our [11:02] our assumption here is that high levels [11:04] of debt are actually associated with [11:06] nurses making different job decisions [11:09] contributing to that leaky bucket. [11:11] Right? We've already prepared this [11:12] nurse. They're working in our setting, [11:13] but they're going to leave us. And part [11:15] of that reasoning is they feel like they [11:18] can make more money elsewhere or improve [11:20] their their finances. And a lot of those [11:23] nurses had to hold were holding debt. So [11:26] that was um that was a big part of it. [11:29] The other thing is that the burden of [11:31] this debt was high. And so among our [11:34] individuals who had debt, [11:37] they were far more likely to tell us [11:39] that their household finances were a top [11:41] concern for their family. So, we often [11:44] hear we we think that nurses are well- [11:46] paid and and I guess relative to the [11:48] entire US that's true, but it's hard [11:51] work. They hold a lot of debt and [11:54] they're feeling this and they're feeling [11:55] it directly in their family. So, they [11:57] were far more likely to be worried about [11:58] their family finances when they held [12:00] debt. So, to to me that speaks to this [12:03] is not the time to put caps on what [12:07] nurses can borrow if they want to pursue [12:09] graduate education, if they want to [12:11] advance in their profession. And in [12:12] fact, the opposite is true. We want to [12:14] open opportunities. We don't want to cut [12:17] people off. And and that's what our [12:19] study showed. [12:21] >> I want to I want to touch back on the [12:23] point that you made that nurses are [12:26] leaving the profession. Where are they [12:29] going? [12:29] >> It's a good question. Most often we see [12:32] nurses leaving to take another job in [12:34] nursing. So they're leaving their [12:36] current employer, moving to another [12:38] employer. And particularly in the in the [12:41] recent study that we did that was [12:42] published in 2026, [12:45] we show that that group is far more [12:48] likely because they have debt to move. [12:50] So that's that's a that's a group. So [12:52] they're looking for a better economic [12:54] opportunity uh etc. The then there's a [12:58] group that leaves nursing entirely and [13:00] they never come back. And then there's a [13:03] group that is not well studied but we [13:05] see this in nursing year after year is [13:08] they leave nursing oftentimes to raise a [13:12] family to attend to caregiving [13:14] responsibilities and then they reenter. [13:17] They come back after their caregiving [13:19] maybe their children have gotten older, [13:21] entered school, their caregiving [13:23] responsibilities have eased and they [13:26] come back into nursing. It's actually [13:28] one of our secret weapons. the [13:30] flexibility that we have in the nursing [13:32] profession to work in one area, step out [13:35] for a bit, come back in, retrain, and [13:38] come back either in the same area or [13:39] another. That's that's the good news. [13:42] The bad news is that that puts [13:44] employers, health systems, and others in [13:47] a pinch because they've invested all [13:48] this money to train these folks and [13:51] support them, and they're likely to [13:54] leave. So, it's a bit of a it's a bit of [13:57] a conundrum for for the economists in [13:59] the room because we we want employees to [14:03] move as they wish, but the substantial [14:06] investments that hospitals and health [14:09] systems put into preparing and training [14:11] these folks on the job once they're in [14:12] the role is money that they don't get [14:15] back and it's quite expensive to replace [14:17] an experienced nurse. [14:19] >> Interesting. The problem most people [14:21] aren't aware of is the lack of nursing [14:24] educators and state laws that limit how [14:26] many students each educator can [14:28] supervise for clinicals. Can you share [14:30] some thoughts on that? As a as a [14:33] profession, we've identified what we [14:35] believe are best practices. The [14:37] complexity of what we're trying to teach [14:38] our students requires expert nurses in [14:41] many cases, not all, but in many of our [14:45] classroom activities or particularly in [14:47] the clinical setting, our profession has [14:50] identified we need expert nurses to do [14:52] that work. That usually means holding a [14:54] master's degree or higher. And we have [14:57] shown that when we have higher and more [14:59] investment in education and nurses, [15:01] outcomes are better for patients, [15:03] educational outcomes are better for [15:05] students. It's a win-win. That comes at [15:07] a cost that that is more difficult to [15:10] do. We have been chronically short on [15:13] nursing faculty, people who are capable [15:17] um and credentialed to teach students [15:19] for quite some time. We've been really [15:21] strapping this together. Most nursing [15:23] schools are actively looking for faculty [15:26] almost every year. And what that does is [15:31] creates a problem because most of the [15:34] individuals who can teach in nursing can [15:37] also be advanced practice nurses like [15:39] nurse practitioners and nurse midwives, [15:41] which is usually reimbured at a higher [15:43] rate. They can get a better salary when [15:45] they're an advanced practice nurse out [15:48] practicing as opposed to teaching. So, [15:50] we don't have the incentives lined up [15:52] for experienced nurses to come into our [15:55] settings and teach. So, that's one of [15:57] the proposals that we put out to say, [15:59] can we incent these advanced practice [16:01] nurses to at least spend part of their [16:03] time teaching? Maybe not all of it, but [16:05] some of it at a minimum. [16:07] I have a family member who has taught [16:10] clinicals in the past and they've been [16:13] unemployed for about two months now and [16:16] they've looked for positions and they've [16:18] been having a hard time. What do you [16:20] what do you say to them to those who [16:22] want to teach but are having a hard [16:24] time? [16:25] >> I think this speaks to the current [16:27] mismatch and the current instability in [16:30] our system right now. I think schools of [16:32] nursing, higher education in general is [16:35] a challenging place to be right now. And [16:37] I think that a lot of schools are trying [16:41] to assess where they're going. And [16:44] because of that, they're probably [16:46] working with the folks that they have in [16:48] place as opposed to lots of hiring in [16:50] this very moment as we speak together in [16:52] 2026. [16:54] What I would say is um what I've always [16:57] loved about nursing is the flexibility [17:00] and the ability to think differently [17:03] about how I I do my role. So I'm a [17:06] professor at the University of Michigan [17:07] School of Nursing for 18 years. I've [17:10] also had a clinical practice almost the [17:13] entire time until very recently. I've [17:15] been able to be flexible with my [17:17] knowledge and skills. And so I know it's [17:20] a difficult time out there in higher [17:21] education. A lot of people there's a lot [17:23] of uncertainty and when there's a lot of [17:25] uncertainty [17:27] people become cautious and they have [17:29] fewer posted positions and they want to [17:32] see if things get better. What I will [17:34] say is it's really clear to me that [17:38] nursing in the long run is a good bet. [17:40] It's a good investment and we will find [17:43] a way to use your skills. One quick [17:46] anecdote. I graduated with my bachelor's [17:49] of science and nursing in 1997. and the [17:51] the entry degree for nursing here and I [17:55] didn't get a job for 6 months as a staff [17:58] nurse. [17:58] >> Wow, that's a long time. [17:59] >> And and that uncertainty was really [18:02] difficult and and I tell that story now [18:06] to my students because everybody hears [18:08] healthc care is booming. There's no [18:10] problem. We do see these pockets of [18:12] uncertainty right now. In the long run, [18:16] like a cat, we will land on our feet. [18:18] There's a lot of instability right in [18:20] this moment as we speak, [18:21] >> right? If the cost of education prevents [18:24] nurses from becoming educators, what [18:26] does that mean for our ability to train [18:28] the next generation and make sure that [18:30] there are enough nurses uh when needed [18:33] most? [18:35] >> I think that's what concerns me the most [18:37] with this proposal as well as the [18:39] broader sort of underinvestment in [18:42] professional nursing in the moment. So [18:45] the cap on graduate loans is one example [18:49] of a structural [18:52] policy decision to make it really hard [18:54] for us to continue to advance in [18:56] nursing. I think that our students [19:01] really require and and benefit from [19:05] expertise in their programs. [19:08] I worry that these these forces that [19:12] we've talked about together, these [19:13] colliding forces of increased demand for [19:15] healthcare services, we need to hire [19:17] nurses quickly. We're starting to see a [19:20] movement to shorten degree programs, get [19:24] people through nursing programs faster. [19:27] Maybe we're making some cuts that we [19:29] wouldn't otherwise make. I think we have [19:32] to be really careful about that to think [19:35] about [19:37] the nursing education programs we have [19:39] in this country are a model for other [19:41] countries. We don't want to make [19:44] decisions quickly that have a long-term [19:47] impact on the quality of nursing [19:49] education. I worry that with some of [19:52] these competing demands, [19:55] the the the thinking will be to let's [19:57] just get people out faster. Again, we're [19:59] pouring more folks in the bucket. We [20:01] haven't stopped the leak, right? We've [20:03] got to make sure that not only are we [20:06] supporting nurses in their workforce, [20:08] but the people that we're bringing in [20:10] are competent, qualified, and prepared [20:13] to work in those settings. And that [20:16] doesn't come with shortcuts. [20:18] >> Many support changing the DOE rules [20:20] before they take effect. Nurses have [20:23] protested outside the White House and a [20:26] bipartisan group of 100 federal [20:28] lawmakers sent a signed letter to the [20:31] Department of Education requesting that [20:33] nurses be included in the department's [20:35] definition of a professional degree. For [20:37] those who want to register their dislike [20:40] of these new rules, what do you suggest [20:44] they do? [20:45] >> So, we're in an interesting time because [20:46] the public comment period has closed. So [20:50] the things that I offer is to make sure [20:52] that lawmakers know hear from their [20:55] constituents that nursing issues matter. [20:57] Thanking the legislators if you're [20:59] supportive, thanking the legislators who [21:02] have signed on to that letter. Uh [21:04] sometimes we forget to thank the folks [21:06] who are supporting the policies that we [21:08] advocate for. So we often work on trying [21:11] to get more people to join and that's [21:12] great, but also thanking people to say [21:14] we saw that you supported [21:16] >> provision X. So we we thank you for [21:18] that. I think we'll have to see where [21:20] the Department of Education weighs in [21:22] here. One thing I think we can just say [21:24] in this moment is we've seen a lot of [21:26] policy proposals issued and then [21:29] retracted or changed after this kind of [21:32] period that we're in right now. So, I [21:34] think letting legislators know that [21:36] these matters are of concern to you. The [21:39] other thing we're starting to see are [21:40] states are picking up strategies. Can [21:43] they reduce the debt burden with their [21:46] own loan repayment programs? We're [21:48] starting to see hospitals do the same [21:49] thing. There's just a piece in the [21:51] Philadelphia Inquirer just a few weeks [21:52] ago um that a donor donated to a [21:56] hospital to pay off student loan debt [21:58] for their nurses. So, it's an [22:00] interesting time and I think we'll have [22:01] to see how these things play out. [22:04] >> Dr. Freeze, we've reached an end of our [22:06] podcast. Any last thoughts? [22:09] >> So, we've talked about some tough issues [22:10] today. What I would say is despite these [22:13] tough issues, I'm optimistic for nursing [22:16] in the long run. I think it's a great [22:19] profession. I think these issues will [22:21] get resolved and I always count on [22:25] nurses to do the right thing and be in [22:27] the right position for patients. [22:29] >> Yes, I I hopefully things change too [22:31] because I I feel like I trust nurses [22:34] more than I do doctors at times. So, [22:36] thank you for being here. [22:37] >> It's a pleasure. Thank you. [22:39] Thank you for listening to this episode [22:41] of Michigan Minds [music] produced by [22:43] Michigan News, a division of the [22:45] university's office of the vice [22:47] president for communications.