A proposal by the Trump Administration wants to redefine which degrees are considered a profession within student loan programs. While fields like chiropractic, law and dentistry are part of the list of 11 “professional” degrees, fields like nursing, education and physical therapy did not make the list.
The proposal indicates that degrees excluded from the list will have a much lower loan spending cap than those considered professional. It states that professional degrees can borrow up to $50,000 a year with a $200,000 lifetime cap, while those excluded from the list are limited to $20,500 a year and a $100,000 lifetime cap.
The new regulations have sparked concern from professionals within the excluded degrees — especially nurses as they navigate a national workforce shortage. The American Nurses Association released a statement on November 10, saying that “at a time when healthcare in our country faces a historic nurse shortage and rising demands, limiting nurses’ access to funding for graduate education threatens the very foundation of patient care” and that the decision will undermine efforts to grow and sustain the nursing workforce.
Kathryn Patterson is a registered nurse of 41 years and the director of the School of Nursing at MSU. She said as a family nurse practitioner who holds an advanced practice nursing role and degree, she thinks there could be a lot at stake.
“So I think if you just single out certain areas that ‘we don’t need these anymore,’ I think it's shortsighted,” she said, "and that you don’t know that long range impact that you're going to have and the impact that's going to have on health care in general.”
Patterson explained that she expects the new proposal to impact graduate students wanting to advance their degrees the most. She said there are four advanced practice roles recognized in the state of Missouri — nurse anesthetists, nurse practitioners, nurse midwives and clinical nurse specialists. But, Patterson said, advanced roles require continued education, adding that there are graduate programs in the School of Nursing that provide nurses with the ability to pursue a master's or doctoral degree.
So, she said, the new proposal will mainly affect those advanced roles by limiting funding available for graduate level education for nurses.
“So these are people that are going back to get their master's or doctorate,” Patterson explained. “So I think when you look at loaning money, for those who are going back, that is where this hits, I think.”
Courtney Carlson is a first semester nursing student at MSU’s School of Nursing, working towards her Bachelor of Science in nursing. She explained that she’s always been drawn to work that allows her to help people and be connected to them.
“In my life I’ve experienced my own hardships and challenges, and nursing has given me a meaningful way to channel those experiences into caring for and advocating for others,” she said.
Carlson said with all she’s accomplished in her first semester; the new loan proposal is "disappointing."
“With the clinical hours, the technical skill, and all the education that goes into it and all that we’re expected to know, it's really disheartening to see that they would make this kind of a change,” Carlson said, "especially seeing as how this is a profession that requires you to be licensed because so much is at stake when you clock into work.”
Carlson said she believes nursing is one of the most professional degrees you could pursue. She explained that while she’s pursuing her bachelor's degree currently, the change still puts a lot of things up in the air for her.
“And it creates a big space of unknown so it's like, well, if nursing is not a profession, then how much funding should go towards this or is financial aid going to be necessary for this?” she said. “So it scares me for that.”
She added that she’s concerned about what this will mean within her profession. Limiting further education and the kind of teachers that can educate future nurses have been topics of conversation among her friends in the nursing program, she said, especially the impact they will see on the floor once they become nurses.
“I’m worried about what the lay of the land is going to look like in terms of the workspace as an RN (registered nurse),” she explained.
Carlson said she relies on financial aid for school, but right now she doesn’t think the change will impact her studies as an undergraduate student. But, she said, she was planning on pursuing an advanced degree after she graduated.
“I hope to be a CRNA (certified registered nurse anesthetist) eventually, once I graduate and get some time under my belt in ICU, I hope to be a CRNA,” said Carlson. “But when I saw this happen, I was like, that's going to be a potential roadblock for me. It’s scary to see it limit financial pathways for people to pursue that, too.”
Patterson emphasized that nurses are an integral part of a functioning health care system. She said the role of a nurse is complex, encompassing many different skills like professional development, advocacy, communication and education, as well as standards of care, practice and education. She said nurses are the one constant in a patient’s experience.
“It’s assessing the patient’s condition, monitoring them, staying up to date with all the current guidelines and treatments, health care planning, collaborating so that we can work with all the other specialists and the health care professionals,” she said. “Everybody has their piece but the nurse kind of pulls that together for the patient.”
She explained that with limited access to advanced roles, the impact could trickle down to the workforce, educators and even patient access. She said without advanced education supporting nursing roles, it will be harder for nurses to advance, which Patterson expects to negatively impact the workforce.
“Generally, employers often prefer or require a BSN (Bachelor of Science in nursing), and then many nurses will pursue a master’s or doctoral degrees if they want to go into those advanced roles, and they’re just squelching the opportunity for nurses to advance,” she explained.
Patterson said that the fields of nursing have worked hard to progress. As a nurse with an advanced education, she called the situation "discouraging" for nurses.
Another concern, she added, is that a master's degree in nursing is required to be eligible to work as a nursing faculty in any prelicensure baccalaureate nursing program.
“That's the bigger question I have, as a school nursing director is, how am I going to get nurses who want to come educate other nurses if the government says, ‘I’m not really going to pay for you to get educated because you’re just not a profession?' ” said Patterson.
She said even patients' access is at risk. With loan caps limiting who can become an advanced practice provider, the ability to access primary care, especially in rural areas, will be limited. Patterson said there is already fewer healthcare providers working in rural areas, making healthcare less accessible.
“But if you take away that, who’s going to go be a nurse practitioner? Nobody because they can’t afford it,” she said. “Well, you think a physician is going to go out to a rural clinic and see them? I don’t think so. Us and the physician assistants fill the void that's going to be left where the physicians really don’t want to go.”
Patterson explained that she is a nurse practitioner and family nurse practitioner at the MSU Care Clinic. The clinic is staffed by physician volunteers and assistants, and family nurse practitioners, where she said they service the uninsured and underserved.
“There's plenty of folks that don’t have access to care. And so we fill that void, especially in rural areas” she explained. “And so I think if you take away the ability for nurses to continue their education, to go on to advanced roles, if that's what they would like to do, that is going to be a hit to not only the nursing profession itself, it's going to be a hit to patient access.”
Patterson said nursing has worked hard to be considered a profession over the years. She said she doesn’t feel like the long-term impacts were taken into consideration.
“You don’t know what goes into it, they don’t know the people that are making the decisions,” Patterson said. “You don’t have a nurse at the table.”
She added that due to life's circumstances, not everyone can save up money or work full time to pursue these advanced degrees, and she said this will limit many nurses whose goal is to advance their practice and education.
