How Student Debt is Impacting Nursing

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Potential limits on borrowing for a nursing education could affect decisions to stay in the profession or seek advanced training.

Transcript

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Welcome to Health Lab, your destination for news and stories about the future of healthcare. 

Today: Research from Michigan shows high levels of nursing school debt as proposed education loan caps loom. Potential limits on borrowing for a nursing education could affect decisions to stay in the profession or seek advanced training.

Nearly a third of registered nurses and advanced practice nurses in Michigan carry sizable student loan debt that is influencing their decision to leave the profession, according to a study from the University of Michigan.

The research appears in the journal Health Affairs Scholar, and comes as the United States Department of Education prepares to finalize new student loan rules that exclude graduate nursing programs from higher-tier loan limits.

That move, the study authors say, could narrow the pathway for advanced clinicians and nursing faculty.

After the current federal administration proposed the loan limits, researchers from the U-M School of Nursing wanted to know what impact debt had on nurses’ career decision-making.

So, the team analyzed data from the Michigan Nurses’ Study, a survey of 13,687 nurses with valid Michigan licenses that launched in March 2022.

Michigan ranks eighth in the nation in number of registered nurses it has, making these data relevant to the national conversation, say study principal investigator Christopher Friese, Ph.D., R.N., the Elizabeth Tone Hosmer Professor of Nursing and Professor of health management and policy.

The study measured current loan balances (adjusted to 2025 U.S. dollars), economic/household concerns and career intentions.

Results were analyzed separately for registered nurses and advanced practice nurses, who include nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists and nurse midwives.

Here are the key findings from the 9,570 respondents:

Approximately 28% of R.N.s and 33% of A.P.N.s hold active student loans.

The median loan balance for A.P.N.s is $66,420, with nearly 29% of those debt-holders owing more than $100,000, the threshold of the government’s new proposed lifetime aggregate cap.

Nurses with student debt cite family finances as a top concern more often compared to their debt-free peers; at 74% vs. 39%.

Among nurses who had recently left or were planning to leave their positions, 51% of those with debt cited inadequate pay and benefits as the reason, compared to only 10% of those without debt. 

Friese says, “These findings suggest a large proportion of Michigan nurses hold student loan debt. Nearly a third of advanced practice nurses had loan balances that exceeded the proposed lifetime cap. Placing this cap would likely limit the entry of current nurses into A.P.N. programs, threatening the ability to deliver primary care, obstetrical care, specialty care and having enough faculty to teach nursing students in the future.”

The study highlights that loan relief and flexible borrowing are incentives for clinicians to work in underserved areas, and by curtailing these, the health care system risks losing the A.P.N.s and nurse midwives who provide essential primary and specialty care in underserved areas.

Friese and colleagues argue that expanding the A.P.N. workforce is critical for health care access in the United States.

Yet the high debt carried by R.N.s, which is the primary pipeline for advanced roles, creates a significant financial barrier, as R.N.s will likely need loans to further their education.

High student debt levels also discourage nurses from entering lower-paying academia jobs, which further restricts the supply of new nurses by limiting school capacity.

The researchers say that to bolster the R.N. and A.P.N. workforce, health systems could partner with nursing schools to provide tuition discounts and long term financial support as recruitment and retention tools.

The Department of Education concludes its rulemaking in July, and the exclusion of graduate nursing programs from higher loan thresholds runs counter to the goal of providing safe, accessible health care, the study concludes.

The authors argue that capping loans for advanced degrees will discourage R.N.s from becoming nurse practitioners or educators, further stretching an already strained health care system.

“If we want a robust health care workforce, we should be giving maximal flexibility to nurses, not curtailing opportunities,” Friese says. “That includes recognizing graduate nurses as professionals who are eligible for the full array of loan programs, and expanding loan repayment programs to support retention of health care workers in key areas across the United States.”

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