High nursing school debt found, as proposed education loan caps loom

“These findings suggest a large proportion of Michigan nurses hold student loan debt,” Friese said.

“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 U.S. health care access.

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 APN programs, threatening the ability to deliver primary care, obstetrical care, specialty care and having enough faculty to teach nursing students in the future."

-Christopher Friese, Ph.D., R.N. 

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

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

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 researchers say.

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 system.

“If we want a robust health care workforce, we should be giving maximal flexibility to nurses, not curtailing opportunities,” Friese said.

“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.”

Additional authors: Lara Khadr, Deanna Marriott, Barbara Medvec and Marita Titler of the U-M School of Nursing. Friese, Marriott and Titler are members of the U-M Institute for Healthcare Policy and Innovation.

Funding/disclosures: The study was funded by Elizabeth Tone Hosmer Professorship Funds.

Paper cited: “Nurses Carry Substantial Student Loans: Health Care Workforce Implications ,” Health Affairs Scholar. DOI: 10.1093/haschl/qxag019