A new University of Michigan study finds that heavy student debt is pushing nurses out of the profession and that proposed federal loan caps for graduate nursing programs could further restrict access to care across the United States.
Nearly a third of nurses in Michigan are carrying student loan debt so large it is shaping their decisions to leave the profession, according to new research from the University of Michigan. The findings arrive just as federal officials prepare to finalize new limits on student borrowing that could make it harder for nurses to pursue advanced training.
The study, published in the journal Health Affairs Scholar, focuses on registered nurses (RNs) and advanced practice nurses (APNs) in Michigan, a state that ranks eighth in the nation for number of registered nurses. The researchers say the patterns they found have implications far beyond state lines, especially as the United States faces ongoing shortages of nurses and primary care providers.
The team from U-M’s School of Nursing launched the research after the Trump administration proposed new caps on federal student loans that would exclude graduate nursing programs from higher borrowing limits. Those limits are now moving toward finalization by the U.S. Department of Education.
First and corresponding author Christopher Friese, the Elizabeth Tone Hosmer Professor of Nursing and a professor of health management and policy, noted that the data show how deeply debt is woven into nurses’ career choices.
“These findings suggest a large proportion of Michigan nurses hold student loan debt,” Friese said in a news release.
The researchers analyzed responses from 9,570 participants in the Michigan Nurses’ Study, a large survey of nurses with active Michigan licenses that began in March 2022. They examined current student loan balances, household financial concerns and career intentions, looking separately at RNs and APNs.
They found that about 28% of registered nurses and 33% of advanced practice nurses still have active student loans. For APNs, who typically hold graduate degrees and provide many of the same services as physicians, the financial burden is especially heavy.
The median student loan balance for advanced practice nurses is $66,420. Nearly 29% of those with debt owe more than $100,000 — the level of the federal government’s proposed lifetime cap on borrowing.
“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,” added Friese.
The study also found that debt changes how nurses think about their finances and their jobs. Nurses with student loans were far more likely to list family finances as a top concern than their debt-free peers, 74% compared with 39%.
Debt was also closely tied to decisions to leave a job. Among nurses who had recently left or were planning to leave their positions, just over half of those with student loans cited inadequate pay and benefits as a key reason. Only 10% of nurses without student debt gave that same reason.
Those patterns matter for patients, the researchers argue, because advanced practice nurses and nurse midwives are often the backbone of care in underserved communities. They provide essential primary and specialty services in rural areas, low-income neighborhoods and other places where physician shortages are most severe.
The study highlights that flexible borrowing and loan relief have been important incentives for clinicians to work in those high-need areas. Tightening loan limits for graduate nursing programs, the authors argue, risks shrinking the pipeline of advanced practice nurses and nurse educators just when they are needed most.
The financial pressures do not stop at the clinic door. High debt levels also discourage nurses from pursuing academic careers, which typically pay less than clinical practice. That, in turn, can limit the number of nursing students schools can admit and train, further constraining the future workforce.
Friese and his colleagues argue that expanding the advanced practice nursing workforce is critical to maintaining and improving access to care across the United States. But with many registered nurses already carrying substantial debt from their initial training, the prospect of taking on even more loans for graduate education can be daunting.
To counter those pressures, the researchers suggest that health systems and nursing schools work together on solutions. Possible strategies include tuition discounts, scholarships and long-term financial support tied to recruitment and retention, especially in high-need areas.
The timing of the study is significant. The Department of Education is expected to conclude its rulemaking process in July. Under the current proposal, graduate nursing programs would be excluded from higher federal loan thresholds, effectively capping how much aspiring nurse practitioners, nurse anesthetists, nurse midwives and nurse educators can borrow.
The study concludes that such caps run against broader national goals of safe, accessible health care. Limiting borrowing for advanced degrees, the authors argue, will discourage registered nurses from becoming advanced practice clinicians or educators, adding strain to an already overburdened system.
“If we want a robust health care workforce, we should be giving maximal flexibility to nurses, not curtailing opportunities,” Friese added. “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.”
As federal officials finalize new loan rules, the Michigan data offer a clear warning: decisions about how nurses can finance their education will ripple through clinics, hospitals, classrooms and communities nationwide.
Source: University of Michigan