Nurses are the backbone of the U.S. healthcare workforce. According to the American Association of Colleges of Nursing (AACN), 5 million registered nurses work across the country. Addressing the nursing shortage requires more than recruiting additional new nurses; it requires an institutional shift in recruitment and retention.
Hospitals need new nurses entering the profession as much as they need experienced nurses to stay in clinical practice, train newer colleagues, and move into senior positions where they can improve workforce development. That said, workforce challenges may affect each employee differently based on their career stages, socioeconomic status, and personal demographics.
There have been many recent studies investigating the current nursing shortage, focusing on barriers such as racial discrimination, lack of mentorship, implicit bias, glass ceilings, and financial hardships that keep low-income individuals and communities of color from advancing.
Black nurses report many training and workplace difficulties that drive them away from the profession. A qualitative study of 30 Black nurses at Central Michigan University found that these barriers discourage qualified nurses from pursuing leadership and faculty positions. Those who stay often report feeling stuck too long in underpaid junior roles. BlackDoctor Pro asked Black nurses and non-Black healthcare hiring managers what they see as problems in the profession (and possible solutions), and they shared five key barriers that need fixing.
Devin Hornick, a partner at KORE1 with over 30 years of experience staffing clinical and IT roles, said many hiring barriers start at the application stage. Financial constraints and other systemic biases weed people out before they can take prerequisite courses for nursing programs. Rigorous college-level courses, like biological sciences and mathematics, may leave prospective nurses intimidated or unprepared. Without the time and financial means to get tutoring in foundational skills or improve test scores, a nursing career may be out of reach.
Prospective candidates may also face barriers to finding and securing clinical placements because of prior employment and/or caregiving demands. Hornick explained that these barriers may make people of color especially underrepresented.
An associate’s degree in nursing can cost $23,000 to $66,000 for a two-year program, and a bachelor’s typically costs the same amount for just one year. As of July 2026, many federally backed loans have been severely capped, well below what students need to complete the degree. Thus, low-income students may struggle to pay for their degree, stopping a future in nursing even before it starts.
Justinna Dixon, PhD, RN, a postdoctoral fellow at the Center for Health Outcomes and Policy Research at Penn Nursing, shared her firsthand experience with the structural challenges Black nurses face when entering this in-demand field. “As someone who has navigated not only undergraduate nursing school but Ivy League doctoral programs and academia as a first-generation college student from a low-income Jamaican immigrant family. I can personally speak to there are many things inherently designed into the academic system that do incentivize talented, diverse perspectives to continue with their education. This comes in many forms, such as financial accessibility to have stability while pursuing training.”
She said nurses pursuing full-time research doctoral training often receive stipends far below the cost of living. Students on certain funding mechanisms are barred from working more than 10 hours per week off campus. Especially for students on scholarships or with limited familial support, cascading financial burdens can saddle future nurses with crushing student loan debt.
Even after graduating from nursing school, salaries and compensation can be insufficient to pay down debt and get ahead. Kisha Pickford, DNP, ACNP-BC, acute care nurse practitioner and founder of Ample Health & Wellness, explained that although nursing salaries are high compared to other careers, many nurses feel poorly compensated for the job’s physical and emotional toll, making take-home pay disproportionate to the work.
Nurses regularly point to unrealistic workloads, staffing levels, burnout, poor compensation, erratic scheduling, limited training, and restricted advancement opportunities as factors that hold back talent in the profession.
Dr. Dixon said that working nurses suffer most from this nurse shortage. “There is no actual shortage of nurses who would like to provide care, but the environments nurses work in are often too tumultuous because of a lack of practical support for administration to reduce nurses’ work burden,” she explained.
The current healthcare financing model does not adequately account for the complex, unique economic value nurses provide to patients, Dr. Dixon said. For example, physician services and other prescribing provider services are billed separately on patients’ bills for an inpatient hospital stay, whereas nursing services are not separately charged based on the number of nurses or the intensity of care they provide. “As a result, healthcare organizations are less financially incentivized to hire more nurses or staff for more nurses on a unit,” she explained.
Hospitals, for their part, also feel the crunch of constantly trying to manage patient care despite inadequate staffing. “Hospitals battle for the same experienced nurses,” Hornick said. “Many hospitals don’t invest time and money for nurse residency programs and other training programs, so [nurses] become discouraged and leave the field, resulting in an even smaller pool of experienced nurses.”
“While sign-on bonuses may drive the best and the brightest to your facility, many of those nurses eventually leave once the bonus period ends,” Hornick said. No-cost options are on the table. Predictable schedules and patient ratios are affordable ways to improve nurse retention and satisfaction. Promoting from within is another strong retention tool and shows employees the institution is invested in their success and career.
In her experience, Dr. Pickford found that workplace issues that could be addressed through conversations escalate too quickly into formal disciplinary complaints, often before meaningful communication is attempted. Dr. Vanessa Grubbs’ study on discipline in medical training environments concluded that “racial and socioeconomic inequities in residency discipline challenge assumptions that discipline reflects merit alone.” Instead, race, gender, and class seem to shape how trainees are treated for similar complaints or interactions. The United Kingdom’s Equity 4 Black Nurses said the same is true across the pond, with Black nurses also reporting racial profiling, microaggressions, and fear of retaliation all playing a part in making them feel isolated and devalued.
“I think healthcare organizations need to create more opportunities for people across generations to sit down, communicate, and understand one another before every issue becomes punitive,” Dr. Pickford said. “If people don’t feel supported, respected or that there is a pathway forward for them, we shouldn’t be surprised when they choose to leave an organization or sometimes the profession altogether.”
Many nurses struggle to find the right support throughout their career journey.
“Sponsorships and mentorships play a role in workforce advancement,” Hornick said. “Individuals without sponsors and/or mentors may not advance in their careers.”
Clinicians can help prospective and early-career nurses understand the realities of the profession, connect them with mentors, encourage continued education, and recognize their contributions once they enter practice. “Nursing is hard work,” Dr. Pickford said. The hours can be difficult, the workload is demanding, and nurses practice under significant rules, regulations, and professional responsibility. Not everyone who joins the profession realizes these realities aren’t just a few years in; they can last an entire career.
Further, frontline work can put your health and safety in jeopardy every day. The trauma may be more than some people bargained for. “Nurses care for people who are critically ill, disabled, and dying,” Dr. Pickford said. “They see people at some of the most difficult moments of their lives, and that carries a physical and emotional burden. We need to prepare people for the reality of the profession, not just promote the rewarding parts of it.”
Prospective Black nurses and other new nurses may need ongoing help navigating financial planning for their education (loans, scholarships, grants, etc.), recruitment perks (sign-on bonuses, leave schedules, etc.), and retention offers (compensation for seniority, continuous learning credits, etc.). This long-term career support may need to go hand in hand with serious institutional changes to overcome obstacles in nursing schools, hospitals, and clinics.
While nurses can move around and take contracts (like travel nursing roles), those options may be less available for working parents, caregivers, or people with certain disabilities.
New nurses need a mentor or ally who helps them understand that while high-earning roles may be available, not every nurse will qualify for them or be a good fit. A salary-enhancement strategy built on these avenues may disappoint if roles are harder to secure than expected or more strenuous to complete.
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