In late November, the Department of Education’s (ED) Reimagining and Improving Student Education (RISE) committee spent several weeks discussing regulations for the One Big Beautiful Bill Act (OBBBA) loan-related provisions. They proposed higher loan limits for students earning professional degrees including “Pharmacy (Pharm.D.), Dentistry (D.D.S. or D.M.D.), Veterinary Medicine (D.V.M.), Chiropractic (D.C. or D.C.M.), Clinical Psychology (Psy.D. or Ph.D.), Law (L.L.B. or J.D.), Medicine (M.D.), Optometry (O.D.), Osteopathic Medicine (D.O.), Podiatry (D.P.M., D.P., or Pod.D.), and Theology (M.Div., or M.H.L.).” (Desjean, 2025) Nursing (D.N.P. or Ph.D.) was not included in this list. (Desjean, 2025)
The voting RISE committee members include six men and four women. Seven of them are employed in research, policy, or leadership positions related to higher education, two are attorneys, and one is a project manager for UnitedHealthcare. (United States Department of Education, 2025) The RISE committee used the Higher Education Act of 1965 definition of professional degrees to determine which programs would qualify for higher student loan amounts. The wording of this definition describes 10 programs as examples but clearly states the definition of professional degree is not limited to these programs. (National Archives, 2025) This definition also states other programs that have the same Classification of Instructional Programs (CIP) code as the 10 examples could also be considered a professional degree program. (Desjean, 2025) The CIP codes were developed in 1980 by the National Center for Education Statistics (NCES) as a coding system for instructional programs. These were meant to be generic categories for statistical coding purposes and were never intended to be an official list of recognized or permitted programs. (National Center for Education Statistics, 2010) This information suggests a very arbitrary designation of professional degrees and an examination of the CIP codes adds confusion. The codes are 01.80 for veterinary medicine, 22.01 for law, 39.06 for theological and ministerial studies, 42.28 for clinical, counseling, and applied psychology, and 51.01, 51.04, 51.12, 51.17, 51.20 respectively for chiropractic, dentistry, medicine, optometry, and pharmacy, pharmaceutical sciences, and administration. (National Center for Education Statistics, 2020) The first Doctor of Nursing Practice program was established in 2001 and three years later the American Association of Colleges of Nursing (AACN) endorsed moving the level of preparation for advanced practice from a master’s degree to a Doctor of Nursing Practice Degree. (American Association of Colleges of Nursing, 2025) While this degree was not yet established at the time of the Higher Education Act of 1965 or the development of the CIP codes in 1980, it is included in the subsequent revisions to the CIP codes. The broad CIP category for registered nursing, nursing administration, and clinical nursing is 51.38 and for the DNP specifically 51.3818. This code is very close to that of the other healthcare related disciplines and the program and licensing requirements are similar so the decision not to include nursing as a professional degree was either very arbitrary or very intentional.
Since this proposal was announced there has been tremendous public backlash, especially from the nursing profession. The Department of Education accused the outraged of creating fake news, distorting the truth, fear mongering, and spreading misinformation. (Laws, 2025 and Miller, 2025) They published a Myth vs. Fact sheet regarding the definition of professional degrees in response to the outrage. (U.S. Department of Education, 2025) This fact sheet targets nurses specifically. Are nurses upset? Absolutely. Do we have a chip on our shoulders? In reality it is more like a boulder. Is this an overreaction borne of hysteria? No. There is good reason for this response.
I have been licensed as a Registered Nurse (RN) in Washington State for 41 years and as an Advanced Registered Nurse Practitioner (ARNP) for 30 years. I have a Bachelor of Science in Nursing (BSN), a Master of Nursing (MN), and a Doctor of Philosophy (Ph.D.) in Nursing Science. In addition to my half-time clinical practice, as an adjunct faculty member I taught undergraduate nursing courses at the University of Washington for 18 years. I feel I am uniquely qualified to discuss this issue.
In order to understand the backlash surrounding the RISE committee’s recent proposal, you need to be familiar with the history of nursing in this country. For centuries, tending to the sick happened at home and was performed by family members and friends. Considered women’s work, most caregivers were (and still are) women. As the population increased, urban environments were created. At the beginning of the 19th century, hospitals began to replace homes as the setting for care for the sick, especially those with serious illnesses or without resources. With few opportunities for formal training, the care nurses provided varied dramatically. The earliest attempts at nursing education in the US were programs or texts developed by physicians specifically focused on maternity patients and home care. (PennNursing, 2011)
The Civil War in the early 1860’s was a catalyst for the development of nursing training. Approximately 20,000 nurses served during the war and the experience of having many individuals specifically dedicated to healing the wounded sparked a number of attempts at formal training programs. Following in the footsteps of Florence Nightingale, who founded nurse education programs in several hospitals in Britain after leading a group of women to care for wounded British soldiers in the Crimea, in 1873 three schools of nursing based on the Nightingale Principles were developed in the US. The Boston Training School at Massachusetts Hospital, the Connecticut Training School at the State Hospital, and the New York Training School at Bellevue Hospital were the forerunners of formal nursing education. By the turn of the century there were approximately 600 nursing programs in the US. (PennNursing, 2011)
The early nursing programs were apprenticeships that took advantage of student nurses for labor. Although popular, they were exploitative. In the late 1890’s the first two professional organizations within nursing were created and were the forerunners of the National League of Nursing Education and the American Nurses Association. The beginning of the 20th century saw significant progress in nursing’s professional development including: the first publication of the American Journal of Nursing in 1900; the formation of state nursing associations in New York, New Jersey, North Carolina and Virginia and creation of the Army Nurse Corps in 1901; passage of the first nurse registration act licensing professional nurses in North Carolina in 1903; creation of the Navy Nurse Corps in 1908; and the opening of the first university based school of nursing at the University of Minnesota in 1909. Nursing has always been a female dominated profession and these women have never shied away from the call to care for and heal the sick and wounded regardless of potential dangers. Approximately 23,000 American nurses served in World War I, over 70,000 in World War II (WWII), around 7,000 in the Korean War, and approximately 10,000 in the Vietnam War. (PennNursing, 2011)
After WWII debate began in the nursing community regarding educational preparation for nurses. Some felt the basic level of preparation should remain with two-year hospital-based programs or community college programs while others argued it should be a Bachelor of Science in Nursing (BSN) degree. By the 1960’s there were roughly 170 BSN college programs. Around that same time advanced practice roles were developing for both Clinical Nurse Specialists and Advanced Registered Nurse Practitioners in many specialty areas. Nursing research was also increasing with the aid of federal funding. (PennNursing, 2011) Today over 70% of the nursing workforce have a BSN or higher degree as their highest level of education. (American Association of Colleges of Nursing, 2024)
For years nurses worked long hours with low pay and little respect, despite being the health providers who spent the most time in direct patient care. Although nursing has been rated as the most honest and ethical profession for the last 23 years, nurses experience one of the highest number of assaults from patients. A recent survey found two nurses are assaulted every hour in the United States. (American Hospital Association, 2025; Walker, 2025) Nurses have worked long and hard to establish themselves as a respected profession and push for workplace protections, regulations, and pay that is commensurate with their education, experience, and job requirements. While significant improvements have been made, it is a constant battle, especially at the advanced practice level. This is part of what makes the recent proposal from the Department of Education so invalidating.
When I was completing my master’s degree 35 years ago, I remember having a conversation with a new acquaintance. They asked what field my degree was in and when I replied nursing, they appeared confused. They asked what my bachelor’s degree was in and when I replied nursing, they seemed even more confused and stated, “I thought nurses were just, you know, nurses”. This made me experience irritation and anger but I realized it would be more helpful to educate them about the field of nursing, the educational and licensing requirements, and what nurses do. I thought over time this situation would rectify itself but within the last six months I had a physician ask me about my Ph.D., specifically what it involved, insinuating it was less rigorous than other Ph.D. programs. Again, my initial feelings were irritation and anger but I explained to the physician that it was the equivalent of other Doctor of Philosophy programs and I was required to conduct research and write a dissertation. This sparked interest on the part of the physician in hearing about my research. While I appreciated the expressed interest it was still frustrating after all these years to be judged as “less than” because I chose the profession of nursing.
Nurses are the backbone of healthcare. We are care coordinators working collaboratively with other members of the health care team to advocate for the needs of patients and families. We spend more time in direct care with patients and families than other members of the health care team. We work in hospitals, clinics, schools, homes, prisons, jails, institutions, corporations, and communities. At both the generalist (registered nurse) and advanced practice (nurse practitioner) levels we provide holistic, patient centered care. Without nurses our entire health care system would collapse.
Photo by Kathy Kroening. Air Force Nurse Corps Pin (Staff of Asclepius representing medicine and healing and the lamp representing knowledge). Seattle, WA
If you or a loved one is in the Intensive Care Unit (ICU) a nurse will be the first person to recognize subtle changes in condition and initiate contact with the team to address the issue. If your child has an injury, allergic reaction, asthma attack, seizure, or other medical emergency at school, a nurse will be the first medical point of contact to manage this event. During COVID nurses played a vital role in patient care. Many nurses found their unit turned into a COVID unit overnight and due to a shortage of personal protective equipment (PPE) many were exposed to the virus resulting in acute illness, long COVID, and death. Nurses were often asked to spend large amounts of time in a room with patients in isolation, covered from head to toe in PPE, and asked to perform not only nursing duties but those of other team members including certified nursing assistants, lab and phlebotomy, and housekeeping. A nurse was frequently the one holding the phone or tablet so loved ones who were not allowed to visit could say goodbye. A nurse was most often the person present when a patient took their last breath. This created tremendous stress and burnout and it is estimated that 100,000 nurses left the profession during the first two years of the pandemic. (National Council of State Boards of Nursing, 2023)
Contrary to long standing beliefs, nurses are not doctor’s assistants. A BSN degree is a rigorous academic and clinical program. While programs vary, applicants to the degree program at the University of Washington are required to complete approximately 80 quarter hour credits worth of prerequisite courses including written communication, math or philosophy of logic and basic statistic, lifespan growth and development and social sciences, arts and humanities, and natural sciences including general chemistry, organic chemistry, human anatomy and physiology, general microbiology, and nutrition. (University of Washington School of Nursing, 2024). After acceptance to the Nursing program they spend their final two years immersed in theory and clinical courses covering: health assessment; professional practice; pharmacotherapeutics; pathophysiology; health equity; introduction to research; healthcare systems; advanced clinical judgment; care coordination and case management; informatics, patient safety, and quality improvement; interprofessional practice involving case simulations with student from other health care disciplines like medicine and pharmacy; and theory and clinical courses in nursing care of ill adults and the specialty areas of community health nursing partnerships, psychosocial nursing, pediatric nursing, and care of childbearing families. In their final quarter, students complete transition to professional practice, a clinical intensive experience in a specialty area with an individual preceptor from the clinical workplace. (University of Washington School of Nursing, 2025) While registered nurses perform many tasks during the course of their day a good representation includes: patient examination and assessment; CPR, basic, and advanced life support when necessary; medication administration; IV placement and monitoring; wound care; catheterization; NG tube placement and feeding; infection control; and electronic medical record charting. These tasks require advanced skills in communication, team leading, critical thinking, organization, and time management. Nursing is an artful combination of science and technical skills informing care that is offered with empathy, compassion, and presence.
Advanced registered nurse practitioners (ARNP’s) provide services similar to those of physicians in many specialty areas including adult gerontology acute and primary care, anesthesia, family care, midwifery, pediatric acute and primary care, population health and leadership, psychiatric mental health, and women’s health. Nurse practice acts vary by state so the level of practice also varies. In my home state of Washington ARNP’s practice independently with no supervision from physicians or other health care professionals. Acceptance into a DNP program requires completion of a Bachelor of Science in Nursing degree or Master of Nursing degree and current licensure as a registered nurse in addition to specific academic, personal, and professional requirements. While programs vary by institution, a sample program covers leadership, appraisal and application of evidence to advanced practice, health equity, health systems and policy, wellness and health promotion, and quality improvement during the first year. The second and third year of the program focus on specialty specific content and clinical experiences working one-on-one with clinical preceptors in practice settings. Completion of a DNP project in collaboration with a community agency is also required. (University of Washington School of Nursing, n.d.) ARNP’s perform the same services as physicians including diagnosis and treatment, prescribing medications, performing procedures, and following patients in the hospital after surgical procedures or illness. They also deliver babies and provide anesthesia.
What effect would limiting student loans for graduate nursing degrees have on nursing and health care? While it may be difficult to answer this question specifically there are several things to consider. Average costs to complete a Bachelor of Science in Nursing degree can range from $90,000 to $211,000 depending on whether the program is at a public or private institution and whether a student is paying in state or out of state tuition. Average costs for a master’s degree in nursing range from $28,000 to $79,000. Average costs for a Doctor of Nursing practice degree range from $111,000 to $172,000. (Robinson, 2025). The Department of Education proposed loan limits allow “professional degree” students to borrow $200,000 while all other degree programs are limited to $100,000. You can do the math. Keep in mind that while a BSN degree would not qualify for these loan limits this is money already spent prior to entering an advanced degree program which impacts students’ financial resources. Will this deter people from entering nursing as a career? It is difficult to predict but may certainly deter some nurses from pursuing advanced practice degrees. A more challenging question to answer is whether such public disrespect from the US government towards the profession of nursing will deter students from choosing it and instead gravitate towards other more respected professions.
Regardless of the cause of fewer individuals entering the nursing profession, loss of both registered nurses and advanced practice nurses would be devastating for a medical system that is already crumbling. By the year 2032 there is expected to be a shortage of approximately 328,000 registered nurses and close to 34,000 advanced registered nurse practitioners. This shortage is due to a combination of a large number of nurses nearing retirement age, nurses leaving the profession due to burnout, and insufficient nursing faculty to accommodate increased enrollment in nursing programs. (Twenter, 2025) This shortage is happening at the same time millions of baby boomers are reaching an age when their medical care needs will increase dramatically. Fewer nurses in hospital settings leads to increased patient infections, hospital stays, readmissions, and mortality. (American Association of Colleges of Nursing, 2024) Higher patient loads lead to stress and burnout in nurses increasing the number of those leaving the profession. Nurse practitioners are already playing a vital role filling the gaps in primary care, especially in rural communities. Projected shortages will increase wait times for appointments leading to decreased access to care for many, increased urgent care and emergency room visits, and increased morbidity and mortality.
Given the potential for significant negative consequences, will the Department of Education stand by their current proposal? The fact sheet they developed in response to the outrage about the exclusion of nursing tries to undo the damage by making several claims. The fact sheet states: 95% of nursing students borrow less than the annual loan limit so they won’t be affected by the new caps; placing caps on loan limits will actually decrease tuition; and the decision to exclude nurses was not a value judgment on the part of the Trump Administration. (U.S. Department of Education, 2025) There is no way to verify most of this information and it seems to have been a hasty response to justify a decision made without much thought. Currently, a bipartisan group of legislators are pressing the RISE committee to change their definition to include nursing. (Binkley, 2025) Even if the definition is changed the damage is already done. Nursing remains the profession with the highest number of women, approximately 89%. (American Association of Colleges of Nursing, 2024) The decision to exclude nursing as a professional degree appears to be yet another assault on women by the current administration, something I have detailed in prior blog posts including Women Are People Too. I hope as nurses we use our wisdom and power in numbers to inform the public about our education and training as well as the invaluable services we provide. If you want to make a nurses’ day, acknowledge their commitment to promoting and maintaining health and wellness and thank them for the care and compassion they provide.
Until next time sisters stay safe, be well, be kind to yourself, support each other, and spread the love.
Photo by Kathy Kroening. Seattle, WA. May 2025
References:
American Association of Colleges of Nursing. (2024). Fact Sheet: Nursing Shortage. https://www.aacnnursing.org/Portals/0/PDFs/Fact-Sheets/Nursing-Shortage-Factsheet.pdf
American Association of Colleges of Nursing. (2024). Nursing Workforce Fact Sheet. https://www.aacnnursing.org/news-data/fact-sheets/nursing-workforce-fact-sheet
American Association of Colleges of Nursing. (2025). Fact Sheet: The Doctor of Nursing Practice (DNP). https://www.aacnnursing.org/Portals/0/PDFs/Fact-Sheets/DNP-Fact-Sheet.pdf
American Hospital Association. (2025). Fact Sheet: Workplace Violence and Intimidation, and the Need for a Federal Legislative Response. https://www.aha.org/fact-sheets/2023-04-19-fact-sheet-workplace-violence-and-intimidation-and-need-federal-legislative-response#:~:text=Data%20supports%20these%20news%20accounts,potential%20for%20adverse%20medical%20events
Binkley, C. (2025). Lawmakers Urge Education Department to add Nursing to “Professional” Programs List Amid Uproar. KCRA. https://www.kcra.com/article/lawmakers-urge-education-department-nursing-to-professional-programs/69704906
Desjean, J. (2025). You Have Questions; We Have Answers: Making Sense of the Student Loan Changes from OBBBA’s RISE Committee. National Association of Student Financial Aid Administrators (NASFAA). https://www.nasfaa.org/news-item/37700/You_Have_Questions_We_Have_Answers_Making_Sense_of_the_Student_Loan_Changes_from_OBBBA_s_RISE_Committee
Laws, J. (2025). Nursing is no Longer Counted as a “Professional Degree” by Trump Admin. Newsweek. https://www.newsweek.com/nursing-not-professional-degree-trump-admin-11079650?fbclid=IwY2xjawONTG9leHRuA2FlbQIxMQBzcnRjBmFwcF9pZBAyMjIwMzkxNzg4MjAwODkyAAEeoTFyphUaKew2-cZlGc22PkOisO7RJxXMtvvX2bj1FhORxlpYuJ1K976sqDM_aem_lEEypTXqCEt8PwoDTd2wsg
Miller, D. (2025). Why Outrage is Erupting Over Trump Plan to Exclude Nursing from “Professional” Designation. Las Angeles Times. https://www.latimes.com/california/story/2025-11-26/trump-plan-exclude-nursing-professional-degree-list-outrage
National Archives. (2025). Code of Federal Regulations: A Point in Time eCFR System. Title 34. https://www.ecfr.gov/current/title-34/subtitle-B/chapter-VI/part-668/subpart-A/section-668.2
National Center for Education Statistics. (2010). Introduction to the Classification of Instructional Programs: 2010 Edition (CIP-2010). https://nces.ed.gov/ipeds/cipcode/Files/Introduction_CIP2010.pdf
National Center for Education Statistics. (2020). CIP: The Classification of Instructional Programs. https://nces.ed.gov/ipeds/cipcode/browse.aspx?y=56
National Council of State Boards of Nursing (NCSBN). (2023). NCSBN Research Projects Significant Nursing Workforce Shortages and Crisis. https://www.ncsbn.org/news/ncsbn-research-projects-significant-nursing-workforce-shortages-and-crisis
PennNursing. (2011). Nursing, History, and Health Care. American Nursing: An Introduction to the Past. https://www.nursing.upenn.edu/nhhc/american-nursing-an-introduction-to-the-past/
Robinson, C. (2025). How Much Does Nursing School Cost? NurseJournal. https://nursejournal.org/resources/how-much-does-nursing-school-cost/
Twenter, P. (2025). Nurse Practitioner, RN Shortage to hit 362,000 by 2032. Becker’s Hospital Review. https://www.beckershospitalreview.com/quality/nursing/nurse-practitioner-rn-shortage-to-hit-362000-by-2032/#:~:text=Advertisement,should%20be%20a%20national%20priority.
United States Department of Education. (2025). Myth vs. Fact: The Definition of Professional Degrees. https://www.ed.gov/about/news/press-release/myth-vs-fact-definition-of-professional-degrees
United States Department of Education: Office of Post Secondary Education. (2025). Rise Negotiated Rulemaking Committee. https://www.ed.gov/media/document/2025-rise-updated-committee-member-list-112372.pdf
University of Washington School of Nursing. (2024). Bachelor of Science in Nursing (BSN) Prerequisite Courses. https://nursing.uw.edu/wp-content/uploads/2025/05/BSN-Prerequisites-Worksheet.pdf
University of Washington School of Nursing. (2024). Bachelor of Science in Nursing Program 2-year Curriculum. https://students.nursing.uw.edu/wp-content/uploads/2025/09/BSN-2025-Curriuculum-Grid.pdf
University of Washington School of Nursing. (n.d.). DNP – Doctor of Nursing Practice: Curriculum. https://nursing.uw.edu/academics/dnp/#curriculum-1
Walker, A. (2025). Nursing Ranked as the Most Ethical and Honest Profession for 23rd Year in a Row. Nurse.org. https://nurse.org/articles/nursing-ranked-most-honest-profession/#:~:text=For%20an%20impressive%2023rd%20year,%E2%80%94all%20the%20more%20impressive.
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