In the last few years, hospital leaders have been faced with a tangled web of needs: easing nurse shortages, retaining nurses, and helping all pursue their career dreams. Their solutions all come down to nurse education.
Health systems have been taking a more active role in providing, supporting and building out nurse education programs in universities and as part of employee benefits. However, they still face a number of complex issues.
The state of nursing program enrollment
In 2023, nearly 66,000 qualified applications were turned away from nursing schools due to deficits in the nurse educator space. For years, universities have struggled to expand or open new nursing programs due to faculty shortages and limited clinical site availability.
“Many people who want to become nurses can’t get into programs due to limited enrollment, but schools are finding creative ways — like online and virtual learning — to reach more students,” Timothy Carrigan, PhD, RN, regional chief nursing officer of Illinois and Indiana at Livonia, Mich.-based Trinity Health, told Becker’s. “We need this growth to continue.”
Now, nursing program enrollment is on the rise after several years of declining rates. Leaders across the nation told Becker’s this will likely be a long-term trend that will be vital in stabilizing the nursing workforce. They point to a few factors that have made nursing a more attractive field post-COVID-19, including increased wages, flexible scheduling and the prestige of a lifelong career that offers many avenues for growth and advancement.
However, with increased enrollment comes a few challenges of its own. In the first quarter of 2025, the NCLEX pass rate for registered nurses dropped to 71.6%, compared to 79.1% in the same period in 2024. The decline affected U.S.-educated and internationally educated nurses, as well as both first-time and repeat test takers.
“If we cast a wider net to include students who might not have traditionally gotten into nursing school, we may see more who don’t pass on the first try and need a second attempt,” Dr. Carrigan said. “That’s not overly concerning to me, but it is something to watch. We need to study whether reaching a broader population means we should adapt undergraduate nursing curriculums to align better with the experiences and needs of today’s students.”
In some cases, leaders are finding students need more support in certain subjects.
“The question is: Are we taking the right students into the programs, and are we preparing them for success?” Lisa Gossett, MSN, RN, system chief nursing officer and chief experience officer at Dayton, Ohio-based Premier Health, told Becker’s. “For example, one of our baccalaureate programs used to lose a lot of ‘nursing intended’ students during the prerequisite science courses.”
These students were often failing foundational math and science courses critical to nursing. This prompted Premier Health to partner with local schools to help support students in these subjects.
“Without that academic foundation and interpersonal skills, it’s hard to succeed in nursing school or in the profession,” she said.
Education and learning do not end with a degree. Many systems are ramping up their professional development programs to fill knowledge gaps and improve nurse retention.
Education’s impact on nurse retention
During the pandemic, many schools switched to online learning, which caused a domino effect of students entering the field not feeling prepared for the role. This, in conjunction with waves of nurses leaving hospitals and fewer students enrolling, pushed hospitals to improve their professional development programs and benefits.
“COVID left us with graduates who weren’t fully practice ready, so hospitals had to pick up what might have been taught in school,” Susan Reeves, EdD, RN, system chief nurse executive at Lebanon, N.H.-based Dartmouth Health, told Becker’s. “The complexity of care is also growing rapidly. In nursing, as in medicine, what you know today isn’t always what you’ll need to know tomorrow. New procedures, new patient populations, and new technologies all require continuous learning. Nurse educators are key to preparing staff for those changes.”
For many systems, it starts with university partnerships to improve clinical experiences for nursing students.
“That means treating students as valuable members of the team, not ‘just’ students,” Ms. Gossett said. “How faculty talk about the profession also influences how students see their careers. Many faculty encourage ongoing education, which helps build a mindset of growth and learning. That benefits both the nurse and the organization in the long run.”
In recent years, more hospitals have launched nurse residency programs that combine skills training, mentorship and support in the first year on the job.
“Residencies build confidence and competence, reducing the shock and stress that can lead to turnover,” Carolyn Santora, MSN, RN, chief nursing officer and chief regulatory officer at Stony Brook (N.Y.) University Hospital, told Becker’s. “We’re even discussing additional support in the second year. Nursing is demanding but rewarding, and structured support makes a big difference in retention.”
Stony Brook’s residency program helped the hospital achieve a 5% vacancy rate.
Chicago-based CommonSpirit boosted its one-year retention rate for new graduates from 50% four years ago to more than 90% in 2025 thanks to its structured residency program, preceptors and nurse educators.
Hospitals are also ramping up their professional development for nurses of all experience levels as a retention strategy.
“Developing a nurse’s career involves more than just their initial graduation,” Dr. Carrigan said. “It’s about creating pathways for both advanced practice and sustained bedside excellence. There’s a strong correlation between professional development and retention. Tuition benefits are a big factor — nurses may stay because they’re enrolled in a program we’re supporting, or they may leave for an organization offering a larger tuition package.”
Professional development comes in many forms, including formal degree programs, continuing education, specialty certifications and professional conference attendance, Dr. Reeves said. These programs help hospitals stay “sticky,” meaning nurses want to stay because they know they can grow their career there.
Continuing education and dedicated learning resources also allow nurses to grow professionally while remaining in direct patient care, Helen Staples-Evans, DNP, RN, senior vice president of patient care services and chief nursing officer at Loma Linda (Calif.) University Health Hospitals, told Becker’s. The system has also found success in implementing virtual nursing and observation opportunities to nurses who think they want to transfer to other units. These opportunities allow them to experience the unit before making the move.
Traditionally, nurses spent their majority of their career at the bedside, stepping into leadership roles only after gaining years of experience. But now, with a shortage of nurses and greater employment competition among hospitals and private companies, systems are providing more leadership and faculty opportunities.
A shift in career trajectories
Hospitals have long worked to ease nurse shortages but now face a catch-22: the same career advancement programs designed to support and retain nurses are contributing to more leaving the bedside.
“A few months ago, I met with our new nurse residents and asked them where they saw themselves in five years,” Ms. Gossett said. “None said they wanted to be at the bedside; most wanted to be nurse practitioners, leaders or managers — some even said they wanted my job. Many were aiming for advanced practice RN roles, MBAs or MHAs to move into leadership or the business side of healthcare.”
Leaders are doing what they can to support nurses in their career goals while also maintaining staff at the bedside. This is becoming increasingly difficult as leaders grapple with how to keep institutional knowledge when experienced nurses leave the field.
“The key will be not just replacing them, but keeping institutional knowledge intact,” Tim Plante, MSN, RN, CNO of the central region of CommonSpirit Health, told Becker’s. “If we simply swap experienced nurses for new grads, we risk losing depth of expertise. Without enough seasoned nurses, you never build that layer of expert practitioners, which is a concern CNOs everywhere share.”
