LA PLATA, Md. — On April 30, the Department of Education issued its final rule on federal student loan regulations. One of the most controversial decisions in that rule is narrowing the regulations on what kinds of students are eligible for student loans above $50,000. Graduate nursing students no longer qualify for loans above $50,000 as they have been removed from the list of “professional” degrees.
The change stems from the 2025 budget bill, dubbed “One Big Beautiful Bill” by President Donald Trump. The bill, signed by Trump in July, included cuts to student loan programs including limits on how much graduate students can take on in federal student loans after July 1, 2026, based on whether the degree program is categorized as a graduate or professional program. Nursing was among the fields not classified as a professional degree for the purposes of these federal student loan regulations — students in graduate programs studying law, medicine, dentistry, veterinary medicine and more are among the 11 fields still classified as “professional.”
According to the University of Maryland School of Nursing’s 2021 COVID-19 impact report, there were 86,954 active, licensed registered nurses in Maryland, with 51,480 nurses employed in Maryland. Estimates say that the number of employed nurses has decreased slightly since then. There are also thousands of open positions across the state, and the Maryland Hospital Association estimates needing roughly 13,800 RNs and 9,200 LPNs by 2035. Maryland also faces some of the longest emergency room wait times in the country.
Health care workers are needed across Maryland and nationally. Nursing is also known for being a career path that has a variety of options, flexibility, and has a direct impact on patients and the community. Nurses can start working in their field with an associate degree and get advanced education as they earn money.
Advocates for the change say it won’t impact students looking for loans for undergraduate degrees. The Department of Education (DEO) wrote in a statement that the change would only affect nurses applying for graduate-level programs. These nurses will still be able to get loans for under the $50,000 cap — and 95% of nursing students borrow below this amount.
The DOE also said that the aim of the change was to force schools to lower the cost of nursing programs — they believe that schools will want to fill seats, and will therefore lower tuition when they can’t rely on loans to pay for those seats. The DOE also called criticism of the proposal “progressive voices fear-mongering.” Professional nursing organizations such as the American Nurses Association and the American Association of Colleges of Nursing also criticized the effort.
While lowering costs for education is an important goal, the realities of running a nursing education program are complicated and several institutions are concerned the consequences of the rule change may outweigh any benefits. The DOE has not publicly addressed concerns raised by some nursing leaders over potential nursing shortages.
Peggy Norton-Rosko, DNP, NEA-BC, the former senior vice president and chief nurse executive at University of Maryland Medical System, explained in an interview with The BayNet that in many rural communities, nurse practitioners serve vital roles in lieu of physicians. NPs are advanced registered nurses that can serve in a primary care role in a variety of settings, including an urgent care or emergency room. Nurses need a master’s degree and advanced training to be an NP — a process many undertake while working as an RN.
“Rural communities rely on primary care NPs as a major provider for a point of access,” Norton-Rosko said. “These advanced degrees are increasingly becoming a part of our hospital and health care system.”
Critically, physician assistants also are excluded from the “professional” designation. NPs and PAs are among the most sought-after health care professionals.
UMMS CEO Mohan Suntha, MD, shared his concerns in an op-ed to The Baltimore Sun in December.
“The Association of American Medical Colleges says we’ll face a physician shortage of up to 86,000 physicians by 2036,” Suntha wrote. “Advanced degree nurses are at least part of the solution to filling critical gaps in our physician workforce by providing high-level, complex care, especially in rural and underserved communities.”
According to Suntha, fewer advanced practice nurses could contribute to higher health care costs for Americans.
The University of Maryland Medical System currently employs approximately 8,300 licensed nurses, with 298 at Charles Regional Medical Center. This is about 30% of the system’s total workforce. The system also currently employs about 800 advanced practice nurses — nurse practitioners, clinical nurse specialists, certified nurse midwives and certified registered nurse anesthetists — with 10 of these individuals working at Charles Regional Medical Center in La Plata.
Norton-Rosko said master’s-educated nurses provide advanced care across a variety of types of medicine, such as certified registered nurse anesthetists and nurse midwives. More nurses with advanced degrees means that more patients can be seen.
“It will impact how patients are able to access care. We’ll have longer delays for people in all settings. For example, if we don’t have enough CRNAs, that affects when we can get patients’ procedures and surgeries scheduled. We learned coming out of COVID that at the RN level, if we can’t keep beds open because we don’t have enough nurses, it impacts access to care, it impacts the whole system,” Norton-Rosko said.
Due to the advanced training NPs and nurses in similar roles receive, there is no way for other health care providers to cover these roles. An RN cannot step in one day for a CRNA in a safe manner.
On the education side, Norton-Rosko says the long-term impacts will be noticeable. The cost to pursue a graduate nursing degree is more than $100,000 at the University of Maryland. Employers do contribute to their employees’ educational pursuits, but don’t come close to covering full tuition. UMMC offers $5,120 a year, which is the highest amount before the recipient will be subject to paying income tax on the award.
Outside of employer help and loans, nurses can turn to private foundations and scholarships. In these cases, the pressure is on the nurse to personally seek out these opportunities and win them against other candidates. This leaves nurses vulnerable to tuition gaps, where some may seek alternative borrowing methods. Plus, it puts added stress on their already stressful job.
While she doesn’t think it will stop people from pursuing nursing altogether, Norton-Rosko says it will certainly alter the trajectory of people who saw themselves in an advanced role. Their timelines might be slower, or they could drop out of the career path if they don’t see opportunities for advancement.
“Work at the bedside is hard,” Norton-Rosko said. “It takes a physical and emotional toll and sometimes people have to step away, especially mid- or late-career. Instead of being able to move to a new, non-bedside role, it could lead some people to leave the profession. They could choose a different career outside health care. And then we lose someone qualified, a potential leader, who could have made a huge impact in the system or a rural area.”
Norton-Rosko agrees that costs have to come down, but nursing programs are expensive to run because of the intense hands-on training nurses receive. Filling nursing instructor roles is challenging because nurses make substantially more working in health care settings and schools don’t usually provide benefits. Norton-Rosko said most nursing instructors she knows still work full time and teach part time. They can’t afford it otherwise.
“The cost of education has to change in general,” Norton-Rosko said. “It’s an unsustainable thing for our society.”
On the other hand, the College of Southern Maryland (CSM), a popular associate degree program, doesn’t anticipate the change impacting enrollment in its nursing program.
“The Department of Education’s change in the definition of a ‘professional’ program does not affect educational or job opportunities for CSM’s nursing students, nor does it change student experiences in the classroom or in clinical settings,” Associate Vice President of Marketing and Communications Avis McMillon wrote in an email to The BayNet. “There continues to be strong demand for nurses, and CSM graduates remain well-positioned for employment with local hospitals and health care agencies. Our clinical partnerships and workforce pipelines are unchanged.”
McMillon added that only 10.4% of all students at CSM received student loans. That’s in part, she says, because of the cost-containment measures in place that help ensure that students continue to have access to high-quality learning opportunities.
Many students choose community colleges because they are affordable and close to home, and many attend part time so they can continue working while enrolled. Attending CSM first and then transferring to a four-year institution is a way students can make becoming a registered nurse more affordable. CSM offers multiple pathways into the nursing profession, including an associate degree in nursing or a practical nursing certificate, along with clear transfer pathways to a bachelor’s degree.
CSM is doing its job to help students get an affordable education and educating nurses that are vital to our health care system. It’s what comes later — filling and training advanced roles within the health care system — that could prove challenging.
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