As Pennsylvania grapples with one of the most severe nursing shortages in the nation, a local lawmaker’s legislative proposal and related investments proposed by the governor aim to bolster the state’s invaluable nursing workforce pipeline.
Longtime nurse and state Rep. Bridget Kosierowski, D-114, Waverly Twp., is the prime sponsor of House Bill 1676, also known as the Nursing Shortage Assistance Program Act, which would establish a program within the state Department of Labor and Industry. It would specifically provide grants to qualified “nursing servicers” to help nursing students secure employment after graduating and repay student loans incurred while obtaining nursing degrees from Pennsylvania educational institutions.
Kosierowski described the proposal as a creative solution to increase recruitment and training of new nurses as the state faces the specter of a roughly 20,000-nurse shortage by 2026. A January 2024 fact sheet published by the Hospital and Healthsystem Association of Pennsylvania noted the state was projected to suffer the worst nursing shortage in the nation by next year, a particularly alarming prospect for a Northeast Pennsylvania region with a large population of older adults where chronic disease is more prevalent.
“The need is so great,” Kosierowski said, echoing a sentiment shared by local health systems and providers. “The workforce is the most important part of health care, and that’s nurses — nurses in long-term care, nurses in critical care, nurses in bedside care.”
Democratic Gov. Josh Shapiro’s administration referenced the 20,000-nurse shortage projection in a March news release touting a proposed $5 million budget investment that would fund the program Kosierowski’s bill creates. The Nurse Shortage Assistance Program, as it’s called in the release, “will provide funding to hospitals that partner with nursing schools to cover tuition costs for students who commit to a three-year work placement at Pennsylvania hospitals after graduation.”
Shapiro and state Labor and Industry Secretary Nancy Walker highlighted the proposed investment in March while visiting Temple University Health System.
“By expanding education programs, providing tuition assistance and strengthening workforce pipelines, we can ensure hospitals have the skilled professionals they need to deliver high-quality patient care,” Shapiro said at the time. “We know this model of tuition assistance works, and for the first time ever, we are proposing to help nursing students with an investment of state dollars that not only gives them peace of mind but creates a pipeline of new, highly trained nurses for our communities.”
The program Kosierowski’s bill would establish would provide grant funding through qualified nursing servicers, entities that contract with educational institutions, prospective nursing students and hospitals “in a manner that promotes greater access to education and career opportunities.” A qualified servicer also contracts with multiple Pennsylvania hospitals to coordinate agreements between hospitals and prospective nursing students “in a manner that facilitates the repayment of student loan expenses” the students incur, per the bill.
Servicers would apply for grant funding via an application listing the partner hospitals that would employ the prospective nurses and the number of prospective nurses the grant money would benefit in the form of loan repayments. The bill defines a partner hospital as a hospital that has a contractual relationship with a qualified servicer, provides loan-repayment assistance to nurses and agrees to provide nonstate matching funds for loan-repayment assistance “equal to 100% of the grant amount” made available by the servicer.
The bill also prohibits servicers and subgrantee partner hospitals from using grant funds for administrative costs, and caps at $10,000 per year, or $30,000 in total, the amount of grant money a nurse employed by a partner hospital can receive in loan-repayment assistance for a degree in nursing.
“My legislation would help the Commonwealth provide more creative and collaborative solutions to the nursing care shortage with the goal of helping our struggling healthcare system better serve the public,” Kosierowski said in a news release issued after the state House’s Labor and Industry Committee approved the bill.
It has yet to go before the full House for a vote.
Mary Jane DiMattio, a professor and chairwoman of the University of Scranton’s nursing department, endorsed the proposal. But she also said addressing the state’s boarder health care workforce challenges will require investments in worker-retention strategies that complement workforce development and recruitment efforts.
“If we don’t look at the retention issues and why nurses leave, particularly the hospital bedside, this initiative isn’t going to do everything that we hoped,” DiMattio said. “So certainly I’m in favor of it and I think it’s great, but I think that … more work needs to be done on why nurses leave the hospital bedside.”
After surveying more than 800,000 nurses, the National Council of State Boards of Nursing released in April findings from its 2024 National Nursing Workforce Study that showed more than 138,000 nurses left the workforce since 2022, with stress, burnout and retirement listed as key reasons. The study also found that almost 40% of responding registered nurses and more than 41% of responding licensed practical nurses and vocational nurses reported an intent to leave the workforce or retire within the next five years, with more than 40% of those respondents identifying stress and burnout as root causes.
Beyond burnout and stress, other top reasons include workload, understaffing and inadequate salary, according to the NCSBN.
“While we have seen some improvements, staffing challenges, stress and burnout, and workforce safety are issues that have permeated the nursing industry before, during and after the (COVID-19) pandemic and are still challenges,” NCSBN Chief Executive Officer Phil Dickison said in an April news release. “It is necessary to continue efforts to retain more experienced nurses and address longstanding factors associated with nurses’ premature intent to leave, ensuring dependable workforce planning moving forward.”
On the retention front, DiMattio said other grant initiatives should aim to help hospitals improve their practice and work environments.
“Because that’s what comes out in every research study that’s been done on this,” she said. “Nurses leave hospitals because of the practice environment, and hospitals that have better practice environments are better at retaining nurses.”
Kosierowski, who worked as a nurse for decades before entering politics, said her legislation and the governor’s proposed budget investment should help the state address the need for new nurses and fill the void.
“This is a huge crisis, but we’ve got to do something and I think the governor’s plan is one more incentive to go to nursing school, to get a job in the hospitals and to stay here,” she said.
She also described nursing as a rewarding but high-stress job made more stressful by staff shortages, long hours, greater patient needs, the growing threat of workplace violence and other factors.
“It’s very difficult work, and we want to make sure that we are rewarding those professionals for the job that they do,” Kosierowski said. “And something like this program does just that.”