The United States faces a deepening nursing shortage, and in this Forbes piece, education author Michael B. Horn argues that the crisis is not simply a pipeline problem. It is a risk problem. Students face enormous financial risk in pursuing healthcare careers. Nursing schools face capacity constraints. Employers face retention uncertainty after investing in new graduates. These interlocking risks are keeping the system stuck even as demand for care grows.
The Risk Problem At Every Level
Horn identifies three distinct failure points. For aspiring nurses, the cost of education, often exceeding $50,000 or more in student loan debt, is a significant barrier to entry. Many qualified candidates forgo nursing programs because the financial risk is too high, particularly given the uncertain path to employment after graduation.
For nursing schools, turning away qualified applicants is not a philosophical choice; it reflects a real shortage of clinical training sites and faculty. Yet without expanding capacity, the pipeline cannot grow fast enough to meet demand. The Health Resources and Services Administration projects the U.S. will face a shortage of more than 200,000 registered nurses by 2037.
For employers, the investment in recruiting and onboarding a new nurse is substantial, often $50,000 to $80,000 per hire, with no guarantee of long-term retention. High turnover rates, especially among first-year nurses, make workforce planning deeply difficult.
Shared Risk as a Solution
Horn's central argument is that shared-risk education and employment models can break this cycle. When employers fund student loan repayment in exchange for a post-graduation work commitment, all parties benefit. Students reduce their personal financial risk. Employers secure a reliable, pre-committed pipeline of trained nurses. And schools can expand enrollment with greater confidence that their graduates will find employment.
Programs like Scholars Network embody this model by connecting nursing students with employer partners who fund loan repayment in exchange for a multi-year commitment. The structure aligns the incentives of students, schools, and employers rather than leaving each party to manage risk independently.
The Urgency Of Acting Now
The demographic pressures driving nursing demand are not reversing. The share of Americans aged 65 and older is projected to grow from 17 percent to 23 percent of the total population by 2050. Without systemic changes to how nursing education is financed and how employers invest in future talent, the gap between supply and demand will only widen.
Horn's analysis points toward models that de-risk entry into the nursing profession as the most promising path forward not just for individual students and employers, but for the healthcare workforce as a whole.