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A Canadian Hospital Scoops Up Nurses Who No Longer Feel Safe in Trump’s America

Brett Kelman — Fri, 27 Feb 2026 19:30:00 +0000

Last year, as the California hospital where she worked was appeasing the Trump administration by erasing words like “equity” and “diversity” from its paperwork, Brandy Frye had seen enough.

Frye, an emergency room nurse with 25 years of experience, felt that ignoring inequality’s role in health and sickness was an affront to the compassionate soul of the nursing profession.

“It felt like a step against everything I believe in,” Frye said. “And I didn’t feel like I belonged there anymore.”

Now Frye has found a new place to belong. She is part of a surge of American nurses and other health care workers moving to Canada��—��specifically,��British Columbia��—��to escape the policies of President Donald Trump. Frye settled in Nanaimo on Vancouver Island, where the local hospital has hired 20 American nurses in less than a year.��

“There are so many like-minded people out there,” said Justin Miller, another American nurse who started at Nanaimo Regional General Hospital this month. “You aren’t trapped. You don’t have to stay. Health care workers are welcomed with open arms around the world.”

More than 1,000 U.S.-trained nurses have been approved to work in British Columbia since April, when the province streamlined its licensing process for Americans, then launched an advertising campaign to take advantage of the “chaos and uncertainty happening in the U.S.” Nursing associations in Ontario and Alberta said they too have seen increased interest from American nurses in the past year.

“Some of them were living in fear of the administration, and they shared a sense of relief when crossing the border,” said Angela Wignall, CEO of Nurses and Nurse Practitioners of British Columbia. “As a Canadian, it’s heartbreaking. And also a joy to welcome them.”

The Trump administration, for its part, doesn’t seem concerned. When asked to comment, the White House dismissed accounts of nurses moving to Canada as “anecdotes of individuals with severe cases of Trump derangement syndrome.”

This aligns with an article we reported last year that found American doctors were also relocating north to get away from the Trump administration. According to the Medical Council of Canada, more than 1,200 American doctors created accounts on in 2025 — typically the first step to getting licensed in Canada — compared with only about 300 in 2024.

��ϳԹ�� News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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‘You Aren’t Trapped’: Hundreds of US Nurses Choose Canada Over Trump’s America

Brett Kelman — Thu, 26 Feb 2026 10:00:00 +0000

Last month, Justin and Amy Miller packed their vehicles with three kids, two dogs, a pet bearded dragon, and whatever belongings they could fit, then drove 2,000 miles from Wisconsin to British Columbia to leave President Donald Trump’s America.

The Millers resettled on Vancouver Island, their scenic refuge accessible only by ferry or plane. Justin went to work in the emergency room at Nanaimo Regional General Hospital, where he became one of at least 20 U.S.-trained nurses hired since April.

Fear of Trump, some of the nurses said, was why they left.

“There are so many like-minded people out there,” said Justin, who now works elbow to elbow with Americans in Canada. “You aren’t trapped. You don’t have to stay. Health care workers are welcomed with open arms around the world.”

The Millers are part of a new surge of American nurses, doctors, and other health care workers , and specifically British Columbia, where more than 1,000 U.S.-trained nurses have been approved to work since April. As the Trump administration enacts increasingly authoritarian policies and decimates funding for , , and , many nurses have felt the draw of Canada’s progressive politics, friendly reputation, and universal health care system.

Additionally, some nurses were incensed last year when the Trump administration said it would reclassify nursing as a , which would impose strict federal limits on the loans nursing students could receive.

Canada is poised to capitalize. Two of its most populous provinces, Ontario and British Columbia, have streamlined the licensing process for American nurses since Trump returned to the White House. British Columbia also launched a last year to recruit nurses from California, Oregon, and Washington state.

“With the chaos and uncertainty happening in the U.S., we are seizing the opportunity to attract the talent we need,” Josie Osborne, the province’s health minister, said in a statement announcing the campaign.

Fears Realized

Amy Miller, a nurse practitioner, said she and her husband were determined to move their children out of the country because they felt Trump’s second term would inevitably spiral into violence.

First, the Millers got nursing licenses in New Zealand, but when the job search took too long, they pivoted to Canada.

Justin was offered a job within weeks.

Amy found one within three months.

So they moved. And just a few days later, the Millers watched with horror from afar as their fears came true.

As federal immigration forces clashed with protesters in Minneapolis on Jan. 24, federal agents fatally shot an ICU nurse, Alex Pretti, as he filmed a confrontation and appeared to be trying to shield a woman who was knocked down. Video of the killing showed border agents pinning Pretti to the ground before seizing his concealed, licensed handgun and opening fire on him.

The Trump administration quickly called Pretti a “domestic terrorist” who intended to kill federal agents. That allegation was disputed by eyewitness videos that circulated on social media and spurred widespread outrage, including from nurses and nursing organizations, some of whom invoked the profession’s duty to care for the vulnerable.

“I don’t want to say it was expected, but that’s why we are here,” Amy Miller said. “Even our oldest kid, she was like: ‘It’s OK, Mom, because we are not there anymore. We are safe here.’ So she recognizes that, and she’s not even in middle school yet.”

Both the U.S. and Canada have a severe need for nurses. The U.S. is projected to be short about 270,000 registered nurses, plus at least 120,000 licensed practical nurses, by 2028, according to from the Health Resources and Services Administration. In Canada, nursing job vacancies tripled from 2018 to 2023, when they reached nearly 42,000, according to from the Montreal Economic Institute, a Canadian think tank.

When asked to comment, the White House noted that shows the number of nurses licensed in the U.S. increased in 2025. It dismissed accounts of nurses moving to Canada as “anecdotes of individuals with severe cases of Trump derangement syndrome.”

“The American health care workforce is the finest in the world, and it continues to expand under President Trump,” White House spokesperson Kush Desai said. “Employment opportunities in the American health care system remain robust, with career advancement and pay that far exceed that of other developed nations.”

An aerial view of Nanaimo, British Columbia. (iStock/Getty Images Plus)

‘A Sense of Relief’

It is unknown precisely how many American nurses have moved north since Trump returned to office, because some Canadian provinces do not track or release such statistics.

British Columbia, which has done the most to recruit Americans, approved the licensing applications of 1,028 U.S.-trained nurses from when the province’s streamlined application process took effect in April 2025 through January, according to the British Columbia College of Nurses and Midwives. In all of 2023, only 112 applicants from the U.S. were approved, the agency said. In 2024, it was 127.

Increased interest from American nurses was also confirmed by nursing associations in Ontario and Alberta, as well as by the nationwide Canadian Nurses Association.

Angela Wignall, CEO of Nurses and Nurse Practitioners of British Columbia, said American nurses used to move north because they had fallen in love with Canada (or a Canadian). But more recently, she said, she had met nurses who feared the White House would spur violence and vigilantism, particularly against families that included same-sex couples.

“Some of them were living in fear of the administration, and they shared a sense of relief when crossing the border,” Wignall said. “As a Canadian, it’s heartbreaking. And also a joy to welcome them.”

Vancouver Island, which has a population of about 860,000, has gained 64 U.S.-trained nurses since April, including those at Nanaimo Regional, said Andrew Leyne, a spokesperson for the island’s health agency.

One of the nurses was Susan Fleishman, a Canadian who moved to the U.S. as a child, then worked for 23 years in American emergency rooms before leaving the country in November.

Fleishman said hateful rhetoric from Trump has fueled an angry division that has permeated and soured American life.

“It wasn’t an easy move — that’s for sure. But I think it’s definitely worth it,” she said, happily back in Canada. “I find there is a lot more kindness here. And I think that will keep me here.”

Brandy Frye, who also worked for decades in American ERs, said she moved to Vancouver Island last year after waiting to see whether Mark Carney would become Canada’s prime minister. Carney’s rise was widely viewed as a rejection of Trumpism.

Meanwhile, Frye said, the California hospital where she worked had been stripping words associated with diversity and equity out of its paperwork to appease the Trump administration. She couldn’t stand it.

“It felt like a step against everything I believe in,” Frye said. “And I didn’t feel like I belonged there anymore.”

Frye and fellow nurse Susan Fleishman work the night shift at Nanaimo Regional General Hospital. Both said they left their longtime U.S. jobs last year to get away from the far-right policies and hateful rhetoric of President Donald Trump. (Taylor Pradine)

Like many of the American nurses who have moved to Vancouver Island, Frye was first wooed to the area by a that was meant to attract tourist dollars but ended up doing much more.

About a year ago, Tod Maffin, a and former CBC Radio host, invited Americans to the port city of Nanaimo for a weekend event designed to offset the impact of Trump’s tariffs on the local economy.

Maffin said about the April event.

“A lot of them were health care workers looking for an escape route,” Maffin said. “They were there to help support our economy but also to look into Canada.”

Maffin saw an opportunity. He repurposed the event website into a recruiting tool and launched a Discord chatroom to help Americans relocate.

Maffin said he believes the campaign helped about 35 health care workers move to Vancouver Island. Volunteers in have since duplicated his website in an effort to attract their own American nurses and doctors.

“There are communities across Canada where the emergency room closes at night because one nurse is out. That’s how thin staffing is,” Maffin said.

“One new nurse in a small town, or in a midsized city like Nanaimo,” he said, “makes a difference.”

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Trump Almost Unveils a Health Plan��

Tue, 25 Nov 2025 19:10:00 +0000

The Host

Julie Rovner ��ϳԹ�� News Read Julie's stories. Julie Rovner is chief Washington correspondent and host of ��ϳԹ�� News’ weekly health policy news podcast, "What the Health?" A noted expert on health policy issues, Julie is the author of the critically praised reference book "Health Care Politics and Policy A to Z," now in its third edition.

Republicans remain divided over how to address the impending expiration of more generous Affordable Care Act plan tax credits, which will send premiums spiraling for millions of Americans starting in January if no further action is taken. The Trump administration floated a proposal over the weekend that included a two-year extension of the credits as well as some restrictions pushed by Republicans, but the plan was met with strong pushback on Capitol Hill and its unveiling was delayed.

Meanwhile, the Department of Education has declared that a long list of health careers are not “professions,” meaning that students pursuing those tracks — including as nurses, physical therapists, and physician assistants — will no longer be eligible for federal student loans large enough to cover their tuition.

This week’s panelists are Julie Rovner of ��ϳԹ�� News, Sarah Karlin-Smith of the Pink Sheet, Alice Miranda Ollstein of Politico, and Sandhya Raman of CQ Roll Call.

Panelists

Sarah Karlin-Smith Pink Sheet

Alice Miranda Ollstein Politico

Sandhya Raman CQ Roll Call

Among the takeaways from this week’s episode:

The news of Trump’s health care plan landed as Sen. Bill Cassidy of Louisiana was working on a separate GOP proposal to direct money into health savings accounts. Congressional Republicans suggested they were left out of Trump’s planning and, among other things, opposed his proposed extension of limited ACA premium tax credits.
Health and Human Services Secretary Robert F. Kennedy Jr. has confirmed that he ordered the change to the Centers for Disease Control and Prevention website to assert the false claim that vaccines may cause autism. That development puts Republicans in a tough spot — particularly Cassidy, a physician who voted for Kennedy’s confirmation after saying he’d secured an agreement that Kennedy would not make changes to the CDC’s vaccine policy.
Three states have revived the lawsuit challenging the approval of mifepristone, adding to the case the FDA’s recent approval of another generic version. The Supreme Court threw out the first case, ruling then that the plaintiffs — who were doctors — lacked standing to prove harm. Yet the revived case may very well end up at the Supreme Court again.

Also this week, Rovner interviews Joanne Kenen and Joshua Sharfstein of the Johns Hopkins Bloomberg School of Public Health about their new book, .

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: The New Yorker’s “,” by Tatiana Schlossberg.

Alice Miranda Ollstein: CNBC’s “,” by Jonathan Vanian.

Sarah Karlin-Smith: The Guardian’s “,” by Sirin Kale and Lucy Osborne.

Sandhya Raman: ��ϳԹ�� News’ “Kids and Teens Go Full Throttle for E-Bikes as Federal Oversight Stalls,” by Kate Ruder.

Also mentioned in this week’s podcast:

The Center for Law and Social Policy’s “.”
The New York Times’ “,” by Sheryl Gay Stolberg.
The Atlantic’s “,” by Katherine J. Wu.
NPR’s “,” by Yuki Noguchi.
Campaign for Accountability’s “.”

click to open the transcript Transcript: Trump Almost Unveils a Health Plan

While Politicos Dispense Blame, These Doctors Aim To Take Shame Out of Medicine

Charlotte Huff — Wed, 05 Nov 2025 09:00:00 +0000

The distress that Will Bynum later recognized as shame settled over him nearly immediately.

Bynum, then in his second year of residency training as a family medicine physician, was wrapping up a long shift when he was called into an emergency delivery. To save the baby’s life, he used a vacuum device, which applies suction to assist with rapid delivery.

The baby emerged unharmed. But the mother suffered a severe vaginal tear that required surgical repair by an obstetrician. Soon afterward, Bynum retreated to an empty hospital room, trying to process his feelings about the unexpected complication.

“I didn’t want to see anybody. I didn’t want anybody to find me,” said Bynum, now an at Duke University School of Medicine in North Carolina. “It was a really primitive response.”

Shame is a common and highly uncomfortable human emotion. In the years since that pivotal incident, Bynum has become a among clinicians and researchers who argue that the intense crucible of medical training can amplify shame in future doctors.

He is now part of an emerging effort to teach what he describes as “” to medical school students and practicing physicians. While shame can’t be eliminated, Bynum and his research colleagues maintain that related skills and practices can be developed to reduce the culture of shame and foster a healthier way to engage with it.

Without this approach, they argue, tomorrow’s doctors won’t recognize and address the emotion in themselves and others. And thus, they risk transmitting it to their patients, even inadvertently, which may . Shaming patients can backfire, Bynum said, making them defensive and leading to isolation and sometimes substance use.

The U.S. political environment presents an additional obstacle. Health and Human Services Secretary Robert F. Kennedy Jr. and other top Trump administration health officials have autism, diabetes, attention-deficit/hyperactivity disorder, and other chronic issues in large part on the lifestyle choices of people with the conditions — or their parents. For instance, FDA Commissioner Marty Makary suggested in a Fox News interview that diabetes could be better treated with cooking classes than “.”

Even before the political shift, that attitude was reflected at doctors’ offices as well. A 2023 study found that when treating patients with Type 2 diabetes. About 44% viewed those patients as lacking motivation to make lifestyle changes, while 39% said they tended to be lazy.

“We don’t like feeling shame. We want to avoid it. It’s very uncomfortable,” said , a nurse at the University of Wisconsin-Madison, who has of related studies, published in 2024. And if the source of shame is from the clinician, the patient may ask, “‘Why would I go back?’ In some cases, that patient may generalize that to the whole health care system.”

Indeed, Christa Reed dropped out of regular medical care for two decades, weary of weight-related lectures. “I was told when I was pregnant that my morning sickness was because I was a plus-size, overweight woman,” she said.

Except for a few urgent medical issues, such as an infected cut, Reed avoided health care providers. “Because going into a doctor for an annual visit would be pointless,” said the now 45-year-old Minneapolis-area wedding photographer. “They would only just tell me to lose weight.”

Then, last year, severe jaw pain drove Reed to seek specialty care. A routine blood pressure check showed a sky-high reading, sending her to the emergency room. “They said, ‘We don’t know how you’re walking around normal,’” she recounted.

Since then, Reed has found supportive physicians with expertise in nutrition. Her blood pressure remains under control with medication. She’s also nearly 100 pounds below her heaviest weight, and she hikes, bikes, and lifts weights to build muscle.

, a California psychiatrist, is among a group of physicians trying to bring attention to the detrimental effects of shame and develop strategies to prevent and mitigate it. While this effort is in the early stages, she co-led a session on the spiral of shame at the American Psychiatric Association’s annual meeting in May.

If physicians don’t acknowledge shame in themselves, they can be at risk of depression, , sleeping difficulties, and other ripple effects that erode patient care, she said.

“We often don’t talk about how important the human connection is in medicine,” Woodward said. “But if your doctor is burned out or feeling like they don’t deserve to be your doctor, patients feel that. They can tell.”

In a survey conducted this year, 37% of graduating students at some point in medical school. And nearly 20% described public humiliation, according to the annual survey by the Association of American Medical Colleges.

Medical students and resident physicians are already prone to perfectionism, along with an almost “masochistic” work ethic, as Woodward described it. Then they’re run through a gantlet of exams and years of training, amid constant scrutiny and with patients’ lives on the line.

During training, physicians work in teams and make presentations to teaching faculty about a patient’s medical issues and their recommended treatment approach. “You trip over your words. You miss things. You get things out of order. You go blank,” Bynum said. And then shame creeps in, he said, leading to other debilitating thoughts, such as “‘I’m no good at this. I’m an idiot. Everyone around me would have done this so much better.’”

Yet shame remains “a crack in your armor that you don’t want to show,” said , a family medicine physician at the University of Utah who has taught medical students about the potential for shame as part of a broader ethics and humanities course.

“You’re taking care of a human life,” she said. “Heaven forbid that you act like you’re not capable or you show fear.”

When students are taught about shame, the goal is to help future physicians recognize the emotion in themselves and others, so they don’t perpetuate the cycle, Pippitt said. “If you felt shamed throughout your medical education, it normalizes that as the experience,” she said.

Above all, physicians-in-training can work to reframe their mindset when they receive a poor grade or struggle to master a new skill, said Woodward, the California psychiatrist. Instead of believing that they’ve failed as a physician, they can focus on what they got wrong and ways to improve.

Last year, Bynum started teaching Duke physicians about shame competence, beginning with roughly 20 OB-GYN residents. This year, he launched a larger initiative with , a research and training partnership between Duke University and the University of Exeter in England that he co-founded, to reach about 300 people across Duke’s Department of Family Medicine and Community Health, including faculty and residents.

This sort of training is rare among Duke OB-GYN resident ’s peers in other programs. Dancel, who completed the training, now strives to support students as they learn skills such as how to suture. She hopes they will pay that approach forward in “a chain reaction of being kind to each other.”

More than a decade after Bynum experienced that stressful emergency delivery, he still regrets that shame kept him from checking on the mother as he usually would following delivery. “I was too scared of how she was going to react to me,” he said.

“It was a little devastating,” he said, when a colleague later told him that the mother wished he had stopped by. “She had passed a message along to thank me for saving her baby’s life. If I had just given myself a chance to hear that, that would have really helped in my recovery, to be forgiven.”

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California’s Nursing Shortage Is Getting Worse. Front-Line Workers Blame Management.

Angela Hart — Wed, 08 Oct 2025 09:00:00 +0000

TURLOCK, Calif. — California, like much of the nation, is not producing enough nurses working at bedsides to of an aging and diverse population, fueling a workforce crunch that risks endangering quality patient care. Nearly 60% of California counties, stretching between the borders with Mexico and Oregon, face a nursing shortage, .

Democratic Gov. Gavin Newsom and state lawmakers have tried to bolster the state’s health care workforce, in part by implementing recommendations from the California Future Health Workforce Commission, a 24-member panel of state, labor, academic, and industry representatives. The state in recent years has expanded the for nurse practitioners, allowing them to practice medicine — ordering tests and prescribing medication, for instance — without traditional doctor supervision, and has academic nursing slots and training programs.

Still, California’s shortage of registered nurses is expected to grow from 3.7% in 2024 to 16.7% by 2033, or more than 61,000 nurses, due to inadequate recruitment, training, and retention, according to Kathryn Phillips, associate director of the Improving Access team at the California Health Care Foundation, a nonprofit philanthropic organization specializing in health care research and education.

Regional shortages, particularly in the Central Valley and rural North, are expected to swell. “There are major deficits and those could get even worse,” Phillips said.

Researchers say the gap between nursing supply and demand is exacerbated by inadequate career pathways and high turnover in a labor-intensive industry, but nurses and argue the problem is driven primarily by a management-induced and poor working conditions. Nurses say nursing remains a noble calling, but many report feeling pressured to turn over beds and take on more patients, stress that can dissuade young people from entering the field and drive experienced nurses to .

Industry representatives cast those concerns as union talking points to drive up labor costs, but nurses say they are losing benefits while being overworked, hobbling morale and hampering their ability to provide even basic health care in hospitals, clinics, and nursing homes around the state.

Lorena Burkett, a registered nurse at Emanuel Medical Center in Turlock, an agricultural city in the heart of the Central Valley, recounted being so overloaded last year that she didn’t promptly log a medical chart after administering a psychiatric patient’s medication, a critical step for ensuring proper drug doses.

“I was being told get him out, and I forgot to scan his opioid medication; I missed it,” said Burkett, a 12-year veteran, who later updated the patient’s record. “After that I said no more. We have to prioritize patient care, but we are under a lot of pressure to get patients out and turn profits.”

Tenet Healthcare, the Dallas-based for-profit hospital system that owns Emanuel, declined to respond to Burkett’s claim, as well as questions about staffing levels. In a statement, Tenet spokesperson Rob Dyer said that the hospital provides “quality and compassionate care” and broadly disputed nurses’ concerns.

“We are currently in contract negotiations with the union which represents our nurses,” he said, “and suspect that this is what is behind these false claims.”

Improving Conditions for Nurses

Two years ago, state lawmakers approved to help hospitals maintain operations, which can include retaining nurses. Lawmakers are also trying to improve nurses’ work conditions in hospitals and to protect patient care by at health care facilities. Some also call for investing in a more robust nursing workforce.

“Nurses are working in hospitals and other places that are severely understaffed,” said Michelle Mahon, director of nursing practice for National Nurses United, a union that represents 225,000 nurses.

Phillips said the reasons vary. In the San Francisco Bay Area, nurses must contend with a high cost of living, a lack of affordable housing, and expensive child care. In the Central Valley, there’s insufficient education, training, and mentoring. And the rural North has a hard time attracting enough nurses to replace those who are retiring and to meet the needs of an aging population.

University of California-San Francisco researchers who have say although people are still seeking jobs in nursing, student enrollments and graduations have declined.

The California Board of Registered Nursing shows nearly 552,000 active licensed registered nurses in California as of Oct. 1. Yet the California Nurses Association says significantly fewer were practicing, pointing to 2024 data indicating only 350,850 were working in the field. The same problem persists nationally, according to National Nurses United, which reported that, as of May 2024, licensed nurses were not working in the field.

California Hospital Association spokesperson Jan Emerson-Shea said hospitals around the state are facing “skyrocketing costs” for labor, pharmaceuticals, medical equipment, and compliance with government mandates. Patient care costs have soared 30% in the past five years and continue to rise, she said. Meanwhile, 53% of hospitals in the state “lose money every day caring for patients,” she said.

And it could get worse.

Under the GOP tax-and-spending bill that President Donald Trump called the “One Big Beautiful Bill,” the state estimates roughly Californians could lose health coverage due in part to major Medicaid cuts and new rules like work requirements that narrow eligibility for low-income and disabled residents. California is at risk of losing in annual funding, and hospitals will be hit particularly hard because they rely on federal reimbursements and need enough insured patients to remain solvent.

Emerson-Shea said California hospitals stand to lose up to $128 billion over 10 years due to the law.

“This projection does not include the likely increases in uncompensated care due to Medicaid work requirements, coverage losses due to the elimination of the Affordable Care Act subsidies, more frequent Medi-Cal redeterminations, and coverage losses for those with unsatisfactory immigration status,” Emerson-Shea said.

While some California hospitals lose money on patient care, financial data shows the industry is making money, earning about $11.5 billion in net income, or profit, in 2024, said Kristof Stremikis, director of Market Analysis and Insight at the California Health Care Foundation, pointing to preliminary state data comparing 365 hospitals. “The industry as a whole has returned to pre-covid profitability levels,” Stremikis said.

He acknowledged, though, that Medicaid cuts will reduce revenue for all facilities.

Hospitals will be burdened as uninsured patients, who often arrive with prolonged illness or injuries that can make treatment more expensive, increase in number. That will exacerbate health care challenges in high-poverty communities with large Medi-Cal populations, since the safety net program generally pays hospitals and providers less than private insurance or Medicare.

Already, some hospitals are closing due to financial struggles, before the impacts of the federal health care cuts are felt, and others are limiting access to care, including by shuttering maternity wards and emergency rooms. Officials at Glenn Medical Center, about 85 miles north of Sacramento, reported that it would be its ER at the due to staffing shortages.

Pandemic-Era Burnout Persists

Front-line nurses said the well-documented from the covid-19 pandemic, mixed with growing hospital demands, is still being felt today as many part ways with the industry. That is prompting some hospitals to hire more traveling nurses from out of state.

At Hazel Hawkins Memorial Hospital, a public facility in San Benito County near the Central Coast, the California Nurses Association said the hospital is employing 22 traveling nurses, although the hospital put the number at 16. Local nurses said temporary workers can ease workloads, but they worry hospitals are using traveling nurses to avoid labor contracts that require higher pay and benefits. They say hospitals should invest in well-trained, local staff familiar with the community.

ER nurse Ariahnna Sanchez said workers at Hazel Hawkins, a , are pressured to discharge patients quickly so more patients can be seen. As union contracts come up for renegotiation, union officials say, hospitals have slashed benefits and haven’t offered adequate raises to keep up with the cost of living. Salaries vary by region but the average annual wage for California registered nurses was $148,330 in 2024, according to the U.S. Bureau of Labor Statistics.

“The morale is so bad right now,” Sanchez said. “We’re trying to fight the good fight but we’re constantly holding people in the emergency room who should be admitted due to the hospital being at max capacity.”

State data shows San Benito County has an of nurses and needs about 180 more to accommodate the local population. But Hazel Hawkins disputes it has a shortage. The California Nurses Association said 40 nurses have left since last year, whereas the hospital said it has replaced 15 of 21 departing nurses.

Hazel Hawkins spokesperson Marcus Young said nurses are conflating staffing levels with protocols for handling ER patients when there aren’t enough beds. “There is no material shortage of nurses and hospital operations are not being impacted today,” Young said. “We are in full compliance with state-mandated nurse-to-patient ratios at all times.”

staffing minimums at hospitals, ranging from one nurse for every three patients to one nurse for every five patients, depending on the level of care the patients require. Research has shown that clinical errors can increase in hospitals and other health care workplaces when nurses are stressed and overwhelmed. that burnout related to work overload, career satisfaction, and patient satisfaction is a major concern and can lead to mistakes.

The state has issued 32 citations to California hospitals since 2020 for violating these minimum nurse staffing levels, financial penalties totaling $840,000, according to the . Neither Hazel Hawkins nor the Turlock hospital Emanuel had any citations. Spokesperson Mark Smith said the agency could not provide information on any “potential, pending or ongoing investigations” into health care facilities alleged to be in violation of state nursing ratios.

Burkett, the nurse in Turlock, said though she can see up to five patients at a time, she exceeded her ratio twice in the past year. In its , Tenet reported $288 million in net income, up from $259 million over the same period last year.

“We have to prioritize patient care,” Burkett says. “But we are under a lot of pressure to get patients out and turn profits.” (Angela Hart/��ϳԹ�� News)

“I’ve taken that assignment against my will,” Burkett said, noting that the union distributes forms protecting nurses from repercussions if mistakes happen on their watch when they take on more patients than the state allows. “It says I’m taking these patients against my better judgment and I’m protected because I am not agreeing to this, but the hospital is making me do it,” she added. “It’s tough. I mean, you just have to juggle and do what you can and hope you’re not going to miss something important. It’s not safe.”

State Sen. Caroline Menjivar, a Democrat representing part of the Los Angeles region, has to strengthen the state’s nurse-to-patient ratio law by requiring hospitals to work harder to identify available nurses to meet staffing mandates.

“Hospitals for years have been getting a pass on minimum nurse staffing,” said Menjivar, a former emergency medical technician. “If we do not provide more support to our nurses, then we do not get the quality care that is needed.”

Menjivar’s niece Megan Noguera-DeLeon is excited about becoming a nurse, despite workplace challenges. A nursing student who expects to graduate next year from West Coast University in Southern California, she said relatives who work as nurses have warned her how tough the job can be. She’s worried about burning out but remains committed to the mission.

“I think taking care of people is a beautiful thing,” Noguera-DeLeon said. “I know this job can be really hard and a lot of nurses are experiencing burnout, but honestly I’ve seen firsthand how much nurses can help people even on the darkest of days, and I want to help people.”

This article was produced by ��ϳԹ�� News, which publishes , an editorially independent service of the .��

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Experts Say Rural Emergency Rooms Are Increasingly Run Without Doctors

Arielle Zionts — Tue, 12 Aug 2025 09:00:00 +0000

EKALAKA, Mont. — There was no doctor on-site when a patient arrived in early June at the emergency room in the small hospital at the intersection of two dirt roads in this town of 400 residents.

There never is.

Dahl Memorial’s three-bed emergency department — a two-hour drive from the closest hospital with more advanced services — instead depends on physician assistants and nurse practitioners.

Physician assistant Carla Dowdy realized the patient needed treatment beyond what the ER could provide, even if it had had a doctor. So, she made a call for a medical plane to fly the patient to treatment at Montana’s most advanced hospital. Dowdy also called out medications and doses needed to stabilize the patient as a paramedic and nurses administered the drugs, inserted IV lines, and measured vital signs.

Emergency medicine researchers and providers believe ERs, especially in rural areas, increasingly operate with few or no physicians amid a nationwide shortage of doctors.

A found that in 2022, at least 7.4% of emergency departments across the U.S. did not have an attending physician on-site 24/7. Like Dahl Memorial, more than 90% were in low-volume or critical access hospitals — a federal designation for small, rural hospitals.

The results come from the 82% of hospitals that responded to a survey sent to all emergency departments in the country, except those operated by the federal government. The study is the first of its kind so there isn’t proof that such staffing arrangements are increasing, said Carlos Camargo, the lead author and a professor of emergency medicine at Harvard Medical School. But Camargo and other experts suspect ERs running without doctors present are becoming more common.

Placing ERs in the hands of nondoctors isn’t without controversy. Some doctors and their professional associations say physicians’ extensive training leads to better care, and that some hospitals are just trying to save money by not employing them.

The , open to all medical students and physicians, and the both support state and federal laws or regulations that would require ERs to staff a doctor around the clock. Indiana, Virginia, and South Carolina recently passed such legislation.

Rural ERs may see fewer patients, but they still treat serious cases, said Alison Haddock, president of ACEP.

“It’s important that folks in those areas have equal access to high-quality emergency care to the greatest extent possible,” Haddock said.

Other health care providers and organizations say advanced-practice providers with the right experience and support are capable of overseeing ERs. And they say mandating that a physician be on-site could drive some rural hospitals to close because they can’t afford or recruit enough — or any — doctors.

“In an environment, especially a rural environment, if you have an experienced PA who knows what they know, and knows the boundaries of their knowledge and when to involve consultants, it works well,” said Paul Amiott, a board member of the Society of Emergency Medicine PAs.

“I’m not practicing independently” despite working 12-hour night shifts without physicians on-site at critical access hospitals in three states, he said.

The hospital in Ekalaka, a small town in sprawling, rural southeastern Montana, sits at the intersection of two dirt roads. (Arielle Zionts/��ϳԹ�� News)

Amiott said he calls specialists for consultation often and about once a month asks the physician covering the day shift at his hospital to come help him with more challenging cases such as emergency childbirth and complicated trauma. Amiott said this isn’t unique to PAs — ER doctors seek similar consultations and backup.

The proportion of ERs without an attending physician always on-site varies wildly by state. The 2022 survey found that 15 states — including substantially rural ones, such as New Mexico, Nevada, and West Virginia — had no such emergency departments.

But in the Dakotas, more than half of emergency departments were running without 24/7 attending physician staffing. In Montana it was 46%, the third-highest rate.

None of those three states have a program to train physicians as ER specialists. Neither does Wyoming or Idaho.

But Sanford Health, which bills itself as “the largest rural health system in the United States,” is launching an emergency medicine residency in the region. The Sioux Falls, South Dakota-based program is intended to boost the ranks of rural emergency doctors in those states, the residency director said in .

Leon Adelman is an emergency medicine physician in Gillette, Wyoming, which, at around 33,800 residents, is the largest city in the state’s northeast. Working in such a rural area has given him nuanced views on whether states should require 24/7 on-site physician coverage in ERs.

Adelman said he supports such laws only where it’s feasible, like in Virginia. He said the state’s emergency physicians’ organization pushed for the law only after doing research that made it confident that the requirement wouldn’t shutter any rural hospitals.

Camargo said some doctors say that if lawmakers are going to require 24/7 on-site physician coverage in ERs, they need to pay to help hospitals implement it.

Adelman said when instituting staffing requirements isn’t possible, states should create other regulations. For example, he said, lawmakers should make sure hospitals not hiring physicians aren’t refraining just to save money.

He pointed to Vermont, where recommended that several of the state’s hospitals cut physicians from their ERs. The report was part of a mandated process to improve the state’s .

Adelman said states should also require PAs and NPs without on-site physician supervision to have extensive emergency experience and the ability to consult with remote physicians.

Some doctors have pointed to in which a 19-year-old woman died after being misdiagnosed by an NP who was certified in family medicine, not emergency care, and working alone at an Oklahoma ER. Few NPs have emergency certification, .

Physician assistant Carla Dowdy (left) takes notes while treating a patient in the Ekalaka hospital as nurse Willow Meyer works nearby. (Arielle Zionts/��ϳԹ�� News)

An Ekalaka ambulance meets a medevac plane from Billings Clinic — which offers the highest level of care in Montana — at the municipal airport. The flight takes an hour, about a quarter of what it takes an ambulance to drive. (Arielle Zionts/��ϳԹ�� News)

The Society of Emergency Medicine PAs PAs should have before practicing in rural areas or without on-site doctors.

Haddock said emergency physicians have seen cases of hospitals hiring inexperienced advanced-practice providers. She said ACEP is asking the federal government to require critical access and rural emergency hospitals to have physicians on-site or on call day and night.

Haddock said ACEP wouldn’t want such a requirement to close any hospital and noted that the organization has various efforts to keep rural hospitals staffed and funded.

Dahl Memorial Hospital has strict hiring requirements and robust oversight, said Dowdy, who previously worked for 14 years in high-volume, urban emergency rooms.

She said ER staffers can call physicians when they have questions and that a doctor who lives on the other side of Montana reviews all their patient treatment notes. The ER is working on getting virtual reality glasses that will let remote physicians help by seeing what the providers in Ekalaka see, Dowdy said.

She said patient numbers in the Ekalaka ER vary but average one or two a day, which isn’t enough for staff to maintain their knowledge and skills. To supplement those real-life cases, providers visit simulation labs, do monthly mock scenarios, and review advanced skills, such as using an ultrasound to help guide breathing tubes into patient airways.

Dowdy said Dahl Memorial hasn’t had a physician in at least 30 years, but CEO Darrell Messersmith said he would hire one if a doctor lived in the area. Messersmith said there’s a benefit to having advanced-practice providers with connections to the region and who stay at the hospital for several years. Other rural hospitals, he noted, may have physicians either as permanent staff who leave after a few years or contract workers who fly in for a few weeks at a time.

People eating at Ekalaka’s sole breakfast spot and attending appointments at the hospital’s clinic all told ��ϳԹ�� News that they’ve been happy with the care they have received from Dowdy and her co-workers.

Ben Bruski had to visit the ER after a cow on his family ranch kicked a gate, smashing it against his hand. And he knows other people who’ve been treated for more serious problems.

“We’ve got to have this facility here because this facility saves a lot of lives,” Bruski said.

Mobile mammogram clinics make it easier for people in the Ekalaka area to get care since their local facilities don’t offer the technology, which helps detect breast cancer. The facilities also don’t have childbirth or chemotherapy services; the nearest that do are about two hours away. (Arielle Zionts/��ϳԹ�� News)

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Dual Threats From Trump and GOP Imperil Nursing Homes and Their Foreign-Born Workers

Jordan Rau — Thu, 26 Jun 2025 09:00:00 +0000

In a top-rated nursing home in Alexandria, Virginia, the Rev. Donald Goodness is cared for by nurses and aides from various parts of Africa. One of them, Jackline Conteh, a naturalized citizen and nurse assistant from Sierra Leone, bathes and helps dress him most days and vigilantly intercepts any meal headed his way that contains gluten, as Goodness has celiac disease.

“We are full of people who come from other countries,” Goodness, 92, said about Goodwin House Alexandria’s staff. Without them, the retired Episcopal priest said, “I would be, and my building would be, desolate.”

The long-term health care industry is facing a double whammy from President Donald Trump’s crackdown on immigrants and the GOP’s proposals to reduce Medicaid spending. The industry is highly dependent on foreign workers: More than 800,000 immigrants and naturalized citizens comprise at home care agencies, nursing homes, assisted living facilities, and other long-term care companies.

But in January, former President Joe Biden’s 2021 policy that from Immigration and Customs Enforcement raids. The administration’s broad immigration crackdown threatens to drastically reduce the number of current and future workers for the industry. “People may be here on a green card, and they are afraid ICE is going to show up,” said Katie Smith Sloan, president of LeadingAge, an association of nonprofits that care for older adults.

Existing staffing shortages and quality-of-care problems would be compounded by other policies pushed by Trump and the Republican-led Congress, according to nursing home officials, resident advocates, and academic experts. Federal spending cuts under negotiation may strip nursing homes of some of their largest revenue sources by limiting ways money and making it harder for new nursing home residents to retroactively . Care for 6 in 10 residents , the state-federal health program for poor or disabled Americans.

“We are facing the collision of two policies here that could further erode staffing in nursing homes and present health outcome challenges,” said , an associate professor of internal medicine at the University of Pennsylvania.

Without foreign-born caregivers, the Rev. Donald Goodness says, he would be “desolate.” (Alyssa Schukar for ��ϳԹ�� News)

Goodness was rector of a New York City church before retiring. He still religiously watches sermons through the church’s website. (Alyssa Schukar for ��ϳԹ�� News)

Goodwin House Alexandria depends heavily on immigrants to care for its nursing home residents. “We see they stay on with us, they have longer tenure, they are more committed to the organization,” says Rob Liebreich, Goodwin Living’s president and CEO. (Alyssa Schukar for ��ϳԹ�� News)

The industry hasn’t recovered from covid-19, which long-term care facility residents and workers and led to massive staff attrition and turnover. Nursing homes have struggled to replace licensed nurses, who can find better-paying jobs at hospitals and doctors’ offices, as well as nursing assistants, who can earn more working at big-box stores or fast-food joints. Quality issues that preceded the pandemic have expanded: The percentage of nursing homes that federal health inspectors cited for putting residents in jeopardy of immediate harm or death alarmingly from 17% in 2015 to 28% in 2024.

In addition to seeking to reduce Medicaid spending, congressional Republicans have proposed shelving the biggest nursing home reform in decades: a Biden-era rule mandating minimum staffing levels that of the nation’s nearly 15,000 nursing homes to hire more workers.

The long-term care industry expects demand for direct care workers to burgeon with an influx of aging baby boomers needing professional care. The Census Bureau has projected the number of people 65 and older would grow from 63 million this year to 82 million in 2050.

In an email, Vianca Rodriguez Feliciano, a spokesperson for the Department of Health and Human Services, said the agency “is committed to supporting a strong, stable long-term care workforce” and “continues to work with states and providers to ensure quality care for older adults and individuals with disabilities.” In a separate email, Tricia McLaughlin, a Department of Homeland Security spokesperson, said foreigners wanting to work as caregivers “need to do that by coming here the legal way” but did not address the effect on the long-term care workforce of deportations of classes of authorized immigrants.

Goodwin Living, a faith-based nonprofit, runs three retirement communities in northern Virginia for people who live independently, need a little assistance each day, have memory issues, or require the availability of around-the-clock nurses. It also operates a retirement community in Washington, D.C. Medicare rates Goodwin House Alexandria as one of the in the country. Forty percent of the organization’s 1,450 employees are foreign-born and are either seeking citizenship or are already naturalized, according to Lindsay Hutter, a Goodwin spokesperson.

“As an employer, we see they stay on with us, they have longer tenure, they are more committed to the organization,” said Rob Liebreich, Goodwin’s president and CEO.

Jackline Conteh spent much of her youth shuttling between Sierra Leone, Liberia, and Ghana to avoid wars and tribal conflicts. Her mother was killed by a stray bullet in her home country of Liberia, Conteh said. “She was sitting outside,” Conteh, 56, recalled in an interview.

Jackline Conteh was a hospital nurse in Sierra Leone and emigrated for better economic conditions. Her mother was killed by a stray bullet in war-torn Liberia. (Alyssa Schukar for ��ϳԹ�� News)

Conteh serves Goodness, who has celiac disease, a gluten-free lunch of steak and ale chowder. (Alyssa Schukar for ��ϳԹ�� News)

Conteh was working as a nurse in a hospital in Sierra Leone in 2009 when she learned of a lottery for visas to come to the United States. She won, though she couldn’t afford to bring her husband and two children along at the time. After she got a nursing assistant certification, Goodwin hired her in 2012.

Conteh said taking care of elders is embedded in the culture of African families. When she was 9, she helped feed and dress her grandmother, a job that rotated among her and her sisters. She washed her father when he was dying of prostate cancer. Her husband joined her in the United States in 2017; she cares for him because he has heart failure.

“Nearly every one of us from Africa, we know how to care for older adults,” she said.

Her daughter is now in the United States, while her son is still in Africa. Conteh said she sends money to him, her mother-in-law, and one of her sisters.

In the nursing home where Goodness and 89 other residents live, Conteh helps with daily tasks like dressing and eating, checks residents’ skin for signs of swelling or sores, and tries to help them avoid falling or getting disoriented. Of 102 employees in the building, broken up into eight residential wings called “small houses” and a wing for memory care, at least 72 were born abroad, Hutter said.

Donald Goodness grew up in Rochester, New York, and spent 25 years as rector of The Church of the Ascension in New York City, retiring in 1997. He and his late wife moved to Alexandria to be closer to their daughter, and in 2011 they moved into independent living at the Goodwin House. In 2023 he moved into one of the skilled nursing small houses, where Conteh started caring for him.

“I have a bad leg and I can’t stand on it very much, or I’d fall over,” he said. “She’s in there at 7:30 in the morning, and she helps me bathe.” Goodness said Conteh is exacting about cleanliness and will tell the housekeepers if his room is not kept properly.

Conteh is one of many African-born caregivers at Goodwin House Alexandria. (Alyssa Schukar for ��ϳԹ�� News)

Grooming Goodness is one of Conteh’s daily tasks. (Alyssa Schukar for ��ϳԹ�� News)

Conteh said Goodness was withdrawn when he first arrived. “He don’t want to come out, he want to eat in his room,” she said. “He don’t want to be with the other people in the dining room, so I start making friends with him.”

She showed him a photo of Sierra Leone on her phone and told him of the weather there. He told her about his work at the church and how his wife did laundry for the choir. The breakthrough, she said, came one day when he agreed to lunch with her in the dining room. Long out of his shell, Goodness now sits on the community’s resident council and enjoys distributing the mail to other residents on his floor.

“The people that work in my building become so important to us,” Goodness said.

While Trump’s 2024 election campaign focused on foreigners here without authorization, his administration has broadened to target those legally here, who fled countries beset by wars or natural disasters. This month, the Department of Homeland Security for migrants and refugees from Cuba, Haiti, Nicaragua, and Venezuela who arrived under a Biden-era program.

“I’ve just spent my morning firing good, honest people because the federal government told us that we had to,” Rachel Blumberg, president of the Toby & Leon Cooperman , a Florida retirement community, said in a . “I am so sick of people saying that we are deporting people because they are criminals. Let me tell you, they are not all criminals.”

At Goodwin House, Conteh is fearful for her fellow immigrants. Foreign workers at Goodwin rarely talk about their backgrounds. “They’re scared,” she said. “Nobody trusts anybody.” Her neighbors in her apartment complex fled the U.S. in December and returned to Sierra Leone after Trump won the election, leaving their children with relatives.

“If all these people leave the United States, they go back to Africa or to their various countries, what will become of our residents?” Conteh asked. “What will become of our old people that we’re taking care of?”

Most of the caregivers in Goodwin House Alexandria are foreign born. “Nearly every one of us from Africa, we know how to care for older adults,” says Jackline Conteh, a certified nursing assistant, standing with one of the residents, the Rev. Donald Goodness. (Alyssa Schukar for ��ϳԹ�� News)

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Nurse Practitioners Critical in Treating Older Adults as Ranks of Geriatricians Shrink

Jariel Arvin — Wed, 18 Jun 2025 09:00:00 +0000

On Fridays, Stephanie Johnson has a busy schedule, driving her navy-blue Jeep from one patient’s home to the next, seeing eight in all. Pregnant with her second child, she schleps a backpack instead of a traditional black bag to carry a laptop and essential medical supplies — stethoscope, blood pressure cuff, and pulse oximeter.

Forget a lunch break; she often eats a sandwich or some nuts as she heads to her next patient visit.

On a gloomy Friday in January, Johnson, a nurse practitioner who treats older adults, had a hospice consult with Ellen, a patient in her 90s in declining health. To protect Ellen’s identity, ��ϳԹ�� News is not using her last name.

“Hello. How are you feeling?” Johnson asked as she entered Ellen’s bedroom and inquired about her pain. The blinds were drawn. Ellen was in a wheelchair, wearing a white sweater, gray sweatpants, and fuzzy socks. A headband was tied around her white hair. As usual, the TV was playing loudly in the background.

“It’s fine, except this cough I’ve had since junior high,” Ellen said.

Ellen had been diagnosed with vascular dementia, peripheral vascular disease, and Type 2 diabetes. Last fall, doctors made the difficult decision to operate on her foot. Before the surgery, Ellen was always colorful, wearing purple, yellow, blue, pink, and chunky necklaces. She enjoyed talking with the half dozen other residents at her adult family home in Washington state. She had a hearty appetite that brought her to the breakfast table early. But lately, her enthusiasm for meals and socializing had waned.

Johnson got down to eye level with Ellen to examine her, assessing her joints and range of motion, checking her blood pressure, and listening to her heart and lungs.

Carefully, Johnson removed the bandage to examine Ellen’s toes. Her lower legs were red but cold to the touch, which indicated her condition wasn’t improving. Ellen’s two younger sisters had power of attorney for her and made it clear that, above all, they wanted her to be comfortable. Now, Johnson thought it was time to have that difficult conversation with them about Ellen’s prognosis, recommending her for hospice.

“Our patient isn’t just the older adult,” Johnson said. “It’s also often the family member or the person helping to manage them.”

Nurse practitioners are having those conversations more and more as their patient base trends older. They are increasingly filling a gap that is expected to widen as the senior population explodes and the number of geriatricians declines. The Health Resources and Services Administration in demand for geriatricians from 2018 to 2030, when the entire baby boom generation will be older than 65. By then, hundreds of geriatricians are expected to retire or leave the specialty, reducing their number to fewer than 7,600, with relatively few young doctors joining the field.

That means many older adults will be relying on other primary care physicians, who already , and nurse practitioners, whose ranks are booming. The number of nurse practitioners specializing in geriatrics has more than tripled since 2010, increasing the availability of care to the current population of seniors, a in JAMA Network Open found.

According to a , of the roughly 431,000 licensed nurse practitioners, 15% are, like Johnson, certified to treat older adults.

Johnson and her husband, Dustin, operate an NP-led private practice in greater Seattle, Washington, a state where she can practice independently. She and her team, which includes five additional nurse practitioners, each try to see about 10 patients a day, visiting each one every five to six weeks. Visits typically last 30 minutes to an hour, depending on the case.

“There are so many housebound older adults, and we’re barely reaching them,” Johnson said. “For those still in their private homes, there’s such a huge need.”

Laura Wagner, a professor of nursing and community health systems at the University of California-San Francisco, stressed that nurse practitioners are not trying to replace doctors; they’re trying to meet patients’ needs, wherever they may be.

“One of the things I’m most proud of is the role of nurse practitioners,” she said. “We step into places where other providers may not, and geriatrics is a prime example of that.”

Practice Limits

Johnson examines her patient Ellen’s foot. Ellen had been diagnosed with vascular dementia, peripheral vascular disease, and Type 2 diabetes. Last fall, doctors made the difficult decision to operate on her foot. (Jariel Arvin for ��ϳԹ�� News)

Nurse practitioners are registered nurses with advanced training that enables them to diagnose diseases, analyze diagnostic tests, and prescribe medicine. Their growth has bolstered primary care, and, like doctors, they can specialize in particular branches of medicine. Johnson, for example, has advanced training in gerontology.

“If we have a geriatrician shortage, then hiring more nurse practitioners trained in geriatrics is an ideal solution,” Wagner said, “but there are a lot of barriers in place.”

In 27 states and Washington, D.C., nurse practitioners can practice independently. But in the rest of the country, they need to have a collaborative agreement with or be under the supervision of another health care provider to provide care to older adults. Medicare generally reimburses for nurse practitioner services at it pays physicians.

Last year, in , the American Medical Association and its partners lobbied against what they see as “scope creep” in the expanded roles of nurse practitioners and other health workers. The AMA points out that doctors must have more schooling and significantly more clinical experience than nurse practitioners. While the AMA says keep costs lower, a study published in 2020 in found similar patient outcomes and lower costs for nurse practitioner patients. Other studies, including one in the journal Medical Care Research and Review, have found health care models including nurse practitioners had better outcomes for patients with multiple chronic conditions than teams without an NP.

Five states have granted NPs full practice authority since 2021, with Utah the most recent state to , in 2023. In March, however, , which would have increased NP independence, failed. Meanwhile, rallied to tamp down full-scope efforts in Austin.

“I would fully disagree that we’re invading their scope of practice and shouldn’t have full scope of our own,” Johnson said.

She has worked under the supervision of physicians in Pennsylvania and Washington state but started seeing patients at her own practice in 2021. Like many nurse practitioners, she sees her patients in their homes. The first thing she does when she gets a new patient is manage their prescriptions, getting rid of unnecessary medications, especially those with harsh side effects.

She works with the patient and a family member who often has power of attorney. She keeps them informed of subtle changes, such as whether a person was verbal and eating and whether their medical conditions have changed.

While there is some overlap in expertise between geriatricians and nurse practitioners, there are areas where nurses typically excel, said Elizabeth White, an assistant professor of health services, policy, and practice at Brown University.

“We tend to be a little stronger in care coordination, family and patient education, and integrating care and social and medical needs. That’s very much in the nursing domain,” she said.

That care coordination will become even more critical as the U.S. ages. Today, about 18% of the U.S. population is 65 or over. In the next 30 years, the share of seniors is expected to reach 23%, as medical and technological advances enable people to live longer.

Patient and Family

In an office next to Ellen’s bedroom, Johnson called Ellen’s younger sister Margaret Watt to recommend that Ellen enter hospice care. Johnson told her that Ellen had developed pneumonia and her body wasn’t coping.

Watt appreciated that Johnson had kept the family apprised of Ellen’s condition for several years, saying she was a good communicator.

“She was accurate,” Watt said. “What she said would happen, happened.”

A month after the consult, Ellen died peacefully in her sleep.

“I do feel sadness,” Johnson said, “but there’s also a sense of relief that I’ve been with her through her suffering to try to alleviate it, and I’ve helped her meet her and her family’s priorities in that time.”

Jariel Arvin is a reporter with the at the University of California-Berkeley Graduate School of Journalism. He reported this article through a grant from .

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Covid Worsened Shortages of Doctors and Nurses. Five Years On, Rural Hospitals Still Struggle.

Natalie Krebs, Iowa Public Radio — Fri, 18 Apr 2025 09:00:00 +0000

Even by rural hospital standards, in southeastern Iowa is small.

The 14-bed hospital, in Sigourney, doesn’t do surgeries or deliver babies. The small 24-hour emergency room is overseen by two full-time doctors.

CEO Matt Ives wants to hire a third doctor, but he said finding physicians for a rural area has been challenging since the covid-19 pandemic. He said several physicians at his hospital have retired since the start of the pandemic, and others have decided to stop practicing certain types of care, particularly emergency care.

Another rural hospital is down the road, about a 40-minute drive east. Washington County Hospital and Clinics has 22 beds and is experiencing similar staffing struggles. “Over the course of the last few years, we’ve had not only the pandemic, but we’ve had kind of an aging physician workforce that has been retiring,” said Todd Patterson, CEO.

The pandemic was difficult for health workers. Many endured long hours, and the stresses on the nation’s health care system prompted more workers than usual .

Matt Ives (left), CEO of Keokuk County Hospital and Clinics, and Todd Patterson, CEO of Washington County Hospitals and Clinics, have struggled to hire doctors and nurses since the pandemic. (Natalie Krebs/Iowa Public Radio)

“There’s a chunk of workers that were lost and won’t come back,” said , who directs the at the University of California-San Francisco. “For a lot of the clinicians that decided and were able to stick it out and work through the pandemic, they have burned out,” Spetz said.

Five years after the World Health Organization declared covid a global pandemic and the first Trump administration announced a national emergency, the United States faces a crucial shortage of medical providers, for an aging population.

That could have , particularly in states like Iowa with significant rural populations. Experts say the problem has , but the effects of the pandemic accelerated the shortages by pushing many doctors over the edge .

“Some of them made it through covid like ‘Let’s get us through this public health crisis,’ and then they came out of it saying, ‘OK, and now? Now I’m exhausted,’” said Christina Taylor, president of the .

“Iowa is absolutely in the middle of a physician shortage,” Taylor said. “It’s a true crisis for us. We’re actually 44th in the country in terms of .”

A 2022 survey by the Centers for Disease Control and Prevention found a who reported feeling burned out and wanting a new job, compared with 2018. The number of people in health care has , said , an associate professor at the University of Minnesota’s School of Public Health, but the growth has not happened fast enough.

“We have an aging population. We have a lot of needs,” she said.

The projected last year that the U.S. of up to 86,000 physicians by 2036 — if lawmakers don’t invest more money in training doctors.

These shortages could push more people to seek care in ERs when they can’t see a local doctor, said , director of workforce studies at the AAMC.

“We’re already at a point where tens of millions of Americans every year can’t get medical care when they need it,” said Dill (no relation to Janette Dill). “If the shortage is sustained or gets even worse, then that problem gets worse too, and it disproportionately negatively impacts the most vulnerable amongst us.”

Iowa lawmakers made addressing the shortage in the current legislative session. They introduced bills aimed at increasing medical student loan forgiveness and requesting federal help to add residency training slots for medical students in the state.

Last year, Gov. Kim Reynolds that drops the residency requirement for some doctors who trained abroad to get a medical license. Lawmakers in at least eight other states have approved similar changes.

Patterson, of the Washington County hospital, appreciates that Iowa lawmakers are trying to increase the pipeline of doctors into Iowa but said it doesn’t address immediate shortages.

“You have a high school student who’s graduating right now; they’re probably nine to 11 years away from entering the workforce as a practicing physician. So it’s a long-term kind of problem,” he said.

For nurses, workforce experts say, the projected national outlook isn’t as dire as in recent years.

“Nursing education is back up. Nursing employment rates are back up. I think, for that workforce, we’ve largely nationally recovered from all the dislocations that occurred,” said Spetz, of the Institute for Health Policy Studies.

But getting nurses to move to the places that need them, like rural communities, will be difficult, she said.

Some rural hospitals in Iowa say an even bigger challenge right now is finding nurses to hire.

Keokuk County Hospital has 14 beds, which makes it one of Iowa’s smaller hospitals. (Natalie Krebs/Iowa Public Radio)

Some of that can be traced to the pandemic, said Sara Bruns, nurse manager at Keokuk County Hospital and Clinics. She recalled that some covid patients in critical condition died when they couldn’t be transferred to larger hospitals with more advanced intensive care unit equipment, because those hospitals didn’t have the staff to take on more patients.

“We had to make the horrible decision of ‘You’re probably not going to make it,’” Bruns recalled, saying many patients were then listed as DNR, for “do not resuscitate.”

“That took a big toll on a lot of nurses,” she said.

Another problem is persuading the area’s young nurses to stay, when they would rather live and work in more urban areas, Bruns said.

Her hospital still relies on contracts with travel nurses to fill some night shifts. That’s something the hospital never had to do before the pandemic, Bruns said. Travel nurses are , adding stress to a small hospital’s budget.

“I think some people just completely got out of nursing,” Bruns said. The pandemic took a special toll “because of the hours that they had to work, the conditions that they had to work.”

Policymakers and health care organizations can’t focus only on recruiting workers, according to Janette Dill at the University of Minnesota. “You also have to retain workers,” she said. “You can’t just recruit new people and then have them be miserable.”

Dill said workers report feeling that patients have been more disrespectful and challenging since the pandemic, and sometimes workers at work. “By ‘unsafe’ I mean physically unsafe. I think that is a very stressful part of the job,” she said.

Research has shown health workers of burnout and poor mental health since the pandemic — though the risks decreased if workers felt supported by their managers.

Gail Grimes, an intensive care nurse in Des Moines, felt more supported by her employer during the worst parts of the pandemic than she does now, she said. Some hospitals offered pay bumps and more to keep nurses on staff.

“We were getting better bonus pay,” Grimes recalled. “We were getting these specialized contracts we could fulfill that were often more worth our time to be able to come in, to miss our families and be there.”

Grimes said she’s seen nurses leave Iowa for neighboring states with better average pay. This creates shortages that she believes affect the care she gives her own patients.

“A nurse taking care of five patients will always be able to provide better care than a nurse taking care of 10 patients,” she said.

She thinks many hospitals have simply accepted staff burnout as a fact, rather than try to prevent it.

“It really is significantly impactful to your mental health when you come home every day and you feel guilty about the things you have not been able to provide to people,” she said.

This article is from a partnership that includes , , and ��ϳԹ�� News.

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UCSF Favors Pricey Doctoral Program for Nurse-Midwives Amid Maternal Care Crisis

Ronnie Cohen — Tue, 03 Sep 2024 09:00:00 +0000

One of California’s two programs for training nurse-midwives has stopped admitting students while it revamps its curriculum to offer only doctoral degrees, a move that’s drawn howls of protest from alumni, health policy experts, and faculty who accuse the University of California of putting profits above public health needs.

UC-San Francisco’s renowned nursing school will graduate its final class of certified nurse-midwives next spring. Then the university will cancel its two-year master’s program in , along with other nursing disciplines, in favor of a three-year doctor of nursing practice, or DNP, degree. The change will pause UCSF’s nearly five decades-long training of nurse-midwives until at least 2025 and will more than double the cost to students.

State Assembly member Mia Bonta, who chairs the health committee, said she was “disheartened” to learn that UCSF was eliminating its master’s nurse-midwifery program and feared the additional time and costs to get a doctorate would deter potential applicants. “Instead of adding hurdles, we need to be building and expanding a pipeline of culturally and racially concordant providers to support improved birth outcomes, especially for Black and Latina birthing people,” she said in an email.

The switch to doctoral education is part of a national movement to require all advanced-practice registered nurses, including nurse-midwives and nurse practitioners, to earn doctoral degrees, Kristen Bole, a UCSF spokesperson, said in response to written questions. The doctoral training will feature additional classes in leadership and quality improvement.

But the movement, which dates to 2004, has not caught on the way the American Association of Colleges of Nursing envisioned when it called for doctorate-level education to be required for entry-level advanced nursing practice by 2015. That deadline came and went. Now, an acute need for maternal health practitioners has some universities moving in the other direction.

This year, Rutgers University reinstated the nurse-midwifery master’s training it had eliminated in 2016. The also restarted its master’s in nurse-midwifery program in 2022 after a 25-year hiatus. In addition, in Washington, D.C., in New Orleans, and the added master’s training in nurse-midwifery.

UCSF estimates tuition and fees will cost $152,000 for a three-year doctoral degree in midwifery, compared with $65,000 for a two-year master’s. that 71% of nursing master’s students and 74% of nursing doctoral students rely on student loans, and nurses with doctorates earn negligibly or no more than nurses with master’s degrees.

Kim Q. Dau, who ran UCSF’s nurse-midwifery program for a decade, resigned in June because she was uncomfortable with the elimination of the master’s in favor of a doctoral requirement, she said, which is at odds with the state’s workforce needs and unnecessary for clinical practice.

“They’ll be equally prepared clinically but at more expense to the student and with a greater time investment,” she said.

are registered nurses with graduate degrees in nurse-midwifery. Licensed in all 50 states, they work mostly in hospitals and can perform abortions and prescribe medications, though they are also trained in managing labor pain with showers, massage, and other natural means. Certified midwives, by contrast, study midwifery at the graduate level outside of nursing schools and are licensed only in some states. Certified professional midwives attend births outside of hospitals.

The California Nurse-Midwives Association also criticized UCSF’s program change, which comes amid a national maternal mortality crisis, a serious shortage of obstetric providers, and a growing reliance on midwives. According to the 2022 “” report, the U.S. has the highest maternal mortality rate of any developed nation and needs thousands more midwives and other women’s health providers to bridge the swelling gap.

, founder and CEO of Grow Midwives, a national consulting firm, likened UCSF’s switch from master’s to doctoral training to “an earthquake.”

“Why are we delaying the entry of essential-care providers by making them go to an additional year of school, which adds nothing to their clinical preparedness or safety to serve the community?” asked Breedlove, a past president of the American College of Nurse-Midwives. “Why they have chosen this during one of the worst workforce shortages combined with the worst maternal health crisis we have had in 50 years is beyond my imagination.”

A 2020 report published in failed to find that advanced-practice registered nurses with doctorates were more clinically proficient than those with master’s degrees. “Unfortunately, to date, the data are sparse,” it concluded.

The American College of Nurse-Midwives also , as have trade associations for , citing “the lack of scientific evidence that … doctoral-level education is beneficial to patients, practitioners, or society.”

There is no evidence that doctoral-level nurse-midwives will provide better care, Breedlove said.

“This is profit over purpose,” she added.

Bole disputed Breedlove’s accusation of a profit motive. Asked for reasons for the change, she offered broad statements: “The decision to upgrade our program was made to ensure that our graduates are prepared for the challenges they will face in the evolving health care landscape.”

Like Breedlove, , vice chair of the health policy committee for the , worries that UCSF’s switch to a doctoral degree will exacerbate the twin crises of maternal mortality and a shrinking obstetrics workforce across California and the nation.

On average, 10 to 12 nurse-midwives graduated from the UCSF master’s program each year over the past decade, Bole said. California’s remaining master’s program in nurse-midwifery is at , south of Los Angeles, and it graduated eight nurse-midwives last year and 11 this year.

More than half of rural counties in the U.S. lacked obstetric care in 2018, according to a .

In some parts of California, expectant mothers must drive two hours for care, said who runs Midtown Nurse Midwives, a Sacramento birth center. It has had to stop accepting new clients because it cannot find midwives.

Donnelly predicted the closure of UCSF’s midwifery program will significantly reduce the number of nurse-midwives entering the workforce and will inhibit people with fewer resources from attending the program. “Specifically, I think it’s going to reduce folks of color, people from rural communities, people from poor communities,” she said.

UCSF’s change will also likely undercut efforts to train providers from diverse backgrounds.

Natasha, a 37-year-old Afro-Puerto Rican mother of two, has spent a decade preparing to train as a nurse-midwife so she could help women like herself through pregnancy and childbirth. She asked to be identified only by her first name out of fear of reducing her chances of graduate school admission.

The UCSF program’s pause, plus the added time and expense to get a doctoral degree, has muddied her career path.

“The master’s was just the perfect program,” said Natasha, who lives in the Bay Area and cannot travel to the other end of the state to attend CSU-Fullerton. “I’m frustrated, and I feel deflated. I now have to find another career path.”

This article was produced by ��ϳԹ�� News, which publishes , an editorially independent service of the .��

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A Canadian Hospital Scoops Up Nurses Who No Longer Feel Safe in Trump’s America

Terry Byrne — Fri, 27 Feb 2026 19:30:00 +0000

Last year, as the California hospital where she worked was appeasing the Trump administration by erasing words like “equity” and “diversity” from its paperwork, Brandy Frye had seen enough.

Frye, an emergency room nurse with 25 years of experience, felt that ignoring inequality’s role in health and sickness was an affront to the compassionate soul of the nursing profession.

“It felt like a step against everything I believe in,” Frye said. “And I didn’t feel like I belonged there anymore.”

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‘You Aren’t Trapped’: Hundreds of US Nurses Choose Canada Over Trump’s America

Khnbrettk — Thu, 26 Feb 2026 10:00:00 +0000

Fear of Trump, some of the nurses said, was why they left.

Fears Realized

Amy Miller, a nurse practitioner, said she and her husband were determined to move their children out of the country because they felt Trump’s second term would inevitably spiral into violence.

First, the Millers got nursing licenses in New Zealand, but when the job search took too long, they pivoted to Canada.

Justin was offered a job within weeks.

Amy found one within three months.

So they moved. And just a few days later, the Millers watched with horror from afar as their fears came true.

An aerial view of Nanaimo, British Columbia. (iStock/Getty Images Plus)

‘A Sense of Relief’

It is unknown precisely how many American nurses have moved north since Trump returned to office, because some Canadian provinces do not track or release such statistics.

Increased interest from American nurses was also confirmed by nursing associations in Ontario and Alberta, as well as by the nationwide Canadian Nurses Association.

One of the nurses was Susan Fleishman, a Canadian who moved to the U.S. as a child, then worked for 23 years in American emergency rooms before leaving the country in November.

Fleishman said hateful rhetoric from Trump has fueled an angry division that has permeated and soured American life.

“It felt like a step against everything I believe in,” Frye said. “And I didn’t feel like I belonged there anymore.”

Like many of the American nurses who have moved to Vancouver Island, Frye was first wooed to the area by a that was meant to attract tourist dollars but ended up doing much more.

About a year ago, Tod Maffin, a and former CBC Radio host, invited Americans to the port city of Nanaimo for a weekend event designed to offset the impact of Trump’s tariffs on the local economy.

Maffin said about the April event.

“A lot of them were health care workers looking for an escape route,” Maffin said. “They were there to help support our economy but also to look into Canada.”

Maffin saw an opportunity. He repurposed the event website into a recruiting tool and launched a Discord chatroom to help Americans relocate.

“There are communities across Canada where the emergency room closes at night because one nurse is out. That’s how thin staffing is,” Maffin said.

“One new nurse in a small town, or in a midsized city like Nanaimo,” he said, “makes a difference.”

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Trump Almost Unveils a Health Plan��

KhnoonaZ — Tue, 25 Nov 2025 19:10:00 +0000

The Host

This week’s panelists are Julie Rovner of ��ϳԹ�� News, Sarah Karlin-Smith of the Pink Sheet, Alice Miranda Ollstein of Politico, and Sandhya Raman of CQ Roll Call.

Panelists

Sarah Karlin-Smith Pink Sheet

Alice Miranda Ollstein Politico

Sandhya Raman CQ Roll Call

Among the takeaways from this week’s episode:

The news of Trump’s health care plan landed as Sen. Bill Cassidy of Louisiana was working on a separate GOP proposal to direct money into health savings accounts. Congressional Republicans suggested they were left out of Trump’s planning and, among other things, opposed his proposed extension of limited ACA premium tax credits.
Health and Human Services Secretary Robert F. Kennedy Jr. has confirmed that he ordered the change to the Centers for Disease Control and Prevention website to assert the false claim that vaccines may cause autism. That development puts Republicans in a tough spot — particularly Cassidy, a physician who voted for Kennedy’s confirmation after saying he’d secured an agreement that Kennedy would not make changes to the CDC’s vaccine policy.
Three states have revived the lawsuit challenging the approval of mifepristone, adding to the case the FDA’s recent approval of another generic version. The Supreme Court threw out the first case, ruling then that the plaintiffs — who were doctors — lacked standing to prove harm. Yet the revived case may very well end up at the Supreme Court again.

Also this week, Rovner interviews Joanne Kenen and Joshua Sharfstein of the Johns Hopkins Bloomberg School of Public Health about their new book, .

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: The New Yorker’s “,” by Tatiana Schlossberg.

Alice Miranda Ollstein: CNBC’s “,” by Jonathan Vanian.

Sarah Karlin-Smith: The Guardian’s “,” by Sirin Kale and Lucy Osborne.

Sandhya Raman: ��ϳԹ�� News’ “Kids and Teens Go Full Throttle for E-Bikes as Federal Oversight Stalls,” by Kate Ruder.

Also mentioned in this week’s podcast:

The Center for Law and Social Policy’s “.”
The New York Times’ “,” by Sheryl Gay Stolberg.
The Atlantic’s “,” by Katherine J. Wu.
NPR’s “,” by Yuki Noguchi.
Campaign for Accountability’s “.”

click to open the transcript Transcript: Trump Almost Unveils a Health Plan

While Politicos Dispense Blame, These Doctors Aim To Take Shame Out of Medicine

Khnkytjaw — Wed, 05 Nov 2025 09:00:00 +0000

The distress that Will Bynum later recognized as shame settled over him nearly immediately.

“I didn’t want to see anybody. I didn’t want anybody to find me,” said Bynum, now an at Duke University School of Medicine in North Carolina. “It was a really primitive response.”

If physicians don’t acknowledge shame in themselves, they can be at risk of depression, , sleeping difficulties, and other ripple effects that erode patient care, she said.

“You’re taking care of a human life,” she said. “Heaven forbid that you act like you’re not capable or you show fear.”

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California’s Nursing Shortage Is Getting Worse. Front-Line Workers Blame Management.

Khnangelah — Wed, 08 Oct 2025 09:00:00 +0000

Regional shortages, particularly in the Central Valley and rural North, are expected to swell. “There are major deficits and those could get even worse,” Phillips said.

“We are currently in contract negotiations with the union which represents our nurses,” he said, “and suspect that this is what is behind these false claims.”

Improving Conditions for Nurses

University of California-San Francisco researchers who have say although people are still seeking jobs in nursing, student enrollments and graduations have declined.

And it could get worse.

Emerson-Shea said California hospitals stand to lose up to $128 billion over 10 years due to the law.

He acknowledged, though, that Medicaid cuts will reduce revenue for all facilities.

Pandemic-Era Burnout Persists

“We have to prioritize patient care,” Burkett says. “But we are under a lot of pressure to get patients out and turn profits.” (Angela Hart/��ϳԹ�� News)

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Experts Say Rural Emergency Rooms Are Increasingly Run Without Doctors

Khnkytjaw — Tue, 12 Aug 2025 09:00:00 +0000