A recently passed congressional spending bill could lead to additional staffing shortages in the Missouri nursing industry, advocates say. That's because the bill places a cap on federal loans available to pay for some graduate programs, including graduate nursing degrees.
The new rule caps loans for grad students in what the Department of Education calls nonprofessional fields. Starting in 2026, those students may now borrow no more than $20,500 a year and $100,000 total. Professional programs, including medicine and law, remain eligible for up to $50,000 annually, or $200,000 total.
The federal government does not designate nursing as a professional degree, though Department of Education officials said last month that the designation is an internal definition used to distinguish programs that cost more money, not a value judgment about the importance of programs.
The cap on graduate nursing loans would affect those studying to become certified nurse midwives, nurse practitioners or researchers and professors who study nursing, Jill Kliethermes, executive director of the Missouri Nurses Association, said.
"If we put a cap on what the loan eligibility is, we're going to have less people likely going to pursue a graduate degree," she said.
The cost of nursing programs in the state varies. A family nurse practitioner degree at the Goldfarb School of Nursing in St. Louis costs around $56,000 with living expenses, according to the school's website. The University of Missouri lists its master's of science in nursing for pediatric nurse practitioners at around $34,000, but that does not include living expenses.
Supporters of the new legislation say the loan limits place guardrails on "unsustainable borrowing." Trump administration officials said the new limits are common sense guardrails that limit future student loan borrowing and simplify student loan repayments.
In a "mythbusting" document the Department of Education published last month, officials said 95% of students borrow below the annual loan limit. However, it did not state whether that referred to just graduate nursing students or for those at all degree levels.
"Placing a cap on loans will push the remaining graduate nursing programs to reduce their program costs, ensuring nurses will not be saddled with unmanageable student loan debt," the document said.
The cap on loans does not apply to undergraduate nursing students. Most bedside nurses — RNs or LPNs — do not need a master's to work in hospitals, clinics and other settings.
Advanced practice registered nurses typically have a master's or doctorate. They receive a more specialized education and training and thus have a broader scope of practice than other nurses.
Such positions have among the highest rates of vacancies in the state, according to labor data compiled by the Missouri Hospital Association.
Limiting how much money students can borrow to become APRNs could mean fewer nurse practitioners, advocates have said.
"Shutting down nurses' access to resources to seek higher education will only further contribute to forces driving nurses away from the bedside," representatives from the National Nurses Organizing Committee/National Nurses United, a nationwide labor union for the profession with members in St. Louis and Kansas City, said in a statement.
Advanced practice nurses are a vital piece of the health care system. That's particularly true in places with health care shortages, where nurse practitioners fill gaps in care, Kliethermes said.
"They have their role in primary and specialty care in communities that are often lacking physicians," she said. "They have a great track record of improving access to care, lowering cost and maintaining very high quality of care."
Kliethermes added it's already hard to find high-level graduates to teach at nursing schools.
"We're not filling our spots for nursing students because we don't have the faculty," she said. "Faculty needs a graduate degree, typically. And this is another area [where] it's just a trickle-down effect."
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