The profession of nursing finds itself at a critical juncture. In the past year, headlines have chronicled escalating workplace violence against health care workers, a rise in strikes and job actions as clinicians call for safe staffing and fair conditions, and a U.S. Department of Education proposal that would exclude graduate nursing from the list of “professional degree” programs tied to higher federal loan limits. Each is individually troubling. Together, they have created a broad sense of vulnerability across the nursing profession and raise urgent questions about patient expectations and trust, nurse retention, and the future of the nursing workforce.
Yet moments of unrest can also be moments of definition. Nursing is the largest and, year after year, most trusted profession in American life. In Gallup’s latest honesty and ethics polling, three in four Americans rated nurses “very high” or “high” for trust, outpacing every other profession. That is not a slogan. It is a social contract and a promise to every individual, family, and community. With that trust and scale comes power: the power to set standards for safe care, to shape policy, and to innovate the models and technologies that will define how health is delivered.
We lead a school of nursing and a health system’s nursing workforce, and we see this convergence of pressures every day. But we also see something else: nurses who are ready to step into leadership, not just respond to crises. The question is whether the profession will claim the power its public trust affords.
Despite current pressures, demand for nurses (registered nurses, nurse practitioners, nurse anesthesiologists, and nurse midwives) remains strong and is projected to grow for years to come, with shortages most acute outside metro areas. That demand intersects with a moment of technological transformation. Artificial intelligence will not replace the judgment nurses bring to complex human situations, but it is reshaping the work. When designed with nurses and governed well, AI tools free nurses from administrative burden and restore time for direct care. The question is not whether nurses will work alongside these technologies, but whether nurses will shape them.
Here is what nurse leadership looks like in practice.
First, nursing education and clinical practice working as one system. Academic and practice partnerships align clinical priorities with educational programs to support lifelong learning and evidence-informed, person-centered care. These partnerships also extend to community colleges and early college programs to strengthen workforce development, facilitate smooth transitions to practice, and expand educational opportunity where it’s needed most.
Second, nurses leading in technology governance. Ambient documentation technology is already reducing clerical burden for thousands of clinicians, restoring time for person-centered care. But technology without oversight is dangerous. Health systems need enterprise governance for AI-assisted clinical decision support and frameworks to evaluate generative AI tools before and after deployment. This is not abstract policy work. It is nurses ensuring that the tools meant to help them actually do.
Third, the profession confronting workplace violence with measurable prevention. National surveillance shows healthcare and social assistance workers face the highest rates of nonfatal workplace violence injuries requiring days away from work. Recent surveys report 60% to 80% of nurses experiencing some form of workplace violence in the past year, conditions that drive turnover and moral distress. Health systems should implement zero-tolerance policies, reporting systems, staffing strategies that reduce risk, and post-incident support consistent with OSHA guidance and Joint Commission standards.
Fourth, career advancement being seen as achievable, not aspirational. Employers, states, and the federal government must offer tuition and scholarship support, flexible scheduling, and career ladders that help RNs pursue BSN, MSN, DNP, or PhD pathways. North Carolina’s cross-sector reports show progress in nursing graduate output while also identifying persistent bottlenecks (faculty shortages, clinical site constraints) that must be addressed with coordinated incentives.
Finally, nurses advocating and telling their stories. Data moves policymakers; stories change minds. The Department of Education’s proposed rule on loan limits has drawn bipartisan opposition from lawmakers and national nursing organizations. The public comment period has closed, but there are always more opportunities for nurses to advocate in their workplaces, regionally, and nationally.
North Carolina has a track record of building what the country needs next. The North Carolina Institute of Medicine forecasts a shortfall of RNs and a larger shortfall of LPNs by 2033 if we do not act, but also offers a roadmap: protect nurse safety and wellbeing, reduce documentation burden, strengthen transition-to-practice, expand faculty, and involve nurses in decision-making. We are acting alongside partners across the state to execute on that roadmap, pairing nurse-led innovation with disciplined governance so technology serves people and investing in the continuum from pre-licensure through doctoral education to clinical leadership.
Nurses have always been on the frontlines of change, often quietly, almost always effectively. This time demands that we be loud. We must change, innovate, and transform, and we must be at the tables where decisions are made. Share your story with your local paper. Meet with your legislators. Run for office. Lead your unit council. Serve on your hospital’s AI governance committee.
If we do not define nursing in this moment, others will define it for us, and they will get it wrong. We are the largest and most trusted profession in healthcare. Together, let’s step into our power and wield our influence with purpose and dignity. Our patients, our colleagues, and the next generation of nurses are counting on us.
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