Profession, Professional, & Professionalism – Post #2 – Policy Implications

In our last post, we shone a light on the potential threat to funding for graduate nurse education currently unfolding over the question of whether nursing is strictly defined in regulatory language as a profession. Graduate nursing education prepares advanced practice nurses who provide a significant percentage of providers in rural and remote settings. Bartnes et al. (2018) found nurse practitioners (NPs) constituted 25.2 percent of providers in rural practices, compared to 17.6 percent in 2008. As noted by the American Association of Nurse Practitioners (2024), more than 102 million Americans across the nation currently lack adequate access to primary care – a 3% jump from one year ago (99 million) – and these shortages exist across urban, suburban, and rural areas. NPs represent 1 in 4 primary care providers in rural practices, with a higher percentage in states that allow them to practice to the full extent of their education and clinical training (AANP Spotlights Five Critical Health Care Trends to Watch, 2024). Patel and colleagues (2025) sampled 18,804 NPs, of which one-fifth (19.1%, n = 3,589) worked in rural areas. The rural APRN workforce was, on average, older, less racially diverse, more experienced, and had lower household income than the non-rural workforce. Those who remained in rural jobs were more likely to report that the length of their commute, the cost of living, their commitment to underserved communities, and proximity to family were factors leading to NP retention in rural areas.

To improve perinatal excellence in rural and remote areas, supporting the flow of NPs into the workforce is essential. We examine the dynamics of the current issue threatening graduate nurse (NP) education below. But recognition of Virginia Henderson must come first.

Virginia Henderson

Virginia Henderson played a pivotal role in moving nursing from an occupation defined by task execution to a profession grounded in an independent body of knowledge. By articulating nursing’s unique function—assisting individuals in activities contributing to health, recovery, or a peaceful death—she clearly distinguished nursing practice from medicine and framed it as an autonomous professional discipline. Her work provided the intellectual foundation for professional standards, education, and accountability that remain central to nursing’s claim to professional status (Henderson, 1966).

Policy

The current debate revolves around how the U.S. Department of Education (ED) plans to implement changes required by the One Big Beautiful Bill Act (Public Law 119-21), which amended the William D. Ford Federal Direct Loan Program under Title IV of the Higher Education Act of 1965. Title IV governs federal student aid, including the definition of a “professional degree” used for determining federal loan limits and eligibility under the Direct Loan program. Under the negotiated regulatory language agreed upon by ED and its rulemaking committee, the definition of professional degree in 34 C.F.R. § 668.2 will include only a narrow list of fields (e.g., medicine, dentistry, law, pharmacy, optometry, veterinary medicine, chiropractic, podiatry, clinical psychology, and theology) tied to specific Classification of Instructional Programs (CIP) codes, and does not explicitly include nursing programs such as MSN, DNP, or NP degrees; programs outside those listed would be treated as general graduate programs with lower loan limits and different borrowing caps under Title IV.

The Congressional Research Service (CRS) (2025) report explains how the rulemaking committee conducted its analysis and the implications of its decision. If you would like to understand the issue in depth, this website explains it with the utmost clarity. In the next post, the rulemaking process and process for input will be explained in detail. We are currently in the Public Comment period, which ends on March 2, 2026.

As summarized by the Congressional Research Service (2025), historically, the Higher Education Act of 1965 (HEA) provisions that authorized Direct Unsubsidized Loans and Direct PLUS Loans for graduate and professional students, and their loan limits, used terms such as “graduate student” and “professional student” but did not specify distinct limits for each group. Thus, the annual and aggregate loan limits for Direct Unsubsidized Loans and Grad PLUS Loans were generally applicable to all qualifying graduate and professional students regardless of field of study or credential level. The Secretary has used HEA authority to extend higher loan limits to individuals in certain postbaccalaureate programs of study with exceptionally high costs, at both the doctoral and master’s degree levels. Thus, the proposed change is a sudden, dramatic shift in policy following 50 years of greater flexibility in interpreting “professional.”

Key Policy Actors

The primary decision-makers are the individuals within the Federal Student Aid (FSA) and the U.S. Department of Education’s policy office. The Office of Management and Budget will review the rule for economic impact and regulatory consistency. These would be considered public sector agencies.

The U.S. Congress has statutory and oversight powers, particularly through the Senate Education & the Workforce Committee. They can hold hearings, apply political pressure, and amend the statute later. The House committee is the Committee on Education and the Workforce. Congress is a public sector body, but not an agency.

The Congressional Research Service provides critical analysis, but its role is analytical, not regulatory.

Private Sector Organizations

Those in the private sector include professional organizations. From a narrow perspective focused solely on nursing, the primary organizations include the American Nurses Association (ANA), the American Association of Colleges of Nursing (AACN), the National Organization of Nurse Practitioner Faculties (NONPF), and the American College of Nurse-Midwives (ACNM).

The AACN published its early response to this issue in November 2025. The organization subsequently developed a resource page addressing the issue, which includes a survey summarizing the profound impact of this change, links to sign a petition, links to contact Congressional representatives, links to receive alerts, and an ongoing blog of related news and issues unfolding since November 2025 (AACN Alarmed Over Department of Education’s Proposed Limitation of Student Loan Access for Nursing, n.d.; Proposed Federal Loan Changes for Nursing Students, n.d.).

The Commission on Collegiate Nursing Education (CCNE) has a direct stake in this rulemaking because federal student loan eligibility materially affects enrollment, access, and sustainability of CCNE-accredited graduate nursing programs. A regulatory definition that excludes nursing from “professional degree” status risks undermining accredited programs’ ability to finance advanced practice education, directly impacting the advanced nurse practitioner workforce pipeline.

The American Nurses Association (ANA) and other specialty nursing groups have also issued statements, for example, the ANA and the American Association of Nurse Practitioners. The American College of Nurse-Midwives has joined a Nursing Community Coalition letter. The National Organization of Nurse Practitioner Faculties (NONPF) joined a coalition of other advanced practice groups in submitting a comment.

Universities and higher education organizations, public and private, are engaged on behalf of their graduate programs and students, stressing the impact of loan eligibility and workforce pipeline concerns. Public universities influence policy but do not exercise governmental authority (Proposal to Implement Loan Caps Threatens Access to Professional Degree Programs | Association of American Universities (AAU), 2025).

Stakeholders

All of the entities described above can be considered stakeholders. From a broad perspective, other important stakeholders include graduate nursing students, prospective applicants to advanced practice programs, rural and remote communities, underserved communities, Schools of Nursing, financial aid administrators, hospitals and health systems, state and local public health departments, Federally Qualified Health Centers, state boards of nursing, health equity organizations, and policy institutes. This is a big issue affecting the fundamental well-being of our society, and the list can go on.

Motivation for policy positions on both sides can be debated. On the one hand, the political goal of reducing government size, limiting spending, and “recreating the image of America” is part of the dialogue. What “nursing” represents to some historically may align with subservience rather than empowerment. Opposition to nursing’s autonomy to provide care may reflect an implicit bias among some. On the other side, those opposed to this change cite multiple reasons, individual, group, and societal, that reflect potential harm. Individuals may not be able to pursue their educational goals. Professional nursing organizations see their current trajectory and evolving scope of practice threatened. Those who take a broad view of public health see a primary intervention to improve health equity threatened as described above.

Other policy issues related to this general debate have unfolded across multiple fronts, often concerning professional autonomy, licensing requirements, and tensions with broader healthcare goals, such as Healthy People 2030.

The next post will describe the statutory and regulatory mechanisms related to this issue. Advocacy requires knowledge of the concepts related to “profession.” A brief discussion follows.

Background: What do these words mean?

Profession

A profession is historically defined as an occupation grounded in a distinct body of specialized knowledge, acquired through formal education, and practiced with a high degree of autonomy and ethical responsibility. Classic professions such as law, medicine, and theology emerged early because they controlled entry through education, governed themselves through licensure and codes of ethics, and claimed socially essential work. Over time, modern professions expanded this model to include university-based scholarship, evidence-informed practice, and accountability to the public rather than solely to employers. In this tradition, professional status is not conferred by prestige or custom, but by demonstrable expertise, self-regulation, and a sustained obligation to serve the public good (Abbott, 1988).

Nursing evolved into a profession by developing a distinct body of knowledge, formalized education, and mechanisms of self-regulation aligned with public accountability. Beginning in the late 19th and early 20th centuries, leaders such as Florence Nightingale advanced nursing education beyond apprenticeship, embedding it in universities and grounding practice in science and ethics. Over time, licensure, accreditation, and professional standards established nursing’s autonomy and jurisdiction over complex clinical and public health work. This trajectory mirrors the classic pathway by which occupations historically became recognized professions (Henderson, 1966).

Professional

A professional is an individual who practices within a recognized field of specialized knowledge, acquired through formal education, and exercises independent judgment guided by ethical standards and accountability to the public. Historically, professionals are distinguished by their autonomy in practice, responsibility for self-regulation through licensure or credentialing, and commitment to service rather than mere employment (Abbott, 1988).

Professionalsim

Professionalism is the collective expression of a profession’s values in practice—demonstrated through ethical conduct, competent performance, accountability, and service to the public good. Historically, professionalism reflects how individuals apply specialized knowledge with integrity and autonomy, while upholding standards established by their professional community rather than solely by employers. It is therefore not a personal style or demeanor, but a social contract that governs how expertise is demonstrated on behalf of society (2025 Code of Ethics for Nurses | American Nurses Enterprise, n.d.).

References

2025 Code of Ethics for Nurses | American Nurses Enterprise. (n.d.). Retrieved January 31, 2026, from https://codeofethics.ana.org/home

AACN Alarmed Over Department of Education’s Proposed Limitation of Student Loan Access for Nursing. (n.d.). AACN. Retrieved January 31, 2026, from https://www.aacnnursing.org/news-data/all-news/aacn-alarmed-over-department-of-educations-proposed-limitation-of-student-loan-access-for-nursing

AANP Spotlights Five Critical Health Care Trends to Watch. (2024, January 3). American Association of Nurse Practitioners. https://www.aanp.org/news-feed/aanp-spotlights-five-critical-health-care-trends-to-watch

Abbott, A. (1988). The system of professions: An essay on the division of expert labor. University of Chicago Press.

Barnes, H., Richards, M. R., McHugh, M. D., & Martsolf, G. (2018). Rural And Nonrural Primary Care Physician Practices Increasingly Rely On Nurse Practitioners. Health Affairs, 37(6), 908–914. https://doi.org/10.1377/hlthaff.2017.1158

Congressional Research Service. (2025, December 17). The Department of Education’s Proposed Rule to Define “Professional Student” (CRS Report R48768). https://www.congress.gov/crs-product/R48768

Henderson, V. (1966). The nature of nursing: A definition and its implications for practice, research, and education. Macmillan.

Patel, E., Gillette, C., Ostermann, J., Everett, C., Caviness, D., & Garvick, S. (2025). What drives advanced practice nurses to stay in rural America? Insights from the 2022 National Survey of Registered Nurses. The Journal of Rural Health, 41(4), e70088.

Proposal to Implement Loan Caps Threatens Access to Professional Degree Programs | Association of American Universities (AAU). (2025, November 14). https://www.aau.edu/newsroom/leading-research-universities-report/proposal-implement-loan-caps-threatens-access

Proposed Federal Loan Changes for Nursing Students. (n.d.). Retrieved January 31, 2026, from https://www.aacnnursing.org/policy-advocacy/take-action/nursing-is-a-professional-degree

U.S. Department of Education. (2026, January 30). Reimagining and Improving Student Education: Proposed Definition of a Professional Degree Program (Proposed Rule). Federal Register. https://www.federalregister.gov/documents/2026/01/30/2026-01912/reimagining-and-improving-student-education