Nursing as a Profession and Professional Degree Designation

Dr. Caruso is senior nurse practitioner at Penn Medicine and Adjunct Assistant Professor at the University of Pennsylvania School of Nursing

Nursing as a profession

Our beginnings are attributed to our nursing giants: Florence Nightingale, the founder of the modern nursing profession, and Dr. Loretta Ford, the founder of the nurse practitioner role. The discipline of nursing encompasses… nursing theory, nursing knowledge, nursing research, nursing ethics and timeless values. It is enduring. Nursing honors human caring, healing, health and illness experiences and phenomena.

Nurses

Florence Nightingale is recognized as the founder of modern nursing. In the 19th century, she was known for her pioneering work in the Crimean war and impact on nursing education. Ms. Nightingale was the first nurse theorist and developed the Environmental Theory which revolutionized nursing practices to create sanitary conditions for patients to receive care. She described the nurse’s initiative to configure an environmental setting or “the act of utilizing the patient’s environment to assist him in his recovery.”

While she authored more than 200 books and pamphlets, her best-authored work was “Notes on Nursing,” published in 1860 outlining nursing principles. She is credited for transforming nursing and influencing public health and hospital policies. Ms. Nightingale spent her lifetime advocating for nursing to be a respected profession. The nursing profession has matured and encompasses many notable nursing theories which are the basis of clinical decision-making. These models shape nursing research and create conceptional blueprints which drive nurse-patient interactions. Nurses are invaluable. The public understands patients enter and remain in the hospital to receive nursing care.

Today, nurses practice in array of healthcare settings providing care in both inpatient and outpatient and are the largest healthcare workforce in the United States with more that 5 million active licensed nurses in 2025.

Nurse Practitioners

The nurse practitioner (NP) is one of the advanced practice roles in the profession of nursing, created in 1965 by founder, visionary and innovator, Dr. Loretta C. Ford and her colleague Dr, Henry Silver. This collaboration between nursing and medicine fashioned the preparation of a new primary healthcare provider, the nurse practitioner. There was a critical need for a professional nurse who could address well-child health needs in rural Colorado as many of the communities did not have access to basic healthcare. Dr. Ford’s idea stemmed from her public health nurse clinical practice in Colorado and her experience as a visiting nurse in the New Jersey ghetto.

This new role of the nurse practitioners quickly expanded to incorporate basic primary care services for adults and older adults. A curriculum was developed and today almost every university education program offers master’s and doctoral degrees in advanced practice nursing. NPs practice in every area of healthcare and offer high quality, assessable, affordable healthcare in community settings (clinics, schools, prisons), outpatient (private and academic specialty practices), homecare, nursing homes, emergency rooms, and inpatient settings (intensive care units).

According to the American Association of Nurse Practitioners (AANP) NP numbers reached 441,000 in the U.S. in 2025! NPs have metamorphosized healthcare in the U.S. and worldwide.

What is the current issue surrounding professional degree designation for NPs

It is my opinion that our founders, Ms. Nightingale and Dr. Loretta Ford would champion NP programs as “professional degrees”, our students as “professional students”, and support full federal loan limits for nurses to pursue further learning to achieve their educational goals.

Early November 2025, the Department of Education’s completed the first part in their Negotiated Rulemaking, or first part of the regulatory process for new loan regulations for HR 1 (The One Big Beautiful Bill Act) in programs which are defined as graduate vs. professional. Unfortunately, at the conclusion of the Negotiated Rulemaking, the negotiators and the Department reached consensus on a limited definition of “professional students” which did not include nurse practitioners. This definition stated that a professional degree is “A degree that signifies both completion of the academic requirements for beginning practice in a given profession and a level of professional skill beyond that normally required for a bachelor’s degree. Professional licensure is also generally required.” While NP programs were not specifically listed as examples on the regulation list, NP programs do meet the criteria developed by the Department for “professional degrees.” The new loan limits signed into law on July 4, 2025, for graduate students are ($20,500 annually, $100,000 aggregate) and professional students ($50,000 annually, $200,000 aggregate). (AANP, 2025)

The American Association for Nurse Practitioners (AANP) is advocating to Congress with the request that NP students be included in the definition of “professional students.” The rulemaking process is not yet complete and is currently in the draft phase of the proposed rule. However, this is not the end of the regulatory process, a comment period occurs prior the “final rule”. Nurses, NPs and the public have the opportunity to comment during a 30-day public comment process. Feedback during this comment period may be successful in persuading the Department to include NPs in the definition of “professional students”.

The nursing profession, like other professions, needs nursing leaders, educators and professionals with advanced roles, and these roles require advanced degrees. Constraints on education access by limiting loan amounts directly impact on our nursing force, and those nurses’ pursing education, leadership, and advanced roles and intern impacts our patients and communities locally and nationwide. Our nation’s health is dependent on our nurses and nurse practitioners!

In summary

I challenge each of you to be an informed advocate for our professional practice. I would say that nursing is an enduring profession of vital importance for our nation. Nursing is a professional degree, and our students should be deemed as “professional students” in consideration for the U.S. Department of Education federal loan funds. What does the future hold? Time will tell for this issue and future issues.

Please feel free to provide your perspective by connecting on LinkedIn.