The Discomfort of Trying to Create Change in Health Care and Beyond

In complex systems, change takes persistence.

Over the years, coworkers have often described me as “the dog with the bone.” Once I become invested in something, I tend not to let it go. That persistence has helped me create meaningful change within health care systems. It has also shown me how much organization, follow-up, patience, and emotional stamina meaningful change often requires.

I have also learned how often the answer is no. Sometimes the “no” is direct. Other times it comes through silence. Some ideas take longer to gain traction within large organizations than people initially expect. Creating change in any environment can be difficult. In health care systems, it can feel especially challenging.

Health care organizations are responsible for large numbers of patients, employees, regulations, budgets, and risks. Decisions that appear simple from the outside often involve layers of oversight, approvals, coordination, and competing priorities that most people never see. Still, understanding those realities does not necessarily make the process less discouraging.

The temptation to give up.

I have experienced this in clinical practice when advocating for patient education initiatives, operational changes, or workflow improvements that initially seemed straightforward. In health care, even small changes can require multiple approvals, coordination across departments, competing priorities, and […]

When Nurses Mobilize: “Professional” Degree Programs

ANA grassroots advocacy manager Katherine Rowe

Few moments in recent history demonstrate the power of nurses as clearly as the fight over the definition of “professional” degree programs. Hundreds of thousands of nurses spoke out against the Department of Education’s proposed definition, loud enough for the issue to gain traction across social media channels and make an impact on Capitol Hill.

How Did We Get There?

We’ve known that the Department of Education (ED) was preparing to scale back support for unsubsidized federal graduate loans; last year’s One Big Beautiful Bill Act (OBBBA) tasked the ED to do so. The question was how. That’s why the American Nurses Association (ANA) pushed for nursing representation on the ED’s Reimagining and Improving Student Education (RISE) Committee and collaborated with partners on strong coalition letters when our calls for including the nurse voice went unheeded.

Despite these efforts, the RISE committee failed to recognize post-baccalaureate nursing programs’ strength and rigor, excluding them from the definition of “professional” degree programs.

Why does this matter? OBBBA eliminated the Grad PLUS Loans program while the RISE committee’s recommendations established two levels of federal student loan limits:

  1. Graduate caps: $20,500 annual / $100,000 total
  2. “Professional” caps: $50,000 annual / $200,000 total

In addition to […]

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