North Carolina’s nursing workforce challenge is a statewide access issue. Forecasts show persistent registered nurse (RN) and licensed practical nurse (LPN) shortages, uneven regional impacts, and pressure on schools, public health, long-term care, and hospitals. This issue brief frames workforce renewal through data, education pathways, retention, public health, school nursing, and community-based care models.
Rising rates of suicide, especially for youth, increasingly require community-based responses. “Our State, Our Wellbeing,” a collaboration between Carolina Across 100 and UNC’s Suicide Prevention Institute, convened 15 cross-sector community teams across 24 counties to develop and implement local suicide prevention strategies. This article details participating teams’ efforts and progress.
North Carolina’s nursing shortage includes a large, underused reserve of licensed but inactive or unemployed nurses. Drawing on licensure data, surveys, and program evidence, this commentary identifies why nurses disengage and outlines a five-part, near-term strategy to re-engage this workforce using existing state infrastructure.
North Carolina’s immigrant communities face mental health challenges driven by restrictive policies, structural barriers, and acculturative stress. These forces reduce access to care and worsen outcomes, particularly in mixed-status families. Community-embedded, culturally responsive models, including stepped care with Community Mental Health Workers, improve engagement, expand access, and support scalable mental health equity statewide.
North Carolina’s nursing workforce challenges are most visible where the health system is most fragile—rural communities, long-term care, behavioral health, correctional health, and home- and community-based services. Expanding practical nurse education is a pragmatic, equity-centered strategy for North Carolina.
Value-based payment models may better support nurses in delivering patient-centered care by emphasizing outcomes, teamwork, and practice at the top of license. These models could have positive implications for clinical workflows, nurse satisfaction, retention, and access to care, particularly for complex and underserved patient populations.
##BACKGROUND Syphilis rates have risen sharply across the United States over the past decade, with the Southeast experiencing a disproportionate burden—a region with the highest concentration of non-Medicaid expansion states. This initiative aimed to design a collaborative strategy between public health entities and public payers across the Southeastern United States to address the congenital syphilis crisis and establish a replicable framework for future public health needs. ##METHODS Public health and public payer leaders across the Southeast united through a multifaceted approach involving pre-summit sessions, an in-person summit, and post-summit convenings. Participants shared jurisdictional data, selected priority areas, and used findings to guide post-summit strategy. ##RESULTS Key outcomes included updated syphilis screening guidance, development of best practice standards, identification of high-impact syphilis measures and data points, and strengthened multi-state collaboration. ##LIMITATIONS Limited funding prevented some state leaders from attending in person; Georgia and Mississippi participated only virtually. Additionally, the absence of a designated “owner” to sustain momentum and navigate differing state structures for public health and payer systems presents an ongoing challenge to regional coordination. ##CONCLUSIONS Cross-state collaboration between public health and public payers is essential to addressing congenital syphilis. The Southeast’s approach fosters critical analysis, coordination, and momentum across the region. It also serves as a replicable model for tackling other public health crises.
As the population of North Carolina continues to increase, so does the demand for a nursing workforce to meet the state’s ever-growing health care needs. This editorial discusses some of the challenges the nursing profession encounters and suggests possible solutions to help mitigate the nursing shortage and bolster retention.
BACKGROUND Transgender and gender diverse (TGD) persons face significant health disparities. We aimed to explore the scope of family physicians’ TGD care and physician factors related to the provision of TGD health care in North Carolina. METHODS Family physicians in North Carolina were invited to complete an observational survey from January 2024 to September 2024, exploring their training, beliefs, and practices related to care for TGD patients. Descriptive statistics characterized the responses, and bivariate analyses explored potential factors associated with whether physicians offered primary care or gender-affirming care (GAC) to TGD patients. Sub-analysis of data compared responses across regions of the state. RESULTS Of the 181 attending family physicians who completed the survey, 66.9% reported participating in some type of training in TGD patient care. Overall, 82.9% of respondents reported providing primary care to TGD patients, and 47.5% reported that they provided GAC to TGD patients. The most commonly reported barrier to providing any care to TGD patients was insufficient training. Bivariate analyses revealed additional physician, clinic, and training factors that may be associated with whether family physicians provide primary care or GAC to TGD patients. LIMITATIONS The present study is limited by a small sample size, with high likelihood of selection bias. CONCLUSIONS This study provides an initial snapshot into family medicine physician practices with regard to primary care and GAC for TGD patients. Our findings highlight the need for an increased focus on training, both mandatory and optional. We also identified key opportunities for targeted outreach, such as residency programs.
This article describes the Brothers and Sisters Like These creative writing program and analyzes the shared use of a non-traditional method of care for Veterans—creative writing and the arts—to help heal the emotional and at times physical toll taken on a Veteran during their military service. This article attempts to illustrate the healing and improvements in mental health that therapeutic writing, combined with other art forms, demonstrably has on our members and the community that we interact with.
North Carolina’s nursing workforce faces a growing shortage driven by pipeline constraints, uneven distribution, and retention challenges. Misaligned policies further hinder progress. Targeted investments and policy decisions can expand education capacity, modernize regulations, and improve workforce sustainability to ensure access to care, reduce costs, and secure the future of health care delivery.
School nurses in North Carolina have a rich history as vital partners to promote educational access for all students. Their critical role highlights the interdependency between health and learning. Students who are not healthy cannot fully participate in their education, which can have lifelong implications.
North Carolina’s nurses serve diverse populations. The state’s large rural population, substantial military community, growing Hispanic population, and American Indian communities shape a complex, evolving landscape. Preparing nurses to deliver culturally competent care strengthens communication, builds trust, supports better outcomes, and creates leadership, education, community health, and advanced practice opportunities.
North Carolina faces an annual nursing deficit despite significant education investments. A capacity mapping study across three community colleges reveals that clinical training generates 3 to 8 times more faculty and preceptor demand than classroom instruction, varying substantially by institution and week. Planning expansion without this operational precision risks new bottlenecks.
Prisons and jails have become the default safety net provider for people with serious mental illness (SMI) across the United States. The North Carolina Formerly Incarcerated Transition Program (NC FIT), including its unique program for people with SMI, FIT Wellness, connects people post-release from incarceration to essential health services.
This interview features Kathleen Welsh-Bohmer, PhD, Professor of Psychiatry and Neurology at Duke University and co-leader of the NC Registry for Brain Health. Dr. Welsh-Bohmer discusses the development of the NC Registry for Brain Health, an effort to connect North Carolinians with brain health resources, clinical research opportunities, and educational materials, with a particular focus on engaging underrepresented communities and improving research literacy.
This article explains how North Carolina is using data, policy research, and collaboration to address the nurse shortage. It focuses on the role of the new Nursing Workforce Coordinating Council to strengthen supply, improve retention, and coordinate statewide action so the state can grow the nursing workforce.
Models of care such as mobile health programs led by nurses bring care directly to communities, improving access and outcomes. These models demonstrate the full value of nursing, support workforce sustainability, and offer practical and scalable solutions to health care challenges, particularly in rural and underserved populations.
