I have spent my career studying nurses and why that workforce so often fails the people it is meant to serve. But my understanding of the system changed deeply the day my daughter died.
She was 21 years old. She had intellectual and developmental disabilities and had just moved into a group home in New Jersey. Within 48 hours, she was gone. Her caregivers accidentally gave her too much medicine.
The people responsible for her care were not nurses. They were direct support professionals — workers who often help people with disabilities live in community settings. Yet their work is deeply connected to nursing. They are part of the same health care system that depends on them even as it gives them too little training, pay, and support.
In the years since my daughter died, I have tried to make sense of what happened, not only as a mother, but as a nurse and researcher. I have come to believe that we are asking the wrong questions.
The world knows it has a nursing shortage, and policymakers have been working to create new nurses. Governments track our progress and publish reports projecting how many more nurses will be needed.
And yet, for all this attention, we’re not fixing the shortfall. It’s worsening as baby boomers age, driving an even greater need for health care.
We focus on producing more nurses (expanding enrollment, accelerating training, recruiting across borders) while paying far less attention to whether the system they enter can sustain them.
But the evidence and the lived reality of care suggest otherwise. It’s the workplace we need to fix.
But what you don’t measure, you can’t fix.
Across countries, workforce data is strongest where the questions are easiest to answer: How many nurses exist? Where are they located?
It is weakest where the answers matter most: What happens when nurses enter practice? Are they supported? Do they stay? These are not secondary questions. They determine whether a workforce functions at all. Yet we rarely measure them.
This blind spot extends beyond nursing. Direct support professionals, or those who care for people with disabilities, older adults, and others with complex needs, are among the least visible workers in the system. Nurses cannot compensate for the deficiencies in the rest of the system.
New nurses often enter practice under intense pressure, expected to manage complex patients with few colleagues and limited support. Structured transition programs like mentorship, residency models, and protected learning time are uneven or absent. The difference often determines whether a nurse stays.
Working conditions are the larger problem.
Burnout, chronic understaffing, and high turnover are among the most consistent predictors of workforce loss, yet they are harder to quantify than headcounts and are often overlooked.
For direct support staff, the situation is even more stark: inconsistent training, low wages, and high turnover in roles that involve caring for some of the most vulnerable people in our system.
In New Jersey, my daughter’s death prompted proposed legislation, still pending, requiring a nurse, or a certified medication aide supervised by a nurse, to administer medications in group homes and supervised apartments. The proposal recognizes a difficult reality: We are often asking workers without sufficient clinical training to manage medications that can become dangerous or even lethal if dispensed incorrectly.
When my daughter entered that group home, she encountered a workforce that was not adequately prepared and a system that relied on staffing models without sufficiently investing in clinical support, training, or supervision.
Expanding the pipeline without fixing the workplace is like pouring water into a bucket with a hole in it.
We see this globally. Health systems invest in training, only to lose early-career nurses within a few years. High-income countries recruit from lower-income ones, shifting shortages rather than solving them.
This is not a failure of individuals. It is a failure of design.
Systems solutions, such as improving training, adding sufficient staff, and supporting early-career professionals, are slower to implement.
But they are the only solutions that endure.
We should track whether new nurses get structured transition support, not just whether they graduate. We should measure retention and turnover with the same rigor as supply.
And we must stop treating the rest of the care workforce as invisible.
Direct support professionals, home care workers, and others are central. Without standardized training, sustainable wages, and meaningful integration into workforce planning, no amount of nurse supply will stabilize care delivery.
I wish I had not learned some of these lessons the way I did. But my daughter’s death enabled me to see the problem more clearly.
I no longer believe that we can fix the system only by training more nurses. Instead, we need to build a health care system that supports the people we are asking to care for us.
Lynne S. Moronski is an associate fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania.