In a new opinion piece for The Orange County Register, HLF’s president addresses California’s dysfunctional nursing pipeline.  Many out-of-state nursing graduates whose goal it is to work in California face issues navigating the state’s licensing process.  Considering the state’s nursing shortage has led to cuts in a variety of medical practices, the need to address these types of barriers is crucial for the healthcare system and patients most of all.

Rural and other underserved communities are feeling the impact the most.  In Imperial County, for example, there is only one operating maternity ward across over 4,000 square miles.

Out-of-state graduates don’t have the ability to start working immediately.  Even after passing the National Council Licensure Examination (NCLEX), the national exam graduates must pass to obtain licensure, they may face uncertainty about whether or not the state sees their education as “in line” with its standards.  This leaves many aspiring nurses waiting for individual approval.

The uncertainty among nursing graduates also slows down hospital and clinic recruiting efforts.  In both rural areas where access to care is limited, and areas that contain large minority populations, this has presented itself as a huge issue.  The lack of available nurses has hurt a variety of different people across the most populated state in the country, from large counties facing staffing problems to navigating potential language barriers.

Fifty counties in California currently face nursing shortages.  In 2025, a study by the California Department of Health Care Access and Information (HCAI) found that the state sat at a deficit of about 18,800 nurses.

By 2033, that number is projected to more than triple.

The longer nursing graduates don’t have a clear and efficient path into the workforce, the more severe the problem becomes.  California needs to introduce new guidelines that welcome out-of-state nursing graduates into the workforce rather than delay or prevent their service to the state’s patients.