Health care—and the systemic challenges facing an aging population—continues to concern Americans nationwide. Here in California, the health system staffing shortfall is a major challenge affecting our communities. Unnecessary and counterproductive barriers obstruct genuine solutions to a larger, stronger pipeline of health professionals.
The Hospital Council of Northern and Central California has previously warned that shortages of nurses, physicians, and other health workers limit access to care. Indeed, some hospitals have stopped offering maternity services, chemotherapy, and other services.
Rural hospitals make the stakes especially clear, as patients in need are forced to travel for treatment. In Imperial County, for example, the 4,000 square mile area has only one operating maternity ward, as El Centro Regional Medical Center shut theirs down three years ago.
As of 2025, the California Department of Health Care Access and Information (HCAI) projects that California needs nearly 18,800 additional registered nurses, with fifty counties facing shortages, and the deficit is projected to triple by 2033. Orange County is not only harmed by limited supply, but by high turnover, workforce churn, and constrained career pathways, all of which destabilize the health system.
A reliable nursing pipeline is a crucial dynamic statewide, considering the wide range of health care needs for the large population and diverse communities. For example, Latino residents, who make up about 40% of California’s overall population, continue to face inequities in wages, healthcare and education, according to UCLA researchers.
In some areas, community health workers known as promotores help families find affordable coverage, manage chronic conditions and navigate services, often by bridging language and cultural barriers. Yet many are not well-paid, and the certification program, originally recommended by California Future Health Workforce Commission, received funding in 2022, but was abruptly eliminated by 2025 due to state-level budget cuts.
Expanding nursing education and creating clear licensing pathways would complement those community-based efforts by strengthening the broader healthcare system people rely on.
But California’s licensing process makes it difficult for graduates to transition from education to employment, compounding the problem. Reports on the most recently available data indicate that only about a third of 57,987 applications by qualified students to nursing schools in California were accepted in 2022-23.
On top of that, California’s nursing board seems keen on introducing new dilemmas that leave students and employers uncertain about their ability to serve in the state.
With services and care stretched thin, one would think that the California policymakers would make increasing the pipeline for providers, including allowing qualified graduates who pursue nursing education outside of California to be part of the solution. But the nursing board makes it difficult for out of state nursing graduates to come to the state to work.
Unnecessary obstacles that make it more difficult to address health care needs hurt all Californians.
One positive step would be to recognize the role of the National Council Licensure Examination (NCLEX) in assessing whether graduates are ready for entry-level positions. The NCLEX is a national licensure exam designed to measure nursing competence, including the ability to make important decisions in clinical settings.
California’s Nursing Board should adopt a transparent, timely process that allows graduates to demonstrate their readiness and move toward licensure, as well as create simpler paths for nursing students who take the NCLEX to work in the state. That would help hospitals and clinics recruit qualified graduates to serve patients.
Modernizing needlessly cumbersome regulations is imperative to addressing health care staffing shortages. Expanding nursing program opportunities, welcoming graduates trained elsewhere, and establishing a clear and responsive licensing process would all be constructive ways to make care more accessible for all Californians.
Born and raised in San Diego, Mario H. Lopez is president of the Hispanic Leadership Fund, a public policy advocacy organization that promotes liberty, opportunity, and prosperity for all.