As the nursing workforce crisis intensifies, hospitals across the country grapple with staffing shortages and rising patient acuity, a familiar narrative continues to dominate the conversation: nurses are burned out.
This narrative, however, overlooks the core issue driving the crisis.
Katie Boston-Leary, PhD, MBA, RN, FADLN, FAONL, FAANS, senior vice president of equity and engagement at the American Nurses Association, asserts that workforce strain stems from system-level failures, not personal inadequacy. Unsafe conditions, lack of support, and leadership decisions detached from frontline realities are the true drivers.
“Many of these issues are systems issues,” she said. “We too often treat them as individual problems, missing the actual root: system failure.”
During an interview at the National Coalition of Ethnic Minority Nurse Associations 2026 Annual Health Policy Summit, Boston-Leary made her central point clear: nursing does not have a resilience problem. The profession faces a structural, systemic crisis.
A Workforce Under Strain
Data from the National Council of State Boards of Nursing shows hundreds of thousands of nurses have left the workforce or are considering it. The reasons cited are familiar: stress, burnout, and working conditions.
Boston-Leary maintains that focusing on stress, burnout, and working conditions alone ignores the real culprit: the environment in which nurses work.
“We emphasize self-care and all the other things for nurses to do when they take care of themselves,” she said. “But what do we do for them while they’re working?”
This distinction highlights a pressing concern: nurses must perform in systems that fail to support them, amplifying the workforce crisis.
“12 hours or 14 hours, which can stretch to, is a long time to suffer,” she said.
The Gap Between Leadership and Reality
Boston-Leary also pointed to a disconnect between leadership messaging and frontline experience.
“We say one thing as leaders, but do another when it comes to supporting nurses on the ground,” she said. “To truly support our workforce, what we say and project externally about valuing staff must be matched by our internal actions and decisions affecting those we lead.”
This misalignment between words and action perpetuates the core problem: workforce instability rooted in system failure.
This crisis manifests in organizational responses—frequently emphasizing recruitment or wellness, while frontline nurses remain unsupported. This gap persists because the system itself is not designed with nurses’ needs at the center.
When Nurses Walk Away
Boston-Leary described a shift in how nurses are responding to these conditions.
“Nursing is becoming harder and harder for nurses to be in these spaces where they’re needed the most when patients are the sickest,” she said. “That’s why they’re voting with their feet.”
Nurses are leaving roles and environments they find unsustainable.
She added that workplace inequities add another layer of strain.
“They see the inequities that exist also in the spaces that they work,” she said. “And that gives them a lot of emotional baggage and psychological stress because they just see that they’re not treated equally.”
The Overlooked Cost of Inequity
For nurses of color, those challenges can be more pronounced.
Boston-Leary described a pattern in which highly educated nurses remain in lower-level roles despite holding advanced degrees and leadership training.
“I tend to see a lot of nurses that are in lower-level, low-paid positions… very well educated,” she said. “They have doctoral degrees and everything else… but yet they’re not in leadership roles.”
She pointed to systemic barriers, including gatekeeping and lack of trust, as ongoing obstacles to advancement.
“There is some gatekeeping that’s happening,” she said. “And we don’t see people of color advancing the way they should.”
The result is not only a leadership gap but also a missed opportunity to strengthen care delivery and workforce stability.
Rethinking What Nurses Need
Boston-Leary’s central message urges a shift: healthcare systems must address structural causes, not just individual symptoms, to solve workforce challenges.
She said organizations must address the conditions nurses encounter at work, not just individual coping.
“We have to think about the whole person and lead fully,” she said. “Seeing them past their roles and their job descriptions and seeing them fully as human beings.”
That includes acknowledging the realities nurses bring with them to work each day, from family responsibilities to physical and emotional strain.
A Defining Moment for the Profession
As the healthcare system continues to evolve, Boston-Leary believes the nursing profession is at a critical inflection point.
The solutions, she said, are not unknown.
The challenge is whether healthcare leaders are willing to act on them.
For nurses, the message is clear: their struggles reflect failures in system design, not personal shortcomings.
Until that system changes, the workforce crisis is unlikely to be resolved.
