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Imagine nearly every seat in Philadelphias Wells Fargo Center over 20,000 seats are empty. Thats the scale of Pennsylvanias projected shortfall of registered nurses by 2026, according to the Hospital and Healthsystem Association of Pennsylvania. Hospitals in the state report an average 14% vacancy rate for registered nurses. In rural areas it is much higher. This shortage, of course, is not just in hospitals. It also affects long-term care facilities, outpatient clinics and home health agencies, which compete with hospitals for a limited pool of registered nurses, licensed nursing professionals and nursing support staff. We are a senior associate dean of nursing and clinical professor of nursing at Drexel Universitys College of Nursing and Health Professions in Philadelphia, and a dean and professor of nursing at Duquesne Universitys School of Nursing in Pittsburgh. We know that the nursing shortage in Pennsylvania, while not the worst in the U.S., is severe and jeopardizes the health care that patients receive. What caused the shortage? Pennsylvanias nursing shortage is the result of long-standing issues in education, workforce retention and health care delivery. Education bottlenecks: Nursing schools in Pennsylvania and nationwide turn away thousands of qualified applicants each year due to faculty shortages, limited classroom space and scarce clinical placements. More than 65,000 qualified applications were turned away from U.S. nursing programs in 2023 alone, according to a report from the American Association of Colleges of Nursing. A key issue is the lack of preceptors. Preceptors are experienced nurses who teach students in real-world settings. A shortage of preceptors directly limits how many students can complete their education. Aging workforce: More than a third of Pennsylvanias registered nurses are 55 or older. This demographic reality means many are nearing retirement. Burnout and attrition: The COVID-19 pandemic worsened already high levels of stress, burnout and mental health strain for nurses. Many left the profession early due to emotional exhaustion, family and personal health concerns, unsafe staffing ratios, moral injury and lack of institutional support. Uneven distribution: While Pennsylvania may have a sufficient number of licensed nurses on paper, those nurses dont all still work in the profession. And among those that do, they are not evenly spread across roles or locations. Rural hospitals, long-term care centers, behavioral health settings and maternal-child health units are experiencing acute shortages. Cost to patients For patients and their families, the consequences of the nursing shortage are delayed care, fewer interactions with providers and less time for compassionate, personalized support. Overextended nurses face increased workloads, raising the likelihood of delayed interventions, medication errors and inadequate patient education. These factors undermine quality of care. Limited access to nursing care can increase hospital deaths, infections and readmissions, reduce early detection of health issues, and slow the response to life-threatening conditions such as stroke, sepsis and cardiac arrest. In Pennsylvania, patients may experience longer emergency room wait times, delayed discharges or transfers to nursing homes or rehabilitation centers, and service disruptions in rural and underserved areas. Effect on nurses Over 600,000 registered nurses across the U.S. plan to leave the workforce by 2027, according to a 2023 analysis by the National Council of State Boards of Nursing. Many cite stress as their reason for leaving the profession. New graduates often leave within their first two years, feeling unprepared for the emotional and operational realities of practice. In Pennsylvania, the shortage has created a feedback loop. Understaffing increases pressure on those who remain. A 2023 National Council of State Boards of Nursing survey found that 41% of nurses under age 35 reported feeling emotionally drained. Meanwhile, some experienced nurses choose to retire early or shift into nonclinical roles for better schedules, slower pace and improved quality of life. This turnover erodes institutional knowledge, increases costs for onboarding and overtime, and limits the capacity to mentor incoming staff. Whats being done To help address the problem, Pennsylvania Gov. Josh Shapiro in March 2025 proposed a US$5 million Nurse Shortage Assistance Program. If approved by the General Assembly, the program would cover tuition costs for nursing students who commit to working in Pennsylvania hospitals for three years after graduation. HB 390 is also currently under review in the Pennsylvania General Assembly. It aims to establish a $1,000 tax deduction for licensed nurses who serve as clinical preceptors. To meet the growing demand for nurses, Pennsylvania hospitals are partnering with colleges and universities to expand clinical training capacity, streamline pathways into nursing and develop innovative education models such as hybrid and accelerated programs. Hospitals statewide are also offering substantial sign-on bonuses, loan forgiveness programs, housing stipends and flexible scheduling to attract nurses. To improve nurse retention, health care organizations have introduced structured residency programs, mentorship networks and clear career advancement pathways designed to reduce burnout and enhance professional satisfaction. They are also increasingly using virtual nursing, telehealth services and AI-driven administrative tools to reduce nurses workloads, enhance patient interactions and address staffing gaps. And some Philadelphia and Pennsylvania colleges offer refresher and license reactivation programs for retired or inactive nurses who want to rejoin the workforce. Duquesne offers a nurse faculty residency to increase the number of high-quality nursing faculty. What more could be done? Continuing Title VIII Nursing Workforce Development Programs are another solution. These federal grants, reauthorized under the March 2020 CARES Act, help fund nursing pathways and the availability of high-quality nursing care for patients nationwide. On April 1, 2025, the Trump administration announced plans to restructure the U.S. Department of Health and Human Services, and the future status of these programs is not yet known. Research consistently demonstrates that care provided by nurses who have earned a bachelors degree or higher directly leads to better patient outcomes, improved safety and overall health. A commitment to shoring up the nurse pipeline in Pennsylvania is a commitment to improving the well-being of individuals and communities across the state. Kymberlee Montgomery is a senior associate dean of nursing at Drexel University. Mary Ellen Smith Glasgow is a professor of nursing at Duquesne University. This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Alexandra Shaker, PhD, is a licensed clinical psychologist with a background across inpatient and outpatient treatment settings. She has experience in research, teaching, and clinical practice. Dr. Shakers writing is an interdisciplinary exploration of the human condition: she integrates psychology, literature, history, anthropology, and language to speak to the meaning and vitality we find in the stories we tell one another and ourselves. Dr. Shaker received her PhD in clinical psychology from The New School for Social Research and conducted her doctoral research at the Brief Psychotherapy Research Program at Mount Sinai Beth Israel. She completed her clinical training at Columbia University Medical Center, and a postdoctoral fellowship in perinatal mental health at The Motherhood Center of New York, where she held a position as a clinical psychologist and is now a clinical consultant. Whats the big idea? Clinical psychologist Dr. Alexandra Shaker explores the deep connection between anxiety and the body, blending psychology, neuroscience, history, and literature. The Narrowing reveals how anxiety shapes not just our thoughts but our physical well-beingand how understanding this relationship can help transform fear into resilience. Through a journey from brain to gut, Dr. Shaker uncovers what our bodies can teach us about anxiety and why, despite scientific advancements, we still struggle with it. The Narrowing offers a fresh perspective on embracing anxiety as a natural part of being humanand using it to grow. Below, Alexandra shares five key insights from her new book, The Narrowing: A Journey Through Anxiety and the Body. Listen to the audio versionread by Alexandra herselfin the Next Big Idea App. 1. Anxiety cannot be hacked. When we are uncomfortable or in pain, it is natural to look for an escape route. In these moments, we want, more than anything, to change how we feel, through whatever means may appear quickest. When I recall moments in my life when Ive felt particularly anxious, I recall, too, my overwhelming wish to flee the anxiety and all of its accompanying thoughts and physical sensationsthe fear of having made a wrong decision, the blood rising to my face, and the sinking feeling in my gut. In these vulnerable states, we can easily fall prey to claims of quick fixesof, say, a diet that will (somehow) eliminate panic attacks, or a wearable device that will induce calm throughout the nervous system with the press of a button. We are living in a time when these so-called cures aboundmost of all, on social mediaand they are often difficult to resist. Their omnipresence is evidence of just how pervasive and troubling anxiety is. But the truth is, anxiety cannot be hacked. Depending on quick fixes inevitably ends in frustration and disappointment because, quite simply, they are not enough. So, instead of looking for hacks to eliminate anxiety, we can instead think about approaching anxiety at two levels. We can learn to use strategies to manage anxiety initially, when it feels particularly overwhelming (like, for instance, breathing techniques and physical exercise), and then we can begin to look deeper. Treating anxiety in a meaningful, lasting way requires an appreciation for its depththat is, for where it is coming from and for what it is trying to tell us. When we try to hack our way out of our distress, we miss an opportunity to learn from it. 2. Anxiety is a problem of attention. Our attention is in constant demand, from the perpetual news cycle to workplace requirements to the seductive nature of social media platforms. Today, in a time of political upheaval, natural disasters, and devastating wars, our attention is newly stretched, even contorted. Despite our best intentions, many of us find ourselves struggling to harness our minds. Our time and energy seem in short supply, our focus is unwieldy, and we are anxious. Anxiety and attention are intertwined aspects of our lives because anxiety is, in many ways, shaped by the movement of our attention. What is it that we pay attention to? Where do our minds linger or become stuck? We might find our minds drawn in many directions at once, or we might think about the same concern repeatedly. And then, what arent we paying attention to? This isnt only a matter of staying on task or getting things done; its more profound. Our attention is finite, so when our minds are stuck in one place, its not just that were miserable, its that we miss out on paying attention to all sorts of other thingsthings about which we may feel curious or that might bring us joy. Although we cant always control the movement of our attention, we can learn to have some sway over it. Research shows that anxiety is associated with heightened attention to threat. When we are anxious, we are particularly aware of potential threats in our environments (Bar-Haim et al., 2007). But we are not powerless. Research shows, too, that attention is a crucial aspect of our capacity for emotional regulation (Tan et al., 2023; Thayer & Lane, 2000; Wadlinger & Isaacowitz, 2011). So, the more we learn to modulate our attention, the more we can regulate our emotional states, especially the uncomfortable and even painful ones. Although we cant always control the movement of our attention, we can learn to have some sway over it. The most widely known (and studied) method for developing greater control over ones attention is consistent engagement in mindfulness practices. Imagine how you might use your attention if you werent constantly moving between your work email and your phone and the news, or if you werent fixated on a conversation you had last week or a family matter about which you have no control. And then, imagine how you might feel as a result. Calmer, perhaps, more focused, and better able to appreciate the present moment. By learning to understand and shape the movement of our attention, we can make meaningful changes to our mental health. 3. Anxiety can be a powerful source of information. Despite the reality that anxiety can be a source of frustration at best and suffering at worst, it is also a powerful source of information. Most of us have learned, in one way or another, to attempt to ignore our anxieties because they are a source of discomfort. But actually, anxiety can warn us of trouble ahead or compel us to look more closely at a situation were unsure of. And anxiety can teach us about ourselves and how we operate in the world and relate to others. Many people live with chronic anxiety that manifests as thoughts and physical sensations without understanding its cause. When we notice anxious thoughts creeping in or the physical sensations of anxiety emergingthe sweaty palms, tightness in the jaw, and racing heartinstead of trying to distract ourselves from these uncomfortable sensations, we can ask ourselves what they might have to tell us. Perhaps there is a difficult family dynamic at play or an issue at work that seems to evoke anxiety every time. We can tune into our anxiety to learn from it instead of ignoring it. Our anxiety can teach us about what we are afraid of. By learning what our anxiety has to teach us, by seeing it as a source of information, we no longer have to live by it. We can observe patterns in our thoughts and behaviors, and in doing so, we can gain greter control over our decisions instead of being ruled by feelings we havent made sense of. In this way, anxiety can become a teacher and a force for good. 4. We should all strive to widen our windows of tolerance. We all have different responses to intense emotions and different levels of tolerance for distress. Over the course of our lives, these responses are etched into us, seemingly a facet of who we are. For some people, a period of, for example, deep anger or exceptional stress seems to take over every thought and every action until it is resolved, whereas for others, these feelings can exist alongside other parts of life. Daniel Siegel, a psychiatrist who is also an expert on mindfulness, developed the term window of tolerance. He explains: Each of us has a window of tolerance in which various intensities of emotional arousal can be processed without disrupting the functioning of the system (Siegel, 2020) That is, the wider our window of tolerance, the more we can experience intense emotions without feeling utterly consumed by them. When we learn to tolerate distress more effectively, we also become less susceptible to anxiety. The principle of the window of tolerance is often used in the context of research on and treatment for trauma, but it can also be applied to a range of other emotional experiences, including anxiety. Research has found that higher levels of distress tolerance are associated with lower levels of anxiety, and conversely, higher levels of anxiety are associated with lower levels of distress tolerance (Keough et al., 2010; Laposa et al., 2015). So, when we learn to tolerate distress more effectively, we also become less susceptible to anxiety. Widening ones window of tolerance isnt a matter of feigning positivity or sweeping feelings under the rug. Instead, it requires acknowledging your emotional state, anxious or otherwise, and learning, over time, to tolerate the accompanying thoughts and sensations, even when they are uncomfortable. Thankfully, our window of tolerance isnt fixed; we arent simply born with a wide window of tolerance or not. We can increase or widen our tolerance with practices including mindfulness and other forms of distress tolerance that can be learned in psychotherapy and elsewhere. We can learn, over time, to better tolerate intense, often uncomfortable feelings (like anxiety) without being so thrown off. A stressor that may, in the past, have consumed your day might become a challenging but manageable part of it in the future. In this way, a wider window of tolerance can make our lives newly open to possibility. 5. Curiosity is a way through anxiety. Anxiety narrows our minds. It creates tunnel vision, and it limits what we see. We know that anxiety is, in many ways, a problem of attention. So, when our attention feels overly fixed or rigid, or when we feel stuck in worry or doubt, we can tap into our curiosity as a way to move forward. I find that curiosity, whether about our own experiences or the experiences of others, allows for gentle questioning rather than interrogation. Instead of berating ourselves with questions about, say, why we are anxious or ruminating about the same issue for hours, we can generate curiosity about how we feel and what is driving our feelings. We can wonder about our experience from an open perspective. Anxiety narrows our minds. Curiosity can open doors to new depths of understanding. We can see the power of curiosity in our relationshipfor instance, how curiosity about other peoples perspectives can deepen our relationships. This holds true in the ways that we relate to ourselves, too. We can see the importance of curiosity at play in a concept introduced by neuroscientist Lisa Feldman Barrett called emotional granularity. Emotional granularity refers to the degree of specificity with which we describe our feelings (Feldman Barrett, 2017). Even for the most of introspective people, it can be difficult to pin down our emotions with precision. We might say that we feel anxious, a nebulous term that reflects a wide range of experiences, and leave it at that, even in the privacy of our own thoughts. In these moments, we seem to hide in our words. We allow our emotional vocabulary to remain broad and general, as if in doing so, we wont feel our pain so acutely. But in fact, its quite the opposite. When we are curious, we can find relief in clarity. Imagine if, rather than telling yourself that what you feel is simply anxious, you homed in on something closer to its essencethat you feel stuck in a cycle of rumination, irritable, and hypervigilant. Through curiosity, there is potential for profound understanding. When we are curious, we become open to new explanations and understandings, whether about our own internal life or the world around us. In this way, curiosity makes the world bigger rather than narrowing it down. This article originally appeared in Next Big Idea Club magazine and is reprinted with permission.
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MrBeast has again defended his philanthropyascontent, clapping back at critics who say he is only in it for the views. On April 13, in a post on X, Jimmy Donaldsonbetter known as MrBeastrebutted accusations of virtuesignalling for profit, pointing out that his two worstperforming videos this year are the charitable ones. He shared a screenshot of his Top Recent Videos and noted that, of the 10 most recent uploads, I Helped 2,000 People Walk Again and Watch This Video To Feed 1 Person In Need had the lowest view counts in their first 22 hours online (24.3 million views and 21.3 million, respectively). By contrast, the top performersBeat Ronaldo, Win $1,000,000 (49 million views) and I Spent 100 Hours Inside The Pyramids (47.5 million views)were overtly entertainmentfocused. He wrote on X: Just thought Id share this because some people think I just do it for views but I would get way more views if I didnt help thousands of people walk and give away a million meals. People would also hate me less lol. Despite the backlash, he added that he will keep producing charitable content because Im the most subscribed YouTube channel in the world and I believe using my platform to inspire people to do good is important, andsimplybecause he enjoys it. With 385 million subscribers at the time of writing, MrBeasts empire is built on this quasiphilanthropic model. Through his Beast Philanthropy channel, he has, in just the past six months, rescued enslaved children in Africa, donated $1 million worth of brandnew teeth, and funded a gym for adaptive athletes. Praise for these efforts is often matched by criticism. Many question the 26yearold creators motives for filming and uploading each act of generosity to millions. Then why do you post, if you don’t care about views? one X user asked. The #1 guy on YouTube saying he doesnt do YouTube for the views lol, another added. Given the volume of negativity online, some observers argue it is shortsighted to concentrate on criticizing someone who uses his influence and wealth to help others. Still, his model of giving is not without flaws. Australian Broadcasting Corporation journalist Matthew Wade recently described such videos as inspiration porn, a term coined by the late Stella Young: The term refers to instances where persons with disabilities are reduced to caricatures, paraded either for their resilience in overcoming their differences or as passive subjects waiting for cashedup abled folk to cure them and save the day, Wade wrote. Whether MrBeast is a benevolent millionaire redistributing wealth or a selfserving virtue signaller exploiting suffering for profit depends on whom you askbut the debate shows no sign of slowing down.
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