By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
Nurse wellbeing is complex. I like the Gallup model for well-being because it moves beyond physical and psychological well-being to also consider social, community, and financial well-being. Few have a model this comprehensive, but they should.
For the past few years, I have been talking to nurse leaders about the social determinants of work health. Justin Montgomery, a Dartmouth Health nursing director, first raised this concept several years ago during a webinar. Justin noted the following in the chat, “Much like we know that improving health is not happening solely by interactions with healthcare, rather it’s better handled by addressing Social Determinants of Health; our ability to retain staff means addressing their work environment AND the Social Determinants of their Work Health. That’s challenging and different.”
Nurses bring their authentic selves to work, including the problems and challenges in their nonwork lives. Social determinants of work health are the conditions nurses are born into, grow up in, attend school in, live in, and work in that shape their work health, such as:
- Student loan debt
- The availability and cost of childcare
- The demands of caretaking with elderly parents and family members
- Household debt
- Cost of living in the geographic area
I was reminded of the importance of this comprehensive way to view well-being as I reviewed the recently released 2026 State of Nursing Survey from Nurse.org. It delivers a sobering message: while nurses remain deeply committed to their profession, their financial stability is fracturing. Despite modest pay increases for 55% of the workforce, the “recovery” seen in previous years has stalled, replaced by a growing sense of financial precariousness. Consider the following findings:
- Only 20% of nurses describe themselves as “financially comfortable”.
- More than 25% of nurses report that their income barely covers—or fails to cover—essential monthly expenses.
- Alarmingly, 37% of nurses could not cover an unexpected $1,000 expense without resorting to debt.
- 37% work extra to pay bills.
- 15% have taken 2nd jobs.
- While 55% of nurses saw raises last year, many reported these did not keep pace with the cost of living.
- The top reason nurses remain at the bedside is financial necessity (41%), ranking far higher than management support (8%) or even personal satisfaction (24%).
It is challenging to have good mental health if you worry about whether you can pay your bills. The “cost of distraction” is a major factor in the business case for the programs described below. Many young Generation Z nurses tell me that they leave their organization for more money, even when they would rather not, because they have extensive debt. My experience is that few healthcare organizations have incorporated financial well-being strategies into their well-being programs, but, given this data, they should. Below are some ideas based on what some employers are currently doing and have demonstrated good outcomes:
- Free Appointments with a Fiduciary Financial Advisor Paid by the Organization: A coaching session with a financial advisor upon hire to develop a budget and make benefit decisions has proven very helpful for many employees who have never received any financial education.
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Behavioral Automation: Integrating automated savings features and digital wage solutions directly into payroll, with an opt-in, not opt-out, default, has been shown to reduce the “willpower” hurdle to creating emergency savings accounts, 401 (k) contributions, and establishing HSA accounts.
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Life-Stage Tailoring of Programs: Providing specific guidance for different career stages, such as student loan repayment for newer graduates and retirement “catch-up” strategies for late-career professionals. Some organizations now connect employees with expert coaching on student loan repayment options.
- Financial Literacy Education: Some businesses offer courses like Dave Ramsey’s Financial Peace to their employees. Courses like this emphasize that most people can’t earn their way out of debt; rather, it requires a behavioral change in how they manage money. A cohort of your co-workers in a class can be a powerful support group in one’s efforts. Dr. Jim Dahle’s White Coat Investor podcast, blog, and instructional materials have helped tens of thousands of physicians and nurses over the last ten years improve their financial situation.
Learning to better manage money is both empowering and improves one’s well-being. It has also been shown to improve retention and reduce absenteeism, often caused by the stress and anguish of a precarious financial situation. The sobering data in this report should be a call to action to health systems to help their nurses.
To effectively lead through these challenges and others, nurse leaders need new tools and strategies. Let me help you as I have helped hundreds of organizations over the past five years. Book a workshop or keynote for your team by contacting me at roseosherman@outlook.com
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