By Raja Ramaswamy

I went up to the ICU to check on a patient and I saw Sarah, a seasoned nurse I’ve worked with for years, juggling six critical patients. Her eyes were tired, her steps hurried, but she still managed a reassuring smile for a frightened family. Between checking IV lines and updating charts, she whispered to me, “I’m drowning, but I can’t let anyone see it.” That moment hit me hard. Sarah’s dedication keeps our hospital running, but the strain of understaffing is breaking her and countless nurses like her across Indiana.

A mother waits hours in an ER for her child’s care. A patient faces delays for surgery. Nurses, the backbone of our health care system, are stretched to the limit. They manage unsafe patient loads, earn modest wages, and live with the fear that one missed sign or delayed response could cost a life. Many are afraid to speak up, silenced by the risk of retaliation. This is a test of Indiana’s political, institutional, and moral priorities. Gov. Mike Braun and hospital leaders need to restore trust among our nurses.

The numbers paint a grim picture. Indiana hospitals face a 10 to 15% nurse vacancy rate and must train 1,300 additional nurses annually through 2031 just to keep up. Meanwhile, burnout is accelerating. A 2024 survey found that 15% of Indiana nurses plan to leave the profession, citing pay and workload as top concerns. During Nurses Week 2025, frontline caregivers shared stories of chronic understaffing, mental fatigue, and a health care culture that treats exhaustion as routine. The pandemic did not cause this. It revealed how fragile the system already was.

Leadership has failed to meet the moment. Braun’s 2025 budget allocated nothing to address this issue. Instead, it prioritized tax cuts and tighter Medicaid eligibility. It’s unclear if policymakers even recognize the crisis for what it is. If they do, they are certainly not treating it like one. His signing of House Bill 1004, which requires nonprofit hospitals to reduce pricing by 2029 or risk losing tax-exempt status, was a modest step on pricing but does nothing for workforce stability. No mandate for better pay. No investment in training. No plan for retention.

At the same time, the legislature has capped nursing program capacity, bottlenecking the pipeline. Hospital boards continue approving massive executive salaries. IU Health’s CEO earned millions while frontline nurses juggle impossible workloads with stagnant pay. IU Health holds $8.5 billion in assets and is building a $4.3 billion campus, yet its staff face critical shortages. A 2023 study directly linked inadequate nurse staffing to higher mortality rates, longer hospital stays, and millions in preventable costs. This amounts to institutional neglect.

We in Indiana are already paying the price in patient outcomes and a deteriorating standard of care. Strategic investment is essential to safeguard care and retain talent. People expect their hospital to be staffed and safe. Indiana’s leaders must listen to the people who keep the system running and act accordingly.

Here is how Indiana can begin to change things:

Medicaid funding to safe, patient-centered staffing and fair compensation.

Hospitals receiving public funds should commit to care models grounded in safety, not cost cutting. That means fair pay for nurses with regular cost-of-living increases and staffing models that reflect patient needs. Keeping nurses in the profession protects both patients and the system.

Cap executive bonuses at nonprofit hospitals that fail to support their workforce.

Systems like IU Health, Community Health, and Ascension must lead by aligning leadership rewards with staff and patient outcomes not just financial performance.

Invest in nursing education and retention.

Raise faculty pay. Expand loan forgiveness. Fully fund a nurse residency program to grow the workforce and retain new graduates in high-need areas.

Protect nurses who speak out.

Enact strong whistleblower protections so nurses can report unsafe conditions without risking their careers.

These actions are necessary, evidence-based, and fiscally responsible. Better staffing means fewer errors and healthier communities. When nurses are supported, patients thrive and the entire system becomes more stable.

We cannot afford to keep building hospitals while ignoring the people who make health care possible. Braun and hospital leaders must protect the workforce now. Because without nurses there is no health care. And without action there soon won’t be enough left to care.