PRESIDENT’S MESSAGE

Delaware is charting a new course in health care—one rooted in prevention, equity, workforce empowerment and personal safety for healthcare workers. The Delaware Nurses Association (DNA) and the state are making tangible progress. But this momentum cannot mask two urgent realities: a growing shortage of nurses, nurse practitioners (NPs), and certified nurse midwives (CNMs), particularly in rural areas, and an epidemic of workplace violence in all clinical settings.

For all its innovation, Delaware faces the same hard truths as much of the nation: rural communities remain underserved, frontline health workers remain under protected, and nurses—the backbone of the health system—are stretched thin. To build a truly Healthy Delaware, we must double down on increasing the number of nurses in the state, and on workplace safety.

The Rural Divide: A Persistent Threat to Health Equity

While Delaware is a small state, its health care access is anything but evenly distributed. Kent and Sussex Counties, which make up roughly 45% of the population (World Population Review, 2025), have consistently faced nursing shortages and lack of primary and specialty care.

The Health Resources and Services Administration (HRSA) has designated all three counties as Health Professional Shortage Areas (HPSAs) for primary care and mental health; Sussex County is the most underserved. (HRSA, 2025)

• While Wilmington and New Castle County house most of the state’s major health systems and training institutions, southern Delaware struggles to attract and retain qualified nurses, NPs and CNMs.
• Many rural clinics and Federally Qualified Health Centers (FQHCs) face high turnover rates, especially among providers who may be drawn to urban areas with higher pay, better resources, or more professional support (RHIHub, 2025).

This is not just a workforce issue. With higher rates of chronic disease, older populations, and transportation barriers, rural residents in Delaware face poorer health outcomes and less access to care. In 2025, the DNA launched the Delaware Nurses Workforce Institute, Inc., establishing a workforce development hub which will collect, analyze, research and report on nursing workforce data. (Antonik, 2025). The Delaware Nursing Workforce Institute received $200,000 in state funds to build out the reporting system, with the hope of securing additional funding.

Why Rural Nurse Practitioners & Nurse Midwives Matter

Nurse Practitioners and CNMs are ideally positioned to fill gaps in rural health care. They are trained to diagnose, treat, prescribe, and manage both acute and chronic conditions, often serving as a patient’s sole primary care provider in underserved areas. Research consistently shows that NPs and CNMs provide high-quality, cost-effective care comparable to that of physicians, with excellent patient satisfaction. Supported by Licensed Practical Nurses and Registered Nurses, this represents a full healthcare system to address healthcare concerns in rural areas.

In rural Delaware, NP and CNM shortages are growing. We need to address the barriers, including:

• Limited clinical training sites in rural settings
• Lower salaries compared to urban hospitals
• Fewer opportunities for mentorship, peer networking, and continuing education
• Limited broadband access and infrastructure to support telehealth
• Without strong rural pipelines, residents in places like Seaford, Laurel, Milford, and other downstate communities are at risk of falling further behind. The DNA has begun collecting data and laying the groundwork for solutions. More aggressive steps are still needed.

1. Expanding Rural Clinical Training Opportunities
   Wilmington University’s and the University of Delaware’s advanced practice nursing tracks have both emphasized rural and community-based clinical experiences. New partnerships with ChristianaCare, Beebe Healthcare, and Bayhealth are helping place students in rural hospitals and clinics—where hands-on exposure often translates into long-term retention.
2. Loan Forgiveness and Scholarship Programs
   More funding and wider promotion of loan forgiveness and scholarship programs is needed to incentivize increases in nursing students and staff. Federal funding for nursing education, as well as support to increase nursing faculty to meet the demands for all levels of nursing, are in danger. Nurses need to continue to advocate for both state and federally grants, scholarships and loan forgiveness programs, which allow nurses to advance their education without the burden of excessive loan debt.
3. Telehealth as a Rural Bridge
   One bright spot is the state’s increased investment in telehealth infrastructure, especially following pandemic-era expansions. For NPs and CNMs willing to practice across county lines or remotely support patients via digital platforms, this offers a partial solution—although broadband and tech access in rural homes remains a challenge.

Workplace Violence: A Hidden Epidemic in All Settings

As Delaware works to send more nurses into the workforce, we must also address a problem that threatens to undermine all workforce expansion efforts – violence against nurses. From urban ERs to small-town urgent care centers to suburban primary care practices to long-term care, workplace violence is on the rise. Nurses report being punched, threatened, bitten, or verbally abused by patients, family members, or even colleagues. The ability to quickly access law enforcement or security personnel make this threat even more dangerous for healthcare workers.

What’s Being Done:

• Hospitals and health systems in Delaware have implemented workplace violence prevention plans. These include panic buttons, staff training, post-incident counseling, and secure facility design. Yet, the violence continues, and the DNA needs to work with healthcare centers of all sizes to create innovative methods of preventing violence.
• Legislation has made assaults on health care workers a felony, while proposed new legislation would create mandatory reporting systems across the state.
• More employers are investing in trauma-informed debriefing, wellness programs, and confidential mental health services for nurses impacted by violence on the job.

Many nurses still feel unsupported or afraid to report incidents. If Delaware truly wants to build a stable nursing workforce, it must prioritize safety as a basic professional right—not just a policy afterthought.

What Comes Next: A Statewide Commitment

Delaware’s progress is promising, but patchwork solutions won’t solve systemic problems. The DNA has committed to finding coordinated approaches, adequate funding, and sustainable action on the issues of healthcare accessibility, increasing and strengthening the nursing workforce, and providing safe, secure workplaces throughout the state.

Recommendations:

1. Fully Fund Workplace Violence Prevention Mandates
   Equip all health care employers, especially small and rural ones, with the training and resources needed to protect staff. Make it a law, not a suggestion.
2. Collect Data on What Works
   More data is needed to see what various healthcare providers are doing to maintain safe work environments, outcomes and best practice recommendations.
3. Make Emergency Responses to Healthcare Violence more Immediate
   Local law enforcement agencies must be aware and alert for the possibility of violence against healthcare workers in any healthcare agency.
4. Encourage reporting of all types of Healthcare Environment Violence
   Nurses must be encouraged to report violence of any type immediately. Reporting of incidents must be tracked and shared. Reporting adds to the data, which enables representation of prevalence, types and origins of healthcare workplace violence.

Conclusion: A Healthy Delaware Requires Courage, Commitment, and Care

Licensed Practical Nurses, Registered Nurses, Nurse Practitioners, and Certified Nurse Midwives are willing to serve in the hardest-to-reach places, under the most difficult conditions to serve our patients and populations. But they should not have to do so alone, under threat, or without the tools they need. The time has come for Delaware to protect, invest in, and uplift its nurses—not just with words, but with action. That’s how we build a Healthy Delaware—for everyone, everywhere.

References

Antonik, J. 2025. Delaware Nurses Association announces initiatives to revitalize workforce. Delaware Business Times, May 7, 2025. Retrieved at https://delawarebusinesstimes.com/news/delaware-nurses-association-workforce/

World Population Review, 2025. Retrieved September 30, 2025 at https://worldpopulationreview.com/us-counties/delaware

Health Resources and Services Administration, 2025. Retrieved September 30, 2025 at https://data.hrsa.gov/topics/health-workforce/shortage-areas/hpsa-find Rural Information Hub, 2025. Retrieved September 30, 2025 at https://www.ruralhealthinfo.org/topics/federally-qualified-health-centers