Strengthening the Primary Care Workforce

Since 2001, The Duke Endowment has invested in the health professions workforce in North Carolina and South Carolina, primarily through a focus on the nursing profession. With the Patient Protection and Affordable Care Act, evidence suggests that strengthening the primary care workforce will be necessary as new approaches to health care delivery are implemented. To improve access to care and health outcomes, the Endowment has broadened the scope of its work to include all primary care practitioners.


More than half of the nurses working today intend to retire by 2020. In 2004, more than 80 percent of RNs and physicians perceived nursing shortages where they worked. Analysts expect all 50 states to experience a nursing shortage to some degree by 2015.

It's no surprise that experts say the U.S. needs 30 percent more annual nurse graduates to meet the demand. The impact on patient health is profound. When nurses have more time to devote to patients, patients are less likely to contract pneumonia and infections, experience internal bleeding and shock, and die from preventable causes. Patient safety depends on an adequate nursing workforce.

Find national statistics and trends in this American Association of Colleges of Nursing fact sheet (pdf).


To understand the circumstances leading to the shortage, The Duke Endowment granted support to the North Carolina Institute of Medicine to convene a Task Force on the North Carolina Nursing Workforce.

Identify Underlying Causes of the Shortage

The Task Force released its first report in 2004 with recommendations to improve:

  • Nursing education: by enhancing faculty recruitment and retention; increasing quality and accessibility of nursing programs; and effecting successful transitions from school to work
  • Work environments: by helping hospitals and medical centers attract and retain more nurses

Address Contributing Factors

Following the Task Force's findings, The Duke Endowment awarded $18 million in grants to organizations in both North and South Carolina. Leveraging the Endowment's longstanding relationships with hospitals, grants targeted three key objectives: expanding nursing education, improving work environments, and investing in related organizations and research.

Participating Sites

View the list of sites that participated in the Nursing Workforce Initiative.


Area of Work

  • Access to health care

Program Area

  • Health Care

Grantmaking Status

The Endowment is continuing to work through current grantees and is not accepting new applications.

Areas of Work

  • Prevention and early intervention for at-risk children

    To equip children and families with skills to ensure that children reach developmental milestones to lead successful lives.

  • Out-of-home care for youth

    To drive child welfare systems toward greater accountability for child well-being.

  • Quality and safety of health care

    Improving the quality and safety of health care delivery

  • Access to health care

    Improving health by increasing access to comprehensive care

  • Prevention

    Expanding programs to promote health and prevent disease

  • Academic excellence

    Enhancing academic excellence through program and campus development

  • Educational access and success

    Increasing educational access and supporting a learning environment that promotes achievement

  • Campus and community engagement

    Promoting a culture of service, collaboration and engagement among schools and communities

  • Rural church development

    Building the infrastructure and capacity of United Methodist churches to enhance ministry and mission

  • Clergy leadership

    Strengthening United Methodist churches by improving the quality and effectiveness of church leadership

  • Congregational outreach

    Engaging United Methodist congregations in programs that serve their communities