How OER Redesigned Courses Are Helping Ease North Carolina’s Nursing Shortage

Like most states in the U.S., North Carolina is challenged with a nursing shortage. The National Center for Health Workforce Analysis reports that North Carolina has 16 percent fewer registered nurses than the demand requires in 2026, and it projects that shortage will grow to nearly 20 percent by 2036.

The University of North Carolina (UNC) System hopes to help address that shortage by improving access and affordability across its 12 public nursing education programs through a new open education resource (OER) initiative. In early 2026, the system began offering two redesigned nursing courses that incorporate OER textbooks.

Because OER are licensed with less-restricted use, are free to students, and often can be adapted to local contexts, they encourage broader implementation and adaptation than traditional course content. Research on OER in nursing has shown they can improve student engagement, satisfaction, and success rates.

In North Carolina, nursing programs are adopting OER textbooks as digital content for two courses the UNC System has redesigned specifically for their use. The courses cover the fundamentals of nursing and population health. In 2026, 7 of the 12 nursing programs in the UNC System are using the no-cost textbooks as part of updated courses, and the system projects that 2,800 students will use them each year.

Lindsay Draper has helped lead the redevelopment of courses to accommodate the use of the OER textbooks. She is an Associate Professor of Nursing; Director of Faculty Credentialing, Compliance, and Special Initiatives; and Helen Brooks Faculty Scholar at the University of North Carolina at Greensboro.

“We can use this as a recruitment tool to get students into our nursing programs in the UNC System,” says Draper. “We can say, ‘By the way, you don’t have to buy textbooks, and here are some really good resources that are accessible.’”

Providing high-quality content

The UNC System didn’t have to look far for help in making nursing education more accessible. Two authors of nursing textbooks developed in 2023 as part of the ONE (OER Nursing Essentials) Project and distributed through OpenStax are faculty at North Carolina universities. Draper is one, and the other is Michael Jones, the Associate Dean for Engagement and Professional Development, Executive Director for Advancement, and Clinical Associate Professor at East Carolina University College of Nursing.

Together, they led teams of faculty and staff from UNC System institutions that spent most of 2025 redesigning the two nursing courses their OER textbooks were meant to support. Their goal: developing high-quality content—from PowerPoint presentations to assignment details—that allows faculty to easily align instruction with lessons in the OER textbooks that Draper and Jones had helped to develop.

“We said, ‘You know? It would be ideal to have everything packaged with a nice little bow, so that faculty could just open the package and it would be ready to go,’” Draper says. “This takes away the burden of course preparation for a new textbook.”

The OER textbooks and the updated course materials are accessible through an institution’s LMS, but they are adaptable for use as part of courses offered in any format.

The redesigned courses can accommodate terms of different lengths as well as remote classes and in-person learning such as clinical work. They also include elements of artificial intelligence (AI)-assisted support to help students clarify concepts.

Generating positive reviews

Early reviews for the OER textbooks and redesigned courses from faculty and students in North Carolina have been positive. Now Jones says it’s critical for those who revised the courses to gather more information from users as they complete the classes.

“In everything we do in healthcare, as nurses and educators, our decisions should be based on data,” he says. “We need to understand, number one, how well it was received, but also, do the faculty members see a difference in how students retain information?”

As they make adjustments to the courses, UNC System faculty and staff also could make them more broadly available. The OpenStax nursing OER textbooks already are in use around the world. Draper says she’s investigating opportunities to make the UNC System courses that feature the textbooks available to faculty outside North Carolina.

But for now, the goal of the UNC System nursing OER effort is to begin opening doors to the educational opportunities that could help close healthcare gaps in that state.

“It’s about understanding that nursing has a direct impact on patient outcomes when that patient comes to the hospital or comes to the clinic,” Jones says, “so we’re trying to seek innovative ways to increase interest for our nurses.”