Nursing Shortage In The United States

Table of Contents

Highlights

Nursing is the nation’s largest healthcare profession, with nearly 5.7 million registered nurses nationwide in 2025.
The average nurse turnover rate will cost a hospital anywhere from $4.4 million to $6.9 million each year.
The use of contracted labour tends to cost hospitals about 50% or more than a typical, permanent, and fully-benefit eligible nurse.
The continued shortages of full-time equivalent registered nurses on a national level, is projected to be upto 10% in 2027, dropping to 8% by 2032 and 6% by 2037.

Introduction

Nursing is both an art and a science and its main goal is to care for people, families and communities. Nurses work in many settings including hospitals, care homes and patients’ homes. Their work involves health promotion, prevention of illnesses and treatment of people who are sick, disabled or dying.

Nurses play an important role in the healthcare sector because they provide direct care to patients, monitor patients’ condition, administer medications and other life saving treatment and they also offer emotional support to both patients and their families.

Is There A Nursing Shortage?

Yes, there is a significant nursing shortage in the United States.
Nursing is the nation’s largest healthcare profession, with nearly 5.7 million registered nurses nationwide in 2025.
Hospital reported turnover of registered nurses increased from 18% to 27% from 2020 to 2021. Although the turnover reduced to 23% in 2022, it still remains high compared to pre-pandemic levels.
About 30% of nurses left the healthcare field at the beginning of the pandemic.
Between 2020 and 2021, the nursing workforce dipped by about 90, 000.
The turnover rates of registered nurses grew from 17% in 2017 to 26% in 2021. While the employment levels declined by 3% between 2020 and 2021- the largest decline in at least 20 years.

When Did the Nursing Shortage Begin?

The nursing shortage started in the mid-1930s. While the country was recovering from the great depression, hospitals started experiencing severe shortages of nurses.
The shortage continued into the World War II and the post-war era due to the dramatic increase in demand for nurses not only to help during the war but for subsequent healthcare needs of the returning soldiers.
In the 1970s and 1980s, the nursing shortage continued due to increased healthcare needs and an aging population.
The aging nursing workforce was a primary driver of the nursing shortage in the 1990s and early 2000s.
The nursing shortage persisted throughout the 2010s, driven by an aging population, retiring nurses, and a lack of nurse educators.
The COVID-19 pandemic exacerbated the nursing shortage, leading to increased workloads, stress levels, and higher rates of nurse burnout and attrition.

Why Is There A Nursing Shortage?

The nursing shortage in the US is caused by several factors including an aging populations which requires more healthcare, increased healthcare demands, the retirement of a significant portion of the nursing workforce coupled with job dissatisfaction and burnout among nurses.
The US population is aging with the number of Americans aged 65 and older projected to increase from 58 million in 2022 to 82 million by 2050. This has led to an increased demand for geriatric care, including care for individuals with chronic diseases and comorbidities.
Many nurses are retiring or approaching retirement age and this has contributed to the shortage. In 2022, about 23% of registered nurses working in outpatient, ambulatory, and clinical settings have retired or plan to retire over the next 5 years.
In addition, there are not currently enough graduating nurses to replace the nurses who are leaving. From 2016 to 2019, new registered nursing licenses grew by about 4% yearly, but in 2020 the growth rate was only about 1%.
More than 1 million registered nurses are expected to retire from the workforce by 2030.
The lack of nursing educators is another factor responsible for the nursing shortage. Nursing schools struggle to expand capacity due to a shortage of nurse educators. This limits the number of new nurses entering the workforce.
Despite an increase in entry-level baccalaureate nursing programs by 0.3% in 2023, there was a drop in both master’s and PhD and master’s nursing programs by 0.9% and 3.1% respectively.
In 2023, US nursing schools turned away 65,766 qualified applications from baccalaureate and graduate nursing programs due to lack of adequate faculty, clinical sites, classroom space, and clinical preceptors, as well as budget constraints.
In a 2023 survey, 45% of inpatient nurses (who make up about half of the total nursing population) reported they are likely to leave their role in the next six months. Their major reasons were not feeling valued by their organization and not having a manageable workload.
About 31% of nurses in a similar survey in 2023 indicated they were likely to leave their current role in direct patient care.This was higher than the reported 22% in a previous survey in 2021.
In a study in 2022, among nurses who are considering leaving the profession, their most influential motivation to stay included higher pay, followed by better support for work-life balance and more reasonable workload.
High levels of burnout and poor working conditions also contribute to nurses leaving the profession. 74% of nurses in a 2023 survey cited burnout as a primary cause of the nursing shortage, while 58% pointed to poor working conditions.
The COVID-19 pandemic has further worsened the nursing shortage, with increased workloads and stress levels leading to higher rates of nurse burnout.
In 2021, 66% of acute care nurses considered leaving nursing after their experiences during the pandemic.
There was an increase in the use of sick time by nurses during the pandemic and it rose more than 50% for full- and part-time staff working in intensive care units.

What is the Current Nursing Shortage?

According to a 2022 report, the US is expected to face a shortfall of 200,000 to 450,000 registered nurses for direct patient care by 2025.
Although a 1% increase in registered nurses supply has been observed, there has been a 3% increase in demand between 2022 and 2025, resulting in a deficit of about 295,800 nurses nationwide.
The nursing shortage varies significantly across states. For example, Utah has one of the lowest nurse-to-state population ratios, with only 6.75 nurses per 1,000 population. In contrast, states like Pennsylvania and Iowa have higher ratios, with 10.64 nurses per 1,000 population.

State Distribution of Employed Registered Nurses In The United States-2023

State	Number of Employed Registered Nurses	Percentage of National Estimate of Employed Nurses
Alabama	50,450	1.59
Alaska	6,590	0.21
Arizona	63,150	1.99
Arkansas	29,690	0.94
California	332,560	10.47
Colorado	53,480	1.68
Connecticut	36,430	1.15
Delaware	11,810	0.37
District of Columbia	10,810	0.34
Florida	207,910	6.55
Georgia	93,730	2.95
Guam	740	0.02
Hawaii	11,920	0.38
Idaho	14,060	0.44
Illinois	139,910	4.41
Indiana	68,850	2.17
Iowa	33,300	1.05
Kansas	31,120	0.98
Kentucky	48,710	1.53
Louisiana	36,840	1.16
Maine	14,770	0.47
Maryland	49,770	1.57
Massachusetts	87,320	2.75
Michigan	102,240	3.22
Minnesota	66,700	2.10
Mississippi	28,910	0.91
Missouri	73,190	2.30
Montana	9,740	0.31
Nebraska	22,870	0.72
Nevada	25,890	0.82
New Hampshire	14,380	0.45
New Jersey	82,950	2.61
New Mexico	18,030	0.57
New York	188,060	5.92
North Carolina	104,380	3.29
North Dakota	10,350	0.33
Ohio	133,300	4.20
Oklahoma	32,610	1.03
Oregon	38,770	1.22
Pennsylvania	144,100	4.54
Puerto Rico	22,860	0.72
Rhode Island	11,350	0.36
South Carolina	48,790	1.54
South Dakota	14,600	0.46
Tennessee	63,460	2.00
Texas	251,840	7.93
Utah	24,730	0.78
Vermont	7,260	0.23
Virgin Islands	380	0.01
Virginia	70,650	2.22
Washington	65,030	2.05
West Virginia	20,860	0.66
Wisconsin	61,870	1.95
Wyoming	5,350	0.17
National	3,175,390

Projected Nursing Shortage

The continued shortages of full-time equivalent registered nurses on a national level, is projected to be upto 10% in 2027, dropping to 8% by 2032 and 6% by 2037.
The projected nursing shortage by 2030 is 63,720 full-time equivalent registered nurses.
However, it is projected that by 2035 there will be an excess supply of approximately 16,180 full-time equivalent registered nurses, assuming historical patterns of attrition, graduation, and labor force participation remain the same.
No specific projections are available for 2040 and 2050 but the ongoing factors contributing to the nursing shortage, such as an aging population and retiring nurses, indicate that the issue may persist if not addressed.
Adequate supply of nurses varies across states, ranging from a projected shortage of 26% in Washington to a projected 48% oversupply in North Dakota in 2035.
The ten states with the largest projected shortage in 2035 are Washington (26%), Georgia (21%), California (18%), Oregon (16%), Michigan (15%), Idaho (15%), Louisiana (13%), North Carolina (13%), New Jersey (12%), and South Carolina (11%).
A small surplus (1%) of registered nurses in 2035 is projected for metro areas.
Whereas, in non metro areas a shortage of 9% is projected for 2030 and 2% by 2035.
Significant nursing shortages will be experienced in 37 states by 2030, with deficiencies in California and two other states higher than any other.

State-wide Projected Demand and Supply of Nurses by 2037

State	2037 Demand	2037 Supply	Difference Between Demand and Supply
Alabama	55,030	64,610	-9,580
Alaska	7,450	8,450	-1,000
Arizona	83,690	77,220	6,470
Arkansas	33,840	34,070	-230
California	367,720	302,720	65,000
Colorado	60,470	54,770	5,700
Connecticut	37,820	40,110	-2,290
Delaware	12,170	11,850	320
District of Columbia	6,210	9,130	-2,920
Florida	270,660	267,260	3,400
Georgia	112,000	93,010	18,990
Hawaii	12,430	16,270	-3,840
Idaho	20,650	17,060	3,590
Illinois	117,490	126,650	-9,160
Indiana	72,190	71,280	910
Iowa	34,040	32,890	1,150
Kansas	34,590	31,850	2,740
Kentucky	53,010	53,770	-760
Louisiana	52,320	46,380	5,940
Maine	18,090	15,570	2,520
Maryland	68,550	54,960	13,590
Massachusetts	72,270	80,190	-7,920
Michigan	111,410	90,120	21,290
Minnesota	58,890	68,980	-10,090
Mississippi	33,000	31,430	1,570
Missouri	69,870	64,520	5,350
Montana	12,480	13,420	-940
Nebraska	20,260	21,760	-1,500
Nevada	31,500	32,940	-1,440
New Hampshire	16,870	15,890	980
New Jersey	90,680	79,540	11,140
New Mexico	20,920	17,000	3,920
New York	191,570	189,880	1,690
North Carolina	129,930	101,080	28,850
North Dakota	8,090	11,670	-3,580
Ohio	123,300	145,620	-22,320
Oklahoma	44,510	36,390	8,120
Oregon	49,200	41,370	7,830
Pennsylvania	148,140	136,880	11,260
Rhode Island	11,770	13,680	-1,910
South Carolina	61,790	49,930	11,860
South Dakota	10,300	12,830	-2,530
Tennessee	81,740	77,950	3,790
Texas	310,700	271,570	39,130
Utah	34,600	42,720	-8,120
Vermont	6,500	8,100	-1,600
Virginia	92,900	84,310	8,590
Washington	87,730	68,790	18,940
West Virginia	19,530	21,000	-1,470
Wisconsin	58,850	68,250	-9,400
Wyoming	5,260	9,310	-4,050

Nursing Shortage Impact on Patient Care

The nursing shortage in the US affects both the quality and accessibility of healthcare services.
The reduction in the number of available nurses increases the patient-to-nurse ratio. This leads to less time for each patient and overworked nurses. This can result in delayed care, longer wait times, and reduced patient satisfaction.
Overworked nurses are more prone to making mistakes. Studies have shown that higher patient-to-nurse ratios are associated with an increased risk of adverse patient safety incidents, including medication errors and patient falls.
The nursing shortage contributes to high levels of burnout among nurses, leading to increased turnover rates. This creates a vicious cycle, as the departure of experienced nurses further worsens the shortage and impacts patient care.
Some healthcare facilities may be forced to curtail services or even close entire units due to the lack of nursing staff. This can limit access to care, particularly in underserved communities.
A 2021 study in Illinois revealed that a patient’s risk of dying within 30 days of admission increased by 16% for every additional patient added to a nurse’s average workload.
A 2013 study observed that higher patient loads were associated with higher hospital readmission rates. The study found that when more than four patients were assigned to a registered nurse in pediatric hospitals, the likelihood of hospital readmissions increased significantly.
A study in Pennsylvania hospitals in 2012 discovered a significant association between high patient-to-nurse ratios and nurse burnout with increased urinary tract and surgical site infections. The researchers found that increasing a nurse’s patient load by just one patient was associated with higher rates of infection.
In a 2011 study that analysed selected hospital records, the data showed that the mortality risk for patients was about 6% higher on units that were understaffed as compared with fully staffed units.

Financial Impact of Nursing Shortage

An average increase of 8% in the daily clinical labor costs is caused by the nursing shortage. This translates to an additional $24 billion in nationwide annual spending on clinical labor and a $17 million increase in the annual labor budget of an average 500-bed health care facility.
These estimated increases in labour costs are as a result of an increase in overtime hours by 52% as well as 130% increase in the use of agency and temporary labor.
The use of contracted labour tends to cost hospitals about 50% or more than a typical, permanent, and fully-benefit eligible nurse.
To replace experienced staff nurses, healthcare systems pay an additional price. The average turnover costs result in hospitals losing $4.4 million to $6.9 million each year.
In a 2019 report, each percentage increase in staff nurse turnover was estimated to cost the average hospital an additional $328,400.43.
The report also found that it took 85 days to fill a staff nursing position, costing about $82,000.

How to Fix The Nursing Shortage

Addressing the nursing shortage requires a multifaceted approach, including increasing the number of nurse educators, improving working conditions, and implementing policies to retain and attract nurses to the profession.
From various studies and surveys, nurses’ top concerns are pay, workload, benefits, and flexibility. Addressing these issues will increase the retention of nurses.
Targeted investment in nursing education will help to increase the number of educators and the capacity of nursing schools to enroll and train more nurses. It will also provide incentives for people to study nursing.
Providing supportive and mentally healthy work environments will help to address issues like burnout and stress among the nursing workforce and promote retention.

Conclusion

The nursing shortage in the US is an important issue that not only affects patient care but also impacts healthcare costs, and the overall efficiency of healthcare systems. It stems from a combination of factors that include an aging population, a wave of retiring nurses, burnout, and insufficient nurse educators, exacerbated by the COVID-19 pandemic. Addressing this shortage requires a concerted effort that includes expanding nursing education programs, improving working conditions, offering financial incentives, and fostering a supportive work environment.