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Understanding Nursing Shortages in the U.S. for 2023

Understanding Nursing Shortages in the U.S. for 2023

Nurses are essential to healthcare, yet nursing shortages have persisted for decades. 

The COVID-19 pandemic has exacerbated these shortages to crisis levels, with demand for nurses outpacing supply in nearly every region. However, healthcare experts had already anticipated a significant nursing shortage before the pandemic, worsening the precarious situation. 

While certain states will experience a more severe impact from nursing shortages in the coming years, a surprising number of states may have a surplus of nurses.

What’s Causing Nursing Shortages?

The perfect storm for a nursing shortage isn’t brewing – it’s already here, and the shortages in nursing staff will only worsen without course corrections. Five significant issues impacting ongoing nursing shortages include:

Turnover: In February 2023, the National Library of Medicine reported that the average turnover rate nationwide was 8.8% to 37%, depending on the nursing specialty and geographic location. While some turnover can be attributed to new graduate nurses deciding the profession isn’t what they thought it would be once they began working, a significant portion could be due to burnout.

Burnout: Staffing shortages often lead to higher patient-to-nurse ratios that put more stress on the staff and result in poorer patient outcomes. Stress leads to burnout, worsened by the lengthy pandemic and compounded by insufficient staffing to create a vicious cycle that leads to further burnout and overall dissatisfaction with the job.

Retirement: Another issue is the substantial number of nurses nearing retirement age. Per a 2020 National Nursing Workforce Study conducted by the National Council of State Boards of Nursing, the average age for a registered nurse (RN) was 52 years old, potentially signaling a large wave of retirements over the next 15 years.

Aging population: As the nation’s aging adult population grows, the demand for complex care grows, as does the need for more nurses to provide this care. The U.S. Census Bureau predicts that by 2034, older adults will outnumber children, a first in U.S. history. It reports that 77 million people will be 65 or older compared to 76.5 million below 18.

Faculty shortage: According to the American Association of Colleges of Nursing, nursing schools turned away nearly 92,000 qualified applications of prospective students for baccalaureate or graduate nursing programs in 2021. This number was the highest in decades due to capacity issues, including insufficient clinical sites, classroom space, faculty, and clinical preceptors. Unfortunately, the salaries for faculty roles aren’t very competitive, making them less attractive to qualified applicants. The shortage in nursing faculty directly affects the number of nurses to fill future demands.Projected Demand for Registered Nurses

To understand the supply issue, we must first look at demand. According to employment information compiled by O*NET Online, an agency within the U.S. Department of Labor, the projected demand for RNs continues to rise in every state, some more than others.

Click here to view a table that provides a comprehensive view of the long-term projections for increased demand in all 50 states and the District of Columbia from 2020 through 2030. The table is sorted from the largest to the smallest change in demand and presents the base number of RNs in 2020, along with the estimated amount needed by 2030.

Projected Nursing Shortages

The American Association of Colleges of Nursing states that nursing is the largest healthcare profession in the nation, with nearly 4.2 million registered nurses nationwide. Furthermore, the U.S. Bureau of Labor Statistics projects that the employment of RNs will grow another 6% from 2021 to 2031, with an average of 203,200 RN job openings every year during the decade.

The Health Resources & Services Administration’s Bureau of Health Workforce projects a national shortage of 78,610 full-time equivalent RNs in 2025 and 63,720 in 2030. However, the data used to create these estimates is from 2020. Therefore, these numbers could be skewed without knowing the full impact of the COVID-19 pandemic on the nursing profession.

While the exact shortage won’t be available until the Bureau of Health Workforce can collect more data, a national shortage of some degree is almost guaranteed. However, not every state may come up short.

An in-depth U.S. Healthcare Labor Market Report created by Mercer in 2021 as a follow-up to its 2017 study explores which states will experience a shortage of RNs and which will have a surplus. If current trends hold, the report projects severe healthcare staff shortages in some states as soon as 2026. However, others will keep up with demand and surpass it.

The Mercer report provides details for the 48 contiguous states. Of those, 21 will fall short of filling the demand for qualified RNs by at least 1,000 nurses by 2026. So they’re already falling behind. The table below shows the five states with the most significant nursing shortages, followed by the remaining 16 states with estimated shortages rounded to the nearest 1,000.

The Mercer report projects that the District of Columbia will have a shortage of about 2,000 nurses during this period.

States Projected to Have a Nursing Surplus

Surprisingly, current trends indicate that 16 states will incur a surplus of nurses by 2026, particularly those in the South. As supply outpaces demand, it’s projected that the first five states in the following table will have the most significant pool of surplus nurses, followed by 11 states with a surplus estimated to be at least 1,000 nurses over demand, rounded to the nearest 1,000.

The report expects the remaining 11 contiguous states to have a shortage or a surplus of less than 1,000 by 2026, so they appear on the list as unchanged. These states include Alabama, Idaho, Nevada, Minnesota, New Hampshire, New Mexico, New York, Rhode Island, Utah, Vermont, and Virginia.

Projections Not Set in Stone

Many factors can impact supply and demand, so a projected surplus can quickly become a shortage and vice versa. Also, different studies may result in differing outcomes based on the parameters used for each.

For example, an August 2022 survey in California conducted by the University of California, San Francisco, indicated supply and demand projections estimate a shortage of RNs, at least for the short term. However, the data suggested that this shortage will dimmish as RN education enrollments return to and surpass pre-pandemic levels.

The Nurse Workforce Projection Report conducted in 2021 by the Florida Hospital Association and the Safety Net Hospital Alliance of Florida also contradicts reports indicating that the state will have a surplus of nurses. Instead, this report projects a significant shortfall of 37,400 RNs and 21,700 licensed practical nurses by 2035 due to an uneven distribution of nurses across the state.

What’s Being Done About Nursing Shortages?

Some national, state, and local entities are attempting to do something about the nursing shortage to prevent it from worsening and eventually reverse the course.

On a national level, the National Council of State Legislatures (NCSL) issued a brief in June 2022 profiling various legislative approaches states could use to address the nursing shortage. These approaches included adapting nursing scope of practice laws and offering preceptors financial incentives.

State-level initiatives already underway address the shortage of RNs and the educators needed to train new nurses by examining various options to recruit and retain nurses. Besides changing the scope of practice laws and offering monetary incentives outlined by the NCSL, they’ve also explored loosening licensure requirements, such as adopting the Nurse Licensure Compact.

Most states also bolster education programs through student loan forgiveness or loan repayment. These programs help attract nurses to the state, and specific programs for nurse educators attract much-needed teaching faculty. For example, the Illinois Nurse Educator Loan Repayment Program repays up to $5,000 annually for up to four years to address the lack of qualified instructors to staff nursing education courses in the state.

Finally, on a local level, individual nursing schools seeking private support and forming strategic partnerships hope to help expand their student capacity. For example, the Minneapolis VA Health Care System committed $53 million to the University of Minnesota School of Nursing in a collaborative agreement to expand clinical placement sites and fund additional faculty.

How Nurse Demand and Shortages Impact You

Whether you’re a travel nurse or a staff nurse looking for a change of scenery, knowing which states expect to have a surplus of nurses versus those facing shortages can help narrow your options. States with nursing shortages will likely pursue recruitment strategies beneficial to nurses, such as offering higher salaries, better benefits, flexible scheduling, and other incentives to attract nurses to the area. On the flip side, states with a surplus of nurses may not offer the most competitive wages.

Some healthcare employment locations have historically paid more than others with or without a shortage. However, higher costs of living often offset these inflated salaries. When comparing your relocation or travel assignment options, make sure the salary is a livable wage.