In 2022, McKinsey & Company, a global consulting firm, anticipated a looming deficit of 200,000 to 450,000 registered nurses (RNs) in the United States by 2025 for direct patient care. Subsequently, between 2022 and 2025, the Department of Health and Human Services (HHS) and the Health Resources and Services Administration (HRSA) observed a modest 1% increase in RN supply, whereas demand surged by 3%. This resulted in a nationwide shortfall of approximately 295,800 nurses, aligning closely with McKinsey’s forecast. The persistent shortage of nurses within U.S. healthcare systems is not merely a temporary crisis but a sustained and critical challenge, placing undue strain on hospitals and healthcare facilities nationwide.
As the demand for healthcare services escalates due to an aging population and ongoing healthcare reforms, the gap between the supply and demand of RNs widens, albeit unequally across different regions. Vivian Health conducted a thorough analysis across all 50 states and the District of Columbia to identify areas where nursing shortages are likely to persist, offering a quantitative overview of the national distribution of nurses.
National Outlook on Nursing Shortages
A study released in February 2024 by the JAMA Health Forum indicated that the nursing workforce rebounded in 2022 and 2023 following a significant decline during the COVID-19 pandemic, projecting a workforce of 4.56 million nurses by 2025, as anticipated prior to the pandemic.
However, conflicting viewpoints exist regarding the trajectory of nursing shortages. While recent projections suggest a gradual reduction in nursing shortages from 2027 to 2037, the gap between supply and demand is expected to persist, albeit diminishing.
HHS and HRSA projections forecast ongoing shortages of full-time equivalent (FTE) RNs on a national scale, with an anticipated 10% deficit in 2027, decreasing to 8% by 2032 and 6% by 2037. Although the shortage is projected to diminish over the coming decade, approximately 207,980 FTE RNs will remain in high demand nationwide. Disparities in shortage distribution persist among states, with some expected to have a surplus of nurses while others grapple with significant deficiencies.
State-Level Projections of RN Shortages Through 2037
The HRSA’s projections, based on historical data up to 2022, offer insights into the varying adequacy of RN supply across different states. By 2037, the following 10 states are predicted to face the most substantial shortages:
– North Carolina: 22%
– Washington: 22%
– Maryland: 20%
– South Carolina: 19%
– Michigan: 19%
– New Mexico: 19%
– Oklahoma: 18%
– California: 18%
– Idaho: 17%
– Georgia: 17%
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Explore the potential changes in the gap between supply and demand for nurses across different states from 2025 to 2037. A study revealed that in 2025, 34 states were expected to experience a shortage of nurses, compared to 29 states in 2037. While some states may see improvements in their shortages, others may face worsening conditions. For instance, North Carolina is projected to have a shortage of 15% in 2025, increasing to 22% by 2037. In contrast, Idaho is anticipated to have a 38% shortage in 2025, which is expected to decrease to 17% by 2037. On the other hand, Wyoming is forecasted to have an oversupply of nurses at 99% in 2025, but this is predicted to decrease to 77% by 2037.
Among the 34 states with a shortage in 2025, all but nine are expected to see an increase in their nurse supply by 2037. However, only seven out of the 26 states that experience a supply increase are projected to have an oversupply ranging from 1% to 23%. Notably, Utah’s adequacy is set to increase from 99% in 2025 to 123% in 2037, representing a 24% jump. Conversely, six states are predicted to witness a decline in nurse adequacy by 1% to 14% between 2025 and 2037. Oregon is expected to have the most substantial decrease, dropping from 98% to 84% adequacy, although this remains higher than North Carolina’s 78%.
Moreover, the HRSA projects that in 2037, 29 states are still expected to face a nursing shortage. However, three states—Florida, Indiana, and New York—will only have a shortage of 1%. In terms of states with overages, Arkansas and Kentucky are anticipated to exceed their nurse supply by 1%.
The District of Columbia experienced the most significant decline in nurse supply versus demand throughout the projection period but remained well above adequacy, decreasing from 193% to 147%. It continues to hold the second-highest overage, with Wyoming maintaining the lead with a decrease from 199% to 177% surplus.
To assess if a state may be understaffed or overstaffed, Vivian Health looked at the nurses per capita metric, indicating the number of nurses for every 1,000 residents in a state. By analyzing data from the Department of Labor and the Census Bureau in 2023, the national per capita rate was 9.43 RNs per 1,000 residents. Any state with a value below this figure would be considered to have a nurse shortage. In this context, 23 states fell below the national rate, highlighting a nationwide deficit in RNs per capita. Please refer to the provided table for detailed information on RN per capita in each state
Another important factor to consider is that there may be numerous licensed Registered Nurses (RNs) compared to those currently employed, and those who are employed may not be working at the bedside, potentially affecting data on nursing shortages. Additionally, RNs may hold licenses in multiple states but can only work in one location at a time, resulting in potential discrepancies in workforce counts across different states. The situation can be further complicated by travel nursing jobs, especially if an RN with a multistate license frequently works in states other than their home state under the Enhanced Nurse Licensure Compact.
Vivian conducted a comparison between the active RN licenses reported by the National Council of State Boards of Nursing and the employed RNs documented by the USDOL in 2023. You can find the differences in the table provided.
While our investigation primarily focused on RNs, Vivian Health also analyzed the future outlook for licensed practical/vocational nurses (LPN/LVNs) and nurse practitioners (NPs). The Health Resources and Services Administration (HRSA) predicts a faster growth in demand for LPN/LVNs compared to supply, but the opposite trend for NPs.
According to the HRSA’s nurse workforce report, there is a projected shortage of 302,440 full-time equivalent (FTE) LPNs by 2037 nationwide. The projected supply of LPN/LVNs is expected to meet only 80% of the demand by 2027, declining to 72% by 2032 and 64% by 2037. Similar to RNs, the adequacy of LPNs varies significantly by state, with Maine projected to experience an 80% shortage by 2037, while West Virginia may have a 17% surplus.
On the other hand, there is a surplus of NPs expected, with a 26% excess by 2027, growing to 53% by 2032 and 76% by 2037. However, the distribution of NPs across states remains a critical factor. For instance, California has introduced measures allowing NPs to practice independently to address the state’s shortage of primary care clinicians, projecting a deficit of 8,000 primary care clinicians by 2030.
The COVID-19 pandemic led to a high number of nurses considering leaving their jobs, with initial expectations of this trend diminishing over time. However, the actual turnover rate remained higher than anticipated, resulting in an overall decrease in the active nursing workforce across many health systems. While some systems have managed to rebuild their nursing staff, others continue to face challenges. As of early 2023, there are still projected nursing shortages nationwide, particularly in acute-care settings.
The persistent nursing shortage is a complex crisis with systemic challenges deeply rooted in the healthcare industry, exacerbated by current issues with significant repercussions. The aging population in the country requires more healthcare services, while the nursing workforce is also aging, leading to a substantial wave of retirements. Furthermore, a shortage of
The aging population, including the baby boomer cohort, is growing older. By 2030, all baby boomers will be 65 or older, leading to an increased demand for complex care and nurses to provide this care. The nursing workforce is also aging, with approximately one million registered nurses expected to retire between 2017 and 2030. This impending retirement wave poses a significant threat of depleting the experienced nursing workforce in a short period of time.
Burnout among nurses is on the rise due to high-stress environments, long working hours, and persistent staffing shortages, resulting in lower job satisfaction, increased absenteeism, and a rise in nurses leaving or contemplating leaving the profession. Many nurses are choosing to move away from stressful bedside roles towards alternative healthcare positions or entirely different industries. Reasons for leaving bedside roles often include burnout, inadequate support, low pay, lack of appreciation, limited breaks, and insufficient mental health resources.
There is also a shortage of nursing faculty, leading to nursing schools having to turn away thousands of qualified applicants for baccalaureate or graduate nursing programs. The lack of faculty is primarily due to capacity constraints, such as inadequate clinical sites, classroom space, faculty, and clinical preceptors, compounded by uncompetitive salaries for teaching roles.
Competitive wages and better working conditions in other sectors are attracting trained nurses away from nursing careers, reducing the number of new entrants into nursing programs. Additionally, violence in healthcare settings poses a significant threat, with healthcare workers being at a higher risk of sustaining injuries due to violence compared to other professions.
The impact of nurse demand and shortages is multifaceted, with discrepancies in data reflecting variations in data collection methods, changes over time, and local or regional impacts. Projections assume historical patterns of graduation, workforce participation, and attrition remain constant, but many factors can alter supply and demand dynamics. Therefore, regular updates are essential to monitor and address these challenges effectively. Vivian Health updates this information annually to provide the latest data to readers.
In any given year, the demand for healthcare services, as well as the need for registered nurses (RNs) and other nursing professionals to deliver these services, remains steady. Whether you are a travel nurse seeking new adventures or a staff nurse contemplating a change of environment, understanding which states are projected to have an excess of nurses in comparison to those facing shortages can assist you in making informed decisions. States experiencing nursing shortages are likely to implement recruitment initiatives aimed at enticing nurses with attractive incentives such as higher salaries, improved benefits, flexible scheduling, and various other perks to encourage them to work in the region. Conversely, states with an oversupply of nurses may not offer as competitive wages or desired benefits, potentially influencing your preferences. Certain healthcare facilities have historically offered more lucrative compensation than others, whether or not there is a shortage of nurses. Nevertheless, the higher living costs in these areas may counterbalance the higher salaries being offered. When evaluating potential relocation opportunities or travel assignments, it is vital to ensure that the salary being offered is sufficient for a comfortable standard of living. This article was created by Vivian Health, and it was reviewed and distributed by Stacker.
