The Qualified Nurses Shortage: What the Numbers Say, Why It Happens and What Helps
Headlines about a nursing shortage are everywhere, but the numbers behind them are often old, mixed up or missing context. Federal projections show the picture changing from year to year, the shortage is much worse for some kinds of nurses and some places than others, and the biggest causes are not all the same. This guide sets out the latest published figures, explains the causes, works through a made-up cost example, and gives you a way to read the next headline critically.
What “shortage” means
A shortage is a gap between the nurses an employer or region needs (demand) and the nurses available to work (supply). Three things make the headline number slippery:
- Projection, not count. Most national figures are model forecasts based on assumptions. They change when the data or assumptions change.
- Full-time equivalents. Forecasts often count FTEs (full-time equivalents), not people. Two half-time nurses equal one FTE.
- Which nurses and where. Registered nurses (RNs), licensed practical or vocational nurses (LPN/LVNs) and nurse practitioners are different workforces. Shortages also differ sharply by state and between city and countryside.
“Qualified” here means licensed and prepared for the role. The pipeline that produces qualified nurses has its own limits, which we cover below.
The numbers
Federal projections of supply and demand
The Health Resources and Services Administration (HRSA) publishes workforce projections. Its December 2025 nursing projections factsheet covers 2023 to 2038. A shortage of 8% means supply is projected to meet 92% of demand.
| Projected shortage | 2028 | 2033 | 2038 |
|---|---|---|---|
| Registered nurses (RNs) | 8% | 6% | 3% (about 108,960 FTEs) |
| LPNs / LVNs | 17% | 24% | 30% (about 245,950 FTEs) |
Three points stand out. The RN gap is projected to narrow over time, while the LPN gap widens. The national average hides large differences: for 2038 the factsheet lists California with the largest projected RN shortage at 22%, followed by North Carolina and Georgia at 20% each, while Wyoming shows a projected oversupply of 79%. And location matters at a basic level: the factsheet projects a 2038 RN shortage of 11% in non-metropolitan areas against 2% in metropolitan ones. The projections assume that historical patterns of attrition, graduation and labor force participation stay the same.
Projections move. An earlier HRSA release reported by the American Organization for Nursing Leadership (December 2024) put the 2027 national RN shortage at 10%. The newer figure for 2028 is 8%. Neither is a prediction of what will happen. Use them as estimates, and check HRSA’s site for updates.
Jobs, pay and growth
The U.S. Bureau of Labor Statistics (BLS) reports 3,465,400 registered nurse jobs in 2025, a median pay of $97,550 a year (May 2025), projected growth of 6% from 2025 to 2035 (faster than average) and about 180,800 openings a year on average over the decade. It lists a bachelor’s degree as typical entry education. Openings include replacing nurses who retire or change careers, not only new jobs.
Leaving the workforce
The National Council of State Boards of Nursing (NCSBN) published findings from its 2024 workforce study in April 2025. It reported that more than 138,000 nurses have left the workforce since 2022, and that 39.9% of RNs and 41.3% of LPN/VNs said they intend to leave or retire within five years. About 41.5% of nurses planning to leave for reasons other than retirement named stress and burnout as the root cause. Stated intentions are not the same as actual departures, so treat them as a warning, not a forecast.
Turnover and vacancies in hospitals
The 2025 NSI National Health Care Retention & RN Staffing Report, covering 2024 data from 450 hospitals in 37 states and summarized by Becker’s Hospital Review, found an RN turnover rate of 16.4% and a vacancy rate of 9.6%. It put the average cost of turning over one staff RN at $61,110, within a range of $49,500 to $72,700, and estimated that each percentage point of RN turnover costs or saves the average hospital $289,000 a year.
Training capacity
The American Association of Colleges of Nursing (AACN) says U.S. nursing schools turned away 92,672 qualified baccalaureate and graduate applications in its 2025-2026 report. Schools pointed to faculty shortages, clinical sites, classroom space, clinical preceptors and budget limits. The AACN nursing faculty shortage fact sheet reports a national faculty vacancy rate of 7.2% in a survey released in October 2025, with 1,588 full-time vacancies across 863 schools. It also says the share of faculty at retirement age rose from 16.9% in 2017 to 34.2% in 2024.
Why it happens
| Cause | Evidence above | What we do not know |
|---|---|---|
| Growing demand for care | BLS projects 6% job growth, with about 180,800 openings a year | How demand will change with new care models and technology |
| Limited training capacity | 92,672 qualified applications turned away; 7.2% faculty vacancy rate; many faculty near retirement age | How many of those applicants would have enrolled, finished and stayed (applicants may apply to several schools) |
| Burnout and turnover | 16.4% hospital RN turnover; large shares of nurses say they intend to leave | How many will actually leave, and how many return |
| Uneven distribution | Non-metro RN shortage of 11% against 2% in metro areas by 2038; wide variation by state | How well telehealth and pay incentives can close the gap |
| The LPN gap | HRSA projects a 30% LPN shortage in 2038 | How employers will substitute between nurse types |
The last column matters. Anyone who says they know exactly how many nurses will be missing in 2038 is overstating what the data can tell us.
What turnover costs: an example
This is a made-up hospital, using the NSI averages above. It shows why employers care about retention.
| Step | Calculation | Result |
|---|---|---|
| RNs at the hospital | 500 | |
| Nurses who leave in a year at 16.4% turnover | 500 × 0.164 | 82 |
| Cost of those departures at $61,110 each | 82 × $61,110 | $5,011,020 |
| Turnover cut by 2 points, to 14.4% | 500 × 0.02 | 10 fewer departures |
| Saving | 10 × $61,110 | $611,100 |
| Retention program cost (made up) | $300,000 | |
| Net, if the 2 points are achieved | $611,100 − $300,000 | $311,100 |
The key word is “if”. If the program only moved turnover by half a point, the saving would be 500 × 0.005 = 2.5 departures, or about $152,775, which is less than the cost. The case for a program depends on the evidence that it works.
What helps
No single fix closes the gap. The table lists common approaches, the cause each targets, and a caution. The evidence on how well each works varies by setting, so treat them as options to test, not guaranteed results.
| Lever | Targets | Examples | Caution |
|---|---|---|---|
| More school capacity | Training bottleneck | More faculty, more clinical placements, partnerships between hospitals and schools | Faculty pay competes with clinical pay; new faculty take years to prepare |
| Retention work | Burnout and turnover | Safer staffing, flexible scheduling, structured onboarding, manageable workloads | Measure turnover before and after, as in the example |
| Career pathways | Supply and advancement | LPN-to-RN and RN-to-BSN routes, tuition support | Support must include time, not only money |
| Targeting regions | Uneven distribution | Loan repayment or incentives for rural service, telehealth support | Incentives may not keep people after the contract ends |
| Better workforce data | Planning | Local forecasts, exit interviews, vacancy tracking | Needs consistent definitions |
Data tools can help with planning and with spotting units at risk. See our guides to business intelligence in healthcare and predictive analytics in healthcare, and to Six Sigma in healthcare, which covers process improvements that can reduce waste in nurses’ time.
If you are a nurse or thinking of becoming one
A shortage does not mean every job is easy to get or every workplace is good. Demand is uneven, and the same pressures that create a shortage can make a job demanding. Questions worth asking before you accept a position:
Questions to ask an employer
- What is the typical nurse-to-patient assignment on this unit, and how often is it exceeded?
- How long is orientation, and who supports new nurses afterward?
- What was nurse turnover on this unit last year?
- How are schedules set, and how far ahead? How often is overtime required?
- Is there tuition help or paid time for a BSN or specialty certification?
- What happens when the unit is short-staffed?
If you are already an RN without a bachelor’s degree, a degree-completion program is a common next step. Compare options in our RN-to-BSN online programs guide and the RN-to-BSN resources. To explore directions your career could take, read nursing specialties and careers and the ICU and critical care nursing job description.
How to read a shortage headline
- Who produced the number? A federal agency, a professional body and an employer survey measure different things.
- Which nurses? RN, LPN/LVN or nurse practitioner?
- Headcount or FTE? The two can differ by a lot.
- What year, and is it a projection? Projections made before recent data may be out of date.
- What area? A national figure can hide a local surplus or a severe local gap.
- What assumptions? Look for what the model holds constant.
- Is it a count or an intention? “Plan to leave” is not the same as “left”.
Frequently asked questions
Is there a nursing shortage in the United States?
Federal projections show a shortfall of registered nurses that is projected to narrow over time, and a larger and growing shortfall of licensed practical and vocational nurses. Local conditions vary widely.
How big is the RN shortage projected to be?
HRSA’s December 2025 projections show an 8% RN shortage in 2028, 6% in 2033 and 3% in 2038. These are estimates that rest on assumptions and can change.
Which states have the largest projected RN shortages?
For 2038, the HRSA factsheet lists California (22%), North Carolina (20%) and Georgia (20%) among the largest. Wyoming shows a projected oversupply.
Why can’t schools just train more nurses?
AACN reports schools turned away tens of thousands of qualified applications and points to limits on faculty, clinical sites, classroom space and budgets.
How many nurses are leaving?
NCSBN reported more than 138,000 nurses left the workforce since 2022 and that roughly 40% of surveyed RNs and LPN/VNs said they intended to leave or retire within five years. Intentions do not always become departures.
What is the average pay for a registered nurse?
BLS reports a median of $97,550 a year (May 2025). Pay varies with location, setting, experience and specialty.
Does a shortage guarantee job security?
No. Demand differs by region and specialty, so check local job listings and ask employers about staffing before you commit.
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