Nursing Shortage: A State-Wise Report on Trends, Challenges, and Workforce Solutions

In 2022, global consulting firm McKinsey & Company projected that by 2025, the United States could face a shortfall of 200,000 to 450,000 registered nurses (RNs) providing direct patient care. Recent data suggest this prediction is on track. Between 2022 and 2025, the Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) reported only a 1% increase in RN supply, while demand grew by 3%, resulting in a nursing shortage of approximately 295,800 nurses nationwide, right within the projected range. This persistent nursing shortage is not just a temporary problem; it remains a critical, ongoing challenge that places significant strain on hospitals and healthcare facilities across the country.

As healthcare needs grow due to an aging population and ongoing reforms, the gap between RN supply and demand continues to expand, though unevenly across regions. nurse.education analyzed data across all 50 states and the District of Columbia to provide a state-wise perspective on the nursing shortage. Our comprehensive review identifies which states face the most severe shortages and which may have a relative oversupply, offering a clear, quantitative understanding of the distribution of nurses nationwide.

Nursing Shortages on a National Level

A study published in February 2024 by the JAMA Health Forum highlights that the nursing workforce experienced a recovery in 2022 and 2023 following the significant decline during the COVID-19 pandemic. The study indicates that the workforce is on track to reach approximately 4.56 million registered nurses (RNs) by 2025, aligning with pre-pandemic projections.

However, not all studies present the same outlook. While recent analyses suggest that nursing shortages may ease slightly over the coming years, the gap between RN supply and demand is expected to close gradually and will not completely disappear within the next decade. Between 2027 and 2037, projections show a slow reduction in shortages, underscoring that the nursing shortage remains a persistent national concern.

The U.S. Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) projects continued deficits of full-time equivalent (FTE) RNs nationwide. According to their forecasts, the national nursing shortage is expected to reach approximately 10% by 2027, decreasing to 8% by 2032 and further to 6% by 2037. Even at 6%, this shortage translates to roughly 207,980 FTE RNs, a substantial gap that can have meaningful impacts on patient care, hospital staffing, and healthcare system efficiency.

Importantly, the nursing shortage is not evenly distributed across the country. Some states may experience a relative surplus of nurses, while others will continue to face significant staffing challenges. These disparities highlight the need for targeted workforce planning and investment in nursing education and retention strategies. Understanding the state-wise dynamics of the nursing shortage is essential for healthcare leaders, policymakers, and educational institutions seeking to address this ongoing challenge and ensure equitable access to care nationwide.

Projected RN Shortages by State Through 2037

The U.S. Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) developed its projections using historical nursing workforce data, including figures through 2022. While these projections provide valuable insights, it’s important to note that the COVID-19 pandemic’s impact on the nursing workforce may only be partially reflected in the available data. The forecasts assume that patterns in nursing school graduation rates, workforce attrition, and active employment levels remain consistent throughout the forecast period.

According to HRSA, the nursing shortage varies considerably from state to state. Some states are projected to face much larger gaps in RN supply compared to demand by 2037. The following ten states are expected to experience the highest projected shortages:

• North Carolina: 22%

• Washington: 22%

• Maryland: 20%

• South Carolina: 19%

• Michigan: 19%

• New Mexico: 19%

• Oklahoma: 18%

• California: 18%

• Idaho: 17%

• Georgia: 17%

It’s important to remember that state-wide projections may not capture regional disparities. For example, HRSA’s November 2024 report indicates that nonmetropolitan areas may experience a 13% nursing shortage, whereas metro areas may face only a 5% shortage. This highlights that even within states with relatively sufficient staffing, certain regions may still struggle to meet healthcare demands.

nurse.education analyzed HRSA’s data to examine how the supply-demand gap may shift between 2025 and 2037. The research shows that 34 states are projected to have a nursing shortage in 2025, decreasing slightly to 29 states by 2037. However, improvements in some states coincide with worsening shortages in others.

For example, North Carolina is expected to see its shortage grow from 15% in 2025 to 22% by 2037, while Idaho is projected to improve from a 38% shortage in 2025 to 17% by 2037. On the opposite end, Wyoming currently has a substantial oversupply of nurses, with nearly double the workforce needed in 2025 (99%), which is projected to decline to 77% by 2037.

These projections underscore the importance of targeted workforce planning and resource allocation. Understanding state-specific trends in the nursing shortage is crucial for healthcare leaders, educators, and policymakers to ensure adequate staffing and equitable access to patient care across all regions. To provide a clear view, we’ve included two tables below, one showing projected RN adequacy in 2025 and another for 2037.

2025 Projected Adequacy by State 

State	2025 Supply	2025 Demand	2025 Adequacy
Idaho	10,940	17,570	62%
New Mexico	12,290	19,350	64%
Oklahoma	28,100	41,020	69%
Virginia	57,720	82,540	70%
South Carolina	39,940	55,120	72%
Maryland	44,680	59,270	75%
Arizona	51,870	68,220	76%
Iowa	25,350	32,020	79%
Colorado	39,320	49,240	80%
Kentucky	39,890	49,470	81%
West Virginia	16,280	20,160	81%
Georgia	82,370	99,260	83%
Missouri	54,230	65,310	83%
Pennsylvania	112,370	135,100	83%
Arkansas	26,870	32,020	84%
Michigan	86,090	102,000	84%
Tennessee	60,580	72,070	84%
Louisiana	42,400	49,750	85%
New Hampshire	11,840	13,980	85%
North Carolina	90,810	107,200	85%
Kansas	24,640	28,720	86%
Maine	13,080	15,230	86%
Nebraska	15,990	18,630	86%
Washington	60,940	69,980	87%
California	286,880	327,670	88%
Texas	222,250	253,610	88%
Mississippi	28,080	31,240	90%
Florida	206,640	225,290	92%
Nevada	25,640	27,830	92%
New Jersey	76,540	83,150	92%
Indiana	65,570	67,310	97%
Ohio	120,690	122,640	98%
Oregon	40,400	41,080	98%
Utah	25,950	26,290	99%
New York	185,050	184,710	100%
Montana	11,440	11,190	102%
Illinois	121,700	116,130	105%
Delaware	11,390	10,630	107%
Connecticut	39,940	37,060	108%
Wisconsin	60,010	55,760	108%
Minnesota	57,850	52,590	110%
Rhode Island	12,260	10,950	112%
South Dakota	10,240	9,130	112%
Alabama	59,250	51,910	114%
Massachusetts	81,040	65,470	124%
North Dakota	9,460	7,540	125%
Hawaii	15,940	11,870	134%
Vermont	8,520	6,350	134%
Alaska	9,570	6,590	145%
District of Columbia	11,200	5,800	193%
Wyoming	10,290	5,160	199%

Of the 34 states projected to experience a nursing shortage in 2025, all but nine are expected to see improvements in RN supply by 2037. However, only seven of the 26 states with increased supply are projected to reach an oversupply, ranging from 1% to 23%. Notably, Utah is expected to grow from 99% adequacy in 2025 to 123% in 2037, an increase of 24%. While this growth is slightly lower than West Virginia’s projected jump of 27%, West Virginia’s total overage is comparatively modest at 108%.

Conversely, six states are anticipated to see a decline in adequacy, dropping between 1% and 14% over the same period. Oregon shows the largest decrease, falling from 98% adequacy in 2025 to 84% in 2037, still above North Carolina’s 78%. Meanwhile, Georgia and Maine are exceptions, maintaining consistent adequacy levels at 83% and 86%, respectively.

Fifteen states, along with the District of Columbia, are projected to have nurse oversupply in 2025. Of these, HRSA predicts eight states will see continued growth, with adequacy increasing between 3% and 19%. North Dakota is projected to experience the most substantial rise, moving from 125% to 144%, ranking it as the third-highest overage nationwide. Of the remaining eight states with decreasing adequacy, six will still maintain an oversupply of nurses.

New York was the only state with exact adequacy at 100% in 2025. By 2037, New York is projected to drop slightly to 99%, while Delaware declines from 107% to 97%, placing both states into the shortage category. By that year, no state is expected to maintain a perfect 100% adequacy, highlighting the dynamic and ongoing nature of the nursing shortage across the country.

Long-Term State-Wide Adequacy Projections Through 2037

State	2037 Supply	2037 Demand	2037 Adequacy
North Carolina	101,080	129,930	78%
Washington	68,790	87,730	78%
Maryland	54,960	68,550	80%
Michigan	90,120	111,410	81%
New Mexico	17,000	20,920	81%
South Carolina	49,930	61,790	81%
California	302,720	367,720	82%
Oklahoma	36,390	44,510	82%
Georgia	93,010	112,000	83%
Idaho	17,060	20,650	83%
Oregon	41,370	49,200	84%
Maine	15,570	18,090	86%
Texas	271,570	310,700	87%
New Jersey	79,540	90,680	88%
Louisiana	46,380	52,320	89%
Colorado	54,770	60,470	91%
Virginia	84,310	92,900	91%
Arizona	77,220	83,690	92%
Kansas	31,850	34,590	92%
Missouri	64,520	69,870	92%
Pennsylvania	136,880	148,140	92%
New Hampshire	15,890	16,870	94%
Mississippi	31,430	33,000	95%
Tennessee	77,950	81,740	95%
Delaware	11,850	12,170	97%
Iowa	32,890	34,040	97%
Florida	267,260	270,660	99%
Indiana	71,280	72,190	99%
New York	189,880	191,570	99%
Arkansas	34,070	33,840	101%
Kentucky	53,770	53,010	101%
Nevada	32,940	31,500	105%
Connecticut	40,110	37,820	106%
Nebraska	21,760	20,260	107%
Illinois	126,650	117,490	108%
Montana	13,420	12,480	108%
West Virginia	21,000	19,530	108%
Massachusetts	80,190	72,270	111%
Alaska	8,450	7,450	113%
Rhode Island	13,680	11,770	116%
Wisconsin	68,250	58,850	116%
Alabama	64,610	55,030	117%
Minnesota	68,980	58,890	117%
Ohio	145,620	123,300	118%
Utah	42,720	34,600	123%
South Dakota	12,830	10,300	125%
Vermont	8,100	6,500	125%
Hawaii	16,270	12,430	131%
North Dakota	11,670	8,090	144%
District of Columbia	9,130	6,210	147%
Wyoming	9,310	5,260	177%

By 2037, HRSA projects that 29 states will continue to experience a nursing shortage, although some shortages will be minimal. Florida, Indiana, and New York are expected to have the smallest deficits, each with just a 1% shortage. On the other end of the spectrum, among the 22 states projected to have nurse overages, Arkansas and Kentucky are only slightly above adequacy, with a 1% surplus each.

The District of Columbia stands out for experiencing the most significant decline in supply relative to demand over the projection period. Despite this drop, it remains well above adequacy, decreasing from 193% to 147%. It holds the second-highest overage nationwide, following Wyoming, which, although seeing a 22% decrease, maintains the largest surplus with an estimated 177% adequacy in 2037.

These projections highlight that while some regions will continue to face moderate or minor nursing shortages, others will maintain significant surpluses, emphasizing the uneven distribution of nursing resources and the ongoing need for targeted workforce planning.

Nurses Per Capita by State

To gain a clearer perspective on how states may experience a nursing shortage, it is helpful to examine nurses per capita. In this context, “per capita” refers to the number of registered nurses (RNs) for every 1,000 residents in a state. Using the most recent 2023 data from the U.S. Department of Labor (USDOL) and the U.S. Census Bureau, we calculated RN per capita for each state and ranked them from lowest to highest.

Nationally, the per capita rate stands at 9.43 RNs per 1,000 residents. By this measure, states with fewer than 9.43 RNs per 1,000 people could be considered to have a potential nursing shortage. Based on this threshold, 23 states fall below the national average, indicating areas at higher risk for staffing gaps.

It’s important to note, however, that even the national per capita rate is influenced by the existing RN deficit. This means that the “average” figure of 9.43 RNs per 1,000 residents already reflects an overall shortage, so states below this benchmark may face even greater challenges in meeting healthcare demands. Understanding RN distribution on a per capita basis provides critical insights for workforce planning, resource allocation, and addressing regional disparities in nurse availability.

Licensed Versus Actively Working Nurses

Another critical factor in understanding the nursing shortage is the distinction between licensed RNs and those who are actively employed. While many nurses hold valid licenses, not all are currently working at the bedside or in direct patient care. This discrepancy can significantly affect calculations of workforce adequacy and perceived shortages.

Additionally, some RNs hold multiple state licenses but can only work in one location at a time. This situation can inflate workforce counts across states and potentially skew shortage data. Travel nurses further complicate the picture, especially those with multistate licenses through the Enhanced Nurse Licensure Compact, who may frequently work in states other than their home state.

nurse.education analyzed the differences between the number of active RN licenses, as reported by the National Council of State Boards of Nursing, and employed RNs from the U.S. Department of Labor (USDOL) in 2023. These differences highlight that while licensed nurses are a critical resource, the actual number of nurses available for direct patient care can be substantially lower, influencing state-specific nursing shortages. You can view the comparison in the table below.

What About Other Types of Nurses?

While the primary focus of our analysis has been on registered nurses (RNs), it’s also important to consider projections for licensed practical/vocational nurses (LPNs/LVNs) and nurse practitioners (NPs) to fully understand the landscape of the nursing shortage across different nursing roles.

According to HRSA projections, the demand for LPNs/LVNs is expected to grow faster than the supply, indicating a widening shortage over the coming years. Nationwide, the projected shortfall could reach 302,440 full-time equivalent (FTE) LPNs by 2037. HRSA reports that the supply of LPNs/LVNs will only meet 80% of demand by 2027, declining to 72% by 2032 and 64% by 2037. Similar to RNs, state-level adequacy varies widely. For instance, Maine may face an 80% shortage of LPNs by 2037, while West Virginia could have a 17% overage.

In contrast, the supply of nurse practitioners is projected to exceed demand, with a 26% overage by 2027, growing to 53% by 2032 and 76% by 2037. However, distribution across states remains uneven. For example, California has implemented pathways allowing NPs to practice independently, without physician supervision, to help address the state’s ongoing primary care shortage. By 2030, California anticipates a shortage of approximately 8,000 primary care clinicians, which includes physicians, physician assistants, and NPs.

These projections underscore that the nursing shortage is not uniform across nursing roles. While RNs and LPNs/LVNs are likely to face significant gaps in supply relative to demand, NPs may experience surpluses in some states but continue to be critical in addressing regional primary care shortages. Understanding these nuances is essential for healthcare workforce planning, nursing education, and policy initiatives aimed at alleviating staffing disparities nationwide.

What’s Causing Nursing Shortages?

The ongoing nursing shortage is a multifaceted issue, intensified by the aftermath of the COVID-19 pandemic. While early forecasts predicted that nurse turnover would decline post-pandemic, the number of nurses leaving their roles has remained higher than anticipated. Many healthcare systems have experienced significant departures, contributing to an overall decrease in the active nursing workforce.

Although some health systems have successfully rebuilt their nursing staff, others continue to face substantial gaps, particularly in acute-care settings. Early 2023 estimates still indicated a nationwide nursing shortage, highlighting the persistent nature of this workforce challenge.

The nursing shortage stems from both systemic issues and current pressures:

• Aging Population: The baby boomer generation continues to grow older, increasing the demand for complex healthcare services. By 2030, all baby boomers will be 65 or older, requiring more nurses to deliver adequate care.

• Aging Workforce: The nursing workforce itself is aging. An estimated one million RNs are projected to retire between 2017 and 2030, posing a significant threat to the experienced nurse pool.

• Increased Burnout: High-stress work environments, long shifts, and chronic staffing shortages have resulted in unprecedented levels of burnout. This leads to reduced job satisfaction, absenteeism, and nurses leaving the profession.

• Nurses Leaving Bedside Jobs: Many nurses are shifting away from high-stress bedside roles to alternative healthcare positions or entirely different careers. Factors include unsafe staffing ratios, inadequate support, low pay, limited breaks, and insufficient mental health resources. According to the National Library of Medicine (February 2023), turnover rates range from 8.8% to 37%, depending on specialty and location.

• Faculty Shortage: Nursing schools turned away nearly 92,000 qualified applicants in 2021 due to capacity constraints, including a lack of classroom space, clinical sites, and qualified faculty. Low salaries for nursing instructors further exacerbate the shortage of qualified educators.

• Economic Incentives in Other Fields: Competitive wages and lower-stress jobs in other industries attract nurses away from the profession, reducing the number entering nursing programs.

• Violence in Healthcare Settings: Physical and emotional abuse in healthcare environments adds to workplace stress, contributing to nurse attrition. Healthcare workers are five times more likely to sustain injury from workplace violence than employees in other sectors.

  
  

How Nursing Shortages Affect You

The impact of the nursing shortage varies by region and specialty. Differences in data collection, changing labor trends, and local workforce dynamics can make projections inconsistent. Supply and demand can shift quickly, turning a projected surplus into a shortage or vice versa, which is why frequent updates are essential.

For nurses, whether staff, travel, or locum tenens, the state-wise outlook on nurse supply can inform career decisions. States with a nursing shortage may offer higher salaries, better benefits, flexible schedules, and other incentives to attract professionals. Conversely, states with a surplus may have less competitive compensation and fewer perks.

When evaluating relocation or travel assignments, consider not only salary but also cost of living to ensure the compensation is livable. Understanding where nursing shortages are most pronounced can help you make strategic career moves while supporting healthcare systems in need.

By addressing these factors, workforce aging, burnout, faculty shortages, and uneven distribution, healthcare leaders and policymakers can begin to mitigate the persistent nursing shortage and ensure adequate staffing to meet growing patient needs.