The United States is approaching a critical turning point in health care staffing. While nursing shortages have been discussed for years, the reality is that the situation now varies dramatically across states. Some areas face moderate gaps that can be managed with strong recruitment, while others are projected to experience severe nurse deficits that could compromise patient care and strain hospital systems.
The registered nurse (RN) workforce is the backbone of hospitals, clinics, and community health organisations. Yet, projections reveal that by 2037, the demand for RNs will far exceed the available supply in many regions. The issue is not only the absolute number of nurses but also where they live, how they work, and the policies that influence their careers.
This article explores the projected RN shortage by state, highlights the nursing shortage hotspots, examines why they exist, and outlines solutions that leaders can adopt to mitigate risks. It provides a state-by-state view of supply adequacy, showcases case studies, and explains why certain states are more vulnerable than others. The goal is to equip hospital leaders, policymakers, and educators with insight and practical strategies to respond effectively.
In This Article
Why State-Level RN Projections Matter?
The phrase “nursing shortage” is often used broadly, but it is misleading if viewed only at the national level. In reality, nursing shortages are highly localised. A state may train thousands of nurses annually, yet still face a gap if population growth and health care demand outpace supply. Conversely, another state may appear stable, but shortages in rural counties can create care deserts even when the overall numbers look balanced.
Understanding the RN shortage by state is therefore critical. National statistics alone do not reflect the lived experience of hospital managers struggling to fill shifts or patients waiting longer for care. By analysing nursing shortage hotspots, we can identify where action is most urgently needed, which policies are working, and how resources should be directed.
Data Sources and Methodology
This article is based on workforce projections from federal and state agencies, labour market data, and nursing association reports. Projections are typically expressed in terms of:
- Full-Time Equivalent (FTE) Nurses: Standardised to represent the hours of one full-time worker.
- Supply Adequacy: The percentage of demand that can be met by the available workforce. A 100% adequacy means balance; below 100% signals shortage.
- Shortage (or Surplus) Gap: The number of nurses the state is projected to lack (or exceed).
- Urban vs Rural Divide: Shortages are often sharper in rural areas, even in states that appear stable overall.
Projections assume steady patterns of retirement, graduation, and workforce participation. They cannot perfectly predict future shocks such as new technology, pandemics, or sudden changes in policy. Nonetheless, they provide a crucial planning framework.
The National Picture
At the national level, the RN workforce is under strain due to several converging factors:
- Retirement Wave: A significant proportion of the nursing workforce is over the age of 55, meaning thousands will retire over the next decade.
- Population Growth and Ageing: An ageing population increases demand for health care services, particularly in chronic disease and long-term care.
- Education Bottlenecks: Nursing schools often turn away qualified applicants due to limited faculty and clinical placement capacity.
- Burnout and Attrition: High stress, long hours, and pandemic pressures have led many nurses to leave the profession early.
Nationally, tens of thousands of RN job openings are expected annually, not just from new demand but also from the need to replace retirees. However, these numbers are unevenly distributed. Some states will face more severe shortages than others.
State Hotspot Analysis: Top-Tier Shortages
Certain states are consistently identified as nursing shortage hotspots, where demand will heavily outstrip supply. Below is a closer look at some of the most concerning states.
1. Washington
Washington faces steep shortages due to a fast-growing population, rising cost of living, and limited nursing school capacity. Urban centres like Seattle attract some talent, but rural eastern regions are critically underserved. Retention is another challenge, as nurses migrate to neighbouring states offering better wages and lower living costs.
2. Georgia
Georgia’s health care system is bracing for major deficits in its nursing workforce. Rapid population growth, especially around Atlanta, is creating soaring demand. At the same time, the state’s nursing schools are unable to expand quickly enough to keep up. Rural areas in southern Georgia face particular difficulty attracting and retaining RNs.
3. California
California already employs the largest number of nurses in the country, yet it continues to project shortfalls. The sheer size of its population, coupled with strict staffing ratio laws, creates high demand. While some regions like Los Angeles are moderately staffed, the Central Valley and northern counties are projected to remain deeply short on RNs.
4. North Carolina
With one of the fastest-growing populations in the United States, North Carolina is facing increasing pressure on its health care system. Shortages are concentrated in rapidly expanding urban hubs and in under-resourced rural counties. Nursing program enrolments are strong, but faculty shortages prevent scaling.
5. Michigan
Michigan’s ageing population and large rural communities put it at high risk of shortages. The decline of manufacturing towns has also affected hospital funding, making recruitment challenging. While urban centres such as Detroit may see more stability, rural hospitals continue to struggle.
6. Louisiana
Louisiana experiences persistent health disparities and high demand for nursing care. The combination of an ageing workforce, challenging working conditions, and limited nursing program capacity has created ongoing shortages. Rural parishes face the most acute gaps, where hospitals rely heavily on travel nurses.
7. New Jersey
Although geographically small, New Jersey is a hotspot due to its dense population and proximity to major metropolitan areas like New York City. Competition for nurses is fierce, and many RNs choose to commute or relocate across state borders for higher wages. This leaves New Jersey hospitals in constant recruitment mode.
7. South Carolina
South Carolina faces growing shortages tied to rapid population increases and retirement of older nurses. Rural areas near the coast are especially vulnerable, while urban centres like Charleston and Columbia also project deficits as demand for specialty care rises.
Nursing Shortage Hotspot
| State | Projected Supply Adequacy | Key Challenges | Areas Most Affected | Policy Response |
|---|---|---|---|---|
| Washington | Below national average | High living costs, rural gaps | Eastern rural counties | Expansion of nursing schools |
| Georgia | Significant shortage | Rapid population growth, limited pipeline | Southern Georgia, Atlanta metro | Rural recruitment programs |
| California | Large gap despite size | Staffing ratios, population growth | Central Valley, Northern CA | Expanded nurse residency |
| North Carolina | Growing shortage | Faculty limits, fast growth | Rural + urban hubs | Scholarship programs |
| Michigan | Ageing workforce | Rural access, economic strain | Northern rural areas | Workforce retention grants |
| Louisiana | Persistent shortage | Ageing nurses, high demand | Rural parishes | Loan forgiveness schemes |
| New Jersey | Competitive environment | Cross-state migration | Statewide, especially hospitals near NYC | Wage adjustments |
| South Carolina | Rising shortage | Retirements, coastal demand | Coastal & urban hubs | Education expansion |
Secondary Hotspots and Surprising Findings
Beyond the top-tier states, several others face less dramatic but still significant shortages. States like Alaska, South Dakota, and Idaho project challenges due to geographic isolation and small training pipelines. Texas, despite training many nurses, faces shortages in specific rural counties and border regions.
Interestingly, some states may show a surplus on paper. For example, Wyoming and Vermont may project adequate or even excess supply relative to demand. However, surpluses often mask local imbalances: rural counties may still lack nurses even if the state overall appears stable. This demonstrates why state-level data must always be paired with regional analysis.
Root Causes of Nursing Shortage Hotspots
The RN shortage by state is driven by a combination of national and local factors.
- Workforce Ageing: Many nurses are nearing retirement, with inadequate replacements entering the workforce.
- Education Bottlenecks: Faculty shortages and limited clinical sites reduce the number of students nursing schools can accept.
- Burnout and Attrition: Stressful working conditions, long shifts, and lack of support cause nurses to leave earlier than expected.
- Geographic Imbalances: Urban areas attract more nurses, leaving rural communities underserved.
- Policy and Pay Disparities: States with lower wages or less support lose talent to neighbouring regions.
- Population Growth: Fast-growing states require more health care staff to meet rising demand.
- Specialty Shortages: Critical care, geriatrics, and community health nursing roles are in highest demand, yet hardest to fill.
Impact on Care Delivery and Outcomes
The consequences of nursing shortages extend beyond staffing frustrations:
- Patient Safety Risks: Higher nurse-to-patient ratios increase the likelihood of errors and lower quality of care.
- Service Delays: Elective surgeries and routine procedures are postponed due to insufficient staff.
- Hospital Closures: Rural hospitals without enough nurses are forced to reduce services or shut down.
- Financial Strain: Hospitals spend heavily on travel nurses and overtime, diverting funds from innovation or expansion.
- Community Health Gaps: Chronic disease management and preventive care are undermined, widening health disparities.
Solutions: Short-, Medium-, and Long-Term
Short-Term (0–2 years)
- Deploy travel and agency nurses strategically.
- Offer retention bonuses, flexible shifts, and wellness support.
- Expand recruitment campaigns targeting recent graduates.
Medium-Term (2–5 years)
- Increase nursing school capacity by hiring faculty and opening simulation labs.
- Create accelerated programs for LPNs and associate-degree nurses to advance to BSN.
- Encourage multi-state licensure compacts to ease cross-border hiring.
Long-Term (5+ years)
- Invest in early pipeline programs encouraging high school students to pursue nursing.
- Redesign workforce models to integrate technology and team-based care.
- Strengthen federal and state funding for rural incentives, scholarships, and residencies.
Policy & Employer Action Checklist
| Action | Implementer | Timeframe | Expected Impact |
|---|---|---|---|
| Retention bonuses & flexible shifts | Hospitals | Short-term | Reduce immediate turnover |
| Expand faculty hiring | State/Schools | Medium | More student slots |
| Multi-state licensure compact | Legislators | Medium | Easier recruitment |
| Rural loan forgiveness | State/Federal | Long | Attract nurses to underserved areas |
| Tech-enabled workforce redesign | Systems/Providers | Long | Sustainable staffing |
What Facilities in Hotspot States Should Do Next
Health system leaders in shortage states should act now with a structured plan:
- Conduct an internal workforce audit to identify gaps.
- Partner with local nursing schools for direct pipelines.
- Invest in staff wellbeing and mental health support.
- Lobby state legislators for expanded nursing education funding.
- Build residency programs to retain graduates locally.
- Monitor KPIs such as vacancy rates, agency spend, and overtime usage.
Case Studies
Arkansas: Education Expansion
Arkansas invested in nursing education grants, expanding clinical slots and simulation facilities. Within three years, enrolments rose, reducing projected shortages and stabilising rural hospital staffing.
Mississippi: Rural Retention Struggles
Despite modest gains in urban centres, rural hospitals in Mississippi continue to close units due to staffing shortages. The state has responded with new loan repayment incentives, but retention remains challenging, highlighting the difficulty of long-term solutions.
Future Outlook
Projections are not destiny. States that invest in their nursing pipelines, retention strategies, and rural recruitment programs can shift outcomes. However, without decisive action, the RN shortage by state will deepen, creating widening gaps in patient care. Monitoring supply and demand trends every few years is essential to adjust strategies as health care evolves.
Must Read:
- Nursing Faculty Shortage & Educational Bottlenecks
- Nurses Aging Workforce & Mass Retirements
- Impact on Patient Care and Health Outcomes
Conclusion:
The nursing shortage hotspots across the United States reveal that the problem is not uniform but concentrated. States like California, Georgia, Washington, and Louisiana face steep gaps that demand urgent solutions. Rural regions across many states are at highest risk.
Policymakers, hospital leaders, and educators must act collaboratively, addressing short-term pressures while building long-term pipelines. Only with coordinated planning, investment, and support will states be able to close the gap and ensure patients have access to safe, high-quality nursing care in the years ahead.
