The U.S. Nursing Shortage: A State-by-State Breakdown

• Nursing shortages continue to affect every state, especially in the southwestern U.S.
• A lack of educators, more nurses leaving the workforce, and the rising demand for healthcare is driving the shortage.
• These factors combine to create a cycle, with overwork leading to more burnout.

The nursing shortage in the U.S. is still a concern. A lack of nurse educators keeps nursing schools from being able to admit enough students to address the shortfall. A shortage of nurses means more burnout and more nurses choosing to leave the profession, contributing to the shortage.

In addition, the aging of Baby Boomers means that more nurses are retiring at a time when an aging population has a greater need for healthcare providers. The COVID-19 pandemic exacerbated the nursing shortage. Learn more about the nursing shortage by state and what legislators are doing to address it.

To best understand the shortage on a national scale, we gathered the most recent available data on the number of registered nurses employed in each state from the U.S. Bureau of Labor Statistics (BLS). We then compared these figures to state population estimates to illustrate the nursing shortage on a state-by-state basis. The table below provides a ranking of states, starting with those with the lowest nurse-to-state population ratios.

Local Nurse Employment vs. National Nurse Employment

Major cities with higher populations tend to always need more nurses, with most city hospitals offering many open positions. According to data from the BLS, the following five states have the lowest local concentrations of nurse employment vs. national nurse employment:

1. Utah (0.68 location quotient)
2. District of Columbia (0.82 location quotient)
3. Nevada (0.82 location quotient)
4. Idaho (0.83 location quotient)
5. Texas (0.86 location quotient)

Metropolitan areas tend to maintain the highest location quotients of local nurse employment to national nurse employment:

1. Bloomsburg Berwick, Pennsylvania (3.14 location quotient)
2. Morgantown, West Virginia (2.90 location quotient)
3. Rochester, Minnesota (2.77 location quotient)
4. Ann Arbor, Michigan (2.37 location quotient)
5. Iowa City, Iowa (2.26 location quotient)

From the BLS data: The location quotient is the ratio of the area concentration of occupational employment to the national average concentration. A location quotient greater than one indicates the occupation has a higher share of employment than average, and a location quotient less than one indicates the occupation is less prevalent in the area than average.

Larger cities tend to suffer more from nursing shortages due to higher population densities. Simply put, there needs to be more new nurses entering the field to properly manage the volume of people who need healthcare within most large cities.

Factors Contributing to the National Nursing Shortage

According to StatPearls there are many factors contributing to the national nursing shortage, including:

• Lack of educators and schooling: Nursing school enrollment hasn't kept up with projected demand. There's also a need for more nursing school instructors. Without enough teachers, thousands of people interested in joining the nursing workforce are unable to do so without degrees.
• High turnover: For years, nurse turnover has climbed at a steady rate. In some cases, nursing graduates quickly enter the workforce and find that the profession is not what they anticipated. In other scenarios, nurses may work for a while, experience burnout, and leave the profession.
• An aging workforce: The rate of retirement for nurses is growing rapidly, as over half of the RN workforce is currently over 50 years old.

State legislators are addressing the nursing shortage. Hospitals and schools are also taking action to combat the nursing shortage and prevent a future deficit.