The U.S. Nursing Shortage: A State-by-State Breakdown
- The demand for nurses continues to grow as nursing shortages across the country increase.
- The lack of educators, burnout, and an aging workforce are among the factors contributing to the national nursing shortage.
- The number of employed nurses in each state compared to its population creates a healthcare deficit.
Nursing has been an in-demand profession for years, with nearly every major hospital hiring for one of healthcare's most important roles. According to the U.S. Bureau of Labor Statistics (BLS), on average, around 195,400 openings for registered nurses are projected from 2021-2031. Many of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force, such as to retire.
As the baby-boom generation ages and overall population numbers increase, the demand for nurses continues to grow, especially due to the COVID-19 pandemic. This demand has led to the growth of the travel nursing industry—which, in turn, has added to the nursing shortages across the U.S.
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 as of August 2022 and compared it to state populations to illustrate the deficit 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.
U.S. Nurse-to-State Population Ratio
|Location||Employed Registered Nurses (2021)||State Population (2020)||Nurses Per 1,000 Population|
|District of Columbia||11,540||689,545||16.74|
Local Nurse Employment vs. National Nurse Employment
Major cities tend to always need more nurses, with most city hospitals offering dozens if not hundreds of open positions. The following lists show the lowest state and highest metropolitan local concentration nurse employment vs. national nurse employment.
States With the Lowest Local Concentrations of Nurse Employment
- Utah (.71 location quotient)
- Washington D.C. (.81 location quotient)
- Texas (.82 location quotient)
- Georgia (.83 location quotient)
- Virginia (.83 location quotient)
Metropolitan Areas With the Highest Concentrations of Local Nurse Employment
- Rochester, MN (3.66 location quotient)
- Bloomsburg Berwick, PA (3.04 location quotient)
- Morgantown, WV (2.52 location quotient)
- Durham — Chapel Hill, NC (2.25 location quotient)
- Ann Arbor, MI (2.20 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 areas tend to suffer more from nursing shortages due to the population density of major metros. Simply put, there are not enough new nurses graduating to properly manage the volume of people who need any level of medical care within most large cities.
Factors Contributing to the National Nursing Shortage
According to a study published in the National Library of Medicine, there are many factors contributing to the national nursing shortage, including:
- Lack of educators and schooling: Nursing school enrollment hasn't kept up with the pace of projected demand. And, there's a lack in the necessary number of nursing school faculty members. 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 others, 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.
Bernstein, L. (2021). As covid persists, nurses are leaving staff jobs — and tripling their salaries as travelers. https://www.washingtonpost.com/health/covid-travel-nurses/2021/12/05/550b15fc-4c71-11ec-a1b9-9f12bd39487a_story.html
Haddad, L, et al. (2022). Nursing shortage. https://www.ncbi.nlm.nih.gov/books/NBK493175/
Nursing shortage. (2020). https://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Shortage
U.S. Bureau of Labor Statistics, Occupational Outlook Handbook. (2021). Registered nurses. https://www.bls.gov/ooh/healthcare/registered-nurses.htm
U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics. (2021). Registered nurses. https://www.bls.gov/oes/current/oes291141.htm
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