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

By Rob Toledo



Nursing has been an in-demand profession for years, with nearly every major hospital hiring for one of healthcare's most important roles. In 2019, it ranked as the third-most in-demand job of any profession in the United States, and this trend shows no signs of slowing down.

As the baby-boom generation continues to age and overall population numbers increase, the demand for nurses continues to grow -- especially in times of crisis like 2020's COVID-19 outbreak. However, the gap between available jobs and people graduating nursing school continues to expand.

To best understand the shortage on a national scale, we gathered the most recent available data on the number of nurses in each state from the Bureau of Health Workforce database 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
  Total Nurses (2018) State Population (2019) Nurses Per 1,000 Population
USA total 3,956,080 328,055,000 12.06
South Carolina 40,600 5,149,000 7.89
Nevada 28,400 3,080,000 9.22
California 365,500 39,512,000 9.25
Texas 279,000 28,996,000 9.62
Georgia 108,600 10,617,000 10.23
Washington 78,100 7,615,000 10.26
Arizona 75,600 7,279,000 10.39
Rhode Island 11,000 1,059,000 10.39
Virginia 89,800 8,536,000 10.52
Idaho 18,800 1,787,000 10.52
Utah 33,900 3,206,000 10.57
Montana 11,500 1,069,000 10.76
New Jersey 97,100 8,882,000 10.93
Oregon 46,500 4,218,000 11.02
New Mexico 23,200 2,097,000 11.06
Oklahoma 44,200 3,957,000 11.17
Maryland 68,300 6,046,000 11.3
Colorado 66,100 5,759,000 11.48
North Carolina 120,600 10,488,000 11.5
Louisiana 54,000 4,649,000 11.62
Arkansas 36,700 3,018,000 12.16
New York 238,300 19,454,000 12.25
Illinois 157,400 12,672,000 12.42
Florida 272,400 21,478,000 12.68
Alabama 62,700 4,903,000 12.79
Nebraska 25,000 1,934,000 12.93
Tennessee 92,000 6,833,000 13.46
New Hampshire 18,400 1,360,000 13.53
Kentucky 61,000 4,468,000 13.65
Michigan 137,500 9,987,000 13.77
Mississippi 41,300 2,976,000 13.88
Alaska 10,200 732,000 13.93
Hawaii 20,000 1,416,000 14.12
South Dakota 12,500 885,000 14.12
Iowa 46,180 3,155,000 14.64
Kansas 42,900 2,913,000 14.73
Connecticut 52,600 3,565,000 14.75
West Virginia 26,600 1,792,000 14.84
Indiana 97,200 6,484,000 14.99
Pennsylvania 193,200 12,802,000 15.09
Missouri 92,900 6,137,000 15.14
Wisconsin 88,500 5,822,000 15.2
Ohio 184,000 11,689,000 15.74
Minnesota 89,000 5,640,000 15.78
Maine 21,500 1,344,000 16
Massachusetts 111,500 6,950,000 16.04
Delaware 15,800 974,000 16.22
North Dakota 12,500 762,000 16.4
Vermont 11,000 624,000 17.63
Washington DC 13,000 706,000 18.41
Wyoming 11,500 579,000 19.86

Nurses Per 1,000 Population - State-By-State

Major cities tend to perpetually need more nurses, with most city hospitals offering dozens if not hundreds of open positions. According to data from the Bureau of Labor Statistics, the following five states have the lowest local concentrations of nurse employment vs. national nurse employment:

  • Washington D.C. (.67 location quotient)
  • Dallas, Texas (.82 location quotient)
  • Los Angeles, California (.88 location quotient)
  • Houston, Texas (.88 location quotient)
  • New York City, New York (.89 location quotient)

Mid-sized cities tend to maintain the highest location quotients of local nurse employment to national nurse employment:

  • Greenville, North Carolina (2.25 location quotient)
  • Ann Arbor, Michigan (2.05 location quotient)
  • Sioux Falls, South Dakota (1.98 location quotient)
  • Durham-Chapel Hill, North Carolina (1.95 location quotient)
  • Gainesville, Florida (1.94 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 nursing school to properly manage the volume of people who need any level of medical care within most large cities.

The American Association of Colleges of Nursing attributes the national shortage to four main reasons:

  • Nursing school enrollment is not keeping pace with projected demand. Even though enrollment is up, it's not keeping pace with the increase in need for nursing services.
  • We lack 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.
  • The rate of retirement for nurses is growing rapidly, as over half of the RN workforce is currently over 50 years old.
  • An aging population in the United States continues to drive more demand than ever seen for nursing services.