Nursing Shortages in 2024: A State-by-State Breakdown

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Global consulting firm McKinsey & Company predicted in 2022 that the United States would see a shortfall of 200,000 to 450,000 registered nurses (RNs) for direct patient care by 2025. Quoting federal data, the American Hospital Association also announced in 2022 that an estimated half a million nurses would leave the profession by the end of that year, bringing the total shortage to 1.1 million. Those aren’t typos or simply statistics. Those are real numbers indicating that the demand for bedside nurses will outpace supply, with impacts felt within health systems across the nation. 

Nurses are crucial members of the patient care team and the foundation of the healthcare field. However, nursing shortages have plagued the profession for decades. The severity of these shortages varies by study and by state, but no matter how you slice it, the issue represents a critical challenge to our nation’s healthcare infrastructure. Based on currently available data, some states may experience a distinct shortage while others may actually see a surplus. Vivian Health dove into various data points to attempt to unravel how dire the looming nursing deficit might be in each state.

What’s Causing Nursing Shortages?

The continuing nursing shortage is a multifaceted crisis with deeply rooted systemic challenges and current issues with equally significant impacts. At its core, the nation’s aging population demands more healthcare services while the nursing workforce ages in parallel, leading to a monumental retirement wave. 

Concurrently, a persistent bottleneck in nursing education hindered by faculty shortages limits the number of new nurses entering the profession. Plus, increased stress and burnout exacerbated by the COVID-19 pandemic led to a substantial exodus of experienced nurses from the profession. 

10 Factors Contributing to Nurse Deficits

Each of the following factors contributes to the complexity of the nurse staffing struggle:

• Aging Population: The baby boomer generation, one of the largest generational cohorts, continues to age. By 2030, all baby boomers will be 65 or older, and as this substantial population segment ages, the demand for complex care and nurses to provide this care increases. 

• Aging Workforce: Like those they serve, the nursing workforce is also aging, with an estimated one million RNs retiring from the workforce between 2017 and 2030. The impending retirement of a large chunk of nurses threatens to sharply reduce the experienced nursing workforce in less than a decade. 

• Increased Burnout: Nurses are experiencing burnout at unprecedented levels due to high-stress environments, long hours and emotional demands of the job. The intense pressure has led to decreased job satisfaction, increased absenteeism and a significant number of nurses leaving or considering leaving the profession altogether. 

• Nurses Leaving Bedside Jobs: An increasing number of nurses are leaving high-stress bedside positions for alternative roles in healthcare or different industries altogether. Commonly cited reasons for nurses leaving the bedside include burnout, unsafe staffing ratios, inadequate support staff, being underpaid and underappreciated, the inability to take breaks or adequate days off and inadequate mental health resources. In February 2023, the National Library of Medicine reported that the average nursing turnover rate nationwide was 8.8% to 37%, depending on the specialty and geographic location. 

• Faculty Shortage: According to the American Association of Colleges of Nursing, nursing schools turned away nearly 92,000 qualified applicants for baccalaureate or graduate nursing programs in 2021. This number was the highest in decades and primarily due to capacity issues, including insufficient clinical sites, classroom space, faculty and clinical preceptors. Unfortunately, the salaries for faculty roles aren’t very competitive, making them less attractive to qualified instructors. 

• Affordable Care Act (ACA) Impact: The ACA’s expansion of healthcare coverage increased the demand for healthcare services, putting additional pressure on the nursing workforce to meet the needs of a larger patient population. 

• Growing Interest in Community-Based Care: The shift towards community-based care models demands more nurses outside traditional hospital settings, further stretching the available workforce. 

• Economic Incentives in Other Fields: Competitive wages and less stressful working conditions in other sectors lure away trained nurses who might otherwise remain in nursing careers or attract potential nursing professionals away from the field, reducing the number of entrants into nursing programs.

• Violence in the Healthcare Setting: The presence of emotional or physical abuse in healthcare settings further adds to an already stressful environment. Violence in nursing has become an ever-present threat, from psychological trauma to varying degrees of physical injury, including death. Healthcare workers are five times more likely to sustain an injury due to workplace violence than other professions.

• Physician Shortage:  The Association of American Medical Colleges (AAMC) foresees a shortage of between 37,800 and 124,000 physicians by 2034, including a projected shortfall of 17,000 to 48,000 doctors in general pediatrics, family medicine, geriatric medicine and similar primary care specialties. A shortage of physicians increases the need for nursing staff to shoulder the additional workloads and responsibilities and heightens the demand for advanced practice nurses impacted by strained educational resources.

RELATED: Can Virtual Nursing Address the Post-Pandemic Nursing Shortages?

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Projected RN Shortages by State Through 2030

Breaking down the national shortage by state, some states might have a shortage of nurses and lower growth potential, while others might have a surplus. Unfortunately, the most recent published reports providing a state-by-state breakdown use data from before the COVID-19 pandemic significantly impacted healthcare professionals. These reports also don’t account for the nurses who left the profession during or shortly after this severe nationwide crisis. 

For this update, we utilized projections from the Health Resources and Services Administration’s (HRSA) Bureau of Health Workforce (BHW), which looked at each state’s projected 2030 RN supply minus demand to reveal state-level shortages and surpluses. The following table ranks states from largest shortage to largest surplus.

Keep in mind that these projections are technically outdated. While the table below indicates that only 7 states can expect shortages based on this report, preliminary data in the upcoming version includes several more. Also, state-by-state projections for registered nursing shortages aren’t uniform between sources, so you may see your state with an overage on one report and a shortage on another.

State	2030 Supply	2030 Demand	Difference	% Deficit / Surplus
Alaska	18,400	23,800	-5,400	-22.7%
South Carolina	52,100	62,500	-10,400	-16.6%
South Dakota	11,700	13,600	-1,900	-14.0%
California	343,400	387,900	-44,500	-11.5%
New Jersey	90,800	102,200	-11,400	-11.2%
Texas	253,400	269,300	-15,900	-5.9%
Georgia	98,800	101,000	-2,200	-2.2%
Arizona	99,900	98,700	1,200	1.2%
Montana	12,300	12,100	200	1.7%
Massachusetts	91,300	89,300	2,000	2.2%
Illinois	143,000	139,400	3,600	2.6%
Minnesota	71,800	68,700	3,100	4.5%
Louisiana	52,000	49,700	2,300	4.6%
Pennsylvania	168,500	160,300	8,200	5.1%
New Hampshire	21,300	20,200	1,100	5.4%
Michigan	110,500	104,400	6,100	5.8%
Oregon	41,100	38,600	2,500	6.5%
Alabama	85,100	79,800	5,300	6.6%
North Dakota	9,900	9,200	700	7.6%
Washington	85,300	79,100	6,200	7.8%
Wisconsin	78,200	72,000	6,200	8.6%
Connecticut	43,500	40,000	3,500	8.8%
New York	213,400	195,200	18,200	9.3%
Delaware	14,000	12,800	1,200	9.4%
Tennessee	90,600	82,200	8,400	10.2%
Oklahoma	46,100	40,600	5,500	13.5%
North Carolina	135,100	118,600	16,500	13.9%
Utah	33,500	29,400	4,100	13.9%
Colorado	72,500	63,200	9,300	14.7%
Maryland	86,000	73,900	12,100	16.4%
Nebraska	24,700	21,200	3,500	16.5%
Indiana	89,300	75,300	14,000	18.6%
Kentucky	64,200	53,700	10,500	19.6%
Hawaii	19,800	16,500	3,300	20.0%
Rhode Island	15,000	12,500	2,500	20.0%
Vermont	9,300	6,800	2,500	20.0%
Mississippi	42,500	35,300	7,200	20.4%
West Virginia	25,200	20,800	4,400	21.2%
Florida	293,700	240,000	53,700	22.4%
Missouri	89,900	73,200	16,700	22.8%
Idaho	18,900	15,300	3,600	23.5%
Virginia	109,200	86,500	22,700	26.2%
Maine	21,200	16,500	4,700	28.5%
Iowa	45,400	35,300	10,100	28.6%
Arkansas	42,100	32,300	9,800	30.3%
Nevada	33,900	25,800	8,100	31.4%
Kansas	47,500	34,900	12,600	36.1%
Ohio	181,900	132,800	49,100	37.0%
New Mexico	31,300	21,600	9,700	44.9%
Wyoming	8,300	5,500	2,800	50.9%

Source: HRSA Supply and Demand Projections of the Nursing Workforce: 2014-2030

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Projected Demand for Registered Nurses

To understand how the COVID-19 pandemic might have impacted the shortage vs. surplus projections listed in HRSA’s report above, let’s look at how it impacted supply between 2020 and 2022. The National Council of State Boards of Nursing’s (NCSBN) research revealed that about 100,000 RNs left the workforce over a two-year period during the pandemic nationwide. To help determine the impact on a state level, we compared the number of employed RNs in 2020 and those employed in 2022 to see which states lost nurses over these two years instead of gaining nurses as they should have.

State	Employed in 2020	Employed in 2022	Amount Change
Maryland	71,390	49,790	-21,600
Pennsylvania	147,280	137,970	-9,310
Oklahoma	39,130	30,320	-8,810
Minnesota	71,780	63,800	-7,980
Nebraska	27,670	19,870	-7,800
Illinois	136,640	129,390	-7,250
New York	197,160	190,470	-6,690
New Jersey	83,660	78,340	-5,320
Oregon	41,000	37,400	-3,600
Wisconsin	64,590	61,100	-3,490
Tennessee	64,280	60,840	-3,440
South Carolina	47,050	44,030	-3,020
Missouri	73,330	70,440	-2,890
New Mexico	18,740	15,910	-2,830
Arizona	58,480	56,040	-2,440
Utah	24,840	22,830	-2,010
Alabama	51,280	49,370	-1,910
Idaho	15,350	13,680	-1,670
Rhode Island	12,680	11,190	-1,490
Michigan	102,590	101,470	-1,120
Ohio	131,400	130,370	-1,030
Colorado	53,100	52,390	-710
Montana	10,680	10,020	-660
New Hampshire	14,010	13,510	-500
West Virginia	21,550	21,110	-440
Kansas	30,920	30,520	-400
Maine	14,950	14,610	-340
Connecticut	34,470	34,290	-180
Delaware	11,660	11,490	-170
Nevada	24,040	23,970	-70
Wyoming	5,080	5,070	-10
Vermont	6,920	6,930	10
Hawaii	11,770	11,800	30
Mississippi	29,270	29,370	100
Indiana	66,740	67,350	610
South Dakota	13,440	14,360	920
Iowa	33,110	34,050	940
Alaska	5,680	6,730	1,050
District of Columbia	10,580	11,820	1,240
North Dakota	10,060	11,300	1,240
Kentucky	43,320	44,970	1,650
California	323,900	325,620	1,720
Louisiana	41,940	43,790	1,850
North Carolina	102,150	104,300	2,150
Virginia	67,340	69,510	2,170
Arkansas	25,890	28,490	2,600
Washington	61,560	64,920	3,360
Massachusetts	87,860	94,100	6,240
Florida	189,120	197,630	8,510
Georgia	73,180	82,970	9,790
Texas	220,980	231,060	10,080

Source: CareerOneStop: Current Employment (2022) vs. 2020 Employment

The BLS estimates that nationwide employment of RNs was 3,172,500 in 2022, with projected employment of 3,349,900 by 2032, resulting in a 6% increase and 193,100 job openings annually. The new projections for RN employment from 2022 to 2032 will likely be higher than the 2020 – 2030 projections.

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Highest and Lowest RNs per Capita by State

To further determine where shortages might occur, we also looked at the number of RNs per capita by state to see which states had more employed RNs available for the current population in 2202. In this instance, per capita means the number of nurses for every 1,000 persons in the population.

Using the most recent (2022) data from the USDOL and U.S. Census Bureau, we calculated RN per capita for each state and ranked them from lowest to highest. Keep in mind the national average in 2022 was 9.22 RNs per resident. We consider any state with a number below the national average to have a shortage. 

State	Employed RNs (2022)	Population (2022)	RNs per 1,000 Residents
United States	3,072,670	333,287,557	9.22
Utah	22,830	3,380,800	6.75
Idaho	13,680	1,939,033	7.06
New Mexico	15,910	2,113,344	7.53
Oklahoma	30,320	4,019,800	7.54
Nevada	23,970	3,177,772	7.54
Georgia	82,970	10,912,876	7.60
Arizona	56,040	7,359,197	7.61
Texas	231,060	30,029,572	7.69
Virginia	69,510	8,683,619	8.00
Maryland	49,790	6,164,660	8.08
Hawaii	11,800	1,440,196	8.19
South Carolina	44,030	5,282,634	8.33
Washington	64,920	7,785,786	8.34
California	325,620	39,029,342	8.34
New Jersey	78,340	9,261,699	8.46
Tennessee	60,840	7,051,339	8.63
Wyoming	5,070	581,381	8.72
Oregon	37,400	4,240,137	8.82
Florida	197,630	22,244,823	8.88
Montana	10,020	1,122,867	8.92
Colorado	52,390	5,839,926	8.97
Alaska	6,730	733,583	9.17
Arkansas	28,490	3,045,637	9.35
Connecticut	34,290	3,626,205	9.46
Louisiana	43,790	4,590,241	9.54
New York	190,470	19,677,151	9.68
New Hampshire	13,510	1,395,231	9.68
Alabama	49,370	5,074,296	9.73
North Carolina	104,300	10,698,973	9.75
Indiana	67,350	6,833,037	9.86
Kentucky	44,970	4,512,310	9.97
Mississippi	29,370	2,940,057	9.99
Nebraska	19,870	1,967,923	10.10
Michigan	101,470	10,034,113	10.11
Rhode Island	11,190	1,093,734	10.23
Illinois	129,390	12,582,032	10.28
Wisconsin	61,100	5,892,539	10.37
Kansas	30,520	2,937,150	10.39
Maine	14,610	1,385,340	10.55
Pennsylvania	137,970	12,972,008	10.64
Iowa	34,050	3,200,517	10.64
Vermont	6,930	647,064	10.71
Ohio	130,370	11,756,058	11.09
Minnesota	63,800	5,717,184	11.16
Delaware	11,490	1,018,396	11.28
Missouri	70,440	6,177,957	11.40
West Virginia	21,110	1,775,156	11.89
Massachusetts	94,100	6,981,974	13.48
North Dakota	11,300	779,261	14.50
South Dakota	14,360	909,824	15.78
District of Columbia	11,820	671,803	17.59

Sources: U.S. Department of Labor and U.S. Census Bureau

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Some States May See Balancing of Supply and Demand

Despite the current unknowns as to potential shortages and surpluses of RNs nationwide, some states have indicated that they’re starting to see a balancing of supply and demand.

For example, California had a projected shortfall of 11.5% by 2030, per the HRSA report above. However, its 2022 Forecasts of the Registered Nurse Workforce in California report created by the University of California, San Francisco, and supported by the California Board of Registered Nursing, noted an expected gap of 6.2% by the end of that year. However, the report predicted that RN shortages would persist only until 2029 when supply and demand became balanced. By 2037, the state projects a nursing surplus of 8.1%.

Conversely, data within Alaska indicates the state will continue grappling with shortcomings in its nursing staff. It had the highest deficit of RNs in the HRSA’s 2014-2030 report at 22.7% but didn’t rank in the top 10 states in its upcoming 2020-2035 projections.

Despite this change, the Alaska Healthcare Workforce Analysis published in December 2022 stated that RNs are the top category needing new healthcare workers annually to keep up with resulting needs. Based on its average quarterly count in 2021, the state had 6,995 RNs, with an average churn of 21%. The state needs 1,463 new workers for replacements, plus 81 more for growth, creating a total of 1,544 new RNs needed each year.

Historically, Alaska has found it challenging to attract and retain skilled nurses and other medical professionals, with the pandemic exacerbating the situation. For nurses seeking job security, the Last Frontier can definitely help them fulfill that goal. Besides RNs, LPNs will also feel a projected shortage of 36%.

According to the 2022 Alaska Hospital and Healthcare Association Salary and Benefits Report, hospital RN vacancy rates averaged 24% in 2022, with an average of 161 days to fill a vacant position. Travel nursing jobs in Alaska are typically abundant to help fill the staffing gaps in hospitals, nursing homes and assisted living facilities, with above-average travel RN salaries.

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Is There Really a Nursing Shortage?

Some organizations and nursing unions insist that the nation has plenty of registered nurses licensed, just not enough of them actively practicing. While recurrent shortages of RNs have been reported for decades, there isn’t any objective measure of whether a labor shortage truly exists (though many RNs attest to routine staffing shortages in their workplaces).

Although rising RN vacancy rates suggest a shortage, higher than usual vacancies may arise temporarily, such as when there’s a particularly bad flu season, transient demand due to seasonality or when an area builds a new hospital. Health systems may also post vacancies without actively seeking to fill these positions.

Per the Oregon Hospital Association’s 2020 Nursing Workforce Data File, the state had 59,778 licensed RNs that year. However, only about 75% were actively practicing. The lower number of practicing nurses versus licensed nurses also occurred in other nursing positions, with about 86% of CNAs, 83% of LPNs and 78% of APRNs actively practicing in their fields during this period compared to the number licensed. 

At the end of 2022, the NCSBN recorded more than 5.3 million active RN licenses nationwide. However, holding a license doesn’t necessarily mean all these professionals are actively working as bedside nurses. They may be retired, hold multiple single-state licenses to work as travel nurses or have found ways to use their nursing credentials in ways that don’t require them to provide direct patient care, such as teaching, consulting or writing. 

The shortage of RNs may be even more severe if you subtract the number of nurses with an active license who aren’t actually practicing. We compared the number of actively licensed nurses by state based on 2022 NCSBN records versus employed RNs based on 2022 USDOL records below.

State	Actively Licensed RNs in 2022 per NCSBN	Employed RNs in 2022 per USDOL	Difference
Alabama	98,929	49,370	49,559
Alaska	16,885	6,730	10,155
Arizona	107,827	56,040	51,787
Arkansas	46,069	28,490	17,579
California	497,668	325,620	172,048
Colorado	85,041	52,390	32,651
Connecticut	89,876	34,290	55,586
Delaware	21,199	11,490	9,709
District of Columbia	36,368	11,820	24,548
Florida	361,134	197,630	163,504
Georgia	140,535	82,970	57,565
Hawaii	33,322	11,800	21,522
Idaho	28,778	13,680	15,098
Illinois	213,163	129,390	83,773
Indiana	128,358	67,350	61,008
Iowa	57,757	34,050	23,707
Kansas	53,240	30,520	22,720
Kentucky	73,649	44,970	28,679
Louisiana	65,627	43,790	21,837
Maine	28,803	14,610	14,193
Maryland	87,672	49,790	37,882
Massachusetts	168,951	94,100	74,851
Michigan*	169,808	101,470	68,338
Minnesota	129,302	63,800	65,502
Mississippi	52,437	29,370	23,067
Missouri	122,150	70,440	51,710
Montana	21,792	10,020	11,772
Nebraska	31,180	19,870	11,310
Nevada	56,601	23,970	32,631
New Hampshire	26,654	13,510	13,144
New Jersey	142,471	78,340	64,131
New Mexico	31,667	15,910	15,757
New York	386,331	190,470	195,861
North Carolina	154,397	104,300	50,097
North Dakota	17,440	11,300	6,140
Ohio	239,491	130,370	109,121
Oklahoma	50,453	30,320	20,133
Oregon	80,932	37,400	43,532
Pennsylvania	245,377	137,970	107,407
Rhode Island	29,294	11,190	18,104
South Carolina	79,061	44,030	35,031
South Dakota	19,672	14,360	5,312
Tennessee	113,294	60,840	52,454
Texas	380,867	231,060	149,807
Utah	44,154	22,830	21,324
Vermont	22,020	6,930	15,090
Virginia	116,181	69,510	46,671
Washington	126,460	64,920	61,540
West Virginia	34,492	21,110	13,382
Wisconsin	118,015	61,100	56,915
Wyoming	9,594	5,070	4,524

Sources: NCSBN, USDOL and Michigan Nurse Mapping Project
(*Michigan wasn’t participating in the Nursys Licensure Verification system in 2022, so we used data from the Michigan Nurse Mapping Project from the Michigan Public Health Institute)

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New Nursing Shortages Data Due Soon

A new HRSA report covering nurse workforce projections for 2020-2035 is expected soon but remains unavailable at this publication. However, preliminary data released via a brief in November 2022 already indicates a significant shift from the previous calculations listed above, including many more states having nurse staff deficits and at much higher rates. While it still predicts a surplus nationally in 2035, these estimates still utilize data from 2020, so the full impact of the pandemic still isn’t reflected. More accurate estimates won’t be possible until several more years of data become available.

However, even with a nationwide surplus, shortages and surpluses among states in 2035 still fluctuate, ranging from the largest shortage of 26% in Washington to the most significant oversupply of 48% in North Dakota. From the details available, the 10 states with the most significant shortfalls in nursing staff in 2035 include: 

• Washington (26%)
• Georgia (21%)
• California (18%)
• Oregon (16%)
• Michigan (15%)
• Idaho (15%)
• Louisiana (13%)
• North Carolina (13%)
• New Jersey (12%)
• South Carolina (11%)

Details for the remaining states haven’t been released as of February 6, 2024.

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What About Other Nurses?

According to the BLS, 59% of RNs worked in hospitals in 2022, compared to just 15% of LPN/LVNs. Nearly half of licensed practical/vocational nurses worked in nursing and residential care facilities or home healthcare services during this period.

While most research focuses on registered nurse shortages, the 2022 report on Nurse Workforce Projections from the HRSA projects that the demand for LPN/LVNs will also grow faster than the supply. It estimates a national shortage of 141,580 LPN/LVNs by 2035 as demand between 2020 and 2035 outpaces the projected supply, resulting in a shortage of 17% overall compared to a 5% shortage in 2025.

Like RNs, the actual shortage or surplus of LPN/LVNs varies by state. According to the HRSA report, Alaska will be hardest hit with an 88% shortage of LPNs, while Arkansas will see a surplus of 51% by 2035. Also notable is that NCSBN research indicates that LPN/LVNs have seen their ranks decline by 33,811 since the pandemic began, and this downward trend continues. 

How Nurse Demand and Shortages Impact You

Bear in mind that many factors can impact supply and demand, so a projected surplus can quickly become a shortage and vice versa. Also, different studies may result in differing outcomes based on the parameters used for each, and projections assume that historical patterns of graduation, labor force participation and departure from the labor force remain unchanged over the entire forecast period.

Many issues can impact whether parameters stay the same over a decade, which is why annual updates are necessary. As new data becomes available, Vivian will update this post to reflect current trends.

There will always be a constant need for healthcare services and registered nurses and other nursing professionals to provide these services. Whether you’re a travel nurse or a staff nurse looking for a change of scenery, knowing which states expect to have a surplus of nurses versus those facing shortages can help narrow your options.

States with nursing shortages will likely pursue recruitment strategies beneficial to nurses, such as offering higher salaries, better benefits, flexible scheduling and other incentives to attract nurses to the area. On the flip side, states with a surplus of nurses may not offer the most competitive wages.

Some healthcare employment locations have historically paid more than others with or without a shortage. However, higher costs of living often offset these inflated salaries. When comparing your relocation or travel assignment options, make sure the salary is a livable wage.

Vivian Health had nearly 93,000 staff, travel, local contract, per diem and locum tenens jobs posted for registered nurses in February 2024. Browse healthcare jobs to plan your next career move faster and easier than ever on Vivian.

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Editor’s Note: This blog post was originally published in October 2021, and has been updated annually to reflect the most recent data.