How to Fix the Nursing Shortage in the US: Current Situation at a Glance, Causes, and Actionable Nursing Shortage Solutions

by | Mar 14, 2025 | Blog

How to Fix the Nursing Shortage in the US

The US healthcare industry is suffering from a shortage of nurses at the local, state, and national levels. The COVID-19 pandemic and the continuing shift in population age trends have worsened the crisis, making it increasingly urgent for all stakeholders to take active steps to reduce disparities in nursing personnel allocations, turnover, and patient outcomes.

We will provide a comprehensive picture of the most recent nursing shortage rates, identify the key causes of the industry’s current state, and provide several actionable nursing shortage solutions that can be adopted at the workplace and higher levels.

Understanding the Ongoing US Nursing Shortage

Understanding the Ongoing US Nursing Shortage

The U.S. is expected to experience nursing shortages both in the short and long term, affecting national and state levels. The most severe shortages are projected in Georgia, California, and Washington, while North Dakota, South Dakota, and Utah have the highest surplus of nursing staff relative to demand. Rural and non-metropolitan areas face more significant staffing deficits than urban, suburban, and metropolitan regions, where nurse availability tends to be higher.

The United States faces a critical nursing shortage. Recent projections by the American Association of Colleges of Nursing (AACN) identify a deficit of up to 450,00 nurses in 2025. The trend is expected to hold over the next five years, with over 1 million Registered Nurses projected to retire by 2030, with the current median age for nurses being 52 years.

COVID-19 pandemic-related effects on the nursing force also accelerated resignations, peaking with a nurse workforce reduction of around 100,000 personnel within just one year. 

Nurse Shortage by Level of Certification

According to the Nurse Workforce Projections published by the Health Resources and Services Administration (HRSA) in November 2024, the US will face a 10% shortage of Registered Nurses in 2027, which will only decrease to a 6% shortage by 2037, given the same patterns in nurse attrition, graduation, and workforce participation hold over the decade. Similarly, the pool of Licensed Practical and Vocational Nurses (LPNs/LVNs) will only account for 80% of the demand in 2027 and 64% in 2037, amounting to a 20% shortage within two years and a 36% shortage over the decade, respectively. 

The only segment of the nursing workforce expected to exceed the demand in the short and long term is represented by Nurse Practitioners (NPs), with the main concern relating to graduate-level professionals being regional distribution discrepancies.

Impact of the Nursing Shortage

Shortages in nursing personnel have broad-ranging effects on all areas of the industry, including the currently active workforce, the costs of running hospital facilities, and the educational infrastructure needed for the industry’s continuity.

Strain on the Workforce and Reduced Patient Outcomes

The consequences of the current and future shortage of nursing professionals lead to an increased patient load and higher nurse-to-patient ratios. Hospital nurse staffing correlates with patient outcomes, and shortages can result in higher stress on currently working healthcare workers, a decline in the quality of care, and longer waiting times for patients in need of care.

Increased Hospital Costs

The Cost of Caring report from the American Hospital Association (AHA) highlights another effect of staff shortages: rising hospital costs. According to the AHA’s findings, 60% of a hospital’s total expenses are constituted by labor costs, which have significantly increased in recent years (over $42.5 billion in labor expenses from 2021 to 2023). 

With an increase in economy-wide inflation of 12.4% within the report’s timeframe, outpacing the 5.2% growth in Medicare reimbursement for hospital inpatient care, healthcare facilities have considerable financial strain. Workforce expenses, along with the cost of drugs and medical supplies, are among the leading contributing factors to economic challenges.

Extensive Reliance on Non-Full-Time Staff Nurses

Contract labor costs have also increased by 285% since 2019, with contract labor full-time equivalents increasing by 139% and median wages paid to contract staffing firms rising by 57%. Healthcare facilities are increasingly forced to rely on temporary and non-full-time professionals, such as Travel Nurses, whose contract costs are 3 to 4 times higher than full-time staff nurses.

Declining Educational Pipeline

Another considerable effect of shortages on the industry’s continuity is the declining educational pipeline. US nursing schools turned away 65,766 qualified applications from baccalaureate and graduate nursing programs in 2023 due to an insufficient number of faculty, clinical sites, classroom space, and clinical preceptors, as well as due to budget constraints, according to the 2023-2024 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing published by the AACN.

Main Causes of the US Nursing Shortage

Main Causes of the US Nursing Shortage

The nursing shortage in the US is driven by a multitude of structural and systemic factors, leading to higher personnel turnover, workforce gaps, and regional disparities.

Burnout and High Turnover

As the nurse-to-patient ratio continues to rise, the mental health and well-being of nurses take a nosedive, leading to increased levels of stress, fatigue, and burnout. According to a study by the National Institutes of Health (NIH) (2023, L. Aiken et al.), nurses who manage more than four patients per shift have a 23% higher risk of experiencing burnout.

The COVID-19 pandemic further increased the strain on the existing pool of nurses, accelerating turnover and departures, leading to approximately 100,000 nurses leaving the profession in one year alone (2021), according to the AACN. The National Nursing Workforce Study (NCSBN) further projects that an additional 610,388 nurses are planning to leave the profession by 2027.

Nurse Educator Shortage

The average age for faculty with doctoral degrees and master’s degrees is 62, and the average age for faculty with master’s degrees is 57, respectively. Many Nurse Educators are approaching retirement, according to the AACN’s Nursing Shortage Fact Sheet, leaving a gap in the educational pipeline that industry stakeholders and academic institutions primarily, may find hard to fill. Fewer educators, coupled with inappropriate funding for academic infrastructure, will reduce the number of new nursing graduates, further worsening the outcomes of the current nursing shortage.

This is why supporting the next generation of nurses is central to any set of nursing shortage solutions. At the Nightingale Foundation, we provide the necessary support for aspiring learners and current students alike. To tackle the gaps in education, we also run the Community Education Outreach program, which offers guidance, support, and the necessary resources to prospective nursing students as early as post-high school graduation. 

You can read more about what we do and how you can help.

Limited Clinical Training Opportunities

As patient loads remain historically high and the pool of nurses proves insufficient to fulfill current healthcare demands, hospitals and healthcare facilities struggle to accommodate and induct new nursing students, leaving aspiring nurses without opportunities to accrue valuable clinical experience.

Past and current educational gaps ripple throughout generations, leaving prospective learners without experienced mentors and educators who may lack the incentives and financial stability to continue teaching.

Additionally, the healthcare academic industry is slow to adopt new technologies that allow students to practice skills in a controlled environment. In the states where legislation permits some clinical hours to be replaced by simulation training, access to the necessary technology remains limited.

Wage Gaps and Compensation Issues

Wage disparities and issues with fair compensation persist in the nursing industry, contributing to shortages of nurses. Such gaps and issues discourage aspiring nurses and push currently affected workforce members to abandon the profession to pursue more equitable careers.

Despite nursing being a female-dominated profession, with women performing 77% of healthcare jobs in the United States, male nurses still earn consistently higher salaries. One 2023 study highlighted how, although gender wage gaps are decreasing over time for high-education healthcare positions (such as Physicians or Advanced Practitioners), they have stagnated or widened for lower-education, frontline roles. The latter are also the roles where non-white and non-traditional nurses are overrepresented, according to the Bureau of Labor Statistics (BLS), making diversity and inclusion in the nursing field more critical.

More critically, nursing personnel in teaching and instructional positions earn considerably less than others in similarly certified positions. According to the BLS, Postsecondary Nursing Instructors and Teachers earn $41,960 less annually than Nurse Practitioners ($86,530 per year, compared to $128,490 per year).

Geographic Imbalances

The gravity of nursing shortages varies significantly across the US, with rural and non-metropolitan areas experiencing more severe shortages than urban and suburban ones. According to the National Rural Health Association, around 77% of rural counties experience severe shortages, compared to 47% of urban counties. Many underlying factors contribute to rural vs. urban discrepancies, including lower salaries, limited professional opportunities, higher workloads, and fewer educational and training facilities in rural areas.

That is why part of the mission of the Nightingale Foundation is to help non-traditional students from underserved and underrepresented communities gain valuable education, both in accessibility and affordability. By lowering the bar and financial resources necessary for enrolling in nursing programs, we can bridge gaps in healthcare distribution and discrepancies in outcome quality.

Find out more about the scholarships provided by the Nightingale Foundation.

How to Fix the Nursing Shortage: Solutions and Case Studies

How to Fix the Nursing Shortage: Solutions and Case Studies

Developing and employing nursing shortage solutions in the United States requires a multifaceted approach involving educational enhancements, policy reforms, employer-driven retention strategies, and the adoption innovative practices within the nursing industry. Here are the main areas worth tackling through reliable and informed solutions to the nursing shortage:

Strengthening Nursing Education Programs

Reinforcing and developing nursing education programs is an essential part of the necessary nurse shortage solutions while also garnering a competent and diverse workforce. Part of this effort is providing aspiring learners with the appropriate guidance to obtain financial aid for nursing school.

The Nightingale Foundation is dedicated to enhancing access to nursing education, particularly for underserved and underrepresented populations. By offering various scholarships and support programs, the Foundation aims to eliminate financial barriers that prospective nursing students often face.

Discover the scholarships provided by the Nightingale Foundation.

Beyond financial assistance, the Nightingale Foundation engages in community education outreach programs targeting low-income and underserved school districts. These nursing shortage solutions aim to inspire and inform prospective students about nursing careers early in their educational journey, fostering a diverse and well-prepared nursing workforce.

By providing financial support and educational outreach, the Nightingale Foundation plays a pivotal role in strengthening nursing education programs and contributing to improved health outcomes and equity nationwide.

Learn more about what we do to help the next generation of nurses.

Federal and State Policy Actions

Actions to mitigate the ongoing nursing shortage must be taken at all levels, including the coordinated efforts of federal and state legislative bodies.

Government programs, such as the Nurse Corps Loan Repayment Program, which offers debt relief and aims to attract more nurses to serve in underserved areas, are critical to expanding and balancing nursing education and workforce development throughout the nation. Additionally, states are increasing funding for clinical training slots and providing tuition assistance to encourage more prospective learners to pursue nursing careers, according to the AACN.

Read our guide to getting financial aid for nursing school to explore government and employer funding options.

Employer-Led Retention Solutions

Healthcare organizations must also take active steps to implement measures to retain the existing nursing staff. Employer-led nursing shortage solutions should include offering competitive salaries, flexible scheduling, and mental health resources. Workplace institutions and employers can also provide tuition reimbursement and leadership development programs to support career advancement. Improvements in workplace culture and a reduction of unnecessary administrative burdens are some of the key factors in decreasing turnover rates.

An example of retention-focused strategies developed by employers is the case of the Mayo Clinic, which created retention programs focusing on professional development, mental health support, and financial incentives for nursing personnel. The Nurse Residency Program provides new graduates with mentorship, guidance, and hands-on training, with considerable effects on nurse turnover: the first-year retention rate for new nurses (often the lowest by work period) increased by 89%, faster than the national average (82%).

Innovation Adoption in the Nursing Industry

Technological advancements are transforming nursing practice. Telehealth integration has expanded patient populations’ access to care, especially in remote and previously inappropriately served areas. AI-driven staffing tools that optimize nurse scheduling can enhance efficiency and reduce burnout, thus fighting against some of the leading causes for nurses leaving the profession. Simulation-based training is also being utilized to address clinical placement shortages, providing realistic practice environments for nursing students.

One recent case study on integrating technology in healthcare environments comes from the Cleveland Clinic’s adoption of AI-driven staffing software to aid in predicting patient demand and optimizing nurse shifts. The development and utilization of the Virtual Command Center resulted in a 15% reduction in nurse overtime and an improved work-life balance for team members, which led to better job satisfaction and a lower personnel turnover.

Rural Health-Focused Strategies

Reducing differences across US states and between rural and urban areas is a must for the continuity of the industry on a national level. However, the modes of addressing differences in personnel distributions are as varied and far-reaching as the causes of said discrepancies; these can include adopting new technologies and technological methods within healthcare environments, promoting nursing education in disadvantaged communities, and developing plans that ensure better job satisfaction and reduce turnover.

We can take as a case study an initiative meant to address rural nursing shortages, the South Dakota Telehealth Initiative, which has expanded remote patient monitoring and virtual consultations across 20 underserved counties. By leveraging telehealth, the state has improved healthcare access while easing the burden on in-person staff. Another example of rural health-focused strategies is Avera Health’s telehealth expansion, which aids rural hospitals and clinics by providing remote specialty consultations and critical care support via its eCARE system. This program has helped stabilize healthcare services in remote areas and reduced the need for patient transfers to urban centers.

However, initiatives meant to provide solutions for more access to healthcare need to be coupled with robust programs that support the next generation of nurses, especially nurse leaders. As we understand the urgency felt by nursing environments, particularly in underserved and underrepresented communities, we aim to support aspiring learners from all walks of life in pursuing quality education in the most accessible way. The scholarships provided by the Nightingale Foundation provide critical material support to non-traditional nursing students. We aim to both promote excellence in the nursing field and reduce the negative impact associated with a lack of resources, poor access to quality education, or systemic bias.

Find out more about the scholarships offered by the Nightingale Foundation.

As we know that material support, as valuable as it is, can only take a prospective student so far, we also organize the Community Education Outreach program that works with schools from low-income and underserved districts across the country to offer educational outreach presentations and engage with potential students as early on as possible in their journey. The program provides education and materials and addresses learners’ financial needs and concerns regarding enrolling in a nursing program after graduation.

Learn more about what we do, how we try to support the nursing industry, and how you can support our efforts to enhance access to nursing education among underserved communities.

Next Steps for Securing the Future of the Industry and Reducing Nursing Shortage

Next Steps: The Future of Nurse Shortage Solutions

Although recent years have seen concerted efforts to “fix” the nursing shortage through various multi-faceted programs and initiatives, the healthcare industry and its stakeholders need to explore several next steps for mitigating projected shortages and the impact of increasing demand for quality care coupled with challenges to continuity:

  • Expansion of Financial Support Means for Nursing Education: Government and private stakeholders need to make efforts to increase the extent of scholarships, loan forgiveness programs, tuition reimbursement, and assistance from employers in order to attract more students to the profession and ensure solvency for new nurses. The scholarships awarded by the Nightingale Foundation are among such critical resources.
  • Upscaling of Residency and Mentorship Programs: With an expected reduction of both nursing faculty and experienced staff in the coming years, enhancements of transition-to-practice programs are a must for the improvement of nurse retention, job readiness, and quality of care.
  • Implementation and Improvement of Workforce Pipeline Initiatives: Partnerships between educational institutions (such as high schools, community colleges, and nursing schools) and healthcare providers and institutions can facilitate the continuity of the nursing workforce by encouraging early nursing career pathways. One such initiative is the Community Education Outreach program organized by the Nightingale Foundation.
  • Steps to Enhance the Conditions in the Workplace: Since lowered job satisfaction and increased levels of stress arising from overburdening and inequalities in the workplace are leading causes for nursing turnover, policies that reduce administrative burdens, improve nurse-to-patient ratios, and support the well-being of currently active personnel can ensure a more stable nursing pool. 
  • Leveraging Technology for Work Optimization: Technological advancements, such as AI solutions for scheduling, telehealth, or simulation-based training, have a proven positive effect on the improvement of working conditions and the turnout of new nurses. Well-planned and actionable initiatives that employ verified nursing shortage solutions should be part of a comprehensive plan to combat current trends.
  • Addressing Rural-Urban Disparities in Nursing Supply: Stakeholders should implement targeted incentives such as higher rural-area salaries, relocation bonuses, housing support, expansion in rural health education, and support for prospective nurses from underserved and underrepresented communities to increase the share of nurses working in rural, underdeveloped, and non-metropolitan areas. Additionally, telehealth programs and regional training partnerships can help bridge the staffing gap between metropolitan and non-metropolitan areas.

We believe that the activities and stated mission of the Nightingale Foundation, its Community Education Outreach programs, and the scholarships and financial support awarded to prospective non-traditional learners align both with the mission of resolving the nursing shortage and supporting the next generation of professionals and leaders in the industry. 

Find out how you can support our efforts to improve the nursing industry and guarantee a better future for nurses and patients alike.

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