Nursing Wiki

The Nursing Shortage

"Nursing shortage" is used for several different things: unfilled hospital posts, a projected gap between supply and demand, an ageing workforce, and a training system that cannot expand. They have different causes and different remedies, and one word covering all four makes the argument harder to follow than it needs to be.

What the evidence supports is narrower than the phrase suggests. Nurses are not scarce in the sense of not existing. Hospitals hired 377,650 registered nurses in a single year, so nurses are available and moving. The binding constraints are the age of the existing workforce, the capacity of the schools, and the ability of individual employers to compete for people who are already licensed.

What the vacancy numbers say

The annual hospital staffing survey put the registered nurse vacancy rate at 8.6 percent for 2025, the lowest of the decade, and the national shortage at 158,600 registered nurses. The typical hospital carried 43 unfilled registered nurse posts and took 78 days to fill one.

Those figures improved, and two cautions come with them. The survey changed how it calculates vacancy that year, so part of the improvement is methodological. And a national average hides an enormous spread: a third of hospitals are at 10 percent vacancy or higher, while one in six is below 5 percent. See nurse turnover and retention.

What makes those vacancies more than an administrative problem is the body of research linking staffing levels to patient mortality. See nurse staffing and patient outcomes.

What the official projections say

The federal occupational projections answer a different question from the vacancy rate, and the two get quoted against each other as though they conflict.

Registered nursing counted 3,465,400 jobs in 2025 and is projected to grow 6 percent by 2035, faster than the average across all occupations. The projection also expects about 180,800 openings a year on average over the decade, a figure far larger than the growth rate alone implies, because most openings come from nurses leaving the occupation or the labour force rather than from new posts being created. Advanced practice roles are projected to grow 36 percent over the same decade.

So the projections describe replacement demand on a very large scale, which is the same phenomenon the demographic data below shows from another angle. What they do not describe is whether a particular hospital can fill a particular post, which is what a vacancy rate measures. A workforce can grow every year and still leave individual employers short.

The demographic constraint

The national workforce survey, drawn from the licensure databases every two years, is the best available picture of who actually does this work. Its 2024 edition found the median registered nurse to be 50 years old, up from 46 two years earlier. The workforce aged four years in two.

That did not happen by everyone getting older. It happened at both ends. Nurses aged 55 or over went from 31.2 percent of the workforce to 39.9 percent, roughly the pre-pandemic share, as experienced nurses who stepped away during the pandemic came back. Nurses under 30 fell from 11.1 percent to 7.9 percent, and nurses under 35 from about 24 percent to 18 percent. The share of registered nurses licensed ten years or less reached its second-lowest level on record at 32 percent, while the share licensed more than 41 years reached its highest at 13 percent.

So the workforce stability welcomed in 2024 was substantially delivered by its oldest members returning. The survey is explicit that this may be temporary, depending on those nurses' revised retirement timelines.

Alongside it, 39.9 percent of working nurses said they planned to retire or leave nursing within five years: 21.9 percent to retire and 18.0 percent to leave for something else. The comparison with 28.7 percent in 2022 is not like-for-like, because the 2024 survey split a single answer option into those two, and the question went only to nurses currently working in nursing. The rise is almost certainly real, since it matches the age data, but the asterisk belongs with the number. Intent to leave is also not leaving: many nurses who said this in 2020 are still working.

Conditions improved over the same period. Burnout reported every day or a few times a week fell from 45.2 percent to 35.4 percent, and nurses saying they were at the end of their rope fell from 29 percent to 22 percent. The problem is not that nursing is becoming intolerable. It is that the people holding the workforce up are close to retirement. See nurse burnout.

The pipeline bottleneck is faculty pay

Demand for nursing school places is not the problem. Entry-level bachelor's enrolment rose 7.6 percent to 283,303 students, and 93,176 qualified applicants were turned away. Not rejected as unsuitable, but refused for want of capacity to teach them.

The reason is a pay gap. A master's-prepared nurse teaching in a school of nursing averages $82,762. The same qualification in clinical practice averages $132,050. That is $49,288 a year to do the job that produces every future nurse, and schools accordingly cannot fill faculty posts: the faculty vacancy rate stands at 7.2 percent.

The supply of future faculty is shrinking rather than growing. Doctoral enrolment in nursing has fallen for eleven consecutive years, to 4,077 students. Faculty shortages cannot be fixed quickly, because the fix requires people who spent years earning a doctorate to then accept a substantial pay cut, and every year the doctoral pipeline shrinks constrains class sizes a decade later. See the nurse faculty shortage for the retirement wave inside the teaching workforce.

Clinical placement capacity is the other limit on class size, and it sits with employers rather than with schools.

Fewer graduates are clearing the licensing exam

The first-time pass rate for United States-educated candidates on the registered nurse licensing examination fell from 91.2 percent to 86.7 percent, and deteriorated within the year from 89.1 percent in the second quarter to 81.2 percent in the fourth. For internationally educated candidates the first-time rate is 47.3 percent, down from 53.8 percent. See internationally educated nurses.

The examination did not get harder. The passing standard has been held since 2013, was reviewed again, and was kept unchanged, so this is not a scoring artefact. The same bar is being cleared by fewer people. No definitive explanation exists yet. Cohorts whose training was disrupted by the pandemic are still moving through, larger classes are being taught by stretched faculty, and clinical placement quality varies. Separating those will take more years of data.

The arithmetic matters regardless of cause. Enrolment up 7.6 percent against a pass rate down 4.5 points means the number of new nurses actually reaching the workforce is growing far more slowly than enrolment alone implies. Workforce plans built on enrolment figures are built on the wrong number.

The three entry routes to the registered nurse licence, and the long argument about the bachelor's degree as the entry standard, are covered under levels of nursing.

Leaving the hospital is not leaving nursing

One more distinction the word "shortage" obscures. The share of registered nurses working in hospitals fell from 57.5 percent to 53.3 percent in two years, and direct patient care as a primary role from 73 percent to 68.3 percent. Ambulatory care accounts for 11.5 percent, and the share teaching in schools of nursing rose from 2.1 percent to 3.2 percent.

Those nurses did not leave the profession. They left the building. To a hospital, a nurse moving to an outpatient clinic leaves exactly as vacant a shift as one who retired. To the profession it is a different problem entirely, and treating the two as one leads to the wrong remedy.

Long-term care sits at the sharp end of this, competing for the same nurses from a weaker position on pay and with almost no federal staffing floor to fall back on. See nursing home staffing requirements.

What follows from all of it

For the next several years most hospital hires will be experienced nurses moving from another employer rather than new graduates, because the new-graduate pipeline is capped by faculty capacity and thinned by licensure results. That makes the practical problem competitive rather than absolute: not whether nurses exist, but whether a given employer reaches them, hires them in less than 78 days, and keeps them past the first year. See nurse residency programs.

Sources

Find your next nursing job here

100% free for nurses. New jobs every day. Travel, per-diem, and permanent positions nationwide.

See something out of date? Sign in to suggest an edit.