Yes, the United States is experiencing a nursing shortage, and federal projections show it will persist for at least the next decade. The Bureau of Health Workforce projects an 8% shortfall of registered nurses by 2028, with demand outpacing supply by roughly 267,000 full-time positions. The gap narrows somewhat over time but doesn’t close. By 2038, the country is still projected to be short nearly 109,000 registered nurses.
The situation is even more severe for licensed practical and vocational nurses. Their projected shortfall grows steadily, reaching a point where supply meets only 70% of demand by 2038, a deficit of nearly 246,000 positions.
Why the Shortage Keeps Growing
The nursing shortage isn’t driven by a single cause. It’s the result of several forces compounding at once: an aging workforce, not enough nursing schools to train replacements, and working conditions that push experienced nurses out of the profession.
The age profile of the registered nursing workforce tells a clear story. According to the most recent federal survey, nearly 38% of registered nurses are 55 or older. That means well over a million nurses are at or approaching retirement age right now. As this wave of retirements accelerates over the next decade, the pipeline of new graduates isn’t large enough to replace them.
At the same time, demand for nursing care is climbing. The population over 65 is the fastest-growing age group in the country, and older adults require significantly more healthcare services. Chronic conditions like diabetes, heart disease, and dementia all require sustained nursing care, and the number of people living with these conditions rises each year.
Nursing Schools Can’t Keep Up
One of the most frustrating aspects of the shortage is that tens of thousands of people want to become nurses and are being turned away. In 2024, U.S. nursing schools rejected 80,162 qualified applicants from bachelor’s and graduate programs. These weren’t students who failed to meet admission standards. They were qualified candidates the schools simply couldn’t accommodate.
The bottleneck comes down to a shortage of nursing faculty. The professors who train nurses are aging out of the workforce themselves, and replacements are hard to find. Hospitals and private-sector employers pay significantly more than universities, so experienced nurses who might otherwise teach choose clinical work instead. Master’s and doctoral programs in nursing aren’t producing enough graduates to fill vacant faculty positions, and budget constraints at many schools prevent them from expanding even when demand is obvious.
Beyond faculty, schools face a shortage of clinical training sites, the hospitals and clinics where students get hands-on experience. Without enough placements, programs cap enrollment regardless of how many applicants they receive.
Some States Face a Much Deeper Crisis
The shortage doesn’t hit every part of the country equally. Some states face projected deficits that could reshape how healthcare is delivered in their communities. The ten states with the largest projected shortfalls by 2035 are:
- Washington (26% shortage)
- Georgia (21%)
- California (18%)
- Oregon (16%)
- Michigan (15%)
- Idaho (15%)
- Louisiana (13%)
- North Carolina (13%)
- New Jersey (12%)
- South Carolina (11%)
Rural areas within these states tend to fare worst. Nurses gravitate toward urban medical centers that offer higher pay, better resources, and more career advancement. Small-town hospitals and clinics often struggle to recruit and retain staff, leaving some communities with dangerously thin coverage.
What Low Staffing Means for Patients
The nursing shortage isn’t just an employment statistic. It directly affects the quality of care patients receive. A large study analyzing data from nearly 80,000 hospital patients found that shifts with low registered nurse staffing had 10% higher odds of patient death compared to adequately staffed shifts. Conversely, shifts with high RN staffing saw mortality odds drop by about 9%.
The relationship between staffing and outcomes is consistent and well documented. When nurses are stretched thin, they have less time to monitor each patient, catch early warning signs of deterioration, administer medications on schedule, and respond to emergencies. Medication errors increase. Falls increase. Infections that could have been prevented with proper monitoring go undetected until they become serious.
Understaffing also creates a vicious cycle. Overworked nurses experience burnout, which leads to more nurses leaving the profession, which worsens the staffing problem for those who remain. This turnover cycle is one reason the shortage has been so difficult to reverse.
Federal Staffing Rules Are Changing
The federal government has started to address the problem through regulation. The Centers for Medicare and Medicaid Services finalized a rule establishing minimum nurse staffing requirements for long-term care facilities, the first comprehensive federal standard of its kind. The rule requires at least 3.48 hours of total nursing care per resident per day, including a minimum of direct registered nurse care and direct nurse aide care. It also requires a registered nurse to be on-site around the clock, seven days a week.
These requirements apply specifically to nursing homes and long-term care settings. Hospitals do not yet face a comparable federal mandate, though California has maintained state-level nurse-to-patient ratio laws for years. The new federal rule is a significant step, but it also raises a practical question: where will the nurses come from to meet these minimums when the workforce is already stretched thin?
The Outlook Through 2038
Federal projections offer a mixed picture. The registered nurse shortage is expected to narrow gradually, from 92% adequacy in 2028 to 94% in 2033 and 97% by 2038. That improvement assumes current trends in nursing school graduation rates, workforce participation, and retirement patterns hold steady.
The licensed practical nurse shortage moves in the opposite direction. Supply drops from 83% of demand in 2028 to just 70% by 2038, a gap that widens every year. LPNs provide a significant share of care in nursing homes, home health settings, and rural clinics, so this growing deficit will hit some of the most vulnerable patient populations hardest.
Whether the overall shortage improves faster than projected depends largely on whether the country can expand nursing education capacity. That means funding more faculty positions, creating financial incentives for experienced nurses to teach, and expanding clinical training partnerships between schools and healthcare systems. Without those investments, the pipeline of new nurses will remain too narrow to meet the country’s growing healthcare needs.