The Nursing Shortage Explained

What Is the Nursing Shortage?

The nursing shortage is a growing problem in the United States, with the  U.S. Bureau of Labor Statistics (BLS) projecting that a 6% growth rate in the demand for registered nurses will result in a need for 3.3 million nurses by 2031. But, how much of that will need will actually be met?

Unfortunately, the Covid-19 pandemic has only exacerbated this issue as front-line nurses feel the strain of increased workloads and decreased staffing levels. This has led to higher rates of nurse burnout due to long hours and high-stress levels.

The nursing shortage is impacting the care that nurses are able to provide for patients and stretching their ability to cope with having to do more work with less help. 

But why is there a nursing shortage? And can anything be done about it? Keep reading to learn about the causes and possible solutions of the nursing shortage based on findings from our own 2023 State of Nursing report and other findings from the AACN. 

>> Download the 2023 State of Nursing Report

Why Is There a Nursing Shortage?

According to the American Association of Colleges of Nursing (AACN), the nursing shortage is a chronic and escalating problem created by several interrelated factors:

1. Nursing school enrollment not keeping up with the demand for nurses
2. Shortage of nurse faculty restricting nursing school enrollments
3. A large number of nurses are retiring or approaching retirement
4. Increase in the aging population and therefore nursing services
5. Insufficient staffing causes nurses to leave the profession

Interestingly, many of the top reasons nurses cited as causes of the nursing shortage are not included in the AACN’s list.  When asked “What do you think are the primary causes of the nursing shortage?” these were the most popular responses from the 2023 State of Nursing survey:

1. Nurses are burned out - 74%
2. Poor working conditions - 58%
3. Inadequate pay for nurses - 57%
4. Lack of appreciation for nurses - 34%

The greater number of patients due to an aging population, changes to the medicare/healthcare system, and lack of nursing school educators/faculty got the least amount of responses from nurses. Indicating that, while these systemic factors may be contributing to the overall nursing shortage, that’s not what nurses are feeling on a day-to-day basis, and not what’s ultimately prompting many nurses to think about leaving the bedside, or even the profession altogether.

Is the Nursing Shortage Getting Worse? 

While a nursing shortage has existed for decades, 91% of nurses believe the nursing shortage is getting worse. Other reports support this as well.

For example, a 2022 report by McKinsey consulting and advisory firm warns that the “nursing shortage will become dire by 2025” due to a projected shortage of 200,000 to 450,000 nurses—roughly 10% to 20% of the nurses required to provide all patient care.

Already some nurses describe having to “ration care” due to inadequate nurse-patient ratios so they can focus on keeping patients “alive”, often at the expense of meeting patients’ other basic needs such as helping them with a much-needed bath.

How Do We Solve the Nursing Shortage?

When asked “What do you think would make the biggest impact on the nursing shortage” 71% of nurses replied that improved staffing ratios would have the biggest impact, followed by better pay (64%) and better working conditions (41%).  

But ultimately, addressing the nursing shortage will require a multi-faceted approach that includes both short-term solutions to improve nurses' daily lives and long-term strategies to address the underlying issues. 

1. Increasing Funding to Improve Nurse-Patient Ratios and Retain Nurses 

Hospitals and healthcare facilities need to start listening to nurses if they want to retain them and improving staffing ratios was the number one factor that nurses thought could positively impact the nursing shortage. 

New York state nurses described “abysmal working conditions” as they went on strike in January 2023 but were told “There’s no money in the budget” to improve working conditions and ensure safe nursing staff levels. Hospital administrators and those that control the purse strings of healthcare facility budgets need to reevaluate their budget priorities if they want to retain and attract nurses and protect patients.

2. Paying Higher Salaries to All Nurses, Particularly to Recruit and Retain Nursing Faculty

As we saw above, 64% of nurses believe that better pay would help lessen the nursing shortage. When we asked nurses how they felt about their current pay, 75% of nurses said they felt underpaid. 

In addition, a major reason for the shortage of nursing faculty is low salaries. While the average salary of an advanced nurse practitioner with a master’s degree is $120,680, master’s prepared nursing faculty were paid just $87,325/year in 2022. 

With the average nursing faculty salary being $33,372/year less than what nurses earn in clinical and private-sectors positions, it’s hard to attract and retain faculty. Therefore, nursing faculty salaries need to be increased substantially if nursing schools want to attract and retain faculty.

3. Better Working Conditions

Being able to do things like take breaks and feeling that they’re able to turn down extra shifts may seem like basics that all nurses should be getting, but our survey shows that they are not. 72% of nurses don’t have adequate backup, 53% of nurses are unable to take sick days, and 36% feel that they can’t turn down extra shifts at work. 

4. Providing Funding for More Master’s and Doctoral Nursing Student Enrollments 

According to the AACN, “Master’s and doctoral programs in nursing are not producing a large enough pool of potential nurse educators to meet the demand.” 

For example, although enrollment in entry-level baccalaureate nursing programs increased by 3.3% in 2021, enrollment in master’s and PhD nursing programs dropped by 7% and 3.8%, respectively. 

Therefore, more funding and recruitment need to be directed at graduate-level nursing programs to help prepare more nursing faculty and create more advanced practice nurses.

5. Designing Nursing Positions That Offer Better Work-Life Balance

And finally, nurse leaders need to start creating nursing positions that allow nurses to have a better work-life balance if they want to attract and retain nurses in these positions. 

The high levels of nurse burnout and chronic stress in nursing are simply unacceptable and cannot continue if the nursing shortage is to be significantly reduced.  81% of nurses said they’ve felt burnt out in the past year, according to our survey. 

Nurses will continue to leave the profession and their jobs in search of a more manageable lifestyle and less stressful work.

By making a commitment to listen to nurses and implement these changes, policymakers, facility administrators, and nurse leaders can reverse this nursing shortage and ensure that our healthcare system has enough nurses to meet the needs of patients now and into the future.

>> Download the 2023 State of Nursing Report