Nursing Shortage May Be Worse By State Than Projected, New Analysis Shows

The nursing shortage is a major issue impacting all nurses. Our 2023 State of Nursing survey revealed that 91% of nurses believe that the nursing shortage is getting worse. Because of this, we wanted to dig a little deeper into the current and future nursing shortage to get a better understanding of where things stand. 

What We Found

• While the 2020 HRSA Nurse Workforce Projections report found that in 2030, 98% of the total demand for nurses will be met, our methodology found that number may actually be lower, at 94%, with a need for an additional 206,553 nurses by 2030. 

• 42 of the 50 states may be coming in short on their nurse needs in 2030. The states that may suffer from the highest % of unmet demand for nurses are North Dakota, Colorado, Texas, Florida, and Nevada.

• Meanwhile, 8 states are predicted to have more nurses than they need. Vermont, Maine, Rhode Island, West Virginia, Alabama, Pennsylvania, Connecticut, and New Hampshire are all projected to have a surplus of nurses in 2030. 

The Nursing Shortage Explained

While a nursing shortage has existed for decades, the COVID-19 pandemic greatly exacerbated this issue. The increased workloads and decreased staffing levels led to higher rates of nurse burnout. Our survey found that 35% of nurses wanted to leave the bedside in 2022. 

In addition to that, our survey found that the number one reason nurses planned on leaving the bedside was because they were retiring. A 2020 National Nursing Workforce Survey found that the average age for an RN is 52 years old. This means that nurses are about to be retiring en masse, and there won’t be enough new nurses to replace them.

This issue is so concerning that The American Nurses Association (ANA) sent a letter to the U.S. Department of Health and Human Services (HHS) on September 1, 2021, urging the country to declare the current and unsustainable nurse staffing shortage to be a national crisis. 

The Nursing Shortage By the Numbers

According to the 2020 HRSA Nurse Workforce Projections report, “Nationally, there is a projected shortage of 78,610 full-time equivalent (FTE) RNs in 2025 and a shortage of 63,720 FTE RNs in 2030.” This means that they’re predicting that 98% of the total demand for nurses will be met. 

The Bureau of Labor and Statistics is estimating a need for just 6% growth in nurses for the next decade, only slightly higher than the average 5% for all occupations.

However, based on the feedback we got from nurses in our survey,  it seems like the issue is worse than is being projected. We heard from nurses that “Staffing is the worst it’s ever been” and stories such as “I haven’t had a lunch break since I became a nurse. All related to the lack of staffing and resources.”  

In fact, a 2022 report by McKinsey warned 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. 

Because of this, we decided to run some projections ourselves and see if there is more to the story. Using publically available data sets from the BLS, US Census Bureau, and the University of Virginia’s Weldon Cooper Center for Public Service, we analyzed the nursing shortage for ourselves. 

By our calculations, the situation may actually be worse than the HRSA is predicting: we found that 94% of the total demand for nurses will be met, with a need for an additional 206,553 nurses by 2030. 

 

 

Our Methodology

We started by finding the current nurse-to-population ratio by state by comparing the Bureau of Labor and Statistics (BLS) 2021 RN employment by state to the US Census Bureau’s 2022 population by state numbers. 

We then looked at population growth estimates by state from the University of Virginia Weldon Cooper Center for Public Service since many states are growing and others are shrinking. Notably, these population projections are from 2018, so they do not factor in the migrations that took place during the COVID-19 pandemic.

We then assumed the same nurse-to-population ratios by state to calculate the delta of nurses needed on a state-by-state level to support population growth and maintain current ratios. 

Our findings suggest that the nursing shortage may be more dire than the HRSA and the BLS are predicting, especially in those states where the population is growing.  And furthermore, we know many states are trying to improve staffing levels post-COVID, but our analysis assumes similar nurse staffing levels to those in place today - staffing levels that may be difficult to maintain or improve in the future.

The HRSA acknowledges in their dataset that all of their projections are likely underestimating the full effect as they don’t fully take into account the effects of the COVID-19 pandemic on the nursing shortage. Our methodology also doesn’t fully take this into account, so the shortage will likely be far worse than even we are predicting.

Nurse Demand by State for 2030 

In order to maintain our current nurse-to-population ratios and factor in population growth by state, we wanted to see how many total nurses will be needed in each state in 2030.

We found that California, Texas, Florida, New York, and Pennsylvania are the states where the highest number of nurses are going to be needed in 2030. Meanwhile, Wyoming, Alaska, Vermont, Montana, and Rhode Island will need the least. 

Nursing Shortage by State

The nursing shortage is not affecting all our states equally. As the HRSA points out in their study, “Geographic distribution remains an issue for the nursing profession. Supply adequacy varies considerably across states.” This was shown to be accurate in our data analysis as well. 

When we look at the difference between our current supply of nurses by state and where we need to be in 2030, we see some pretty stark variances:

• 42 of the 50 states may be coming in short on their nurse needs in 2030 

• Meanwhile, 8 states are predicted to have more nurses than they need 

North Dakota, Colorado, Texas, Florida, and Nevada are all projected to have the largest shortages of nurses, with North Dakota only getting 84% of its demand met. 

Vermont, Maine, Rhode Island, West Virginia, Alabama, Pennsylvania, Connecticut, and New Hampshire are all projected to have a surplus of nurses in 2030. 

Top 5 States Where RN Demand is Expected to Be Met in 2030

State	Projected RN Surplus/Deficit
Vermont	105%
Maine	103%
Rhode Island	102%
West Virginia	102%
Alabama	101%

 

Worst 5 States Where RN Demand is Not Expected to Be Met in 2030

State	Projected RN Surplus/Deficit
North Dakota	84%
Colorado	86%
Texas	86%
Nevada	88%
Florida	88%

So, while broadly, 94% of the nursing demand is projected to be met in 2030, at the state level, we see a very different picture. 

One caveat here is that this data doesn’t account for all the population migrations that happened during COVID-19. A 2022 study using U.S. Postal Service data found that more than 15.9 million people moved during the pandemic. Accurate data sources of populations and migrations by state haven't been collected post-COVID, so our analysis may still undercount nurses needed in some areas of high growth.

Nurse-to-Population Ratios by State

In our above calculations, we assumed nurse-to-population ratios hold steady with current levels, but there is a wide range of nurse-to-population ratios amongst the states. 

Utah currently has the lowest number, with just 7 RNs per 1,000 people, while South Dakota has more than double that, with 15.5 nurses per 1,000. 

Critically, 79% of nurses already report that their units are inadequately staffed per our 2023 State of Nursing survey. This means that for most states, maintaining their current levels won’t be enough to stop the shortage.

The Nursing Shortage Is Likely Going to Be Worse Than We're Predicting

What these numbers tell us is that looking at broad metrics like an assumed 6% growth rate for nurses from the BLS, or the HRSA's projected 98% adequacy for nurses over the next decade doesn’t portray the real picture of what’s happening. 

The nursing shortage will be experienced very differently at the state level as populations change over time, a factor that has only been exacerbated by the amount of migration shifts that took place during the pandemic - migrations not captured in this data.

Our analysis didn’t dig into cities and rural areas, which see even more disparities. The HRSA found that metro areas will actually have a slight surplus of nurses; however, non-metro areas are predicted to have a 13% shortage in 2025 and a 9% shortage in 2030.

In addition, none of this data really captures the impacts that COVID has had on the nursing workforce. Many nurses have left the bedside or left the profession overall, but the data is going to take years to catch up to that. How bad is the nursing shortage going to be? Likely far worse than we’re predicting.