The U.S. Nursing Shortage: A State-by-State Breakdown
To gain insight into the widespread nursing shortage, let’s examine the latest data that compares the number of nurses in each state with the respective state populations. The persistent demand for nurses is on the rise, exacerbated by the increasing occurrence of nursing shortages nationwide. This shortage is influenced by several factors, including limited educators, burnout among nurses, and an aging workforce, all contributing to the larger issue of inadequate nursing staffing.
The employment figures of nurses in each state, when contrasted with the state’s population, reveal a shortfall in healthcare resources. Nursing has remained a high-demand profession for a considerable time, with major healthcare institutions frequently recruiting for this vital role. According to the U.S. Bureau of Labor Statistics (BLS), there is a projected average of approximately 195,400 job openings for registered nurses from 2021 to 2031. Many of these openings are anticipated due to the need to replace nurses who transition to different careers or retire from the workforce.
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As the generation of baby boomers ages and the overall population continues to grow, the necessity for nurses escalates, particularly highlighted by the impact of the COVID-19 pandemic. This increased demand has led to the expansion of the travel nursing sector, which in turn has intensified the prevailing nursing shortages across the entire United States.
To comprehensively grasp the extent of this shortage at the national level, we have collected the most recent data available on the count of registered nurses employed in each state as of August 2022, and we have compared this data with the respective state populations. This comparison enables us to illustrate the shortfall in nursing resources on a state-by-state basis. The subsequent table presents a ranking of states, beginning with those exhibiting the lowest nurse-to-state population ratios.
U.S. Nurse-to-State Population Ratio
| Location | Employed Registered Nurses (2021) | State Population (2020) | Nurses Per 1,000 Population |
|---|---|---|---|
| United States | 3,047,550 | 331,449,281 | 9.19 |
| Utah | 23,760 | 3,271,616 | 7.26 |
| Georgia | 78,290 | 10,711,908 | 7.31 |
| Texas | 217,630 | 29,145,505 | 7.47 |
| Hawaii | 11,110 | 1,455,271 | 7.63 |
| Virginia | 66,980 | 8,631,393 | 7.76 |
| Idaho | 14,400 | 1,839,106 | 7.83 |
| Nevada | 24,590 | 3,104,614 | 7.92 |
| Oklahoma | 31,510 | 3,959,353 | 7.96 |
| Arizona | 57,260 | 7,151,502 | 8.01 |
| New Mexico | 17,030 | 2,117,522 | 8.04 |
| Washington | 62,470 | 7,705,281 | 8.11 |
| California | 324,400 | 39,538,223 | 8.20 |
| Alaska | 6,060 | 733,391 | 8.26 |
| Maryland | 51,550 | 6,177,224 | 8.35 |
| New Jersey | 77,980 | 9,288,994 | 8.39 |
| Wyoming | 4,890 | 576,851 | 8.48 |
| Florida | 187,920 | 21,538,187 | 8.72 |
| Arkansas | 26,320 | 3,011,524 | 8.74 |
| Montana | 9,640 | 1,084,225 | 8.89 |
| Oregon | 37,780 | 4,237,256 | 8.92 |
| Colorado | 51,680 | 5,773,714 | 8.95 |
| Tennessee | 62,250 | 6,910,840 | 9.01 |
| South Carolina | 46,160 | 5,118,425 | 9.02 |
| Louisiana | 42,870 | 4,657,757 | 9.20 |
| New York | 188,300 | 20,201,249 | 9.32 |
| New Hampshire | 12,890 | 1,377,529 | 9.36 |
| Connecticut | 34,320 | 3,605,944 | 9.52 |
| Kentucky | 43,540 | 4,505,836 | 9.66 |
| Mississippi | 29,140 | 2,961,279 | 9.84 |
| Indiana | 66,800 | 6,785,528 | 9.84 |
| Kansas | 28,980 | 2,937,880 | 9.86 |
| Rhode Island | 10,860 | 1,097,379 | 9.90 |
| Alabama | 49,780 | 5,024,279 | 9.91 |
| North Carolina | 104,810 | 10,439,388 | 10.04 |
| Illinois | 129,260 | 12,812,508 | 10.09 |
| Michigan | 102,480 | 10,077,331 | 10.17 |
| Iowa | 32,650 | 3,190,369 | 10.23 |
| Nebraska | 20,660 | 1,961,504 | 10.53 |
| Maine | 14,380 | 1,362,359 | 10.56 |
| Wisconsin | 62,860 | 5,893,718 | 10.67 |
| Ohio | 129,270 | 11,799,448 | 10.96 |
| West Virginia | 19,800 | 1,793,716 | 11.04 |
| Vermont | 7,210 | 643,077 | 11.21 |
| Missouri | 69,240 | 6,154,913 | 11.25 |
| Pennsylvania | 149,270 | 13,002,700 | 11.48 |
| Delaware | 11,760 | 989,948 | 11.88 |
| Minnesota | 69,000 | 5,706,494 | 12.09 |
| Massachusetts | 88,270 | 7,029,917 | 12.56 |
| North Dakota | 11,810 | 779,094 | 15.16 |
| South Dakota | 14,140 | 886,667 | 15.95 |
| District of Columbia | 11,540 | 689,545 | 16.74 |
Comparing Local Nurse Employment to National Nurse Employment
It’s a common trend that major cities consistently require a larger number of nurses, often featuring numerous job openings in city hospitals. Below are lists highlighting states with the lowest local concentration of nurse employment and metropolitan areas with the highest local concentration of nurse employment in comparison to the national average.
States with Low Local Concentrations of Nurse Employment:
– Utah (Location Quotient: 0.71)
– Washington D.C. (Location Quotient: 0.81)
– Texas (Location Quotient: 0.82)
– Georgia (Location Quotient: 0.83)
– Virginia (Location Quotient: 0.83)
Metropolitan Areas with High Concentrations of Local Nurse Employment:
– Rochester, MN (Location Quotient: 3.66)
– Bloomsburg Berwick, PA (Location Quotient: 3.04)
– Morgantown, WV (Location Quotient: 2.52)
– Durham — Chapel Hill, NC (Location Quotient: 2.25)
– Ann Arbor, MI (Location Quotient: 2.20)
Source: U.S. Bureau of Labor Statistics (BLS)
According to BLS data: The location quotient measures the ratio of the local concentration of occupational employment to the national average concentration. A location quotient above one indicates a higher employment share than the national average, while a location quotient below one indicates less prevalence in the area compared to the national average.
Larger urban areas tend to face more significant nursing shortages due to the higher population density found in major metropolitan regions. In essence, there aren’t enough new nursing graduates to adequately handle the volume of individuals in need of various levels of medical care within these populous cities.
Contributing Factors to the National Nursing Shortage
A study published in the National Library of Medicine highlights various factors contributing to the nationwide nursing shortage, including:
– Insufficient educators and educational programs: Nursing school enrollment has not matched the projected demand, and there’s a shortage of faculty members in nursing schools. This scarcity of teachers prevents many individuals interested in pursuing nursing from obtaining the required degrees.
– High turnover rate: Nurse turnover has been steadily increasing for years. Some nursing graduates enter the workforce and find that the reality of the profession differs from their expectations. Others experience burnout and leave the field.
– Aging nursing workforce: A significant portion of registered nurses (RNs) are over 50 years old, leading to a growing rate of retirements.
Addressing the Nursing Shortage
Efforts to address the nursing shortage are underway, including actions by state legislators, hospitals, and educational institutions to counter the shortage and prevent future deficits.
Sources
Haddad, L, et al. (2022). Nursing shortage. https://www.ncbi.nlm.nih.gov/books/NBK493175/
Nursing shortage. (2020). https://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Shortage
U.S. Bureau of Labor Statistics, Occupational Outlook Handbook. (2021). Registered nurses. https://www.bls.gov/ooh/healthcare/registered-nurses.htm
U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics. (2021). Registered nurses. https://www.bls.gov/oes/current/oes291141.htm
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