Regional nurse shortages are shaping staffing strategies across the U.S.
Table of Contents
- Regional Shortages Disrupt Hospital Staffing Plans
- States with highest projected RN deficits by 2035
- How rural and urban areas are affected differently
- Hospitals Adapt Staffing Models to Meet Local Needs
- Use of travel nurses and per diem staff in shortage zones
- Hybrid staffing models in high-demand regions
- Learning about flexible hiring platforms for local facilities
- Policy Makers Respond to the Nursing Shortage in America
- State-level legislation on nurse-to-patient ratios
- Federal funding for nursing education and faculty
- Visa reform proposals to bring in foreign-trained nurses
- Nurse Shortages Impact Patient Outcomes and Workforce Stability
- Building a Stronger Foundation for the Future
America is facing a critical nursing shortage, with federal projectionsindicatinga gap of more than 78,000 full-time registered nurses by 2025. As the Baby Boomer population ages and healthcare demands grow, hospitals and clinics across the country are struggling to keep up. Although the Bureau of Labor Statistics expects the RN workforce to expand by 6 percent over the next decade, this modest growth will not be enough to meet the nation’s rising needs.
The shortage affects regions differently, creating uneven pressure on healthcare systems. The Health Resources and Services Administration estimates a 13 percent RN shortage in nonmetropolitan areas by 2037, compared with only a 5 percent shortfall in urban regions.
Tomaintainquality patient care, healthcare organizations must adopt flexible, region-specific staffing strategies. Creative solutions, supported by technology and local workforce partnerships, will be essential in closing the gap and ensuring every community has access to the skilled nurses it needs.
Regional Shortages Disrupt Hospital Staffing Plans
America’snursing workforceshows significant regional differences throughout the country. Healthcare facilities face unique challenges as hospital administrators deal with staffing patterns that change based on location, population trends, and economic conditions.
States with highest projected RN deficits by 2035
HRSAprojectsWashington state will experience the country’s worst nursing shortage by 2035, with a 26% deficit. Georgia follows with 21%, California with 18%, Oregon with 16%, and both Michigan and Idaho show 15% shortages. Louisiana and North Carolina both face 13% deficits, while New Jersey shows 12% and South Carolina 11%. Recent data paints an even more concerning picture. California’s preliminary 2022 data reveals that 22.5% of RNs between 55-64 years and 47.3% of RNs 65 and older plan to leave the profession between 2022 and 2024. Texas shows a steady decline with shortage rates climbing from 11.1% (29,165 nurses) in 2020 to 11.8% (33,340 nurses) in 2023.
How rural and urban areas are affected differently
Metropolitan and rural regions experience nursing shortages in distinct ways. Metro areas might see a small 1% surplus of RNs by 2035, while nonmetro areas could face a 2% shortage. Short-term projections look more severe, with rural areas expected to have a 13% shortage by 2025.
Rural hospitals face greater challenges in this staffing crisis. These healthcare facilities have fewer BSN-educated nurses, inadequate staffing resources, and lower nursing skill mix compared to their urban counterparts. Financial struggles compound the problem—almost half of rural hospitalsoperatedat a loss in 2021, with just33 daysof cash reserves.
Rural hospital closures, which have affected 138 facilities since 2010, create a ripple effect. Neighboring rural hospitals see increases in nursing staff as workersrelocate—one study shows staffing levels rose up to 55.9% at nearby facilities four years after a closure. All the same, this staff redistributiondoesn’tsolve the basic shortage problem, especially since 453 rural facilities risk closure. Healthcare organizations can support expansion and visa sponsorships with specialized EB2 NIW Petition Business Plans that showcase national importance.
Region-specific solutions that consider both state-level projections and the urban-rural workforce gaps are needed to address this nursing shortage crisis.
Hospitals Adapt Staffing Models to Meet Local Needs
Healthcare facilities across America face regional nursinggapsand new staffing solutions areemergingfaster than ever. Hospitals have started to implement multiple strategies that match their specific geographic challenges.
Use of travel nurses and per diem staff in shortage zones
The need for travel nurses jumped by 35% in 2020, with expectations of a 40%additionalrise in 2021. These professionals work on 13-week contracts that can extend based on requirements. California, Texas, New Jersey, and South Carolina willlikely continueto experience nurse deficits through 2030, making these states the top destinations for travel nurses.
Per diem nurses serve a vital roleto maintainadequate staffing levels. They help facilities stay flexible as patient numbers change by working on an as-needed basis. Their pay rates vary significantly by location – ICU nurses earn over $60 per hour in Seattle while OR RNs in New York City can make up to $99 per hour.
Hybrid staffing models in high-demand regions
Hybrid staffing mixes different approaches by employing both in-house staff and outsourced teams to handle patient volume changes better.Rural hospitals find this model especially valuable because they face unique challenges from limited resources and geographic isolation.
Rural facilities can adjust their workforce based on current needs through block shifts, 24-hour guaranteed coverage, and on-demand staffing.
Learning about flexible hiring platforms for local facilities
Healthcare facilities now use technology platforms that connect them directly with available nurses.CareRev’splatform gives access to professionals ready to work on demand, and 79% of them have five or more years of experience. Facilities that use this approach have cut labor costs by 18% and filled shifts 50% faster.
Platforms likeNursaalso let healthcare facilities post shifts that nurses can claim through phone apps or websites. This client’s platform specializes in providing local nursing options that help hospitals, clinics, and long-term care centers fill urgent staffing gaps with qualified professionals. This direct hiring approach reduces costs, improves flexibility, and increases job satisfaction by giving nurses greater control over their schedules.
Policy Makers Respond to the Nursing Shortage in America
Lawmakers at federal and state levels are taking strong steps to tackle the nursing workforce crisis through focused policy changes.
State-level legislation on nurse-to-patient ratios
All but one of these 16 stateshavelaws that deal with hospital nurse staffing. California led the way with mandatory nurse-to-patient ratios. The staterequiresone nurse for every five patients in medical-surgical units and one nurse for every two patients in intensive care.
Massachusetts now demands a one-to-one standard for ICU patients. States like Illinois, New Jersey, New York, Rhode Island, and Vermont ask hospitals to make their staffing levels public. Minnesota takes a different approach and uses nurse-driven staffing committees. These committees must include at least 50% of nurses who provide direct patient care to set appropriate ratios.
Federal funding for nursing education and faculty
The Department of Labor launched an $80 million Nursing Expansion Grant Program in October 2022. This program aims to train nursing instructors and create professional pathway programs. The Health Resources and Services Administration (HRSA) runs several targeted programs.
The Nurse Faculty Loan Programwipes outup to 85% of educational loans when graduates commit to teaching. The Faculty Loan Repayment Program offers up to $40,000 to disadvantaged individuals who become faculty. Nurse educators can get up to 85% of their debt canceled over three years through the Nurse Corps Repayment Program.
Visa reform proposals to bring in foreign-trained nurses
Hospitals that manage 45% of all hospital beds hire foreign-educated RNs, whichrepresents32% of all hospitals. The visa processing for international nurses has stopped since April 2023. A bipartisan Healthcare Workforce Resilience Act suggests using 25,000 unused immigrant visas for nurses and 15,000 for physicians.
Nurse Shortages Impact Patient Outcomes and Workforce Stability
Nursing shortages across the United Statesaffect far more than staffing levels—they directly influence patient safety, care quality, and nurse well-being. Hospitals and healthcare systems are struggling tomaintainstability as workloadsriseand experienced professionals leave the field.
Key impacts of the nursing shortage include:
- High burnout and turnover:The burnout rate among nurses has reached over 90 percent, significantly higher than that of other healthcare workers. Turnover rates climbed from 17 percent in 2017 to 26 percent in 2021, with more than a quarter of nurses planning to retire or leave the profession within five years. Each bedside RN who leaves costs healthcare facilities an average of $61,000 in turnover expenses.
- Patient safety concerns:Studies show that for everyadditionalpatient assigned to a nurse, the risk of mortality increases by 7 percent within30 daysof admission. Insufficient staffing contributes to infections, longer hospital stays, and higher readmission rates, with global studies confirming that inadequate nurse-to-patient ratios lead to preventable deaths.
- Declining morale and trust:Persistent shortages create a damaging cycle of exhaustion and attrition.Nearly allnurses report experiencing burnout, and many lose confidence in management’s ability to address patient care issues. This decline in morale reduces team cohesion and worsens overall job satisfaction.
- System-wide operational strain:Staff gaps disrupt workflow efficiency, increase costs, and reduce care quality. Hospitals must manage unpredictable workloads, and remaining staff often shoulder unsustainable responsibilities, further weakening workforce stability.
Building a Stronger Foundation for the Future
The nursing shortage across the United States has become more than a workforce concern—it is a defining test for the nation’s healthcare system. As patient needs continue to grow and the workforce ages, regional differences make it clear that every community faces unique challenges.
Innovation will be the driving force in overcoming these shortages. Flexible staffing models, predictive workforce planning, and the thoughtful use of technology can help healthcare facilities stay responsive to shifting demands. When hospitals adapt to regional realities instead of applying uniform strategies, they not only improve staffing efficiency but also create healthier, more stable work environments for their teams.
Collaboration between healthcare organizations, educators, and policymakersremainsessential. Expanding training opportunities, improving retention programs, and developing smarter staffing frameworks can build resilience across the system. Together, these efforts can ensure that communities of every size have access to skilled nurses and consistent, high-quality care.
The way healthcare leaders respond today willdeterminethe system’s strength for years to come. Those who invest in adaptability, compassion, and long-term planning will create a future where both nurses and patients can thrive. For insights on improving recruitment and profitability, explore Legal Recruitment Trends That Impact Law Firm Profitability.