Five States Facing the Biggest Nursing Shortages

Five States Facing the Biggest Nursing Shortages

Projected demand and a talent shortage show a workforce disconnect

According to the US Bureau of Labor Statistics (BLS), the number of registered nurses (RNs) in the United States is projected to grow by 6% through 2033, leading to approximately 194,500 job openings for nurses annually. However, the BLS also forecasts that fewer than 175,000 new nurses will enter the workforce during this period. This disconnect between the number of available positions and the incoming workforce highlights a persistent issue in healthcare.

While the supply and demand imbalance in nursing is nothing new, the nursing shortage exacerbated the COVID-19 pandemic. The global crisis led to a significant increase in nurse burnout, as one survey found that nearly 40% of nurses wanted to leave the profession in 2022. Additionally, nursing salaries aren’t keeping pace with the workload, and many nurses feel their compensation does not match the job’s demands. Coupled with the cost of a nursing education, it’s no surprise that the pool of nursing talent is dwindling, even as the demand for nurses continues to rise.

A nationwide problem with state-level implications 

With fewer nurses available to meet patient demand, healthcare facilities struggle to maintain adequate services. Rural areas, in particular, feel the strain as hospitals and clinics experience longer wait times, increased patient loads, and even potential facility closures due to staffing challenges. 

As the demand for nursing professionals continues to grow, identifying the states with the most pressing need for nurses can guide workforce development strategies in healthcare. Highlighting the states with the greatest need can also draw attention to opportunities for nursing professionals looking to move to areas of the country they may not have previously considered.

Nationwide, nurse practitioners, nurse anesthetists, and nurse midwives are expected to remain in demand until 2037. Workforce projections indicate that the greatest need will be for registered nurses (RNs) and Licensed Practical Nurses (LPNs), as significant shortages are anticipated in both roles in the coming years.

This problem varies tremendously from state to state. The following states are seeing the greatest need for nurses by the year 2037:

  1. Maryland

The Old Line State currently has the 6th highest shortage in the nation at 25%. While demand is around 60,000, Maryland only has around 45,000 RNs. By 2037, the state is expected to reduce its shortage to 20%. However, that’s still in the top three for the country’s worst shortage by then. This is the equivalent of Maryland needing over 13,500 nurses to meet demand in 2037.  

Things have become so dire in Maryland that the head of external affairs for the MHA called the situation “unsustainable.” The primary cause of this significant shortage is that qualified nurses in Maryland are choosing to work for agencies as travel nurses rather than remaining in the state. 

  1. South Carolina

The Palmetto State is projected to experience a registered nurse (RN) shortage of approximately 19% by 2037. This equates to the state needing nearly an additional 12,000 full-time hours in 2037 to meet demand.  

As of 2025, South Carolina is facing a 28% shortage of registered nurses (RNs). The state currently has just under 40,000 RNs but needs over 55,000 to meet demand. The shortage has been exacerbated by a lack of full- and part-time faculty to adequately teach aspiring students. Additionally, retirement projections (people living longer in the state) and South Carolina’s growing population have intensified the state’s shortage crisis. 

  1. Michigan

Michigan is also projected to have a shortage of 19%. The difference is that since the state is larger, an additional 21,000+ full-time hours are required to meet demand by 2037. 

Unlike South Carolina, which is projected to improve over time, Michigan is projected to be on a downward spiral until 2037. The Great Lakes State has a current shortage of 16%. 

Michigan’s demand for nursing care stems from a shortage of graduating nurses. Those with graduate degrees often pursue more lucrative options, such as clinical practice, research, or teaching. Each year, many qualified applicants are turned away from master’s or doctoral programs due to limited capacity and faculty shortages. For instance, one community college in Flint, MI, reduced its new admissions from 80 to 64 students in response to a decision for a higher faculty-to-student ratio for clinical training by the Michigan Board of Nursing.

  1. Washington

Washington currently has a shortage of 13%. While alarming at first, there are still 20 states in a worse position than the Evergreen State. However, it’s expected that the state will have a shortage of 22% by 2037, putting it in the second-worst position in the country. This is the equivalent of Washington needing an additional 19,000 full-time hours to meet demand.  

The state recently passed a bipartisan bill, Senate Bill 5582 to combat this. This bill aims to address the nursing shortage in the state by expanding educational opportunities and reducing barriers for nurses. The bill will allow high school students in training to become certified nursing assistants in understaffed rural hospitals throughout the state.  

  1. North Carolina  

The Tar Heel State is also expected to face a 22% nursing shortage. To meet demand, nearly 30,000 full-time hours will be needed by 2037.  

Currently, North Carolina is experiencing a 15% shortage, ranking as the 20th worst in the nation. However, it’s projected to become the state with the worst shortage due to a lack of individuals interested in pursuing nursing careers and a shortage of nursing educators in the state.  

The NC Institute of Medicine recently released eight recommendations to solve workforce issues, focusing on recruitment and retention. Their report claims that increasing the number of nursing graduates by 10% could reduce the projected shortage by about 2,000 nurses.  

Another problem is the lack of pay for nurses in North Carolina. With an average salary of just south of $80,000, the state is on the lower end. This may lead to nurses in North Carolina looking for work elsewhere.  

The ongoing nursing challenge

With an aging population and rising demand for healthcare services nationwide, nursing shortages are a challenge in every state and community. States such as Maryland, North Carolina, and Washington underscore an urgent need for workforce management intervention, including more education, training, and faster hiring to meet demand.

These workforce gaps aren’t just numbers; they represent longer waiting times, reduced access to care, and increased strain on existing nurses. A lot hinges on whether state and federal policymakers can respond effectively to this growing challenge. Decisions about education funding, licensing pathways, workplace standards, and retention will shape the future of nursing. Hospitals and healthcare organizations that are proactively reacting to shortages with better hiring and retention programs will be better positioned for overall success.

Woman in a striped shirt indoors.

Leah Moss

VMS Operations

Check out these other great StaffDNA articles

Healthcare organizations face some of the toughest workforce challenges: tight budgets, lean IT teams and limited tools for sourcing, hiring and onboarding staff. Add in manual scheduling, rising labor costs and high burnout, and the pressure grows. Rolling out complex systems can feel out of reach without dedicated tech support. Even simply evaluating new technology can overwhelm already stretched-thin teams.

These challenges make it clear that technology isn’t just helpful; it’s essential for healthcare organizations. Especially when they’re striving to do more with less. Not only are healthcare organizations falling short on implementing new technology, but they’re struggling to update outdated systems. A 2023 CHIME survey found that nearly 60% of hospitals use core IT systems, such as EHRs and workforce platforms, that are over a decade old. Outdated tools can’t integrate or scale, creating barriers to smarter staffing strategies. But the opportunity to modernize is real and urgent.

Tech in Patient Care Falls Short

In healthcare, technology has historically focused on clinical and patient care. Workforce management tools have taken a back seat to updating patient care systems. Yet many big tech companies have failed when it comes to customizing healthcare infrastructure and connecting patients with providers. Google Health shuttered after only three years, and Amazon’s Haven Health was intended to disrupt healthcare and health insurance but disbanded three years later.

Why the failures? It’s estimated that nearly 80% of patient data technology systems must use to create alignment is unstructured and trapped in data silos. Integration issues naturally form when there’s a lack of cohesive data that systems can share and use. Privacy considerations surrounding patient data are a challenge, as well. Across the healthcare continuum, federal and state healthcare data laws hinder how seamlessly technology can integrate with existing systems.

Why Smarter Staffing Is Now Essential

These data and integration challenges also hinder a healthcare organization’s ability to hire and deploy staff, an urgent healthcare priority. The U.S. will face a shortfall of over 3.2 million healthcare workers by 2026. At the same time, aging populations and rising chronic conditions are straining teams already stretched thin.

Smart workforce technology is becoming not just helpful, but essential. It allows organizations to move from reactive staffing to proactive workforce planning that can adapt to real-world care demands.

Global Inspiration: Japan’s AI-Driven Workforce Model

Healthcare staffing shortages aren’t just a U.S. problem. So, how are other countries addressing this issue? Countries like Japan are demonstrating what’s possible when technology is utilized not just to supplement staff, but to transform the entire workforce model. With one of the world’s oldest populations and a significant clinician shortage, Japan has adopted a proactive approach through its Healthcare AI and Robotics Center, where several institutions like Waseda University and Tokyo’s Cancer Institute Hospital are focusing on developing AI-powered hospitals.

Japan’s focus on integrating predictive analytics, robotics and data-driven scheduling across elder care and hospital systems is a response to its aging population and workforce shortages. From robotic assistants to AI-supported shift planning, Japan’s futuristic model proves that holistic tech integration, not piecemeal upgrades, creates sustainable staffing frameworks.

Rather than treating workforce tech as an IT patch for broken systems, Japan’s approach embeds these tools throughout care operations, supporting scheduling, monitoring, compliance and even direct caregiving tasks. U.S. health systems can draw critical lessons here: strategic investment in integrated platforms builds resilience, especially in a labor-constrained future.

The Power of Smart Workforce Technology

In the U.S., workforce management is becoming increasingly seen as more than a back-office function; it’s a strategic business operation directly impacting clinical outcomes and patient satisfaction. Smart technology tools are designed to improve care quality, staff satisfaction, scheduling, pay rates, compliance and much more.

For example, by using historical data, patient acuity, seasonal trends and other data points, organizations can predict their staff needs more accurately. The result is fewer gaps in scheduling, fewer overtime payouts and a flexible schedule for staff. AI-powered analytics can help healthcare leadership teams spot patterns in absenteeism, see productivity and forecast needs in multiple clinical areas in real-time. Workforce management tools can help plan scheduling proactively, rather than reactively. It’s a proven technology tool that can help drive efficiency and reduce costs.

Why So Many Are Still Behind

Despite the clear benefits, many healthcare organizations are slow to adopt smart tools that empower their workforce. Several things are holding them back from going all-in on technology:

Financial Pressures

Over half of U.S. hospitals are operating at or below break-even margins. For them, investing in new technology solutions is financially unfeasible. Scalable, subscription-based and even free workforce management tools are available, but most organizations are unaware of or lack the resources to source these products. Workforce management tools can deliver long-term return on investment for most organizations. Taking the time to understand where the value lies and which tools to invest in needs to happen.

Outdated Core Systems

Many facilities still depend on legacy technology infrastructure that lacks real-time capabilities. Many large players in the healthcare workforce management industry dominate hospital systems. Other smaller, real-time tools that offer innovative solutions to scheduling, workforce hiring, rate calculators and more are available at a fraction of the cost.

Competing Priorities and Strategic Blind Spots

Healthcare organizations and hospitals have many high-priority business objectives and regulatory demands. Digital transformation naturally falls down on the priority list, which causes them to miss improvements that can lead to long-term stability. With patient care and provider satisfaction at the top of the priority mountain, technology changes can be easily missed or shoved to the side when other business objectives are perceived to “move the needle” more.

Poor Change Management

Even the best technology efforts can fail without the right strategy for adoption and support from senior leadership. Resistance from staff, lack of training, or poor rollout communication can undermine success. Effective change management—clear leadership, role-based training and feedback loops—is essential.

Faster than the speed of technology

Change needs to come quickly to healthcare organizations in terms of managing their workforce efficiently. Smart technologies like predictive analytics, AI-assisted scheduling and mobile platforms will define this next era. These tools don’t just optimize operations but empower workers and elevate care quality.

Slow technology adoption continues to hold back the full potential of the healthcare ecosystem. Japan again offers a clear example: they had one of the slowest adoption rates of remote workers (19% of companies offered remote work) in 2019. Within just three weeks of the crisis, their remote work population doubled (49%), proving that technological transformation can happen fast when urgency strikes. The lesson is clear: healthcare organizations need to modernize faster for the sake of their workforce and the patients who rely on providers to deliver care.

 

Share On

Facebook
LinkedIn
WhatsApp
X
Email

Check out StaffDNA Insights