Two years ago news coverage warned of a national nursing shortage. Vacancies surged, burnout dominated conversations, and hospitals stretched themselves to staff essential units. Today the sense of alarm has faded. Inside hospitals, however, the crisis has not passed. Administrators still struggle to fill shifts, and the conditions that pushed nurses out of the profession remain largely unchanged.
It is understandable that many policymakers still view this as a shortage that should correct itself through supply and demand. That model held true for most of the past century. The first large-scale shortage appeared in the 1930s, and it deepened during World War II when Congress enacted the 1943 Bolton Act, which funded the U.S. Cadet Nurse Corps and expanded training through stipends and free education. Later shortages followed a familiar pattern. New hospital construction under the Hill-Burton Act and waves of retirement repeatedly outpaced supply. Expanding training programs or creating new roles helped close the gap. Once the cycle turned, the immediate crisis eased.
That history explains why many leaders believe the current workforce crisis will resolve the same way. However, this one is fundamentally different. It is no longer a cyclical shortage, it is a structural failure.
The 2022 National Nursing Workforce Survey found that the United States lost an estimated 200,000 registered nurses between 2020 and 2022. The Bureau of Labor Statistics projects that while the RN workforce will grow modestly from 3.1 million in 2022 to 3.3 million by 2032, nearly two hundred thousand openings will arise every year because of retirements and exits from the profession. Even maximum enrollment in training programs cannot offset this loss.
Burnout, moral injury, administrative overload and unsafe working conditions now drive nurses away. A 2023 study by the National Council of State Boards of Nursing estimated that one hundred thousand RNs left the workforce in just two years, with hundreds of thousands more planning to leave by 2027. Nearly one third of the nursing workforce is older than fifty. Large scale retirement is approaching at the same time younger nurses are leaving earlier than ever. These are not temporary pressures; they are persistent forces eroding the core of the workforce.
Education is another limiting factor. Enrollment in nursing programs declined in 2021 for the first time since 2000, not because of waning interest but because schools lacked faculty, clinical placements and adequate funding. Although enrollment has improved slightly, it is not growing fast enough to meet the projected demand for RN and APRN services. In the past, training capacity could be scaled quickly. Today it cannot.
National statistics hide the severity of regional disparities. Tennessee reported fewer than nine nurses per 1,000 residents, and wages remain low. According to the Health Resources and Services Administration’s 2024 projections, the adequacy of RN supply will vary dramatically by 2037, from a significant shortage in North Carolina to surpluses in other states. Rural and nonmetropolitan communities remain the most vulnerable. There is no single national crisis, there are fifty distinct labor markets, each moving in different directions.
This imbalance also extends beyond U.S. borders. Nursing shortages are a global challenge. The World Health Organization estimates a global shortage of nearly six million nurses, noting that migration may strengthen some health systems while straining others.
The persistence of today’s crisis reflects a powerful feedback loop: high turnover increases workloads for those who remain, fueling further exhaustion and exits. Recruitment incentives can even worsen conditions when retention is poor, because new hires inherit the same pressures that drove colleagues away.The result is a cycle that intensifies rather than resolves.
What Health System Leaders Must Do Now
1. Shift from recruitment to retention
Hiring bonuses attract candidates but do not keep them. Leaders should prioritize safe staffing ratios, flexible scheduling, manageable patient loads, and tangible reductions in administrative burden.
2. Stabilize and strengthen mid-career staff
These nurses anchor clinical units, precept new hires, and carry institutional knowledge. Focused career development pathways, compensation structures, and recognition programs should be tailored to this group.
3. Expand training capacity through incentives for nurse educators
States and health systems can create financial incentives for experienced nurses to transition into teaching roles, expanding capacity without losing clinical expertise to burnout.
4. Build rapid-response workforce planning for seasonal surges
Winter respiratory viruses routinely stretch EDs and pediatric hospitals. Leaders should prepare proactive staffing models that support nurses during peak demand rather than relying on costly short-term fixes.
Just as important is how we talk about nursing. For too long, nurses have been celebrated as the backbone of healthcare while being treated as a cost center. Their presence directly determines patient safety, length of stay, and mortality. Research consistently shows that hospitals with higher proportions of bachelor-prepared nurses achieve better outcomes, including lower surgical mortality. Workforce instability is therefore not only a staffing issue; it is a patient safety issue.
We have been here before, but the stakes are now higher. In the past, shortages eased as new nurses filled the gaps left by those who retired or left. Without structural reform, that recovery may no longer happen. The lesson from nearly a century of cycles is clear: we cannot recruit our way out of burnout. Valuing nurses means creating environments where they can stay, grow, and teach the next generation. Anything less risks repeating history with fewer nurses left to hold the system together.
As the country enters winter and respiratory season, one of the most demanding periods for emergency departments and pediatric hospitals, this becomes even more evident. The ability of hospitals to respond to surges in illness depends on the presence, skill, and judgment of nurses. Leaders who invest in the workforce today will determine whether their organizations remain resilient tomorrow.
