The U.S. currently holds about 5.6 million active registered nurse (RN) licenses and just under 1 million licensed practical nurse (LPN) licenses, yet federal projections show demand outpacing supply by hundreds of thousands of positions over the next decade. By 2038, the country is projected to be short roughly 109,000 full-time RNs and 246,000 full-time LPNs. The gap is real, but it varies dramatically by state, specialty, and how you measure it.
The Current Nursing Workforce by the Numbers
At the start of 2024, there were 5,641,311 active RN licenses and 968,948 active LPN licenses in the United States. Not all of those license holders are working bedside shifts, though. About 88% of licensed nurses are employed in nursing, and just under three-quarters of those work full time. That puts the actual working RN workforce at roughly 3.3 million full-time equivalents today.
The Bureau of Labor Statistics projects RN employment will grow 5% from 2024 to 2034, faster than the average for all occupations. That translates to about 189,100 openings for registered nurses every year over the decade, driven by a combination of new positions and nurses leaving the field.
How Big the Shortage Gets by 2038
The Health Resources and Services Administration (HRSA) models both supply and demand at five-year intervals. Their latest projections paint a clearer picture of how the gap widens over time:
- RNs in 2033: Projected supply of about 3.27 million full-time equivalents against a demand of 3.47 million, leaving the workforce at 94% adequacy.
- RNs in 2038: Supply rises to 3.51 million but demand reaches 3.62 million, narrowing the gap to a 3% shortage (about 109,000 positions).
- LPNs in 2033: Supply of 578,000 against demand of 764,000, meeting just 76% of the need.
- LPNs in 2038: Supply drops to 566,000 while demand climbs to 812,000. Only 70% of LPN demand gets filled, leaving a deficit of nearly 246,000.
The RN picture is somewhat encouraging: supply is growing and the percentage gap stays relatively small. The LPN shortage is far more severe, worsening steadily as fewer people enter the profession while demand from long-term care facilities and home health agencies keeps climbing.
Not everyone agrees on the exact trajectory. Some researchers project the RN workforce could actually reach 4.5 million by 2035, which would represent a surplus. The discrepancy comes down to different assumptions about how many new graduates enter the field, how many nurses return to practice, and how quickly demand grows in an aging population.
States With the Biggest Gaps
National averages hide enormous regional differences. The ten states facing the largest projected RN shortages by 2035 are Washington (26% shortfall), Georgia (21%), California (18%), Oregon (16%), Michigan (15%), Idaho (15%), Louisiana (13%), North Carolina (13%), New Jersey (12%), and South Carolina (11%). A state like Washington could be missing more than a quarter of the nurses it needs, while states in the Midwest generally fare better.
These gaps track closely with local factors: population growth rates, the age of the existing nursing workforce, how many nursing schools operate in the state, and whether pay and working conditions are competitive enough to attract and retain staff.
Why the Pipeline Can’t Keep Up
One of the most frustrating bottlenecks is that thousands of people who want to become nurses are turned away from school every year. In the 2021-2022 academic year, 91,938 qualified applicants were denied admission to baccalaureate and graduate nursing programs across the country. These weren’t unqualified candidates. They met the academic standards but couldn’t get a seat.
The top reasons are a shortage of nursing faculty, not enough clinical training sites, limited classroom space, and budget constraints. The problem is worst in the West, where nearly 33,000 applications were denied and the faculty vacancy rate hit 9%. The Midwest had the fewest denials (about 10,500) and the lowest faculty vacancy rate at 7%. Until schools can expand capacity, the education pipeline will continue to limit how fast the workforce can grow.
Turnover Makes the Problem Worse
Even as the profession tries to recruit more nurses, it’s losing them at a significant clip. The national average turnover rate for hospital staff RNs was 16.4% in 2024. That’s actually an improvement, down 2.4 percentage points from the year before, but it still means roughly one in six hospital nurses leaves their position each year.
Replacing a single staff RN costs a hospital an average of $61,110, with the range spanning $49,500 to $72,700 depending on specialty and location. For a large hospital system losing dozens or hundreds of nurses annually, those costs add up to millions of dollars that could otherwise fund new positions or better working conditions. High turnover creates a vicious cycle: remaining staff pick up heavier workloads, burn out faster, and are more likely to leave themselves.
Why Staffing Levels Matter for Patients
This isn’t just a labor market problem. Nurse staffing levels directly affect whether patients live or die. Research controlling for hospital and patient characteristics consistently shows that lower nurse staffing is associated with higher patient mortality. Two separate systematic reviews found strong evidence linking better staffing to lower death rates.
The effects extend beyond mortality. When nurses are stretched thin, they miss critical tasks: repositioning patients to prevent bedsores, catching early signs of deterioration, educating patients about medications before discharge. These gaps show up in longer hospital stays, higher readmission rates, and lower patient satisfaction scores. Every unfilled nursing position represents not just a budget line item but a measurable increase in risk for the patients in that unit.
Federal Efforts to Close the Gap
Congress is actively working to fund nursing workforce growth. The Title VIII Nursing Workforce Reauthorization Act of 2025 would authorize roughly $305 million per year from 2026 through 2030 for nursing workforce development programs. That money targets the exact pressure points: training more nursing faculty, expanding clinical education capacity, and supporting loan repayment programs that draw people into underserved areas.
Whether that funding level is sufficient depends on who you ask. Growing the workforce by the tens of thousands of positions needed annually requires not just money but physical infrastructure, willing clinical partners, and enough experienced nurses to teach the next generation. The shortage, in other words, feeds itself: you need more nurses to train more nurses, and the system is already stretched.