How bad is the nursing shortage?

The supply of nurses in the U.S. is looking up—but not everywhere.

Employment for registered nurses is expected to grow much faster than the average for all occupations through 2026, according to the Bureau of Labor Statistics. The agency still expects 203,800 job openings in the field each year, but it’s likely these vacancies will be centralized in key areas of the country, while others will experience steep competition for jobs.

Another government projection of supply and demand for RNs suggests that, by 2030, there will be a surplus of 53,700 full-time equivalents in Florida, compared with a shortage of 44,500 in California, according to a 2017 report from the Health Resources and Services Administration.

“These projections highlight the inequitable distribution of the nursing workforce across the United States, as recent research shows that nursing workforce represents a greater problem with distribution across states than magnitude at the national level,” the report reads.

There’s also variation in the type of nurses most in-demand. “It’s both regional, but also specialty within nursing,” said Kendra McMillan, a senior policy adviser with the American Nurses Association. “How many nurses do we have that are going into labor and delivery, for example? How many nurses do we have electing to go into the (intensive-care unit)?”

Pamela Ograbisz, a nurse practitioner and director of telehealth for LocumTenens.com, an online job board and staffing agency for advanced-practice clinicians, said she’s noticed a high demand for specialty-trained nurse practitioners, including psychiatric, cardiothoracic, gastrointestinal and oncology nurse practitioners.

The shortage is a multifaceted problem.

Part of the issue is an aging workforce, as many who flocked to the profession in the 1970s prepare to retire, according to an article in the Journal of Nursing Regulation. Since 2012, roughly 60,000 RNs have exited the workforce each year, and some 1 million RNs are projected to retire between 2017 and 2030.

The population is also aging nationwide. By 2035, adults age 65 and older are expected to outnumber children, according to estimates from the U.S. Census Bureau.

Many of those patients will have complex needs, possibly sparking a higher demand for specialty nurses, said Simmy King, nursing director for clinical information systems and professional development at Children’s National Health System in Washington, D.C., and an American Organization for Nursing Leadership board member.

And that’s not to mention an ongoing shortage of instructors. More than 75,000 qualified applicants to bachelor and graduate nursing programs were turned away last year due to factors like insufficient faculty, clinical sites or classroom space, as well as budget constraints, according to the American Association of Colleges of Nursing. “There’s not enough professors there to actually teach the next crop of nurses,” Ograbisz said.

A few actions hospitals have taken to address these challenges, according to McMillan, include setting up residency programs to train nurses who are recent graduates or are entering a new specialty, as well as offering tuition reimbursement or loan repayment programs. “We have to look at the whole picture,” she added, noting these efforts can help with both recruitment and retention.