How To Ease the Nursing Shortage in America

Introduction and summary

Since the COVID-19 pandemic began more than two years ago, no region of the United States has been spared an acute shortage of registered nurses. In January, governors across the country, some for the second time, called in the National Guard to assist health care providers, and 1,118 hospitals—more than 1 in 6 hospitals in America¹—reported critical nursing shortages.² As of March 2022, almost every state had taken executive actions to address the shortage,³ such as issuing temporary licenses to put nursing students to work.⁴

Registered nurses are among the professionals most sought after today. They provide care in every possible health care setting, including hospitals, physicians’ offices, outpatient care centers, and skilled nursing facilities, as well as in behavioral health settings, the home, schools, universities, prisons, and private employer settings. Nurses are not only critical providers of patient care, but they also have an important role in addressing inequities within health outcomes and improving the health of the population as a whole.

At the same time, nursing is a bedrock profession of the middle class and is particularly important for the economic security of women, especially women of color. Last year, there were approximately 3 million nurses working in the United States—the single largest category of health care professionals and the fifth-largest profession nationally, after retail salespeople, home health and personal care aides, cashiers, and fast food workers.⁵

And yet the United States still needs more registered nurses. Tens of thousands of qualified students are turned away every year from the university degree programs that train students to become registered nurses,⁶ while nurses are considering leaving the profession in large numbers after bearing too much of the burden of the country’s response to the pandemic.⁷

These problems have not received the attention they deserve, especially the lack of capacity within institutions of higher education to educate enough nurses. This report examines factors behind the current nursing shortage and discusses why nursing is a crucial occupation for improving health, economic security, and racial equity in this country. It also explores the problems inhibiting higher education from educating more nurses and inhibiting more cohesive management of nursing shortages.

Central to building a strong nursing workforce is a higher education system that has the capacity to supply enough nursing graduates to meet the demands of the health care system. This report recommends that Congress pass legislation that would invest in nursing faculty, clinical placements, and nursing program facilities so that colleges and universities have the resources to enroll and graduate more students. Policymakers should also invest in programs to help nurses who have associate degrees obtain bachelor’s degrees, which would boost the training level, wages, and career trajectories of many nurses of color.

In addition, to create a more organized strategy to address the nursing shortage, this report makes recommendations to establish or designate federal and state-level entities to monitor nursing shortages and advise policymakers and the health care and education sectors.

While this report’s recommendations are focused on the pipeline into the nursing profession, it is just as important for health care employers, policymakers, and others to address the conditions in the workplace affecting retention of nurses. This problem, and approaches that other organizations have proposed to address it, is discussed at the end of this report. (see Appendix)