Supply and Demand Projections of the
Nursing Workforce: 2014-2030
July 21, 2017
U.S. Department of Health and Human Services
Health Resources and Services Administration
Bureau of Health Workforce
National Center for Health Workforce Analysis
About the National Center for Health Workforce Analysis
The National Center for Health Workforce Analysis (the National Center) informs public and
private-sector decision-making on the U.S. health workforce by expanding and improving health
workforce data and its dissemination to the public, and by improving and updating projections of
supply of and demand for health workers. For more information about the National Center,
please visit our website at http://bhw.hrsa.gov/healthworkforce/index.html.
Suggested citation:
U.S. Department of Health and Human Services, Health Resources and Services Administration,
National Center for Health Workforce Analysis. 2017. National and Regional Supply and
Demand Projections of the Nursing Workforce: 2014-2030. Rockville, Maryland.
Copyright information:
All material appearing in this documentation is in the public domain and may be reproduced or
copied without permission. Citation of the source, however, is appreciated.
Supply and Demand Projections for the Nursing Workforce: 2014-2030 1
Contents
Overview......................................................................................................................................... 3
Key Findings................................................................................................................................... 4
Registered Nurses........................................................................................................................ 4
Licensed Practical/Vocational Nurses......................................................................................... 4
Background..................................................................................................................................... 5
Results............................................................................................................................................. 7
Trends in RN Supply and Demand ............................................................................................. 8
Exhibit 1: Baseline and Projected Supply of and Demand for Registered Nurses by State:
2014 and 2030 ......................................................................................................................... 9
Exhibit 2: RN Supply versus Demand, by State, 2030.......................................................... 12
Trends in LPN Supply and Demand ......................................................................................... 12
Exhibit 3: Baseline and Projected Supply of and Demand for Licensed Practical Nurses by
State: 2014 and 2030 ............................................................................................................. 13
Exhibit 4: LPN Supply versus Demand, by State, 2030........................................................ 16
Strengths and Limitations ............................................................................................................. 16
Discussion and Conclusions ......................................................................................................... 18
Supply and Demand Projections for the Nursing Workforce: 2014-2030 2
Supply and Demand Projections of the Nursing Workforce:
2014-2030
Overview
This report presents projections of supply of and demand for registered nurses (RNs) and
licensed practical/vocational nurses (LPNs) in 2030, with 2014 serving as the base year. These
projections highlight the inequitable distribution of the nursing workforce across the United
States, as recent research
1,2
shows that nursing workforce represents a greater problem with
distribution across states than magnitude at the national level. Projections were developed using
the Health Resources and Services Administration’s (HRSA) Health Workforce Simulation
Model (HWSM).
The HWSM is an integrated microsimulation model that estimates current and future supply of
and demand for health workers in multiple professions and care settings. While the nuances of
modeling supply and demand differ for individual health professions, the basic framework
remains the same. The HWSM assumes that demand equals supply in the base year.
3
For supply
modeling, the major components (beyond common labor-market factors like unemployment)
include characteristics of the existing workforce in a given occupation; new entrants to the
workforce (e.g., newly trained workers); and workforce participation decisions (e.g., retirement
and hours worked patterns). For demand modeling, the major components include population
demographics; health care use patterns (including the influence of increased insurance coverage);
and demand for health care services (translated into requirements for full-time equivalents
(FTEs))..
Important limitations for these workforce projections include an underlying model assumption
that health care delivery in the future (projected until 2030) will not change substantially from
1
U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health
Workforce Analysis. The Future of the Nursing Workforce: National- and State-Level Projections, 2012-2025. Rockville,
Maryland, 2014.
2
PI Buerhaus, DI Auerbach, DO Staiger, U Muench “Projections of the long-term growth of the registered nurse workforce: A
regional analysis”. Nursing Economics, 2013
3
Ono T, Lafortune G, Schoenstein M. “Health workforce planning in OECD countries: a review of 26 projection models from
18 countries.” OECD Health Working Papers, No. 62. France: OECD Publishing; 2013: 8-11.
Supply and Demand Projections for the Nursing Workforce: 2014-2030 3
the way health care was delivered in the base year (2014) and that there will be stability in the
current rates of health care utilization. In addition, the supply model assumes that current
graduation rates and workforce participation pattern will remain unchanged in the future (2030).
Changes in any of these factors may significantly impact both the supply and demand projections
presented in this report. Alternative supply and demand scenarios were developed to explore the
impact of such changes. A detailed description of the HWSM can be found in the accompanying
technical document available at http://bhw.hrsa.gov/healthworkforce/index.html.
Key Findings
Registered Nurses
Substantial variation across states is observed for RNs in 2030 through the large differences
between their projected supply and demand.
Looking at each state’s 2030 RN supply minus its 2030 demand reveals both shortages
and surpluses in RN workforce in 2030 across the United States. Projected differences
between each state’s 2030 supply and demand range from a shortage of 44,500 FTEs in
California to a surplus of 53,700 FTEs in Florida.
If the current level of health care is maintained, seven states are projected to have a
shortage of RNs in 2030, with four of these states having a deficit of 10,000 or more
FTEs, including California (44,500 FTEs), Texas (15,900 FTEs), New Jersey (11,400
FTEs) and South Carolina (10,400 FTEs).
States projected to experience the largest excess supply compared to demand in 2030
include Florida (53,700 FTEs) followed by Ohio (49,100 FTEs), Virginia (22,700 FTEs)
and New York (18,200 FTEs).
Licensed Practical/Vocational Nurses
Projected changes in supply and demand for LPNs between 2014 and 2030 vary substantially by
state.
Thirty-three states are projected to experience a shortage - a smaller growth in the supply
of LPNs relative to their state-specific demand for LPNs. States projected to experience
the largest shortfalls of LPNs in 2030 include Texas, with a largest projected deficit of
33,500 FTEs, followed by Pennsylvania with a shortage of 18,700 FTEs.
Supply and Demand Projections for the Nursing Workforce: 2014-2030 4
In seventeen states where projected LPN supply exceeds projected demand in 2030, Ohio
exhibits the greatest excess supply of 4,100 FTEs, followed by California with 3,600
excess FTEs.
Background
Health care spending is approximately 18 percent of the U.S. economy (GDP). Nursing is the
single largest profession in the entire U.S. health care workforce with RNs and LPNs making up
the two largest occupations in this profession.
4
RNs and LPNs perform a variety of patient care
duties and are critical to the delivery of health care services across a wide array of settings,
including ambulatory care clinics, hospitals, nursing homes, public health facilities, hospice
programs, and home health agencies. Distinctions are made among different types of nurses
according to their education, role, and the level of autonomy in practice.
LPNs typically receive training for a year beyond high school and, after passing the national
NCLEX-PN exam, become licensed to work in patient care. LPNs provide a variety of direct
care services including administration of medication, taking medical histories, recording
symptoms and vital signs, and other tasks as delegated by RNs, physicians, and other health care
providers.
5,6
RNs usually have a bachelor's degree in nursing, a two year associate’s degree in nursing, or a
diploma from an approved nursing program. They must also pass a national exam, the NCLEX-
RN, before they are licensed to practice.
7,8,9
RN responsibilities involve work that is more
4
U.S. Department of Labor, Bureau of Labor Statistics. (2012). Occupational Outlook Handbook, 2012-13 Edition. Washington,
D.C.: GPO, U.S. Bureau of Labor Statistics. Retrieved from http://www.bls.gov/ooh/healthcare/registered-nurses.htm;
http://www.bls.gov/ooh/healthcare/licensed-practical-and-licensed-vocational-nurses.htm
5
Mueller, C., Anderson, R., McConnel, E. (2012). Licensed Nurse Responsibilities in Nursing Homes: A Scope-of-Practice
Issue. Journal of Nursing Regulation. 3(1): 13-20.
6
Lubbe, J., Roets, L. (2014) Nurses’ Scope of Practice and the Implication for Quality Nursing Care, Journal of Nursing
Scholarship. 46(1): 58-64.
7
Sochalski, J., & Weiner, J. (2011). Health care system reform and the nursing workforce: Matching nursing practice and skills
to future needs, not past demands. The future of nursing: Leading change, advancing health, 375-400.
8
Pittman, P., & Forrest, E. (2015). The changing roles of registered nurses in Pioneer Accountable Care Organizations. Nursing
outlook, 63(5), 554-565.
9
Anderson, D. R., & St Hilaire, D. (2012). Primary care nursing role and care coordination: An observational study of nursing
work in a community health center. Online journal of issues in nursing, 17(2), E1.
Supply and Demand Projections for the Nursing Workforce: 2014-2030 5
complex and analytical than that of LPNs. RNs provide a wide array of direct care services, such
as administering treatments, care coordination, disease prevention, patient education, and health
promotion for individuals, families, and communities. RNs may choose to obtain advanced
clinical education and training to become Advanced Practice Nurses (who usually have a
master's degree, although some complete doctoral-level training) and often focus in a clinical
specialty area.
10,11
Advanced Practice Registered Nurses are not included in the analysis
12
13
presented here, but are covered in separate reports.
The historical relationship between nurse supply and demand in the U.S. has been cyclical, with
periodic shortages of nurses where demand outstrips available supply, followed by periods of
overproduction which lead to nursing surpluses. This cycle necessitates regular monitoring of the
nursing workforce, and thus, periodic updates of HRSA’s workforce projections. This report
updates HRSA’s estimates provided in the 2014 report on the nursing workforce.
14
According to HRSA’s 2014 report, state-level variation had been observed in projections of
nursing supply relative to demand. Nurse shortage or surplus appear to reflect local conditions,
such as the number of new graduates from nursing schools. Nurses tend to practice in states
where they have been trained. The 2014 report demonstrated that nursing shortages represent a
problem with workforce distribution across states rather than magnitude at the national level. As
such, this report focuses on the inequitable distribution of nursing workforce across states as
oppose to a national-level projections.
10
Blegen, M. A., Goode, C. J., Park, S. H., Vaughn, T., & Spetz, J. (2013). Baccalaureate education in nursing and patient
outcomes. Journal of Nursing Administration, 43(2), 89-94.
11
Hamric, A. B., Hanson, C. M., Tracy, M. F., & O'Grady, E. T. (2013).Advanced practice nursing: An integrative approach.
Elsevier Health Sciences.
12
U.S. Department of Health and Human Services, Health Resources and Services Administration,. National and Regional
Projections of Supply and Demand for Primary Care Practitioners: 2013-2025. National Center for Health Workforce Analysis.
Rockville, Maryland, 2016.
U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health
Workforce Analysis. Health Workforce Projections: Certified Nurse Anesthetists. Rockville, Maryland, 2016.
14
U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health
Workforce Analysis. The Future of the Nursing Workforce: National- and State-Level Projections, 2012-2025. Rockville,
Maryland, 2014.
Supply and Demand Projections for the Nursing Workforce: 2014-2030
13
6
Results
Future supply of and demand for nurses will be affected by a host of factors, including
population growth, the aging of the nation’s population, overall economic conditions, expanded
health insurance coverage, changes in health care reimbursement, geographic location, and
health workforce availability. The HWSM is an integrated microsimulation model that estimates
supply of and demand for health workers in multiple professions and care settings, and accounts
for these factors when adequate data are available to estimate their impact.
15
For supply modeling, the major components include characteristics of the existing workforce in
the occupation, new entrants to the workforce (e.g., newly trained workers); and workforce
decisions (e.g., retirement, hours worked patterns, and migration across states); as well as
common labor-market factors like unemployment and wage rates. For the national demand
modeling, the HWSM assumes that RN and LPN demand at the national level equals supply in
2014, consistent with standard workforce research methodology, in the absence of documented
evidence of a substantial imbalance between national supply and demand in the base year
(2014).
16
The state-level demand estimates assumes state-level RN and LPN demand in 2014
equals supply, to project future demand for each state to provide a level of care consistent with
what was provided in 2014 in that state. Over the projection period, the model assumes that
current national patterns of supply and demand, such as newly trained workers, retirement, hours
worked patterns and health care use, remain unchanged within each demographic group (as
defined by age, sex, etc.).
All supply and demand estimates and projections are reported as FTEs, where one FTE is
defined as 40 hours per week. This measure standardizes the definition of FTE over time and
across health occupations. Previous nurse workforce projections define FTE as estimated average
hours worked among nurses working at least 20 hours, which is 37.3 for both RNs and LPNs in
15
For additional information about the HWSM, please see “About the Model” on the last page of this report.
16
HRSA’s 2014 report modeled a scenario where each state was in equilibrium in the base year—which scenario models whether
each state’s future nurse supply will be adequate to maintain nursing care at a level of care consistent with the state’s 2012
staffing levels.
Supply and Demand Projections for the Nursing Workforce: 2014-2030 7
this study. Consequently, the supply and demand numbers presented in this report are slightly
lower than in previous nursing workforce projection reports.
Alternative supply and demand scenarios presented in this report show the sensitivity of
projections to changes in key supply and demand determinants and assumptions. The alternative
supply scenarios modeled include the impacts of graduating 10 percent more or 10 percent fewer
nurses annually than the status quo. The alternative demand scenario reflects a potential change
in health care delivery focusing on population health and preventive care.
17
Trends in RN Supply and Demand
At the national level, the projected growth in RN supply (39 percent growth) is expected to
exceed growth in demand (28 percent growth) resulting in a projected excess of about 293,800
RN FTEs in 2030.
The estimation of RN supply starts from approximately 2,806,100 RN FTEs that were active in
the U.S. workforce in 2014. The number of graduates from U.S. nursing programs has steadily
increased from approximately 68,800 individuals in 2001 to nearly 158,000 in 2015. Between
2014 and 2030, about 2,282,500 new RN FTEs will enter the workforce (assuming new RNs will
graduate at the current rate), an estimated 1,043,500 RN FTEs will leave the workforce, and a
decline in about 149,500 RN FTEs is associated with reduced work hours as the nurse workforce
ages. This net growth of about 1,089,500 RN FTEs will result in a national RN workforce of
3,895,600 FTEs by 2030.
The demand for RNs is projected to be 2,806,100 in 2014 and will increase to 3,601,800 in 2030
(an increase of 795,700 FTEs between 2014 and 2030), based on current health care utilization
and staffing patterns and assuming the national RN demand equaled supply in 2014. Growth in
disease burden attributable to changing patient demographics contributes to an increased demand
of about 776,400 RNs. HRSA’s HWSM reflects increased insurance coverage associated with
17
IHS Markit Inc., The Complexities of Physician Supply and Demand: Projections from 2013 to 2025. Prepared for the
Association of American Medical Colleges. Washington, DC: Association of American Medical Colleges; 2015.
Supply and Demand Projections for the Nursing Workforce: 2014-2030 8
Medicaid expansion and insurance marketplaces. This expanded insurance coverage accounts for
projected demand of an additional 19,300 RNs between 2014 and 2030.
Across states, projected differences between supply and demand for RNs in 2030 vary
considerably. The demand estimates for each state in Exhibit 1 reflect the number of RN FTEs
required to provide a level of care consistent with what was provided in 2014 in that state, given
each state’s demographics and the prevalence of health risk factors.
Looking at each state’s 2030 RN supply minus their 2030 demand reveals both state-level
shortages and surpluses. The most severe shortage is seen in California, where the undersupply is
estimated to be 44,500 RN FTEs, while the largest surplus is seen in Florida, with an estimated
oversupply of 53,700 RN FTEs. Among the seven states that have estimated 2030 shortages, four
states have shortages of more than 10,000 RN FTEs including California, followed by Texas
(15,900 fewer FTEs), New Jersey (11,400 fewer FTEs) and South Carolina (10,400 fewer FTEs).
Meanwhile, three states have a surplus of more than 20,000 RN FTEs, including Florida,
followed by Ohio (with 49,100 more FTEs), and Virginia (with 22,700 FTEs).
Exhibit 1: Baseline and Projected Supply of and Demand for Registered Nurses by State:
2014 and 2030
2014
2030
Region and State
Supply/
a
Demand
Supply
Difference
b
c
Adequacy
Northeast
Connecticut
34,000
43,500
3,500
8.8%
Maine
14,600
21,200
4,700
28.5%
Massachusetts
73,200
91,300
2,000
2.2%
New Hampshire
15,500
21,300
1,100
5.4%
New Jersey
81,700
90,800
(11,400)
(11.2%)
New York
174,100
213,400
18,200
9.3%
Pennsylvania
133,200
168,500
8,200
5.1%
Rhode Island
11,000
15,000
2,500
20.0%
Vermont
6,000
9,300
2,500
36.8%
Midwest
Illinois
116,300
143,000
3,600
2.6%
Indiana
62,900
89,300
14,000
18.6%
Iowa
32,500
45,400
10,100
28.6%
Kansas
29,500
47,500
12,600
36.1%
Michigan
91,600
110,500
6,100
5.8%
Supply and Demand Projections for the Nursing Workforce: 2014-2030 9
2014
2030
Region and State
Supply/
a
Demand
Supply
Difference
b
c
Adequacy
Minnesota
56,200
71,800
3,100
4.5%
Missouri
59,600
89,900
16,700
22.8%
Nebraska
20,300
24,700
3,500
16.5%
North Dakota
7,600
9,900
700
7.6%
Ohio
122,800
181,900
49,100
37.0%
South Dakota
10,300
11,700
(1,900)
(14.0%)
Wisconsin
58,100
78,200
6,200
8.6%
South
Alabama
68,000
85,100
5,300
6.6%
Arkansas
28,400
42,100
9,800
30.3%
Delaware
9,600
14,000
1,200
9.4%
Distr. of Columbia
d
1,800
8,800
6,500
282.6%
Florida
170,600
293,700
53,700
22.4%
Georgia
77,200
98,800
(2,200)
(2.2%)
Kentucky
44,900
64,200
10,500
19.6%
Louisiana
40,600
52,000
2,300
4.6%
Maryland
58,700
86,000
12,100
16.4%
Mississippi
29,100
42,500
7,200
20.4%
North Carolina
90,000
135,100
16,500
13.9%
Oklahoma
32,500
46,100
5,500
13.5%
South Carolina
36,900
52,100
(10,400)
(16.6%)
Tennessee
61,000
90,600
8,400
10.2%
Texas
180,500
253,400
(15,900)
(5.9%)
Virginia
67,900
109,200
22,700
26.2%
West Virginia
18,800
25,200
4,400
21.2%
West
Alaska
16,400
18,400
(5,400)
(22.7%)
Arizona
65,700
99,900
1,200
1.2%
California
277,400
343,400
(44,500)
(11.5%)
Colorado
41,900
72,500
9,300
14.7%
Hawaii
10,900
19,800
3,300
20.0%
Idaho
11,200
18,900
3,600
23.5%
Montana
9,600
12,300
200
1.7%
Nevada
18,300
33,900
8,100
31.4%
New Mexico
15,900
31,300
9,700
44.9%
Oregon
30,400
41,100
2,500
6.5%
Utah
20,000
33,500
4,100
13.9%
Washington
56,700
85,300
6,200
7.8%
Wyoming
4,200
8,300
2,800
50.9%
Notes: The model assumes increased insurance coverage associated with Medicaid expansion and insurance marketplaces, together with
year 2014 health care use and delivery patterns. Numbers may not sum to totals due to rounding.
a
The projections assume that each state’s supply and demand are equal in 2014.
b
Difference = 2030 projected supply – demand.
Supply and Demand Projections for the Nursing Workforce: 2014-2030 10
c
Adequacy = 100 * (projected supply – projected demand)/(projected demand); a negative adequacy indicates a shortage (i.e., supply is
less than demand) while a positive adequacy indicates a surplus (i.e., supply is greater than demand); adequacies associated with 2030
projected shortages are highlighted in blue.
d
Starting supply for Washington D.C. is based on small sample size in the American Community Survey so supply estimates might be
unreliable.
.
In addition to presenting RN shortages and surpluses by state, Exhibit 1 shows measures of
adequacy (last column). For the purpose of this report, adequacy is defined as the projected 2030
state-level provider shortage or surplus expressed as a percentage of that state’s 2030 provider
demand. Adequacy is interpreted as follows:
A negative adequacy indicates a 2030 shortage and reflects the percentage of 2030
demand that is unmet.
A positive adequacy indicates a 2030 surplus and reflects the size of the projected surplus
relative to the projected demand.
Expressing each 2030 state-level shortage or surplus as a percentage of the state’s 2030 demand
helps to inform comparisons of differences between supply and demand across states by
considering how the size of each state’s surplus or shortage relates to that state’s underlying
provider demand.
Based on the adequacies shown in Exhibit 1, the excessive 2030 supply for RNs is greatest in
Wyoming (except Washington D.C.
18
), where the projected RN shortage is 51 percent of
projected demand. The unmet 2030 RN demand is lowest in Arizona, where the projected
shortage is about 1 percent of projected demand. As noted above, 2030 RN supply is lower than
demand in 7 states, with shortage ranging from 2 percent of RN demand in Georgia to 23 percent
of demand in Alaska.
Mapping the states with unmet demand in 2030 illustrates the geographic distribution of RN
shortages projected across the United States (Exhibit 2).
18
Washington D.C. shows the largest percentage of surplus. However, starting supply for Washington D.C. is based on small sample
size in the American Community Survey so supply estimates might be unreliable.
Supply and Demand Projections for the Nursing Workforce: 2014-2030 11
Exhibit 2: RN Supply versus Demand, by State, 2030
Trends in LPN Supply and Demand
Approximately 809,700 LPN FTEs were active in the U.S. workforce in 2014. The number of
first time LPN NCLEX-PN takers from U.S. nursing programs steadily increased from
approximately 34,600 individuals in 2001 to a peak of slightly over 66,800 by 2010 before
declining to about 47,000 in 2016. Trending forward to 2030 using current supply determinants
(such as rates of entry and attrition from the profession) there will be 784,100 new LPN FTEs in
the workforce and an estimated 493,500 LPN FTEs will leave the workforce. In addition, supply
will decrease by approximately 83,600 LPN FTEs based on change in average hours worked.
The net growth of about 207,000 new LPN FTEs by 2030 will result in a national workforce
supply of approximately 1,016,700 LPN FTEs, an increase of 26 percent.
Assuming LPN demand equals supply in 2014 at the national level, by 2030 LPN demand is
projected to reach 1,168,200 LPN FTEs, an increase of 358,500 (44 percent). Growth in demand
is driven primarily by a growing and aging population, resulting in increased health service
needs in nursing homes, residential care and hospital settings. The impact of expanded insurance
Supply and Demand Projections for the Nursing Workforce: 2014-2030 12
coverage associated with Medicaid expansion and insurance marketplaces is relatively small
(4,100 FTEs).
At the national level, the demand for LPNs is projected to start growing faster than supply
starting in about 2022. By 2030, a projected national shortage of about 151,500 LPN FTEs (13
percent of 2030 demand) could develop. That possibility notwithstanding, the risk associated
with an LPN shortfall of this magnitude is limited because LPNs can be trained more quickly and
at lower cost than RNs.
Exhibit 3 presents future state-level supply and demand for services if states were to continue
providing a level of nursing care consistent with what the state provided in 2014. Under this
scenario, substantial variation across states is observed in projected differences between supply
and demand for LPNs. Overall, 33 states are projected to see that their LPN supply will be
outpaced by demand by 2030 – including 14 states in the South, 7 in the Midwest, and 6 each in
the West and Northeast. States with relatively large projected shortfalls are mostly in the South:
Texas, with a largest projected deficit of 33,500 LPN FTEs, and other 6 states (North Carolina,
Georgia, Florida, Alabama, Maryland, and Tennessee) with project deficits between 8,300 and
11,700 FTEs. Other states with larger projected shortfalls include Pennsylvania in the Northeast
with a shortage of 18,700 FTEs and Indiana in the Midwest with a shortage of 7,000 FTEs.
Among the other 18 states, Ohio exhibits the greatest projected excess supply of 4,100 FTEs by
2030, followed by California with 3,600 FTEs.
Exhibit 3: Baseline and Projected Supply of and Demand for Licensed Practical Nurses by
State: 2014 and 2030
2014
2030
Region and State
Supply/
a
Demand
Supply
Difference
b
c
Adequacy
Northeast
Connecticut
9,600
11,000
(2,200)
(16.7%)
Maine
2,000
3,400
800
30.8%
Massachusetts
14,400
16,500
(3,600)
(17.9%)
New Hampshire
4,700
4,700
(2,800)
(37.3%)
New Jersey
19,400
30,500
3,100
11.3%
New York
52,400
58,900
(3,600)
(5.8%)
Pennsylvania
49,300
48,600
(18,700)
(27.8%)
Supply and Demand Projections for the Nursing Workforce: 2014-2030 13
2014
2030
Region and State
Supply/
a
Demand
Supply
Difference
b
c
Adequacy
Rhode Island
2,000
2,300
(100)
(4.2%)
Vermont
1,800
2,500
100
4.2%
Midwest
Illinois
26,500
34,400
(2,700)
(7.3%)
Indiana
19,900
19,900
(7,000)
(26.0%)
Iowa
7,900
13,000
3,100
31.3%
Kansas
8,400
14,400
3,000
26.3%
Michigan
21,500
24,800
(3,300)
(11.7%)
Minnesota
16,200
24,700
1,700
7.4%
Missouri
20,000
23,200
(4,900)
(17.4%)
Nebraska
6,200
6,000
(500)
(7.7%)
North Dakota
2,500
3,900
500
14.7%
Ohio
42,500
54,900
4,100
8.1%
South Dakota
2,100
2,800
(400)
(12.5%)
Wisconsin
12,600
16,300
(1,700)
(9.4%)
South
Alabama
22,200
20,500
(9,600)
(31.9%)
Arkansas
12,200
17,800
2,200
14.1%
Delaware
2,900
4,200
(300)
(6.7%)
Distr. of Columbia
d
900
1,800
500
38.5%
Florida
54,200
73,600
(10,300)
(12.3%)
Georgia
26,300
25,800
(10,500)
(28.9%)
Kentucky
12,600
14,400
(2,800)
(16.3%)
Louisiana
18,400
20,700
(4,800)
(18.8%)
Maryland
13,300
11,300
(8,400)
(42.6%)
Mississippi
9,900
11,800
(2,400)
(16.9%)
North Carolina
22,900
24,400
(10,700)
(30.5%)
Oklahoma
14,800
18,400
(2,400)
(11.5%)
South Carolina
8,000
8,200
(4,700)
(36.4%)
Tennessee
24,000
29,600
(8,300)
(21.9%)
Texas
70,900
80,900
(33,500)
(29.3%)
Virginia
25,500
32,200
(4,400)
(12.0%)
West Virginia
7,600
10,900
1,100
11.2%
West
Alaska
1,700
2,000
(1,100)
(35.5%)
Arizona
9,100
12,200
(3,600)
(22.8%)
California
72,000
121,000
3,600
3.1%
Colorado
6,900
10,400
(2,100)
(16.8%)
Hawaii
2,300
4,700
400
9.3%
Idaho
2,500
4,300
200
4.9%
Montana
2,300
2,800
(600)
(17.6%)
Nevada
3,200
4,200
(1,000)
(19.2%)
Supply and Demand Projections for the Nursing Workforce: 2014-2030 14
2014
2030
Region and State
Supply/
a
Demand
Supply
Difference
b
c
Adequacy
New Mexico
3,000
4,900
0
0.0%
Oregon
3,100
4,900
300
6.5%
Utah
2,900
6,700
1,700
34.0%
Washington
11,200
13,600
(5,100)
(27.3%)
Wyoming
1,000
1,800
200
12.5%
Notes: The model assumes increased insurance coverage associated with Medicaid expansion and insurance marketplaces, together
with year 2014 health care use and delivery patterns. Numbers may not sum to totals due to rounding.
a
The projections assume that each state’s supply and demand are equal in 2014.
b
Difference = 2030 projected supply – demand.
c
Adequacy = 100 * (projected supply – projected demand)/(projected demand); a negative adequacy indicates a shortage (i.e., supply
is less than demand) while a positive adequacy indicates a surplus (i.e., supply is greater than demand); adequacies associated with
2030 projected shortages are highlighted in blue.
d
Starting supply for Washington D.C. is based on small sample size in the American Community Survey so supply estimates might
be unreliable.
As shown in Exhibit 3, 2030 adequacy for LPNs ranges from more than 34 percent surplus of
2030 demand in Utah (except Washington D.C.
19
) to about 43 percent shortage of 2030 demand
in Maryland.
Exhibit 4 maps the 33 states with projected unmet LPN demand in 2030.
19
Washington D.C. shows the largest percentage of surplus. However, starting supply for Washington D.C. is based on small sample
size in the American Community Survey so supply estimates might be unreliable.
Supply and Demand Projections for the Nursing Workforce: 2014-2030 15
Exhibit 4: LPN Supply versus Demand, by State, 2030
Strengths and Limitations
The model that was used to develop the supply and demand projections presented in this report
relies on a microsimulation approach. Microsimulation techniques provide greater flexibility and
granularity than the traditional cohort based approaches.
Major strengths of the current HWSM include:
Application of a consistent approach to analyzing supply and demand across practitioner
type, and U.S. state.
Incorporation of current demographic and health data of sufficient size and
representativeness to provide reliable estimates of key population characteristics.
Consideration not only of population growth and changing demographics across the
United States for both supply and demand, but also of the effects of changes in policy
(such as expanded health insurance coverage) on demand.
Supply and Demand Projections for the Nursing Workforce: 2014-2030 16
HRSA’s Health Workforce Simulation Model operates under many assumptions regarding the
current status and future trends in health care utilization and workforce supply. The HRSA
model, like most other health workforce projection models, assumes that the national labor
market for nurses is currently in balance (i.e., supply and demand in the base year are equal) as
indicated by the paucity of recent studies suggesting high vacancy rates and difficulties hiring
nurses.
20
Therefore, the results in this report reflect future changes in the nursing workforce
relative to a balanced 2014 baseline. The supply projections presented here illustrate what future
supply is likely to be if the production of nurses from nursing programs remains consistent with
the current level. However, there have historically been large swings in enrollment and the
resulting labor supply, which, if repeated in the future, would affect the results reported here.
State-level projections require assumptions about the geographic mobility of nurses. Nurse
migration patterns presented here suggest that nurses tend to practice in states where they have
been trained. As a result, a number of states are projected to have a shortage of RNs in 2030
despite the fact that, on a national level, there is projected to be an excess of RNs. If migration
were optimal (i.e., nurses were able and willing to migrate to states where the in-state supply did
not meet demand), then the larger state-level nursing surpluses would be driven to areas of
greater need and every state would show a relative surplus of RNs in 2030. This accentuates the
fact that nursing shortages currently (and in 2030) represent a problem with workforce
distribution rather than magnitude. Although there is evidence that some very specialized
settings may be facing nurse shortages,
21
this report looks at the nursing profession as a whole
and does not look at individual nursing specialty areas (e.g., public health, home health care,
etc.) or sites of practice (e.g., hospitals, nursing homes, ambulatory settings, etc.).
The baseline demand projections account for increased utilization of health care services due to
expanded insurance coverage. However, policy changes in this arena may have an effect on
nursing demand not examined by this analysis, and that such changes are difficult to anticipate.
Also, because of the uncertainties in its effects on staffing patterns and the evolving roles of
different health professionals on care teams, changes in health care service delivery currently are
20
Ono, T., Lafortune, G., Schoenstein, M. (2013). Health workforce planning in OECD countries: a review of 26 projection
models from 18 countries. OECD Health Working Papers, No. 62. France: OECD Publishing; 2013:8-11.
21
American Association of Colleges of Nursing. (2014). Nursing shortage fact sheet. Retrieved from
http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage.
Supply and Demand Projections for the Nursing Workforce: 2014-2030 17
not incorporated into the model. In addition, if the growing emphasis on care coordination,
preventive services, and chronic disease management in care delivery models leads to a greater
need for nurses, this report may underestimate the projected nurse demand. Likewise, improved
care coordination could reduce demand for nurses in hospital settings.
Discussion and Conclusions
Using the most recent data available on the nurse education pipeline, labor supply, and
retirement patterns, HRSA’s Health Workforce Simulation Model projected a national RN
excess of about 8 percent of demand, and a national LPN deficit of 13 percent by 2030.
However, because these national estimates mask large geographic disparities in adequacy of
supply, it is important to examine and focus on state-level projections.
For RNs, the state-level projections show both projected deficits of RNs in a number of states,
and large variations in oversupply in other states. The variation ranges from a deficit of 44,500
FTEs in California to excess supply of 53,700 FTEs in Florida.
Similarly, national estimates of LPNs in 2030 obscure the considerable spread in state estimates,
which range from a deficit of 33,500 FTEs in Texas to an excess supply of 4,100 FTEs in Ohio.
These findings underscore the potential complexity of ensuring adequate nursing workforce
supply across the United States.
While the projections presented here are directionally consistent with findings in recent studies
on RN supply,
22, 23
historical experience demonstrates how sensitive enrollment in training
programs and the resulting labor supply of nurses are to the job market and economic
22
Auerbach, D. I., Buerhaus, P. I., & Staiger, D. O. (2014). Registered nurses are delaying retirement, a shift that has contributed
to recent growth in the nurse workforce. Health Affairs, 33(8), 1474-1480.
23
Auerbach, D. I., Buerhaus, P. I., & Staiger, D. O. (2011). Registered nurse supply grows faster than projected amid surge in
new entrants ages 23–26.Health Affairs, 30(12), 2286-2292.
Supply and Demand Projections for the Nursing Workforce: 2014-2030 18
conditions.
24, 25
Alternative supply scenarios modeled show that graduating 10 percent
more/fewer RNs annually than the status quo would increase/decrease the RN supply in 2030 by
slightly over 200,000 FTEs. Similarly, graduating 10 percent more/fewer LPNs annually than the
status quo would increase/decrease the LPN supply in 2030 by around 58,000 FTEs
Looking to the future, many factors will continue to affect demand for and supply of nurses
including demand for health services broadly and within specific health care settings.
26
To date,
the insurance reform has expanded the number of people with health insurance coverage and
encouraged new value-based models of care. With an emphasis on disease management and
prevention and redirecting care from institutional to community- and home-based settings, these
models are providing new opportunities and roles for nurses within the health care delivery
system.
27
For example, under a scenario that reflects a health care delivery with increased focus
on preventive care and population health such as a medical home model with appropriate
counseling and improved adherence to medications (e.g., statins, antihypertensives, metformin
and other medications), an increase in the demand for RNs could be seen. This scenario assumed
a 2016 intervention that 1) sustained a 5 percent reduction in body weight for people who were
overweight or obese; 2) improved uncontrolled hypertension, high cholesterol, and high blood
glucose levels; and 3) eliminated smoking. Model outcomes suggest that achieving these
lifestyle and clinical goals would result in significant reduction in disease prevalence by 2030.
However, achieving these population health goals would also cause reduction in mortality such
that a greater number of people would require care. Under such a scenario, HWSM estimates
that the demand for RNs would be about 105,800 FTE higher than the current RN demand
projected in 2030 (3,601,800 FTEs).203
On the other hand, emerging care delivery models such as Accountable Care Organizations could
change the way that RNs and LPNs deliver service, but there is currently insufficient information
24
Buerhaus, P. I., Auerbach, D. I., & Staiger, D. O. (2009). The recent surge in nurse employment: Causes and
implications. Health Affairs, 28(4), w657-w668.
25
Staiger, D. O., Auerbach, D. I., & Buerhaus, P. I. (2012). Registered nurse labor supply and the recession—are we in a
bubble? New England Journal of Medicine, 366(16), 1463-1465.
26
Institute of Medicine (US). Committee on the Future Health Care Workforce for Older Americans. (2008). Retooling for an
aging America: Building the health care workforce. National Academies Press.
27
Rother, J., & Lavizzo-Mourey, R. (2009). Addressing the nursing workforce: A critical element for health reform. Health
Affairs, 28(4), w620-w624..
Supply and Demand Projections for the Nursing Workforce: 2014-2030 19
to project the extent to which these new delivery models will materially affect the demand for
nurses.
As the health care system continues to evolve in response to shifting financial incentives and
economic pressures, efforts to improve care access and quality, and changes in federal and state
policies, the net effects of these and other factors on supply and demand projections will
continue to be researched—with some policies and trends anticipated to increase nurse demand
while others may decrease demand. HRSA will continue to update supply and demand
projections as changes emerge in workforce supply and demand determinants.
Supply and Demand Projections for the Nursing Workforce: 2014-2030 20
About the Model
The results presented in this report come from HRSA’s Health Workforce Simulation Model,
which is an integrated health professions projection model that estimates the current and future
supply of and demand for health care providers.
The supply component of the Model simulates workforce decisions for each provider based on
his or her demographics and profession, along with the characteristics of the local or national
economy and the labor market. The starting supply, plus new additions to the workforce, minus
attrition provides an end of year supply projection, which becomes the starting supply for the
subsequent year. This cycle is repeated through 2030. The basic file that underlies the supply
analysis contains individual records of the RNs and LPNs in the workforce from the American
Community Survey (ACS) and the state licensure data.
Demand projections for health care services in different care settings are produced by applying
regression equations for individuals’ health care use on the projected population. The current
nurse staffing patterns by care setting are then applied to forecast the future demand for nurses.
The population database used to estimate demand consists of records of individual characteristics
of a representative sample of the entire U.S. population derived from the ACS, National Nursing
Home Survey, and the Behavioral Risk Factor Surveillance System. Using the Census Bureau’s
projected population and the Urban Institute’s state-level estimates of the impact of the
healthcare reform on insurance coverage,
1, 2
the Model simulates future populations with
expected demographic, socioeconomic, health status, health risk and insurance status.
This Model makes projections at the state level, which are then aggregated to the national level.
A detailed description of the Model can be found in the accompanying technical documentation
available at http://bhw.hrsa.gov/healthworkforce/index.html.
1
Holahan, J. & Blumberg, L. (2010 January). How would states be affected by health reform? Timely analysis of immediate
health policy issues. Retrieved August 2013 from http://www.urban.org/UploadedPDF/412015_affected_by_health_reform.pdf.
2
Holahan, J. (2014 March) The launch of the Affordable Care Act in selected states: coverage expansion and uninsurance
Retrieved August 2013 from http://www.urban.org/uploadedPDF/413036-the-launch-of-the-Affordable-Care-Act-in-selected-
states-coverage-expansion-and-uninsurance.pdf. Washington D.C., The Urban Institute.
Supply and Demand Projections for the Nursing Workforce: 2014-2030 21