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North Carolina faces shortage of up to 21,000 nurses in coming decade

Fayetteville State University, Nursing Program, FSU
Fayetteville State University

North Carolina faces a shortage of as many as 21,000 qualified nurses in the coming decade if burnout rates continue.

"We have a nursing shortage, straight across the board," said Erin Fraher, deputy director for policy at the Cecil G. Sheps Center for Health Services Research at the University of North Carolina. "Of the workforce that I am most concerned about right now, I am most concerned about nursing. We have shortages in urban areas. We have shortages in rural areas. We have hospitals desperate for nurses."

Researchers began the work of analyzing the nursing workforce before the Covid-19 pandemic. Even then, projections showed a shortage of 12,000 nurses by 2033. But as health care workers, and nurses in particular, have been pushed to the brink of exhaustion while treating thousands of Covid-19 patients, Fraher and others worry shortages will grow even bigger.

The projections were released by health workforce experts with The Sheps Center, in partnership with the North Carolina Board of Nursing. The models were condensed into an online tool that allows users to see thousands of different forecast outcomes by changing variables.

If nurses exit 5 years early: The baseline shortage is significantly worsened—to exceed 21,000 RNs—if nurses leave the workforce five years earlier
Sheps Center
If nurses exit 5 years early: The baseline shortage is significantly worsened—to exceed 21,000 RNs—if nurses leave the workforce five years earlier

Unlike physicians, where rural areas of North Carolina face far bigger shortages than urban areas, the need is actually flipped for registered nurses. That's because it's the bigger hospitals that are in desperate need of these RNs, and bigger hospitals are more likely to locate in and around metropolitan areas.

That said, any time a smaller hospital loses a nurse, it affects them to a greater degree because of the smaller overall nurse population.

"So the loss of a nurse or two has a greater impact on that (smaller) hospital, because they're not the Orange County, the Durham County, that can pull from a wider supply of nurses," said Fraher.

While increasing enrollments in nursing schools would certainly help, Sheps experts worry it would be only a drop in the bucket. For one, North Carolina already imports more registered nurses from outside the state than it trains here. Of the roughly 8,500 nurses who enter the North Carolina workforce every year, about 44% are North Carolina educated, something that makes North Carolina "vulnerable to competition from other states as they also face shortages in the future," according to the Sheps experts.

It would be far more impactful to keep nurses who are already in the field, or even recruiting nurses back who left the profession because of burnout or other reasons.

"So the message that I want to leave you with, leave policymakers with, is: It would be great if we could expand enrollments. But what we're really going to have to focus on is retention," said Fraher. "And it's going to get worse before it gets better."

Jason deBruyn is WUNC's Supervising Editor for Digital News, a position he took in 2024. He has been in the WUNC newsroom since 2016 as a reporter.
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