Turn on the television or flip through a newspaper, and you might think that the U.S. desperately needs to train more nurses.
Arizona has nearly 30,000 nursing vacancies, local TV stations there recently reported; Pennsylvania Republicans met in early June to discuss how to fill the state’s nursing shortage, two schools are even opening new nursing programs in Georgia to meet that state’s projected nursing shortage. “The Nursing Shortage Starts in the Classroom,” a recent Wall Street Journal headline proclaimed.
Yet more people are going into nursing; 280,308 people passed the NCLEX examination to become a registered nurse (RN) or licensed practical nurse (LPN) in 2025, a 34% increase from 2016, according to the National Council of State Boards of Nursing. And currently 7 million registered nurses and practical nurses hold an active license in at least one state, according to the National Council of State Boards of Nursing.
But there were only about 3.4 million jobs for registered nurses in 2024, the most recent year for which data are available, and 651,400 jobs for licensed practical and licensed vocational nurses in that year, according to the Bureau of Labor Statistics—meaning that there are substantively more actively licensed nurses than there are nursing jobs. This suggests that well over two million licensed nurses are not currently working as nurses for patients.
This data—and the experience of many nurses across the country—suggest that the U.S. may have less of an actual shortage of licensed nurses than a shortage of nurses who are willing to work in bedside jobs that have become increasingly demanding. Pressure on nursing has not let up since the pandemic, nurses say, because of cost-cutting at hospitals and health systems that ask them to do more work with fewer resources.
“We’re really putting a lot of money into building a pipeline for nursing, but if nurses are leaving after a year or two of getting into employment, the problem isn’t so much a pipeline problem as a leaking gas tank,” says Karen Lasater, a professor at the University of Pennsylvania School of Nursing who studies what she calls the nursing-retention crisis.
Why nursing jobs are getting more difficult
Conditions for nurses were bad before the pandemic, got even worse during it, and appear to be deteriorating further a few years out, according to research Lasater and her colleagues recently published. Postpandemic, more than two thirds of hospital nurses reported having too few staff, compared to 57% before the pandemic, according to the paper, which surveyed 50,044 nurses in hospitals across New York and Illinois. From December 2023 to March 2024, about one third of nurses said they were dissatisfied and that they intended to leave their employer—“significantly” higher than pre-pandemic and pandemic levels, according to the paper.
It wasn’t just their imagination that the work seemed like it was getting harder. Among nurses working on medical-surgical units, the average staffing ratio increased to six patients per nurse, up from 5.7 prepandemic, according to the paper. (In California, one of the few states with mandated staffing ratios, ER nurses are staffed at a ratio of four per patient, and labor and delivery nurses are staffed at a ratio of two per patient.)
“I fear that we’re headed to a worse place, because it’s apparent that we didn’t learn much from the COVID-19 pandemic,” Lasater says.
Ariana Lucio, a 45-year-old nurse in El Paso, Texas, has been a nurse for 14 years and currently works in the medical-surgical unit at Del Sol Medical Center, which is owned by HCA Healthcare, the largest health system in the U.S. HCA operates a network of for-profit hospitals across the country. Her hospital has been cutting back on staffing and embracing technology that makes work harder for nurses, says Lucio. Adequate staffing is a key issue for nurses unions and organizations, and Lucio, who is a member of National Nurses United, has protested staffing conditions at the hospital in the past.
Her unit used to have a unit clerk who would answer the phones, stock supplies, and handle paperwork, but the hospital eliminated the position, she says. Now, she says nurses are running to answer phones, clean the break room, and pick up the tasks the unit clerk used to do. In the past, the charge nurse—often the person managing a specific hospital unit—wasn’t assigned patients, Lucio says. No longer. The added responsibility of patients means the charge nurse can’t as easily help other nurses with difficulties they may encounter.
The hospital also used to predominantly use “sitters”: hospital employees who stay in a patient’s room for a given amount of time to keep a patient company or ensure that they stay in bed for safety reasons. But Lucio says that the hospital is relying more on virtual sitters: a person on a computer screen who watches and can talk to the patient remotely. If a patient tries to get out of bed and doesn’t listen to the virtual sitter’s instructions to get back in bed, the virtual sitter messages the nurses on duty, who then have to get the patient back in bed, Lucio says. With in-person sitters, the nurse is called less frequently because the in-person sitters can get the patient back in bed.
“It’s gotten harder, especially after COVID,” says Lucio, who recently became so burned out that she went from working full-time to part-time. “It’s coming not so much from patients but from changes in the administration.”
HCA, which owns Del Sol Medical Center, referred questions about staffing to a public relations team handling the hospital’s communications. In a statement to TIME responding to these examples of how staffing conditions have changed, Del Sol Medical Center said that its staffing is “safe and appropriate” and that it utilizes technology to “limit administrative tasks so our nurses can spend more time taking care of patients.”
“Like hospitals across the nation, we are actively recruiting new nurses to join our staff,” the hospital said. “We continue to provide a competitive wage for a hospital system in El Paso, as well as support our colleagues and their families by providing a generous and flexible benefit package with benefits specifically designed to support our colleagues’ families and careers.”
A study of nearly 8,000 nurses who left the profession between 2018 and 2021 found that 26% left because of burnout, and 21% cited insufficient staffing. About two-thirds left because of planned retirement, suggesting that many of the others left before retirement age.
Data show that lower staffing ratios lower nurse burnout and improve patient outcomes. In one study of nurses at hospitals across Queensland, Australia, those who worked at hospitals that followed a minimum nurse staffing policy had 24% lower odds of high burnout and 27% lower odds of job dissatisfaction.
Minimum staffing ratios were good for patients, too; they were linked to lower mortality, a shorter length of stay, and less readmission, according to a separate study. The costs avoided due to fewer readmissions and shorter length of stay were more than twice the cost of the additional nurse staffing, the study found.
“There’s really substantive cost savings,” Lasater says.
But hospitals are often reluctant to invest in lowering their nurse-to-patient ratios. Doctors can bill for their services, making it easy for administrators to see that they bring in money, Lasater points out. But it’s harder for administrators to see that nurses have an impact on the balance sheet. Instead, hospitals treat nurses like a labor expense, she says.
Yet nurses can save hospitals money, research suggests. Generally in the U.S., insurance or government payers like Medicare pay hospitals to treat certain conditions in a patient. But if the patient stays longer than most patients with that condition do, the hospital foots the bill for the extra time. So if nurses can reduce patient length of stay and readmission, they can be good for the balance sheet.
In one study of hospitals in New York state, hospitals with fewer than six patients per nurse, patients were discharged sooner and readmitted less often than they were at hospitals with seven or more patients per nurse. Had hospitals been staffed at a ratio of four patients per nurse—a ratio proposed most recently in 2025 in legislation that did not pass—an estimated 4,370 lives and $720 million would have been saved over two years, the study projected.
Yet rather than add nurses, many hospitals are paring back, sometimes turning to apps where they can hire nurses as gig workers. Such apps often allow hospitals to avoid paying for benefits for these workers, says Katie Wells, a senior fellow at the AI Now Institute, which has studied gig apps for nursing. “Lean staffing has just become the norm,” Wells says.
The American Hospital Association argues that the issue is not lean staffing but that instead there are workforce shortages that are projected to continue for more than a decade.
“The growing complexity and intensity of patient care, along with overly burdensome regulatory requirements and increased administrative demands from corporate insurers, continue to place significant demands on nurses,” the association said in a statement provided to TIME.
Hospitals are also facing increased costs of caring for patients, according to a March 2026 post by Rick Pollack, AHA’s president and CEO. In 2025, he writes, hospital expenses grew 7.5%, more than twice the rate of growth in hospital prices. Hospitals are also caring for patients who are sicker and whose care is more complex than it used to be, he points out.
Some of the lean staffing can likely be attributed to the wave of private equity takeovers of hospitals in recent years. Hospitals that were acquired by private equity reduced full-time employees staffing by 11.6%, while control hospitals—those that were not taken over—increased staffing in the same time period, according to one 2025 study. The study also found that hospitals acquired by private equity reduced hospital-wide salary expenditures.
Lean staffing has also been embraced by for-profit hospitals that aren’t owned by private equity, Wells says. About one-quarter of hospitals were for-profit in 2020, but that share is growing. For-profit hospitals had “statistically significant” lower investments in nursing services, higher nurse staffing ratios, worse nurse job outcomes, and worse patient safety outcomes when compared to non-profit hospitals, one 2025 study looking at hospitals in Illinois found.
A few states have mandated minimum staffing ratios for hospitals. California has had minimum staffing ratios for nurses since 2004; research has shown that hospital nurses there have lower burnout than nurses nationally. (In California, the ratios differ depending on the unit; the medical-surgical unit has a mandated ratio of no more than five nurses to one patient, for instance, while the ICU has a mandated ratio of no more than two nurses for one patient.) Oregon passed mandatory nurse staffing ratios in 2023, which went into effect in June 2026.
Other states have considered nurse-to-patient ratio legislation but have not passed it, though a few states require hospitals to publicly report their nurse-to-patient ratios. Other states allow hospital nurses to formally decline assignments they believe are unsafe.
It’s one reason Lasater, the nursing professor, says that the best solution for getting more nurses to stay at hospitals is to mandate nurse-to-patient ratios by legislation. It works, she says.
“Hospitals have always had the opportunity to create better staffing conditions and to create more favorable working conditions,” she says. “They can voluntarily do this, but a large portion of them haven’t.”