Nursing Doesn't Have One Shortage — It Has Three Moving in Opposite Directions

THOUGHT LEADERSHIP | Gabrielle Fisher, RN, American Association of Critical-Care Nurses (AACN), with Timothy Agnew

The Future of Nursing: Campaign for Action, established by AARP, AARP Foundation, and the Robert Wood Johnson Foundation to enact the National Academy of Medicine's 2020-2030 directives, ceased operations in May 2025. Its own site now says that it is no longer maintained. That closure occurred five years into a ten-year plan, with the 2030 target still on the calendar and most of the report's nine major recommendations only partially implemented. The organizational engine built to drive the profession's own roadmap went dark before the roadmap expired.

The framework built to implement the plan is gone. The plan's deadline is not.

That timing is worth considering because it happens at the precise moment workforce data shows the future of nursing isn't one story anymore. It's three, and they negate each other.

The RN Shortage Is Evident, and Improving

Health Resources and Services Administration’s (HRSA) current workforce projections reveal a national RN shortage of approximately 8% in 2026, predicted to decrease to around 4% by the mid-2030s as nursing school graduates align with demand. That's legitimate improvement, though it undermines the pain still clustered in specific settings — behavioral health units, rural facilities, and long-term care get more of the shortage than national averages suggest. In the 2023–2024 academic year, nursing programs turned away more than 65,000 capable individuals, primarily because of a faculty shortage, not a lack of demand.

The LPN Shortage Remains Volatile

While the RN pipeline steadies, the licensed practical nurse shortage is moving in the opposite direction — Health Resources and Services Administration (HRSA) suggests it increasing from approximately 14% today to 28% within a decade, including a combined shortfall threatening 300,000 full-time-equivalent LPNs by 2037. That deficit falls heavily on long-term care, specifically on an aging population who needs it most. A workforce narrative formed entirely around 'the nursing shortage' as a solitary, organized crisis blindly overlooks that a vital component of the profession is dissolving the quickest.

Advanced Practice Nursing Is in Surplus

Conversely, demand for nurse practitioners will probably fall short by over 60%, as nurse employment expects to increase by about 35% between 2024 and 2034, growing almost seven times faster than registered nurses. Nationally, over 290,000 NPs have received licenses. That development is effectively colliding with a conflicting policy shift: as of 2026, approximately 30 states and the District of Columbia grant nurse practitioners full practice authority, allowing them to diagnose, prescribe, and operate independent practices without physician oversight. Research on states that embraced full practice authority shows NPs in those states were more inclined to work in federally designated shortage areas and to become self-employed — meaning scope development doesn't just add credentials, it visibly reorganizes care into places that had none.

Why Labeling The Nursing Debacle as One Shortage Is a Misnomer

An isolated 'nursing shortage' headline encourages a single response — more nursing school seats — and that response only encourages one of the three scenarios discussed. Pouring resources into RN pipeline expansion does nothing for the LPN collapse in long-term care, and it vigorously competes with the faculty capacity problem holding back nursing education, since RN and LPN programs rely on the same decreasing pool of qualified instructors.

However, the NP surplus implies a need for a completely different approach. Instead of adding more positions, the focus should be on expediting the removal of scope-of-practice restrictions in nearly twenty states. This would allow a significant number of trained and licensed advanced-practice nurses, currently underutilized, to address primary care needs.

Workforce strategy that matches these three truths would look different at each tier:

●       RN pipeline: prioritize nursing faculty capacity over new enrollment slots, since faculty shortage — not applicant interest — is the irrevocable constraint.

●       LPN pipeline: treat the long-term care shortfall as its own crisis with its own funding stream, rather than a rounding error inside broader RN statistics.

●       NP scope of practice: accelerate full-practice-authority legislation in restricted states, since the workforce surplus needed to fill primary-care gaps in underserved areas already exists. It's licensed to practice, just not everywhere it's needed.

What Next?

The Future of Nursing 2020–2030 report set an ambitious, still-pertinent agenda: remove practice barriers, value nursing's contribution, prepare the workforce for health equity work, and expand who enters the profession. Losing the campaign infrastructure built to execute that agenda doesn't make the agenda wrong, but it means that state nursing associations, health systems, and professional organizations now must bear management work that once ran through a national campaign. The 2030 deadline is four years away, and current workforce data presents three separate narratives, so the next phase of this work needs a specific focus instead of a general "nursing shortage" label.

References

American Association of Nurse Practitioners. (2026). NP workforce data.

Campaign for Action. (2025). Action Hub: Future of Nursing 2030 [site sunset notice, May 31, 2025].

Health Resources and Services Administration, National Center for Health Workforce Analysis. (2026). Health workforce projections: Nursing workforce, 2023–2038.

National Academies of Sciences, Engineering, and Medicine, National Academy of Medicine, Committee on the Future of Nursing 2020–2030. (2021).

The future of nursing 2020–2030: Charting a path to achieve health equity. National Academies Press.

NurseJournal.org. (2025). Nurse practitioner practice authority: A state-by-state guide.

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