The nursing shortage: then and now

If you’ve heard the phrase “nursing shortage” so many times that it sounds like background
noise, you’re not alone. Hospitals and clinics have been talking about a lack of nurses for
more than a century. The twist? It’s never quite the same problem twice. The nursing shortage
of 1918, the staffing crunch of the 1950s, and the post-COVID workforce crisis all share a
common headline, but the fine print looks very different.

Today’s nursing shortage is a mix of familiar issuesaging patients, retiring nurses, stressful
working conditionsand some very modern pressures, like pandemic burnout and the high cost of
nursing education. To understand where we’re headed, it helps to look back at where we’ve
already been.

How it started: early waves of the nursing shortage

World War I and the 1918 flu: the first big shock

The United States’ first severe nursing shortage showed up in the late 1910s, when World War I
and the 1918 influenza pandemic collided. Thousands of nurses were recruited into military
service just as a deadly flu tore through civilian communities. Local leaders begged for more
nurses, and retired or inactive nurses and volunteers stepped in wherever they could.

Hospitals at the time were already transitioning from charity institutions to centers of
medical treatment. Demand for trained nurses skyrocketed, but the pipeline to create them was
still small and highly localized. Training was hospital-based, pay was low, and working
conditions were harsh. Being a nurse meant long hours, rigid hierarchies, and not much say in
how care was delivered.

Mid-20th century: chronic shortage, chronic underpay

If you jump forward to the period from roughly 1945 to the mid-1960s, you’ll find another
persistent nursing shortage. Studies of that era show hospitals “making do with fewer nurses,”
often by stretching staff thinner instead of significantly improving pay or working
conditions.

The core pattern was already clear:

• Demand for nursing care rose as hospitals added beds and technology.
• Wages and staffing levels lagged behind that demand.
• Nurses were asked to “do more with less”a phrase that still hasn’t gone out of style.

Nursing shortages in the 20th century were often demand-driven: healthcare
systems were expanding faster than training programs and hiring budgets could keep up.
Yet even when nurses were in short supply, compensation and respect didn’t always rise in
proportion to their value.

Late 20th century and early 2000s: boomers and new expectations

By the late 1990s and early 2000s, another round of headlines warned of a looming “nursing
crisis.” This time, the focus was on the aging Baby Boomer generationon both sides of the
bedrail. As Boomers aged, they needed more care; at the same time, many experienced nurses from
that generation were preparing to retire.

Health systems leaned heavily on hospital-based care, intensive care units, and high-tech
treatments. That meant more patients, more complexity, and more pressure on nurse staffing.
It’s also when conversations about nurse-to-patient ratios and burnout started to get louder,
not just in professional journals but in state legislatures.

California, ratios, and why staffing levels matter

One of the most famous policy responses to nurse understaffing came from California. In 2004,
the state became the first in the U.S. to mandate minimum nurse-to-patient ratios in acute care
hospitals. Later research compared California’s hospitals with similar ones in states without
mandated ratios and found that better staffing was associated with lower 30-day mortality and
fewer “failure-to-rescue” events.

In plain language: when nurses have fewer patients per shift, people are less likely to die
from complications. That data has shaped today’s debates about the staffing crisis and helped
nurses argue that safe ratios aren’t a luxurythey’re a patient safety requirement.

How it’s going: the nursing shortage today

The numbers behind the headline

Fast-forward to the 2020s, and “nursing shortage” isn’t just a talking pointit’s backed by a
lot of hard numbers:

• The U.S. Bureau of Labor Statistics (BLS) projects that employment of registered nurses will
  grow about 5% from 2024 to 2034, faster than the average for all occupations.
• Analyses of the workforce suggest roughly 189,000 RN job openings per year through the mid-2030s,
  reflecting both new positions and nurses leaving the field.
• Some projections estimate an RN shortfall of over 500,000 by 2030 if trends don’t
  improve.
• A major study from the National Council of State Boards of Nursing (NCSBN) found that about
  100,000 RNs left the workforce during the COVID-19 pandemic, and roughly one-fifth of RNs
  nationally could leave by 2027 due to stress, burnout, and retirement.

In other words, we’re not just talking about “a bit of understaffing.” We’re talking about
large swaths of the workforce leaving or planning to leave while demand for care keeps rising.

Burnout and the COVID-19 shock

The COVID-19 pandemic took long-standing issuesheavy workloads, moral distress, and
insufficient staffingand turned the volume all the way up. Studies show that the pandemic
dramatically increased burnout, especially among younger and less experienced nurses, and that
burnout is closely linked to an intention to leave the job or the profession.

Surveys in recent years have found that many nurses either left bedside roles or seriously
considered doing so. High turnover rates peaked in 2021, with some reports noting RN turnover
around 27%, and although those rates have improved somewhat since then, they remain high enough
to keep hospital HR teams very awake at night.

It’s not just about exhaustion, either. Nurses frequently report feeling unsafe, unsupported, or
unable to give the kind of care they were trained to provide. That mismatchbetween what
nurses know patients need and what the system allows them to docreates moral injury that can
be even harder to recover from than physical fatigue.

The pipeline problem: schools turning students away

You might assume that the fix is simple: “Just train more nurses!” Unfortunately, nursing
education has its own bottlenecks. According to data from the American Association of Colleges
of Nursing (AACN), U.S. nursing programs turned away more than 65,000 qualified applications to
baccalaureate and graduate programs in 2023. The reasons: not enough faculty, limited clinical
sites, lack of preceptors, and budget constraints.

At the same time, nursing faculty themselves are aging and often earn less than they could in
advanced clinical roles, making academic careers a tough sell. Some recent federal policy
changes affecting student loan access and borrowing limits for nursing degrees have raised
additional concerns about whether future students will even be able to afford the training
required for advanced practice and leadership roles.

Older patients, older nurses

The U.S. population is aging, and so is the nursing workforce. A significant share of RNs are
over age 50 and moving closer to retirement.
As older adults live longer with chronic conditions, they need more frequent and more complex
care in hospitals, clinics, long-term care facilities, and at home. That increased demand
collides directly with a shrinking supply of experienced nurses.

The result? Younger nurses often find themselves thrust into high-responsibility roles faster,
with fewer mentors availableand under intense pressure not to make mistakes.

A geographically uneven crisis

The “nursing shortage” isn’t uniform. Some metro areas have competitive job markets and plenty
of nurses; others, especially rural communities and certain states, struggle to fill positions
at all. National analyses show that dozens of states are facing or are projected to face
critical RN shortages over the next decade, while a minority have relatively stable supply.

Facilities in areas with the worst shortages often rely heavily on travel nurseswho are
essential but expensivewhile permanent staff may feel burned out and undervalued. That
creates a cycle where retention becomes even harder.

Then vs. now: what’s really changed?

On the surface, the story hasn’t changed much: more patients than nurses, difficult working
conditions, and a sense that the system is always playing catch-up. But several trends make
today’s shortage different from earlier ones:

1. Complexity of care

A nurse in 1955 and a nurse in 2025 share the same core missionkeep patients safe, comforted,
and healingbut the complexity of that job has exploded. More technology, more medications, and
more chronic conditions mean today’s nurses juggle tasks that used to be reserved for
physicians or specialists. That increases cognitive load and risk of error.

2. The burnout data is harder to ignore

While nurses have been tired for generations, we now have robust research documenting the link
between poor staffing, burnout, turnover, and patient outcomes. Large systematic reviews and
workforce surveys make it clear that chronic understaffing doesn’t just make people grumpyit
raises costs and harms patients.

3. Public recognition and patient expectations

Social media, online reviews, and news coverage have made the nurse staffing crisis far more
visible. Patients and families now openly question staffing levels, and nurses can share their
experiences on widely read platforms. That visibility can spur policy changes, but it also
increases pressure on individual nurses who feel watched from every angle.

4. Education, debt, and career options

Earlier generations of nurses often had fewer alternative career paths. Today, someone who
wants to help people and work in healthcare can choose from dozens of roles that may come with
less stress or better pay. At the same time, the cost of nursing school and uncertainty about
financial aid make it harder for some students to even start the journey.

Can we fix the nursing shortage?

There’s no single magic solution, but experts point to several strategies that, together, can
make a real difference:

Invest in staffing and fair pay

It sounds obvious, but it’s foundational: hospitals and healthcare systems need to fund enough
nurse positions to maintain safe nurse-to-patient ratiosand pay competitively. Analyses of the
shortage highlight inadequate staffing, high turnover, and low pay relative to responsibilities
as core drivers of the current crisis.

Expand education capacity

Increasing student seats without adding faculty or clinical placements is a recipe for burnout
on the educator side. Solutions include:

• Loan repayment or salary incentives for nurse educators.
• Partnerships between academic programs and health systems to create more clinical sites.
• Thoughtful use of high-quality simulation to supplement (not replace) hands-on training.

Addressing faculty shortages and infrastructure limits will be critical if schools are going to
stop turning away qualified applicants.

Support nurses’ mental health and well-being

Research on burnout and intent to leave is very clear: nurses who feel supported, staffed
safely, and included in decision-making are more likely to stay. Evidence-informed strategies
include:

• Peer support and counseling programs.
• Flexible scheduling and time-off policies that are actually honored.
• Shared governance models that give nurses a real voice in practice decisions.

These aren’t just “nice-to-have perks.” They’re key retention tools in a labor market where
nurses have options.

Use technology wisely (not as a band-aid)

Electronic health records, smart pumps, and AI-driven decision support tools can helpbut only
if they’re designed to reduce busywork rather than add it. Technology won’t fix an unsafe
ratio, but it can free up time for the work only nurses can do: patient assessment, teaching,
and advocacy.

Experiences from the front lines: then and now

Beyond the statistics and policy debates, the nursing shortage is deeply personal. To see how
“then and now” really feels, imagine two nurses whose careers are separated by half a century.

Mary, a hospital nurse in the 1970s

Mary starts her shift on a busy medical-surgical unit in 1974. Her patients are mostly older
adults recovering from surgery or managing long-term conditions like heart failure. She trained
in a diploma program directly attached to the hospital; many of her instructors now work
alongside her.

Staffing is tight. On some nights, Mary and one aide care for more patients than feels safe,
but the pace is slower than what many nurses face today. There are fewer invasive procedures,
fewer high-tech devices, and less documentation to complete. Charting is done on paper; the
“computer room” is a mysterious place in the basement that she never sees.

When the hospital has trouble filling shifts, leaders offer small bonuses or ask nurses to stay
late. Discussions about nursing shortages pop up, but they mostly revolve around “not enough
young people going into nursing” or needing to “recruit more girls into the profession.”
Burnout exists, but it doesn’t have a name yet. Many nurses simply “power through” until they
retire, switch specialties, or step away to raise families.

Alex, an ICU nurse in the mid-2020s

Now picture Alex, an intensive care nurse in 2025. Their day begins with a screen full of
alarms: ventilator settings, continuous infusions, lab results, telemetry, and messages from
physicians and pharmacists. Each patient has multiple lines, devices, and medications to
manage. Charting is done electronically, with hard stops and alerts that can be life-saving
but also time-consuming.

Alex has lived through the COVID-19 surges. At the height of the pandemic, the ICU was filled
beyond capacity, with nurses training on the fly to manage ventilators and prone positioning
for patients with severe respiratory failure. Some days, Alex and colleagues had to care for
more critically ill patients than guidelines recommended, making heartbreaking triage decisions
when supplies and staff ran short.

Today, the COVID units are quieter, but the aftermath lingers. Several experienced colleagues
retired early or left the bedside altogether. New graduates arrive eager and anxious, trying to
learn advanced skills quickly in a high-stakes environment. Orientation programs are compressed
to cover staffing gaps. When Alex looks around the break room, they can count several coworkers
who have talked openly about changing careers or moving to less acute settings.

What keeps Alex going? Small moments of impactthe patient who finally comes off the
ventilator, the family that says “you made this bearable,” the sense that their critical care
skills genuinely save lives. But the margin for error feels razor thin, and the idea of doing
this exact job for another 20 or 30 years can feel overwhelming.

Common threads and key differences

Mary and Alex might recognize each other instantly as nurses: the same quick humor, the same
habit of scanning a room for who needs help, the same instinct to put patients first. Both
juggle competing demands with limited time and imperfect systems. Both experience the frustration
of knowing exactly what a patient needs but not having the staff, equipment, or authority to
make it happen quickly.

But Alex faces pressures Mary never did: real-time scrutiny on social media, escalating
workplace violence in some settings, complex documentation tied directly to reimbursement and
quality scores, and an unprecedented global pandemic early in their career. Mary had fewer
gadgets and less data, but also fewer regulations, fewer alarms, and sometimes more space to
form long-term relationships with patients and families.

Their stories highlight a key truth about the nursing shortage: it’s not just a matter of
numbers. It’s about the lived experience of the people inside the professionhow supported they
feel, how much control they have over their work, and whether they can imagine a healthy
future for themselves in nursing.

The bottom line

The nursing shortage is both an old story and a new one. Past generations struggled with
understaffing, low pay, and limited respect; today’s nurses face many of the same challenges,
amplified by higher complexity, widespread burnout, and growing financial and educational
barriers. The difference is that we now have strong evidence about what happens when nurses are
stretched too thinand what can help keep them at the bedside.

Investing in safe staffing, fair compensation, robust education pipelines, and genuine
well-being programs isn’t just “nice for nurses.” It’s a direct investment in patient safety,
community health, and the long-term stability of the entire healthcare system. If history has
taught us anything, it’s this: ignoring the nursing shortage doesn’t make it go away. Listening
to nursesand acting on what they’ve been saying for more than a centuryjust might.