RN Shortage 108,960 by 2038: HRSA Workforce Projections

Quick Answer

HRSA's December 2025 NCHWA projections forecast a national shortage of 108,960 registered nurses and 245,950 LPNs by 2038. The nonmetropolitan RN shortage is projected at 11% versus 2% in metropolitan areas. The BLS projects 189,100 RN job openings per year over the 2024-2034 decade.

Last verified: Sep 16, 2026.

At a glance

• RN shortage (2038): 108,960 FTE
• LPN shortage (2038): 245,950 FTE
• Nonmetro RN shortage: 11%
• Metro RN shortage: 2%
• Annual RN openings: ~189,100 (BLS 2024-2034)
• RN median pay (2024): $93,600/year
• RN jobs (2024): 3,391,000
• RN growth (2024-2034): 5%

What HRSA's December 2025 projections say

The 108,960 RN shortage projection is the headline number, but the geographic breakdown matters more for policy. The National Center for Health Workforce Analysis (NCHWA) released updated projections in December 2025 covering 2023-2038. The 11% nonmetropolitan RN shortage is five times larger than the 2% metropolitan shortage as a percentage of demand, meaning the rural healthcare delivery model is the most exposed (HRSA NCHWA December 2025 projections).

The LPN shortage of 245,950 FTE is larger in absolute terms than the RN shortage. LPN demand is concentrated in long-term care facilities, home health settings, and skilled nursing facilities — segments that are growing with the aging baby-boomer population. LPN supply is constrained by lower pay relative to RNs and by the same retirement dynamics that affect all healthcare workers.

What BLS projections say

The BLS OOH 2024-2034 outlook is consistent with HRSA's projection. The Bureau of Labor Statistics projects 5% employment growth for RNs from 2024 to 2034, faster than the 3% average for all occupations. Approximately 189,100 RN job openings are projected each year, on average, over the decade. Most of those openings result from the need to replace workers who transfer to different occupations or exit the labor force, such as to retire (BLS OOH Registered Nurses, June 30, 2026).

The BLS number is higher than the HRSA FTE shortage because the BLS measures openings (including turnover) while the HRSA measures net shortage (demand minus supply). Both perspectives are useful: BLS for the recruiting market size, HRSA for the policy response.

Why the nonmetro shortage is so much larger

The nonmetro-metro disparity reflects three structural issues. First, rural areas have older populations per capita, which drives higher per-capita demand for nursing services. Second, rural nursing schools produce fewer graduates per capita than urban schools, and the graduates who do complete tend to migrate to metro areas. Third, rural facilities pay less than urban facilities for comparable work, making retention harder (HRSA NCHWA December 2025 projections).

Federal policy responses target the third issue most directly. The Nurse Corps Scholarship Program pays education costs in return for a commitment to serve in a Critical Shortage Facility (CSF). The Nurse Corps Loan Repayment Program reimburses a portion of unpaid educational debt in return for serving in a CSF or as nurse faculty in an eligible nursing school. Both programs are sized to the geographic disparity: more funding flows to nonmetro facilities than metro facilities, which is the right allocation given the projection data.

Where nurses get hired

The BLS breaks down 2024 RN employment by industry. Hospitals employ the largest share of RNs, followed by ambulatory healthcare services, nursing and residential care facilities, and government. The aging-population demand profile favors outpatient care centers that provide same-day care such as chemotherapy, rehabilitation, and surgery; home health; and residential care facilities. Demand growth in inpatient hospital nursing is more measured (BLS OOH Registered Nurses, June 30, 2026).

For prospective nursing students evaluating career paths, the implication is that the highest-growth settings — home health, residential care, outpatient specialty centers — are also the settings where the HRSA shortage projections are most acute. Specializing in geriatric nursing, home health, or rehab nursing is a reasonable bet for both job security and geographic flexibility.

What the median pay data means

The 2024 median RN pay of $93,600 per year ($45.00 per hour) is competitive with many white-collar bachelor's-degree-required professions. The pay distribution skews higher in metro areas and in specialty settings (ICU, OR, ER) — travel nurse pay can run $80-$120 per hour in 2026 depending on specialty and location. For new RNs, the typical entry path is hospital medical-surgical or telemetry, where pay is closer to $32-$40 per hour (BLS OOH Registered Nurses, June 30, 2026).

The pay growth path is significant. RNs who specialize in ICU, ER, or OR can earn $50-$60 per hour within 3-5 years. Nurse practitioners earn substantially more — median NP pay is over $120,000 per year. The MSN-FNP and DNP pipelines are the highest-leverage career paths in nursing in 2026.

What nursing students and schools should do

Three actions for prospective nursing students in 2026.

1. Apply to accredited BSN programs. The BLS reports the typical entry-level education for RNs is a bachelor's degree, and the HRSA shortage projections favor BSN-prepared RNs for hospital and specialty roles. ABSN (Accelerated BSN) programs are the fastest path for career changers.
2. Plan for NCLEX-RN prep with UWorld or Kaplan. NCLEX pass rates vary significantly by prep provider. UWorld is the most cited prep course; Kaplan is the second-most-cited. Hurst and Board Vitals are alternatives. Pass on first attempt to avoid retake fees.
3. Consider geographic flexibility. The 11% nonmetro shortage is five times the metro shortage. Federal loan repayment programs through Nurse Corps can fund education in return for service in Critical Shortage Facilities. Signing bonuses and relocation support are common in nonmetro facilities.

What to watch next

Three near-term datapoints. First, the next NSSRN (National Sample Survey of Registered Nurses) update — the 2026 fielding has been sent to select nurses; results will be the primary source of nursing workforce supply data for the next 5+ years. Second, the December 2026 or early 2027 update to the HRSA NCHWA projections — the model is refreshed every 3-5 years. Third, any federal legislative response to the projected shortage — immigration policy for international nurses, expanded funding for the Nurse Corps programs, or new community-college-to-BSN pipeline programs.