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.
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.
“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
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.)
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.
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.
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.”
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.
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.
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.
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.
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.
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.
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.
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.
“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.”
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