Understanding the Nursing Shortage and What’s Driving It
Nursing shortage solutions have become one of the most urgent priorities in health care. The U.S. nursing workforce has been under pressure for years, but a combination of factors — an aging RN workforce approaching retirement, a nursing education pipeline that can’t keep pace with demand, and accelerated burnout following the COVID-19 pandemic — has pushed the shortage to a critical level. The Bureau of Labor Statistics projects that the healthcare industry will add over 2 million new jobs through 2030, but the supply of available nurses, particularly BSN-prepared RNs, is not growing fast enough to meet that need.
The shortage is not uniform. Rural communities face the steepest access gaps, where health care organizations struggle to recruit and retain staff at any level. Meanwhile, nursing programs across the country continue to turn away qualified applicants — not because of lack of interest, but because of a shortage of faculty and clinical sites to train them.
COVID-19 accelerated what was already a structural problem. Early retirements surged, experienced nurses shifted out of hospital settings into less demanding roles, and the workforce that remained grew increasingly strained. The post-pandemic nursing workforce looks different — younger, less experienced on average, and under different pressures than at any prior point in the profession’s history.
Root Causes That Still Drive the Shortage Today
• Aging RN workforce. The median age of registered nurses continues to rise, with a significant share of the current workforce approaching retirement age within the next decade.
• Nursing education gaps. Nursing education programs lack sufficient faculty to grow capacity. Continuing education pipelines for new clinical instructors are underfunded and undersupplied, limiting how many students can enter the profession each year.
• Burnout-driven attrition. Nurse turnover driven by burnout, workload, and poor leadership quality continues to drain the existing workforce faster than it can be replenished.
• Regional supply disparities. Urban health systems and rural facilities are competing for the same shrinking pool of nurses, with rural organizations routinely losing out.
Why Generic Solutions Aren’t Enough — What’s Changed
The nursing shortage is structural — and structural problems don’t respond to one-dimensional fixes. Organizations that focus only on recruitment, only on retention, or only on care model redesign will continue to struggle. Sustainable nursing workforce stability requires simultaneous action on all three fronts.
Post-pandemic, the nature of the nursing shortage has also shifted. It’s no longer just about headcount — it’s about where nurses are choosing to work and under what conditions. Workplace culture has become a competitive differentiator: organizations with toxic or unsupportive environments are losing nurses to those that invest in leadership, flexibility, and professional development. Generic shortage responses — travel nurse contracts, sign-on bonuses, one-off recruitment campaigns — address symptoms rather than causes. The organizations making the most progress are those building comprehensive, multi-pronged approaches.
Nursing Shortage Solutions: Redesigning How Care Is Delivered
A combination of patient surges and nursing shortages has forced health care organizations to pursue new strategies for care delivery. Pre-pandemic care models are stretching thin during a nurse shortage. As shortage solutions go, redesigning how care is structured and delivered is one of the most immediate levers available — it makes existing nursing staff more effective without requiring new headcount. Health systems are deploying alternative staffing models to address the shortage, and it’s all-hands-on-deck.
Team-Based Nursing Care Models
Team-based care is becoming a new reality. Team nursing allows clinicians with varying skill levels to collaborate in providing patient-centered nursing care. A team-based approach brings together RNs, unlicensed assistive personnel (UAPs), and LPNs with other disciplines, including physical therapists and rehab therapists.
By distributing appropriate duties to LPNs, UAPs, and less-experienced RNs under the direction of an experienced RN, a team-based care model has shown it can enable care settings to do more with less. This model provides support to patients while allowing experienced RNs to operate at the top of their license — a core principle of effective shortage response. Team-based approaches also improve staff satisfaction by reducing the isolation that comes with primary nursing, giving nurses built-in collaboration and backup on every shift.
Advent Health recently completed a study integrating LPNs to help nurses with care delivery needs. LPNs were hired into the acute care setting to work alongside RNs on a team-based nursing care model. The study revealed that implementing a new care delivery model can help address staff resource issues and provide adequate patient care. Advent Health’s research also found that the model enhances the nurses’ work environment in the areas of autonomy, control over practice, and teamwork.
Cross-Training and Float Pool Strategies
Hospitals are cross-training nurses in non-critical areas to fill labor needs in critical care. Float pools help manage this issue. Utilizing and cross-training float pools allows organizations to redeploy labor resources quickly and efficiently. This agile labor model involves cross-training a pool to work across adjacent specialty areas, with full-time staff cross-trained as emergency backup.
Cross-training also reduces per-shift coverage gaps — when nurses can flex across two adjacent units, a single absence is no longer a crisis. Health care organizations that invest in this approach report greater scheduling stability and a workforce that feels more confident and versatile. Float pool staffing models give organizations the flexibility to scale up or down with patient census rather than defaulting to costly agency contracts.
Expanding Scope of Practice for LPNs and Support Staff
The post-COVID period prompted a broader conversation about scope of practice restrictions that limit how efficiently the existing workforce can be deployed. Where regulatory frameworks allow, expanding the scope of practice for LPNs and advanced support staff enables organizations to redistribute nursing tasks more effectively across the team. Pandemic-era emergency waivers demonstrated that this model works — quality and safety outcomes held up while nursing bandwidth expanded.
The argument is straightforward: if a care task can be safely performed by a qualified LPN or trained support staff member, requiring an RN to perform it is an inefficient use of a scarce resource. The highest-value use of every RN is at the top of their license.
Virtual Nursing and Virtual Preceptors as Workforce Extenders
Telehealth and virtual care models accelerated dramatically during COVID-19 — and they haven’t retreated. Virtual nursing extends RN capacity without adding headcount. A virtual RN can monitor patients remotely, conduct assessments, oversee documentation review, and support new nurses on the floor from a command center environment.
Virtual preceptors represent one of the most promising shortage-response tools for onboarding new graduates. Rather than requiring a 1:1 bedside preceptor who is pulled from patient care, virtual preceptors can guide multiple new nurses simultaneously, providing real-time coaching and feedback through telehealth technology. This model addresses the dual shortage of both bedside nurses and clinical preceptors — extending the reach of experienced staff without removing them from the unit.
Building the Nursing Pipeline from Within
Competing for external nursing talent is expensive, slow, and unsustainable. The most resilient health systems are building their own pipeline — identifying high-potential entry-level employees and creating structured pathways that move them into nursing roles over time. This approach addresses nursing education gaps at the source by investing in workforce development services that train from within.
Programs that help entry-level healthcare workers identify a career pathway toward nursing — with financial support for education, including pathways to a BSN, and built-in career coaching — create a self-reinforcing supply pipeline. Organizations like East Alabama Health have built destination-employer reputations specifically because they invest in the advancement of their frontline staff rather than importing talent from outside.Catalyst Learning’s frontline healthcare career pathway programs through CareerCare are designed exactly for this purpose — helping organizations connect entry-level employees to the growth opportunities and student resources they need to advance into harder-to-fill clinical roles.
Internal Mobility as a Nursing Shortage Strategy
Every nurse promoted from within is one you don’t need to recruit externally. Internal mobility is both a nurse retention tool and a pipeline solution — when employees see a clear path forward, they stay longer and grow faster. Organizations that treat retention bonuses as their primary retention strategy often find they’re simply buying time rather than building loyalty. Career advancement infrastructure creates loyalty.
Internal mobility programs also create a strategy for bringing retired nurses back into the workforce in meaningful but less physically demanding roles — as educators, virtual preceptors, mentors, or quality coaches. Retired nurses represent a significant reserve of clinical expertise that most organizations leave entirely untapped.
Using Workforce Data to Identify Pipeline Gaps
The Veterans Health Administration (VHA) offers one of the most rigorous models for data-driven nursing workforce planning. The VHA’s annual Workforce Planning Cycle identifies “shortage occupations” — defined as roles that are difficult to recruit and retain across at least 20% of VHA facilities. The resulting Workforce & Succession Plan, published every two years, provides infographics for each shortage occupation covering risk levels, loss rates, retention rates, and demographic data, along with specific recruitment and retention strategies.
This level of specificity — occupation-by-occupation, facility-by-facility — allows nurse leaders to make targeted investments rather than blanket ones. The VHA model is directly replicable at the health system level, and the 2025 Catalyst Learning webinar “Turning Data into Action” brought this model to life with real-world examples from VHA and East Alabama Health.
Nurse Retention as a Nursing Shortage Solution
Retention is often discussed separately from shortage strategy — but they are the same problem. Every nurse who leaves is a vacancy that must be filled from a shrinking external pool. Improving nurse retention is one of the most direct nursing shortage solutions available to any organization. It doesn’t require building new supply — it requires protecting the supply you already have.The full suite of nurse retention strategies is covered in depth in Catalyst Learning’s consolidated nurse retention strategies article. What follows is a brief summary of the leadership-level levers most directly connected to shortage reduction.
Why Nurses Leave — and What Keeps Them
Workforce fatigue, poor leadership quality, and career stagnation are the three most consistent drivers of nurse turnover across organizations. Nurses don’t leave the profession — they leave supervisors and workplaces that don’t invest in them. Addressing burnout before it becomes resignation requires a leadership culture that recognizes early warning signs and has the skill and authority to intervene. Nurse managers who coach rather than manage, and charge nurses who support rather than just direct, are the front line of shortage prevention.
Retention Strategies That Reduce Nurse Turnover
The most effective nurse turnover reduction strategies are leadership development strategies. Developing nurse managers and charge nurses into coaching-oriented leaders directly addresses the #1 driver of voluntary departure: the supervisor relationship. Recognition programs, stay interviews, career development conversations, and continuing education opportunities all signal that the organization sees its nurses as long-term investments — not interchangeable resources.Catalyst Learning’s charge nurse leadership development program builds exactly these capabilities in first-level supervisory nurses, and the NCharge Recognition Program provides a structured framework for unit-level recognition that supports nurse retention over time.
Workforce Planning and Sustainable Nursing Staffing Models
Reactive shortage management — filling vacancies as they appear — keeps organizations perpetually behind. Sustainable nursing workforce stability requires proactive planning: identifying where gaps will appear before they become crises, building succession pipelines for nursing leadership roles, and aligning workforce development investments with data on where shortages are actually occurring.
The nursing workforce challenge is ultimately a supply-demand planning problem. Organizations that treat it that way — using data, forecasting, and structured development programs — are better positioned to weather future disruptions than those relying on reactive hiring and retention bonuses alone.
How to Use Workforce Data to Plan for Nursing Gaps
Workforce data planning starts with identifying your organization’s high-risk occupations before vacancies spike. The VHA’s model — tracking loss rates, retirement projections, and recruitment difficulty by role — is a replicable framework for any health system. At the unit level, nurse managers who track engagement data, tenure by cohort, and first-year turnover rates can identify at-risk nurses before they leave. Shortage solutions built on data are fundamentally more efficient than those built on instinct.
Succession Planning for Nurse Leadership Roles
Nurse leadership succession is one of the most underdeveloped nursing shortage solutions in the field. When experienced nurse managers and charge nurses leave, their institutional knowledge and team relationships leave with them — and units destabilize quickly. Building a bench of prepared nurse leaders through structured leadership development programs is not a luxury; it’s a workforce continuity strategy.
Programs like NCharge help organizations develop their first-level supervisory nurses systematically, so that when nurse managers move up or move on, there are prepared candidates ready to step into leadership roles. This is how organizations build sustainable nursing staffing models rather than reactive ones.
What the Most Effective Health Systems Are Doing Differently
The nursing shortage solutions that are working share a common trait: they address more than one dimension of the problem simultaneously. The health systems making the most measurable progress are not the ones that found a single silver bullet — they’re the ones that built comprehensive, internally coherent strategies spanning care model redesign, pipeline development, and leadership investment.
Case Example: Advent Health’s LPN-RN Care Delivery Model
Advent Health’s LPN-RN team-based model is among the most rigorously studied alternative care delivery approaches currently in use. By hiring LPNs into acute care settings to work alongside RNs on a structured team model, Advent Health achieved improvements in nurse autonomy, teamwork, and care quality — while extending the effective capacity of its existing RN workforce. Multiple Advent Health campuses have now implemented the model, and the organization is developing standardized training processes to scale it further.
Case Example: East Alabama Health’s Internal Advancement Program
East Alabama Health (EAH) has built a regional reputation as a destination employer by investing in its own frontline workforce for nearly 20 years. EAH’s Pathways 2 Advancement program — built on Catalyst Learning’s workforce development model — provides a structured framework for moving entry-level healthcare workers into harder-to-fill clinical and nursing roles. EAH was recognized as a 2018 Healthcare Frontline Champion for this work. The Pathways 2 Advancement approach treats workforce development as an organizational strategy, not a benefit — and EAH’s retention numbers reflect that investment.
EAH’s experience reinforces a central insight: organizations that build internal advancement infrastructure create both a nursing shortage solution and a workplace culture advantage simultaneously. The same investment that grows your pipeline keeps your existing staff engaged.
A Multi-Pronged Approach to Solving the Nursing Shortage
No single nursing shortage solution is enough on its own. Organizations that redesign care models but neglect retention will keep rebuilding the same depleted teams. Those that invest in pipeline development without fixing their leadership culture will find new talent leaving almost as quickly as it arrives. Sustainable progress requires action on all four fronts simultaneously: care model redesign, pipeline development, nurse retention, and proactive workforce planning.
The good news: every one of these strategies supports the others. A strong leadership culture reduces turnover, which stabilizes the team, which makes care model changes easier to implement, which reduces the dependence on agency staff, which frees resources to invest in pipeline development. The cycle is virtuous when you build it deliberately.Catalyst Learning offers programs across all four dimensions of nursing shortage response. Charge nurse leadership development through NCharge builds the first-level leadership quality that drives retention. Frontline healthcare career pathway programs through CareerCare grow your internal pipeline. Teamwork training for healthcare teams through CLiMB supports the collaboration and professionalism that team-based care models require. Together, these programs provide the organizational support infrastructure that allows health systems to build workforces that last.
Sources:
“The Impact of an Innovative LPN-RN Care Delivery Model,” Advent Health Celebration, Marie L. Desir MSN, RN, CCRN-K, Deborah Laughon MSN-Ed, DBA, CCRN, CENP, AONL National Conference 2022
“Nursing’s Wakeup Call: Innovative Approaches to Talent, Technology, and Care Models,” Health Leaders Media, Anne Dabrow Woods DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, April 22, 2022
“The nursing shortage demands boldness and creativity. Now.,” Wolters Kluwer, April 1 2022
“Building Capacity in a Pandemic,: An Alternative Staffing Model,” AONL, Laura Jansen, MSN, RN, CNML, Kelly Poskus, MS, RN, CNRN, Jeannette Bronsord, DNP, RN, NEA-BC, Sept. 2020
“Bringing Back the Team Approach: It’s Time for Alternative Staffing and Onboarding Models,” Lippincott NursingCenter, Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, March 26 2020
“Cross-Training for Workforce Resiliency,” Minority Nurse, Michele Wojciechowski, September 14 2021
“Nursing’s Wake-up Call: Change is Now Non-Negotiatble,” Nursing Workforce Survey, UKG/Wolters Kluwer, Nursing Workforce Survey – Nursing’s Wake-up Call: Change is Now Non-negotiable (ukg.com)