In 2021, the U.S. registered nurse workforce shrank by more than 100,000 in a single year. The largest single-year reduction in four decades. Hospital nurse vacancies spiked. Staffing agencies reported unprecedented demand. The hospital nursing shortage dominated every workforce conversation in healthcare.
The moment felt like collapse. ICUs were overwhelmed. Burnout hit levels that had no historical precedent. Experienced nurses retired early, took travel contracts, or left the bedside entirely. Peter Buerhaus, Professor of Nursing and Director of the Center for Interdisciplinary Health Workforce Studies at Montana State University, described it as "a perfect storm," where the pandemic simultaneously increased the demand for nurses with very specialized skills needed to treat very sick patients and at the same time decreased the supply of those very nurses that were needed.¹
Three years later, the data tells a different story.
RN Workforce Recovery: What the 2024 JAMA Data Shows
In February 2024, Buerhaus, Auerbach, Donelan, and Staiger published updated workforce projections in JAMA Health Forum.
Their finding: after a sharp decline in 2021, RN employment recovered, and the total number of FTE RNs in 2022 and 2023 was 6% higher than in 2019. By 2035, the RN workforce is projected to reach 4.56 million, close to what had been forecast before the pandemic.²
On numbers alone, the crisis appears resolved.
But inside the same study, a different pattern emerges.
Why Nurses Are Leaving Hospitals Despite Overall Workforce Growth
Total RN employment grew. Hospital RN share did not.
The percentage of RNs working in hospitals dropped from 60.3% before the pandemic to 57.8% after. That shift was driven almost entirely by a decline in hospital employment among RNs aged 40 and older.²
To be precise: nurses did not disappear. They moved. Into outpatient clinics. Into community care settings. Into NP pathways. Some into travel nursing. The total workforce is larger. But the form of labor supply that hospitals depend on most, experienced bedside RNs, is contracting.
Buerhaus named this in the 2022 podcast: "We could be experiencing a qualitative shortage of nurses, not enough nurses with all the knowledge and skill needed to take care of increasing numbers of older people who will be requiring hospitalization."¹
The pipeline is intact. The destination has changed.
Why Hospital Nurse Vacancies Persist Despite Workforce Recovery
The 2026 NSI National Health Care Retention and RN Staffing Report puts the current picture in operational terms. The average time to recruit an experienced RN is 78 days. The average hospital is running with 43 unfilled RN positions at any given time.³
The supply side has partially recovered. But the hospital-specific shortage continues, shaped now less by how many nurses exist and more by where they choose to work and how long it takes to bring them in when a position opens.
When a vacancy opens, a candidate applies, clears screening, and waits. The decision belongs to a clinical leader whose day is organized around patient care, not hiring queues. Between handling staffing call-outs, patient escalations, shift coordination, and bedside coverage, hiring decisions get pushed to the next available moment. That moment rarely comes during a shift.
Most hospital hiring systems assume hiring is a desk task. For frontline clinical leaders, it is an interrupt-driven task competing against patient care in real time. The ATS notification arrives. It sits in an inbox that the nurse manager will check when the unit stabilizes. The unit rarely stabilizes on a predictable schedule. The candidate waits. After 78 days, on average, the role is filled.
And the longer that vacancy runs, the more the nurses who remained absorb the difference. Workload increases. Burnout deepens. Another nurse considers leaving. Another position opens. Hiring speed is not a recruiting efficiency problem. It is a workforce stability problem.
What the Nursing Workforce Data Points Toward for Hospital Hiring
Buerhaus has spent decades tracking the supply side of this equation. His 2024 findings offer measured reassurance: the workforce is not in permanent decline.
But the same research makes clear that total headcount is not the only variable. Where nurses work, under what conditions, and how quickly hospitals can bring them in when positions open, these are the operational factors that determine whether a recovering workforce actually reaches the bedside.
The future of nursing is not only about how many nurses exist. It is also about building systems that can move them into position when they are needed, before the vacancy compounds into something harder to recover from.
Sources
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Buerhaus PI. "No Silver Bullet: Diagnosing Hospital Workforce Crisis." Hospitals In Focus, Federation of American Hospitals. Podcast transcript, 2022. https://fah.org/podcasts/no-silver-bullet-diagnosing-hospital-workforce-crisis-with-peter-buerhaus
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Auerbach DI, Buerhaus PI, Donelan K, Staiger DO. "Projecting the Future Registered Nurse Workforce After the COVID-19 Pandemic." JAMA Health Forum. 2024;5(2):e235389. https://doi.org/10.1001/jamahealthforum.2023.5389
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NSI Nursing Solutions, Inc. 2026 NSI National Health Care Retention & RN Staffing Report. March 2026. https://www.nsinursingsolutions.com/documents/library/nsi_national_health_care_retention_report.pdf