North Carolina’s Nursing Shortage: A Looming Crisis

By Michele Lynn

North Carolina, as well as the rest of the nation, is facing a nursing shortage crisis. By 2033, North Carolina faces an estimated shortage of nearly 12,500 registered nurses. This scarcity will challenge the ability of our health care systems to provide the proactive and personalized care that every patient deserves.

The COVID-19 pandemic has helped shine a light on an issue the health care community has been aware of for years. While nursing shortages are not new, they are projected to worsen. 

The largest shortfalls for registered nurses are projected to occur in hospitals where demand could exceed supply by nearly 10,000 positions by 2033. The second largest projected shortage of registered nurses in absolute numbers—and the largest shortage as the percent of the workforce—is forecast to be in nursing homes and extended care and assisted living facilities.

The projected shortage by 2033 of RNs in these facilities is nearly 2,000, which is 31% of the workforce. These projections were developed by NC Nursecast—a project of The Cecil G. Sheps Center for Health Services Research at the University of North Carolina, in partnership with the North Carolina Board of Nursing—which forecasts the future supply and demand of nurses in North Carolina in various settings and regions throughout the state. 


Emily McCartha, PhD, research project manager at the Sheps Center, says that the shortage is alarming and should be of concern to residents of the Tar Heel State. “North Carolina is an attractive state which has many people moving here,” she says. “Our population is also aging and that is placing high demands on the health care system.” Growing numbers of older patients with more health challenges, combined with the increasing number of nurses leaving the field, adds up to less optimum care for each patient. 

More than 47 million Americans voluntarily quit their jobs in 2021, according to the U.S. Bureau of Labor Statistics. The Great Resignation—this unprecedented mass exit from the workforce, spurred on by the COVID -19 pandemic—has seen nurses leave the profession. COVID has had a significant impact on nurses on the front lines of the pandemic, who have dealt with trauma, burnout and stress.

A 2021 Washington Post-Kaiser Family Foundation survey found that nearly 30% of health care workers are considering leaving their profession altogether, and nearly 60% reported impacts to their mental health stemming from their work during the COVID-19 pandemic. 

The aging of the workforce is another factor in the nursing shortage. According to the American Hospital Association, in 2017, more than half of all nurses were age 50 or older, and almost 30% were age 60 or older. At the same time, nurse faculty are likewise aging, with an average age of 65 for nurse professors in the U.S. The pipeline of nurse faculty is not replenishing, leading to a shortage of the educators necessary to prepare the coming generations of nurses.  

“Even before the pandemic, there were reports that nurses nearing retirement would be leaving the profession; during the pandemic, some nurses who were planning retirement did so, as did others who had not planned on retiring at that time,” says Cheryl B. Jones, RN, PhD, FAAN, UNC Sarah Frances Russell Distinguished Professor, Director of the Hillman Scholars Program in Nursing Innovation and research fellow at the Sheps Center. 

“Nurses who left the profession earlier than planned did so for any number of reasons, including burnout, stressful working conditions, staffing or shortages,” adds Jones. “These working conditions also increased turnover by nurses who remained in the profession. The upshot is that we’re losing nursing expertise at all levels – from the bedside to the C-suite.

At the same time, early career nurses are entering the profession without the benefit of learning from those with extensive knowledge of nursing, practice, and health care systems.


While the pandemic has alerted the public to the nursing shortage, the public also became more aware of the critical and essential role that nurses play in health care, says Jones. That sentiment is echoed by UNC Health’s Chief Nurse Executive, Cathy Madigan, DNP, RN, NEA-BC.

“Last year, nursing again was rated as the most trusted profession – for the twentieth year in a row – which I think is a wonderful testament to the role that nurses play for patients and their families,” she says. “We are a very trusted profession, but what the pandemic has shown is we’re a vital profession.”

Cathy Madigan

Madigan points to the critical role that nurses played during the pandemic. “It was a nurse who was the person at the bedside of very sick patients during the pandemic, not only caring for medical needs but also bringing in an iPad so family members could connect to their loved one in the hospital,” she says. Madigan says the looming nursing crisis should be of concern to everyone. 

While hospitals in the UNC system have been able to maintain high-quality patient care, the lack of nurses has had an effect. Eric Wolak, DNP, MHA, RN, NEA-BC—Chief Operating Officer and Chief Nursing Officer at UNC Chatham Hospital—feels confident that his facility can continue meeting needs from a clinical standpoint, but the nursing shortage makes it challenging.

Eric Wolak, Chief Operating Officer & Chief Nursing Officer at UNC Chatham Hospital

During the pandemic, Wolak closed beds due to insufficient numbers of nurses, which led to fewer patients in the emergency department (ED) being admitted as inpatients. “We were very proactive in working through the patients in the ED who needed placement, but other hospitals were experiencing the same challenges, so it took longer to move patients to receive specialty care,” he says.  

Madigan notes that having fewer nurses has meant delays in elective surgeries, longer waiting times in the ED and the need to move patients to another hospital so that patients with more serious illness could be treated at UNC Medical Center.

“It’s exhausting for our nurses who are working at full capacity, all the time, without a lot of breathing room,” she says. With fewer nurses, the patient-nurse ratio may be higher, creating significant work stress for the nurse. That stress can create a snowball effect with nurses becoming weary and leaving the job. 

The shortage may impact patients. “If you’re a patient in a bed, and you press the call bell, you want a response within a couple minutes,” says Wolak. “That response may take a lot longer if hospitals don’t have enough nurses.”  


The UNC School of Nursing is carefully studying these looming shortages and is preparing to tackle them through both traditional and innovative means, including increased enrollment in its top-ranked programs, RN refresher programs, accelerated PhD programs to train new faculty, and unique partnerships with health care systems. 

“UNC has been a pioneer in creatively leveraging our academic-service partnership with UNC Health through the Hillman Scholars Program in Nursing Innovation,” says Jones. “This program is designed to prepare the next generation of PhD researchers – faculty and service leaders – who will influence health care early in their careers.” UNC Health leaders, including Jones, Madigan, and Wolak, have been integral to the success of this program.  
While Carolina Nursing is committed to enrolling more nursing students, it faces frustrating physical limitations in doing so, including the size, condition, and outdated technology of its current facilities. To meet the projected demand for nurses by graduating more new nurses, Carolina Nursing is in the design phase of a new Nursing Education Building.

This world-class facility will increase the school’s overall space by 20,000 square feet and provide a modern structure complete with the latest technologies to better prepare students. The new building will enable an increase in class size each year, which means more Carolina Nurses entering the workforce each year to provide quality, compassionate care on the frontlines of our health care systems. 

Early rendering of the new Nursing Education Building

This story is featured in the fall 2022 issue of Carolina Nursing Quarterly.

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