To cite, please include the following: The Program on Health Workforce Research and Policy at the Cecil G Sheps Center. “NC Nursecast: A Supply and Demand Model for Nurses in North Carolina.” November 1, 2021. https://ncnursecast.unc.edu/briefs/overview/
What is NC Nursecast?
NC Nursecast is a web-based, interactive
workforce model that forecasts the future supply and demand for
Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) in North
Carolina. NC Nursecast gives policy makers, legislators, educators,
professional organizations, employers, and other nursing stakeholders
the data they need to understand and plan for the future. It is built on
data derived from 2015-2018 NC Board of Nursing licensure files; this
rich source of state-specific information about nurse demographics,
educational institutions, practice locations, and employment settings
provides a more accurate basis for a North Carolina model than any other
available data source.
The NC Nursecast website enables users to customize forecasts by nurse
type (RN or LPN) and geography (state-wide, Medicaid regions, AHEC
regions, metro/nonmetro) for various practice settings. The model also
allows users to explore different “what if” scenarios that may alter the
forecast. For example, what if nurses experience increased burnout and
exit the workforce two or five years earlier than they have
historically? Conversely, what if more students enter nurse training
programs?
What does NC Nursecast say about NC’s future nursing workforce?
By 2033, North Carolina is expected to face an estimated shortage of nearly
12,500 registered nurses and slightly more than 5,000 LPNs. After
factoring in the size of the projected workforce in 2033, RNs will face
an 11% shortfall and LPN demand will outstrip supply by 27%. Not
surprisingly, since the majority of RNs work in hospitals, the largest
numeric shortfalls for RNs occur in hospitals where demand will exceed
supply by nearly 10,000 positions. North Carolina’s rapidly expanding
and aging population also fuels demand for RNs in nursing home, extended
care, and assisted living facilities where demand for RNs will exceed
supply by nearly 31% in 2033.
Unlike RNs who are more likely to be employed in hospitals, nursing
home, extended care, and assisted living facilities employ the greatest
number of LPNs and these settings face a nearly 50% forecasted shortage
of LPNs by 2033. As LPNs leave hospital employment, hospitals will also
face a large percentage shortfall (31.7%) of LPNs by 2033. More detailed
information about how the future supply and demand of LPNs and RNs will
vary by setting is available in our brief: Nurse Workforce Projections
by Setting.
Which areas of NC will face the greatest shortages?
A powerful feature of NC Nursecast is the ability to examine workforce forecasts at
the sub-state level including Medicaid, AHEC and metropolitan and
non-metropolitan regions of the state:
• Most regions of the state are projected to face RN shortages except
for the Southeast region; all regions will face LPN shortages.
• Something unique is happening in Southeast NC – The small projected
RN surplus in the area is likely due to high retention of nursing
graduates from local training programs.
• Large metropolitan areas face significantly higher RN shortages than
non-metro areas; both metro and non-metro areas face similar levels of
LPN shortages.
• Wake AHEC (including Raleigh-Durham) and Northwest AHEC (including
Winston-Salem) face the largest RN shortages.
• The Mountain AHEC (western NC) and Wake AHEC face the largest LPN shortages
What about the pandemic? How will that affect the nursing workforce?
Workforce models are often assumed to produce one “answer” about how
well RN and LPN supply will meet demand in the future for a given
employment setting or geographic area.1 However, nursing workforce
participation patterns, models of care, and other factors are likely to
change in the future. For this reason, NC Nursecast includes “what if”
scenarios that allow users to explore what will happen if nurses exit
the workforce earlier than expected or the number of new nurse graduates
increases or the supply of nurses entering NC to practice from
out-of-state nurses decreases. These scenarios can be compared to the
“baseline model” that uses historical data on nurse practice patterns
and assumes trends in the supply and demand for nurses will remain the
same in the future.
Although the effects of COVID on the NC nurse workforce remain unknown at this point,
we can simulate how multiple scenarios might combine to
affect the workforce. Nurses may exit the workforce five years earlier than expected due to various reasons including burnout, vaccine mandates, or the rising demand for traveling nurses. NC may face increased competition from other states, reducing our ability to import nurses from outside NC. The state may follow national trends with increased enrollments in pre-licensure nursing programs. If we combine all these effects—nurses exiting the workforce five years earlier + a 10% increase in nurse graduate supply + a 2.5% reduction in out-of-state supply—the net effect is a shortage of over 18,000 Registered Nurses (Figure 1).
How can we address future workforce shortages?
The power of NC Nursecast is that it gives policymakers, educators, employers, and other
nursing stakeholders easily accessible, usable to understand which
employment settings and geographies may struggle to meet patient care
demands in the future.
One common reaction to workforce shortages is to invest in expanding training program
enrollments. However, faculty and preceptor shortages in North Carolina,
along with limited clinical site availability and physical space capacity, constrain
the number of students that can be admitted to nursing programs. Given
these challenges, NC will not likely be able to dramatically increase
nursing program enrollments. However, even if the state could achieve a 10%
increase in new graduate nurse supply, we will still face a shortage of
over 10,000 nurses in 2033. These findings highlight the importance of investing in efforts to retain the current NC nurse workforce rather than assuming that growth in the number of nurse graduates will address emerging workforce shortfalls.
Although increasing nursing program enrollment alone will not solve
workforce shortages, increasing funding of nursing programs, raising
faculty wages so they can better compete with clinical salaries, and
addressing the shortage of preceptors in the state can help increase
supply. The good news is that investments in nursing programs yield a
high return on investment. Table 1 shows that LPN and ADN programs
retain 92% of their graduates and BSN programs retain 86% of graduates
in North Carolina. By comparison, medical schools in North Carolina
retain 38% of their graduates in the state.2
Table 1. Nursing Program Retention Rates in North Carolina
Nurse Education Programs in North Carolina
Retention Rate in NC
Retention in Non-metropolitan counties*
Licensed Practical Nurse (LPNs) Programs
92%
33%
Associate Degree Nurse (ADN) Programs
92%
29%
Bachelor of Science in Nursing (BSN) Programs
86%
10%
Source: NC Tower data. https://nctower.com. NC Nursecast. https://ncnursecast.unc.edu/diffusion. *Among nurses who stay in North Carolina. Non-metropolitan counties are defined using the 2017 Office of Management and Budget Core Based Statistical Areas (CBSAs). Rural/non-metropolitan counties include micropolitan counties and counties without CBSAs. Using this definition, NC has 54 non-metropolitan counties.
The Graduate Diffusion Tool enables users to view the “footprint” of ADN, BSN, and LPN programs in the state. It can be used to see the
percent of a nursing program’s graduates that are retained in North
Carolina, practicing in hospitals, and in non-metropolitan areas. Table
2 shows, for example, that there is significant variation between BSN
programs within the University of North Carolina System in the percent
of new grads entering rural practice, ranging from about 1.8% of
UNC-CH’s graduates to 49% of UNC-Pembroke’s grads. The tool can also be
used to see which programs are producing graduates for a more local
versus more regional market. Both UNC-CH and Fayetteville State
graduates travel an average 20 miles from their program to their first
practice location, while graduates from Appalachian State University,
East Carolina, UNC-Wilmington, and Western Carolina University diffuse
their graduates more broadly across the state.
Table 2. Percent of BSN Graduates Retained in NC and In Rural Areas, Two Years after Graduation
Institution
# of Grads
% Working in NC
% Non-Metro (i.e. Rural)*
Mean distance in miles
Appalachian State University
127
88.5%
15%
90
East Carolina University
848
87.7%
9.3%
71
Fayetteville State University
50
73.6%
26%
20
North Carolina A & T State University
118
88.4%
4.2%
35
North Carolina Central University
190
89.2%
7.4%
15
University of North Carolina Wilmington
314
84.5%
2.5%
76
University of North Carolina at Chapel Hill
497
79.8%
1.8%
20
University of North Carolina at Charlotte
333
88.0%
3.0%
35
University of North Carolina at Greensboro
321
92.9%
3.4%
31
University of North Carolina at Pembroke
104
77.2%
49%
32
Western Carolina University
250
83.6%
12%
68
Source: NC Tower data. https://nctower.com. NC Nursecast. https://ncnursecast.unc.edu/diffusion. *Among nurses who stay in North Carolina. Non-metropolitan counties are defined using the 2017 Office of Management and Budget Core Based Statistical Areas (CBSAs). Rural/non-metropolitan counties include micropolitan counties and counties without CBSAs. Using this definition, NC has 54 non-metropolitan counties.
Fraher, E., Knapton, A. (2021). Workforce Planning in a Rapidly Changing Healthcare System. In C.J. Sampson, B.J Fried (Ed.). Human Resources in Healthcare (pp. 429-456). Health Administration Press. ↩︎
Want to learn about the future supply and demand of our state's licensed practical
nurses and registered nurses across settings and geographic regions?
This project is brought to you by The Cecil G. Sheps Center For Health Services Research at the
University of North Carolina in partnership with the North Carolina Board of Nursing.