NC Nursecast Nurse Workforce Projections by Region

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RN Shortages by Medicaid Region

NC Nursecast estimates that by 2033, North Carolina will face an estimated shortage of 12,459 RNs (or 11% of the projected RN workforce). However, model forecasts vary by region. Almost all of the state’s Medicaid regions will face RN shortages in the future except the Southeast, which is projected to see a slight surplus of RNs by 2033, likely due to the high retention of graduates from local training institutions (Figure 1). Figure 2 shows that, after adjusting for population size, metropolitan areas will face far greater RN shortages than rural areas, with the Northwest/Triad Medicaid region (including Greensboro and Winston-Salem) facing the greatest shortages, followed by the Piedmont/Triangle (including Raleigh-Durham-Chapel Hill), and, finally, Southcentral/Charlotte. Eastern NC is projected to have a balance of supply and demand for RNs.

A map of North Carolina broken into medicaid regions and a row chart where the colors in both indicate the relative shortage and surplus.

Figure 1. RN Shortage/Surplus per 10K Population, All Settings, by Medicaid Region

Source: NC Nursecast. https://ncnursecast.unc.edu/

A map of North Carolina broken into metropolitan and nonmetropolitan regions and a row chart where the colors in both indicate the relative shortage and surplus.

Figure 2. RN Shortage/Surplus per 10K Population, All Settings, by Metropolitan and Non-Metropolitan Areas

Source: NC Nursecast. https://ncnursecast.unc.edu/

RN Shortages by AHEC Region

The nine AHEC regions provide a useful grouping of counties through which to examine RN and LPN shortages because they make up the major health care service areas in the state. As such, AHEC regions reflect regional employment patterns of nurses. Further, within the AHEC regions there are strong ties between the community colleges and universities where nurses are educated and the hospitals and other health care institutions that provide the vast majority of their clinical experiences. These factors make the AHEC regions particularly helpful in any analysis of nurse workforce trends. Not surprisingly, NC Nursecast projects that, even after adjusting for population, AHECs with large health care systems and hospitals in the Wake and Northwest AHEC regions will face the largest shortages (Figure 3).

A map of North Carolina broken into AHEC regions and a row chart where the colors in both indicate the relative shortage and surplus.

Figure 3. RN Shortage/Surplus per 10K Population, All Settings, by AHEC regions

Source: NC Nursecast. https://ncnursecast.unc.edu/

RN workforce projections by setting and region

NC Nursecast allows users to examine the future supply and demand for nurses by setting within a specific region. Table 1 shows, for example, that in the Northwest AHEC region, hospitals will experience the largest shortage of RNs in absolute numbers, but nursing home, extended care, and assisted living facilities will face the greatest shortage as a percent of the future projected workforce. Home health/hospice and nursing education settings are also projected to have shortfalls relative to the size of their projected workforce.

Table 1. Projected Registered Nurse Workforce Shortages, Northwest AHEC Region in 2033 by Setting

Setting Difference between Projected Supply/Demand in 2033 % Difference between Projected Supply/Demand
Nursing Home/Extended Care/Assisted Living -291 -29.1%
Hospital -2,328 -28.9%
Home Health/Hospice -231 -15.3%
Nursing Education -28 -13.8%
Correctional Facility -8 -9.4%
Ambulatory Care -96 -4.5%
Community and Population Health -33 -3.9%
Mental Health Hospital/Facility 6 1.0%
Source: NC Nursecast. https://ncnursecast.unc.edu/

Examining supply and demand in specific regions and by setting provides a more nuanced understanding of future workforce needs in a given geographic area. For example, while the South East AHEC region is forecast to experience a small surplus in nurses overall, two settings in South East AHEC face shortages. Home care and hospice faces an RN shortage of 44 nurses (or 6.7% of its workforce) and nursing home, extended care and assisted living facilities face an RN shortage of 83 nurses (or 24.3% of its workforce).

LPN Shortages by Medicaid Region

LPNs are projected to be in shortage in every region of the state in the future. Although RN shortages will be significantly more pronounced in metropolitan areas (Figure 2), LPNs are almost equally in shortfall in both metropolitan and non-metropolitan areas (Figure 4). The Western region and Piedmont/Triangle Medicaid regions are projected to face the largest shortages of LPNs.

A map of North Carolina broken into metropolitan and nonmetropolitan regions and a row chart where the colors in both indicate the relative shortage and surplus.

Figure 4. LPN Shortage/Surplus per 10K Population, All Settings, by Metropolitan and Non-Metropolitan Areas

Source: NC Nursecast. https://ncnursecast.unc.edu/

A map of North Carolina broken into medicaid regions and a row chart where the colors in both indicate the relative shortage and surplus.

Figure 5. LPN Shortage/Surplus per 10K Population, All Settings, by Medicaid Region

Source: NC Nursecast. https://ncnursecast.unc.edu/

LPN workforce projections by setting and region

NC Nursecast gives users the ability to examine nurse supply and demand by region, setting, and nurse type. For example, the Piedmont/Triangle Medicaid region has the second largest projected shortage of both LPNs and RNs. For LPNs, the greatest numeric and percent shortages are in nursing home, extended care, and assisted living facilities, followed by home health/hospice, and mental health facilities (Table 2). For RNs, the greatest numeric shortages are in hospitals, but nursing home, extended care and assisted living facilities face the greatest shortfalls as a percentage of their workforce.

Table 2. Projected Licensed Practical Nurse Workforce in 2033 in Piedmont/Triangle Region by Setting

2033 Workforce Shortage/Surplus
Setting (# of RNs) (% of RNs) (# of LPNs) (% of LPNs)
Nursing Home/Extended Care/Assisted Living -593 -44.7% -981 -70.7%
Home Health/Hospice -495 -27.5% -325 -58.6%
Mental Health Hospital/Facility -136 -15.8% -67 -52.3%
Ambulatory Care -260 -5.7% -61 -13.4%
Hospital -3,403 -19.7% -60 -43.2%
Correctional Facility -120 -34.1% -15 -14.9%
Source: NC Nursecast. https://ncnursecast.unc.edu/

Careful consideration must be given to interpreting forecasts.

Despite the power of the NC Nursecast tool to project region-specific estimated supply and demand of nurses, careful consideration must be given when using this tool for planning purposes. As explained in the NC Nursecast Projections by Setting brief, the forecasts rely on the historical utilization of LPNs and RNs (per population) in different employment settings by region. They do not reflect the number of LPNs and RNs that would be needed to fully meet patients’ needs for care or fill position vacancies. Therefore, if a region is using the tool to make decisions about workforce planning, additional research and expert opinions and insights are needed to complement NC Nursecast data and adequately reflect local trends.

Explore

Supply & Demand

Want to learn about the future supply and demand of our state's licensed practical nurses and registered nurses across settings and geographic regions?

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Graduate Diffusion

Want to see how different North Carolina nursing programs impact the distribution of health professionals in their area and across the state?

Examine graduate diffusion

Key Findings

What are the main takeaways from the nursecast projections? In what regions and settings will nurses be in shortage?

Read key findings

Who are we?

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.