If you think the nursing shortage is bad now, wait until you see the 2026 state-by-state map.
Using the latest BLS projections, Census demographics, and HRSA health workforce data, one state stands out as the clear “ground zero” for the next wave of RN pain — while four others are quietly positioning themselves as relative safe havens.
The Worst: California
Projected RN shortfall by end of 2026: –58,000 to –62,000 FTEs
That’s the equivalent of losing every nurse for every 640 residents.
Why California is in free-fall:
- Aging population + high chronic disease burden driving demand
- Strict nurse-to-patient ratio laws (already understaffed)
- High cost of living pushing new grads to lower-cost states
- Retirement wave of 55+ nurses accelerating (23 % of CA RNs are 55+ vs. national 19 %)
Result: traveler RN costs already 40–60 % above staffed rates — expected to hit 80–100 % premiums by late 2026 in many facilities.
The Four States That Will Hurt the Least (and why)
- Texas – Net surplus projected (~+18,000 RNs)
Aggressive nursing school expansion + lower cost of living + strong loan repayment programs. - Florida – Near balance (~–2,000 gap)
Massive retiree in-migration offset by equally massive nursing school growth and retiree RNs staying in workforce. - North Carolina – Small surplus (~+8,000)
UNC system + community college pipeline + rural incentive programs working. - Arizona – Small deficit (~–4,000)
Rapid population growth but equally rapid nursing program scaling + high in-migration of experienced RNs from California.
The Hidden Surprise: The Midwest Squeeze
States like Illinois, Michigan, Ohio, and Pennsylvania face double jeopardy: aging populations + stagnant or declining nursing school output. Expect 10–14 % vacancy rates by late 2026 even with aggressive traveler use.
What Smart Leaders Are Doing Right Now
- Geographic arbitrage – recruiting heavily from surplus states (TX, FL, NC) with relocation packages
- Internal pipeline acceleration – partnering with community colleges for dedicated cohorts (12–18 month RN programs)
- Retention redesign – 4-day weeks, student loan payoff matching, and mental health days are now table stakes in shortage zones
- Tech leverage – virtual nursing and AI-assisted documentation to stretch existing staff 15–25 %
Wrapping It Up
The nursing shortage isn’t national anymore — it’s hyper-local.
Your state’s forecast will determine whether you spend the year fighting for talent… or quietly building a surplus while everyone else panics.
Where does your state rank?
Check the full 50-state forecast in the premium report below — or keep watching your traveler budget explode.
