North Carolina has made incremental progress in addressing its shortage of registered nurses (RNs), but faces a worsening deficit of licensed practical nurses (LPNs), creating a fragile and complex healthcare landscape. That is the key finding from a new analysis released on September 15 by the NC Health Talent Alliance, a public-private partnership focused on the state’s healthcare workforce.
The report, which surveyed 110 healthcare organizations representing over 1,560 facilities, reveals a nuanced picture. The vacancy rate for RNs—the largest segment of the nursing workforce—has improved, dropping to 13% from 17% last year. While this is a positive step, the rate remains above the national average of 10%.
In contrast, the shortage of LPNs, who provide essential frontline care, has intensified. The data shows that roughly one-third of the state’s LPN positions are now vacant, a significant increase from last year’s rate of approximately one-quarter.
Andy MacCracken, director of the NC Center on the Workforce for Health, cautioned that the gains in RN staffing are at risk. He explained that persistent shortages among LPNs and other support staff place additional burdens on registered nurses. “When we don’t have allied health professionals and LPNs at sufficient staffing levels, RNs have to take on a whole lot of extra duties,” MacCracken said. “That contributes to untenable situations where we see folks either leave the employer or leave the profession overall.”
Decades-Old Challenges Compounded by Current Pressures
The nursing shortage in North Carolina is not a new phenomenon, with legislative records acknowledging the issue as far back as 1989. The root causes are multi-faceted and persistent:
Signs of Progress and Strategic Investments
Despite the challenges, there are promising signs of progress, driven largely by a focus on education. The number of newly licensed RNs has increased by nearly 15% in the last three years, while the educational output for LPNs has climbed by 13%.
This growth is being fueled by targeted investments. In 2023, the N.C. General Assembly appropriated $55 million to expand nursing and other high-demand programs across the state’s 58 community colleges. Melissa Smith of the North Carolina Community College System noted that these funds have had a significant impact, especially in rural counties, allowing schools to build new labs and create a “spark of excitement” for students and staff.
An Urgent Look to the Future
Maintaining this educational pipeline is critical as North Carolina faces a looming demographic challenge. The state’s population aged 65 and older is projected to grow by nearly one million by 2042. Compounding this, a 2023 survey found that over a quarter of current RNs plan to retire or leave the profession within the next five years.
To meet the demands of its aging and growing population, North Carolina is estimated to need an additional 17,500 nurses over the next decade. MacCracken stressed that the entire healthcare system is an interconnected “ecosystem,” warning that severe shortages in long-term care will inevitably strain hospitals and primary care providers. The alliance will use its data to develop targeted regional strategies to address these critical workforce needs.
