The Shortage Is Not a National Number. Your Workforce Plan Quietly Subtracts Wyoming.

This week: why the shortage figure in your workforce plan understates your exposure by roughly a quarter, which twenty states are projected to have nurses to spare, and the one number that decides whether your market loosens by 2028 or stays exactly as tight as it is now.

By Christina Archer, Founder · Week of September 28, 2026

There is a number in almost every nursing workforce plan written this year. It comes from HRSA, it is quoted in board decks and budget requests across the country, and it is the reason your 2028 staffing assumptions look the way they do.

It is also a net, and the subtraction inside it is working against you.

▪The number in your workforce plan already subtracted states you cannot hire from

HRSA projects a national registered nurse shortage of 267,330 FTE by 2028, at 92% supply adequacy. I pulled the fifty-one state rows underneath it. They reconcile to that figure exactly, so the arithmetic is sound. What the arithmetic does is the problem.

Summed separately, the states projected to be short are short 328,960 FTE. The states projected to be long are long 61,630 FTE. HRSA nets the two and publishes the difference.

Nurses in Wyoming do not staff beds in Virginia.

If you operate in a state on the short side of that line, the number everyone is planning against understates the shortfall you are actually competing in by 23%. That gap is not a rounding difference. It is the entire surplus of twenty states being quietly applied to your market from a thousand miles away.

▪Twenty states are projected to have nurses to spare, and almost none of them have beds

By 2028, twenty states are projected at or above 100% adequacy. Wyoming leads at 195.1%, followed by the District of Columbia at 168.4%, Alaska at 138.6%, Vermont at 132.7% and Hawaii at 131.2%.

Those ratios look like an opportunity. Look at the denominators instead.

The seven loosest markets in the country have a combined projected 2028 demand of 54,170 FTE — less than Virginia is short on its own. Wyoming’s entire projected demand is 5,350 nurses. A 195% adequacy ratio on a base that size is a statistical curiosity, not a labor pool.

Meanwhile 78.4% of all projected 2028 RN demand — 2,588,260 of 3,301,690 FTE — sits in the thirty-one states on the short side. The beds and the surplus are in different places, and the surplus is in the smaller place.

▪Whether your market recovers depends on its nursing schools, not on the size of its gap

Here is the comparison that reorganized how I read this data.

Arizona is projected short 10,010 FTE at 86.3% adequacy. Maryland is projected short 13,910 FTE at 77.0%. Comparable problems, one somewhat worse than the other.

Arizona’s nursing schools graduate 8,613 entry-level nurses a year. Maryland’s graduate 2,902.

Divide the gap by annual production and Arizona needs 1.2 years of its own output to cover its deficit. Maryland needs 4.8.

Same country, same projection, same year. One market has a problem its own pipeline can absorb inside two graduating classes. The other does not have a pipeline answer at any realistic horizon.

My read: adequacy tells you how tight your market is today, and production tells you whether that is temporary. Most workforce plans track the first and ignore the second, which is why so many of them assume a recovery that the graduate numbers do not support.

▪Six states are running a deficit their own schools cannot close

Above three years of total production, a gap stops being a recruiting target. Maryland sits at 4.8 years, Virginia at 4.0, Oklahoma and Louisiana at 3.9, South Carolina at 3.8 and Idaho — the tightest market in the country at 71.0% adequacy — at 3.7.

Every one of those figures assumes a fantasy: that every graduate stays in state, that nobody retires or leaves the bedside, that licensure is instant. Relax any of those and the real number is worse.

For a hospital in one of those six, the strategic consequence is specific. Net new supply is not arriving. Every experienced nurse you hire comes off a competitor’s unit inside the same state, which means your market is a closed system and your competitors are running the same play against you.

Compare that to New York at 0.6 years, Texas and Florida at 0.9, and Nebraska, Kansas and Indiana at 0.8. Those markets are tight right now and structurally fine. The plan that works in Dallas will not work in Baltimore, and the reason is not management quality.

▪If you are going to recruit out of market, three states are worth the airfare

Recruiting across state lines only pays where the surplus has volume behind it. Three states clear that bar.

Illinois is projected 7,700 FTE long on 13,975 annual completions. Minnesota is 4,210 long on 12,394. Utah is 4,080 long on 9,994 — the highest production-to-demand ratio of any sizable state in the country.

Alabama and Massachusetts are also projected long, at 6,100 and 5,820 FTE, on smaller graduating classes. Those five are the real exporters. Everything else on the surplus list is a small state with a favorable ratio and nobody to spare.

This is the sourcing map most talent teams do not have, and it is the one that changes where a travel budget or a relocation package earns its keep. Our Workforce Intelligence dashboards carry adequacy, gap and production for every state, refreshed weekly.

▪Four moves before your next workforce plan goes to the board

1. Find your state’s adequacy number before your next headcount plan goes up. If it is under 100, the national figure understates what you are planning against. If it is over 100, you have a cost argument nobody in your market is making yet. Either way it is one number, and it changes the ask.
2. Rebuild your out-of-market sourcing list on production, not proximity. Illinois, Minnesota and Utah graduate more nurses than their own 2028 demand requires. The small surplus states do not — Wyoming’s entire projected demand is 5,350 FTE, so there is no reservoir there to draw on however good the ratio looks.
3. If your state needs more than three years of total output, stop calling it a recruiting problem. Maryland, Virginia, Oklahoma, Louisiana, South Carolina and Idaho all sit above that line. In those markets every nurse you hire comes off a competitor’s unit, and the only lever that adds net supply is the one that keeps the nurses you already have.
4. For staffing and recruiting firms: price the four-year markets differently. A contract in Maryland is not the same product as a contract in Texas, and the client who understands why will stop treating your rate as the variable. Bring them the production number.

▪You are not planning against a national shortage, and you never were

The 267,330 figure will keep appearing in trade press and board decks, and it will keep being quoted as though every hospital in the country faces the same market. Thirty-one states face a harder version of it than that number admits. Twenty face something else entirely.

Pull your state’s adequacy number and your state’s annual completions. Two figures, ten minutes, and they will tell you more about your next four years of hiring than any national average ever will.

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