Nurses: In Demand, Well-Paid, and Burned Out

A conversation I had with a colleague a few weeks ago about his wife’s experience working as a nurse sparked my curiosity about where the profession currently sits in the vast expanse of the U.S. workforce. Last week I noticed a sign on the train promoting National Nurses Week and found it more than enough inspiration to dig into any data available on the current state of a job at the heart of one of the largest and most consequential industries in the economy today.

According to data from the Bureau of Labor Statistics’ Occupational Employment and Wage Statistics (OEWS) registered nurses alone are the sixth largest profession in the country with an estimated 3,175,390 people working as RNs in 2023. This does not even include the estimated 280,140 nurse practitioners, 47,810 nurse anesthetists, and 6,960 nurse midwives, among other advanced practice registered nurses (APRNs). This makes the total nursing workforce in the U.S. roughly the size of the population of Puerto Rico.

Nursing is also somewhat unique among the other prodigious occupations in the workforce in that it is also relatively high paying. Last year the median annual salary for registered nurses was $86,070. Among the thirteen careers that have over 2 million workers, RNs were one of 3 that made more than the median annual salary among all occupations of $48,060. Only general and operational managers at a yearly median salary of $101,280 made more.

Aside from being big and high paying the nursing workforce is also growing. BLS OEWS data show that since 2012 the nursing workforce has grown by over 20% compared to the overall workforce which has increased by 16% during that same time period. Much of the job growth in nursing has been mirrored by the overall increase in employment in the health care sector generally, which jumped about 21% in size since 2012.

And although median wages for nurses haven’t quite kept pace with the overall workforce since 2012 – due in large part to the relatively large pay gains workers in lower earning jobs have seen over the past four years – pay for RNs has still risen by over 31% in the last eleven years.

Crucially, the growth in the nursing is set to continue. Data from the Bureau of Labor Statistics’ Employment Projections program show that the nursing profession is projected to increase by 177,400 RNs from 2022 to 2032, a 5.6% gain that is the fifth largest raw increase among all occupations in the country. As the historically large and longer-living Baby Boomer generation ages, the need for healthcare services – especially geriatrics – is set to continue to spur the demand for more nurses.

This job growth is coupled with the fact that registered nurses also have the second highest median annual wage of any career that is reported in BLS data to need no work experience in a related occupation or on-the-job training. Only software developers are projected to have more openings and have a higher median annual salary.

So nursing is a large and growing occupation that has a relatively high average salary, especially for the amount of schooling, work experience, and on-the-job training required for the job. Looking at the macroeconomic data one could make a reasonable assumption that nurses are feeling increasingly positive about their jobs. However, data from the Health Resources and Services Administration’s National Sample Survey of Registered Nurses (NSSRN) show that the exact opposite is the case.

Between the 2018 and 2022 surveys, the latter of which was just released two months ago, job dissatisfaction among registered nurses increased from 11.3% to 20.6%. Dissatisfaction among nurse practitioners and advanced practice registered nurses also had a somewhat smaller rise from 9.1% to 16.4% and 8.2% to 14.6%, respectively.

One of the major drivers of this job dissatisfaction among nurses is the fact that a substantially larger proportion of them reported experiencing being burned out by their job much more frequently. In fact, between 2019 and 2022 the proportion of RNs that stated they felt burned out by their job a few times a week or every day rose from just 27.6% to 51.6%. A full 72.1% of nurses reported being burned out by their job at least a few times a month.

It isn’t hard to connect the dots to see what is causing these massive rises in burnout and job dissatisfaction. Since 2020 nurses have been at the forefront of one of the largest global pandemic in modern history. The onset of COVID-19 has made their jobs immensely more dangerous and emotionally taxing. It’s completely understandable that trying to provide health care for a large number of people suffering and dying from a novel coronavirus while trying to not contract it yourself creates a stressful and unsustainable work environment. According to the NSSRN data, a full 5% of the nursing workforce left their jobs due to the pandemic. Among those estimated 195,000 nurses, the most common reasons given for leaving were high-risk working conditions, being overworked or burned out, and inadequate staffing.

What’s important to note about these responses is that they have the potential to create a spiraling negative feedback loop for the industry at the precisely the worst time. Almost 200,000 nurses left the profession in the wake of the COVID-19 pandemic due to the increased stress and danger associated with working in nursing. Of those that did permanently leave the job, about 40% of those did so to retire, often earlier than anticipated according to NSSRN data. Nurses later in their careers that are much more likely to be older choosing to retire early rather than continue working through the pandemic is also incredibly sensible considering the elevated risks older people have to the COVID-19 virus. These nurses leaving the workforce, whether to retire or to switch careers, then exacerbate the staffing shortage issue, which in turn leads to more nurses who are still in their jobs being overworked or burned out, which happen to be the second and third most common reason for nurses leaving the industry.

For nurses that have stayed in the profession many have contemplated leaving imminently as data from the 2022 NSSRN show that a full 55.9% of RNs who remained in their primary nursing position stated they considered leaving in the past year. Additionally, the proportion of nurses who plan to retire in more than five years declined from 67.2% to 60.9% from 2018 to 2022, with the response category with the largest increase being “undecided”.

All of this is of increasing concern because as covered earlier, we need more nurses! Not just to deal with events like to COVID-19 pandemic but also to meet the needs of an aging society that will require more healthcare professionals to care for it. Projections data from the 2022 NSSRN show that if the current labor force patterns continue, the demand for RNs will be 9% more than supply by 2036, a shortfall of about 337,970 nurses. This shortage is also forecasted to be more acute in non-metro areas at a 14% deficit compared to metro areas at 8%.

How is this trend reversed? Of course the macroeconomic trend of keeping nurses salaries relatively high and the barrier to entry relatively low will help, but so will increasing worker power. As of 2023, only about 13.1% those working in healthcare practitioner and technical occupations – a full third of which are made up by nurses – were represented by a union. Overall higher collective bargaining power can lead to both higher pay and more defined benefit plans that include paid sick leave, holidays, and personal leave. This aligns closely with two of the three most common reasons nurses provided for remaining in their position according to 2022 NSSRN data which were balanced schedule/hours at 54.2% and salary and benefits at 49.2%.

Data and code underlying this article can be found here.