The Nursing Shortage May Actually Be a Nurse Retention Crisis
I spent some time at a conference recently where much of the conversation centered around two ideas: the nursing shortage, and how AI might help solve it. Both are interesting topics. Both are important. Though as I sat there, listening, I kept coming back to the same thought: I’m not sure we’re talking about the right problems.
To start with the issue of the “nursing shortage”. This particular buzz word(s) was fully buzzing! “There’s a nursing shortage” was said in every presentation throughout the day. Although the data seems to point to a parallel issue. But, I’ll get to that in a minute.
First, let’s look at the data. In 2025, the National Counsel of State Boards of Nursing (NCSBN) reported 5.96 million actively licensed registered nurses¹. That’s over a two million nurse surplus than the reported 3.3 million available nursing positions². Two million. Stop and think about that for a moment. TWO MILLION!
A significant surplus, if just consider the raw data.
But, what do the numbers mean exactly? My hypothesis -formed by working actively in the emergency department as a staff nurse for quite some time- is this: what healthcare leaders are attributing to the physical shortage of nurses is actually a shortage of nurses who are willing to work in conditions that have become increasingly unsafe, hostile, and exhaustive.
Those are different issues. VERY different.
Because if the problem was truly a lack of people entering the profession, the solution looks one way; get more nurses through nursing school (which is being done; BSN entrance and graduation rates have increased year over year recently³), past the NCLEX, and into the workforce. Fairly simple.
However, if the problem is that early and mid-career nurses are leaving, burning out, or choosing not to stay at the bedside, then no amount of recruitment or marketing is going to fix that. You’re not solving a pipeline problem. You’re dealing with a retention problem.
My official stance is that the ‘nursing shortage’ problem is the latter. You’re not solving a pipeline problem. You’re dealing with a retention problem.
And those problems require different conversations. VERY different.
Here’s one main tenet: that we, as the largest collective of healthcare professionals, need to reshape our mental framework of how we’re thinking about the ‘nursing shortage’. One way to do that could be to rephrase “nursing shortage” to “work environment crisis”. This description -to me, based on years of anecdotal experience- more accurately reflects the root cause of the problem.
Although, I suspect nursing leadership and professional organizations would never go for that because of the subtle implication that it is not the nurses who are the issue but the systems which they work. Looking inward is very hard. As humans and as organizations. Yet, not impossible. And if we can, from a grassroots level, begin to substitute ‘work environment crisis’ when someone uses ‘nursing shortage’, that just might be the catalyst needed.
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Second on the conference idea list was that AI could help reduce the number of tasks nurses have to complete, which would allow more time for the “human” side of care. On the surface, that sounds reasonable. But I think it oversimplifies what actually happens in practice.
Because it assumes that if you remove tasks, that time gets given back to the nurse. All nurses who have ever worked at the bedside knows that’s not usually how it works. More often, that time gets reallocated. More documentation. More expectations. More throughput (oh, how leadership loves measuring -and reporting on- those figures!).
The system tends to absorb any efficiency gains and convert them into something else. Again, practicing nurses know this (…have you updated your whiteboard yet…). They know the struggle of having just sat down for the first time in 4 hours, only to have the manager come around the corner at that exact moment and say “slow today”.
To this ‘reallocation issue’, the question isn’t just: Can AI reduce tasks? It’s: what will the system, the managmeent, the C-suite, do with the time that creates? Every hospital organization has the same general mission statement: to improve patient outcomes through quality care. With the undertones being, increases in direct nursing patient care are the true metric that drives quality care. The survey data shows this year over year, hospital after hospital.
This, if the goal is truly to create more space for human connection in care, that requires more than technology. It requires intention at the system level. It requires leadership and administration at all levels to make human connection a priority. Even above creating another data point to track.
Otherwise, we risk solving for efficiency while missing the bigger issue entirely.
I don’t have a perfect answer here. On either issue. But I do think we need to be careful about how we define the problem. Both problems. Because the way we define it determines everything that comes after.
-Mitch
