Nursing in America: what the numbers actually say in 2026

There are more registered nurses working in the United States than there are people living in Chicago and Houston combined. It is the largest single healthcare occupation in the country, and almost everything about it is changing at once: where nurses work, what they are paid, how long they stay, and who is coming up behind them.

If you are a nurse deciding what to do next, the national picture matters. It tells you which way the wind is blowing before it reaches your unit. Here is what the most recent federal and regulatory data actually says about nursing in America right now.

The size of the profession

The Bureau of Labor Statistics counted 3,379,720 employed registered nurses in its May 2025 occupational survey, alongside 648,410 licensed practical and licensed vocational nurses. No other healthcare occupation comes close in headcount.

That scale is why small percentage shifts in nursing turn into very large absolute numbers. A single point of turnover across the profession is more than thirty thousand people changing jobs.

Where nurses actually work, and why it is shifting

Hospitals remain the centre of gravity. BLS puts 59 percent of RNs in hospitals, with 19 percent in ambulatory healthcare services and 6 percent in nursing and residential care.

But the direction of travel is away from inpatient. The National Council of State Boards of Nursing, which asks nurses directly rather than classifying employers, found 53 percent working in hospitals in its 2024 workforce survey, down 4.2 percentage points from 2022. The two figures differ because the methods differ, and both are defensible. What matters is that they point the same way.

Employment data backs it up. In the year to July 2026, ambulatory healthcare services added roughly 217,500 jobs while hospitals added about 102,000. Growth is real, and it is increasingly happening outside the hospital walls.

What that means for your job search

If you have only ever looked at hospital postings, you are looking at a shrinking share of the market. Outpatient surgery centres, infusion clinics, dialysis, home health and physician offices are where a growing share of new roles sit. Many trade shift differentials and premium pay for predictable hours, which is a trade some nurses want and others do not.

Pay

The BLS May 2025 figures put the median hourly wage for registered nurses at $46.90, with a mean annual wage of $101,420. The most recent annual median BLS published outright was $93,600, covering May 2024.

Geography moves that number more than almost anything else. California's mean annual RN wage was $150,280, while the lowest states sat near $77,000. That is close to a two to one spread for the same licence and often the same work, though cost of living absorbs a large part of the gap.

Nurses themselves report lower numbers than the employer survey suggests. Median self-reported pre-tax earnings in the NCSBN 2024 survey were $88,000, up from $80,000 in 2022. Survey design explains some of the difference, part-time work explains more.

The retention problem is the real story

Recruitment gets the headlines. Retention is where the money and the misery actually are.

The 2026 NSI National Health Care Retention Report, covering calendar year 2025, found:

• RN turnover of 17.6 percent across all staff RNs
• First year RN turnover of 22.7 percent, meaning close to one in four new hires leaves within twelve months
• An average cost of $60,090 per RN turnover
• An average annual loss of $5.19 million per hospital
• A national RN vacancy rate of 8.6 percent, and 78 days to recruit an experienced RN

Read those together and the picture is a profession that has no trouble attracting people and considerable trouble keeping them, particularly in the first year.

An ageing workforce with an exit intention problem

The median age of registered nurses is 50. In the same NCSBN survey, 39.9 percent of RNs said they intend to leave nursing or retire within five years, and of those, 41.5 percent cited stress and burnout. More than 138,000 nurses left the workforce between 2022 and 2024.

Intention is not the same as action, and it never has been. But a two in five figure sitting alongside a median age of 50 is not a soft signal.

The pipeline is full, and the bottleneck is not applicants

Here is the part that surprises people. Interest in nursing is strong. Entry level BSN enrolment rose 7.6 percent to 283,303 students in the American Association of Colleges of Nursing's Fall 2025 survey, released in May 2026. Master's enrolment was up 6.8 percent, doctoral practice programmes up 5.9 percent.

And yet roughly 93,000 qualified applications were turned away in 2025.

The constraint is faculty and clinical placements, not demand for seats. AACN's October 2025 survey found a national faculty vacancy rate of 7.2 percent, with 1,588 unfilled full time positions and 80.8 percent of those roles requiring or preferring a doctorate. PhD enrolment, which feeds the faculty pipeline, has now fallen for eleven consecutive years and is down 20.8 percent since 2013.

That is the quiet structural issue underneath every nursing shortage headline. You cannot teach your way out of a shortage without teachers.

What the projections say

BLS projects registered nursing to grow 5 percent between 2024 and 2034, adding 166,100 jobs, with an average of 189,100 openings per year. Most of those openings come from replacement rather than growth, which is exactly what you would expect in a large occupation with an older workforce.

The Health Resources and Services Administration models it differently and projects an RN shortfall of about 8 percent in 2028, narrowing to roughly 3 percent by 2038. Its rural finding is the one worth remembering: an 11 percent shortfall in non metro areas against 2 percent in metro areas by 2038. National averages hide a distribution problem.

Five things to take from all of this

1. The shortage is uneven. It is worse in rural areas, worse in specific specialties, and much less severe in well served metro markets. Where you look matters more than the national number.
2. Hiring has cooled from its peak. The RN add rate fell to 2.9 percent in 2025 from 5.6 percent in 2024. The frantic pandemic era market has normalised.
3. Travel still pays a premium, but hospitals are pulling back. Average travel bill rates ran $91.23 per hour against a loaded staff RN cost of $59.46, and 73.5 percent of hospitals expect to reduce travel usage.
4. Your first year is the risky one. With 22.7 percent first year turnover, the quality of a residency or onboarding programme is a legitimate thing to interrogate in an interview.
5. Geography is the biggest single lever on pay. Bigger than specialty, bigger than shift, bigger than years of experience.

None of this tells you what to do next. It tells you what you are negotiating inside, which is a market with real leverage for nurses who know where to look.

Figures in this article come from the Bureau of Labor Statistics (Occupational Employment and Wage Statistics, May 2025, and Employment Projections 2024 to 2034), the National Council of State Boards of Nursing 2024 National Nursing Workforce Survey, the American Association of Colleges of Nursing (Fall 2025 enrolment survey and October 2025 faculty vacancy survey), NSI Nursing Solutions' 2026 National Health Care Retention Report, and HRSA nurse workforce projections published December 2025.