Solutions to the Nursing Shortage: What's Working and What Isn't

Most conversations about the nursing shortage collapse several problems into one. That leads to broad commitments, mismatched spending, and disappointing results.

There are at least three distinct constraints:

• Education capacity: whether qualified applicants can secure a seat, faculty instruction, and a clinical placement.
• Retention: whether nurses already in the workforce stay, particularly as they transition into practice.
• Distribution: whether nurses are available in the locations, shifts, and specialties that need them, including rural communities, night shifts, and hard-to-staff clinical areas.

These constraints overlap, but they are not interchangeable. A campaign that produces more applicants does not create faculty capacity. A tuition benefit does not repair an unsustainable workload. A general recruiting campaign does not necessarily solve a night-shift coverage problem.

That distinction should be the starting point for evaluating nursing shortage solutions. Name the constraint first. Then choose an intervention designed to change it.

Education capacity is the constraint on new supply

The education capacity problem is not a lack of interest in nursing. It is the ability of schools to educate qualified applicants.

AACN reports that nursing programs turned away 92,672 qualified applications in 2025. That figure changes the diagnosis. More awareness, outreach, or employer recruiting will not solve a system in which qualified applicants cannot secure a place to train.

Faculty and clinical capacity are central bottlenecks. AACN identified 1,588 full-time faculty vacancies across 863 nursing schools with baccalaureate and post-baccalaureate programs for the 2025–2026 academic year. The national full-time faculty vacancy rate was 7.2%. Schools also cited insufficient clinical sites, classroom space, clinical preceptors, and budget constraints among the top reasons for turning away qualified applicants.

The implication for hospital workforce leaders is direct: you cannot recruit your way past a seat shortage. A health system can improve its employer brand and still compete for a supply of graduates limited by educational capacity.

Addressing this constraint requires investment where the bottleneck is. That includes supporting faculty capacity and building durable clinical-placement partnerships between employers and nursing schools. Clinical education cannot be treated as an occasional favor granted when staffing allows. It is part of a region’s workforce infrastructure.

The relevant question is not whether an initiative generates more applicants. It is whether the initiative helps a school educate more qualified students by addressing faculty, placement, preceptor, space, or budget constraints. That is the test for an education capacity investment.

Retention is where employer spending has direct leverage

Retention is a separate constraint, and employers can influence it more directly.

According to the 2026 NSI National Health Care Retention & RN Staffing Report, national RN turnover rose to 17.6% in 2025, up from 16.4% the prior year. The report puts the average cost to replace one bedside RN at $60,090.

Those figures should shape how workforce leaders assess spending. Retention is an operational and financial priority. Each preventable departure creates a replacement cost, disrupts continuity, and adds pressure to the workforce that remains.

The budget context matters. Kaufman Hall reported that the adjusted 2026 year-to-date hospital operating margin closed out March at 1.7%. Workforce interventions therefore need to justify themselves against measurable costs, not an unlimited budget. For retention programs, the relevant comparison is often the $60,090 average replacement cost reported by NSI.

This is why retention spending can make a clearer business case than additional recruitment spending. Recruitment competes for a supply of graduates constrained by education capacity. Retention spending addresses a cost the hospital is already incurring.

Distribution is not the same as total supply

A workforce can appear adequate in aggregate while a particular hospital, community, shift, or specialty remains persistently understaffed.

“We need more nurses” may be true, but it is often incomplete. The immediate operating problem may be a need for nurses willing and prepared to work in a rural setting, on nights, or in a specialty with a demanding transition into practice. General recruitment may enlarge the applicant pool without changing coverage in those roles.

Distribution interventions need to be specific. The role, location, shift, specialty, timing, and support should be clear. Without that precision, employers may recruit more broadly while their hardest vacancies remain open.

What isn’t working

Some common approaches can help in limited circumstances. They fail when they are treated as substitutes for structural solutions.

• Treating agency and travel labor as a permanent staffing model. Contingent labor can cover acute gaps. It does not, by itself, rebuild a stable workforce or address the conditions behind recurring vacancies. It is a bridge, not a long-term workforce plan.
• Relying on one-off sign-on bonuses. A bonus can influence a near-term hiring decision, but it does not change the work after arrival. If scheduling, workload, management, and transition support remain the same, the organization eventually faces the same retention problem again.
• Using pipeline marketing when seats are scarce. Marketing nursing careers is not the same as increasing nursing education capacity. When qualified applicants are already being turned away, adding applicants without adding faculty or clinical placements does not produce more graduates.
• Offering wellness programming instead of changing workload. Wellness resources can be useful. They are not substitutes for credible workloads or meaningful schedule control. A resilience workshop does not create schedule control. Programs that ask nurses to cope with conditions leaders can change have misidentified the constraint.

These approaches are not necessarily failures of effort. They are failures of targeting. Each may serve a narrow purpose, but none should be asked to solve a constraint it does not address.

What is working

The strongest solutions to the nursing shortage have a defined target and a measure tied to that target.

• Structured nurse residency and transition-to-practice programs. These programs support first-year retention by giving new nurses a deliberate path into clinical practice. Effective programs provide structured development, feedback, mentorship, clear milestones, and support during a demanding transition.
• Direct investment in faculty capacity and clinical placements. This addresses the education constraint at its source. Hospitals and schools can work together on faculty support, teaching roles, preceptor capacity, and predictable clinical-placement agreements.
• Schedule and workload control. Predictable scheduling, meaningful input into shifts, and credible workload expectations address the experience of the job itself. These are retention interventions, not culture-program substitutes.
• Early commitment tied to a defined employment relationship. Financial support during nursing school can be connected to a clear post-graduation role. This is most useful when the employer specifies the location, timing, shift or specialty expectations, and transition support.

The measures should match the intervention. Education capacity work should be evaluated by whether it expands the ability to educate students. Residency and workload initiatives should be evaluated through retention. Distribution programs should be assessed against the specific roles and locations they are intended to fill.

What early commitment does and does not solve

Employer-funded early commitment does not add faculty lines or clinical placement slots. It does not solve the education capacity constraint.

What it does address is retention and distribution. It can help fill seats that already exist with students who might not otherwise afford to finish, attach those students to an employer before graduation, and improve first-job retention at the point where turnover is most expensive.

The specificity of the commitment matters. A vague promise of future employment does little to solve a distribution problem. A defined relationship gives the student and employer a basis for planning. It can connect financial support to a role in a particular facility, shift, or specialty, then pair that commitment with a structured transition into practice.

Clasp is one option on this retention and early-commitment side of the work. Its role is narrower than increasing education capacity: helping employers establish financial support tied to a defined employment relationship before graduation.

That narrower scope is useful when it matches the employer’s actual constraint. It should not be presented as a replacement for investment in faculty or clinical placements.

Sequence the work around the constraint

There is no single intervention that resolves every part of the nursing shortage. A stronger workforce plan begins with a local diagnosis:

• If qualified applicants cannot enter or complete nursing programs because capacity is limited, invest in faculty capacity and clinical-placement partnerships.
• If employed nurses are leaving, focus on transition-to-practice, schedule control, workload, and the conditions of the job.
• If vacancies persist in particular locations, shifts, or specialties, use defined commitments and role-specific support rather than generic recruiting.

Then measure each intervention against the cost it is intended to reduce. For retention work, that means comparing the investment with the $60,090 average cost of replacing one bedside RN reported by the 2026 NSI National Health Care Retention & RN Staffing Report.

With Kaufman Hall reporting a 1.7% adjusted 2026 year-to-date hospital operating margin through March, employers have little room to fund an intervention aimed at the wrong problem. Match the intervention to the constraint. Build education capacity where new supply is blocked. Improve the job where retention is failing. Create specific commitments where distribution is the issue. That is how workforce leaders can identify solutions to the nursing shortage that hold up operationally and financially.