If you operate a skilled nursing facility today, you've already felt the LPN squeeze. The harder question is what the next decade and beyond looks like, and the data does not look good.
The numbers to know
The U.S. Health Resources and Services Administration (HRSA) projects a 30% LPN shortfall by 2038, equivalent to about 246,000 full-time equivalent positions the country won't be able to fill at the current trajectory. That figure comes from HRSA's December 2025 nursing workforce projections. HRSA's broader workforce report shows the LPN supply contracted 6% between 2020 and 2024, meaning we're not just failing to grow the pipeline, we're losing ground.
Significantly, the post-acute and senior care sectors are feeling the brunt of this impact, as roughly four in 10 LPNs nationwide work in skilled nursing or residential care settings. That concentration is the part that matters for operators in our space. When the pool shrinks, our facilities feel the hit first.
Geography matters
While the 30% figure is a national projection, the shortage is uneven across regions: it's concentrated in specific states and falling hardest on non-metropolitan markets.
HRSA identifies Oklahoma, South Carolina, Louisiana and Virginia as the states with the largest projected RN shortages by 2038. Notably, rural areas are projected to face an 11% RN shortage by 2038, compared to just 2% in metropolitan areas. The same dynamics apply to the LPN workforce.
What this means in practice: a multi-site operator running facilities across a mix of urban, suburban and rural markets is looking at different workforce dynamics in each environment. Any strategic conversation about workforce sustainability needs to start with where your facilities sit on the regional curve, not what the national headlines say.
Recruiting harder won't solve it
We’ve seen operators who are responding to workforce pressures by doubling down on traditional recruiting, with bigger sign-on bonuses, expanded recruiter teams and aggressive outreach. These efforts assume the underlying problem is execution, and it isn't.
This is a supply problem. The pipeline feeding LPN roles, such as nursing school graduates, NCLEX-PN test takers and new license holders, is under structural pressure across the country.
Wage competition between facilities just redistributes a shrinking pool, it doesn't grow the pool. Operators who recognize this key distinction will make different decisions than operators who don't.
Strategies operators are acting on now
The good news is that some forward-thinking leaders are paying attention and aren't waiting. A few patterns are emerging from those who are planning ahead.
- Holding on to the people you already have. LPNs who walk out the door make the situation worse for your facility – and maybe for the entire sector if they leave the profession. Retention is one of the highest-leverage move operators can make, but it's often deprioritized by the urgency of filling open shifts. Stay interviews, schedule predictability, real career pathways and manager training are not new ideas, but they are even more valuable in a structurally constrained market. Operators who treat retention as a workforce strategy, not just an HR program, will be the ones whose problems don't worsen year after year.
- Building the pipeline from within through CNA-to-LPN laddering. Instead of waiting for external supply to recover, a growing number of senior care operators are creating earn-and-learn pathways for their existing CNAs. Kane Community Living Centers, a Western Pennsylvania operator, partnered with a licensed practical nurse program to educate CNAs and other team members at no cost, building a clear ladder from CNA to LPN to RN. Similar earn-and-learn models are running in Hawaii, Wisconsin, Indiana and Arizona, with operators reporting that the pipeline effect is real, including stronger CNA recruitment as candidates pursue facilities that offer a real path forward.
- Revisiting the RN mix in certain roles. Some operators are taking a hard look at their care model and asking whether shifting certain responsibilities toward RNs in specific units can offset projected LPN shortfalls. This isn't right for every facility, and the bottom-line math needs to work, but it's a planning conversation worth having before the gap widens further.
- Maintaining flexible access to independent licensed professionals. Internal pipeline programs can take years to develop to maturity. CNA-to-LPN laddering programs typically run 10 to 16 months per cohort, and facility benefits increase gradually. In the interim, operators need reliable access to credentialed independent professionals to keep schedules covered without resorting to long-term contracts that lock in costs at the wrong moment. This is where ShiftKey's marketplace fits: we connect facilities to a vast network of independent licensed professionals in their local communities, providing the flexibility to scale workforce access up or down as internal strategies take hold.
The operators getting this right are running multiple plays in parallel, not just relying on one.
The time for planning is now
Twelve years sounds like a lot of runway, but workforce strategy decisions made now in 2026 (pipeline investments, care model adjustments, marketplace partnerships) determine which operators have credentialed professionals available in 2030 and beyond.
The facilities building strategies now will be in a fundamentally different position than those still reacting to next quarter's open shifts five years from now.
What we're hearing from operators across the care space is that the conversation is shifting. Leaders who used to frame this as a recruiting challenge are starting to frame it as a structural one and they're acting accordingly. That's the right read of the data, and it's the right time to act on it.
The 30% shortfall is not set in stone, but it's a reliable indicator of an increasing challenge for operators. Managing the outcomes of this challenge requires treating the next 24 months as the planning window that matters most.
About Brandon Tappan
Brandon’s deep industry knowledge and experience in the post-acute space gives him a unique perspective on growing revenue at ShiftKey. Prior to joining, he led growth and acquisition for multi-facility/multi-state operations in the post-acute space, and was President of Operations at Senior Care Centers. Brandon is a licensed nursing facility administrator and is a sought after expert on workforce strategies. He served on the Texas Health Care Association Board for five years and often advises on legislative proposals impacting care facilities.
Sources
“U.S. Supply of LPNs to be Short by 30% by 2038," (AHCA/NCAL)
“Nurse Workforce Projections Fact Sheet - December 2025,” (HRSA)
“State of the U.S. Health Care Workforce, 2025,” (HRSA)
"SNF providers turn to in-house training programs," (McKnight's Long-Term Care News)
"Inside the 'Learn and Earn' Trend," (Skilled Nursing News)
