High Point University opened its Department of Nursing with a simulation lab and 21st century curriculum, won North Carolina Board of Nursing approval, and has since graduated multiple classes with strong pass rates on the state licensing exam. A few miles down the road in Randolph County, Randolph Community College’s nursing program just landed the third-best ranking in North Carolina on RegisteredNursing.org’s annual rankings, with a perfect four-year pass rate for its graduates. If you only read local headlines, it would be easy to assume the Piedmont Triad has quietly solved its nursing shortage.
Both schools deserve the credit they’re getting. A new 50,000-square-foot nursing complex and a top-five community college ranking are the kind of local wins that genuinely move a region’s healthcare capacity forward over time, and residents of High Point and the surrounding Triad counties will feel the benefit of both programs for years as their graduates take jobs at Cone Health, Novant Health, Atrium Health and the smaller practices scattered across Guilford and Randolph counties.
It hasn’t been solved, though, and the reason has less to do with how many people want to become nurses and nurse practitioners than with how many of them can get through the clinical training it takes to finish. For nurse practitioner students specifically, that means finding a licensed preceptor willing to supervise hundreds of hours of hands-on clinical work, often the single hardest step in an NP program. Clinical Match Me, a nationwide preceptor placement service, exists because so many NP students hit that wall. Students who register at clinicalmatchme.com/ submit the specialty, location and hours they need, and preceptors who have open capacity send them offers directly. It’s a narrow slice of a much bigger problem, but it sits right at the point where a lot of otherwise-qualified students get stuck.
That bigger problem is worth looking at closely, because the numbers don’t match the optimism a new nursing building or a strong ranking might suggest.
North Carolina is still near the top of the shortage list
The federal government’s own health workforce analysts don’t see North Carolina’s nursing shortage easing anytime soon. In a December 2025 brief, the Health Resources and Services Administration’s National Center for Health Workforce Analysis projected that North Carolina will have a 20% shortage of registered nurses by 2038, a gap of 25,710 full-time positions. Among every state in the country, only California’s projected shortage, at 22%, is larger. Georgia ties North Carolina at 20%. No other state cracks the top three.
That 20% figure isn’t a worst-case scenario or an advocacy estimate. It comes from HRSA’s own Health Workforce Simulation Model, the same tool the agency uses to project supply and demand across the entire U.S. health workforce, and it assumes current graduation rates and labor force participation simply continue. In other words, North Carolina’s nursing schools would need to do meaningfully more than “continue as usual” to close that gap, not less.
The same HRSA brief breaks the national registered nurse shortage down by three-year intervals, and the trend line matters as much as any single year’s number. Nationally, the brief projects an 8% RN shortage by 2028, narrowing slightly to a 3% shortage by 2038, a gap of 108,960 full-time positions at the national level even in the improving scenario. North Carolina isn’t tracking toward that national average. It’s one of only three states, alongside California and Georgia, projected to still be sitting at a 20% shortage or worse once the rest of the country has largely closed the gap. Rural and nonmetro areas face the steepest climb of all: the same analysis projects an 11% RN shortage in nonmetro areas nationally by 2038 compared to just 2% in metro areas, a gap that matters for a state like North Carolina where a large share of the population lives outside its handful of metro centers.
Nationally, the same HRSA brief notes something that cuts against a simple “not enough people want to be nurses” story: the supply of nurse practitioners is projected to exceed demand across the country through 2038. The brief is blunt about what that means in practice, stating plainly that “distribution remains the most important issue.” Supply and demand can balance out in aggregate while North Carolina, specifically, still falls short, because the nurses and nurse practitioners entering the workforce aren’t landing where the demand is.
The demand side was never the problem
If NP training programs were struggling to fill seats, the shortage story would be simple: not enough interest, not enough applicants, end of story. That isn’t what’s happening.
The U.S. Bureau of Labor Statistics projects that employment of nurse practitioners will grow 41% between 2025 and 2035, adding roughly 137,800 new NP positions to the economy. That’s one of the fastest growth rates the BLS tracks for any occupation in the country. Broaden the lens slightly to the combined category of nurse anesthetists, nurse midwives and nurse practitioners, and the BLS still projects 36% growth off a 2025 base of 399,000 jobs, with about 32,200 openings expected every year on average as the field expands and as current clinicians retire or change careers.
The American Association of Nurse Practitioners tracks the other side of that growth curve: how many NPs are out there. Its 2025 count put the number of licensed nurse practitioners across the U.S. at more than 461,000, describing it as “about 30,000 more NPs than our last count, which is a 7% increase” over the prior count, which had used 2023 data. That’s not a profession running out of people willing to do the work. It’s a profession adding tens of thousands of new clinicians every couple of years while demand keeps climbing even faster.
Put the BLS and AANP numbers side by side and a pattern emerges. The workforce is growing by tens of thousands of new nurse practitioners every couple of years, and the job market is projected to keep expanding even faster than that. Nobody is choosing to walk away from this profession at the rate that would explain a persistent state-level shortage. The growth is real on both the supply and the demand side, which means something else entirely is slowing the pipeline down between “accepted into a program” and “working as a licensed clinician.”
So the applicants exist. The job demand exists. The growth in the workforce exists. What doesn’t scale at the same pace is the system that turns an interested applicant into a licensed clinician, and that’s where the actual bottleneck shows up.
Where the bottleneck sits
The American Association of Colleges of Nursing publishes an annual Nursing Faculty Shortage Fact Sheet that quantifies exactly how many qualified students get turned away from nursing education every year, and why. The most recent figure is stark: U.S. nursing schools turned away 92,672 qualified applications from baccalaureate and graduate nursing programs in 2025. That’s not a shortfall of interested, able students. These are applicants who met admission standards and still couldn’t get a seat.
AACN’s fact sheet names the reasons directly, and it’s a longer list than most people expect: schools cited “insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints,” with faculty shortages topping the list most often. A separate AACN survey of 863 nursing schools, conducted in October 2025, found a national faculty vacancy rate of 7.2%, meaning more than one in fourteen full-time teaching positions at nursing schools nationwide currently sits empty.
Read that list again: faculty, clinical sites, classroom space, clinical preceptors, budget. Four of those five items are about capacity to deliver hands-on clinical training, not classroom seats or marketing to prospective students. A school can admit a full class and still produce fewer graduates than it wants, simply because there aren’t enough supervising clinicians available to sign off on every student’s hours. For nurse practitioner programs specifically, this often means a student finishes every didactic requirement and then spends weeks or months hunting for a preceptor willing to take them on, a search that can delay graduation by a full semester or more if it drags on.
This is the layer of the shortage that doesn’t show up in a university’s press release about a new simulation lab, and it’s also the layer where a service built around preceptor matching does the most good: students submit a placement request specifying their specialty and location, and preceptors with open capacity across the country can choose to send them an offer, rather than the student cold-calling clinics one by one and hoping someone has room.
The mismatch is easy to miss if you only look at enrollment numbers, because enrollment was never the constraint. A program can fill every available seat, teach every course on schedule, and still watch a chunk of its class slip past its expected graduation date because the clinical placement side of the equation didn’t keep pace with the classroom side. Faculty members who could be teaching are instead spending hours trying to track down preceptors for their own students, work that a dedicated placement service exists specifically to take off their plate. That’s a quieter failure than a rejection letter, and it’s one that shows up in graduation timelines rather than admission statistics, which is probably why it gets so much less attention than the raw applicant numbers do.
What this means for a Triad nursing student
None of this takes anything away from what’s happening locally. HPU’s nursing complex, with its sixteen-bed skills lab and high-fidelity simulation suites, genuinely prepares students for real clinical environments before they ever touch a patient. RCC’s third-place NCLEX ranking, with a perfect pass rate across its small cohort, reflects real teaching quality at the community college level. Both are legitimate, positive stories for the Piedmont Triad’s healthcare future.
But the HRSA projection that puts North Carolina second in the country for projected RN shortage, and the AACN data showing nearly 93,000 qualified applicants turned away nationally for lack of faculty and clinical capacity, describe a pipeline problem that no single university’s new building solves by itself. Every additional nursing or NP student the Triad trains still has to find a working clinical placement somewhere in the system, and that system is strained at exactly the point where supervision, not enrollment, becomes the limiting factor.
For a nurse practitioner student in High Point weighing graduate programs, or already enrolled and starting to search for a clinical rotation, that reality is worth planning around early rather than discovering it in the final semester. The data backs up what many NP program advisors have been saying quietly for years: getting accepted into a program and finishing the coursework was never the hard part. Finding the preceptor who will actually put in the supervised hours with you is.
That’s also the piece of this story a prospective student has the most control over. Nobody applying to HPU or RCC today can change North Carolina’s statewide RN shortage projection or the national faculty vacancy rate on their own. What a student can do is start the search for a clinical preceptor earlier than they think they need to, treat it as its own milestone rather than an afterthought once coursework wraps up, and use every tool available, from faculty connections to a dedicated placement platform, rather than relying on cold calls to clinics that may already be stretched thin supervising their own staff’s training needs.
North Carolina’s local nursing news is genuinely encouraging. The state-level numbers underneath it haven’t caught up yet, and the gap between those two pictures is almost entirely about clinical placement capacity. That’s the piece of the puzzle worth watching closest as the Triad’s new nursing programs start sending their first graduates into the workforce.
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