SC confronts worsening nursing shortage along with a growing demand for care 

South Carolina’s healthcare system is facing a critical nursing shortage that could worsen over the next decade.   

Projections from the National Center for Health Workforce Analysis show South Carolina will face a 20% shortfall in registered nurses by 2036. The state will have an estimated demand for 61,340 nurses but a supply of only 49,130, leaving a gap of 12,210.  

Experts say this shortage is caused by numerous factors, from workforce burnout to not enough nursing faculty.   

“I think this notion of shortage, while it’s complex, it’s not all just about the numbers,” said Katie Gaul, director of the South Carolina Office for Healthcare Workforce. “Hospitals are having a hard time recruiting and keeping nurses. That’s not so much a number problem as it is a matter of working conditions, placement and support.”  

Gaul said overwhelming responsibilities have contributed to the strain.   

“Working long hours, not feeling supported, not feeling like you have a voice and not seeing change, that can also really weigh you down,” she said. “All that feeds into burnout.”  

Beth Morgan, director of clinical affairs and workforce for the South Carolina Hospital Association, said the state’s aging population is making the shortage worse.   

By 2030, more than 1.5 million South Carolinians are expected to be over the age of 65.   

“You’ve got an aging workforce, so a large portion of our nursing workforce is nearing retirement age,” Morgan said. “We’ve got an aging population, which typically equates to more nursing needs or healthcare needs.”  

Morgan said the COVID-19 pandemic worsened existing challenges in the healthcare workforce.   

“I think the burnout thing was real,” Morgan said. “… We knew that there was lot of lingering emotional and physical stuff from COVID.”  

Kelli Evans, a nursing student at USC, has already experienced how emotionally demanding the profession is during clinicals.  

“From what I’ve learned about being a nurse so far, it doesn’t only take education, it also takes a lot of emotional effects on you,” she said. “We’re using everything we’ve learned from the textbook, but we’re also having to use a lot of social and emotional skills.”  

As nursing students prepare to enter the field, there’s still a challenge in training enough new nurses. Many nursing programs lack the faculty needed to accept more students.  

The state-funded BOLD (Better Outcomes, Less Debt) Nursing Faculty Program addresses this by offering graduate-level nursing students $30,000 per year for teaching at one of the state’s public nursing schools. Recipients can receive up to $90,000 in tuition reimbursement and must commit to teaching for at least two years. The program started in the fall of 2023.  

According to the South Carolina Student Loan Corporation, the program has provided more than $5.6 million in specialized loans to more than 300 healthcare students and nursing faculty so far. 

“A lot of people worry about the shortage of faculty, including clinical instructors,” Gaul said. “This is consistently cited as one reason that schools can’t produce more nursing graduates.”  

Kristyn Childress, the department chair of nursing at Midlands Technical College, shared that concern.   

“From an educational standpoint, it limits clinical sites,” she said. “We have to have somewhere to go. We have to have clinical faculty.”  

Childress said it’s hard to recruit faculty because the pay doesn’t match what nurses can earn elsewhere.   

“The South Carolina state board of nursing requires that all nurses that teach in the classroom have at least a master’s degree,” she said. “Nursing education does not pay what a nurse practitioner in a private sector pays.”  

At USC, Jeanne Cavanaugh, director of clinical partnerships and the center for nursing leadership, said they’re working to grow their faculty.  

“We’re hiring more faculty so we can graduate more pre-licensure nurses,” she said. “We’re already doing that, we’re already up to like 370 graduates per year.”  

In the Lowcountry, the South Carolina Nurse Retention Initiative offers stipends to new nurses who agree to work locally after graduation.   

“It was created almost four years ago now to address the nursing shortage in our local area,” said Bob Elliott, the co-founder of the South Carolina Nurse Retention Initiative. “It’s a post-graduation stipend that we pay a nurse for up to two years as long as they remain employed in our local communities.”  

The non-profit program offers $6,000 to associate degree nurses and $9,000 to bachelor’s degree nurses. Since its inception, the initiative has supported 63 nurses and aims to expand to 30 to 35 new recipients each year, depending on available funding. 

SCNRI is led by an independent volunteer committee responsible for raising funds and selecting recipients. The Community Foundation of the Lowcountry supports the effort by handling the platform, finances and distribution of the stipends. 

Elliott believes the program could be expanded statewide.  

“It’s a unique retention model that can be picked up and implemented anywhere,” he said. “And, so, what we’ve been trying to do for three, four years is not only address our local shortage but raise the awareness and try to bring this to a higher level.”  

Evans said students don’t always see the shortage during school but notice it after graduating.  

“It’s been extremely hard for new grad nurses to get employed because although there is a nursing shortage, they’re really wanting people who are experienced that they don’t have to train as much,” she said.  

Gaul said schools and employers are trying to do more to support new nurses.  

“The hospital association and the hospitals are all doing what they can to recruit more nurses,” Gaul said. “I think that employers and also educators are trying to find ways to partner up to support those new nurse graduates a little better once they start practicing.”  

Hospitals are testing new strategies to improve retention, from offering flexible schedules to adopting high-reliability practices.    

“One of the principles of high reliability is what we call deference to expertise,” Morgan said. “And that basically means when you’re trying to fix something or change something, go ask the people that actually do the work.”  

Other incentives include signing bonuses and flexible schedules.  

“I think hospitals are getting better at listening to and responding to the needs of their staff,” Morgan said. “They’re already doing a great job.”  

Despite the challenges, healthcare leaders remain hopeful that innovation and collaboration can ease the shortage.  

“I think that is really going to come down to employers to find better solutions for recruiting nurses and retaining them,” Gaul said.