A few years ago, alarm bells started going off in the health care industry: Florida was going to need more nurses — many, many, many more nurses. Tens of thousands of them, in fact.
A 2021 report from the Florida Hospital Association and the Safety Net Hospital Alliance of Florida projected that the state would face a shortage of nearly 60,000 nurses by 2035 due to its aging and growing population.
“Unlike a lot of other states around the country, our population in Florida continues to grow significantly,” says Mary Mayhew, president and CEO of the Florida Hospital Association, which represents more than 200 hospitals and health systems. “At one point we were growing at nearly 1,000 individuals a day, and many of those that are coming to our state are over the age of 65. So the demand for health care services is skyrocketing in Florida, and that’s what we’ve got to keep pace with.”
This projected nursing shortage was so alarming that it made state officials sit up and take notice. Lawmakers responded by pouring large sums of money into increasing Florida’s supply of nursing school graduates.
“The good news is that the Legislature aggressively took action, and they have now prioritized over $135 million to our community colleges and our universities to expand capacity in our nursing schools,” Mayhew says.
So, how well is it working? Well, that remains to be seen. “It will take us a while to evaluate all these efforts to determine how they’re affecting that forecasted shortage,” Mayhew says. “It’s going to take some time.”
One thing that’s clear: There’s no easy fix to this problem.
One challenge is that Floridians who graduate from nursing school have to pass the national nursing licensing exam, which is called the NCLEX (pronounced EN-klex), before they can begin their nursing careers. And not enough of them are passing. Out of 50 states, Florida had the most nursing students taking the exam last year (21,428 of them), but it also had the lowest percentage of students passing the test compared to the other 49 states.
Only about 77% of Florida students passed the NCLEX-RN exam on their first try in 2023, compared to about 88% nationwide, according to the Florida Center for Nursing, a state-funded organization headquartered at the University of South Florida. It researches the supply and demand for nursing, including issues related to recruitment and retention.
State-run schools aren’t the problem with Florida’s exam-passing rate. In 2023, nursing students from Florida’s public universities and colleges had a pass rate of about 88%, the exact same as the national average. Private nonprofit schools had a pass rate of about 87%, while private for-profit schools had a pass rate of only 71%, according to the center.
Nursing education advocates say the key to dealing with this issue is to keep boosting funding and enrollment at high-quality, accredited nursing schools.
“What our data has shown over the years is that accredited programs tend to have higher pass rates on the first attempt of that NCLEX,” says Rayna Letourneau, executive director of the Florida Center for Nursing. “We want to strive to have our candidates pass on the first attempt because we want them to be able to enter the workforce in a timely manner.”
But it can be a challenge to add capacity to these programs, partly because there’s an ongoing shortage of nursing instructors. Most nurses don’t want to leave their clinical nursing jobs to earn less as an instructor. Many Florida nursing education programs also have a shortage of clinical settings for their students to train in.
“Because nursing is a practice discipline, we need those clinical opportunities and experiential learning settings to be able to make sure our candidates are qualified to come into the workforce,” Letourneau says.
Still, in the world of nursing, certain indicators are looking up. For example, Florida hospitals have reduced nurse vacancies and turnover rates over the past two years, according to a report released in September by the Florida Hospital Association.