Health care employers in western North Carolina reported registered nurse turnover of 38%, the highest of any region in the state and nearly four times the 10% rate in the southeast. The figures come from the third annual health workforce analysis by the NC Center on the Workforce for Health, released this week, North Carolina Health News reported.
Western North Carolina has consistently posted some of the state’s weakest workforce numbers, and Hurricane Helene, which struck the region in September 2024, appears to have compounded those long-standing problems. Emily McCartha, a senior policy analyst at the center, said some displaced health workers left their jobs or moved, possibly to Tennessee or Georgia. Mountain transportation barriers and fewer schools that train health workers add to the strain, and graduates do not always stay in the region.
High turnover means more nurses are new to their units, and it puts extra pressure on those who stay.
Inside the Statewide Staffing Numbers
The analysis drew on survey data from more than 150 employers through the NC Health Talent Alliance. Statewide, vacancy and turnover rates fell for registered nurses (RNs), licensed practical nurses (LPNs), certified nursing assistants (CNAs), and medical assistants, but they remain above national and recommended levels.
Twelve percent of RN positions and 16% of LPN and CNA positions were unfilled. RN and medical assistant vacancies stayed open for about 10 weeks on average. Only 4% of 2026 hiring was for new positions, meaning nearly all recruiting replaced workers who left.
Churn, which tracks employees moving into and out of an organization within a year, fell for all four professions. It was most dramatic for CNAs, dropping from 117% in 2025 to about 60% in 2026.
“Improvement doesn’t equal good necessarily,” said Andy MacCracken, director of the NC Center on the Workforce for Health. McCartha stressed that retention is now critical: “The workforce will not even come close to sustaining if you don’t retain your people.”
Shortfalls in Nursing and Emergency Medical Services
The gap extends beyond hospitals. Paramedic vacancies stayed open an average of about 110 days, and EMT vacancies about 94 days. Employers reported about 840 combined EMT and paramedic openings, against an estimated annual supply of about 400 new workers.
For nurses, employers reported an average of 6,930 RN openings a year, while the annual supply of new RNs covers only about two-thirds of that demand. The NC Nursecast model at UNC projects a statewide shortage of about 12,500 RNs and more than 5,000 LPNs by 2033.
Turnover is also expensive. A Sheps Center brief on nurse retention at UNC cited a national industry estimate of $61,110 for the turnover of one bedside nurse, along with about three months needed to recruit an experienced RN.
Mountain Patients and the Road to Recovery
Residents of rural mountain counties already have fewer nearby care options, and Helene exposed cracks in the region’s health care safety net. Because the report’s figures come from employer surveys, rates at individual facilities may differ.
Patients with chronic conditions can schedule follow-up visits early, ask whether telehealth is an option and keep an updated list of their medications. Anyone with chest pain, stroke symptoms or trouble breathing should call 911 right away.
The report notes that statewide averages can hide local shortages and calls for strategies tailored to each community. One option is bringing nurses back to the field. NC AHEC cited Board of Nursing data showing nearly 170,000 RNs with active licenses but only about 127,000 working in nursing, and its RN refresher program offers a path back for nurses who left.
RN pay in North Carolina has consistently trailed national averages, but McCartha noted that national nurse surveys rank work environment above pay. MacCracken said workplace violence is a serious problem, particularly in emergency departments and walk-in clinics. A 2022 Sheps Center report, citing federal data, found health care workers made up about 14% of the U.S. workforce but experienced about 75% of nonfatal, intentional workplace injuries.
Some employers are testing new approaches. Atrium Health Lincoln, Lincoln County Schools and Gaston College created an accelerated pathway that lets high school students start preparing for health careers before graduation. In addition, 11 hospital systems across North and South Carolina share retention strategies through the CaroNova Workforce Experience Accelerator.
Key Questions Answered
What did the report find in western North Carolina? RN turnover among surveyed employers reached 38%, the highest in the state, compared with 10% in the southeast.
How did Hurricane Helene affect staffing? Helene appears to have compounded long-standing shortages, as some displaced workers left their jobs or moved, possibly to Tennessee or Georgia.
Did staffing improve statewide? Yes. Vacancy and turnover rates fell for RNs, LPNs, CNAs and medical assistants, but they remain above national and recommended levels.
How short is North Carolina on nurses? The NC Nursecast model projects a shortage of about 12,500 RNs and more than 5,000 LPNs by 2033.
Are ambulance services affected? Yes. Paramedic vacancies averaged about 110 days, and employers reported about 840 EMT and paramedic openings against an annual supply of about 400.
What can patients do? Book follow-up care early, ask about telehealth, and call 911 for emergencies.
Published by Medicaldaily.com
