TEANECK, N.J. — New Jersey is facing a growing nursing shortage, and one of the biggest problems may be getting enough nurses through the classroom door in the first place.

More than 13,000 qualified applicants sought admission to New Jersey nursing programs in 2024, but only about 4,700 spots were available, according to the New Jersey Collaborating Center for Nursing.

The result is a growing bottleneck in a state already projected to face a shortage of 12 percent of its registered nurses and 25 percent of its licensed practical nurses by 2037.

The projected shortage of registered nurses is twice the national forecast of 6 percent, according to NJCCN.

"For years, experts have pointed to rising demand for healthcare as the nation's population ages with more chronic conditions and complex care needs," said NJCCN Executive Director Daria Waszak. "At the same time, the nursing workforce is also aging, with many Baby Boomer nurses at or approaching retirement age."

The problem is not simply a lack of people interested in becoming nurses. Nursing schools themselves are struggling to expand capacity because of shortages of faculty and clinical preceptors, limited clinical sites and a lack of classroom and laboratory space.

And even after nurses enter the workforce, keeping them there remains a challenge. NJCCN reports turnover rates of 31 percent for registered nurses, 38 percent for nurse practitioners and 56 percent for licensed practical nurses.

At Holy Name Medical Center in Teaneck, the state's broader nursing shortage is being felt firsthand.

"We're different," said Michele Acito, Holy Name's executive vice president and chief nursing officer. "New Jersey's population is generally older, denser and sicker than much of the country."

That combination means more patients requiring care at a time when fewer people are entering or remaining in the nursing profession.

Acito, who experienced New Jersey's last major nursing shortage in the mid-1980s, said today's problem is more complicated.

"It's not one single problem," she said. "It's several, stacked on top of each other."

The nursing workforce itself is aging, while the job can mean 12-hour shifts, high-stakes decisions and constantly changing medical knowledge.

The COVID-19 pandemic added another layer to the problem.

Nurses became the public face of the healthcare response, remaining at patients' bedsides during some of the most difficult moments of the pandemic.

That visibility attracted some people to the profession, Acito said, but it also showed prospective nurses just how demanding the job could be.

Holy Name is trying to address the shortage before those prospective nurses ever reach the hospital floor.

The hospital's Sister Claire Tynan School of Nursing, which is now a century old, recently enrolled its largest class ever after receiving $3.8 million in federal funding. The money allowed the school to add faculty and expand its simulation lab, where students can train for scenarios ranging from postpartum hemorrhages to dementia care.

Holy Name has also invested in retention, including tuition reimbursement, loan forgiveness and a first-year residency program designed to give new nurses support as they transition into the profession.

Hospital President and CEO Mike Maron said continued federal investment is critical to maintaining the healthcare workforce.

"Federal appropriations like this are critical in building and supporting a robust healthcare workforce," Maron said. "Similarly, we're seeking continuing federal funding for our Graduate Medical Education program to address N.J.'s critical physician shortage."

The nursing shortage also comes as demand grows for nurse practitioners, who can increasingly fill gaps created by a shortage of primary care physicians.

Although NJCCN's federal projections show New Jersey with a potential 43 percent surplus of nurse practitioners by 2037, Acito said the reality on the ground is more complicated.

"As primary care physicians grow scarcer by the year, NPs may be stepping into that gap," she said. "But the state still needs even more of them."

NJCCN says expanding nursing education capacity will have to be part of the solution. The organization is supporting legislation aimed at increasing the number of nursing-school seats and expanding programs that help new nurses transition into the workforce.

One such NJCCN program involves 22 hospitals and more than 5,000 participants. The program has helped raise one-year retention rates to 90 percent, compared with a 76.2 percent national average, according to the organization.

For Holy Name, however, the issue comes down to more than filling hospital shifts.

"We don't want people to jump in, get that education, and then join us and say, 'This isn't what I thought it would be,'" Acito said.

The challenge for New Jersey will be expanding the pipeline without sacrificing the quality of training, while also making nursing a career people can afford to enter and stay in.

Waszak said the state needs investment in nursing schools, stronger career pathways and more nursing faculty, along with healthcare workplaces that offer fair wages, manageable workloads and safe working conditions.

"Nursing is the backbone of healthcare," she said. "When the nursing workforce struggles, it will ultimately impact the patients."