The Market
The active U.S. RN license count stood at 5,641,311 as of the start of 2024, per the NCSBN/National Forum of State Nursing Workforce Centers' 2024 National Nursing Workforce Study, alongside 968,948 active LPN/LVN licenses. This is a stock figure — a headcount of valid licenses, not a count of nurses currently employed in nursing (NCSBN's own data puts employment-in-nursing at roughly 88% of license holders). The workforce works predominantly in hospitals and nursing homes/extended care, is aging (median age 50 in 2024), and has grown steadily more credentialed, with over 73% now holding a bachelor's degree or higher.
Demand is driven by demographic and structural forces that are well documented but graded differently depending on time horizon. HRSA's Bureau of Health Workforce (National Center for Health Workforce Analysis) modeled a projected 8% national RN shortage in 2028, narrowing to a 3% shortage (108,960 FTEs) by 2038 — explicitly a projection built on an assumption that historical attrition, graduation, and labor-force-participation patterns hold constant. This is a materially different message than the shortage figures still circulating from HRSA's earlier 2012–2025 projection cycle, which had actually projected a national RN surplus of over 340,000 by 2025 — a reminder that HRSA's own model has flipped direction across cycles and that citing a single vintage of the projection as settled fact is a sourcing error common in trade coverage. The BLS separately projects RN employment growing 5% from 2024 to 2034 (slower than nurse practitioner growth of 40% over the same period) with about 189,100 average annual openings — a flow figure describing job openings, not a shortage.
The pipeline's most visible current friction point is licensure exam throughput, not the classroom seat count alone. NCSBN's own 2025 preliminary data show the overall NCLEX-RN pass rate (all candidate types combined) fell to 69.1% in 2025, down from 73.3% in 2024 and roughly matching 69.7% in 2023 — the first year-over-year decline since the Next Generation NCLEX redesign took effect in April 2023. Critically, this aggregate decline is not evenly distributed: Kaplan's summary of NCSBN data through November 2025 put first-time U.S.-educated candidates at 87.1% passing, while first-time internationally educated candidates passed at only 47%, and repeat internationally educated candidates at 30.3% — a roughly 40-point gap that several outlets attribute in part to a rising share of internationally educated candidates in the total test-taking pool. Separately, more than 65,000 qualified applicants were turned away from nursing programs in the 2023–2024 academic year due to operational limitations (per HRSA-sourced state and industry compilations), with faculty capacity repeatedly cited as the binding constraint on program throughput — though this figure originates from advocacy-oriented industry compilations rather than a single federal audit and should be read as representative of a widely reported constraint rather than an independently audited stock count.
On the international pipeline specifically, most foreign-educated RNs enter the U.S. green card system through the EB-3 Schedule A pathway, which the Department of Labor has classified as a pre-certified shortage occupation, allowing employers to skip the standard PERM labor certification step. As of early 2026, EB-3 applicants from most countries face a backlog of approximately two years from filing before their priority date becomes current, with India facing a materially longer wait, while applicants from the Philippines — the single largest historical source country for U.S. internationally educated nurses — face a similarly structured but somewhat shorter timeline. Texas Center for Nursing Workforce Studies data on that state's IEN population found the Philippines supplied 50.2% and India 18.0% of internationally licensed original-country nurses as of 2023, with IENs estimated at between 5.6% and 16% of the total U.S. nursing workforce as of 2020 — a wide range that itself signals the absence of a single authoritative national headcount for this subgroup.
The wage record does not show the acceleration a binding national shortage would predict. BLS reported the median RN annual wage at $93,600 in May 2024, with the mean at approximately $98,430; nurse.org's analysis of BLS's subsequent May 2025 release found the median-state RN wage increase was 3.4% year-over-year — modest and roughly in line with broader wage growth, not the kind of double-digit acceleration economic theory predicts when demand structurally outstrips supply everywhere. States showing the largest wage gains (West Virginia at 7.8%, South Dakota at 6.8%, Nebraska at 6.6%) are lower-cost, historically lower-paying markets catching up, not uniform acceleration nationally. Meanwhile, 40% of RNs and 41% of LPN/LVNs told NCSBN's 2024 survey they intend to leave the profession within five years — a stated-intention flow figure, not a confirmed exit count, but one that, set against modest wage growth, is more consistent with a working-conditions and retention problem than a pure supply deficit that wages alone would resolve.
Demand Drivers (4)
Population aging and Baby Boomer retirement cohort reaching peak healthcare utilizationdemographicdurable
HRSA's Bureau of Health Workforce projections note that by 2030, all Baby Boomers will be age 65 or older, comprising 1 in 5 Americans, driving demand for long-term services and support requiring a larger nursing and direct-care workforce.
Nurse Practitioner scope expansion drawing experienced RNs into advanced practice rolesstructuraldurable
BLS projects NP employment growing 40% from 2024 to 2034, the fastest growth rate of any healthcare occupation BLS tracks, versus 5% RN growth over the same period — creating an internal pull on the experienced RN pool toward advanced practice.
Baseline hospital and long-term-care replacement demand from retirement and occupational exitstructuraldurable
BLS projects approximately 189,100 average annual RN job openings through 2034, with many openings arising from workers transferring occupations or exiting the labor force rather than net new job creation.
Post-pandemic staffing volatility and reliance on contingent/travel laborcyclicalcyclical
NCSBN's 2024 survey found the workforce has exhibited greater stability in the past two years with a return to a more typical age distribution, following pandemic-era loss of hundreds of thousands of experienced RNs and LPNs/LVNs.
The Supply Pipeline (6)
01Nursing education program admission and capacityrepresentative
Prospective nurses apply to associate's and bachelor's degree nursing programs, which are capacity-constrained by classroom seats, clinical placement slots, and faculty availability.
Constraint: More than 65,000 qualified applicants were turned away from nursing programs in the 2023-2024 academic year due to operational limitations, according to industry compilations citing HRSA and state workforce center data; faculty shortages and limited clinical placement sites are the most commonly cited causes.
02Program completion and NCLEX-RN candidacydocumented
Graduates of ACEN/CCNE-accredited nursing programs become eligible to sit for the NCLEX-RN licensure examination, administered by NCSBN.
Constraint: none evident for U.S.-educated first-time candidates specifically, who passed at 87.1% through November 2025 per Kaplan's summary of NCSBN data
03NCLEX-RN licensure examinationdocumented
Candidates must pass the Next Generation NCLEX-RN, redesigned in April 2023 to emphasize clinical judgment assessment, before obtaining an RN license in any U.S. state.
Throughput: Overall 2025 NCLEX-RN pass rate across all candidate types was 69.1%, down from 73.3% in 2024 (NCSBN preliminary data) · Constraint: First-time internationally educated candidates passed at only 47% and repeat internationally educated candidates at 30.3% through November 2025, versus 87.1% for first-time U.S.-educated candidates — a roughly 40-point gap that becomes a binding constraint specifically for the international pipeline.
04Credential verification and visa screening for internationally educated nursesdocumented
Internationally educated nurses must obtain a VisaScreen certificate (or equivalent) from CGFNS International, verifying education equivalency, licensure status, and English proficiency, before USCIS or a consular officer can approve their visa.
Constraint: none independently evidenced beyond the standard credentialing timeline; this stage is a documented statutory requirement under INA Section 212(a)(5)(C) but processing-time data was not found in the grounding record
05Employment-based immigration (EB-3 Schedule A) and green card issuancedocumented
Most internationally educated RNs enter through the EB-3 Schedule A shortage-occupation designation, which allows employers to bypass the standard PERM labor certification process.
Constraint: EB-3 applicants from most countries face an approximately two-year backlog from filing before their priority date becomes current as of early 2026; India-born applicants face a substantially longer wait tied to per-country visa caps.
06Interstate licensure and multistate practice via the Nurse Licensure Compactdocumented
Once licensed, RNs in NLC member states can obtain a multistate license allowing practice across all other compact states without separate applications.
Constraint: California, New York, and Illinois — three of the largest nurse-employing states — remain outside the compact as of mid-2026, requiring nurses relocating to or from those states to obtain separate single-state licenses regardless of compact status elsewhere.
Where the Pipeline Binds (4)
The gates that actually constrain supply — each tagged documented (evidenced for this workforce) or representative (true of the class).
NCLEX-RN pass-rate differential for internationally educated candidateslicensuredocumented
Even after clearing the visa and credentialing process, internationally educated candidates fail the NCLEX-RN at a rate roughly 40 percentage points higher than first-time U.S.-educated candidates, meaning a large share of internationally recruited nursing talent cannot convert into licensed U.S. RNs on the first attempt.
Evidence: First-time internationally educated candidates passed the NCLEX-RN at 47% versus 87.1% for first-time U.S.-educated candidates, per Kaplan's summary of NCSBN data through November 2025; repeat internationally educated candidates passed at just 30.3%.
EB-3 per-country visa cap and priority-date backlogimmigrationdocumented
Federal law caps green cards per country of origin regardless of occupation-specific shortage designations, so even Schedule A pre-certification cannot fully bypass wait times for nurses from high-demand origin countries.
Evidence: EB-3 applicants from most countries face an approximately two-year backlog as of early 2026; India-born applicants, who supplied 18.0% of Texas's internationally-licensed RN population as of 2023, face a materially longer wait tied to per-country caps.
Nursing faculty and clinical placement capacityeducation capacityrepresentative
Nursing programs cannot expand enrollment without proportional increases in faculty and clinical placement sites, both of which are reported as limiting factors independent of student demand or applicant volume.
Evidence: More than 65,000 qualified applicants were turned away from nursing programs in the 2023-2024 academic year due to operational limitations, with faculty shortages and limited clinical sites cited as the binding constraints in industry compilations of state and HRSA-sourced data.
Incomplete interstate licensure reciprocitylicensuredocumented
Nurses cannot freely relocate to or accept remote/telehealth assignments in California, New York, or Illinois using an out-of-state compact license, requiring separate state-specific licensure applications that add processing time in exactly the large-population states where demand is often highest.
Evidence: California, New York, and Illinois remain outside the Nurse Licensure Compact as of mid-2026, even as 40-41 other states have fully implemented it.
Attrition & Retention (4)
Stated intent to leave the profession within five yearspushing out
40% of RNs and 41% of LPNs/LVNs reported intent to leave the nursing profession within the next 5 years, per NCSBN's 2024 National Nursing Workforce Study — a stated-intention survey finding, not a confirmed exit count.
Post-pandemic workforce loss among experienced nursespushing out
NCSBN's 2024 study documents that the COVID-19 pandemic emergency phase produced heightened burnout, increased workloads, and the loss of hundreds of thousands of experienced RNs and LPNs/LVNs from the workforce.
Recent stabilization in age distribution and workforce compositionretaining
NCSBN's 2024 survey found the workforce has exhibited greater stability in the past two years, marked by a return to a more typical age distribution, suggesting some older nurses who departed during the pandemic re-entered the workforce.
Wage and inflation-linked pay increasesretaining
NCSBN's 2024 survey attributes notable increases in RN and LPN/LVN salaries in part to inflation and increased demand for nursing services, though the median state-level wage increase of 3.4% (BLS, May 2024 to May 2025) remained modest relative to reported turnover pressure.
The Projections Ledger (6)
The shortage and surplus claims commonly made about this workforce, checked against the record — each with its issuer named and what it actually measures.
“The U.S. faces an 8% national RN shortage by 2028, narrowing to 3% by 2038”evidenced
Issuer: HRSA National Center for Health Workforce Analysis (federal agency) — Federal statistical/planning agency; produces this projection to guide federal workforce funding and program design, with an institutional interest in demonstrating continued need for programs like Nurse Corps Scholarship and Loan Repaymentmeasures: projection
HRSA's December 2025 factsheet explicitly states an 8% shortage in 2028 narrowing to 3% (108,960 FTEs) by 2038, with the caveat that this assumes historical attrition, graduation, and labor-force-participation patterns remain constant.
confidence: High
“HRSA's national RN supply will exceed demand by over 340,000 nurses by 2025”contradicted
Issuer: HRSA (2012-2025 projection cycle, published December 2014) — Federal statistical/planning agency; earlier model vintage using a different projection methodology (IHS Inc./GlobalData) than the current HRSA modelmeasures: projection
This earlier HRSA projection for the same target year (2025) predicted a large national surplus, directly contradicting the current HRSA model's shortage projection for the following years — demonstrating that shortage projections are highly model- and vintage-dependent and should never be treated as a fixed, settled fact.
confidence: Medium
“Non-metro areas face a substantially larger RN shortage (24%) than metro areas (7%) in 2027”evidenced
Issuer: HRSA National Center for Health Workforce Analysis, as summarized by the American Organization for Nursing Leadership (AONL) — AONL is a national nursing leadership association with an institutional interest in highlighting workforce distribution challenges to support policy advocacy for its hospital and health-system-affiliated membershipmeasures: projection
HRSA's own 2027 projection shows a stark non-metro (24%) versus metro (7%) shortage split, confirming that the national aggregate figure conceals substantial geographic concentration of scarcity.
confidence: High
“More than 65,000 qualified nursing school applicants were turned away in 2023-2024 due to capacity constraints”partially evidenced
Issuer: Industry workforce compilations (e.g., IntelyCare, The World Data) citing HRSA and state nursing workforce center data — IntelyCare and similar outlets are commercial staffing/workforce-technology platforms with a direct financial interest in framing nursing capacity as constrained, since their business model depends on demand for contingent staffing solutionsmeasures: stock
The figure is repeated consistently across multiple secondary compilations attributing it to HRSA and state data, but the grounding record does not surface the original primary HRSA or AACN publication with full methodology; the figure should be treated as representative of a widely reported capacity constraint rather than an independently verified national audit count.
confidence: Medium
“40% of RNs intend to leave the nursing profession within 5 years, signaling a looming exodus”evidenced
Issuer: NCSBN and the National Forum of State Nursing Workforce Centers (2024 National Nursing Workforce Study) — NCSBN is the licensure regulatory body coalition; it has an institutional interest in accurate workforce data for regulatory planning but also in demonstrating continued relevance and scale for its biennial survey programmeasures: flow
The 40% (RN) and 41% (LPN/LVN) figures are directly reported in NCSBN's 2024 survey as stated future intentions, not confirmed departures; the same survey notes the workforce has stabilized over the prior two years despite this stated intent, indicating actual attrition has not yet tracked the stated intention level.
confidence: High
“Nurses fill a federally recognized shortage occupation (Schedule A), justifying accelerated international recruitment”partially evidenced
Issuer: U.S. Department of Labor (20 CFR §656.5, Schedule A designation) — Federal regulatory agency; the designation is a standing regulatory classification rather than a fresh empirical determination re-evaluated annually, meaning its currency as evidence of an active, present-day shortage is limitedmeasures: stock
Schedule A is a Department of Labor pre-certification that nursing occupations generally qualify for PERM-exempt sponsorship; it reflects a standing regulatory determination rather than a real-time labor-market measurement, and its persistence does not by itself confirm a current national shortage of the magnitude often implied by staffing agencies citing it.
confidence: Medium
How the Market Is Adapting (3)
Interstate Nurse Licensure Compact expansion to enable multistate practice and travel/contract staffing mobilityestablished
National Council of State Boards of Nursing (NCSBN), state legislatures and boards of nursing — 40-41 states have fully implemented the NLC as of mid-2026, with Pennsylvania and Connecticut having completed implementation in 2025 and Massachusetts pending, reducing licensure friction for nurses relocating or accepting travel assignments across most of the country.
International recruitment via EB-3 Schedule A sponsorship and specialized nurse staffing agenciesestablished
Healthcare employers and international nurse staffing/recruitment agencies — Sponsored internationally recruited RNs reportedly earn in a range that recruitment-industry sources describe as comparable to or above prevailing domestic wages by law, since sponsors must pay at least the prevailing wage for the role and location under EB-3 rules.
Legislative proposals for expanded temporary nurse visas and recapture of unused prior-year immigrant visa numbersemerging
U.S. Congress (proposed NURSE Visa Act of 2026, introduced February 2026) and immigration policy advocates — The proposed NURSE Visa Act of 2026 would create 20,000 new nonimmigrant visas annually for nurses in shortage areas, and separate advocacy exists for recapturing roughly 40,000 unused immigrant visas from prior fiscal years (approximately 25,000 for nurses, 15,000 for physicians) — as of the sourced coverage this remains a legislative proposal, not enacted law.
Watch Signals (5)
NCSBN's next NCLEX-RN annual pass-rate release (typically published in the following calendar year) showing whether the international-candidate pass-rate gap narrows or widens
A persistent or widening gap between U.S.-educated and internationally educated first-time pass rates would confirm licensure exam performance, not visa caps, as the primary binding constraint on converting international recruitment into licensed practice.
Where to watch: NCSBN's published annual NCLEX Examination Statistics report and state board of nursing pass-rate disclosures
Monthly Department of State Visa Bulletin EB-3 Final Action Date movement for Rest-of-World, Philippines, and India categories
Continued forward movement (as seen in the March 2026 bulletin) versus renewed retrogression would directly indicate whether the international nurse pipeline's visa-backlog gate is easing or tightening.
Where to watch: U.S. Department of State's monthly Visa Bulletin publication
BLS Occupational Employment and Wage Statistics annual RN wage release (next due for May 2026 reference period)
Sustained wage growth above the 3.4% median seen in the May 2025 release would indicate a tightening labor market consistent with a binding shortage; continued modest growth would reinforce the current wage-test finding of a distributional rather than aggregate shortage.
Where to watch: BLS Occupational Employment and Wage Statistics program, published annually
Congressional action on the proposed NURSE Visa Act of 2026 or immigrant visa recapture legislation
Enactment would materially expand the temporary and permanent visa pathways available to internationally trained nurses, directly loosening the immigration-related pipeline gate identified in this analysis.
Where to watch: Congress.gov legislative tracking and USCIS policy manual updates
NCSBN's next biennial National Nursing Workforce Study (expected 2026 data collection cycle)
This survey is the primary authoritative source for U.S. RN headcount, employment status, and stated attrition intentions; its next release will show whether the 40% five-year exit intention reported in 2024 has translated into actual departures.
Where to watch: NCSBN and National Forum of State Nursing Workforce Centers joint publication, typically in the Journal of Nursing Regulation
Facts & Figures (14)
The claims behind this analysis, each with its verification status — including what is contested, unverified, or could not be established.
The U.S. faces an 8% national RN shortage by 2028, narrowing to 3% by 2038
HRSA's December 2025 factsheet explicitly states an 8% shortage in 2028 narrowing to 3% (108,960 FTEs) by 2038, with the caveat that this assumes historical attrition, graduation, and labor-force-participation patterns remain constant.
✓ EVIDENCEDissued by HRSA National Center for Health Workforce Analysis (federal agency) (Federal statistical/planning agency; produces this projection to guide federal workforce funding and program design, with an institutional interest in demonstrating continued need for programs like Nurse Corps Scholarship and Loan Repayment) · measures: projection · High confidence
HRSA's national RN supply will exceed demand by over 340,000 nurses by 2025
This earlier HRSA projection for the same target year (2025) predicted a large national surplus, directly contradicting the current HRSA model's shortage projection for the following years — demonstrating that shortage projections are highly model- and vintage-dependent and should never be treated as a fixed, settled fact.
◑ CONTRADICTEDissued by HRSA (2012-2025 projection cycle, published December 2014) (Federal statistical/planning agency; earlier model vintage using a different projection methodology (IHS Inc./GlobalData) than the current HRSA model) · measures: projection · Medium confidence
Non-metro areas face a substantially larger RN shortage (24%) than metro areas (7%) in 2027
HRSA's own 2027 projection shows a stark non-metro (24%) versus metro (7%) shortage split, confirming that the national aggregate figure conceals substantial geographic concentration of scarcity.
✓ EVIDENCEDissued by HRSA National Center for Health Workforce Analysis, as summarized by the American Organization for Nursing Leadership (AONL) (AONL is a national nursing leadership association with an institutional interest in highlighting workforce distribution challenges to support policy advocacy for its hospital and health-system-affiliated membership) · measures: projection · High confidence
More than 65,000 qualified nursing school applicants were turned away in 2023-2024 due to capacity constraints
The figure is repeated consistently across multiple secondary compilations attributing it to HRSA and state data, but the grounding record does not surface the original primary HRSA or AACN publication with full methodology; the figure should be treated as representative of a widely reported capacity constraint rather than an independently verified national audit count.
○ PARTIALLY EVIDENCEDissued by Industry workforce compilations (e.g., IntelyCare, The World Data) citing HRSA and state nursing workforce center data (IntelyCare and similar outlets are commercial staffing/workforce-technology platforms with a direct financial interest in framing nursing capacity as constrained, since their business model depends on demand for contingent staffing solutions) · measures: stock · Medium confidence
40% of RNs intend to leave the nursing profession within 5 years, signaling a looming exodus
The 40% (RN) and 41% (LPN/LVN) figures are directly reported in NCSBN's 2024 survey as stated future intentions, not confirmed departures; the same survey notes the workforce has stabilized over the prior two years despite this stated intent, indicating actual attrition has not yet tracked the stated intention level.
✓ EVIDENCEDissued by NCSBN and the National Forum of State Nursing Workforce Centers (2024 National Nursing Workforce Study) (NCSBN is the licensure regulatory body coalition; it has an institutional interest in accurate workforce data for regulatory planning but also in demonstrating continued relevance and scale for its biennial survey program) · measures: flow · High confidence
Nurses fill a federally recognized shortage occupation (Schedule A), justifying accelerated international recruitment
Schedule A is a Department of Labor pre-certification that nursing occupations generally qualify for PERM-exempt sponsorship; it reflects a standing regulatory determination rather than a real-time labor-market measurement, and its persistence does not by itself confirm a current national shortage of the magnitude often implied by staffing agencies citing it.
○ PARTIALLY EVIDENCEDissued by U.S. Department of Labor (20 CFR §656.5, Schedule A designation) (Federal regulatory agency; the designation is a standing regulatory classification rather than a fresh empirical determination re-evaluated annually, meaning its currency as evidence of an active, present-day shortage is limited) · measures: stock · Medium confidence
Active U.S. RN licenses totaled 5,641,311 and active LPN/LVN licenses totaled 968,948 as of the start of 2024, per the NCSBN/National Forum of State Nursing Workforce Centers 2024 National Nursing Workforce Study.
This is the authoritative stock figure for the workforce's size and anchors every shortage percentage against a known denominator.
✓ GROUNDED
HRSA's National Center for Health Workforce Analysis (December 2025 factsheet) projects an 8% national RN shortage in 2028, narrowing to a 3% shortage (108,960 FTEs) by 2038, explicitly assuming historical attrition, graduation, and labor-force-participation patterns hold.
This is the current federal projection and it shows the shortage narrowing over time under the model's own assumptions, contradicting narratives of an ever-worsening national deficit.
✓ GROUNDED
HRSA's earlier 2012-2025 projection model, published in December 2014, had projected the national supply of RNs would exceed demand by over 340,000 by 2025.
This shows HRSA's own federal model has previously projected a surplus for the same target year that trade press now cites as a shortage year, demonstrating that shortage projections are model- and vintage-dependent, not fixed facts.
✓ GROUNDED
The overall 2025 NCLEX-RN pass rate across all candidate types was 69.1%, down from 73.3% in 2024, per preliminary NCSBN data; first-time U.S.-educated candidates passed at 87.1% while first-time internationally educated candidates passed at 47% (Kaplan's summary of NCSBN data through November 2025).
This identifies licensure examination performance, with a stark U.S.-educated versus internationally-educated pass-rate gap, as a specific binding gate in the supply pipeline rather than a uniform bottleneck.
✓ GROUNDED
The median annual RN wage was $93,600 in May 2024 (BLS Occupational Employment and Wage Statistics), and the median state-level RN wage increase from May 2024 to May 2025 was 3.4%.
This is the wage-test anchor: a 3.4% median increase is modest and does not show the kind of price acceleration a binding, economy-wide labor shortage would be expected to produce.
✓ GROUNDED
40% of RNs and 41% of LPNs/LVNs reported in NCSBN's 2024 survey that they intend to leave the nursing profession within the next 5 years.
This is a stated-intention flow figure that, combined with modest wage growth, points toward retention and working-conditions problems rather than a pure numerical supply shortfall.
✓ GROUNDED
As of early 2026, EB-3 visa applicants for nurses under the Schedule A shortage designation face a backlog of approximately two years from filing before their priority date becomes current for most countries, with India facing a substantially longer wait; internationally educated nurses from the Philippines supplied 50.2% and India 18.0% of the internationally-licensed nurse population in a 2023 Texas state study.
This identifies the visa/green-card backlog as a specific, named binding gate for the international nurse pipeline, and quantifies which source countries are most exposed to it.
✓ GROUNDED
As of mid-2026, 40-41 U.S. states have fully implemented the Nurse Licensure Compact (NLC), with several additional states enacted but not yet implemented; California, New York, and Illinois remain outside the compact.
This identifies interstate licensure reciprocity as a partial but incomplete gate, since three of the largest nurse-employing states remain outside the compact and require separate single-state licensure.
✓ GROUNDED