North Carolina
Why NC nurses are leaving big systems for smaller facilities
By Flor for Nurses ·
Nearly 10,000 of North Carolina's projected 12,459 RN vacancies by 2033 are in hospitals (NC Nursecast settings brief). The nurses filling them are not all going to the big systems. Here is why, with numbers.
You talk to the person who hires you
At a 60-bed home or a one-office agency, the director of nursing or the administrator makes the offer. No applicant tracking system, no third-party recruiter, no 50 unanswered applications.
94% of nurses we surveyed have encountered hidden pay during a job search (n=16, RI and surrounding states) (Flor nurse survey, 2026).
On Flor, every North Carolina listing shows its pay range when the employer has given it to us, and says so when it hasn't, before you apply.
The shortage is on your side
Nursing homes, extended care and assisted living face a projected LPN shortage of nearly 50% by 2033 (NC Nursecast key findings, Nov 2021 model), and an RN shortfall of nearly 31% in the same settings (NC Institute of Medicine, Nov 2021). Large metro areas face higher RN shortages than non-metro areas (NC Nursecast key findings, Nov 2021 model). That is leverage on pay, schedule and shift.
PSLF works at nonprofits of any size
A 501(c)(3) retirement community in Davidson counts the same as a 900-bed hospital. Public Service Loan Forgiveness eligibility follows the employer's tax status, not its size or your job title (studentaid.gov; the rule is 34 CFR 685.219). Check any employer by EIN on the PSLF employer search.
Pay is not automatically lower
$84,350 median annual pay for RNs in North Carolina ($40.56 an hour), 14% below the US median of $97,550 (BLS OEWS, May 2025).
The gap is between employers that show the number and employers that write “competitive pay”, not between big and small.
What you give up
- Fewer specialty units, so fewer places to move without changing employers.
- Thinner float pools, so a sick call can land on you.
- Less tuition reimbursement, especially at small for-profits.
- A ratio that depends on who runs the place.
Ask about all four at the interview.
The numbers behind this page: The North Carolina nursing shortage, in numbers.
Questions
Is there a nursing shortage in North Carolina?
Yes. NC Nursecast projects North Carolina will be short 12,459 RNs by 2033, 11% of the projected RN workforce, and 5,044 LPNs.
Do smaller facilities pay less than hospitals in NC?
Not automatically. The median annual pay for RNs in North Carolina ($40.56 an hour), 14% below the US median of $97,550 is $84,350 (BLS OEWS, May 2025). The bigger difference is whether an employer shows its pay before you apply.
Does PSLF work at a small nonprofit?
Yes. Public Service Loan Forgiveness follows the employer, not its size or your job title: a 501(c)(3) nonprofit qualifies whether it has 60 beds or 900. Check any employer by EIN on the federal PSLF employer search.
What should I ask a small facility before accepting?
Four things: which specialty units they have, who covers a sick call and how big the float pool is, what tuition reimbursement they offer, and the nurse-to-patient ratio on the unit you'd work.
Which NC cities have jobs on Flor right now?
None of our North Carolina launch cities has a live job on Flor today. They appear here as soon as one does.
