Your hospital is short of nurses. The licence roster is not.

If you run nurse hiring for a hospital or a medical group, two things are true at once. Your vacancy rate is real, your time to fill runs to months, and the agency invoices keep coming. And the state you hire in has far more licensed nurses than working ones. Neither fact cancels the other. The gap between them is where the next hire is.

The short version

The nurses your hospital needs are licensed in your state, and most of them are employed somewhere else. A job board reaches the ones who are looking this month. An agency rents you the ones it has already found. The state board's roster is the only public list of every licensed nurse in the state, and a direct, verifiable message from the employer reaches nurses a posting never will. Kandidate does both for nurses: it sources from the roster and writes to each nurse from your domain. That does not make every licensed nurse recruitable. It makes the conversation possible with the ones a posting cannot start it with.

Problem one: 78 days and an 8.6% vacancy

The 2026 NSI National Health Care Retention and RN Staffing Report, a survey of 527 acute-care hospitals, puts staff RN turnover at 17.6% for 2025 and the vacancy rate at 8.6%, with a third of hospitals at ten percent or more. It took 78 days to recruit an experienced RN. Each bedside RN replaced cost $60,090. After raising pay scales and sign-on bonuses, the average hospital still carried 43 unfilled RN FTEs.

What the roster shows. Every state board of nursing keeps a register of active licences, and fifteen publish it as a file. Kandidate loads those files, matches them to people on name, and places each nurse in the state they live in, so a traveller holding three of our licences counts once. The match is an estimate: it can merge two nurses with the same name or split one recorded two ways. On that basis the roster holds 2,005,015 licensed people against 1,368,060 employed RNs in the same states. Nationally, NCSBN counts 5.64M active RN licences and BLS counts 3.40M employed RNs. Those two count different things, licences and jobs, which is why a roster has to be matched to people before it says anything.

The pattern holds in each of the eight boards where we measured the raw file. Before matching, the ratio runs from 1.40 in Delaware to 1.84 in Connecticut.

What the gap is made of. An active licence is not an idle nurse, and the 636,955 difference is not a reserve waiting to be hired. NCSBN's 2024 survey finds 87.7% of licensed RNs employed in nursing, so roughly one in eight is not, and California's board survey puts the state's non-working resident RNs at about 60,000, half of them past 65. The remainder is some mix of nurses licensed where they do not live and nurses who moved into management, education, insurance or informatics and kept the licence; the rosters do not say how much of each. What is left after all of that is still the largest group on the file: the working nurse in your state who is not applying anywhere. A posting cannot reach them. A message can.

What Kandidate does about it. Sourcing starts from the state roster, not from applicants. Give us a role and a site and the first thing you see is how many licensed nurses sit inside a commutable radius, then how many of those fit the specialty and experience the role needs, before anyone decides the requisition is hard. Check your own state and role with a market probe.

Problem two: the nurses who left the floor

NCSBN's workforce survey counts 138,000 nurses gone since 2022 and almost 40% saying they intend to leave by 2029. National Nurses United subtracts BLS employment from NCSBN licences, gets 1.15 million licensed RNs not working as nurses, and argues the answer is retention rather than recruitment. They are right about retention. They are also describing a pool few hospitals recruit from.

What the roster shows. A nurse who leaves a hospital job for a clinic, a school, a payer or a travel contract keeps the licence, so the roster still has their name and their state. Most of the ones who retire keep it for a while too. The ones who moved to a different hospital are simply employed elsewhere. All of them are on the file, and none of them are on your careers page. Finding them does not mean they will come back. It means the conversation can start, which a posting cannot do.

What Kandidate does about it. We reach them directly. Starting from the licence record, we resolve a direct channel to the nurse, and the message goes from the hospital's own domain, naming the unit, the shift and the site, so the nurse can verify the role before deciding whether to answer. When one of our clients ran this for five clinical roles, 291 clinicians contacted, none of them staff nurses, one in ten replied within nine days, against a healthcare-wide recruiting reply rate under three percent. The per-role figures are in why clinicians don't reply to recruiting emails; the nurse-specific number is the one we are measuring next.

Problem three: the agency invoice

Travel nurses are employed, so they sit inside the working count, not the gap. The Bureau of Labor Statistics counted 130,890 RNs employed by employment-services firms in May 2023, the closest public count of agency and travel nurses: nurses on a staffing firm's payroll rather than the hospital's.

What the roster shows. A second, third and fourth state licence is the strongest public sign of a travel nurse, though not proof of one. Across the fifteen rosters, 3,271 name-matched nurses hold active licences in three or more of our states with at least one issued in the last two years; on a looser name match it is 11,465. Counting licences rather than nurses, the number issued each year to names already holding two elsewhere roughly doubled between 2019 and 2025, from about 3,700 to 6,900. And the home states are not where the rosters are.

Then there is the larger, cleaner pool. The Nurse Licensure Compact covers 43 jurisdictions, and a multistate licence lets a nurse work in any of them without a second licence, which also means they never appear on the destination board. Three of our boards publish the flag, and between them they hold 103,747 nurses with a declared multistate licence: nurses who would not need a new licence to take a role across a state line.

What Kandidate does about it. The multistate flag is a filter. For a role that can take a relocation, the search starts with nurses who would not have to wait for a licence, and the message goes to them directly. Eligibility, fit and interest still have to be checked one nurse at a time; what changes is that the list comes from the state, and you pay for the placement, not the list.

Problem four: your tools cannot see nurses

Sourcing tools that start from the National Provider Identifier registry do well on physicians, therapists and nurse practitioners, because those clinicians bill and so hold an NPI. A staff nurse works under the hospital's billing number and rarely needs one. The registry holds 246,011 RN records against 3,400,950 employed RNs, about seven for every hundred. A tool that starts there cannot see most nurses, which is why a search that finds a physiatrist in a week returns almost nothing for an ICU nurse.

What Kandidate does about it. Our nurse index is built on the licence, not the NPI, so an ICU nurse in Ohio is searchable the way a physiatrist in California is, and the same direct channel applies.

Three moves this quarter

Count the licensed pool inside a commutable radius before calling the requisition hard; a market probe does it for one role and one site. Write to that pool directly, from the hospital's own domain, naming the unit, the shift and the site. And for any role that can take a relocation, start with the multistate licensees, who would not have to wait for a licence.

Send us one open RN role

Send us one open RN role and the site address. Within 48 hours you get the licensed nurses within a commutable radius who fit it, up to 50, each with a direct channel to reach them. It is a free sourcing sample, three roles a week, no contract, and it is how the managed service starts.