Recommendations to strengthen North Carolina’s nursing, direct care, and mental health/substance use services workforce.
Recognizing the importance increasing its resilient caregiver workforce, the North Carolina Department of Health and Human Services and North Carolina Department of Commerce convened a Caregiving Workforce Strategic Leadership Council to generate solutions for strengthening the state’s Nursing, Mental Health/Substance Use Services, and Direct Care workforce.
Recognizing the need for long-term persistence in these efforts, the Caregiving Council identified the NC Center on the Workforce for Health as a key partner to drive implementation of Caregiving Council recommendations. The ongoing work of organizing state-level, public sector action on health workforce needs will live as an initiative of the Center with the Caregiving Council providing direction and commitment to collaborative action.
With approximately 153,000 RNs and 23,000 LPNs, North Carolina boasts a substantial nursing workforce, however it faces estimated shortages of 12,500 RNs and 5,000 LPNs by 2033. This shortage spans multiple regions and health care settings, making it imperative to address the critical need for nursing professionals.
The state’s mental health landscape underscores the urgency of focusing on mental health/substance use services. A staggering 94 out of North Carolina’s 100 counties are designated as mental health professional shortage areas. Addressing this issue is vital to ensure comprehensive mental health support for North Carolinians.
National research projects that North Carolina will have more than 186,000 direct care job openings between 2018 and 2028. Most of these openings are created by vacancies arising as current workers transition careers or exit the workforce. These projections emphasize the urgent need for the essential care provided by direct care workers.
This report encapsulates the collaborative efforts of the North Carolina Department of Health and Human Services (NCDHHS) and the North Carolina Department of Commerce in prioritizing the development of a resilient caregiver workforce to meet current and future caregiving needs in the state.
Spearheaded by a coalition of leaders from public agencies, educational institutions, and organizations, the strategic blueprint was crafted to guide the growth of a thriving caregiving workforce.
The recommendations in the report, endorsed by the Council, aim to establish a sustainable structure and governance model for the realization of the strategic blueprint.
Progress
The Caregiving Workforce Strategic Leadership Council, formed in late 2022, brings together experts to address challenges and present solutions, with a focus on the nursing, mental health/substance use service, and direct care workforces.
In 2024, the Council released Investing in North Carolina’s Caregiving Workforce: Recommendations to strengthen North Carolina’s nursing, direct care and behavioral health workforce.
Updates on Council Initiatives
In January, 2026, the Council released its CY2026 Metrics and in April 2026 released its first update on the metric progress.
In September 2025, the Council reconvened to share key updates on its progress. Updates are available in Investing in North Carolina’s Caregiving Workforce, Updates on Select Initiatives of the NC Caregiving Workforce Strategic Leadership Council.
Synthesis of Direct Care Workforce Workshops
To more fully explore the NC Caregiving Workforce Strategic Leadership Council’s direct care workforce recommendations, the NC Center on the Workforce for Health partnered with NC Institute of Medicine, NC AHEC and the NC Coalition on Aging to host a series of public workshops. Building North Carolina’s Direct Care Workforce, Report on 2025 Workshop Series summarizes the discussion and insights shared during these workshops.
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