High tuition costs and low student retention rates are creating some of the toughest environments for future nurses.
Nursa has identified the U.S. states where becoming a nurse may be most challenging, based on two key factors: the average cost of tuition and student retention rates at nursing schools. Across all 50 states analyzed, the average in-state tuition was $13,432 per year, while the average student retention rate was 75.2%. States with higher tuition costs and lower retention rates were considered to present greater challenges for aspiring nurses.
With demand for nurses continuing to grow nationwide, the findings highlight the financial and academic barriers many students face before entering the workforce.
To identify where aspiring nurses face the greatest obstacles, Nursa analyzed state-level nursing education data, focusing on average tuition costs and student retention rates as indicators of financial and academic barriers.
The states where aspiring nurses face the greatest financial and academic barriers
Oregon ranks as the most challenging state for aspiring nurses
Oregon emerged as the state where future nurses may face the greatest barriers, combining one of the highest average tuition costs in the country with the lowest average student retention rate.
Nursing students in Oregon face an average in-state tuition cost of $18,990, while schools report an average retention rate of just 60.4%, the lowest figure recorded in the study.
The findings suggest that students in Oregon may face both significant financial pressure and a greater risk of leaving their studies before completion compared with their peers in many other states.
Hawaii and Maryland also present significant challenges
Hawaii ranks second, with average in-state tuition costs of $18,639 and an average retention rate of 65.6%.
Maryland follows closely behind, with average tuition costs exceeding $20,000 per year and a retention rate of 71.9%.
In both states, above-average education costs combined with comparatively lower retention outcomes may create additional challenges for students pursuing a nursing degree.
High tuition remains a major barrier
Several states reported particularly high average tuition costs for nursing education.
The states with the highest average in-state tuition were:
- New York ($23,676.60)
- Georgia ($23,668.00)
- North Carolina ($23,275.20)
- Illinois ($21,485.80)
- Connecticut ($21,354.57)
While retention outcomes vary across these states, the financial commitment required to pursue a nursing education remains substantial.
Student retention remains a key workforce challenge
The analysis also highlighted several states with notably low retention rates.
The states with the lowest average retention rates were:
- Oregon (60.4%)
- New Mexico (62.3%)
- Colorado (63.6%)
- Idaho (63.8%)
- Maine (64.6%)
Retention rates can be influenced by a range of factors, including academic demands, financial pressures, student support services, and personal circumstances.
Lower retention rates may also have implications for the future nursing workforce, as fewer students successfully progress through nursing education programs.
Miranda Belcher, a Registered Nurse and spokesperson for Nursa shares:
"Nurses are essential to every healthcare system, but the path to becoming one can look very different depending on where a student lives. Our findings show that in some states, students are navigating both steep tuition costs and lower retention outcomes at the same time. Understanding these barriers is an important step toward building a stronger and more accessible nursing workforce."
As healthcare employers across the country continue to face staffing shortages, improving access to nursing education remains a critical issue. The data highlights where students may need additional financial, academic, and institutional support to help strengthen the future nursing pipeline.
Methodology
Nursa analyzed nursing education data across all 50 U.S. states using information from NurseJournal's state nursing school directories and rankings (accessed May 2026). View the full dataset here.
State-level averages were calculated from available school data, including tuition costs, retention rates, enrollment figures, acceptance rates, and institution type.
To identify the states where becoming a nurse may be most challenging, the analysis focused on two key factors: average in-state tuition costs and average student retention rates.
States with higher tuition costs and lower retention rates were considered to present greater financial and educational challenges for aspiring nurses.
Source:
- NurseJournal state nursing school directories and rankings, May 2026.
