RN Supply: New Survey Offers Snapshot of the Nursing Workforce

By Megan M. Krischke, contributor

July 22, 2013 - Are there enough nurses now, and will be there enough in the future, to ensure the nation’s healthcare needs are met? For many years, this question was answered in part by the National Sample Survey of Registered Nurses, which the Health Resources and Services Administration (HRSA) conducted every four years. But that survey was discontinued after 2008, leaving a gap of vital information that many health officials and employers used for forecasting and planning.

In order to fill the void and gather critical information about the nursing workforce, the National Council of State Boards of Nursing (NCSBN) and The National Forum of State Nursing Workforce Centers (The Forum) worked together to develop the National Nursing Workforce Survey of Registered Nurses. The survey took place between January and March 2013, and the results were unveiled in the July issue of the Journal of Nursing Regulation (JNR).

Jill Budden, NCSBN: Only a small percentage of RNs report difficulty finding a job.
Jill Budden, PhD, research associate at NCSBN, said that fewer than 2% of RNs in their nursing workforce survey reported difficulty finding a job.

“We used the minimum data set (MDS) questions which are basic demographic questions important for understanding the nursing workforce. We wanted our survey to be as short as possible, but still collect the most important information,” explained Jill Budden, PhD, research associate at NCSBN. “The HRSA survey contained the MDS questions, however it also contained many additional questions. Because of this, grouping of the data could not be performed in a similar manner in some instances.”

“The survey provided us with data with which to analyze the workforce and particular aspects of the workforce such as education levels, where nurses are working, and the diversity of the workforce,” stated Maryann Alexander, PhD, RN, FAAN, chief officer of nursing regulation at NCSBN.

“National demographic data is helpful for state workforce centers so they can see how their state level workforce compares with the national averages,” added Patricia Moulton, PhD, executive director of the North Dakota Center for Nursing and research committee chair for the National Forum of State Nursing Workforce Centers. “The idea was to provide a lot of the same analysis as the HRSA survey, mainly so that people could use the information to plan, forecast, and to have a better understanding of their local workforce.”

Moulton pointed out that the survey did not turn up any big surprises, but there were some encouraging advances in the areas of education, men joining the profession and in racial diversity.

Maryann Alexander: the percentage of RNs working in the field is down slightly
Maryann Alexander, PhD, RN, FAAN, says the percentage of nurses working in the nursing field is down some since 2008.

“We are always interested in how many nurses are actually employed in nursing,” noted Alexander. “Eighty-two percent responded that they were actively employed in nursing. That was down just a bit from the 2008 data.”

“We also found that 47 percent of those 65 and older are still employed in some capacity in nursing, which is a pretty large number for being over the retirement age,” added Budden. “Of the 7 percent who were unemployed, 27 percent of those were unemployed and having difficulty finding a nursing position Overall, it is a very small percentage--approximately 2 percent of those surveyed. I would say that the 7 percent unemployment was reflective of the U.S. unemployment rate at the time the data was gathered.”

The study revealed an increase in the number of men entering the profession: among the nurses surveyed who obtained their licenses before 2000, only 5 percent were male; among the cohort who obtained their licenses between 2010 and 2013, however, the percentage of males jumped to 11 percent.

While this survey also seemed to show that the average age of registered nurses is rising, now reported at 50 years of age, some have questioned whether or not that is the case. The last HRSA survey based on 2008 data showed the average age of nurses at 46 years old. However, data collected by HRSA from the 2010 census showed the average age of a nurse at 44.6 years. 

Educational indicators included both good and bad trends.

“Our data showed that 61 percent of respondents had obtained a bachelor’s degree or higher, compared with 50 percent in the HRSA survey.  On a concerning note, 72 percent of full-time nursing faculty were age 50 or older,” Moulton added, indicating a faculty shortage could be looming as these educators near retirement.

Even with the growing number of nurses obtaining a bachelor’s of science in nursing (BSN) degree, Peter McMenamin, PhD, health economist for the American Nurses Association (ANA), thinks it is unlikely that the profession will reach the goal set forth by the Institute of Medicine that 80 percent of nurses should have a BSN or higher by 2020.

Peter McMenamin: Shorter shifts could keep mature RNs in nursing workforce longer
Peter McMenamin, PhD, says that healthcare employers should consider shorter shifts for mature nurses to keep them in the workforce longer.

“It is a good notional goal, but I would be surprised if that happens,” he remarked. “However, the market currently is putting some pressure on nurses in that direction as hospitals are choosing RNs who have BSN degrees over those who don’t.”

When it comes to the supply of nurses, there are several factors at play.  One piece of good news is that the number of nurses taking the NCLEX-RN licensing exam more than doubled, from about 70,000 in 2000 to 149,000 in 2012. 

“On the other hand,” said McMenamin, “we are likely to see a tsunami of nurse retirements, roughly 1 million, in the next five to 10 years as the economy recovers and nurses who have been delaying their retirement delay no longer.”

McMenamin urges hospital leaders seriously consider how to enable to their mature nurses to stay in the workforce.  He offers that one solution could be offering shorter shifts.  Additionally, he suggests that these mature nurses could also be part of filling the great need for nursing faculty.

The AACN reports that 75,587 qualified applicants were not accepted into undergraduate and graduate nursing programs in the 2011-2012 academic year due to faculty shortages.

“In this case, the market is not helping the faculty shortage because APRNs can make $20,000-$30,000 more a year by practicing rather than teaching,” McMeamin explained. “Nursing schools may need to think about using guest lecturers and making it possible for experienced nurses to lead classes without giving up a lucrative practice.”

Moulten pointed out that this survey only provides a snapshot of the supply side of the nursing workforce: how many and what kinds of nurses are currently available. To have the most complete sense of the workforce, leaders need to factor in demand issues--such as how many hospitals currently have vacancies, how many nurses are nearing retirement, and how more patients qualifying for health coverage through health reform will impact demand in the coming months. 

Educational issues also need to be considered, including how many nursing students are currently in programs, how many are graduating and how many faculty members will be there to help educate future students.

“We didn’t see any dramatic shifts over a four year period and that is probably good,” reflected Alexander. “Additionally, we are seeing some steady increases in the areas we want, so things are headed in positive directions.”

For more information:
Highlights of National Workforce Survey of Registered Nurses,” Journal of Nursing Regulation. The full survey results are also available for purchase.

Related articles:
HRSA Reports on Nursing Supply and Education Trends
Supply of Nurses in the Workforce Expected to Vary by Region

© 2013. AMN Healthcare, Inc. All Rights Reserved.