by David Keepnews, JD, MPH, RN
The National Sample Survey of Registered Nurses, conducted in 1996 and released last year, contains a wealth of valuable information about the RN population in the U.S. and offers the opportunity to take a look at where the profession is going. The National Sample Survey was conducted by the Division of Nursing of the Bureau of Health Professions in the Health Resources and Services Administration (HRSA), a division of the U.S. Department of Health and Human Services. The most recent prior survey was released in 1992; surveys previously were released in 1977, 1980, 1984 and 1988. It is based on a sample of 29,766 registered nurses surveyed in order to provide estimates of the population of individuals who hold current licenses to practice as registered nurses in the U.S.
The ANA has recognized the importance of maintaining current data on the RN population as a means to identify trends within the profession in terms of education, practice, workforce changes, percentage of minorities and a range of other issues that help to provide a picture of the RN population and that help the profession draw conclusions about its capacity to meet the nation's needs for nursing care. During a time of intense change in the health care system, the need for current, reliable data is even more critical. For this reason, the ANA worked with HRSA to ensure that a 1996 sample survey was conducted and has pushed for adequate funding for HRSA to perform this and other important functions.
ANA is continuing to analyze the data in depth and to draw conclusions about its implications for nursing and for the nation. An initial reading of the survey results, however, provides a great deal of interesting and valuable information. (See below for specifics.)
What do the numbers mean?
While the string of numbers in the box below may be of some interest simply to the extent that it represents a snapshot of the RN population, it is also important to look at what the numbers mean in terms of trends, issues and implications for policy and advocacy for the profession and our patients. While a full analysis of this information is not possible in this article, a few highlights stand out:
- The nursing population is aging, and the age of new entrants to the profession is increasing. This poses real concerns as to whether there will be enough RNs to meet the nursing care needs of the nation -- as aging RNs leave the profession or retire, and as their ranks are replenished by new nurses who themselves are older, and as the aging of the population as a whole likely increases needs for care in acute, chronic, home-based and community settings.
- The percentage of minority RNs is increasing, but at a very slow rate, and the percentage of minority RNs within the RN population still lags behind the percentage of minorities within the general population.
- Most practicing RNs continue to work in hospital settings, but there is a notable shift to non-hospitals settings. This has significance for nursing practice in terms of skills and competencies that nurses will need. It also has implications for RN wages, since non-hospital settings tend to pay less, and may have an impact on collective bargaining as more RNs practice in settings with smaller numbers of RNs.
- Reorganization and cost-cutting moves are, at least in part, fueling the migration of RNs from one job to another.
Of course, much more analysis of these number needs to be done. It also should be understood that there is information that the survey does not provide, such as trends in staffing in hospitals and other practice settings, the impact on safety and quality and related questions. But the survey does include a tremendous amount of information about the nursing profession -- information that will continue to be examined, analyzed and discussed for some time to come.
David Keepnews, JD, MPH, RN is an independent consultant in health policy based in Boston.
Who Is Today's RN?
The following statistics were revealed in the Division of Nursing's most recent sample survey of registered nurses.
- In 1996, there were 2,558,873 RNs (defined as individuals holding a current RN license) in the United States ¥ up from 2,239,816 in 1992.
- More than 17 percent of RNs are not working in nursing -- the same percentage as in 1992. In 1988, 20 percent of RNs were not employed in nursing.
- Between 1995 and 1996, 16 percent of RNs who were employed changed employers and/or positions - 27 percent of these because of reorganization or "cost control" in their previous work settings. Twenty-one percent of licensed RNs were not employed in nursing in one or both years, and 63 percent were employed in the same position in both years.
- Approximately 89.7 percent of the RN population is white, compared to 90.1 percent of the RN population in 1992 -- and compared to 72.3 percent of the population as a whole.
- The proportion of male RNs has increased -- from 4 percent in 1992 to 4.9 percent in 1996.
- The RN population is aging. The average age of all RNs in 1996 was 44.3 years. The average age for RNs employed in nursing was 42.3 years. More than 62 percent of RNs are 40 or older. The largest age group of RNs, at 18.2 percent, are between 40 and 44. Only 20.9 percent of RNs are under age 35. In addition, the ages of the new entrants into the profession are increasing. Among those who graduated in 1991 and after, the average age at graduation is 33.5. Among those who graduated in 1980 or earlier, it was 26.9.
- Approximately 60 percent of RNs are employed in hospitals (compared to 66.5 in 1992); 8.1 percent in nursing homes and extended care facilities (7 percent in 1992); 1 percent in occupational health (no change); and 8.5 percent in ambulatory care (compared to 7.8 percent in 1992). About 13 percent work in "community health/public health" (as compared to 9.7 percent in 1992), which includes non-hospital based home health agencies, where 7.3 percent of RNs work (4.9 percent in 1992); including RNs in hospital-based home health, a total of about 8.1 percent of RNs worked in home health as of 1996 (5.3 percent in 1992).
- Of RNs employed in nursing, 71.4 percent work full-time and 28.6 percent work part-time. The percentage of part-time RNs has gone down slightly since 1992, from 25.7 percent of all RNs to 23.7 percent.
- More than 41 percent of RNs held a BSN degree or higher. Approximately 32 percent of RNs in staff nurse or related positions held a BSN degree as their highest nursing-related degree; 2.5 percent a master's degree; and less than 0.1 percent held a doctoral degree. More than 25 percent held a diploma as their highest nursing-related degree; and 40 percent an associate degree.
- RNs spent approximately 59.8 percent of their time providing direct patient care.
- The average annual salary for RNs was $42,071. For staff nurses, it was $38,567; for hospital staff nurses, $40,097. Nurse practitioners and nurse midwives averaged $54,192; nursing administrators, $52,213; certified registered nurse anesthetists, $86,319.
- More than 15 percent of employed RNs worked a second job.
- There were 63,191 RNs prepared as nurse practitioners in 1996, 53,799 clinical nurse specialists, and 7,802 prepared both as NPs and CNSs. There were 6,534 nurse-midwives and 30,386 nurse anesthetists.