At a time when the Institute of Medicine (IOM) has called for better data collection on the nursing workforce, the federal government is discontinuing a long-running survey of registered nurses this year. The move is sparking mixed reactions among nurse researchers and other experts in health and health care.
Some nurse researchers are mourning the end of the National Sample Survey of Registered Nurses (NSSRN) because it provided the most detailed source of national data available about nursing education and practice. “We use that data all the time,” said Shirley Gibson, MSHA, RN, FACHE, president of the Virginia Nurses Association and co-leader of the Virginia Action Coalition. “I personally use it. Not having it available is extremely unfortunate.”
Sharon Adkins, MS, RN, executive director of the Tennessee Nurses Association, called the decision to end the survey, which has been fielded every four years since 1977, “a real problem” because it provided “some good data. It’s really unfortunate that they decided to defund that.”
Other nurse researchers, however, are not as concerned about the end of the survey. They note that it cannot be used to make detailed predictions about the supply of, and demand for, nurses in some states because the sample size is not large enough. In addition, findings from the survey are not available for at least two years, often rendering them somewhat outdated by the time they are released.
Nurse researchers are reassured by the fact that professional nurse organizations are stepping in to collect their own sets of data about the nursing workforce. The NSSRN met some important needs, said Linda Tieman, RN, MN, FACHE, executive director of the Washington Center for Nursing, co-lead of Washington state’s Action Coalition and president of the Forum of State Nursing Workforce Centers. “But it’s time to move on to something else.”
Accurate, consistent data about the nursing workforce is imperative to ensure that patients have access to the care they need, experts say. Without the right data, researchers will not be able to determine the number and kind of nurses needed to meet projected demands for their services—critical information at a time when demand for nurses is expected to soar due to an aging population, higher rates of chronic illness, and more people entering the health care system.
That means that “legislators are at risk of missing the information they need to make the best decisions for the allocation of nursing resources, particularly for nursing education and for research on nursing’s impact on the population and how nurses can improve access to care,” Tieman said. “We need good data to provide correct information for decision-makers who influence direction of resources.”
The sentiment echoes a report on the future of nursing released by the IOM in 2010. The report, The Future of Nursing: Leading Change, Advancing Health, is the product of a two-year study convened under the auspices of the Robert Wood Johnson Foundation (RWJF) Initiative on the Future of Nursing, at the IOM. It sounded a call for better data collection and an improved information infrastructure to ensure that nurses and other health care workers are able to meet the country’s current and future health care needs.
The IOM report identified major gaps in knowledge needed to transform the health care system, such as the number of primary care providers needed to ensure the nation can deliver accessible, quality care; the proportion of physicians, nurses and others needed to meet that need; and the education system’s capacity to train needed providers.
Researchers, the report said, need to develop and routinely update core data sets on the health care workforce supply and demand; survey the health care workforce market conditions; and study the impact of new models of care delivery on the health care workforce and on health care costs, quality and access. “Policy-makers must have reliable, sufficiently granular data on workforce supply and demand, both present and future, across the health professions” to realize the overarching goal of a transformed health care system, the report states.
State-Level Data is a Mixed Bag
Data collection efforts at the state level, meanwhile, do not yield a comprehensive picture of the nursing workforce across the nation, and the quality of state-specific data varies.
More than 30 states have formal structures in place called nursing workforce centers, many of which collect and analyze statewide nursing workforce data. Some of these centers have been hampered by budget shortfalls in the wake of the recession, according to an informal survey of workforce centers. And three centers—in Massachusetts, North Carolina and Tennessee—have had to suspend operations due to lack of funding, according to Jeannie Cimiotti, DNSc, MS, RN, executive director of the New Jersey Collaborating Center for Nursing.
“Everyone has been experiencing challenges,” said Mary Lou Brunell, MSN, RN, executive director of the Florida Center for Nursing and co-lead of the Florida Action Coalition. “We’re all looking for money.”
Also complicating the picture is the fact that some state nursing workforce centers collect their own unique sets of data, making it difficult for researchers to make state-by-state comparisons or come up with a national picture of the nursing workforce from their data alone.
Nurse leaders and government officials are stepping in to fill the void.
The Forum of State Nursing Workforce Centers adopted national nursing workforce “minimum data sets” in the areas of nursing supply, demand and education. The data sets are intended to establish standardized data to be collected by each state as part of a larger effort to effectively quantify and address the looming nurse shortage. Some centers are already collecting the minimum data sets, while others aspire to do so.
The National Council of State Boards of Nursing (NCSBN) has joined forces with the forum to utilize the forum’s data sets on the supply of the nursing workforce to more accurately measure the supply of nurses. The groups will aggregate the data from states already collecting the minimum nurse supply data set and gather data themselves in states that do not have nursing workforce centers. They also anticipate doing a “one-time” national study this year on the supply of nurses and plan to publish the results early next year.
Tieman has called it “a terrific first step toward a better national picture about both what is happening in individual states but also at larger national level.”
Both groups are working closely with the National Center for Health Workforce Analysis at the Health Resources and Services Administration (HRSA), which used the data sets created, vetted and endorsed by the forum as models for other health professions that are also being encouraged to develop national databases on practitioners in their professions. The project will give researchers a detailed “census” of the nursing and other workforces, said the center’s director, Ed Salsberg.
Researchers, Salsberg added, will not lack for adequate sources of data in the absence of the federal NSSRN. The Census Bureau, the Bureau of Labor Statistics and many nursing organizations collect important data on the nursing workforce, he said. In addition, HRSA is conducting a new national sample survey of nurse practitioners. Researchers like Cimiotti are looking forward to new information about nurse practitioners. “We have few details on these providers, who will be called upon in a big way in light of health care reform,” she said.
In addition, the federal government authorized the creation of a commission to study the health care workforce. A leading nurse researcher, Peter Buerhaus, PhD, RN, FAAN, was tapped to chair the commission when it was authorized two years ago, but it has not yet been funded.
Still, Joanne Spetz, PhD, RN, FAAN, a professor at the Phillip R. Lee Institute for Health Policy Studies at the University of California San Francisco, said it will be hard to replace the NSSRN’s rich trove of information about the nursing workforce.
Some states, she said, are reluctant to establish their own minimum data set surveys. Other data sources, such as those collected by the Census Bureau and the Bureau of Labor Statistics, do not provide as much information as the NSSRN did on certain subjects, such as unemployed nurses. “I think we’re looking at a 10-year period during which we’ll be able to say very little about the national nursing workforce,” she said.
Tieman takes a more optimistic tone. “I believe our efforts will provide us with the data we need to ensure we have an adequate supply of nurses in the coming years.”