Over the last few years, the nursing workforce in the United States has grown larger, more diverse, better educated, a little older and a bit better paid, according to newly released data from the federal government.
The quadrennial report, The Registered Nurse Population: Initial Findings from the 2008 National Sample Survey of Registered Nurses, by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services draws on a survey of more than 33,000 registered nurses across the nation. The survey includes questions on nurses’ educational background, practice specialty areas, employment settings, position levels, job satisfaction and salaries, geographic distribution, and personal demographics such as gender, racial/ethnic background, age and family status. HRSA released its preliminary report on the data in March 2010, and plans a final report for this summer.
The Demographics of Nursing
According to the report, the nation has more licensed registered nurses today than ever before, with an estimated 3.06 million. That figure represents a 5.3-percent increase since HRSA’s last survey in 2004, outpacing U.S. population growth of 3.8 percent during the same period. As a result, the ratio of nurses to people went up—from 825 nurses per 100,000 people in 2004 to 854 nurses per 100,000 people in 2008. That ratio varies from state to state. Utah has the fewest registered nurses per person with 598 per 100,000 people, while the District of Columbia has the most, with 1,868 per 100,000. The great majority of those nurses, 84.4 percent, are still in practice, according to the data and most, 63.2 percent, are working full-time—up from 58.4 percent working full-time four years ago.
The nation’s nurses are also a more diverse group than they were in 2004, although white women are still over-represented by comparison to the general population. White, non-Hispanics (65.6 percent of the U.S. population) are 83.2 percent of licensed registered nurses. That represents a noticeable drop since 2004, when 87.5 percent of registered nurses were white. Asian, Native Hawaiian and Pacific Islanders account for the next largest demographic group at 5.8 percent (while 4.5 percent of the U.S. population). Non-Hispanic Blacks are 5.4 percent of registered nurses (while 12.2 percent of the U.S. population), and Hispanics/Latinos (of any race) are 3.6 percent of registered nurses (while 15.4 percent of the U.S. population).
Women continue to outnumber men in the profession, by more than 15 to 1 in 2008. But the trend line is beginning to change: Among those who became registered nurses after 1990, the ratio is just 10 to 1.
Better Educated Nurses
Nurses today are better educated than they were a few years ago, continuing a long-term trend. According to the HRSA data, the percentage of registered nurses whose highest degree is a nursing diploma has declined over the last 30 years from 54.7 percent in 1980 to 13.9 percent in 2008. Meanwhile, at the other end of the educational spectrum, the percentage of nurses with master’s or doctorates has increased from 5.2 percent in 1980 to 13.2 percent in 2008. But the bigger sign of increased educational attainment is on display in the two groups in between. The share of nurses with bachelor’s degrees has increased from 22.3 percent in 1980 to 36.8 percent in 2008, and the share of nurses with associate degrees has increased from 17.9 percent to 36.1 percent.
“The gains in numbers, diversity and educational attainment are no accident,” says the Robert Wood Johnson Foundation’s senior adviser for nursing, Sue Hassmiller, Ph.D., R.N., F.A.A.N. “That progress is the result of hard work over the years by our grantees and others, who long ago recognized that the future of health care in the United States depended on building a nursing work force that was large enough to meet the sharp increases in demand for care that are coming, and who had the training to take on a larger role in patient care. We also need a nursing workforce that is more diverse than in the past, so that nurses will be able to communicate with patients, understand their cultural background, and provide care that truly meets their needs. We’re pleased by the obvious signs of progress, but also recognize that we’ve got an awful lot of work ahead.”
An Aging Nursing Workforce
Over the long term, the average age of registered nurses has grown steadily higher, indicating that a coming wave of retirements will create a massive shortfall of nurses just as aging baby boomers drive a marked increase in demand for health care services. The HRSA data holds a limited bit of good news on this front: The average age of registered nurses held relatively steady over the last four years, increasing from 46.8 years to 47.0 years. While still an increase, it was a small one. By contrast, in 2000, the average age was 45.2 years, and in 1996, it was 44.3 years.
Examined through a slightly different lens, however, the data about nurses’ age do nothing to diminish the need for an increase in the size of the nursing workforce. According to the study, nearly 45 percent of registered nurses were 50 years of age or older in 2008. That represents an increase in the percentage of nurses in that age group by comparison to previous years, effectively validating concerns about a long-term nursing shortage.
Nurses’ Pay Inches Up
HRSA also found that nurses’ earning power has increased. Since 2004, average annual earnings for full-time registered nurses increased by 15.9 percent, to $66,973. Adjusted for inflation, that represents a 1.7 percent increase in actual buying power—modest but an increase nonetheless.
· Read news coverage of the report in HealthLeadersMedia.