U.S. Dept. of Health and Human Services Survey of RNs Shows Critical Shortage Driven by the Exodus of Experienced Nurses, Slowed Recruitment of New Nurses And Job Satisfaction Levels that Rank Nurses Below Nearly All Other Employee/Professional Groups

U.S. Department of Health and Human Services Secretary Tommy G. Thompson has released the final report of the 2000 National Sample Survey of Registered Nurses.

HHS' nursing survey is the most extensive and comprehensive statistical resource on registered nurses with current licenses to practice in the United States. It shows that the average age of the nation's RNs continues to increase, the rate of nurses choosing to not practice in nursing is increasing while the rate of nurses entering the profession has slowed over the past four years. It also shows that nurses have significantly lower job satisfaction than other types of employees and professionals, which the survey attributes to their working/staffing conditions.

"The results of this survey confirm what the nurses of Massachusetts have known and been communicating to the public and to policy makers for years: we are losing experienced nurses and driving out new nurses because we have failed to create working conditions, specifically, safe staffing ratios, that make the practice of nursing the rewarding and fulfilling profession it is meant to be," said Karen Higgins, President of MNA. "To fix this problem and end this crisis, we need to pass legislation that guarantees safe nurse to patient ratios that allow nurses to practice the profession they way it is supposed to be practiced."

Hundreds of nurses and senior citizens took this very message t the Massachusetts State House on March 12, as the Massachusetts Nurses Association and the Mass. Senior Action Council hosted a "Nurses Lobby Day for Safe RN Ratios and Safe Patient Care They appealed to legislators to support passage of HB 1186, a safe staffing bill that would regulate nurse to patient ratios in the Commonwealth. Similar legislation was enacted in California last month.

Below is a summary of some of the key findings of the survey. You can find the full text of the report on the web at The 2000 nursing survey report is available at http://www.bhpr.hrsa.gov/nursing


REGISTERED NURSES IN THE U.S.

In March 2000, 2,594,540 persons were estimated to have licenses to practice as RNs in this country, an increase of 62.2 percent since 1980.

The years between 1996 and 2000 marked the slowest growth in the RN population over the 20-year period between 1980 and 2000. On average, the RN population grew only about 1.3 percent each year between 1996 and 2000 compared with average annual increases of 2-3 percent in earlier years.
This slow down in growth reflects fewer new entrants to the nurse population coupled with a larger volume of losses from the nurse population than in earlier years.

During this period, the number of RNs employed in nursing grew by an average annual rate of only one percent, the lowest of any four-year interval between surveys.

The number of RNs not employed in nursing changed little from 1980 to 1992, although the total number of RNs grew substantially during those years. However, between 1992 and 2000 the number of RNs not employed in nursing increased about 28 percent.


JOB SATISFACTION FOR NURSES

For the first time in the seven national surveys of RNs conducted by the HHS Division of Nursing, the March 200 survey asked respondents working in nursing to assess their level of job satisfaction.

Across the entire sample, just over two-thirds of nurses (69.5 percent) report being satisfied in their current position. This general level of satisfaction is markedly lower than levels seen in the employed general population. Data from the General Social Survey of the National Opinion Research Center show that 85 percent of workers in general and 90 percent of
professional workers expressed satisfaction with their job.

Nurses working in nursing homes and hospitals report the lowest level of overall job satisfaction, at 65 percent and 67 percent, respectively, while 83 percent of those working in nursing education are satisfied with their job. Even at 83 percent, the job satisfaction level among those in nursing education only approaches the level of job satisfaction in the general
population.

Across employment settings, two factors appear to play powerful roles in level of job satisfaction: age and position, specifically, whether the respondent is a staff nurse. In the four settings that employ 88 percent of all nurses, and substantial number of staff nurses, we find that staff nurses in each report lower level of job satisfaction when compared to those in the same settings who are not staff nurses.

Non-staff nurses who spend more than 50 percent of their time in direct patient care report higher job satisfaction than staff nurses spending similar amounts of time with patients. This suggests that it is the structure of the job, rather than the compensation of the work, that is influencing satisfaction.

However, the higher satisfaction levels early in the careers of nurses suggests that attention to working conditions could improve job satisfaction and help retain a well-trained and experienced workforce.


AGE

In 1980, the majority (52.9 percent) of the RN population was under the age of 40, while in 2000 less than one-third (31.7 percent) were under 40. The major drop was among those under the age of 30. In 1980, 25.1 percent of RNs were under the age of 30 compared to only 9.1 percent in 2000. The average age of the RN population was 45.2 in 2000 compared to 44.3 in 1996.


GENDER

Men still comprise a very small percentage of the total RN population although their numbers have continued to grow. Of the estimated 2,694,540 RNs in the US, 146,902 or 5.4 percent are men. This is a 226 percent increase in the number of male RNs in two decades. (Each of the surveys indicates that the number of men has grown at a much faster rate than has
the total RN population.)


RACIAL/ETHNIC BACKGROUND

The number of nurses identifying their background as one or more racial minority groups or Hispanic/Latino numbered 333,368 in 2000. This is nearly triple the number of nurses estimated to be minorities in 1980. Minority RNs grew at a greater rate than non-minority RNs for all of the years from
1980-2000, except the period from 1984-988.

Most of the increase in the RN population between 1996-2000 was a result of the growth in the minority nurse population. However, because the population of non-minority nurses is 7 times larger than the population of minority nurses even small percentage changes in the non-minority nurse population involve a much larger volume of nurses.

The representation of minority nurses among the total nurse population increased from 7 percent in 1980 to 12 percent in 2000. Despite these increases, the diversity of the RN population remains far less than that of the general population where minority representation was more than 30 percent in 2000.

Growth in the number of African American/Black and Hispanic/Latino nurses in the years between 1996 and 2000 was greater than during any other four-year period between 1980 and 2000. The largest relative increase was among Hispanic/Latino nurses, with a 35.3 percent increase followed by African American/Black nurses with an increase of 23.7 percent. Hispanics, despite showing the largest relative increase between 1996 and 2000 remain the most underrepresented group of nurses when compared with the representation of Hispanics in the population.


EMPLOYMENT SETTINGS

Hospitals remain the major employer of nurses although the number of nurses employed in other sectors has increased. The number of RNs employed in hospital increased by nearly one-half million between 1980 and 2000. However, reflecting the growth in nurse employment in other sectors, the percentage of the nurse workforce employed in hospitals, after a peak of approximately 68 percent in 1984, declined steadily. In 1980 approximately 66 percent of employed RNs worked in hospitals; by 2000 the proportion had declined to 59 percent.

The data for 2000 indicate the number of nurses who provided direct care in inpatient units decreased five percent between 1996 and 2000, in contrast to the two percent increase in hospital nurses overall.

Public and community health, ambulatory care, and other non-institutional settings had the largest percentage gain in RN employment between November 1980 and March 2000. RNs employed in public health and community health settings increased by 155 percent and those employed in ambulatory care settings increased by 127 percent between 1980 and 2000.

The number of nurses employed in nursing homes and other extended are facilities, although 51 percent higher in 2000 than in 1980, decreased between 1996 and 2000 following a substantial increase between 1992 and 1996. This decline in nursing home employment occurred among nurses of all
ages except those between 45 and 54 years of age; but was especially sharp for younger nurses.


LONG-TERM TRENDS IN AVERAGE SALARIES/EARNINGS

The average actual earnings of RNs employed full-time in March 2000 was $46,782, 11.2 percent higher than in March 1996. This is similar to the 11.5 percent increase between 1992 and 1996. The eight years from 1992 to 2000 were a period of relative stability in the cost of living, where the CPI increased about 10 percent over each 4-year period. Thus, it appears that nearly all of the increases over each of these four-year periods may be due to inflationary factors.

In contrast to the large real earnings increases from 1980 to 1984 and 1988 to 1992, real earnings were relatively stagnant over the years from 1992 to 2000.


CHARACTERISTICS WITHIN EMPLOYMENT SETTING

A comparison of the number of scheduled hours per week and the actual number of hours worked showed that for the week of March 22, 2000, nurses in all employment settings tended to work more hours than they were scheduled.


DIRECT CARE NURSES ON DECLINE

Although the number of staff nurses has increased, their proportion of the total nurse workforce has declined from 67 percent in 1988 to 62 percent in 2000. In addition to the decline in the percentage of employed nurses who are staff nurses there has been a notable decline in the percentage of those with the position title of supervisor (from 5.6 percent to 3.6 percent during the period from 1988 to 2000).

The 1992 and the 1996 studies, showed a decreasing percent of nurses who spent more than half their time in direct patient care. Overall, the average percent of time RNs spent in direct patient care was about 63 percent in 2000.


NURSES EMPLOYED IN NON-NURSING OCCUPATIONS

The 135,696 RNs who were employed in non-nursing occupations in March 2000 represented a 15.2 percent increase over the 117,820 such nurses in 1996 and a 35.8 percent increase over the estimated number of 99,955 in 1992. The predominant reasons that RNs in 2000 cited for working in non-nursing positions were: the other positions' scheduled hours were more convenient, better salaries, great safety than in the health care environment, more professionally rewarding, and taking care of home and family.