2011 Indiana Registered Nurse Licensure Survey Report

Transcription

1 2011 Indiana Registered Nurse Licensure Survey Report Produced by: The Indiana Center for Health Workforce Studies Bowen Research Center, Department of Family Medicine Indiana University School of Medicine In collaboration with the: Indiana Area Health Education Centers Program February 2013 Authors: Zachary T. Sheff, MPH Komal Kochhar, MBBS, MHA Terrell W. Zollinger, DrPH Stands for Jobs INDIANA AHEC NETWORK

2 2011 Indiana Registered Nurse Licensure Survey Report Produced by: The Indiana Center for Health Workforce Studies Bowen Research Center, Department of Family Medicine Indiana University School of Medicine In collaboration with the Indiana Area Health Education Centers Program February 2013 Zachary T. Sheff, MPH Komal Kochhar, MBBS, MHA Terrell W. Zollinger, DrPH

3 Acknowledgements We would like to extend our gratitude to all dedicated individuals who provided valuable and timely assistance to us during this project. Preparing this report required the assistance, cooperation, and effort of many individuals and agency staff. The survey data and additional data elements were provided by the Indiana Professional Licensing Agency through the Indiana State Department of Health. An advisory committee provided direction and insights to the data analysis and report generation: Biff Williams, PhD., Professor and Dean, Indiana State University, College of Nursing, Health, and Human Services Elizabeth Kiefner Crawford, Director, Nurse Licensing Board, Indiana Professional Licensing Agency Jennifer Bruner, Staff Attorney, Indiana State Department of Health Kimberly Harper, MS, RN, Executive Director, Indiana Center for Nursing Marcia Plant Jackson, FNP, Director, Health Policy, Coalition of Advanced Practice Nurses of Indiana The cooperation and support of the Indiana State Department of Health was instrumental in obtaining the survey data and interpreting it. The authors are grateful for the financial support received from the Indiana Area Health Education Centers Program to produce this report. Zachary T. Sheff, MPH Komal Kochhar, MBBS, MHA Terrell W. Zollinger, DrPH

4 Table of Contents Executive Summary... 1 Introduction... 1 Responses to the 2011 Indiana Registered Nurse Survey... 1 Nursing Faculty... 1 Advanced Practice Nurses... 2 Principal Practice Location... 2 Trends in the Registered Nurse Workforce... 2 Conclusions... 3 Chapter 1: Introduction... 4 Methods... 4 Inclusion and Exclusion Criteria... 5 Weighting for County Level Data... 7 Calculation of FTE for Maps... 8 Response Rate Data Analysis Limitations of the Survey Chapter 2: Responses to the 2011 Indiana Registered Nurse Survey Demographic Composition Education Characteristics Professional Characteristics Chapter 3: Nursing Faculty Demographic Composition Educational Characteristics... 33

5 Chapter 4: Advanced Practice Nurses Demographic Composition Educational Characteristics Primary vs. Non-Primary Care Nurse Practitioners Chapter 5: Principal Practice Location Chapter 6: Trends in the Registered Nurse Workforce Chapter 7: Conclusions Appendix 1: 2011 Indiana Registered Nurse Survey Instrument... 56

6 Executive Summary Introduction A total of 98,235 registered nurse licenses were issued or renewed in The survey on which this report is based was offered to licensees during the licensure process and received a response rate of 90.7 percent. Of the 80,429 registered nurses who responded to the survey 54,588 were actively practicing in Indiana and 53,591 met the criteria for inclusion in analysis. Responses to the 2011 Indiana Registered Nurse Survey The majority of respondents were white (94.0%), non-hispanic (98.2%) females (94.6%) between the ages of 45 and 54 (27.1%). Nearly one-half (45.1%) of respondents held an Associate degree as their highest credential in nursing. Another 38.7 percent held a Bachelor s degree. Less than one-tenth (8.4%) of the registered nurse workforce completed training as an advanced practice nurse. The most common work setting among respondents was as a staff nurse or direct care nurse (54.6%) at a non-federal, short-term, non-psychiatric hospital (41.4%) in an urban county (85.9%). The most common medical specialties in which respondents practiced were surgery (10.7%) and critical care (8.2%). Nursing Faculty There were 971 respondents who indicated that they currently worked as a faculty member of a nurse training program. Nursing faculty were demographically similar to the rest of the registered nurse workforce, but differed in their educational background. Only 8.8 percent of the entire registered nurse workforce held a Master s degree and less than one percent (0.5%) of the workforce held a doctorate. Over one-half (52.0%) of nursing faculty held a Master s degree and 14.7 percent held a doctorate. 1 P age

7 Advanced Practice Nurses There were 3,222 respondents currently working as an advanced practice nurse. Advanced practice nurses include clinical nurse specialists, nurse anesthetists, nurse practitioners, and nurse midwives. Nurse practitioners accounted for two-thirds (68.1%) of advanced practice nurses and were evenly split between primary care and non-primary care roles. Advanced practice nurses were demographically similar to the overall registered nurse population (except nurse anesthetists who were evenly split between males and females). Advanced practice nurses had a much higher proportion of respondents who held a Master s or doctorate degree (76.9% compared to 8.8% of all registered nurses). Non-primary care nurse practitioners were more likely to work full-time compared to primary care nurse practitioners (84.0% vs. 73.9%, respectively). Principal Practice Location As expected, counties with larger populations had the highest number of registered nurse FTEs and advanced practice nurse FTEs. Urban counties tended to have higher numbers of registered nurse FTEs. The proportion of registered nurses in each county holding a Bachelor s degree or higher ranged from 18.7% (Sullivan County) to 62.3% (Marion County). Trends in the Registered Nurse Workforce The number of registered nurses who renewed their license in Indiana as well as the number of registered nurses who are actively practicing in Indiana has been increasing since 1997 and peaked in After a decline in 2009 it appears to be rising again in Since 1997 the majority of registered nurses were between the ages of 31 and 44. The most commonly held degree in each year since 1997 has been an Associate degree in nursing followed closely by Bachelor s degrees. The proportion of the registered nurse workforce holding a Master s degree has doubled over this time period. 2 P age

8 Conclusions The Indiana registered nurse workforce is primarily composed of white, non-hispanic females between the ages of 45 and 54. Associate and Bachelor s degrees were the most commonly held credentials, but the proportion of respondents holding a Master s degree has doubled since Nursing faculty and advanced practice nurses were demographically identical to the overall registered nurse population, but were more likely to hold a Master s or doctorate degree. The majority of respondents worked as staff or direct care nurses in nonfederal, short-term, non-psychiatric hospitals in urban counties. 3 P age

9 Chapter 1: Introduction Having an accurate understanding of the personal and professional characteristics of registered nurses licensed in Indiana is critical to develop and manage effective programs to recruit and retain registered nurses where they are most needed in the State. The purpose of this report is to provide those data. The findings from this report may be used to identify registered nurse shortage areas, develop more recruitment and retention strategies, and plan additional locations for training registered nurses within the state. The Indiana State Department of Health (ISDH) and the Indiana Professional Licensing Agency (IPLA) collaborated in implementing the Indiana Registered Nurse Licensure Surveys. In 1997 and 2001, licenses were renewed by mail and an accompanying paper questionnaire was included. Beginning in 2003, IPLA began electronic license renewals. Since then, all Indiana registered nurses who renewed their license electronically were asked to complete an electronic survey instrument. The 2011 Indiana Registered Nurse Licensure Survey instrument included items to address current work status, principal practice location, principal position, activities performed in the principal practice location, practice setting, average hours worked, current education level, and plans for obtaining future degrees. A copy of the Indiana Registered Nurse Licensure Survey instrument is included in Appendix 1. This report summarizes the responses to the 2011 Indiana Registered Nurse Licensure Survey and compares the results from the current survey to the results of the prior registered nurse surveys (1997, 2001, 2005, 2007, and 2009). Due to the low response rate of 66.3 percent, the 2003 survey results are generally not reported because of the possibility of a nonresponse bias. Methods The data used to generate this report were extracted from the 2011 Indiana Registered Nurse Licensure Survey dataset collected by the ISDH and the registered nurse license dataset maintained by the IPLA. The 2011 Indiana Registered Nurse Licensure Survey instrument 4 P age

10 included questions on current work status, principle practice location, activities performed in the principle practice location, position title, specialty, principal practice setting, average hours worked, and demographic information. The data provided by the IPLA included date of birth for all licensed registered nurses who were practicing in Indiana at the time of the survey. The datasets were merged in order to match the respondents approximate age to his or her survey responses. The datasets were merged by matching the license number of each physician using SAS 9.3 and age was calculated using September 30, 2011 as a reference point since surveys were completed from August 31, 2011 through October 31, The merged dataset was then used to filter the records to include only the respondents who met the inclusion criteria. Inclusion and Exclusion Criteria The merged dataset was filtered initially to include only registered nurses with an active or probationary license and who reported an Indiana address for their primary practice location. Almost all of the respondents who reported Indiana as their primary practice location held an active Indiana license (refer to Table 1.1). Table 1.1 Current License Status Physician License Status Number Percent Active 54, Probation Other Total 54, P age

11 The dataset was further refined by work status. Only those registered nurses who were currently practicing in Indiana were included in the analysis. Registered nurses who were actively working in a position other than nursing, working only on a non-paid basis, retired, temporarily inactive, currently unemployed, or practicing outside Indiana were excluded from the analyses. A total of 53,591 registered nurses (98.4%) were selected for inclusion (refer to Table 1.2). Table 1.2 Current Work Status* Registered Nurse Work Status Number Percent Excluded from Dataset Actively working in paid health care position, but not in nursing Actively working, but not in nursing or health care Working in nursing ONLY on a non-paid basis Retired or permanently inactive as a nurse Temporarily inactive as a nurse Unemployed and seeking work as a nurse in Indiana Total Excluded from Dataset Included in Dataset Actively working in a paid position related to nursing 53, Total Included in Dataset 53, Total Indiana-based Survey Respondents 54, No Response Given 344 *These numbers represent survey respondents only. 6 P age

12 Table 1.3 includes the work status of registered nurses in previous years reports ( ) to provide a comparison from year to year. In each year a large proportion of Indianabased RNs were included in the analysis. Table 1.3 Current Work Status ( )* Registered Nurse Work Status Num Pct Num Pct Num Pct Excluded from Dataset Actively working in paid health care position, but not in nursing 1, , , Actively working, but not in nursing or health care Working in nursing ONLY on a non-paid basis Retired or permanently inactive as a nurse , Temporarily inactive as a nurse , Unemployed and seeking work as a nurse in Indiana Total Excluded from Dataset 3, , , Included in Dataset Actively working in a paid position related to nursing 43, , , Total Included in Dataset 43, , , Total Indiana-based Survey Respondents 46, , , No Response Given *These numbers represent survey respondents only. Weighting for County Level Data A key component of identifying potential health profession shortage areas is determining the number of existing professionals in each county. Two strategies were employed to create an accurate measure of the availability of registered nurses in each county. First, rather than performing a simple headcount of registered nurses in each county, the number of full-time equivalent (FTE) registered nurses was calculated for each county. The method for calculating and defining FTEs is discussed below. After FTEs for each county were calculated, the second strategy used to ensure an accurate estimate was to weight the FTEs in each county. The estimated number of registered nurse FTEs in each county was calculated by 7 P age

13 summing the number of respondent FTE in each county of principle practice location, then assigning a weight of 90.2 percent to the sum. The weight was determined by calculating the proportion of registered nurses who renewed their license electronically and responded to the survey (n = 88,650) to the total number of registered nurse license renewals (n = 98,235) (refer to Table 1.4). Thus, the counts of registered nurse FTEs are estimates of the actual number of registered nurses in each county and not the number of respondents in each county. The estimated number of registered nurse FTEs per county also does not necessarily reflect the total number of practicing RNs, but the number of RN FTEs available to serve the community at large. Table 1.4 Weighting for County Data Weighting for County Level Data Number Percent Renewed electronically and responded to the survey 80, Total Nurse License Renewals in ,235 Calculation of FTE for Maps The data shown on maps are registered nurse FTEs rather than a simple headcount because not all respondents indicated that they worked full-time in patient care activities. Thus, measuring the number of registered nurse FTEs per county provides a more accurate picture of the availability of registered nurses for the communities of each county. Each 8 P age

14 respondent had an FTE assigned to them based on their survey response indicating the average number of weekly hours spent in patient care or in professional duties (refer to Table 1.5). While the weighted headcount of registered nurses is not used in maps, the estimated headcount of registered nurses in each county is included in the county-by-county tables in Chapter 5. Table 1.5 FTE Definition for Registered Nurses Average Number of Weekly Hours Spent in ALL Nursing Related Activities FTE or more 1 9 P age

15 Response Rate Although only registered nurses who met the inclusion criteria were included in the analysis of this report, the denominator used for determining the survey response rate was based on the total number of registered nurses who renewed their licenses electronically in 2011 (refer to Table 1.6). The response rate for the survey was calculated by dividing the number of registered nurses who renewed their license electronically and responded to at least one question on the survey by the total number of electronic renewals. The response rate for those who had the opportunity to take the survey was 90.7 percent. Table 1.7 shows the response rate for previous years surveys as a comparison. Each year had a high proportion of responders with the exception of 2003 (66.3%), therefore data from each year (except for 2003) are included in the analyses when the survey question was asked in each year to visualize trends in the registered nurse workforce. Table 1.6 Survey Response Rate Survey Response Rate Number Percent Renewed electronically and responded to the survey 80, Total Electronic Renewals 88,650 Table 1.7 Survey Response Rate ( ) 1997* 2001* 2003** Survey Response Rate Num Pct Num Pct Num Pct Renewed electronically and responded to the survey 62, , , Total Electronic Renewals 69,893 72,928 71,585 *Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission. ** 2009 Indiana Registered Nurse Survey Report, Indiana Center for Health Workforce Studies, Indiana Area Health Education Centers Program. Table 1.7 Survey Response Rate ( ) (Cont d.) 2005** 2007** 2009** Survey Response Rate Num Pct Num Pct Num Pct Renewed electronically and responded to the survey 56, , , Total Electronic Renewals 70,982 81,786 88,852 *Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission. ** 2009 Indiana Registered Nurse Survey Report, Indiana Center for Health Workforce Studies, Indiana Area Health Education Centers Program. 10 P age

16 Data Analysis Frequency and cross-tabulation analyses were performed to describe the characteristics of the registered nurses within Indiana. The data were coded in Microsoft Excel 2007 and analyzed using SAS 9.3 and IBM SPSS Statistics 20. Graphic Information Systems (GIS) maps were developed to illustrate the estimated number of registered nurse FTEs per Indiana county, the ratio of registered nurse FTEs per 100,000 residents, and delineate rural and nonrural counties. Rural counties were defined by the United States Department of Agriculture as non-metropolitan counties and were designated by hash marks on the map. The GIS maps were designed in ArcGIS 9.3. Data from 2011 also was compared to data collected in previous surveys of registered nurses from 1997, 2001, 2005, 2007, and 2009 for variables that matched. Limitations of the Survey The survey instrument used in 2011 is shown in Appendix 1. Several changes were implemented in the 2011 survey instrument in response to discussions with members of the advisory board. Some questions have been added and others re-worded to obtain more precise information. As a result, the 2011 data may not be fully comparable to data from previous years. Only those registered nurses who participated in the licensure survey were included in the data analysis. In 2011 there was a 81.9 percent response rate; therefore there is only a small possibility of non-response bias. 11 P age

17 Chapter 2: Responses to the 2011 Indiana Registered Nurse Licensure Survey This chapter summarizes responses to items on the 2011 Indiana Registered Nurse Licensure Survey. Responses from the 1997, 2001, 2005, 2007, and 2009 surveys are also summarized for those items that matched the 2011 survey instrument. Caution should be taken when making generalizations about all Indiana RNs. The responses from previous surveys have been taken from the 2009 Registered Nurse Licensure Survey Report. The data shown may not be representative of all licensed registered nurses in Indiana since registered nurses who renewed their license by paper, as well as those who did not respond to the electronic survey are not included in these results. Each table shows the number of valid and missing responses to each survey item and the percentage of valid responses. The tables and text describe the responses to the survey. Demographic Composition The demographics shown include age, gender, race, and ethnicity of survey respondents. The age distribution of respondents from 2005 to 2011 is provided in Table 2.1. Demographic questions were not asked in In 2011, the majority of respondents were between the ages of 45 and 54 (27.1%). However, respondents ages were distributed relatively evenly among age groups under 65 years old. A small proportion of respondents (4.1%) were over 65 years old. From year to year, the distribution of respondents ages has remained relatively unchanged. Table 2.1 Age of Respondents ( ) Age Groups Num Percent Num Percent Num Percent Num Percent Under 35 9, , , , , , , , , , , , , , , , or older , , , Total 42, , , , No Response Given P age

18 The gender of respondents from 1997 to 2011 are provided in Table 2.2. In each year the vast majority of respondents were female. This trend continued in 2011 in which 94.6 percent of respondents were female. Table 2.2 Gender of Respondents ( ) Gender Num Percent Num Percent Num Percent Female 36, , , Male 1, , , Total 37, , , No Response Given Table 2.2 Gender of Respondents ( ) (Cont d.) Gender Num Percent Num Percent Num Percent Female n/a n/a 46, , Male n/a n/a 2, , Total n/a n/a 49, , No Response Given 1,202 1, P age

19 Table 2.3 displays the racial and ethnic demographics for the population of Indiana to provide a comparison with the demographics of the registered nurse workforce. Compared to the population of Indiana, minorities are underrepresented in the registered nurse workforce. Table 2.3 Demographic Composition of Indiana 1 Indiana Demographic Information Number Percent White 5,467, Black or African-American 591, American Indian/Alaska Native 18, Asian 102, Asian Indian 27, Chinese 22, Filipino 10, Japanese 4, Korean 10, Vietnamese 6, Other Asian 19, Native Hawaiian 2,348 0 Hispanic or Latino (of any race) 389,707 6 Total Population 6,483, Source: 2010 US Census data P age

20 Table 2.4 shows the race of survey respondents from 1997 to The majority of respondents in each year were white. This is still the case in Table 2.4 Race of Respondents ( ) Race Num Percent Num Percent Num Percent White 36, , , Black/African American 1, , , Asian/Pacific Islander American Indiana/Native Alaskan Multiracial n/a n/a Other Total 38, , , No Response Given Table 2.4 Race of Respondents ( ) (Cont d.) Race Num Percent Num Percent Num Percent White n/a n/a 46, , Black/African American n/a n/a 1, , Asian/Pacific Islander n/a n/a American Indiana/Native Alaskan n/a n/a Multiracial n/a n/a n/a n/a Other n/a n/a n/a n/a Total n/a n/a 49, , No Response Given 1,535 1, P age

21 The ethnicity of survey respondents from 1997 to 2011 is shown in Table 2.5. In each year since 1997, less than two percent of respondents indicated that they have a Hispanic or Latino ethnicity. Table 2.5 Ethnicity of Respondents ( ) Ethnicity Num Percent Num Percent Num Percent Hispanic or Latino Not Hispanic or Latino 35, , , Total 36, , , No Response Given 2,347 4, Table 2.5 Ethnicity of Respondents ( ) (Cont d.) Ethnicity Num Percent Num Percent Num Percent Hispanic or Latino n/a n/a Not Hispanic or Latino n/a n/a 44, , Total n/a n/a 44, , No Response Given 5,816 3, P age

22 Education Characteristics The data displayed in Table 2.6 represent the highest degree obtained by respondents in the registered nurse workforce from 1997 to The proportion of respondents who hold a diploma as their highest degree has decreased from 21.0 percent in 1997 to 6.9 percent in The decrease in respondents holding a diploma has corresponded with an increase in respondents seeking higher degrees. From 1997 to 2011 the proportion of respondents with a Bachelor s degree has risen from 30.2 percent to 38.7 percent, and the proportion of respondents with a Master s degree has risen from 4.4 percent to 8.8 percent in that same period. In each year, the majority of respondents held an Associate degree. Table 2.6 Highest Degree in Nursing Completed by Respondents ( ) Highest Degree in Nursing Num Percent Num Percent Num Percent Diploma 8, , , Associate 17, , , Bachelor's 11, , , Master's 1, , , Doctorate Total 38, , , No Response Given Table 2.6 Highest Degree in Nursing Completed by Respondents ( ) Highest Degree in Nursing Num Percent Num Percent Num Percent Diploma 4, , , Associate 20, , , Bachelor's 16, , , Master's 3, , , Doctorate Total 45, , , No Response Given 3, P age

23 Table 2.7 shows the highest degree held by registered nurse respondents in 2011 by age group. Less than one-tenth (8.3%) of 2011 respondents under the age of 44 held a diploma as their highest degree in nursing. The majority of respondents under the age of 44 held either an Associate or Bachelor s degree. Respondents between the ages of 55 and 64 had the largest proportion of registered nurses with a diploma (43.2% of all respondents holding a diploma as their highest degree in nursing) as well as the highest percentage of registered nurses with a doctorate (47.8% of all respondents holding a doctorate as their highest degree in nursing). The high proportion of diplomas could be due to changing trends in nursing degrees (younger respondents were more likely to hold an Associate or Bachelor s degree). The higher proportion of respondents holding a doctorate could be due to the amount of time it takes to complete a doctorate degree. Table 2.7 Highest Degree in Nursing by Age Group of 2011 Respondents Under Highest Degree in Nursing Number Percent Number Percent Number Percent Diploma , Associate 5, , , Bachelor's 6, , , Master's , Doctorate Total 12, , , No Response Given Table 2.7 Highest Degree in Nursing by Age Group of 2011 Respondents (Cont d.) and older Total Highest Degree in Nursing Number Percent Number Percent Number Percent Diploma 1, , Associate 5, , Bachelor's 3, , Master's 1, , Doctorate Total 11, , , No Response Given P age

24 Table 2.8 shows the percentage of RNs that plan to pursue additional degrees in nursing in the next two years. This question was not included on the survey prior to Respondents were allowed to choose all responses that applied. Therefore percentages may not sum to 100. The majority of respondents do not plan on pursuing additional degrees in the next two years (73.3% in 2009 and 66.0 % in 2011). The most common degree that respondents indicated they would seek in the next two years is a Bachelor s degree, with a similar proportion planning to pursue a Master s degree. Table 2.8 Additional Nursing Degrees to be Pursued by Respondents in the Next Two Years Future Degrees Num Percent Num Percent Bachelor's 6, , Master's 5, , Doctor of Nursing Practice (DNP) , Other Doctorate (PhD) I plan on getting more than one degree n/a n/a I do not intend to pursue further nursing education 34, , No Response Given 5,293 Table 2.9 shows the proportion of respondents who indicated that they had completed an advanced practice nursing degree since completing their initial nursing program. Nearly one-tenth (8.4%) of respondents had completed an advanced practice nursing degree. Table 2.9 Respondents Who Completed Advanced Practice Nursing Degree Completed Advanced Practice Nursing Degree since Graduating from Initial Nursing Program Number Percent No 47, Yes 4, Total 52, No Response Given 1, P age

25 Professional Characteristics The information displayed in Table 2.10 shows the principal position currently held by respondents. Over half of respondents (54.6%) held a position as a staff nurse or direct care nurse. Charge nurses/team leaders were the next most commonly held position (8.6% of respondents) followed by other nurses (4.5%) and those working in middle management/administration (4.3%). Table 2.10 Currently Held Principal Practice Position of Respondents (2011) Current Position Number Percent Staff Nurse or Direct Care Nurse 28, Charge Nurse or Team Leader 4, Other 2, Middle Management/Administration (Asst. Director, House Supervisor) 2, Patient Care Coordinator, Case Manager, Discharge Planner 1, Nurse Practitioner 1, First Line Management (Head Nurse, Floor Supervisor) 1, School Nurse 1, No position title 1, Senior Management/Administration (CEO, Vice President, Nursing Executive) Faculty Quality Improvement Nurse, Utilization Review Nurse Clinical Nurse Specialist Advice/Triage Nurse Staff Educator or Instructor in Clinical Setting Community Health Nurse Consultant Instructor/Lecturer Public Health Nurse Patient Educator Informatics Nurse Certified Registered Nurse Anesthetist (CRNA) Researcher Surveyor/Auditor/Regulator Infection Control Nurse Staff Development Director Legal Nurse Certified Nurse-Midwife Total 52, No Respone Given P age

26 Table 2.11 shows the principal work setting of respondents. The most common work setting was non-federal, short-term (non-psychiatric) hospitals (41.4%) followed by other types of hospitals (11.8%) and nursing home/extended care facilities (5.6%). Table 2.11 Principal Work Setting of Respondents (2011) Work Setting at Primary Position Number Percent Non-Federal, short-term hospital, except psychiatric 21, Other type of hospital 6, Nursing Home/Extended Care Facility - Free standing nursing home/extended 2, Other 2, Home health agency (non-hospital based) 1, Non-Federal, long-term hospital, except psychiatric 1, Federal Government hospital 1, Ambulatory Care Setting - Group practice (physicians) 1, Ambulatory Care Setting - Ambulatory surgical center 1, Community/neighborhood health center 1, Public school system Home health service unit (hospital based) Ambulatory Care Setting - Hospital owned off-site clinics Rural health care center Ambulatory Care Setting - Partnerships (physicians) Non-Federal psychiatric hospital Nursing Education Program - Bachelor's Degree Ambulatory Care Setting - Other Community mental-health organization or facility Other public or community health setting Hospice Nursing Home/Extended Care Facility - Other types of extended care facility Nursing Education Program - Associate's Degree College or university Ambulatory Care Setting - Dialysis center/clinic Ambulatory Care Setting - Partnership or Group Practice (mixed practitioners) Ambulatory Care Setting - Solo practice (physicians) Visiting nurse service (VNS/NA) Official City or County Health Department Nursing Home/Extended Care Facility - Nursing home unit in hospital Occupational Health (Employee Health Service) - Private industry Ambulatory Care Setting - Freestanding clinic (physicians) Correctional Facility Retirement community center P age

27 Table 2.11 Principal Work Setting of Respondents (2011) (Cont d.) Work Setting at Primary Position Number Percent Nursing Education Program - Higher degree nursing program Official State Mental Health Agency Official State Health Department Nursing Education Program - LPN/LVN program Nursing Education Program - Other nursing education program Home-based self-employment Ambulatory Care Setting - Group practice (nurses) Occupational Health (Employee Health Service) - Other Combination (official/voluntary) nursing service Nursing Home/Extended Care Facility - Facility for mentally challenged Ambulatory Care Setting - Freestanding clinic (nurses) Private or parochial elementary or secondary school Ambulatory Care Setting - Solo practice (nurses) Substance abuse center/clinic Other school health service Planned Parenthood/Family Planning Center Private duty in a home setting Nursing Education Program - Diploma program (RN) Ambulatory Care Setting - Partnerships (nurses) Day care center Ambulatory Care Setting - Health Maintenance Organization (HMO) Ambulatory Care Setting - Dental practice Occupational Health (Employee Health Service) - Government Total 51, No Response Given 1, P age

28 Table 2.12 displays the number of paid positions in nursing held by respondents from 2009 and The majority of registered nurses in both years held only one position (87.3% in 2009 and 87.6% in 2011). Table 2.12 Number of Paid Positions Held by Respondents Number of Positions Held in Nursing Num Percent Num Percent 1 43, , , , or more Total 50, , No Response Given 588 1,393 Table 2.13 shows the additional work settings of respondents. These work settings have been grouped into broader categories. Two-fifths (40.6%) of respondents indicated that their secondary work setting was a hospital. One-third (32.3%) of respondents indicated that the question was not applicable to them. Table 2.13 Work Setting of Other Position(s) of Respondents (2011) Work Setting at Positions Other than Primary Position Number Percent Hospital 19, Not applicable 15, Insurance Claims/Benefits 3, Ambulatory Care Setting 2, Other 2, Nursing Home/Extended Care Facility 2, Public or Community Health Setting 1, Nursing Education Program School Health Service Occupational Health (Employee Health Service) Policy, Planning, Regulatory, or Licensing Agency Total 48, No Response Given 7, P age

29 Table 2.14 shows the distribution of respondents practice locations in urban and rural counties. The majority (85.9%) of respondents worked in urban counties. Table 2.14 Respondents Practice Location by Urban and Rural Counties (2011) Practicing in Urban or Rural County Number Percent Rural 7, Urban 46, Total 53, No Response Given 9 The average number of hours per week spent in nursing related activities by respondents in 2009 and 2011 are displayed in Table The majority of RNs worked 36 or more hours per week in each year (73.3% in 2009 and 73.9% in 2011). Table 2.15 Average Number of Hours per Week Spent in Nursing Related Activities by Respondents Average Hours per Week Spent in Nursing Related Activities Num Percent Num Percent , , , , , , or more , Total 48, , No Response Given 1,878 2, P age

30 Table 2.16 shows the clinical specialty in which respondents spent the majority of their time. Respondents were spread over more than 30 specialties. Surgery (10.7%) was the most common specialty followed by critical care (8.2%) and general medical surgery (7.1%). Table 2.16 Clinical Specialty in which Respondents Spent the Majority of their Time (2011) Clinical Specialty in which Most Time is Spent at Primary Nursing Position Number Percent Surgery (ambulatory, pre/post-operative, post-anesthesia) 5, Critical Care 4, General Medical Surgical 3, Cardiac or Cardiovascular Care 3, Other Specialty 3, Long-term Care/Nursing Home 3, Emergency or Trauma Care 3, Pediatrics/Neonatal 2, Home Health 2, Obstetrics 2, Ambulatory Care (including primary care, outpatient, NOT surgical) 2, No Patient Care 1, Primary Care 1, Psychiatric or Mental Health (Substance Abuse Counseling) 1, Education 1, Oncology 1, Labor and Delivery Hospice No Specific Area Renal/Dialysis Community Health Gastrointestinal Public Health Neurological Occupational Health Gynecology (Women's Health) Chronic Care Radiology (Diagnostic or Therapeutic) Pulmonary/Respiratory Infectious/Communicable Disease Dermatology Total 52, No Response Given P age

31 Table 2.17 displays the respondents who indicated that they are currently practicing in an advanced practice nursing role. Approximately one-third of advanced practice nurses indicated that they were a nurse practitioner in primary care (34.1%) and another third of advanced practice nurses were nurse practitioners in a field other than primary care (34.0%). A total of 3,226 respondents indicated that they were advanced practice nurses, or about 6 percent of all respondents. Table 2.17 Respondents Currently Practicing in an Advanced Practice Nursing Role (2011) Currently Practicing in an Advanced Practice Role Number Percent Nurse Practitioner - Primary Care (eg. School based Clinics, Community Health) 1, Nurse Practitioner - Other (eg. Orthopedics, Neurology, Acute Care, ER) 1, Clinical Nurse Specialist Nurse Anesthetist Nurse Midwife Total 3, No Response Given 50, P age

32 Table 2.18 displays the age distribution by degree type of registered nurses in the year Age groups are separated into two categories: those who will be less than 63 years old in 2020 and those who will be 63 years or older in These categories were chosen to approximate the registered nurses who will be nearing retirement by Approximately one-quarter (26.2%) of respondents will be 63 years or older in The majority of registered nurses holding both diplomas and doctorates (61.4% and 58.6%, respectively) will be over the age of 63 in The proportion of the registered nurse workforce holding a diploma is expected to continue declining as more RNs are choosing to earn an Associate or Bachelor s degree. On the other hand, it is likely that by 2020 the number of registered nurses holding a doctorate and under 63 years old will increase as more respondents complete doctorate degrees. Refer to Table 2.8 to see a list of degrees current respondents plan to pursue in the near future. Table 2.18 Age of Respondents in 2020 by Highest Degree in Nursing Under 63 years old in or older in 2020 Total Highest Degree Number Percent Number Percent Number Percent Diploma 1, , , Associate 18, , , Bachelor's 16, , , Master's 2, , , Doctorate Total 38, , , No Response Given P age

33 The estimated time until retirement of respondents in each age category are shown in Table As expected, the majority of already retired respondents were over 65 years old and younger respondents indicated that they were further away from retirement. Table 2.19 Respondents Anticipated Time to Retirement by Age Categories (2011) Under to to to 64 Over 65 Total Estimated Time to Retirement No. % No. % No. % No. % No. % No. % I am retired already Less than 1 year years , , years , , , or more years 12, , , , , Total 12, , , , , , No Response Given 2, P age

34 Table 2.20 shows the primary reasons indicated by respondents who are not currently in a paid nursing position for why they are not currently employed as a registered nurse. Respondents were allowed to choose all options that applied to their situation so percentages may not sum to 100. The most common reason was other which may indicate that the reasons provided on the survey instrument are not capturing the primary reasons that respondents are not currently employed in nursing positions. Alternatively, the reasons respondents are not working may be too unique to neatly classify into a list of broadly applicable reasons. The second most common reason was career advancement out of nursing followed by family obligations. Table 2.20 Primary Reasons for not Currently Working a Paid Nursing Position (2011) If you are not currently working in a paid nursing position, what are the primary reasons? Number Percent Other Career Advancement/Promotion to non-nursing Position Never worked in a paid RN position Family Obligations Disability/Illness Retired Burnout/Stressful Environment Pursuing a Career in a Different Field Relocated Inadequate Pay/Benefits Laid Off/Downsizing of Staff No Response Given 53, P age

35 Respondents who were not currently employed in a paid nursing position were also asked how long it had been since they had worked in a paid nursing position. Table 2.21 shows the length of time indicated by respondents. The majority of respondents who were not currently working in a paid position indicated that they had not worked in a paid position for 10 or more years (37.4%). Table 2.21 Time Since Working in a Paid Position in Nursing (2011) If you are not currently working in a paid nursing position, how long has it been since you worked in a paid position in nursing? Number Percent Less than 1 year years years or more years Never worked in a paid RN position Total No Response Given 52, P age

36 Chapter 3: Nursing Faculty The results presented in this chapter show the demographic and professional characteristics of nursing program faculty who responded to the 2005, 2007, 2009, and 2011 Indiana Registered Nurse Licensure Surveys. Respondents were asked to identify their principal position on the surveys. Only those respondents who identified their principal position as faculty in a nursing program were included in the analysis reported in this chapter. Demographic Composition Table 3.1 shows the ages of respondents whose principal position was in nursing faculty from 2005 to In 2011, compared to previous years, there was an increased proportion of nursing faculty under the age of 35 (16.0% in 2011 compared to an average of 6.1% in 2005 to 2009). Additionally, there was a decrease in the proportion of nursing faculty between the ages of 45 and 54 compared to previous years (26.8% in 2011 compared to an average of 39.6% in 2005 to 2009). Table 3.1 Age of Nursing Faculty ( ) Age Groups Num Percent Num Percent Num Percent Num Percent Under Over Total , No Response Given P age

37 The gender of respondents whose principal position was in nursing faculty from 2005 to 2011 is shown in Table 3.2. Demographic variables were not collected in The majority of nursing faculty respondents were female in each year. Table 3.2 Gender of Nursing Faculty ( ) Gender Num Percent Num Percent Num Percent Num Percent Female n/a n/a 1, Male n/a n/a Total n/a n/a 1, No Response Given Tables 3.3 and 3.4 display the racial and ethnic distribution of respondents who indicated that their primary position was in nursing faculty from 2005 to 2011 (demographic variables were not collected in 2007). The majority of nursing faculty in each year were white and non-hispanic. Table 3.3 Race of Nursing Faculty ( ) Race Num % Num % Num % Num % White n/a n/a Black/African American n/a n/a Asian/Pacific Islander n/a n/a American Indiana/Native Alaskan n/a n/a Multiracial n/a n/a n/a n/a Other n/a n/a n/a n/a Total n/a n/a 1, No Response Given Table 3.4 Ethnicity of Nursing Faculty ( ) Ethnicity Num Percent Num Percent Num Percent Num Percent Hispanic or Latino n/a n/a Not Hispanic or Latino n/a n/a Total n/a n/a No Response Given P age

38 Educational Characteristics Table 3.5 shows the highest degree in nursing obtained by respondents who indicated that their principal position was in nursing faculty from 2005 to The proportion of nursing faculty holding an Associate degree has risen from 1.9 percent in 2005 to 15.8 percent in On the other hand, the proportion of faculty holding Bachelor s and Master s degrees has fallen from 20.4 percent and 61.9 percent, respectively, in 2005 to 16.4 and 52.0 percent, respectively, in The increased number of nursing faculty holding a Master s degree in 2009 could be due to the overall higher number of nursing faculty included in the 2009 survey, but the subsequent return to the previous years numbers in 2011 may warrant further analysis. Table 3.5 Highest Degree in Nursing among Nursing Faculty ( ) Highest Degree in Nursing Num Percent Num Percent Num Percent Num Percent Diploma Associate Bachelor's Master's Doctorate Total , No Response Given P age

39 Chapter 4: Advanced Practice Nurses This chapter presents the demographic and professional characteristics of the advanced practice nurses (APNs). Advanced practice nurses include the following specialties: nurse practitioners, clinical nurse specialists, nurse-midwives, and nurse anesthetists. Only those respondents who indicated they were currently working as an advanced practice nurse were included in the analysis reported in this chapter. Demographic Composition Table 4.1 shows the age distribution of each APN specialty in While clinical nurse specialists, nurse anesthetists, and nurse midwives each had approximately one-tenth of respondents (9.6%, 13.5%, and 9.4%, respectively) under age 35, nearly one-fifth (18.8%) of nurse practitioners were under 35 years old. All specialties except nurse anesthetists had the majority of respondents between 45 and 54 years old. The greatest proportion of nurse anesthetists, on the other hand, was between 35 and 44 years old. Table 4.1 Age Distribution of Advanced Practice Nurses by Specialty (2011) Clinical Nurse Specialist Nurse Anesthetist Nurse Practitioner Nurse Midwife Total Age Groups No. % No. % No. % No. % No. % Under , and older Total , , No Response Given 4 34 P age

40 The gender distribution of APNs (listed by specialty) can be found in Table 4.2. In each specialty the majority of respondents were female. Nurse anesthetists were nearly evenly split between males and females. Table 4.2 Gender Distribution of Advanced Practice Nurses by Specialty (2011) Clinical Nurse Specialist Nurse Anesthetist Nurse Practitioner Nurse Midwife Gender Num Percent Num Percent Num Percent Num Percent Female , Male Total , No Response Given Tables 4.3 and 4.4 show the racial and ethnic distribution of APNs among respondents by specialty. The majority of respondents were white and non-hispanic in each specialty. Table 4.3 Racial Distribution of Advanced Practice Nurses by Specialty (2011) Clinical Nurse Specialist Nurse Anesthetist Nurse Practitioner Nurse Midwife Race Num Percent Num Percent Num Percent Num Percent White , Black/African American Asian/Pacific Islander American Indiana/Native Alaskan Multiracial Total , No Response Given Table 4.4 Ethnic Distribution of Advanced Practice Nurses by Specialty (2011) Clinical Nurse Specialist Nurse Anesthetist Nurse Practitioner Nurse Midwife Ethnicity Num Percent Num Percent Num Percent Num Percent Hispanic or Latino Not Hispanic or Latino , Total , No Response Given P age