The Center for Indiana Health Workforce Studies. Bowen Research Center, Department of Family Medicine Indiana University School of Medicine

Transcription

1 2005 Indiana Registered Nurse Survey Report Produced by: The Center for Indiana 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 November 2007 Authors: Terrell W. Zollinger, DrPH Michael J. Przybylski, PhD Brittany S. Sutton, MPH Linda D. Jackson, MS, RN, CCRN AHEC

2 Acknowledgements Preparing this resource guide 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: Jonathan Barclay, MA, Indiana Health Education Center Program Donna Boland, PhD, RN, Indiana Nursing Workforce Development Collaborative S. Kim Genovese, RN, PhD(c), MSN, MSA, Nursing 2000 North Ernest K. Klein, RN, Indiana State Nurses Association Cynthia L. Stone, DrPH, RN, IU School of Nursing Kathy Weaver, JD, MPA, RN, Indiana State Department of Health The cooperation and support of the Indiana State Department of Health and the Indiana State Nurses Association were instrumental in obtaining the survey data and interpreting it. The authors are grateful for the financial support received from the Indiana Area Health Education Center Program to produce this report. Terrell W. Zollinger, DrPH Michael J. Przybylski, PhD Brittany S. Sutton, MPH Linda D. Jackson, MS, RN, CCRN ii

3 Table of Contents Executive Summary Pages iv - vi Chapter 1: Introduction Pages 1-4 Chapter 2: Frequencies of Survey Item Responses Pages 5-17 Chapter 3: Crosstabulation of Nurse Characteristics with Selected Items Highest Degree in Nursing Pages Principal Position Pages Setting of the Principal Position Pages Key Activities in the Principal Position Pages Chapter 4: Detail for Specialty Nurses Nursing Faculty Pages Advanced Practice Nurses Pages Chapter 5: Location of Nurses by County in Indiana Pages Chapter 6: Trends in the Registered Nurse Workforce Pages Chapter 7: Conclusions Pages Appendix 1: 2005 Indiana Registered Nurse Survey Instrument Appendix 2: National Sample Survey of Registered Nurses Survey Instrument Appendix 3: Recommendations to Improve the Survey iii

4 Executive Summary Introduction A voluntary survey instrument was attached to the Registered Nurse (RN) license renewal form during the 2005 Indiana RN re-licensure period. The RN survey was implemented through a collaboration of the Indiana State Department of Health and the Indiana Professional Licensing Agency. This report summarizes the responses to the survey items and compares the results of this survey to the results of previous RN surveys. Methods The purpose of the survey was to provide high quality data about RNs in Indiana to help policy makers and program directors understand the RN work environments and other related information. Survey items included current work status, their positions and the activities they perform in their principal positions as well as the setting and location of their work sites. Other items included the RN level of educational achievement and their plans to obtain higher degrees in the future. Finally items to measure the demographic characteristics of the RNs were included. Survey Response Rate A total of 70,982 RNs renewed their Indiana licenses in 2005; 61,792 renewed their licenses on-line and were invited to complete the survey. Of these nurses, 56,670 (91.8%) completed the survey, representing 79.8% of all who renewed their licenses in Actively Practicing Over 85 percent of the respondents (48,435 nurses) indicated that they were actively practicing in a nursing position. Among those actively practicing, 43,616 (90.1%) were practicing in Indiana. Demographic Characteristics One-half (49.7%) of the nurses were age 45 or older, an increase from 42.7% age 45 or older in Almost all (94.9%) were females; however, the percent who are men has increased from 3.7% in 1997 to 5.1% in In 2005, most (94.2%) RNs were white. This was a slight decrease since 1997 (95.4%). Very few respondents indicated that they were Hispanic (1.5%). The most common levels of training for RNs were an Associate degree (44.6%) or Bachelor s degree (36.7%). The percent with a Bachelor s degree had increased from 30.2% in Nearly one-half of RNs (44.7%) indicated that they desired a higher degree; most commonly a Master s degree (51.8%). Very few (3.9%) indicated that they were fluent in a language other than English. Nearly 4 in 10 (38.4%) have been licensed as an RN in Indiana for less than 10 years; nearly one-third (31.8%) have held their Indiana RN license for 20 or more years. Employment Characteristics Over one-half (61.2%) of the RNs worked in a hospital setting in 2005; most of the rest worked in ambulatory care settings (14.3%) or other facilities (8.2%). A few (14.1%) reported that they worked in more than one paid position. Nearly two-thirds (63.9%) reported that their principal position was a direct patient care position. One-fifth (21.6%) worked in indirect patient care positions. Key activities reported in the nurses primary positions included patient care (76.8%), patient education (33.6%), medication management (19.3%), and supervision or management (18.3%). The RNs reported that they frequently cared for non-elderly adults (74.1%) and elderly adults (62.0%). Nearly one-half (47.1%) of the RNs reported working 40 or more hours per week; another one-third (31.5%) worked hours per week. One-half (49.2%) reported working in other health care positions prior to becoming a RN. iv

5 Characteristics Related to Level of Education Those with Associate and Bachelor s degrees were younger, while those with Master s and Doctorate degrees were older. Men were more often in the higher education categories. Most of those with Associate and Bachelor s degrees were working in patient care settings. More of those with Master s and Doctorate degrees were working in educational settings. Characteristics Related to Principal Position Younger RNs were more often working in patient care positions, while the older RNs were more often employed in educational positions and advanced practice nursing positions. Black/African American nurses were more often working in indirect patient care or nursing related business positions. Men were more often employed in advanced practice positions, particularly as nurse anesthetists (53.4% of whom were male). RNs with less than 5 years of Indiana licensure were more often working in direct patient care positions. Characteristics Related to Principal Work Setting Younger RNs more often worked in hospital settings, while older RNs more often worked in government and education settings. Black/African American nurses more often worked in private business settings. Male RNs were more often working in private business and hospital patient care settings and less often in education settings. Those with less than 5 years of Indiana licensure were more often practicing in hospital patient care settings. Characteristics Related to Key Activities Most of the younger RNs reported performing patient care activities; relatively fewer of the older nurses reported patient care as a key activity. White nurses more often reported continuing education/staff development, consulting with agencies and other professionals, and quality assurance/utilization review as key activities. Male nurses more often reported administrative activities as key activities. Nurses with the fewest years of Indiana licensure more often reported patient care as a key activity. Nursing Faculty The age distribution of nursing faculty was older than that for all RNs. Nursing faculty members were less likely to be male and more likely to be black or African-American. As expected, nursing faculty much more often held Master s and Doctorate degrees. Most, but not all faculty members reported their principal positions were in an education setting. Faculty members were much less likely to report patient care and administrative activities among their key activities. Nursing faculty members had, on average, held their Indiana RN licenses much longer than other RNs. Advanced Practice Nurses Nearly two-thirds (64.4%) of all Advance Practice Nurses (APN) were Nurse Practitioners and another 30.2 percent were Clinical Nurse Specialists. Nurse Practitioners tended to be slightly younger than those in the other APN categories and Certified Nurse Midwives tended to be older. The majority of Certified Nurse Anesthetists were males (53.4%) while other APN nurses were less likely to be males (4.2%) than nurses overall (5.1%). APN nurses were less likely to be black or African-American (1.9%) than nurses overall (2.9%). Most of the APN nurses had Master s degrees (75.2%). A majority of all APNs were in patient care settings. But most of the Nurse Practitioners (72.1%) and Certified Nurse Midwives (52.0%) were in non-hospital patient care settings while most Certified Nurse Anesthetists and Clinical Nurse Specialists were in hospital patient care settings (77.2% and 53.7% respectively). Over 80 percent of APNs listed direct patient care as a key activity and over one-half listed patient education and counseling. Generally, APNs had held Indiana RN licenses longer than other RNs. v

6 Location of RNs in Indiana Higher numbers of RNs and higher ratios of RNs per population were found in urban counties including Allen, Elkhart, Lake, Marion, St. Joseph, Tippecanoe, Vanderburgh and Vigo. In addition, higher ratios of RNs per population were noted in Bartholomew, Dubois, Floyd, Knox, and Wayne Counties. Time Trends in the RN Workforce The total number of individuals renewing Indiana RN licenses has been fairly constant over the past nine years; however, the number of RNs who are active in Indiana has been increasing. The number of nurses in the age group has increased over the nine year period. The number of diploma trained nurses has been decreasing, while the numbers of RNs in the other education groups have been increasing. There has been an increase in the number of nurses who reported working hours. There have been sharp increases in the number of Advanced Practice Nurses of all types over the nine year period. However, the number of nursing faculty has remained fairly constant. Conclusions There has been an increase in the number of licensed nurses actively practicing in Indiana, but many do not work in direct patient care positions. Clearly, the nursing work force is getting older, as is the population in general. This aging trend suggests that as the baby boomer nurses retire, there will be a drop in the number of active nurses in Indiana a trend also forecast in HRSA s 2004 report. The number of Advance Practice Nurses has increased rapidly in the past nine years. There is a demand for obtaining higher degrees in nursing, yet the number of nursing faculty has not increased over the past nine years. Recommendations A number of changes to the survey instrument were suggested to improve the quality of the data and to improve comparability with other surveys. In addition, it is recommended that all nurses be instructed to complete the survey as part of the licensing process. vi

7 Chapter 1: Introduction Indiana continues to experience chronic shortages of a wide range of health professionals. These shortages are more serious in specific geographical areas of the state and with specific health professionals. Of particular concern is the current shortage of Registered Nurses (RNs). Having an accurate understanding of the personal and professional characteristics of registered nurses licensed in Indiana is critical when developing and managing programs to recruit and retain nurses where they are most needed. Having quality data about registered nurses in Indiana will help policy makers and program directors make better decisions than they would be able to make otherwise. The purpose of this report is to provide those quality data. Starting in 1997, registered nurses have been asked to complete surveys as part of their relicensure process, which occurs every two years. In addition to the 1997 survey, registered nurse surveys were also conducted in 2001, 2003, and The 1997 and 2001 Indiana Registered Nurse Surveys were conducted by mail using a paper format. Online license renewal was implemented in early A voluntary survey instrument was attached to the on-line renewal form during 2003 and 2005, but no surveys were collected by mail in these years. The 2001 survey items were revised for 2003 and 2005, with nine additional questions added, a longer list of response options provided, and other minor changes. The 2005 online Registered Nurse survey was implemented through a collaboration of the Indiana State Department of Health (ISDH) and the Indiana Professional Licensing Agency (PLA). The 2005 registered nurse survey instrument included items to address current work status, primary position, and the activities performed in the principal position, as well as the setting and location of their work site. Other items address the education of the nurses and their plans for obtaining future degrees. Finally, items to address specific demographic characteristics were added. A copy of the 2005 Indiana Registered Nurse Survey instrument is included in Appendix 1. This report summarizes the responses to the 2005 Indiana Registered Nurse Survey and compares the results from the current survey to the results of the prior Registered Nurse surveys. Included in this analysis was information from the IPLA database regarding the age of the nurses, their license status, and initial year of their licensure in Indiana. Response Rate As shown in Table 1.1 (on the next page), 70,982 registered nurses renewed their licenses in 2005; 61,792 renewed online and the other 9,190 renewed by mail. The total number of nurses who renewed their license increased from 1997 to 2001, but has declined slightly since. Only those who renewed online were given the opportunity to complete the survey in 2003 and Of the total number who renewed online in 2005, 91.7 percent (56,670 of 61,792) completed the survey, a rate comparable to the overall response rates shown for 1997 and 2001 (89.0% and 93.6% respectively). But due to the inability to survey nurses who renewed by mail, the overall response rate was only 79.8 percent in This was an improvement from the 66.3 percent total response rate in 2003 (But the response rate among nurses renewing electronically was also good in %). The overall response rates are shown in bold in the bottom row of Table

8 Table 1.1 Renewal Method, Survey Responses, and Percent Active: Registered Nurses Number Percent Percent Percent Percent Number Number Number of Total of Total of Total of Total Total Renewing 69, , , , Renewed Electronically , , Respondents 62, , , , Registered Nurses Active in Indiana It is important to note that these data reflect only the registered nurses who renewed their licenses. Initial licensees are not surveyed since few of the questions would be relevant to them. Thus, the total number of active registered nurses is greater than shown in the tables and projections of this report. Table 1.2 Registered Nurses: Percent Active in Indiana: Registered Nurses Number % Number % Number % Number % Total Respondents Active (% of Respondents) 48, , , , Respondents Active in Indiana* (% of Active) 38, , , , * Indiana location was determined from zip code of principal position response in 1997 and 2001 but from whether your spend most of the time in your principal position in Indiana response in 2003 and The number of active survey respondents shown in Table 1.2 cannot be interpreted as a trend because it is a reflection of the survey response rate; only respondents could indicate their work status. The percent of respondents who report being active may indicate an interesting trend, increasing from 77.4 percent in 1997 to 85.5 percent in One caveat to this conclusion is that in 2003 and 2005 only nurses responding electronically could indicate whether they were actively practicing. Any relation between electronic license renewal and whether a nurse is active could introduce a bias. A caveat is also necessary in interpreting the trend of active nurses practicing in Indiana vs. elsewhere (shown in the bottom row of Table 1.2). In 1997 and 2001 the percentages in Table 1.2 (80.4% and 84.3% respectively) were based on the ZIP code reported by each nurse for the location of their primary nursing position. In 2003 and 2005 another question was also asked: Do you spend most of the time in your principal position within the sate of Indiana? Higher percentages answered yes to this question in 2003 and 2005 (90.3% and 90.1% respectively). The ZIP code was also requested in 2003 and Some nurses answering yes to the within Indiana question reported ZIP codes outside Indiana. Data Analysis The Department of Family Medicine s Bowen Research Center staff received a data disk from ISDH that contained the responses to the 2005 registered nurse survey as well as two additional variables from the IPLA registered nurse licensure dataset: age and year first licensed in Indiana. A Statistical Program for the Social Sciences (SPSS) dataset was created from the data provided. A data dictionary was available from the contractor of the data disk to describe the data in the dataset. A new age variable was created to remove extreme age values. 2

9 The SSPS software was used to analyze the data compiled from the online survey and licensure information about the registered nurses from the IPLA database. Only nurses with active license status, nurses on probation or licenses being reviewed, were included in most of the results presented in this report. Nurses with suspended licenses as well as those who were inactive and those who were working in non-paid nursing positions were excluded. A working data set was created for only those registered nurses working or living in Indiana. This data set was further divided into three data sets: 1) actively working registered nurses, 2) registered nurses not working in a paid nursing position, and 3) unemployed registered nurses. Of the 56,819 respondents to the 2005 survey, 46,429 (81.7%) registered nurses were working or living in Indiana. About 6.7 percent of these (3,121) were not actively working in a paid nursing position. The major focus of this report is on the 43,161 actively working registered nurses in paid nursing positions in Indiana, as shown in Table 1.3. Table 1.3 Current Work Status of Indiana Registered Nurses, 2005 Work Status Number Percent Actively working in a paid position in nursing *43, Actively working in paid position in health care, but not in nursing 1, Actively working, but not in nursing or in health care Working in nursing, but ONLY on a non-paid basis Unemployed and seeking work as a nurse in Indiana Temporarily inactive as a nurse Retired from nursing or permanently inactive as a nurse Total Valid Responses 46, No response on work status 147 Total Living or Working in Indiana 46,429 * 3 suspended nurses were included as actively working in a paid registered nurse position in this table, but were excluded from the data analysis. Thus, data on 43,161 nurses active in Indiana are shown in the tables in the following sections. Limitations of the Survey Several concerns with the survey instrument, the administration of the survey, and with the consistency of nurses responses were raised during discussions with members of the advisory committee. Appendix 3 includes recommendations for improvement, along with the justifications for the proposed changes. Implementing these recommendations will improve the validity and reliability of the data collected and reported. However, implementing some of the changes will reduce the ability to measure time trends since specific items may not be comparable. The authors of this report believe it is more important to improve the quality of the data than to continue to collect flawed data for the sake of comparisons with earlier surveys. Organization of this Report The following chapters in this report present the results of several different analyses of the 2005 registered nurse survey data. Chapter 2 provides tables summarizing the responses to all of the survey questions as well as the additional licensing and age data provided by PLA. Graphs illustrating responses to key items are also shown. Summary statements relating to the tables and graphs are presented in text form following each table and graph. When comparisons are made between the 2005 and the earlier surveys, the percentages of responses are discussed in the text, rather than the number of nurses. The numeric trends over time are estimated in Chapter 6, in which the estimated number of nurses each year 3

10 included a correction for the differing response rates of the surveys. Chapter 3 shows the relationships between the nurses demographic, personal and professional characteristics. Four sets of tables are included that break down the respondents characteristics by level of education, by principal position, by work setting and by key activities. The response options for principal position, work setting and key activities were collapsed into general themes. The results of these analyses are presented as crosstabulation tables showing both the number of respondents and percent of respondents within each cell. Chapter 4 focuses on the characteristics of the faculty in nursing education programs and on advanced practice nurses (APN). Chapter 5 presents maps of Indiana and tables showing the number of nurses and the ratio of nurses to population in each county. Chapter 6 uses the responses from the 1997, 2001, 2003 and 2005 registered nurse surveys to project time trends for a number of nurse characteristics. The analysis of trends corrected for the three surveys differing response rates. Since the projections are based on values at only four points in time, the projections should be interpreted with caution. None-the-less, it is important to consider the apparent trends. Chapter 7 summarizes the results of the data analysis. 4

11 Chapter 2: Responses to the 2005 Indiana Registered Nurse Survey This chapter summarizes the responses to the items included on the 2005 Indiana Registered Nurse Survey as well as the additional registered nurse data provided by the Indiana Professional Licensing Agency. Unless otherwise noted, the number of respondents for the 2005 registered nurse survey shown in the tables below was 43,161. The number of missing responses is shown for each question and only the percentages of valid responses are shown. Where possible, comparisons are presented between the responses to the 2005 and prior surveys (1997 and 2001). The total respondents to the 1997 and 2001 surveys were 38,721 and 45,615 respectively. The 2003 survey results are not reported because the response rate was lower (66%) increasing the possibility of a non-response or self-selection bias among those who did respond in Table 2.1 Age of Active Registered Nurses, 2005 Age Groups Number Percent 24 or younger 1, , , , , or older missing 390 Table 2.2 Age Groups of Inactive Registered Nurses, 2005 *Employed **Unemployed Age Groups Number Percent Number Percent 24 or younger or older missing Total 2, * Employed or volunteering, but not in a paid registered nurse position. ** Unemployed and seeking work as a nurse in Indiana, temporarily inactive as a nurse, or retired from nursing. Tables 2.1 and 2.2 show age data from the 2005 survey. These data are somewhat biased relative to all nurses because nurses with newly-issued licenses (who are often among the youngest) were not included in this survey (it was taken upon re-licensure). Among survey respondents active in Indiana, Table 2.1 shows that about one-half were 45 years of age or older (33.5% % + 1.8%). About onefourth (20.0% + 2.9%) were under age 35. Respondents not working as nurses in 2005 are shown in Table 2.2. These inactive nurses tended to be older than the active nurses (the percentage of respondents in higher age groups was larger and the percentage in lower age groups was smaller). Among those who were employed or volunteering, about 64 percent were age 45 or older. Over 74 percent of the unemployed, inactive nurses were 45 or older. Figures 2.1 through 2.3 compare the age distributions graphically. 5

12 Figure 2.1 Age Groups of Active Registered Nurses, % 65 or older 2% 24 or younger 3% % % % *Nurses in their initial license period are not in this sample. Younger nurses may be under-represented. Figure 2.2 Age Groups of Employed, Inactive Registered Nurses, % 65 or older 6.6% 24 or younger 0.6% % % % *Nurses in their initial license period are not in this sample. Younger nurses may be under-represented. Figure 2.3 Age Groups of Unemployed, Inactive Registered Nurses, or older 22.3% 24 or younger 0.4% % % % % *Nurses in their initial license period are not in this sample. Younger nurses may be under-represented. 6

13 Table 2.3 Age Groups of Registered Nurses, 1997, 2001, and * 2001* 2005 Age Groups Number Percent Number Percent Number Percent 30 or younger 4, , , , , , , , , , , and older , missing * Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission. Available at: (and /01nurse/toc.htm) Table 2.3 shows the age distribution of active registered nurses in 1997, 2001, and Generally speaking, the age 45 and older group grew from 1997 to 2001, while the group younger than 45 decreased. Table 2.4 Gender of Registered Nurses, 1997, 2001, and * 2001* 2005 Gender Number Percent Number Percent Number Percent Female 36, , , Male 1, , , Missing * Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission. A trend toward more male registered nurses is shown in Table 2.4. While nearly 95 percent of nurses were female in 2005, the percentage male steadily increased from 3.7 percent in 1997 and 4.3 percent in There was a nearly 40 percent increase from 1997 (1,403 to 2,182). Table 2.5 Race of Registered Nurses, 1997, 2001, and * 2001* 2005 Race Number Percent Number Percent Number Percent White 36, , , Black/African American 1, , , Asian/Pacific Islander American Indian / Native Alaskan Multi-racial **NA **NA Other Missing * Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission. ** NA- not asked -- "Multi-racial" was not included as a response option on the 1997 survey. The percentage of registered nurses reporting their race as White decreased slightly from 1997 to 2005 as shown in table 2.5. The percentage reporting Black/African American rose between 1997 and 2001, but not between 2001 and There was little change in the percent of nurses identifying with Other racial groups throughout the period. 7

14 Table 2.6 Ethnicity of Registered Nurses, 1997, 2001, and * 2001* 2005 Hispanic Origin Number Percent Number Percent Number Percent Hispanic Origin Not of Hispanic Origin 35, , , Missing 2,347 4, * Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission. Registered nurses reporting Hispanic ethnicity increased over the 1997 to 2005 period. However, only 658 respondents identified themselves as Hispanic in 2005, about 1.5 percent of all nurses active in Indiana. Many more nurses responded to this question in the 2005 survey; over four thousand had skipped this question in Table 2.7 Highest Degree in Nursing, 1997, 2001, and * 2001* 2005 Highest Degree in Nursing Number Percent Number Percent Number Percent Diploma** 8, , , Associate 17, , , Bachelor's 11, , , Master's 1, , , Doctorate Missing * Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission. ** Although a nursing diploma is not a degree, the survey question language of highest degree will be followed in this report to avoid awkwardness and confusion. Table 2.7 shows a very clear trend toward higher nursing degrees between 1997 and The proportion with a nursing diploma has greatly declined (from 21.0% to 10.7%) reflecting the decline in diploma training programs. The proportion with a master s degree or higher has greatly increased (from 4.6 % to 7.9 %) while those with a bachelor s degree increased from 30.2 percent to 36.7 percent. Figures 2.4 through 2.6 below highlight the changes in nursing education among registered nurses, particularly the decrease in the percentage of nurses with nursing diplomas. Figure 2.4 Highest Nursing Degree, Registered Nurses, 1997 Doctorate 0.2% Bachelor's 30.2% Master's 4.4% Diploma 21% Associate 44.2% 8

15 Figure 2.5 Highest Nursing Degree, Registered Nurses, 2001 Master's 6.2% Doctorate 0.4% Diploma 14.7% Bachelor's 34.8% Associate 43.9% Figure 2.6 Highest Nursing Degree, Registered Nurses, 2005 Master's 7.2% Doctorate 0.6% Diploma 10.7% Bachelor's 36.8% Associate 44.7% Table 2.8 Highest Degree in Any Field, Registered Nurses, 2005 Highest Degree in Any Field Number Percent Diploma 4, Associate 17, Bachelor's 17, Master's 4, Doctorate Missing 135 ** Although a diploma is not a degree, the survey question language of highest degree will be followed in this report to avoid awkwardness and confusion. In 2005, unlike in the earlier surveys, nurses were asked about their highest degree in any field as shown in Table 2.8. Since, by definition, each nurse s response to highest degree in any field cannot be lower than their response to highest degree in nursing, the distribution is higher in Table 2.8 than in Table 2.7 (a greater percent of higher degrees and lower percent of lower degrees). But Tables 2.7 and 2.8 cannot be directly compared to analyze how many individual nurses have a higher degree in a field other than nursing. A separate analysis of individual nurse s responses (not shown) was done to quantify the extent to which nurses have higher, non-nursing degrees. This analysis showed that among the 17,296 nurses reporting a Bachelor s degree of some kind, 12.7 percent (2,201 nurses) had a lower-level nursing 9

16 degree. Among 4,090 respondents with a master s degree, about 25 percent (1,024 nurses) did not have a master s degree in nursing. There were 457 nurses who held doctorates as shown in Table 2.8. Of those nurses, 42.5 percent (194 nurses) held doctorates only in non-nursing fields. Nurses with higher degrees in non-nursing areas vary on their level of nursing degrees. For example, the 194 nurses with non-nursing doctorates had nursing degrees ranging from the nursing diploma to the master s of nursing. Table 2.9 Desired Future Nursing Degrees, Registered Nurses, 2005 Degree Number Percent Associate Bachelor's 158 6, Master's 8, Doctorate 1, Total desiring a higher degree 16, No higher degree desired 20, missing 5,392 Table 2.9 shows that 44.7 percent of respondents in 2005 desired a higher nursing degree than they currently hold. This percentage would be 39.1 (not shown) even if it was assumed that all the 5,392 nurses who skipped this question did not desire a higher degree. Figure 2.7 Desired Future Nursing Degrees of Registered Nurses, 2005 Doctorate 7% Associate 1% Bachelor's 40% Master's 52% Figure 2.7 shows the distribution of degrees sought by the 16,887 nurses desiring higher degrees shown in Table 2.09 above. Over half (52%) of the nurses represented in Figure 2.7 wanted a master s degree. Table 2.10 Fluency in Other Languages, Registered Nurses, 2005 Language Number Percent Spanish Filipino Tagalong French German Hindi Chinese Polish Other Total 1, Few registered nurses (3.94%) reported fluency in languages other than English in However, fluency is a high standard in language proficiency. If the question were worded differently, such as, Do you have the ability to communicate languages other than English? one would expect that a higher percentage of registered nurses would indicate that they have such ability. Spanish was the most 10

17 common fluent language (1.49%) followed by the languages of the Philippines (1.09%) [which include Tagalong (0.50%) and Filipino (0.59%)]. Table 2.11 Principal Work Settings of Registered Nurses, 1997, 2001, and * 2001* 2005 Principal Work Settings Number Percent Number Percent Number Percent Hospital (in-patient) 9, , , Hospital (in- & out-patient) 10, , , Hospital (out-patient) 1, , , Hospital ER/ED 1, , , Hospital Total 22, , , Ambulatory care setting (surgical/other) 1, , , Physician/dentist private office 2, , , Primary care center/clinic Community/public health clinic Urgent care center/clinic Clinic/Office Total 5, , , Long-term care facility/unit 3, , , Mental health/addictions facility/unit , Care facility/unit Total 3, , , Home care/hospice 3, , , School/college setting 1, , , Nursing education Other 1, , , Missing ,466 * Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission. Table 2.11 shows the principal work settings of registered nurses in 1997, 2001, and There was a large increase in missing data and in the other category between 2001 and Over 5,000 survey respondents either skipped this question or answered other in 2005 suggesting that this question may have been unclear. Appendix 3 discusses this issue in detail and makes a recommendation to clarify this item. The majority of nurses worked in a hospital setting and the percentage has been increasing slightly over time (see Hospital Total in Table 2.11). There was an increase in nurses working the Hospital ER/ED setting (3.3% to 5.1%). There was a decrease in the Hospital (in- & out-patient) setting and a corresponding increase in the Hospital (in-patient) setting; a shift of more than 5 percentage points from 2001 to Among the clinic and office settings, the percentage of nurses working in Ambulatory care setting (surgical/other) nearly doubled between 1997 and 2005 (3.1% to 5.9%). Another trend was a decline in the home care/hospice category between 1997 and 2001 (9.1% to 5.4%). These conclusions about trends in the work settings of registered nurses should be interpreted with caution due to the large number of other responses and non-responses to this question. The work setting question also may not be fully comparable over time due to the difference between the 2005 response options and those of earlier surveys. The choices in Table 2.11 were the only ones included in the 1997 and 2001 surveys, but the 2005 results were compiled from a larger list of response options presented in Table 2.12 on the next page. An asterisk (*) indicates options not available in the previous surveys. 11

18 Table 2.12 Principal Work Settings of Registered Nurses, 2005 Principal Work Settings Number Percent Hospital (in- & out-patient) 8, Hospital (in-patient) 12, Hospital (out-patient) 1, Hospital ER/ED 2, Hospital operating room * 1, Ambulatory care setting (surgical./other) 2, Physician/dentist private office 1, Primary care center/clinic Community health center/clinic Urgent care center/clinic Long-term care/extended care facility/unit 1, Long-term acute care facility/unit * Psychiatric inpatient facility/unit * Mental health/addictions facility/unit Home health care agency * (formerly w/hospice) 1, Hospice * (formerly w/homecare) Continuing education/staff development * Drug company * Insurance company * Nursing education program Prison * Public health department (city, county or state) * School/college setting 1, Adult day care * Assisted living facility/unit * Community mental health center * Community substance abuse agency * Supplemental staffing agency * Law firm * Non-residential care facility/unit * Occupational health setting * Private duty nursing * Research setting * Federal agency * State agency (other than state public health department) * Other Missing 2,466 Table 2.13 More than One Paid Position as a Registered Nurse, 2005 More than One Paid Position Number Percent Yes 6, No 36, Missing 140 About one out of seven respondents (14.1%) indicated that they had more than one paid position as a registered nurse in This question was not asked on earlier Indiana registered nurse surveys. 12

19 Table 2.14 Registered Nurse Principal Position, 1997, 2001, and * 2001* 2005 Principal Positions Number Percent Number Percent Number Percent Direct patient care 23, , , Indirect patient care 10, , , Nursing related business Education 1, , , Advanced Practice Nurse (APN) 1, , , Other 1, , , missing * Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission. Table 2.14 shows the principal nursing position reported by respondents in 1997, 2001, and The categories in the table were defined from a much longer list on each of the surveys. Between 1997 and 2005 there was a decrease in Indirect patient care, but all other categories increased. Differences over time shown in Table 2.14 should be interpreted with caution due to changes in response options to this question from one survey to the next. The full list of principal position response options for all three surveys is presented in Table 2.15 below (continued on the following page). Table 2.15 RN Principal Position, 1997, 2001, and 2005: Components of Major Categories Principal Positions * 1997 * Major categories % of % of % of category category category Direct patient care 27,490 29,486 23,153 Staff/general nurse 11, , , Critical care nurse 4, Office nurse 2, , , Operating room nurse 2, ER/ED nurse 2, Home care nurse 1, , , School nurse , Psychiatric nurse Longterm care nurse , Hospice nurse Public health nurse Dialysis nurse Occupational health nurse Prison nurse Private duty nurse Indirect patient care 9,314 10,460 10,573 Administrator/manager 2, , , Charge nurse/team leader 2, , , Case manager/care coordinator 1, , , Infection control nurse Quality assurance/utilization review Director of nursing Head nurse or assistant head nurse , , Nurse clinician * Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission. 13

20 Table 2.15 RN Principal Position, 1997, 2001, and 2005: Components of Major Categories (continued) Principal Positions * 1997* Major categories % of % of % of category category category Nursing related business Nursing consultant Temporary nurse staffing service Legal consultant Education 1,402 1,243 1,144 Faculty in a nursing program Continuing education/staff development Diabetes educator Advanced Practice Nurse (APN) 1,904 1,806 1,097 Nurse Practitioner 1, , Clinical Nurse Specialist **Certified Nurse Anesthetist Certified Nurse Midwife Other 2,566 2,156 1,795 Other 2, , , Researcher * Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission. **The Certified Nurse Anesthetist position does not require an Indiana certification and was not included in analyses of Advanced Practice Nurses in the 1997 and 2001 Indiana Registered Nurse Survey Databooks. This position is included in the APN category here following the practice of the National Sample Survey of Registered Nurses (NSSRN). Table 2.16 Activities in Principal Position of Registered Nurses, 2005 Activities in Principal Position Number Percent Administration 4, Case management/care coordinator 6, Community health activities 2, Consulting with agencies/other professionals 5, Continuing education/staff development 6, Direct patient care 33, Environmental health (air, water, food safety) Financial management 1, Infection control 4, Medication management 8, Patient education/counseling 14, Program management 2, Policy and planning 5, Prenatal care coordination Psychiatric nursing 1, Public health activities 1, Quality assurance/utilization review 3, Research 1, Staff supervision/management 7, Teaching nursing students 4, Other 6, This question (Table 2.16) measured all of the activities the nurses perform in their principal position; the respondents were instructed to mark all that apply. Consequently, the responses on this table 14

21 will not match the similar categories in the Principal Position tables. This was a new question in the 2005 survey that was not included in the 1997 and 2001 registered nurse surveys. Over three-quarters of the nurses (76.8%) indicated that they provided direct patient care and one-third (33.6%) provided patient education and/or counseling. Other common activities listed by at least 10 percent of the respondents were: medication management (19.3%), staff supervision/management (18.3%), case management/care coordinator (15.4%), continuing education/staff development (14.4%), consulting with agencies/other professionals (12.9%), policy and planning (12.4%), infection control (11.1%), administration (10.7%), and teaching nursing students (10.6%). Table 2.17 Age of Patients Most Frequently Served by RNs, 2005 Age of Patients Number Percent Infants (0-4) 11, Children (5-9) 10, Adolescents (10-14) 10, Youth (15-19) 14, Adults (20-64) 31, Elders 65 and older 26, RN does not provide direct patient services This question (shown in Table 2.17) asked respondents to indicate the age of patients that they most frequently serve. However, they were also instructed to select all that apply. These two instructions appear to contradict each other. This is a new question in the 2005 survey that was not included in the 1997 or 2001 registered nurse surveys. For 2005, 74.1 percent of the respondents indicated that they cared for adults and 62.0 percent cared for elders. Many of the nurses who did not provide direct patient care (based on responses to earlier questions) did not select the I do not provide direct patient care services response option (based on separate analysis not shown). Table 2.18 Registered Nurses' Average Number of Weekly Hours Worked in all Activities in Nursing, 2001 and * 2005 Average Number of Weekly Hours Number Percent Number Percent 9 hours or less 1, , , , , , , , hours or more 23, , Missing * Indiana Registered Nurse Survey Databook 2001, Indiana Health Care Professional Development Commission. The 2001 registered nurse survey asked the question shown in Table 2.18 by allowing the respondent to write in a specific number of hours worked in all activities in nursing. In 2005, the respondents were asked to choose a category of hours worked from a drop-down list. In 2005, nearly onehalf (47.1%) selected the 40 or more response option which would indicate full time status for nurses working one job. It is likely that some of the respondents who chose the response option in 2005 may also be full-time employees since 36 hour (3 x 12) full-time options are sometimes available. The percentage of nurses reporting hours was up from 26.2 percent in 2001 to 31.5 percent in Since the hour category may be too wide to evaluate the number of 36 hour full-time nurses, future surveys should allow more response options or allow the entry of a specific number of hours. The distribution of Average Number of Weekly Hours Worked for 2005 is shown graphically in figure 2.8 on the next page. 15

22 Figure 2.8 Registered Nurses' Average Number of Weekly Hours Worked, hours or more 47% 9 hours or less 2% % % % Table 2.19 Registered Nurses with Prior Work Experience, 2005: Prior Work Experience Number Percent Certified Nurse Aide 7, Nursing Assistant 12, Paramedic Emergency Medical Technician 1, Licensed Practice Nurse 6, One or more of these 21, None of these 21, The question on registered nurses with prior work experience presented in Table 2.19 was not included in the 1997 or 2001 surveys, so no comparisons of responses to the 2005 survey are possible. Nearly half of the respondents (49.2%) reported work experience in one or more of these health care occupations before they became a Registered Nurse. Most commonly (28.6%), that previous work experience was as a Nursing Assistant. Table 2.20 Years of Licensure of Registered Nurses, 2005 Years of Licensure Number Percent 5 years or less 8, , , , , , years or more 4, This data element was not a survey item. It was provided by the Indiana Professional Licensing Agency to accompany the 2005 registered nurse survey data set. It was not included in the reports summarizing the earlier surveys. Well over one-third of the respondents (38.4%) had been licensed to practice in Indiana for less than 10 years. Over one-half (56.0%) had been licensed in Indiana for less 16

23 than 15 years. Nearly one-third (31.8%) had been licensed more than 20 years. Figure 2.9 below presents the same data graphically. Figure 2.9 Years of Licensure of Registered Nurses, % 30 years or more 11% 5 years or less 20% % % % % 17

24 Chapter 3: Crosstabulations from the 2005 Indiana Registered Nurse Survey The data analysis presented in this chapter shows the relationships between specific demographic and professional characteristics of the Registered Nurses responding to the 2005 survey. There are four sections in this chapter showing the breakdown of responses by level of education ( Highest Degree in Nursing ), collapsed setting groups, collapsed principal position groups and collapsed major activities groups. In the discussion of the tables, categories of these variables (the columns) will appear in bold type. Marginal totals are not shown on these tables; please refer to Chapter 2 for discussion of the distribution of individual variables. Statistical tests are not presented on the bivariate relationships shown in this chapter. The large number of cases would result in statistically significant results for virtually all of the tables. In spite of their statistical significance, these bivariate relationships may not be important from a practical perspective. Nurse Characteristics by Highest Degree in Nursing Table 3.1 Age and Highest Degree in Nursing of Registered Nurses, 2005 Diploma Associate Bachelor's Master's Doctorate Age Groups # % # % # % # % # % Under , , , , , , , , , , , or older Nurses with diplomas and those with master s and doctorate degrees were older while those with associate and bachelor s degrees were younger. Younger nurses would be less likely to have diploma-level training because the number of nursing diploma programs has declined in Indiana. Also, younger nurses would not be as likely to have higher degrees because of the time required to obtain them. Table 3.2 Race and Highest Degree in Nursing of Registered Nurses, 2005 Diploma Associate Bachelor's Master's Doctorate Race # % # % # % # % # % White 4, , , , Black/African American Asian/Pacific Islander American Indian/Native Alaskan Multi-racial Other Level of education and race of the respondents do not appear to be related, except that those with nursing diplomas were more often White and less often Black/African American. 18