NCHWA s Nursing Workforce Research Activities and Findings

NCHWA s Nursing Workforce Research Activities and Findings Jennifer Nooney, PhD Public Health Analyst, National Center for Health Workforce Analysis U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Health Professions National Center Webinar Series May 14, 2013

The HRSA National Center for Health Workforce Analysis Mission To support more informed public and private sector decision making related to the health workforce through expanded and improved health workforce data, projections and information. To promote the supply and distribution of wellprepared health workers to ensure access to high quality, efficient care for the nation. 2

Goals of the Presentation Review the National Center s approach to nursing workforce analysis Present key findings on nursing workforce trends Discuss key sources of data on the nursing workforce 3

NCHWA Approach to Nurse Workforce Analysis A. Build on Existing Data Sources B. Promote a Nursing Minimum Dataset C. Collect Original Data Where Needed D. Nursing Workforce Projections E. Collaboration 4

A. Build on Existing Data Sources Assess, analyze, and compile existing data for reports Work with other organizations to improve nursing data collection: National Ambulatory Medical Care Survey enhancements Participation on the Standard Occupational Classification (SOC) policy committee 5

B. Promote a Nursing Minimum Dataset (MDS) In 2010, HRSA began establishing a MDS across more than a dozen professions (including nursing) Building on existing MDS efforts in nursing begun by the National Council of State Boards of Nursing and the National Forum of State Nursing Workforce Centers Goal is to cost-effectively integrate workforce data collection into nurse license renewal at the state level This is the only strategy that will yield local-area data on an ongoing basis for workforce analysis and planning. 6

C. Collect Original Data Where Needed When key data elements are missing for a critical health occupation, undertake original data collection 2012 National Sample Survey of Nurse Practitioners Growing importance of NPs for primary and other care Lack of reliable estimates of workforce size, specialty, and employment characteristics Data collected from about 13,000 NPs (60% response rate) Survey will support policy analysis and workforce projections 7

D. Nursing Workforce Projections 2012: Conducted background research and outreach to inform modeling Research on economic drivers of nurse workforce participation and migration Outreach to stakeholders in education, practice, and policy 2013: Developing new nurse workforce forecasting models using microsimulation modeling of both nurse supply and demand Tool will facilitate detailed forecasting at the state level Upcoming clinical projections by medical specialty will integrate Nurse Practitioners and Physician Assistants. 8

Interagency Consortium on Nursing Statistics (ICONS) member Dissemination of analysis and projections Webinars Reports Modeling tools E. Collaboration Supporting organizations involved in minimum dataset implementation Working with states to develop analysis capacity 9

The U.S. Nursing Workforce: Trends in Supply and Education The Report s Objective Provide timely information, easily updatable, on key nursing workforce metrics for policymakers, workforce planners, and researchers Explore existing federal and non-federal data sources for nurse workforce analysis Include both RNs and LPNs Available at: http://bhpr.hrsa.gov/healthworkforce/reports/nursingwork force/index.html 10

Supply Data Sources Census Bureau s American Community Survey (ACS) 2008-2010 Public Use Microdata Sample Approximately 3% sample of US residents yields a large sample of RNs and LPNs Robust estimates at national and state level New file available annually Census 2000 Long Form, 5% Public Use Sample Techniques available for comparing to the ACS 11

Nursing Workforce Size Estimated # of Nurses in the Nursing Workforce Nurses per 100K residents RNs 2,824,641 920.9 LPNs 690,038 225.0 Data Source: HRSA analysis of the ACS 2008-2010 three-year file But, distribution across the country is uneven... 12

The RN Workforce per 100,000 Population, by State Data Source: HRSA analysis of the ACS 2008-2010 three-year file 13

The LPN Workforce per 100,000 Population, by State The RN Workforce per 100,000 Population, by State Data Source: HRSA analysis of the ACS 2008-2010 three-year file 14

Distribution Across Rural and Urban Areas 1,000 852.7 934.8 920.8 800 600 400 200 318.3 205.8 225.0 0 RNs LPNs Per Capita Rural Per Capita Urban Per Capita U.S. Data Source: HRSA analysis of the ACS 2008-2010 three-year file 15

Nursing Workforce Trends: Growth Workforce 3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000,000 500,000 0 15.5% Growth 597,523 690,038 LPN Census 2000 Long Form 24.1% Growth 2,275,276 2,824,641 RN ACS 08-10 Three-Year File Per Capita Supply 2000 Per Capita Supply 08-10 % Change in per Capita Supply RNs 808.5 920.9 13.9% LPNs 212.3 225.0 6.0% Data Sources: HRSA analysis of the ACS 2008-2010 three-year file and Census 2000 Long Form 5% sample 16

Nursing Workforce Trends: RN Educational Attainment Associate's, 38.0% Bachelor's, 40.8% RN Diploma, 12.3% Graduate, 8.9% Master's, 8.6% Bachelor's, 44.6% Associate's, 37.9% Graduate, 10.6% RN Diploma, 6.9% Master's, 10.3% Doctorate, 0.3% Doctorate, 0.4% Data Sources: HRSA analysis of the ACS 2008-2010 three-year file and Census 2000 Long Form 5% sample 17

Nursing Workforce Trends: RN Age Distribution 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 500,000 450,000 400,000 350,000 300,000 250,000 200,000 150,000 100,000 50,000 0% 25 or younger 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 71-75 76 and older 0 25 or younger 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 71 and older Census 2000 ACS 08-10 Census 2000 ACS 08-10 Data Sources: HRSA analysis of the ACS 2008-2010 three-year file and Census 2000 Long Form 5% sample 18

Nursing Workforce Trends: RN Diversity Census 2000 (RNs) % ACS 08-10 (RNs) % ACS 08-10 (Wrk. Age Pop) % White 80.4 75.4 66.9 Black/African American 8.8 9.9 11.8 Hispanic/Latino 3.3 4.8 14.2 Asian 5.7 8.2 4.8 Am Ind/AK Native 0.4 0.4 0.6 Haw. Nat./ Pac. Isl. 0.1 0.1 0.1 Multiple/Other 1.3 1.3 1.5 Data Sources: HRSA analysis of the ACS 2008-2010 three-year file and Census 2000 Long Form 5% sample 19

Nursing Workforce Trends: Setting of Employment RNs LPNs Census 2000 % ACS 08-10 % Census 2000 % ACS 08-10 % Hospitals 62.7 63.2 34.9 29.3 Nursing Care Facilities 8.3 7.4 30.2 30.7 Offices of Physicians 6.9 4.8 11.2 8.2 Home Health Care Services 4.5 3.8 5.6 6.3 Outpatient Care Centers 3.1 4.6 3.6 5.7 Other Health Care Services 2.9 5.4 2.3 7.0 Elementary and Secondary Schools 2.3 2.2 0.8 1.7 Employment Services 2.0 2.1 3.4 3.8 Insurance Carriers and Related 1.0 0.9 0.3 0.2 Activities Administration of Human Resource 0.9 1.4 0.3 0.9 Programs Justice, Public Order, and Safety 0.7 0.6 1.0 1.3 Activities Offices of Other Health 0.6 0.3 0.9 0.4 Practitioners Colleges and Universities, Including 0.6 0.6 0.2 0.3 Junior Colleges Residential Care Facilities, Without 0.5 0.4 1.8 1.3 Nursing All Other Settings 3.1 2.5 3.6 3.4 Data Sources: HRSA analysis of the ACS 2008-2010 three-year file and Census 2000 Long Form 5% sample 20

Education and Pipeline Data Sources National Council of State Boards of Nursing NCLEX examination data American Association of Colleges of Nursing annual survey data Advanced practice credentialing bodies for nurse midwives and anesthetists 21

Pipeline Trends: Growth in Annual NCLEX-RN Passers Passers 150,000 140,000 130,000 120,000 110,000 100,000 90,000 107.7% Growth, 2001-2011 109,726 85,824 98,365 127, 592 116,045 137,834 134,027 142,390 80,000 70,000 60,000 70,474 75,821 68,561 50,000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Year Data Source: HRSA compilation of data from the National Council of State Boards of Nursing, Nurse Licensure and NCLEX Examination Statistics Publications, 2002-2012, and from the National Council of State Boards of Nursing, Number of Candidates Taking the NCLEX Examination and Percent Passing, by Type of Candidate, https://www.ncsbn.org/table_of_pass_rates_2011.pdf 22

Pipeline Trends: Growth in Annual NCLEX-RN Candidates, by Degree Type Candidates 100,000 90,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 43,927 24,832 44,871 Non-Bachelor's Candidates: 96.5% Growth, 2001-2011 50,056 25,821 26,632 56,543 30,628 63,690 35,496 69,357 41,346 73,793 45,772 79,375 82,467 49,736 52,260 85,475 55,407 Bachelor's Candidates: 134.6% Growth, 2001-2011 86,337 58,246 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Year Bachelor's-Prepared Non-Bachelor's Data Source: HRSA compilation of data from the National Council of State Boards of Nursing 23

Pipeline Trends: Growth in Annual NCLEX-PN Passers 70,000 Year 65,000 60,000 55,000 50,000 45,000 40,000 35,000 80.3% Growth 42,723 36,662 58,209 57,450 51,136 54,464 48,155 63,777 60,548 60,302 30,000 33,448 25,000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Passers Data Source: HRSA compilation of data from the National Council of State Boards of Nursing 24

Post-Licensure Education: RN-BSN Graduates RN-BSN Graduates 32,000 27,000 22,000 17,000 86.3% Growth, 2007-2011 16,802 19,606 22,531 27,845 12,000 14,946 2007 2008 2009 2010 2011 Year Data Source: HRSA compilation of data from the AACN Research and Data Center, 2012 25

Post-Licensure Education: Graduate Degrees Awarded 30,000 5,000 Master's Graduates 25,000 20,000 15,000 10,000 5,000 653 15,172 17,247 1,227 916 19,063 1,815 21,730 24,311 2,196 4,000 3,000 2,000 1,000 Doctoral Graduates 0 2007 2008 2009 2010 2011 Master's Graduates Doctoral Graduates 0 Data Source: HRSA compilation of data from the AACN Research and Data Center, 2012 26

Post-Licensure Education: NP Graduates NP Graduates 13,500 12,500 11,500 10,500 9,500 8,500 7,500 6,500 5,500 7,261 69.0% Growth, 2001-2011 6,979 6,611 6,526 7,583 6,900 8,865 8,014 9,698 11,135 12,273 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Year Data Source: HRSA compilation of data from the AACN Research and Data Center, 2012 27

25,000 Post-Licensure Education: International NCLEX-RN Passers 22,879 20,942 20,000 18,935 Passing Candidates 15,000 10,000 5,000 10,152 12,870 6,682 14,954 14,760 13,808 8,880 6,108 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Year Data Source: HRSA compilation of data from the National Council of State Boards of Nursing 28

Summary Strong growth in the nursing workforce over past decade, but current distribution uneven across the country Aging remains a concern, as one-third of workforce nears typical retirement ages Rapid growth in new entrants over the past decade, and strong growth in post-licensure education More work remains to project RN and LPN supply and demand into the future 29

Nursing Workforce Projects Underway Analysis of existing data on the nursing workforce The 2012 National Sample Survey of NPs Projections of RN supply/demand through 2025 Clinical projections including NPs, PAs and physicians Analysis of diversity within the health professions 30