A Brief Review of Nursing Workforce Research from The Oregon Center for Nursing Kris Campbell RN, PhD campbelk@up.edu 503-943-7184 In 2001, the Oregon Nursing Leadership Council (ONLC), comprised of the major statewide nursing leadership organizations, released its comprehensive strategic plan that set forth an agenda for addressing Oregon s nursing shortage. The Oregon Center for Nursing (OCN) was established to carry out ONLC s strategic plan. In 2005, OCN published an assessment of Oregon s registered nurse workforce titled When, Not If A Report on Oregon s Registered Nurse Workforce. Key findings included: Nursing education programs were expanding to double enrollment as planned. Between 2001 and 2004, the number of graduates from RN education programs increased by 45 percent. Oregon had a large pool of qualified nursing school applicants, two to three times more than educational capacity. More new RN licenses were issued annually to experienced nurses moving to the state than to recent nursing school graduates. Nearly one-half of Oregon s RNs were 50 years of age or older. The proportion of nurses over 50 had more than doubled over the past 20 years. An exodus of retiring nurses was underway. By 2025, 41 percent of currently licensed RNs were expected to retire. Demand for RNs would continue to grow steadily. An additional 15,700 RN job openings were expected statewide over the next 15 years. The age distribution of Oregon s population would change dramatically over the next 20 years. The number of Oregonians 65 years of age or older was set to exceed one million by 2025, accounting for nearly 25 percent of all Oregon residents. Specific recommendations derived from the study were: Implement strategies to retain nurses currently working in Oregon. Continue aggressive efforts to increase educational supply. Transform the work, roles, and work environments of professional nurses. Support nurses to practice autonomously, and to deliver the full scope of nursing care services for which they are licensed. Recruit nurses to, or back home to, Oregon. Improve representation of ethnic minorities and males in the nursing workforce. Encourage nurses who have left the workforce to return. Fund advanced nursing education. Expand nurse workforce research efforts.
The following charts and tables illustrate some important facts about Oregon s nurse workforce. Figure 1 shows the annual increase in the number of actively licensed RNs in Oregon over the past 15 years. The number of active Oregon RN licenses has grown by 37 percent since 1995. On average, the number of licensees increases by 600 RNs annually. Figure 1. Registered Nurses Actively Licensed in Oregon, 1995-2009 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 2.3% 1.7% 2.1% 2.6% 1.1% 0.5% 0.7% 4.3% 3.0% 1.0% 2.2% 32,469 33,012 33,695 34,570 34,954 35,144 35,403 36,928 38,042 38,425 39,276 40,456 41,972 43,167 44,480 3.0% 3.7% 2.8% 3.0% 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 5.0% 4.5% 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% Number of Licensees Percent Change from Previous Year Figure 2 shows the age distribution of the nurse workforce in Oregon. More than one-half of Oregon s nurses are over 50. The 20-29 and 30-39 year age cohorts are expanding while the 40-49 year age cohort is shrinking. Figure 2. Oregon s Licensed Registered Nurses by Age Cohort, 2000 and 2009 20-29 years 30-39 years Age 40-49 years 50-59 years 60-69 years 70+ years -50% -40% -30% -20% -10% 0% 10% 20% 30% 40% 50% Percent of Licensed RNs 2000 2009 5000 N Willamette Blvd, MSC 192 Portland, OR 97203 2
Figure 3 shows the number of RN licenses issued in Oregon over the past 15 years. More nurses are licensed by endorsement (experienced nurses moving here from another state) than by exam (new nursing program graduates seeking initial licensure). Figure 3. Registered Nurse Licenses Issued in Oregon, 1995-2009 2207 2293 2105 Number Issued 1644 1427 1270 1230 880 830 819 863 1476 1156 776 782 1383 950 786 1817 1643 1297 1408 1319 1227 1198 1053 1073 1805 1413 1465 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Fiscal Year by Exam by Endorsement Figure 4 depicts the age of nurses when they receive their Oregon RN license. On average, those licensed by exam are in their early thirties while those licensed by endorsement are in their early 40s. Figure 4. Average Age of Oregon RNs at Time of Licensure, 1996-2008 39.2 39.1 39.6 39.8 41.6 42.7 41.6 Average Age (yrs) 33.5 32.2 31.2 30.5 31.4 32.1 31.8 1996 1998 2000 2002 2004 2006 2008 by Exam by Endorsement 5000 N Willamette Blvd, MSC 192 Portland, OR 97203 3
Table 1 and Figure 5 describe Oregon s pre-licensure RN education programs, the supply pipeline of nursing students, and the number of nursing program graduates. Note the increase in number of graduates since 2001. Table 1. Description of ADN and BSN Nursing Education Programs in Oregon Associate Degree (ADN) Baccalaureate Degree (BSN) Number of programs 15 6* Where offered Community colleges Colleges and Universities Number of enrolled students (2008) 1,387 1,752 Number of graduates (2008) 613 564 Increase in graduations since 2001 58% 84% * The Oregon Health & Science University School of Nursing offers programs in five locations. Figure 5. Graduations from Associate and Baccalaureate Degree Nursing Programs in Oregon, 1995-2008 909 919 1033 1168 1194 1200 Number of Gradua 701 711 711 704 712 651 694 388 404 431 375 406 400 387 313 307 280 276 298 312 307 780 429 351 497 522 412 397 568 465 599 569 600 594 636 564 1995 1996 1997 1998 1999* 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year BSN Graduates ADN Graduates Total Graduates 5000 N Willamette Blvd, MSC 192 Portland, OR 97203 4
In 2009, the Oregon Center for Nursing published two additional studies. Who Gets In? Pilot Year Data from the Nursing Student Admissions Database Pilot Project examines the actual number of applicants to Oregon s nursing programs, accounting for redundant applicants, and reveals Oregon s nursing programs accept almost half of all applicants (see Table 2). Table 2. Application, Applicant, and Enrolled Student Pools: Oregon Pre-licensure Registered Nurse Education Programs, 2008-2009 Oregon ADN Programs Oregon BSN Programs Oregon RN Programs Applications* 3,308 2,878 6,186 (% all Oregon program applications) (53%) (47%) (100%) Applicants* 2,343 2,025 3,821 (% all Oregon program applicants) (61%) (53%) (100%) Multiple Program Applicants 38% 46% 34% Unqualified Applicants 7% 19% 12% Qualified Applicants 93% 81% 88% Qualified Applicants Not Accepted 61% 43% 49% Accepted Applicants (Selectivity Rate) 36% 46% 45% Accepted Applicants Enrolled (Yield Rate) 81% 81% 85% Available Seats 697 758 1,455 Qualified Applicants per Seat 3.1 2.2 2.3 Source: Oregon Center for Nursing, Nursing Student Admissions Database Pilot Project (2008-2009). Percentages are within group unless otherwise noted *Includes students pre-admitted as sophomores contingent upon passing grades in pre-requisite courses NOTE: Those applying to both ADN and BSN programs are included in both the ADN and BSN Programs columns as well as the Oregon RN Programs column. Oregon s Nurse Faculty Workforce describes the status of Oregon s nurse faculty. The report highlights the shortage of nurse faculty and the increase in faculty workload that has accompanied the doubling of enrollment in Oregon s nursing programs. Figure 6. Numbers of Nurse Faculty and Enrolled Nursing Students, 2001 & 2008 3581 1677 465 529 Student:Faculty Ratio=3.6 2001 Student:Faculty Ratio=6.8 2008 *Enrolled nursing students Nurse Faculty * Includes enrollees in Practical Nursing, Associate Degree, and Baccalaureate Degree programs. 5000 N Willamette Blvd, MSC 192 Portland, OR 97203 5
Addendum The Oregon Health Workforce Project The Oregon Health Workforce Project, a first-of-its-kind effort in Oregon to quantify the supply of health care professionals, was funded by the Northwest Health Foundation and carried out by Oregon Health & Science University s Oregon Area Health Education Centers (AHEC) Program. Together with key stakeholders representing a variety of constituencies interested in issues surrounding health workforce requirements, AHEC conducted surveys of Oregon s licensed health professionals in 2000 and 2002. 1 As a first step toward carrying out the project s mission, the Statewide AHEC Program convened a Health Workforce Interest Group in December 1998. Representatives from the following organizations, agencies, educational institutions and health professions licensing boards participated: Oregon Board of Dentistry Oregon Board of Medical Examiners Oregon Medical Association Oregon State Board of Nursing Oregon Department of Education Oregon Employment Department Oregon Health Division Oregon State Department of Labor Office of Community Colleges Office of Health Policy and Research OHSU Department of Family Medicine OHSU Oregon AHEC Program OHSU Physician Assistant Program OHSU School of Dentistry OHSU School of Medicine OHSU School of Nursing Oregon Association of Hospitals and Health Systems Oregon Dental Association Oregon Dental Hygienists Association Oregon Health Policy Institute Oregon Nurses Association Oregon Office of Rural Health Oregon Society of Physician Assistants Multnomah County School/Community Dental Health Salem Hospital Ultimately, the survey did not allow for the quantification of the supply of health care professionals in Oregon, but the descriptive profiles and lessons learned from this project were an important first step in improving our understanding of Oregon s health workforce information needs and estimating workforce shortfalls and excesses. 1 The 2000 survey targeted registered nurses, nurse practitioners, physicians, physician assistants, dentists, and dental hygienists. The 2002 survey included the six aforementioned groups and pharmacists. 5000 N Willamette Blvd, MSC 192 Portland, OR 97203 6