2018 National Sample Survey of Registered Nurses Brief Summary of Results

U.S Department of Health and Human Services Health Resources and Services Administration

Bureau of Health Workforce National Center for Health Workforce Analysis

About the National Center for Health Workforce Analysis The National Center for Health Workforce Analysis (the National Center) informs public and private-sector decision-making on the U.S. health workforce by expanding and improving health workforce data and its dissemination to the public, and by improving and updating projections of supply of and demand for health workers. For more information about the National Center, please visit our website at http://bhw.hrsa.gov/healthworkforce/index.html.

Suggested citation: U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. 2019. Brief Summary Results from the 2018 National Sample Survey of Registered Nurses, Rockville, Maryland.

Copyright information: All material appearing in this documentation is in the public domain and may be reproduced or copied without permission. Citation of the source, however, is appreciated.

i

Table of Contents____________________________________________

List of Figures ................................................................................................................................................ ii

List of Tables ................................................................................................................................................. ii

Executive Summary ....................................................................................................................................... 1

Key Findings .................................................................................................................................................. 1

Summary of Survey Methodology ................................................................................................................ 2

Initial Findings from the NSSRN Survey ........................................................................................................ 3

The Workforce .......................................................................................................................................... 3

Demographics and Diversity ................................................................................................................. 4

Education and Training ............................................................................................................................. 6

Employment .............................................................................................................................................. 8

Telehealth ............................................................................................................................................. 9

Salary and Earnings ............................................................................................................................. 11

Appendix ..................................................................................................................................................... 12

ii

List of Figures_______________________________________________

Figure 1: Distribution of RNs by Graduation Year ........................................................................................ 3

Figure 2: Distribution of RNs by Age ............................................................................................................ 4

Figure 3: Distribution of RNs by Race and Ethnicity ..................................................................................... 5

Figure 4: Distribution of Race and Ethnicity by Initial Nursing Program Graduation Year .......................... 5

Figure 5: Initial Nursing Education ............................................................................................................... 6

Figure 6: Highest Nursing and Nursing-Related Educational Attainment .................................................... 6

Figure 7: Distribution of Advanced Practice Registered Nurse Licenses ..................................................... 7

Figure 8: Distribution of Full-Time/Part-Time Employment by Age Group ................................................. 8

Figure 9: Distribution of Employment Setting by Sex .................................................................................. 9

Figure 10: Telehealth in the Workplace ..................................................................................................... 10

Figure 11: Telehealth Usage by RNs ........................................................................................................... 10

Figure 12: Median Full-Time Earnings by Sex ............................................................................................ 11

Figure 13: Median Full-Time Earnings by Degree Type ............................................................................. 11

Figure 14: Median Full-Time Earnings by Advanced Practice Type ........................................................... 11

List of Tables________________________________________________

Table 1: RN Employment by State ............................................................................................................. 12

1

EXECUTIVE SUMMARY

The National Sample Survey of Registered Nurses (NSSRN) is the longest running survey of registered nurses (RNs) in the United States. Since its inaugural assessment in 1977, the NSSRN has provided educators, health workforce leaders, and policymakers with key details and developments of the nursing workforce supply. Considered the cornerstone of nursing workforce data, this comprehensive exploration provides a dynamic status of the RN population by revealing their demographics, educational attainment, licenses and certifications, and employment characteristics. These continued data collections have supported evaluations of government RN workforce programs, assisting in critical decision making affecting the U.S. healthcare system. Highlighting the intricacies of the current RN status is essential for developing strategies that address present-day healthcare challenges and the evolving nursing workforce needs.

Since the last survey administration in 2008, the NSSRN questionnaire underwent a complete content review, and large improvements were made based on changes in US health care landscape and best practices in survey methodology. The latest survey also aims to reduce redundancy in the collection of data and lower the response burden on participants. The 2018 NSSRN comprises questions derived from both the National Sample Survey of Nurse Practitioners (NSSNP) and the NSSRN for one concise survey capturing a broader RN workforce and is the first production implementation that provides data for both RNs and Nurse Practitioners (NPs) at the state and national levels.

In collaboration with the U.S Census Bureau, the National Center for Health Workforce Analysis administered the 10th NSSRN data collection in 2018. From April 2018 to October 2018, a total of 50,273 registered nurses completed the survey via a web instrument or a paper questionnaire with an unweighted response rate of 50.1 percent (49.1% weighted). This instrument gathered data from participants with active RN licenses from all U.S. states revealing a comprehensive look into the RN workforce.

Key Findings There are an estimated 3,957,661 licensed registered nurses living in the United States. In 2017,

roughly 83 percent (3,272,872 RNs) held a nursing related job. The average age of an RN was 50 years old; however, most nurses (53%) were less than 50 years

old. Nurses are more diverse today than shown in the 2008 NSSRN study. Both minority groups and

men have seen a slight increase within the RN population. Most of the RN workforce is college educated (63.9%). Of them, nurses with a master’s or

doctorate degree accounted for 19.3 percent. Advanced Practice RNs account for approximately 11.5 percent of the nursing workforce. Telehealth capabilities were reported in 32.9 percent of nurses’ workplaces. Among them, 50.3

percent of nurses used telehealth in their practice. Median earnings for full-time RNs were $73,929, while part-time RNs earned a median amount

of $39,985.

2

Summary of Survey Methodology

In order to capture the current state of the RN workforce, the 2008 NSSRN questionnaire was revised and tested to minimize respondent response time burden and includes questions for Nurse Practitioners and on new health care delivery patterns.

A sample of 102,690 registered nurses were randomly selected from over 4.6 million licensure records provided by the National Council of the State Boards of Nursing and individual state nursing boards. The licensure records were sorted by state, license type (RN or NP), and demographic variables. Sampling rates from each state were then determined to set a baseline for representation.

Data collection for the NSSRN spanned 24 weeks. The survey offered respondents the opportunity to participate via a web instrument or paper questionnaire, after being contacted by mail. Additionally, respondents had access to a staffed questionnaire assistance telephone line where they could receive login assistance, language support, or other assistance. A total of 50,273 eligible participants completed this survey with an unweighted response rate of 50.1 percent (49.1% weighted).

Additional information about the development, plan, and operations for the 2018 NSSRN can be found in the Technical Documentation for the NSSRN located on the National Center for Health Workforce Analysis’ NSSRN website.1

1 https://bhw.hrsa.gov/health-workforce-analysis/data/national-sample-survey-registered-nurses

3

Initial Findings from the NSSRN Survey

The Workforce As of December 31, 2017, there were an estimated 3,957,661 actively licensed registered nurses living in the United States, a 29 percent increase from 2008. Of those, 3,272,872 (83%) were actively licensed and employed in nursing (a 26% increase from 2008). Approximately 40% of the current RN workforce graduated from their initial nursing program in 2005 or later (Figure 1). In 2017, respondents had an average of 18.9 years of experience post initial RN licensure.

Figure 1: Distribution of RNs by Graduation Year

*Data for this time period reflects more than a two-year interval. As the survey sample was selected from a list of licensed nurses constructed from different sources during year 2017, the count of new graduates in the most recent year(s) may not be fully reflected in the “2015 and later” estimate.

3.3%

1.5% 2.

0%

3.1%

3.0% 3.

2%

3.2%

3.1% 3.4%

3.0%

2.7%

3.6% 4.

2% 4.3%

3.8%

3.7%

3.5% 3.

9%

5.1%

6.5% 7.

1% 7.2% 7.4% 8.

1%

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

Pece

ntag

e

Year of Graduation

4

Demographics and Diversity The average age of respondents was 47.9 years old, with nearly half (47.5%) of all RNs aged 50 or older (Figure 2). Figure 3 shows that White, non-Hispanic RNs accounted for the largest proportion (73.3%), followed by Hispanic RNs (10.2%), Black, non-Hispanic, RNs (7.8%), Asian, non-Hispanic RNs (5.2%), and multiple races (1.7%). Racial and ethnic minority groups accounted for 26.7 percent of the RNs in this study. In particular, for RNs who graduated in the past two decades, the proportion of minority groups (those of not NH White descent) appeared to be higher when compared to those licensed prior to that period. This increase in proportion in minority groups is largely driven by Hispanic RNs (Figure 4).

Men in nursing also continue to be a growing demographic in nursing. In 2018, male RNs represented 9.6 percent of the population, an increase from 7.1 percent in the 2008 NSSRN study.

Figure 1: Distribution of RNs by Age

8.5%

10.7%11.5%

10.3%

11.5%

9.7%

12.0% 11.9%

8.5%

3.4%

2.0%

0%

2%

4%

6%

8%

10%

12%

14%

<30 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+

Perc

enta

ge

Age

5

Figure 2: Distribution of RNs by Race and Ethnicity

Figure 3: Distribution of Race and Ethnicity by Initial Nursing Program Graduation Year

White,non-Hispanic,

73.3%Hispanic, Latino,

or Spanish, 10.2%

Black, non-Hispanic, 7.8%

Asian, non-

Hispanic, 5.2%

American Indian or

Alaska Native, non-Hispanic,

0.3%

Native Hawaiian or Other Pacific Islander, non-Hispanic, 0.6%

Some Other Race, non-Hispanic,

1.0%

Multiple Races, non-Hispanic, 1.7%

Other, 26.7%

68.8%

71.9%

72.3%

72.9%

77.8%

77.1%

83.3%

82.8%

86.0%

19.5%

14.4%

15.0%

13.7%

9.5%

9.4%

10.0%

7.4%

6.2%

10.3%

10.3%

9.7%

12.0%

9.4%

8.4%

8.5%

7.5%

7.0%

5.1%

6.5%

6.9%

6.7%

7.6%

9.5%

3.4%

6.9%

4.8%

5.5%

4.5%

4.9%

4.8%

4.5%

5.7%

3.5%

4.6%

3.3%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2013 and after

2008-2012

2003-2007

1998-2002

1993-1997

1988-1992

1983-1987

1978-1982

1977 and before

White, non-Hispanic Hispanic Black, non-Hispanic Asian, non-Hispanic All Others, non-Hispanic

6

Education and Training In the 2018 survey, the most commonly reported initial educational qualification for registered nurses in the United States were the Associate (48.5%) and Bachelor (39.2%) degrees (Figure 5). When asked about the highest nursing or nursing-related educational attainment, nearly two-thirds of the RNs (63.9 %) had a Bachelor degree or higher (44.6% earned a Bachelor degree and 19.3% earned a graduate degree) (Figure 6). An estimated 5.0 percent of registered nurses in the United States completed their training outside of the United States and nearly half of them were from the Philippines, followed by Canada and India.

Figure 4: Initial Nursing Education

Figure 5: Highest Nursing and Nursing-Related Educational Attainment

Associate Degree, 48.5%

Bachelor Degree, 39.3%

Graduate Degree, 0.9%

Diploma and Other , 11.4%

Diploma in Nursing, 6.4%

Associate Degree, 29.6%

Bachelor Degree, 44.6%

Masters Degree17.5%

Doctorate Degree,

1.9%

Graduate Degree, 19.3%

Diploma in Nursing Associate Degree Bachelor Degree Masters Degree Doctorate Degree

7

Registered nurses may expand their scope of practice by earning a graduate degree and an advanced practice certification including Nurse Practitioner (NP), Certified Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), and Certified Nurse Midwife (CNM). This survey estimates that 11.5 percent of RNs (n=439,527) have completed their training for advanced practice, an increase from 8.1 percent in 2008. Figure 7 highlights the breakdown of all Advanced Practice Registered Nurse (APRN) licenses. 2 NPs accounted for 68.7 percent of all APRN licenses, followed by CNSs (19.6%), CRNAs (9.3%), and CNMs (2.4%).

Figure 6: Distribution of Advanced Practice Registered Nurse Licenses

2 Nurses may hold multiple APRN licenses. Figure7 displays the distribution of APRN licenses.

68.7%

19.6%

9.3%

2.4%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Nurse Practitioner Certified Nurse Specialists Nurse Anesthetist Nurse Midwives

Perc

ent o

f all

APRN

Lic

ense

s

Type of APRN License

8

Employment Among the 3,272,872 RNs who were employed in nursing, 78.9 percent worked full-time. Figure 8 shows the distribution of full-time and part-time RNs who are currently employed by age. Most nurses reported working in a hospital (59.9%), while others reported working at clinics and ambulatory settings (15.6%), other inpatient settings (8.3%), and other types of settings (16.2%). When compared to women, the percentage of men who reported working in a hospital was higher (67.8% for men and 55.6% for women) (Figure 9). Approximately 16.6 percent of employed nurses did not have direct patient care as part of their duties in their primary nursing position. Of the nurses who were actively licensed to practice but had left their position held at the end of 2017, 12.9 percent reported that they stopped working due to retirement. Table 1 in the appendix shows RN employment by state.

Figure 7: Distribution of Full-Time/Part-Time Employment by Age Group

11.8%

21.4% 22.1% 20.5%16.6% 16.2% 18.1%

23.0%

37.5%

71.0% 71.6%

88.2%

78.6% 77.9% 79.5%83.4% 83.8% 81.9%

77.0%

62.5%

29.0% 28.4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

≤ 29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+

Perc

ent o

f Nur

sing

Wor

kfor

ce

Age

Part Time Full Time

9

Figure 8: Distribution of Employment Setting by Sex

Telehealth Telehealth technologies in the workplace were reported by 32.9 percent of nurses (Figure 10). Of those nurses, 50.3 percent reported using some form of telehealth in their primary nursing position. Participants of the survey were asked what type of telehealth they utilized as part of their work. Provider-to-provider consults accounted for 54.4 percent of type of telehealth usage and RN to patient direct calls accounted for 49.2 percent (Figure 11).

67.8%55.6%

15.1%

13.3%

5.5%

13.7%

11.6%17.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Male Female

Hospital Other Inpatient Setting Clinic/Ambulatory Other Setting

10

Figure 9: Telehealth in the Workplace

Figure 10: Telehealth Usage by RNs

*Participants in this study had the option to select all that applied for this question

No, 67.1%

Yes, 32.9%

54.4%

49.2%

4.5%

0%

10%

20%

30%

40%

50%

60%

Provider-to-Provider RN to Direct Patient NP Primary Care e-visits

Perc

ent o

f RN

s Usin

g Te

lehe

alth

Type of Telehealth Usage

11

Salary and Earnings In 2018, the median earnings for full-time RNs was $73,929, while part time RNs earned a median of $39,985. The median earnings for RNs with and without a graduate degree are shown in Figure 13. The highest median earnings were reported by Nurse Anesthetists ($161,076), followed by Certified Nurse Midwives ($102,115), and Nurse Practitioners ($99,962) (Figure 14). Men in nursing also had higher median earnings ($79,928) when compared to female nurses ($71,960) (Figure 12).

Figure 11: Median Full-Time Earnings by Sex

Figure 13: Median Full-Time Earnings by Degree Type

Figure 12: Median Full-Time Earnings by Advanced Practice Type

$79,928 $71,960

$-

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

$90,000

$100,000

Male Female

Earn

ings

Sex

$69,663

$95,804

$-

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

$90,000

$100,000

Without GraduateDegree

With GraduateDegree

Earn

ings

Highest Degree Attainment

$99,962 $95,723 $102,115

$161,076

$- $20,000 $40,000 $60,000 $80,000

$100,000 $120,000 $140,000 $160,000 $180,000

Nurse Practitioner Certified Nurse Specialist Nurse Midwife Nurse Anesthetist

Earn

ings

APRN Type

12

Appendix

Table 1: RN Employment by State State/Census Division Total Active

Licenses Percent

Employed3 Percent

Unemployed New England

CONNECTICUT 52,265 82.7% 17.3% MAINE 21,535 79.9% 20.1%

MASSACHUSETTS 111,545 83.5% 16.5% NEW HAMPSHIRE 18,400 89.7% 10.3%

NEW ENGLAND OTHER* 22,464 87.8% 12.2% Middle Atlantic

NEW JERSEY 97,103 84.6% 15.4% NEW YORK 238,280 81.7% 18.3%

PENNSYLVANIA 193,212 81.5% 18.5% East North Central

INDIANA 97,223 80.0% 20.0% ILLINOIS 157,452 80.9% 19.1%

MICHIGAN 137,541 77.8% 22.2% OHIO 184,000 82.4% 17.6%

WISCONSIN 88,565 80.3% 19.7% West North Central

IOWA 46,180 84.2% 15.8% NEBRASKA 25,044 92.6% 7.4%

KANSAS 42,927 81.6% 18.4% MINNESOTA 89,047 83.8% 16.2%

MISSOURI 92,982 82.4% 17.6% WEST NORTH CENTRAL OTHER* 25,734 89.2% 10.8%

South Atlantic DELAWARE 15,894 86.1% 13.9%

WASHINGTON DC 13,028 95.8% 4.2% FLORIDA 272,378 78.7% 21.3% GEORGIA 108,599 85.1% 14.9%

MARYLAND 68,323 87.7% 12.3% NORTH CAROLINA 120,647 84.7% 15.3% SOUTH CAROLINA 40,586 78.7% 21.3%

VIRGINIA 89,801 84.7% 15.3% WEST VIRGINIA 26,592 85.5% 14.5%

East South Central ALABAMA 62,725 81.9% 18.1% KENTUCKY 60,983 85.2% 14.8%

MISSISSIPPI 41,331 87.7% 12.3% TENNESSEE 91,974 88.9% 11.1%

West South Central ARKANSAS 36,726 82.0% 18.0% LOUISIANA 54,067 85.5% 14.5%

3 Employment may include self-employment

13

State/Census Division Total Active Licenses

Percent Employed3

Percent Unemployed

OKLAHOMA 44,199 80.2% 19.8% TEXAS 278,983 81.3% 18.7%

Mountain ARIZONA 75,566 80.2% 19.8%

COLORADO 66,179 81.9% 18.1% IDAHO 18,766 82.3% 17.7%

NEW MEXICO 23,215 84.9% 15.1% UTAH 33,899 85.8% 14.2%

NEVADA 28,244 88.7% 11.3% MOUNTAIN OTHER* 23,073 81.8% 18.2%

Pacific ALASKA 10,298 87.9% 12.1%

CALIFORNIA 365,464 81.5% 18.5% HAWAII 20,006 84.2% 15.8% OREGON 46,490 88.6% 11.4%

WASHINGTON 78,127 88.4% 11.6% * The weighted or unweighted cell counts for the population of active nurse licenses in these states did not meet the Census disclosure avoidance standards for the Public Use File data. Please access the NSSRN Technical Report for more information. New England Other: Rhode Island, Vermont West North Central Other: North Dakota, South Dakota Mountain Other: Montana, Wyoming