Trends in the Supply and Distribution of Nurse 

Practitioners in North CarolinaKatie Gaul, MA and Erin Fraher, PhD MPP

Program on Health Workforce Research & PolicyCecil G. Sheps Center for Health Services Research, UNC‐CH

NCNA NP Spring Symposium

April 2, 2014This work is funded  by the North Carolina AHEC Program, 

and through grant # 69991, Interdisciplinary Nursing Quality Research Initiative (INQRI), Robert Wood Johnson Foundation.

Presentation overview

• Where do we get data on NPs in North Carolina?

• How many NPs are there and where are they?

• What are the demographic, education and practice characteristics of NPs?

Data Sources

• Data are from the North Carolina Board of Nursing initial and annual renewal forms

• Not a survey; full census of NPs in active practice in North Carolina in 2011

• Data collected annually and cleaned by staff at the North Carolina Health Professions Data System at the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill

Supply of NPs in North Carolina outstripping US supply in recent years 

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Nurse Practitioners per 10,000 Population, US and NC, 1979 to 2012

Figures include all licensed, active, instate nurse practitioners. Sources: North Carolina Health Professions Data System, 1979 to 2012; The Registered Nurse Population- Findings from the National Sample Survey of Registered Nurses, 2008, 2004, 2000, 1996,1992, 1988, 1984, 1980; North Carolina Office of State Planning; U.S. Bureau of the Census; North Carolina population data are smoothed figures based on 1980, 1990, 2000, and 2010 Censuses.

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MetropolitanNonmetropolitan

Figures include all licensed, active, instate nurse practitioners. Sources: North Carolina Health Professions Data System, 1979 to 2012; North Carolina Office of State Planning; US Census Bureau & Office of Management and Budget, 2009 and 2013. North Carolina population data are smoothed figures based on 1980, 1990, 2000, and 2010 Censuses.

Nurse Practitioners per 10,000 by Metropolitan and Nonmetropolitan Counties, North Carolina, 1979 to 2012

Supply increasing more rapidly in urban counties, but disparity not as large as other providers

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Not a PHPSA

Whole County PHPSA

Figures include all licensed, active, instate nurse practitioners. Sources: North Carolina Health Professions Data System, 1979 to 2012; NC Office of State Planning; Area Resource File, HRSA, Department of Health and Human Services, 2000-2012. North Carolina population data are smoothed figures based on 1980, 1990, 2000, and 2010 Censuses. Persistent HPSAs are those designated as HPSAs by HRSA from 1999 through 2010. PHPSA calculations from 2011 onward completed using most recent 7 HPSA designations.

Widening gap between well‐supplied and shortage counties

Nurse Practitioners per 10,000 by Persistent Health Professional Shortage Area (PHPSA) Status, North Carolina, 1979 to 2012

80% of counties below state ratio of NPs per 10,000 population; 2 counties have no NPs

Nurse Practitioners (NPs) per 10,000 PopulationNorth Carolina, 2011

Nonmetropolitan County* (54)

Note: Figure includes all active, instate nurse practitioners licensed in NC as of October 31, 2011; US Census Bureau and Office of Management and Budget, March 2013.*Note: ”Core Based Statistical Area” (CBSA) is the OMB’s collective term for Metropolitan and Micropolitan Statistical areas. Here, nonmetropolitan counties include micropolitan and counties outside of CBSAs. Source: Source: North Carolina Health Professions Data System, with data derived from the North Carolina Board of Nursing, 2011.

Demographic Characteristics:NP Age, 2011

Age  Number Percent<25 9 0.2%25‐29 260 7%30‐34 540 14%35‐39 565 14%40‐44 547 14%45‐49 600 15%50‐54 617 16%55‐59 530 13%60‐64 237 6%65 & over 67 2%Total 3,972 100%

Average Age: 44.9

Sources:  North Carolina Health Professions Data System with data derived from the North Carolina Board of Nursing, 2011. Figures include all licensed, active, instate NPs licensed in NC as of October 31, 2011.

<451,921

≥452,051

NPs predominantly white, female

SexNumber Percent

Male 274 7%

Female 3,693 93%

Total 3,967 100%

Note:  5 NPs were missing sex data

RaceRace Number Percent

White, not Hispanic  3,172 82%

Black, not Hispanic  271 7%

American Indian/Alaskan Native 37 1%

Hispanic 41 1%

Asian/Pacific Islander 54 1%

Other 29 1%

Multi‐racial 14 0.4%

Total 3,618 100%

Note:  354 NPs were missing race data

Sources:  North Carolina Health Professions Data System with data derived from the North Carolina Board of Nursing,  2011. Figures include all licensed, active, instate NPs licensed in NC as of October 31, 2011.

Vast majority of NPs hold a MSNHighest Degree

Number Percent

Diploma 56 1%

Associate 65 2%

BSN 293 8%

Bacc. in other field 21 1%

MSN 3132 84%

Masters in other field 62 2%

Doctorate in nursing 78 2%

Doctorate in other field 31 1%

Total 3,738 100%Note: 234 NPs were missing data on highest degree

Entry Degree

Sources:  North Carolina Health Professions Data System with data derived from the North Carolina Board of Nursing, 2011. Figures include all licensed, active, instate NPs licensed in NC as of October 31, 2011.

Number Percent

Diploma 391 10%

Associate 1099 29%

BSN 2255 59%

MSN 74 2%

Total 3819 100%

Diploma 391 10%

Associate 1099 29%

BSN 2255 59%Total 3,738 100%Note: 152 NPs were missing data on entry degree

Although average hours per week vary slightly by employment setting

40.8 39.6 39.1 38.8 38.737.1 36.9 36.7 35.6

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Hospital noIPE, OPD

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Practice Setting

Average Hours per Week by Setting, NPs in North Carolina, 2011

N=13 N=124 N=452 N=31 N=303 N=105N=1,438

N=263N=66 N=61 N=55

Sources:  North Carolina Health Professions Data System with data derived from the North Carolina Board of Nursing, 2011. Figures include all licensed, active, instate NPs licensed in NC as of October 31, 2011.

About one in three (36%) NPs are in practice for 5 or fewer years

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Number of Years in Practice

Years in Practice, North Carolina NPs, 2011

Sources:  North Carolina Health Professions Data System with data derived from the North Carolina Board of Nursing, 2011. Figures include all licensed, active, instate NPs licensed in NC as of October 31, 2011.

Are NPs and PAs the answer to emerging primary care workforce needs?

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Physicians

Cumulative rate of growth since 1990:Physicians, NPs and PAs in North Carolina

Sources: North Carolina Health Professions Data System with data derived from the North Carolina Medical Board and North Carolina Board of Nursing, 1990 to 2010; Figures include all licensed, active, instate, non-federal, non-resident-in-training physicians, PAs and NPs.

Contact info

Katie GaulResearch Associate

Program on Health WorkforcePolicy and Research

k_gaul@unc.edu

919‐966‐6529

http://www.healthworkforce.unc.edu