Source

The National Sample Survey of Registered Nurses (NSSRN), U.S. Department of Health & Human Services, Bureau of Health professions, Division of Nursing, Health Resources and Services Administration. For the full report in its entirety, http://bhpr.hrsa.gov/healthworkforce/reports/rnpopulation/preliminaryfindings.htm.

Background

The Registered Nurse Population

The total number of licensed RNs living and working in the United States was estimated to be 2,909,467 as of March 2004, an increase of 7.9 percent or 212,927 above the 2,696,540 licensed RNs estimated in 2000.

The Registered Nurse Workforce Of the total estimated population of nurses in 2004, 58.3 percent (1,696,916) were working full-time, almost 25 percent (724,544) were working part-time in 2004, and 16.8 percent were not employed in nursing. This estimate of the number employed in nursing represents an increase of 219,647 RNs (10 percent) over the projected 2,201,813 RNs employed in nursing in 2000.

Age

The trend toward more RNs in older age groups continued, as demonstrated by the changes across surveys. In March 2004, the average age of the RN population was estimated to be 46.8 years of age, more than a year older than the average age of 45.2 years estimated in 2000; and more than 4 years greater than in 1996 when the average age was 42.3 years.

In 2000, an estimated 31.7 percent of all RNs were under the age of 40; in 2004 only 26.6 percent of all RNs were estimated to be under the age of 40. Similarly, in 1980, 40.5 percent of RNs were under the age of 35, compared to only 16.6 percent in 2004. The RN population under 30 dropped from an estimated 9.1 percent in 2000 to 8.1 percent in 2004.

Gender

Continuing the history of nursing, relatively few men are licensed as RNs, with a slight, insignificant increase estimated for 2004 from 5.4 percent in 2000 to 5.7 percent in 2004. However, it appears that the initial nursing preparation for more male RNs was an associate’s degree rather than a diploma (53.5 percent for men compared to 42.2 percent for women). More female RNs graduated from a diploma program (26.3 percent of female RNs compared to 13.9 percent of men). The percentages of male and female RNs completing a baccalaureate or higher degree initial nursing program were surprisingly similar, 32.7 percent and 31.5 percent, respectively. When the highest nursing-related educational preparation is considered, 47.7 percent of female RNs completed at least a baccalaureate program compared to 46.2 percent of males.

Racial/Ethnic Background

In March 2004, about 7.5 percent of RNs did not specify their racial/ethnic background and 81.8 percent of the RN population were estimated to be White (non-Hispanic), leaving 10.6 percent in one or more of the identified racial and ethnic minority groups. In 2000, 12.3 percent of the RN population was estimated to be in one of the non-White racial/ethnic minority groups identified.

Of the nurses who indicated their racial/ethnic background in 2004, 88.4 percent (an estimated 2,380,639) were White, non-Hispanic; 4.6 percent or 122,495 were Black/African American, non-Hispanic; 3.3 percent or 89,976 were Asian or Pacific Islander, non-Hispanic; 1.8 percent or 48,009 were Hispanic; 0.4 percent or 9,453 were American Indian/Alaskan Native; and 1.5 percent were from two or more racial backgrounds

Family Status

The 2004 survey estimated that 70.5 percent of RNs are married; 18.1 percent are widowed, divorced, or separated; and 9.2 percent have never married. The majority (52.1 percent) of RNs have children and/or other adults at home. Of these RNs and allowing for multiple responses, 28.3 percent have children under age 6 at home, 65.2 percent have children 6 to 18 at home, and 30.6 percent have other adults at home. An additional 14.8 percent of nurses have other dependents who do not live at home.

RNs on the Job

Employment Settings

Five major employment settings were identified for RNs: hospitals; nursing homes and extended care facilities; community and public health settings; nursing education; and ambulatory care settings.

Results from the 2004 survey indicate a slight trend away from the hospital as the setting for the principal nursing position, although changes in the structure of hospitals (e.g., more specialty outpatient clinics) may explain some of the change. In March 2004, out of an estimated 2,421,460 RNs employed in nursing, 56.2 percent (1,360,956) worked in hospital settings compared to 59 percent (1,300,323) in March 2000.

Community and public health settings remained the next largest type of predominant employment for RNs; but the percent of RNs employed in these settings also decreased, from an estimated 18.3 percent of RNs reporting public or community health settings in 2000 to 14.9 percent in March 2004. The percent of RNs reporting nursing homes and extended care facilities as their principal setting remained relatively constant between 2000 (6.9 percent) and 2004 (6.3 percent).

In contrast, the percent of RNs reporting their principal nursing position in other types of settings, particularly ambulatory care, increased from 2000 to 2004. In 2004, 11.5 percent of RNs were estimated to be employed in ambulatory care settings, including physician-based practices, nurse-based practices, and health maintenance organizations, compared to 9.5 percent in 2000. The remaining RNs employed in nursing reported working in such settings as nursing education, f ederal administrative agencies, s tate boards of nursing or other health associations, health planning agencies, prisons/jails, insurance companies, and other miscellaneous settings such as pharmaceutical and durable medical equipment companies. It appears likely that the number and percent of nurses employed in these “other” settings may continue to increase given changes in health care delivery.

Education

Educational Preparation

In 2004, the most common initial preparation for nursing was an associate’s degree. During the past two decades or so, there has been a downward trend in the number of nurses whose initial preparation for nursing was a diploma program. The trend away from diploma programs and toward associate degree or baccalaureate programs continued in 2004.

Since 1996, the number of RNs completing associate’s degrees has exceeded the number graduating from diploma programs. In 2004, the number of RNs whose initial preparation was either an associate’s degree or a baccalaureate program exceeded the number graduating from a diploma program. In contrast, in the 1980 survey, 63.2 percent of licensed RNs had received their initial nursing education in a diploma program; while in 2004, only 25.2 percent (733,377 licensed RNs ) had received their initial RN nursing education in a diploma program.

Corresponding figures for RNs with an associate degree increased from 19 percent (308,616 nurses) in 1980 to 40.3 percent (1,087,602) in 2000 to 42.2 percent (1,227,256) in 2004. For RNs who completed their initial preparation in a baccalaureate degree program, the estimated figures indicate an increase from 17.3 percent (287,993) in 1980 to 29.3 percent (791,004) in 2000 and to 30.5 percent (887,223) in 2004. In addition, an estimated 0.5 percent of RNs in 2004 (15,511) had received their initial nursing education through a master’s or doctoral degree program.

Age at Graduation from Initial Nursing Education Programs

The average age at graduation for recent RN graduates appears to be slightly lower than in 2000. The average age at graduation for RNs during the 5 years prior to the survey was 29.6 years for the 2004 survey compared to 30.5 years in the 2000 survey; however, RNs who graduated between 1995 and 1999 in the 2004 survey were 30.9 years of age at graduation.

When the distribution of age at graduation is observed by age groups, the indication that graduates from initial education programs in more recent years are younger becomes clearer. In the 2004 survey, 39.2 percent of those graduating between 2000 and 2004 were under 25 compared to 31 percent of RNs under age 25 who completed their initial education between 1990 and 1999. Complementing this increase in younger graduates, 29.5 percent of nurses who completed their initial education between 1990 and 1999 were in the 35 to 49 age interval, but only 20.9 percent of RNs completing their initial education programs between 2000 and 2004 were in the 35 to 49 year age interval.

The average age at graduation from initial nursing programs varied by the type of program. Graduates of associate degree programs tend to be older, as are recent diploma graduates. For the 5-year period before the March 2004 survey, the average age of diploma graduates was 31.8 years; associate degree graduates averaged 31.9 years and baccalaureate graduates averaged 26.2 years.

Advanced Nursing Education

Similarly, in terms of the highest level of preparation for nursing, the trend from 1980 to 2004 indicates that an increasing number of RNs receive baccalaureate and master’s degrees, even if their initial preparation for nursing was an associate’s degree or a diploma. The 2004 survey indicates that the RN population is increasingly prepared with a baccalaureate, a master’s, or doctorate degree. The highest level of preparation for an estimated 17.5 percent of RNs (510,209) is a diploma; for an estimated 33.7 percent (981,238) the highest preparation is an associate degree; for 34.2 percent (994,240) it is a baccalaureate degree; and for 13.0 percent (377,046) it is a master’s or doctoral degree.

In fact, the highest increase from 2000 to 2004 was for the number of RNs receiving their master’s or doctorate degrees (an estimated increase of 101,978 RNs or 37 percent) compared to a decrease of 91,495 nurses or 15.2 percent in the number of RNs whose highest degree was a diploma. Over the entire period from 1980 to 2004, there was a 43.5 percent decrease (an estimated change from 903,131 RNs to 510,209) in the number whose highest level of preparation was a diploma, while the number whose highest level was a master's or doctorate increased by 339 percent (from 85,860 to 377,046). Similarly, the estimated number of RNs whose highest preparation was a baccalaureate increased by 170 percent (367,816 to 994,240) and the estimated number whose highest preparation was an associate’s degree increased by 232 percent from 295,318 to 981,238 RNs.

Additional Nursing Education Preparation

About 23.1 percent of the RN population in 2004 or an estimated 671,883 RNs completed additional academic nursing or nursing-related preparation after they graduated from their initial nursing education. Of the 1,227,256 RNs initially prepared in associate degree programs, 20.7 percent or an estimated 253,453 of the nurses (i.e., 8.7 percent of all RNs) obtained additional nursing-related degrees. Of the 733,377 RNs initially prepared in diploma programs, 30.2 percent or an estimated 221,608 (i.e., 7.8 percent of all RNs) obtained post-RN nursing or nursing-related degrees. In addition, of the 887,223 RNs initially prepared in baccalaureate programs, 22.2 percent or an estimated 196,639 (i.e., 6.8 percent of all RNs) subsequently received master's or doctorate nursing-related degrees.

Title and Earnings

Average Earnings

Changes in average earnings of RNs were examined based on the actual average earnings of RNs employed full-time in the labor market and the “real” average earnings (average earnings inflated by the consumer price index (CPI) for 1980-2004). The actual average annual earnings of RNs employed full-time in 2004 were $57,784 which appears to be an increase from average earnings in 2000 ($46,782).

When changes in the purchasing power of the dollar are taken into account utilizing the CPI, the “real” earnings of RNs employed full-time in 2004 were estimated as $26,366 compared to $17,398 in 1980 and $23,369 in 2000. This change represents a 12.8 percent increase since 2000 and is the first significant up-turn in “real” earnings since 1988. Between 1988 and 1992 RNs experienced an 11.2 percentage increase in “real” earnings, but “real” salaries were relatively flat from 1992 through 2000.

Advanced Practice Nurses

Advanced practice registered nurses (APRN) include clinical nurse specialists, nurse anesthetists, nurse midwives, and nurse practitioners. In March 2004, the number of RNs prepared to practice in at least one advanced practice role was estimated to be 240,461, or 8.3 percent of the total RN population, compared to an estimated 196,000, or 7.3 percent estimated from the 2000 Survey. The largest group among APRNs was nurse practitioners, followed by the clinical nurse specialists. These two groups together, including those with dual or multiple training as a nurse practitioner, clinical nurse specialist, nurse midwife, and/or or nurse anesthetist, comprised over 199,000 nurses, or 82.8 percent of all advanced practice nurses.

Nurse Practitioners

Nurse Practitioners (NPs) included RNs prepared beyond initial nursing education in an NP program of at least three months. In March 2004, there were an estimated 141,209 RNs with credentials as NPs, indicating an estimated increase of 38,560 NPs from 2000. About 65.5 percent of NPs had completed a master’s degree program and an additional 10.5 percent had a post-master's certificate as their NP preparation. An estimated 87.7 percent of NPs were employed in nursing, with 65.7 percent of NPs employed in nursing reporting the position title as “Nurse Practitioner.” Of the nurses who were NPs, 74.8 percent reported being currently certified by a national organization in an APRN specialty.

Clinical Nurse Specialists

Clinical nurse specialists (CNS) were defined in this survey as RNs who had formal clinical preparation resulting in a master’s degree. The estimated number of CNSs increased from 69,071 in 2000 to 72,521 in 2004. These estimates include RNs who have CNS preparation alone or in combination other APN specialty preparation. The vast majority of prepared CNSs, 93.3 percent, received their CNS award through a master’s program, with an additional 3.8 percent of CNSs prepared through a post-master’s certificate.

About 85.1 percent of the prepared CNSs were employed in nursing; however, only 16.5 percent were practicing with the position title of “Clinical Nurse Specialist.” About 16 percent of the CNSs were estimated to be in nursing education positions and the remaining CNSs reported a variety of position titles.

Nurse Practitioner/Clinical Nurse Specialist

The estimated number of RNs prepared as both NPs and CNSs was about the same as in 2000, with 14,643 NP/CNSs estimated in March 2000 and 14,689 estimated in March 2004. RNs prepared as both NPs and CNSs were more than 10 times more likely to function in the NP role than in the CNS role, as indicated by position title.

Nurse Anesthetist

The third largest group of RNs who indicated APN preparation were nurse anesthetists. The number of nurse anesthetists estimated in March 2004 was 32,523 compared to 29,844 in 2000. While 37.2 percent of the nurse anesthetists had received their educational nurse anesthetist preparation through a master’s program, 58.0 percent received their education preparation through a post-RN certificate. In 2004, 89.6 percent of the nurse anesthetists were employed in nursing; 82.3 percent of the employed nurse anesthetists held the position title of “Nurse Anesthetist.” Of those who were prepared as nurse anesthetists, 93.1 percent were estimated to be currently certified in an APN specialty by a national organization.

Nurse Midwives

In March 2004, there were an estimated 13,684 RNs formally prepared as nurse midwives compared to 9,232 in 2000. While 56.5 percent of these RNs received their educational preparation in this specialty through a master’s program and an additional 5.8 percent through a post-master's certificate, 36.9 percent were estimated to have received their nurse midwife preparation through a certificate program. Of those prepared as nurse midwives, 89.3 percent were employed in nursing in 2004 compared to 85.7 percent in 2000. An estimated 57.6 percent of the nurse midwives employed in nursing in 2004 identified their position title as nurse midwife. Of the RNs who were prepared as nurse midwives, an estimated 93.7 percent are currently being certified in an APN specialty by a national organization.

Registered Nurses in Nursing Faculty Positions

One issue that has received considerable attention in recent years is the shortage of nurses in faculty positions. The 2004 defined the principal nursing position as a faculty position if a RN was teaching RNs in diploma, associate, baccalaureate, and/or higher degree programs. It is estimated that the principal nursing position of 48,666 RNs in March 2004 was as nursing faculty. Of these nurses, 11 percent were faculty in diploma programs, 40.1 percent were faculty in associate degree programs, and 48.8 percent were in baccalaureate and/or higher degree programs. The average age of faculty nurses was 46.8 years, but the estimated average age of faculty nurses with doctorates in nursing or a related field was 55.7 years. However, the age group with the highest percent of faculty was the 50 to 54 year age group with 21.4 percent of faculty in this age group. An additional 25.4 percent were in the age groups 40 to 50 and 12.1 percent of RNs in faculty positions were in the age group 25 to 34 years. Although only 19.6 percent of faculty nurses were in the under 40 age group, 30.1 percent were over age 55.

Foreign-Educated Nurses

The 2004 survey estimates that 3.5 percent of the RNs practicing in the United States (100,791) received their basic nursing education outside the United States, not including the 0.3 percent (an estimated 9,687) who received their initial nursing education in Guam, Puerto Rico, the U.S. Virgin Islands or in unspecified States and territories. This percentage was about the same as in the 2000 survey. The main countries where the highest number of these RNs received their education were: Philippines (50.2 percent of foreign-educated RNs) and Canada (20.2 percent). A much smaller percent of RNs received their basic nursing education in other countries such as the United Kingdom (8.4 percent), followed at a distance by Nigeria (2.3), Ireland (1.5), India (1.3), Hong Kong (1.2), Jamaica (1.1), Israel (1.0), and South Korea (1.0). An additional 12 percent of RNs received their training in 47 other countries. In contrast, in 2000, the Philippines (43 percent of foreign-educated nurses), Canada (16 percent), United Kingdom (8 percent), and India (10 percent) were the main countries of origin for foreign-educated nurses.

Geographic Distribution of the Registered Nurse Population

In March 2004, the New England area of the country had the highest concentration of employed RNs in relation to the area’s population, 1,107 employed RNs per 100,000 population. The West North Central area had the next greatest concentration with 1,026 employed RNs per 100,000 population. The West South Central area had one of the lowest concentrations, 677 RNs per 100,000 population. However, the Pacific area, with 645 employed RNs per 100,000 population, had a lower ratio than the West South Central.

Georgia's Population

As of March 2004, Georgia employed 753 RNs per 100,000 population equating to more than 132 population per RN.  Of nine South Atlantic states, Georgia is eighth.  Of employed RNs in Georgia, 77.2 percent are full-time while 22.8 percent are part-time.