National Center for Health Workforce Analysis
The U.S. Nursing Workforce: Trends in Supply and Education – Results in Brief Understanding the supply, distribution, and educational pipeline of nurses is an important tool to inform the programs and policies that will ensure access to care and an effective health care system. This brief analyzes data from a variety of sources to present recent trends and the current status of the registered nurse (RN) and licensed practical nurse (LPN) workforces.
The Current Supply of Nurses and Trends Over Time There were 2.8 million RNs (including advanced practice RNs) and 690,000 LPNs working in the field of nursing or seeking nursing employment in 2008 to 2010. About 445,000 RNs (16 percent) and 166,000 LPNs (24 percent) lived in rural areas. The per capita distribution of RNs varied substantially across states (see Figure 1).
Figure 1. The RN Workforce per 100,000 Population, by State Washington
Oregon
Nevada
Montana Idaho
Wyoming
North Dakota
Minnesota
Colorado
Kansas
California
Arizona
New Mexico
Wisconsin
South Dakota Nebraska
Utah
Oklahoma
Alaska Texas
Maine Vermont New Hampshire MassachuseNs New York Rhode Island ConnecMcut
Iowa
Michigan
Pennsylvania Indiana Illinois
Missouri
Ohio
New Jersey
Delaware Maryland
West Virginia Virginia
Kentucky Tennessee
Washington, DC
North Carolina
South Carolina Arkansas Mississippi Alabama Georgia Louisiana
Florida
Hawaii
Data Source: HRSA analysis of the American Community Survey (ACS) 2008-2010 three-year file
The nursing workforce grew substantially in the past decade, with RNs growing by more than 500,000 (24 percent) and LPNs by more than 90,000 (16 percent), as shown in Figure 2. The U.S. Nursing Workforce: Trends in Supply and Education - Results in Brief April 2013
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Figure 2. Growth in the U.S. Nurse Workforce 3,500,000
24.1% Growth
3,000,000
Workforce
2,500,000
2,824,641
2,275,276
2,000,000 1,500,000 1,000,000
15.5% Growth
597,523
690,038
500,000 0
LPN Census 2000 Long Form
RN ACS 2008-‐2010 Three-‐Year File
Data Sources: HRSA analysis of the Census 2000 Long Form 5% sample and the ACS 2008-2010 three-year file
Growth in the nursing workforce outpaced growth in the U.S. population. The number of RNs per 100,000 population (per capita) increased by nearly 14 percent, and the number of LPNs per capita increased by about 6 percent. Other key findings about changes in the nurse supply over the past decade include: • Education: Currently, about 55 percent of the RN workforce holds a bachelor’s or higher degree. An associate’s degree in nursing was the first nursing degree for many of these nurses. The percentage of the RN workforce holding a bachelor’s or higher degree increased from 50 to 55 over the past decade. • Diversity: RNs and LPNs are slowly becoming more diverse over time. The proportion of non-white RNs increased from 20 to 25 percent during the past decade. The proportion of men in the RN workforce increased from 8 to 9 percent. • Age: Owing to strong growth in new entrants, the absolute number of RNs younger than 30 has increased. Nevertheless, the average age of nurses has also increased slightly, and about one-third of the nursing workforce is older than 50. • Workplace: The majority of RNs (63 percent) are providing inpatient and outpatient care in hospitals. The distribution of RNs across settings held relatively steady over the past decade. However, while the proportion of RNs in hospitals held steady,
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The U.S. Nursing Workforce: Trends in Supply and Education - Results in Brief April 2013
the number of RNs working in hospitals increased by more than 350,000 (about 25 percent). In contrast, fewer than one-third of LPNs (29 percent) work in hospitals, and that proportion has declined slightly over the past decade. A higher percentage of LPNs now work in skilled nursing facilities (31 percent) than in hospitals.
The RN and LPN Pipeline The nursing pipeline, measured by the number of individuals who pass national nursing licensing exams, grew substantially from 2001 to 2011. In 2011, more than 142,000 new graduate RNs passed the NCLEX-RN®, compared with 68,561 in 2001 (see Figure 3). LPN passers grew by 80 percent over the same time period.
Figure 3. NCLEX-RN Passers, 2001 to 2011 150,000
107.7% Growth, 2001-‐2011
140,000 130,000
137,834 134,027
Passers
120,000
100,000 85,824
90,000 80,000
70,474
70,000 60,000 50,000
116,045
109,726
110,000
142,390
127,592
98,365
75,821
68,561
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Year
Data Sources: 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
Among first-time test takers, the number of bachelor’s prepared RN candidates taking the NCLEX-RN exam more than doubled, from 24,832 individuals in 2001 to 58,246 in 2011. Non-bachelor’s prepared RN candidates taking the NCLEX-RN exam nearly doubled, increasing from 43,927 in 2001 to 86,337 in 2011. Non-bachelor’s prepared RN candidates continue to constitute the majority of all RN candidates (60 percent in 2011). Figure 4 presents the annual number of candidates, by degree type.
The U.S. Nursing Workforce: Trends in Supply and Education - Results in Brief April 2013
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90,000 100,000 80,000 90,000 70,000 80,000 60,000 70,000 50,000 60,000 40,000 50,000 30,000 40,000 20,000 30,000 10,000 20,000 0 10,000 0
85,475 86,337 85,475 Candidates: Candidates: 82,467 82,467 79,375 79,375 Growth, 2001-‐2011 96.5% Growth, 296.5% Non-‐Bachelor's P001-‐2011 repared 73,793 73,793 80,000 85,475 86,337 Candidates: 69,357 69,357 82,467 79,375 96.5% Growth, 2001-‐2011 63,690 63,690 70,000 73,793 90,000
58,246 58,246 56,543 55,407 55,407 69,357 52,260 52,260 63,690 49,736 49,736 50,056 50,056 45,772 45,772 44,871 44,871 58,246 50,000 56,543 55,407 41,346 52,260 41,346 35,496 49,736 35,496 50,056 43,927 40,000 45,772 BSN Candidates: BSN Candidates: 44,871 43,927 30,628 30,628 26,632 26,632 25,821 25,821 41,346 134.6% Growth, 134.6% Growth, 30,000 35,496 2001-‐2011 43,927 BSN Candidates: 2001-‐2011 30,628 24,832 24,832 20,000 25,821 26,632 Candidates
Candidates Candidates
Figure 4. Growth in NCLEX-RN First-Time Test Takers, 100,000 100,000 Prepared Non-‐Bachelor's PNon-‐Bachelor's repared Degree by Bachelor’s and Non-Bachelor’s Status, 2001 to 201186,337
10,000 24,832 0 2001 2002 2001
56,543
60,000
2002
134.6% Growth, 2001-‐2011
2001 2004 2002 2005 2003 2006 2004 2007 2005 2008 2006 2009 2007 2010 2008 2011 2009 2003 2003
2004
2005
Year 2006
2007
Year 2008 2009
2010
2010
2011
2011
Bachelor’s PYear repared Non-‐Bachelor’s Prepared Bachelor’s Prepared Non-‐Bachelor’s Prepared Data Sources: HRSA compilation of the National Council of State Boards of Nursing, Nurse Licensure and NCLEX Examination Bachelor’s repared Council ofNon-‐Bachelor’s repared “Number of Candidates Taking Statistics Publications, 2002-2012, and from thePNational State Boards ofPNursing, the NCLEX Examination and Percent Passing, by Type of Candidate,” https://www.ncsbn.org/Table_of_Pass_Rates_2011.pdf
The number of internationally educated RNs passing the NCLEX fluctuated significantly from 2001 to 2011. While the number of passers increased steadily each year from 2001 to 2007, the annual number of internationally educated NCLEX passers has dropped since 2007 and was 6,100 in 2011. Nearly 28,000 RNs were awarded a post-licensure bachelor’s in nursing (RN-BSN) in 2011, and another 26,200 were awarded master’s or doctoral degrees. There has been an estimated 86-percent increase in the annual number of RN-BSN graduates, and a 67-percent increase in graduate degree awards, over just the past four years. However, the annual number of postlicensure graduates is still too small, and the rapid growth too recent, to have generated large increases in the portion of the workforce prepared with bachelor’s or graduate degrees. Nurses will continue to play a critical, growing role in health care delivery. In the coming years, HRSA will monitor the key indicators tracked in this brief, including supply, distribution, and educational pipeline. It will be important to follow these trends closely as the nation’s demographic and health systems evolve. For more information about the data, methods, and findings in this brief, see the full report, “The U.S. Nursing Workforce: Trends in Supply and Education,” at http://bhpr.hrsa.gov/healthworkforce/index.html.
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The U.S. Nursing Workforce: Trends in Supply and Education - Results in Brief April 2013