HEALTH CARE AND HUMAN SERVICES POLICY, RESEARCH, AND CONSULTING - WITH REAL-WORLD PERSPECTIVE.
Current Knowledge and Research Gaps for
Projecting Future Adequacy of RN Supply
for: Academy
June 27, 2009
Health Workforce Interest Group
Definitions
 Supply
 Licensed supply: number of RNs with an active license (represents
potential short-term workforce)
 Active supply: number of RNs who are working in nursing or who are
seeking work in nursing
 Full-time-equivalent (FTE) supply:




Supply of nursing services
RNs full time in nursing = 1 FTE
RNs working part time in nursing or working for part of the year = <1 FTE
RNs not working in nursing = 0 FTE
 Requirements
 Demand: number of RNs that employers are willing and able to pay
for given population demand for health care services and economic
considerations
 Need: An assessment of the number of RNs that the
nation/community should have—often based on providing a specified
level of care
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Definitions, cont.

Shortfall (shortage) and surplus


Vacancy rate



Difference between requirements and supply
Percent of budgeted positions that are unfilled at a given point in time
Adequate supply:

Right number of RNs, in the right place, with the right skill/experience
mix, at the right time

FTE supply ≈ FTE requirements

Adequate supply does not mean vacancy rate = 0
For updated HRSA study (2009):
FTE Demand=FTE Supply+Excess Vacancies
= FTE Supply+FTE Demand × ( Vacancy rate − .05 )
=
FTE Supply
1 − ( Vacancy rate − 0.05 )
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Supply-related information where we have a good
handle on the data
 Current demographics of RNs
(especially age)
120,000
 National Sample Survey of RNs
 Education mix
 NSSRN
 Employment setting
 NSSRN
 Geographic location
 State licensure databases
 NSSRN, CPS
80,000
Total RNs
(NSSRN)
 Current Population Survey (CPS)
 Information collected by some
states during licensure renewal
100,000
60,000
40,000
20,000
22
25
28
31
34
37
40
43
46
49
52
55
58
61
64
RN Age
Associate or Diploma
BSN
MSN or PhD
Source: Analysis of the 2004 NSSRN
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Supply-related information where we have a good
handle on the data
 Labor force participation rates and hours worked
 National Sample Survey of RNs
 Current Population Survey
FTE RNs as Percentage of Licensed RNs
100%
100%
90%
90%
80%
80%
70%
70%
Percent FTE
Percent of RNs Active
Active RNs as Percentage of Licensed RNs
60%
50%
40%
60%
50%
40%
30%
30%
20%
20%
10%
10%
0%
0%
20
25
30
35
40
45
50
55
RN Age
Associate or Diploma
60
65
20
25
30
35
40
45
50
55
60
65
RN Age
BSN
MSN or PhD
Associate or Diploma
BSN
MSN or PhD
Source: Analysis of the 2004 NSSRN
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Supply-related information where we have a good
handle on the data
 Initial nursing degree
graduates from US
nursing programs
25%
 National Council of
 American
Association of
Colleges of Nursing
(initial entry MSNs)
 Age distribution of
new graduates
Percent of Graduates
State Boards of
Nursing (first-time
NCLEX-RN takers)
20%
15%
10%
5%
0%
20
25
30
35
40
45
50
55
60
65
RN Age at Graduation with Initial Nursing Degree
Associate or Diploma
BSM
MSN or PhD
Source: Analysis of the 2004 NSSRN
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Supply-related information gaps
 Retirement rates
Workforce Separation Rates for College-Educated Women
 Long term rates
25%
 Short term
fluctuations
20%
between
retirement and

Wages

Working
conditions
Attrition Rate
 Relationship
15%
10%
5%
0%
20
25
30
35
40
45
50
55
60
65
RN Age
Source: Analysis of the 2005 Current Population Survey + CDC
mortality rates
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Supply-related information gaps
 Sensitivity of short-term and long-term RN supply to wages,
working conditions, economic conditions
 Retirement rates
 Labor force participation rates
 New graduates from nursing programs
 Migration patterns (cross state, within state)
 Sensitivity of graduates from nursing programs to
 Wages/working conditions
 Tuition/other costs for nursing programs
 This information, in the form of “elasticities” is needed to help
transform a static supply model to a dynamic model
 Elasticity = % change in supply ÷ % change in supply determinant
 Useful for understanding migration patterns of RNs; how RNs
migrate towards locations with more job opportunities
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Demand-related information where we have a relatively
good handle on the data
 Current utilization of nursing services, by setting and population
demographic group
Annual Inpatient Days per 1,000 Population
Age Category
0-4 years
5-17 years
18-24 years
25-44 years
45-64 years
65-74 years
75-84 years
85 years plus
Female
Metropolitan
Non-metropolitan
1,030
466
97
42
435
337
477
271
637
343
1,614
791
2,366
1,559
4,299
3,548
Male
Metropolitan
Non-metropolitan
1,084
509
84
30
168
68
287
137
726
296
1,627
820
1,504
2,883
5,089
2,633
 Population projections, by demographic
 U.S./state Census Bureau
 RN vacancy rates
 For some settings (hospitals, nursing homes, academia)
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Demand-related information gaps
 Sensitivity of demand to
 RN wages
 Changes in technology
 Changes in average patient acuity levels
 Trends in nurse staffing patterns
 Trends in mandated minimum staffing ratios
 Growth in demand by skill set (e.g., critical care)
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What is the projected future adequacy of RN supply?
 ???
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To make good policy decisions regarding RN supply
 Need accurate projections to
 Justify expansion of nursing programs/funding
 Inform RNs and candidates for nursing programs regarding career
opportunities
 Accurate projections requires solid, rigorous research
 Rigorous research is possible
 Access to good data
 Funding
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Tim Dall
The Lewin Group
3130 Fairview Park Drive
Suite 800
Falls Church, VA 22042
Phone: (703) 269-5743
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