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THE REGISTERED NURSE WORKFORCE
Proposal to the NCSBN Board of Directors
INTRODUCTION
Registered nurses are the only health care providers that are available in most health care facilities 24 hours a day, 7 days a week. Having an adequate supply of registered nurses in the US is a health care priority. There is s substantial body of evidence to suggest that the aging of the general population, health care reform, and the aging of the nurse workforce will result in a significant shortfall of registered nurses in the coming years. This anticipated shortfall of registered nurses must be carefully monitored if we are to avoid what could be a health care catastrophe.
Over the past three decades the Health Resources and Services Administration
(HRSA) has monitored our supply of registered nurses through the National Sample
Survey of Registered Nurses (NSSRN). Since data collection from the most recent
(and final) NSSRN was completed in 2008, we have no current data on the nationwide supply of registered nurses in the US. For this proposed project the
National Council of State Boards of Nursing (NCSBN) and Forum of State Nursing
Workforce Centers will combine their efforts to collect up-to-date data on the current supply of registered nurses in the US. We propose two projects outlined below using a well-established methodology: 1) to survey all of the actively licensed registered nurses in the US, a task that has never been attempted in the past, and 2) survey a random sample of the actively licensed registered nurses in the US.
METHODS PROJECT 1 (TOTAL POPULATION)
This is a cross-sectional project that will involve surveying all (~3 million) registered nurses who are actively licensed and reside in the US. Using mailing addresses from individual state boards of nursing that are currently available in
NCSBN’s databases and telephone numbers from a private vendor we will use a modified Dillman 1 methodology, which includes postcards and repeat mailing of the survey to non-respondents. To obtain in the survey external validity consistent with a high response rate, we will employ a method of double sampling.
Data Collection
The initial contact with nurses will be in the form of a mailed postcard. The postcard will be visually stimulating, it will announce the survey and its voluntary nature, and it will include a URL for online completion of the survey. This will be immediately followed by a telephone voice broadcast that will describe the survey and encourage participation. A week later the paper survey will arrive in the mail with the option of completing the survey online or completing and returning the paper survey. This will be following with another telephone voice broadcast and a second mailing of the paper survey to those nurses who had yet to complete and return the original survey.
1 Dillman, D. A., Smyth, J. D., Christian, L. M. (2009). Internet, Mail, and Mixed-Mode
Surveys: The Tailored Design Method. ASIN: B00387FOGM

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It is growing consensus within survey research that there is no acceptable level of response for a mail survey, except for 100%; 2 therefore, in this proposed project we will implement a double sampling method in an effort to assess and reduce nonresponse bias.
Phase 2: For this Phase of the project we will draw a smaller (~10,000) random sample from those nurses who did not complete and return the original survey in
Phase 1. We will employ a more vigorous mail and telephone follow up, plus a monetary incentive. Initial contact will be visually stimulating postcard alerting the nurse to the survey and the incentive that will be arriving in the mail. This will be immediately followed by a telephone voice broadcast that will describe the survey and its voluntary nature. A week later the paper survey and the incentive will arrive in the mail. This will be followed by personal telephone calls, and repeat mailings of the survey until a high rate of response is obtained.
METHODS PROJECT 2 (POPULATION SAMPLE)
This is a cross-sectional project that is similar to Project 1; however, we will now survey a stratified random sample (~n= 85,000) of registered nurses who are actively licensed and reside in the US. The sampling strategy will be determined through consultation with national sampling strategy experts. Using mailing addresses from individual state boards of nursing available on NCSBN databases and telephone numbers from a private vendor we will use a modified Dillman 3 methodology, which includes postcards and repeat mailing of the survey to nonrespondents. To obtain in the survey external validity consistent with a high response rate, we will employ a method of double sampling.
Data Collection
Phase 1: The initial contact with nurses will be in the form of a mailed postcard. The postcard will be visually stimulating, it will announce the survey and its voluntary nature, and it will include a URL for online completion of the survey. This will be immediately followed by a telephone voice broadcast that will describe the survey and encourage participation. A week later the paper survey will arrive in the mail with the option of completing the survey online or completing and returning the paper survey. This will be following with another telephone voice broadcast and a second mailing of the paper survey to those nurses who had yet to complete and return the original survey.
Phase 2: For this Phase of the project we will draw a smaller (~2,000) random sample from those nurses who did not complete and return the original survey in
2 Babbie, E. (2009). The Practice of Social Research, 12 th ed., Belmont, CA:
Wadsworth.
3 Dillman, D. A., Smyth, J. D., Christian, L. M. (2009). Internet, Mail, and Mixed-Mode
Surveys: The Tailored Design Method. ASIN: B00387FOGM

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Phase 1. We will employ a more vigorous mail and telephone follow up, plus a monetary incentive. Initial contact will be visually stimulating postcard alerting the nurse to the survey and the incentive that will be arriving in the mail. This will be immediately followed by a telephone voice broadcast that will describe the survey and its voluntary nature. A week later the paper survey and the incentive will arrive in the mail. This will be followed by personal telephone calls, and repeat mailings of the survey until a high rate of response is obtained.
Data Analysis
Initial work will consist of assembling and cleaning survey data. Survey data will be examined for missing values and imputation methods will be used when appropriate. A data analyst and/or statistician will compute the double sample response rate and will be held responsible for ongoing analytic procedures.
FINAL REPORTS
All final reports will be descriptive in nature and distributed to appropriate agencies. Characteristics of nurses will be reported as means and percentages in the form of text, tables and figures.
BUDGET (PROJECT 1)
The following are rough cost estimates of this project:
 Design & set-up costs = $2,000
 $0.50 per post card o $0.50* (3 million) = $1,500,000
 Estimate 2% response = 60,000
 $1.00 - $1.50 per hard copy survey (including survey return costs) o $1.25*(3 million – 60,000) = $3,675,000
 Estimated additional 10% response rate = 294,000 o $1.25* (3 million – 354,000) = $3,307,500
 Estimated additional 10% response rate = 264,600
 $0.50 - $0.75/survey data entry o $0.60*558,600 = $335,160
 Incentive = raffle where 3 participants get an iPad = $1,500
 TOTAL PRELIMINARY ESTIMATE = $8,821,160
BUDGET (PROJECT 2)
The following are rough cost estimates of this project:
 Design & set-up costs = $2,000
 $0.50 per post card o $0.50* (82,497) = $41,249
 Estimate 2% response = 1,650
 $1.00 - $1.50 per hard copy survey (including survey return costs) o $1.25*(82,497 – 1,650) = $101,059
 Estimated additional 10% response rate = 8,250

o $1.25* (82,497 – 9,900) = $90,746
 Estimated additional 10% response rate = 7,260
 $0.50 - $0.75/survey data entry o $0.60*15,510 = $9,306
 Incentive = raffle where 3 participants get an iPad = $1,500
 TOTAL PRELIMINARY ESTIMATE = $245,860
Costs do not include media campaign, potential list purchase costs and staffing.
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METHODOLOGY TEAM
The methodology team will be involved in all aspects of the proposed project including the final research design, collection of data, analysis and report/manuscript preparation. Both NCSBN and Forum members will have access to resulting de-identified data sets through procedures that will be developed specifically for this project by the methodology team.
Jill Budden, PhD
Associate, Research
National Council of State Boards of Nursing (NCSBN)
111 E. Wacker Drive, Suite 2900
Chicago, IL 60601-4277
312.525.3658 Direct
312.525.3600 NCSBN Main phone
312.279.1032 Fax jbudden@ncsbn.org
Elizabeth H. Zhong, PhD
Associate, Research
National Council of State Boards of Nursing (NCSBN)
111 E. Wacker Drive, Suite 2900
Chicago, IL 60601-4277
312.525.3636 (phone)
312.279.1032 (fax) ezhong@ncsbn.org
Jeannie P. Cimiotti, DNSc, RN
Associate Professor
Executive Director, NJ Collaborating Center for Nursing
Rutgers University College of Nursing
180 University Avenue
Newark, NJ 07102-1803 p. 973-353-1041 f. 973-353-1874 cimiotti@rutgers.edu
Patricia Moulton, PhD
Executive Director
ND Center for Nursing patricia.moulton@ndcenterfornursing.org
701-852-1810 www.ndcenterfornursing.org
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