Received LT 4/23/12
K.1. Attachment A
2012 National Sample Survey of Registered Nurses
Proposal
Having an adequate supply of RNs in the United States workforce is among the priorities of a safe and effective
health care system. Over time, there has been a substantial body of evidence predicting a potential shortfall of
nurses that could have a major impact on health care delivery in the future. Possible reasons for this include the
aging of the U.S. population and the new health care reform law, The Affordable Care Act, which predicts that 30
million more U.S. residents will become insured and seek medical care in the years ahead. Knowledge of supply
workforce data can be used to predict possible shortages and assist in the allocation of resources, program
development and recruitment efforts in both the health care system and education sectors.
Over the past three decades the Health Resources and Services Administration (HRSA) has examined the supply of
registered nurses through the National Sample Survey of Registered Nurses (NSSRN). Data collection from the most
recent, and final, NSSRN was completed in 2008; hence, there is no current data on the nationwide supply of RNs.
A variety of methods to collect workforce data about the U.S. nursing population has been examined for this
project. The most comprehensive and cost effective method is described in this proposal.
Purpose
To conduct a sample survey of all licensed U.S. registered nurses using The Forum of State Nursing Workforce
Centers Minimum Dataset (MDS) and collect supply data about the current U.S. RN workforce. Three methods of
collecting the workforce data are presented; however, the first method is the method we are recommending.
Data Collection Method 1 (Stratified Sample of the Population, State-level Focus)
Instrument. The Forum of State Nursing Workforce Centers Minimum Dataset (MDS) will be the instrument used
to collect the workforce data. This instrument was created through a process of consensus-building. Forum
workgroups (participating states included: Alabama, Colorado, Florida, Hawaii, Illinois, Indiana, Iowa,
Massachusetts, New Jersey, North Dakota, Oklahoma, Tennessee, Vermont, and West Virginia) drafted the
dataset. Following a public comment period, which allowed input from national organizations, the Forum voted
and approved the datasets in September 2009. NCSBN and The National Forum of State Nursing Workforce
Centers currently use the dataset to collect data about individual state nursing workforce and believe that the
dataset will enhance the ability to plan for the future (See Attachment B). The instrument will be used to collect
demographic and workforce data about the U.S. nursing population.
Sample. All registered nurses in the continental U.S. including Alaska and Hawaii with active RN licensees will be
eligible for survey participation. A stratified random sample will be obtained through the following methods:
1.
2.
A portion of the sample will be drawn from Nursys, NCSBN’s licensure database. This contains basic
contact and demographic information for RN licensees from 43 U.S. jurisdictions (includes 42 states and
the District of Columbia). Nursys will be used to draw a random stratified sample of nurses from those
states providing licensure information into Nursys. Currently, Nursys contains information on 3,998,416
RNs licensed to practice in U.S. jurisdictions. This number, however, includes duplicate licenses. Specific
measures will be taken to de-duplicate the data and ensure that none of the participants in the sample
are duplicative.
The remaining eight jurisdictions (states), which do not participate in Nursys, will be contacted and asked
for a database of all active RN licensees in their state. The same process will be used to draw a random
stratified sample of licensees in these states. Because some of the licensees from Nursys may also have
one or more licenses in the states that are non-participating in Nursys, the final sample of nurses selected
to participate will be checked to ensure there are no duplicate surveys being disseminated.
Non-Nursys participating boards: Alabama, Connecticut, Georgia, Hawaii, Illinois, Kansas, Oklahoma,
Pennsylvania.
The MDS survey will be sent to an outside vendor for design and printing. The vendor will set-up the mailing
process and clean addresses. The vendor will also supply a list that contains the telephone numbers of all survey
participants drawn for the sample so that participants may be contacted by phone prior to the survey and
afterwards. Surveys will be returned to the vendor and the vendor will transfer them to a data entry facility. During
this time, the online version of the survey will be developed. For the online survey, participants will be directed to
a simple web address (e.g., www.RNsurvey.org) which will contain a link to answer the survey.
The telephone number list will be used to broadcast a reminder to answer the survey or provide a thank you to
those that completed it.
Survey Administration. In administering the surveys, a modified Dillman approach (Dillman, Smyth, & Christian,
2009) will be implemented. This includes the following steps:
1.
2.
3.
4.
5.
Week 1: Each participant will receive a telephone announcement of the survey. The telephone
announcement will state the purpose of the survey, and state the importance of completing the survey.
Participants will also receive a vibrantly designed postcard, or letter with an incentive, sent to participants
which will contain a link to an online survey. The post card or letter will be sent first class to allow invalid
addresses to be sent back.
Week 3: A hardcopy of the survey will be sent to non-responders, with an online option.
Week 5: A telephone blast to remind non-responders to complete the survey, and to thank those who
have already participated.
Week 7: Hardcopy of survey sent to non-responders, with an online option.
Week 10: Deadline for surveys/closure of online option.
Prior to the initiation of the survey, numerous nursing organizations will be contacted and informed of the project.
Their assistance will be solicited to inform their members of the survey and encourage participation.
The estimated survey response rate is 52% (see Table 1). A formal non-response analysis will be conducted
following the close of the survey to ensure the study does not contain response bias. Although response rates are
a valuable indicator of survey quality, they may not be a good measure of response bias. An analysis of basic
demographic and professional data (e.g., age, year licensed, etc.) for all RN licensees in the Nursys database will be
used to compare the composition of the complete sample frame with that of the survey respondents, and nonrespondents, to determine how representative the sample is of the full population of RNs. We anticipate using this
information to make final determinations regarding the development of non-response sample weights for the final
data set.
The Dillman method was used by HRSA in the 2008, National Sample Survey and yielded a 65% response rate
(HRSA, 2010).
Table 1 provides an overview of the number of active licensees that must be drawn from each jurisdiction for 95%
confidence and a 3% error. Anticipated response rates are also described.
Table 1
Jurisdiction
Number of Active RN
Licensees
95% confidence, 3% error
(# of surveys to be
received)
Est. online
response
rate*
Est. 1st
mailing
response
rate**
Total estimated
response rate
Number of surveys need
to mail
AK
14,529
995
24%
32%
56%
1,777
AL
49,963
1,045
12%
13%
25%
4,180
AR
35,119
1,036
24%
28%
52%
1,992
AZ
71,194
1,052
24%
31%
55%
1,913
CA
374,587
1,065
24%
32%
56%
1,902
CO
61,871
1,049
24%
34%
58%
1,809
CT
59,155
1,049
12%
13%
25%
2,017
DC
23,592
1,021
24%
28%
52%
1,963
DE
14,810
996
24%
35%
59%
1,688
FL
251,044
1,063
24%
24%
48%
2,215
GA
97,043
1,056
12%
13%
25%
4,224
HI
20,159
1,014
12%
13%
25%
4,056
IA
47,331
1,044
24%
35%
59%
1,769
ID
19,083
1,011
24%
37%
61%
1,657
IL
153,262
1,060
12%
13%
25%
4,240
IN
93,928
1,056
24%
33%
57%
1,853
KS
46,724
1,044
12%
13%
25%
4,176
KY
59,617
1,049
24%
30%
54%
1,943
LA
56,228
1,048
24%
27%
51%
2,055
MA
119,969
1,058
24%
31%
55%
1,924
MD
70,487
1,052
24%
30%
54%
1,948
ME
21,984
1,018
24%
34%
58%
1,755
MI
138,146
1,059
24%
32%
56%
1,891
MN
87,798
1,055
24%
40%
64%
1,648
MO
93,822
1,056
24%
33%
57%
1,853
MS
41,385
1,041
24%
22%
46%
2,263
MT
15,666
1,000
24%
32%
56%
1,786
NC
116,197
1,058
24%
38%
62%
1,706
ND
11,640
978
24%
39%
63%
1,552
NE
27,700
1,028
24%
41%
65%
1,582
NH
20,238
1,014
24%
40%
64%
1,584
NJ
114,470
1,058
24%
28%
52%
2,035
NM
24,275
1,023
24%
34%
58%
1,764
NV
26,930
1,027
24%
32%
56%
1,834
NY
279,563
1,064
24%
32%
56%
1,900
OH
176,092
1,061
24%
34%
58%
1,829
OK
42,743
1,042
12%
13%
25%
4,168
OR
47,733
1,044
24%
38%
62%
1,684
PA
208,313
1,062
12%
13%
25%
4,248
RI
18,181
1,008
24%
28%
52%
1,938
SC
56,721
1,048
24%
31%
55%
1,905
SD
15,180
998
24%
38%
62%
1,610
TN
84,619
1,054
24%
25%
49%
2,151
TX
243,629
1,063
24%
27%
51%
2,084
UT
28,656
1,029
24%
30%
54%
1,906
VA
92,036
1,055
24%
30%
54%
1,954
VT
17,651
1,007
24%
35%
59%
1,707
WA
83,321
1,054
24%
36%
60%
1,757
WI
82,610
1,054
24%
32%
56%
1,882
WV
28,862
1,030
24%
32%
56%
1,839
WY
8,907
954
24%
41%
65%
1,468
Virgin Islands
1,577
637
24%
32%
56%
1,138
Guam
924
496
24%
32%
56%
886
American Samoa
86
80
24%
32%
56%
143
Northern Mariana
Islands
1,066
534
24%
32%
56%
954
TOTAL
3,998,416
54,652
22%
30%
52%
113,703
Note. Jurisdictions in green italics are 2010 data and are non-Nursys participating boards. For all other jurisdictions, data are as of March 15, 2012. *24% was
overall online response rate for HRSA’s NSSRN.
**Estimates for 1st mailing response rate are from NCSBN’s CORE project; lists from Nursys participating boards averaged a 32% response rate, while non-Nursys
lists averaged a 13% response rate. HRSA’s overall paper survey response rate was 27%.
Results. Data will be collected, analyzed and reported in the aggregate. Individual state data may be reported if it
differs from that of the aggregate or illustrates important findings. State boards of nursing as well as State
Workforce Centers will have access to their own individual state data.
Budget. There are two methods that can be used to deliver information to participants about the survey. One is to
send a post card that directs the participant to a website that contains the online survey. This is followed by two
hard copy mailings and two telephone blasts. The incentive offered is participation in a raffle for an iPad.
The second method substitutes a letter in place of the post card which contains a $1.00 incentive. This directs the
participant to the website for the survey. This is followed by the two additional mailings of hard copies of the
survey and the telephone blasts. Dr. Tim Johnson, who is a consultant on this study, suggests that this method may
yield a higher response rate.
Cost Estimates (postcard)
Item
Survey design & set-up costs
Postcard (with online survey)
1st hard copy survey mailing
2nd hard copy survey mailing
Two telephone blasts
Data Entry
RN database from Non-Nursys
participating states
Incentive
TOTAL ESTIMATE
Details











$0.50 per postcard
$0.50* (113,703) = $56,852
Estimate 2% response = 2,274
$1.00 - $1.50 per hard copy survey (including survey
return costs)
$1.25*(113,703 – 2,274) = $139,286
Estimated additional 30% response rate = 33,429
$1.25* (113,703 – 35,703) = $97,500
Estimated additional 22% response rate = 17,160
Estimated $138/1200 people = $26,152
$0.50 - $0.75/survey data entry
$0.60*15,859 = $9,515
Total
$2,000
$56,852
$139,286
$97,500
$26,152
$9,515
$5,329
 Raffle where 3 participants get an iPad
$1,500
$338,134
OR
Cost Estimates (letter + incentive)
Item
Survey design & set-up costs
Letter and $1 incentive (with
online survey)
1st hard copy survey mailing
2nd hard copy survey mailing
Two telephone blasts
Data Entry
RN database from Non-Nursys
participating states
TOTAL ESTIMATE
Details











$0.80 per letter + $1 incentive
$1.80* (113,703) = $204,665
Estimate 2% response = 2,274
$1.00 - $1.50 per hard copy survey (including survey
return costs)
$1.25*(113,703 – 2,274) = $139,286
Estimated additional 30% response rate = 33,429
$1.25* (113,703 – 35,703) = $97,500
Estimated additional 22% response rate = 17,160
Two telephone blasts (estimate $138/1200 people) =
13,076*2 = $26,152
$0.50 - $0.75/survey data entry
$0.60*15,859 = $9,515

Total
$2,000
$204,665
$139,286
$97,500
$26,152
$9,515
$5,329
$484,447
Data Collection Method 2 (Sample of the Population, National-level Focus)
Method 2 uses the same methodology as option 1 except a national-level sampling strategy will be employed; that
is, a sample of RNs will be randomly selected from the population of RNs across country (i.e., RNs will not be
randomly selected/stratified by state). Using this method, rural states may be underrepresented in the total
sample. Overall, with 1% margin of error, at 99% confidence, with a population of 3,998,416 million RN licensees,
16,519 RNs will need to complete the survey. With an estimated 52% response rate (see Table 1), 31,767 surveys
will need to be sent out.
Cost Estimates (post card)
Item
Survey design & set-up costs
Postcard (with online survey)
1st hard copy survey mailing
2nd hard copy survey mailing
Two telephone blasts
RN database from Non-Nursys
participating states
Data Entry
Details









$0.50 per post card
$0.50* (31,767) = $15,884
Estimate 2% response = 635
$1.00 - $1.50 per hard copy survey (including survey
return costs)
$1.25*(31,767 – 635) = $38,915
Estimated additional 30% response rate = 9,340
$1.25* (31,767 – 9,975) = $27,240
Estimated additional 22% response rate = 4,794
Two telephone blasts (estimate $138/1200 people) =
3,653*2 = $7,306
Total
$2,000
$15,884
$38,915
$27,240
$7,306
$5,329
 $0.50 - $0.75/survey data entry
$2,659
Incentive
TOTAL ESTIMATE
 $0.60*4,431 = $2,659
 Raffle where 3 participants get an iPad
$1,500
$100,833
Cost Estimates (letter + incentive)
Item
Survey design & set-up costs
Letter and $1 incentive (with
online survey)
1st hard copy survey mailing
2nd hard copy survey mailing
Two telephone blasts
Details









$0.80 per letter + $1 incentive
$1.80* (31,767) = $57,181
Estimate 2% response = 635
$1.00 - $1.50 per hard copy survey (including survey
return costs)
$1.25*(31,767 – 635) =
Estimated additional 30% response rate = 9,340
$1.25* (31,767 – 9,975) = $27,240
Estimated additional 22% response rate = 4,794
Two telephone blasts (estimate $138/1200 people) =
3,653*2 = $7,306
RN database from Non-Nursys
participating states
Data Entry
Total
$2,000
$57,181
$38,915
$27,240
$7,306
$5,329
 $0.50 - $0.75/survey data entry
 $0.60*4,431 = $2,659
TOTAL ESTIMATE
$2,659
$140,630
Data Collection Method 3 (Full Population)
Method 3 is a survey of all active RN licensees in the United States. While this method may seem more
comprehensive, it will not provide increased accuracy or more information than method 1.
Cost Estimates
Item
Survey design & set-up costs
Postcard (with online survey)
1st hard copy survey mailing
2nd hard copy survey mailing
Two telephone blasts
Data Entry
Details











$0.50 per post card
$0.50* (3,998,416) = $1,999,208
Estimate 2% response = 79,968
$1.00 - $1.50 per hard copy survey (including survey
return costs)
$1.25*(3,998,416 – 79,968) = $4,898,060
Estimated additional 30% response rate = 1,175,534
$1.25* (3,998,416 – 1,255,502) = $3,428,643
Estimated additional 22% response rate = 603,441
Two telephone blasts (estimate $138/1200 people) =
459,818*2 = $919,636
$0.50 - $0.75/survey data entry
$0.60*557,683 = $334,610
RN database from Non-Nursys
participating states
Incentive
Total
$2,000
$1,999,208
$4,898,060
$3,428,643
$919,636
$334,610
$5,329
 Incentive = raffle where 3 participants get an iPad =
$1,500
$1,500
TOTAL ESTIMATE
$11,589,986
Research 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
CONSULTANT:
Timothy P. Johnson, PhD
Direct, Survey Research Laboratory
Professor, Public Administration
University of Illinois at Chicago
412 S Peoria St
Chicago, IL 60607
Office: 312.996.5310
Fax: 312.996.3358
timj@uic.edu
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
Reference
Dillman, D. A., Smyth, J. D., Christian, L. M. (2009). Internet, Mail, and Mixed-Mode Surveys: The Tailored Design
Method.