Fact Sheet 2006

Nurses: Vital Signs
A BRIEF OVERVIEW OF THE STATE OF THE
NURSING PROFESSION IN THE UNITED STATES

 

 More Nurses Are Needed

·         Registered nursing was among the fastest growing occupations in the 1990s.  By 2005, the number of employed RNs was 2,416,000 – an increase of 52% since 1990.¹

·         In 2005, the U.S. Department of Labor identified “Registered Nurse” as the occupation expected to experience the second largest job growth in the 10 years from 2004 to 2014.  The need for RNs is projected to grow rapidly, rising by 29.4% between 2004 and 2014, compared to 13% during the same period for all occupations.  More than 1.2 million openings for RNs are projected by 2014 due to growth and replacements.²

·         Despite small declines from 2002 to 2004, the number of Licensed Practical Nurses and Licensed Vocational Nurses is expected to increase 17.1% between 2004 and 2014.  The number of LPN/LVNs is projected to increase during this period from 726,000 to 850,000.^3,4
 

The Nurse Work Force Is Aging and Changing

·         The vast majority of nurses are women, although the percentage of men in the field increased slightly in the last decade:  the percentage of male RNs rose from 6.9% in 1995 to 7.7% in 2005, and the percentage of male LPN/LVNs increased slightly from 4.6% to 6.6%.⁵

·         Most nurses are white, although the percentage of minorities among nurses is increasing.  From 1995–2005:

—  The Black or African American share of RN positions increased from 8.4% to 10%.  The proportion of black LPN/LVNs also increased from 19.6% to 21.6%.  African Americans made up 10.8% of the total labor force in 2005.⁶

—  The percentage of Hispanic or Latino RNs increased from 2.6% to 4.3% from 1995–2005.  Latinos’ share of LPN/LVN positions increased from 3.7% to 5.5%, while they made up 13.1% of the labor force in 2005.⁷

·          The nurse population is aging, since fewer people are entering the profession.  The average age of RNs increased from 36 in 1980 to 45 in 2000.  Over two-thirds of RNs are 40 or older.  In 1992, 24% of RNs were between the ages of 25 and 34; by 2000, less than 16% of RNs were in that age group.⁸
 

A Severe Shortage of Nurses Causes a Crisis

·         The U.S. is experiencing a severe nursing crisis that will intensify as baby boomers age and the need for health care grows.  The Health Resources and Services Administration estimated nurse shortages in 30 states in 2000 and projects the problem to expand to 44 states and the District of Columbia by 2020.⁹  Another study predicts a shortfall of 400,000 RNs by 2020¹⁰, while yet another projects a shortage of 800,000 by 2020.¹¹   Factors involved in the shortage include insufficient new nursing school graduates, partly due to a serious shortage of nursing school faculty; an aging nurse population, and widespread burnout among nurses because of understaffing.

·         Nursing School Enrollment:  Enrollments in entry-level RN baccalaureate programs began declining in 1995 and continued until 2000.  Recently, however, there has been resurgence in the number of students studying nursing, with five consecutive years of increasing enrollments.  Most recently, 2005 saw a 13% increase in enrollments; 2003 and 2004 also had increases in the double digits.  The number of graduates from entry-level baccalaureate programs also increased, up 19.1% in 2005.¹²

·         Shortage of Faculty for Nursing Schools:  The shortage of faculty makes it impossible to train sufficient nurses, a problem which is becoming especially acute as enrollments at nursing schools increase.  The American Association of Colleges of Nursing has reported a national nurse faculty vacancy rate of 8.1%.  In 2005, 32,797 qualified applicants to baccalaureate, master’s and doctoral programs were not accepted.  This is a nine-fold increase since 2002 in the number of qualified applicants turned away, and a shortage of faculty has been cited as the reason why more students were not admitted.  Of these qualified applicants denied admission, some 3,000 could potentially have filled faculty roles.¹²

·         Understaffing:  There are not enough nurses to do what needs to be done on any given shift and the nurses who are on duty are exhausted and stressed.  A 2003 study by the Institute of Medicine (IOM) found the environment in which nurses work a breeding ground for medical errors which will continue to threaten patient safety until substantially reformed.  The IOM points to numerous studies showing that increased infections, bleeding and cardiac and respiratory failure are associated with inadequate numbers of nurses.1³  A 2002 report by the Joint Commission on Accreditation of Healthcare Organizations called the nursing shortage “a prescription for danger” and found that a shortage of nurses contributed to nearly a quarter of the anticipated problems that result in death or injury to hospital patients.¹⁴

·         Low Nurse -to-Patient Ratios:  With managed care restructuring the health care industry in the 1990s, hospitals reduced staffing levels to lower costs.  Nurses care for more patients and patients who are more acutely ill due to shorter hospital stays.  One study of hospital staffing found that decreases in the number of LPN/LVNs added to RNs’ patient load.¹⁵  Studies have linked low nurse-to-patient ratios to medical errors and to poorer patient outcomes, as well as to nurses leaving patient care.  A 2002 study by Linda Aiken, et al., found that for each additional patient over four in an RN’s workload, the risk of death increases by 7% for hospital patients.  Patients in hospitals with eight patients per nurse have a 31% higher risk of dying than those in hospitals with four patients per nurse.¹⁶  The IOM study  recommends that nurse staffing levels be raised in all health care facilities.¹⁷

Implementing laws regulating nurse-to-patient ratios can have a big effect on understaffing.  The California Nurses’ Association reports that after the enactment of a staffing ratio law at the beginning of 2004, the number of actively licensed nurses in California increased by more than 48,000 (20%), and the number of license applications increased by 60% since 2002.  Furthermore, California nursing schools increased their capacities, and the state reported a net influx of nurses from other states.¹⁸

·         Mandatory Overtime and Floating:  Because of the nursing shortage, many hospitals routinely require nurses to work unplanned or mandatory overtime and to “float” to departments outside their expertise.  On average, RNs work 8.5 weeks of overtime per year according to a recent union survey.¹⁹  Mandatory overtime was an issue in several recent strikes and 77% of RNs favor a law banning it except when an emergency is declared.²⁰

·          Burnout:  Among nurses there are high rates of emotional exhaustion and job dissatisfaction which are strongly associated with inadequate staffing and low nurse-to-patient ratios.  The Aiken study found each additional patient per nurse corresponds to a 23% increased risk of burnout, as well as a 15% increase in the risk of job dissatisfaction.2¹

A 2000 survey reported a satisfaction rate of just 69.5% among RNs, substantially lower than the 90% overall job satisfaction among professionals.  This dissatisfaction is clearly linked to the departure of RNs from the nursing work force.  In a survey conducted by the American Nurses Association, 33% of nurses under the age of 30 stated their intent to leave their present job within the year.2²

·         A study by Peter Hart & Associates found 50% of employed RNs had considered leaving patient care within the last two years for reasons other than retirement, and 21% of them said they expect to quit within five years.  Nurses who are considering leaving patient care and those who have quit consistently cite better staffing levels and more time with patients as key to persuading them to stay or return to patient care.2³

·         Some nurses have left hospitals to work in less stressful environments.  In 2000, an estimated 21% of all acute care hospital nurses left their positions.2⁴  The proportion of RNs who work in hospitals fell from 66.5% in 1992 to 59% in 2000.2⁵

·          Healthcare employers are increasingly recruiting nurses from overseas, which allows them to avoid making fundamental changes to improve the quality of care, retain nurses, and make nursing an attractive career.  The nursing crisis is an  international problem:  nurses’ organizations from 69 countries and every geographic area reported a shortage of nurses.  Overseas recruitment drains health care personnel from countries with more limited resources and health care personnel, and jeopardizes the well-being of their citizens.  In Ghana, more than 500 nurses left the country in 2000 for higher paying jobs in richer countries – three times the total recorded in 1999 and more than twice the number of nursing graduates Ghana produced that year.  Thirty-three countries – primarily in Oceania, Africa, Central America and the Caribbean – reported that the outflow of nurses to more affluent countries was a serious to extremely serious problem, which worsens the shortage that already exists.2⁶

In addition, extensive use of temporary visa programs frequently depresses wages and guest workers themselves are particularly open to exploitation. 

 Nursing Is a Dangerous Occupation

Nurses are at high risk of injury or illness due to occupational hazards.

·         Registered nursing is one of 10 jobs with the highest levels of occupational injury or illness requiring days away from work, with 20,500 cases reported in private industry in 2004.  Among nurses, 21% of all workplace injuries or illnesses required three to five days off work, and almost 24% of cases required 31 days off or more.  Sixteen percent of all workplace injuries occurred in the health care and social assistance industry, more than in the construction, mining, and agriculture, forestry, fishing & hunting industries combined.²⁷

·         In 2004, the non-fatal occupational injury and illness rate was 7.1 cases per 100 health care workers, compared to 3.9 cases per hundred among workers in the social assistance sector and 4.8 cases per 100 workers in the private sector generally.28

·         In a 2001 survey, the American Nurses Association (ANA) found that 40% of their members had been injured in the previous year, including needle sticks, but many had not reported the injuries.²⁹
 

Nurses Are Still Undervalued and Underpaid

Nursing has historically been an undervalued and underpaid profession, considering the high level of education, skills and responsibility required of nurses.

·         RNs’ wages have generally stagnated during the past ten years, particularly after 1994 when managed care restructured the health care industry and many nurses were laid off.  In spite of the difficulty in retaining  experienced nurses, employers have yet to raise nurses’ salaries dramatically, as they did in the late 1980s in response to the last nurse shortage.³⁰  Some employers have offered bonuses as incentives to attract new nurses to their hospitals, but this policy does not benefit experienced nurses or help to retain them.

·         Adjusted for inflation, RNs’ median weekly earnings increased by a mere 0.6% from 1995 to 2000, while wages for the total labor market increased by 6.5% during that period.31

·         RNs’ wages regained some ground between 2000 and 2005, increasing 4.5% during that period, during which time the earnings of the labor force as a whole actually fell by 0.3%.  This translates to real (inflation-adjusted) weekly earnings of $895 in 2000 to $935 in 2005.32

·         These gains only minimally offset the previous losses, as RNs’ wages rose by only 5% from 1995 to 2005, while real wages for the total labor force rose 6.2%.³³

·         LPN/LVNs’ median weekly earnings increased by 2.8% from 1995 to 2000.  In the past five years, these earnings increases have accelerated, increasing 7% from 2000–2005, with a net result of 10% growth for the decade.  In dollar amounts, median real weekly earnings for LPN/LVNs increased from $584 in 2000 to $625 in 2005.34

·         Unions can have a very significant impact on nurse wages.  Nurses covered by a union contract in 2005 earned 16% more per week than non-covered nurses, while LPN/LVNs represented by unions earned a wage premium of nearly 15%.  This translates to a weekly earnings increase of about $148 for RNs and $89 for LPN/LVNs—an annual gain of $7,696 and $4,628, respectively.³⁵

·         In cities with a strong union presence, wages are higher even for those nurses who are not in unions.³⁶
 

 Benefits Are Poor but Increasing

·         Healthcare employers spend less on benefits than other non-manufacturing employers.  Healthcare employers contributed only 6.7% of payroll costs to employees’ pensions in 2002, compared to 9.6% spent by all non-manufacturing employers.  For medical and medically-related benefits, the health care industry provided 6.6% of payroll, while all non-manufacturing employers spent 9.9%.37   The healthcare percentage is a significant increase from 2000, however, when only 1.5% of payroll for healthcare employers surveyed went to employee pensions.

·         Because the nursing profession is overwhelmingly female, health care employers have justified lower benefits contributions by arguing that women tend to move in and out of the workforce and rely on their husbands’ pensions and insurance.  However, fewer women can count on a husband’s benefits, both because fewer women are married and because more employers are reducing or  eliminating coverage for workers and their families.38

·         There are considerable variations in wages and benefits based on geographic region, full-time/part-time status, work setting, hospital characteristics and union/non-union status.  Union members have significantly better benefits.³⁹

 After Accelerating for a Decade, Union Organizing Declines

·         Health care workers represent a large portion of all workers holding representation elections.  More than one in eight of the 2,674 NLRB representation elections held in 2005 was held among workers in the health care industry.  Workers in this industry were more likely to vote for a union than in industries in general:  almost 58% for health care, compared to 52% for all industries in 2005.⁴⁰

·         The number of representation elections in the health care industry increased by 47.7% between 1990 and 2000, while overall, there was a 6% decline in representation elections.  However, between 2000 and 2005, the number of representation elections held decreased by almost 35%.⁴¹

·         Among RNs, union membership dropped off between 1994 and 1995, falling from 17.3% to 15.2%.  In the decade since, union membership has rebounded slightly, to 16.6% in 2005.  Union density fell from 12.8% in 1995 to 11.3% in 2005 among LPN/LVNs.⁴²

·         The percentage of RNs represented by a union also jumped downward between 1994 and 1995, from 20.1% to 17.6%.  Again, in the following decade there was only a slight rebound, to 18.7% in 2005.  For LPN/LVNs, union representation dropped from 15.6% to 12.9% in 2005.⁴³

________________________________________________________________________________

 1 U.S. Department of Labor, Bureau of Labor Statistics, Current Population Survey [CPS], Table 11, 1991, 2006.

2 Hecker, Daniel.  “Occupational Employment Projections to 2014”.  U.S. Department of Labor, Bureau of Labor Statistics, Monthly Labor Review, November 2005, Vol. 128, No. 11.

³ U.S. Department of Labor, Bureau of Labor Statistics, Current Population Survey, Table 11, 2005, 2006.

4Hecker, Daniel, op. cit.

⁵ U.S. Department of Labor, Bureau of Labor Statistics, Current Population Survey, Table 11, 1996, 2006.

⁶ Ibid.

⁷ Ibid.

⁸ U.S. Department of Health and Human Services, Bureau of Nursing, National Sample Survey of Registered Nurses, 1980–2000.

⁹ U.S. Department of Health and Human Services, Health Resources and Services Administration, Projected Supply, Demand, and Shortages of RNs:  2000–2020, July 2002.

¹⁰ Buerhaus, Peter.  Journal of the American Medical Association, June 14, 2000.

¹¹ American Association of Colleges of Nursing, Press Release, “New Data Confirms Shortage of Nursing School Faculty Hinders Efforts to Address the Nation's Nursing Shortage”, March 8^th, 2005.

¹² Ibid.

13 Institute of Medicine, Keeping Patients Safe:  Transforming the Work Environment of Nurses, 2003.

¹⁴ Joint Commission on Accreditation of Healthcare Organizations, Healthcare at the Crossroads:  Strategies for Addressing the Nursing Crisis, August 2002.

¹⁵ Unruh, Lynn.  “Licensed Nurse Staffing and Adverse Events in Hospitals”, Medical Care, Vol. 41, No. 1, 2003.

¹⁶ Linda H. Aiken, PhD, RN; Sean P. Clarke, PhD, RN; Douglas M. Sloane, PhD; Julie Sochalski, PhD, RN; Jeffery H. Silber, MD, PhD, “Hospital Nurse Staffing and Patient Mortality, Nurse Burnout and Job Dissatisfaction,” Journal of the American Medical Association, Vol. 288, No. 16, October 23–30, 2002.

¹⁷ Keeping Patients Safe, op. cit.

¹⁸   California Nurses’ Association, “RN Staffing Ratios:  The Real Story on the Nursing Shortage”, http://www.calnurses.org/nursing-practice/, 2005.

¹⁹ Service Employees International Union, The Shortage of Care:  A Study by SEIU Nurse Alliance, 2001.

²⁰ The Shortage of Care, op. cit.

²¹ “Hospital Nurse Staffing and Patient Mortality, Nurse Burnout and Job Dissatisfaction” op. cit.

²² Keeping Patients Safe, op. cit.

²³ Peter D. Hart Research Associates, The Nurse Shortage:  Perspectives from Current Direct Care Nurses and Former Direct Care Nurses, April 2001.

²⁴ Keeping Patients Safe, op. cit.

²⁵ The Nurse Shortage:  Perspectives from Current Direct Care Nurses and Former Direct Care Nurses, April 2001.

²⁶ International Council of Nurses, Socio-Economic News, “Global Issues in the Supply and Demand of Nurses”, January–March 2003.

²⁷ U.S. Department of Labor, Bureau of Labor Statistics, Lost-Worktime Injuries and Illnesses:  Characteristics and Resulting Time Away from Work 2004, 2005.

²⁸ Ibid.

²⁹ American Nurses Association, On-Line Health and Safety Survey, 2001.

³⁰ American Federation of Teachers, Healthcare, State of the Healthcare Workforce, 2002, 2003.

³¹ U.S. Department of Labor, Bureau of Labor Statistics, Current Population Survey, Table 39, 1996, 2001.

³² Wage estimates from the 1996, 2001, and 2006 CPS data are adjusted to reflect inflation using the Consumer Price Index.

³³ U.S. Department of Labor, Current Population Survey, Table 39, 1996, 2001, 2006.

³⁴ Ibid.

³⁵ Bureau of National Affairs, Union Membership and Earnings Data Book:  Compilations of the Current Population Survey, 2006.

³⁶ Lovell, Vicky.  “Solving the Nursing Shortage Through Higher Wages”.  Institute for Women’s Policy Research, 2006.

³⁷ U.S. Chamber of Commerce, The 2002 Employee Benefits Study, 2003.

³⁸ The State of the Healthcare Workforce, op. cit.

³⁹ Ibid; U.S. Department of Labor, Bureau of Labor Statistics, “National Compensation Survey, Employee Benefits in Private Industry in the United States, March 2005”, August 2005.

⁴⁰ The National Labor Relations Board, “The Annual Report of the National Labor Relations Board”, 1991, 2001, 2005.

⁴¹ Ibid.

⁴² Bureau of National Affairs, Union Membership and Earnings Data Book:  Compilations of the Current Population Survey, 2006.

⁴³ Ibid.

For further information on professional workers, check out DPE’s Web site:  www.dpeaflcio.org. 

The Department for Professional Employees, AFL-CIO (DPE) comprises 23 AFL-CIO unions representing over four million people working in professional, technical and administrative support occupations.  DPE-affiliated unions represent:  teachers, college professors and school administrators; library workers; nurses, doctors and other health care professionals; engineers, scientists and IT workers; journalists and writers, broadcast technicians and communications specialists; performing and visual artists; professional athletes; professional firefighters; psychologists, social workers and many others.  DPE was chartered by the AFL-CIO in 1977 in recognition of the rapidly-growing professional and technical occupations.

Source:      Department for Professional Employees

                  Research Department
815 16th Street, NW, N.W.

                  7th Floor

                  Washington, DC 20006

Contact:    Pamela Wilson

                  (202) 638-6684
                  pwilson@dpeaflcio.org