In March 2000, an estimated 2,714,671 individuals
had current licenses to practice as RNs in the
United States. Of these, 2,696,540 were located
in this country, 9,831 were located outside
the United States and the District of Columbia,
and 8,300 who were listed as having an active
license to practice were identified as deceased.
The data in this report focus on RNs located
in the United States. RNs are considered to
be located in the U.S. if they were employed
in nursing in one of the 50 States and the District
of Columbia or, if not employed in nursing,
were residents of the U.S. Of the 2,696,540
RNs located in this country, 81.7 percent or
2,201, 813 were employed in nursing (see Appendix
A, Table 1).
Age
The average age of the total RN population
(including those who are retired and not employed
in nursing) was estimated as 45.2 years in March
2000, the highest since the survey series was
initiated. Only 9.1 percent of the RN population
were under the age of 30, 18.3 percent were
under the age of 35 and 31.7 percent were under
the age of 40. (See Appendix A, Table 1). Despite
the increasing age of RNs, the percent of RNs
who are employed in nursing continues to be
at a relatively high level.
The aging RN workforce reflects fewer young
nurses entering the RN population, large cohorts
of the RN population moving into their 50s and
60s, and older graduates from basic nursing
education programs who have been entering the
RN population.
The average age of an RN who graduated from
a basic education program in the five years
preceding the March 2000 study, was 30.9 years
compared to 23.9 years for those who had graduated
16 or more years before the survey (see Appendix
A, Table 5).
The average age of graduates from basic nursing
programs varies by type of program. Graduates
of associate degree programs tend to be older
than diploma graduates, while baccalaureate
graduates tend to be the youngest. The average
age of graduates from the basic nursing programs
during the five-year period preceding the 2000
survey was: 33.2 for associate degree graduates,
30.8 for diploma graduates,and 27.5 for baccalaureate
graduates. Data show that, for each type of
basic education program, the average age at
graduation is higher for those who graduated
in 1995 and later than for those who graduated
in the years prior to 1995. (See Chart 10).
[D]
However, age at graduation has increased less
among 1990 and later graduates than it did among
those who graduated prior to 1990 (see Appendix
A, Table 5).
Gender
As noted in Chapter II (Gender), of the
estimated 2,694,540 RNs in the US in March 2000,
146,902 or 5.4 percent were men. (See Appendix
A, Table 1). Gender differences exist with regard
to age, employment status and choice of basic
nursing education programs. Male RNs generally
are younger than female RNs and more likely to
be employed in nursing. Thirty eight percent of
male RNs were under 40 years of age compared with
31percent of female RNs, and 21 percent of male
RNs were 50 years of age or older compared with
34 percent of female RNs. Approximately 88 percent
of male RNs were employed in nursing compared
with 81 percent of female RNs.
With respect to the type of program in which
they received their basic nursing education,
differences between male and female RNs are
found in the proportions graduating with either
a diploma or an associate degree. Approximately
15 percent of male RNs graduated from diploma
programs, compared with 30 percent of female
RNs; and 53 percent of male RNs graduated from
associate degree programs, compared with 40
percent of female RNs.
These gender differences can also be observed
in the highest educational preparation of RNs.
Diploma preparation is more likely to be the
highest preparation of female RNs than of male
RNs, while males RNs are more likely to have
associate degree preparation. Men and women
are comparable in the percentages prepared at
the baccalaureate and higher levels. (See chart
11).
[D]
Racial
/ Ethnic Background
An estimated 333,368 RNs, (12 percent) came
from racial and ethnic minority backgrounds.
Of these RNs, 133,041 were African American/Black
(non-Hispanic); 93,415 were Asian; 54,861 were
Hispanic/Latino; and, 13,040 were American Indians/Alaska
Natives. For the first time in the survey series,
estimates also are available of the number of
Native Hawaiian and Other Pacific Islander RNs
apart from the Asian total an estimated
6,475; and of non-Hispanic RNs who reported
two or more races an estimated 32,536.
RNs from minority backgrounds were more likely
than non-minority nurses to be employed in nursing
and to work full time. Eighty-six percent of
minority nurses were employed in nursing compared
with 81 percent of non-minority nurses. Minority
nurses employed in nursing were also more likely
than non-minority nurses to be employed full
time. The percentage of the workforce employed
full time ranged from 77 percent for Hispanic/Latino
RNs to 86 percent for African American/Black,
Asian, and Native Hawaiian and Other Pacific
Islander RNs. In comparison, 70 percent of employed
non-Hispanic White RNs worked full time.
With the exception of RNs from Asian, Native
Hawaiian and Pacific Islander backgrounds, most
RNs receive their basic nursing preparation
in associate degree programs. The proportion
of RNs who received basic nursing education
in associate degree programs ranged from 40
percent of white nurses to 57 percent of American
Indian/Alaska Native nurses. White nurses were
more likely than other nurses to have received
their basic nursing education in diploma programs.
Thirty-one percent of white nurses were prepared
for RN licensure in diploma programs compared
with 16 to 25 percent of minority nurses. On
the other hand, the majority (54.3 percent)
of RNs from Asian backgrounds and Native Hawaiian
and Pacific Islanders (55.7 percent) received
basic nursing education in baccalaureate programs.
Chart 12 illustrates how racial/ethnic groups
compare in terms of highest educational preparation.
Asians, Native Hawaiians and Other Pacific Islanders;
and African Americans/Blacks were more likely
than all other nurses to have at least baccalaureate
preparation. Native Hawaiian and Other Pacific
Islander, African American/Black, and white
nurses were the racial/ethnic groups with the
highest percentages of masters or doctoral degrees.
EDUCATION
AND EMPLOYMENT PRIOR TO BASIC NURSING EDUCATION
Individuals come into nursing through various
pathways. A significant number were employed
in other health care occupations or received
post high school academic degrees prior to entering
a basic nursing education program. Both the
number and percentage of nurses with these employment
and educational backgrounds increased notably
between 1996 and 2000. In March 2000, about
37 percent of RNs (1,006,617 RNs) had worked
in a health care occupation immediately prior
to attending a basic nursing education program
(see Appendix A, Table 2). This compares with
34 percent in 1996. The majority (51 percent)
of those coming through the pathway of other
health care employment had worked as nursing
aides, and another relatively large group, 26
percent, had worked as licensed practical or
vocational nurses (LPN/LVN) immediately prior
to going into a basic nursing education program
to become RNs.
Nurses who had been health occupation workers
just before entering a basic nursing education
program tended to enroll in associate degree
programs (56.3 percent) to prepare for RN licensure.
This is particularly true of those who worked
as LPNs/LVNs. Eighty-two percent of RNs who
were employed as LPNs/LVNs immediately prior
to beginning their basic education program,selected
associate degree programs. In total there were
305,842 RNs who had been LPNs/LVNs sometime
prior to becoming registered nurses. It is estimated
that 256,730 of these nurses were employed as
LPNs/LVNs immediately prior to their basic nursing
education.
In 2000 about 13 percent of the RN population,
or 358,520 RNs, had post high school academic
degrees prior to entering a basic nursing education
program (See Appendix A, Table 4). RNs with
post-high school academic degrees were less
likely to receive their basic education in an
associate degree program than those who had
been licensed practical/vocational nurses. About
53 percent of these RNs received their basic
education in an associate degree program, compared
with 80 percent of those who had been LPNs/LVNs
sometime before becoming RNs.
There are more RNs who had post high school
academic degrees prior to their nursing education
than RNs who had been LPNs/LVNs among recent
entrants to the RN population. Twenty-five percent
of RNs who graduated 5 years or less before
the 2000 survey had post high school academic
degrees compared with 15 percent who were previously
employed as LPNs/LVNs.
[D]
Family
Status
In March 2000, 71.5 percent of all RNs were
married, 17.9 percent were widowed, divorced
or separated and 9.9 percent were never married.
Fifty two percent had children living at home,
and 16 percent had children under 6 years of
age. (See Appendix A Table 6)
Family status made a difference in whether
nurses were employed full-time or part-time.
Employed married nurses with children, particularly
those with children under the age of six, were
more likely than other employed nurses to be
employed on a part-time basis. Approximately
28 percent of the 2,201,813 employed RNs were
working on a part-time basis. Nearly 45 percent
of employed married nurses with children under
6 worked part time. Married nurses with children
under 6 years of age were 8.1 percent of all
employed nurses.
Nursing
Educational Preparation
The basic educational preparation for the largest
proportion of RNs is the associate degree. Forty
percent, or 1,087,602 of the 2,696,540 RNs received
their basic nursing education in an associate
degree program. Equal proportions (about 30
percent) attended diploma programs and baccalaureate
programs. RNs employed in nursing were even
more likely to have been initially educated
in associate degree programs; 43.3 percent of
them came from associate degree programs, 25.7
percent from diploma programs and 30.3 percent
from baccalaureate programs. (See Appendix A,
Table 8.)
Of those RNs obtaining their initial nursing
education in the past 5 years, 55.4 percent
graduated from an associate degree program and
38 percent graduated from a baccalaureate program;
only six percent graduated from diploma programs.
(See Appendix A, Table 5)
Approximately 19 percent of the RN population
in 2000 had completed additional academic nursing
or nursing related preparation after they graduated
from basic nursing education. About 16 percent
of those initially prepared in associate degree
programs and 24 percent of those prepared in
diploma programs had obtained post-RN nursing
or nursing related degrees. In most instances,
the highest educational level achieved by these
nurses was the baccalaureate degree. Among associate
degree nurses 71.6 percent of those who had
received additional degrees had a baccalaureate
as their highest degree. For diploma prepared
nurses, the comparable percentage was 59.9 percent.
About 19 percent of those prepared initially
in a baccalaureate program had obtained post-RN
degrees. As illustrated by Chart 13, the majority
(53.2 percent) of nurses who earn a masters
or a doctoral degree received a baccalaureate
degree as their initial preparation.
When all formal education of the RN population
in 2000 is taken into account, including initial
education preparing individuals for licensure
and any education subsequent to licensure, 22.3
percent or 601,704 had a diploma, 34.3 percent
or 925,516 had an associate degree, and
32.7 percent or 880,997 had a baccalaureate
as their highest educational preparation for
nursing. The number of RNs with a masters
or doctoral degree is estimated at 257,812 (9.6
percent) and 17,256 (0.6 percent) respectively
(see Appendix A, Table 8). [D]
It should be noted that a number of nurses
have degrees that are not in nursing but related
to their career in nursing. About 21 percent
of masters degrees and 51 percent doctoral
degrees held by RNs are in nursing related fields.
One-half of the nurses who had post-RN masters
degrees in nursing or a nursing-related field
chose clinical practice as their field of study
(see Appendix A, Table 9). Sixteen percent
majored in supervision /administration and 13
percent in education.
Post-RN doctoral degrees were focused primarily
on either education or research. The primary
field of study for 30 percent of the RNs with
such degrees was education while 24 percent
focused on research. Clinical practice was the
focus of about 13 percent of nurses receiving
post-RN doctoral degrees.
In March 2000, 6.7 percent of the countrys
RNs, or 180,765 of the 2,696,540 population,
were enrolled in formal education programs leading
to a nursing or nursing related-degree. Those
enrolled in academic programs tended to be part-time
students (76 percent) and to be employed in
nursing on a full-time basis (72 percent) (see
Appendix A, Table 10.)
Approximately 53 percent of the 180,765 nurses
pursuing formal education were enrolled in programs
leading to a baccalaureate degree, 36.4 percent
were enrolled in programs leading to a masters
degree and almost 4 percent were enrolled in
doctoral programs (see Appendix A, Table 11).
RNs attending school relied on multiple resources
to pay for some portion of education expenses.
The two primary sources were personal resources
and employer reimbursement plans. An estimated
73 percent of students used some personal resources
such as earnings, savings and/or family assistance
to pay for tuition and fees; 41 percent obtained
assistance from employer reimbursement plans.
Federal sources of support in the form of traineeships,
scholarships or grants were a resource for six
percent of RNs, and Federally assisted loans
were a resource for about 12 percent of RNs
attending school. Federal resources were more
likely to be used to support masters and
doctoral degree students than baccalaureate
students. About 28 percent of masters
degree students and 26 percent of doctoral degree
students had obtained some type of Federal support
compared to about 12 percent of baccalaureate
students (see Appendix A, Table 11).
Advanced
Practice Nurses
Increased interest in expanding the access
and availability of health care services led
to particular emphasis on advanced practice
nurses. Advanced practice nurses include clinical
nurse specialists, nurse anesthetists, nurse
midwives and nurse practitioners. Responses
to multiple areas of the questionnaire were
combined to determine appropriate classification
of nurses for each category of advanced practice
nurses. In total, an estimated 196,279 RNs,
or 7.3 percent of the RN population, were prepared
to practice in at least one of these advanced
practice roles (see Appendix A, Table 12).
As shown in Chart 14, the largest group among
advanced practice nurses were nurse practitioners
(88,186) followed by clinical nurse specialists
(54,374). These two groups together, including
those with dual preparation of nurse practitioner
and clinical nurse specialist (14,643) make
up an estimated 80 percent of all advanced practice
nurses.
Nurse
Practitioners
The nurse practitioner (NP) group included
all RNs prepared beyond basic nursing education
in a formal nurse practitioner program of at
least three months. In March 2000, there were
an estimated 102,829 NPs; 14,643 of these NPs
also were prepared as clinical nurse specialists
(CNS).
The data show that increasingly the education
of NPs takes place primarily in masters
degree programs. In March 2000, it was estimated
that about 62 percent of NPs completed a masters
degree program, compared with about 46 percent
of NPs in 1996.
[D]
The number of RNs educated as NPs increased
by 44.8 percent between March 1996 and March
2000. In 1996, there were an estimated 70,993
NPs which included 7,802 nurse practitioners
that also were prepared as clinical nurse specialists.
By March 2000 these numbers had increased to
102,829, which included 14, 643 with both nurse
practitioner and clinical nurse specialist training.
Eighty-nine percent, or 91,591 of 102,829 NPs
were employed in nursing, although not necessarily
with the position title of Nurse Practitioner.
It was estimated that 58,512 or 64 percent of
those trained as NPs and employed in nursing
had the title of nurse practitioner.
An estimated 74 percent or 75,650 of the 102,829
RNs with formal preparation as nurse practitioners,
also had national nurse practitioner certification
as an advanced practice nurse or nurse practitioner.
The number with State Board of Nursing recognition
was 67,490. (See Appendix A, Table 12)
Clinical
Nurse Specialists
There were an estimated 69,017 RNs prepared
to practice as clinical nurse specialists in
March 2000, including the 14,643 who were both
nurse practitioners and clinical nurse specialists.
Between 1996 and 2000, the number of CNS increased
12 percent. In March 1996, there were 61,601
clinical nurse specialists. By March 2000, that
number had risen to 69,017 almost entirely as
a result of increases in those RNs with both
nurse practitioner and clinical nurse specialist
preparation.
Because the 2000 survey shows that RNs who
are prepared as both clinical nurse specialists
and nurse practitioners are more likely to function
in the nurse practitioner role, the following
data refer only to the 54,374 RNs identified
as having formal preparation as clinical nurse
specialists but not also as nurse practitioners.
Eighty-seven percent, or 47,225 of the 54,374
were employed in nursing, however, only 11,309
(24 percent) were practicing with the position
title of clinical nurse specialist.
A total of 19,864 had national certification and
11,347 had State recognition as an advanced practice
nurse or as a clinical nurse specialist. Nurses
employed with the position title of clinical nurse
specialist were more likely than those without
the title to have national certification or State
recognition.
Nurse
Anesthetists
Nurse anesthetists are the third largest group
of advanced practice nurses. Included in the
nurse anesthetist category were all those with
formal preparation beyond basic nursing education
in which the specialty of anesthesia was studied.
Using this definition, there were 29,844 nurses
who were nurse anesthetists, 85.7 percent of
whom were employed in nursing. Most of those
who were employed in nursing, 22,794 of the
25,575 employed in nursing, were in positions
where the job title was that of nurse anesthetist.
Virtually all of those employed in nursing with
the position title of nurse anesthetist had
national certification and two-thirds had State
Board of Nursing recognition.
Nurse
Midwives
Among the advanced practice nurses there are
fewer nurse midwives than there are members
of the other three groups. To assure that nurse
midwives were appropriately classified, several
screening steps were taken via responses to
the survey questionnaire. The formal education
beyond basic nursing education had to be at
least 9-months in length. A second screen was
needed for the relatively large proportion of
RNs in the sample who indicated they had formal
preparation as nurse midwives and were initially
foreign educated. Such nurses usually need additional
education to qualify for certification in this
country.
Therefore, in addition to the nine-month educational
requirement, anyone who was foreign educated
had to be nationally certified as a nurse midwife
in order to fit the definition. Based on these
criteria there were 9,232 nurses formally prepared
as nurse midwives, 85.7 percent of whom were
employed in nursing. Of the 7,914 nurse midwives
employed in nursing, 4,773 had the position
title of nurse midwife. Virtually all of those
employed in nursing with the position title
of nurse midwife had national certification
as nurse midwives and two-thirds had State Board
of Nursing recognition.
Minority
Advanced Practice Nurses
Nearly 10 percent of advanced practice nurses
were from racial/ethnic minority backgrounds.
Minority nurses were more likely to be found
among nurse practitioners than among other advanced
practice nurses. Approximately 11 percent of
nurse practitioners were minority nurses compared
with 8 to10 percent of other advanced practice
groups.
RNs
in the Workforce
In March 2000, 81.7 percent of the RN population,
or 2,201,813 RNs were employed in nursing. Although
RNs can be found in all sectors of the health
care system, the predominant employment setting
remains the hospital. Of the 2,201,813 RNs employed
in nursing, 1,300,323 or 59.1 percent, worked
in hospitals. The next largest group, 402,282,
or 18.2 percent, worked in public/community
health settings including State or local health
departments, community based home-health agencies,
various types of community health centers, student
health services, and occupational health services.
An estimated 9.5 percent or 209,324 RNs were
in ambulatory care settings, including physician-based
practices; nurse based practices, and health
maintenance organizations. A total of 152,894
(6.9 percent) of all RNs employed in nursing,
worked in nursing homes and extended care facilities.
The remaining group of those employed in nursing
were working in such settings as nursing education,
federal administrative agencies, State boards
of nursing or other health associations, health
planning agencies, prisons/jails, or insurance
companies (see Appendix A, Table 13).
The percent of RNs employed in hospitals did
not change substantially between 1996 and 2000,
declining from 60.1 percent to 59.1 percent.
The number of RNs employed in hospitals increased
by 2 percent compared with a 4 percent increase
in the total number of RNs employed in nursing.
Nearly three-fourths of RNs employed in hospitals
reported spending more than 50 percent of their
time in direct patient care, as illustrated
in Chart 15. However, approximately 90 percent
of RNs employed in hospitals spent some portion
of their time in direct patient care. As shown
in Chart 16 in both 1996 and 2000, inpatient
bed units were by far the work site where hospital
nurses spent the majority of their direct patient
care time. The data for 2000 indicate the number
of nurses who provided care in these units decreased
five percent between 1996 and 2000, in contrast
to the two percent increase in hospital nurses
overall. Also, RNs working in outpatient departments
decreased by 10 percent from 77,437 in 1996
to 69,707 in 2000. Among nurses who provided
direct patient care services in 2000 and reported
the type of work unit, 58 percent worked in
intensive care bed units, step down/transitional
bed units, and general/specialty bed units (see
Appendix A, Table 14). In 1996, 59 percent of
hospital RNs providing direct patient care worked
in these units. Changes between 1996 and 2000
in the number of nurses providing direct patient
care in specific types of units in the hospital
should be interpreted with caution because of
the significant increase in the number of nurses
in 2000 who did not report the type of unit
in which they spent the majority of their patient
care time. Eight percent of hospital employed
RNs who provided direct patient care in 2000
did not report the type of work unit in which
they spent the majority of their time. In 1996
virtually all nurses reported this.
[D]
As might be expected, nurses worked predominantly
with medical/surgical patients in both inpatient
bed units and outpatient departments. In 2000,
an estimated 32 percent of the nurses primarily
cared for such patients (see Appendix
A, Table 15). The next single largest percentage
of RNs (18 percent) reported that they worked
predominately with coronary care patients.
Characteristics
within Employment Setting
An estimated 28.4 percent or 625,139 of the
2,201,813 RNs employed in nursing, were working
on a part-time basis in March 2000. The percentage
employed part-time varied according to the employment
setting. The highest percentage of part-time
employees was found among RNs working in ambulatory
care settings. The lowest percentages
of part time workers were found among those
working in nursing homes and other extended
care facilities and occupational health settings,
23 and 24 percent, respectively. (See Appendix
A, Table 16)
The average scheduled work hours per year for
full-time principal nursing positions, including
paid vacations, holidays and sick leave was
estimated to be 1,996 hours; for part-timers
it was 1,102 hours. A comparison of the number
of scheduled hours per week and the actual number
of hours worked showed that for the week of
March 22, 2000, nurses in all employment settings
tended to work more hours than they were scheduled.
During that week, full-time nurses averaged
42.4 actual hours in contrast to average scheduled
hours of 39.5. The difference between scheduled
and actual hours worked was less for part time
employees24.7 actual hours worked compared
with 23.1 hours scheduled (see Appendix A, Table
17).
[D]
As indicated in earlier surveys, younger nurses
are more likely than older nurses to be employed
in hospitals. In March 2000, the average age
of the hospital nurse was 41.8, almost two years
less than the average age of 43.3 for all employed
RNs. Nurses in student health services, nursing
education, and planning or licensing agencies
had the highest average ages (see Chart 17).
Nearly three-fourths of all employed nurses
under the age of 30 worked in the hospital.
In contrast, less than half of nurses who were
50 years of age or older worked in hospitals
(see Appendix A, Table 18).
In most employment settings the majority of
nurses had an associate or baccalaureate degree
as their highest nursing educational preparation
(see Chart 18). Seventy-four percent of the
nurses working in hospitals had an associate
or baccalaureate degree; 57 percent had less
than a baccalaureate. Nursing homes and extended
care facilities were less likely than other
patient care service settings to have nurses
with a baccalaureate and higher degrees. Nursing
homes drew 73 percent of their nurses from among
those whose highest preparation was that of
a diploma or associate degree. As would be expected,
the majority of those in nursing education (64
percent) had a masters or doctoral degree
(see Appendix A, Table 19).
Base
of Employment
Most nurses were employees of the facility
in which they worked. About 2 percent of RNs
were self-employed, and 2 percent worked in
their principal nursing position through a temporary
employment service (Appendix A, Table 20).
Nearly 40,000 nurses were employed in their
principal position through a temporary employment
service in 2000. This number is 36 percent higher
than the comparable number in 1996 (28,971)
and reverses a declining trend observed between
1988 and 1996. An additional 71,490 nurses were
not employed in their principal positions through
a temporary employment service, but had additional
positions through temporary agencies. Considered
together, the total number of nurses employed
through temporary employment services in 2000
was 110,994 an increase of 65.6 percent from
the 1996 estimate of 67,016, and considerably
higher than the 84,414 estimate in 1992 and
the 88,444 estimate in 1988.
[D]
[D]
Position
Levels
More than 60 percent or 1,357,349 of the 2,201,813
employed nurses in 2000 were in staff-level
positions. (See Appendix A, Tables 21 and 22).
Although the number of staff nurses has increased,
their proportion of the total nurse workforce
has declined from 67 percent in 1988 to 62 percent
in 2000. A total of 184,098, or 8.4 percent
of RNs were in head nurse or supervisory positions
in 2000 and 124,461 or 5.7 percent were in administrative
positions. Chart 19 illustrates the shifts that
have occurred in the distribution of RNs by
selected position titles since the late 1980s.
In addition to the decline in the percentage
of employed nurses who are staff nurses there
has been a notable decline in the percentage
of those with the position title of supervisor
(from 5.6 percent to 3.6 percent during the
period from 1988 to 2000). At the same time,
significant increases have occurred in the percentage
of those with the position title of nurse practitioner
- they grew from 1.3 percent of employed RNs
in 1988 to 2.8 percent in 2000. It should be
noted that the survey respondents use
of the position title "nurse practitioner"
as well as the position title for other advanced
practice nurses (i.e. clinical nurse specialist,
nurse midwife and nurse anesthetist) is not
restricted to those who had formal educational
preparation in programs to prepare them as such.
The variation in educational preparation according
to position title can be seen in Chart 20 and
Table 23 in Appendix A. Those data show that
60 percent or more of those with the position
titles of supervisor, staff nurse, and private
duty nurse have less than baccalaureate preparation.
Whereas more than one-half of nurses employed
with other position titles (except head nurse)
had baccalaureate preparation or higher. Head
nurses were nearly evenly divided between those
with less than and those with at least baccalaureate
preparation.
[D]
Functions
During Usual Workweek
In 2000, an estimated 69 percent of RNs employed
in nursing spent at least 50 percent of their
usual workweek in direct pa in direct patient
care activities tended to increase from the
1977 study to the 1988 study. The 1992 and the
1996 studies, however, showed a decreasing percent
of nurses who spent more than half their time
in direct patient care.
Overall, the average percent of time RNs spent
in direct patient care was about 63 percent
in 2000 (See Chart 21). Nurses with less than
a masters degree averaged 63-66 percent
of their usual workweek in direct patient care
activities (See Appendix A, Table 25). Nurses
with masters degrees averaged 43.9 percent
of their time in direct patient care, 19.8 percent
of their time in administration, and 12.4 percent
in teaching. Nurses with doctorates averaged
31.6 percent of their time in teaching and 29.2
percent in administration. Doctorally prepared
nurses were the only group that spent significant
time in research. In 2000, they averaged 11.4
percent of their usual workweek in research,
higher than the 1996 average of 9.5 percent,
but lower than the 13 percent in 1992 and the
16 percent shown in the 1988 study.
[D]
Recent
Indices of Annual Salaries/Earnings Trends
In March 2000, the average annual earnings
of full-time employed registered nurses in their
principal nursing positions was $46,782 (See
Appendix A, Table 26). As indicated below and
in the respective Appendix A Tables, annual
earnings vary by level of nursing education,
position, employment setting, and geographic
location.
Average annual earnings varied according to
the highest level of nursing educational preparation.
(See Appendix A, Table 27). The pattern of earnings
is predictable in many instances, nurses with
advanced degrees achieved higher earnings. For
almost all positions where masters-prepared
RNs were employed in significant numbers, their
average earnings were higher than those with
diploma, associate, or baccalaureate degrees.
The earnings of masters prepared nurses
averaged $61,262. Holders of doctoral degrees,
numerically much smaller, averaged slightly
higher at $63,522.
In those categories where the educational preparation
did not reach the masters level, the average
earnings are noticeably lower. The overall average
earnings for those whose highest nursing educational
preparation was a diploma was $46,624, while
it was $46,570 for those whose highest nursing
education was a baccalaureate degree. Earnings
for those with baccalaureate degrees and diplomas
as their highest nursing educational preparation
are about 10 percent higher than the average
earnings for those with associate degrees ($42,676)
as the highest nursing education. Earnings/education
patterns appear to be more complex than simply
assuming that higher levels of education automatically
translate to higher earnings. Larger proportions
of diploma nurses in the workforce have more
years of experience than do those with baccalaureate
or associate degrees. They also comprise a large
percentage of those RNs in administrative positions
(see Chart 20). These circumstances of the workforce
may possibly explain why diploma earnings appear
to be competitive with baccalaureate earnings.
[D]
Comparisons of nurses earnings from 1996
and 2000 were made among each of the levels
of nursing education, to determine whether the
increases were consistent across degree of highest
preparation. There was a wide range in the rate
of earnings increases across the levels of highest
nursing educational preparation. Those with
masters degrees in nursing received annual
earnings increases of 3.8 percent, while those
with baccalaureate degrees as their highest
nursing education only averaged salary rate
increases of 2.2 percent, a rate slightly less
than the CPI. Nurses whose highest nursing education
were either diploma or associate degrees, experienced
increases of 2.8 percent and 2.7 percent, respectively.
There are large variations in actual earnings
by position type. Staff nurses, the largest
group of employed nurses, had average earnings
of $42,133. The staff nurse earnings level is
about 10 percent below the overall average earnings
for all RNs with full-time employment in nursing.
To some extent, higher earnings can be attributed
to highest education level at the masters degree
and above which prevail in some positions. Those
RNs in advanced practice nurse (APN) positions
had earnings that were higher than average,
overall. Certified registered nurse anesthetists
had the highest average earnings, $93,787, among
RNs in all employment settings and position
types. Nurse practitioners had average earnings
of $60,126. Nurse midwives had average earnings
of $64,940. Clinical nurse specialists had average
earnings of $50,800.
Growth in actual earnings from 1996 and 2000
were compared for selected positions. While
the average reported earnings for all full-time
nurses increased by 2.7 percent on an annual
basis between the 1996 and 2000 Sample Survey,
there was a broad range to the level of increase
across positions. Categories of nursing positions
that experienced annual rate increases which
were higher than the average rate of increase
include: administrators (3.7 percent), instructors
(3.4 percent), supervisors (3.3 percent), and
head nurses (3.3 percent).
However, staff nurse earnings only increased
on average by 2.2 percent annually. Furthermore,
staff nurse earnings in hospitals only increased
by 2.0 percent. This lower increase contrasts
to the earnings increases of staff nurses in
nursing homes, where the latter reported increases
of 3.6 percent annually. It appears that demand
for a high level of skills in staff nurse hospital
service is not being compensated at a rate that
meets even the CPI. Nevertheless, the larger
rate of increases in earnings for nursing home
staff RN services may begin to raise basic compensation
levels for nursing home staff RNs who have been
difficult to recruit and whose earnings have
been historically-lower than comparative earnings
in hospitals.
Among those working as advanced practice nurses,
earnings of the nurse practitioner/nurse midwife
group increased by 2.8 percent annually while
clinical nurse specialists and certified nurse
anesthetists experienced average annual earnings
increases of 1.9 and 2.1 percent, respectively,
between 1996 and 2000. Over this period, the
number of nurse practitioners entrants grew
sharply. It appears that these newly-trained
nurse practitioners are in demand and are finding
professional employment, since the number of
RNs working as nurse practitioners has
increased by more than 50 percent over this
period.
Annual earnings varied according to the setting
in which the RN was employed. At $47,759, the
average annual earnings for those working full
time in the hospital setting were higher than
the overall full time earnings average across
all types of settings. Those settings where
RNs earned less than the overall average included
ambulatory care, at $45,256 public health settings,
at $45,150; nursing homes, at $43,779; and student
health services, with the lowest average annual
earnings of $38,204.
The hospital setting earnings average of $47,759
in 2000 and the 1996 average of $43,496, both
reflect the CPI annual increase of 2.4 percent.
Of note, the information in Table 26 indicates
that hospital-based RNs of each position type
generally average higher earnings than their
position counterparts in other employment settings
such as public health nursing, nursing homes,
ambulatory care, occupational health services,
and student health services.
Looking at the full-time earnings of staff
nurses working in the hospital setting across
the country, it was found that those with associate
degrees as the highest nursing education had
average earnings of $41,863. For those whose
highest education was a diploma, the average
earnings were $45,807. For the baccalaureate-prepared
hospital staff nurse, the average earnings were
$43,934. It is important to note that these
numbers do not discriminate by years of experience
in nursing, an important factor to be considered
when conducting an analysis of earnings and
differences in education.
A significant percent of employed nurses work
either part time in their principal job or work
more than one job in nursing. Fifteen percent
of all the employed nurses held other paid nursing
positions in addition to their principal nursing
position. As would be expected, the average
actual annual earnings of the latter group were
higher than the average annual earnings of nurses
with only one nursing position. For all RNs
employed in nursing, regardless if they had
more than one position and if they worked full-time
or part-time in their principal position, the
average annual earnings was $42,475. If they
had more than one nursing position the average
earnings were $49,769. Those with only one full-time
or part-time position in nursing averaged $41,298
(See Appendix A, Table 28). The increase in
earnings for those with additional part-time
employment in nursing is substantial, adding
an average of approximately 20 percent to their
nursing earnings.
Looking at the full-time earnings of staff
nurses working in the hospital setting across
the country, it was found that those with associate
degrees as the highest nursing education had
average earnings of $41,863. For those whose
highest education was a diploma, the average
earnings were $45,807. For the baccalaureate-prepared
hospital staff nurse, the average earnings were
$43,934. It is important to note that these
numbers do not discriminate by years of experience
in nursing, an important factor to be considered
when conducting an analysis of earnings and
differences in education.
A significant percent of employed nurses work
either part-time in their principal job or work
more than one job in nursing. Fifteen percent
of all the employed nurses held other paid nursing
positions in addition to their principal nursing
position. As would be expected, the average
actual annual earnings of the latter group were
higher than the average annual earnings of nurses
with only one nursing position. For all RNs
employed in nursing, regardless if they had
more than one position and if they worked full-time
or part-time in their principal position, the
average annual earnings were $42,475. If they
had more than one nursing position the average
earnings were $49,769. Those with only one full-time
or part-time position in nursing averaged $41,298
(See Appendix A, Table 28). The increase in
earnings for those with additional part-time
employment in nursing is substantial, adding
an average of approximately 20 percent to their
nursing earnings.
JOB
SATISFACTION
For the first time in the seven national surveys
of RNs conducted by the Division of Nursing,
the March 2000 survey asked respondents working
in nursing to assess their level of job satisfaction.
The level of job satisfaction provides a window
into the working conditions that nurses face,
and the relationship between these conditions
and nurses expectations regarding their
work. There is a wealth of empirical literature
linking job satisfaction and other important
workplace features, such as turnover rates while
the body of work linking job satisfaction with
quality of patient care is just emerging. The
growing reports of nursing shortages across
the country, declining enrollments in nursing
schools and the aging of the nursing workforce
all provide ample reason to examine job satisfaction
and what it may reveal regarding the retention
of the current nursing workforce.
[D]
Across the entire sample, just over two-thirds
of nurses (69.5 percent) report being satisfied
in their current position. This general level
of satisfaction is markedly lower than levels
seen in the employed general population. Data
from the General Social Survey of the National
Opinion Research Center indicate that, from
1986 through 1996, 85 percent of workers in
general and 90 percent of professional workers
expressed satisfaction with their job.1
Aggregate levels of job satisfaction vary by
the setting where nurses work (see Chart 22).
Nurses working in nursing homes and hospitals
report the lowest levels of overall job satisfaction,
at 65 percent and 67 percent, respectively,
while 83 percent of those working in nursing
education are satisfied with their job. Even
at 83 percent, the job satisfaction level among
those in nursing education only approaches the
level of job satisfaction in the general population.
Across employment settings, two factors appear
to play powerful roles in level of job satisfaction:
age and position, specifically, whether the
respondent is a staff nurse. In the four settings
that employ 88 percent of all nurses, and substantial
numbers of staff nurses, we find that staff
nurses in each setting report lower levels of
job satisfaction when compared to those in the
same settings who are not staff nurses (see
Chart 23). In each instance these differences
are noteworthy.
[D]
The lower job satisfaction among staff nurses
endures across other comparisons. For example,
job satisfaction varies by level of nursing
education, with diploma nurses reporting the
lowest overall level of job satisfaction and
doctoral-prepared nurses reporting the highest
level.
In each educational group, staff nurses report
lower levels of job satisfaction compared to
their counterparts who are not staff nurses.
Furthermore, position appears to be a greater
factor regarding job satisfaction than function.
Non-staff nurses who spend more than 50 percent
of their time in direct patient care report
higher job satisfaction than staff nurses spending
similar amounts of time with patients. This
suggests that it is the structure of the job,
rather than the composition of the work, that
is influencing satisfaction.
Furthermore, with the exception of ambulatory
care, job satisfaction levels decline with age
among staff nurses in each setting. The contrast
between ambulatory care and the other sites
suggests that working conditions in ambulatory
care settings may accommodate older workers
better than other settings, with regards to
physical demands as well as other job features.
Data indicate that job satisfaction declines
with age and does not seem to return to the
higher levels seen earlier in nurses careers.
However, the higher satisfaction levels early
in the careers of nurses suggests that attention
to working conditions could improve job satisfaction
and help retain a well-trained and experienced
workforce.
REGISTERED
NURSES NOT EMPLOYED IN NURSING
In March 2000, of the 2,696,540 individuals
with current licenses to practice as registered
nurses, 494,727, or 18.3 percent, were not employed
in nursing. Twenty-seven percent of the 494,727
RNs were working in non-nursing positions. About
seven percent (35,968) of those not employed
in nursing were actively seeking nursing employment
(See Appendix A, Table 30).
In 2000, 263,856 nurses who were not employed
in nursing at the time of the survey had been
employed as nurses within the 5-year period
preceding the survey. These nurses who recently
became unemployed in nursing accounted for somewhat
more than one-half (53 percent) of all RNs who
were not employed in nursing. The number of
nurses recently unemployed in nursing in 2000
is lower than the comparable number in 1996,
which was 311,583. Moreover, they comprise a
much smaller proportion of the total pool of
those not employed in nursing than in 199653
percent compared with 70 percent in 1996. The
percent of RNs who never worked in nursing dropped
from 1.9 percent in 1996 to 1.4 percent in 2000.
RNs who had most recently become unemployed
in nursing were the most likely to be actively
seeking nursing positions. Approximately 18
percent of those who had become unemployed in
nursing within 1 year of the 2000 survey were
actively seeking nursing employment compared
with only seven percent of all inactive nurses.
The average age of nurses who had recently become
unemployed in nursing was 51.7 years compared
to 53.6 years for all those not employed in
nursing.
Nurses
Seeking Nursing Employment
The 35,968 registered nurses not employed in
nursing in March 2000 but actively seeking nursing
employment, represented 1.4 percent of the 2.7
million RNs in the country. This percentage
is about the same as in 1996.
RNs not employed in nursing but actively seeking
nursing employment were likely to have been
employed in nursing more recently than other
RNs not working in nursing. Seventy-eight percent
of the job seekers had been employed in nursing
less than five years prior to the study with
most (47.5 percent) having been employed less
than a year before. Only 8.8 percent of the
nearly 7,000 nurses who had never worked in
nursing were seeking employment in nursing.
(See Appendix A, Table 30) This is in contrast
to 41 percent of more than 8,000 nurses in 1996
who had never been employed in nursing and were
actively seeking nursing employment.
Nearly one-half (49 percent) of the RNs who
were looking for nursing positions sought part-time
employment. Over one half (53 percent) had been
looking for nursing employment for less than
5 weeks prior to the study. Another 18 percent
had been looking for at least 15 weeks (See
Appendix A, Table 31).
Nurses
Employed in Non-Nursing Occupations
The 135,696 RNs who were employed in non-nursing
occupations in March 2000 represented a 15.2
percent increase over the 117,820 such nurses
in 1996 and a 35.8 percent increase over the
estimated number of 99,955 in 1992. The 135,696
RNs employed in non-nursing occupations include
7,707 RNs seeking nursing employment. Those
who were employed in non-nursing occupations
and were not looking for nursing positions were
4.7 percent of the total 2.7 million RN population,
a slightly higher proportion than the 4.2 percent
observed in 1996 and 1992.
Fifty-four percent of those employed in non-nursing
positions were in non-health-related occupations;
almost 44 percent held health-related positions.
Sixty percent of the nurses in non-nursing occupations
were full-time workers. However, the nurses
in health-related occupations were somewhat
more likely to be full-time workers (74 percent)
than those in non health related occupations
(52 percent) (See Appendix A, Table 32).
Similar to the 1996 study, the predominant
reasons that RNs in 2000 cited for working in
non-nursing positions were: the other positions
scheduled hours were more convenient, better
salaries, greater safety than in the health
care environment, more professionally rewarding,
and taking care of home and family. The survey
reported the following information: Forty six
percent of nurses indicated convenience of hours,
44.9 percent indicated that the non nursing
occupation was professionally more rewarding,
35.4 percent noted better salaries, 24.9 percent
were taking care of home and family and 19.8
percent indicated concerns about safety in the
health care environment (See Appendix A, Table
33).
Inactive
Registered Nurses
The largest segment of the nurses who were
not employed in nursing were neither looking
for nursing positions nor employed in a non-nursing
occupation. This inactive segment numbered 322,453,
and similar to what was found in the 1996 survey,
represented 65 percent of all unemployed RNs
and 12 percent of the RN population.
Most of the 322,453 inactive nurses were older
nurses. Slightly less than half of these nurses
(48.7 percent) were at least 60 years old. Only
about 15 percent were under the age of 40. Seventy
percent of this group under 40 were married
and had preschool age children at home. An additional
15 percent of them were married with children
older than preschoolers (See Appendix A, Table
34).
[D]
GEOGRAPHIC
AND EMPLOYMENT MOBILITY
The survey instrument provided for the exploration
of a number of changes that registered nurses
might experience during the course of their
careers in nursing, and the reasons for such
changes. Among these were geographic relocations,
movement in or out of work status, and changes
in employment setting.
Location
of Basic Nursing Education
About 4 percent, or 99,456 out of the 2,696,540
registered nurses, received their basic nursing
education outside of the 50 States and the District
of Columbia. The racial/ethnic background of
the RNs had particular relevance to whether
or not they had received their initial nursing
educational preparation outside the United States.
Only an estimated 1.3 percent of white (non-Hispanic)
nurses graduated from such programs. However,
the majority of Asians, 55.4 percent, and 30.7
percent of Native Hawaiian or Pacific Islanders
had received their basic nursing education outside
the United States. Almost 7 percent of Hispanic
nurses and about 6 percent of the African American/Black
(non-Hispanic/Latino) nurses were in that category.
Thirty-five percent of those with current licenses
to practice in March 2000 had received their
basic nursing education outside the United States
or in a State different from the State in which
they were located at the time of the survey.
As would be expected, the longer the time lapse
between graduation from the basic nursing education
program and March 2000, the more likely that
the nurse was in a different location. Forty-three
percent of the nurses who had graduated more
than 15 years prior to the survey were in a
different location compared to 22 percent of
those who had graduated no more than 5 years
before.
There were noticeable differences among the
graduates from the different types of basic
nursing educational programs. Associate degree
graduates were most likely to be located in
the State where they received their basic nursing
education (about three-fourths). Fifty eight
percent and 59 percent of diploma and baccalaureate
graduates, respectively, were located in the
same State (See Appendix A, Table 35)
Residence
in March 1999 and 2000
Most nurses with current licenses to practice
in March 2000 were residents of the same State
in which they lived in March 1999. About three
percent had changed their residential State
between 2000 and 1999. As was true in the past
studies, younger nurses were far more likely
than older ones to have moved their State of
residence. Almost 13 percent of the nurses who
were less than 25 years old and 7 percent of
those in the 25-29 year bracket had changed
their resident State of residence. Among the
older age groups, the proportion that had done
so declined with age. About 2 percent of those
in the 50 years of age or older group had changed
their State of residence between 1999 and 2000
(See Appendix A, Table 36).
Employment
Status in March 1999 and 2000
Taking into account all the registered nurses
located in this country and licensed to practice
as of March 2000, most had the same employment
status in March 1999 and March 2000. Only 13
percent of them had shifted their employment
status (See Appendix A, Table 37). Those who
were employed on a full-time basis in March
1999 were most likely (91.5 percent) to be so
employed in March 2000. Only 8.5 percent of
these nurses had shifted their employment status
between 1999 and 2000. Among the RNs who were
not employed in nursing in March 1999, about
21 percent were employed in nursing in March
2000. However, if those who were newly licensed
in 1999 or 2000 are excluded, only 13.2 percent
of the RNs not employed in 1999 had become employed
in 2000.
Employment
Setting Changes
Eighty-six percent of registered nurses that
were working in a hospital in 2000 were working
in a hospital in 1999. Ninety two percent
of registered nurses that were working in a
hospital in 1999 were working in a hospital
in 2000. Nurses were less likely to be employed
in the same type of setting if it was not a
hospital. Nevertheless, the vast majority of
nurses in the other settings had also been employed
in the same type of employment setting in each
of those years (See Appendix A, Table 38).
In order to get more data on job market conditions
for registered nurses, the 2000 survey asked
the nurses whether they had changed employers
or positions between 1999 and 2000 and if so,
why. As Chart 24 shows, 61 percent of those
in the RN population in March 2000 were employed
both years in the same position. Nineteen percent
of nurses were employed both years but changed
employers and/or positions. The major reasons
noted by registered nurses for the shift in
positions were promotion (24.6 percent), employer
shifted position (11 percent), and interested
in a different job (23.3 percent).
GEOGRAPHIC
DISTRIBUTION OF THE REGISTERED NURSE POPULATION
In March 2000, as was true in the prior surveys
in this series, the New England region of the
country had the highest concentration of employed
nurses in relation to the areas population,
1,075 employed RNs per 100,000 population. The
West South Central region, which has typically
had one of the lowest concentrations, had 650
RNs per 100,000 population. However, in March
2000, the Pacific area had 596 employed RNs
per 100,000 population, a lower ratio than the
West South Central. This ratio for the Pacific
area is lower than the 621 per 100,000 estimated
for the 1996 study and largely reflects the
comparatively low ratio in California. Comparison
of the ratios for each of the nine geographic
regions or areas of the country shows that New
England with a ratio of 1,075 per 100,000 population
had 80 percent more employed nurses per 100,000
population than did the Pacific area. In general,
the southern part of the country and the upper
plains experienced greater gains than did other
areas. The Middle Atlantic area, the largest
among the nine geographic areas in the country
in terms of numbers of nurses, showed an increase
of nearly 2 percent in the RN population between
1996 and 2000. However, the number of employed
nurses in that area declined by slightly more
than 1 percent compared with a 4 percent increase
for the country as a whole. The decline in the
number of employed nurses in this area largely
reflects the 3 percent decline in New York,
the State with the second largest number of
nurses. The distribution of the State-by-State
ratios of employed nurses per 100,000 population
is shown in Appendix A, Table 39. Table 39 shows
that nursing resources vary across the country.
This is also true for the personal and professional
characteristics of the RN population.
Distribution
by State
The RN population in each State varied from
about 4,500 in Wyoming to over 226,000 in California.
Eight States had nurse populations of over 100,000
while 7 States had less than 10,000 nurses (See
Appendix A, Table 39). States with more than
100,000 nurses include New York, Pennsylvania,
Texas, Florida, Michigan, Illinois, Ohio, and
California. States with less than 10,000 nurses
include Wyoming, Delaware, North Dakota and
South Dakota, Montana, Alaska, and Vermont.
The RN population increased in all but nine
States between March 1996 and March 2000. The
nine States are Delaware, Virginia, Alaska,
New Hampshire, Hawaii, New Jersey, New York,
Connecticut and Illinois. Pennsylvania, the
State with the third largest RN population and
part of the Middle Atlantic area, increased
its RN population only by 0.9 percent in 2000.
California, the State with the largest RN population,
and part of the Pacific area, showed a 2.2 percent
increase in RN population.
The country as a whole had a decrease in the
ratio of employed RNs to population ratio from
798 per 100,000 in 1996 to 782 per 100,000 in
2000. The number of employed nurses per 100,000
varied by State in 2000 from a low of 544 (California)
to a high of 1675 (District of Columbia). On
a State-by-State basis, the proportion of the
RN population employed in nursing in 2000 ranged
from a low of 75 percent in Pennsylvania to
a high of 93 percent in the District of Columbia.
As shown in Table 40 of Appendix A, the proportion
of employed nurses who worked on a part-time
basis also varied considerably from State to
State. The percentage of nurses employed on
a part time basis varied from a low of 15 percent
in the District of Columbia and Louisiana to
a high of 46 percent in Washington State.
Metropolitan
Areas
As was true in previous studies, the overwhelming
majority of RNs (82 percent) were in metropolitan
areas. This proportion varied across geographic
areas of the country as would be expected given
the distribution of metropolitan areas in the
country. The highest concentrations of metropolitan
areas were found in the Middle Atlantic and
Pacific regions and the lowest in the West North
Central (See Appendix A, Table 43). As Table
43 further illustrates, RNs who were located
in metropolitan areas were generally more likely
than those in non-metropolitan areas to be employed
in nursing.
Racial
/ Ethnic Background
The Pacific area had the highest proportion
of minority nurses21 percent. The predominant
group of minority nurses in the Pacific area
were those with Asian background, 9.9 percent
of the nurse population. In addition to the
Pacific area, Asian nurses were also more likely
to be a part of the nurse population in the
Middle Atlantic and West South Central areas
(4.6 percent) than in other parts of the country.
Black (non-Hispanic) nurses were more prevalent
among the nurse populations in the South Atlantic
(8.6 percent), West South Central (8.2 percent),
and East South Central areas than elsewhere.
Hispanic nurses, although a relatively small
part of any areas nurse population, were
more likely to be found among the nurses in
the West South Central (4.7 percent), Pacific
(4.1 percent), and Mountain areas (3.2 percent)
(See Appendix A, Table 44).
Age
Distribution
Nurses in the West South Central area of the
country were more likely to be younger than
were those in other parts of the country. About
41 percent of those nurses were less than 40
years old compared with 25 to 35 percent of
nurses in other areas of the country. Pacific
area nurses were the least likely to be in this
younger age group, only 25.2 percent were less
than 40 years old. (See Appendix A, Table 45).
Employment
Settings
As expected, the predominant employment setting
for the nurses in each area was the hospital.
The proportion of the nurse supply working in
hospitals in each area ranged from 54 percent
in New England to 62 percent in the East and
West South Central. The East North Central and
New England areas were more likely than the
other areas to have higher proportions of their
nurses employed in nursing homes or other extended
care facilities, with 10 percent respectively.
New England, the Middle and South Atlantic,
and the East South Central areas each had over
13 percent of nurses employed in community/public
health facilities, proportionately more than
other areas. New England had the highest percentage,
15.5 percent, of nurses employed in Public/Community
Health setting. The East and West North Central
areas as well as the Mountain and Pacific areas
had more than 10 percent of their registered
nurses employed in ambulatory care settings
(See Appendix A, Table 46).
Changes
in Employers and/or Positions
About 19 percent of the RN population were
employed in both March 1999 and 2000 but changed
employers and/or positions between those dates.
Nurses in the Southern and Mountain sections
of the country were more likely to have done
so than those in other parts of the country.
Eighteen percent of the 494,800 nurses who
changed employers and/or positions did so because
of their interest in another position. This
is one of the top three reasons cited by nurses
for changing positions or employers. The other
main reasons listed by nurses irrespective of
the Census division were : changes in the organization
made work more stressful, and the nurse relocated
to a different geographic area. (See Appendix
A, Table 47).
Average
Earnings within Geographic Area
The average annual earnings of full-time staff
nurses in each of the nine geographic regions
were examined to get some indication of variations
in earnings around the country. The average
earnings for full-time staff nurses in their
principal positions ranged from $36,958 in the
West North Central area to $49,825 in the Pacific
area (see Appendix A, Table 48). The areas where
earnings reached above the national average
for full time staff nurses ($42,133) included
the Middle Atlantic, New England and Pacific
regions.
There were some geographic variations in the
rate at which earnings increased among the nine
regions. Earnings of staff nurses in the Pacific,
Mountain, South Atlantic, and East North Central
Regions increased at a higher rate than those
in New England, Mid-Atlantic, East South Central,
West South Central, and West North Central Regions.
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