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The Registered Nurse Population: Findings from the National Sample Survey of Registered Nurses

 
Printer-Friendly NSSRN 2000
Preface

Chapter I: Introduction

Chapter II: The RN Population 1980 - 2004

Chapter III: The Registered Nurse Population 2004

Appendix

Chapter III

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).

Chart 10: Average Age at Graduation from Basic Nursing Education Programs[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).

Chart 11: Percent Distribution of Male and Female RNs by Type of Basic and Highest Nursing Education Program[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.

 Chart 12: Distribution of Registered Nurses in Each Racial/Ethnic Group by Highest Educational Preparation, March 2000[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 master’s 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 master’s or doctoral degree is estimated at 257,812 (9.6 percent) and 17,256 (0.6 percent) respectively (see Appendix A, Table 8). Chart 13: RNs Whose Highest Education was a Master's or Doctoral Degree, by Type of Basic Nursing Education, March 2000[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 master’s degrees and 51 percent doctoral degrees held by RNs are in nursing related fields.

One-half of the nurses who had post-RN master’s 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 country’s 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 master’s 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 master’s and doctoral degree students than baccalaureate students. About 28 percent of master’s 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 master’s degree programs. In March 2000, it was estimated that about 62 percent of NPs completed a master’s degree program, compared with about 46 percent of NPs in 1996.

Chart 14: Registered Nurses Prepared for Advanced Practice, March 2000[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.

Chart 15:  Distribution of RNs Employed in Hospitals by Dominant Function, March 2000[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 employees—24.7 actual hours worked compared with 23.1 hours scheduled (see Appendix A, Table 17).

Chart 16: Work Units of Hospital Registered Nurses[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 master’s 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.

Chart 17: Average Age of RNs in Each Type of Employment Setting, March 2000[D]

Chart 18:Distribution of Employed RNs by Highest Educational Preparation for Selected Employment Settings, March 2000 [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.

Chart 19: Distribution of RNs by Selected Position Titles, 1988-2000[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 master’s degree averaged 63-66 percent of their usual workweek in direct patient care activities (See Appendix A, Table 25). Nurses with master’s 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.

Chart 20: Distribution of RNs With Selected Position Titles by Highest Educational Preparation, March 2000 [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 master’s-prepared RNs were employed in significant numbers, their average earnings were higher than those with diploma, associate, or baccalaureate degrees. The earnings of master’s 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 master’s 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.

Chart 21: Average Percent of Time in Work Week Spent by RNs in Each Function, March 2000[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 master’s 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 RN’s 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.

Chart 22: Percent of RNs Who Reported Being Satisfied in Their Jobs by Employment Setting, March 2000[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.

Chart 23:Percent of RNs Who Reported Being Satisfied With Their Job, By Employment Setting and Position, March 2000[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 1996—53 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).

Chart 24: Changes in Employment of RNs Between 1999 and 2000[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 area’s 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 nurses—21 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 area’s 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.