Skip to main content

Currently Skimming:

3 The Nursing Workforce
Pages 59-98

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 59...
... , such as food insecurity and poverty, as well as by limited access to health care services. The size, distribution, diversity, and educational preparation of the nursing workforce needed to assist in addressing these health challenges are therefore critically important.
From page 60...
... The emergence and growth of nurse practitioners (NPs) in the mid1960s, together with other advanced practice nursing roles (certified nurse midwives, nurse anesthetists, and clinical nurse specialists)
From page 61...
... spending on acute care, seemingly impervious to either government or market-oriented efforts aimed at constraining the overutilization of costly health care services. With unemployment rates rarely exceeding 1.5 percent, job availability has seldom been a problem for nurses (BLS, 2020; Zhang et al., 2018)
From page 62...
... The increase in educational attainment has been particularly strong among POC RNs. Table 3-2 shows that nationally, a higher percentage of Black/African American, Hispanic, and particularly Asian RNs relative to White RNs have a BSN.1 Proportionately, more Black/African American and Asian RNs than White and Hispanic RNs have a master's degree, or a doctor of nursing practice (DNP)
From page 63...
... (34.9%) Overall 42.68 43.87 44.37 43.69 Average SOURCE: Calculations of data from the American Community Survey (IPUMS USA, 2020)
From page 64...
... (0.2%) 0.9% Total 1,985,472 226,766 170,083 311,188 84,059 SOURCE: Calculations of data from the 2018 National Sample Survey of Registered Nurses.
From page 65...
... The table also shows that the average annual earnings of RNs are lowest in settings (e.g., critical access hospitals, nursing homes, inpatient and outpatient mental health facilities, public clinics, public health, school health, and home health) where RNs often interact with people facing multiple social risk factors.
From page 66...
... SOURCE: Data calculated from data from the American Association of Colleges of Nursing. TABLE 3-3 Number of Registered Nurses (RNs)
From page 67...
... 38,130 1.4 92,522 21,366 56.0 All 2,778,476 100.0 76,180 1,137,176 SOURCE: Calculations based on the 2018 National Sample Survey of Registered Nurses.
From page 68...
... , the number of RNs and physicians practicing in rural areas could decline further during this decade, complicating policies aimed at increasing access to care for the populations in these areas. Looking to the future, the size of the FTE RN workforce is projected to grow substantially, from 3.35 million in 2018 to 4.54 million in 2030, enough to replace all the baby boom RNs who will retire over the decade.
From page 69...
... Box 3-2 provides information on the impacts of COVID-19 on the nursing workforce in nursing homes. Advanced Practice Registered Nurses APRNs are nurses who hold a master's degree, post-master's certificate, or practice-focused DNP degree in one of four roles: NP, certified registered nurse anesthetist (CRNA)
From page 70...
... . As of the end of July 2020, more than 60,000 deaths had occurred in nursing homes and long-term care facilities in the United Sates, and close to 800 staff had died (McGarry et al., 2020)
From page 71...
... These findings suggest that poorly resourced nursing homes with nurse staffing shortages may be more susceptible to the spread of COVID-19 (Figueroa et al., 2020)
From page 72...
... –Prepared RNs Employed in Nursing Prepared in the role of a CNS only 34,987 55,111 Prepared as a CNS and also in another APRN role 14,806 15,626 Total 49,793 70,737 Share of all CNS-prepared APRNs also prepared in another APRN role 30% 22% Certified Registered Nurse Anesthetist (CRNA) –Prepared RNs Employed in Nursing Prepared as a CRNA only 31,156 29,869 Prepared as a CRNA and also in another APRN role 871 7,542 Total 32,027 37,411 Share of all CRNA-prepared APRNs also prepared in another APRN role 3% 20% SOURCE: Calculations based on the 2008 and 2018 National Sample Survey of Registered Nurses.
From page 73...
... SOURCE: Calculations based on data from the 2018 National Sample Survey of Registered Nurses.
From page 74...
... 1,064 0.5 100,000 Total 14,185 7.3 105,000 Hospitals Critical access hospital (CAH) 7,971 4.1 $112,000 Inpatient unit, non-CAH 28,855 14.9 110,000 Hospital-sponsored ambulatory care 21,464 11.1 109,000 Emergency department, non-CAH 6,077 3.1 120,000 Other hospital-based setting 3,758 1.9 105,000 Total 68,125 35.2 112,000 Other Inpatient Settings Nursing home, nonhospital 2,687 1.4 $105,000 Rehabilitation facility/long-term care 3,705 1.9 105,000 Inpatient mental health/substance abuse 2,502 1.3 111,000 Correctional facility 1,567 0.8 108,000 Other inpatient setting 288 0.1 103,000 Total 10,749 5.6 SOURCE: Calculations from data in the 2018 National Sample Survey of Registered Nurses.
From page 75...
... worked in other inpatient settings, including nursing homes, rehabilitation and long-term care facilities, and correctional facilities. With regard to annual earnings, NPs' median earnings varied considerably by setting, ranging from a low of $90,000 for those employed in school health settings to $120,000 for those working in emergency departments in non–critical access hospitals.
From page 76...
... 12,482 6.4 Total 193,587 SOURCE: Calculations based on data from the 2018 National Sample Survey of Registered Nurses. somewhat.
From page 77...
... Salient sociodemographic factors include the aging population, increases in mental and behavioral health conditions, increases in lack of access to primary health care, persistently high maternal mortality rates, and worsening physician shortages.
From page 78...
... . The nation's aging population will pose extraordinary challenges for society at large and for health care delivery organizations, nurses, social workers, and families.
From page 79...
... projects could worsen to a shortfall of as many as 250,000 workers by 2025. Despite current and projected shortages of mental and behavioral health workers, the regulatory policies of many states limit the capacity of existing NPs who provide psychiatric and mental health care.
From page 80...
... Foundation, Registered Nurses: Partners in Transforming Primary Care (Bodenheimer and Mason, 2016) , emphasizes the need to overcome the limited ways in which many primary care practices currently use RNs (e.g., telephoning prescriptions to pharmacies, performing administrative duties)
From page 81...
... Crucial gaps in the APRN workforce need to be filled to improve maternal health. At a time when CNMs are needed more than ever, their numbers are growing slowly.
From page 82...
... Rightsizing the Clinical Specialty Distribution of Nurses As described above, the health and social ramifications associated with the nation's aging population, growth in mental and behavioral health conditions, inadequate access to primary care, and unacceptably high maternal mortality rates will increasingly fall on the nursing workforce. Not only are there too few nurses and APRNs working in the settings where these populations receive care, but also the number of nurses specializing in these clinical areas needs to increase.
From page 83...
... Moreover, given the large number of RNs working in critical access/rural hospitals (more than 300,000) and the number of such hospitals that could close in the years ahead, the number of nurses practicing in rural areas could decline even more during the decade, further complicating policies aimed at increasing access to care for rural populations.
From page 84...
... Ensuring a Nursing Workforce That Is Diverse and Prepared with the Knowledge and Skills to Address Social Determinants of Health A fourth challenge facing the nursing workforce over the current decade is to ensure that nurses reflect the people and communities with whom they interact. In addition, nurses need to be prepared to address SDOH that negatively affect health and well-being.
From page 85...
... . For nurse practitioners (NPs)
From page 86...
... Overcoming Current and Future Barriers Affecting Workforce Capacity A fifth major challenge facing the nursing workforce over the current decade involves overcoming regulatory restrictions placed on nurses' scope of practice and avoiding disruptions in care associated with the retirement of large numbers of baby boom RNs. Such restrictions limit access to care generally and to the high-quality care offered by APRNs.
From page 87...
... . FIGURE 3-3 Scope of practice for nurse practitioners by state.
From page 88...
... According to the above-cited study by Graves and colleagues (2016) , state-level scope-ofpractice restrictions on NPs were associated with up to 40 percent fewer primary care NPs per capita in restrictive versus full-practice states, and people living in states allowing for the full practice authority of NPs had significantly greater access to primary care (63 percent)
From page 89...
... Allowing APRNs to practice to the full extent of their education and training as recommended in the 2011 The Future of Nursing report would help remediate inequities in access to health care and enable more people to enjoy the benefits of care provided by NPs and other APRNs. Disruptions in Care Delivery Associated with the Retirement of Baby Boom Registered Nurses An estimated 600,000 baby boom RNs have not yet retired and are expected to leave the workforce by 2030.
From page 90...
... These questions were generated by experts in nursing health services research and represent their views on the most important and feasible research questions that need to be investigated to increase nurses' ability to • improve access to mental and behavioral health care and assess the effectiveness of interventions and services; • improve access to primary health care and the effectiveness of primary care delivery systems;
From page 91...
... Among these challenges is the growing population of older people, many of whom, particularly frail older adults, have multiple comorbid conditions that increase the complexity and intensity of the nursing care they require. Nurses at all levels will also be challenged to help expand the capacity of the primary care workforce, provide care to rural populations, improve maternal health outcomes, and deliver more health and preventive care in community-based settings. And nurses will be called on to provide mental and behavioral health care to treat growing numbers of Americans with mental health conditions and help stem increases in substance abuse, suicide, and gun violence. Projected shortages of physicians in both primary care and non–primary care specialties, combined with projections of decreasing numbers of physicians practicing in rural areas, will increase the demand for RNs and APRNs.
From page 92...
... Experts in the fields of health services and social sciences research, survey and outcomes research, informatics, health workforce research, economics and policy, as well as physicians, and leaders in nursing education and public health, focused on identifying the key research questions that, if acted upon over the next decade, would generate evidence needed to help nurses meet the challenges of the current decade: 1. Improve Access to Behavioral Health and the Effectiveness of Interventions and Services • What are the emerging roles and functions of RNs and APRNs providing behavioral and mental health as health care delivery becomes increas ingly value-based?
From page 93...
... 5. Help Control Healthcare Spending, Reduce Costs, and Increase the Value of Nurses' Contribution to Health and Health Care Delivery • What are the drivers of variation in the productivity of individual nurses and can studying individual variation identify ways to improve nurse's contribution to value of services provided to patients and consumers?
From page 94...
... These factors include the aging population, the increasing incidence of mental and behavioral health conditions, and the increasing lack of access to primary and maternal health care. Conclusion 3-2: Eliminating restrictions on the scope of practice of advanced practice registered nurses and registered nurses so they can practice to the full extent of their education and training will increase the types and amount of high-quality health care services that can be provided to those with complex health and social needs and improve both access to care and health equity.
From page 95...
... 2018. Improving efficiency in the health-care system: Removing anticompetitive barriers for advanced practice registered nurses and physician assistants.
From page 96...
... 2017. The quality of primary care provided by nurse practitioners to vulnerable Medicare beneficiaries.  Nursing Outlook 65(6)
From page 97...
... 2010. The registered nurse population: Initial findings from the 2008 National Sample Survey of Registered Nurses.
From page 98...
... 2019. Primary care nurse practitioners and physicians in low-income and rural areas, 2010–2016. Journal of the American Medical Association 321(1)


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.