Nursing Workforce Getting More Diverse, Older

An extensive federal survey of nursing trends from 2004 to 2008 shows a growing diversity of backgrounds in an increasing registered nurse workforce.

The report—entitled The Registered Nurse Population: Initial Findings from the 2008 National Sample Survey of Registered Nurses—also reveals a trend of more highly educated, male, and foreign-trained nurses.

The trends, however, showed dramatic increases among older registered nurses, prompting concerns from officials about retirements impeding the growth of the nursing workforce.

The Health Resources and Services Administration (HRSA), a division of the Department of Health and Human Services, released the report this month. Published every four years by HRSA's Bureau of Health Professions, the National Sample Survey of Registered Nurses is what officials describe as the preeminent source of statistics on trends over time for the nation's largest health profession.

The report also includes comparisons from eight recurring surveys, 1980 through 2008.

The report showed that:

• The number of licensed registered nurses in the U.S. grew to a new high of 3.1 million between 2004 and 2008.


• 16.8% of nurses in 2008 were Asian, Black/African-American/American Indian/Alaska Native, and/or Hispanic—an increase from 12.2% in 2004.


• An estimated 170,235 registered nurses (RN) living in the US received their initial nursing education in another country or a US territory, comprising 5.6% of the US nursing population, compared with 3.7% in 2007. About half of the internationally educated RNs living in the US in 2008 were from the Philippines, with another 11.5% from Canada, and 9.4% from India.


• Women outnumber men by more than 15 to 1 in the overall number of RNs, but among those who became RNs after 1990, there is one male RN to every 10 women, the report stated.


• The average age of all licensed RNs increased to 47 years in 2008 from 46.8 in 2004; this represents "stabilization after many years of continuing large increases in the average age," the report stated.

Nearly 45% of RNs were 50 years of age or older in 2008, a dramatic increase from 33% in 2000 and 25% in 1980. "The aging trends in the RN population has raised concerns that future retirements could substantially reduce the size of the US nursing workforce at the same time the general population is growing older and the proportion who are elderly is increasing," the report said.

Overall, Dr. Mary K. Wakefield, the HRSA administrator, said officials are "encouraged by growth in the numbers and diversity of registered nurses and HRSA is committed to continuing this trend to ensure an adequate supply and distribution of nurses in the future."

Reacting to the findings, the American Nurses Association said it was "pleased to note the increasing diversity of the nation's population of registered nurses."

"More and more nurses have advanced training; more than half of American registered nurses have a bachelor's degree or higher," the ANA said. "Registered nurses in the US exhibit an increasing diversity of origins."

"By gender, race, and ethnic origin, US nurses are also increasingly diverse," the ANA said. "In the 2008 data, there were more male nurses, more non-white nurses, and more Hispanic nurses than ever before."

"Greater minority involvement in the health professions, including nurses, is critical," Wakefield said in a statement to HealthLeaders Media. "Numerous studies indicate that underserved communities benefit from the service of minority providers, who are more likely to choose to practice in these communities," she said.

The National Council of State Boards of Nursing reported that there was a large increase in the number of internationally-educated nursing graduates who passed the National Council Licensure Examination, from 5,000 nurses in 1998 to more than 22,000 nurses in 2007.

"The growth in the number of internationally-educated nurses passing the NCLEX is consistent with the substantial growth in the number of internationally educated RNs living in the US," the report stated.

Additional findings included:

• There are also wide variations across states in the number of employed nurses per 100,000 people. The lowest numbers of employed RNs per 100,000 were in Utah, (598), Nevada (681), and California (638), while the largest numbers were in the District of Columbia, (1,868), South Dakota, (1,333), and North Dakota, (1,273).


• Half of RNs have achieved a baccalaureate or higher degree in nursing or a nursing related field in 2008, compared to 27.5% in 1980.


• The number of RNs with a master's or doctor's degree rose to 404,163 in 2008, an increase of 46.9% from 2004, and up from 85,860 in 1980.


• Average annual earnings for RNs in 2008 were $66,973, an increase of almost 15.9 % from 2004, a figure that slightly outpaced inflation.