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Nursing Ranks, Employment Growing

 |  By jsimmons@healthleadersmedia.com  
   September 24, 2010

The number of licensed registered nurses (RNs) nationwide grew 5% to a new annual high of 3.1 million between 2004 and 2008—representing a net growth of 153,806 nurses, according to a report released Wednesday by the federal Health Resources and Services Administration (HRSA).

The youngest population of nurses also grew for the first time in 30 years, which helped "restock the pool" of RNs, according to the report. An estimated 444,668 RNs received their first U.S. license from 2004 through 2008, while about 291,000 RNs allowed their licenses to lapse, possibly indicating the substantial number of retirements that have begun to take place.

The most commonly reported initial nursing education of RNs is the associate degree in nursing (AD), representing 45.4% of nurses. Bachelor's or graduate degrees were received by 34.2% of RNs, and 20.4% received their initial education in hospital-based diploma programs. Nearly two-thirds of RNs reported working in a health occupation prior to their initial nursing education.

Fewer than half of nurses with master's degrees work in hospitals. However, more than 18% are in ambulatory care settings and nearly 12% are in academic education.

In 2008, an estimated 2,596,399 RNs were employed in nursing— representing 84.8% of licensed RNs. This was the highest rate of nursing employment since the national survey started in 1977. Also, the first increase was reported in full-time employment since 1996—rising from 58.4% of RNs in 2004 to 63.2% in 2008.

Among nurses under 50 years, 90% or more are employed in nursing positions. This percentage, though, drops to less than half of RNs over age 65.

Hospitals still remain the most common employer for RNs—increasing from 57.4% in 2004 to 62.2% of employed RNs in 2008. The increase in this percentage is the first increase since 1984. While nearly 90% of RNs under 25 years old work in hospitals, less than 53% of RNs age 55 and older work in hospitals. Fewer than half of nurses with master's degrees work in hospitals; more than 18% are in ambulatory care settings and nearly 12% are in academic education.

The most common job title of RNs in the U.S. is "staff nurse"—or its equivalent (66.3%). Between 2004 and 2008, the proportion of staff RNs increased by 2.2%. Just below 20% of RNs with graduate degrees are staff RNs, compared with 72.8% of those without a graduate degree. The next most common job title in 2008 included management and administration titles (12.5%).

Many registered nurses held more than one job in nursing, according to the report. Overall, about 12% of RNs with full-time primary nursing positions, and 14% of those with part-time primary positions have additional nursing positions.

More than half of RNs work at least 40 hours per week in their principal nursing position. Another 24.2% work 32 to 39 hours per week. A total of 19.1%t of RNs report that they worked on-call or could have been called to work (on "standby") during a typical work week in their principal nursing positions. Among RNs employed in nursing positions, 27.5% report that they worked overtime, averaging 7.5 hours per week and received pay for such work.

The average annual earnings for RNs employed full-time in 2008 were $66,973—rising 15.9% since the 2004 average of $57,785. While annual earnings are adjusted for inflation to 1980 dollars, earnings in 2008 increased only 1.7% from average inflation-adjusted 2004 earnings. The highest earnings were reported by nurse anesthetists (NAs), who averaged $135,776 per year. Staff nurses on average earned $61,706 per year.

Registered nurses with graduate degrees earned an average of at least $20,000 more than did RNs with other levels of education. In 2008, 29.3% of RNs reported they were extremely satisfied, while 51.8% reported being moderately satisfied with their principal nursing position. This compares with 2004 rates of satisfaction of 27.5% and 50.5%, respectively.

Only 11.1% were dissatisfied with their education in 2008, as compared with 13.8 in 2004. The highest rates of being moderately or extremely satisfied were reported by registered nurses working in academic education programs (86.6%), while the lowest rate of being either moderately or extremely satisfied was reported by nurses in nursing homes/extended care (74.5).

In 2008, an estimated 158,348 nurses had preparations as nurse practitioners (NPs). NPs represent the largest group of advanced practiced registered nurses (APRNs). About 35% of NPs were under 45 years old. Nearly 85% of NPs reported that they held a master's degree and 3.9% reported holding a doctorate degree. Of all NPs, 10.3% also were prepared as clinical.

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.

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