Report Explores State of Nursing Workforce

Throughout its history, nursing has been one of the greatest economic elevators for working women.

In the U.S. today, while nursing is overwhelmingly female, nurses still earn about a median $68,450 per year, more than 6% higher than the average salary for other workers in professional or management jobs, according to 2016 data from the U.S. Bureau of Labor Statistics.

However, while nursing has allowed many to take big steps up the ladder, healthcare leaders faced with pressure to reduce costs also face significant challenges now and in coming years to ensure nursing remains a strong and viable career choice.

Nursing report explores upward mobility outlook

This summer, the Center on Education and the Workforce at Georgetown University in Washington, D.C., released a report discussing those challenges.

The report, “Nursing: Can It Remain a Source of Upward Mobility Amidst Healthcare Turmoil?” reflected more than a year of research, springing out of a desire to see how the Affordable Care Act has impacted the nursing profession,” said Nicole Smith, chief economist at the Georgetown Center, who co-authored the report with Georgetown Center Director Anthony P. Carnevale.

But Smith said a looming shortage is only “the tip of the iceberg,” as demographic changes in America’s population place other pressures on the nation’s nursing workforce.

Key nursing workforce findings

  1. New gold standard: In the past, new nurses could enter the profession with a relatively small amount of education. Today, two-thirds of RNs hold a bachelor’s degree or higher. In 1980, only 32% did. The number is expected to continue to increase as professional standards setters, including the National Academies of Sciences, formerly the Institute of Medicine, push to make sure eight in every 10 nurses working in U.S. healthcare organizations hold at least a bachelor’s degree.

  2. Whites are over represented: Even as people of color come to represent an increasing share of the U.S. general population and its patient population, the number of nurses of color — particularly blacks and Latinos — working in hospitals continues to lag. According to the report, non-Hispanic whites made up 71% of the RN workforce in 2016, compared to 12% black and only 7% Latino. While the percentage of blacks in the RN workforce was reflective of the American population, the percentage of Latinos working as RNs lagged behind their overall share of 16% of the nation’s populace. Meanwhile, whites outpaced their 64% share of the overall population by 7%.

  3. Lessening disparities: The nursing workforce is diversifying from the bottom up, but slowly, the report said. Among nurses whom received a BSN degree between 2014 and 2015, 64% were white and 11% were Latino. However, blacks accounted for only 9% of the total number of degree holders.

  4. LPNs/LVNs are far more diverse: In 2016, fully 44% of all LPNs/LVNs were among America’s traditional racial minorities, including 27% black and 9% Latino. However, these certified positions paid significantly less, with LPNs and LVNs earning only about $46,000 on average. Further, the report noted that only about 18% of all RNs got their start as LPNs/LVNs, making such certifications tenuous rungs on the upward ladder.

  5. Call to climb higher: As hospitals and other healthcare organizations seek to reduce costs, an expanding share of care responsibilities has shifted to nurses, and particularly to advanced practice nurses. However, Smith said many APRNs today are foreign-born and foreign-trained. She said she expects the profession will begin placing a greater emphasis on training U.S. nurses to fill those roles. That particularly applies to nurses of color, who can help fill gaps in care in underserved areas.

Are new care standards creating new barriers?

Across the nursing profession, the drive to boost quality of care has resulted in an unprecedented number of nurses holding at least a bachelor’s degree.

The Campaign for Action, an alliance of organizations assembled to implement the nursing standards called for in the IOM report, estimates more than half of RNs hold BSNs, which is a slightly lower figure than that in the Georgetown Center’s report, said Susan Hassmiller, PhD, RN, FAAN, senior adviser for nursing at the Robert Wood Johnson Foundation and director of the Campaign for Action.

She hailed the surge in nurses holding bachelor’s degrees as a historical landmark. “We are making very good progress and, most importantly, there is now a culture shift in the thinking of students and faculty and employers,” Hassmiller said.

Smith said she believes the higher educational standards will boost care. However, she noted the Georgetown report reveals that those standards could continue to leave behind black and Latino nurses. This is because their cultural experiences and high school careers may have left them less prepared to meet the standards needed to enter many four-year nursing degree programs.

Smith said the Georgetown report should be used to spur changes needed to account for these key differences.

Among other policy shifts, she said, nursing schools should look at opening new pathways into nursing, or widening existing ones, particularly to allow LPNs and LVNs to become RNs. She recommended allowing more academic credits to transfer from courses completed at foreign schools. Using more articulation agreements and offering academic credit for prior nursing experience also might spur enrollment in degree programs.

Smith also encouraged greater representation of minorities among nursing mentors within schools. And, she said, those already in the nursing workforce would benefit from:

  • More flexible class times
  • Learning opportunities
  • Financial support

“It will help these nurses, these students, to see [a degree program] is an option,” Smith said. She said such changes could help boost the pace at which nursing diversifies and comes to better reflect the changing American population it serves.

Hassmiller said she was proud at the rate nursing has already diversified, saying, “We have made more progress than any other health profession. New students coming into nursing are now much more diverse.” But she acknowledged the nursing profession still had “much more work to do.”

We must encourage very strong outreach and mentoring programs, not only for students, but [also] for brand new nurses, so we don’t lose them out of the gate,” Hassmiller said.

Nursing workforce must take specific next steps

From here, Hassmiller and Smith said RNs will be needed to step up into advanced practice to fill gaps in primary care, to continue to replenish the ranks of nursing instructors and to boost the earning potential of nurses overall. Smith said nurses moving into advanced practice could pull salaries as much as $150,000.

“We need to let them (nursing students) know this, to know what the potential is here,” she said. “There is a lot of opportunity here, and a lot of money.”

Hassmiller agreed that recruiting minority nurses into these roles will be key for nursing and healthcare in general in coming years as the profession tries to meet healthcare needs in underserved areas and serves as faculty and nursing role models.

“There must be many more incentives for nurses to work towards these positions, especially minority nurses,” Hassmiller said.

Jonathan Bilyk contributed to the writing and research of this article.