Over the past two weeks there’s been an interesting discussion brewing on our blog as well as Minnesota Public Radio’s MinnEcon on the supply and demand of registered nurses. Lots of good questions have come up (see our original post for more) so we wanted to clarify a few things.
First, about EMSI’s methodology: To compare labor market demands vs. educational output, EMSI uses a program-to-occupation crosswalk developed by the National Center for Education Statistics (NCES). In our registered nursing analysis, we took the annual openings figure for each state and the nation using our labor market database and compared it to graduates from IPEDs (compiled by NCES) to gauge the shortage or oversupply of RNs.
Here’s what we found: According to the 2008-09 IPEDs data and projected annual openings through 2015, the US is on pace to produce nearly 86,000 too many nurses each year. States like New York, California and Pennsylvania are estimated to have an excess of thousands of RNs annually.
There are well-known limitations to IPEDs data, but we feel our methodology gives researchers and educators a rough estimate of supply and demand.
Why the Higher Completion Numbers
A few readers have wondered why the completion numbers shown in our post were often higher than other estimates by state-level nursing organizations or boards of nursing. One reason, as Mary Bennett of Western Kentucky University told us in a Q&A, is that IPEDs does not differentiate nurses who may have earned an associate’s degree, taken a job, then gone back for a bachelor’s or more specialized degree. These nurses aren’t new graduates. As Bennett said in a comment under our original post, “they are just nurses with additional education. They don’t need another job opening (or if they do take a new job they leave an old job open for someone else).”
Another reason for the higher counts is that NCES’ crosswalk incorporates programs that might be producing graduates who go into other fields besides nursing. This includes everything from Nursing Science (CIP 51.1610), which turns out master’s- and PhD-level graduates who could become nursing educators, etc., to Health Services/Allied Health/Health Sciences (CIP 51.0000).
According to NCES, CIP 51.0000 is a “general, introductory, undifferentiated, or joint program in health services occupations that prepares individuals for either entry into specialized training programs or for a variety of concentrations in the allied health area. Includes instruction in the basic sciences, research and clinical procedures, and aspects of the subject matter related to various health occupations.”
The following table shows all the programs included in the RN analysis, accompanied by their number of 2008-09 grads.[table "9" not found /]
The huge majority of completions (162,501) comes from the general Nurse/Registered Nurse program. Keep in mind: Even if we take out all other offerings and include only the traditional Registered Nurse program, there’s still an estimated surplus of more than 57,000 RN grads each year.
Where RN Grads Are Coming From
Another nuance is which institutions and programs are reporting RN completions. IPEDS accounts for all colleges and universities that participate or are applicants for any federal financial assistance program authorized by the Higher Education Act (HEA), which includes most of the well-known federal loans (e.g., Pell Grants, Stafford Loans). All public colleges and universities and a number of private postsecondary schools accept federal assistance loans and therefore are included in this analysis.
It would take lots of space to list every institution included, but here are the top 20 producers of registered nurses in the 2008-09 academic year:[table "8" not found /]
The top two institutions on the list — Excelsior College and University of Phoenix — are both online, distance-learning providers. They accounted for more than 3,600 RN completions alone in 2008-09, according to IPEDs.
Further, if you count only postsecondary degrees at the associate’s level or below, IPEDs shows 88,323 completions nationally. It’s at this level of education where a potential oversupply is occurring. As Bennett alluded to, many hospitals are able to be choosy in this economic climate with their hires, and that means two-year degree RNs appear to be getting bypassed for more highly educated nurses.
An article from the Philadelphia Enquirer does a nice job outlining the issue:
[John Jerzak, a] 55-year-old former airline worker thought a predicted shortage of nurses would ensure him a secure, well-paid job. But he discovered that growing numbers of Philadelphia hospitals do not think his brand of R.N. – one you can earn at a community college – is good enough. They want only nurses with bachelor’s degrees in nursing, even though they have exactly the same license.
Incensed, the feisty Jerzak has been turning up the heat, lobbying against what he perceives as discrimination with nursing and political leaders.
“The mere fact that we’re being denied a chance to compete for a job based on merit is maddeningly difficult to accept,” he said.
Ann Torregrossa, director of Gov. Rendell’s office of health-care reform, recently spent an hour with Jerzak. She is still “fact-gathering,” but was obviously sympathetic. With the shortage still looming, she said, she sees associate-degree programs as an “absolutely critical source of nurses.”
The problem is that all indications point to a dramatic increase in the number of new nurses with associate’s degrees in recent years. The below chart, taken from MinnEcon, shows this trend in Minnesota. We have yet to look at this data nationally, but we suspect the trend line would look similar.
We’d love to hear more of your thoughts on this topic. You can comment below or email Josh Wright at firstname.lastname@example.org. This discussion is also taking place at our LinkedIn user forum; feel free to become a member and check it out.