Digging Deeper into Data on Registered Nurses

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.

Name 2009 National Completions
Registered nurses 190,615
Pre-Nursing Studies (CIP Code – 51.1105) 496
Health/Medical Preparatory Programs, Other (CIP Code – 51.1199) 1,454
Nursing/Registered Nurse (RN, ASN, BSN, MSN) (CIP Code – 51.1601) 162,501
Adult Health Nurse/Nursing (CIP Code – 51.1603) 693
Nurse Anesthetist (CIP Code – 51.1604) 1,579
Family Practice Nurse/Nurse Practitioner (CIP Code – 51.1605) 2,030
Maternal/Child Health and Neonatal Nurse/Nursing (CIP Code – 51.1606) 215
Nurse Midwife/Nursing Midwifery (CIP Code – 51.1607) 106
Nursing Science (MS, PhD) (CIP Code – 51.1608) 3,286
Pediatric Nurse/Nursing (CIP Code – 51.1609) 193
Psychiatric/Mental Health Nurse/Nursing (CIP Code – 51.1610) 220
Public Health/Community Nurse/Nursing (CIP Code – 51.1611) 130
Perioperative/Operating Room and Surgical Nurse/Nursing (CIP Code – 51.1612) 90
Clinical Nurse Specialist (CIP Code – 51.1616) 263
Critical Care Nursing (CIP Code – 51.1617) 203
Occupational and Environmental Health Nursing (CIP Code – 51.1618) 2
Nursing, Other (CIP Code – 51.1699) 9,249
Health Services/Allied Health/Health Sciences, General (CIP Code – 51.0000) 7,905

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:

CIP Code Title Institution Award Level 2009 Completions
51.1601 Nursing/Registered Nurse (RN, ASN, BSN, MSN) Excelsior College Associate’s degree 2,005
51.1601 Nursing/Registered Nurse (RN, ASN, BSN, MSN) University of Phoenix-Online Campus Bachelor’s degree 1,607
51.1601 Nursing/Registered Nurse (RN, ASN, BSN, MSN) Chamberlain College of Nursing-St Louis Campus Bachelor’s degree 798
51.1601 Nursing/Registered Nurse (RN, ASN, BSN, MSN) University of Phoenix-Online Campus Master’s degree 635
51.1601 Nursing/Registered Nurse (RN, ASN, BSN, MSN) Indiana Wesleyan University Bachelor’s degree 628
51.1608 Nursing Science (MS, PhD) University of Phoenix-Online Campus Master’s degree 601
51.1601 Nursing/Registered Nurse (RN, ASN, BSN, MSN) Grand Canyon University Bachelor’s degree 543
51.1601 Nursing/Registered Nurse (RN, ASN, BSN, MSN) Miami Dade College Associate’s degree 540
51.1601 Nursing/Registered Nurse (RN, ASN, BSN, MSN) Texas Tech University Health Sciences Center Bachelor’s degree 438
51.1601 Nursing/Registered Nurse (RN, ASN, BSN, MSN) University of Oklahoma Health Sciences Center Bachelor’s degree 426
51.1601 Nursing/Registered Nurse (RN, ASN, BSN, MSN) Texas Woman’s University Bachelor’s degree 424
51.1601 Nursing/Registered Nurse (RN, ASN, BSN, MSN) Baptist Health System School of Health Professions Associate’s degree 418
51.1601 Nursing/Registered Nurse (RN, ASN, BSN, MSN) Community College of Allegheny County Associate’s degree 405
51.1601 Nursing/Registered Nurse (RN, ASN, BSN, MSN) Winston-Salem State University Bachelor’s degree 403
51.1601 Nursing/Registered Nurse (RN, ASN, BSN, MSN) Drexel University Bachelor’s degree 386
51.1601 Nursing/Registered Nurse (RN, ASN, BSN, MSN) West Coast University Associate’s degree 375
51.1601 Nursing/Registered Nurse (RN, ASN, BSN, MSN) Indiana University-Purdue University-Indianapolis Bachelor’s degree 374
51.1601 Nursing/Registered Nurse (RN, ASN, BSN, MSN) Washington State University Bachelor’s degree 374
51.1601 Nursing/Registered Nurse (RN, ASN, BSN, MSN) Florida State College at Jacksonville Associate’s degree 364
51.1601 Nursing/Registered Nurse (RN, ASN, BSN, MSN) University of Central Florida Bachelor’s degree 363

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.

mnscu.nursegrads.JPG

We’d love to hear more of your thoughts on this topic. You can comment below or email Josh Wright at jwright@economicmodeling.com. This discussion is also taking place at our LinkedIn user forum; feel free to become a member and check it out.

7 Responses to “Digging Deeper into Data on Registered Nurses”

  1. Jim Zentner

    The work we have done with healthcare and workforce through our department suggests that hospitals in particular are interested in hiring four year graduates. The main issue we keep hearing is that four year nursing students have better critical thinking skills than the associate degreed nurse. The problem with hiring is in the specialty areas and your data show the lower number of graduates in those specialties. I think your research is important because the MnSCU system keeps looking for more money to expand the capacity without serious discussion regarding the true level of demand and what that demand really looks like. Hope to see more on this subject.

  2. Joshua Wright

    Thanks for the comment, Jim. The more we look into this issue, the more I think you are right — hospitals are really focusing on four-year graduates at this point. This clearly leaves associate’s degree holders in a bind, and there are a lot of them out there.

  3. Alexis Newton

    I agree and appreciate this national snapshot. As nursing education leaders, we must insure that our statistics are current and accurate. I have seen questionable success rates in the past and I am bewildered by the inability of some institutions and programs to provide accurate data. This practice does not assist us in portraying nursing as a professional discipline.
    Alexis M. Newton RN PhD CNS
    Chair of Nursing Programs
    Front Range Community College
    Boulder County Campus

  4. Lois Wagner

    In Tennessee, we survey every School of Nursing every year to determine, among other things, the number of new graduates each year. By mandate of the Tennessee Board of Nursing, all schools of nursing must complete this survey. Thus, we have complete data from ALL of Tennessee’s 41 professional (RN) nursing programs. In 2009, Tennessee had 2816 graduates from initial licensure RN programs. Your estimate of 4,223 “completers”, overestmates our number by 677 students or 24%. Even if, as others have suggested, your numbers do include persons seeking an MSN, doctoral degree, or RN to BSN graduates, they are still inaccurate. In Tennesse in 2009 we had 730 graduates from basic MSN and doctoral degree programs and 461 graduates from RN to BSN programs. I, therefore, question the veracity of your published data and recommend, as did Jen Nooney, that groups involved in conducting nursing workforce research consult the experts in the field such as the National Forum of State Nursing Workforce Centers.

  5. Tanya Spanner

    Hey this is a good article . Can I use part of it on my blog ? I would of course link back to your site so people could read the full article if they wanted to. Thanks either way.

    • Joshua Wright

      Yes, Tanya, feel free to use part of the article as you see fit. We only ask, as you mentioned, that you cite EMSI as the source. Thanks!

  6. Jason

    It seems like hospitals are really looking for graduates with a four year degree. Having an associates degree seems to only get you so far. When having a four year degree they believe that you have better critical thinking and management skills.