The U.S. Nursing Workforce: Trends in Supply and Education 3

Section 1 The Registered Nurse and Licensed Practical Nurse Workforce

An analysis of recent trends in the nursing workforce is important to anticipate future

supply growth and identify likely changes in educational and demographic composition.

Information on the size of the U.S. nursing workforce and its distribution across states and

in rural and urban areas is presented. Growth in the workforce over time is measured against

growth in the general population. Next, key trends in educational attainment, racial/ethnic

composition, and gender are highlighted. The section concludes with an analysis of trends in

the setting and work hours of the nursing workforce.

Two sources of data from the U.S. Census Bureau were used to examine the current supply

of registered nurses (RNs) and licensed practical nurses (LPNs), as well as changes in the

workforce that have occurred during the past decade: the American Community Survey (ACS)

three-year combined file for 2008 to 2010 and the Census 2000 Long Form 5-percent sample.

(See “About the Data” below.)

Owing to the household sampling strategy of these Census surveys, all results presented

in this section are for the nursing workforce—those individuals who report their current

occupation as nursing and who currently have or are seeking a job. It is not possible to count,

with either data source, the number of individuals educated or licensed as nurses who are

working in another field or are out of the workforce entirely. Another important note is that

advanced practice registered nurses are included in results for RNs. The Census data sources

used here do not separate them.

The U.S. Nursing Workforce: Trends in Supply and Education4

About the Data

The ACS 2008 to 2010 three-year file and Census 2000 Long Form 5-percent sample offer nearly identical question wording and an established set of techniques for comparing results over time. The sources also offer large sample sizes: more than 110,000 RNs and 31,000 LPNs are included within the 2000 5-percent sample, while nearly 90,000 RNs and more than 21,000 LPNs are included in the ACS 2008 to 2010 three-year file. This means that estimates derived from these sources are highly precise and, in most cases, can be made at both state and national levels.

The ACS 2008 to 2010 three-year file was selected over a single-year file in order to improve the precision of state and national estimates. Unlike the Census 2000 data, which represent a point in time, the ACS three-year file represents an average of the three-year time period. It is inappropriate to refer to this estimate as representing 2009. Throughout this section, we refer to this as the “current” nurse supply because it was the most up-to-date three-year file available at the time of our analysis.

For most estimates, relative standard errors (RSEs) are quite small.

Because of the large sample size, even small differences across

time (1 or 2 percentage points) are statistically significant at the

0.05 level. All differences over time discussed within the text of

this section are statistically significant, though detailed results of

significance testing are not presented. All estimates reported in

this section have an RSE of less than 30 percent. More information

about the data sources and methods used in this report can be

found in “The U.S. Nursing Workforce: Technical Documentation,”

available at http://bhpr.hrsa.gov/healthworkforce/index.html.

The U.S. Nursing Workforce: Trends in Supply and Education 5

Workforce Size and Distribution

There were an estimated 2,824,641 RNs and 690,038 LPNs within the nursing workforce during

the 2008 to 2010 time period. Based on the size of the U.S. population during the period,

this equates to 921 RNs and 225 LPNs per 100,000 members of the population (per capita).

Tables 1 and 2, below, show the RN and LPN workforces by state, based on the ACS 2008 to

2010 three-year file. Nurses who live in one state but work in another were placed according

to the state in which they work. The total population in each state, also derived from the ACS

three-year file, was used to calculate the number of RNs per 100,000 population in each state.

Table 1. The RN Workforce, by State, per 100,000 Population

State1 RNs Total Population RNs per 100,000

Alabama 45,666 4,753,812 960.6

Alaska 5,605 700,113 800.6

Arizona 50,841 6,345,751 801.2

Arkansas 27,415 2,897,671 946.1

California 274,722 36,971,641 743.1

Colorado 43,480 4,970,333 874.8

Connecticut 37,555 3,561,486 1,054.5

Delaware 10,380 891,791 1,163.9

District of Columbia2 9,869 592,306 1,666.2

Florida 167,476 18,674,425 896.8

Georgia 75,976 9,612,759 790.4

Hawaii 9,357 1,347,518 694.4

Idaho 10,527 1,553,404 677.7

Illinois 120,203 12,795,658 939.4

Indiana 63,655 6,458,253 985.6

Iowa 33,378 3,033,163 1,100.4

The U.S. Nursing Workforce: Trends in Supply and Education6

Table 1. The RN Workforce, by State, per 100,000 Population (cont’d)

State1 RNs Total Population RNs per 100,000

Kansas 28,556 2,833,318 1,007.9

Kentucky 44,755 4,317,738 1,036.5

Louisiana 42,856 4,490,487 954.4

Maine 16,153 1,329,222 1,215.2

Maryland 55,944 5,733,779 975.7

Massachusetts 80,725 6,514,611 1,239.1

Michigan 89,445 9,908,690 902.7

Minnesota 57,639 5,279,601 1,091.7

Mississippi 29,016 2,958,873 980.6

Missouri 63,756 5,960,413 1,069.7

Montana 11,172 983,763 1,135.6

Nebraska 22,260 1,813,164 1,227.7

Nevada 19,428 2,680,981 724.7

New Hampshire 13,860 1,316,255 1,053.0

New Jersey 75,269 8,756,104 859.6

New Mexico 15,701 2,037,799 770.5

New York 196,189 19,303,930 1,016.3

North Carolina 90,663 9,440,195 960.4

North Dakota 7,702 665,681 1,157.0

Ohio 126,582 11,526,823 1,098.2

Oklahoma 29,366 3,716,087 790.2

Oregon 32,113 3,805,432 843.9

Pennsylvania 140,077 12,662,926 1,106.2

Rhode Island 12,744 1,053,846 1,209.3

South Carolina 42,254 4,585,057 921.6

The U.S. Nursing Workforce: Trends in Supply and Education 7

Table 1. The RN Workforce, by State, per 100,000 Population (cont’d)

State1 RNs Total Population RNs per 100,000

South Dakota 10,076 807,563 1,247.7

Tennessee 67,159 6,303,437 1,065.4

Texas 186,573 24,789,312 752.6

Utah 18,771 2,720,974 689.9

Vermont 6,528 624,976 1,044.5

Virginia 64,268 7,928,022 810.6

Washington 56,607 6,658,052 850.2

West Virginia 19,220 1,847,352 1,040.4

Wisconsin 60,813 5,667,100 1,073.1

Wyoming 4,296 556,787 771.6

U.S. Total 2,824,641 306,738,434 920.9

Data Source: HRSA analysis of the ACS 2008-2010 three-year file 1All state estimates have a relative standard error (RSE) of less than 10%. 2The nursing workforce is likely denser in the District of Columbia (D.C.) in part because of the presence of several academic medical centers, like most cities, that require a large RN workforce. Many nurses and patients commute into D.C. for work and health services. Since most states include rural and/or suburban areas, it is not instructive to compare D.C. with states in terms of per capita supply.

Table 2. The LPN Workforce, by State, per 100,000 Population

State LPNs Total Population LPNs per 100,000

Alabama 12,297 4,753,812 258.7

Alaska3 782 700,113 111.7

Arizona 7,853 6,345,751 123.8

Arkansas 10,734 2,897,671 370.4

California 54,817 36,971,641 148.3

Colorado 5,843 4,970,333 117.6

Connecticut 8,605 3,561,486 241.6

Delaware2 1,679 891,791 188.3

District of Columbia1 1,982 592,306 334.6

The U.S. Nursing Workforce: Trends in Supply and Education8

Table 2. The LPN Workforce, by State, per 100,000 Population (cont’d)

State LPNs Total Population LPNs per 100,000

Florida 45,686 18,674,425 244.6

Georgia 22,076 9,612,759 229.7

Hawaii2 2,107 1,347,518 156.4

Idaho1 2,880 1,553,404 185.4

Illinois 20,949 12,795,658 163.7

Indiana 17,114 6,458,253 265.0

Iowa 7,397 3,033,163 243.9

Kansas 7,056 2,833,318 249.0

Kentucky 9,857 4,317,738 228.3

Louisiana 17,457 4,490,487 388.8

Maine1 1,952 1,329,222 146.9

Maryland 11,733 5,733,779 204.6

Massachusetts 14,390 6,514,611 220.9

Michigan 19,196 9,908,690 193.7

Minnesota 15,462 5,279,601 292.9

Mississippi 9,719 2,958,873 328.5

Missouri 18,841 5,960,413 316.1

Montana2 1,737 983,763 176.6

Nebraska 5,882 1,813,164 324.4

Nevada 3,101 2,680,981 115.7

New Hampshire1 3,526 1,316,255 267.9

New Jersey 16,584 8,756,104 189.4

New Mexico1 2,555 2,037,799 125.4

The U.S. Nursing Workforce: Trends in Supply and Education 9

Table 2. The LPN Workforce, by State, per 100,000 Population (cont’d)

State LPNs Total Population LPNs per 100,000

New York 46,063 19,303,930 238.6

North Carolina 20,535 9,440,195 217.5

North Dakota2 2,802 665,681 420.9

Ohio 36,934 11,526,823 320.4

Oklahoma 13,335 3,716,087 358.8

Oregon1 2,998 3,805,432 78.8

Pennsylvania 38,202 12,662,926 301.7

Rhode Island1 1,735 1,053,846 164.6

South Carolina 10,149 4,585,057 221.3

South Dakota2 2,149 807,563 266.1

Tennessee 23,373 6,303,437 370.8

Texas 58,189 24,789,312 234.7

Utah1 2,728 2,720,974 100.3

Vermont2 1,229 624,976 196.6

Virginia 22,276 7,928,022 281.0

Washington 8,226 6,658,052 123.5

West Virginia 6,346 1,847,352 343.5

Wisconsin 10,279 5,667,100 181.4

Wyoming 641 556,787 115.1

U.S. Total 690,038 306,738,434 225.0

Data Source: HRSA analysis of the ACS 2008-2010 three-year file Note: The LPN population in small states is more difficult to estimate with precision. Higher RSEs in these states mean less precise estimates. 1State has an RSE between 10% and 14.9%. 2State has an RSE between 15% and 19.9%. 3State has an RSE between 20% and 25%.

The U.S. Nursing Workforce: Trends in Supply and Education

As Table 1 shows, the per capita supply of RNs varies substantially across states, from a high

of 1,248 in South Dakota to a low of 678 in Idaho. Per capita RN supply does not take into

account differences in population age, disease prevalence, or the number of hospital beds

that must be staffed. Still, it is informative because it illustrates that national-level information

masks substantial local-level differences. Figures 1 and 2 present the information graphically,

showing that states located in the West and West South Central Census areas tend to have a

lower per capita supply of RNs, whereas states in the Midwest and Northeast tend to have a

higher per capita supply.

Table 2 and Figures 3 and 4 present the same information for LPNs. Similar to the density of

RNs, LPN density is lowest in Western states. In general, areas of the country with a

comparatively dense population of RNs also have a comparatively dense population of LPNs.

Figure 1. The RN Workforce per 100,000 Population, by State

Washington

Oregon  

California

Nevada  

Idaho

Montana

Wyoming  

ColoradoUtah

New MexicoArizona

Texas

Oklahoma

Kansas  

Nebraska  

South Dakota

North  DakotaMinnesota

Wisconsin

Illinois

Iowa

Missouri

Arkansas

Louisiana

Alabama

Tennessee

Michigan

Pennsylvania

New York

Vermont

Georgia

Florida

Mississippi

Kentucky  

South Carolina

North Carolina

MarylandOhioDelaware

Indiana West Virginia

New Jersey

Connecticut

MassachuseNs

Maine

Rhode Island

Virginia

New Hampshire

Alaska  

Hawaii  

Washington, DC

Data Source: HRSA analysis of the ACS 2008-2010 three-year file

10

The U.S. Nursing Workforce: Trends in Supply and Education 11

Figure 2. The per Capita RN Workforce, Ranked by State

0 200 400 600 800 1,000 1,200 1,400 South Dakota

Massachusetts Nebraska

Maine Rhode Island

Delaware North Dakota

Montana Pennsylvania

Iowa Ohio

Minnesota Wisconsin

Missouri Tennessee

Connecticut New Hampshire

Vermont West Virginia

KentuckyNew York

Kansas Indiana

MississippiMarylandAlabama

North Carolina Louisiana Arkansas

Illinois South Carolina

U.S. Average Michigan

Florida Colorado

New JerseyWashington

OregonVirginia Arizona Alaska

GeorgiaOklahoma Wyoming

New Mexico Texas

California Nevada Hawaii

Utah Idaho

Data Source: HRSA analysis of the ACS 2008-2010 three-year file

The U.S. Nursing Workforce: Trends in Supply and Education22

Figure 9. Age Distribution of RNs, in Five-Year Increments

20%

18%

16%

14%

12%

10%

8%

6%

4%

2%

0%25or   26-­‐30 31-­‐35 36-­‐40 41-­‐45 46-­‐50 51-­‐55 56-­‐60 61-­‐65 66-­‐70 71-­‐75 76andyounger   older

Census  2000 ACS  08-­‐10

Data Sources: HRSA analysis of the ACS 2008-2010 three-year file and Census 2000 Long Form 5% sample

Another way to view the changing age structure of nurses is through a comparison of absolute

numbers in the workforce (see Figure 10). The workforce has grown overall, but this growth

is concentrated in the older and younger ends of the age spectrum, and there are actually

fewer RNs aged 36 to 45 working today, compared with nine years ago. Although the nursing

workforce has aged over the past decade, it is encouraging to see growth in the number aged

35 and younger. This finding suggests that young people continue to see nursing as a viable

career and predicts longer-term stability in the age distribution of the nursing workforce.

However, the tremendous growth of RN cohorts nearing retirement age is still a cause for

concern. Over the next 10 to 15 years, the nearly 1 million RNs older than 50—about one-

third of the current workforce—will reach retirement age. Retirement of large numbers of

RNs over the next two decades means a loss of experiential knowledge and

leadership brought to the workforce by seasoned RNs. The retirement decisions of this

older cohort, which may be influenced by the pace of economic recovery, will affect the

nursing workforce going forward.

The U.S. Nursing Workforce: Trends in Supply and Education 25

18%

16%

14%

12%

10%

8%

6%

4%

2%

0% 25 or 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 71-75 76 and

younger older

Census 2000 ACS 08-10

LPN Workforce Demographics

Many of the demographic trends observed for RNs hold for LPNs as well. As Figure 12 shows,

the LPN age distribution has also flattened and shifted toward older ages. Also consistent

with the findings for RNs, the proportion of younger nurses appears to be holding reasonably

steady. During the time period covered by this analysis, the average age of LPNs increased by

about 1.75 years, from 41.9 in 2000 to 43.6 in the ACS 2008 to 2010.

Figure 12. Age Distribution of LPNs, in Five-Year Increments

Data Sources: HRSA analysis of the ACS 2008-2010 three-year file and Census 2000 Long Form 5% sample

Similar to RNs, the absolute number of LPNs has grown overall, but this growth has occurred

only among those younger than 30 and older than 50 (see Figure 13). The number of LPNs

aged 31 to 50 has actually decreased over the past 10 years. More than one-third of the LPN

workforce is older than age 50.

The U.S. Nursing Workforce: Trends in Supply and Education30

Table 7. Estimated Number of RNs, by Setting of Employment Census

2000 Estimate

ACS 08-10 Estimate

Estimated Growth/ Decline

% Change in Growth

Hospitals 1,427,497 1,785,304 357,807 25.1%

Nursing Care Facilities 189,594 208,051 18,457 9.7%

Offices of Physicians 156,559 134,231 -22,328 -14.3%

Home Health Care Services

101,895 105,922 4,027 4.0%

Outpatient Care Centers 70,224 131,022 60,798 86.6%

Other Health Care Services 66,723 153,449 86,726 130.0%

Elementary and Secondary Schools

51,495 61,323 9,828 19.1%

Employment Services 45,835 58,362 12,527 27.3%

Insurance Carriers and Related Activities

22,919 25,155 2,236 9.8%

Administration of Human Resource Programs1

20,509 38,136 17,627 85.9%

Justice, Public Order, and Safety Activities2

14,793 18,137 3,344 22.6%

Offices of Other Health Practitioners

13,346 7,596 -5,750 -43.1%

Colleges and Universities, Including Junior Colleges

12,637 16,320 3,683 29.1%

Residential Care Facilities, Without Nursing

10,853 9,928 -925 -8.5%

All Other Settings3 70,397 71,705 1,308 1.9%

Totals 2,275,276 2,824,641 549,365 24.1%

Data Sources: HRSA analysis of the ACS 2008-2010 three-year file and Census 2000 Long Form 5% sample 1Category includes RNs whose jobs focus primarily on administration. 2Category includes the majority of nurses working in public health settings. 3For this analysis, all settings holding less than 1% of the RN population have been recoded to “Other.”

The U.S. Nursing Workforce: Trends in Supply and Education

    -­‐

The average hours worked by LPNs also held quite steady over time, hovering around 37

hours per week across all ages. Similar to RNs, the ACS 2008 to 2010 data suggest that

LPNs are working more hours than in 2000 within older age categories (refer to Figure 16).

The difference is particularly noticeable in the 61 to 70 age category.

Figure 17 shows the average salary of a full-time nurse (36 or more hours per week). Full-time

salary has increased by about $20,000 for RNs and about $11,500 for LPNs over the past decade.

An increasing average salary can reflect the influence of many factors, including inflation, an

older (and more experienced) workforce, and wage hikes to stimulate employment interest

in areas facing a nursing shortage. Figure 17 presents the average salary within the ACS 2008

to 2010 adjusted to 2000 constant dollars to remove the impact of inflation (darker part of

the bar). As the figure also shows, once inflation has been accounted for, the salary increase

remains notable at nearly 15 percent ($6,600) over 10 years.

Figure 17. Growth in Full-Time Nurse Salaries

$70,000.00

$60,000.00

$50,000.00

$40,000.00

$30,000.00

$20,000.00

$10,000.00

$0.00 RNs   2000 RNs08-­‐ 10 LPNs  2000 LPNs 08 10

$43,906.46

$31,083.31   *

$39,360.64 **

$50,497.10   *

$63,944.22 **

$27,809.77

Data Sources: HRSA analysis of the ACS 2008-2010 three-year file and Census 2000 Long Form 5% sample *Inflation adjusted to 2000 constant dollars. **Actual salary in the ACS 2008-2010, adjusted to 2010 dollars.

33