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Introduction
Since its inception,
the Health Resources and Services Administration,
Bureau of Health Professions, Division
of Nursing has had primary responsibility
for the assessment and examination of
the Nation’s nursing workforce. This responsibility
includes examination of the supply, the
composition, and the distribution of nurses
nationally and on a State level. The Division
of Nursing has worked with other agencies
within Federal and State governments,
and with various nursing organizations
in the development of methods for the
study and acquisition of data on the nurse
population.
Early
Registered Nurse Workforce Studies
National
studies to determine the number and characteristics
of the Nation’s registered nurses were
initiated in 1949 when the American Nurses
Association (ANA) conducted the first
Inventory of Registered Nurses1. Data
were collected through postcard questionnaires
mailed by the licensing entity in the
States and territories that require renewal
of registration to each registrant on
record at the time of the study. In Maryland
and Ohio, where renewal and registration
was not required, questionnaires were
distributed through State nurses associations
and employing agencies. About 62 percent
of all questionnaires sent to nurses by
the States were returned. The number of
nurses who had licenses to practice in
1949 was estimated by eliminating duplication
resulting from nurses having licenses
in more than one State, and accounting
for those nurses who did not respond to
the survey. 2
The ANA conducted a similar study in
1951, but decided to mail the questionnaires
with the license renewal notices to registered
nurses (RNs) in each State. About 71 percent
of the questionnaires were returned. This
change in data collection methodology
improved the response rate but lengthened
the data collection period because of
variation in renewal dates from State
to State. The number of nurses who had
licenses to practice in 1951 was estimated
using the same estimation procedures used
in the 1949 inventory: elimination of
duplication due to RNs’ licensure in more
than one State, and accounting for nonrespondents
to the inventory.
In
the mid-1950s, the ANA promoted the inclusion
of a uniform set of questions about RNs’
characteristics on each State’s licensing
application form rather than the use of
a postcard or a separate questionnaire.
An Inventory of Registered Nurses using
this data collection process was initiated
in 1956. The length of time it took to
include the questions in the licensing
process and the limited funds available
for compiling and analyzing the data resulted
in an extended time frame for both the
data collection and its analysis. The
actual data summary for the 1956-1958
inventory was published in 1963.3
The
ANA conducted four subsequent inventories
of registered nurses4,5,6,7. The Division
of Nursing was instrumental in providing
Federal financial support to the ANA to
defray the costs of obtaining and processing
the data for these studies. This support
ensured a more centralized approach to
data collection and processing as well
as greater use of automated procedures
to summarize the data.
Development
of Present Study Methodology
The nursing inventories were based on
data collection at the State level using
the licensing mechanism as an opportune
time for asking registered nurses to complete
a questionnaire. This data collection
process, although logical and potentially
comprehensive, encompassed some serious
limitations. The size of the questionnaire
had to be limited and follow-up on forms
not returned, missing data, or ambiguous
data were not part of the data collection
process. Moreover, the wide variation
in renewal dates from State to State led
to a lengthy data collection period. It
took as long as three years to present
a national picture through analysis of
data from all States.
The
need for more comprehensive data on the
nursing workforce, concerns about the
limitations of the nursing inventories
and the enactment of Public Law (P.L.)
94-63, were the impetus for the development
of the present methodology for collecting
data on the nursing workforce. Section
951 of P.L. 94-63 mandates the collection
of information on a continuous basis regarding
the current and future supply, distribution,
and requirements for nurses, nationally
and within each State. The data acquisition
requirements listed in the law are very
specific. For example, the law requires
data on the number of nurses with advanced
education or graduate degrees by specialty,
and data on average rates of compensation
by type of employment and location of
practice.8
In
the mid 1970s the Division contracted
with Westat Inc., a survey research firm
with expertise in complex survey design
to develop a comprehensive survey plan.
Westat worked with the American Nurses
Association (ANA) and the Division of
Nursing to develop a survey plan to implement
the data element requirements in section
951 of P.L. 94-63: provide baseline data
for the development of estimates and projections
regarding the registered nurse population
both nationally and for each State, and
provide data on nurse characteristics
needed for program planning, administration,
monitoring, and evaluation by Congress,
State legislators, and Federal and State
agencies and associations.9 A complex
sample survey was developed using licensure
listings from each of the fifty States
and the District of Columbia. A single
questionnaire was designed; data collection
and data follow-up processes also were
established. The data collection was to
be done by mail with telephone follow-up
for nonrespondents.
The
first study using this survey methodology
was conducted in September 1977 under
contract to the ANA with a subcontract
to Westat, Inc. During the conduct of
that study, the design and data processing
procedures were refined.10 Subsequent
studies using the same design were carried
out in 1980, 1984, 1988, 1992 and 199611,
12,13,14,15 .
The
2000 National Sample
Survey of Registered Nurses (NSSRN)
The sample survey collected data as of
March 2000. Research Triangle Institute,
under a contract with the Division of
Nursing, carried out the sample selection,
data collection, and processing of this
study. This report summarizes results
of the study.
As in previous NSSRN studies, the data
collection instrument responds to specific
data requirements cited in section 951
of P.L. 94-63 and provides the necessary
base data for developing projections of
the supply and distribution of and requirements
for registered nurses. It also contains
some new areas of inquiry designed to
provide information on issues of current
importance. However, as in prior studies,
the survey instrument was designed to
ensure that the data collected from study
to study provides sufficient continuity
so that an evaluation can be made of trends
in nursing resources.
In this study series, samples were drawn
for each State’s list of active licensees,
because no single unduplicated list of
licensed registered nurses exists in this
country. Disproportionate sampling from
State to State was used to provide statistically
improved estimates of the number of nurses
in each State while maintaining the overall
sample size within reasonable bounds.
Larger proportions of licensees were sampled
in the States with fewer registrants than
in States with more registrants. In the
2000 study, the sampling methodology included
oversampling of minority RNs into the
sample. The intent was to increase the
sample size for minorities so as to provide
more reliable estimates for this group
of the RN population. A weighting procedure
was used to account for duplication of
licenses from State to State so that estimates
could be developed of the number of individuals
who hold active licenses to practice
as RNs regardless of the number of State
licenses they hold. Based on March 2000
data, over 3,066,000 licenses to practice
as registered nurses in the United States
were held by an estimated 2,696,540 nurses.
The initial sample selection for this
survey consisted of about 54,000 licenses
of which 4,520 were identified
at the time of selection or in subsequent
data collection as duplicates for nurses
licensed in other states or other frame
errors. Ninety-seven registered nurses
listed as having active licenses were
identified as deceased. After taking account
of duplications and sample selection errors,
the overall response rate was estimated
at 72 percent. Responses from a total
of 35,579 individual nurses were used
to derive the data. This report primarily
presents data and analysis of those RNs
who, as of March 2000, were employed in
nursing in the United States, or, if not
employed in nursing, reside in the country—35,358
of the 35,579 respondents fit this definition
of location.
To ensure an adequate response to the
survey, three mailings were sent out,
and these were followed by telephone interviews
of those who did not respond. Unlike previous
iterations of the RN study, the packages
for the third mailing were shipped via
Federal Express in an attempt to improve
responsiveness. In addition to the efforts
to reduce the nonresponse to the survey,
careful screening of responses was undertaken
to minimize ambiguous responses and nonresponse
to individual questions.
Questions on the survey instrument were
prioritized as to their importance to
the overall registered nurse database,
and the degree to which a question might
be sensitive in nature. A response rate
goal was established for each question.
Based on the priority rankings and the
response rate goals, respondents were
called to clarify the response made or
to obtain the missing information. When
a call was made concerning a high priority
question, the respondent also was queried
about any other ambiguous or missing items
regardless of their priority order. All
respondents to the survey were classified
according to whether they were employed
in nursing as of March 2000, and also
according to State of residence and/or
employment.
In addition to the identification and
follow-up of missing data, items specified
in the "other" categories within
the questions were reviewed and reclassified
to already stated categories if possible.
The remaining ones were reviewed to determine
whether there was a sufficient number
of a particular response to warrant a
separate itemization.
Organization
of the Report
The substantial database resulting from
the 2000 study may be used for many different
types of analyses concerning a variety
of subjects. This report presents an overview
of the personal, professional, and employment
characteristics of the almost 2.7 million
registered nurses in the country as of
March 2000. A summary of the findings
from the study and some comparisons to
the findings of prior studies in this
series, are presented in the succeeding
chapters. Appendix A contains a series
of tables summarizing the data. A review
of the survey methodology and the statistical
techniques used in sample selection, response
weighting, and identification of sampling
errors are found in Appendix B. The survey
instrument is included in Appendix C.
References
- Inventory
of Professional Registered Nurses 1949,
American Nurses Association, Inc., New
York.
- Inventory
of Professional Registered Nurses 1951,
American Nurses Association, Inc. New
York.
- "Nurses
….Numbers and Characteristics",
American Journal of Nursing, Vol. 63,
Jan 1963.
- Marshall,
Eleanor D. and Moses, Evelyn B. The
Nation’s Nurses, the 1962 Inventory
of Professional Registered Nurses, American
Nurses Association, New York, 1965.
- Marshall,
Eleanor D. and Moses, Evelyn B. RNs
1966….An Inventory of Registered
Nurses. American Nurses Association,
New York, 1965.
- Roth,
Aleda V. and Walden, Alice R. The
Nation’s Nurses, 1972 Inventory of Registered
Nurses. American Nurses Association,
Kansas City, 1981.
- Schulte,
Duane C. Inventory of Registered
Nurses 1977-1978. American Nurses
Association, Kansas City 1981.
- First
Report to Congress, February 1, 1977,
Nursing Training Act of 1975. Health
Resources and Services Administration,
Public Health Service, USDHEW, DHEW
publication No. HRA 78-38, 1977. (Available
through NTIS, Access Number HRP-0900501.)
-
Sample Survey for the National Survey
of Registered Nurses, Technical Report
(Volume I), and Appendices (Volume II).
Westat Inc. and the American Nurses
Association, 1976 (unpublished).
- Roth,
Aleda, Graham, Deborah, and Schmittling,
Gordon. 1977 National Sample Survey
of Registered Nurses and Factors Affecting
their Supply. American Nurses Association,
Kansas City, 1978. (Available through
NTIS, Access Number HRP-0900603.)
- The
Registered Nurse Population, An Overview
from the National Sample Survey of Registered
Nurses, November 1980. Office of
Data Analysis and Management, Bureau
of Health Professions, Health Resources
and Services Administration, PHS, USDHHS,
1982. (Available through NTIS, Access
Number HRP-0904551.)
- Moses,
Evelyn B., 1984. The Registered Nurse
Population, Findings from the National
Sample Survey of Registered Nurses,
November 1984. Division of Nursing,
Bureau of Health Professions, Health
Resources and Services Administration,
PHS, USDHHS, 1986. (Available from NTIS,
Access Number HRP-0904551.)
- Moses,
Evelyn B. 1988. The Registered Nurse
Population, Findings from the National
Sample Survey of Registered Nurses,
March 1988. Division of Nursing,
Bureau of Health Professions, Health
Resources and Services Administration,
PHS, USDHHS, 1990. (Available from NTIS,
Access Number PB91-145391.)
- Moses,
Evelyn B. 1992. The Registered Nurse
Population, Findings from the National
Sample Survey of Registered Nurses,
March 1992. Division of Nursing,
Bureau of Health Professions, Health
Resources and Services Administration,
PHS, USDHHS, 1990. (Available from NTIS,
Access Number PB97- 108187.)
- Moses,
Evelyn B. 1996. The Registered Nurse
Population, Findings from the National
Sample Survey of Registered Nurses,
March 1996. Division of Nursing,
Bureau of Health Professions, Health
Resources and Services Administration,
PHS, USDHHS, 1990.
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