The World Health Organization designated 2020 as the “Year of the Nurse and Midwife,” honoring the 200
th birth anniversary of Florence Nightingale. Nurses have always served on the frontline of health crises, natural disasters, and epidemics, and today it’s no different. Comprised of dedicated and compassionate individuals, nurses are present at birth and in death, in moments of great joy and in times of unspeakable sorrow – they are the backbone of the health care system. Let’s take a look at the latest U.S. data and statistics of a profession that has come a very long way over the last two centuries.
Demographics
With approximately 4 million registered nurses (RNs) in the United States, nursing is our country’s largest healthcare profession (American Nurses Association [ANA], 2020). Results from a 2018 national survey conducted by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA) (2019) provided basic demographic data from over 50,000 registered nurse (RN) respondents:
- Average age of RNs is 48-50, nearly half of all nurses are over the age of 50
- Growing number of male RNs – 9.6% in 2018
- 26.7% of RN respondents were minorities.
- The RN population in the U.S. is comprised of the following racial backgrounds:
- 73.3% White/Caucasian
- 7.8% African American
- 5.2% Asian
- 10.2% Hispanic
- 0.3% American Indian/Alaskan Native
- 0.6% Native Hawaiian/Pacific Islander
- 1.7% Two or more races
- 1.0% Other
- Approximately 5% of RNs in the U.S. completed their training in other countries and nearly half were from the Philippines, followed by Canada and India.
Education (Campaign for Action, 2020)
The Campaign for Action (2020), an organization co-founded by the Robert Wood Johnson Foundation and the American Association of Retired Persons (AARP) has been tracking the progress of efforts to implement recommendations in the 2010 Institute of Medicine’s (IOM)
The Future of Nursing: Leading Change, Advancing Health. One IOM goal focused on increasing the proportion of nurses with baccalaureate degrees to 80% by 2020. As of 2018, the percentage of nurses that have graduated with a Bachelor of Science degree in nursing (BSN)
or higher is about 57% (Campaign for Action, 2020). A recent American Association of Colleges of Nursing (AACN) report found nursing schools could not accept over 75,000 qualified applicants for baccalaureate and graduate nursing programs in 2018 due to inadequate faculty, clinical sites, classroom space, clinical preceptors and budgets (AACN, 2019).
Approximately 18% of nurses hold a graduate level degree such as a Master of Science in Nursing (MSN). Another IOM recommendation involved doubling the number of nurses with a doctorate by 2020. This target has been met as the number of nurses with a doctoral degree increased from just over 10,000 in 2010 to over 33,000 in 2018, roughly 1% of the nursing workforce (Campaign for Action, 2020).
Salary
Salaries for nurses vary based on level of education, experience, role and geographic location. The demand for RNs will continue to increase. Nurses with a baccalaureate degree will be in higher demand than those without a BSN. Employers may also prefer nurses with work experience or certification in a specialty area. Data from the U.S. Bureau of Labor and Statistics (2019a) found:
- RN median pay = $73,300/year ($35.24/hour)
- Typical entry-level education: Bachelor’s degree
- Number of jobs (2018) = 3,059,800
- Job outlook: growth rate projection between 2018-2028 = 12% (average for all occupations is 5%)
- Employment change: projected numeric change = +371,500 over 10 years (between 2018 – 2028)
- This projected job growth, while positive, will not be enough to offset the projected job openings of approximately 210,400 RNs each year, on average, over the next decade due to retirement or change of occupation.
Employment
Where do nurses work? Nurses provide healthcare services in a variety of settings. The U.S. Bureau of Labor and Statistics (2019a) breaks down these workplaces into the following categories:
- Hospitals (state, local, private): 60%
- Ambulatory healthcare services (including physicians’ offices, home healthcare, and outpatient centers): 18%
- Nursing and residential care facilities: 7%
- Government: 5%
- Educational services (state, local, private): 3%
However, there are a significant number of employment opportunities for nurses beyond these environments. The medical knowledge, clinical skills, time management and problem-solving abilities of nurses can be applied to a variety of fields. Examples include:
- Administration and management positions – another IOM goal was the advancement of nurses as Board Members for corporations and institutions and to increase that number to 10,000. As of January 28, 2020, the number of nurses on boards was 7,100 (Campaign for Action, 2020).
- Certified registered nurse anesthetists (CRNAs) administer anesthesia and other medications during surgical, obstetric and other procedures.
- Forensic nurses assist with death or crime investigations.
- Informatics nurse specialists support selecting and implementing technology in an institution.
- Legal nurse consultants interpret medical terminology for legal professionals, serve as expert witnesses during legal trials and consult with insurance companies and law enforcement agencies.
- Mental health nurses may work in addiction treatment clinics and psychiatric facilities.
- Nurse educators are often employed within hospitals to provide clinical staff training or in private and public academic institutions to educate future nurses.
- Occupational health nurses assist corporations in improving the health and safety of their workforce.
- Public health nurses provide health and wellness education programs to communities and may work in schools, non-profit organizations, and government agencies.
- Research nurses investigate the development and improvement of medical treatments and may work in academic institutions, pharmaceutical and biotechnology companies.
- Medical sales/marketing opportunities exist for nurses within research and manufacturing industries.
- Writers and clinical editors publish content in medical and nursing journals, textbooks, training manuals, digital resources, and marketing materials.
Advanced Practice Nurses
Many of the roles listed above require specialized training or certification and, in some cases, an advanced practice degree. Advanced practice nurses account for approximately 11.5% of the nursing workforce with nurse practitioners (NPs) accounting for 68.7% of advanced practice licenses, followed by 19.6% clinical nurse specialists (CNS), 9.3% certified registered nurse anesthetists and 2.4% certified nurse midwives (U.S. Department of Health and Human Services, 2019). Let’s take a closer look at advanced practice nurses.
| Advanced Practice Role |
U.S. Numbers |
| Nurse Anesthetists |
54,000Ŧ |
| Nurse Practitioners (NP) |
290,000§ |
| Clinical Nurse Specialists (CNS) |
70,000¥ |
| Nurse Midwives |
11,826Ɛ |
Ŧ American Association of Nurse Anesthetists (2020)
§ American Association of Nurse Practitioners (2020)
¥ National Association of Clinical Nurse Specialists (2020)
Ɛ American College of Nurse-Midwives [ACNM] (2017)
Conclusion
Over the last few months, nurses, alongside other health care providers, have been lauded for their courage and commitment during the COVID-19 pandemic. The role that nurses are playing during this public health crisis underscores the importance and critical need for a sustained workforce. While registered nursing is expected to be one of the leading occupations in terms of job growth, it may not be enough to offset the high numbers of nurses exiting the profession. It will be interesting to monitor the trajectory of nursing school enrollment following one of the most devasting natural disasters of our time.
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