New nursing workforce data sheds a light on supply and demand in an increasingly changing health care landscape

The Washington Center for Nursing, the state’s nursing workforce center, has released several new reports that give insight into the changing nursing workforce in the state.

Washington State Data Snapshots: a high-level overview

WCN’s Snapshot reports are prepared every other year by the University of Washington Center for Health Workforce Studies, with funding through a grant from the Washington State Department of Health. Each Data Snapshot uses data from Washington’s RN, LPN and ARNP license files, which contain the nurse’s name, mailing address, birthdate and gender. This minimal data has been used since 2004 to produce estimates of characteristics of the state’s nursing workforce. Washington population data are from the Washington State Office of Financial Management.

What do we know about Washington’s Registered Nurses?

The number of registered nurses with addresses in Washington state and holding active Washington licenses is 71,386, up by 2,729 or 4 percent from 2016. That translates to about 977 registered nurses per 100,000 people in Washington.

The average age of RNs has gone down from 47.1 two years ago to 45.7 today. The number of male RNs continues climbing and is at 11.9 percent, a slight increase from 11.3 percent in 2016.

RNs are distributed in rural and urban areas fairly similarly to the overall population: 6.1 percent of RNs are in rural settings, compared with 8.3 percent of the state population.

What do we know about Licensed Practical Nurses?

The number of licensed practical nurses (LPNs) continues to decline. Currently, Washington has 9,859 LPNs with Washington addresses, which has dwindled each year since reaching a peak of 13,751 in 2008. In 2018, this translates to about 135 LPNs per 100,000 people in Washington. Licensed Practical Nurses perform a variety of tasks under the supervision of a registered nurse. They oversee basic care, such as administering medicine and injections and taking vital signs. Although many stay in licensed practical nursing throughout their career, many LPNs want to move on to registered nursing.

LPNs, like RNs, are distributed in rural and urban areas similar to the overall population: 7.6 percent of LPNs have addresses in Washington’s rural areas, home to 8.3 percent of Washingtonians, compared with just over 92.4 percent of LPNs in urban areas, where 91.7 percent of the state’s population lives.

The percentage of LPNs who are male is 13.6 percent, staying roughly the same since 2014.

What do we know about Advanced Registered Nurse Practitioners?

The ARNP license category in Washington includes certified registered nurse anesthetists (CRNA), certified nurse midwives (CNM), clinical nurse specialists (CNS) and nurse practitioners (ARNP).

The number of ARNPs licensed in Washington with in-state addresses continues to climb steadily, reaching 5,981 today, from 2,835 in 2006. That is an increase from 50 ARNPs per 100,000 Washington population in 2006 to about 82 per 100,000 in 2018.

The average age of ARNPs in Washington was 47.7 years in 2018 and has been declining in the past 10 years as more younger ARNPs enter the workforce. Male ARNPs increased slightly to 15.3 percent in 2018 from 14.5 percent in 2016. About 6 percent of ARNPs have rural addresses compared with 8.3 percent of the state population.

Washington State Advanced Registered Nurse Practitioner Survey Data Report

WCN has published a new report on the Washington state Advanced Registered Nurse Practitioner (ARNP) workforce, which identifies and describes characteristics of previous and current Washington state ARNP practice owners and independent contractors and analyzes the ways in which reductions in reimbursement by Washington state health plans in 2013 and 2015 affected ARNP-owned practices and independent contractors.

The report was co-sponsored by Washington State University and the American Association of Nurse Practitioners and prepared by Louise Kaplan, PhD, ARNP, FNP-BC, FAANP, FAAN, Principal Investigator and Justin Gill, MS, ARNP, FNP-C, Yale University DNP Student, Co-Investigator. As part of a longitudinal study of ARNPs in Washington, this report was also published in 2001, 2003, 2006 and 2015.

The survey was sent to all 6,188 Washington ARNPs with valid contact information, and the report reflects responses from 1,235 ARNPs at a response rate of 20.7 percent.

Key findings from the 2018 ARNP Survey:

• ARNPs are predominately white (88%) females (86%) with an average age of 48 years.
• Almost all ARNPs (98%) have a graduate degree (master’s or doctorate).
• Family nurse practitioners represent the largest group (47.8%) of ARNPs.
• The top two locations of practice are a healthcare office/clinic owned by a health care system or organization (30.5%) or independent/privately owned practice (19.6%).
• Ten percent of ARNPs own a practice alone or with others.
• Less than half (41%) of respondents provide primary care while 15% work in rural areas.
• The average portion of time worked in providing direct patient care was 60%.
• Two-thirds (68%) were moderately or very satisfied with their current position.
• An average gross income for an ARNP who works full time is $128,529.
• Only one-third (33%) of respondents prescribe for patients with chronic non-cancer pain.
• The top two reasons prior practice owners and independent contractors closed their practice were reduced reimbursement (29%) and inability to compete with large health systems (20%).

The Washington State RN Survey

Expanding the Snapshots with a more complete picture of nurses in Washington state

In the past, available data on nurses has been minimal and inconsistent, contributing to confusing predictions about supply and demand of the nursing workforce. In March 2018, WCN and their research partners at the University of Washington Center for Health Workforce Studies conducted a pilot statewide RN sample survey using the Minimum Data Set (MDS), a set of questions developed by a national coalition committed to promoting having comparable data about the nurse workforce across the country. We asked nurses about:

• Employment status.
• Job setting, title and position (up to two jobs).
• Hours worked per week.
• Practice zip code.
• Basic demographic information, including educational attainment.
• Initial and current license information.
• Current credentials.

The Washington survey added questions to capture additional nurse characteristics to create a more accurate picture of the ability of Washington’s nursing workforce to meet the needs of our communities. The additional questions asked additional career satisfaction questions including:

• Salary.
• More-detailed information on hours worked and education history.
• Health care-related employment prior to becoming a nurse.

The goal of the survey was to strengthen understanding of Washington’s current registered nurse workforce and inform policymakers and educators about future needs. The information from this survey will be used to create a baseline profile of the state’s registered nurses that can be compared with findings from data collected through license renewals in the years to come.

A total of 9,214 nurses responded to the survey, with 7,607 employed as an RN in their primary job.

Survey highlights

• Overall, 62 percent of surveyed nurses have baccalaureate degrees or higher (70 percent when including non-nursing degrees).
• 76 percent of nurses in the 19–29 age group have a baccalaureate in nursing or higher.
• Washington’s RNs are quite satisfied with their jobs and roles, although some report feeling overwhelmed.
• RN median salaries in WA are higher than the U.S. as a whole ($70,000 in 2017) but vary by age, setting and educational attainment.
• The proportion of RNs who are white is higher than the proportion of white residents in the state as a whole.

The results of this survey will be a crucial step to getting the complete picture of the Washington RN workforce, as well as learning the best ways to support nurses in education, career advancement, and job satisfaction.

What all Washington state nurses need to know about the Nursing Commission Survey

A key recent change in the Washington State Nursing Care Quality Commission’s license renewal procedure has added a monumental — and exciting — shift to getting a clearer view of the workforce, how nurses are prepared to meet health care demands and what support is needed. Beginning Jan. 1, 2018, all nurses in Washington state were required to fill out the Nursing Commission’s Demographic Survey online at the time they renew their licenses. WCN will oversee the annual data analysis and publish findings, which will help inform policy recommendations on how to expand and improve nursing education programs and strengthen the nursing workforce to better serve our changing communities.

Measuring employer demand

WCN is regularly engaged in the Washington Health Workforce Sentinel Network, which links the health care sector with policymakers, workforce planners and educators to identify and respond to changing demand for healthcare workers, with a focus on identifying newly emerging skills and roles required by employers. The Sentinel Network is an initiative of Washington’s Health Workforce Council, conducted collaboratively by Washington’s Workforce Board and the University of Washington’s Center for Health Workforce Studies. According to the Sentinel Network’s recent findings for RNs (July 2016 to September 2018), RNs are the top occupation with exceptionally long vacancies recently reported by small (25 beds or fewer) acute care hospitals as well as skilled nursing facilities.

• RNs are also among occupations with long vacancies in:
• Federally Qualified Health Centers/community clinics.
• Behavioral health/mental health clinics.
• Psychiatric/substance abuse hospital.
• Large acute care hospitals.
• Schools.
• Specialty medical clinics.

How do we ensure Washington state can produce enough nurses to take care of all patients?

Washington state needs more nurses, yet we are experiencing a dire nursing faculty shortage, which means qualified students are being turned away from programs due to lack of space, not all students have access to practice experiences due to high competition for spots and funding for nursing education fails to keep pace. All of these factors provide a clog in the production of a highly qualified nursing workforce needed by our communities. Coupled with these issues is a national call to advance nursing education to increase access to and support success at baccalaureate and graduate levels.

As WCN engages in workforce development issues at the state and national level, a key area of focus is Action Now!, which is the statewide coalition to strengthen the nursing education system to meet the increasing demand for nursing services. The effort is co-led by WCN, the Council on Nursing Education in Washington State and the Nursing Care Quality Assurance Commission. We launched Action Now! because we understand the critical link between nursing education, the nursing workforce and the health of the people of Washington state. Our vision statement is: “Nursing Education: Securing the Future of a Healthier Washington.”

In November, we produced the Action Now! Solution Summit, a culmination of two years of our collaborative work among stakeholders from higher education, health care practice, workforce development, policy and the business community to transform the state’s nursing education system, securing the future of a healthier Washington. With an inspiring keynote address on innovation from renowned futurist Pablos Holman, the message was clear: we need to transform the system from within. We heard some fascinating ideas from our attendees. More importantly, we got commitment from them to do some of the heavy lifting — a few organizations have stepped up to participate in a pilot simulation project, others have offered valuable resources as we proceed. This work is complex but it is all the more important to continue and persevere.

Are you interested in joining our efforts? Send us an email at ActionNow@wcnursing.org.