REPORT: February 2003
New York State Nurses Association (NYSNA)
New Study Provides a "snapshot" of New York State's Nurse Workforce
A new analysis of New York state data confirms a worsening shortage of RNs and suggests possible remedies, including the recruitment of more minority nurses. It shows how the nursing shortage has reached crisis proportions in every region of the state, indicates where it is worst, and suggests possible solutions.
The analysis was done by NYSNA member Carol Brewer, associate professor of nursing at the University at Buffalo, and her colleagues, Timothy Servoss and Thomas Feely. The researchers say that, while shortages have come in cycles for the past 40 years, the current one is made worse by several factors, including declining nursing-student enrollments and the aging of the RN workforce.
"With fewer people entering the profession and expectations that RNs will [work less] as they enter their 50s, experts predict a steeper downward trend in the nursing workforce," the report says. "This is a demographic, structural shift in the population of potential and active nurses."
The report provides grim details: New York state has a current vacancy rate of 11% in RN positions, which is expected to rise to 23.6% by 2020. In 2000, there were 843 RNs per 100,000 population in the state, while in 1996 there were 911. And in 2000, 81.1% of RNs in the state were working in nursing, while in 1996, 84.8% were.
Brewer's team analyzed four regions: Western (Buffalo- and Rochester-area counties); Central (Syracuse- and Utica-areas and northern counties); Eastern (the Albany, eastern Adirondack, Catskill, and Hudson Valley areas); and Metro (the five boroughs of New York City, plus Westchester and Long Island).
Many of the findings are dramatic, although some may be unsurprising to NYSNA members and other readers of Report
. Some offer tantalizing hints at strategies for solving the nursing shortage in our state.
**Job Satisfaction, Age, Gender, and Employment Setting**
The researchers found that RNs in New York state are more likely to be moderately or extremely dissatisfied with their jobs than are nurses nationwide (22.6% to 19.5%). The proportion of "extremely dissatisfied" RNs rises with each older age group and dissatisfaction peaks with the 50-59-year-old age group. That adds even greater significance to another statistic: the average age of a New York state RN is 45.8 years old, up from 44.5 in 1996.
The researchers said: "Nurses in all age groups need to be enticed back into work, but strategies focused on the older nurse should be the focus of employers wanting to keep RNs in their workforce longer."
The report shows a clear reduction in workforce participation of New York state RNs from 1996 to 2000 across all age groups. And only 55.2% of state RNs now work in hospitals, compared to 59.1% in 1996. In fact, in three of the four regions of the state, most
working nurses do not
work in hospitals. Only in the Metro region do hospital-based nurses make up most (61.1%) of the RN workforce. The Western region has the lowest proportion of RNs working in hospitals, 45.4%. Other popular settings include nursing homes; occupational, public, and student health care; ambulatory care; and nursing education.
Also, the report found, "consistent with concerns that delivering patient care is stressful and difficult, RNs who provide direct patient care...are significantly less satisfied than those who do not." The three most-often-cited reasons for leaving nursing are: a more rewarding new job; more convenient hours; and a better salary. (Click here to view Table 2)
The average income for fulltime RNs is just over $53,000 per year, but that is skewed upward by the much higher average for RNs working in the New York Metro region-$61,510. For the Eastern, Central, and Western regions, the average income for RNs is $41,000-$46,000. "Income in the Metro region is clearly affected by the higher cost of living," the report states. Average fulltime-RN income rose by 15.3% compared with the 1996 average of $46,119.
Minority Nurses Underrepresented
The proportion of minority nurses, the researchers found, is relatively large, at 19.8%, compared with other states. However, the 2000 U.S. Census Bureau estimates that the New York state "non-white" population is 29.9%. Minority nurses are mostly concentrated in the New York Metro region. (Click here to view Table 1)
Even there, their percentage is smaller than the 42.2% minority population of that region. The report presents two additional intriguing facts: minority RNs are more likely to be working than their caucasian colleagues, and minority nurses, especially Asian nurses, are more likely to be educated in baccalaureate programs.
One group that is greatly underrepresented in the profession is males. They still make up only 5% of the nursing workforce in the state. In the Metro region, males and female RNs are equally likely to be working, while in the Central and Western regions, males are more likely to be employed. In the Eastern area, however, which has the lowest employment rate for both male and female nurses, men are more likely to be unemployed.
Concluding that "minority nurses are still underrepresented" and that "concerted effort is still needed to attract minorities into nursing," the report proposes some solutions:
* Identifying and publicizing successful models for getting more minority nurses into and through the educational pipeline;
* Developing minority faculty role models; and
* Developing minority nursing leadership.
The report offers some recommendations to alleviate the shortage that is threatening the future of the profession and the health of communities in all regions of New York state. These include:
* retention of experienced nurses through improved working conditions;
* expansion of programs to provide child care, elder care, flexible work environments and hours, and other benefits designed to draw back RNs who have left the field;
* creation of councils or forums in each region to prioritize and work on local solutions;
* legislation (such as tuition breaks and scholarships
tied to service in New York state) designed to recruit minorities into nursing, and to increase funding of Medicaid, Medicare, or other programs that affect employers' ability to raise wages; and
* long-term image promotions in the media, focusing on the positive aspects of nursing.
The 33-page report was derived from a nationwide sample survey in 2000. The number of nurses responding from New York state was 1,928, which constituted a representative sample, according to Brewer's team. Regional analyses, however, based on much smaller numbers of respondents, "should be interpreted with an appropriate level of caution," the authors note.
"Examining New York State Nurses" was produced for the New York State Area Health Education Center (AHEC) System, a nonprofit organization whose mission is to enhance the quality of health care in the state. The report is available online at www.ahec.buffalo.edu.
Hard copies may be obtained by e-mailing Andrea Nikischer at email@example.com
or by writing to the NYS AHEC System at 462 Grider St., Buffalo, NY 14215.