Better-educated RNs filling a need

The registered nursing workforce is growing and getting better educated, with more RNs pursuing advanced degrees, according to the latest numbers from the Health Resources and Services Administration. And that's exactly what the Institute of Medicine and many hospital systems want to see.

Over a 10-year period, the number of RNs holding a bachelor's or higher degree has increased to 55% in 2010 from 50% in 2000, according to the HRSA nursing workforce report. That means of the 2.8 million RNs in the workforce—as estimated by HRSA—more than 1.5 million have at least a four-year degree. The rest have two-year associate degrees.

The RN workforce has grown by 24.1% since 2000, increasing by nearly 550,000. HRSA concluded that “growth in the nursing workforce outpaced growth in the U.S. population,” citing the number of RNs per 100,000 population increased about 14% from 2000 to 2010. But leaders of nursing organizations warned that growth is barely keeping up with the rising demand for nurses, which is expected to continue because of healthcare reform and baby boomer retirements.

“We will have to continue to see this very bold production of new nurses, and we may need to increase production with specific targets in mind,” said Geraldine “Polly” Bednash, CEO of the American Association of Colleges of Nursing.

A larger and better-educated workforce is good news for a healthcare world that's demanding higher performance out of nurses, said Peter Buerhaus, a professor of nursing at Vanderbilt University in Nashville. The findings are in line with IOM's 2010 recommendations that 80% of nurses hold a baccalaureate degree by 2020. Buerhaus isn't sure if the workforce will hit the IOM's suggested target in seven years, but the HRSA data show Buerhaus the promise of progress.

The annual pay for full-time nurses has increased by 45.6% since 2000, growing from $43,906 to $63,944 in 2010, according to HRSA data.

Healthcare reform, and pressure for higher quality and efficiency, is also driving the trend toward better-educated nurses. Multiple studies have tied nurses with advanced degrees to lower patient mortality rates, fewer medication errors and better outcomes.

“Hospitals are more interested now in a nursing workforce that will decrease those risks of mortality, therefore they're more interested in baccalaureates,” Buerhaus said.

The influx of nurses under age 30 entering the profession is also speeding the trend toward more schooling. Younger nurses understand that investing in a four-year degree will help their careers. The number of RNs under 30 jumped to about 420,000 in 2010 from 325,000 in 2000, even though the average age of RNs rose to 44.6 in 2010, from 42.7 in 2000.

An influx of younger nurses is needed as older nurses retire. The report called the number of RNs reaching retirement a concern. About 1 million RNs older than 50—about a third of the workforce—will reach retirement age over the next 10 to 15 years.

“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,” according to the report. “The retirement decisions of this older cohort, which may be influenced by the pace of economic recovery, will affect the nursing workforce going forward.”

Bednash is particularly interested in the increased number of RNs with associate degrees who enrolled in bachelor's programs. That number grew by 86% over four years, jumping from 14,946 in 2007 to 27,485 in 2011. Despite lower pay, two-year programs are still attractive as they churn out licensed nurses in a shorter period of time to meet workforce demands.

Even if associate-degree holders don't pursue a bachelor's degree, they will still find work at long-term care facilities and have other opportunities, Bednash said.

There's also pressure for better-educated nurses from policymakers. Some state legislators have drafted bills mandating four-year degrees from nurses.

Last year, a bill in New York that would require all RNs to earn a bachelor's degree within 10 years failed. Bednash said there's still a possibility that the legislation could be resurrected. However, lawmakers supporting such measures would be hard pressed to find support from the HRSA numbers.

“I think it's the market, rather than the legislature, that's taking care of this issue,” Bednash said.

HRSA's data are a bit dated, coming from 2010. The numbers might not reflect changes made in anticipation of healthcare reform, said Peter McMenamin, a senior fellow at the American Nurses Association. As the industry braces for reform, having up-to-date information is invaluable.

“We need the information to be able to tell the story of nurses,” McMenamin said. “The more information we have, the more visible nurses become and then they won't be forgotten.”

Follow Ashok Selvam on Twitter: @MH_aselvam