By Debra Wood, RN, contributor
California nurses are growing older and more frequently return to school for additional education and certification than in years past, but the state still does not educate enough of its own nurses, according to a recent survey completed for the California Board of Registered Nursing.
“It’s fairly startling to see some of the figures,” said Susan Brank, assistant executive officer with the California Board of Registered Nursing. “California has an aging, middle-aged nursing workforce, with over three-fourths of the state’s RNs age 40 or older and almost half age 50 and older. That’s of great concern.”
The 2004 survey, conducted at California State University, Chico, collected data from 5,168 randomly selected registered nurses currently licensed in the state and 1,018 nurses whose license became inactive during the past two years. Investigators compared current information to surveys conducted for the Board in 1990, 1993 and 1997.
The nursing workforce’s average age is 47.7, with nurses entering the profession later in life. The average age of first time licensure increased to 30.9 years in 2004 from 28.7 years in 1990.
The number of nurses educated in the state remained steady from 1997 to 2004, at 55 percent. About 27 percent of California nurses receive their training in other states and 18 percent in foreign countries.
“It appears what we are dealing with is a shortage of nursing education,” Brank said. “We have an ample number of applicants who wish to go to school but not enough slots to accept them. To address future needs, we will need to come up with creative and innovative ways to expand existing schools and to facilitate opening additional schools.”
More than a quarter of California nurses educated in a diploma program returned to school for a degree, and 18.7 percent of nurses entering the profession with an associate degree went on to obtain a bachelor’s or master’s degree. In addition, a greater proportion of nurses entering the field held a college degree before starting nursing school, 44 percent compared to 30.3 percent in 1990.
This year’s survey found about one-third of the state’s registered nurses had received one or more additional certifications from the Board, doubling from 16.4 percent in 1993 and an increase from 21 percent in 1997. Another 13.7 percent of respondents said they planed to obtain certification.
More than 95 percent of responding nurses said that direct patient care represented a primary or a secondary function of their job. About 61 percent work in acute, hospital settings, up slightly from 60.2 percent in 1997. The number of nurses employed in ambulatory care decreased 33 percent, from 11.8 percent in 1990 to 7.8 percent in 2004. However, more than half of nurse practitioners work in ambulatory settings.
Time worked remained stable at 36 hours per week, but eight-hour shifts have vanished, a dramatic change from 1997 when 45 percent of the nurses reported working eight-hour days. The average length of a shift is now 10.4 hours.
Three-fourths of nurses said they do not work mandatory overtime and 13 percent work fewer than five hours per week of mandatory overtime. Nurses in management roles tended to work more hours than staff nurses.
Most active nurses, 56.7 percent, planned to continue working a similar number of hours during the next five years, up from 46.1 percent in 1990. About 22 percent expect to cut back their hours, and 7 percent will increase the amount of time they work. Another 3.4 percent plan to leave nursing and 10.6 percent expect to retire.
The number of nurses working for temporary and travel nursing companies increased, from 5.2 percent in 1990 to 8 percent in 2004. The increase in agency nurses came as no surprise to Brant who said, “We’ve been inundated with a great volume of applicants for temporary licenses, many of them coming directly to the office.”
More than two thirds of these nurses said they work for an agency because of the wages, more than half due so to control their schedule and work location. Critical care and emergency departments topped the areas of the hospital where most agency nurses are assigned.
More nurses of Asian or Pacific Island decent have joined the California nursing workforce, a 72.4 percent increase from 1990.
“Even though the ethnic diversity improved, it still is not a reflection of our total population,” Brant said. “Diversity still needs to be a high goal.”
For the first time, the Board surveyed nurses with inactive licenses and those not working in the profession and found it could likely only entice a small percentage back into nursing positions.
About two-thirds of nurses with inactive licenses said they definitely would not return to nursing, and 47 percent said, “Nothing would change my mind.” Among nurses with active licenses, not practicing in the field, 34.7 percent said they definitely would not return to the profession, and 25.3 percent said nothing would change their minds.
The Board plans to make the survey data available to policymakers, employers and nursing organizations to help them plan programs to ease the nursing shortage. It has commissioned an additional study to compare California nursing workforce patterns with the rest of the country and to project future needs and number of nurses per capita.
It has worked closely with the California Institute for Nursing and Health Care to help come up with solutions to combat the nursing shortage, access grants and increase the number of nursing students who can receive training in California.
“Our primary mission has to do with protecting the consumer by making sure nurses entering the workforce are safe to practice, but as an additional goal, we believe quality patient care depends on quality nursing care,” Brant said. “Along with that you have to have a sufficient number of nurses.”
© 2004. AMN Healthcare, Inc. All Rights Reserved.