Funded by BlueCross BlueShield of Tennessee
Analysis of Nurse Staffing in Tennessee
Introduction and Summary
There are four individual reports included in this study. These reports were prepared for the Tennessee Healthcare Consortium on Nursing. The reports look at the current and future demand for and supply of nurses in Tennessee, specifically focusing on registered nurses. The results show that currently and for the immediate future, overall supply and demand are very close to each other. In some geographic areas, and some practice locations, there are shortages of RNs. Tennessee has a current and future demand for more registered nurses to serve its population.
The main focus of these reports is to show the data available to determine whether, and to what extent there is or will be a nursing shortage. Accordingly, many tables and charts are presented throughout the reports, and the methodology of collecting or updating the data is explained. Some preliminary analysis of the data is presented, but no extensive conclusions are drawn.
The four reports included in this study are:
1. Nursing Supply Model and Computer Program SPLMDL96- This is a computer based modeling program used to predict future RN supplies. The data in the model was updated using current data for Tennessee to give updated projections.
2. Nurse Demand Based Requirements Forecasting Model – Also a computer based modeling program which is used to predict future RN demand. The data in the model was updated using current data for Tennessee to give updated projections.
3. Tennessee Nursing Data and Projections- Tennessee data, both current and longitudinal, was analyzed. The report shows the current state of nursing in Tennessee, with projections into the future in some areas.
4. THCN Nurse Staffing Survey- The results and a database from a survey administered by THA to Tennessee hospitals in May/June, 2001.
Nursing Supply and Demand
As table 1 shows, over the short term overall RN supply slightly exceeds demand. Over the long term, overall demand exceeds supply by a large margin. The RN FTE Supply column is from the Nursing Supply Model and Computer Program SPLMDL 96. This model was updated with current data and is presented in more detail in the reports section. The RN Patient Care FTE demand column is from the Nurse Demand Based Requirements Forecasting Model, also updated with new data and presented later in detail. Note that the model only predicts demand for patient care nurses. Nurses employed in insurance and other non-patient care areas are excluded.
The next column shows the percent of nurses from the Tennessee RN license file (March, 2001) that were not employed in patient care areas. This percentage is assumed to stay constant throughout the entire study period, although it may in fact be increasing. The total FTE demand represents the number of RNs needed including a projection of non-patient care nurses.
The last two columns show the difference and percent difference in supply and demand. Supply exceeds demand through 2007. However, the difference is very small. Although it is beyond the scope of this study to determine the level at which a shortage in nursing should be declared, the percent difference in supply and demand is less than the normal unemployment rate for the general economy (4 ½ % to 5 ½%).
Table 1. Supply and Demand for RNs, 2000-2020
Year |
RN FTE Supply |
RN Patient Care FTE Demand |
Percent not In Patient Care* |
Total FTE Demand |
Excess of Demand over Supply |
Percent Difference |
2000 |
44,988 |
33,895 |
24% |
44,599 |
(389) |
-0.87% |
2001 |
46,095 |
34,434 |
24% |
45,308 |
(787) |
-1.71% |
2002 |
46,924 |
34,943 |
24% |
45,978 |
(946) |
-2.02% |
2003 |
47,732 |
35,450 |
24% |
46,645 |
(1,087) |
-2.28% |
2004 |
48,390 |
35,954 |
24% |
47,308 |
(1,082) |
-2.24% |
2005 |
48,964 |
36,468 |
24% |
47,984 |
(980) |
-2.00% |
2006 |
49,612 |
37,164 |
24% |
48,900 |
(712) |
-1.44% |
2007 |
50,218 |
37,870 |
24% |
49,829 |
(389) |
.77% |
2008 |
50,637 |
38,629 |
24% |
50,828 |
191 |
.38% |
2009 |
50,978 |
39,319 |
24% |
51,736 |
758 |
1.49% |
2010 |
51,126 |
39,974 |
24% |
52,597 |
1,471 |
2.88% |
2011 |
51,321 |
40,490 |
24% |
53,276 |
1,955 |
3.81% |
2012 |
51,285 |
41,177 |
24% |
54,180 |
2,895 |
5.65% |
2013 |
51,300 |
41,735 |
24% |
54,914 |
3,614 |
7.05% |
2014 |
51,267 |
42,301 |
24% |
55,659 |
4,392 |
8.57% |
2015 |
51,288 |
42,888 |
24% |
56,432 |
5,144 |
10.03% |
2016 |
51,270 |
43,459 |
24% |
57,183 |
5,913 |
11.53% |
2017 |
51,077 |
44,047 |
24% |
57,957 |
6,880 |
13.47% |
2018 |
51,008 |
44,618 |
24% |
58,708 |
7,700 |
15.10% |
2019 |
51,006 |
45,248 |
24% |
59,537 |
8,531 |
16.73% |
2020 |
51,937 |
45,928 |
24% |
60,432 |
9,495 |
18.64% |
*This percentage is based on the percent of active nurses not working in direct patient care from the March, 2001 RN licensure file.
Beginning in 2008, and throughout the rest of the period studied, nursing demand outpaces supply. Increases in population and changes in utilization account for some of the difference. However, the bulk of the difference may be due to the aging of the RN workforce. As registered nurses age and drop out of the workforce, they are not being replaced. The nursing supply report details the shift in age and RN FTE supply.
Overall, the supply and demand models, using updated data, show that supply and demand are currently very close. Over the long term, demand will exceed supply. This gap becomes greater each year beginning in 2008, and a total shortage of over nine thousand RNs is predicted by 2020. More study of the problem and exploration of potential solutions are needed.
Tennessee Nursing Data, Projections, and THCN Survey
Historical and current data, as well as future projections were analyzed for this report. Most of the focus was on the hospital setting, where over fifty-eight percent of full time equivalent registered nurses are employed. The Tennessee RN license file, as well as the Tennessee LPN license file, were also used to summarize the demographic and practice of Tennessee nurses. The THA/TSHHRA Joint Annual Salary Survey was used to compare salaries across the state for nurses. The Tennessee Job Outlook, 1998-2008 was reviewed to compare future nursing demand to other employment sectors. Preliminary findings from the National Sample Survey of Registered Nurses, 2000 and the American Hospital Association Special Workforce Survey were also analyzed for the national perspective. A survey of Tennessee Hospitals was also administered by THA for THCN.
The data show that there is a perceived shortage of nurses in Tennessee and nationwide. In Tennessee hospitals, data from the Joint Annual Report of Hospitals show that FTE Vacancy rates have averaged a little over seven percent from 1991-1999. The Memphis Metropolitan Statistical Area (MSA) has seen the highest vacancy rates in the past few years, with twelve percent in 1998 and fifteen percent in 1999. These rates are shown in Table 2.
Table 2. RN Vacancy Rates By MSA, 1991-1999
| MSA |
1991 |
1992 |
1993 |
1994 |
1995 |
1996 |
1997 |
1998 |
1999 |
| Rural Areas |
12 % |
12% |
9% |
2% |
2% |
1% |
1% |
3% |
2% |
| Chattanooga |
20% |
8% |
6% |
7% |
9% |
6% |
9% |
3% |
9% |
| Clarksville- Hopkinsville |
21% |
12% |
15% |
13% |
1% |
0% |
0% |
2% |
0% |
| Jackson |
8% |
5% |
7% |
4% |
3% |
5% |
7% |
6% |
8% |
| Knoxville |
5% |
4% |
2% |
1% |
2% |
2% |
3% |
2% |
2% |
| Memphis |
10% |
10% |
10% |
7% |
8% |
11% |
9% |
12% |
15% |
| Nashville |
8% |
7% |
6% |
10% |
7% |
8% |
10% |
5% |
8% |
| Tri-Cities |
4% |
9% |
4% |
2% |
2% |
4% |
4% |
1% |
3% |
| Statewide |
10% |
8% |
7% |
6% |
6% |
6% |
7% |
5% |
8% |
The Tennessee RN license file and population data for 2001 show that the number of RNs per thousand persons in the Memphis MSA was the lowest around the state among the metropolitan statistical areas. Because of the concentration of healthcare services in MSA areas, all of the MSA ratios exceed the rural ratio. Average salaries for nurses in the MSA from the THA/TSHHRA Joint Annual Salary Survey were also reviewed. Memphis also paid one of the lower salaries in the state. This data is presented in Table 3.
Table 3. RNs per 1,000 Population and Salary for General Duty RNs
MSA |
Vacancy Rate, 1999 |
RNs per 1000 Population |
2001 Average Wage General Duty RN |
Rural Areas |
2% |
5.3 |
$ 17.57 |
Chattanooga |
9% |
13.7 |
$ 17.88 |
Jackson |
8% |
15.8 |
$17.38 |
Knoxville |
2% |
10.5 |
$ 18.72 |
Memphis |
15% |
10.2 |
$ 17.42 |
Nashville |
8% |
11.6 |
$ 20.79 |
Tri-Cities |
3% |
10.2 |
$ 18.77 |
Statewide |
8% |
9.2 |
$ 18.50 |
The Tennessee Job Outlook, Hospital Joint Annual Report (HJAR) Nursing Supplement, and THCN Nurse Staffing Survey show that demand for nurses in Tennessee will increase. The Job Outlook predicts that there will be at least 1,564 openings for registered nurse each year through 1998. 55% of respondents to the THCN Nursing survey indicated that they anticipate the number of RN positions increasing over the next two years (through 2003). The HJAR supplement showed that Tennessee hospitals planned on increasing RN positions by 7% over 1999.
The National Sample Survey of Registered Nurses (Special County File) was obtained for use in the study. This file differed from the regular survey file in two areas. First, it included the practice county and county of residence for the respondent. Second, almost half of the respondents were removed from the file to ensure that no respondent could be identified. After the data was loaded and analyzed, it was determined that the small sample size- 437 Tennessee nurses for the special county file, made the file unusable. For example, using the sample at the county level showed that Obion county nurses earned an average of $100,000 per year. 1
Therefore, data from this survey was not presented in any of the reports.
The above data analyses and reviews are presented in detail in the following reports. Overall, they show a problem with the supply of nurses in Tennessee that should be addressed with further study and action.
1 The manual accompanying the software suggested that data be grouped by similar geographical areas on a national level to create the requisite sample size that would result in accurate projections |
