Projected Supply of RNs

Funded by BlueCross BlueShield of Tennessee

Nursing Supply Projections
Introduction and Executive Summary

This report was prepared for the Tennessee Healthcare Consortium on Nursing. The report shows the supply of Registered Nurses in Tennessee in a variety of practice areas. Nursing supply is forecasted for the years 1999 – 2020.

The base model used was the Nursing Supply Model and Computer Program SPLMDL96, produced by the Division of Nursing, Bureau of Health Professions, Health Resources and Services Administration, U.S. Dept. of Health and Human Services. 1 The model used 1995 data to predict the supply of Registered nurses from 1996-2020. In this study, the data was updated using the most recent data sources to result in the most accurate supply forecast possible for the period 2000-2020.

The model predicts the RN population, RN supply, and FTE RN supply for the future years. The RN population is expected to increase from 55,756 in 2000 to 67,254 in 2020 (21%). The RN supply is expected to increase from 49,583 to 55,975 (13%). The FTE supply is expected to increase from 44,988 to 50,937 (13%). Table 1 shows the year by year increase, tables 2-4 show the data by age group for 2000,2005, 2010, 2015, and 2020. Tables 5-67 show detail information by age and educational preparation for each year of the projection.

One shortcoming in the model is that it cannot take into account influences that may play a part in inducing more, or less, of the population to go into nursing. These influences include salary considerations, recruiting programs, and general economic trends. A second problem was encountered entering updated population projections, explained later, which may have caused a slightly conservative estimate.

Overall, this forecast, which uses an accepted forecasting model and the most recent valid data available, provides a well grounded, realistic estimation of the number of registered nurses that will be available in Tennessee over the next two decades.

Methodology

Nursing Supply Model and Computer Program SPLMDL96 (SPLMDL96)

Development of this model began in the 1970’s; data and forecasts using various versions of the model began in 1982. The model uses the National Sample Survey of Registered Nurses and population estimates as its input for forecasting the future supply of RNs.

The model is available as a PC based computer program, along with the layout for all the input files that are available for editing. The program is delivered with 1995 data from the National Sample Survey of Registered Nurses and population forecasts. Although not user friendly, the data can be updated with more current data and new RN supply models can be run.

SPLMDL96 Analytical Procedure

The model uses a base year of nursing data to predict RN populations through future years. General population projections for the period studied are a second source of data. Other calculations and projections developed independently are also used in the forecast (mortality rates, licensing rates). Complete details of the analytical model are available in the manual accompanying the software.

The model produces three projections for the RN population. The manual defines these projections as:

1. State Nurse population; i.e., all registered nurses having a current license to practice somewhere in the United States and who are employed in the state or, if not employed in nursing, reside in the state;

2. State Nurse Supply; i.e., the part of the state nurse population which is employed in nursing or available for employment in nursing; and

3. State full-time equivalent supply, i.e., the state nurse supply on the basis of its relationship to the full-time employment.

SPLMDL96 Input files

The purpose of this project was to modify the model with the latest data available to update the projections of the RN supply. The model purported to be amenable to modification; however, the layout of the data files made this a difficult, but not impossible, proposition. Two datasets could be modified within the model- RN population and the general population projections.

RN Population

The RN population in the original model used the National Sample Survey of Registered Nurses, 1996, to estimate the number of RNs in each state in each age group. There were seventy overlapping age groups with three nursing degree groups within each age group (AD/Diploma, baccalaureate, and master’s and above).

March 2001 data from the RN license file was used to update the data. The license file was imported into a database and queries and calculations were used to process the data into the 210 aggregate groups needed for the model.

The model read the 2001 RN licensure file data as though it were baseline 1999 data. Although this probably resulted in a slight overstatement of the supply of RNs throughout the years, it was necessary because the same 2001 data was used for the Nursing demand model that also used 1999 as the baseline year. 2

General Population

The model used population estimates from the year 1995 through 2020. These files were updated with current U.S. census projections from the same period.

The data layout was 1300 rows of data, with year one of data for each state, D.C. and the U.S. in rows 1-52, unmarked and in alphabetical order, then the same order for year 2 in rows 53-104, and so on. Although this made for difficult modification of the data, the new information was entered.

The model’s manual was unclear as to how the population data would be treated when a new base year (1999) was used. Population data was entered for the years 1995- 2020. It was assumed that the model would account for the difference between the base year and the population year. If the model does not account for the difference, then the projections are underestimated.

Other data files

Other data files were used in the analysis. These included migration rates, predicting movement between states, mortality rates, and licensing rates (the number of newly licensed nurses projected). These data files were not changed.

Two additional data files which projected the number of basic and advanced graduates from nursing programs were based on past graduation data (pre 1996) and were not updated. These files were not updated for two reasons- historical data was only available for 5 years (1996-2000) at the time of this project. More importantly, the model did not explain the method used to project graduation rates within the dataset. Future use of this model should note the value of updating the projected graduation dates for a more accurate supply forecasts.

Results

Table 1 shows the overall results of the study for total RNs. Figure 1 shows this data graphically. Although the population of RNs grows rapidly and steadily, the supply and FTE supply do not keep pace. The reason for this may be the aging of the RN population. RNs by age are shown in tables 2-4 and Figures 2-11.

The data show that population, supply, and FTE supply parallel and are close for the under thirty age groups. After age thirty, the gap between the population, supply, and FTE supply grows. At the age of sixty and above the gap between the population and the other groups expands dramatically, reflecting that fact that nurses drop out of the workforce as they grow older.

Tables 5-67 detail the results by age group and educational status for each year. One anomaly should be noted. In the age groups starting with 65-69, RN supply and FTE RN supply increase in some categories and age groups and not in others. For example, the baccalaureate RN supply in the 65-69 age group is 0 for all years, while the baccalaureate RN supply in the 70-74 age group increases from year to year. This anomaly was also present in the model using the original data before updating. It is probably due to an activity rate variable supplied by the model.

Beginning in 2005, the aging of the nursing population is seen. More nurses move into the fifty and older age group. This trend continues in 2010 with more nurses moving into the sixty and older age groups. Overall, the RN population and workforce is shown to be aging over the next two decades.

Table 1. RN population, 2000-2020

Table 2. RN population by age group, 2000-2020

Table 3. RN supply by age group, 2000-2020

Table 4. RN FTE supply by age group, 2000-2020

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