Supply of Nurses in Utah the 2020 Survey of Utah’S Registered Nurses & Licensed Practical Nurses Utah Medical Education Council

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Supply of Nurses in Utah The 2020 Survey of Utah’s Registered Nurses & Licensed Practical Nurses Utah Medical Education Council

SUPPLY OF NURSES IN UTAH

2 | Supply of Nurses in Utah: The 2020 Survey of Utah’s Registered Nurses and Licensed Practical Nurses

SUPPLY OF NURSES IN UTAH

Supply of Nurses in Utah: The 2020 Survey of Utah’s Registered Nurses and Licensed Practical Nurses

The Utah Medical Education Council State of Utah https://umec-nursing.utah.gov 2020

Prepared by: Victoria Gonce, BS Clark Ruttinger, MPA, MBA

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Supply of Nurses in Utah: The 2020 Survey of Utah’s Registered Nurses and Licensed Practical Nurses

Printed in the United States of America.

Internet Address: https://umec-nursing.utah.gov

This publication cannot be reproduced or distributed without permission. Please contact the UMEC at [email protected] or call (801) 526-4550 for permission to do so.

Suggested Citation:

Utah Medical Education Council (2020). Supply of Nurses in Utah: The 2020 Survey Utah’s Registered Nurses. Salt Lake City, UT.

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THE UTAH MEDICAL EDUCATION COUNCIL

The Utah Medical Education Council (UMEC) was created in 1997 out of a need to secure and stabilize the state’s supply of healthcare clinicians. The enabling legislation authorized the UMEC to conduct ongoing healthcare workforce analyses and to assess Utah’s training capacity and graduate medical education (GME) financing policies. The UMEC is presided over by an eight-member board appointed by the Governor to bridge the gap between public/private healthcare workforce and education interests.

Core Responsibilities – Healthcare Workforce

• Assess supply and demand. • Advise and develop policy. • Seek and disburse Graduate Medical Education (GME) funds. • Facilitate training in rural locations.

UMEC’s Current Board Members

CHAIR C. Gregory Elliott, MD Wayne M. Samuelson, MD Intermountain Healthcare Vice Dean, School of Medicine University of Utah Sue Wilkey, DNP, RN Public Member John Berneike, MD Director Mary Williams, PhD, RN Family Practice Residency Program Public Member Utah Health Care Institute Gar Elison Public Member Amy Khan, MD Executive Medical Director Regence BlueCross BlueShield of Utah

Douglas D. Gray, MD School of Medicine University of Utah

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ACKNOWLEDGEMENTS

The Utah Medical Education Council (UMEC) is proud to present the second comprehensive statewide report on Utah’s nursing workforce focused on describing the supply of registered nurses and licensed practical nurses across various work settings in Utah. This study on the supply of nurses is based on a survey disseminated in 2019 by the UMEC. The report below is the product of collaboration with thousands of nurses licensed within the state who responded to the survey. The UMEC would like to extend a special thanks to the following individuals for their participation on this year’s Nursing Advisory Committee and their considerable contributions to this report:

Lawrence Marsco, MSN, RN, OCN Sheryl Steadman, PhD, MSN, RN Sr. Nursing Director, Huntsman Cancer Dean Hospital Inpatient Services (Interim) School of Nursing & Health Sciences Director of Clinical Operations Westminster College

Teresa Garrett, DNP, RN, PHNA-BC Sharon Dingman, DNP, MS, RN Assistant Professor, University of Utah President, Utah Nurses Association College of Nursing Healthcare Consultant/Patient Co-Lead, Utah Action Coalition Satisfaction Outcomes & Founder of The Caring Model® (TCM) Stephen Weaver, MS, RN-BC LLC Informatics Nurse Specialist and Research Nurse Study Coordinator, Susan Thornock, EdD, MS, RN Office of Research and Development, Endowed Chair, School of Nursing Department of Veteran Affairs Dumke College of Health Professions Weber State University Joan Gallegos, MSW, RN Executive Director Selena Young, MBA, BSN, RN CASC Comagine Health Utah Sr. Nursing Director, Perioperative Services/Ambulatory Surgery Jen Wagenaar, MBA, RN, CPHQ, University of Utah Hospital and Clinics FACHE, CENP Chief Nursing Executive Sally Cantwell HCA- Mountain Division Chair, School of Nursing Dumke College of Health Professions Weber State University

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ADDITIONAL RESOURCES

HEALTHCARE WORKFORCE REPORTS

Since its establishment, the UMEC has completed multiple reports on different healthcare workforces within Utah, including:

• Advanced Practice Nurses (CNM, • Podiatrists CNS, CRNA, NP) • Physicians • Dentists • Physician Assistants • Medical Technologists • Radiology Technologists • Mental Health Professionals • Registered Nurses • Pharmacists For access to any of these reports, please refer to our website at: https://umec.utah.gov

NURSING JOB OPPORTUNITIES IN UTAH

The UMEC conducts annual job fairs for Physicians and Advanced Practitioners (PAs and APRNs including CNAs, CNMs, CRNAs, and NPs) attending training programs and/or practicing in the state of Utah. These job fairs are free of cost for attendees and are geared towards promoting retention of Utah-trained workforce in Utah. Major healthcare employers in the state are invited to recruit at these fairs. As a part of its rural workforce initiative, the UMEC encourages rural and frontier hospitals, clinics, and practices to participate in these job fairs by discounting their participation fees.

In addition, the UMEC also hosts a job board on its website. For a listing of available nursing jobs, please access our website at: https://umec.utah.gov/umec-job-board

TABLE OF CONTENTS

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The Utah Medical Education Council ...... 5 Acknowledgements ...... 6 Additional Resources ...... 7 List of Figures ...... 9 List of Tables ...... 11 Acronyms & Abbreviations ...... 13 Executive Summary ...... 14 Utah RN Profile ...... 14 Utah LPN Profile ...... 14 Utah’s Registered Nurse & Licensed Practical Nurse Workforce, 2020 ...... 15 Introduction & Overview ...... 15 Methodology ...... 15 Background ...... 18 Registered Nurse Report Findings ...... 20 Workforce Characteristics ...... 20 Practice Characteristics ...... 31 Licensed Practical Nurse Report Findings ...... 43 Workforce Characteristics ...... 43 Practice Characteristics ...... 52 Utah’s Future Nursing Workforce...... 61 Summary Findings & Conclusion ...... 65 Recommendations ...... 65 APPENDICES ...... 67 Appendix A: Survey Instrument & Cover Letter ...... 67 Appendix B: References...... 72

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LIST OF FIGURES

Figure 1: RN Gender Distribution ...... 21

Figure 2: Median Income based on Licensure Year for FT RNs ...... 21

Figure 3: Highest Obtained Nursing Education by Gender ...... 21

Figure 4: Distribution of RNs by Age Group ...... 23

Figure 5: RN Age Distribution based on Licensure Year ...... 24

Figure 6: Distribution of RNs with Plans to Leave the Workforce ...... 25

Figure 7: Distribution of RNs Planning to Leave Workforce Stratified by Age ...... 25

Figure 8: Initial Nursing Education Distribution for RNs ...... 26

Figure 9: Median Debt from Initial RN Education ...... 28

Figure 10: Highest-Level Nursing Education Distribution for RNs ...... 29

Figure 11: Median Income for FT RNs based on Licensure Year & Highest Obtained Education ...... 30

Figure 12: Distribution of RNs based on Employment Status ...... 33

Figure 13: Median Weekly Hours Worked by RNs based on Licensure Year ...... 33

Figure 14: Median Income for FT/PT RNs based on Licensure Year ...... 34

Figure 15: RN Employment Setting based on Highest-Level of Education ...... 36

Figure 16: Gender Distribution for LPNs ...... 43

Figure 17: Distribution of LPNs by Age Group ...... 45

Figure 18: Age Distribution of LPNs based on Licensure Year ...... 46

Figure 19: Distribution of LPNs with Plans to Leave the Workforce ...... 47

Figure 20: Distribution of LPNs Planning to Leave the Workforce Stratified by Age Group...... 47

Figure 21: Qualifying Credential for LPN License ...... 48

Figure 22: Distribution of LPNs by Highest Obtained Nursing Degree ...... 50

Figure 23: Time Elapsed between LPN and RN Licensure ...... 51

Figure 24: Distribution of LPNs based on Employment Status ...... 54

Figure 25: Median Weekly Hours Worked by LPNs based on Licensure Year ...... 54 9 | Supply of Nurses in Utah: The 2020 Survey of Utah’s Registered Nurses and Licensed Practical Nurses

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Figure 26: RN and LPN Licenses Changes by Year ...... 61

Figure 27: Active RN and LPN Licenses by Year ...... 62

Figure 28: Current RN Population Ratio per 100,000 ...... 62

Figure 29: Current LPN Population Ratio per 100,000 ...... 63

Figure 30: RN Projected Growth ...... 63

Figure 31: LPN Projected Growth ...... 64

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LIST OF TABLES

Table 1: RN Gender Distribution Comparisons ...... 20

Table 2: Distribution of RNs by Race/Ethnicity ...... 22

Table 3: Racial/Ethnic Distribution of RNs Stratified by Age Group ...... 22

Table 4: RN Age Distribution Comparisons ...... 23

Table 5: Initial Nursing Education Distribution Comparisons for RNs ...... 26

Table 6: RN Funding for Initial Nursing Education ...... 27

Table 7: Highest-Level Nursing Education Distribution Comparisons for RNs ...... 29

Table 8: Distribution of RNs Holding BSN or Above ...... 30

Table 9: Distribution of RNs by County and Local Health District ...... 31

Table 10: RN Employment Status Distribution Comparisons ...... 33

Table 11: RN Employment Satisfaction based on Income ...... 34

Table 12: Distribution of RNs by Employment Setting ...... 35

Table 13: Distribution of RNs by Specialty ...... 37

Table 14: Top 10 RN Specialties Compared by Position Title ...... 38

Table 15: Distribution of RNs based on Level of Care Provided ...... 39

Table 16: Patient Population Distribution for RNs ...... 40

Table 17: Distribution of RNs by Position Title ...... 41

Table 18: Nursing Mentorship Distribution for RNs ...... 42

Table 19: LPN Gender Distribution Comparisons ...... 44

Table 20: Distribution of LPNs based on Race/Ethnicity ...... 44

Table 21: LPN Age Distribution Comparisons ...... 45

Table 22: Initial Nursing Education Distribution Comparisons for LPNs ...... 48

Table 23: Funding for Initial LPN Education ...... 49

Table 24: Highest-Level Nursing Education Distribution Comparisons for LPNs ...... 50

Table 25: Distribution of LPNs by County and Local Health District...... 52 11 | Supply of Nurses in Utah: The 2020 Survey of Utah’s Registered Nurses and Licensed Practical Nurses

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Table 26: LPN Employment Status Distribution Comparisons ...... 54

Table 27: Distribution of LPNs by Employment Setting ...... 55

Table 28: Distribution of LPNs by Specialty ...... 56

Table 29: Distribution of LPNs based on Level of Care Provided ...... 58

Table 30: Patient Population Distribution for LPNs ...... 58

Table 31: Distribution of LPNs based on Position Title ...... 59

Table 32: Nursing Mentorship Distribution for LPNs ...... 60

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ACRONYMS & ABBREVIATIONS

ADN associate degree in nursing APRN advanced practice registered nurse BLS US Bureau of Labor Statistics BSN bachelor's degree in nursing COVID-19 coronavirus disease 2019 DOPL Utah Division of Occupational and Professional Licensing DNP doctor of nursing practice FT full-time (employment) GME graduate medical education HRSA Health Resources and Services Administration IOM Institute of Medicine LPN licensed practical nurse MDS Minimum Data Set NAM National Academy of Medicine NCLEX-RN National Council Licensure Examination for Registered Nurses NCSBN National Council of State Boards of Nursing NSSRN National Sample Survey of Registered Nurses PhD doctor of philosophy PT part-time (employment) RN registered nurse UMEC Utah Medical Education Council US United States UT Utah WHO World Health Organization

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EXECUTIVE SUMMARY

UTAH RN PROFILE

The typical RN working in Utah:

• Female (88%) • Median Age: 46 years old • White/Caucasian (92%) • Holds Bachelor’s Degree as highest-level of nursing education (56%) • Earns a median of $69,319 per year for full-time employment • Works in a hospital setting (55%) • Hired as a staff nurse (42%) • Provides care to multiple age groups (43%) followed by adult care (22%)

UTAH LPN PROFILE

The typical LPN working in Utah:

• Female (87%) • Median Age: 51 years old • White/Caucasian (84%) • Holds Vocational/Practical Certificate as highest-level of nursing education (50%) followed by Associate Degree (37%) • Earns a median of $50,076 per year for full-time employment • Works in a nursing home setting (29%) followed by hospital settings (22%) • Hired as a staff nurse (56%) • Provides care to multiple age groups (38%) followed by geriatric care (26%)

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UTAH’S REGISTERED NURSE & LICENSED PRACTICAL NURSE WORKFORCE, 2020

INTRODUCTION & OVERVIEW

In 2013, the Utah Medical Education Council (UMEC) was designated as the Utah Nursing Workforce Information Center. With this designation, the UMEC began undertaking measures to understand the different facets of the nursing workforce within the state. Specifically, the UMEC expanded its efforts to describe the systemic interaction of three major aspects of the current and future nursing workforce: 1) supply of nurses, 2) demand for nurses, and 3) education of nurses.

Supply of Nurses in Utah: The 2020 Survey of Utah’s Registered Nurses and Licensed Practical Nurses is the UMEC’s second report on Utah’s registered nurse (RN) workforce and the first report on Utah’s licensed practical nurse (LPN) workforce. The first RN report was published in 2016. The current report captures demographics, practice characteristics, and projections for the future supply of Utah’s RNs and LPNs. It also compares both state and national characteristics and trends to better understand the current and future supply of RNs and LPNs in Utah.

METHODOLOGY

LICENSE DATA

The Utah Division of Occupational and Professional Licensing (DOPL) provided information for all 37,743 licensed RNs and LPNs in the state. Variables obtained through DOPL license data included age, gender, and a mailing address for survey distribution. Survey responses were validated in comparison to age and gender based on the complete DOPL record in order to calculate appropriate weighting factors. As of May 2020, 34,756 RNs and 2,716 LPNs held active nursing licenses in Utah.

SURVEY DESIGN & DISTRIBUTION

The data used for this report was collected using a survey instrument designed by the UMEC (see Appendix A). The 2020 survey instrument design was based on the UMEC’s 2015 Registered Nurse Workforce Survey. Using Snap Survey Software, questions from the previous survey were updated to coincide with the current revisions from the National Forum of State

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Nursing Workforce Center’s Minimum Nurse Supply Dataset (MDS)1. Additionally, the survey instruments from the 2017 National Nursing Workforce Survey conducted by the National Council of State Boards of Nursing (NCSBN) and the 2018 National Sample Survey of Registered Nurses (NSSRN) conducted by the Health Resources and Services Administration (HRSA) were used as references to guide the final design for the current survey instrument. Other revisions made to the survey involved rephrasing of questions to simplify and shorten them for clarity, as well as identifying and reformatting similar response options. The 2020 survey instrument captured all MDS variables not already provided by DOPL license data, and it also incorporated seven questions not asked in the previous survey including:

• Type of school attended for initial nursing licensure • Influential factors for working as a nurse in Utah • Employment satisfaction level • Debt incurred from nursing education • Interstate nursing licensure obtainment and use • Obtainment of nursing credentials and organization involvement • Number of nursing positions held

The survey instrument was presented to a pre-established Nursing Advisory Committee for insight and feedback prior to its distribution and throughout the design process. The paper version of the survey consisted of 33 questions and was delivered to all 37,473 registered nurses and licensed practical nurses in Utah over the course of three mailing periods from 12/09/2019 to 05/13/2020.

This was the first nursing workforce survey that offered the option to respond to the questionnaire electronically. Qualtrics Survey Software was used to collect online responses. Every survey mailing presented this option. Instructions for accessing the electronic version of the survey were included in a cover letter that was delivered alongside the paper survey (see Appendix A). These instructions provided a personalized, non-identifying access code that respondents were prompted to enter before they were re-directed to the questionnaire. This code was used in the data cleaning process, to track response rates, and to ensure only one entry was accepted per respondent.

DATA COLLECTION & VERIFICATION

The first survey mailing occurred in December of 2019. After four months, a second mailing was issued in April of 2020 to those who had not yet responded to the survey. Finally, a third and final mailing was sent in May of 2020 to encourage survey response rates among the remaining nurses. Data collection subsequently ended in September of 2020.

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Returned surveys were verified by their unique identification codes and were further sorted to identify and remove any duplicate responses.

DATA ENTRY & ANALYSIS

A master database was constructed to compile data from both paper and electronic survey responses. In order to create one uniform file for analysis, electronic responses needed to be processed separately from paper responses, and all variables were formatted to correspond with both survey types then added to the master data file.

SURVEY SCOPE & LIMITATIONS

Only one official report existed for the Utah nursing workforce prior to the current study. Because only one previous supply survey was conducted for Utah RNs, the earliest recorded data for Utah nurses began in 2015. The best data for comparisons prior to 2015 comes from what is reported in national surveys by the NCSBN and the HRSA. Also, there was no LPN study prior to this current one; therefore, the best comparisons for the LPN workforce are from the national NCSBN survey, and data presented on Utah’s LPNs in this report should be used as a baseline for future state workforce analysis.

In addition, the 2020 survey was entirely based on self-reporting. Due to this, there was the possibility of misinterpretation or confusion of the survey questions among its recipients. Likewise, non-response of individual questions might have impacted variable estimations, although the majority of weighted variables approximately ranged from <1% to 9% in non- response for RNs and <1% to 15% in non-response for LPNs. Item non-response for individual variables were as follows:

To address non-response, survey variables were calculated using an applied weight factor. Non- response weighting was determined using age and gender variables obtained through DOPL license data. Ultimately, weighting based on age was favored over weighting based on gender as

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there did not appear to be any correlation between gender and survey response rates. Unlike the previous RN study prepared by the UMEC, this year’s study based weighting on age group rather than applying an overall weight factor to account for non-response. For further clarity, all data presented in this report is based on valid responses, meaning non-response of individual variables was excluded from the final distribution outputs.

Furthermore, differences in particular question presentation and analysis between the 2020 and 2015 UMEC surveys affected the ability to make suitable comparisons among specific variables. For example, questions regarding employment settings and specialties were posed as single- response questions in 2015, whereas the 2020 survey allowed respondents to select all options that applied to their current nursing employment. Such changes were made to acknowledge the nurses who provide consultation to more than one setting or specialty area or who travel to multiple venues for work. Other variables that were presented as multiple-response questions rather than single-response questions in the 2020 survey included patient population, position title, and level of care provided. As such, these variables should be used as an updated baseline for future nursing workforce analysis.

Lastly, this supply study began before the onslaught of a global pandemic (COVID-19). Because of this, some survey responses might have been affected as nurses could have experienced changes to their normal employment status during the survey distribution and collection process.

BACKGROUND

As aforementioned, when updating the 2020 survey instrument, some questions were revised to address relevance, rephrased or condensed for better understanding, or simplified by combining similar response options. For example, in the previous survey, respondents were asked about health-related jobs prior to their nursing education. The question was not asked in the current survey because the report has since been expanded to include analysis for the LPN workforce in conjunction with the RN workforce.

In addition, while both the HRSA and NCSBN published national reports, more data comparisons were made with the NCSBN data as they provided a more comprehensive report for both RNs and LPNs. Regardless, available data from both the HRSA and NCSBN is presented in the current UMEC report to provide thorough analysis.

Finally, the purpose of this report is to describe the supply of registered nurses and licensed practical nurses actively providing services in the state of Utah. With an increasing demand for healthcare within Utah, it is imperative to monitor changes within the state’s nursing workforce to ensure that healthcare providers can adequately adapt to accommodate the needs of an ever- changing healthcare system. Therefore, conclusions made in this analysis should be used in tandem with other nursing reports available for the state, namely, the demand and education

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SUPPLY OF NURSES IN UTAH reports published by the UMEC and other relevant resources such as the Institute of Medicine (IOM)’s Future of Nursing report when describing the overall nursing workforce.

WORKFORCE TRENDS

According to the most recently published NCSBN report, a total of 4,639,548 RNs and 975,988 LPNs held active nursing licenses in the United States in 2017. This was a 6.0% increase for RN licenses, but a 5.1% decrease for LPN licenses in comparison to the previous NSCBN study conducted in 2015. Data from the most recent national study presented evidence of a gradual yet steady growth of an aging workforce consistent with what was reported by the state of Utah. In addition, 19.2% of RN respondents were racial minorities, while approximately 29% of LPNs reported belonging to minority groups. Gender diversity remained relatively unchanged for both groups according to NCSBN data.

In terms of education, the NCSBN reported a continued increase of RN respondents pursuing a bachelor’s degree for their initial nursing credential. Pursuit of graduate education also saw steady growth since the last national survey. When looking at the LPN workforce, the NCSBN reported the majority as pursuing a vocational or practical certificate for their qualifying licensure. However, of this group, more than three-fourths did not report pursuit of higher-level nursing education.

The national report anticipated substantial upcoming changes to the nursing workforce over the next few years. Because of this, it recognized the need for ongoing observation and assessment of the workforce to meet the expectations of patients as the health system transforms and expands with the use of technology and telehealth as a means to deliver care. As the largest segment of the healthcare workforce and an integral part of the inter-professional healthcare team, nurses are at the forefront of these system changes. By examining different aspects of the nursing workforce, it is easier to assess the need for higher degrees of knowledge and skills from nurses in relation to “population health and wellness, multi-disciplinary care coordination, technological advances in healthcare delivery, evidence-based data analytics, and quality improvement.”2 Such elements provide an idea of what the future of nursing aims to achieve.

2 https://www.journalofnursingregulation.com/action/showPdf?pii=S2155-8256%2818%2930131-5 19 | Supply of Nurses in Utah: The 2020 Survey of Utah’s Registered Nurses and Licensed Practical Nurses

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REGISTERED NURSE REPORT FINDINGS

WORKFORCE CHARACTERISTICS

SECTION 1: AGGREGATE SUPPLY

The 2020 survey yielded a 39.2% response rate from 13,626 of Utah’s 34,756 RNs. This response rate resulted in a margin of error of <1% at a 95% confidence level. Although this was a statistically valid sample, it was a lower response rate than what was reported in 2015 at 42%. The current survey estimated that approximately 80.2% of RNs licensed in Utah were actively providing nursing services in the state. Comparatively, the previous survey reported 94% of RNs as actively providing nursing services in Utah. The difference in percentages might be attributed to many factors: lower response rates, employment changes due to the pandemic, increases in the use of telehealth across state lines, or the result of interstate compact migration resulting in more nurses with Utah licenses working in other states. Further analysis is necessary to examine this change in more depth.

Additionally, this was the first report produced by the UMEC that required the data to be weighted based upon age. Younger age groups were weighted up as older cohorts had higher survey response rates. Weight factors for each age group were applied to the data as follows:

• Under 35=3.34 • 35-44=3.03 • 45-54=2.47 • 55-64=1.93 • Over 64=1.66

Previously, other reports from the UMEC needed only to apply an overall weight factor to account for non-response to the surveys.

SECTION 2: DEMOGRAPHICS

GENDER

Table 1: RN Gender Distribution Comparisons

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Figure 1: RN Gender Distribution

Females still largely dominated the RN workforce in Utah, but there did appear to be a slight male increase from 2015 of 0.5% (described in Figure 1). In addition, Utah reported a slightly more diverse distribution of male RNs compared to the NCSBN (2.4% increase) and the HRSA (1.9% increase) national surveys as shown by Table 1.

Figure 2: Median Income based on Licensure Year for FT RNs

Licensure Year Interestingly, male RNs reported higher median incomes for full-time employment although females made up the majority of the workforce (shown in Figure 2). There did appear to be a correlation between gender and income, although this does not imply causation. This might likely be due to the fact that more male RNs reported obtaining a bachelor’s degree (BSN) or higher compared to females as seen in Figure 3. It did seem that the wage gap between males and females was much smaller among nurses who held their license for less than five years.

Figure 3: Highest Obtained Nursing Education by Gender

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RACE & ETHNICITY

The 2020 survey asked respondents to specify all races and ethnicities that applied to them. Those who marked more than one option were then re-coded into the “Two or More Races” category, allowing for mutually exclusive analysis of the data. Additionally, the 2020 questionnaire presented one new response option not included in the 2015 survey for Middle Eastern or North African nurses.

Table 2: Distribution of RNs by Race/Ethnicity

NOTE: Variables marked with an asterisk (*) denote response options not included in the 2015 survey. The racial distribution for the RN workforce shown in Table 2 did not differ much from the 2015 report, but as Table 3 shows, younger cohorts appeared to be slightly more diverse. Although the workforce was still predominantly white, RNs of Hispanic, Latino, or Spanish descent were the next top reported ethnic group at 2.8% (an increase of 0.6% from 2015) followed by RNs of two or more races at 2.6%. When stratified by age, 6.3% of Hispanic, Latino, or Spanish RNs were under the age of 45 and 6.8% of RNs who reported being two or more races also reported being under age 45.

Table 3: Racial/Ethnic Distribution of RNs Stratified by Age Group

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AGE

Figure 4: Distribution of RNs by Age Group

The median reported age of Utah’s RN workforce was 46 years compared to a national workforce median of 53 years according to the 2017 NCSBN report. About 57.3% of Utah RNs were estimated to be under the age of 45 (seen in Figure 4). Although there was evidence of an aging workforce, there were also increases of younger RNs entering the workforce (as described by Table 4).

Table 4: RN Age Distribution Comparisons

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Figure 5: RN Age Distribution based on Licensure Year

When stratified by licensure year as shown in Figure 5, the age distribution for RNs further emphasized an increased inflow to the workforce of younger RNs obtaining licensure as older cohorts gradually exited the workforce. Age groups within the RN distribution appeared to be more evenly dispersed compared to what was reported by Utah’s LPN workforce, especially among nurses under age 35.

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RETIREMENT

RETIREMENT OUTLOOK FOR STATE POPULATION

The 2020 survey prompted RNs to specify general plans for the next three years in regard to their current nursing employment. The following options were provided, and respondents were asked to mark all options that applied to their situation, including: Retire, Move to Another Nursing Position, Leave the Nursing Field Temporarily, Leave the Nursing Field Permanently, No Plans to Leave within the Next Three Years, Cease Working in Utah, Pursue Further Education, Pursue Other or Different Work, Increase Client Hours, Decrease Client Hours, Increase Teaching Hours, Decrease Teaching Hours, or Undecided. Of the 27,298 weighted responses, 10.7% of the population indicated plans to leave the nursing field in some capacity within the next three years (shown in Figure 6).

Figure 6: Distribution of RNs with Plans to Leave the Workforce

RETIREMENT OUTLOOK FOR NURSES BY AGE GROUP

For further analysis, the population of RNs who expressed plans to leave the nursing workforce was stratified by age group, as shown in Figure 7. As expected, the majority of RNs with plans to retire were over the age of 55. Of the RNs planning to leave nursing temporarily, 25.6% were under age 45, and 62.8% of this group were under age 35. A small proportion of nurses also indicated plans to leave nursing permanently. Of this group, 68.3% were under age 45.

Figure 7: Distribution of RNs Planning to Leave Workforce Stratified by Age

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SECTION 3: EDUCATION

QUALIFYING DEGREE

Figure 8: Initial Nursing Education Distribution for RNs

There was an increasing number of RNs who reported entering the workforce with a bachelor’s degree compared to what was reported in 2015 (as seen in Figure 8). Table 5 also shows that BSN training increased by 4.4% from 27.0% in 2015, although this still fell behind both the NCSBN and HRSA surveys by 10.4% and 7.9%, respectively.

Table 5: Initial Nursing Education Distribution Comparisons for RNs

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FUNDING FOR EDUCATION

Table 6: RN Funding for Initial Nursing Education

NOTE: Variables marked with an asterisk (*) denote response options not included in the 2015 survey. Using the variables listed in Table 6, survey respondents were prompted to signify all resources that were used to fund their initial nursing education. Both the 2020 and 2015 UMEC surveys allowed for multiple responses; therefore, analysis totals may be greater than 100%. The 2020 survey also included an option for Federal Traineeship, Scholarship, or Grant funding that was not included in the previous survey.

Federal traineeship, scholarship, or grant funding was the top reported resource for tuition disbursement among Utah RNs in 2020. Following this, earnings from healthcare-related employment was the top reported resource for funding nursing education in both 2020 and 2015. Personal household savings and federally assisted loans were also top resources used to pay for school in both 2020 and 2015.

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DEBT FROM SCHOOL

Figure 9: Median Debt from Initial RN Education

The 2020 survey also requested respondents to indicate the amount of debt accrued while obtaining their education in nursing as illustrated by Figure 9. As expected, the amount of debt incurred from school appeared to decrease the longer an RN held their license. RNs who entered the workforce with an associate or bachelor’s degree reported having no debt after ten to fifteen years of licensure, while RNs with graduate degrees reported having no debt after twenty to twenty-five years of licensure. Surprisingly, RNs who entered the workforce with an associate degree reported higher median debt burdens than RNs who entered the workforce with a bachelor’s degree.

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HIGHEST-LEVEL OF EDUCATION

Figure 10: Highest-Level Nursing Education Distribution for RNs

Looking at the distribution for highest obtained nursing education in Figure 10, there was a continued increase of RNs pursuing BSN and graduate degrees past the initial nursing education and licensing from 47.3% and 8.0% in 2015 to 56.2% and 9.8% in 2020 for BSN and graduate degrees, respectively (shown in Table 7). This coincided with the goals set forth by the IOM’s Future of Nursing report as Utah RNs showed a persistent pursuit for higher nursing education. Although the Future of Nursing report recommended that at least 80% of the workforce should be trained at the bachelor’s level or higher by 2020, the Utah RN workforce fell short of this goal by roughly 14%.

Table 7: Highest-Level Nursing Education Distribution Comparisons for RNs

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Figure 11: Median Income for FT RNs based on Licensure Year & Highest Obtained Education

Licensure Year When stratified by current education level as seen in Figure 11, the median income for full-time RNs appeared to increase the longer an RN held their licensure. Furthermore, obtainment of higher education also tended to yield higher median incomes. This trend might incentivize RNs who currently hold an associate degree (ADN) to pursue further education in nursing. Interestingly, the median income for full-time RNs who held a bachelor’s degree did not differ much from RNs who held an ADN until the two groups obtained a bit of experience in the workforce. Although this might be influenced by the fact that younger age cohorts had higher reports of obtaining their BSN. This trend should be examined for changes over the next few years to see how the median incomes evolve as the number of bachelor-trained nurses continues to increase.

Table 8: Distribution of RNs Holding BSN or Above

Among RNs holding a bachelor’s degree or higher, Table 8 shows that the largest concentration obtained a BSN as their highest-level of nursing education. Clinical practice as a DNP is associated with APRN licensure. The distribution of percentages shown is based only on those nurses who reported maintaining an active RN license in conjunction with graduate-level training. For a more comprehensive look at graduate education, the UMEC produces an APRN supply report (most recently published in 2017), as well as a nursing education report available on the Utah Nursing Workforce Information Center website.

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PRACTICE CHARACTERISTICS

SECTION 4: GEOGRAPHIC DISTRIBUTION

PRACTICE LOCATION

Table 9: Distribution of RNs by County and Local Health District

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Table 9 displays the distribution of Utah’s RNs by county. Because the previous study accounted for approximately 40% in non- response for this specific question, the distribution for 2015 was re- calculated using only valid responses in order to make comparisons to the 2020 survey possible. Non-response of this question in 2020 was roughly 8.7%; therefore, there was not much difference between overall response and valid response in the current study. Values presented represent only valid response outputs.

As seen in the state map provided and in Table 9, the most prevalent concentrations of Utah’s RNs were reported within the state’s urban counties including: Salt Lake, Utah, Weber, Davis, Washington, and Cache Counties. Salt Lake County remained the number one reported location for primary nursing employment among RNs. This number increased by 1.6% from 2015. Similarly, Davis County also experienced a 1.6% increase since the last report. In addition, Washington, Summit, and Wayne Counties all reported a 0.1% increase from 2015.

RNs employed in Weber County reported a decrease of 1.6% from 2015, while Cache County reported a decrease of 0.9%, and Duchesne decreased by 0.2%. Additionally, Utah County, Beaver County, Rich County, Piute County, and Daggett County all reported decreases of 0.1%. There did not appear to be any other significant changes among the state’s other counties since the previous study.

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SECTION 5: SPECIALTY DISTRIBUTION

EMPLOYMENT HOURS

Figure 12: Distribution of RNs based on Employment Status

Table 10: RN Employment Status Distribution Comparisons

It was estimated that 73.6% of RNs were employed full-time as presented by Figure 12. This was an increase of 12.6% from 20153, and it was also comparable to the LPN workforce, with 76.4% of Utah’s LPNs reporting full-time employment. The estimation for RNs was greater than the NCSBN report by 8.2% and less than the HRSA report by 5.3% (shown in Table 10).

Figure 13: Median Weekly Hours Worked by RNs based on Licensure Year

Licensure Year Analysis to compare both median and average hours worked weekly were produced to examine potential trends in employment hours. As seen in Figure 13, median weekly hours were reported

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instead of average weekly hours in order to account for outliers due to the self-reported nature of the survey. Upon further analysis, there did not appear to be a correlation between years licensed and hours worked per week for full-time RNs, but the number of hours worked for part-time status appeared to drop off gradually as the number of years licensed increased.

Figure 14: Median Income for FT/PT RNs based on Licensure Year

Licensure Year Median income based on licensure year was also analyzed to further examine trends among full- time and part-time employment, shown in Figure 14. As predicted, income grew steadily over time for full-time RNs, but part-time income appeared to be much more gradual.

Table 11: RN Employment Satisfaction based on Income

Furthermore, when analyzing reported employment satisfaction level compared to income as shown by Table 11, those who reported higher earnings tended to also be more satisfied in their current employment. It is also important to mention that several analyses were conducted to identify other possible correlations between employment satisfaction and other survey variables such as gender, specialty, and degree type; however, there did not appear to be any other relationships with employment satisfaction other than to income.

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WORKPLACE SETTING

Table 12: Distribution of RNs by Employment Setting

NOTE: Variables marked with an asterisk (*) denote response options not included in the 2015 survey. The 2020 survey allowed respondents to mark all employment settings that applied to their primary position in nursing, as opposed to the 2015 survey, in which respondents were instructed to select only one option. The question was posed differently in the current survey to account for nurses who provided care within multiple facilities such as different departments within a hospital or travelled between different venues for consulting. Additionally, the 2020 questionnaire included five more response options not asked in 2015. These variables included: Multiple Facilities, Telehealth/Telenursing/Call Center, Nephrology/Dialysis Center, Part-Time Faculty/Part-Time in a like Facility, and Travel to Other Venues for Consulting. Because of this, it was difficult to make comparisons between the current survey and the 2015 report. Rather, the 2020 survey should be used as a baseline for future comparisons.

Nevertheless, when looking at the distribution of RNs by employment setting from Table 12, there appeared to be a bit of a transition away from the hospital setting compared to what was reported in 2015. The 2020 distribution actually fell more in line with the reported national work setting distribution from the 2017 NCSBN study. Despite this transition, hospitals were still the primary reported work setting for more than half of the RN workforce. Ambulatory care, nursing homes, and home health remained the next top reported employment settings following hospitals.

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Figure 15: RN Employment Setting based on Highest-Level of Education

The current workforce was also beginning to see more BSN-trained RNs across all employment settings compared to 2015. For example, in 2015, the hospital setting consisted of 47% bachelor-trained RNs and 35% associate-trained RNs; whereas Figure 15 shows that the amount of BSN-trained RNs in 2020 increased to 63.1%, while the proportion of associate-trained RNs consequently dropped to 30.1%. A large proportion of associate-trained RNs also worked in nursing homes, correctional facilities, and hospice/home health, all of which reported over 50% of RNs holding an associate degree as their highest obtained nursing education. This was consistent with what was reported in 2015. Furthermore, while graduate-trained RNs experienced percentage increases across all employment settings, the largest proportion of this group remained in academia.

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SPECIALTY

Table 13: Distribution of RNs by Specialty

NOTE: Variables marked with an asterisk (*) denote response options not included in the 2015 survey. In regards to employment specialty, the 2020 survey prompted respondents to select all options that applied to their primary position in nursing, whereas the 2015 survey requested respondents 37 | Supply of Nurses in Utah: The 2020 Survey of Utah’s Registered Nurses and Licensed Practical Nurses

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to specify only one response for employment specialty. Moreover, the current survey expanded this question to include sixteen options not included in the previous survey. These variables included: Multiple Areas, No Specific Area, Adult Health, Family Health, Anesthesia, Community Health, Genetics, Gerontology/Geriatric Health, Orthopedics, Neonatal Health, Pediatrics, Perioperative, Public Health, Rehabilitation, School Health, and Urology. The responses that indicated more than one specialty area were re-coded to fall under the “Multiple Areas” category. This group yielded 26.9% of the RN population as seen in Table 13. Following this, acute/critical care was the next top reported specialty at 6.0% of the workforce. This appeared to be a lower proportion than what was reported in 2015 and in the 2017 NCSBN study. Although the lower percentages might be due to the re-categorization of this question for analysis purposes.

The next highest reported specialty was obstetrics at 5.4%, which was a 1.1% decrease from what was reported in 2015, but a 0.7% increase from what was reported by the NCSBN. Home health and hospice care was also within the top reported specialties for both the state and national studies, with Utah RNs reporting 3.6% more than what was recorded by the NCSBN.

Table 14: Top 10 RN Specialties Compared by Position Title

Top reported specialties were compared to primary position title in Table 14. Of this population, the heaviest concentrations of staff nurses appeared to work in perioperative care, neonatal health, medical-surgical, obstetrics, and acute care. Not surprisingly, the largest concentration of nurses providing no patient care was seen among nursing faculty, followed by case managers. There also appeared to be a higher concentration of case managers working in hospice and home care. Of the RNs who reported having no position title, the largest cohorts were found to be working in multiple specialty areas, providing no patient care, or working in emergency/trauma.

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LEVEL OF CARE

Table 15: Distribution of RNs based on Level of Care Provided

Similar to employment specialty and setting, the 2020 survey requested respondents to indicate all variables that applied to the level of care provided. Those who marked more than one checkbox were then re-coded into the “Multiple Areas” category (shown by Table 15). Of this group, 19.2% of RNs reported providing more than one type of care to patients. General or specialty inpatient care was the next highest reported type of care among RNs at 13.5%. This was about a 6.9% decrease from 20.4% reported in 2015, with lower proportions reported in 2020. The other top categories among RNs included: surgery at 11.4% (0.8% increase from 2015), critical/intensive care (2.9% decrease from 2015), and ambulatory care (3.2% increase from 2015). Percentages for home health and emergency care appeared to have no change from 2015.

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PATIENT POPULATION

Table 16: Patient Population Distribution for RNs

When referencing patient populations, the 2020 survey requested respondents to indicate which groups they spend fifty percent or more of their time in providing care. The question allowed RNs to mark all variables that applied to their primary nursing employment position, while the 2015 report only allowed respondents to select one option. Due to this, it was difficult to provide a comparison between the current survey and the previous study, and the 2020 data should therefore be used as a baseline analysis for future comparisons. Those who selected more than one option were re-coded into the “Multiple Age Groups” category, as described by Table 16. This group yielded the largest concentration of the RN workforce with 42.9%, an almost 35% difference from what was reported in 2015.

Patients who fell under the “Pre-Natal” and “Other” categories appeared to be the only other groups that experienced increases from 2015, albeit small increases of only 0.1% for both variables. All other categories appeared to show decreases, the largest reported in adult care (a 25.9% decrease from 48.0%), geriatric care (a 6.4% decrease from 14.0%), and newborn/neonatal care (a 2.6% decrease from 7.0%). The differences in percentages from 2015 might be attributed to differences in question presentation and analysis.

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POSITION TITLE

Table 17: Distribution of RNs by Position Title

NOTE: Variables marked with an asterisk (*) denote response options not included in the 2015 survey. Similar to other multiple-response questions in the 2020 survey, RNs were allowed to mark all options that applied to their current position title in order to account for those nurses whose responsibilities fell under more than one category. Nurses who indicated more than one position title were then re-coded in order to provide a mutually exclusive analysis for comparisons. This differs from the 2015 survey, in which respondents were asked to mark only one option to describe their primary position title.

As seen in Table 17, there seemed to be a 21.7% decrease in RNs who reported their primary position title as staff compared to 2015; however, this might be influenced by the fact that 16.4% of RNs reported having no position title. In fact, there appeared to be decreases in all reported position titles compared to 2015. This might again be due to the inclusion of additional response options in the current survey. These additional options included: No Position Title, Clinical Nurse Leader, Community/Public Health Nurse, Advice/Triage Nurse, Infection Control, Informatics, Surveyor/Auditor/Regulator, and Quality Improvement/Utilization Review (QI/UR). The data also showed decreases in all position titles when compared nationally, other than nurse faculty, which indicated a 3.7% increase and nurse executives, which presented a 0.5% increase.

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PRECEPTORSHIP

Table 18: Nursing Mentorship Distribution for RNs

Both the 2020 and 2015 surveys inquired about nursing mentorship. Table 18 shows that there did not appear to be much change from the previous report. These RNs reported mentoring a median of three students per year. This amount did not change from the 2015 report.

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LICENSED PRACTICAL NURSE REPORT FINDINGS

WORKFORCE CHARACTERISTICS

SECTION 6: AGGREGATE SUPPLY

Of the 2,716 LPNs contacted, 607 returned the 2020 survey, generating a final response rate of 22.3%. This was a lower rate than what was reported by RNs (39.2%), but it was still statistically valid with a 4% margin of error at a 95% confidence level. Of this sample, 77.0% of LPNs reported actively providing nursing services in the state.

Similar to the RN workforce, weighting for the LPN workforce was based on age as older cohorts yielded higher response rates. The weight factors for each age group were applied to the data as follows:

• Under 35=7.60 • 35-44=5.38 • 45-54=4.71 • 55-64=3.39 • Over 64=2.72

SECTION 7: DEMOGRAPHICS

GENDER

The gender distribution for the LPN workforce appeared to be more diverse than what was reported by the NCSBN (shown in Figure 16 and Table 19). This could be due to the fact that the Utah LPN workforce reported a larger proportion of younger LPNs. Additionally, Utah LPNs reported a slightly larger proportion of males compared to the RN workforce, which could potentially aid in further diversifying the Utah RN workforce if these LPNs can be moved through the education pipeline to obtain further nursing education.

Figure 16: Gender Distribution for LPNs

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Table 19: LPN Gender Distribution Comparisons

RACE & ETHNICITY

The LPN workforce showed a bit more diversity than what was reported for RNs with minority groups making up 16.2% of the total workforce compared to 8.4% for RNs.

Table 20: Distribution of LPNs based on Race/Ethnicity

Shown in Table 20, the Black/African American LPN population appeared to be vastly underrepresented compared to the NCSBN 2017 survey with a difference of 15.8%. When looking at the state population however, Black/African American LPNs seemed to be slightly overrepresented at a difference of 1.0%.

Utah LPNs reported backgrounds of two or more races at a slightly high rate compared to the national distribution. Additionally, Utah LPNs also reported higher percentages of American Indian/Native Alaskan LPNs compared to the national study.

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AGE

Figure 17: Distribution of LPNs by Age Group

Table 21: LPN Age Distribution Comparisons

Utah LPNs reported a younger workforce compared to the national distribution as described in Figure 17 and Table 21. The cohort for LPNs under age 35 was almost double what was reported by the NCSBN at 28.4% for Utah LPNs compared to 17.4% nationally.

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Figure 18: Age Distribution of LPNs based on Licensure Year

When looking at the distribution of LPNs compared to licensure year in Figure 18, the largest increase in licenses occurred within the last five years at 31.1%. This appeared to be a larger influx of younger LPNs entering the workforce compared to RNs. Both distributions behaved as would be expected however, with LPNs belonging to older age groups gradually beginning to exit the workforce as younger cohorts entered.

RETIREMENT

RETIREMENT OUTLOOK FOR STATE POPULATION

The 2020 survey prompted LPNs to specify their plans for the next three years in regard to their current nursing employment. The following options were provided, and respondents were asked to mark all options that applied, including: Retire, Move to Another Nursing Position, Leave the Nursing Field Temporarily, Leave the Nursing Field Permanently, No Plans to Leave within the Next Three Years, Cease Working in Utah, Pursue Further Education, Pursue Other or Different Work, Increase Client Hours, Decrease Client Hours, Increase Teaching Hours, Decrease Teaching Hours, or Undecided. Of the 2,087 weighted responses, Figure 19 shows that 15.6% of the population indicated plans to leave the nursing field in some capacity within the next three years (a higher proportion than the RN workforce by 4.9%).

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Figure 19: Distribution of LPNs with Plans to Leave the Workforce

RETIREMENT OUTLOOK FOR NURSES BY AGE GROUP

Similar to the RN analysis, the LPN population with plans to leave nursing was stratified by age group in Figure 20 to examine potential loss to the workforce. Not surprisingly, 94.4% of LPNs with plans to retire in the next three years were over age 55. Of the LPNs who planned to leave temporarily, 30.4% were under age 45, while another 43.0% were under age 35. Approximately 2.6% of the LPN workforce indicated plans to leave nursing permanently, an increase of 0.7% from what was reported by RNs. Of this group, 47.8% of LPNs were under age 45.

Figure 20: Distribution of LPNs Planning to Leave the Workforce Stratified by Age Group

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SECTION 8: EDUCATION

QUALIFYING DEGREE

Figure 21: Qualifying Credential for LPN License

Figure 21 shows that 30.2% of the LPN workforce reported obtaining an associate degree as their qualifying nursing credential. Compared to the NCSBN 2017 survey data, the Utah LPN workforce appeared to have a much higher proportion of associate-trained LPNs.

Unsurprisingly, the national data presented in Table 22 demonstrates higher counts of LPNs who held a diploma as their initial nursing education. This makes sense, as the national workforce was reportedly older than the Utah workforce. Moreover, there were smaller proportions of LPNs entering the workforce with vocational or practical certificates reported in Utah.

Table 22: Initial Nursing Education Distribution Comparisons for LPNs

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FUNDING FOR EDUCATION

The 2020 survey requested LPNs to indicate all resources utilized to fund their initial nursing education. Because they were asked to mark all options that applied to their situation, an average percent for each resource was calculated. Therefore, the total distribution for Table 23 may be greater than 100%.

Table 23: Funding for Initial LPN Education

On average, 27.5% of Utah LPNs reported earnings from healthcare-related employment as the top resource used to fund their initial nursing education. This was followed closely by the use of federally assisted loans at 27.1%. Personal household savings were also a top reported resource used to fund education, with 24.5% of LPNs indicating use of their own savings to pay for school. The current distribution should be monitored in the coming years to assess and identify potential trends associated with the payment of school tuition and fees.

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HIGHEST-LEVEL OF EDUCATION

Figure 22: Distribution of LPNs by Highest Obtained Nursing Degree

Table 24: Highest-Level Nursing Education Distribution Comparisons for LPNs

Approximately half of the current LPN workforce reported holding a certificate as their highest obtained nursing education (shown in Figure 22). In comparison to the NCSBN data in Table 24, there appeared to be an almost 30% difference between LPNs who pursue a certificate as their highest obtained nursing education. However, Utah LPNs also reported much higher proportions of those who hold an associate degree as their highest obtained education compared to the national workforce.

Likewise, there seemed to be a larger proportion of bachelor-trained LPNs as well. Typically nurses who hold a BSN have their RN license; but this might just mean that these LPNs were either currently in school, or they possibly graduated recently and had not yet obtained licensure as an RN.

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LPN TO RN EDUCATION PATHWAY

Figure 23: Time Elapsed between LPN and RN Licensure

Years between LPN and RN Licensure

Of the LPNs that continued on to obtain an RN license in Utah, nearly 80% earned their RN license within a year and a half of their LPN licensure (seen in Figure 23). Of this group, 28.7% became RNs within nine months of earning their LPN credential and another 38.3% became RNs within a year of earning their LPN licensure. There did not appear to be much advancement after the first two years of LPN licensure. However, about 5.0% of this population reported pursuing their RN license after seven or more years following their initial LPN credentialing.

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PRACTICE CHARACTERISTICS

SECTION 9: GEOGRAPHIC DISTRIBUTION

PRACTICE LOCATION

Table 25: Distribution of LPNs by County and Local Health District

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Similar to the RN workforce, the majority of Utah LPNs reported employment in urban counties as seen in the provided map and Table 25. Salt Lake, Utah, and Davis Counties had the highest concentrations of LPNs at 22.8%, 22.2%, and 11.4%, respectively. However, it did appear that LPNs were more spread out among rural counties compared to what RNs reported. Sanpete (3.2%), Box Elder (2.3%), Uintah (2.9%), Duchesne (2.6%), San Juan (2.4%), and Carbon (2.1%) Counties all reported having over 2% of LPNs. In comparison, the proportions for these same counties were significantly smaller for RNs, with most falling below 1%, other than 1.1% of RNs reported in Box Elder County. The counties that did not appear to have any LPNs reported include: Rich, Piute, Wayne, Garfield, and Kane Counties.

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SECTION 10: SPECIALTY DISTRIBUTION

EMPLOYMENT HOURS

Figure 24: Distribution of LPNs based on Employment Status

Table 26: LPN Employment Status Distribution Comparisons

Over three-fourths of the LPN workforce reported full-time employment. Figure 24 illustrates that this was a slightly higher proportion than what was reported for RNs. Additionally, it was an 11.4% increase compared to the NCSBN data as shown by Table 26.

Figure 25: Median Weekly Hours Worked by LPNs based on Licensure Year

Licensure Year As seen in Figure 25, part-time employment ranged from 15-25 hours per week, while full-time employment ranged between 36-40 hours worked weekly. These ranges were the same for both the LPN and RN workforces. Utah LPNs also reported a median income of $50,076 annually for full-time employment, while part-time LPNs reported median yearly earnings of $26,336. 54 | Supply of Nurses in Utah: The 2020 Survey of Utah’s Registered Nurses and Licensed Practical Nurses

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WORKPLACE SETTING

Table 27: Distribution of LPNs by Employment Setting

Nursing homes were the top reported employment setting among LPNs both in Utah and nationally through the NCSBN, with Utah LPNs reporting lower proportions than the national survey (28.7% in Utah compared to 37.3% nationally). As described by Table 27, hospitals and home health were still within the top three highest reported employment settings for both LPNs and RNs, but there were more LPNs reporting work outside of the hospital than the RN workforce at a difference of 32.9% less LPNs working within a hospital. There was also a higher proportion of LPNs who reported traveling to other venues for consulting than what was reported for RNs. Furthermore, Utah LPNs reported higher proportions of employment in ambulatory care compared to the NCSBN report as well as the Utah RN workforce. There were 2.2% more LPNs reportedly working in ambulatory care in comparison to the NCSBN 2017 survey, and 1.9% more LPNs in ambulatory care compared to Utah’s RNs.

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SPECIALTY

Table 28: Distribution of LPNs by Specialty

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Again, the 2020 survey prompted respondents to mark all specialties that applied to their primary employment position. The responses with more than one option marked were then re-coded into the “Multiple Areas” category. This yielded about 22.4% of the LPN population (described in Table 28). The distribution of employment specialties might be under-estimations of the actual workforce due to the way the survey question was posed in comparison to the NCSBN survey. The 2020 survey was designed to address those LPNs who travel to several work settings for employment or who provide consultation to more than one specialty area. Additionally, the 2020 survey provided more specialty response options than the national survey including: Multiple Areas, No Specific Area, Chronic Care, Dermatology, Gastrointestinal Health, Genetics, Infectious/Communicable Disease, Neurology/Neurosurgical, Orthopedics, Primary Care, Pulmonary/Respiratory, Radiology, and Urology.

Geriatric care was the top reported specialty among LPNs who reported only one specialty area. This fell in line with what the national survey reported. Similarly, Utah’s other top reported specialties for LPNs also coincided with the NCSBN report. Utah’s LPNs reported working in home health at a rate of 7.3% compared to 10.2% reported nationally. Likewise, 6.2% of Utah LPNs reported employment in pediatrics compared to 7.5% for the nation, and 6.0% reported work in rehabilitation compared to 4.3% nationally.

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LEVEL OF CARE

Table 29: Distribution of LPNs based on Level of Care Provided

The top reported types of care provided by LPNs included long-term/nursing home care at 20.2% followed by home health at 15.9% as seen in Table 29.

PATIENT POPULATION

Table 30: Patient Population Distribution for LPNs

The 2020 survey prompted respondents to indicate the patient groups where fifty percent or more of their time was spent delivering care. Responses with more than one option selected were then re-coded into the “Multiple Age Groups” category, yielding 38.0% of the LPN workforce as shown by Table 30. Geriatric care made up the next top reported patient population among LPNs at 25.8%, coinciding with the top reported employment specialty among LPNs, which also 58 | Supply of Nurses in Utah: The 2020 Survey of Utah’s Registered Nurses and Licensed Practical Nurses

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involved geriatric health. Compared to RNs, 18.2% more LPNs worked with geriatric patients. Adult patients were the next top reported group for both LPNs and RNs with 4.3% less LPNs providing adult care in comparison to Utah’s RNs.

POSITION TITLE

Table 31: Distribution of LPNs based on Position Title

As described in Table 31, 56.2% of Utah’s LPNs reported their primary position title as staff. This was a 16.9% smaller proportion than what the NCSBN survey reported for LPNs. When compared to RNs, 13.9% more LPNs reported working as staff. Additionally, 13.1% of LPNs indicated having no position title, compared to 16.4% of RNs reporting no position title. Of the LPNs who reported having a faculty or educator position, there was an 8.8% difference between Utah LPNs and what was reported nationally, with the larger proportion reported in Utah. Similarly, 2.1% more LPNs reported employment as faculty compared to the RN workforce.

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PRECEPTORSHIP

Table 32: Nursing Mentorship Distribution for LPNs

Less than 20% of Utah’s LPN workforce reported serving as a mentor to nursing students according to Table 32. This was a 26.1% difference from what was reported by the state’s RNs. LPNs who did serve as preceptors for nursing students reported a median of three students mentored each year. The median number of nursing students mentored yearly was the same for both LPNs and RNs.

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UTAH’S FUTURE NURSING WORKFORCE

SECTION 11: PROJECTED SUPPLY OF UTAH NURSES

The future workforce supply of Utah’s nurses was estimated using license data. RN and LPN license issuance and expiration was analyzed to calculate the yearly growth rates of the nursing workforce. As Figure 26 shows, over the last decade, an average of 1,533 new RN licenses and 19 new LPN licenses were issued per year. Within the last five years, that average changed to 1,695 new RN and 44 new LPN licenses per year. License expirations remained steady in correlation with licenses issued.

Figure 26: RN and LPN Licenses Changes by Year

3500 3000 2500 2000 1500 1000 500 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

RNs Issued LPNs Issued RNs Expired LPNs Expired

Between 2014 and 2019, the number of active RN licenses increased by 21.5%. Concurrently, active LPN licensure also increased by 8.1%. Within the last five years, these growth rates yielded an average increase of 7,866 active RN and 545 active LPN licenses, as seen in Figure 27. If such trends continue, the nursing supply is predicted to increase steadily over the next decade.

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Figure 27: Active RN and LPN Licenses by Year

50000

40000

30000

20000

10000

0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

RN LPN

The UMEC’s licensed RN and LPN per 100,000 population ratios (837 and 64, respectively) were greater than the estimates reported by the Bureau of Labor Statistics (BLS). The BLS approximated that the ratios were 906 RNs and 212 LPNs nationally, 537 RNs and 105 LPNs in the Western region (including California, Oregon, Washington, and Nevada), and 664 RNs and 60 LPNs in Utah. Illustrated by Figure 28 for RNs and Figure 29 for LPNs, these comparisons indicated that Utah had more nurses working within the population compared to surrounding states for RNs and slightly less reported for LPNs.

Figure 28: Current RN Population Ratio per 100,000

906.1 837.2

664.1 536.5

Utah, UMEC Utah, BLS Western, BLS National, BLS

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Figure 29: Current LPN Population Ratio per 100,000

211.9

104.6

64.0 60.4

Utah, UMEC Utah, BLS Western, BLS National, BLS

In order to maintain the current nurse per 100,000 population ratio of 837 for RNs and 64 for LPNs, the state needs to issue 479 RN licenses and 37 LPN licenses per year over the next ten years. Based on the changes in active licensure for the last five and ten years, it has been estimated that some 4,793 RNs and 366 LPNs will need to enter the workforce over the next decade in order to maintain the current nurse per 100,000 population ratio as illustrated by Figure 30 for RNs and Figure 31 for LPNs.

Figure 30: RN Projected Growth

44246

42623

27298 32091

2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029

Range (5 & 10 Year Growth Average) Linear (RNs Needed to Maintain Current Population Ratio)

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Figure 31: LPN Projected Growth

2529

2087 2453

2279

2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029

Range (5 & 10 Year Growth Average) Linear (LPNs Needed to Maintain Current Population Ratio)

Analysis of recent workforce expansion aided in projecting future growth. As mentioned, an average increase of 1,532 RN and 19 LPN licenses were added to the workforce in the last five years, while an average of 1,695 RN and 44 LPN licenses were added in the last ten years. Both the five- and ten-year rates were used to project the growth of the nursing workforce into the next ten years. Using the slower, ten-year average rate, the nursing workforce was estimated to yield some 44,246 RNs and 2,529 LPNs, whereas the five-year average rate was projected to produce 42,623 RNs and 2,279 LPNs. Even at the slower rate, the projected growth is predicted to generate more RNs and LPNs than the current ratios.

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SUMMARY FINDINGS & CONCLUSION

The World Health Organization (WHO) designated 2020 as the International Year of the Nurse and the Midwife in honor of the 200th anniversary of Florence Nightingale’s birth. Nurses make up the largest portion of the healthcare workforce in the United States and across the globe. A Gallup poll released in January of 2020 confirmed that for the 18th year in a row, Americans rated the honesty and ethics of nurses highest among a list of professions that Gallup asks US adults to assess annually.4

The nursing workforce is also experiencing some of the most direct impacts of the COVID-19 pandemic. Nurses are on the front lines, working with patients in hospitals and long-term care on a daily basis. As nursing continues to grow and evolve as a profession, it is important to continue tracking changes in demographic distribution, especially racial and ethnic distributions, as well as scope of practice and the migration of nurses from the settings they are in currently, into areas of identified population health needs such as primary care and geriatric care. Nursing workforce migration across the country in response to local and regional demands as related to expansion of the nurse licensure compact and its resulting affect on the workforce actually practicing in each state in comparison to the number licensed in each state is also an area that should have more attention into the future. Particular effort should be made to describe exactly the types of services that are most appropriate for nurses to provide in response to population health needs in order to more accurately describe shortage or surplus of the nursing workforce in the state.

RECOMMENDATIONS

In 2010, the National Academy of Medicine (formerly the Institute of Medicine) in partnership with the Robert Wood Johnson Foundation released The Future of Nursing: Leading Change, Advancing Health. The report recommended that nurses’ roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by healthcare reform and to advance improvements in America’s increasingly complex health system. The Utah Nursing Workforce Information Center has had the opportunity to track progress toward these national goals using the data collected from our nursing workforce supply surveys. The Future of Nursing report also emphasized that “effective workforce planning and policy-making require better data collection and an improved information infrastructure.”

Over the last decade, nursing has undergone transformations that include improved laws that have led to better access for more people to healthcare, a more highly educated nursing workforce, growth in the number of nurses in leadership roles, and growing diversity in nursing. The onset of the COVID-19 pandemic caused the National Academy of Medicine (NAM) to take a step back on their planned release of a new Future of Nursing 2020-2030 report that had been

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planned for release in December of 2020. The delay will allow for inclusion of analysis of the dramatically changed context and rapidly deployed changes in clinical care, nurse education, leadership, and community partnerships that are occurring as a result of the pandemic.

It is anticipated that the coming report will set the direction for nursing workforce policy for the next ten years. According to press releases from the NAM study committee5, this report will focus on the role of the nursing profession to allow everyone fair and just opportunity for health, reduction of health inequities, and improvement of health and well-being of the US population into the 21st century.

In order to support the pursuit of established and forthcoming goals of the nursing workforce, the Utah Nursing Workforce Information Center will:

1. Continue tracking changes in workforce supply factors about nursing roles, education progression, demographic equity with the state population, and workforce growth and retirement changes. These factors include: a. Percent of nurses prepared at the baccalaureate level or higher b. Number of licenses issued/retired per year c. Percent of nurses licensed in-state who practice in-state d. Race, ethnicity, and gender distribution e. Specialty and practice setting

2. Pursue continued improvement to information systems, data collection, and automation of analysis to provide relevant and timely information about progress toward established goals and swift response to emerging issues. a. Support efforts to request legislative change in order to incorporate supply survey data collection into the DOPL license and renewal process.

3. Further integrate workforce demand and education data with supply data to provide the best possible picture of the systemic factors involved in health workforce planning including: a. Workforce employment/setting migration b. Retention and import of workforce into the state by tracking licenses obtained by endorsement vs. National Council Licensure Examination (NCLEX-RN exam) c. Describe evolving nursing roles in inter-professional and primary care delivery

5 https://campaignforaction.org/future-of-nursing-2020-2030-report-delayed-until-spring- 2021/#:~:text=Initially%20planned%20for%20release%20in,nursing%20leadership%2C%20and%20nursing%2D community 66 | Supply of Nurses in Utah: The 2020 Survey of Utah’s Registered Nurses and Licensed Practical Nurses

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APPENDICES

APPENDIX A: SURVEY INSTRUMENT & COVER LETTER

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APPENDIX B: REFERENCES

Future of nursing 2020-2030 report delayed until spring 2021. (2020, July 30). Campaign for Action. Retrieved from https://campaignforaction.org/future-of-nursing-2020-2030- report-delayed-until-spring-2021/#:~:text=Initially%20planned%20for%20release%20in, nursing%20leadership%2C%20and%20nursing%2Dcommunity

National Academy of Medicine (formerly Institute of Medicine). (2010). The future of nursing: Leading change, advancing health.

National Forum of State Nursing Workforce Centers. (2016, September). Minimum nurse supply dataset. Retrieved from https://nursingworkforcecenters.org/minimum-datasets/

Reinhart, R. J. (2020, January 6). Nurses continue to rate highest in honesty, ethics. Gallup. Retrieved from https://news.gallup.com/poll/274673/nurses-continue-rate-highest- honesty-ethics.aspx Smiley, R. A., Lauer, P., Bienemy, C., Berg, J. G., Shireman, E., Reneau, K. A., & Alexander, M. (2019). The 2017 national nursing workforce survey. Journal of Nursing Regulation, 9(3), 1-88. U.S. Bureau of Labor Statistics. (2019). Occupational employment statistics, May 2019. Retrieved from https://www.bls.gov/oes/current/oes291141.htm U.S. Census Bureau. (2019a). Quick facts (United States). Retrieved from https://www.census.gov/quickfacts/fact/table/US/PST045219 U.S. Census Bureau. (2019b). Quick facts (Utah). Retrieved from https://www.census.gov/quickfacts/fact/table/UT/PST045219 U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health and Workforce Analysis. (2019a). Brief summary results from the 2018 national sample survey of registered nurses. U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. (2019b). Technical report for the national sample survey of registered nurses. Utah Medical Education Council. (2016). Supply of nurses in Utah: The 2016 survey of Utah’s registered nurses.

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