Indiana Registered Nurse Survey Draft Report oct 5ahec.medicine.iu.edu/files/8112/9589/2062/WF-RN-2005.pdfAHEC 2005 Indiana Registered Nurse2005 Indiana Registered Nurse Survey ReportSurvey

AHEC

2005 Indiana Registered Nurse2005 Indiana Registered NurseSurvey ReportSurvey Report

Produced by:

The Center for Indiana Health Workforce Studies

Bowen Research Center, Department of Family MedicineIndiana University School of Medicine

In collaboration with the:

Indiana Area Health Education Centers Program

November 2007

Authors:Terrell W. Zollinger, DrPHMichael J. Przybylski, PhDBrittany S. Sutton, MPHLinda D. Jackson, MS, RN, CCRN

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Acknowledgements

Preparing this resource guide required the assistance, cooperation, and effort of many individuals and agency staff. The survey data and additional data elements were provided by the Indiana Professional Licensing Agency through the Indiana State Department of Health.

An advisory committee provided direction and insights: Jonathan Barclay, MA, Indiana Health Education Center Program Donna Boland, PhD, RN, Indiana Nursing Workforce Development Collaborative S. Kim Genovese, RN, PhD(c), MSN, MSA, Nursing 2000 North Ernest K. Klein, RN, Indiana State Nurses Association Cynthia L. Stone, DrPH, RN, IU School of Nursing Kathy Weaver, JD, MPA, RN, Indiana State Department of Health

The cooperation and support of the Indiana State Department of Health and the Indiana State

Nurses Association were instrumental in obtaining the survey data and interpreting it. The authors are grateful for the financial support received from the Indiana Area Health Education Center Program to produce this report.

Terrell W. Zollinger, DrPH Michael J. Przybylski, PhD Brittany S. Sutton, MPH Linda D. Jackson, MS, RN, CCRN

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Table of Contents

Executive Summary Pages iv - vi Chapter 1: Introduction Pages 1 - 4 Chapter 2: Frequencies of Survey Item Responses Pages 5 - 17 Chapter 3: Crosstabulation of Nurse Characteristics with Selected Items

Highest Degree in Nursing Pages 18 - 21 Principal Position Pages 22 - 26 Setting of the Principal Position Pages 27 - 30 Key Activities in the Principal Position Pages 30 - 36

Chapter 4: Detail for Specialty Nurses

Nursing Faculty Pages 37 - 39 Advanced Practice Nurses Pages 39 - 43

Chapter 5: Location of Nurses by County in Indiana Pages 44 - 45 Chapter 6: Trends in the Registered Nurse Workforce Pages 46 – 49 Chapter 7: Conclusions Pages 50 – 51 Appendix 1: 2005 Indiana Registered Nurse Survey Instrument Appendix 2: National Sample Survey of Registered Nurses Survey Instrument Appendix 3: Recommendations to Improve the Survey

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Executive Summary Introduction A voluntary survey instrument was attached to the Registered Nurse (RN) license renewal form during the 2005 Indiana RN re-licensure period. The RN survey was implemented through a collaboration of the Indiana State Department of Health and the Indiana Professional Licensing Agency. This report summarizes the responses to the survey items and compares the results of this survey to the results of previous RN surveys. Methods The purpose of the survey was to provide high quality data about RNs in Indiana to help policy makers and program directors understand the RN work environments and other related information. Survey items included current work status, their positions and the activities they perform in their principal positions as well as the setting and location of their work sites. Other items included the RN level of educational achievement and their plans to obtain higher degrees in the future. Finally items to measure the demographic characteristics of the RNs were included. Survey Response Rate A total of 70,982 RNs renewed their Indiana licenses in 2005; 61,792 renewed their licenses “on-line” and were invited to complete the survey. Of these nurses, 56,670 (91.8%) completed the survey, representing 79.8% of all who renewed their licenses in 2005. Actively Practicing Over 85 percent of the respondents (48,435 nurses) indicated that they were actively practicing in a nursing position. Among those actively practicing, 43,616 (90.1%) were practicing in Indiana. Demographic Characteristics One-half (49.7%) of the nurses were age 45 or older, an increase from 42.7% age 45 or older in 1997. Almost all (94.9%) were females; however, the percent who are men has increased from 3.7% in 1997 to 5.1% in 2005. In 2005, most (94.2%) RNs were white. This was a slight decrease since 1997 (95.4%). Very few respondents indicated that they were Hispanic (1.5%). The most common levels of training for RNs were an Associate degree (44.6%) or Bachelor’s degree (36.7%). The percent with a Bachelor’s degree had increased from 30.2% in 1997. Nearly one-half of RNs (44.7%) indicated that they desired a higher degree; most commonly a Master’s degree (51.8%). Very few (3.9%) indicated that they were fluent in a language other than English. Nearly 4 in 10 (38.4%) have been licensed as an RN in Indiana for less than 10 years; nearly one-third (31.8%) have held their Indiana RN license for 20 or more years. Employment Characteristics Over one-half (61.2%) of the RNs worked in a hospital setting in 2005; most of the rest worked in ambulatory care settings (14.3%) or other facilities (8.2%). A few (14.1%) reported that they worked in more than one paid position. Nearly two-thirds (63.9%) reported that their principal position was a direct patient care position. One-fifth (21.6%) worked in indirect patient care positions. Key activities reported in the nurses’ primary positions included patient care (76.8%), patient education (33.6%), medication management (19.3%), and supervision or management (18.3%). The RNs reported that they frequently cared for non-elderly adults (74.1%) and elderly adults (62.0%). Nearly one-half (47.1%) of the RNs reported working 40 or more hours per week; another one-third (31.5%) worked 30-39 hours per week. One-half (49.2%) reported working in other health care positions prior to becoming a RN.

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Characteristics Related to Level of Education Those with Associate and Bachelor’s degrees were younger, while those with Master’s and Doctorate degrees were older. Men were more often in the higher education categories. Most of those with Associate and Bachelor’s degrees were working in patient care settings. More of those with Master’s and Doctorate degrees were working in educational settings. Characteristics Related to Principal Position Younger RNs were more often working in patient care positions, while the older RNs were more often employed in educational positions and advanced practice nursing positions. Black/African American nurses were more often working in indirect patient care or nursing related business positions. Men were more often employed in advanced practice positions, particularly as nurse anesthetists (53.4% of whom were male). RNs with less than 5 years of Indiana licensure were more often working in direct patient care positions. Characteristics Related to Principal Work Setting Younger RNs more often worked in hospital settings, while older RNs more often worked in government and education settings. Black/African American nurses more often worked in private business settings. Male RNs were more often working in private business and hospital patient care settings and less often in education settings. Those with less than 5 years of Indiana licensure were more often practicing in hospital patient care settings. Characteristics Related to Key Activities Most of the younger RNs reported performing patient care activities; relatively fewer of the older nurses reported patient care as a key activity. White nurses more often reported continuing education/staff development, consulting with agencies and other professionals, and quality assurance/utilization review as key activities. Male nurses more often reported administrative activities as key activities. Nurses with the fewest years of Indiana licensure more often reported patient care as a key activity. Nursing Faculty The age distribution of nursing faculty was older than that for all RNs. Nursing faculty members were less likely to be male and more likely to be black or African-American. As expected, nursing faculty much more often held Master’s and Doctorate degrees. Most, but not all faculty members reported their principal positions were in an education setting. Faculty members were much less likely to report patient care and administrative activities among their key activities. Nursing faculty members had, on average, held their Indiana RN licenses much longer than other RNs. Advanced Practice Nurses Nearly two-thirds (64.4%) of all Advance Practice Nurses (APN) were Nurse Practitioners and another 30.2 percent were Clinical Nurse Specialists. Nurse Practitioners tended to be slightly younger than those in the other APN categories and Certified Nurse Midwives tended to be older. The majority of Certified Nurse Anesthetists were males (53.4%) while other APN nurses were less likely to be males (4.2%) than nurses overall (5.1%). APN nurses were less likely to be black or African-American (1.9%) than nurses overall (2.9%). Most of the APN nurses had Master’s degrees (75.2%). A majority of all APNs were in patient care settings. But most of the Nurse Practitioners (72.1%) and Certified Nurse Midwives (52.0%) were in non-hospital patient care settings while most Certified Nurse Anesthetists and Clinical Nurse Specialists were in hospital patient care settings (77.2% and 53.7% respectively). Over 80 percent of APNs listed direct patient care as a key activity and over one-half listed “patient education and counseling”. Generally, APNs had held Indiana RN licenses longer than other RNs.

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Location of RNs in Indiana Higher numbers of RNs and higher ratios of RNs per population were found in urban counties including Allen, Elkhart, Lake, Marion, St. Joseph, Tippecanoe, Vanderburgh and Vigo. In addition, higher ratios of RNs per population were noted in Bartholomew, Dubois, Floyd, Knox, and Wayne Counties. Time Trends in the RN Workforce The total number of individuals renewing Indiana RN licenses has been fairly constant over the past nine years; however, the number of RNs who are active in Indiana has been increasing. The number of nurses in the 45-54 age group has increased over the nine year period. The number of diploma trained nurses has been decreasing, while the numbers of RNs in the other education groups have been increasing. There has been an increase in the number of nurses who reported working 30-39 hours. There have been sharp increases in the number of Advanced Practice Nurses of all types over the nine year period. However, the number of nursing faculty has remained fairly constant. Conclusions There has been an increase in the number of licensed nurses actively practicing in Indiana, but many do not work in direct patient care positions. Clearly, the nursing work force is getting older, as is the population in general. This aging trend suggests that as the “baby boomer” nurses retire, there will be a drop in the number of active nurses in Indiana – a trend also forecast in HRSA’s 2004 report. The number of Advance Practice Nurses has increased rapidly in the past nine years. There is a demand for obtaining higher degrees in nursing, yet the number of nursing faculty has not increased over the past nine years. Recommendations A number of changes to the survey instrument were suggested to improve the quality of the data and to improve comparability with other surveys. In addition, it is recommended that all nurses be instructed to complete the survey as part of the licensing process.

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Chapter 1: Introduction

Indiana continues to experience chronic shortages of a wide range of health professionals. These shortages are more serious in specific geographical areas of the state and with specific health professionals. Of particular concern is the current shortage of Registered Nurses (RNs). Having an accurate understanding of the personal and professional characteristics of registered nurses licensed in Indiana is critical when developing and managing programs to recruit and retain nurses where they are most needed. Having quality data about registered nurses in Indiana will help policy makers and program directors make better decisions than they would be able to make otherwise. The purpose of this report is to provide those quality data.

Starting in 1997, registered nurses have been asked to complete surveys as part of their relicensure

process, which occurs every two years. In addition to the 1997 survey, registered nurse surveys were also conducted in 2001, 2003, and 2005. The 1997 and 2001 Indiana Registered Nurse Surveys were conducted by mail using a paper format. Online license renewal was implemented in early 2003. A voluntary survey instrument was attached to the on-line renewal form during 2003 and 2005, but no surveys were collected by mail in these years. The 2001 survey items were revised for 2003 and 2005, with nine additional questions added, a longer list of response options provided, and other minor changes. The 2005 online Registered Nurse survey was implemented through a collaboration of the Indiana State Department of Health (ISDH) and the Indiana Professional Licensing Agency (PLA). The 2005 registered nurse survey instrument included items to address current work status, primary position, and the activities performed in the principal position, as well as the setting and location of their work site. Other items address the education of the nurses and their plans for obtaining future degrees. Finally, items to address specific demographic characteristics were added. A copy of the 2005 Indiana Registered Nurse Survey instrument is included in Appendix 1.

This report summarizes the responses to the 2005 Indiana Registered Nurse Survey and compares the results from the current survey to the results of the prior Registered Nurse surveys. Included in this analysis was information from the IPLA database regarding the age of the nurses, their license status, and initial year of their licensure in Indiana. Response Rate

As shown in Table 1.1 (on the next page), 70,982 registered nurses renewed their licenses in 2005; 61,792 renewed online and the other 9,190 renewed by mail. The total number of nurses who renewed their license increased from 1997 to 2001, but has declined slightly since. Only those who renewed online were given the opportunity to complete the survey in 2003 and 2005. Of the total number who renewed online in 2005, 91.7 percent (56,670 of 61,792) completed the survey, a rate comparable to the overall response rates shown for 1997 and 2001 (89.0% and 93.6% respectively). But due to the inability to survey nurses who renewed by mail, the overall response rate was only 79.8 percent in 2005. This was an improvement from the 66.3 percent total response rate in 2003 (But the response rate among nurses renewing electronically was also good in 2003 – 93.2%). The overall response rates are shown in bold in the bottom row of Table 1.1.

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Table 1.1 Renewal Method, Survey Responses, and Percent Active: 1997 – 2005

1997 2001 2003 2005

Registered Nurses Number Percent of Total Number Percent

of Total Number Percent of Total Number Percent

of Total Total Renewing 69,893 100.0 72,928 100.0 71,585 100.0 70,982 100.0

Renewed Electronically 0.0 0.0 50,969 71.2 61,792 87.1

Respondents 62,230 89.0 68,258 93.6 47,495 66.3 56,670 79.8 Registered Nurses Active in Indiana

It is important to note that these data reflect only the registered nurses who renewed their licenses.

Initial licensees are not surveyed since few of the questions would be relevant to them. Thus, the total number of active registered nurses is greater than shown in the tables and projections of this report.

Table 1.2 Registered Nurses: Percent Active in Indiana: 1997 – 2005 1997 2001 2003 2005

Registered Nurses Number % Number % Number % Number %

Total Respondents Active (% of Respondents) 48,147 77.4 54,132 79.3 39,829 83.9 48,435 85.5

Respondents Active in Indiana* (% of Active) 38,721 80.4 45,615 84.3 35,963 90.3 43,161 90.1

* Indiana location was determined from zip code of principal position response in 1997 and 2001 but from “whether your spend most of the time in your principal position in Indiana” response in 2003 and 2005.

The number of active survey respondents shown in Table 1.2 cannot be interpreted as a trend because it is a reflection of the survey response rate; only respondents could indicate their work status. The percent of respondents who report being active may indicate an interesting trend, increasing from 77.4 percent in 1997 to 85.5 percent in 2005. One caveat to this conclusion is that in 2003 and 2005 only nurses responding electronically could indicate whether they were actively practicing. Any relation between electronic license renewal and whether a nurse is active could introduce a bias.

A caveat is also necessary in interpreting the trend of active nurses practicing in Indiana vs.

elsewhere (shown in the bottom row of Table 1.2). In 1997 and 2001 the percentages in Table 1.2 (80.4% and 84.3% respectively) were based on the ZIP code reported by each nurse for the location of their primary nursing position. In 2003 and 2005 another question was also asked: “Do you spend most of the time in your principal position within the sate of Indiana?” Higher percentages answered “yes” to this question in 2003 and 2005 (90.3% and 90.1% respectively). The ZIP code was also requested in 2003 and 2005. Some nurses answering “yes” to the “within Indiana” question reported ZIP codes outside Indiana. Data Analysis

The Department of Family Medicine’s Bowen Research Center staff received a data disk from ISDH that contained the responses to the 2005 registered nurse survey as well as two additional variables from the IPLA registered nurse licensure dataset: age and year first licensed in Indiana. A Statistical Program for the Social Sciences (SPSS) dataset was created from the data provided. A data dictionary was available from the contractor of the data disk to describe the data in the dataset. A new age variable was created to remove extreme age values.

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The SSPS software was used to analyze the data compiled from the online survey and licensure information about the registered nurses from the IPLA database. Only nurses with active license status, nurses on probation or licenses being reviewed, were included in most of the results presented in this report. Nurses with suspended licenses as well as those who were inactive and those who were working in non-paid nursing positions were excluded. A working data set was created for only those registered nurses working or living in Indiana. This data set was further divided into three data sets: 1) actively working registered nurses, 2) registered nurses not working in a paid nursing position, and 3) unemployed registered nurses. Of the 56,819 respondents to the 2005 survey, 46,429 (81.7%) registered nurses were working or living in Indiana. About 6.7 percent of these (3,121) were not actively working in a paid nursing position. The major focus of this report is on the 43,161 actively working registered nurses in paid nursing positions in Indiana, as shown in Table 1.3.

Table 1.3 Current Work Status of Indiana Registered Nurses, 2005 Work Status Number PercentActively working in a paid position in nursing *43,164 93.3Actively working in paid position in health care, but not in nursing 1,337 2.9Actively working, but not in nursing or in health care 526 1.1Working in nursing, but ONLY on a non-paid basis 452 1.0Unemployed and seeking work as a nurse in Indiana 220 0.5Temporarily inactive as a nurse 409 0.9Retired from nursing or permanently inactive as a nurse 174 0.4

Total Valid Responses 46,282 100.0No response on work status 147

Total Living or Working in Indiana 46,429 * 3 suspended nurses were included as actively working in a paid registered nurse position in this table, but were excluded from the data analysis. Thus, data on 43,161 nurses active in Indiana are shown in the tables in the following sections.

Limitations of the Survey

Several concerns with the survey instrument, the administration of the survey, and with the consistency of nurses’ responses were raised during discussions with members of the advisory committee. Appendix 3 includes recommendations for improvement, along with the justifications for the proposed changes. Implementing these recommendations will improve the validity and reliability of the data collected and reported. However, implementing some of the changes will reduce the ability to measure time trends since specific items may not be comparable. The authors of this report believe it is more important to improve the quality of the data than to continue to collect flawed data for the sake of comparisons with earlier surveys.

Organization of this Report

The following chapters in this report present the results of several different analyses of the 2005 registered nurse survey data. Chapter 2 provides tables summarizing the responses to all of the survey questions as well as the additional licensing and age data provided by PLA. Graphs illustrating responses to key items are also shown. Summary statements relating to the tables and graphs are presented in text form following each table and graph. When comparisons are made between the 2005 and the earlier surveys, the percentages of responses are discussed in the text, rather than the number of nurses. The numeric trends over time are estimated in Chapter 6, in which the estimated number of nurses each year

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included a correction for the differing response rates of the surveys. Chapter 3 shows the relationships between the nurses’ demographic, personal and professional characteristics. Four sets of tables are included that break down the respondents’ characteristics by level of education, by principal position, by work setting and by key activities. The response options for principal position, work setting and key activities were collapsed into general themes. The results of these analyses are presented as cross-tabulation tables showing both the number of respondents and percent of respondents within each cell. Chapter 4 focuses on the characteristics of the faculty in nursing education programs and on advanced practice nurses (APN). Chapter 5 presents maps of Indiana and tables showing the number of nurses and the ratio of nurses to population in each county. Chapter 6 uses the responses from the 1997, 2001, 2003 and 2005 registered nurse surveys to project time trends for a number of nurse characteristics. The analysis of trends corrected for the three surveys’ differing response rates. Since the projections are based on values at only four points in time, the projections should be interpreted with caution. None-the-less, it is important to consider the apparent trends. Chapter 7 summarizes the results of the data analysis.

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Chapter 2: Responses to the 2005 Indiana Registered Nurse Survey

This chapter summarizes the responses to the items included on the 2005 Indiana Registered Nurse Survey as well as the additional registered nurse data provided by the Indiana Professional Licensing Agency. Unless otherwise noted, the number of respondents for the 2005 registered nurse survey shown in the tables below was 43,161. The number of missing responses is shown for each question and only the percentages of valid responses are shown. Where possible, comparisons are presented between the responses to the 2005 and prior surveys (1997 and 2001). The total respondents to the 1997 and 2001 surveys were 38,721 and 45,615 respectively. The 2003 survey results are not reported because the response rate was lower (66%) increasing the possibility of a non-response or self-selection bias among those who did respond in 2003.

Table 2.1 Age of Active Registered Nurses, 2005 Age Groups Number Percent 24 or younger 1,241 2.925-34 8,541 20.035-44 11,761 27.545-54 14,312 33.555-64 6,150 14.465 or older 766 1.8missing 390

Table 2.2 Age Groups of Inactive Registered Nurses, 2005 *Employed **Unemployed Age Groups Number Percent Number Percent 24 or younger 14 0.6 3 0.4 25-34 210 9.2 56 7.1 35-44 594 26.0 146 18.5 45-54 861 37.6 201 25.4 55-64 458 20.0 209 26.4 65 or older 151 6.6 176 22.3 missing 27 12 Total 2,315 803

* Employed or volunteering, but not in a paid registered nurse position. ** Unemployed and seeking work as a nurse in Indiana, temporarily inactive as

a nurse, or retired from nursing.

Tables 2.1 and 2.2 show age data from the 2005 survey. These data are somewhat biased relative to all nurses because nurses with newly-issued licenses (who are often among the youngest) were not included in this survey (it was taken upon re-licensure). Among survey respondents active in Indiana, Table 2.1 shows that about one-half were 45 years of age or older (33.5% + 14.4% + 1.8%). About one-fourth (20.0% + 2.9%) were under age 35. Respondents not working as nurses in 2005 are shown in Table 2.2. These inactive nurses tended to be older than the active nurses (the percentage of respondents in higher age groups was larger and the percentage in lower age groups was smaller). Among those who were employed or volunteering, about 64 percent were age 45 or older. Over 74 percent of the unemployed, inactive nurses were 45 or older. Figures 2.1 through 2.3 compare the age distributions graphically.

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*Nurses in their initial license period are not in this sample. Younger nurses may be under-represented.



Figure 2.1 Age Groups of Active Registered Nurses, 2005

24 or younger 3%

25-34 20%

35-44 27%

45 - 54 34%

55- 64 14%

65 or older 2%

Figure 2.3 Age Groups of Unemployed, Inactive Registered Nurses, 2005

55-6426.4%

45-5425.4%

35-4418.5%

25-347.1%65 or older

22.3%

24 or younger0.4%

Figure 2.2 Age Groups of Employed, Inactive Registered Nurses, 2005

45-54 37.6%

55-64 20%

65 or older 6.6%

24 or younger 0.6%

25-349.2%

35-44 26%

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* Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission. Available at: http://www.in.gov/isdh/publications/97nurse/toc.htm (and …/01nurse/toc.htm)

Table 2.3 shows the age distribution of active registered nurses in 1997, 2001, and 2005.

Generally speaking, the age 45 and older group grew from 1997 to 2001, while the group younger than 45 decreased.

Table 2.4 Gender of Registered Nurses, 1997, 2001, and 2005 1997* 2001* 2005 Gender Number Percent Number Percent Number Percent Female 36,572 96.3 43,192 95.7 40,619 94.9 Male 1,403 3.7 1,951 4.3 2,182 5.1 Missing 746 472 360

* Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission.

A trend toward more male registered nurses is shown in Table 2.4. While nearly 95 percent of nurses were female in 2005, the percentage male steadily increased from 3.7 percent in 1997 and 4.3 percent in 2001. There was a nearly 40 percent increase from 1997 (1,403 to 2,182).

Table 2.5 Race of Registered Nurses, 1997, 2001, and 2005 1997* 2001* 2005 Race Number Percent Number Percent Number Percent White 36,653 95.4 42,650 94.8 40,373 94.2 Black/African American 1,011 2.6 1,344 3.0 1,233 2.9 Asian/Pacific Islander 378 1.0 453 1.0 492 1.1American Indian / Native Alaskan 68 0.2 73 0.2 93 0.2 Multi-racial **NA **NA 155 0.3 210 0.5 Other 326 0.8 319 0.7 476 1.1 Missing 285 621 284

* Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission. ** NA- not asked -- "Multi-racial" was not included as a response option on the 1997 survey.

The percentage of registered nurses reporting their race as “White” decreased slightly from 1997 to 2005 as shown in table 2.5. The percentage reporting “Black/African American” rose between 1997 and 2001, but not between 2001 and 2005. There was little change in the percent of nurses identifying with “Other” racial groups throughout the period.

Table 2.3 Age Groups of Registered Nurses, 1997, 2001, and 2005 1997* 2001* 2005 Age Groups Number Percent Number Percent Number Percent 30 or younger 4,376 11.5 3,903 8.7 5665 13.2 31-44 17,488 45.8 16,793 37.3 15,878 37.1 45-54 10,999 28.8 15,911 35.4 14,312 33.5 55-64 4,658 12.2 7,121 15.8 6,150 14.4 65 and older 665 1.7 1,279 2.8 766 1.8 missing 535 608 390

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Registered nurses reporting Hispanic ethnicity increased over the 1997 to 2005 period. However, only 658 respondents identified themselves as Hispanic in 2005, about 1.5 percent of all nurses active in Indiana. Many more nurses responded to this question in the 2005 survey; over four thousand had skipped this question in 2001.

Table 2.7 Highest Degree in Nursing, 1997, 2001, and 2005 1997* 2001* 2005 Highest Degree in Nursing Number Percent Number Percent Number PercentDiploma** 8,121 21.0 6,663 14.7 4,602 10.7Associate 17,077 44.2 19,879 43.9 19,190 44.6Bachelor's 11,667 30.2 15,745 34.8 15,809 36.7Master's 1,690 4.4 2,828 6.2 3,162 7.3Doctorate 94 0.2 172 0.4 263 0.6Missing 72 328 135

* Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission. ** Although a nursing diploma is not a “degree”, the survey question language of “highest degree” will be followed in this report to avoid awkwardness and confusion.

Table 2.7 shows a very clear trend toward higher nursing degrees between 1997 and 2005. The proportion with a nursing diploma has greatly declined (from 21.0% to 10.7%) reflecting the decline in diploma training programs. The proportion with a master’s degree or higher has greatly increased (from 4.6 % to 7.9 %) while those with a bachelor’s degree increased from 30.2 percent to 36.7 percent. Figures 2.4 through 2.6 below highlight the changes in nursing education among registered nurses, particularly the decrease in the percentage of nurses with nursing diplomas.

Table 2.6 Ethnicity of Registered Nurses, 1997, 2001, and 2005 1997* 2001* 2005 Hispanic Origin Number Percent Number Percent Number PercentHispanic Origin 418 1.1 555 1.3 658 1.5Not of Hispanic Origin 35,956 98.9 40,723 98.7 42,014 98.5Missing 2,347 4,337 489

Figure 2.4 Highest Nursing Degree, Registered Nurses, 1997

Diploma 21%

Associate 44.2%

Bachelor's 30.2%

Master's 4.4%

Doctorate 0.2%

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Table 2.8 Highest Degree in Any Field, Registered Nurses, 2005 Highest Degree in Any Field Number Percent Diploma 4,015 9.3 Associate 17,168 39.9 Bachelor's 17,296 40.2 Master's 4,090 9.5 Doctorate 457 1.1 Missing 135

** Although a diploma is not a “degree”, the survey question language of “highest degree” will be followed in this report to avoid awkwardness and confusion.

In 2005, unlike in the earlier surveys, nurses were asked about their highest degree in any field as

shown in Table 2.8. Since, by definition, each nurse’s response to “highest degree in any field” cannot be lower than their response to “highest degree in nursing”, the distribution is higher in Table 2.8 than in Table 2.7 (a greater percent of higher degrees and lower percent of lower degrees). But Tables 2.7 and 2.8 cannot be directly compared to analyze how many individual nurses have a higher degree in a field other than nursing. A separate analysis of individual nurse’s responses (not shown) was done to quantify the extent to which nurses have higher, non-nursing degrees. This analysis showed that among the 17,296 nurses reporting a Bachelor’s degree of some kind, 12.7 percent (2,201 nurses) had a lower-level nursing


Bachelor's 36.8% Associate

44.7%

Diploma 10.7%

Doctorate 0.6%Master's

7.2%


Bachelor's 34.8%

Associate 43.9%

Diploma 14.7%

Master's 6.2%

Doctorate 0.4%

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degree. Among 4,090 respondents with a master’s degree, about 25 percent (1,024 nurses) did not have a master’s degree in nursing. There were 457 nurses who held doctorates as shown in Table 2.8. Of those nurses, 42.5 percent (194 nurses) held doctorates only in non-nursing fields. Nurses with higher degrees in non-nursing areas vary on their level of nursing degrees. For example, the 194 nurses with non-nursing doctorates had nursing degrees ranging from the nursing diploma to the master’s of nursing.

Table 2.9 Desired Future Nursing Degrees, Registered Nurses, 2005 Degree Number Percent Associate 158 0.4 Bachelor's 6,821 18.1 Master's 8,740 23.1 Doctorate 1,168 3.1

Total desiring a higher degree 16,887 44.7 No higher degree desired 20,882 55.3 missing 5,392

Table 2.9 shows that 44.7 percent of respondents in 2005 desired a higher nursing degree than

they currently hold. This percentage would be 39.1 (not shown) even if it was assumed that all the 5,392 nurses who skipped this question did not desire a higher degree.

Figure 2.7 shows the distribution of degrees sought by the 16,887 nurses desiring higher degrees

shown in Table 2.09 above. Over half (52%) of the nurses represented in Figure 2.7 wanted a master’s degree.

Table 2.10 Fluency in Other Languages, Registered Nurses, 2005 Language Number Percent Spanish 641 1.49 Filipino 256 0.59 Tagalong 214 0.50 French 157 0.36 German 156 0.36 Hindi 46 0.11 Chinese 45 0.10 Polish 44 0.10 Other 143 0.33 Total 1,702 3.94

Few registered nurses (3.94%) reported fluency in languages other than English in 2005.

However, fluency is a high standard in language proficiency. If the question were worded differently, such as, “Do you have the ability to communicate languages other than English?” one would expect that a higher percentage of registered nurses would indicate that they have such ability. Spanish was the most

Figure 2.7 Desired Future Nursing Degrees of Registered Nurses, 2005

Bachelor's40%

Master's 52%

Associate 1%

Doctorate 7%

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common fluent language (1.49%) followed by the languages of the Philippines (1.09%) [which include “Tagalong” (0.50%) and “Filipino” (0.59%)].

Table 2.11 Principal Work Settings of Registered Nurses, 1997, 2001, and 2005 1997* 2001* 2005 Principal Work Settings Number Percent Number Percent Number Percent Hospital (in-patient) 9,243 24.1 11,889 26.1 13,231 32.5 Hospital (in- & out-patient) 10,978 28.6 11,916 26.2 8,575 21.1 Hospital (out-patient) 1,003 2.6 1,228 2.7 1,010 2.5 Hospital ER/ED 1,256 3.3 2,169 4.8 2,078 5.1

Hospital Total 22,480 58.6 27,202 59.8 24,894 61.2 Ambulatory care setting (surgical/other) 1,200 3.1 1,918 4.2 2,385 5.9 Physician/dentist private office 2,263 5.9 3,158 6.9 1,994 4.9 Primary care center/clinic 700 1.8 854 1.9 688 1.7 Community/public health clinic 614 1.6 683 1.5 628 1.5 Urgent care center/clinic 226 0.6 321 0.7 129 0.3

Clinic/Office Total 5,003 13.0 6,934 15.2 5,824 14.3 Long-term care facility/unit 3,193 8.3 3,368 7.4 2,500 6.1 Mental health/addictions facility/unit 703 1.8 1,187 2.6 872 2.1

Care facility/unit Total 3,896 10.1 4,555 10.0 3,372 8.2 Home care/hospice 3,506 9.1 2,437 5.4 2,195 5.4 School/college setting 1,088 2.8 1,291 2.8 1,300 3.2 Nursing education 677 1.8 709 1.6 476 1.2 Other 1,712 4.5 2,365 5.2 2,634 6.5 Missing 359 122 2,466


Table 2.11 shows the principal work settings of registered nurses in 1997, 2001, and 2005. There was a large increase in missing data and in the “other” category between 2001 and 2005. Over 5,000 survey respondents either skipped this question or answered “other” in 2005 suggesting that this question may have been unclear. Appendix 3 discusses this issue in detail and makes a recommendation to clarify this item. The majority of nurses worked in a hospital setting and the percentage has been increasing slightly over time (see “Hospital Total” in Table 2.11). There was an increase in nurses working the Hospital ER/ED setting (3.3% to 5.1%). There was a decrease in the “Hospital (in- & out-patient)” setting and a corresponding increase in the “Hospital (in-patient)” setting; a shift of more than 5 percentage points from 2001 to 2005. Among the clinic and office settings, the percentage of nurses working in “Ambulatory care setting (surgical/other)” nearly doubled between 1997 and 2005 (3.1% to 5.9%). Another trend was a decline in the “home care/hospice” category between 1997 and 2001 (9.1% to 5.4%). These conclusions about trends in the work settings of registered nurses should be interpreted with caution due to the large number of “other” responses and non-responses to this question.

The work setting question also may not be fully comparable over time due to the difference

between the 2005 response options and those of earlier surveys. The choices in Table 2.11 were the only ones included in the 1997 and 2001 surveys, but the 2005 results were compiled from a larger list of response options presented in Table 2.12 on the next page. An asterisk (*) indicates options not available in the previous surveys.

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Table 2.12 Principal Work Settings of Registered Nurses, 2005

Principal Work Settings Number Percent Hospital (in- & out-patient) 8,575 21.1 Hospital (in-patient) 12,201 30.0 Hospital (out-patient) 1,010 2.5 Hospital ER/ED 2,078 5.1 Hospital operating room * 1,030 2.5 Ambulatory care setting (surgical./other) 2,385 5.9 Physician/dentist private office 1,994 4.9 Primary care center/clinic 688 1.7 Community health center/clinic 628 1.5 Urgent care center/clinic 129 0.3 Long-term care/extended care facility/unit 1,698 4.2 Long-term acute care facility/unit * 644 1.6 Psychiatric inpatient facility/unit * 445 1.1 Mental health/addictions facility/unit 218 0.5 Home health care agency * (formerly w/Hospice) 1,603 3.9 Hospice * (formerly w/Homecare) 592 1.5 Continuing education/staff development * 101 0.2 Drug company * 88 0.2 Insurance company * 336 0.8 Nursing education program 375 0.9 Prison * 141 0.3 Public health department (city, county or state) * 255 0.6 School/college setting 1,300 3.2 Adult day care * 32 0.1 Assisted living facility/unit * 158 0.4 Community mental health center * 191 0.5 Community substance abuse agency * 18 0.0 Supplemental staffing agency * 33 0.1 Law firm * 49 0.1 Non-residential care facility/unit * 28 0.1 Occupational health setting * 347 0.9 Private duty nursing * 69 0.2 Research setting * 112 0.3 Federal agency * 147 0.4 State agency (other than state public health department) * 97 0.2 Other 900 2.2 Missing 2,466

Table 2.13 More than One Paid Position as a Registered Nurse, 2005 More than One Paid Position Number Percent Yes 6,055 14.1 No 36,966 85.9 Missing 140

About one out of seven respondents (14.1%) indicated that they had more than one paid position

as a registered nurse in 2005. This question was not asked on earlier Indiana registered nurse surveys.

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Table 2.14 Registered Nurse Principal Position, 1997, 2001, and 2005

1997* 2001* 2005 Principal Positions Number Percent Number Percent Number PercentDirect patient care 23,153 61.0 29,486 64.9 27,490 63.9Indirect patient care 10,573 27.9 10,460 23.0 9,314 21.6Nursing related business 184 0.5 269 0.6 348 0.8Education 1,144 3.0 1,243 2.7 1,402 3.3Advanced Practice Nurse (APN) 1,097 2.9 1,806 4.0 1,904 4.4Other 1,795 4.7 2,156 4.7 2,566 6.0missing 775 195 137

* Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission. Table 2.14 shows the principal nursing position reported by respondents in 1997, 2001, and 2005.

The categories in the table were defined from a much longer list on each of the surveys. Between 1997 and 2005 there was a decrease in “Indirect patient care”, but all other categories increased. Differences over time shown in Table 2.14 should be interpreted with caution due to changes in response options to this question from one survey to the next. The full list of principal position response options for all three surveys is presented in Table 2.15 below (continued on the following page).

Table 2.15 RN Principal Position, 1997, 2001, and 2005: Components of Major CategoriesPrincipal Positions 2005 2001* 1997 *

Major categories % of category

% of category

% of category

Direct patient care 27,490 29,486 23,153 Staff/general nurse 11,409 41.50 21,776 73.85 17,614 76.08Critical care nurse 4,435 16.13

Office nurse 2,138 7.78 3,096 10.50 2,393 10.34Operating room nurse 2,133 7.76

ER/ED nurse 2,072 7.54 Home care nurse 1,062 3.86 1,485 5.04 2,277 9.83

School nurse 921 3.35 1,114 3.78 869 3.75Psychiatric nurse 836 3.04

Longterm care nurse 803 2.92 1,634 5.54 Hospice nurse 467 1.70 381 1.29

Public health nurse 378 1.38 Dialysis nurse 376 1.37

Occupational health nurse 326 1.19 Prison nurse 89 0.32

Private duty nurse 45 0.16 Indirect patient care 9,314 10,460 10,573

Administrator/manager 2,957 31.75 2,801 26.78 3,048 28.83Charge nurse/team leader 2,831 30.40 4,443 42.48 4,404 41.65

Case manager/care coordinator 1,788 19.20 1,430 13.67 1,229 11.62Infection control nurse 116 1.25

Quality assurance/utilization review 362 3.89 471 4.50 507 4.80Director of nursing 608 6.53

Head nurse or assistant head nurse 351 3.77 1,078 10.31 1,148 10.86Nurse clinician 301 3.23 237 2.27 237 2.24


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Table 2.15 RN Principal Position, 1997, 2001, and 2005: Components of Major Categories

(continued) Principal Positions 2005 2001* 1997*

Major categories % of category

% of category

% of category

Nursing related business 348 269 184 Nursing consultant 169 48.56 269 100.0 184 100.0

Temporary nurse staffing service 142 40.80 Legal consultant 37 10.63

Education 1,402 1,243 1,144 Faculty in a nursing program 739 52.71 664 53.42 681 59.53

Continuing education/staff development 542 38.66 579 46.58 463 40.47Diabetes educator 121 8.63

Advanced Practice Nurse (APN) 1,904 1,806 1,097 Nurse Practitioner 1,226 64.39 1,174 65.01 668 60.89

Clinical Nurse Specialist 458 24.05 443 24.53 331 30.17**Certified Nurse Anesthetist 164 8.61 140 7.75 76 6.93

Certified Nurse Midwife 56 2.94 49 2.71 22 2.01Other 2,566 2,156 1,795

Other 2,313 90.14 2,156 100.0 1,795 100.0Researcher 253 9.86

* Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission. **The “Certified Nurse Anesthetist” position does not require an Indiana certification and was not included in analyses of Advanced Practice Nurses in the 1997 and 2001 Indiana Registered Nurse Survey Databooks. This position is included in the APN category here following the practice of the National Sample Survey of Registered Nurses (NSSRN).

Table 2.16 Activities in Principal Position of Registered Nurses, 2005 Activities in Principal Position Number Percent Administration 4,605 10.7 Case management/care coordinator 6,637 15.4 Community health activities 2,183 5.1 Consulting with agencies/other professionals 5,574 12.9 Continuing education/staff development 6,203 14.4 Direct patient care 33,136 76.8 Environmental health (air, water, food safety) 625 1.4 Financial management 1,602 3.7 Infection control 4,806 11.1 Medication management 8,312 19.3 Patient education/counseling 14,490 33.6 Program management 2,388 5.5 Policy and planning 5,332 12.4 Prenatal care coordination 755 1.7 Psychiatric nursing 1,955 4.5 Public health activities 1,424 3.3 Quality assurance/utilization review 3,898 9.0 Research 1,263 2.9 Staff supervision/management 7,894 18.3 Teaching nursing students 4,587 10.6 Other 6,827 15.8

This question (Table 2.16) measured all of the activities the nurses perform in their principal position; the respondents were instructed to mark all that apply. Consequently, the responses on this table

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will not match the similar categories in the Principal Position tables. This was a new question in the 2005 survey that was not included in the 1997 and 2001 registered nurse surveys. Over three-quarters of the nurses (76.8%) indicated that they provided direct patient care and one-third (33.6%) provided patient education and/or counseling. Other common activities listed by at least 10 percent of the respondents were: medication management (19.3%), staff supervision/management (18.3%), case management/care coordinator (15.4%), continuing education/staff development (14.4%), consulting with agencies/other professionals (12.9%), policy and planning (12.4%), infection control (11.1%), administration (10.7%), and teaching nursing students (10.6%).

Table 2.17 Age of Patients Most Frequently Served by RNs, 2005 Age of Patients Number Percent Infants (0-4) 11,375 26.4 Children (5-9) 10,040 23.3 Adolescents (10-14) 10,599 24.6 Youth (15-19) 14,088 32.6 Adults (20-64) 31,982 74.1 Elders 65 and older 26,772 62.0 RN does not provide direct patient services 216 0.5

This question (shown in Table 2.17) asked respondents to indicate the age of patients that they

most frequently serve. However, they were also instructed to select all that apply. These two instructions appear to contradict each other. This is a new question in the 2005 survey that was not included in the 1997 or 2001 registered nurse surveys. For 2005, 74.1 percent of the respondents indicated that they cared for adults and 62.0 percent cared for elders. Many of the nurses who did not provide direct patient care (based on responses to earlier questions) did not select the “I do not provide direct patient care services” response option (based on separate analysis not shown).

Table 2.18 Registered Nurses' Average Number of Weekly Hours Worked in all Activities in Nursing, 2001 and 2005

2001* 2005 Average Number of Weekly Hours Number Percent Number Percent 9 hours or less 1,194 2.6 1,056 2.510-19 2,142 4.7 1,801 4.220-29 6,820 15.0 6,231 14.630-39 11,871 26.2 13,427 31.540 hours or more 23,312 51.4 20,061 47.1Missing 276 585

* Indiana Registered Nurse Survey Databook 2001, Indiana Health Care Professional Development Commission.

The 2001 registered nurse survey asked the question shown in Table 2.18 by allowing the respondent to write in a specific number of “hours worked in all activities in nursing”. In 2005, the respondents were asked to choose a category of hours worked from a drop-down list. In 2005, nearly one-half (47.1%) selected the “40 or more” response option which would indicate full time status for nurses working one job. It is likely that some of the respondents who chose the “30-39” response option in 2005 may also be full-time employees since 36 hour (3 x 12) full-time options are sometimes available. The percentage of nurses reporting 30-39 hours was up from 26.2 percent in 2001 to 31.5 percent in 2005. Since the 30-39 hour category may be too wide to evaluate the number of 36 hour full-time nurses, future surveys should allow more response options or allow the entry of a specific number of hours. The distribution of “Average Number of Weekly Hours Worked” for 2005 is shown graphically in figure 2.8 on the next page.

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Table 2.19 Registered Nurses with Prior Work Experience, 2005: Prior Work Experience Number Percent Certified Nurse Aide 7,135 16.5 Nursing Assistant 12,357 28.6 Paramedic 297 0.7 Emergency Medical Technician 1,718 4.0 Licensed Practice Nurse 6,116 14.2

One or more of these 21,217 49.2 None of these 21,944 50.8

The question on “registered nurses with prior work experience” presented in Table 2.19 was not

included in the 1997 or 2001 surveys, so no comparisons of responses to the 2005 survey are possible. Nearly half of the respondents (49.2%) reported work experience in one or more of these health care occupations before they became a Registered Nurse. Most commonly (28.6%), that previous work experience was as a Nursing Assistant.

Table 2.20 Years of Licensure of Registered Nurses, 2005 Years of Licensure Number Percent 5 years or less 8,596 19.9 5-9 7,964 18.5 10-14 7,595 17.6 15-19 5,762 13.4 20-24 4,607 10.7 25-29 3,953 9.2 30 years or more 4,684 10.9

This data element was not a survey item. It was provided by the Indiana Professional Licensing Agency to accompany the 2005 registered nurse survey data set. It was not included in the reports summarizing the earlier surveys. Well over one-third of the respondents (38.4%) had been licensed to practice in Indiana for less than 10 years. Over one-half (56.0%) had been licensed in Indiana for less

Figure 2.8 Registered Nurses' Average Number of Weekly Hours Worked, 2005

20-2915%

30-3932%

40 hours or more 47%

9 hours or less2%

10-194%

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than 15 years. Nearly one-third (31.8%) had been licensed more than 20 years. Figure 2.9 below presents the same data graphically.

Figure 2.9 Years of Licensure of Registered Nurses, 2005

5-918%

10-1418%

15-1913%

30 years or more11%

25-299%

20-2411%

5 years or less20%

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Chapter 3: Crosstabulations from the 2005 Indiana Registered Nurse Survey

The data analysis presented in this chapter shows the relationships between specific demographic and professional characteristics of the Registered Nurses responding to the 2005 survey. There are four sections in this chapter showing the breakdown of responses by level of education (“Highest Degree in Nursing”), collapsed setting groups, collapsed principal position groups and collapsed major activities groups. In the discussion of the tables, categories of these variables (the columns) will appear in bold type. Marginal totals are not shown on these tables; please refer to Chapter 2 for discussion of the distribution of individual variables. Statistical tests are not presented on the bivariate relationships shown in this chapter. The large number of cases would result in statistically significant results for virtually all of the tables. In spite of their statistical significance, these bivariate relationships may not be important from a practical perspective.

Nurse Characteristics by Highest Degree in Nursing

Table 3.1 Age and Highest Degree in Nursing of Registered Nurses, 2005 Diploma Associate Bachelor's Master's Doctorate Age Groups # % # % # % # % # % Under 25 9 0.2 479 2.6 721 4.7 3 0.1 4 1.625-34 146 3.3 3,889 20.9 3,994 26.0 319 10.6 17 6.735-44 734 16.6 5,535 29.7 4,441 29.0 733 24.3 45 17.845-54 1,668 37.8 6,357 34.1 4,431 28.9 1,327 44.0 112 44.355-64 1,550 35.1 2,184 11.7 1,577 10.3 570 18.9 64 25.365 or older 303 6.9 180 1.0 174 1.1 61 2.0 11 4.3

Nurses with diplomas and those with master’s and doctorate degrees were older while those

with associate and bachelor’s degrees were younger. Younger nurses would be less likely to have diploma-level training because the number of nursing diploma programs has declined in Indiana. Also, younger nurses would not be as likely to have higher degrees because of the time required to obtain them.

Table 3.2 Race and Highest Degree in Nursing of Registered Nurses, 2005 Diploma Associate Bachelor's Master's Doctorate

Race # % # % # % # % # % White 4,323 96.8 17,679 94.6 14,307 93.0 2,856 94.0 234 92.1Black/African American 57 1.3 537 2.9 499 3.2 97 3.2 8 3.1

Asian/Pacific Islander 48 1.1 100 0.5 295 1.9 36 1.2 4 1.6

American Indian/Native Alaskan

4 0.1 50 0.3 25 0.2 8 0.3 3 1.2

Multi-racial 5 0.1 99 0.5 88 0.6 13 0.4 1 0.4Other 27 0.6 232 1.2 171 1.1 29 1.0 4 1.6

Level of education and race of the respondents do not appear to be related, except that those with nursing diplomas were more often “White” and less often “Black/African American”.

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Table 3.3 Gender and Highest Degree in Nursing of Registered Nurses, 2005 Diploma Associate's Bachelor's Master's Doctorate

Gender # % # % # % # % # % Female 4,348 97.6 17,512 93.9 14,673 95.4 2,863 94.6 235 92.9Male 106 2.4 1,142 6.1 703 4.6 165 5.4 18 7.1

Males were more likely to have associate and doctorate degrees as shown in Table 3.3. They

were less likely to have nursing diplomas.

Table 3.4 Ethnicity and Highest Degree in Nursing of Registered Nurses, 2005 Diploma Associate's Bachelor's Master's Doctorate Ethnicity # % # % # % # % # % Hispanic 29 0.7 321 1.7 239 1.6 50 1.7 3 1.2Not Hispanic 4,405 99.3 18,300 98.3 15,075 98.4 2,973 98.3 248 98.8

Too few of the respondents were reported to be “Hispanic” to allow conclusions to be made with

confidence about the relationship between education level and ethnicity.

Table 3.5 Principal Work Setting and Highest Degree in Nursing of Registered Nurses, 2005 Diploma Associate's Bachelor's Master's Doctorate Principal Work Setting # % # % # % # % # % Non-hospital patient care 1,593 38.4 5,470 30.8 3,522 23.9 1,071 37.5 41 17.7Hospital patient care 2,112 50.9 11,265 63.4 9,769 66.4 1,101 38.6 68 29.3Government agency 70 1.7 149 0.8 206 1.4 56 2.0 5 2.2Education 198 4.8 338 1.9 597 4.1 495 17.3 104 44.8Private business 63 1.5 168 0.9 224 1.5 34 1.2 4 1.7Other 113 2.7 380 2.1 388 2.6 98 3.4 10 4.3

Table 3.5 shows that nurses with master’s degrees or doctorates were much more likely to be in education settings and much less likely to be in a hospital patient care setting. They were also somewhat more likely to be in government agencies or “Other” settings. The categories of work settings in Table 3.5 differ from those used in Chapter 2 (see Table 2.11). There the purpose was to create categories consistent across all three registered nurse surveys; 1997, 2001, and 2005. The crosstabulations in this chapter refer only to the 2005 survey so a different categorization was possible based on a larger list of settings. Table 3.6 on the next page presents all settings available in the 2005 survey and shows how they were categorized for the tables in Chapter 3. Table 3.6 also gives the percentages of all respondents in each of the major categories. The majority (61.4%) said they were in a hospital patient care setting. A non-hospital patient care setting was next most likely (29.6%). Less than 5 percent of the respondents were classified into the other categories. “Education” was the largest of these categories with 4.4 percent.

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Table 3.6 Setting of Principal RN Position, 2005: Components of Major Categories

Settings of Principal Position

Major categories Number of Nurses % of categoryNon-Hospital patient care (29.6% of total) 12,008

Ambulatory care setting (surgical./other) 2,385 19.86Physician/dentist private office 1,994 16.61

Long-term care/extended care facility/unit 1,698 14.14Home health care agency 1,603 13.35Primary care center/clinic 688 5.73

Long-term acute care facility/unit 644 5.36Community health center/clinic 628 5.23

Hospice 592 4.93Psychiatric inpatient facility/unit 445 3.71

Occupational health setting 347 2.89Mental health/addictions facility/unit 218 1.82

Community mental health center 191 1.59Assisted living facility/unit 158 1.32

Prison 141 1.17Urgent care center/clinic 129 1.07

Private duty nursing 69 0.57Adult day care 32 0.27

Non-residential care facility/unit 28 0.23Community substance abuse agency 18 0.15

Hospital patient care (61.4% of total) 24,894 Hospital (in-patient) 12,201 49.01

Hospital (in- & out-patient) 8,575 34.45Hospital ER/ED 2,078 8.35

Hospital operating room 1,030 4.14Hospital (out-patient) 1,010 4.06

Government agency (0.9% of total) 348 Public health department (city, county or state) 255 51.10

Federal agency 147 29.46State agency (other than state public health department) 97 19.44Education (4.4% of total) 1,776

School/college setting 1,300 73.20Nursing education program 375 21.11

Continuing education/staff development 101 5.69Private business (1.2% of total) 506

Insurance company 336 66.40Drug company 88 17.39

Law firm 49 9.68Supplemental staffing agency 33 6.52

Other (2.5% of total) 1,012 Other 900 88.93

Research setting 112 11.07

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Table 3.7 Principal Positions and Highest Degree in Nursing of Registered Nurses, 2005

Diploma Associate Bachelor's Master's Doctorate Principal Positions # % # % # % # % # % Direct patient care 2,926 65.8 13,374 71.7 9,958 65.1 471 15.6 66 26.1Indirect patient care 1,085 24.4 3,821 20.5 3,610 23.6 531 17.6 32 12.6Nursing Related Business 27 0.6 157 0.8 137 0.9 15 0.5 2 0.8

Education 77 1.7 207 1.1 448 2.9 523 17.4 110 43.5Advanced Practice Nurse (APN) 72 1.6 156 0.8 193 1.3 1,387 46.0 36 14.2

Other 262 5.9 941 5.0 942 6.2 85 2.8 7 2.8

Nurses with master’s degrees or doctorates were much less likely to be in direct patient care positions. They were also less likely to be in indirect patient care or “other” positions. As expected, they were very much more likely to be in education or Advanced Practice Nursing positions. Table 2.15 in Chapter 2 defines the groupings of principal positions used in Table 3.7.

Table 3.8 Years of Registered Nurse Licensure and Highest Degree in Nursing of Registered Nurses, 2005

Diploma Associate Bachelor's Master's Doctorate Years of Licensure # % # % # % # % # % < 5 228 5.1 4,859 25.9 3,039 19.7 226 7.4 33 12.85-9 273 6.1 4,042 21.5 3,037 19.6 389 12.8 28 10.910-14 299 6.7 3,816 20.3 2,805 18.1 447 14.7 25 9.715-19 597 13.3 2,411 12.8 2,117 13.7 448 14.7 38 14.720-24 575 12.8 1,701 9.1 1,698 11.0 478 15.7 30 11.625-29 698 15.6 1,157 6.2 1,446 9.4 477 15.7 48 18.630+ 1,809 40.4 786 4.2 1,321 8.5 580 19.0 56 21.7

The patterns shown in Table 3.8 for years of licensure are similar to those for age shown in Table 3.1. One exception is that nurses with doctorates are more likely to be recently licensed (23.7% with less than 10 years) and less likely to be young (8.3% under 35 years of age – Table 3.1).

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Nurse Characteristics by Principal Position

Table 3.9 Age Group and Principal Positions* of Registered Nurses, 2005

Direct Patient Care

Indirect Patient Care

Nursing Related Business Education Advanced Practice

Nurse (APN) Other

Age Groups # % # % # % # % # % # %

Under 25 1,115 4.1 52 0.6 3 0.9 3 0.2 2 0.1 58 2.525-34 6,471 23.7 1,165 12.6 52 15.2 108 7.8 257 13.6 426 18.635-44 7,584 27.8 2,535 27.5 104 30.3 283 20.4 547 29.0 611 26.745-54 8,232 30.2 3,626 39.3 128 37.3 602 43.5 750 39.7 817 35.655-64 3,399 12.5 1,672 18.1 50 14.6 343 24.8 303 16.0 332 14.565 or older 460 1.7 166 1.8 6 1.7 45 3.3 29 1.5 48 2.1

* See Table 2.15 for definitions of the Principal Position categories Nurses under 35, and especially those under 25, were more likely to be in direct patient care and “Other” positions. Nurses aged 35-44 were fairly equally distributed among positions (from 26.7% to 30.3%) except that somewhat fewer were in education (20.4%). In older age groups, especially 55 and over, education positions were much more likely. Indirect care and advanced practice nursing positions were also more likely reported by nurses aged 45 and older.

Table 3.10 Race and Principal Positions of Registered Nurses, 2005

Direct Patient Care


Nursing Related

Business Education

Advanced Practice

Nurse (APN) Other

Race # % # % # % # % # % # % White 25,723 94.2 8,682 93.7 328 94.3 1,319 94.9 1,805 95.4 2,165 94.6Black/ African American 725 2.7 359 3.9 13 3.7 41 2.9 36 1.9 47 2.1

Asian/ Pacific Islander 332 1.2 99 1.1 0 0.0 9 0.6 17 0.9 31 1.4

American Indian/ Native Alaskan 56 0.2 21 0.2 2 0.6 5 0.4 3 0.2 5 0.2

Multi-racial 149 0.5 34 0.4 1 0.3 3 0.2 8 0.4 14 0.6Other 328 1.2 74 0.8 4 1.1 13 0.9 24 1.3 27 1.2

In all categories of nursing positions, over 93 percent of nurses were white. “Black/African American” nurses were more likely to be in indirect patient care (3.9%) or nursing related business positions (3.7%). They were less likely to be in advanced practice nursing positions (1.9%). “Asian/Pacific Islander” nurses were more likely to be in “Other” positions (1.4%) or in patient care positions, either direct (1.2%) or indirect (1.1%). The numbers of nurses in the other racial categories were too small to allow conclusions.

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Table 3.11 Gender and Principal Positions of Registered Nurses, 2005

Direct Patient Care


Nursing Related

Business Education

Advanced Practice Nurse

(APN) Other

Gender # % # % # % # % # % # % Female 25,900 95.0 8,759 94.8 328 94.5 1,348 96.8 1,727 91.5 2,199 96.2Male 1,377 5.0 478 5.2 19 5.5 44 3.2 161 8.5 86 3.8

Male nurses were less likely to be in education (3.2%) or “Other” positions (3.8%) and much more likely to be advanced practice nurses (8.5%). As shown in Table 4.10 in chapter 4 below, the higher representation of men among advanced practice nurses is entirely due to their very much higher percentage among nurse anesthetists (53.4%).

Table 3.12 Ethnicity and Principal Positions of Registered Nurses, 2005

Direct Patient Care


Nursing Related

Business Education


(APN) Other

Hispanic Origin # % # % # % # % # % # %

Yes 458 1.7 102 1.1 8 2.3 17 1.2 34 1.8 36 1.6No 26,732 98.3 9,124 98.9 337 97.7 1,367 98.8 1,849 98.2 2,237 98.4

Although Hispanic nurses are a small percentage of the total, they hold relatively more “Nursing Related Business” positions (2.3%).

Table 3.13 Principal Work Setting by Principal Positions of Registered Nurses, 2005

Direct Patient Care


Nursing Related

Business Education


(APN) Other

Principal Work Setting* (%)

# % # % # % # % # % # %

Non-hospital patient care (29.6) 7,002 26.9 3,143 36.0 105 32.4 164 12.5 1,041 59.1 470 21.7

Hospital patient care (61.4) 17,532 67.3 4,834 55.3 116 35.8 439 33.5 575 32.7 1,274 58.8

Government agency (0.9) 334 1.3 102 1.2 8 2.5 9 0.7 24 1.4 22 1.0

Education (4.4) 859 3.3 80 0.9 8 2.5 675 51.5 49 2.8 84 3.9Private business (1.2) 60 0.2 301 3.4 49 15.1 6 0.5 7 0.4 52 2.4

Other (2.5) 266 1.0 278 3.2 38 11.7 17 1.3 65 3.7 266 12.3* See Table 3.6 for definitions of the Principal Work Setting categories and Table 2.15 for definitions of the Principal Position categories It is difficult to interpret the relationship between nurses’ principal positions and the settings of those principal positions. Appendix 3 presents further discussion of this relationship. Table 3.13 shows that patient care settings, both non-hospital and hospital settings, were reported most often for nurses in all principal positions except education. In education, 51.5% of the education positions were in an

24

education setting. Of the “Nursing Related Business” positions, 15.1 percent were in private business settings compared to only 1.2 percent of respondents overall. Advanced practice nurses were about as likely as others to be in a patient care setting but were much less likely to be in hospital (and more likely to be in non-hospital) settings. See Table 4.14 in chapter 4 for more detail on the settings of APN positions.

Table 3.14 Key Activities and Principal Positions of Registered Nurses, 2005

Direct Patient Care


Nursing Related

Business Education

Advanced Practice

Nurse (APN) Other

Key Activities (%) # % # % # % # % # % # %

Direct patient care (74.6) 24,729 90.0 4,815 51.7 162 46.6 346 24.7 1,604 84.2 1,328 57.4

Patient education/ counseling (33.4) 9,455 34.4 2,822 30.3 75 21.6 294 21.0 990 52.0 766 33.1

Administrative Activities (27.8) 4,415 16.1 5,988 64.3 119 34.2 437 31.2 506 26.6 545 23.6

Medication management (19.1)

5,435 19.8 1,759 18.9 58 16.7 100 7.1 638 33.5 267 11.5

Case management/ care coordination (16.5)

3,190 11.6 3,050 32.7 56 16.1 77 5.5 448 23.5 300 13.0

Continuing education/ staff development (14.3)

2,721 9.9 2,151 23.1 94 27.0 568 40.5 326 17.1 312 13.5

Consulting with agencies/other professionals (12.8)

2,806 10.2 1,640 17.6 135 38.8 170 12.1 444 23.3 323 14.0

Infection control (11.1) 2,780 10.1 1,607 17.3 48 13.8 116 8.3 123 6.5 121 5.2

Teaching nursing students (9.0) 2,514 9.1 745 8.0 23 6.6 803 57.3 310 16.3 183 7.9

Quality assurance/ utilization review (10.6)

1,182 4.3 2,189 23.5 70 20.1 92 6.6 168 8.8 175 7.6

Community/Public health activities (6.4)

1,588 5.8 656 7.0 22 6.3 140 10.0 174 9.1 187 8.1

Other (21.2) 5,034 18.3 2,128 22.8 129 37.1 323 23.0 533 28.0 1,003 43.4

Table 3.14 shows that direct patient care was listed as a key activity for about three-fourths of all nurses (74.6%). However, only about one-half of the respondents in the “Indirect patient care”, “Nursing related business”, or “Other” positions indicated that direct patient care was a key activity for them. Only one-fourth of the nurses in education positions (24.7%) reported direct patient care activity. Over one-third of the respondents (33.4%) reported “Patient education/counseling” as a key activity. The percentage was much higher for advanced practice nurses (52.0%) but lower for nurses with positions in education (21.0%) or nursing related business (21.6%).

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The majority of respondents were in “Direct Patient Care” positions (63.9% as reported Table 2.14), so their reported job activities most closely followed the overall percentage distribution (shown in parenthesis in the first column of Table 3.14). As expected, they were more likely to be in direct patient care activities (90.0% compared to 74.6% for all nurses), but were less likely to be involved in administrative activities, “Case management / care coordination”, “Continuing education / staff development”, or “Quality assurance / utilization review”. Nurses in “Indirect Patient Care” positions were more likely than other nurses to be involved in all of these activities, especially “Administrative activities” and “Case management / care coordination” (64.3% and 32.7% compared to 27.8% and 16.5% for all nurses). Indirect patient care nurses were also more likely to be involved in “Consulting with agencies / other professionals” and “Infection control”. Activities where “Nursing Related Business” respondents were more prevalent than others included “Consulting with agencies / other professionals” (38.8% compared to 12.8%), “Continuing education / staff development”, and “Quality assurance / utilization review”. Nurses in education positions were, as expected, more likely to list “Teaching nursing students” and “Continuing education / staff development” as activities (57.3% and 40.5% compared to 9.0% and 14.3% for all nurses). They were also more involved with “Community / public health” activities (10.0% versus 6.4%). “Advanced practice nurses” were much more likely than others to be involved with “Patient education/ counseling” (52.0% vs. 34.4%), “Medication management” (33.5% vs. 19.1%), “Teaching nursing students” (16.3% vs. 9.0%), and “Consulting with agencies/other professionals” (23.3% vs. 12.8%).

Table 3.15 Categories of Key Activities of Registered Nurses, 2005

Key Activity optionsKey Activity categories # % of All

Nurses % of

Category Direct patient care 33,136 76.8 Patient education/counseling 14,490 33.6 Administrative Activities 12,108 28.1

Staff supervision/management 7,894 65.2 Policy and planning 5,332 44.0

Administration 4,605 38.0 Program management 2,388 19.7

Financial management 1,602 13.2 Case management/ care coordination 7,167 16.6

Case management/care coordinator 6,637 92.6 Prenatal care coordination 755 10.5

Medication management 8,312 19.3 Continuing education/staff development 6,203 14.4 Consulting with agencies/other professionals 5,574 12.9 Infection control 4,806 11.1 Quality assurance/utilization review 3,898 9.0 Teaching nursing students 4,587 10.6 Community/Public health activities 2,778 6.4

Community health activities 2,183 78.6 Public health activities 1,424 51.3

Other 9,431 21.9 Other 6,827 72.4

Psychiatric nursing 1,955 20.7 Research 1,263 13.4

Environmental health (air, water, food safety) 625 6.6

Table 3.15 shows the full list of key activities appearing as response options on the 2005 survey. It also shows how they were grouped to create the categories used in Table 3.14 (and other key activity tables in this report). For categories with more than one response option, Table 3.15 shows the

26

percentages of nurses choosing each response option within the category. These percentages, both within categories and overall, do not add to 100 percent because multiple responses are possible.

A nurse was considered to be involved with “Administrative activities” if any of five response

options were indicated. “Staff supervision/management” was the most common response option (65.2%), followed by “Policy and planning” (44.0%) and “Administration” (38.0%). The “Case management/ care coordination” category included two options. The “Case management/ care coordinator” option was chosen by 92.6 percent of those in the category and the “Prenatal care coordination” option by 10.5 percent. Community health and public health activities were combined to form “Community/public health activities”. Most nurses in this category reported performing community health activities (78.6%).

Table 3.16 Years of Licensure and Principal Positions of Registered Nurses, 2005

Direct Patient Care


Nursing Related

Business Education


(APN) Other

Years Licensed # % # % # % # % # % # %

< 5 6,823 24.8 984 10.6 51 14.7 87 6.2 177 9.3 413 17.95-9 5,409 19.7 1,585 17.0 66 19.0 168 12.0 292 15.3 376 16.310-14 4,762 17.3 1,782 19.1 66 19.0 203 14.5 340 17.9 389 16.815-19 3,381 12.3 1,470 15.8 50 14.4 194 13.8 307 16.1 291 12.620-24 2,532 9.2 1,162 12.5 48 13.8 222 15.8 292 15.3 310 13.425-29 2,119 7.7 1,044 11.2 29 8.3 220 15.7 241 12.7 251 10.930+ 2,464 9.0 1,287 13.8 38 10.9 308 22.0 255 13.4 283 12.2

Table 3.16 shows that nurses in “Direct Patient Care” positions were much less likely to have 20 or more years of licensure and very much more likely to have less than five years. This differs from their age distribution shown in Table 3.9 where older nurses were not less likely to be in these positions. Nurses in “Indirect Patient Care” positions were less likely to have less than five years of licensure but were about as likely as other nurses to be in the other categories of licensure. Education positions were much more likely to be held by nurses with more years of licensure, especially by those with over 30 years of licensure. These positions were less likely to be held by nurses with under 15 years of licensure. Advanced practice nursing (APN) positions were also less likely to be held by nurses with fewer years of licensure. APN positions were more likely to be held by nurses with 15 to 25 years.

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Nurse Characteristics by Setting of the Principal Position

Table 3.17 Age Groups and Principal Work Settings of Registered Nurses, 2005

Non-hospital Patient Care

Hospital Patient Care

Government Agency Education Private

Business Other

Age Groups # % # % # % # % # % # % Under 25 96 0.8 1,087 4.4 3 0.6 3 0.2 5 1.0 11 1.125-34 1,660 14.0 6,235 25.2 50 10.1 111 6.3 62 12.4 141 14.135-44 3,236 27.2 7,089 28.7 91 18.3 425 24.3 133 26.7 249 24.945-54 4,421 37.2 7,340 29.7 207 41.7 766 43.7 202 40.6 389 38.855-64 2,119 17.8 2,734 11.1 125 25.2 392 22.4 90 18.1 184 18.465 or older 352 3.0 214 0.9 20 4.0 54 3.1 6 1.2 28 2.8

* See Table 3.6 for definitions of the work setting categories Nurses under 35 were much more likely to be in hospital patient care settings compared to non-hospital settings. They were less likely to be in educational settings. Nurses aged 35 to 54 were fairly equally distributed among positions except that fewer aged 35 to 44 were in government agencies (18.3%) and fewer aged 45 to 54 were in hospital patient care settings. For those in older age groups (55 and over), education settings and government agency settings were much more likely.

Table 3.18 Race and Principal Work Settings of Registered Nurses, 2005




Business Other

Race # % # % # % # % # % # % White 11,325 94.8 23,215 93.8 462 92.8 1,663 94.3 456 90.5 954 95.5Black/ African American 325 2.7 685 2.8 22 4.4 71 4.0 35 6.9 29 2.9

Asian/Pacific Islander 112 0.9 334 1.4 4 0.8 8 0.5 4 0.8 3 0.3



In all nursing settings, over 92 percent of nurses were white. “Black / African American” nurses were more likely to be in private business (6.9%), government agencies (4.4%) or education settings (4.0%). “Asian / Pacific Islander” nurses were more likely to be in hospital patient care settings (1.4%). The numbers of nurses in the other racial categories were too small to yield valid conclusions.

Table 3.19 Gender and Principal Work Settings of Registered Nurses, 2005




Business Other

Gender # % # % # % # % # % # % Female 11,409 95.8 23,276 94.2 477 95.8 1,719 97.7 473 94.4 954 95.8Male 502 4.2 1,432 5.8 21 4.2 41 2.3 28 5.6 42 4.2

Over 94 percent of nurses in all settings were female. Male nurses were more likely to be in private business (5.6%) or hospital patient care settings (5.8%) and less likely to be in education (2.3%).

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Table 3.20 Ethnicity and Principal Work Settings of Registered Nurses, 2005




Business Other

Hispanic Origin # % # % # % # % # % # % Yes 144 1.2 440 1.8 7 1.4 22 1.3 5 1.0 13 1.3No 11,741 98.8 24,202 98.2 491 98.6 1,734 98.7 496 99.0 975 98.7 Although Hispanic nurses were a small percentage of the total, they were relatively most likely to be in hospital patient care settings (1.8%) and least likely to be in private business settings (1.0%).

Table 3.21 Key Activities and Principal Work Settings of Registered Nurses, 2005




Business Other

Key Activities (%) # % # % # % # % # % # % Direct patient care (74.6) 8978 74.8 20850 83.8 238 47.7 540 30.4 79 15.6 424 41.9

Patient education/ counseling (33.4) 5510 45.9 7172 28.8 237 47.5 471 26.5 104 20.6 358 35.4

Administrative Activities (27.8) 4550 37.9 5775 23.2 198 39.7 549 30.9 138 27.3 343 33.9

Medication management (19.1) 3655 30.4 3556 14.3 127 25.5 505 28.4 52 10.3 175 17.3

Case management/ care coordination (16.5)

3529 29.4 2402 9.6 168 33.7 638 35.9 244 48.2 265 26.2

Continuing education/ staff development (14.3)

2111 17.6 3161 12.7 101 20.2 366 20.6 51 10.1 167 16.5

Consulting with agencies/other professionals (12.8)

2463 20.5 1958 7.9 177 35.5 76 4.3 119 23.5 251 24.8

Infection control (11.1) 2054 17.1 2074 8.3 121 24.2 800 45.0 13 2.6 79 7.8

Teaching nursing students (9.0) 780 6.5 2752 11.1 62 12.4 324 18.2 3 0.6 47 4.6

Quality assurance/ utilization review (10.6)

1692 14.1 1713 6.9 51 10.2 635 35.8 137 27.1 125 12.4

Community/Public health activities (6.4) 1021 8.5 672 2.7 277 55.5 858 48.3 23 4.5 114 11.3

Other (21.2) 3451 28.7 4031 16.2 197 39.5 1066 60.0 167 33.0 509 50.3* See Table 3.15 for definitions of the key activities categories

Direct patient care was a key activity for about three-fourths of all nurses (74.6%) as shown in Table 3.21. It was most often identified by nurses in hospital patient care (83.8%) and non-hospital patient care (74.8%) settings. However, direct patient care activities were identified by less than half of the respondents in all other settings. The lowest percentages of direct patient care activities were reported by nurses in education (30.4 %) and private business settings (15.6%).

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Nurses in education settings were more likely than others to report “Teaching nursing students” (18.2% vs. 9.0% for all nurses). But they were even more likely to report “Community / public health” activities (48.3% vs. 6.4% for all nurses), infection control activities (45.0% vs. 11.1% for all nurses), “Quality assurance / utilization review” activities (35.8% vs. 10.6% for all nurses), and “Medication management” activities (28.4% vs. 19.1% for all nurses). Nurses in government agency settings were more likely than any others to report “Community / public health” activities (55.5%), “Patient education and counseling” (47.5%), “Administrative activities” (39.7%), and “Consulting with other agencies / professionals” (35.5%). The key activities for nurses in private business settings included “Case management / care coordination” (48.2% vs. 16.5% for all nurses) and “Quality assurance / utilization review” activities (27.1% vs. 10.6% for all nurses).

The large majority of survey respondents were in patient care settings, both in hospitals (61.4%)

and elsewhere (29.6%) as reported in Table 3.6. As expected, nurses in both settings were more likely to report “Direct patient care” activities (83.8% in hospitals and 74.8% elsewhere), but the two patient care settings differed greatly in many of the other key activities. Nurses in hospital patient care settings were clearly less likely than nurses overall to report key activities other than direct patient care. Nurses in non-hospital patient care settings were more likely than other nurses to report these key activities. These differences between hospital and non-hospital patient care settings are shown graphically in Figure 3.1 below. Activities are shown in order of the ratio of nurses’ reported rates in non-hospital and hospital settings. For example, the ratio is greatest for “Community / Public Health activities” (8.5 / 2.7), over 3 times greater for nurses in non-hospital settings. Other than direct patient care activities (mentioned above) the only activity reported more often by nurses in hospital settings was “Teaching nursing students”.

Figure 3.1: Key Activities by Nurses in Patient Care Settings

6.5

17.6

45.9

37.9

28.7

14.1

17.1

30.4

20.5

29.4

8.5

11.1

12.7

28.8

23.2

16.2

6.9

8.3

14.3

7.9

9.6

2.7

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0

Teaching nursing students

Continuing education/staff development

Patient education/counseling

Administrative Activities

Other

Quality assurance/utilization review

Infection control

Medication management

Consulting with agencies/ other professionals

Case management/ care coordination

Community/Public health activities

Percent Reporting

non-hospital hospital

30

Table 3.22 Years of Licensure and Principal Work Settings of Registered Nurses, 2005




Business Other

Years of Licensure # % # % # % # % # % # %

< 5 1,562 13.0 6,373 25.6 58 11.6 110 6.2 49 9.7 117 11.65-9 2,153 17.9 4,929 19.8 66 13.2 191 10.8 92 18.2 168 16.610-14 2,407 20.0 4,185 16.8 86 17.2 262 14.8 85 16.8 173 17.115-19 1,718 14.3 3,123 12.5 74 14.8 248 14.0 77 15.2 158 15.620-24 1,363 11.4 2,413 9.7 50 10.0 268 15.1 68 13.4 136 13.425-29 1,181 9.8 1,968 7.9 62 12.4 293 16.5 58 11.5 97 9.630+ 1,624 13.5 1,903 7.6 103 20.6 404 22.7 77 15.2 163 16.1

Table 3.22 shows that nurses in patient care settings differed from other nurses in years of

licensure in Indiana. Hospital patient care settings were much less likely to have 20 or more years of licensure and very much more likely to have less than five years. Nurses in non-hospital patient care were only somewhat more likely than nurses in non-patient care settings to have less than five years and somewhat less likely to have 25 or more years of licensure. Nurses in government agency or education settings were most likely to have 25 or more years of licensure in Indiana. Nurses in education settings were least likely to have less than 15 years of licensure in Indiana.

Nurse Characteristics by Key Activities in the Principal Position

The columns of the tables in this section show eleven key activities of registered nurses in their primary position along with an “other” activities category. There are two tables for each of the nurse characteristics because of the large number of key activities. The 2005 survey had 21 response options for key activities; some categories in these tables are groupings of multiple response options as described in Table 3.15. Each row of each table totals to more than 100 percent because multiple activities could be indicated by each respondent.

Table 3.23.1 Age Groups and Key Activities of Registered Nurses, 2005 (Part 1)

Direct Patient Care

Patient Education/ Counseling


Medication Management

Case Management/

Care Coordination

Continuing Education/

Staff Development

Age Groups # % # % # % # % # % # %

Under 25 1,161 93.6 442 35.6 108 8.7 256 20.6 76 6.1 98 7.925-34 7,457 87.3 3,017 35.3 1,740 20.4 1,670 19.6 1,001 11.7 1,090 12.835-44 9,258 78.7 4,057 34.5 3,335 28.4 2,279 19.4 2,007 17.1 1,732 14.745-54 10,321 72.1 4,623 32.3 4,636 32.4 2,659 18.6 2,712 18.9 2,257 15.855-64 4,155 67.6 1,993 32.4 1,964 31.9 1,226 19.9 1,179 19.2 874 14.265 or older 512 66.8 238 31.1 195 25.5 159 20.8 128 16.7 89 11.6

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Table 3.23.2 Age Groups and Key Activities of Registered Nurses, 2005 (Part 2)

Consulting with Agencies/ Other

Professionals

Infection Control

Teaching Nursing Students

Quality Assurance/ Utilization

Review

Community/ Public Health

Activities Other

Age Groups # % # % # % # % # % # % Under 25 103 8.3 140 11.3 142 11.4 28 2.3 27 2.2 187 15.125-34 906 10.6 896 10.5 1,031 12.1 515 6.0 346 4.1 1,547 18.135-44 1,511 12.8 1,353 11.5 1,171 10.0 1,074 9.1 735 6.2 2,387 20.345-54 2,069 14.5 1,551 10.8 1,498 10.5 1,548 10.8 1,076 7.5 3,407 23.855-64 840 13.7 725 11.8 651 10.6 636 10.3 494 8.0 1,611 26.265 or older 94 12.3 94 12.3 50 6.5 58 7.6 74 9.7 204 26.6 Tables 3.23.1 and 3.23.2 give a crosstabulation of the 12 key activity categories with age groups of the respondents. “Direct Patient Care” showed a clear negative relationship to age; reported by 93.6 percent of the youngest and by only 66.8 percent of the oldest nurses. “Patient Education and Counseling” showed a weaker negative relationship to age. Seven other key activities were positively related to age. “Community / Public Health Activities” and “Other” activities increased with age over all age groups. “Case Management / Care Coordination” activities increased with age until age 65. Four activities increased with age until age 55 and decreased in the two oldest age groups. These four included “Administrative Activities”, “Continuing Education / Staff Development”, “Quality Assurance / Utilization Review”, and “Consulting with Agencies/ Other Professionals”. The remaining three activities, “Medication Management”, “Infection Control”, and “Teaching Nursing Students” showed no clear relation to the age of nurses.

Table 3.24.1 Race and Key Activities of Registered Nurses, 2005 (Part 1)

Direct Patient Care




Case Management/

Care Coordination


Staff Development

Race # % # % # % # % # % # % White 31,071 77.0 13,597 33.7 11,418 28.3 7,755 19.2 6,764 16.8 5,857 14.5Black/ African American 854 69.3 396 32.1 346 28.1 249 20.2 226 18.3 159 12.9


American Indian/ Native Alaskan

70 75.3 34 36.6 31 33.3 19 20.4 20 21.5 18 19.4


32

Table 3.24.2 Race and Key Activities of Registered Nurses, 2005 (Part 2)


Professionals

Infection Control



Review


Activities

Other

Race # % # % # % # % # % # % White 5,262 13.0 4,494 11.1 4,271 10.6 3,704 9.2 2,600 6.4 8,790 21.8Black/ African American 148 12.0 140 11.4 134 10.9 101 8.2 104 8.4 293 23.8



Multi-racial 31 14.8 34 16.2 26 12.4 15 7.1 16 7.6 58 27.6Other 45 9.5 49 10.3 63 13.2 29 6.1 24 5.0 123 25.8 The relationship between race and key activities is shown in Tables 3.24.1 and 2. Comments are given only for whites, “Blacks / African Americans”, and “Asians / Pacific Islanders” because the numbers for the other groups were too small to draw conclusions. Whites were more likely to report “Continuing Education / Staff Development”, “Consulting with Agencies/ Other Professionals”, and “Quality Assurance/ Utilization Review”. They were less likely to report “Medication Management”. “Black / African American” nurses were more likely to report “Case Management / Care Coordination” and “Community / Public Health” activities. They were less likely to report “Direct Patient Care”. Nurses classified as “Asian / Pacific Islander” were more likely than others to report “Direct Patient Care”, “Medication Management”, and “Teaching Nursing Students”. But these nurses were clearly less likely than whites or “Black / African American” nurses to report six different key activities including “Community / Public Health” activities, “Administrative Activities”, “Case Management / Care Coordination”, “Continuing Education / Staff Development”, “Consulting with Agencies/ Other Professionals”, and “Quality Assurance/ Utilization Review”.

Table 3.25.1 Gender and Key Activities of Registered Nurses, 2005 (Part 1)

Direct Patient Care




Case Management/ Care Coordination

Continuing Education/ Staff

Development Gender # % # % # % # % # % # % Female 31,195 76.8 13,788 33.9 11,350 27.9 7,866 19.4 6,856 16.9 5,839 14.4Male 1,721 78.9 615 28.2 674 30.9 392 18.0 269 12.3 313 14.3

Table 3.25.2 Gender and Key Activities of Registered Nurses, 2005 (Part 2)


Professionals

Infection Control


Quality Assurance/

Utilization Review


Activities Other

Gender # % # % # % # % # % # % Female 5,283 13.0 4,518 11.1 4,323 10.6 3,663 9.0 2,660 6.5 8,837 21.8Male 245 11.2 260 11.9 239 11.0 212 9.7 97 4.4 530 24.3

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Male nurses, as shown in Tables 3.25.1 and 3.25.2, were more likely to be involved in administrative activities and less likely to report “Patient Education / Counseling”, “Medication Management”, “Case Management / Care Coordination”, “Consulting with Agencies/ Other Professionals”, or “Community / Public Health” activities. They also were slightly more likely to be involved in direct patient care (78.9% compared to 76.8% for female nurses).

Table 3.26.1 Ethnicity and Key Activities of Registered Nurses, 2005 (Part 1)

Direct Patient Care




Case Management/

Care Coordination


Development

Hispanic Origin # % # % # % # % # % # %

Hispanic 545 82.8 245 37.2 139 21.1 126 19.1 68 10.3 89 13.5 Non-Hispanic 32,289 76.9 14,109 33.6 11,879 28.3 8,107 19.3 7,048 16.8 6,058 14.4

Table 3.26.2 Ethnicity and Key Activities of Registered Nurses, 2005 (Part 2)


Professionals

Infection Control


Quality Assurance/ Utilization Review

Community/ Public Health Activities Other

Hispanic Origin # % # % # % # % # % # %

Hispanic 79 12.0 65 9.9 76 11.6 36 5.5 39 5.9 146 22.2Non-Hispanic 5,447 13.0 4,696 11.2 4,462 10.6 3,839 9.1 2,716 6.5 9,193 21.9 Tables 3.26.1 and 3.26.2 compare Hispanic and non-Hispanic nurses. Hispanic nurses were more likely to be involved in direct patient care (82.8% vs. 76.9%) and “Patient Education and Counseling” (37.2% vs. 33.6%). Hispanics were less likely to report administrative activities (21.1% vs. 28.3%), “Case Management / Care Coordination” (10.3% vs. 16.8%), and “Quality Assurance / Utilization Review” (5.5% vs. 9.1%).

Table 3.27.1 Principal Work Setting and Key Activities of Registered Nurses, 2005 (Part 1)

Direct Patient Care




Case Management/

Care Coordination


Development

Principal Setting # % # % # % # % # % # %

Non-hospital patient care 8,978 74.8 5,510 45.9 4,550 37.9 3,655 30.4 3,529 29.4 8,978 17.6

Hospital patient care 20,850 83.8 7,172 28.8 5,775 23.2 3,556 14.3 2,402 9.6 20,850 12.7

Government agency 238 47.7 237 47.5 198 39.7 127 25.5 168 33.7 238 20.2

Education 918 51.7 710 40.0 635 35.8 540 30.4 324 18.2 918 26.5Private business 79 15.6 104 20.6 138 27.3 52 10.3 244 48.2 79 10.1Other 424 41.9 358 35.4 343 33.9 175 17.3 265 26.2 424 16.5

34

Table 3.27.2 Principal Work Setting and Key Activities of Registered Nurses, 2005 (Part 2)


Professionals

Infection Control



Review


Activities Other

Principal Setting # % # % # % # % # % # % Non-hospital patient care 2,463 20.5 2,054 17.1 780 6.5 1,692 14.1 1,021 8.5 3,451 28.7

Hospital patient care 1,958 7.9 2,074 8.3 2,752 11.1 1,713 6.9 672 2.7 4,031 16.2

Government agency 177 35.5 121 24.2 62 12.4 51 10.2 277 55.5 197 39.5

Education 505 28.4 366 20.6 800 45.0 76 4.3 549 30.9 638 35.9Private business 119 23.5 13 2.6 3 0.6 137 27.1 23 4.5 167 33.0Other 251 24.8 79 7.8 47 4.6 125 12.4 114 11.3 509 50.3 Some of the key activities were quite obviously correlated to particular work settings as shown in Tables 3.27.1 and 3.27.2. Direct patient care activities were reported by 83.8 percent of the nurses in “Hospital patient care” settings and by 74.8 percent of those in “Non-hospital patient care”. Nurses in the most of the other settings reported “Direct Patient Care” activities at rates between 41.9 and 51.7 percent; but those in private business settings reported at a rate of only 15.6 percent. “Teaching Nursing Students” was a reported activity for 45.0 percent of nurses in education settings but never more than 12.4 percent by those in other settings. “Continuing Education / Staff Development” activities were also reported most often by nurses in education settings (26.5%), but those in “Government agency” settings were also often involved (20.2%). “Community / Public Health Activities” were most often reported by nurses in “Government agency” settings (55.5%). Nurses in government agencies were also the most likely to report “Consulting with Agencies/ Other Professionals” (35.5%) and “Infection Control” activities (24.2%). Nurses in private business settings were by far the most likely to report “Quality Assurance / Utilization Review” activities (27.1% vs. 14.1% of nurses in the next most likely setting) or “Case Management / Care Coordination” activities (48.2% vs. 33.7%).

Table 3.28.1 Principal Positions and Key Activities of Registered Nurses, 2005 (Part 1)

Direct Patient Care




Case Management/

Care Coordination


Staff Development

Principal Position # % # % # % # % # % # % Direct patient care 24,729 90.0 9,455 34.4 4,415 16.1 5,435 19.8 3,190 11.6 2,721 9.9Indirect patient care 4,815 51.7 2,822 30.3 5,988 64.3 1,759 18.9 3,050 32.7 2,151 23.1Nursing Related Business 162 46.6 75 21.6 119 34.2 58 16.7 56 16.1 94 27.0

Education 346 24.7 294 21.0 437 31.2 100 7.1 77 5.5 568 40.5Advanced Practice Nurse (APN) 1,604 84.2 990 52.0 506 26.6 638 33.5 448 23.5 326 17.1

Other 1,328 57.4 766 33.1 545 23.6 267 11.5 300 13.0 312 13.5

35

Table 3.28.2 Principal Positions and Key Activities of Registered Nurses, 2005 (Part 2)


Professionals

Infection Control



Review


Activities Other

Principal Position # % # % # % # % # % # %Direct patient care 2,806 10.2 2,780 10.1 2,514 9.1 1,182 4.3 1,588 5.8 5,034 18.3Indirect patient care 1,640 17.6 1,607 17.3 745 8.0 2,189 23.5 656 7.0 2,128 22.8Nursing Related Business 135 38.8 48 13.8 23 6.6 70 20.1 22 6.3 129 37.1Education 170 12.1 116 8.3 803 57.3 92 6.6 140 10.0 323 23.0Advanced Practice Nurse (APN) 444 23.3 123 6.5 310 16.3 168 8.8 174 9.1 533 28.0

Other 323 14.0 121 5.2 183 7.9 175 7.6 187 8.1 1,003 43.4

Tables 3.28.1 and 3.28.2 show that some of the key activities were also correlated to particular work positions. Direct patient care activities were reported by 90.0 percent of the nurses in direct patient care positions. Nurses in indirect patient care positions were, by far, the most likely to report administrative activities (64.3%). They were also the most likely to report “Case Management / Care Coordination” activities (32.7%), “Infection Control” activities (17.3%), and “Quality Assurance / Utilization Review” activities (23.5%). “Teaching Nursing Students” was a reported activity for 57.3 percent of nurses in education positions but never more than 16.3 percent by those in other positions. “Continuing Education / Staff Development” activities were also reported most often by nurses in education positions (40.5%). These activities were also often reported by nurses in “Nursing related business” and “Indirect patient care” positions (27.0% and 23.1% respectively).

Direct patient care nurses ranked second in reporting “Medication Management” activities

(19.8%) and “Patient Education / Counseling” activities (34.4%). Nurses in “Nursing related business” positions were most often involved in “Consulting with Agencies/ Other Professionals” (38.8%). Advanced Practice Nurses most often reported “Patient Education / Counseling” activities (52.0%) and “Medication Management” activities (33.5%) and ranked second in several activities including “Case Management / Care Coordination” activities (23.5%), “Teaching Nursing Students” (16.3%), “Consulting with Agencies/ Other Professionals” (23.3%), and “Community/ Public Health Activities” (9.1%).

Table 3.29.1 Years of Licensure and Key Activities of Registered Nurses, 2005 (Part 1)

Direct Patient Care




Case Management/

Care Coordination


Development


< 5 7,557 87.9 3,049 35.5 1,497 17.4 1,850 21.5 996 11.6 889 10.35-9 6,503 81.7 2,827 35.5 2,117 26.6 1,637 20.6 1,244 15.6 1,185 14.910-14 5,879 77.4 2,612 34.4 2,304 30.3 1,563 20.6 1,401 18.4 1,181 15.515-19 4,220 73.2 1,865 32.4 1,854 32.2 1,041 18.1 1,050 18.2 891 15.520-24 3,261 70.8 1,465 31.8 1,447 31.4 784 17.0 851 18.5 744 16.125-29 2,722 68.9 1,198 30.3 1,315 33.3 642 16.2 757 19.2 607 15.430+ 2,994 29.9 1,474 8.0 1,574 5.6 795 15.9 868 5.6 706 15.1

36

Table 3.29.2 Years of Licensure and Key Activities of Registered Nurses, 2005 (Part 2)


Professionals

Infection Control



Review


Activities Other


< 5 906 10.5 1,103 12.8 974 11.3 414 4.8 320 3.7 1,568 18.25-9 998 12.5 911 11.4 836 10.5 667 8.4 434 5.4 1,619 20.310-14 1,026 13.5 881 11.6 765 10.1 767 10.1 486 6.4 1,696 22.315-19 782 13.6 589 10.2 565 9.8 602 10.4 395 6.9 1,306 22.720-24 628 13.6 445 9.7 511 11.1 508 11.0 361 7.8 1,097 23.825-29 574 14.5 368 9.3 427 10.8 432 10.9 320 8.1 957 24.230+ 660 13.2 509 15.1 509 2.4 508 2.1 462 5.4 1,188 25.4

The nurses with the fewest years of licensure were most likely to be involved in “Direct Patient Care” activities (87.9%), “Patient Education / Counseling” (35.5%), “Medication Management” activities (21.5%), and “Teaching Nursing Students” (11.3%). Except for “Teaching Nursing Students”, the percentage of nurses reporting these activities clearly declined with years of licensure. The reporting of “Infection Control” activities also tended to decrease with years of experience except that nurses licensed for 30 or more years reported this activity at the highest rate (15.1%). The activities that tended to increase with years of licensure included “Administrative Activities”, “Community/ Public Health Activities”, “Case Management / Care Coordination” activities, “Continuing Education / Staff Development” activities, and “Quality Assurance / Utilization Review” activities. However, for all of these activities that generally increased with years of licensure, the rate was lower for those with 30 or more years than for those with 25-29 years.

37

Chapter 4: Detail for Specialty Nurses

Nursing Faculty

As shown in Table 2.15 in Chapter 2, 739 nurses identified their principal nursing position as “Faculty in a nursing program”. This section presents their characteristics separately and contrasts them to those of all nurses who responded to the 2005 survey. The totals shown in tables in this section are less than 739 to the extent that some nurses identifying as “Faculty in a nursing program” did not respond to some of the items.

Table 4.1 Age of Nursing Faculty, 2005

Age Groups Number % % of All Nurses

Under 25 1 0.1 2.925-34 51 7.0 20.035-44 120 16.4 27.545-54 325 44.5 33.555-64 211 28.9 14.465 or older 23 3.1 1.8Total 731

Table 4.1 shows that nursing faculty tended to be older than other nurses; over three-fourths of them were 45 years of age or older (76.5%). Only 7.1 percent were under 35 as compared to 22.9 percent of all nurses.

Table 4.2 Gender of Nursing Faculty, 2005

Gender Number % % of All Nurses

Female 712 97.1 94.9Male 21 2.9 5.1Total 733

Fewer nursing faculty were male (2.9%) than other nurses (5.1%) as shown in Table 4.2.

Table 4.3 Race of Nursing Faculty, 2005

Race Number % % of All Nurses

White 690 94.3 94.2 Black/ African American 27 3.7 2.9 Asian/ Pacific Islander 6 0.8 1.1 American Indian/ Native Alaskan 2 0.3 0.2 Multi-racial 0 0.0 0.5 Other 7 1.0 1.1 Total 732

Although 94.3 percent of nursing faculty were white, they were more likely to be “Black / African American” than other nurses (3.7% compared to 2.9%). There were too few nursing faculty of other races to draw meaningful conclusions.

38

Table 4.4 Ethnicity of Nursing Faculty, 2005

Hispanic Origin Number % % of All Nurses

Not Hispanic Origin 8 1.1 1.5Hispanic Origin 719 98.9 98.5Total 727

Only eight nursing faculty members reported being of Hispanic origin, as shown in Table 4.4. Although the proportion of Hispanics among nursing faculty is lower than for other nurses (1.1% vs. 1.5%), the number of Hispanics is too small to draw conclusions with confidence. A continuity-corrected Chi-square test of the cross-tabulation in Table 4.4 yielded p-value of 0.411.

Table 4.5 Highest Degree in Nursing of Nursing Faculty, 2005

Highest Degree in Nursing Number % % of All Nurses

Diploma 8 1.1 10.7 Associate 14 1.9 44.6 Bachelor's 147 20.4 36.7 Master's 447 61.9 7.3 Doctorate 106 14.7 0.6 Total 722

Table 4.5 shows the distributions of nursing faculty and all nurses by “Highest Degree in Nursing”. Nursing faculty were very likely to have Master’s degrees or doctorates as would be expected. But degrees at the Bachelor’s level or lower were reported by 23.4 percent of the nursing faculty. It is unclear whether this indicates errors in reporting, or the existence of nursing faculty positions that do not require advanced degrees in nursing.

Table 4.6 Setting of Principal Position of Nursing Faculty, 2005

Principal Setting Number % % of All Nurses

Non-hospital patient care 21 3.1 29.5 Hospital patient care 61 8.9 61.2 Government agency 2 0.3 1.2 Education 595 87.1 4.4 Private business 2 0.3 1.2 Other 2 0.3 2.5 Total 683

As expected, the vast majority of nursing faculty reported their “Principal Setting” to be in

education (87.1%) as shown in Table 4.6. However, there were a few nursing faculty members in other settings. These may be part-time faculty or faculty supervising clinical training.

39

Table 4.7 Key Activities of Nursing Faculty, 2005

Key Activities Number % % of All Nurses

Direct patient care 148 20.0 38.1 Patient education/counseling 79 10.7 8.3 Administrative Activities 157 21.2 11.5 Medication management 42 5.7 9.2 Case management/ care coordination 15 2.0 11.6 Continuing education/ staff development 44 6.0 14.4 Consulting with agencies/other professionals 83 11.2 2.5 Infection control 30 4.1 3.0 Teaching nursing students 701 94.9 5.5 Quality assurance/utilization review 8 1.1 4.6 Community/Public health activities 73 9.9 3.4 Other 168 22.7 21.8

Nearly all nursing faculty reported that “Teaching nursing students” was a key activity (94.9%) as

shown in Table 4.7. “Research” was another faculty-related activity among the response options on the 2005 survey. But only two respondents indicated that “Research” was a key activity (not shown). Research” is included in the “other” category in Table 4.7.

Table 4.8 Years of Licensure of Nursing Faculty, 2005 Years of Licensure Number % % of

All Nurses < 5 44 6.0 19.9 5-9 71 9.6 18.5 10-14 102 13.8 17.6 15-19 90 12.2 13.3 20-24 111 15.0 10.7 25-29 128 17.3 9.2 30+ 193 26.1 10.8 Total 739

Table 4.8 shows that nursing faculty members have been licensed to practice in Indiana for longer periods of time than other nurses. More nursing faculty have 20 or more years of licensure and less have fewer than 20 years (compare the percentages in Table 4.8). This likely reflects the time required to obtain advanced degrees and the experience required of instructors.

Advanced Practical Nurses This section presents data on survey responses from Advanced Practical Nurses (APNs). In Indiana, APN positions include “Nurse Practitioner”, “Clinical Nurse Specialist”, and “Certified Nurse Midwife”. Another position, “Certified Registered Nurse Anesthetist”, is counted among APNs in many other states and on the National Sample Survey of Registered Nurses. As mentioned in the discussion of Table 2.15 above, the “Certified Registered Nurse Anesthetist” position is included in the “Advanced Practice Nurse (APN)” category in this study. This section provides detail on the responses of the four types of Advanced Practice Nurses.

40

Table 4.9 Age Groups of Advanced Practice Nurses

Nurse Practitioner

Clinical Nurse Specialist

Certified Nurse Midwife

Certified Nurse Anesthetist % of All

Age Groups (% All APNs) # % # % # % # %

Nurses

Under 25 (0.1%) 0 0.0 0 0.0 1 1.8 1 0.6 2.9 25-34 (13.6%) 188 15.4 43 9.5 7 12.5 19 11.7 20.0 35-44 (29%) 371 30.4 117 25.9 11 19.6 48 29.6 27.5 45-54 (39.7%) 478 39.2 189 41.9 30 53.6 53 32.7 33.5 55-64 (16%) 170 13.9 93 20.6 6 10.7 34 21.0 14.4 65 or older (1.5%) 12 1.0 9 2.0 1 1.8 7 4.3 1.8 Total 1,219 451 56 162 Table 4.9 shows that among nurses holding APN positions, “Nurse Practitioners” tended to be younger than other APNs. They were more often in the younger age groups (under 45) than other APNs (Except in the youngest group (under 25) which contained only 2 APNs). “Nurse Practitioners” were also less likely than others to be in the older age groups. However, “Certified Nurse Anesthetists” were even less likely to be in the “45-54” age group and “Certified Nurse Midwives” were even less likely to be in the “55-64” age group. “Nurse Practitioners” tended to be older than other nurses answering the 2005 survey (compare to the “% of All Nurses” column). Fewer were in the groups under age 35 and more were in the groups aged 35 to 54. Comparing the first and last columns in Table 4.9 shows that, in general, APNs tended to be older than other nurses, but fewer APNs were 65 or older (1.5% vs. 1.8%).

Table 4.10 Gender of Advanced Practice Nurses

Nurse Practitioner Clinical Nurse

Specialist Certified Nurse

Midwife Certified Nurse

Anesthetist % of All Gender (% All APNs) # % # % # % # %

Nurses

Female (91.5%) 1,160 95.4 439 96.5 53 94.6 75 46.6 94.9 Male (8.5%) 56 4.6 16 3.5 3 5.4 86 53.4 5.1 Total 1,216 455 56 161

“Certified Nurse Anesthetists” were more likely to be male (53.4%) than female (46.6%) as

shown in Table 4.10. All other Advanced Practice Nurses were much more likely to be female (over 94% in each category). APNs overall were more likely to be male (8.5%) than were all nurses (5.1%), but “Clinical Nurse Specialists” were less likely to be male (3.5%).

41

Table 4.11 Race of Advanced Practice Nurses

Nurse Practitioner


Certified Nurse Midwife

Certified Nurse Anesthetist

Race (% All APNs) # % # % # % # %

% of ALL

Nurses

White (95.4%) 1,177 96.5 425 93.2 56 100.0 147 91.3 94.2 Black/ African American (1.9%) 19 1.6 16 3.5 0 0.0 1 0.6 2.9 Asian/ Pacific Islander (0.9%) 7 0.6 4 0.9 0 0.0 6 3.7 1.1 American Indian/ Native Alaskan (0.2%) 2 0.2 0 0.0 0 0.0 1 0.6 0.2

Multi-racial (0.4%) 7 0.6 0 0.0 0 0.0 1 0.6 0.5 Other (1.3%) 8 0.7 11 2.4 0 0.0 5 3.1 1.1 Total 1,220 456 56 161 Over 95 percent (95.4%) of all Advanced Practice Nurses were white compared to 94.2% of nurses overall as shown in Table 4.11. “Clinical Nurse Specialists” were more likely to be “Black / African American” (3.5%) than other types of APNs (0% to 1.6%) or Indiana registered nurses in general (2.9%).

Table 4.12 Ethnicity of Advanced Practice Nurses Nurse

Practitioner Clinical Nurse



Anesthetist % of All Hispanic Origin (% All APNs) # % # % # % # % Nurses Yes (1.8%) 17 1.4 10 2.2 1 1.8 6 3.7 1.5 No (98.2%) 1,195 98.6 445 97.8 54 98.2 155 96.3 98.5 Total 1,212 455 55 161

Table 4.12 shows that very few Hispanic nurses were in APN positions in 2005. The 17 Hispanic Nurse Practitioners represented 1.4 percent of all nurses in that position, about the same percentage as Hispanics in the general registered nursing population (1.5%). Other APN positions had higher percentages of Hispanics. The highest was “Certified Nurse Anesthetist” at 3.7 percent.

Table 4.13 Highest Degree in Nursing of Advance Practice Nurse

Nurse Practitioner

Clinical Nurse

Specialist

Certified Nurse

Midwife

Certified Nurse

Anesthetist Highest Degree in Nursing (% All APNs)

# % # % # % # %

% of All

Nurses

Diploma (3.9%) 15 1.3 27 6.1 2 3.6 28 17.6 10.7 Associate (8.5%) 23 1.9 114 25.9 0 0.0 19 11.9 44.6 Bachelor's (10.5%) 81 6.8 76 17.2 9 16.4 27 17.0 36.7 Master's (75.2%) 1,046 88.0 214 48.5 43 78.2 84 52.8 7.3 Doctorate (2.0%) 24 2.0 10 2.3 1 1.8 1 0.6 0.6

Total 1,189 441 55 159

Table 4.13 shows that 77.2 percent of all APNs held master’s degrees or doctorates in nursing in 2005 (75.2% + 2.0%). The percentage of these advanced degrees was much lower among “Clinical

42

Nurse Specialists” (50.8%) and “Certified Nurse Anesthetists” (53.4%). About 23 percent (3.9% + 8.5% + 10.5%) of APN nurses reported credentials lower than a Master’s degree. This reflects the fact that criteria for APN positions do not (or did not in the past) always require advanced degrees in nursing.

Table 4.14 Principal Work Setting of Advanced Practice Nurses Nurse

PractitionerClinical Nurse



Anesthetist % of AllPrincipal Work Settings (% All APNs) # % # % # % # %

Nurses

Non-hospital Patient Care (55.1%) 825 72.1 158 37.9 26 52.0 32 21.5 29.6 Hospital Patient Care (30.5%) 220 19.2 224 53.7 16 32.0 115 77.2 61.4 Government Agency (1.3%) 21 1.8 2 0.5 1 2.0 0 0.0 0.9 Education (2.6%) 36 3.1 9 2.2 4 8.0 0 0.0 4.4 Private Business (0.4%) 3 0.3 3 0.7 0 0.0 1 0.7 1.2 Other (3.4%) 40 3.5 21 5.0 3 6.0 1 0.7 2.5 Total 1,145 417 50 149 As shown in Table 4.14, a large majority of Advance Practice Nurses (85.6%) reported that they worked in patient care settings; 55.1 percent in “Non-hospital Patient Care” and 30.5 percent in “Hospital Patient Care”. While most APNs worked in non-hospital patient care settings, the opposite was true for Indiana nurses overall (29.6% non-hospital and 61.4% hospital patient care settings). “Nurse Practitioners” were even less likely than other APNs to work in “Hospital Patient Care” settings (19.2%). Both “Clinical Nurse Specialists” and “Certified Nurse Anesthetists” were much more likely than other APNs to work in hospitals (53.7% and 77.2% respectively).

Table 4.15 Key Activities of Advanced Practice Nurses

Nurse Practitioner


Certified Nurse

Midwife

Certified Nurse

Anesthetist Key Activities (% All APNs)

# % # % # % # %

% of All

Nurses

Direct patient care (80.9%) 1033 84.3 309 67.5 51 91.1 148 90.2 74.6 Patient education/counseling (49.5%) 650 53.0 237 51.7 29 51.8 27 16.5 33.4 Administrative Activities (27.3%) 297 24.2 185 40.4 12 21.4 26 15.9 27.8 Medication management (32.6%) 477 38.9 111 24.2 9 16.1 24 14.6 19.1 Case management/ care coordination (22.4%) 264 21.5 133 29.0 16 28.6 13 7.9 16.5 Continuing education/ staff development (17.3%) 174 14.2 135 29.5 4 7.1 16 9.8 14.3

Consulting with agencies/other professionals (23.1%) 290 23.7 127 27.7 7 12.5 16 9.8 12.8

Infection control (6.9%) 82 6.7 39 8.5 4 7.1 7 4.3 11.1 Teaching nursing students (17.8%) 239 19.5 75 16.4 13 23.2 11 6.7 9.0 Quality assurance/utilization review (9.1%) 85 6.9 73 15.9 2 3.6 13 7.9 10.6 Community/Public health activities (9.1%) 123 10.0 45 9.8 3 5.4 2 1.2 6.4

Other (28%) 287 23.4 220 48.0 5 8.9 22 13.4 21.2

43

Advanced Practice Nurses report almost all key activities at a higher rate than other registered nurses. This can be seen by comparing the percentages in the first and last columns of Table 4.15. The only exceptions are “Administrative Activities” (APNs 27.3% - All Nurses 27.8%), “Infection control” (APNs 6.9% - All Nurses 11.1%), and “Quality assurance / Utilization review” (APNs 9.1% - All Nurses 10.6%). “Certified Nurse Anesthetists” are more likely than other APNs to be involved in “Direct patient care” (90.2% vs. 80.9%) but less likely to be involved in any of the other key activities; often much less likely. “Certified Nurse Midwives” were also less involved in most of the key activities while being more involved with direct patient care (91.1% vs. 80.9%). They were also the most likely type of APN to be involved with “Teaching nursing students” (23.2%). “Clinical Nurse Specialists” were less likely than other APNs to be involved in “Direct patient care” (67.5% vs. 80.9%). But they were more likely to report several of the other activities including “Administrative activities”, “Continuing education / staff development”, “Infection control”, and “Quality assurance / utilization review”. “Nurse Practitioners” were, by far, the most numerous type of APN so that their distribution of activities was very similar to that of all APNs. But they were somewhat more likely than other APNs to be involved with “Medication management” and somewhat less likely to report “Continuing education / staff development” and “Quality assurance / utilization review”.

Table 4.16 Years of Licensure of Advanced Practice Nurses Nurse

Practitioner Clinical Nurse



Anesthetist Years Licensure (% All APNs)

# % # % # % # %

% of All

Nurses

< 5 (9.3%) 75 6.1 45 9.8 10 17.9 47 28.7 19.9 5-9 (15.3%) 196 16.0 62 13.5 7 12.5 27 16.5 18.5 10-14 (17.9%) 231 18.8 75 16.4 12 21.4 22 13.4 17.6 15-19 (16.1%) 209 17.0 72 15.7 6 10.7 20 12.2 13.4 20-24 (15.3%) 197 16.1 69 15.1 6 10.7 20 12.2 10.7 25-29 (12.7%) 156 12.7 58 12.7 8 14.3 19 11.6 9.2 30+ (13.4%) 162 13.2 77 16.8 7 12.5 9 5.5 10.9 Total 1,226 458 56 164 Table 4.16 shows that “All APNs” were less likely than “All Nurses” to have under 10 years of licensure and more likely to have ten or more. The proportions of “All APNs”, “Nurse Practitioners” and “Clinical Nurse Specialists” increased with years of licensure up to 15 years, but there was no clear pattern above that level. The proportion of “Certified Nurse Anesthetists” decreased with years of registered nurse licensure throughout the entire range (from 28.7% with under 5 years to only 5.5% with 30 or more years).

44

Chapter 5: Location of Nurses by County in Indiana

Map 5.1 shows that the number of survey respondents in Indiana counties is distributed roughly by population. The counties with the largest populations have the greatest number of these registered nurses, as would be expected. These larger counties include Marion (Indianapolis), Lake (Gary), Allen (Fort Wayne), Vigo (Terre Haute), Tippecanoe (Lafayette), St. Joseph (South Bend), Elkhart, Hamilton (Carmel/Fishers), and Vanderburgh (Evansville). The data for the maps in this chapter used the 2005 survey question that asked the zip code location of nurses’ principal employment location, not their mailing address. The reported zip codes were coded to counties by the survey contractor.

Allen

Jay

Lake

Knox

Vigo

White

Jasper

Cass

Clay

Pike

Rush

Parke

Grant

Greene

Perry

Ripley

Clark

Noble

La Porte

Gibson

Porter

Wells

Posey

Elkhart

Owen

Henry

Boone

Miami

Jackson

Putnam

Dubois

Shelby

Pulaski Fulton

MarionWayne

Clinton

Sullivan

Harrison

Benton Carroll

Daviess Martin

Orange

Kosciusko

Monroe

Morgan

Madison

Marshall

Newton

Warrick

Wabash

Warren

Brown

Franklin

Adams

Starke

Spencer

Decatur

Randolph

Lawrence

Whitley

De Kalb

FountainHamilton

Washington

St. Joseph

TippecanoeTipton

Jennings

Delaware

Hendricks

Lagrange

Montgomery

Jefferson

Steuben

Howard

Johnson

Scott

Hancock

Crawford

Fayette Union

Floyd

Switzerland

Huntington

DearbornBartholomew

Vermillion

Ohio

Vanderburgh

Blackford

Map 5.1: Registered Nurses Practicing in Indiana 2005 Number of Survey Respondents by County

Number of Survey Respondents

5 - 100 101 - 500

501 - 1000

1001 - 2500

2501 - 9695

45

Map 5.2 shows an estimate of the total number of registered nurses per 100,000 population by county in Indiana. The estimates assumed the same survey response rate (80%) in every county. Many counties rank higher on Map 5.2 than on the absolute number of nurses (Map 5.1). These include several counties in north central Indiana (for example: Starke, Pulaski, Fulton, and Wabash counties), east central Indiana (for example: Grant, Jay, Rush, and Decatur counties), and southwestern Indiana (for example: Vigo, Sullivan, Greene, Knox, Dubois, Warrick, and Perry counties). These counties do not necessarily have an adequate number of registered nurses. Many of them rank in the lowest level of total population (lightest color on Map 5.1) and the second lowest level in nurses per population (next to lightest color on Map 5.2). Several counties rank lower on nurses per population (Map 5.2) than on the total number of nurses (Map 5.1). These generally include populous counties such as Lake (Gary), St. Joseph (South Bend), Elkhart (Elkhart), Hamilton (north suburban Indianapolis), and Hendricks (west suburban Indianapolis).

Allen

Jay

Lake

Knox

Vigo

White

Jasper

Cass

Clay

Pike

Rush

Parke

Grant

Greene

Perry

Ripley

Clark

Noble

La Porte

Gibson

Porter

Wells

Posey

Elkhart

Owen

Henry

Boone

Miami

Jackson

Putnam

Dubois

Shelby

Pulaski Fulton

Marion

Wayne

Clinton

Sullivan

Harrison

Benton Carroll

Daviess Martin

Orange

Kosciusko

Monroe

Morgan

Madison

Marshall

Newton

Warrick

Wabash

Warren

Brown

Franklin

Adams

Starke

Spencer

Decatur

Randolph

Lawrence

Whitley

De Kalb

Fountain Hamilton

Washington

St. Joseph

TippecanoeTipton

Jennings

Delaware

Hendricks

Lagrange

Montgomery

Jefferson

Steuben

Howard

Johnson

Scott

Hancock

Crawford

Fayette Union

Floyd

Switzerland

Huntington

DearbornBartholomew

Vermillion

Ohio

Vanderburgh

Blackford

Map 5.2: Registered Nurses Practicing in Indiana 2005 Estimated Number Per 100,000 Population by County

Estimated Nurses Per 100,000

91 - 314

345 - 653

656 - 976

996 – 1193

1335 - 1632

46

Chapter 6: Trends in the Registered Nurse Workforce

The figures in this chapter show registered nurse trends based on the four Indiana surveys of registered nurses (1997, 2001, 2003, and 2005). The data are not adequate for confident future predictions, but trend lines (fit to the four data points using linear regression) are shown in each figure to provide an understanding of the changing supply of registered nurses. To make the data comparable among surveys, they were adjusted (weighted) for the differing survey response rates in the different years. The percentages shown in this chapter will correspond to those in Chapter 2 where some items were compared over time. But the numbers of nurses will differ between Chapter 2 and this Chapter because of the response-rate adjustment.

Figure 6.1: Registered Nurses Licensed by the State of Indiana

30,000

35,000

40,000

45,000

50,000

55,000

60,000

65,000

70,000

75,000

80,000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Num

ber

Total Licensed Active in Indiana Total Licensed (trend) Linear (Active in Indiana)

Source: Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission and previously unpublished data from the Indiana Registered Nurse Surveys of 2003 and 2005. Figure 6.1 shows that the total number of nursing licenses renewed by the state of Indiana has not changed much between 1997 and 2005 (between about 70,000 and about 73,000). In fact, there has been a slight decline from 2001 through 2005. But the figure shows that the estimated number of these nurses actively practicing in Indiana has increased from under 45,000 to around 53,000. These estimates assume that nurses responding to the surveys accurately represent all nurses licensed in Indiana. This was a good assumption for 1997, 2001, and 2005. In 2003, however, survey response rates were lower since nurses renewing licenses by mail could not participate and since electronic renewal was not as prevalent in 2003 as in 2005 (see the discussion in Chapter 1). Therefore the data point for nurses active in Indiana in 2003 is less reliable and is not shown in Figure 6.1. The trend line shown is based on only three data points and should be interpreted with caution. The other figures in this chapter show detailed information for nurses active in Indiana that do include estimates for 2003 and trends based on four data points. These trends must also be interpreted with caution.

47

Figure 6.2: Nurses Active in Indiana by Age Groups

0

4,000

8,000

12,000

16,000

20,000

24,000

28,000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

30 or younger 31-44 45-54 55-64 65 and older

Source: Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission and previously unpublished data from the Indiana Registered Nurse Surveys of 2003 and 2005.

The number of registered nurses active in Indiana has increased in all age groups, except 65 and older, as shown in Figure 6.2. The fastest growth was in the 45 to 54 year old age group.

Figure 6.3: Nurses Active in Indiana by Highest Degree in Nursing

0

4,000

8,000

12,000

16,000

20,000

24,000

28,000

32,000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Diploma Associate Bachelor's Master's Doctorate

Source: Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission and previously unpublished data from the Indiana Registered Nurse Surveys of 2003 and 2005. Figure 6.3 shows that the number of nurses is growing at all levels of education except the nursing diploma. Absolute growth is greatest at the bachelor’s level (+8,000) while growth rates are greatest at the master’s and doctorate level, both of which doubled between 1997 and 2005.

48

Figure 6.4: Nurses Active in Indiana by Weekly Hours Worked

0

4,000

8,000

12,000

16,000

20,000

24,000

28,000

32,000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

9 hours or less 10-19 hours 20-29 hours 30-39 hours 40 or more

Source: Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission and previously unpublished data from the Indiana Registered Nurse Surveys of 2003 and 2005. The largest group of nurses reported 40 or more hours of work per week, but those reporting 30 to 39 hours had greater growth over the period (+6,000). There was also growth in the 20 to 29 hour group.

Figure 6.5: Nurses Active in Indiana: Advanced Practical Nurses and Nursing Faculty

0

500

1,000

1,500

2,000

2,500

3,000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Num

ber

All Advanced Practical Nurses Nurse Practitioner (NP) Faculty in Nursing ProgramsAll APNs (trend) Nurse Practitioner (trend) Nursing Faculty (trend)

Source: Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission and previously unpublished data from the Indiana Registered Nurse Surveys of 2003 and 2005. Figure 6.5 shows that there has been great growth in the number of advanced practice nurses (APNs) between 1997 and 2005. Most of that growth is due to more Nurse Practitioners. Other categories

49

of APNs are shown in Figure 6.6 below. The number of nursing faculty (shown in Figure 6.5) was also increasing; but more slowly.

Figure 6.6: Nurses Active in Indiana: Advanced Practical Nurses Other Than Nurse Practitioners

0

100

200

300

400

500

600

700

800

900

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Num

ber

Clinical Nurse Specialist (CNS) Certified Nurse Midwife (CNM) *Certified Nurse AnesthetistClinical Nurse Specialist (trend) Certified Nurse Midwife (trend) Certified Nurse Anesthetist (trend)

Source: Indiana Registered Nurse Survey Databook 1997 (& 2001), Indiana Health Care Professional Development Commission and previously unpublished data from the Indiana Registered Nurse Surveys of 2003 and 2005.

* The “Certified Nurse Anesthetist” position does not require an Indiana certification and was not included in analyses of Advanced Practice Nurses in the 1997 and 2001 Indiana Registered Nurse Survey Databooks. This position is included in the APN category here following the practice of the National Sample Survey of Registered Nurses (NSSRN).

Figure 6.6 shows growth in the other three types of advanced practice nurses; clinical nurse specialists, certified nurse midwives, and certified nurse anesthetists.

50

Chapter 7: Conclusions

A total of 70,982 RNs renewed their Indiana licenses in 2005. Most of the respondents indicated that they were actively practicing in a nursing position. Among those actively practicing, 43,616 were practicing in Indiana.

One-half of the nurses were age 45 or older and almost all were females. In 2005, most RNs were white. The most common levels of training for RNs were an Associate degree or Bachelor’s degree. Nearly one-half of RNs indicated that they desired a higher degree; most commonly a Master’s degree. Very few indicated that they were fluent in a language other than English. Nearly 4 in 10 have been licensed as an RN in Indiana for less than 10 years, while nearly one-third have held their Indiana RN license for 20 or more years.

Over one-half of the RNs worked in a hospital setting in 2005; most of the rest worked in ambulatory care settings or other facilities. A few reported that they worked in more than one paid position. Nearly two-thirds reported that their principal position was a direct patient care position. One-fifth worked in indirect patient care positions. Key activities reported in the nurses’ primary positions included patient care (most common), patient education, medication management, and supervision or management. Nearly one-half of the RNs reported working 40 or more hours per week; another one-third worked 30-39 hours per week. One-half reported working in other health care positions prior to becoming a RN.

The age distribution of nursing faculty was older than that for all RNs. Nursing faculty members were less likely to be male and more likely to be black or African-American. As expected, nursing faculty much more often held Master’s and Doctorate degrees. Most, but not all faculty members reported their principal positions were in an education setting. Faculty members were much less likely to report patient care and administrative activities among their key activities. Nursing faculty members had, on average, held their Indiana RN licenses much longer than other RNs.

Nearly two-thirds of all Advance Practice Nurses (APN) were Nurse Practitioners and another one-third were Clinical Nurse Specialists. Nurse Practitioners tended to be slightly younger than those in the other APN categories and Certified Nurse Midwives tended to be older. The majority of Certified Nurse Anesthetists were males while other APN nurses were much less likely to be male than nurses overall. APN nurses were less likely to be black or African-American than nurses overall. Three-fourths of the APN nurses had Master’s degrees. A majority of all APNs were in patient care settings. But most of the Nurse Practitioners and Certified Nurse Midwives were practicing in non-hospital patient care settings while most Certified Nurse Anesthetists and Clinical Nurse Specialists were in hospital patient care settings. Generally, APNs had held Indiana RN licenses longer than other RNs.

Higher numbers of RNs and higher ratios of RNs per population were found in urban counties including Allen, Elkhart, Lake, Marion, St. Joseph, Tippecanoe, Vanderburgh and Vigo. In addition, higher ratios of RNs per population were noted in Bartholomew, Dubois, Floyd, Knox, and Wayne Counties.

The total number of individuals renewing Indiana RN licenses has been fairly constant over the past nine years; however, the number of RNs who are active in Indiana has been increasing. The number of nurses in the 45-54 age group has increased over the nine year period. The number of diploma trained nurses has been decreasing, while the numbers of RNs in the other education groups have been increasing. There has been an increase in the number of nurses who reported working 30-39 hours. There have been

51

sharp increases in the number of Advanced Practice Nurses of all types over the nine year period. However, the number of nursing faculty has remained fairly constant.

There has been an increase in the number of licensed nurses actively practicing in Indiana, but many do not work in direct patient care positions. Clearly, the nursing work force is getting older, as is the population in general. This aging trend suggests that as the “baby boomer” nurses retire, there will be a drop in the number of active nurses in Indiana – a trend also forecast in HRSA’s 2004 report. The number of Advance Practice Nurses has increased rapidly in the past nine years. There is a demand for obtaining higher degrees in nursing, yet the number of nursing faculty has not increased over the past nine years.

A number of changes to the survey instrument were suggested to improve the quality of the data and to improve comparability with other surveys. In addition, it is recommended that all nurses be instructed to complete the survey as part of the licensing process.

52

Appendices

Appendix 1: Survey Questions

Indiana RN E-Survey, 2005

Your answers to these questions will help the Indian State Department of Health to respond to emergencies and to identify health professional shortages and geographic shortage areas. The survey is voluntary and will not affect the status of your license. Thank you very much for your help. 1. CURRENT WORK STATUS. What is your current work status in nursing? Consider yourself

actively working in nursing if you are involved in direct patient care, case management, nursing education, administration or research. Please select only one. DROP-DOWN LIST Actively working in a paid position related to nursing. Actively working in a paid position in health care but not in nursing. Actively working, but not as a nurse or in health care. Working in nursing, but ONLY on a non-paid basis (volunteer or religious order). Unemployed and seeking work as a nurse in Indiana. Temporarily inactive as a nurse. Retired or permanently inactive as a nurse.

2. Please type the 5-digit zip code for your principal position location in the box next to this

question. Your “principal position” is the one in which you work the most hours. If you work in multiple zip codes (for example, if you are a home care nurse and travel to different patients’ homes), please put the zip code of the agency/employer at which you are based. IF YOU ARE NOT WORKING IN NURSING OR ARE RETIRED OR TEMPORARILY INACTIVE AS AN RN, PLEASE TYPE THE ZIP CODE WHERE YOU LIVE AND SKIP TO QUESTIONS 10-20. TEXT BOX.

3. Do you hold more than one paid position as a nurse (more than one employer)? DROP-DOWN LIST Yes No

4. Please choose the term that best describes your principal position as a nurse (the position in which you work the most hours). PLEASE SELECT ONLY ONE.

DROP-DOWN LIST Administrator/manager Case manager/Care Coordinator Certified nurse midwife Certified registered nurse anesthetist Charge nurse/team leader Clinical nurse specialist Continuing education/staff development nurse Critical care nurse Diabetes educator Dialysis nurse Director of nursing ER/ED nurse Faculty in a nursing program

Head nurse or assistant head nurse Home care nurse Hospice nurse Infection control nurse Legal consultant Long term care nurse Nurse clinician Nurse practitioner Nursing consultant Occupational health nurse Office nurse Operating room nurse Prison nurse Private duty nurse Psychiatric nurse Public health nurse Quality assurance/utilization review nurse Researcher School nurse Staff/general nurse Temporary nurse staffing service nurse Other

5. Do you spend most of your principal position time in the state of Indiana?

DROP-DOWN LIST Yes No

6. Which of the following best describes the setting where you work at your principal position?

PLEASE SELECT ONLY ONE. DROP-DOWN LIST Adult day care Ambulatory/outpatient care setting (surg., dialysis, other) Assisted living facility/unit Community health center/clinic Community mental health center Community substance abuse agency Continuing education/staff development Drug company Federal agency Home health care agency Hospice Hospital (in & out-patient) Hospital (in-patient) Hospital (out-patient) Hospital ER/ED Hospital operating room Insurance company Law firm Long term acute care facility/unit Long term/extended care facility/unit Mental retardation facility/unit Non-residential care facility/unit (e.g. elder day care)

Nursing education program Occupational health setting Physician/dentist private office Primary care enter/clinic Prison Private duty nursing Psychiatric inpatient facility/unit Public health department (city, county or state) Research setting School/college setting State agency (other than state public health department) Supplemental staffing agency Urgent care center/clinic Other

7. Please describe the activities in which you spend time in your principal position.

PLEASE SELECT ALL THAT APPLY.

DROP-DOWN LIST Administration Case management/care coordination Community health activities Consulting with agencies/other professionals Continuing education/staff development Direct patient care Environmental health (air, water or food safety) Financial management Infection control Medication management Patient education/counseling Policy and planning Prenatal care coordination Program management Public health activities Quality assurance/utilization review Research Psychiatric nursing Staff supervision/management Teaching nursing students Other

8. Which age patients do you most frequently work with? PLEASE SELECT ALL THAT APPLY.

DROP-DOWN LIST Infants (0-4) Children (5-9) Adolescents (10-14) Youth (15-19) Adults (20-64) Elders (65-Older) I do not provide direct patient care services

9. How many hours per week on average do you spend in ALL activities in nursing? PLEASE SELECT ONLY ONE. DROP-DOWN LIST 1-9 10-19 20-29 30-39 40 or more

10. Have you ever worked as any of the following? PLEASE SELECT ALL THAT APPLY.

DROP-DOWN LIST CNA (Certified Nurse Aide) Nursing assistant Paramedic Emergency Medical Technician (EMT)

11. Have you ever worked as a Licensed Practical Nurse (LPN) or Licensed Vocational Nurse

(LVN)? DROP-DOWN LIST Yes No

12. What is your highest degree in nursing? PLEASE SELECT ONLY ONE.

DROP-DOWN LIST Diploma Associate Bachelor’s Master’s Doctorate

13. What other nursing degrees would you like to earn in the future? Please select ALL that apply.

DROP-DOWN LIST Associate Bachelor’s Master’s Doctorate I do not intend to pursue further nursing education.

14. What is your highest degree IN ANY FIELD? Please select only one.

DROP-DOWN LIST Diploma Associate Bachelor’s Master’s Doctorate

15. Would you be willing to provide service in case of a bio-terrorism event or other public health emergency? If you answer “Yes”, we may use your licensure mailing address information to contact you? DROP-DOWN LIST Yes No

16. Would you be willing to attend specialized training in disaster-related services?


17. Are you fluent in any of the following languages? PLEASE SELECT ALL THAT APPLY.

DROP-DOWN LIST Arabic Chinese Filipino French German Greek Hindi Italian Japanese Korean Polish Russian Spanish Tagalog Thai Turkish

18. Which of the following best describes your race? PLEASE SELECT ONLY ONE.

DROP-DOWN LIST White Black/African American Asian/Pacific Islander American Indiana / Native Alaskan Multi-racial Other

19. Are you of Hispanic origin?


20. What is your sex?

DROP-DOWN LIST Female Male

APPENDIX 2: NSSRN Survey Instument

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Appendix 3 page 1

APPENDIX 3:

Part 1: Recommendations for 2007 RN Survey A. Administration of survey. All who renew their license should be required to complete the survey before their license is renewed. If they are not actively nursing there are still several survey items that they need to answer. B. Specific recommendations for the items on the Indiana RN E-Survey instrument used in 2005: 1. Current Work Status. For those selecting responses options OTHER than “a. currently a paid position related to nursing” (response option 1) or “d. working in nursing, but ONLY on a non-paid basis”, skip to question 10 and continue. Most web-based survey packages have the capability to automatically skip to future questions depending on their responses. Those selecting either response option a. or d. should continue with question 2. No changes recommended to the response options. 2. Principal Work Location. The instructions indicate that those not working in paid positions should enter the Zip Code of their residence. However, their residence Zip Code is likely to be the one to which the license will be mailed, so it is recommended that this part of the instructions be removed – note that item 1 above instructs the respondent to skip to question 10 if they are not working in a paid nursing position. 3. More than One Paid Position. Most, (86%) work in only one paid position as a nurse. If the percentage who work in more than one position increases significantly in the future, follow up questions should be added about their secondary work location, setting and position. 4. Principal Position. The response options for this question are a significant problem and need to be addressed. Please see Dr. Przybylski’s analysis report on pages 4 to 8 of this appendix. The 34 option list used in 2005 included some settings as well as positions. It is recommended that the response options for this question match the 37 options listed in the 2004 National Sample Survey of Registered Nurses, item 24 (see page 16 below). Not only will this change clear up some confusion, but it will also allow comparisons with the National Survey results. 5. Principal Position time in Indiana. No changes recommended. 6. Setting. The response options for position in #4 above occasionally overlap with setting (i.e. operating room nurse). This item is also included in Dr. Przybylski’s analysis report on pages 4 to 5 and 9 to 13 of this appendix. Again, it is recommended that the response options here match the 10 major categories (and perhaps some or all of the sub-categories) listed in the 2004 National Sample Survey of Registered Nurses, for item 23 and shown on pages 9-12 below. 7. Activities in Principal Position. Respondents are instructed to mark all that apply. No changes recommended. 8. Age of patients. Many respondents marked multiple categories even though they were asked to indicate the age of patients that they most frequently serve. The multiple responses were encouraged because respondents were also instructed to select all that apply. These two instructions appear to contradict each other and future surveys should clarify whether one response or multiple responses are sought. The

Appendix 3 page 2

question also assumes that the respondent provides direct patient care. Some respondents were apparently inconsistent in their response to this question in that they listed (an) age group(s) here while claiming elsewhere to not be involved in direct patient care. This question would be best placed as a follow-up to the “direct patient care” response to the “key activities” question. 9. Hours per week nursing. Few nurses worked less than 20 hours per week (less than 7%), even fewer worked less than 10 hours per week (2.5%). Thus, the categories “9 hours or less” and “10-19” could be combined into a “less than 20 hours” category. A significant problem exists with the “30-39” hour category. While normally 40 hours per week would be considered full time, some facilities consider 36 hours (3 days X 12 hours) full time. Other creative arrangements have been made to attract and retain nurses that involve even fewer hours of work to be considered “full-time,” such as working 12 hour shifts on the weekend days every weekend. The current grouping does not allow for identification of the “full time” nurses versus “part-time.” Again, it is suggested that this item follow the format similar to the related items on the National Sample Survey of Registered Nurses as two separate questions:

30. When you work at this principal nursing position, do you work…? Full-time Part-time 33a. Number of hours worked in your last full workweek (including paid hours of on-call duty

and overtime) ___ ___ 10. Worked as a CNA, Nursing assistant, Paramedic, EMT. It is suggested that the items from question 11 (LPN or LVN) be added to the list. 11. Worked as a LPN or LVN. It is recommended that this item be omitted if the response options are added to #10. 12. to 16. No changes recommended 17. Foreign language spoken. Very few (less than 5%) of respondents indicated that were fluent in a foreign language – including Spanish. With the growing Hispanic population in Indiana, it is important that to know what percentage of the RNs can speak Spanish. However, since so few (2.2%) could speak a language other than English or Spanish, is it necessary to ask about their ability to speak languages other than Spanish (and English)? It is recommended that this question only ask if the respondent can speak Spanish fluently. Also, fluency is quite a high standard in language proficiency. Perhaps asking about an “ability to communicate” would result in higher percentages and retain the intent to measure language proficiency. 18. to 20. If these are in the permanent RN licensure database – they don’t need to be asked on the survey. It is recommended that these items be omitted. C. Other items to add to the survey instrument: How long inactive: If you are not working for pay in nursing, how long has it been since you stopped working in a paid position as a registered nurse? (NSSRN #41) I have never worked in a paid position as a registered nurse. Less than one year __ __ years

Appendix 3 page 3

Why left nursing: If you are not currently working for pay in nursing, what is the primary reason(s) for not actively working as a nurse? PLEASE SELECT ALL THAT APPLY (NSSRN #59 -- modified) I have never worked in a paid position as a registered nurse. Burnout/stressful environment Career advancement/promotion Disability/illness Interested in another position/job Laid off/downsizing of staff Pay/benefits Relocated Retired Other: _______________________________ Advanced Training: Since graduating from your initial nursing program, have you completed a formal education program preparing you for advanced practice nursing as a clinical nurse specialist, nurse anesthetist, nurse-midwife, or nurse practitioner? (NSSRN #12 -- modified) No Yes Are you currently certified as a: Clinical Nurse Specialist

Nurse Anesthetist Nurse-midwife Nurse Practitioner

Income: Please estimate your current, gross annual earnings (pre-tax) from your principal nursing position. Include overtime and bonuses, but exclude sign-on bonuses. ___ ___ ___ , ___ ___ ___ . 00 (NSSRN #34) D. Other data from the permanent licensure database to be added to the survey responses for the report:

• Age = Month/year of survey – birth month/year • Gender • Race • Hispanic • Name of school where nursing training was completed • Location of school where nursing training was completed • Years registered as a nurse = Year of survey - year first registered as a nurse • Number of years licensed in Indiana = Year of survey – year first licensed in Indiana

Appendix 3 page 4

Part 2: Principal Nursing Positions and Settings

A. Indiana Registered Nurse Survey: Issues of Concern 1. The concepts of “principal nursing position” and the “setting” of that position are measured very differently in

the major national nursing survey (NSSRN) than they are in the Indiana Nursing Survey of 2005. 2. Changes to the Indiana nursing survey between 2001 and 2005 tended to increase the differences from the

national survey. Most of these changes were apparently made between 2001 and 2003. 3. Closer correspondence between the Indiana survey and the NSSRN would facilitate comparability to national

data and data for other states. 4. There is evidence that respondents to the Indiana nursing survey of 2005 are confused in answering the

“principal position” question. 5. The Indiana “principal position” question includes categories more appropriate to the “setting” question. 6. The categories of the Indiana “principal position” question are very difficult to combine into meaningful groups. 7. The NSSRN poses the question on “setting” of the principal position differently than the Indiana survey; using a

two-level definition of setting that greatly facilitates groping of categories. 8. Some Indiana settings are not included in the NSSRN settings. The Indiana survey gives much more detail on

settings within hospitals. 9. Some of the Indiana settings are confusing and the Indiana survey has much less detail in the areas of ambulatory

care, school health, occupational health, and nursing education.

In analyzing the results of the 2005 Indiana Registered Nurse Survey, we have discovered some inconsistencies that seem to be due to problems with the survey instrument. The problems are mostly with two questions, the nurse’s “principal position” and the “setting” of that position. These problems must be addressed before the survey is repeated. Our general recommendation is that these two questions should more-closely follow similar ones in the National Sample Survey of Registered Nurses (NSSRN).

Point 4 above refers to unsuspected results in crosstabulations of “principal position” with other variables.

For example, nurses reporting particular positions sometimes report settings or levels of education that are apparently inconsistent.

As mentioned in point 5, Indiana “positions” that seem to also be “settings” include the following response

options: Critical care nurse Dialysis nurse

Operating room nurse Occupational health nurse ER/ED nurse Temporary nurse staffing service Psychiatric nurse Diabetes educator Long-term care nurse Prison nurse Hospice nurse

All of these, with the exception of long-term care nurse and hospice nurse, were added since the 2001 survey.

Appendix 3 page 5

B. Comparing the 2005 Indiana Registered Nurse Survey to The 2004 National Sample Survey of Registered Nurses (NSSRN)

This brief comparison seeks to inform the discussion about possible changes to the questions on principal

position and the setting of that position in the Indiana RN Survey. The Indiana survey needs more clarity in these areas. Better comparability with the national survey also seems preferable. In this study, the NSSRN categorization will be presented and the Indiana categorization will be compared to it. Full listings of both surveys appear in Appendix 1 and Appendix 2 above.

On the following pages two large tables are presented. Table A3.1 compares the principal position response

options between the two surveys while Table A3.2 compares the options for the settings of the principal position. In general, the positions describe roles and/or functions while the settings describe the places and/or organizations where these roles and functions occur. The comparison also emphasizes the importance of being able to group both positions and settings into categories for purposes of reporting and analysis.

[Tables continue on the following pages]

Appendix 3 page 6

Part 1: The Principal Nursing Position

TABLE A3.1: Comparison of Principal Position Categories; 2004 National Sample Survey of RNs vs. Indiana RN Survey 2005

NSSRN Principal Positions & Codes Indiana Principal Positions & Codes type of 2005 New in

NSSRN category CODE match * Indiana Nursing Survey category CODE Count 2005? Administrator of organization/facility/agency or assistant administrator 1 Administrator/manager 1 2957 Administrator of nursing or assistant (e.g., vice president for nursing, director or assistant director of nursing services) 2 Director of nursing 10 608 yes

Case manager 3 Case manager/care coordinator 2 1788 Certified nurse anesthetist (CRNA) 4 Certified registered nurse anesthetist 4 164 Charge nurse 5 33 Charge nurse/team leader 5 2831 Clinical nurse specialist 6 Clinical Nurse Specialist 6 458 Consultant 7 Nursing consultant 20 169 Consultant 7 ? Legal consultant 29 37 yes Dean, director, or assistant/associate director of nursing education program 8 25 Faculty in a nursing program 12 739

Float nurse 9 Discharge planner/outcomes manager 10 ? Case manager/care coordinator 2 Head nurse or assistant head nurse 11 Head nurse or assistant head nurse 13 351 Infection control nurse 12 Infection control nurse 16 116 yes Informatics nurse 13 Instructor at a school of nursing 14 Insurance reviewer 15 Nurse clinician 16 Nurse clinician 18 301 Nurse coordinator 17 ? Case manager/care coordinator 2 Nurse manager 18 ? Administrator/manager 1 Nurse-midwife 19 Certified nurse midwife 3 56 Nurse practitioner 20 Nurse practioner 19 1226

Nursing staff development director 21 22 Continuing education/staff development nurse 7 542

Nursing staff development instructor 22 21 Continuing education/staff development nurse 7

Patient care coordinator 23 ? Case manager/care coordinator 2 Private duty nurse 24 Private duty nurse 32 45 yes

Table continues on the following page

Appendix 3 page 7

TABLE A3.1 (continued): Comparison of Principal Position Categories; 2004 National Sample Survey of RNs vs. Indiana RN Survey 2005

NSSRN Principal Positions & Codes Indiana Principal Positions & Codes type of 2005 New in

NSSRN category CODE match * Indiana Nursing Survey category CODE Count 2005? Professor or assistant/associate professor 25 8 Faculty in a nursing program 12 Public health nurse 26 Public health nurse 34 378 yes

Quality improvement nurse 27 Quality assurance/utilization review nurse 23 362

Researcher 28 School nurse 29 School nurse 24 921 Staff nurse 30 Staff/general nurse 25 11409 Staff nurse 30 ? Office nurse 21 2138 Supervisor or assistant supervisor 31 ? Case manager/care coordinator 2 Surveyor/auditor/regulator 32 Team leader 33 5 Charge nurse/team leader 5 Traveling nurse 34 Visiting nurse/home health nurse 35 Home care nurse 14 1062 No position title 36 Other (Specify) 37 Other 27 2313 none Critical care nurse 8 4435 yes none Operating room nurse 22 2133 yes none ER/ED nurse 11 2072 yes none Psychiatric nurse 33 836 yes none Long-term care nurse 17 803 none Hospice nurse 15 467 * type of match definitions: none Dialysis nurse 28 376 yes blank = good match none Occupational health nurse 30 326 yes ? = questionable match none Temporary nurse staffing service 26 142 yes number(s) = other NSSRN category(ies) included in this Indiana category none Diabetes educator 9 121 yes

none = matches no NSSRN category none Prison nurse 31 89 yes

Table A3.1 shows all 37 categories of ‘principal position’ in the 2004 NSSRN with the Indiana Nursing Survey category that seems to be the best match. Among the Indiana categories matched tone or more NSSRN categories, 5 are new to the Indiana survey in 2005. Four of the five are exact matches. Five of the Indiana categories seem to match more than one NSSRN category each. The Indiana category “Case manager/care coordinator” seems to match as many as 5 of the NSSRN categories. Eleven Indiana categories that match no NSSRN category are shown at the bottom of Table 3. Nine of these eleven are new categories since 2001 and all of them seem to describe work settings more than they describe principal positions. The number of respondents is shown for each Indiana category.

Appendix 3 page 8

Part II: The Setting of the Principal Nursing Position

Discussion of the categorization of principal nursing position must be related to discussion of the setting of that position. The two concepts of position and setting are related and may sometimes be difficult to distinguish. The NSSRN classifies settings by “major categories” first and then describes individual settings. The Indiana survey does not have “major categories”, but we created groupings for our first draft of the survey analysis (January 7, 2007). The individual Indiana categories are shown in Table 4 as they relate to the NSSRN categories, but their membership in our groupings is also shown.

TABLE A3.2: Comparison of Work Setting Categories; 2004 National Sample Survey of RNs vs. Indiana RN Survey 2005

NSSRN Work Settings & Codes Indiana Work Settings & Codes type of 2005 Group Membership New in

Classifications (Grouped by Major Categories) CODE match * Classifications (Not Grouped) CODE Count (for this study) 2005 Hospital (Exclude nursing home units and all off-site units of hospitals, but include all on-site clinics and other services of the hospitals)

Non-Federal, short-term hospital, except 110 ?? Hospital (in- & out-patient) 7 8,575 hosp patient care psychiatric (for example, acute care hospital) 110 ?? Hospital (in-patient) 8 12,201 hosp patient care Non-Federal, long-term hospital, except 120 ?? Hospital (out-patient) 9 1,010 hosp patient care psychiatric 120 ?? Hospital ER/ED 10 2,078 hosp patient care Non-Federal psychiatric hospital 130 ?? Hospital operating room 11 1,030 hosp patient care yes Federal Government hospital 140 Other type of hospital 150 Nursing Home/Extended Care Facility Nursing home unit in hospital 210 ? Long-term acute care facility/unit 29 644 non-hosp patient care yes

Other nursing home 220 ?? Long-term care/extended care facility/unit 13 1,698 non-hosp patient care

Facility for mentally retarded 230 Psychiatric inpatient facility/unit 33 445 non-hosp patient care yes

230 extended care? Mental health/addictions facility/unit 14 218 non-hosp patient care

Other type of extended care facility 240 ?? Assisted living facility/unit 24 158 non-hosp patient care yes

Table continues on next page

Appendix 3 page 9

NSSRN Work Settings & Codes Indiana Work Settings & Codes

type of 2005 Group Membership New in Classifications (Grouped by Major Categories) CODE match * Classifications (Not Grouped) CODE Count (for this study) 2005 Nursing Education Program ?? Nursing education program 15 375 education LPN/LVN program 310 Diploma program (RN) 320 Associate degree program 330 Bachelor’s and/or higher degree nursing program 340 Other program 350 Public or Community Health Setting

Official State Health Department 402 410 Public health department (city, county or state) 19 255 government agency yes

Official State Mental Health Agency 405 920, 940 State agency (other than state public health department) 36 97 government agency yes

Official City or County Health Department 410 402 Public health department (city, county or state) 19 255 government agency yes

Combination (official/voluntary) nursing service 415 Visiting nurse service (VNS/NA) 420 Home health service unit (hospital-based) 422 425 Home health care agency 5 1,603 non-hosp patient care Home health agency (non-hospital based) 425 422 Home health care agency 5 1,603 non-hosp patient care Community mental-health organization or facility (including freestanding psychiatric outpatient clinics)

430 Community mental health center 25 191 non-hosp patient care yes

430 outpatient? Mental health/addictions facility/unit 14 218 non-hosp patient care Substance abuse center/clinic 431 Community substance abuse agency 26 18 non-hosp patient care yes Community/neighborhood health center 435 Community health center/clinic 2 628 non-hosp patient care Planned Parenthood/family planning center 440 Day care center 445 Adult day care 23 32 non-hosp patient care yes Rural health care center 450 Retirement community center 455 Hospice 460 Hospice 6 592 non-hosp patient care Other 465


Appendix 3 page 10

NSSRN Work Settings & Codes Indiana Work Settings & Codes type of 2005 Group New in

Classifications (Grouped by Major Categories) CODE match * Classifications (Not Grouped) CODE Count (for this study) 2005 School Health Service ?? School/college setting 20 1,300 education Public school system 510 Private or parochial elementary or secondary school 520 College or university 530 Other 540 540 Occupational Health (Employee Health Service) ?? Occupational health setting 31 347 non-hosp patient care yes Private industry 610 Government620 620 Other 630 630

Ambulatory Care Setting ?? Ambulatory care setting (surgical/other) 1 2,385 non-hosp patient care

Solo practice (physician) 710 ?? Physician/dentist private office 16 1,994 non-hosp patient care Solo practice (nurse) 715 ?? Primary care center/clinic 17 688 non-hosp patient care Partnerships (physicians) 720 720 ?? Urgent care center/clinic 21 129 non-hosp patient care Partnerships (nurses) 725 ?? Non-residential care facility/unit 30 28 non-hosp patient care yes Group practice (physicians) 730 outpatient? Mental health/addictions facility/unit 14 218 non-hosp patient care Group practice (nurses) 735 Partnership or group practice (mixed group of professionals) 740 Freestanding clinic (physicians) 750 750 Freestanding clinic (nurses) 755 Ambulatory surgical center 760 Dialysis center/clinic761 761 Dental practice 770 770 Hospital owned off-site clinics 775 775 Health Maintenance Organization (HMO) 780 780 Other 790 790


Appendix 3 page 11

NSSRN Work Settings & Codes Indiana Work Settings & Codes

type of 2005 Group Membership New in

Classifications (Grouped by Major Categories) CODE match * Classifications (Not Grouped) CODE Count (for this study) 2005 Insurance Claims/Benefits Government 810 State or local agencies 820 Insurance company 830 Insurance company 12 336 private business yes Private industry/organization 840 ? Drug company 4 88 private business yes 840 ? Law firm 28 49 private business yes Policy, Planning, Regulatory, or Licensing Agency Central or regional Federal agency 910 Federal agency 35 147 government agency yes

State Board of Nursing 920 405, 940 State agency (other than state public health department) 36 97 government agency yes

Nursing or health professional membership association 930

Health planning agency, non-Federal 940 405, 920 State agency (other than state public health department) 36 97 government agency yes

Other 945 Other Correctional facility 950 Prison 18 141 non-hosp patient care yes Private duty in a home setting 955 Private duty nursing 32 69 non-hosp patient care yes Home-based self-employment 960 Other 965

* type of match definitions: none Research setting 34 112 research yes blank = good match none Other 22 900 other ? = questionable match none Supplemental staffing agency 27 33 private business yes

?? = match to summary category only none Continuing education/staff development 3 101 education yes

number(s) = other NSSRN category(ies) included in this Indiana category

text? = question about which NSSRN category is relevant

none = matches no NSSRN category

Appendix 3 page 12

In general, the NSSRN and the Indiana survey correspond better on work setting categories than on primary position categories. The greatest difference between the two surveys on work settings is in the “hospital” major category. The NSSRN distinguishes among types of hospitals while the Indiana survey distinguishes among different hospital settings. Distinction among types of hospitals is lost by the Indiana survey while distinction among types of hospital settings is lost by the NSSRN. It seems that the distinctions among hospital settings may be more important. Making both kinds of distinctions may not be necessary and would be cumbersome. However, the particular hospital settings referring to outpatients and inpatients in the Indiana survey may need clarification.

In several other major categories the NSSRN has much greater detail than the Indiana survey. These include the areas of ambulatory care, school health, occupational health, and nursing education. More detail and more clarity may be needed in the Indiana survey, particularly in the areas of ambulatory care and school health.

Some Indiana categories are difficult to categorize in the NSSRN system. Mental health settings and state government settings are particularly difficult to reconcile with NSSRN.

Conclusion

The most pressing problem with the design of the Indiana Registered Nurse Survey concerns the “principal position” categories. It would seem that closely following the NSSRN categorization would be the best solution. In addition, very clear labeling of APN-related categories is needed. Many nurses could reasonably identify themselves as a “clinical nurse specialist” because they specialize to some extent in particular clinical areas. Clearer identification seems necessary so that “clinical nurse specialist” is recognized as a specific designation within the broader “Advanced Practical Nurse” designation. Some Indiana “principal position” categories that clearly refer to “settings” should be dropped. The distinction between “position” and “setting” is not always clear and is sometimes confusing even in the NSSRN. But the Indiana survey need not be more confusing than the NSSRN and following the national design provides advantages in comparability. The current Indiana principal positions are also very difficult to summarize into broad major categories.

The work “settings” in the Indiana survey correspond more closely to NSSRN than the principal positions. But even with the “settings”, closer correspondence to NSSRN is desirable. Much of the difference between the two surveys with regard to settings is due to differing detail in different areas. The Indiana survey may need more detail in hospital settings than the NSSRN provides. But the detail and clarity of ambulatory care settings in the NSSRN should be more closely followed in the Indiana survey. The Indiana survey should explicitly group their settings into major categories as the NSSRN does. The same major categories should be probably be used in the Indiana survey.

Documents

Indiana Registered Nurse Survey Draft Report oct 5ahec.medicine.iu.edu/files/8112/9589/2062/WF-RN-2005.pdfAHEC 2005 Indiana Registered Nurse2005 Indiana Registered Nurse Survey ReportSurvey