Data

The Washington Center for Nursing, the state’s nursing workforce center, has released several new reports that give insight into the changing nursing workforce in the state.
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Washington State Data Snapshots: a high-level overview #

WCN’s Snapshot reports are prepared every other year by the Univer­sity of Washington Center for Health Workforce Studies, with funding through a grant from the Washington State Depart­ment of Health. Each Data Snapshot uses data from Washington’s RN, LPN and ARNP license files, which contain the nurse’s name, mailing address, birth­date and gender. This minimal data has been used since 2004 to produce estimates of charac­ter­is­tics of the state’s nursing workforce. Washington popula­tion data are from the Washington State Office of Finan­cial Management. 

What do we know about Washington’s Registered Nurses? 

The number of regis­tered nurses with addresses in Washington state and holding active Washington licenses is 71,386, up by 2,729 or 4 percent from 2016. That trans­lates to about 977 regis­tered nurses per 100,000 people in Washington. 

The average age of RNs has gone down from 47.1 two years ago to 45.7 today. The number of male RNs continues climbing and is at 11.9 percent, a slight increase from 11.3 percent in 2016. 

RNs are distrib­uted in rural and urban areas fairly similarly to the overall popula­tion: 6.1 percent of RNs are in rural settings, compared with 8.3 percent of the state population. 

What do we know about Licensed Practical Nurses? 

The number of licensed practical nurses (LPNs) continues to decline. Currently, Washington has 9,859 LPNs with Washington addresses, which has dwindled each year since reaching a peak of 13,751 in 2008. In 2018, this trans­lates to about 135 LPNs per 100,000 people in Washington. Licensed Practical Nurses perform a variety of tasks under the super­vi­sion of a regis­tered nurse. They oversee basic care, such as admin­is­tering medicine and injec­tions and taking vital signs. Although many stay in licensed practical nursing throughout their career, many LPNs want to move on to regis­tered nursing. 

LPNs, like RNs, are distrib­uted in rural and urban areas similar to the overall popula­tion: 7.6 percent of LPNs have addresses in Washington’s rural areas, home to 8.3 percent of Washing­to­nians, compared with just over 92.4 percent of LPNs in urban areas, where 91.7 percent of the state’s popula­tion lives. 

The percentage of LPNs who are male is 13.6 percent, staying roughly the same since 2014. 

What do we know about Advanced Registered Nurse Practitioners? 

The ARNP license category in Washington includes certi­fied regis­tered nurse anesthetists (CRNA), certi­fied nurse midwives (CNM), clinical nurse special­ists (CNS) and nurse practi­tioners (ARNP).

The number of ARNPs licensed in Washington with in-state addresses continues to climb steadily, reaching 5,981 today, from 2,835 in 2006. That is an increase from 50 ARNPs per 100,000 Washington popula­tion in 2006 to about 82 per 100,000 in 2018. 

The average age of ARNPs in Washington was 47.7 years in 2018 and has been declining in the past 10 years as more younger ARNPs enter the workforce. Male ARNPs increased slightly to 15.3 percent in 2018 from 14.5 percent in 2016. About 6 percent of ARNPs have rural addresses compared with 8.3 percent of the state population. 

Washington State Advanced Registered Nurse Practitioner Survey Data Report #

WCN has published a new report on the Washington state Advanced Regis­tered Nurse Practi­tioner (ARNP) workforce, which identi­fies and describes charac­ter­is­tics of previous and current Washington state ARNP practice owners and indepen­dent contrac­tors and analyzes the ways in which reduc­tions in reimburse­ment by Washington state health plans in 2013 and 2015 affected ARNP-owned practices and indepen­dent contractors. 

The report was co-sponsored by Washington State Univer­sity and the American Associ­a­tion of Nurse Practi­tioners and prepared by Louise Kaplan, PhD, ARNP, FNP-BC, FAANP, FAAN, Principal Inves­ti­gator and Justin Gill, MS, ARNP, FNP‑C, Yale Univer­sity DNP Student, Co-Inves­ti­gator. As part of a longi­tu­dinal study of ARNPs in Washington, this report was also published in 2001, 2003, 2006 and 2015. 

The survey was sent to all 6,188 Washington ARNPs with valid contact infor­ma­tion, and the report reflects responses from 1,235 ARNPs at a response rate of 20.7 percent. 

Key findings from the 2018 ARNP Survey: 
  • ARNPs are predom­i­nately white (88%) females (86%) with an average age of 48 years. 
  • Almost all ARNPs (98%) have a graduate degree (master’s or doctorate). 
  • Family nurse practi­tioners repre­sent the largest group (47.8%) of ARNPs. 
  • The top two locations of practice are a health­care office/​clinic owned by a health care system or organi­za­tion (30.5%) or independent/​privately owned practice (19.6%).
  • Ten percent of ARNPs own a practice alone or with others. 
  • Less than half (41%) of respon­dents provide primary care while 15% work in rural areas. 
  • The average portion of time worked in providing direct patient care was 60%. 
  • Two-thirds (68%) were moder­ately or very satis­fied with their current position. 
  • An average gross income for an ARNP who works full time is $128,529.
  • Only one-third (33%) of respon­dents prescribe for patients with chronic non-cancer pain.
  • The top two reasons prior practice owners and indepen­dent contrac­tors closed their practice were reduced reimburse­ment (29%) and inability to compete with large health systems (20%).

The Washington State RN Survey #

Expanding the Snapshots with a more complete picture of nurses in Washington state

In the past, avail­able data on nurses has been minimal and incon­sis­tent, contributing to confusing predic­tions about supply and demand of the nursing workforce. In March 2018, WCN and their research partners at the Univer­sity of Washington Center for Health Workforce Studies conducted a pilot statewide RN sample survey using the Minimum Data Set (MDS), a set of questions devel­oped by a national coali­tion committed to promoting having compa­rable data about the nurse workforce across the country. We asked nurses about:

  • Employ­ment status.
  • Job setting, title and position (up to two jobs).
  • Hours worked per week.
  • Practice zip code.
  • Basic demographic infor­ma­tion, including educa­tional attainment.
  • Initial and current license information.
  • Current creden­tials.

The Washington survey added questions to capture additional nurse charac­ter­is­tics to create a more accurate picture of the ability of Washington’s nursing workforce to meet the needs of our commu­ni­ties. The additional questions asked additional career satis­fac­tion questions including:

  • Salary.
  • More-detailed infor­ma­tion on hours worked and educa­tion history.
  • Health care-related employ­ment prior to becoming a nurse.

The goal of the survey was to strengthen under­standing of Washington’s current regis­tered nurse workforce and inform policy­makers and educa­tors about future needs. The infor­ma­tion from this survey will be used to create a baseline profile of the state’s regis­tered nurses that can be compared with findings from data collected through license renewals in the years to come.

A total of 9,214 nurses responded to the survey, with 7,607 employed as an RN in their primary job.

Survey highlights
  • Overall, 62 percent of surveyed nurses have baccalau­reate degrees or higher (70 percent when including non-nursing degrees).
  • 76 percent of nurses in the 19 – 29 age group have a baccalau­reate in nursing or higher.
  • Washington’s RNs are quite satis­fied with their jobs and roles, although some report feeling overwhelmed.
  • RN median salaries in WA are higher than the U.S. as a whole ($70,000 in 2017) but vary by age, setting and educa­tional attainment.
  • The propor­tion of RNs who are white is higher than the propor­tion of white residents in the state as a whole.

The results of this survey will be a crucial step to getting the complete picture of the Washington RN workforce, as well as learning the best ways to support nurses in educa­tion, career advance­ment, and job satisfaction.

What all Washington state nurses need to know about the Nursing Commis­sion Survey

A key recent change in the Washington State Nursing Care Quality Commission’s license renewal proce­dure has added a monumental — and exciting — shift to getting a clearer view of the workforce, how nurses are prepared to meet health care demands and what support is needed. Begin­ning Jan. 1, 2018, all nurses in Washington state were required to fill out the Nursing Commission’s Demographic Survey online at the time they renew their licenses. WCN will oversee the annual data analysis and publish findings, which will help inform policy recom­men­da­tions on how to expand and improve nursing educa­tion programs and strengthen the nursing workforce to better serve our changing communities.

Measuring employer demand

WCN is regularly engaged in the Washington Health Workforce Sentinel Network, which links the health care sector with policy­makers, workforce planners and educa­tors to identify and respond to changing demand for health­care workers, with a focus on identi­fying newly emerging skills and roles required by employers. The Sentinel Network is an initia­tive of Washington’s Health Workforce Council, conducted collab­o­ra­tively by Washington’s Workforce Board and the Univer­sity of Washington’s Center for Health Workforce Studies. According to the Sentinel Network’s recent findings for RNs (July 2016 to September 2018), RNs are the top occupa­tion with excep­tion­ally long vacan­cies recently reported by small (25 beds or fewer) acute care hospi­tals as well as skilled nursing facilities.

  • RNs are also among occupa­tions with long vacan­cies in:
  • Feder­ally Quali­fied Health Centers/​community clinics.
  • Behav­ioral health/​mental health clinics.
  • Psychiatric/​substance abuse hospital.
  • Large acute care hospitals.
  • Schools.
  • Specialty medical clinics. 
How do we ensure Washington state can produce enough nurses to take care of all patients?

Washington state needs more nurses, yet we are experi­encing a dire nursing faculty shortage, which means quali­fied students are being turned away from programs due to lack of space, not all students have access to practice experi­ences due to high compe­ti­tion for spots and funding for nursing educa­tion fails to keep pace. All of these factors provide a clog in the produc­tion of a highly quali­fied nursing workforce needed by our commu­ni­ties. Coupled with these issues is a national call to advance nursing educa­tion to increase access to and support success at baccalau­reate and graduate levels.

As WCN engages in workforce devel­op­ment issues at the state and national level, a key area of focus is Action Now!, which is the statewide coali­tion to strengthen the nursing educa­tion system to meet the increasing demand for nursing services. The effort is co-led by WCN, the Council on Nursing Educa­tion in Washington State and the Nursing Care Quality Assur­ance Commis­sion. We launched Action Now! because we under­stand the critical link between nursing educa­tion, the nursing workforce and the health of the people of Washington state. Our vision state­ment is: Nursing Educa­tion: Securing the Future of a Healthier Washington.”

In November, we produced the Action Now! Solution Summit, a culmi­na­tion of two years of our collab­o­ra­tive work among stake­holders from higher educa­tion, health care practice, workforce devel­op­ment, policy and the business commu­nity to trans­form the state’s nursing educa­tion system, securing the future of a healthier Washington. With an inspiring keynote address on innova­tion from renowned futurist Pablos Holman, the message was clear: we need to trans­form the system from within. We heard some fasci­nating ideas from our atten­dees. More impor­tantly, we got commit­ment from them to do some of the heavy lifting — a few organi­za­tions have stepped up to partic­i­pate in a pilot simula­tion project, others have offered valuable resources as we proceed. This work is complex but it is all the more impor­tant to continue and persevere.

Are you inter­ested in joining our efforts? Send us an email at ActionNow@wcnursing.org.

The Washington Center for Nursing supports a healthier Washington by engaging nurses’ exper­tise, influ­ence, and perspec­tive and by building a diverse, highly quali­fied nurse workforce to meet future demands. Our vision: Trans­forming commu­ni­ties in Washington state through increased access to quality nursing care.