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NEBRASKA RN SURVEY REPORT 2016 NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES NEBRASKA CENTER FOR NURSING March 2017
NEBRASKA RN SURVEY REPORT
2016
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
NEBRASKA CENTER FOR NURSING
March 2017
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EXECUTIVE SUMMARY
As also mentioned in the 2014 Nursing Report, nursing workforce continues to
expand in the State of Nebraska, although most of the growth has been
concentrated in metropolitan areas, as in the cities of Lincoln and Omaha. This
contrasts with rural Nebraska where there is a number of counties without a
presence of nurses (RNs, APRNs, or LPNs).
The average age of RNs has kept quite stable over the years, with a minimum
average age of 43.3 in 2004 and a maximum average of 44.7 years in 2010. The
current (2016) average age is 43.9 years, and nationwide the average age is
44.6 years (HRSA, 2013) 1.
The percent of males within Registered Nurses has steadily increased over the
years, reaching a high of 6% in the year 2016 (similar to 2014). The percentage
of males within RNs is still lower than the national average (9.1%). RNs who are
considered minorities have also increased over the years, from 3.1% in the year
2000, to 6% in the year 2016. At the state level, 19% of the population is
considered a minority2. Nationwide, 14.8% of RNs are considered minorities
(HRSA, 2013).
In terms of education attainment, RNs with bachelor degrees or higher have
increased 12.5% from the year 2008 to the year 2016 (51.3% vs. 63.8%,
respectively). At the national level, about 55% of RNs hold a bachelor degree or
higher. Also, RNs with doctoral degrees have nearly tripled, from 74 RNs with
doctoral degrees in 2003 to a total of 216 RNs in 2016. Overall, RNs holding
masters and doctoral degrees represent 11.4% of the workforce, which is slightly
higher compared to the national statistics of 10.6% (HRSA, 2013).
A total of 585 faculty work in Nebraska (Nursing Colleges’ Annual Reports, 2015-
2016). Ninety-seven percent of faculty is female, and 53% of faculty is 45 years
old or older.
1 US Department of Health and Human Services. (2013). The US nursing workforce: Trends in
supply and education.
(https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/nursingworkforcetrendsoct2013
.pdf)
2 U.S. Census Bureau (2013 estimates).
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CONTENTS
EXECUTIVE SUMMARY .............................................................................................................................................. 2
2016 RN Renewal Survey ........................................................................................................................................ 4
Demographics....................................................................................................................................................... 4
Age ....................................................................................................................................................................... 4
Race/ethnicity ................................................................................................................................................... 6
Gender ................................................................................................................................................................ 7
Education ........................................................................................................................................................... 7
Work Environment ................................................................................................................................................ 8
Type of Setting ................................................................................................................................................... 8
Employment ..................................................................................................................................................... 11
Advance Practice Role ................................................................................................................................ 12
Satisfaction levels with employment ......................................................................................................... 13
Geographic distribution of RNs in Nebraska ............................................................................................... 18
Appendix: Registered Nursing Workforce Survey 2016 ................................................................................ 20
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2016 RN RENEWAL SURVEY
A total of 27,572 surveys were received (96% surveys were submitted online and
4% on paper). From this total, 23,754 surveys (86%) were analyzed as they
represent RNs who mentioned that they work in the State of Nebraska. When
warranted, results are compared with 2014 or earlier RN Renewal Survey results.
DEMOGRAPHICS
AGE
The average age of RNs in Nebraska is 43.9 years old. Nurses 40 years old or
younger have proportionally increased in comparison to the 2014 Renewal
Survey (46% vs. 45.8%, respectively). On the contrary, nurses over 60 years old the
opposite is shown, especially for those over 70 years of age who seem to start
retiring at an older age than in previous years. See Figure 1.
When comparing average age since the year 2000, no major differences were
found; the highest average age was in 2000 (45.0 years of age), and the lowest
20.4%
25.4%
19.2%
23.7%
10.4%
0.8%
19.4%
26.6%
18.6%
21.5%
12.7%
1.1%
0%
5%
10%
15%
20%
25%
30%
20-30 31-40 41-50 51-60 61-70 >70
2014 2016
Figure 1: RNs by age 2014-2016
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in 2004 (43.3 years of age). Figure 2 shows the average age of RNS for the last
16 years, and Figure 3 shows the current age frequency of nurses.
Figure 2: RNs Average Age - 2000 - 2016
Figure 3: RN Age Frequency (2016)
45.0
44.1
43.3
44.5
43.7
44.7
44.043.8 43.9
2000 2002 2004 2006 2008 2010 2012 2014 2016
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RACE/ETHNICITY
Percentage of RNs who are considered a minority (i.e., African Americans,
Native Americans, Asian, Hispanics,) has grown over time. In the year 2000, 3.1%
of the nursing workforce was racially/ethnically considered a minority. Currently,
6.3% of RNs are minorities. Although this percentage is still lower than the
national statistics, it shows that over time the presence of minorities in the State
of Nebraska has steadily grown, as has also been the statewide trends.
Hispanics represent the highest ethnic group among minorities (2.3%), followed
by Black/African Americans (1.6%). See Figure 4.
Figure 4: Race/Ethnicity
0.1%
0.3%
0.8%
1.2%
1.6%
2.3%
93.7%
NAT I V E HAW AI I A N O R O T HE R
PAC I F I C I S L AND E R
AM E R I C A N I ND I A N O R AL AS KA
NAT I V E
O T HE R
AS I AN
B L AC K/ AF R I C A N AM E R I C A N
HI S PA N I C
W HI T E / C A U C A S I A N
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GENDER
The presence of men in the nursing
profession has also grown over time,
and again at a lower percentage
than the national trends, but the
trend has always been positive.
Currently, 6.0% of RNs are male.
Figure 5. Comparatively, in the year
2000 only 4.1% of the nursing
workforce were males.
EDUCATION
Education levels among nurses have increased over the years, especially those
who hold a Baccalaureate degree. Doctoral degrees have also increased
among RNs. According to the 2016 RN Renewal Survey, there are 216 nurses
(0.9%) with doctoral degrees (DNPs, EdDs, ad Ph.Ds.) working in the State of
Nebraska. This represents a 33% increase compared to the year 2014.
12.2%
24.0%
51.5%
10.5%
1.0% 0.9%
D I P L O M A A S S O C I A T E B A C C A L A U R E A T E M A S T E R P O S T - M A S T E R D O C T O R A T E
Figure 5: Gender Distribution
Female
94%
Male
6%
Figure 6: Highest Level of Education
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There were only 74 nurses with doctoral degrees in the year 2003. Figure 6 shows
the highest level of education held by RNs (2016).
One of the goals of the Institute of Medicine (IOM) is to achieve 80% of nurses
who hold a Bachelors degree in the year 2020. The following chart shows the
percentage of RNs who hold a bachelor degree (it includes all RNs with higher
degrees) in the last eight years (Renewal Surveys 2008 – 2016). RNs who hold at
least a bachelor degree have increased 12.5% during that time period (51.3% to
63.8%, respectively). See Figure 7.
Figure 7: RNs with Baccalaureate Degree
WORK ENVIRONMENT
TYPE OF SETTING
The 2016 Renewal Survey lists 18 working nurse practice positions. Hospitals
represent the main setting where RNs carry out their work (57.1%), followed by
Ambulatory Care Setting (10.1%), Other (8.0%), and then by Nursing
Home/Extended Care (7.6%). Only 0.6% of RNs are self-employed, and just 1.8%
of them work in either Community Health or School Health Service. Less than 2%
51.3
53.7
57.6
61
63.8
2008
2010
2012
2014
2016
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of RNs work in academic settings. See Figure 8. In the year 2000, 51% of RNs
worked in Hospitals. Figure 9 shows the percentage of RNs employed in Hospitals
since the year 2000.
0.2%
0.4%
0.6%
0.7%
0.7%
0.7%
1.1%
1.2%
1.3%
1.4%
1.7%
1.8%
1.8%
3.6%
7.6%
8.0%
10.1%
57.1%
Policy/Planning/Regulatory/Licensing Agency
Correctional Facility
Self-employed
Dialysis Center
Occupational Health
Assisted Living Facility
School of Nursing
Hospice
Public Health
Insurance Claims/Benefits
Academic Setting
Community Health
School Health Service
Home Health
Nursing Home/Extended Care
Other
Ambulatory Care Setting
Hospital
Figure 8: Type of Setting Primary Nursing Practice Position
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Figure 9: Hospital: Percent of Employment (2000 – 2016)
Nearly two-thirds of RNs work as “Staff Nurse” (64.5%), followed by “Nurse
Manager” (10.8%), and then by “Advanced Practice Nurse” position (6.7%). See
Figure 10.
51
53
57.4
55.6
58 57.9
56.6
57.657.1
2000 2002 2004 2006 2008 2010 2012 2014 2016
Figure 10: RN Position Title
0.2%
0.6%
1.3%
2.0%
3.5%
5.0%
5.4%
6.7%
10.8%
64.5%
O T HER - N O T HEAL T H REL AT ED
NU R S E R E S E A R C H E R
C O NSUL T A NT
NU R S E E XE C U T I V E
N U R S E F A C U L T Y / E D U C A T O R
O T HE R - H E A L T H R E L AT E D
C AS E M ANAG E R
AD V AN C E D PR AC T I C E NU R S E
NU R S E M ANAG E R
S T AF F NU R S E
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EMPLOYMENT
The majority of RNs work for one employer (86.3%), and nearly two percent work
for three or more employers. Figure 11. Those who work for one employer, 79%
are full-time employees. Those who work for three or more employers, 78% of
nurses are full-time employees, and the majority (57.3%) work in Hospitals,
followed by 8%, who work in “Ambulatory Care Setting”.
Overall, nearly five out of ten RNs work 40 hours a week or more, and 7% of RNs
work less than or equal to 20 hours a week. See Figure 12. Just 9% of RNs work
50 hours or more per week, although this still represents a staggering number of
2,016 RNs. Eight percent of them work in academic settings, which is quite
relevant considering that this activity only represents 1.7% of all RNs’ professional
settings, as shown in Figure 6 (page 9).
Figure 11: Number of Positions Currently Employed as a Nurse
1
86.3%
2
11.9%
3 or more
1.8%
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Figure 12: Hours worked per week
ADVANCE PRACTICE ROLE
According to the 2016 RN
Renewal Survey, there are
1,783 RNs licensed with an
advanced practice role
working in Nebraska.
Three-fourths of RNs who
hold an advance practice
role are Nurse Practitioners
(75%), followed by Nurse
Anesthetist (18%), Clinical
Nurse Specialist (5%), and Nurse Midwife (2%). See Figure 13.
3%
3%
11%
33%
42%
9%
10 hours or less
More than 10 hours but less than 20 hours
At least 20 hours but less than 30 hours
At least 30 hours but less than 40 hours
At least 40 hours but less than 50 hours
50 hours or more
Figure 13: RNs Advanced Practice Role
Clinical Nurse
Specialist (APRN-CNS)
5% Nurse
Anesthetist
(APRN-CRNA)
18%
Nurse
Midwife
(APRN-
CNM)
2%
Nurse Practitioner
(APRN-NP)
75%
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SATISFACTION LEVELS WITH EMPLOYMENT
One-fourth of RNs indicated that what they like the most about their job is to
provide services to patients (26%), followed by Work itself (23%), and then by the
People with whom they work (co-workers) (21%). See Figure 14.
Figure 14: What do you like MOST about your principal nursing employment?
When RNs were asked about what they like the least, three out of ten indicated
that there is nothing they do not like (30%), followed by Salary (19%), and then
by Hours/schedule (14%). See Figure 15.
2%
3%
3%
6%
16%
21%
23%
26%
Other
Salary
Location
Benefits (insurance paid vacation…
Hours/schedule
People with whom I work (co-workers)
Work itself
People for whom I provide service (patients)
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Figure 15: What do you like the LEAST about your principal nursing employment?
RNs were asked how satisfied they are with their current job. One out of two
nurses indicate that they are “Very satisfied” with their jobs (54.0%). Only 0.7% of
nurses indicated that they were “Very dissatisfied” with their current job. When
merging positive remarks about their jobs (i.e., “Very satisfied” and “Somewhat
satisfied”), a total of 95.9% of RNs feel satisfied with their current jobs. See Figure
16.
1%
3%
3%
5%
12%
13%
14%
19%
30%
People for whom I provide service (patients)
People with whom I work (co-workers)
Work itself
Location
Other
Benefits (insurance paid vacation…
Hours/schedule
Salary
Nothing there isn’t anything I don’t like
Very
Satisfied
54.0%
Somewhat
Satisfied
41.9%
Dissatisfied
3.4%
Very
Dissatisfied
0.7%
Figure 16: How satisfied are you with your current job?
Satisfied: 95.9%
Dissatisfied: 4.1%
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RNs were also asked how satisfied they are with nursing as a career. Nearly two-
thirds of RNs answered that they were “Very satisfied” (65.4%), followed by
“Somewhat satisfied” (32.0%). Overall, 2.6% of RNs answered that they were not
satisfied with their career. See Figure 17.
A high proportion of RNs indicate that they would encourage others to choose
nursing as a career (87.9%), and 85.4% of RNs would do it over if they had the
opportunity to choose nursing as a career again. When comparing with
previous renewal surveys, these percentages are quite consistent, even when
facing difficult workforce challenges such as nursing shortages. See Figures 18
and 19.
Very
Satisfied
65.4%
Somewhat
Satisfied
32.0%
Dissatisfied
2.1%
Very
Dissatisfied
0.5%
Satisfied: 97.4%
Dissatisfied: 2.6%
Figure 17: How satisfied are you with nursing as a career?
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Figure 18: Encourage others to
choose nursing as a career.
Figure 19: Would you choose nursing
as a career again?
Historical trends (Renewal Surveys 2000 – 2016) show that an increasing number
of nurses would have encouraged others to choose nursing as a career, or
would have chosen nursing if they had to do it over. For instance, encouraging
others to choose nursing as a career increased from 65.9% in the year 2000 to an
historical high of 88.8% in the year 2010. Figure 20.
Figure 20: Encourage others to choose nursing as career 2000 - 2016
No
12.1%
Yes
87.9%
No
14.6%
Yes
85.4%
65.9
74.8
82.185 86.2 88.8 88.5 87.2 87.9
34.1
25.2
17.915 13.8 11.2 11.5 12.8 12.1
0
10
20
30
40
50
60
70
80
90
100
2000 2002 2004 2006 2008 2010 2012 2014 2016
Pe
rce
nta
ge
Yes No
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In the year 2000, only 70% of RNs indicated that they would have chosen nursing
as a career. As shown in Figure 21, that percentage increased to 85% in the
year 2014 (differences are statistically significant).
Figure 21: Would you chose nursing as a career again 2000 – 2016?
70.774.4
81.2 81 82.786.1 86.1 85 85.4
29.325.6
18.8 19 17.313.9 13.9 15 14.6
0
10
20
30
40
50
60
70
80
90
100
2000 2002 2004 2006 2008 2010 2012 2014 2016
Pe
rce
nta
ge
Yes No
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GEOGRAPHIC DISTRIBUTION OF RNS IN NEBRASKA
Figure 22 shows the number of RNs by County according to the 2016 RN
Renewal Survey. Six counties did not report any RN working in them: Grant,
Arthur, McPherson, Loup, Wheeler, and Hayes. The highest number of RNs was
reported in Douglas County (n = 10,202), followed by Lancaster County (n =
4,340). Six counties reported having just one RN working in them: Sioux, Banner,
Thomas, Keya Paha, Logan, and Blaine.
Figure 22: Number of RNs by County
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Figure 23 shows the number of RNs per 1,000 people by county. Buffalo County
shows the highest number of RNs per 1,000 people (19.4 RNs per 1,000), followed
by Douglas County (19 RNs per 1,000), and then Madison County (18.7 RNs per
1,000). Sioux County shows the lowest number of RNs per 1,000 people (0.8 RNs
per 1,000), followed by Frontier (1.17 RNs per 1,000), and then Logan County
(1.18 RNs per 1,000).
Figure 23: RNs per 1,000 People by County
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APPENDIX: REGISTERED NURSING WORKFORCE SURVEY 2016
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