hosp_v_nonhosp_60percent_final

For many years, we have used data from Current Population Surveys (CPS) to identify employment characteristics of the nation’s registered nurses (RNs). Our analysis of 2013 CPS data shows that, for the first time since we began recording this data in 1979, the proportion of RNs employed on a full-time-equivalent (FTE) basis in hospitals dropped below 60%. The figure above highlights trends over the last 6 years and shows that employment of RNs in hospitals (in red) has remained relatively constant (growth from 2008 to 2013 was 2%) while employment in non-hospital settings (shown in green) has grown substantially (27%). This shift has caused the proportion of all RNs employed in hospital settings to drop to 59%.

fteRNhosp60

 

Over time, efforts have sought to shift care delivery out of expensive, acute care hospitals and into less expensive ambulatory and community based settings.   Such efforts began in the 1980s with the shift from cost-based to prospective hospital based payments, followed by the use of market competition and health maintenance organizations in the 1990s.  Steady advances in technologic innovation have also contributed by enabling many procedures to be performed outside of hospitals.   However, despite these forces, the shift in RN employment out of acute care hospitals appeared to have paused for most of the 2000s, hovering between 60 and 65%.

In the 2010s, however, the decrease appears to have resumed. In fact, the Bureau of Labor Statistics reported unprecedented overall declines in hospital employment of over 4,000 in December 2013 and January, 2014. These changes could be influenced by the Affordable Care Act, which reduced hospital payment updates, emphasizes care coordination, prevention and wellness, and created Accountable Care Organizations, which seek to reduce costs of care for Medicare beneficiaries and could add further pressure on providers to seek alternatives to costly hospital care.

Table 1:  Full-Time-Equivalent (FTE) Registered Nurses Employed in Hospitals by Age, 2011 – 2013

Year

RNs

21-34

RNs

35-49

RNs

50+

Total FTE RNs

Employed

2010

483,037

626,770

542,829

1,652,705

2011

493,562

602,460

563,798

1,659,820

2012

487,322

621,105

571,664

1,680,090

2013

500,045

616,826

540,346

1,657,216

While the number of RN FTEs employed in hospitals increased in 2012, overall employment growth in hospitals has slowed, with nearly the same number employed in 2013 as four years earlier in 2010.

  • Over the past four years, hospital employment of younger RNs (those ages 21-34) has remained above 480,000.  In the last year of these data, employment increased by roughly 13,000, reaching 500,000 RNs in 2013
  • With regard to middle age RNs (those ages 35-49), the largest component of hospital employed RNs by age, their employment growth has see-sawed in the low 600,000s since 2010
  • The number of RNs over age 50 grew from 2010 to 2012, but then fell back sharply (by 30,000) in 2013

Table 2:  Full-Time-Equivalent (FTE) Registered Nurses Employed in Non-Hospital Settings by Age, 2011 – 2013

Year

RNs

21-34

RNs

35-49

RNs

50+

Total FTE RNs

Employed

2010

191,895

386,437

391,377

969,709

2011

222,345

382,196

408,148

1,012,689

2012

229,448

388,157

438,183

1,055,788

2013

254,481

391,944

507,487

1,153,913

Employment of RNs in non-hospital settings has grown substantially since 2010, increasing by nearly 185,000 FTEs to reach over 1.15 million RNs in 2013.

  • FTE employment occurred among both younger RNs (those ages 21-34) and more seasoned RNs (those over age 50) and stagnated among middle aged RNs
  • Employment increased among younger RNs by nearly 55,000 FTEs over the four year period, reaching just under 255,000 in 2013
  • Even stronger growth in employment occurred among RNs over age 50 as their numbers increased by nearly 116,000 FTEs between 2010 and 2014!  In fact, there are far more older RNs working on a FTE basis in non-hospital settings than any other age group

 

Center for Interdisciplinary Health Workforce Studies, Research Brief No. 1
May 2014
Peter Buerhaus, David Auerbach, Douglas Staiger, and Christine Friedman