Effect of the Shortage on:
Hospitals
Longterm Care
Home Care
 
 
 

"Hospitals remain the major employer of nurses although the number of nurses employed in other sectors has increased. The number of RNs employed in hospitals
increased by nearly one-half million between 1980 and 2000. However, reflecting the growth in nurse employment in other sectors, the percentage of the nurse
workforce employed in hospitals, after a peak of approximately 68 percent in 1984, declined steadily. In 1980, approximately 66 percent of employed RNs worked in
hospitals; by 2000 the proportion had declined to 59 percent.

Public and community health, ambulatory care, and other non-institutional settings had the largest percentage gain in RN employment between November 1980 and
March 2000. RNs employed in public health and community health settings increased by 155 percent and those employed in ambulatory care settings increased by
127 percent between 1980 and 2000. (See Chart 8)....
The number of nurses employed in nursing homes and other extended care facilities, although 51 percent higher in 2000 than in 1980, decreased between 1996 and
2000 following a substantial increase between 1992 and 1996. This decline in nursing home employment occurred among nurses of all ages except those between 45
and 54 years of age; but was especially sharp for younger nurses. The number of nurses under 45 years of age who were employed in nursing homes and other
extended care facilities in 2000 was 18 percent lower than the comparable number in 1996....
In March 2000, 81.7 percent of the RN population, or 2,201,813 RNs were employed in nursing. Although RNs can be found in all sectors of the health care
system, the predominant employment setting remains the hospital. Of the 2,201,813 RNs employed in nursing, 1,300,323 or 59.1 percent, worked in hospitals.
The next largest group, 402,282, or 18.2 percent, worked in public/community health settings including State or local health departments, community based
home-health agencies, various types of community health centers, student health services, and occupational health services. An estimated 9.5 percent or 209,324
RNs were in ambulatory care settings, including physician-based practices; nurse based practices, and health maintenance organizations. A total of 152,894 (6.9
percent) of all RNs employed in nursing, worked in nursing homes and extended care facilities. The remaining group of those employed in nursing were working
in such settings as nursing education, federal administrative agencies, State boards of nursing or other health associations, health planning agencies, prisons/jails,
or insurance companies (see Appendix A, Table 13).

The percent of RNs employed in hospitals did not change substantially between 1996 and 2000, declining from 60.1 percent to 59.1 percent. The number of RNs
employed in hospitals increased by 2 percent compared with a 4 percent increase in the total number of RNs employed in nursing.

Nearly three-fourths of RNs employed in hospitals reported spending more than 50 percent of their time in direct patient care, as illustrated in Chart 15. However,
approximately 90 percent of RNs employed in hospitals spent some portion of their time in direct patient care. As shown in Chart 16 in both 1996 and 2000,
inpatient bed units were by far the work site where hospital nurses spent the majority of their direct patient care time. The data for 2000 indicate the number of
nurses who provided care in these units decreased five percent between 1996 and 2000, in contrast to the two percent increase in hospital nurses overall. Also,
RNs working in outpatient departments decreased by 10 percent from 77,437 in 1996 to 69,707 in 2000. Among nurses who provided direct patient care services
in 2000 and reported the type of work unit, 58 percent worked in intensive care bed units, step down/transitional bed units, and general/specialty bed units (see
Appendix A, Table 14). In 1996, 59 percent of hospital RNs providing direct patient care worked in these units. Changes between 1996 and 2000 in the number of
nurses providing direct patient care in specific types of units in the hospital should be interpreted with caution because of the significant increase in the number of
nurses in 2000 who did not report the type of unit in which they spent the majority of their patient care time. Eight percent of hospital employed RNs who
provided direct patient care in 2000 did not report the type of work unit in which they spent the majority of their time. In 1996 virtually all nurses reported this.
As might be expected, nurses worked predominantly with medical/surgical patients in both inpatient bed units and outpatient departments. In 2000, an estimated
32 percent of the nurses primarily cared for such patients (see Appendix A, Table 15). The next single largest percentage of RNs (18 percent) reported that they
worked predominately with coronary care patients.....
The average scheduled work hours per year for full-time principal nursing positions, including paid vacations, holidays and sick leave was estimated to be 1,996
hours; for part-timers it was 1,102 hours. A comparison of the number of scheduled hours per week and the actual number of hours worked showed that for the week
of March 22, 2000, nurses in all employment settings tended to work more hours than they were scheduled. During that week, full-time nurses averaged 42.4 actual
hours in contrast to average scheduled hours of 39.5. The difference between scheduled and actual hours worked was less for part time employeesó24.7 actual
hours worked compared with 23.1 hours scheduled (see Appendix A, Table 17)....
Nearly 40,000 nurses were employed in their principal position through a temporary employment service in 2000. This number is 36 percent higher than the
comparable number in 1996 (28,971) and reverses a declining trend observed between 1988 and 1996. An additional 71,490 nurses were not employed in their
principal positions through a temporary employment service, but had additional positions through temporary agencies. Considered together, the total number of
nurses employed through temporary employment services in 2000 was 110,994 an increase of 65.6 percent from the 1996 estimate of 67,016, and considerably
higher than the 84,414 estimate in 1992 and the 88,444 estimate in 1988....
More than 60 percent or 1,357,349 of the 2,201,813 employed nurses in 2000 were in staff-level positions. (See Appendix A, Tables 21 and 22). Although the
number of staff nurses has increased, their proportion of the total nurse workforce has declined from 67 percent in 1988 to 62 percent in 2000. A total of 184,098, or
8.4 percent of RNs were in head nurse or supervisory positions in 2000 and 124,461 or 5.7 percent were in administrative positions. Chart 19 illustrates the shifts
that have occurred in the distribution of RNs by selected position titles since the late 1980s. In addition to the decline in the percentage of employed nurses who are
staff nurses there has been a notable decline in the percentage of those with the position title of supervisor (from 5.6 percent to 3.6 percent during the period from
1988 to 2000). 
"  National Survey 2000, put in link
"Primary Practice Setting
* 1,148709 (45%) Hospitals
* 195,581 (17%) Intensive Care bed unit
* 78,269 (6.8%) Telemetry/Step Down/PCU 
* 89,300 (7.8%) Emergency Department 
* 103,835 (9%) Operating room
* 36,696 (3.2%) Post Operative/Recovery 
* 403,139 (35.1%) General/Specialty unit
* 79,258 (6.9%) Labor/Delivery room"
[cited to Mezibov D. (1997). Nursing school enrollments some vital perspective. Media Backgrounder. Washington DC: American Association of Colleges of Nursing.]
Registered Nurse Statistics FACT SHEET Oct 1998
At the American Association of Critical Care Nurses Web pages.