Nursing By the Numbers ( part 1 )
"With our population predicted to grow and with an aging Baby Boomer generation, it is only logical to conclude that unless a statewide nursing workforce plan is developed - and soon - the demands for RNs will continue to outpace supply."
Does South Carolina have enough registered nurses (RNs) to support the increase in staffing necessary to enhance patient outcomes? Recent studies from Harvard University reinforce a growing body of evidence linking hospital workforce with better patient outcomes - which is another way of saying "better quality care."
Findings from various patient care models demonstrate that increasing the level of registered nurse staffing results in better patient outcomes.1 Because RNs represent the largest portion of hospital labor costs, the expense of additional staffing is not insignificant. Research indicates, however, that the monetary benefits of reducing adverse events (injury, disability, and death) offset the costs of hiring additional RNs.2
South Carolina's supply of RNs expanded from 32,294 in 2003 to 33,845 in 2005.3 All areas in South Carolina experienced an upswing in the supply of RNs during this time, with the Low Country having the largest boost (6.22 percent).4
Even with almost 5 percent more RNs, however, hospitals and other health care providers are competing to recruit sufficient numbers of nurses to meet staffing demands.5 Comparing South Carolina's ratio of RNs to population (783 per 100,000) to the national ratio (825 per 100,000) is a basic indicator of the already-limited supply of nurses in the state. With our population predicted to grow, and with an aging Baby Boomer generation, it is only logical to conclude that unless a statewide nursing workforce plan is developed - and soon - the demand for RNs will continue to outpace supply.
Emerging Trends
There are several emerging trends to be seen in South Carolina's RN supply data. One positive trend is diversity. Nationally, there is concern about the aging of the nursing pool, and limited representation by males and minorities. In South Carolina, however, a greater percentage of nurses are under 40 years of age than in the nation as a whole (37.0 percent versus 26.3 percent, respectively). South Carolina's RN workforce also has greater numbers of males and minorities than national data show (Table 2).6 These proportions of males and minorities, however, are not reflective of South Carolina's general population.
The bottom line is that both the nation and South Carolina are generally experiencing a nursing workforce that is approaching retirement age.
Another trend has to do with growth in the South Carolina supply of RNs, which has traditionally come from two sources: new graduates obtaining licensure and the recruitment of RNs from other states and countries. The growth rate (number of RNs gained less the number of RNs lost) has declined from a 7.1 percent increase in 2003 to a 3.3 percent increase in 2005. While South Carolina's pool of RNs continues to grow, it is important to note that this growth is at a slower pace.7
Enrollments are increasing in South Carolina's nursing programs, and all of the state's nursing programs (at the baccalaureate and technical levels) can share the credit. While RNs are prepared with one of the two basic levels of preparation - the associate degree or the bachelor of science in nursing degree - the majority of South Carolina's RN workforce are prepared at the technical colleges. The percentage of RNs in South Carolina that have an associate degree in nursing continues to rise, from 46.15 percent in 1996 to 51.92 percent in 2005. This is in contrast to the national trend, which saw the number of RNs with an associate degree decline from 34.3 percent in 2000 to 33.7 percent in 2004.8 Efforts must be made to increase the numbers of RNs in the state graduating from baccalaureate programs.
A troubling trend for South Carolina's RN supply is the decreasing proportion of RNs gained from other states and countries. From 1999 to 2000, 1,395 RNs were recruited to South Carolina; in 2005, this number fell to an estimated 1,125.9 While some nursing employers may have come to depend on other states and other countries to fill the gap, the nursing shortage is global, and the supply from outside of South Carolina is expected to diminish.
Where RNs work is also changing. Hospitals, physicians' offices, and nursing homes remain the largest employers of RNs. In 2005, ambulatory surgery/other professional offices and school nurses entered the ranks of the top five nursing employers, while public health nursing and private home health nursing dropped out of the top five. While hospital inpatient services remains the No. 1 employment setting, RNs are now more likely to work in hospital outpatient areas such as clinics, emergency rooms, and ambulatory surgery. This mirrors the migration of health care services to the nonhospital outpatient arena.10
What We Need
