Report to the Chairman, Subcommittee

on Health, Committee on Ways and

Means, House of Representatives

United States General Accounting Office

GAO

July 2001 NURSING

WORKFORCE

Emerging Nurse

Shortages Due to

Multiple Factors

GAO-01-944
Page i GAO-01-944 Emerging Nurse Shortages

Letter 1

Results in Brief 1

Background 2

Evidence Suggests Emerging Shortages of Nurses 3

Multiple Obstacles to Increasing Supply of Nurses 6

Demand for Nurses Will Continue to Grow As the Supply Dwindles 11

Concluding Observations 13

Appendix I Change in RN Employment, per 100,000 Population by

State, 1996-2000 14

Figures

Figure 1: Age Distribution of the Registered Nurse Population, 1980

and 2000 8

Figure 2: Cumulative Annual Increase in Median RN Earnings and

the Consumer Price Index, 1989-2000 11

Figure 3: Decline in Elderly Support Ratio Expected, 2000 to 2040 12

Contents
Page 1 GAO-01-944 Emerging Nurse Shortages

July 10, 2001

The Honorable Nancy L. Johnson

Chairman

Subcommittee on Health

Committee on Ways and Means

House of Representatives

Dear Madam Chairman:

The health and long-term care systems in the United States rely heavily on

the services of nurses, the largest group of health care providers. Recent

media reports and other accounts have raised concerns about the

adequacy of both the current and projected supply of nurses to meet the

nation’s needs. Over the last few months, several congressional hearings

have been held on this issue, including two at which we testified on nurse

recruitment and retention problems.1

In response to your request, we are providing information on (1) whether

there is evidence of a current nursing shortage, (2) the reasons for current

nurse recruitment and retention problems, and (3) what is known about

the projected future supply of and demand for nurses. To provide

information on the nurse workforce, we relied primarily on published

reports and data from the Department of Health and Human Services’

(HHS) Health Resources and Services Administration (HRSA) and the

Department of Labor’s Bureau of Labor Statistics (BLS). We also reviewed

the relevant professional and research literature and interviewed industry

and professional association representatives, researchers, union officials,

and other experts. We performed our work during May and June 2001 in

accordance with generally accepted government auditing standards.

National data are not adequate to describe the nature and extent of nurse

workforce shortages, nor are data sufficiently sensitive or current to

compare nurse workforce availability across states, specialties, or

provider types. Nonetheless, current evidence suggests emerging

 1

See Nursing Workforce: Recruitment and Retention of Nurses and Nurse Aides Is a

Growing Concern (GAO-01-750T, May 17, 2001) and Nursing Workforce: Multiple Factors

Create Nurse Recruitment and Retention Problems (GAO-01-912T, June 27, 2001).

United States General Accounting Office

Washington, DC 20548

Results in Brief
Page 2 GAO-01-944 Emerging Nurse Shortages

shortages of nurses available or willing to fill some vacant positions in

hospitals, nursing homes, and home care. The number of employed

registered nurses (RN) per capita has declined in recent years while the

national unemployment rate for RNs has declined to 1 percent in 2000. In

addition, providers from around the country are reporting growing

difficulty recruiting nurses to work in a range of settings, and surveys of

providers in several states and localities indicate rising RN vacancy rates.

Furthermore, there has been an increase in public sector activities related

to nurse workforce issues in many states.

While shortages emerge because of an imbalance of demand and supply,

there are insufficient data to measure how each may be affecting the

current situation. The multiple factors that affect recruitment and

retention problems include the aging of the nurse workforce resulting

from reduced entry of younger people into the profession as well as

nurses’ job dissatisfaction. Sources of dissatisfaction include working

conditions such as inadequate staffing, heavy workloads, the increased use

of overtime, a lack of sufficient support staff, and the adequacy of wages.

A serious shortage of nurses is expected in the future as demographic

pressures influence both demand and supply. The future demand for

nurses is expected to increase dramatically as the baby boomers reach

their 60s, 70s, and beyond. Moreover, the nurse workforce will continue to

age, and, by 2010, approximately 40 percent will likely be older than 50.

Registered nurses are responsible for a large portion of the health care

provided in this country. RNs make up the largest group of health care

providers, and, historically, have worked predominantly in hospitals; in

2000, 59.1 percent of RNs were employed in hospital settings. A smaller

number of RNs work in other settings such as ambulatory care, home

health care, and nursing homes. Their responsibilities may include

providing direct patient care in a hospital or a home health care setting,

managing and directing complex nursing care in an intensive care unit, or

supervising the provision of long-term care in a nursing home. Individuals

usually select one of three ways to become an RN—through a 2-year

associate degree, 3-year diploma, or 4-year baccalaureate degree program.

Background
Page 3 GAO-01-944 Emerging Nurse Shortages

Once they have completed their education, RNs are subject to state

licensing requirements.2

The U.S. healthcare system has changed significantly over the past 2

decades, affecting the environment in which nurses provide care.

Advances in technology and greater emphasis on cost-effectiveness have

led to changes in the structure, organization, and delivery of health care

services. While hospitals traditionally were the primary providers of acute

care, advances in technology, along with cost controls, shifted care from

traditional inpatient settings to ambulatory or community-based settings,

nursing facilities, or home health care settings. The number of hospital

beds staffed declined as did the patient lengths of stay. While the number

of hospital admissions declined from the mid-1980s to the mid-1990s, they

increased between 1995 and 1999. At the same time, the overall acuity

level of the patients increased as the conditions of those patients

remaining in hospitals made them too medically complex to be cared for

in another setting. The transfer of less acute patients to nursing homes and

community-based care settings created additional job opportunities and

increased demand for nurses.

Current evidence suggests emerging shortages of nurses available or

willing to fill some vacant positions in hospitals, nursing homes, and home

care. Some localities are experiencing greater difficulty than others.

National data are not adequate to describe the nature and extent of these

potential nurse workforce shortages, nor are data sufficiently sensitive or

current to allow a comparison of the adequacy of the nurse workforce size

across states, specialties, or provider types. However, total employment of

RNs per capita and the national unemployment rate for RNs have declined,

and providers from around the country are reporting growing difficulty

recruiting and retaining the number of nurses needed in a range of

settings. Another indicator that suggests the emergence of shortages is a

rise in recent public sector efforts related to nurse workforce issues in

many states.

The national unemployment rate for RNs is at its lowest level in more than

a decade, continuing to decline from 1.5 percent in 1997 to 1.0 percent in

 2

Licensed practical nurses (LPN) make up the second-largest group of licensed health care

givers, accounting for 23 percent of the nurse workforce. LPNs primarily provide direct

patient care under the direction of a physician or RN. Unless otherwise specified, our

discussion of nurse workforce issues in this report generally refers only to RNs.

Evidence Suggests

Emerging Shortages

of Nurses
Page 4 GAO-01-944 Emerging Nurse Shortages

2000. At the same time, total employment of RNs per capita declined 2

percent between 1996 and 2000, reversing steady increases since 1980.

Between 1980 and 1996, the number of employed RNs per capita

nationwide increased by 44 percent. At the state level, changes in per

capita nurse employment from 1996 to 2000 varied widely, from a 16.2

percent increase in Louisiana to a 19.5 percent decrease in Alaska. (See

appendix I.) Overall a decline in per capita nurse employment occurred in

26 states and the District of Columbia between 1996 and 2000. Declining

RN employment per capita may be an indicator of a potential shortage. It

is an imprecise measure, however, because it does not account for

changes in care needs of the population or how many nurses relative to

other personnel providers wish to use to meet those needs. Moreover,

total employment includes not only nurses engaged in clinical or patient

care activities but also those in administrative and other nondirect care

positions. Data on how much nurse employment may have shifted

between direct care and other positions are not available.

Recent studies suggest that hospitals and other health care providers in

many areas of the country are experiencing greater difficulty in recruiting

RNs.3

 For example, a recent survey in Maryland conducted by the

Association of Maryland Hospitals and Health Systems reported a

statewide average vacancy rate for hospitals of 14.7 percent in 2000, up

from 3.3 percent in 1997. The association reported that the last time

vacancy rates were at this level was during the late 1980s, during the last

reported nurse shortage. A survey of providers in Vermont found that

hospitals had an RN vacancy rate of 7.8 percent in 2001, up from 4.8

percent in 2000 and 1.2 percent in 1996. For 2000, California reported an

average RN vacancy rate of 20 percent, and for 2001, Florida reported

nearly 16 percent and Nevada reported an average rate of 13 percent.

Concerns about retaining nurses have also become more widespread. A

recent survey reported that the national turnover rate among hospital staff

nurses was 15 percent in 1999, up from 12 percent in 1996.4

 Another

industry survey showed turnover rates for overall hospital nursing

 3

Caution must be used when comparing vacancy rates from different studies. While nurse

vacancy rates are typically the number of budgeted full-time RN positions that are unfilled

divided by the total number of budgeted full-time RN positions, not all studies identify the

method used to calculate rates.

4

The Nursing Executive Center, The Nurse Perspective: Drivers of Nurse Job Satisfaction

and Turnover (Washington, D.C.: The Advisory Board Company, 2000).
Page 5 GAO-01-944 Emerging Nurse Shortages

department staff rising from 11.7 percent in 1998 to 26.2 percent in 2000.5

Nursing home and home health care industry surveys indicate that nurse

turnover is an issue for them as well.6

 In 1997, an American Health Care

Association survey of 13 nursing home chains identified a 51-percent

turnover rate for RNs and LPNs.7 A 2000 national survey of home health

care agencies reported a 21-percent turnover rate for RNs.8

Increased attention by state governments is another indicator of concern

about nurse workforce problems. According to the National Conference of

State Legislatures, as of June 2001, legislation to address nurse shortage

issues had been introduced in 15 states, and legislation to restrict the use

of mandatory overtime for nurses in hospitals and other health care

facilities had been introduced in 10 states. A variety of nurse workforce

task forces and commissions have recently been established as well. For

example, in May 2000, legislation in Maryland created the Statewide

Commission on the Crisis in Nursing to determine the current extent and

long-term implications of the growing shortage of nurses in the state.

Available data on supply and demand for RNs are not adequate to

determine the magnitude of any current imbalance between the two with

any degree of precision. Both the demand for and supply of RNs are

influenced by many factors. Demand for RNs not only depends on the care

needs of the population, but also on how providers—hospitals, nursing

homes, clinics, and others—decide to use nurses in delivering care.

Providers have changed staffing patterns in the past, employing fewer or

more nurses relative to other workers such as nurse aides. For example,

following the introduction of the Medicare Prospective Payment System

(PPS), hospitals increased the share of RNs in their workforces. However,

in the early 1990s, in an effort to contain costs, acute care facilities

restructured and redesigned staffing patterns, introducing more non-RN

caregivers and reducing the percentage of RNs. While the number of RNs

 5

Hospital and Healthcare Compensation Service, Hospital Salary and Benefits Report, 2000-

2001 (Oakland, N.J.: Hospital & Healthcare Compensation Service, 2000).

6

Like vacancy rates, caution must be used when comparing turnover rates from different

studies. While nurse turnover rates are typically the number of nurses that have left a

facility divided by the total number of nurse positions, there is no standard method for

calculating turnover, and methods used in different studies vary.

7

American Health Care Association, Facts and Trends 1999, The Nursing Facility

Sourcebook (Washington, D.C.: AHCA, 1999).

8

Homecare Salary and Benefits Report, 2000-2001, 2000.
Page 6 GAO-01-944 Emerging Nurse Shortages

employed by hospitals remained relatively unchanged from 1995 to1997,

hospitals reported significant growth in RN employment in 1998 and 1999.

Supply depends on the size of the pool of qualified persons and the share

of them willing to work. Current participation by licensed nurses in the

work force is relatively high. Nationally, 81.7 percent of licensed RNs were

employed in nursing in 2000.9

 Although this represents a slight decline

from the high of 82.7 percent reported in 1992 and 1996, this rate of

workforce participation remains higher than the 76.6 to 80.0 percent rates

reported in the 1980s. Moreover, some RNs are employed in nonclinical

settings, such as insurance companies, reducing the number of nurses

available to provide direct patient care.

Current problems with the recruitment and retention of nurses are related

to multiple factors. The nurse workforce is aging, and fewer new nurses

are entering the profession to replace those who are retiring or leaving.

Furthermore, nurses report unhappiness with many aspects of the work

environment including staffing levels, heavy workloads, increased use of

overtime, lack of sufficient support staff, and adequate wages. In many

cases this growing dissatisfaction is affecting their decisions to remain in

nursing.

The decline in younger people, predominantly women, choosing nursing as

a career has resulted in a steadily aging RN workforce. Over the last 2

decades, as opportunities for women outside of nursing have expanded

the number of young women entering the RN workforce has declined.10 A

recent study reported that women graduating from high school in the

1990s were 35 percent less likely to become RNs than women who

graduated in the 1970s.11 Reductions in nursing program enrollments

within the last decade attest to this narrowing pipeline. According to a

1999 Nursing Executive Center Report, between 1993 and 1996, enrollment

 9

In 2000, workforce participation rates by RNs vary across states, from a high of 92 percent

in North Dakota and Louisiana to a low of 75 percent in Pennsylvania and 76 percent in

Virginia, Indiana, and Arizona.

10Peter I. Buerhaus, Douglas O. Staiger, and David I. Auerbach, “Implications of an Aging

Registered Nurse Workforce,” JAMA, Vol. 283, No. 22 (June 14, 2000).

11Peter I. Buerhaus, Douglas O. Staiger, and David I. Auerbach, “Policy Responses to an

Aging Registered Nurse Workforce,” Nursing Economic$, Vol. 18, No. 6 (Nov.-Dec. 2000).

Multiple Obstacles to

Increasing Supply of

Nurses

Nurse Workforce Is Aging
Page 7 GAO-01-944 Emerging Nurse Shortages

in diploma programs dropped 42 percent and enrollment in associate

degree programs declined 11 percent. Furthermore, between 1995 and

1998, enrollment in baccalaureate programs declined 19 percent, and

enrollment in master’s programs decreased 4 percent.12 The number of

individuals passing the national RN licensing exam declined from 97,679 in

1996 to 74,787 in 2000, a decline of 23 percent.

The large numbers of RNs that entered the labor force in the 1970s are

now over the age of 40 and are not being replenished by younger RNs.

Between 1983 and 1998, the number of RNs in the workforce under 30 fell

by 41 percent, compared to only a 1-percent decline in the number under

age 30 in the rest of the U.S. workforce.13 Over the past 2 decades, the

nurse workforce’s average age has climbed steadily. While over half of all

RNs were reported to be under age 40 in 1980, fewer than one in three

were younger than 40 in 2000. As shown in figure 1, the age distribution of

RNs has shifted dramatically upward. The percent of nurses under age 30

decreased from 26 percent in 1980 to 9 percent 2000, while the percent age

40 to 49 grew from 20 to 35 percent.

 12In addition to the lack of students entering and graduating from nursing programs, there

is concern about a pending shortage of nurse educators. The average age of professors in

nursing programs is 52- and 49 for associate professors.

13“Policy Responses to an Aging Registered Nurse Workforce,” Nursing Economic$.
Page 8 GAO-01-944 Emerging Nurse Shortages

Figure 1: Age Distribution of the Registered Nurse Population, 1980 and 2000

Source: HRSA, The Registered Nurse Population: National Sample Survey of Registered Nurses,

March 2000.

Job dissatisfaction has also been identified as a major factor contributing

to the current problems of recruiting and retaining nurses. A recent

Federation of Nurses and Health Professionals (FNHP) survey found that

half of the currently employed RNs who were surveyed had considered

leaving the patient-care field for reasons other than retirement over the

past 2 years.14 Over one-fourth (28 percent) of RNs responding to a 1999

survey by The Nursing Executive Center described themselves as

somewhat or very dissatisfied with their jobs, and about half (51 percent)

were less or much less satisfied with their jobs than they were 2 years

 14Federation of Nurses and Health Professionals, The Nurse Shortage: Perspectives from

Current Direct Care Nurses and Former Direct Care Nurses (opinion research study

conducted by Peter D. Hart Research Associates)(Washington, D.C.: 2001).

Job Dissatisfaction Cited

As a Major Factor

0

5

10

15

20

25

30

35 Percent

<=29 30-39 40-49 50-59 >=60

Age distribution

1980

2000
Page 9 GAO-01-944 Emerging Nurse Shortages

ago.15 In that same survey, 32 percent of general medical/surgical RNs, who

constitute the bulk of hospital RNs, indicated that they were dissatisfied

with their current jobs. According to a survey conducted by the American

Nurses Association, 54.8 percent of RNs and LPNs responding would not

recommend the nursing profession as a career for their children or friends,

while 23 percent would actively discourage someone close to them from

entering the profession. 16

Inadequate staffing, heavy workloads, and the increased use of overtime

are frequently cited as key areas of job dissatisfaction among nurses.

According to the recent FNHP survey, of those RNs responding who had

considered leaving the patient-care field for reasons other than retirement

over the past 2 years, 56 percent indicated that they wanted a less stressful

and less physically demanding job. 17 The same survey found that 55

percent of current RNs were either just somewhat or not satisfied by their

facility’s staffing levels, while 43 percent of current RNs surveyed

indicated that increased staffing would do the most to improve their jobs.

Another survey found that 36 percent of RNs in their current job more

than 1 year were very or somewhat dissatisfied with the intensity of their

work.18 Some providers report increased use of overtime for employees.

Twenty-two percent of nurses responding to the FNHP survey said they

were concerned about schedules and hours. A survey of North Carolina

hospitals conducted in 2000 found significant reliance on overtime for

staff nurses. Nine percent of rural hospitals reported spending more than

25 percent of their nursing budget on overtime, and, among urban

hospitals, 49 percent expected to increase their use of overtime in the

coming year.19 The trend toward increasing use of overtime is currently a

major concern of nurse unions and associations.

 15The Nurse Perspective: Drivers of Nurse Job Satisfaction and Turnover, 2000.

16American Nurses Association, Analysis of American Nurses Association Staffing Survey

(Internet survey of self-selected participants compiled by Cornerstone Communications

Group for the American Nurses Association)(Warwick, R.I., 2001).

17The Nurse Shortage: Perspectives from Current Direct Care Nurses and Former Direct

Care Nurses, April 2001.

18The Nurse Perspective: Drivers of Nurse Job Satisfaction and Turnover, 2000.

19North Carolina Center for Nursing, Nursing Shortage Areas in North Carolina Hospitals

(February 2001).
Page 10 GAO-01-944 Emerging Nurse Shortages

Nurses have also expressed dissatisfaction with a decrease in the amount

of support staff available to them over the past few years. More than half

the RNs responding to the recent study by the American Hospital

Association (AHA) did not feel that their hospitals provided adequate

support services.20 RNs, LPNs, and others responding to a survey by the

ANA also pointed to a decrease of needed support services. Current nurse

workforce issues are part of a larger health care workforce shortage that

includes a shortage of nurse aides.21

Some nurses have also expressed dissatisfaction with their wages. While

surveys indicate that increased wages might encourage nurses to stay at

their jobs, money is not always cited as the primary reason for job

dissatisfaction. According to the FNHP survey, of those RNs responding

who had considered leaving the patient-care field for reasons other than

retirement over the past 2 years, 18 percent wanted more money, versus 56

percent who were concerned about the stress and physical demands of the

job. However, the same study reported that 27 percent of current RNs

responding cited higher wages or better health care benefits as a way of

improving their jobs. Another study indicated that 39 percent of RNs who

had been in their current jobs for more than 1 year were dissatisfied with

their total compensation, but 48 percent were dissatisfied with the level of

recognition they received from their employers.22 AHA recently reported

on a survey that found that 57 percent of responding RNs said that their

salaries were adequate, compared to 33.4 percent who thought their

facility was adequately staffed, and 29.1 percent who said that their

hospital administrations listened and responded to their concerns.23

Wages can have a long-term impact on the size of a workforce pool as well

as a short-term effect on people’s willingness to work. After several years

of real earnings growth following the last nursing shortage, RN earnings

growth lagged behind the rate of inflation from 1994 through 1997. In 2 of

the last 3 years, however, 1998 and 2000, RN earnings growth exceeded the

rate of inflation. The cumulative effects of these changes are such that RN

 20AHA and The Lewin Group, “The Hospital Workforce Shortage: Immediate and Future,”

TrendWatch, Vol. 3, No. 2 (June 2001).

21Analysis of American Nurses Association Staffing Survey, 2001.

22The Nurse Perspective: Drivers of Nurse Job Satisfaction and Turnover, 2000.

23“The Hospital Workforce Shortage: Immediate and Future,” 2001.
Page 11 GAO-01-944 Emerging Nurse Shortages

earnings have just kept pace with the rate of inflation from 1989 to 2000 as

shown in figure 2.

Figure 2: Cumulative Annual Increase in Median RN Earnings and the Consumer

Price Index, 1989-2000

Source: GAO analysis of median weekly earnings for RNs employed full-time as reported by the

Bureau of Labor Statistics (BLS) using data from the Current Population Survey. Consumer Price

Index data for each year represent annual averages as reported by BLS.

A serious shortage of nurses is expected in the future as pressures are

exerted on both demand and supply. The future demand for nurses is

expected to increase dramatically when the baby boomers reach their 60s,

70s, and beyond. The population age 65 years and older will double

between 2000 to 2030. During that same period the number of women

between 25 and 54 years of age, who have traditionally formed the core of

the nurse workforce, is expected to remain relatively unchanged. This

potential mismatch between future supply of and demand for caregivers is

Demand for Nurses

Will Continue to Grow

As the Supply

Dwindles

0

5

10

15

20

25

30

35

40

45

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Year

Percent change

Median RN Earnings

Consumer Price Index
Page 12 GAO-01-944 Emerging Nurse Shortages

illustrated by the change in the expected ratio of potential care providers

to potential care recipients. As shown in figure 3, the ratio of the workingage population, age 18 to 64, to the population over age 85 will decline

from 39.5 workers for each person 85 and older in 2000, to 22.1 in 2030,

and 14.8 in 2040. The ratio of women age 20 to 54, the cohort most likely to

be working either as nurses or nurse aides, to the population age 85 and

older will decline from 16.1 in 2000 to 8.5 in 2030, and 5.7 in 2040.

Figure 3: Decline in Elderly Support Ratio Expected, 2000 to 2040

Source: GAO analysis of U.S. Census Bureau Projections of Total Resident Population, Middle

Series, December 1999.

Unless more young people choose to go into the nursing profession, the

nurse workforce will continue to age. By 2010, approximately 40 percent

of the workforce will likely be older than 50. By 2020, the total number of

full time equivalent RNs is projected to have fallen 20 percent below

HRSA’s projections of the number of RNs that will be required to meet

demand.24

 24“Implications of an Aging Registered Nurse Workforce,” JAMA.

0

5

10

15

20

25

30

35

40

45

2000 2010 2020 2030 2040

Year

Workers per person 85 and older

Women age 20-54 to each persons 85 and older

Working-age population 18-64 to each person 85 and older
Page 13 GAO-01-944 Emerging Nurse Shortages

Providers’ current difficulty recruiting and retaining nurses may worsen as

the demand for nurses increases with the aging of the population.

Impending demographic changes are widening the gap between the

numbers of people needing care and those available to provide it.

Moreover, the current high levels of job dissatisfaction among nurses may

also play a crucial role in determining the extent of current and future

nurse shortages. Efforts undertaken to improve the workplace

environment may both reduce the likelihood of nurses leaving the field

and encourage more young people to enter the nursing profession. While

state governments and providers have begun to address recruitment and

retention issues related to the nurse workforce, more detailed data are

needed to assist in planning and targeting corrective efforts.

As we agreed with your office, unless you publicly announce its contents

earlier, we plan no further distribution of this report until 30 days after its

issue date. At that time, we will send copies to interested parties and make

copies available to others upon request.

If you or your staff have any questions, please call me on (202)512-7119 or

Helene Toiv, Assistant Director, at (202)512-7162. Other major

contributors were Eric Anderson, Connie Peebles Barrow, Emily Gamble

Gardiner, and Pamela Ruffner.

Sincerely yours,

Janet Heinrich

Director, Health Care—Public Health Issues

Concluding

Observations
Appendix I: Change in RN Employment, per

100,000 Population by State, 1996-2000

Page 14 GAO-01-944 Emerging Nurse Shortages

Employed RNs per 100,000

population

State 1996 2000 Percent change 1996-2000

Alabama 756 766 1.3%

Alaska 974 784 -19.5%

Arizona 721 628 -12.9%

Arkansas 683 701 2.6%

California 566 544 -3.9%

Colorado 806 737 -8.6%

Connecticut 1,029 942 -8.5%

Delaware 1,046 936 -10.5%

District of Columbia 1,710 1,675 -2.0%

Florida 800 785 -1.9%

Georgia 712 683 -4.1%

Hawaii 733 703 -4.1%

Idaho 583 636 9.1%

Illinois 863 819 -5.1%

Indiana 780 761 -2.4%

Iowa 989 1,060 7.2%

Kansas 806 885 9.8%

Kentucky 748 833 11.4%

Louisiana 718 834 16.2%

Maine 1,053 1,025 -2.7%

Maryland 842 856 1.7%

Massachusetts 1,190 1,194 0.3%

Michigan 816 798 -2.2%

Minnesota 945 957 1.3%

Mississippi 701 750 7.0%

Missouri 932 960 3.0%

Montana 771 812 5.3%

Nebraska 925 958 3.6%

Nevada 580 520 -10.3%

New Hampshire 985 916 -7.0%

New Jersey 844 800 -5.2%

New Mexico 663 656 -1.1%

New York 911 843 -7.5%

North Carolina 794 858 8.1%

North Dakota 1,072 1,096 2.2%

Ohio 893 882 -1.2%

Oklahoma 581 635 9.3%

Oregon 791 793 0.3%

Pennsylvania 1,019 1,010 -0.9%

Rhode Island 1,128 1,101 -2.4%

Appendix I: Change in RN Employment, per

100,000 Population by State, 1996-2000
Appendix I: Change in RN Employment, per

100,000 Population by State, 1996-2000

Page 15 GAO-01-944 Emerging Nurse Shortages

Employed RNs per 100,000

population

State 1996 2000 Percent change 1996-2000

South Carolina 693 728 5.1%

South Dakota 1,059 1,128 6.5%

Tennessee 856 872 1.9%

Texas 629 606 -3.7%

Utah 632 592 -6.3%

Vermont 911 957 5.0%

Virginia 790 711 -10.0%

Washington 776 738 -4.9%

West Virginia 794 858 8.1%

Wisconsin 876 893 1.9%

Wyoming 787 780 -0.9%

United States 798 782 -2.0%

Source: GAO analysis of data from the 1996 and 2000 National Sample Survey of Registered

Nurses, HRSA’s Bureau of Health Professions, Division of Nursing.

(290081)

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