United States Government Accountability Office

Washington, DC 20548 

April 30, 2007

The Honorable Edward M. Kennedy 

Chairman 

The Honorable Michael B. Enzi 

Ranking Member 

Committee on Health, Education, Labor and Pensions 

United States Senate 

The Honorable John D. Dingell 

Chairman 

The Honorable Joe Barton 

Ranking Member 

Committee on Energy and Commerce 

House of Representatives 

Subject: Nursing Workforce: HHS Needs Methodology to Identify Facilities with a 

Critical Shortage of Nurses

Registered nurses (RN) are the single largest group of health care providers in the United 

States, with more than 2.4 million people employed as RNs in 2004.1

 Basic RN training may be 

completed through a 2-year associate’s degree, a 3-year diploma, or a 4-year bachelor’s

degree. RNs work in a wide variety of settings, including hospitals, nursing homes, 

physicians’ offices, and public health clinics. Reports by government agencies and others 

have raised concerns about nurse shortages. In 2001, we reported on an emerging shortage of 

RNs to fill vacant positions across a range of health care settings.2

 The Health Resources and 

Services Administration (HRSA), an agency in the Department of Health and Human Services 

(HHS), estimated that the supply of RNs nationally fell approximately 111,000 short of 

demand in 2000 (5.5 percent) and projected the gap would widen in the ensuing years.

3

 1

This includes RNs employed both full-time and part-time. Data for 2004 were the most recent available

on the overall RN workforce. 

2

GAO, Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors, GAO-01-944

(Washington, D.C.: July 10, 2001). 

3

HRSA Bureau of Health Professions, Projected Supply, Demand, and Shortages of Registered Nurses: 

2000-2020 (Rockville, Md., 2002). 

GAO-07-492R Nursing Workforce 
A shortage of RNs, like general workforce shortages, occurs when the demand for RNs 

exceeds supply.4

 The supply of RNs, or the number of RNs employed, is influenced by

multiple factors, including the size of the overall labor force, the number of licensed RNs 

choosing to work in nursing, the number of new RNs graduating from nursing school, the 

capacity of nursing schools, and funding available for higher education. Demand, or the 

number of RNs that employers would like to hire, is also affected by multiple factors, 

including demographic characteristics and health status of the population, economic factors 

such as personal income and health insurance coverage, and characteristics of the health 

care system such as nurse wages and health care reimbursement rates. Having an adequate 

supply of RNs is important because reports have established a positive relationship between 

the quality of care and RN staffing levels in settings such as hospitals and nursing homes.5

To support the recruitment and retention of RNs in health care facilities with a critical 

shortage of nurses, Congress passed the Nurse Reinvestment Act of 2002 (NRA).6 The NRA 

established the Nursing Scholarship Program (NSP) to provide scholarships for individuals to 

attend schools of nursing.7

 The NRA also modified an existing program, the Nursing 

Education Loan Repayment Program (NELRP), which was established by Congress in 1992 to 

help repay education loans for RNs. Under both programs, awardees must agree to work for 

at least 2 years in a health care facility with a critical shortage of nurses, with preference 

given to qualified applicants with the greatest financial need.8

 To implement this, HRSA, 

which administers both programs, designates several types of facilities as having a critical 

shortage of nurses for the purposes of the NSP and NELRP.9

 The Secretary of HHS is required 

 4

For a recent study of labor shortages, the Department of Labor defined a shortage as “a market 

disequilibrium between supply and demand in which the quantity of workers demanded exceeds the

supply available and willing to work at a particular wage and working conditions at a particular place

and point in time.” See The Urban Institute, Skill Shortages and Mismatches in Nursing Related 

Health Care Employment (Washington, D.C., April 2002). 

5

See J. Needleman et al., Nurse Staffing and Patient Outcomes in Hospitals, Final Report for HRSA, 

Contract No. 230-99-0021, Harvard School of Public Health (Boston, Mass., 2001). See also M.W.

Stanton and M.K. Rutherford, Hospital Nurse Staffing and Quality of Care, Agency for Healthcare

Research and Quality (Rockville, Md., 2004). 

6

Pub. L. No. 107-205, 116 Stat. 813 (2002). 

7

In this report, we consider any RN training program, including 2-year, 3-year, and 4-year programs, to

be a school of nursing. 

8

According to program guidance, for the NELRP, applicants with the “greatest financial need” are

those with nursing educational loans 40 percent or greater than their annualized salary. For the NSP,

applicants with the greatest financial need were defined as those who had zero expected family 

contribution on their federal financial aid application. NSP awardees begin to fulfill their service

obligation after graduation from nursing school. Because NELRP awardees have already completed

nursing school, they begin to fulfill their obligation upon receipt of the award. 

9

For the NSP, the facility types are: (1) Indian Health Service health center; (2) rural health clinic; 

(3) Native Hawaiian health center; (4) nursing home; (5) home health agency; (6) federally-designated

migrant health center; (7) hospice program; (8) federally-designated community health center; (9) state

or local public health department including a clinic within the department; (10) federally-designated

health care for the homeless health center; (11) skilled nursing facility; (12) federally-qualified lookalike health center (a migrant, community, or health care for the homeless health center meeting 

federal Public Health Service grant requirements but not currently receiving such funds); and 

(13) ambulatory surgical center; and (14) hospital. The NELRP includes these facility types but 

2 GAO-07-492R Nursing Workforce
to report annually to Congress on various aspects of the programs including the locations 

where award recipients are fulfilling their service obligation.10

The NRA directed us to conduct several studies related to the nationwide shortage of 

nurses.11 As discussed with the committees of jurisdiction, in this report we are: (1) providing 

information on how the number of employed RNs and the shortage of RNs has changed since 

2000, both nationally and across states; and (2) describing characteristics of NELRP and NSP 

awardees and examining whether these programs have improved the supply of RNs in 

facilities with critical shortages of nurses. 

To determine how the employment of RNs changed since 2000 and how it varied across 

states, we analyzed data on RN employment from the 2000 and 2004 National Sample Survey 

of Registered Nurses (NSSRN). This survey has been conducted by HRSA approximately 

every 4 years since 1977.12 We also analyzed data on newly licensed RNs from the National 

Council of State Boards of Nursing to identify the number of potential new RNs entering the 

workforce each year from 2000 through 2005. To determine whether the nursing shortage has 

changed since 2000, we conducted interviews of experts, researchers, HRSA officials, and 

provider and professional associations. We also reviewed current literature and research on 

the RN workforce. Further, we compared HRSA’s most recent state-level shortage estimates 

from 2000 to the growth in RN employment from 2000 to 2004;

13 examined changes in statelevel per capita RN employment from 2000 to 2004; analyzed annual Current Population 

Survey (CPS) data from 1999 through 2005 on RN earnings growth relative to the overall 

workforce;14 and examined trends reported by the American Hospital Association (AHA) in 

hospital RN vacancy rates—that is, the number of unfilled employment positions at hospitals. 

To describe the characteristics of NELRP and NSP awardees, we analyzed HRSA 

administrative data, reviewed published reports on the programs, and interviewed HRSA 

officials. We relied on data about the programs from fiscal year 2004 to make comparisons of 

the awardees to the overall RN workforce and RN student and recent graduate populations 

because data from 2004 were the most recent data on the RN workforce available. Data on 

employment location of the programs’ awardees for the fiscal years 2003 through 2005 period 

were obtained from both published reports on the programs and HRSA officials. To examine 

whether these programs have improved the supply of RNs in facilities with a critical shortage 

of nurses we reviewed past and current program guidance, reviewed published reports on the 

programs, and interviewed HRSA officials and research contractors. 

 separates hospitals into three subtypes: federal hospital; disproportionate share hospital (a hospital 

that receives supplemental payments through the Medicare or Medicaid programs to subsidize the 

costs of caring for a high proportion of low-income patients); and nonfederal, nondisproportionate 

share hospital.

10HRSA has prepared and provided these reports on behalf of the department. 

11Pub. L. No. 107-205, § 204, 116 Stat. 811, 818-19. 

12This survey was first conducted in 1977, again in 1980, and every 4 years thereafter. The most recent

survey was conducted in 2004. 

13In this report, we use the term “state” to refer to the 50 states and the District of Columbia. 

14The Current Population Survey is a monthly survey of households conducted by the Bureau of the 

Census for the Bureau of Labor Statistics (BLS). 

3 GAO-07-492R Nursing Workforce
Our review focused only on registered nurses (RN), and our results cannot be generalized to 

other types of nurses, such as licensed practical nurses (LPN). We also did not conduct 

assessments of projected shortages. We used the most recent data available, which were 

from 2004 for some sources and from 2005 for other sources, as we noted. We assessed the 

reliability of data used in our analyses and determined them to be sufficiently reliable for our 

purposes. We performed this work from March 2006 through March 2007 in accordance with 

generally accepted government auditing standards. 

Results in Brief 

Between 2000 and 2004, the number of employed RNs in the United States grew by 

10 percent, with a total of 2.4 million RNs employed in nursing in 2004. Most of the increase 

occurred in hospitals and ambulatory care settings, and the extent of employment growth 

varied widely among states. For example, among the 48 states where the number of 

employed RNs increased, the growth in employment ranged from 2 percent in Connecticut to 

47 percent in New Hampshire. Despite evidence of growth in RN employment between 2000 

and 2004, there are no data available for estimating the magnitude of changes in the shortage 

of RNs over this time period. Estimating changes in the RN shortage requires data on both 

the supply of and the demand for RNs in 2000 and 2004. Although there are data indicating 

that the supply or number of employed RNs increased, there are no data—either nationally or 

at the state level—on RN demand in 2004, because demand estimates have not been updated 

since 2000. However, several indirect measures suggest that the shortage of RNs has eased 

since 2000. For example, RN employment growth from 2000 to 2004 was generally strongest 

in those states that HRSA designated as having greater shortages in 2000. In addition, 

between 2000 and 2004 the number of employed RNs relative to the size of the general

population increased from 782 per 100,000 people in 2000 to 825 per 100,000 people in 2004—

reflecting an increase in RN supply relative to one measure of demand for RNs. Finally, the 

rate of unfilled RN positions in hospitals declined nationally from 13 percent in 2001 to 

9 percent in 2005. 

Recipients of NSP and NELRP awards are more likely to be from a minority group and are 

more likely to have received or be pursuing a 4-year bachelor’s degree rather than a 2-year 

associate’s degree when compared to the overall RN workforce. In both programs, an 

applicant’s minority status is not used as a criterion in making awards. In 2004, 11 percent of 

the overall nursing workforce was minority while minorities made up 36 percent of NSP 

awardees and 21 percent of NELRP awardees. NSP and NELRP awardees are required to be 

employed in one of the types of facilities identified by HRSA as having a critical shortage of 

nurses. However, HRSA does not have a sound basis for determining the number of RNs 

needed for that facility to be considered as one experiencing a critical shortage of RNs. 

Consequently, we cannot identify which facilities fall into this category. Furthermore, 

awardees may not be serving in facilities actually experiencing a nursing shortage. HRSA is 

working to develop an approach for identifying facilities with critical shortages of RNs, and 

researchers contracted by HRSA have produced a report detailing an approach that uses 

available county-level data to determine facilities that could be identified as having critical 

shortages of RNs. This report is currently under review, so HRSA’s efforts at developing an 

empirically-based approach for identifying facilities with critical shortages of RNs have not 

been completed. 

In order to target funding effectively for the Nursing Education Loan Repayment Program 

(NELRP) and the Nursing Scholarship Program (NSP) to nurses working in health care 

facilities with a critical shortage of nurses, we recommend that the Secretary of HHS: 

4 GAO-07-492R Nursing Workforce
(1) identify the specific steps and a time frame for implementing an empirical methodology 

for identifying health care facilities with a critical shortage of nurses; and (2) direct the 

Administrator of HRSA to include a description of steps taken and progress on its time frame 

for implementing such methodology in HRSA’s annual report to Congress on these programs. 

In commenting on a draft of this report, HHS provided technical comments, which we 

incorporated as appropriate. 

Background 

Hospitals employ the largest share of the RN workforce with 56 percent of RNs employed in 

hospital settings in 2004. After hospitals, 12 percent of RNs were employed in ambulatory 

care, 11 percent in public or community health settings, and 6 percent in nursing homes and 

extended care facilities. The remaining 15 percent were employed in a variety of other 

settings such as nursing education and insurance companies. Although basic RN education 

may be completed through a 2-year associate’s degree, a 3-year diploma program, or a 4-year 

bachelor’s degree, the largest proportion of RNs has an associate’s degree, with 44 percent of 

the current RN workforce and 61 percent of newly licensed RNs having an associate’s

degree.15 (See fig. 1.) Once they have completed their education, RNs must meet state 

licensing requirements and pass a national licensing examination. 

Figure 1: Percentage of Employed Registered Nurses by Initial Degree Type, 2004 

Degree type

Percent

Source: HRSA and National Council of State Boards of Nursing. 

45

61

23

4

32

35

0

10

20

30

40

50

60

70

80

2004 New RN licensees

2004 RN workforce

2-yr Associate's 3-yr Diploma 4-yr Bachelor's

Note: Data are from HRSA’s 2004 National Sample Survey of Registered Nurses and the National Council of State Boards of 

Nursing’s 2004 National Council Licensing Examination (NCLEX) statistics. 

 15RNs may also obtain graduate nursing degrees that may qualify them to teach in a university setting 

or work as a nurse practitioner or as other advanced nursing specialists. 

5 GAO-07-492R Nursing Workforce
Although numerous reports of an emerging nursing shortage have been published by 

researchers, provider associations, and government agencies, nurse shortages have 

historically been cyclical, with periods of shortage alternating with periods of equilibrium or 

surplus. There is often a time lag in the adjustment of RN supply to increased demand, in part 

due to the time it takes for a new RN to complete the educational requirements for licensure. 

Future demand for RNs is expected to increase dramatically as members of the baby boom 

generation reach their 70s, 80s and beyond—ages at which use of health care typically

increases. While the population aged 65 and older is expected to double between 2000 and 

2030, 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. The Bureau of 

Labor Statistics (BLS) projected that in order to accommodate growth in demand for RNs 

and to replace RNs leaving the workforce, 120,000 new nurses will be needed per year from 

2004 through 2014. 

To support the recruitment and retention of RNs, the NSP and NELRP programs provide 

awards to nursing students or working nurses, respectively, in exchange for a minimum of 

2 years service at a health care facility with a critical shortage of nurses. The NELRP provides 

loan repayment awards of up to 85 percent of educational loans and the NSP provides 

scholarship awards to individuals attending an accredited school of nursing. From fiscal 

years 2003 through 2005, HRSA granted 2,262 loan repayment awards totaling $51 million and 

419 scholarship awards totaling $18.9 million. (See table 1.) Total funding and the number of 

awards granted under both programs have increased since fiscal year 2003. In fiscal year 

2005, HRSA provided NELRP awards to 803 individuals, or 18 percent of applicants, with a 

median award of $20,925. For the NSP, HRSA provided awards to 212 individuals, or 

6 percent of applicants, with a median award of $38,078. 

Table 1: Nursing Education Loan Repayment Program and Nursing Scholarship Program Applicants, 

Awards, and Funding, Fiscal Years 2003–2005 

2003 2004 2005 

2003–2005 

Total

Nursing Education Loan Repayment Program 

(NELRP)

Applicants 8,231 4,873 4,465 17,569

Awards 602 857 803 2,262

Total Award Funding $14.4 million $17.6 million $19.0 million $51.0 million

Median Award Amount $20,911 $17,379 $20,925 

Nursing Scholarship Program (NSP) 

Applicants 4,408 3,476 3,482 11,366

Awards 81 126 212 419

Total Award Funding $3.3 million $5.9 million $9.7 million $18.9 million

Median Award Amount $34,920 $38,387 $38,078 

Source: HRSA. 

6 GAO-07-492R Nursing Workforce
Number of Employed RNs Increased since 2000, Although Gains Varied among 

States, and Indirect Evidence Suggests Shortage Has Eased 

Between 2000 and 2004, the number of employed RNs in the United States grew by 

10 percent. Most of the increase occurred in hospitals and ambulatory care settings, and the 

extent of employment growth varied widely among states. Despite evidence of growth in RN 

employment between 2000 and 2004, we are unable to estimate the magnitude of changes in 

the shortage of RNs over this time period. Estimating changes in the RN shortage requires 

data on both the supply of and the demand for RNs in 2000 and 2004. While HRSA’s National 

Sample Survey of Registered Nurses provides data on the number of employed RNs in 2000 

and 2004, HRSA’s estimates of demand for RNs have not been updated since 2000. However, 

indirect evidence suggests that the shortage of RNs has eased since 2000. This evidence 

includes strong growth in RN employment in the states HRSA designated as having a 

shortage in 2000 and increases in the number of employed RNs relative to the size of the 

general population. In addition, after several years of strong relative earnings growth for RNs 

following reports of an emerging shortage around 2000, RN earnings have grown at a rate 

comparable to the overall workforce in recent years. 

Number of Employed RNs Increased between 2000 and 2004, and Gains Varied by Facility 

Type and among States

According to data from HRSA’s 2000 and 2004 National Sample Survey of Registered Nurses, 

the number of employed RNs, either full-time or part-time, increased 10 percent between 

2000 and 2004, with a total of 2.4 million RNs employed in nursing in 2004.16 The number of 

RNs employed full-time grew by 8 percent from 2000 to 2004, while those employed part-time, 

representing approximately 30 percent of all employed RNs in 2004, grew by 15 percent. In 

addition, of all licensed RNs, the percentage who were employed in nursing, either full-time 

or part-time, increased from 81.7 percent in 2000 to 83.2 percent in 2004; this compares to 

82.7 percent in 1992 and 1996, and to rates at or below 80 percent throughout the 1980s. 

Nationally, between 2000 and 2004, the extent of increases in the number of RNs employed 

varied by facility type or setting, with the greatest gains occurring in hospitals and 

ambulatory care settings such as physicians’ offices, clinics, and ambulatory surgical centers. 

(See table 2.) These settings accounted for most of the change in the number of employed 

RNs over the 4 years. Employment gains also occurred in teaching positions associated with 

nursing education, while the number of RNs employed in public and community health 

settings declined. Between 2000 and 2004, the number of RNs employed in long-term care 

facilities remained essentially unchanged. 

 16This represents a sizable increase compared to the previous 4 years when RN employment grew by

about 4 percent from 1996 to 2000. 

7 GAO-07-492R Nursing Workforce
Table 2: Changes in RN Employment by Facility Type or Setting, 2000–2004 

Facility type or setting 

2000 

Employment

2004 

Employment 

Change

2000–2004

All facility types or settings 2,201,813 2,421,351 219,538

Hospitals 1,300,323 1,360,847 60,524

Ambulatory care 209,324 277,774 68,450

Public/community health 282,618 259,911 -22,707

Long-term care facility 152,894 153,172 278

School/student health 83,269 78,022 -5,247

Nursing education 46,655 63,444 16,789

Occupational health 36,395 22,447 -13,948

Other and unknown 90,335 205,736 115,401

Source: HRSA. 

Note: Data are from the 2000 and 2004 National Sample Survey of Registered Nurses. Numbers represent RNs employed both 

full-time and part-time. Estimated numbers may not equal totals due to rounding. 

While the number of employed RNs increased nationally from 2000 to 2004, the growth varied 

widely among states. According to data from HRSA’s 2000 and 2004 National Sample Survey 

of Registered Nurses, all but three states—Louisiana, Massachusetts, and Rhode Island—

posted gains in RN employment between 2000 and 2004 (see enc. I). Among the 48 states 

where the number of employed RNs increased, the growth in employment ranged from 

2 percent in Connecticut to 47 percent in New Hampshire. Growth exceeded 15 percent in 

11 states, and ranged from 10 to 15 percent in 15 other states. 

The growth in the number of employed RNs is due in part to an increase in the number of 

newly licensed nursing school graduates entering the workforce.17 The number of newly 

licensed RNs available to enter the workforce, as reflected in the annual number of RNs 

passing the national licensing examination, grew from approximately 75,000 in 2000 to

101,000 in 2004 and 113,000 in 2005, an increase of 51 percent from 2000 to 2005 (see fig. 2).18

From 2000 to 2005, the number of newly licensed RNs educated in the United States 

increased 41 percent from 69,569 to 98,363, and the number of newly licensed RNs who were 

educated outside the United States grew by 182 percent from 5,231 to 14,750. 

 17To be licensed as an RN in a state, a nurse must graduate from an approved nursing program and 

pass a national licensing exam developed by the National Council of State Boards of Nursing. 

18We use the number of nurses passing the national RN licensing exam to approximate the number of 

newly licensed RNs. Some states may impose additional requirements prior to issuing a license. 

8 GAO-07-492R Nursing Workforce
Figure 2: Number of RNs Passing the National Licensing Exam, by Year, U.S.- and Foreign-Educated, 

2000–2005 

0

20,000

40,000

60,000

80,000

100,000

120,000

Foreign-educated

U.S.-educated

2000 2001 2002 2003 2004 2005

Year

Number passing the national RN licensing exam

Source: GAO analysis of National Council of State Boards of Nursing data. 

Increase of 51 percent

Indirect Evidence Suggests Shortage of RNs Has Eased since 2000

Although there are data indicating that the supply of RNs—that is, the number employed—

increased between 2000 and 2004, we are unable to estimate changes in the shortage of RNs 

over this time period. Estimating changes in the RN shortage requires data on both the supply 

of and the demand for RNs in 2000 and 2004. While HRSA’s National Sample Survey of

Registered Nurses provides data on the number of employed RNs in 2000 and 2004, HRSA’s 

estimates of demand for RNs have not been updated since 2000.

19 Furthermore, HRSA’s 

estimates of RN supply and demand are at the state level and cannot provide information on 

whether there is a shortage within states, in rural or urban areas, or among facilities or other 

settings.20

Despite the absence of data to assess directly the magnitude of changes in the RN shortage 

between 2000 and 2004, indirect evidence suggests that the overall shortage of RNs has eased 

since 2000. This evidence consists of (1) relatively strong growth in the number of employed 

RNs in the states designated by HRSA as having shortages in 2000, (2) growth in the number 

of employed RNs relative to the size of the general population, (3) growth in the earnings of 

RNs that is consistent with the earnings growth for the overall U.S. workforce in recent years, 

and (4) reported decreases in the number of unfilled employment positions for hospital RNs. 

 19HRSA has a contract to update its model for estimating demand, but the update is not expected to be

available until 2008. 

20In our 2001 report, we noted that available national data were not adequate to describe the nature

and extent of nurse shortages across states or provider types.

9 GAO-07-492R Nursing Workforce
First, RN employment growth from 2000 to 2004 was generally strongest in those states that 

HRSA designated as having greater shortages in 2000.

21 (See fig. 3.) HRSA estimates of RN 

shortages in 2000 show that 30 states were estimated to have a shortage; 9 states were 

estimated to have a surplus, and 12 states had no clear shortage or surplus in 2000.

22 In the 

states HRSA estimated as having shortages in 2000, growth in employed RNs averaged about 

14 percent from 2000 to 2004, while states that HRSA designated as having surpluses in 2000 

averaged about 5-percent growth.23 Arizona, the state with the largest estimated shortage in 

2000, had almost a 23 percent growth in RN employment from 2000 to 2004. Montana, the 

state with the largest estimated surplus in 2000, experienced a 3 percent growth in 

employment between 2000 and 2004. (See enc. II.) 

 21See HRSA Bureau of Health Professions, Projected Supply. 

22Due to uncertainties in the estimation process, only states with a difference between supply and 

demand of greater than 3 percent were considered to have a shortage or surplus. 

23Because HRSA calculated state RN shortage estimates based on full-time equivalents (FTE), we 

calculated state-level RN employment change in terms of FTEs for this comparison. An FTE is the

percentage of time a staff member works, represented as a decimal. A full-time person is 1.00, a halftime person is .50 and a quarter-time person is .25. 

10 GAO-07-492R Nursing Workforce
Figure 3: Full-time equivalent (FTE) RN Employment Growth by State, 2000–2004 

Source: HRSA and GAO analysis of HRSA data. Copyright © Corel Corp. All rights reserved (map).

States with a HRSA-designated shortage in 2000

States with no clear shortage or surplus in 2000

States with a HRSA-designated surplus in 2000

X.X% FTE-RN employment change in state between 2000 and 2004 

+2.4%

+13.8%

+36.6%

+9.4%

+3.1%

+ 4.7%

+19.3%

+22.6% +14.7%

+10.2%

+10.6%

+5.3%

+15.7%

+11.3%

+0.6%

+10.0%

+8.3%

+6.0%

+3.9%

+6.8%

-6.7%

+9.2%

+10.8%

+21.1%

+11.2%

+10.3%

+2.4%

+4.2%

+18.4%

+4.0%

+9.0%

+9.9%

+11.5%

+44.7%

-0.9%

+6.3% -2.7%

+13.8%

+15.7%

+6.4% +8.8%

+17.0%

+8.9%

+2.1%

+36.9%

+6.1%

+1.1%

+5.0%

+19.4%

+3.7%

+14.8%

Note: RN employment based on FTEs. 

Second, between 2000 and 2004 the number of employed RNs relative to the size of the 

general population increased, reflecting an increase in RN supply relative to one measure of 

demand. According to HRSA’s National Sample Survey of Registered Nurses, nationally there 

were 825 employed RNs per 100,000 people in 2004, compared with 782 per 100,000 in 2000 

and 798 per 100,000 in 1996. Between 2000 and 2004, on a per capita basis, the number of 

employed RNs increased by 5.5 percent. This followed a 2 percent decline in per capita RN 

employment between 1996 and 2000. (See enc. III.) Changes in the per capita RN employment 

varied across states between 2000 and 2004. (See fig. 4.) 

11 GAO-07-492R Nursing Workforce
Figure 4: Change in State Per Capita RN Employment, 2000–2004 

Source: GAO analysis of HRSA data. Copyright © Corel Corp. All rights reserved (map).

Less than 0% change in per capita RN employment from 2000 to 2004 

0 to 9.99% change in per capita RN employment from 2000 to 2004 

10 to 19.99% change in per capita RN employment from 2000 to 2004 

20 to 29.99% change in per capita RN employment from 2000 to 2004 

30% or higher change in per capita RN employment from 2000 to 2004 

Pa.

Ore.

Nev.

Idaho

Mont.

Wyo.

Utah

Ariz. N.Mex.

Colo.

N.Dak.

S.Dak.

Nebr.

Tex.

Kans.

Okla.

Minn.

Iowa

Mo.

Ark.

La.

Ill.

Miss.

Ind.

Ky.

Tenn.

Ala.

Fla.

Ga.

S.C.

N.C.

Va.

Ohio

N.H.

Mass.

Mich. R.I.

Calif.

Wash.

Wis. N.Y.

Maine

Vt.

W.Va.

Alaska

Hawaii

Conn.

N.J.

Del.

Md.

D.C.

Third, after several years of strong relative earnings growth for RNs following reports of an 

emerging shortage around 2000, RN earnings have grown at a rate comparable to the overall 

workforce during the most recent period from 2003 through 2005.24 (See fig. 5.) In a period of 

shortage, wage or earnings growth for RNs would be expected to exceed the earnings growth 

for all workers as employers raise wages to attract more RNs. Growth in RN earnings lagged 

behind earnings growth for all workers through most of the 1990s, and in particular in the 

mid-1990s period. During the 2001 through 2003 period, earnings growth for RNs averaged 

4.4 percent per year while earnings for all workers grew by an average of 2.5 percent per 

year. During the most recent period, however, from 2003 through 2005, RN earnings rose at 

an average annual rate of 2.2 percent, the same as for all workers. 

 24According to labor economists, in a condition of shortage, where demand exceeds the supply of

workers, labor market data will generally show strong employment and wage growth for an 

occupation relative to the workforce overall. See C. Veneri, “Can occupational labor shortages be 

identified using available data?” Monthly Labor Review, March 1999. 

12 GAO-07-492R Nursing Workforce
Figure 5: Earnings Growth for Registered Nurses and All Workers, 1999–2005 

Years

Percent change

Source: GAO analysis of Bureau of Labor Statistics data.

0

1

2

3

4

5

6

All workers

RN

1999–01 2000–02 2001–03 2002–04 2003–05

Note: Data are from the Current Population Survey (CPS) monthly household survey and represent 3-year annual averages. 

Fourth, reports of declines in the percentage of unfilled employment positions at some 

facilities that employ RNs are also evidence of an easing of the RN shortage because they 

indicate less unmet employer demand for RNs. Although no comprehensive data exist on 

how many of these positions go unfilled each year, some trade associations gather 

information on such employment vacancies from member surveys. For example, the AHA 

reported a national decline in the rate of unfilled RN positions in hospitals, from 13 percent in 

2001 to 9 percent in 2005. The extent of the decline varied across regions of the country. For 

example, AHA reported that from 2001 through 2005 the greatest decline in the rate of 

employment vacancies occurred among hospitals in the West, where the average rate of RN 

vacancies fell from 15 to 9 percent. In contrast, the smallest decline occurred among 

hospitals in the South, where during the same time period, the average rate of RN vacancies 

fell from 13 to 10 percent.

Characteristics of NELRP and NSP Awardees Differ from the Overall RN Workforce, 

and GAO Cannot Assess Programs’ Effect on Nursing Supply 

As a group, NSP and NELRP awardees have a higher percentage of minorities and are more 

likely to have received or be pursuing 4-year bachelor’s degrees rather than 2-year associate’s 

degrees than the overall RN workforce. Although NSP and NELRP awardees are required to 

be employed in one of the types of facilities identified by HRSA in order to meet the NRA 

requirement intended to address critical nursing shortages, we cannot assess whether the 

two programs have improved the supply of RNs in facilities with critical shortages of RNs. 

HRSA does not have a sound basis for identifying critical shortage facilities, and as a result, 

awardees of the programs may not be serving in facilities actually experiencing such 

13 GAO-07-492R Nursing Workforce
shortages. HRSA is working to develop an empirically-based approach for identifying 

facilities with critical shortages of RNs, but these efforts have not yet been completed. 

NSP and NELRP Awardees Have a Higher Percentage of Minorities and Obtain Higher

Degrees than Overall RN Workforce

In our comparison of minority status, we found that as a group, awardees of the NSP and 

NELRP have a higher percentage of minorities than the overall nursing workforce, but are 

similar to current nursing school students and recent graduates.25 (See fig. 6.) In both 

programs, an applicant’s minority status is not used as a criterion in making awards. While 

minorities made up 11 percent of the overall RN workforce in 2004, they constituted 

36 percent of NSP awardees, 21 percent of NELRP awardees and 26 and 22 percent of nursing 

school students and graduates, respectively.26 (See enc. IV for more detailed data on NELRP 

and NSP awardees.) 

Figure 6: Percentage of Minorities among Awardees in the NSP and NELRP, RN Students and RN 

Graduates, and the Overall RN Workforce, 2004 

Source: HRSA and National League for Nursing (NLN).

NSP Awardees NELRP Awardees Nursing School Students Nursing School Graduates RN Workforce

36%

64%

21%

79%

26%

74%

22%

11%

78%

89%

Percent minority

Percent non-minority (white, non-Hispanic)

Note: Minorities include African Americans, Hispanics, American Indians, Native Hawaiians, Native Alaskans, Asians, and 

Pacific Islanders. NSP and NELRP awardee data are for fiscal year 2004. 

 25Because the NELRP provides awards to RNs with student loan debt, we use nursing school graduates 

as the closest comparison group for NELRP awardees. Similarly, because the NSP provides awards to 

individuals entering nursing school, we use nursing school students as the best comparison for NSP 

awardees. 

26While race and ethnicity are not criteria for awards for the NSP or NELRP, the Institute of Medicine

and the National Advisory Council on Nurse Education and Practice (NACNEP), an advisory body for 

HRSA on nurse workforce issues, have identified the need to increase racial and ethnic diversity 

among RNs and other health professionals. 

14 GAO-07-492R Nursing Workforce
Awardees of the NSP and NELRP programs are also more likely to be pursuing or have 

received higher degrees than the overall RN workforce or current nursing student population. 

In fiscal year 2004, the percentage of NSP awardees pursuing a bachelor’s degree was higher 

than it was among the nursing student population.27 While 49 percent of the nursing student 

population was pursuing a bachelor’s or graduate degree in 2004, 70 percent of NSP awardees 

were pursuing this degree. (See fig. 7.) Similarly, in the NELRP, the majority of awards in 

fiscal year 2004 were given to applicants with bachelor’s or higher degrees. This is largely due 

to the way in which awards are funded, with preference given to those with greatest financial 

need. Applicants who obtain higher level degrees (bachelor’s or graduate degrees) are likely 

to have higher levels of debt than those with an associate’s degree. 

Figure 7: Degree Types of NSP and NELRP Awardees Compared to Nursing School Students, Graduates, 

and the RN Workforce, 2004

0

20

40

60

80

100

Bachelor's or higher

Diploma

Associate's

NSP awardees Nursing school students RN workforce

0

20

40

60

80

100

NELRP awardees Nursing school graduates RN workforce

Degree type

Degree type

Percent Percent

NSP Awardees, 2004 NELRP Awardees, 2004

28

2

70

47

4

49

36

15

48

13

2

83

55

4

41

36

15

48

Source: HRSA and NLN data.

Note: NSP and NELRP awardee data are for fiscal year 2004. 

Other characteristics of NSP and NELRP awardees include the type of facility in which the 

awardees work. As of fiscal year 2005, 78 of 419 NSP awardees had completed their 

education and had begun their service in a critical shortage facility. Of these, 71 were serving 

in hospitals, 3 in Indian Health Service Health Centers, and 1 each in a home health agency, 

hospice, nursing home, and skilled nursing facility. As shown in table 3, the majority of 

NELRP awardees were completing their service requirement in disproportionate share 

hospitals and public health departments as of fiscal year 2005. In addition, most NELRP 

 27While the educational degree type is not a criterion for NSP awards, the NACNEP and the American

Association of Colleges of Nursing have called for increasing the proportion of bachelor’s-prepared

RNs in the workforce. As of 2004, 53 percent of the RN workforce held a bachelor’s or higher degree. 

15 GAO-07-492R Nursing Workforce
awardees were working in not-for-profit facilities and in facilities located in the South and 

West.28

Table 3: Work Locations of Nursing Education Loan Repayment Program Awardees, Fiscal Years 

2003–2005 

Year

2003 2004 2005

Total Awardees 602 857 803

Facility type Disproportionate share hospital

a

473 531 663

Public health department 91 128 85

Nursing home 38 66 32

Federally-designated community health 

center 0 3 19

Hospital 0 52 0

Rural health clinic 0 4 4

Indian Health Service health center 0 1 0

Other not-for-profit health facility 0 72 0

Facility ownership status Not-for-profit 425 411 510

For-profit 177 446 293

Region of facilitybNortheast 88 103 111

Midwest 107 246 160

South 243 270 299

West 164 238 233

Urban 566 770 713

Rural 36 87 90

Source: HRSA. 

a

Disproportionate share hospitals receive supplemental payments through the Medicare or Medicaid programs to subsidize the 

costs associated with providing care to a high proportion of low-income patients. 

b

Regions consist of the following: Northeast—Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, 

New York, New Jersey, Pennsylvania; Midwest—Ohio, Indiana, Illinois, Michigan, Wisconsin, Minnesota, Iowa, Missouri, North 

Dakota, South Dakota, Nebraska, Kansas; South—Delaware, Maryland, District of Columbia, Virginia, West Virginia, North 

Carolina, South Carolina, Georgia, Florida, Kentucky, Tennessee, Alabama, Mississippi, Arkansas, Louisiana, Oklahoma, 

Texas; and West—Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada, Washington, Oregon, California, 

Alaska, Hawaii. 

Effect of NELRP and NSP Cannot Be Assessed Because HRSA Lacks a Sound Basis for 

Identifying Facilities with a Critical Shortage of RNs

We cannot assess whether the NELRP and NSP have improved the supply of RNs at facilities 

that actually have critical shortages of RNs because HRSA does not have a sound basis for 

identifying facilities with critical shortages of RNs. To meet the requirement established by 

NRA designed to help facilities with critical shortages, HRSA uses its list of critical shortage 

facility types. HRSA created the list based on the assumption that the facility types on the list 

target the underserved and are generally believed to be facing nursing shortages. In addition, 

 28HRSA established preference categories to target certain facility types on the list. For example, 

priority for NELRP awards in fiscal year 2005 was given to RNs working in disproportionate share

hospitals, nursing homes, state or local public health departments, federally-designated community 

health centers, federally-designated migrant health centers, or rural health clinics. 

16 GAO-07-492R Nursing Workforce
the Secretary of HHS determined that the NELRP should emphasize serving the underserved, 

improving the public health infrastructure, and addressing needs at nursing homes, so the 

agency currently gives preference to loan repayment applicants working in disproportionate 

share hospitals, community health centers, rural health clinics, Indian Health Service health 

centers, public health departments or clinics, and nursing homes. Some awardees of the 

NELRP must submit a letter or other documentation from their employer that provides 

support that the awardee is employed at one of the critical shortage facility types. Although 

HRSA uses the list of facility types in making awards to NELRP and NSP applicants, HRSA 

does not determine the number of RNs needed for a facility to be considered as one 

experiencing a critical shortage of RNs. As a result, HRSA does not know the extent to which 

specific facilities served by NELRP and NSP awardees are actually experiencing critical 

nursing shortages. Therefore, we cannot assess whether the two programs have increased the 

supply of RNs at facilities with critical shortages. 

HRSA began using the current list of facility types after passage of the NRA. Prior to the NRA, 

the law required that preference be given to qualified applicants who agreed to work in 

certain health facilities located in geographic areas with a shortage of and need for nurses.29

To implement this, HRSA considered whether the facility was located in what was known as 

a nurse shortage county or in a Health Professional Shortage Area (HPSA).30 However, HRSA 

recognized limitations in both the county and the HPSA definitions. According to HRSA 

officials, the nurse shortage county designation was not sufficiently reflective of the entire 

nursing workforce because it was based only on hospital data. Similarly, according to HRSA 

officials, HPSAs are designed for the placement of primary care physicians, and RN work 

settings are both more diverse and more complex than those of physicians.31 As a result of 

these limitations to both the nurse shortage counties and HPSAs, and because the NRA 

deleted the requirement that preference be given to applicants serving in certain facilities 

located in geographic areas with a shortage of and need for nurses, HRSA discontinued the 

use of geographic areas in favor of using only the list of critical shortage facility types. At the 

same time, HRSA officials acknowledged that this new approach did not represent a 

scientific or empirical method for identifying actual shortage facilities and was only intended 

as an interim approach to meet the short-term needs of the program. 

 29These facilities included an Indian Health Service health center, native Hawaiian health center, public 

hospital, migrant health center, community health center, rural health clinic, or public or nonprofit 

private health facility determined by the Secretary to have a critical shortage of nurses. The law also 

required preference be given to qualified applicants with the greatest financial need. 

30The nurse shortage county designation was developed using AHA hospital survey data. It was based 

on the number of full-time equivalent nursing staff relative to the average daily census among hospitals 

in a county. HRSA designates HPSAs based on the ratio of the number of primary care physicians 

relative to the population, among other factors. A HPSA can be a distinct geographic area such as a 

county, a specific population group within an area, or a specific health care facility.

 

31HPSAs are used by HRSA for primary care physicians. See GAO, Health Professional Shortage Areas: 

Problems Remain with Primary Care Shortage Area Designation System, GAO-07-84 (Washington,

D.C.: Oct. 24, 2006). 

17 GAO-07-492R Nursing Workforce
HRSA has efforts underway to develop a new approach for identifying facilities experiencing 

critical shortages of RNs, though these efforts have not been completed. In 2004 HRSA 

contracted with researchers at the Center for Health Workforce Studies at the State 

University of New York (SUNY) at Albany to develop an empirical, data-driven method for 

identifying “health care facilities with a critical shortage of RNs.” According to the SUNY 

researchers, among the contract’s guiding principles were that the approach had to (1) be 

practical, that is, not overly burdensome on facilities or HRSA; (2) be applicable to all facility 

types; (3) use data that were easy to access and available over time; and (4) be easy to

update. 

The first approach the SUNY researchers developed and tested was a facility-based model 

using data from North Carolina and North Dakota, two states that are recognized as having 

good facility-level data on RN staffing, vacancy rates, and turnover. However, the researchers 

found that these data were not sufficiently reliable predictors of whether a facility had an RN 

shortage. Also, the analysis required data that are not collected and reported by health care 

facilities in most states. The SUNY researchers concluded that the burden and cost of 

gathering facility/provider-level data from every health facility or provider in every state 

rendered this approach impractical. As a result, the researchers began work on an approach 

that could use available county-level data to determine which geographic areas could be 

defined as having critical shortages of RNs, so that the facilities in such areas could be 

identified as having critical shortages of RNs.32 HRSA received the final report on the results 

of this work from the SUNY researchers in February 2007. The report contains a 

recommended method for estimating the extent of nursing shortages in all counties in the 

United States. The advisory committee for this study recommended that before any method is 

adopted by HRSA it be validated in a number of states, facilities, and settings. As of March 

2007, the report and its recommendations were under review, and HRSA officials said they 

plan to publish the results sometime in 2007. 

Conclusions 

HRSA is in its fifth year granting awards under the Nursing Education Loan Repayment 

Program (NELRP) and the Nursing Scholarship Program (NSP) since passage of the Nurse 

Reinvestment Act. While these two programs are aimed at encouraging graduating and 

employed nurses to work in facilities with a critical shortage of nurses, they may not always 

be achieving their intended goals. Because HRSA does not have a sound basis for identifying 

facilities with a critical shortage of RNs, HRSA’s awardees may be working in facilities that 

may not be actually experiencing such shortages. HRSA received a report from its 

contractors that identifies available data and an approach to identify such facilities, and, as of 

March 2007, the report and its recommendations were under review. Because these two 

HRSA programs are able to support relatively few nurses, it is important that HRSA ensure 

that its work to develop a methodology for identifying facilities with a critical shortage of 

nurses is completed so that the resources of these programs can be targeted effectively to 

meet their intended purpose. 

 32In contrast to the facility-based methodology initially developed by the SUNY researchers, this 

approach considered other sources of data, including the decennial Census, the American Community 

Survey, the National Sample Survey of Registered Nurses, and the Area Resource File. 

18 GAO-07-492R Nursing Workforce
Recommendations for Executive Action 

In order to target funding effectively for the Nursing Education Loan Repayment Program 

(NELRP) and the Nursing Scholarship Program (NSP) to nurses working in health care 

facilities with a critical shortage of nurses, we recommend that the Secretary of HHS take the 

following steps: 

1. identify the specific steps and a time frame for implementing an empirical methodology 

for identifying health care facilities with a critical shortage of nurses; and 

2. direct the Administrator of HRSA to include a description of steps taken and progress on 

its time frame for implementing such methodology in HRSA’s annual report to Congress 

on these programs. 

Agency Comments 

In commenting on a draft of this report, HHS provided technical comments, which we 

incorporated as appropriate. 

- - - - - 

We are sending copies of this report to the Secretary of HHS, the Administrator of HRSA, and 

other interested parties. We will also make copies available to others on request. In addition, 

the report is available at no charge on the GAO Web site at http://www.gao.gov. Contact 

points for our Offices of Congressional Relations and Public Affairs may be found on the last 

page of this report. If you or your staff members have any questions about this report, please 

contact Kathleen King at (202) 512-7119 or kingk@gao.gov. Major contributors to this report 

are listed in 

enclosure V.

Kathleen King 

Director, Health Care 

Enclosures – 5 

19 GAO-07-492R Nursing Workforce
Enclosure I Enclosure I

Change in Number of Registered Nurses (RN) Employed in Nursing, 

by State, 2000–2004 

State 2000 RN employment 2004 RN employment 

Percent change in RN 

employment 2000–2004

Alaska 4,914 6,777 37.9

Alabama 34,073 36,538 7.2

Arkansas 18,752 20,115 7.3

Arizona 32,222 39,136 21.5

California 184,329 211,531 14.8

Colorado 31,695 34,654 9.3

Connecticut 32,073 32,718 2.0

Dist. of Col. 9,583 11,583 20.9

Delaware 7,337 8,633 17.7

Florida 125,439 132,758 5.8

Georgia 55,881 66,512 19.0

Hawaii 8,518 9,335 9.6

Idaho 8,230 8,753 6.4

Illinois 101,660 113,779 11.9

Indiana 46,244 54,624 18.1

Iowa 31,020 32,664 5.3

Kansas 23,779 24,869 4.6

Kentucky 33,655 37,631 11.8

Louisiana 37,275 35,369 -5.1

Maine 13,072 15,077 15.3

Maryland 45,323 47,124 4.0

Massachusetts 75,795 75,398 -0.5

Michigan 79,353 84,967 7.1

Minnesota 47,102 51,914 10.2

Mississippi 21,338 24,009 12.5

Missouri 53,730 57,365 6.8

Montana 7,327 7,914 8.0

North Carolina 69,057 76,761 11.2

North Dakota 7,039 7,484 6.3

Nebraska 16,399 18,532 13.0

New Hampshire 11,321 16,670 47.2

New Jersey 67,280 72,980 8.5

New Mexico 11,932 13,570 13.7

Nevada 10,384 14,095 35.7

New York 160,009 174,208 8.9

Ohio 100,144 112,806 12.6

Oklahoma 21,905 24,433 11.5

Oregon 27,121 30,850 13.7

20 GAO-07-492R Nursing Workforce 
Enclosure I Enclosure I 

State 2000 RN employment 2004 RN employment 

Percent change in RN 

employment 2000–2004

Pennsylvania 123,997 127,013 2.4

Rhode Island 11,542 11,368 -1.5

South Carolina 29,226 30,711 5.1

South Dakota 8,511 9,278 9.0

Tennessee 49,626 54,338 9.5

Texas 126,436 145,336 14.9

Utah 13,229 15,778 19.3

Vermont 5,829 6,444 10.6

Virginia 50,359 56,726 12.6

Washington 43,482 48,421 11.4

West Virginia 15,523 16,042 3.3

Wisconsin 47,895 51,679 7.9

Wyoming 3,849 4,079 6.0

United States 2,201,813 2,421,351 10.0

Source: GAO analysis of Health Resources and Services Administration (HRSA) data. 

Note: Data are from the 2000 and 2004 National Sample Survey of Registered Nurses, HRSA. 

21 GAO-07-492R Nursing Workforce
Enclosure II Enclosure II

Change from 2000 to 2004 in Full-time equivalent (FTE) Registered Nurse (RN) 

Employment by Degree of State Shortage in 2000 as Estimated by the Health 

Resources and Services Administration (HRSA) 

State 

Percent FTE RN shortage

estimated by HRSA, 2000

Percent change in FTE RN 

employment 2000–2004

States with a shortage in 2000 

Arizona -17.3 22.6

Tennessee -13.4 10.3

New Jersey -12.9 5.0

Connecticut -12.4 1.1

Maine -11.7 17.0

Delaware -11.1 19.4

Nevada -10.9 36.6

New York -10.9 8.8

Colorado -10.7 10.2

Massachusetts -10.5 -0.9

Rhode Island -10.1 -2.7

Virginia -9.8 9.9

New Hampshire -9.7 44.7

Indiana -9.6 20.4

Hawaii -9.2 6.1

Washington -9.2 15.7

Texas -8.9 11.3

Utah -8.1 19.3

Missouri -7.9 3.9

Arkansas -7.7 6.8

California -7.6 13.8

New Mexico -7.4 14.7

Georgia -6.8 18.4

Ohio -5.4 11.5

Nebraska -5.2 15.7

Pennsylvania -4.9 2.4

Alaska -4.5 36.9

Oregon -3.8 13.8

Iowa -3.5 6.0

Minnesota -3.5 8.3

States with no clear RN shortage or surplus in 2000a

Alabama -2.9 2.4

Florida -2.8 4.2

Dist. of Col. -2.4 14.8

Maryland -1.4 3.7

Michigan -1.3 6.3

22 GAO-07-492R Nursing Workforce 
Enclosure II Enclosure II 

State 

Percent FTE RN shortage

estimated by HRSA, 2000

Percent change in FTE RN 

employment 2000–2004

Vermont -0.5 8.9

South Carolina -0.4 4.0

Mississippi 0.0 10.8

North Dakota 0.2 10.6

North Carolina 1.0 9.0

Illinois 1.6 9.2

Wyoming 2.0 4.7

States with a surplus in 2000 

Oklahoma 4.6 10.0

Kentucky 5.9 11.2

Wisconsin 6.2 6.4

South Dakota 8.1 5.3

Idaho 8.5 9.4

Louisiana 9.0 -6.7

Kansas 9.0 0.6

West Virginia 10.3 2.1

Montana 14.5 3.1

United States -5.5 8.9

Source: HRSA and GAO analysis of HRSA data. 

Notes: HRSA’s shortage estimates are for 2000. GAO analysis is of data from the 2000 and 2004 National Sample Survey of

Registered Nurses, HRSA. 

a

Due to uncertainties in the estimation process, only states with a difference between supply and demand of greater than 3

percent were considered to have a shortage or surplus.

23 GAO-07-492R Nursing Workforce
Enclosure III Enclosure III 

Change in Registered Nurse (RN) Employment per 100,000 Population, 

by State, 2000–2004 

Employed RNs per 100,000 persons

State 2000 2004 Percent change 2000–2004

Alaska 784 1034 31.9

Alabama 766 807 5.4

Arizona 628 681 8.4

Arkansas 701 731 4.3

California 544 589 8.3

Colorado 737 753 2.2

Connecticut 942 934 -0.8

Delaware 936 1040 11.1

Dist. of Col. 1675 2093 25.0

Florida 785 763 -2.8

Georgia 683 753 10.2

Hawaii 703 739 5.1

Idaho 636 628 -1.3

Illinois 819 895 9.3

Indiana 761 876 15.1

Iowa 1060 1106 4.3

Kansas 885 909 2.7

Kentucky 833 908 9.0

Louisiana 834 783 -6.1

Maine 1025 1145 11.7

Maryland 856 848 -0.9

Massachusetts 1194 1175 -1.6

Michigan 798 840 5.3

Minnesota 957 1018 6.4

Mississippi 750 827 10.3

Missouri 960 997 3.9

Montana 812 854 5.2

Nebraska 958 1061 10.8

Nevada 520 604 16.2

New Hampshire 916 1283 40.1

New Jersey 800 839 4.9

New Mexico 656 713 8.7

New York 843 906 7.5

North Carolina 858 899 4.8

North Dakota 1096 1180 7.7

Ohio 882 984 11.6

Oklahoma 635 693 9.1

Oregon 793 858 8.2

24 GAO-07-492R Nursing Workforce 
Enclosure III Enclosure III 

Employed RNs per 100,000 persons

State 2000 2004 Percent change 2000–2004

Pennsylvania 1010 1024 1.4

Rhode Island 1101 1052 -4.5

South Carolina 728 732 0.5

South Dakota 1128 1204 6.7

Tennessee 872 921 5.6

Texas 606 646 6.6

Utah 592 660 11.5

Vermont 957 1037 8.4

Virginia 711 760 6.9

Washington 738 781 5.8

West Virginia 858 884 3.0

Wisconsin 893 938 5.0

Wyoming 780 805 3.2

United States 782 825 5.5

Source: Source: GAO analysis of Health Resources and Services Administration (HRSA) data. 

Note: Data are from the 2000 and 2004 National Sample Survey of Registered Nurses, HRSA. 

25 GAO-07-492R Nursing Workforce
Enclosure IV Enclosure IV

Characteristics of Nursing Education Loan Repayment Program (NELRP) and 

Nursing Scholarship Program (NSP) Awardees 

Table 4: Race and Ethnicity of Registered Nurse (RN) Workforce, Nursing School Graduates, and NELRP 

Awardees, 2004 

Race and ethnicity 

2004 RN workforce 

(percent)

2004 Nursing 

school graduates

(percent) 

2004 NELRP awardees 

(percent)

White (non-Hispanic) 81.2 73.6 70.1

Black (non-Hispanic) 4.4 10.4 9.7

Asian/Pacific Islandera3.3 3.6 3.0

American Indian/Alaska Native 0.3 0.9 0.7

Hispanic (any race) 1.7 6.0 5.7

Other/unknownb9.0 5.5 10.7

Source: Health Resources and Services Administration (HRSA), National League for Nursing, and GAO analysis of HRSA administrative data. 

a

Includes Native Hawaiians among the RN workforce and NELRP awardees. 

b

Includes 1.5 percent identified as two or more races among the 2004 RN workforce.

Table 5: Race and Ethnicity of RN Workforce, Nursing School Students, and NSP Awardees, 2004 

Race and ethnicity 

2004 RN workforce 

(percent)

2004 Nursing 

school students

(percent) 

2004 NSP awardees 

(percent)

White (non-Hispanic) 81.2 69.2 61.9

Black (non-Hispanic) 4.4 13.0 29.4

Asian/Pacific Islandera3.3 5.4 2.4

American Indian/Alaska Native 0.3 0.8 0.8

Hispanic (any race) 1.7 5.7 1.6

Other/unknownb9.0 5.9 4.0

Source: HRSA, National League for Nursing, and GAO analysis of HRSA administrative data. 

a

Includes Native Hawaiians among the RN workforce and NSP awardees. 

b

Includes 1.5 percent identified as two or more races among the 2004 RN workforce.

26 GAO-07-492R Nursing Workforce 
Enclosure V Enclosure V

GAO Contact and Staff Acknowledgments 

GAO Contact 

Kathleen King, (202) 512-7119 or kingk@gao.gov

Acknowledgments: 

In addition to the contact names above, Linda T. Kohn, Assistant Director; Eric Anderson, 

Krister Friday, Romonda McKinney, Dae Park, Ollie Richie, and Jessica C. Smith made key 

contributions to this report. 

(290529) 

27 GAO-07-492R Nursing Workforce 
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