Critical Care Nurses' Transitions out of the Critical Care Specialty AreaA State‐Wide Study

Research ObjectiveThe COVID‐19 pandemic has revealed our healthcare system's dependence on critical care registered nurses (CC RNs). Because of the specific training that CC RNs receive, the ability to identify and redeploy registered nurses (RNs) with prior critical care (CC) experience is important knowledge for organizational leaders and policymakers during these times of acute need. Using life course theory, we used state nurse licensure data to identify the specialty areas that CC RNs transition into, the prevalence of transitions, and predictors of transition.Study DesignThis was a secondary analysis of longitudinal RN state licensure data from 2001 to 2013. The annual records of all active licenses were combined and linked to follow individual RNs over time (n = 129,058). Descriptive statistics and logistic regression were used to examine the CC RN workforce and identify predictors of CC RN transitions in the first year they reported their primary employment to be in non‐CC or missing specialty areas.Population StudiedThe sample consisted of unique RNs in NC who identified CC as their primary employment specialty in any of the study years (n = 12,969). To allow enough time for a CC RN transition to occur, a CC RN sub‐sample was constructed of RNs (n = 8408) whose first years observed in CC were between 2001 and 2008.Principal FindingsThe CC RN workforce represented 6–7% of all licensed, actively practicing RNs in NC each year, was the third most frequently reported RN specialty area, and increased in numbers annually. In this 13‐year period, more than a third of CC RNs were observed to transition to another specialty area and nearly a quarter became inactive or non‐licensed.Those CC RNs who transitioned out of CC remained primarily in acute care‐related specialty areas, such as emergency, peri‐operative care, and cardiology. CC RNs who made transitions primarily reported working in hospital inpatient settings and urban areas, ranged in age between 30–39, and had a mean of 8.1 years of RN experience and 3.4 years of CC experience.Higher education and rural employment increased the likelihood of CC RNs making transitions out of CC. RNs with masters or doctoral degrees were almost twice as likely to have made specialty transitions than those with bachelors degrees (OR = 1.80;p = 0.006). Being employed in a rural area increased CC RNs' likelihood of making specialty transitions by 1.24 times (p = 0.010). Male CC RNs were less likely to have made a specialty transition than females (OR = 0.76;p < 0.001).ConclusionsFindings indicate that CC RNs are quite mobile within and out of the RN workforce. CC RNs transition into specialty areas that are similarly related to CC. Education and employment location influence RNs' transitions.Implications for Policy or PracticeIt is imperative to consider how highly prepared and skilled segments of the RN workforce can be identified and incentivized to transition into needed areas of healthcare and meet changing care demands. This study is an example of how pre‐existing workforce data can be used to offer insights for organizational leaders and policymakers to design targeted strategies and enhance health workforce capacity during times of change in the immediate and long‐term future.Primary Funding SourceThe Robert Wood Johnson Foundation.