© Copyright 2002 by the Wyoming Department of Employment, Research & Planning
Nursing in Wyoming, Part Two: Turnover
by: Tony Glover, Senior Research Analyst
"Health care related industries have a low turnover rate when compared to the overall turnover rate in Wyoming."
In response to reports by the U.S. General Accounting Office (GAO) of a nationwide nursing
shortage,1 Research & Planning (R&P) began examining Wyoming’s position in terms of the State’s supply of Registered Nurses
(RNs),2 as well as our current and future demand. R&P’s findings appear as a three-part series in
Wyoming Labor Force Trends. Part One, featured in the September 2002 issue, focused on the supply of RNs based on the number of nursing graduates and licenses issued. This article,
Part Two, looks at factors that will likely affect the future demand for RNs in the State.
The GAO report suggests that the national nursing shortage is spurred by four issues:
· Aging of the nursing population
· Diversification of the health services industry
· Working conditions
· Growth in the number of care recipients
R&P found that these same issues are also affecting the supply of RNs in Wyoming. Table 1 shows the number of RNs working, the average quarterly wage, and the average age of those working in Wyoming’s labor force by industry for selected years between 1992 and 2000. The average age of RNs working in Wyoming has increased over the past decade from 40.2 years to 44.5. This finding coincides with data collected by the GAO which states that, “the nurse workforce will continue to age, and, by 2010, approximately 40 percent will likely be older than 50.”3 As with the national trend, the aging and pending retirements of Wyoming’s nursing workforce will further increase the demand for RNs over the next decade.
Another factor discussed by the GAO report is the diversification of the health care industry as a result of technological advances. This factor creates an increasing demand for RNs outside a hospital setting because patients who were once cared for in hospitals are now more often accommodated in outpatient clinics and physicians’ offices. Additionally, technology has expanded the treatment of medically complex conditions (e.g., organ transplants and serious illnesses). These conditions generally require more intensive services and a larger, more specialized staff of doctors and nurses. The data in Table 1 demonstrates that there has been growth in the number of RNs, thus suggesting diversification in Wyoming. However, growth is varied across health care industries. For example, the number of RNs working in hospital settings has increased to 2,224 in 2000 from 1,349 in 1992 (64.9%). The number of RNs working in offices and clinics has increased to 442 in 2000 from 186 in 1992 (137.6%). Though the increase in the actual number of RNs working in offices and clinics seems small, the percentage job growth for clinic-based RNs was twice as fast as for RNs working in hospitals.
Table 1 also shows that in 2000, the highest paid RNs in Wyoming’s labor force worked in hospitals earning an average quarterly wage of $10,073. The lowest paid worked in offices and clinics at $7,298 per quarter. However, the wage difference is likely attributable to the working conditions. The wages of RNs working in hospitals may reflect compensation for shift work, scheduled overtime, and working in an occupation that is often cited as lacking respect and recognition.4 These factors, which may lessen the appeal of the occupation, likely contribute to the enrollment decline in college nursing programs.5
R&P has been working with several other states to adopt a consensus on common definitions relating to turnover. This project is leading to the development of comparable data across these states, using the administrative databases collected for Unemployment Insurance tax purposes. The methodology is beyond the scope of this article, but is discussed in “Turnover Analyses; Definitions, Process, and Quantification.”6 Table 2 presents the annual turnover rates by industry from 1992 to 2000. The rows in bold reflect RNs with active licenses within each industry. Table 2 indicates that the health care related industries have a low turnover rate (17.6% in 2000) when compared to the overall turnover rate in Wyoming (24.5% in 2000). This disputes the common assumption that turnover is relatively high in the health care industries. Further, Table 2 demonstrates that RNs in hospitals have even lower relative turnover rates (6.6% for hospital RNs compared to 11.6% for all RNs). Higher pay in hospitals may be reducing turnover among RNs in this industry.
Exiting and entering behavior offers a useful way to examine labor market activity. Tables 3 and 4 show the number of RNs exiting (Table 3) and entering (Table 4) their primary industries. The primary industry is the industry which constitutes the largest portion of an individual’s income. There were 2,152 RNs employed by hospitals (their primary industry) in 1999 (see Table 1). Based on Table 3, we know that 283 (13.2%) of these individuals left this industry by the end of 1999. Further, we know that 375 of the 2,152 (17.4%) RNs employed by hospitals in 1999 came from some other industry or state in 1998 (see Table 4). This represents a gross churning of 29.6 percent.7
The average age of both the RNs exiting (41.5) and those entering (40.7) in 1999 was lower than the overall average age of all RNs employed (43.2). Tables 3 and 4 give insight into the churning (exits and entries) of RNs occurring within Wyoming. They do not, however, provide information as to the origin of the RNs entering Wyoming or the destination of RNs who leave. Part three of this series will focus on where Wyoming’s RNs are coming from and where they are going after leaving employment in the State.
Research indicates that the four factors influencing the nation’s supply of nurses (i.e., the aging of the nursing population, diversification of the health services industry, working conditions, and growth in the number of care recipients) are also affecting the supply of RNs in Wyoming. The average age of RNs working in Wyoming has increased over the past decade from 40.2 years to 44.5, moving them closer to retirement. Diversification within the health services industry and more care recipients may have led to increases in both the percentage of RNs employed by hospitals (64.9%) and those working in offices and clinics (137.6%). Unfortunately, the lower pay associated with working in offices and clinics and the working conditions experienced by RNs employed by hospitals may have lessened the appeal of the nursing profession, thus reducing enrollment in college nursing programs. The relatively low turnover rate of RNs in Wyoming indicates a measure of stability in terms of the current supply of nurses. However, unless efforts are made to improve working conditions and encourage enrollment in nursing programs, Wyoming’s supply of RNs may not meet future demand.
1U.S. General Accounting Office, “Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors,” GAO Report GAO-01-944, July 10, 2001, <http://www.gao.gov> (September 10, 2002).
2The shortage of nursing-related health care practitioners is not limited to Registered Nurses (RNs) but also includes many of the support occupations such as Licensed Practical Nurses (LPNs) and Certified Nursing Assistants (CNAs). Due to time constraints and difficulties associated with occupational analysis, this article series focuses on RNs who were issued licenses in the State of Wyoming during the past decade.
3U.S. General Accounting Office, “Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors,” GAO Report GAO-01-944, July 10, 2001, <http://www.gao.gov> (September 10, 2002).
4U.S. General Accounting Office, “Nursing Workforce: Multiple Factors Create Nurse Recruitment and Retention Problems,” GAO Report GAO-01-912T, June 27, 2001, <http://www.gao.gov> (September 26, 2002).
5U.S. General Accounting Office, “Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors,” GAO Report GAO-01-944, July 10, 2001, <http://www.gao.gov> (September 10, 2002). See also Tony Glover, “Nursing in Wyoming, Part One: Supply and Retention,” Wyoming Labor Force Trends, September 2002, pp. 9-15.
6Tony Glover, “Turnover Analyses; Definitions, Process, and Quantification,” Working paper distributed to multi-state turnover group, Wyoming Department of Employment, Research & Planning, Casper, WY, December 2001.
7The formula for determining gross churning of Registered Nurses (RNs) is ([exits + entries] / total number of RNs)*100.
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