© Copyright 2002 by the Wyoming Department of Employment, Research & Planning
Nursing in Wyoming, Part One: Supply and Retention
by: Tony Glover, Statistical Analyst
"Turnover data indicate that Wyoming graduates are more likely to remain in Wyoming than out-of-state graduates."
Federal research suggests our country is currently in the middle of a nursing shortage which will increase substantially over the next decade. The General Accounting Office (GAO) report, “Emerging Nurse Shortages Due to Multiple Factors,” states that “national data are not adequate to describe the nature and extent of nurse workforce shortages, nor are the data sufficiently sensitive or current to compare nurse workforce availability across states, specialties, or provider
types.”1 Research and Planning’s (R&P) analysis is based on Wyoming administrative databases and has the capacity to answer issues of nurse shortages specifically for the State. Our findings on Wyoming’s supply of nurses are similar to many of the conclusions of the GAO report regarding national trends. This article presents part one of a three-part series exploring Wyoming’s nursing supply and demand.
The 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 series of articles focuses on RNs who were issued licenses in the State of Wyoming during the past decade. Eighty-four percent of RNs in this country work in public and private health services (SIC 80)2 and are often cited as the industry’s occupational backbone. The majority of the remaining RNs are employed in Public Administration (6.3%), public and private educational services (3.3%), business services (3.3%), and social services (1.5%).3
In Wyoming, health services has grown 25.1 percent from 1992 to 2000. Within this industry, the range of growth is between 39.2 percent of jobs created during the eight-year period in offices and clinics of doctors and 7.1 percent of jobs created in nursing and personal care facilities. During the same period, average employment for all industries in Wyoming grew 16.6 percent. Trends in industry employment provide the foundation for occupational projections. Because RNs comprise the largest proportion of the health care industry, it is not surprising that the projected demand for RNs over the next decade will be great. Table 1 presents projected demand from 1998 to 2008 and the 1999 average hourly wage of RNs for all 50 states and the nation.4
Table 1 shows that while nationally the number of RNs is projected to grow 21.7 percent from 1998 to 2008, Wyoming should experience 12.7 percent growth. All of Wyoming’s border states have a greater projected demand: Montana (19.0%), South Dakota (22.2%), Nebraska (25.2%), Colorado (26.6%), Idaho (28.7%) and Utah (46.0%). Wyoming’s border states also paid higher wages in 1999 than Wyoming, which ranked 49th of the 50 states in average hourly wage. Given this, it may be difficult to attract and retain RNs in the State. Part two of this series will demonstrate that while health care services, and in particular the RNs in this industry, have relatively low turnover rates compared to other industries in Wyoming, the turnover rates are increasing. Based on the occupational projections and wages in Table 1, turnover is likely to continue to increase.
Wyoming Specific Data
The Wyoming State Board of Nursing (WSBN) provided an exhaustive database of all Registered Nurse licenses active in the State of Wyoming from 1992 to 2001. Database variables include the following:
This database was merged with R&P’s Wage Records5 database which contains the employer and wages by SSN for all calendar quarters from 1992Q1 to 2001Q3. Combining these two data sets made it possible to track RNs across time through the labor force. Wyoming’s Wage Records is further supplemented with wage record data provided through data sharing agreements with several other states (Colorado, Idaho, Nebraska, New Mexico, South Dakota, Texas, and Utah). Interstate wage data provide the basis for the detailed analysis of RNs working in hospitals in 1999, which will be presented in part three.
Our databases provide us two perspectives when measuring the labor supply of RNs in Wyoming. The first is the supply of RNs with degrees from Wyoming colleges. The second is the number of RNs that actually become licensed in the State, of which graduates from Wyoming-based nursing programs are a subset. Table 2 lists the number of graduates with nursing degrees from all Wyoming colleges offering nursing programs.6 A review of Table 2 shows that the number of graduates from Wyoming schools has declined 33.2 percent over the last decade (using the first and last three-year averages). Although of much greater magnitude, this coincides with the GAO report which states that nationally, enrollments in RN associate degree programs have declined 11 percent and baccalaureate programs 19 percent from 1995 to 1998.
Table 3 lists the number of new licenses issued to RNs in the State by school and year7 from 1992 to 2001. Overall, the number of new licenses issued has declined by 20.0 percent from 1992-1994 to 1999-2001. Additionally, the proportion of those licenses issued to graduates of Wyoming schools has declined from 41.3 percent to 25.3 percent. State employers are relying more heavily on graduates from institutions outside Wyoming to fill nursing positions. In comparing Tables 2 and 3, it appears that the decline in the proportion of licenses issued to graduates from Wyoming schools is not entirely explained by the decline in the number of Wyoming graduates. In 1992-1994, 83.0 percent of Wyoming graduates were licensed in the State; by 1999-2001, only 69.8 percent were. The decline may be due to the increased demand for RNs elsewhere in the country. So, not only is Wyoming producing fewer RNs but a greater percentage of those we do produce do not become licensed in the State.
The importance of Wyoming colleges in providing a supply of nurses for the State is demonstrated by Table 4. Table 4 was created using the merged WSBN and Wage Records database and shows the number of individuals issued new licenses by their appearance in Wage Records.8 For example, of the 227 nursing graduates of Wyoming colleges who were issued a license in 1993 (1992Q4 to 1993Q3), 208 (91.6%) worked in Wyoming in all four quarters immediately following the license issue date. In contrast, of the 342 who graduated outside Wyoming, 211 (61.7%) were found working in Wyoming. The WSBN9 suggests that there are several reasons why an individual would obtain a Wyoming license but not always work in Wyoming. For example, some may be circuit nurses who come to work in Wyoming on a temporary basis,10 or insurance company representatives employed in other states who review health insurance claims of clients residing in Wyoming.
Table 4 also presents data related to retention, defined as the number of those who start working in the first year following the license issue date who still appear in Wyoming Wage Records three years later. Of the 208 nursing graduates of Wyoming colleges who appeared in the first year of license issue, 183 (88.0%) were found working for employers in Wyoming three years later. In contrast, of the 211 who graduated outside Wyoming, only 135 (64.0%) were found working in the State three years later. Thus, in terms of retention, it appears advantageous for State health services firms to solicit nursing graduates of Wyoming educational institutions.
Research suggests that the nation is experiencing a nursing shortage and Wyoming is no exception. This article, part one of the series, examined the supply of RNs in Wyoming based on the number of nursing graduates and licenses issued. Our analysis indicates that from 1998 to 2008 the demand for RNs is projected to grow 21.7 percent nationally and 12.7 percent in Wyoming. Furthermore, the number of graduates from Wyoming’s RN degree programs has declined 33.2 percent. Not only are there fewer graduates but fewer Wyoming graduates are obtaining a Wyoming license (69.8% in 1999-2001 compared to 83.0% in 1992-1994). However, even though numbers are down, turnover data indicate that Wyoming graduates are more likely to remain in Wyoming than out-of-state graduates. One implication of this research is efforts that increase the number of Wyoming nursing graduates will increase the pool of RNs willing and able to remain in the State.
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 health services industry is defined as firms in Standard Industrial Classification (SIC) 80. It includes offices and clinics of health practitioners, nursing care facilities, hospitals, medical/dental laboratories, and home health care services.
3Wyoming Department of Employment, Research & Planning, Customized Staffing Patterns and Wages, July 2001, <http://LMI.state.wy.us/staffing/Staffing.htm> (September 3, 2002).
4U.S. Department of Labor, Bureau of Labor Statistics, Wages by Area and Occupation, November 28, 2001, <http://stats.bls.gov/bls/blswage.htm> (August 13, 2002). U.S. Department of Labor, Employment and Training Administration, State Occupational Projections 1998-2008, n.d.,
<http://almis.dws.state.ut.us/occ/projhome.asp> (August 13, 2002).
5Wage Records is an administrative database. Each employer in the State that has employees covered under Unemployment Insurance, by law, must submit quarterly tax reports to the State showing each employee’s Social Security Number and wages earned. For more information, see Wayne M. Gosar, “Insurance Wage Record Summary: A New Way to Look at Wyoming,” Wyoming Labor Force Trends, May 1995.
6Graduate data supplied by the Wyoming State Board of Nursing (WSBN) on August 6, 2002. Initially the draft of this article used data on the number of graduates provided by the Directors of Institutional Research for the corresponding colleges. Using the WBSN data did not materially affect the conclusion or observations in the final report.
7Tables 1 to 4 are based on a calendar school year.
8The Wage Records database does not reflect Federal employment. Therefore, some Wyoming nursing graduates who were issued licenses are unaccounted for because they are or were employed by the Federal Government.
9Wyoming State Board of Nursing, Meeting, February 26, 2002.
10The wages of temporary workers are included in the Wage Records database.
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