Arizona Board of Nursing — Edition 30
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Pamela K. Randolph

Review of Problem
Efforts to increase the number of new nurses were supported both nationally and locally from 2002 through 2007. Funding for nursing programs and subsidies for students increased. Throughout the early and mid-2000's, a shortage was experienced and an even worse crisis predicted. The prime strategy for alleviating this predicted shortage was to increase the supply of new nurses. Future predictions were based on the average age of the RN and assumptions regarding retirement and economic growth (Buerhaus, 2009). Students were recruited into nursing with promises of easy employment, job mobility and high salaries.

However, with the recession and unanticipated growth in nursing program enrollments, those projections have been modified. Aurebach, Buerhaus and Steiger (2011) reported that the registered nurse supply is growing faster than projected due to younger individuals entering the profession. Mancino (2013) questions whether future demand can be measured using models of the past. She believes it is time to re-calculate the number of RNs needed for the future.

Arizona Supply and Demand for RNs--2013
In an effort to quantify the overall supply and demand in Arizona for nurses in 2013, the following methodology was used:

• The US Department of Labor (2013) predicts a national 19% growth in RN employment from 2012 to 2022, meaning that 526,800 new RNs will be needed to account for job growth.
• Utilizing US Census Bureau (2013) estimates, Arizona is home to approximately 2.1% of the national population (6,626,624 (AZ pop)/316,128,839 (US pop),
• Arizona should be expected to produce 2.1% of the job growth total RNs needed from 2012-2022 (11,062 or 1,100 per year).
• In 2014 there are 25,820 nurses with active RN licenses age 56 and older who may retire in the next 9 years.
• Arizona will need to replace retiring nurses at approximately 2,600 per year.
• Of approximately 17,400 RNs due to renew in 2013, 4,507 did not renew, indicating that not all attrition is due to reaching retirement age.
• Subtracting the estimated 2,600 nurses who are expected to retire, Arizona lost 1,907 nurses due to attrition which would include moving to another state, changing careers or leaving nursing practice before retirement age.
• In 2008 only 85% of the RN renewal population worked in nursing (a 15% downward adjustment to demand is made for nurses not working in an RN job) (AZHHA, 2009)
• Approximately 65% of nurses who renewed in 2008 were working full time (AZHHA, 2009) (A 5% downward adjustment to demand is made for part-time workers needing replacement)
• Based, in part, on longitudinal data gathered for this report, it is assumed that endorsing RNs and new graduates are seeking fulltime employment in nursing.
• 127 RNs reactivated their license following a refresher course in 2012.

Currently Arizona appears to have a greater supply of RNs than jobs available, however these data should be interpreted cautiously and require additional exploration. Additionally, it is reported that employers are seeking experienced nurses (endorsement nurses) rather than the more readily supplied new graduates. Therefore there is an imbalance between employer expectations and preferences (experienced nurses) and available nurses (non-experienced nurses). A more complex factor that cannot be fully accounted for is that nearly all newly licensed nurses are seeking full-time positions, however many retiring nurses are retiring from part time positions. However, these data are consistent with new graduate employment experiences in Arizona.

In an effort to understand employment of newly licensed RNs in Arizona and provide longitudinal comparison data, the Arizona State Board of Nursing surveyed all persons licensed by exam (e.g. new graduates) in Arizona between October 1, 2012 and September 30, 2013.

Electronic mail surveys were sent on October 7, 2013 to 2605 RNs with e-mail addresses who were initially licensed October 1, 2012-Sept. 30, 2013. Of that total, 165 surveys were returned undeliverable resulting in a surveyed population of 2,437 RNs. There were a total of 709 respondents yielding a response rate of 29%. Of those responding, 83% indicated they were practicing as an RN and 17% indicated they were not currently practicing as an RN. This represents a slightly better employment outlook for newly licensed nurses when compared to previous years.

Type of Nursing Program
There were few differences between practicing and non-practicing RNs based on educational preparation in 2013. Thirty-nine percent of practicing nurses held BSN or higher degrees compared to 38 percent of non-practicing nurses, indicating little preference among all employers for BSN or higher prepared nurses.

Length of Licensure
Length of licensure was different between the practicing and non-practicing groups with 85% of the non-practicing nurses licensed less than 6 months, versus 56% of practicing nurses. This result is quite different from previous years where the majority of practicing nurses were licensed 6 months or greater. The chart below illustrates differences between practicing and non-practicing RNs over length of licensure. The most common length of licensure (43%) for practicing nurses was 3-6 months, compared to 9-12 months 2011 and 2012 and 1-3 months (30%) in 2010.

Employed RNs
For the first time, newly licensed nurses were asked about job satisfaction. The majority of respondents (53%) reported being highly satisfied, with 33% reporting mild to moderate satisfaction. Only 6% of newly licensed nurses reported any level of dissatisfaction, with 2% being highly dissatisfied.

Factors that influenced choice of employment
Respondents were then asked to check the top 3 reasons for choosing their current practice setting. The majority (52%) choose type of unit. The second most frequently cited factor was location of the worksite (41%). Five responses were chosen by 33-35 percent of respondents: salary (35.1%), hours (35%), availability of openings (34%) and staff attitudes (33%). Table 1, below, provides a list of the responses and the percent who identified the item as one of the top three factors in choosing employment.

Residency Experience
Newly licensed employed nurses were asked about whether their employers offered a residency experience to help them transition into practice. For the first time since this survey began in 2010, over half the respondents (53%) reported that their employer offered such a program. Ninety-four percent of those whose employer offered a residency program worked in acute care settings; 2% worked in long-term care. For acute care nurses, the most common length of the residency program was 2-3 months (36%). However 20% reported a residency program of greater than 6 months, nearly the same as 2012 (22%). Six percent reported less than a month. For those nurses working in non-acute care settings, the length of residency was shorter with 54% reporting less than a month. Only one respondent reported a residency lasting longer than 6 months. Experts suggest (Instituted of Medicine, 2011; Benner, Stupen, Leonard & Day, 2010) that residency program be 6 months to one year in acute care and at least 3 months in non-acute settings.

Non-Employed RNs
Similar to the three previous surveys, the most common reason cited for not practicing was "not enough jobs for new RN grads in the area" (52%), similar to the 56% of respondents who chose this in 2012. This same response was chosen by 85% of nurses surveyed in 2010 and 91% in 2011. In the past two years, fewer nurses perceived a difficult job market. Similar to 2012, 28% of respondents chose "do not have the experience background employers are seeking." The chart below depicts the percent of new nurses who state there are not enough jobs for new RNs from 2010 to 2013.

Discussion and Conclusion
These findings, when compared to other years, must be interpreted with some caution as the licensees surveyed were licensed between October 1 to September 30, rather than April 1 to March 30, the time span for the other surveys. This year's population included a greater proportion of nurses who were licensed for a shorter period of time because more students graduate in May than any other time. One would expect to see less employment in this group. However, 2013 survey results indicate that RN graduates had less difficulty finding employment than during any other period surveyed. Fewer survey participants identified "lack of jobs" as a reason for unemployment. Whether this is a sustainable phenomenon or the early warning sign of the next nursing shortage, remains to be seen. While there is no difference in overall employment between associate and baccalaureate prepared nurses, anecdotal evidence suggests that baccalaureate prepared nurses may have more employment opportunities in acute care hospitals. National level data suggests that baccalaureate nurses were employed more frequently (Mancino, 2013).

Newly licensed nurses who are employed are overwhelmingly satisfied with their employment, an unexpected finding when compared to job turnover statistics in the first year of employment, estimated to range between 35%-60% (Holfer & Graf, 2006). A mixture of characteristics about the work itself and employment conditions are important to newly licensed RNs. Foremost among these is the type of unit, indicating that new nurses are looking for jobs in a unit of preference. Location of the workplace, as the second highest factor, may indicate that new graduates are interested in quality of life issues and work-life balance.

The 2013 data on residency programs suggests that more employers are offering residencies, although, given the plethora of data supporting residencies, this growth is slower than expected. The length of the residency program remains sub-optimal and residencies are almost exclusively offered in acute care settings.

In conclusion, the employment outlook for newly licensed RNs appears to have improved to a small extent in 2013. New RNs were more optimistic about employment opportunities and, if employed, were satisfied with their jobs. RNs are being employed closer to the time of licensure. There was no difference in overall employment between associate degree educated nurses and baccalaureate degree educated nurses. Based on supply and demand estimates, Arizona is well positioned for the future as the supply of nurses appears to be greater than the estimated demand.

The complete report may be accessed at