2020 biennial report
TRANSCRIPT
Nebraska Center for Nursing
https://center4nursing.nebraska.gov Phone: 402-471-4376
301 Centennial Mall South. Lincoln, NE 68509-4986
2020 BIENNIAL REPORT
The Nebraska Center for Nursing https://center4nursing.nebraska.gov Executive Director: Ann Oertwich, Ph.D., RN DHHS, Division of Public Health, Licensure Unit 301 Centennial Mall South Nebraska Lincoln, NE 68509 Phone: (402) 471-0317, Fax: (402) 471-1066 [email protected] Nursing Education Consultant: Jacci Reznicek, MSN, RN, ANP-BC Nursing Practice Consultant: Kathy Hoebelheinrich MSN, APRN-NP, ANP-BC, BC-ADM, CDE Independent Consultant: Juan-Paulo Ramírez, Ph.D. September 2020 – Lincoln, Nebraska Report based on 2018 RN renewal data and 2019 LPN renewal data
Photo Source: http://blog.diversitynursing.com/blog Teamwork In Nursing Posted by Erica Bettencourt
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Table of Contents THE NEBRASKA CENTER OF NURSING: WHO WE ARE .................................................. 4
STRATEGIC PLAN ................................................................................................................... 5
Vision..................................................................................................................................... 5
Mission .................................................................................................................................. 5
Strategic Focus #1: Data .................................................................................................. 5
Strategic Focus #2: Collaboration ................................................................................... 5
Strategic Focus #3: Promotion .......................................................................................... 5
EXECUTIVE SUMMARY .......................................................................................................... 6
THE NEBRASKA NURSING WORKFORCE .......................................................................... 6
METHODOLOGY .................................................................................................................... 8
THE NEBRASKA REGISTERED NURSE & LICENSED PRACTICAL NURSE WORKFORCE9
Nebraska Workforce Distribution across Rural and Urban Counties...................... 14
Nebraska Nursing Workforce by Demographic Cohort ........................................... 20
Satisfaction Levels with the Nursing Profession ........................................................... 23
NURSING WORKFORCE PROJECTIONS ........................................................................ 24
Nursing Workforce Model ............................................................................................. 24
Nursing Workforce Gap by Economic Region ............................................................ 27
ACKNOWLEDGMENTS ...................................................................................................... 29
APPENDIX ............................................................................................................................. 30
NEBRASKA CENTER FOR NURSING – LIST OF BOARD MEMBERS ............................. 33
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THE NEBRASKA CENTER OF NURSING: WHO WE ARE
The Nebraska Center for Nursing (CFN) was created via LB 1025 by the Nebraska Legislature on July 13, 2000, to monitor the nursing workforce in Nebraska including supply and demand, recruitment, retention, and utilization of nurses. The Center consists of a 16-member board, composed primarily of nurses from across Nebraska appointed by the Governor (see list of board members in the Appendix). The Center is funded through nursing licensure fees and meets approximately six times a year.
The primary goals for the center are: (1) To develop a strategic statewide plan to alleviate the nursing shortage in Nebraska by:
(a) Establishing and maintaining a database on nursing supply and demand in Nebraska, including current supply and demand and future projections; and (b) Selecting priorities from the plan to be addressed.
(2) To convene various groups representative of nurses, other health care providers, business and industry, consumers, legislators, and educators to:
(a) Review and comment on data analysis prepared for the center. (b) Recommend systemic changes, including strategies for implementation of recommended changes; and (c) Evaluate and report the results of these efforts to the Legislature and the public.
(3) To enhance and promote recognition, reward, and renewal activities for nurses by:
(a) Proposing and creating recognition, reward, and renewal activities; and (b) Promoting media and positive image-building efforts for nursing. Source: Laws 2000, LB 1025, § 3. Effective date July 13, 2000.
The Center produces biennial and annual reports on Nursing Workforce Data. The Center has recently purchased and implemented a state-of-the-art workforce supply and demand model. This one-of-a-kind model utilizes Nebraska nursing supply data and projects demand for nurses based on information from the nine economic regions of the state. This biennial report highlights the work of this dynamic group.
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THE NEBRASKA CENTER OF NURSING: STRATEGIC PLAN
Vision Nebraska Nurses: when and where we need them
Mission
The Nebraska Center for Nursing drives change in the nursing workforce through data, education, and policy development
Strategic Focus #1: Data
Provide essential, reliable forecasting and workforce information resulting in equitable access and distribution of nurses.
Strategic Focus #2: Collaboration
Collaborate with key stakeholders to address the nursing shortage in Nebraska
▪ Collaborate to build and maintain the current workforce
▪ Maintain competency/skill level of the current workforce Strategic Focus #3: Promotion
▪ Promote the value of the nursing profession
▪ Develop the image and the voice of the CFN
We are Building Healthier Communities through Nursing:
Nebraska’s 30,000 nurses are key to promoting health and creating communities in which everyone has access to high-quality care
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EXECUTIVE SUMMARY THE NEBRASKA NURSING WORKFORCE
The nursing workforce continues to expand in the State of Nebraska, although at a much slower pace than the anticipated demand for nurses as shown by the Nebraska Multiregional Nursing Workforce model. The current nursing shortage in the State of Nebraska is 4,192, which will increase to 5,436 in the year 2025. According to the renewal survey data, the total number of RNs working in Nebraska is 23,972 (1,965 are APRNs), and LPNs totaled 4,584, whose principal employment is in Nebraska. Most of the nursing growth has been concentrated in metropolitan areas (90%), specifically the cities of Lincoln and Omaha. This is in contrast to rural Nebraska where there are several counties without the presence of nurses (RNs, APRNs or LPNs). According to the 2018 RN Renewal Survey, eleven counties reported zero RNs working in them: Sioux, Duel, Grant, Arthur, McPherson, Thomas, Logan, Keya Paha, Loup, Wheeler, and Hayes. The 2019 LPN Renewal Survey reported zero LPNs working in nine counties: Banner, Deuel, Grant, Arthur, McPherson, Logan, Thomas, Loup, and Hayes. There are eight counties with zero RNs and LPNs: Grant, Arthur, McPherson, Logan, Thomas, Loup, Wheeler, and Hayes.
Counties with zero RNs: Counties with zero LPNs:
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The average age of RNs has remained stable over the years, with a minimum average age of 43.3 in 2004 and a maximum average age of 44.7 in 2010. The current (2018) average age is 43.8, and nationwide the average age is 44.6 (HRSA, 2013). The average age for LPNs is 47.4, which is four years older than the average age ten years ago. Nationwide the average age for LPNs is 43.6. The percentage of males that are Registered Nurses has steadily increased over the years, reaching a high of 6.3% in the year 2018. Male participation within the LPN workforce has historically been lower than the RN workforce, although male participation has grown in previous years, reaching 3.2% in 2017. The male participation remained the same in 2019 (3.2%). The percentage of males within Nebraska RNs and LPNs is still lower than the national average (9.1%, and 7.6%, respectively). RNs who are considered ethnic minorities have also increased over the years, from 3.1% in the year 2000 to 7% in the year 2018. Among LPNs, minority representation has also increased over time, from 4.6% in 2003 to 13% in 2019. At the state level, nearly 22% of the population is considered a minority1. Nationwide, 33.1% of RNs and 36.8% of LPNs are considered minorities (HRSA, 2013). In terms of education attainment, RNs with bachelor’s degrees and higher have increased 16.3% from the year 2008 to the year 2018 (51.3% vs. 67.6%, respectively2). At the national level, 55% of RNs hold bachelor’s degrees (AACN, 2017). Also, RNs with doctoral degrees have more than doubled, from 74 RNs with doctoral degrees (DNPs, Ed Ds, and Ph.Ds.) in 2003 to a total of 322 RNs in 2018 (335% growth). Overall, RNs holding masters and doctoral degrees represent 12.5% of the workforce, which is similar to the national statistics (HRSA, 2013).
Nearly five out of ten RNs work in Nebraska hospitals (49.5%) which is lower than
the national data (60.0%; U.S. Bureau of Labor Statistics, 20183). Only 8.7% of
Nebraska LPNs work in hospitals. In comparison, at the national level, 29.3% of
LPNs work in hospitals. About four out of ten LPNs work in Nursing
Homes/Extended Care/ Assisted Living Facility (41%).
1 U.S. Census Bureau (2018 estimates).
2 Includes bachelor and higher degrees in nursing and non-nursing fields.
3 https://www.bls.gov/ooh/healthcare/Print/registered-nurses.htm
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METHODOLOGY
The 2020 Center for Nursing Biennial Report contains nursing workforce data analysis for RNs and LPNs collected through the renewal surveys from 2018 and 2019, respectively. The biennial report contains information about nursing workforce projections from the year 2020 through the year 2025 for RNs, APRNs, and LPNs based on a multiregional nursing supply and demand model for each of the nine Nebraska economic regions. This model is one of a few multiregional nursing workforce models available in the United States that projects the nursing workforce at the regional level by considering degrees of urbanization (i.e., urban vs. rural/frontier) and nursing intensity factors by setting (i.e., hospital, long-term care, education).
The Nebraska Center for Nursing has been analyzing nursing workforce data since the year 2000, collected from surveys completed by Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) upon renewing their respective nursing licenses. These surveys are analyzed to identify nurses who only work in the State of Nebraska to provide clear demographic estimates of the nursing workforce providing health care to the citizens of the State. Nursing projections, including demand and supply of nurses, are calculated using the full-time equivalent (FTE). The renewal surveys are collected by the Nebraska DHHS Licensure Unit in both digital and paper formats, to gather information that includes demographic data, job location, work settings, and satisfaction levels of the nursing profession and workplaces. The renewal surveys comply with the minimum dataset developed by the National Forum of State Nursing Workforce Centers. Both RN and LPN renewal surveys contain nearly 30 questions, which can be cross-tabulated, to enrich the statistical analysis of the workforce data. The Nebraska Center for Nursing invites nurses and the general public interested in these databases to request additional information by directly contacting the Executive Director of the Center, Ann Oertwich, at [email protected].
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THE NEBRASKA REGISTERED NURSE & LICENSED PRACTICAL NURSE WORKFORCE
Workforce Size and Distribution
A total of 23,972 surveys from RNs (2018) and 4,584 surveys from LPNs (2019) were analyzed representing nurses who indicated work in the State of Nebraska. Eleven counties reported zero RNs working in them: Sioux, Duel, Grant, Arthur, McPherson, Thomas, Logan, Keya Paha, Loup, Wheeler, and Hayes. The highest number of RNs was reported in Douglas County (n = 10,329), followed by Lancaster County (n = 4,188). One county reported having just one RN working: Banner. Nine counties reported zero LPNs working in them: Banner, Deuel, Grant, Arthur, McPherson, Logan, Thomas, Loup, and Hayes. The highest number of LPNs was reported in Douglas County (n = 948), followed by Lancaster County (n = 718). Five counties reported having just one LPN working in them: Blaine, Frontier, Keya Paha, Sioux, and Wheeler. The total per capita number of RNs (2018) and LPNs (2019) is 1,242.5 and 237.0 per 100,000 people, respectively. (See Appendix for details, pages 31-32). The table below shows the RN and LPN workforce and the total number of inhabitants by county in 2018 and 2019 (U.S. Census Bureau population estimates). Counties highlighted in red show a lower number of RNs per capita compared to the state average. These counties total 80 out of the 93 counties in the State of Nebraska. See Table 1 and Figure 1 below. Table 1: Nebraska Nursing Workforce
County 2018 Total Population
2019 Total Population
RNs - 2018
LPNs - 2019
RNs per 100,000
LPNs per 100,000
Adams 31,511 31,363 488 60 1,548.7 191.3
Antelope 6,336 6,298 55 17 868.1 269.9
Arthur 465 463 0 0 0.0 0.0
Banner 730 745 1 0 137.0 0.0
Blaine 476 465 2 1 420.2 215.1
Boone 5,239 5,192 66 31 1,259.8 597.1
Box Butte 10,772 10,783 87 56 807.6 519.3
Boyd 1,955 1,919 19 6 971.9 312.7
Brown 2,973 2,955 22 7 740.0 236.9
Buffalo 49,615 49,659 867 176 1,747.5 354.4
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County 2018 Total Population
2019 Total Population
RNs - 2018
LPNs - 2019
RNs per 100,000
LPNs per 100,000
Burt 6,488 6,459 24 9 369.9 139.3
Butler 8,058 8,016 46 29 570.9 361.8
Cass 26,159 26,248 31 21 118.5 80.0
Cedar 8,446 8,402 22 19 260.5 226.1
Chase 3,977 3,924 35 15 880.1 382.3
Cherry 5,761 5,689 44 11 763.8 193.4
Cheyenne 9,310 8,910 69 39 741.1 437.7
Clay 6,214 6,203 11 13 177.0 209.6
Colfax 10,881 10,709 36 16 330.9 149.4
Cuming 8,940 8,846 84 29 939.6 327.8
Custer 10,840 10,777 73 37 673.4 343.3
Dakota 20,083 20,026 17 9 84.6 44.9
Dawes 8,716 8,589 52 10 596.6 116.4
Dawson 23,709 23,595 153 71 645.3 300.9
Deuel 1,825 1,794 0 0 0.0 0.0
Dixon 5,709 5,636 8 4 140.1 71.0
Dodge 36,791 36,565 365 81 992.1 221.5
Douglas 566,880 571,327 10,329 948 1,822.1 165.9
Dundy 1,770 1,693 18 14 1,016.9 826.9
Fillmore 5,527 5,462 49 33 886.6 604.2
Franklin 3,023 2,979 17 10 562.4 335.7
Frontier 2,608 2,627 2 1 76.7 38.1
Furnas 4,715 4,676 41 20 869.6 427.7
Gage 21,493 21,513 174 137 809.6 636.8
Garden 1,897 1,837 15 10 790.7 544.4
Garfield 1,987 1,969 8 11 402.6 558.7
Gosper 1,996 1,990 3 6 150.3 301.5
Grant 660 623 0 0 0.0 0.0
Greeley 2,356 2,356 2 4 84.9 169.8
Hall 61,607 61,353 700 194 1,136.2 316.2
Hamilton 9,280 9,324 56 26 603.4 278.9
Harlan 3,401 3,380 19 9 558.7 266.3
Hayes 916 922 0 0 0.0 0.0
Hitchcock 2,806 2,762 6 7 213.8 253.4
Holt 10,178 10,067 156 42 1,532.7 417.2
Hooker 682 682 4 2 586.5 293.3
Howard 6,468 6,445 43 5 664.8 77.6
Jefferson 7,097 7,046 51 31 718.6 440.0
Johnson 5,134 5,071 28 21 545.4 414.1
Kearney 6,544 6,495 32 23 489.0 354.1
Keith 8,021 8,034 45 7 561.0 87.1
Keya Paha 810 806 0 1 0.0 124.1
Kimball 3,618 3,632 26 4 718.6 110.1
Knox 8,419 8,332 57 19 677.0 228.0
Lancaster 317,272 319,090 4,188 718 1,320.0 225.0
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County 2018 Total Population
2019 Total Population
RNs - 2018
LPNs - 2019
RNs per 100,000
LPNs per 100,000
Lincoln 35,185 34,914 456 95 1,296.0 272.1
Logan 749 748 0 0 0.0 0.0
Loup 618 664 0 0 0.0 0.0
Madison 35,392 35,099 655 167 1,850.7 475.8
McPherson 492 494 0 0 0.0 0.0
Merrick 7,733 7,755 35 17 452.6 219.2
Morrill 4,686 4,642 35 17 746.9 366.2
Nance 3,532 3,519 21 14 594.6 397.8
Nemaha 6,958 6,972 44 12 632.4 172.1
Nuckolls 4,195 4,148 63 13 1,501.8 313.4
Otoe 15,985 16,012 109 35 681.9 218.6
Pawnee 2,632 2,613 20 6 759.9 229.6
Perkins 2,929 2,891 44 11 1,502.2 380.5
Phelps 8,996 9,034 128 45 1,422.9 498.1
Pierce 7,142 7,148 54 23 756.1 321.8
Platte 33,363 33,470 302 99 905.2 295.8
Polk 5,278 5,213 31 19 587.3 364.5
Red Willow 10,726 10,724 126 39 1,174.7 363.7
Richardson 7,937 7,865 60 41 756.0 521.3
Rock 1,360 1,357 20 10 1,470.6 736.9
Saline 14,350 14,224 82 29 571.4 203.9
Sarpy 184,459 187,196 568 130 307.9 69.4
Saunders 21,303 21,578 80 35 375.5 162.2
Scotts Bluff 35,989 35,618 520 135 1,444.9 379.0
Seward 17,318 17,284 98 34 565.9 196.7
Sheridan 5,190 5,246 22 14 423.9 266.9
Sherman 3,038 3,001 12 5 395.0 166.6
Sioux 1,187 1,166 0 1 0.0 85.8
Stanton 5,970 5,920 4 7 67.0 118.2
Thayer 5,039 5,003 49 29 972.4 579.7
Thomas 720 722 0 0 0.0 0.0
Thurston 7,303 7,224 85 6 1,163.9 83.1
Valley 4,190 4,158 46 17 1,097.9 408.9
Washington 20,667 20,729 89 27 430.6 130.3
Wayne 9,403 9,385 68 17 723.2 181.1
Webster 3,533 3,487 12 12 339.7 344.1
Wheeler 805 783 0 1 0.0 127.7
York 13,772 13,679 152 50 1,103.7 365.5
Total population
1,929,268 1,934,408 23,972 4,584 1,242.5 237.0
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Figure 1: Counties (highlighted in red) that have RNs per capita below the state average
“Per capita [nursing] supply does not take into account differences in
population age, disease prevalence, [intensity factors] or the number of
hospital beds that must be staffed. Still, it is informative because it
illustrates that [state]-level information masks substantial local-level
differences.” Adapted from HRSA report (2013).
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Figures 2 and 3 show Nebraska per capita RN and LPN per 100,000 people by county. These graphic representations help to identify the diversity of the nursing workforce needed at the county and regional levels. Figure 2: Nebraska RN Workforce per 100,000 People, by County
Figure 3: Nebraska LPN Workforce per 100,000 People, by County
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Nebraska Workforce Distribution across Rural and Urban Counties
A total of 21,021 RNs and 3,552 LPNs work in urban counties. And a total of 1,791 RNs and 731 LPNs work in rural counties. Nearly one-fifth (17 percent) of LPNs work in rural counties, while only 8.2% of RNs work in those areas. As the state nursing workforce data is reported where nurses work and the national data is reported where nurses live, it’s not possible to compare both geographies. As a proxy, 24% of LPNs nationwide live in rural areas, which is higher than the percentage of LPNs who work in rural areas in Nebraska. However, nationwide data of RNs living in rural areas is 16%, which is higher than the percentage of reported of RNs working in rural areas of Nebraska (8.2%). As a reference, nearly 20% of the total population in Nebraska live in rural counties (American Community Survey, 5-year estimates, 2014-2018). Figure 4 shows the nursing workforce distribution in rural and urban areas of Nebraska. Figure 4: Nebraska Nursing Workforce Distribution in Rural and Urban Areas
21,0213,552 1,565,929
1,791731 338,831
RN LPN Nebraska
Urban Rural
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Counties classified as urban by the U.S. Census Bureau present the highest number of RNs per capita in Nebraska. On average, there are 1,342 RNs per capita in urban counties compared to 529 RNs in rural counties. Counties classified as urban by the U.S. Census Bureau present the highest number of LPNs per capita in Nebraska. On average, there are 227 LPNs per capita in urban counties compared to 216 LPNs in urban counties. Table 2 compares the per capita number of RNs and LPNs that work in urban vs. rural counties in Nebraska.
Table 2: RN and LPN per capita by Urban and Rural Counties in Nebraska
Nurse Type: Urban County per capita
Rural County per capita
RNs 1,342 529
LPNs 227 216
RNs in urban areas are more likely to hold a bachelor’s degree or higher than RNs working in rural areas (69.3% vs. 46.1%, respectively). RNs working in rural counties are more likely to be over 51 years of age in comparison to RNs working in urban counties (39.8% vs. 30.3%, respectively). On average, RNs working in rural counties are 3.6 years older than RNs working in urban counties. RNs in rural counties are less likely to work in hospitals and more likely to work in Nursing Homes/Extended Care Facilities when compared to RNs working in urban counties. LPNs working in rural areas are more likely to be white non-Hispanic when compared to LPNs working in urban counties (93.6% vs. 85.9%, respectively). LPNs in rural counties are more likely to work in Nursing Homes/Extended Care Facilities than LPNs working in urban counties (49.9% vs. 31.5%, respectively). The following Tables 3 and 4 show demographics and employment characteristics for RNs and LPNs by urban and rural areas in Nebraska.
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Table 3: Residential Distribution of the RN Workforce across Urban and Rural Areas in Nebraska
Age (RN) Urban Areas
(%) Rural Areas
(%) All Areas
(%)
25 or younger 7.1% 3.0% 6.6%
26-30 13.7% 10.0% 13.2%
31-35 15.9% 13.7% 15.5%
36-40 13.6% 12.8% 13.4%
41-45 10.4% 10.9% 10.3%
46-50 9.1% 9.7% 8.9%
51-55 8.4% 9.4% 8.4%
56-60 10.0% 12.8% 10.2%
61-65 8.1% 10.7% 8.7%
66-70 3.0% 5.3% 3.7%
71 or older 0.8% 1.6% 1.1%
Total 100.0% 100.0% 100.0%
Average age 43.2 46.8 43.8
Race/Ethnicity
White 92.6% 96.1% 92.9%
Black/African American 2.0% 0.3% 1.8%
Hispanic/Latino 2.8% 1.8% 2.7%
Asian 1.4% 0.7% 1.3%
American Indian/Alaska Native 0.2% 0.6% 0.3%
Native Hawaiian or Other Pacific Islander
0.2% 0.0% 0.2%
Other 0.9% 0.5% 0.8%
Total 100% 100% 100%
Gender
Percent Female 93.5% 96.4% 93.7%
Percent Male 6.5% 3.6% 6.3%
Total 100% 100% 100%
Education (highest degree attained) – Includes nursing and non-nursing degrees
RN Diploma 8.8% 15.3% 10.0%
Associate's 21.1% 40.0% 22.5%
Bachelor's 55.6% 37.5% 53.8%
Master's 11.6% 5.9% 11.1%
Post Master's 1.4% 0.8% 1.3%
Doctoral 1.5% 0.6% 1.4%
Total 100.0% 100.0% 100.0%
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Setting (RN) Urban Areas
(%) Rural Areas
(%) All Areas
(%)
Ambulatory Surgical 4.4% 1.5% 4.1%
Assisted Living 0.6% 1.2% 0.6%
Birthing Center 0.4% 0.0% 0.4%
Clinic 13.8% 11.7% 13.7%
College Health 0.4% 0.1% 0.4%
Correctional/Prison 0.3% 0.5% 0.3%
Developmental Disability 0.3% 0.4% 0.3%
Dialysis Center 0.8% 0.2% 0.7%
Emergency Department 2.8% 1.3% 2.6%
Federally Qualified Health Center 0.4% 0.0% 0.3%
Health Department 0.3% 0.3% 0.3%
Home Health 3.5% 2.8% 3.5%
Hospice/Palliative Care 1.4% 0.1% 1.3%
Hospital 50.3% 42.1% 49.5%
Industry/Sales/IT 0.4% 0.1% 0.3%
Insurance 1.5% 0.4% 1.5%
Military/DOD 0.1% 0.0% 0.1%
Nursing Home (SNF/NF) 5.3% 25.6% 6.9%
Occupational/Employee/Workplace Health
0.7% 0.9% 0.8%
Policy/Planning/Regulatory/Licensing Agency
0.1% 0.1% 0.1%
Psych-Mental Health 1.8% 0.2% 1.6%
Public Health 0.6% 0.8% 0.6%
Research 0.4% 0.0% 0.4%
Retail Clinic 0.2% 0.0% 0.2%
Rural Health Clinic 0.3% 2.7% 0.5%
School Health Service 1.6% 5.4% 1.9%
Substance Use/Addiction 0.2% 0.0% 0.2%
University/Academic 2.4% 0.0% 2.2%
Urgent Care 0.5% 0.0% 0.4%
VA Facility 0.8% 0.0% 0.7%
Volunteer Clinic 0.0% 0.0% 0.0%
Other 3.6% 1.8% 3.5%
Total 100.0% 100.0% 100.0%
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Table 4: Residential Distribution of the LPN Workforce across Urban and Rural Areas in Nebraska
Age (LPN) Urban Areas
(%) Rural Areas
(%) All Areas
(%)
25 or younger 3.3% 3.1% 3.6%
26-30 7.2% 6.6% 7.2%
31-35 10.4% 9.6% 10.4%
36-40 15.1% 12.7% 14.6%
41-45 12.7% 10.3% 12.0%
46-50 11.2% 12.1% 11.2%
51-55 10.7% 11.7% 10.9%
56-60 13.1% 12.4% 12.9%
61-65 10.6% 14.9% 11.1%
66-70 4.3% 5.2% 4.6%
71 or older 1.3% 1.4% 1.5%
Total 100.0% 100.0% 100.0%
Average age 47.2 48.6 47.4
Race/Ethnicity
White 85.9% 93.6% 87.1%
Black/African American 6.4% 0.7% 5.4%
Hispanic/Latino 4.9% 3.6% 4.6%
Asian 0.9% 0.4% 0.8%
American Indian/Alaska Native 0.5% 0.8% 0.6%
Native Hawaiian or Other Pacific Islander
0.2% 0.1% 0.2%
Other 1.3% 0.7% 1.3%
Total 100% 100% 100%
Gender
Percent Female 96.8% 98.3% 96.8%
Percent Male 3.2% 1.7% 3.2%
Total 100% 100% 100%
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Setting (LPN) Urban Areas
(%) Rural Areas
(%) All Areas
(%)
Ambulatory Surgical 6.5% 1.4% 5.6%
Assisted Living 0.5% 0.4% 0.5%
Birthing Center 0.0% 0.0% 0.0%
Clinic 27.8% 16.8% 25.7%
College Health 0.2% 0.0% 0.1%
Correctional/Prison 1.3% 1.0% 1.3%
Developmental Disability 1.1% 1.7% 1.3%
Dialysis Center 0.2% 0.0% 0.2%
Emergency Department 0.2% 0.3% 0.2%
Federally Qualified Health Center 0.2% 0.0% 0.2%
Health Department 0.3% 0.6% 0.4%
Home Health 6.4% 2.0% 5.7%
Hospice/Palliative Care 1.2% 0.0% 0.9%
Hospital 7.3% 16.7% 8.7%
Industry/Sales/IT 0.2% 0.0% 0.1%
Insurance Claims/Benefits 0.6% 0.0% 0.6%
Military/DOD 0.1% 0.0% 0.1%
Nursing Home (SNF/NF) 31.5% 49.9% 34.8%
Occupational/Employee/Workplace Health
1.0% 0.7% 1.0%
Policy/Planning/Regulatory/Licensing Agency
0.1% 0.0% 0.0%
Psych-Mental Health 1.6% 0.4% 1.4%
Public Health 0.5% 0.6% 0.5%
Research 0.4% 0.0% 0.4%
Retail Clinic 0.1% 0.0% 0.1%
Rural Health Clinic 1.1% 2.5% 1.3%
School Health Service 2.3% 1.9% 2.2%
Substance Use/Addiction 0.3% 0.1% 0.3%
University/Academic 0.2% 0.0% 0.1%
Urgent Care 0.4% 0.0% 0.4%
VA Facility 1.2% 0.1% 1.0%
Volunteer Clinic 0.0% 0.0% 0.0%
Other 5.1% 2.8% 4.7%
Total 100.0% 100.0% 100.0%
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Nebraska Nursing Workforce by Demographic Cohort
Figures 5 and 6 show the age frequency of RNs and LPNs by demographic cohort. Table 5 shows the percentage of RNs and LPNs that belong to each generation. As a whole, “Generation X” (born 1965-1981) represents the highest concentration of nurses in the State of Nebraska (36%), followed by 33% “Baby Boomers” (born 1946-1964). “Millennials” represent 36.4% of the total nursing workforce. Figure 7 shows the change in percentage from 2016 to either 2018 or 2019; the Silent Generation was not included in figure 7 because no change occurred in percentage.
Figure 5: Nebraska RN Age Frequency (2018) by Demographic Cohort
Millennials (1982-2000)
Generation X (1965-1981)
Baby Boomers (1946-1964)
Silent Generation (1927-1945)
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Figure 6: Nebraska LPN Age Frequency (2019) by Demographic Cohort
Table 5: Nebraska Representation of the Nursing Workforce in Percentage by Generation
Generation: RN - 2016
RN - 2018
LPN – 2016
LPN - 2019
All Nebraska Nurses -
2016
All Nebraska Nurses -
2018
Millennials 31% 38% 24% 27% 30% 36%
Generation X 35% 34% 40% 41% 36% 35%
Baby Boomers 32% 27% 35% 32% 33% 28%
Silent Generation
1% 1% 1% 1% 1% 1%
Total 100% 100% 100% 100% 100% 100%
Millennials (1982-2000)
Generation X (1965-1981)
Baby Boomers (1946-1964)
Silent Generation (1927-1945)
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Figure 7: Generation Change for Nebraska RNs (2018), LPNs (2019), and All Nebraska Nurses*
*The Silent Generation was not included in the chart because no change occurred in the RN, LPN, and All Nebraska Nurses
percentage.
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Satisfaction Levels with the Nursing Profession
Historically nurses in Nebraska have shown high levels of satisfaction with their nursing profession. The following charts (Figure 8 and Table 6) show satisfaction levels with “nursing as a career” for RNs in 2018 and for LPNs in 2019. Figure 8: RN and LPN satisfaction levels with their nursing career
Table 6: RN and LPN satisfaction and dissatisfaction levels with their nursing career
Total Satisfied
Total Dissatisfied
RN 97.4% 2.6%
LPN 97.6% 2.4%
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NURSING WORKFORCE PROJECTIONS Nursing Workforce Model
Purpose: The Nursing Workforce Model is used to predict nursing workforce supply and demand for Registered Nurses (RNs), Advanced Practice Registered Nurses (APRNs), and Licensed Practical Nurses (LPNs) until the year 2025. What it is: The Nursing Workforce Model is a forecasting policy tool that provides a picture of the alternative future supply and demand under different scenarios and simulations for the nine economic regions defined by the Nebraska Department of Labor (DOL). The forecasting models use these regions as geographic areas to identify nursing workforce needs over time. Economic Regions: The Nebraska nursing workforce model uses the nine economic regions as geographic units to project the supply and demand of nurses (RNs, APRNs, and LPNs). The Nebraska DOL uses employer and employee information to create job flows known as “Local Employment Dynamics (LED).” The Economic Development Regions defined by DOL are based on work commuting patterns (LED) across cities and counties, along with demographics and employment data. See Figure 9. Figure 9: The “9 Economic Regions”
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Table 7 shows counties that belong to each of the nine economic regions:
Table 7: Nebraska Economic Regions and Respective Counties
Economic Region
Counties
1. Panhandle Banner, Box Butte, Cheyenne, Dawes, Deuel, Garden, Kimball, Morrill, Scotts Bluff, Sheridan, Sioux
2. Sandhills Arthur, Boyd, Brown, Cherry, Garfield, Grant, Holt, Keya Paha, Loup, Rock
3. Mid Plains Chase, Dawson, Dundy, Frontier, Furnas, Gosper, Hayes, Hitchcock, Hooker, Keith, Lincoln, Logan, McPherson, Perkins, Red Willow, Thomas
4. Central Adams, Blaine, Buffalo, Clay, Custer, Franklin, Greeley, Harlan, Kearney, Nuckolls, Phelps, Sherman, Valley, Webster
5. Grand Island Hall, Hamilton, Howard, Merrick
6. Northeast Antelope, Boone, Burt, Butler, Cedar, Colfax, Cuming, Dakota, Dixon, Dodge, Knox, Madison, Nance, Pierce, Platte, Polk, Stanton, Thurston, Wayne, Wheeler
7. Omaha Consortium
Cass, Douglas, Sarpy, Saunders, Washington
8. Lincoln MSA Lancaster, Seward
9. Southeast Fillmore, Gage, Jefferson, Johnson, Nemaha, Otoe, Pawnee, Richardson, Saline, Thayer, York
Major Findings
Overall, the nursing supply and demand model projects a nursing shortage of 5,436 nurses through the year 2025. It is expected that the nursing workforce in the State of Nebraska will grow by 3.8% between 2020 and 2025. The highest growth will be experienced by RNs (4.7%), followed by LPNs (1.8%). APRNs will experience a negative growth between 2020 and 2025 (-1.1%). Table 8 shows the expected growth and nursing workforce gap for each type of nurse in the State of Nebraska through the year 2025.
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Table 8: Nursing Workforce Projections and supply gaps (unfilled FTE positions) for RNs, APRNs, and LPNs
NURSE TYPE: GROWTH, 2020-2025
2025 EXPECTED NURSING WORKFORCE GAP
RN 4.7% -3,238
APRN -1.1% -592
LPN 1.8% -1,606
Total Nursing Workforce Expected Growth 3.8% -5,436
Figure 10 shows that all nurse types will experience a workforce shortage that will
increase each year from 2020 through 2025.
Figure 10: Expected unfilled FTE positions (nursing gap) by type of nurse from 2020 to 2025
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Nursing Workforce Gap by Economic Region
As expected, economic regions that contain the highest number of nurses will experience the highest demand for additional nurses to meet the nursing workforce needs from the population. The Omaha Consortium (Douglas, Sarpy, Washington, and Cass counties) and Lincoln Metropolitan Statistical Area - MSA (Seward and Lancaster counties) Economic Regions encompass two-thirds of the total RN shortage in the year 2020. Figure 11 shows the gap proportion for unfilled RN positions in each economic region. Figure 11: 2020 Proportion of unfilled RN positions in relation to the total by economic region
The following tables show the total number of unfilled FTE nursing positions (RNs, APRNs, and LPNs) in the years 2020 and 2025 (Tables 9 and 10). Table 9: 2020 projected unfilled FTEs positions for RNs, APRNs, and LPNs by economic region
Panhandle Sandhills Mid Plains Central Grand Island
Northeast Omaha Lincoln Southeast State Total
RNs -125 -30 -95 -151 -103 -184 -1,239 -473 -83 -2,482
APRNs 3 -1 1 -79 0 2 -246 -104 -1 -423
LPNs -61 -19 -75 -110 -54 -123 -593 -168 -84 -1287
Total Unfilled Positions
-182 -50 -168 -339 -157 -305 -2,077 -745 -167 -4,191
Note: positive numbers show a surplus and negative numbers a shortage of nurses
Omaha Consortium and Lincoln MSA Economic Regions represent two-thirds of the 2020 RN shortage.
-1,239
-473
-151
-184
-125
-103
-95
-83
-30
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Table 10: 2025 projected unfilled FTEs positions for RNs, APRNs, and LPNs by economic region
Panhandle Sandhills Mid Plains Central Grand Island
Northeast Omaha Lincoln Southeast State Total
RNs -146 -23 -115 -185 -127 -191 -1,572 -745 -132 -3,238
APRNs -4 -1 -4 -93 -3 -16 -316 -150 -5 -592
LPNs -64 -18 -86 -127 -76 -133 -783 -244 -74 -1,606
Total Unfilled Positions
-215 -42 -205 -406 -206 -340 -2,671 -1,139 -211 -5,436
Note: negative numbers show a shortage of nurses
The following line chart (Figure 12) shows the projected RN shortage changes from 2020 to 2025 by economic region. As expected, the Omaha Consortium and Lincoln MSA economic regions will encompass 70% of the total nursing shortage in Nebraska by the year 2025.
▪ RN workforce shortage will increase by 30% between 2020 and 2025 ▪ APRN workforce shortage will increase by 40% between 2020 and 2025 ▪ LPN workforce shortage will increase by 25% between 2020 and 2025
Overall, total FTE nursing shortage will increase by
30% between 2020 and 2025
Figure 12: Projected Nursing Shortage by Economic Region: 2020-2025
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ACKNOWLEDGMENTS
Organizations:
▪ Nebraska Center for Nursing and its Board of Directors
▪ Nebraska Board of Nursing
▪ Nebraska Hospital Association
▪ Nebraska Organization of Nurse Leaders
▪ Nebraska Assembly of Nursing Deans and Directors Individuals:
▪ Craig L. Moore, Ph.D., Consultant
▪ Ann Oertwich, Ph.D., Executive Director, Nebraska Board of Nursing
▪ Lisa Walters, President of the Nebraska Center for Nursing
▪ Lina Bostwick, President of the Nebraska Center for Nursing Foundation
▪ Becky Wisell, Nebraska DHHS Licensure Unit
▪ Jacci Reznicek, MSN, RN, ANP-BC, DHHS Nurse Consultant
▪ Kathy Hoebelheinrich MSN, APRN-NP, ANP-BC, BC-ADM, CDE, DHHS Nurse Consultant
▪ The staff of the Nebraska Center for Nursing for their support
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APPENDIX Chart 1 shows Nebraska per capita supply of RNs which varies from a high of 2,017 in Buffalo County, to a low of 76 in Sioux County.
Chart 2 shows Nebraska per capita supply of LPNs which varies from a high of 841 in Boone County, to a low of 30 in Dakota County.
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Chart 1: Nebraska per Capita RN Workforce, Ranked by County
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Chart 2: Nebraska per Capita LPN Workforce, Ranked by County
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NEBRASKA CENTER FOR NURSING – LIST OF
BOARD MEMBERS (as of 9/2020):
Name Board position
Tamara Allen Member Selected by Governor
Sheila Bjerrum Recommended by the State Board of
Health
Lina Bostwick (Secretary)
Selected by Governor
Kathy Bowman Hospital Industry Representative
Selected by Governor
Beth Burbach Nurse Educator Recommended by
Board of Regents of the University of
Nebraska
Suszanne Deyke RN, Selected by Governor
Kayleen Dudley Selected by Governor
Charity Ebert Long-Term Care Industry
Representative
Ronda Ehly RN, Selected by Governor
Christi Glesmann Independent Colleges Representative
Kathy Harrison Nurse Educator Recommended by the
Nebraska Community College
Association
Joan Nelson Recommended by Board of Health
D. J. Scrivner Recommended by Board of Health
Lisa Walters (Chair)
RN, Selected by Governor
Laura Weber Selected by Governor
LPN Position (Vacant)
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