US releases survey on nursing

The sample survey of registered nurses as at 2018 shows that 17% of registered nurses did not hold nursing-related jobs, the average age of a registered nurse was 50 years and male nurses on average earn 11% more than female nurses. Coming up as we mark 2020 as the International Year of the Nurse and Midwife, these numbers are a wakeup call for policymakers to improve employment and working conditions of nurses, and address all forms of gender inequality.

The United States’ Health Resources and Services Agency (HRSA) released the 2018 National Sample Survey of Registered Nurses (NNSRN) in the first week of January. According to the HRSA in the sample survey, “the NSSRN is designed to provide necessary data to understand the characteristics and distribution of RNs throughout the United States, including education, employment, licensing and certification, and demographics.”

Coming up at the beginning of 2020, designated as the International Year of the Nurse and Midwife by the World Health Assembly last year, the sample survey is of great importance for nurses, policymakers and the entire population of the United States. Nurse play a central role in health care delivery, constituting about half of the health workforce. The improvement of employment and working conditions of nurses, in the United States and globally, is thus critical for universal health care to be achieved.

The United States government commenced cycles of the sample survey as a “cornerstone of nursing workforce data” in 1977. This was subsequent to amendment of the country’s Public Health Act in July 1975. Since then, there have been nine survey cycles before this i.e. 1977, 1980, 1984, 1988, 1992, 1996, 2000, 2004, and 2008. Thus, we see that, after an average of four years in its first three decades, it took ten good years to conduct the current NNSRN.

3,957,661 licensed registered nurses were estimated to be living in the United States as at the end of 2017, according to the survey. Of these, 3,272,872 Registered Nurses (RNs), which is about 83% held nursing related jobs. And of these, 78.9% worked fulltime. It is significant that just 12% of RNs not working as nurses are retired, while the average age of an RN was 50 years old.

It could be inferred from this that, on one hand there is the need to train more nurses and on the other hand, working conditions must be improved to ensure retention of RNs in the health sector. Nursing shortages and poor working conditions have dire impact on healthcare delivery. Increased nurses’ patients’ workloads, which is a direct consequence of this results in increased risks of: error, thereby compromising patient safety; adverse outcomes, and; occupational injury.

The situation presently might however be more nuanced. There are many states and counties where there appear to be surpluses of nurses, with shortages being in a few areas. But, as the American Association of Colleges of Nursing, the “U.S. is projected to experience a shortage of Registered Nurses (RNs) that is expected to intensify as Baby Boomers age and the need for health care grows”. Thus, government has to urgently take necessary policy steps to improve nurses’ employment and working conditions and strengthen the public health system.

Sadly enough, the NSSRN is not designed to cover simple reporting on nurse staffing level, thus leaving a major gap in data necessary for addressing nursing shortages. This is however an area of focus for PSI affiliates such as the American Federation of Teachers (AFT). Another important concern of nurses which the survey is not designed to cover is the incidence of workplace violence. This increased by 123 percent in hospitals and 201 percent in in psychiatric and substance use facilities from 2007 to 2017.

The AFT championed legislation to curb this worrisome trend. And its efforts were crowned with the passage of the Violence Prevention for Health Care and Social Service Workers Act (H.R. 1309) in the U.S. House of Representatives, last November.

But while there might be gaps in terms of the scope of working conditions covered by the survey, it also presents further insights on some important issues. These include the increasing diffusion of digitalisation in the health sector and gender inequality in terms of remuneration.

“Telehealth technologies in the workplace were reported by 32.9 percent of nurses”. But contrary to the dominant narrative of digital health being aimed at making the patient experience of health care provision more satisfactory from the patient perspective, 54.4 percent of the nurses who utilized telehealth technologies had to use these for provider-to-provider consults as against 49.2 percent who used these for RN to patient direct calls. This implies the need for focused interrogation of the role of digitalization, which is gradually being mainstreamed into the affective work of health care delivery.

A worrisome finding of the survey is the 11% difference between the median earnings of male nurses at $79,960, to those of women nurses at $71,960. Considering the fact that women constitute the bulk of nursing personnel, all obstacles to achieving gender parity should be removed.

In conclusion, the release of the NSSRN 2018 is a welcome development. It provides data for PSI affiliates in the United States’ to use for policy advocacy to enhance the trade union and labour rights of nurses. Across the world, PSI and its affiliates will vigorously campaign for improved employment, remuneration and working conditions of nurses and midwives in 2020, placing the concerns of nurses and midwives as workers on the front burner in the course of the International Year of the Nurse and Midwife. Addressing these concerns is central to achieving the goal of health for all.