KANSAS REGISTERED NURSE WORKFORCE SURVEY

KANSAS REGISTERED NURSE WORKFORCE SURVEY PRELIMINARY REPORT March 2014 Prepared by: Cynthia Teel, PhD, RN, FAAN Professor and Associate Dean, Graduate Programs School of Nursing, University of Kansas Co-lead, Kansas Action Coalition Qiuhua Shen, PhD, APRN, RN Assistant Professor School of Nursing, University of Kansas Project Staff, Promoting Nursing Education in Kansas Jill Peltzer, PhD, APRN-CNS, RN Assistant Professor School of Nursing, University of Kansas Project Staff, Promoting Nursing Education in Kansas

Kansas Registered Nurse Workforce Survey Preliminary Report, March 2014 1 The Kansas Registered Nurse (RN) Workforce Survey link was sent via email to 44,568 Kansas RNs in November 2013. The sample included RNs whose email addresses were known by the Kansas State Board of Nursing and represented 94.4% of Kansas RNs licensed in FY2012. The survey closed on January 31, 2014. A total of 7,053 responses were received and 105 were identified as duplicate entry. The following is brief summary of data on demographics, education, licensure, and employment status of the final sample (N = 6,948, 15.6%). The Workforce Survey sample is representative of the Kansas RN population, based on gender, age, and race/ethnicity.* DEMOGRAPHICS Most respondents were female (n = 6,199, 92.1%) and Caucasian (n = 6,174, 91.9%). The mean age of RNs was 48 years old (n = 6,691). 30.4% of RNs were between 21-40 years old (n = 2,037), 53.3% were between 41-60 years old (n = 3,564), and 16.2% were 61 years or older (n = 1,082). Gender (n = 6,729) Race/Ethnicity (n = 6,718) Age (n = 6,691) MILITARY STATUS There were 371 RNs (5.5%) who were a U.S. military veteran. Fifty-eight RNs were currently a member of the military with 19 serving as reserves/guards and 23 serving as active duty. EDUCATION Initial Nursing Education: Type of Initial License Of the 6,552 RNs who reported their nursing education for initial licensure, most 3,035 (46.3%) RNs qualified for their first U.S. RN license by a baccalaureate degree in nursing (BSN), while 2,594 (39.6%) qualified by an associate degree in nursing (ADN) and 923 (14.1%) through a diploma program. Time of Initial License Almost 40% of RNs (n = 2,497, 38.6%) obtained their initial nursing licensure in the 2000s or later. With each previous decade, percentages declined as shown in the figure below. Time of Initial License (n = 6,475)

2 Current Nursing Education Level: Many RNs have obtained additional nursing education since their initial RN licensure. Nursing Educational Level Number Baccalaureate degree in nursing 936 Master s degree in nursing (MSN) 976 Doctoral degree-nursing (PhD) 49 Doctoral degree-nursing (DNP) 32 Doctoral degree-nursing (other) 4 Combining initial licensure with the additional education nurses had obtained indicated that the current nursing education level of RNs in Kansas is: Educational Level n (%) Cumulative % Diploma in Nursing 589 (8.8) 8.8 Associate in Nursing 2,039 (30.6) 39.4 Baccalaureate in Nursing 3,035 (45.6) 85.0 Master s in Nursing 909 (13.7) 98.7 PhD in Nursing 49 (0.7) 99.4 DNP 32 (0.5) 99.9 Other doctoral degree 4 (0.1) 100 With respect to the level of nursing education among Kansas RNs, more than 60% of survey participants (n = 4,029, 60.5%) held a BSN or higher. This has increased 14% from initial license. Education Level at Initial RN Licensure (n = 6,552) Current Nursing Education Level in Kansas RNs (n = 6,657) Intent to Advance Nursing Education: One third of RNs (n = 2,400, 35.7%) planned to advance their education in the following programs: Intent to Advance Nursing Education n (%) Master's degree 1050 (43.8%) Doctoral degree - DNP 585 (42.4%) Baccalaureate degree 553 (23.0%) Doctoral degree - PhD 117 (4.9%) Either PhD or DNP 26 (1.1%) Currently in the BSN program 2 (0.1%) Currently in the MSN program 9 (0.4%) Currently in the DNP program 5 (0.2%) Other fields (Education, MD, etc.) 12 (0.5%) Undecided 41 (1.7%)

3 LICENSURE Most RNs had an active license in Kansas (n = 6,739, 99.6%) and were initially licensed in the United States (n = 6,407, 99.1%). A total of 548 RNs held advanced practice RN licenses. Advanced Practice RN Licenses (n = 548) EMPLOYMENT Employment Status: A total of 6,702 RNs reported their employment status as shown in the table below: Employment Status n (%) Actively employed - Kansas RN License is required 5365 (80.1%) Actively employed - Other state RN License is required 701 (10.5%) Actively employed - in other field 161 (2.4%) Retired 226 (3.4%) Unemployed 204 (3.0%) Working in nursing as a volunteer 45 (0.7%) Most actively employed RNs worked full-time (n = 5,067, 84.0%). Employment Status by Full-time, Part-time, or Per diem (n = 6,034) Primary Reasons for Unemployment: The primary reasons for unemployment were identified by 197 RNs in the table below. 52.2% of unemployed RNs are currently seeking work as a nurse (n = 106). Primary Reasons for Unemployment n (%) Taking care of family and home 67 (34.0%) Difficult to find a nursing position 36 (18.3%) Laid off 27 (13.7%) Personal choice 25 (12.7%) Dissatisfaction with nursing job and/or profession 15 (7.6%) Attending school 14 (7.1%) Disabled 13 (6.6%)

Employment Settings: Approximately 62.0% of RNs held their principal nursing positions in the following counties: Johnson (n = 970, 18.4%), Sedgwick (n = 860, 16.3%), Wyandotte (n = 656, 12.4%), Shawnee (n = 416, 7.9%), and Jackson (n = 372, 7.0%). 4 Principal Nursing Positions by Counties (n = 5,280) The principal nursing practice settings are listed in the below table (n = 5,851):: Principal Nursing Practice Setting n (%) Hospital (Acute Care/LTAC/Inpatient Rehabilitation) 2812 (48.1%) Ambulatory Care Setting 927 (15.8%) Academic Setting 479 (8.2%) Long-Term Care Facility (Nursing Home/Extended 335 (5.7%) Care/Assisted Living) Public Health/Community Health 333 (5.7%) Home Health/Home Hospice 269 (4.6%) School Health Service 246 (4.2%) Healthcare Business 131 (2.2%) Indirect Care Setting 123 (2.1%) Case Management 69 (1.2%) Occupational Health 52 (0.9%) Correctional Facility 38 (0.6%) Transitional Care 37 (0.6%) Employment Positions (n = 5,839): Half of RNs worked as staff nurses (n = 2,883, 49.4%). Other positions that RNs held are listed in the below table: Employment Positions n (%) Staff nurse 2883 (49.4%) Nurse Manager 626 (10.7%) Nurse Coordinator 410 (7.0%) Advanced Practice Nurse 393 (6.7%) Public Health/Community Health Nurse 351 (6.0%) Nurse Faculty 257 (4.4%) Nurse Executive 247 (4.2%) Staff Educator, Service Setting 171 (2.9%) Consultant 157 (2.7%)

Employment Positions n (%) Case Manager 129 (2.2%) Informatics Specialist 52 (0.9%) Nurse Researcher 50 (0.9%) Quality/Safety Specialist 45 (0.8%) Occupational Health Nurse 35 (0.6%) Non-nursing Executive 29 (0.5%) Non-nursing Faculty 4 (0.1%) 5 Clinical Areas: There were 1,045 RNs who were not involved in direct patient care (17.9%). Among the 4,788 RNs who were involved in direct patient care, the clinical areas in which they worked are listed below: Clinical Areas n (%) Medical/Surgical/Progressive care/telemetry 782 (13.4%) Ambulatory/Outpatient are 641 (11.0%) Pediatric (RN and APRN focus) 470 (8.1%) Intensive Care/Critical Care 358 (6.1%) (Burn/Medical/Surgical/Neurosurgical) Emergency Department 341 (5.8%) Pre-op/post-op/PACU/Anesthesia (includes Interventional 332 (5.7%) Radiology & GI/Endoscopy Labor and Delivery/Mother Baby or New Born Nursery 259 (4.4%) Home Health/Hospice 244 (4.2%) Adult Health (RN and APRN focus, including specialty areas 224 (3.8%) such as Cardiology, Dermatology, & Corrections) Geriatrics/Gerontology (RN and APRN focus) 221 (3.8%) Psychiatric/Mental Health/Substance Abuse 187 (3.2%) Family Health (APRN focus) 126 (2.2%) Intensive Care/Critical Care (Neonatal/Pediatric) 125 (2.1%) Rehabilitation 113 (1.9%) Community/Public Health 104 (1.8%) Anesthesia (APRN focus) 79 (1.4%) Palliative Care/Hematology/Oncology 81 (1.4%) Specialty Nursing (IV therapy, Pain Management, Wound Care) 52 (0.9%) Case Management 27 (0.5%) Midwifery/Women s Health (APRN focus) 22 (0.4%) Over 2,000 RNs had been working in their current principal nursing positions for 1-5 years (n = 2,025, 34.6%); 32.7% for 5-15 years (n = 1,915), 16.7 % for over 15 years (n = 978), and 15.9% for less than 1 year (n = 933). Working History in the Current Principal RN Position (n = 5,851)

Reasons for Selecting Current RN Employment: When asked for the important factors in selecting principal RN employment, more than 48% of RNs identified that able to work shirt desired/work more convenient hours (n = 3,390, 48.8%) and desire to work in this particular setting (n = 3,402, 49.0%) were the two major factors. 6 Important Factors in Selecting Principal RN Employment Number of RN Positions: Majority of RNs held one position that required an RN license (n = 4,781, 81.7%). About 7.5% of RNs (n = 440) reported that they planned to retire in the next two years. Number of Positions Hold by RNs that Require an RN License (n = 5,921) Commute to Work: The average one-way distance from residence to principal nursing position was 16.7 miles. Majority of RNs lived less than 30 miles away from work (n = 5,164, 89.3%). About 1% of RNs lived more than 90 miles away (n = 66). Among the 31 nurses who commuted more than 150 miles, 11 were travel nurses and 3 commuted weekly from residence to work. The primary reasons for the commute were identified by 1,295 RNs: Reasons for Commute n (%) Quality of life/culture/environment of the community 544 (42.0%) Living closer to family 245 (18.9%) School system preference 232 (17.9%) Partner/spousal employment 203 (15.7%) Housing affordability/preference 155 (12.0%) Job availability 86 (6.6%) Job requirement/travel nurse 80 (6.2%) Employment setting/working environment/employer 41 (3.2%) Higher pay/flexible schedule/benefits 19 (1.5%) Job security/satisfaction 18 (1.4%)

7 Sample Comparison with KSBN FY 2012 RN Demographics: The demographics of the sample were comparable to the Kansas RN population (N = 47,225)*. Kansas RN Workforce Survey Sample Kansas RN Population Gender (n = 6,729) Gender (N = 47,225) Age (n = 6,691) Age (N = 47,225) Race/Ethnicity (n = 6,718) Race/Ethnicity (N = 47,225) *Based on Kansas State Board of Nursing 2012 Annual Report Any additional thoughts or ideas about the nursing profession in Kansas, or the survey : A total of 522 RNs provided comments. Most comments were coded and collapsed into 7 themes, with sub-themes embedded. Comments are reported as entered by the RN. Comments about workplace setting, role, or clinical area are not reported here. Comments that did not contribute to the understanding of the nursing profession and its workforce were not included in the analysis. Theme 1. Advocacy for Nurses and Patients Overarching Theme: Providing A Voice to Kansas RNs Comments A means for nurses to have a stronger voice, better advocacy and more control over determining work environment. We need to join together in an attitude of respect. It would also be nice to have nurses in the State of Kansas who are willing to be mentors and experienced advisors for nurses who are wanting to expand their knowledge and advance their degrees. I think that is how we could really foster and manifest excellent nurses and advanced degreed nurses.

Theme 2. Career Opportunities 3. Discrimination in the Profession Overarching Theme: Providing A Voice to Kansas RNs Comments I am very interested in the future of Kansas Nurses, as I currently have two daughters in Nursing School @ XXX. Please let me know how to be more involved. Thank you! I am concerned about the quality of nursing care with the pressure on healthcare organizations to reduce costs which I believe will translate to increased workload on nurses and driva many from the workforce or at least away from acute care. Nurses are very poorly treated in my work environment. It is an abusive environment that does not properly utilize my skill set or provide me with adequate resources to do the work I am trained and qualified to do. There is a huge layer of middle management that contributes nothing to the health of our population but does consume an unhealthy proportion of the dollars available in our system. Day or Night nurses should only have a total of 4-5 pt per 12 hour shifts. It is very hard on a nurse to have more pt per a shift. Lots of mistakes happen. I believe 12 hour shifts for a nurse is too long and dangerous. I am very concerned about the ever increasing expectation that a nurse can provide safe and quality care when being expected to care for 7-10 patients. The nursing profession is a highly misunderstood profession by Hospital Boards of Directors... Hospital Boards could benefit from educational power points in a professional venue, such as a Board Retreat, on the different degrees available to nurses, as well as positions held by nurses, from floor nurses to administrative nurses, to research nurses, etc., for a clearer understanding of those roles. I have loved being an RN the past 35 years. I wouldn't change a thing! Best job: wide variety of areas to work and widely available. How wonderful there are so many choices for nurses of all ages to continue to do what we love the most...care for the patients and their families!!! I have been looking for a full-time job as a graduate RN, and its not what everyone is looking for. They want experienced RN and many want BSN not Associates degree The pay is very low for teaching and I fear the generation behind me will not want to do the teaching due to the pay difference. The pay could be better but feel fortunate to have a good job in these times. I feel nurses are underpaid, especially working in the ER where we are a target for pt abuse. I am currently selling my home to go back to school to hopefully leave the bedside. Although bedside nursing is rewarding, it's just as awful. Clinic nurses need more recognition for all the work they do. While it is not the same as hospital nursing, clinic nurses still deserve the same respect and admiration as hospital nurses get. Age discrimination is very apparent. I could not even get an interview after my last position was "realigned" (laid off). If I did not know my current supervisor from previous experience with her I am not sure I would even be in my current part time position. I need full time work and continue to pursue that but have not been successful. As a nursing student at XXX, during my visit to the legislative day at Topeka, I was told by the representatives of the XXX Foundation that I would not qualify to apply for scholarships through their organization because I was not a US citizen. When I inquired the reason because you people could go back to the place where you came from. 8 Kansas does not seem to appreciate people of color. There is way too much racism here and the ignorance is costing valuable lost professional skills and lives of patients who need service regardless of the ethnicity of the professional. 4. Education I think BSN should be entry level for R.N. s. Nurses are not recognized for the breadth of their knowledge.

Theme 5. Importance of Data 6. Lifelong Learning 7. Regulatory Issues Overarching Theme: Providing A Voice to Kansas RNs Comments The availability of on-line education advancements has given me the opportunity to acquire a masters degree! All students I have mentored have a wonderful knowledge out of the books, but they need experience. It doesn't say much for the school when a new BSN cannot draw blood, cath a patient or too many other simple procedures. Give them experience! More clinical time and not getting classes and clinicals from a computer. Nurses should be working in hospitals w instructors. Advancing nursing education can be very cost prohibitive. In education, teachers receive loan foregiveness for working in impoverished area. At the same educational level, providing services to the same student population, nurses are not included due to guidelines provided thru the federal department of education. Perhaps there should be such options provided for nurses who work in such areas, as these areas are usually not areas of high financial compensation. Love being a nurse. Would like to see additional pay by hospitals mandatory for additional education such as masters or BSN Each nurse in Kansas should be offered the opportunity to update this information each time the license is renewed. That would allow for changes in employment, educational level and retirement plans to be added. Thank you for providing this survey. Your work with regard to promoting the profession of nursing is appreciated. Thank you so much for starting off on this project. We need this data. I have additional certifications..these do require work in related fields to obtain and remain certified: and continuing education credits related to these areas. Finding, tracking, taking time off work, and paying for Nursing CE's that meet Kansas standards is sometimes difficult and I live in the Kansas City metro area. I can imagine that nurses in more rural parts of the state would have even more difficulty. I don't feel you should have to get "permission" to use ON-Line College Nursing classes as CEU's. There should be a stipulation that if you are advancing your NURSING degree, you should not have to obtain this. (I could see if you were taking college courses not related to nursing degree) but when you are in a BSN program, you should not have to do this and I think its pretty cumbersome & ridiculous. I strongly feel that Kansas needs to join with the Compact States and honor others licenses. Will graduate with DNP 12/2013. Kansas needs to adopt the regulations as promulgated by the NCSBN and become a compact state. I come from the Long Term Care sector with several years in management level positions. I remain proud to serve in this this profession and I believe KSBN does a great job supporting KS nurses. Believe Kansas needs a union to support nurses concerns. KSBN would do a service in publishing articles that help to track future opportunities for RNs, and/or let us know what training we need to stay competitive. So many jobs are switching their qualifications, and I feel most of us are in the dark as to what would be the best way to stay "tooled up" and to not waste money and energy toward training that may not suit further employment situations. Thank you for your consideration of my concern--one I know many other nurses share as well. I have a dual license in CO & KS for almost 30 years, live near the state line in rural area and have worked both places. It would really help all of us if the state line didn t define what we can do, we need to all get on the same page. 9