california
Health Care Almanac
California Nurses Facts and Figures
November 2010
C A L I FOR N I A
H EALTH C ARE
F OU NDATION
California Nurses Facts and Figures
Introduction
Overview
Close to 300,000 actively licensed registered nurses (RNs) reside in California, making nursing the single largest health
contents
profession in the state. In the last 10 to 15 years, nurses’ roles have expanded as they have taken on more responsibility
for the delivery of health care. Recognizing the key role that nurses play in providing care to patients across the health
<< r e t u r n to c o n t e n t s
General Population. . . . . . . . . . . . . . . . . . . . . . 3
care system, legislators have passed nurse-to-patient staffing ratios in hospitals, colleges have increased the number of
RN Population. . . . . . . . . . . . . . . . . . . . . . . . . . . 4
educational programs, and private-sector investments have supported the growth of the profession’s ability to meet
RN Demographics. . . . . . . . . . . . . . . . . . . . . . . 6
demand. This report examines California’s nursing workforce, including supply, education, and demographics.
Key findings include:
• The number of practicing California nurses nearly doubled between 1980 and 2008, outpacing overall population
growth. However, California still ranks near the bottom of all states in the number of RNs per capita.
• Over the last two decades, California’s nursing workforce has grown increasingly diverse; the percent of non-white
nurses has nearly doubled to comprise more than 40 percent of the workforce. However, the workforce still does
not reflect California’s general population as a large part of the non-white growth is made up of foreign-trained
nurses from the Philippines.
Education. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Work Setting and Satisfaction. . . . . . . . . . . . 16
Compensation. . . . . . . . . . . . . . . . . . . . . . . . . . 22
Licensed Vocational Nurses. . . . . . . . . . . . . . 25
Authors and Data Sources. . . . . . . . . . . . . . . 31
Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
• Over the past decade, California has seen significant growth in the number of RN educational programs
and graduates.
• Between 2004 and 2008, the number of nurse practitioners (NPs) in California more than doubled. The NP
credential is the most frequently held advanced practice certification.
• RN incomes increased by more than 50 percent from 1990 to 2008, significantly outpacing inflation.
• Since 2000, the number of licensed vocational nurse (LVN) educational programs in California has more than
doubled to over 200, driven by the proliferation of private, for-profit programs. LVN employment per capita
increased slightly.
Note: Throughout this report, registered nurses in California refers to actively licensed RNs residing in California, who are employed in nursing.
©2010 California HealthCare Foundation
2
California Nurses Facts and Figures
General Population
Projected 5-Year Population Growth Rates,
<< r e t u r n to c o n t e n t s
General Population vs. Age 65 and Older, California, 2000 to 2030
General Population
An aging population is
likely to increase the
Age 65 and Older
demand for health care
services, including nurses.
25%
Californians ages 65 and
older are expected to grow
20%
16.2%
at a rate much faster than
the overall population.
15%
By 2030, the number of
10%
Californians aged 65 and
9.3%
over is projected to double.
8.4%
5%
5.4%
0%
2000–2005
2005–2010
2010–2015
2015–2020
2020–2025
2025–2030
Source: State of California, Department of Finance, Race/Ethnic Population with Age and Sex Detail, 2000 – 2050. Sacramento, CA, July 2007.
©2010 California HealthCare Foundation
3
California Nurses Facts and Figures
Actively Licensed RNs and RNs Employed in Nursing,
California, 1980 to 2008, Selected Years
Actively Licensed RNs
RN Population
<< r e t u r n to c o n t e n t s
From 1980 to 2008, the
number of actively licensed
RNs Employed in Nursing
RNs in California increased
350,000
78 percent. During this
300,000
277,575
time, the number of RNs
employed in nursing nearly
250,000
doubled, as the percent
234,530
200,000
from 78 to 85 percent.
155,739
Minimum nurse staffing
150,000
100,000
working in nursing increased
ratios, which were passed in
122,176
1999 and implemented in
2004, have likely contributed
50,000
to the increase in the
0
1980
1984
1988
1992
1996
2000
2004
2008
number of employed RNs.
Note: These data refer to RNs who have an active license and reside in California.
Source: “The Registered Nurse Population, Initial Findings from the 2008 National Sample Survey of Registered Nurses”; “The Registered Nurse Population, Findings from the National Sample Survey of
Registered Nurses” (1992, 1996, 2000, 2004); National Sample Survey of Registered Nurses, Public Use Data Files (1980, 1984, 1988).
©2010 California HealthCare Foundation
4
California Nurses Facts and Figures
Employed Registered Nurses per 100k Population,
California vs. United States, 1980 to 2008, Selected Years
California
RN Population
<< r e t u r n to c o n t e n t s
California’s RN per capita
ratio remains significantly
United States
lower than the nation.
1,000
854
900
800
700
600
500
638
560
516
400
300
200
100
0
1980
1984
1988
1992
1996
2000
2004
2008
Note: The data for California refer to actively licensed RNs employed in nursing who reside in California.
Source: “The Registered Nurse Population, Initial Findings from the 2008 National Sample Survey of Registered Nurses”; “The Registered Nurse Population, Findings from the National Sample Survey of
Registered Nurses” (1992, 1996, 2000, 2004); National Sample Survey of Registered Nurses, Public Use Data Files (1980, 1984, 1988); “Intercensal Estaimtes of the Total Resident Population of States: 1980 to
1990”, Population Estimates Branch, U.S. Bureau of the Census.
©2010 California HealthCare Foundation
5
California Nurses Facts and Figures
RN Demographics
Registered Nurses, by Age Group,
<< r e t u r n to c o n t e n t s
California, 1990 to 2008, Selected Years
3%
23%
— 2%
3%
25%
9%
6%
6%
 65 and older
 50 to 64
 35 to 49
 Under 35
The California RN workforce
is aging. More RNs are
approaching retirement
age with fewer RNs to
28%
replace them. Nearly half
42%
39%
40%
of the nursing workforce is
over 50 and a recent survey
50%
found that 12 percent are
53%
planning to retire over the
55%
37%
37%
18%
17%
37%
24%
1990
19%
15%
12%
1993
1997
2004
2006
2008
43.6
44.6
47.6
47.1
47.1
next 5 years.
average age
42.9
Source: California Board of Registered Nursing, Survey of Registered Nurses, 2008.
©2010 California HealthCare Foundation
6
California Nurses Facts and Figures
RN Demographics
Registered Nurses, by Gender,
<< r e t u r n to c o n t e n t s
California, 1993 vs. 2008
Although California’s
1993
2008
RN workforce remains
predominantly female, in
recent years more men
Male
6%
have been entering the
Male
14%
workforce. The share of
men working in nursing
in California more than
doubled between 1993
Female
94%
Female
86%
and 2008.
Source: California Board of Registered Nursing, Survey of Registered Nurses, 2008.
©2010 California HealthCare Foundation
7
California Nurses Facts and Figures
RN Demographics
Registered Nurses, by Race/Ethnicity,
<< r e t u r n to c o n t e n t s
California, 1990 to 2008
California’s RN workforce
 Non-White
has become increasingly
racially/ethnically diverse
over the past two decades.
Non-whites grew from
23 percent to 41 percent
of the RN workforce
since 1990.
36%
23%
1990
39%
38%
2004
2006
41%
27%
1993
1997
2008
Note: White refers to White, not Hispanic or Latino.
Source: California Board of Registered Nursing, Survey of Registered Nurses, 2008.
©2010 California HealthCare Foundation
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California Nurses Facts and Figures
RN Demographics
Registered Nurses and Population, by Race/Ethnicity,
<< r e t u r n to c o n t e n t s
California, 2008
Although registered
 RN Workforce
 General Population
nurses are one of the
more racially/ethnically
59%
diverse health professions
in California, Latino RNs
remain substantially
42%
underrepresented in relation
37%
to the state’s general
Latino population. In
contrast, Filipinos account
for 18 percent of the RN
18%
workforce but just 3 percent
8%
9%
4%
3%
White
Filipino
Latino
of the general population.
9%
Asian
6%
African American
3%
4%
Other
Notes: Asian includes Asian Indian and excludes Filipino. Other includes Native Hawaiian/Pacific Islander, American Indian and Alaska native, mixed race/ethnicity, and other.
Sources: California Board of Registered Nursing, Survey of Registered Nurses, 2008. American Community Survey Public Use Microdata Sample for California, 2008.
©2010 California HealthCare Foundation
9
California Nurses Facts and Figures
Race/Ethnicity of Newly Enrolled Students in Pre-Licensure
RN Education Programs, California, 2001 and 2009
2001
Native American
<1%
increasingly racially/
ethnically diverse over the
past eight years. The change
in overall composition has
White
44%
Latino
21%
Other Race
4%
7%
Filipino
12%
Asian
11%
New students enrolling in
RN programs have become
African American
African
American
10%
<< r e t u r n to c o n t e n t s
California’s pre-licensure
2009
Native American
<1%
RN Demographics
been driven by growing
Filipino
15%
White
39%
numbers of Filipino and
Asian students.
Asian
17%
Latino
18%
Notes: “Other Race” was not a category in the 2001 data. Asian includes Native Hawaiian/Pacific Islander and excludes Filipino. Segments may not add to 100 percent due to rounding.
Source: California Board of Registered Nursing, School Report Data, Prelicensure Interactive Database, www.rn.ca.gov/schools/reports.shtml.
©2010 California HealthCare Foundation
10
California Nurses Facts and Figures
Pre-Licensure RN Education Programs, by Degree Level,
California, 2001 to 2009
138
117
97
4
22
71
100
104
5
5
8
23
23
23
72
73
73
<< r e t u r n to c o n t e n t s
California’s colleges and
 Entry-Level Master’s
universities offer three
 Bachelor of Science
degree paths for entry-level
 Associate’s Degree
RNs. While associate degree
(ELM)
101
Education
109
9
24
76
14
130
131
16
15
32
32
16
(ADN)
36
in nursing (ADN) programs
comprise the majority
26
77
(BSN)
of nursing programs,
82
84
86
the number of bachelor
of science and master’s
degree-level programs have
significantly increased.
2001
2002
2003
2004
2005
2006
2007
2008
2009
Note: See Appendix A for descriptions of the education programs.
Source: California Board of Registered Nursing, School Report Data, Prelicensure Interactive Database, www.rn.ca.gov/schools/reports.shtml.
©2010 California HealthCare Foundation
11
California Nurses Facts and Figures
Applications to Pre-Licensure RN Education Programs,
Total vs. Accepted Applications, California, 2001 to 2009
Total Qualified Applications
Education
<< r e t u r n to c o n t e n t s
Despite the growth in
the number of degree
Accepted Applications
40,000
programs, the demand for
36,511
nursing education has far
exceeded the number of
35,000
available spots. In 2009,
30,000
60 percent of applicants
meeting the admission
25,000
criteria were not accepted.
20,000
A recent survey found that
the most common barriers
15,000
10,021
13,988
10,000
to program expansion
were lack of clinical sites,
5,000
6,128
insufficient funding for
faculty salaries, and non-
0
2001
2002
2003
2004
2005
2006
2007
2008
2009
Notes: Data represents total applications not an unduplicated count of applicants. The number of unique applicants is unknown. “Qualified applicant” is a determination made by schools individually, or by the
California Community College Chancellor’s office in the case of associate degree programs in the community college system. In total, 33 percent of applicants were accepted into ADN programs, 47 percent
into BSN programs, and 35 percent into ELM programs.
competitive faculty salaries.
Source: California Board of Registered Nursing, School Report Data, Prelicensure Interactive Database, www.rn.ca.gov/schools/reports.shtml.
©2010 California HealthCare Foundation
12
California Nurses Facts and Figures
Education
Pre-Licensure RN Education Program Graduates,
<< r e t u r n to c o n t e n t s
by Degree Level, California, 2001 to 2009
 Entry-Level Master’s
550%
GROWTH
 Bachelor of Science
118%
GROWTH
 Associate’s Degree
87%
GROWTH
(ELM)
(BSN)
(ADN)
104%
Graduates from California’s
pre-licensure RN programs
10,570
9,580
OVERALL GROWTH
8,317
11,000
nearly doubled from 2001 to
10,000
2009. In 2009, approximately
9,000
2 out of every 3 graduates
8,000
7,528
6,677
7,000
6,158
5,178
5,346
5,623
6,000
completed an associate
degree program. Although
graduates of bachelor
and entry-level master’s
5,000
programs are far fewer in
4,000
number, their numbers
3,000
have grown rapidly in
2,000
recent years.
1,000
2001
2002
2003
2004
2005
2006
2007
2008
2009
0
Source: California Board of Registered Nursing, School Report Data, Prelicensure Interactive Database, www.rn.ca.gov/schools/reports.shtml.
©2010 California HealthCare Foundation
13
California Nurses Facts and Figures
Registered Nurses, by Location of Initial RN Education,
California, 1993 vs. 2008
Education
<< r e t u r n to c o n t e n t s
Despite the increase in
1993
the number of nursing
2008
graduates, California has
become more reliant on
foreign-educated nurses.
Foreign
Country
16%
Other
U.S. State
30%
In 2008 almost one in four
Foreign
Country
24%
California
53%
Other
U.S. State
21%
employed RNs were trained
outside the United States
California
55%
and nearly two-thirds of
those were trained in the
Phillipines.
Notes: Segments may not add to 100 percent due to rounding.
Source: California Board of Registered Nursing, Survey of Registered Nurses, 2008.
©2010 California HealthCare Foundation
14
California Nurses Facts and Figures
Education
Advanced Practice Nurses, by Type,
<< r e t u r n to c o n t e n t s
California, 2004 and 2008
Many nurses become
 2008
 Total: 243,761
 2004
 Total: 216,852
advanced practice nurses,
requiring at least a
master’s degree. The nurse
17,307
practitioner (NP) credential
is the most frequently
held advanced practice
certification. Between 2004
and 2008, the number of
8,240
7,373
NPs more than doubled.
6,582
434
Nurse Practitioner
Clinical Nurse Specialist
1,463
Nurse Midwife
651
975
Nurse Anesthetist
Note: See Appendix A for descriptions of positions.
Source: California Board of Registered Nursing, Survey of Registered Nurses, 2008.
©2010 California HealthCare Foundation
15
California Nurses Facts and Figures
RNs, by Work Setting and Specialty Certification,
California, NPs vs. Clinical Nurse Specialists, 2008
6%
— 2%
— 1%
— 2%
<< r e t u r n to c o n t e n t s
Nurse practitioners are
 Other
 Home Health Agency
 Skilled Nursing Facility
 Public Health Department/
25%
26%
Work Setting and Satisfaction
Community Health Agency
 Ambulatory Care
 Acute Care Hospital
much more likely to work
in an ambulatory care
setting than are clinical
nurse specialists, half of
5%
whom work in a hospital.
10%
An increasing number of
9%
nurse practitioners are
35%
also practicing in retail
clinics. Researchers predict
a significant growth in the
50%
31%
number of retail clinics over
the next 5 years, which
could increase the demand
Nurse Practitioner
Clinical Nurse Specialist
for NPs (not shown).
Note: Other listed organization types include mental health, hospice, dialysis, occupational/employee health, forensic (correctional facility, prison, jail), government agency, and self-employed. These are the
only specialty certifications for which there is an adequate number of sample observations. Other specialty certifications include nurse midwives, nurse anesthetists, and psychiatric mental health nurses.
Source: California Board of Registered Nursing, Survey of Registered Nurses, 2008.
©2010 California HealthCare Foundation
16
California Nurses Facts and Figures
Work Setting and Satisfaction
Registered Nurses, by Work Setting,
<< r e t u r n to c o n t e n t s
California, 2008
Estimated Number of RNs working
in nursing: 243,761
Almost two-thirds of all
RNs work in a hospital
setting. The next most
Other
18%
Public Health
Department
3%
Home Health
Agency
3%
Acute Care
Hospital
64%
Ambulatory
Care
9%
popular work setting,
ambulatory care, employs
less than 10 percent of
California’s RNs.
Skilled Nursing/
Extended Care/
Rehabilitation
3%
Note: The category “Other” includes more than 20 different work settings. In 2008, the five most frequently reported were: case management/disease management, school health (K-12 or post-secondary),
academic nursing, hospice, and dialysis. (In 1993 mental health/drug and alcohol treatment was the most frequently reported “other” setting.)
Source: California Board of Registered Nursing, Survey of Registered Nurses, 2008.
©2010 California HealthCare Foundation
17
California Nurses Facts and Figures
Nursing Hours per Patient Day in GAC Hospitals,
California, 1999 to 2006
All RNs
Work Setting and Satisfaction
<< r e t u r n to c o n t e n t s
RN hours per patient day
Non-Registry RNs
LVNs
Registry Nurses
8
rapidly increased since 2002.
The increase was likely
due to minimum nurse
•
MNS LEGISLATION PASSED
staffing legislation.
7
6
5
4
3
2
1
0
1999
2000
2001
2002
2003
2004
2005
2006
Note: GAC stands for general acute care.
Source: California HealthCare Foundation issue brief “Assessing the Impact of California’s Nurse Staffing Ratios on Hospitals and Patient Care,” February 2009.
©2010 California HealthCare Foundation
18
California Nurses Facts and Figures
Work Setting and Satisfaction
RN Use of Health Information Technologies,
<< r e t u r n to c o n t e n t s
by Type of Activity, California, 2008
Use of health information
Electronic Lab Reports
59%
Computerized Medication Distribution
54%
Electronic Patient Records
53%
systems in the delivery
of patient care by RNs is
widespread. Eighty-five
percent of RNs reported
using IT in some part of
Electronic Radiology Reports
51%
Electronic Nurse Charting
46%
Electronic Medication Administration Records
their workflow. The activities
most commonly mediated
by IT systems are lab reports,
30%
medication distribution,
Electronic Care Plans
29%
Computerized Physician Orders
Scanning for Supplies
patient records, and
25%
radiology reports.
16%
Scanning for Medication
14%
No Use of IT
0
15%
10
20
Source: California Board of Registered Nursing, Survey of Registered Nurses, 2008.
©2010 California HealthCare Foundation
30
40
50
19
California Nurses Facts and Figures
Overall Job Satisfaction Among Registered Nurses,
California, 1990 to 2008
Work Setting and Satisfaction
<< r e t u r n to c o n t e n t s
Overall job satisfaction
continues to increase
VERY
SATISFIED
▴
among RNs working in
5
California.
4
3.77
3.94
3.95
3.92
1993
1997
2004
4.05
4.14
3
2
1
VERY
DISSATISFIED
1990
2006
2008
Source: California Board of Registered Nursing, Survey of Registered Nurses, 2008.
©2010 California HealthCare Foundation
20
California Nurses Facts and Figures
Work Setting and Satisfaction
Most and Least Satisfying Aspects of RN Employment,
<< r e t u r n to c o n t e n t s
California, 2008
The most satisfying aspect
Interactions with Patients
4.34
MOST SATISFYIN G
Feeling that Work Is Meaningful
Job Overall
the amount of required
paperwork.
4.10
4.10
3
4
▴
2
Clerical Support
5
VERY
SATISFIED
3.39
Leadership from Administration
L EA S T S ATI SF YI NG
least satisfying aspect is
4.14
Work Schedule
1
with patients, while the
4.20
Job Security
VERY
DISSATISFIED
of nursing is the interaction
3.23
Involvement in Policy and Management Decisions
3.15
Non-Nursing Tasks Required
Amount of Paperwork Required
3.13
2.88
Source: California Board of Registered Nursing, Survey of Registered Nurses, 2008.
©2010 California HealthCare Foundation
21
California Nurses Facts and Figures
Annual Income from all Registered Nursing Positions,
California, 1990 to 2008
Compensation
<< r e t u r n to c o n t e n t s
California RNs have enjoyed
Real Average annual income
large increases in income
$100,000
over the last two decades.
$90,000
$81,428
$80,000
increased by more than
50 percent from 1990 to
$70,000
$60,000
Inflation-adjusted incomes
2008.
$52,462
$50,000
$40,000
$30,000
$20,000
$10,000
$0
1990
1993
1997
2004
2006
2008
Notes: Real income estimates have been adjusted for inflation and are expressed as 2008 dollars. These data refer to income earned from all RN positions.
Sources: California Board of Registered Nursing, Survey of Registered Nurses, 2008. California Employment Development Department.
©2010 California HealthCare Foundation
22
California Nurses Facts and Figures
Compensation
Annual Income from all RN Positions, by Region,
<< r e t u r n to c o n t e n t s
California, 2008
RN incomes vary
STATE AVERAGE: $81,428
substantially by region.
Greater Bay Area
In 2008, RNs in the
$94,014
Bay Area earned from
Sacramento Area
$82,175
14 percent to 34 percent
Inland Empire
more than RNs in other
$81,161
regions.
San Joaquin Valley
$80,804
Orange County
$77,911
Central Coast
$77,714
Los Angeles County
$76,913
San Diego
$72,850
Northern and Sierra Counties
$69,975
Source: California Board of Registered Nursing, Survey of Registered Nurses, 2008.
0
20000
©2010 California HealthCare Foundation
40000
60000
80000
100000
23
California Nurses Facts and Figures
Compensation
Real Average Annual Wage Growth,
<< r e t u r n to c o n t e n t s
Registered Nurses vs. Selected Professions, California, 2001 vs. 2009
 2001
 2009
RN wage growth between
GROWTH
SINCE 2001
Physical Therapists
$84,778
4.3%
2001 and 2009 was strong
compared with other
occupations that have
similar demographic
Registered Nurses
$84,627
18.6%
characteristics and
educational requirements.
Respiratory Therapists
$66,698
Among the selected
20.0%
occupations, only respiratory
Secondary School Teachers
therapists experienced a
$65,184
2.2%
similarly large relative gain
in wages between 2001
Elementary School Teachers
$62,767
and 2009.
5.7%
Child/Family/School Social Workers
$51,387
Employment Statistics Survey.
0Source: California Employment Development
20000 Department, Occupational 40000
©2010 California HealthCare Foundation
60000
11.9%
80000
100000
24
California Nurses Facts and Figures
LVN Total Employment per 100k Population,
California, 2002 vs. 2009
Licensed Vocational Nurses
<< r e t u r n to c o n t e n t s
Licensed vocational nurses,
who work under the
supervision of physicians
and registered nurses, are
157
163
an important provider of
patient care. LVNs per capita
increased slightly from 2002
to 2009.
2002
2009
Sources: California Employment Development Department, Occupational Employment Statistics Survey. State of California, Department of Finance, E-4 Population Estimates for Cities, Counties and the State,
2001–2010, with 2000 Benchmark. Sacramento, California, May 2010.
©2010 California HealthCare Foundation
25
California Nurses Facts and Figures
Licensed Vocational Nurses, by Age Group,
California, 2008
Licensed Vocational Nurses
<< r e t u r n to c o n t e n t s
California’s LVN workforce
65 and Older
3%
Estimated Number of LVNs: 56,113
is younger than its RN
counterpart. Roughly
71 percent of LVNs are
under the age of 50,
compared to 54 percent
Under 35
31%
50 to 64
26%
of RNs
35 to 49
40%
Source: American Community Survey, Public Use Microdata Sample for California, 2008.
©2010 California HealthCare Foundation
26
California Nurses Facts and Figures
Licensed Vocational Nurses
LVN Workforce, by Race/Ethnicity,
<< r e t u r n to c o n t e n t s
California, 2008
Other
Asian
5%
3%
The LVN workforce is racially
and ethnically diverse,
with three different groups
representing 20 percent
or more of the workforce:
Filipino
16%
Latino
21%
White
31%
white, African American,
and Latino.
African
American
24%
Note: Asian includes Asian Indian and excludes Filipino. Other includes Native Hawaiian/Pacific Islander, American Indian and Alaska native, mixed race/ethnicity and other.
Source: American Community Survey, Public Use Microdata Sample for California, 2008.
©2010 California HealthCare Foundation
27
California Nurses Facts and Figures
Licensed Vocational Nurses
LVN Education Programs,
<< r e t u r n to c o n t e n t s
California, 2000 to 2010
LVN education programs in
Number of programs reporting NCLEX candidates*
California have more than
250
doubled since 2000, with
208
a rapid increase occuring
between 2004 and 2010.
200
150
100
79
50
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
*NCLEX is the certifying exam that all candidates for licensure as an LVN must pass.
Source: California Board of Licensed Vocational Nursing and Psychiatric Technicians.
©2010 California HealthCare Foundation
28
California Nurses Facts and Figures
Graduates of California’s LVN Education Programs,
Nonprofit vs. For-Profit Programs, 2001 vs. 2009
<< r e t u r n to c o n t e n t s
The dramatic growth in the
 Community College/
5,138
Licensed Vocational Nurses
Public Adult Ed/
Private Nonprofit Programs
 Private For-Profit Programs
number of LVN program
graduates in California has
been driven by the private,
for-profit sector. In 2001,
2,109
these programs produced
fewer than one-quarter of all
LVN graduates; by 2009 their
share had grown to nearly
1,897
3,029
60 percent of the total
number of graduates.
1,498
399
2001
2009
Note: The Integrated Postsecondary Data System (IPEDS) is administered by the federal Department of Education. It is the most complete database describing postseconday education, although not all LVN
programs report data to IPEDS.
Source: Integrated Postsecondary Education Data System (IPEDS), 2001 and 2009.
©2010 California HealthCare Foundation
29
California Nurses Facts and Figures
Licensed Vocational Nurses
Licensed Vocational Nurses, by Work Setting,
<< r e t u r n to c o n t e n t s
California, 2008
Residential Mental Health
Facility (2%)
Other*
9%
Acute Care
Hospital
29%
Ambulatory Care (2%)
Elderly Community
Care Facility (3%)
Physician’s
Office (6%)
LVNs work in a range of
settings. The two most
frequently reported are
hospitals and nursing care
facilities, but home health
agencies and offices of
physicians are also signficant
sources of employment.
Home Health
Agency
11%
Nursing
Facility
25%
Roughly 12 percent of
LVNs are reported as
employed by a professional
Professional
Employment
Service
12%
employment service, which
could cause the estimates
of employment in other
settings to be understated.
*Other includes: government (federal, state, and local) — roughly 5 percent of the workforce; psychiatric, substance abuse, and other hospitals — roughly 2.5 percent of workforce; individual and family social
service agencies; elementary and secondary schools; offices of other health care practitioners; administrative services; and facilities support services.
Note: Roughly 10 percent of LVNs are reported as employed by a professional employment service, which could cause the estimates of employment in other settings to be understated.
Source: California Employment Development Department, Staffing Patterns by Occupation and Industry.
©2010 California HealthCare Foundation
30
California Nurses Facts and Figures
<< r e t u r n to c o n t e n t s
Authors
Tim Bates, M.P.P., senior analyst, and Catherine Dower, associate
director of research, Center for the Health Professions, University
of California, San Francisco.
Data Sources
California Board of Licensed Vocational Nursing and
Psychiatric Technicians
Licensure Exam Pass Rates
www.bvnpt.ca.gov
California Board of Registered Nursing
Annual School Report, Prelicensure Interactive Database
www.rn.ca.gov
Survey of Registered Nurses, 2008
www.rn.ca.gov
California Department of Finance,
Demographic Research Unit
E-4 Population Estimates for Cities, Counties and the State,
2001– 2010, with 2000 Benchmark, May 2010
www.dof.ca.gov
Race/Ethnic Population with Age and Sex Detail, 2000 – 2050,
July 2007
www.dof.ca.gov
©2010 California HealthCare Foundation
California Employment Development Department,
Labor Market Information Division
Occupational Employment Statistics Survey
www.labormarketinfo.edd.ca.gov
Staffing Patterns by Occupation and Industry
www.labormarketinfo.edd.ca.gov
California HealthCare Foundation
“Assessing the Impact of California’s Nurse Staffing Ratios on
Hospitals and Patient Care,” February 2009
www.chcf.org
Health Resources and Services Administration,
Geospatial Data Warehouse
National Sample Survey of Registered Nurses, General Public
Use Files (1980, 1984, 1988)
datawarehouse.hrsa.gov
National Sample Survey of Registered Nurses, 1992–2008
bhpr.hrsa.gov
National Center for Education Statistics
Integrated Postsecondary Education Data System (IPEDS),
Completions Survey (2001, 2009)
nces.ed.gov/ipeds/datacenter
U.S. Census Bureau, American Community Survey
Public Use Microdata Sample for California, 2008
factfinder.census.gov
f o r m o r e i n f o r m at i o n
California HealthCare Foundation
1438 Webster Street, Suite 400
Oakland, CA 94612
C A L I FOR N I A
H EALTH C ARE
F OU NDATION
510.238.1040
www.chcf.org
31
California Nurses Facts and Figures
Appendices
Appendix A: Glossary and Survey Descriptions
Occupational Definitions
Clinical Nurse Specialist. A clinical nurse specialist’s (CNS) role is to
function as an expert in a specific clinical area, either in the direct care of
patients, or in consultation with physicians, nurses, and other hospital staff.
Area of expertise may relate to a specific patient population (e.g., neonatal,
geriatric); a work setting (e.g., intensive care unit, emergency room); or a
disease, medical subspecialty, or clinical problem (e.g., diabetes, oncology,
pain). A CNS must possess a master’s degree in a clinical field of nursing or
related to nursing.
Registered Nurse. Registered nurses treat patients, provide support
to families of patients, and educate both patients and the public about
medical conditions. RNs are responsible for tracking patient histories,
conducting diagnostic tests and analyzing results, operating medical
technologies, administering medication, and generally assisting in the care
and rehabilitation of patients. Other specific responsibilities will depend
on the work setting and whether or not the RN has received training in a
specialty area.
Source: Bureau of Labor Statistics, Occupational Outlook Handbook, 2010 –11 edition.
Sources: California Board of Registered Nursing; National Association of Clinical Nurse Specialists.
Licensed Vocational Nurse. LVNs provide patient care under the
supervision of physicians and registered nurses. Frequently, LVNs provide
basic bedside care, such as measuring and recording vital signs, preparing
and giving injections, and assisting patients with the needs of daily
living. LVNs may also collect medical samples for testing and perform
routine laboratory tests. Generally, LVNs play an important role as patient
educators and providers of support to patients’ families.
Source: Bureau of Labor Statistics, Occupational Outlook Handbook, 2010 –11 edition.
Nurse Anesthetist.* Nurse anesthetists provide the full spectrum of
anesthesia care and anesthesia-related care for patients across a variety of
health care settings (e.g., hospitals, ambulatory surgery centers, physician
offices). Nurse anesthetists must hold a master’s degree or a post-master’s
certificate from an accredited program.
Nurse-Midwife.* The certified nurse-midwife provides a full range of
primary health care services to women, including gynecologic care, family
planning services, preconception care, prenatal and postpartum care,
childbirth, and care of the newborn. Nurse-midwives may furnish medical
devices and drugs (including controlled substances) under circumstances
regulated by the state. Nurse mid-wives have attended a BRN-approved
training program (many of which award master’s degrees or post-master’s
certificates).
Nurse Practitioner.* Nurse practitioners (NPs) serve as autonomous
primary or acute health care providers. NPs diagnose and treat patients
with undifferentiated symptoms, as well as those with established
diagnoses, and provide initial, ongoing, and comprehensive care. NPs
may order, perform, supervise, and interpret laboratory and imaging
studies; prescribe medication and durable medical equipment; and make
appropriate referrals for patients and families. As of January 2008, licensed
nurse practitioners in California must possess a master’s degree in nursing.
Pre-Licensure Registered Nursing Education
Note: Pre-license RN education refers to the initial RN education; i.e.,
graduates have not yet been licensed as RNs. This is distinct from postlicense education, which describes individuals who have been licensed as
RNs and return to school for a higher degree in nursing or for advanced
training in a specialty area (e.g., programs that train clinical nurse
specialists, nurse anesthetists, nurse-midwives, and nurse practitioners).
Associate Degree in Nursing (ADN). Programs are offered mostly at
community colleges and prepare entry-level RNs to provide general care
across numerous settings. Completion time is 2 to 3 years.
Bachelor of Science in Nursing (BSN). Programs are offered at many
California State Universities and some private colleges and prepare
RNs to provide care across numerous settings, as well as to move into
administrative and leadership positions. Completion time is 4 years
(sometimes referred to as Baccalaureate degree).
<< r e t u r n to c o n t e n t s
Description of the California Board of Registered Nursing
Survey of Registered Nurses
The Survey of California Registered Nurses is an ongoing series of surveys
designed to describe licensed nurses in California and to examine changes
over time. The first study was conducted in 1990, and other studies were
completed in 1993, 1997, 2004, 2006 and 2008. The analysis presented in
this report focused exclusively on RNs with active licenses (and primarly on
those residing in California and currently employed in nursing).
The sample size of actively licensed RNs in the 2008 survey was 10,000
with a response rate of 54.4 percent, yielding information about 5,439 RNs
(4,889 RNs living in California and 550 RNs residing out-of-state). Registered
nurses in the Bay Area were oversampled at the request of the Gordon and
Betty Moore Foundation.
The following table breaks down the set of survey respondents according
to the regional geography used in this report.
Number of Sample Observations of RNs
Residing in California, by Region
California
Central Coast
Greater Bay Area
4,889
489
1,174
Inland Empire
407
Los Angeles County
442
Master’s Entry Level Program in Nursing (ELM). Designed for adults
who have a baccalaureate degree in another field and wish to become
registered nurses. Completion time is 1 to 2 years depending on how
many nursing course prerequisites already completed. Graduates receive
a master’s degree.
Northern and Sierra counties
518
Orange County
170
Sacramento Area
876
San Diego
418
Source: California Board of Registered Nursing.
San Joaquin Valley
395
Licensed Vocational Nursing Education
Note: Central Coast is Monterey, San Benito, San Luis Obispo, Santa Barbara, Santa Cruz, Ventura;
Greater Bay Area is Alameda, Contra Costa, Marin, Napa, San Francisco, San Mateo, Santa Clara,
Solano, Sonoma; Inland Empire is Riverside and San Bernardino; Northern and Sierra counties
are Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Inyo, Lake, Lassen,
Mariposa, Mendocino, Modoc, Mono, Nevada, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama,
Trinity, Tuolumne, Yuba; Sacramento Area is El Dorado, Placer, Sacramento, Yolo; San Diego
Area is Imperial and San Diego; San Joaquin Valley is Fresno, Kern, Kings, Madera, Merced,
San Joaquin, Stanislaus, and Tulare.
LVN training programs typically take 12 to 14 months to complete on a
full-time basis, or 18 to 20 months on a part-time basis. Many graduates
of LVN training programs receive an associate’s degree upon completion,
but the degree is not required for licensure. Graduates of an LVN training
program may receive a certificate of program completion.
Source: California Board of Vocational Nursing and Psychiatric Technicians.
Source: California Board of Registered Nursing, Survey of Registered Nurses, 2008.
*Source: California Board of Registered Nursing; “Final Report of the APRN Consensus Work Group
and the National Council of State Boards of Nursing APRN Advisory Committee,” July 2008.
©2010 California HealthCare Foundation
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California Nurses Facts and Figures
Appendix B: Registered Nurse Workforce, by Location of Initial RN Education
Appendices
<< r e t u r n to c o n t e n t s
and Region, California, 2008
T r a i n e d
i n
california
other
U.S. state
foreign
country
Northern and Sierra counties
71.1%
25.5%
3.5%
San Joaquin Valley
66.3%
13.6%
20.1%
Central Coast
62.4%
23.5%
14.2%
Sacramento Area
60.0%
23.6%
16.4%
Orange County
58.6%
18.6%
22.9%
Inland Empire
55.6%
21.4%
23.0%
Greater Bay Area
50.0%
28.9%
21.1%
Los Angeles County
49.4%
17.1%
33.5%
San Diego
47.3%
36.4%
16.2%
California
54.7%
23.1%
22.3%
Region
©2010 California HealthCare Foundation
33
California Nurses Facts and Figures
Appendix C: Registered Nurse Workforce, by Race/Ethnicity and Region,
Appendices
<< r e t u r n to c o n t e n t s
California, 2008
Region
White
Filipino
Latino
Asian
Mixed
African
American
Other
Northern and Sierra counties
89.5%
1.5%
3.0%
1.5%
2.8%
0.3%
1.4%
Central Coast
73.0%
12.6%
9.5%
1.8%
2.5%
0.3%
0.3%
Sacramento Area
70.2%
14.2%
3.1%
4.9%
2.0%
3.6%
2.1%
San Diego
62.5%
21.4%
7.5%
2.7%
2.6%
2.0%
1.2%
Greater Bay Area
59.7%
17.7%
3.6%
11.5%
2.4%
3.5%
1.6%
San Joaquin Valley
58.0%
16.9%
11.1%
8.9%
1.8%
1.5%
1.7%
Orange County
57.1%
22.3%
7.8%
9.5%
1.6%
0.8%
0.8%
Inland Empire
48.4%
20.6%
15.1%
6.7%
1.2%
7.7%
0.2%
Los Angeles County
35.0%
27.6%
11.2%
14.7%
1.8%
7.8%
1.8%
Notes: Asian includes Asian Indian and excludes Filipino. Other includes Native Hawaiian/Pacific Islander, American Indian and Alaska native, and other.
Source: California Board of Registered Nursing, Survey of Registered Nurses, 2008.
©2010 California HealthCare Foundation
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California Nurses Facts and Figures
Appendix D: Registered Nurses, by Select Employment Characteristics,
Appendices
<< r e t u r n to c o n t e n t s
California, 2004 to 2008
2004
2006
2008
Working full-time
67.2%
71.4%
69.4%
Working part-time
32.8%
28.6%
26.8%
n/a*
n/a*
3.8%
216,852
225,013
243,761
21.9%
17.2%
17.9%
Working as RN but unknown
full-time/part-time status
Estimated size of RN workforce
RNs working more than 1 position
*Data was not reported in 2004 and 2006.
Source: California Board of Registered Nursing, Survey of Registered Nurses, 2008.
©2010 California HealthCare Foundation
35