Registered Nurses in Colorado: 1997 Report
Table of Contents
Introduction
All Respondents
Rural (NON-MSA) Respondents Compared with Urban Respondents
Comparisons by Highest Level of Nursing Education
Introduction
This report describes the results of a survey of all registered nurses (RN's) mailed 1997 re-licensure materials by the Colorado Board of Nursing Examiners (n = 20,851). Roughly half of all RN's were surveyed inasmuch as they must re-license every other year, and annual mailings are about evenly divided in number. Thus, inferences to the total RN population of the state must be adjusted for this aspect of the process.
Re-licensure materials were returned by 17,986 (86%) nurses. Of those 17,986, 13,177 (73%) also returned the manpower survey. In order of descending frequency:
9,232 (70%) worked in Colorado;
2,099 (16%) worked outside Colorado;
1,001 (8%) lived in Colorado and did not work in nursing;
729 (6%) lived in Colorado and probably worked there; and
116 (1%) did not provide information about work or residency status.
The following report includes only RN's known to work in Colorado.
This document consists three sections with tabled data and narrative. The first depicts overall response. It will be followed by a section contrasting RN's on the basis of rural versus urban practice or employment, and then one comparing RN's by nursing education levels. Each section contains tabled data giving profiles of (1) demographic characteristics, (2) professional education, and (3) practice or work characteristics. Caution should be used in drawing inferences from the raw numbers in this report because those figures represent only a selected response from half of the State's licensed registered nurses.
All Respondents
Table 1 contains information about demographic characteristics. Only 5.1% of respondents (455) were male. This proportion was only slightly smaller than that of ethnic minorities (6.6%). About half of non-Anglo respondents were Hispanic, approximately 1 percent were Asian or Native American (Indian). In general, ethnic minorities remain profoundly underrepresented in the Colorado nursing workforce. Mean age of working RN's was 43.7 (? 9.3) years, and age was fairly normally distributed around that figure. The largest single age category was that of 40-49 years (41.5%). The majority of respondents grew up in a state other than Colorado (70.6%) or in an urban/suburban community (62.9%).
Respondents’ professional education profiles are reported in Table 2. Most nursing entry-level education occurred outside Colorado (59.1%). The baccalaureate degree was the most frequent entry credential (37.6%) as well as highest level of nursing education (43.2%). The Associate Degree was next most frequent (31.1% and 27.3% respectively). Currently, less than one RN in 10 holds a graduate degree. However, there are nearly as many RN's considering or actively pursuing graduate degrees as held them in nursing in 1997.
Practice characteristics are reported in Table 3. Small proportions of RN's reported holding Colorado licenses as certified nurse assistants (4.6%) or vocational/practical nurses (13.0%). Nearly all respondents (94.1%) had been practicing nursing two years before, most of those (93.8%) in Colorado. The primary practice/employment site for 13.2 percent was in a rural area; defined as one of Colorado's 52 non-Metropolitan Statistical Area (MSA) counties. This figure is close to the proportion of Colorado’s citizens (14%) who resided in non-MSA counties in 1997.
Although the list for designating primary clinical specialty was somewhat elaborate, it failed to capture one-quarter (25.0%) of respondent specialties (Table 3). Critical care was the most frequently reported single specialty (18.3%).
Respondents averaged 25.3 (? 16.3) hours and 10.6 (? 15.8) hours per week in direct and indirect patient care services respectively. All together, the average respondent reported 37.9 (? 14.1) average total hours per week spent in nursing work or educational activities. Twelve percent of respondents held an active nursing license in another state even though they worked in Colorado.
Nearly half (49.3%) of RN's reported themselves to be staff/office nurses (Table 3). Just 4.2% declared themselves nurse practitioners, most having family or adult specialties (28.4% and 27.1% respectively). Hospitals were the predominant work location, being the clinical setting for 54.9% of respondents
Rural (NON-MSA) Respondents Compared with Urban Respondents
Rural areas of the state were the practice/employment location for 13.2% of all respondents (Table 3). Demographic profiles for rural and urban respondents (Table 4) were virtually identical with regard to gender and age group. With regard to ethnicity, Hispanics were the only ethnic minority proportionately over-represented among RN's working in rural counties (4.3%). In contrast, Black and Asian respondents primarily worked in urban areas. Respondents working in rural areas were more likely to have been raised in Colorado (36.9% versus 28.4%) and/or in a rural community (55.2% versus 34.2%) than their urban counterparts.
Table 5 compares educational backgrounds of rural and urban respondents. More rural respondents had received their basic nursing education in Colorado (45.5%) than urban respondents (40.4%). The pattern for entry-level education differed between urban and rural respondents: the single most frequent entry-level credential for rural respondents was the Associate Degree (38.8%). Second most frequent entry-level credential for rural respondents was the Baccalaureate Degree (29.2%). In contrast, most frequently urban respondents entered nursing with a Baccalaureate Degree (38.9%); second most frequent entry-level degree was the Associate Degree (30.0%). However, there is a detectable trend toward acquiring the Baccalaureate Degree regardless of work location; this is seen as an approximately six percent increase in that credential between entry-level and highest nursing education. This same trend is echoed in the approximately 23 percent of respondents seeking higher education, although the degree sought or considered was most likely to be a graduate degree (master’s or doctoral degree) if it was in a field other than nursing.
RN's serving rural populations were somewhat more likely to have been licensed as a certified nurse aide (6.6% versus 4.1%) or licensed visiting or practical nurse (21.1% versus 11.8%) at an earlier time. There was very little difference in licensure status two years before (94% licensed), and, among those who were licensed then, to not be active in practice was rare for RN's in both rural (1.9%) and urban (1.2%) communities. A slightly greater percentage of urban RN's were either new to practice or had in- migrated to Colorado over the two year period (6.2% versus 5.5%).
The largest disparity among primary clinical specialties was observed for generalists. They comprised 13.2 percent of rural RN's versus just 4.6 percent of those serving in an MSA county. A public health specialty was also more common in rural areas (6.6% versus 2.5%). Rural RN's averaged 0.3 (25.6 ? 15.4 versus 25.3 ? 16.4) more direct patient care hours each week, but 0.5 (10.1 ? 14.1 versus 10.6 ? 16.1) fewer hours weekly in other clinically related activities. Internet utilization was greater for RN's in MSA communities for each frequency category (Table 6). Still, almost two-thirds of urban respondents (64.4%) never accessed the Internet for information. A greater percentage of rural RN's had active licenses in other states (16.8 versus 11.6%). This may simply reflect their closer geographic proximity to a border with another state.
A majority (50.0%) of RN's in urban Colorado held positions as staff/office nurses. By contrast, rural RN's were more likely to self-classify as charge nurses (16.0% versus 11.7%), nurse managers (7.2% versus 4.8%), supervisors (6.7% versus 3.7%), and administrators (4.8% versus 3.4%). Among nurse practitioners, specialty was much more diverse in urban counties, 68.8% in rural areas were family nurse practitioners. Hospitals were by far the most common work setting in both areas (56.2% urban and 46.4% rural). Long-term care was more often the site of practice/employment in rural than in urban Colorado (13.1% versus 6.4%).
Comparisons by Highest Level of Nursing Education
Table 7 portrays the demographics of RN's by highest level of education, with all graduate degrees (principally the Master’s Degree) collapsed into a single category. While entry into nursing clearly is difficult for members of ethnic minorities, those admitted have done so across the educational programs. More than half the Hispanics reported having an Associate Degree. At least half of Asian and African-American respondents reported receiving baccalaureate degrees. The number of respondents reporting baccalaureate degree attainment was inversely related to the age category (Table 7). Among the 20-29 age group, 379 (64.5% of the total) had earned that degree.
Table 8 shows that the highest proportion of respondents who were raised in Colorado reported an Associate Degree as their highest credential (39.5%); the majority (58.6%) of those same Associate-degreed respondents had received their basic nursing education in Colorado. Respondents who began their nursing careers with diplomas have been especially active educationally; about one in three (31.5%) has gone on to attain baccalaureate or graduate degrees. Current demand for additional nursing education from professionals already in the field is proportionately greatest for associate-degreed respondents (26.1%), the vast majority of whom are seeking baccalaureate degrees. Of the 14.3 percent of baccalaureate-degreed nurses who were seeking or considering further nursing education, nearly all were seeking graduate degrees.
More than one-third of respondents reporting an Associate Degree as their highest credential have been licensed in Colorado as practical nurses in the past (36.6%). Proportionately more respondents with the Associate Degree as their highest credential (18.6%) work in rural areas than do respondents with other educational credentials. Proportionately twice as many respondents with Associate Degrees or diplomas reported specialties in geriatrics or general nursing as did respondents with other credentials.
Respondents with graduate degrees as their highest credential engaged in less patient care (average, 19.2 ? 17.4 hours per week) and more non-patient care activity (average, 17.4 ? 19.6 hours per week) than any of the respondents with less education. Accordingly, more of the group with graduate degrees held advanced practice positions (nurse practitioner, 26.3%; clinical specialist, 10.3%; CRNA, 1.7%; and nurse midwife, 3.0%) and were more likely to extract information from the Internet (61.5% at least monthly). Respondents reporting the other types of educational credentials were distributed similarly across nursing positions, with most members of each group holding staff/office nurse positions. With regard to employment setting, the hospital was the clinical setting for the majority of respondents except for those with graduate degrees, the majority of whom worked either in the hospital setting (38.5%) or in private/group practice (16.2%).