Need for expanded career-ladder programs to stabilize the registered nurse workforce supply

Objective: Past studies suggested an LPN/LVN-to-RN career-ladder program to stabilize the registered nurse (RN) workforce supply. Our major objective is to examine the need for an expanded career-ladder program for persons having worked in non-RN health-related positions to transition to RN positions.

Methods: We analyzed the time trends of the proportion of RNs with “prior employment in health-related positions before completing their initial RN education (PRIOR-RN)”, using the National Sample Survey of Registered Nurses (NSSRN) 1992-2008 (un-weighted/weighted N=29,800~35,600/2.2~3.1 million per year). Also, we ran multivariate logistic regression models to test our hypothesis that having a prior non-RN health-related position (with a wage lower than that of an RN) is positively associated with subsequently working as an RN (the dependent variable).

Principal Findings: Among all RNs, the proportion of PRIOR-RN increased steadily from 29% in 1992 to 37% in 2000 and substantially thereafter, i.e., 52% (2004) and 67% (2008). This large increase was caused primarily by the increase in RNs with prior non-LPN/LVN positions. For instance, the proportion for prior employment as an LPN/LVN increased from 9.5% (2000) to 14.3% (2008). The proportions for prior employment as Nursing Aide, Allied Health, and Clerk increased from 19%, 4.3%, <1.6% in 2000 to 46%, 8.6%, 8.0% in 2008, respectively. It should be noted that these proportions are not directly comparable between 2000 (in which only one prior position was listed) and 2008 (multiple prior positions listed). For instance, 26% of all RNs experienced more than one type of prior non-RN health-related positions in 2008. Still, 29% of all RNs listed Nursing Aide as the single prior health-related position in 2008, while only 14.3% listed LPN/LVN. These results indicate the importance of an expanded career-ladder program, beyond the conventional LPN/LVN-to-RN ladder program. Preliminary regression results supported our hypotheses. Prior employment as a Clerk (mean hourly wage in 2008: $12) or Nursing Aide ($12) was positively associated with working as an RN (OR=1.3~2.3, p<.05; the reference group is those without any prior health-related employment). For comparison, RN's wage was $31.

Conclusions and Policy Implications: Our analyses indicate that RNs who held prior non-RN health-related positions other than LPN/LVN increased rapidly. This group of health workers is more likely to stabilize the RN workforce supply than those without such prior experience. One policy implication is to promote an expanded career-ladder program that targets those already engaged in broader health-related positions with an interest in becoming RNs.