The numbers leave little doubt that attention and action are required. There are 86,483 nurses with a current license in Connecticut, but only about half that number – 44,086 – are actively practicing in Connecticut, according to a just-completed analysis by the Connecticut Data Collaborative and the Center for Nursing Workforce. Of that number, 36,953 are registered nurses (RN) and 7,130 are licensed practical nurses (LPN).
It is easy to assume that with more than 80,000 licensed nurses, Connecticut has more than a sufficient number of RNs and LPNs to handle the continuing pandemic crisis and anything else that comes our way. We now understand, conclusively, that assumption would be wrong.
That is not the only alarm bell ringing. The data indicates that 7,917 nurses are age 60 or older, while only 4,390 are under age 30. The data also shows that RNs and LPNs in Connecticut have an overall median age of 47. RNs are most likely to be age 50-59, while LPNs are most likely to be age 30-39. Connecticut does not have nearly the number of younger nurses needed to replace those who will be retiring within this decade.
Statewide, seat capacity in RN programs – Associate, Baccalaureate, and Accelerated- is just over 2,800 students, which is vastly below the number of seats needed to maintain a robust and sustainable nursing pipeline. In fact, only 24% of qualified student applicants are accepted into RN programs due to near capacity enrollments and limited attrition.
Thus, the only way that Connecticut can increase annual graduation numbers for the RN would be to expand enrollments at our existing schools and programs of nursing, which will require both additional full-time and part-time faculty, simulation professionals and practice-based clinical experiences. Each nursing student at both the RN and LPN level must complete hundreds of hours of required clinical experiences in the field prior to graduation.
Connecticut has the 7th oldest population in the nation, which underscores the need for medical professionals, particularly nurses, in a variety of settings from hospitals to home care. Yet, as the population grows older, the number of nurses is not keeping pace, and some hospitals and healthcare facilities are experiencing double digit vacancy rates.
Two years ago, our organizations collaborated to issue a report entitled, “Understanding Connecticut’s Nursing Workforce- Who’s Caring for You?” that stressed the importance of devoting state resources to better understand the education, supply and demand dynamics for nursing professionals to ensure that our State can produce the numbers and types of nurses that we will need to provide safe and quality care to our residents. That imperative is even more acute today.
Work settings differ greatly between RNs and LPNs, with RNs most likely to work in a hospital (57%) or ambulatory care (13%) while LPNs work predominantly in long term care (63%) and home health (17%). LPNs are also more likely to work in community health, correctional facilities, and public health settings.
Current circumstances in Connecticut tend to thwart efforts to increase diversity, even when possible solutions are apparent. In the state workforce, the majority of nurses self-identified as White (75%), followed by Black (12%) and Hispanic or Latino (6%). There were 40,401 responses (33,920 RNs and 6,481 LPNs) to the race and ethnicity data survey question.
Of the RNs actively practicing in Connecticut, 55% have earned a baccalaureate degree, 20% have earned a master’s degree and 2% have earned a doctoral degree. Among LPNs – who are not required to obtain an associate’s or baccalaureate degree – 18% have earned an associate’s, 7% a baccalaureate and 1% a master’s degree. LPNs are required to graduate from a state-approved certificate program and pass a national licensing exam to receive their LPN license.
Only about 1 in 4 LPNs have pursued higher education after receiving their license, which points to another of the workforce challenges facing Connecticut. Many who have earned an LPN, who are substantially more likely to be individuals of color, and who might otherwise be interested in advancing to RN, are unable to do so, often because of their own limited financial resources or the limited availability of slots in RN programs. That prevents the state from achieving greater diversity among RNs and limits the total number of RNs working in Connecticut, in a variety of healthcare settings, amidst increasing need.
Among students pursing nursing, 66% of those in RN programs are White and 23% are Black or Hispanic. However, the numbers are substantially different in LPN programs, where 51% of students are Black, 20% are Hispanic and 17% are White. That suggests that expanded capacity in RN programs could have a significant effect on diversity.
Connecticut has some of the best nursing education programs in the country. Complementing the classroom/didactic elements of the curriculum, an essential component is the attainment of clinical hours in specific nursing specialties required for graduation. Coordinating these experiences has long been a challenge because of the limited number of experiences being offered and the reduction in the number of students allowed in each clinical group.
Moreover, the impact of COVID over the past two years has further reduced the number of clinical experiences available to students; in turn, limiting the number of students that can be accepted into nursing programs each year, even as the demand for graduates continues to grow.
With nursing the largest job category within healthcare in Connecticut, the financial cost to employers – and our state – of the current nursing workforce shortcomings is impacting providers and beginning to compromise access to care for our residents.
The data revealed by this analysis reflects public health, education and jobs impacts. It underscores what informed, data-based decision-making is all about – making data easily accessible and encouraging decision-makers to use the data as a basis for action. That’s what should happen next. We’ve yet to really move the needle on what needs to be done.
Michelle Riordan-Nold is Executive Director of the Connecticut Data Collaborative.
Marcia Proto, M.Ed., CAS, is Executive Director of the CT Center for Nursing Workforce and CT League for Nursing.
The data can be seen at http://nursing.ctdata.org