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The 2020 National Nursing Workforce Survey

      Background

      Every two years, the National Council of State Boards of Nursing (NCSBN) and the National Forum of State Nursing Workforce Centers (Forum) conduct the only national-level survey focused on the entire U.S. nursing workforce. The survey generates data on the supply of registered nurses (RNs) and licensed practical nurses/licensed vocational nurses (LPNs/LVNs). These data are especially crucial in providing information on emerging nursing issues which in 2020 was the significant burden placed on nurses and the healthcare system by the coronavirus (COVID-19) pandemic.

      Purpose

      To provide data critical to planning for enough adequately prepared nurses and ensuring a safe, diverse, and effective healthcare system.

      Methods

      This study used a national, randomized sample survey of 157,459 licensed RNs and 172,045 LPNs/LVNs. Data from 42,021 RN respondents and 39,765 LPN/LVN respondents were collected between February 19, 2020, and June 30, 2020. Data included nurse demographics, educational attainment, employment, practice characteristics, and trends.

      Results

      The total number of active RN and LPN/LVN licenses in the United States were 4,198,031 and 944,813, respectively. The median age of RNs was 52 years and 53 years for LPNs/LVNs. The nursing workforce has become more diverse than in any other study year as nurses between 19 and 49 years of age have introduced greater racial diversity. Findings suggest the nursing workforce is becoming increasingly more educated and experienced. An average of 83% of all nurses who maintain licensure are employed in nursing with roughly two-thirds working full-time. Hospitals and nursing/extended care facilities continue to be the primary practice setting for RNs and LPNs, respectively. More than one-fifth of all nurses reported they plan to retire from nursing over the next 5 years. Nursing incomes have remained essentially flat over time.

      Conclusion

      Employment setting, age, diversity, and education have all changed over the last 2 years. Challenges will continue in the nursing workforce such as matching workforce diversity to the population, compensation, and opportunities; preparing for the large numbers of nurses retiring; exploring the role of nurses in new practice settings; and changes in healthcare delivery modalities such as telehealth.

      Keywords

      Executive Summary

      Worldwide, the coronavirus (COVID-19) pandemic has simultaneously strained healthcare infrastructures and demonstrated the agility and resilience of frontline healthcare professionals. In the United States, significant demand has been placed on the nursing workforce as cases continue to rise (National Council of State Boards of Nursing [

      National Council of State Boards of Nursing. (2020a). Policy brief: U.S. nursing leadership supports practice/academic partnerships to assist the nursing workforce during the COVID-19 crisis. https://www. ncsbn.org/Policy_Brief_US_Nursing_Leadership_COVID19.pdf

      ). The collection of nursing data is especially crucial during this time because of the burden on our healthcare delivery systems. Evidence on the supply of nurses can be used to help curb potential shortages, guide recruitment efforts, influence policy decisions, and plan for future healthcare challenges (
      • Fraher E.P.
      • Pittman P.
      • Frogner B.K.
      • Spetz J.
      • Moore J.
      • Beck A.J.
      • Armstrong D.
      • Buerhaus P.I.
      Ensuring and sustaining a pandemic workforce.
      ).
      Since 2013, the NCSBN and the National Forum of State Nursing Workforce Centers (Forum) have collaborated every 2 years to conduct a national sample survey of registered nurses (RNs) and licensed practical nurses/licensed vocational nurses (LPNs/LVNs) in the United States. A team of scientists from both organizations developed and analyzed the data. The purpose of this study is to provide the most accurate data available on the characteristics of the U.S. nursing workforce. This study presents a national, randomized sample survey of 157,459 licensed RNs and 172,045 LPNs/LVNs. Data were collected between February 19, 2020, and June 30, 2020, from 42,021 RN respondents and 39,765 LPN/LVN respondents. Data collected included nurse demographics, educational attainment, employment, practice characteristics, and trends of the U.S. nursing workforce as of 2020. The data are also compared with data from previous Workforce Surveys. The 2020 data provide a portrait of the current state of the nursing workforce in the United States. Healthcare policy makers and leaders in nursing education and practice can use this evidence-based research when making decisions that impact the future of nursing in America.

      Selected Survey Results

      Size of the Workforce

      As of December 31, 2019, the total number of active RN licenses in the United States was 4,948,914, an increase of 309,366 (6.7%), and active LPN/LVN licenses was 996,154 (

      National Council of State Boards of Nursing. (2020b). Number of nurses in U.S. and by jurisdiction. https://www.ncsbn.org/14283.htm

      ), an increase of 20,166 (2.1%), compared to 2017. After adjusting for nurses with multiple licenses, the total number of active RNs in the United States was 4,198,031, an increase of 246,970 (6.3%), and active LPN/LVNs was 944,813 (

      National Council of State Boards of Nursing. (2020b). Number of nurses in U.S. and by jurisdiction. https://www.ncsbn.org/14283.htm

      ), an increase of 24,070 (2.6%), compared to 2017.

      Aging of the Workforce

      The median age of RNs was 52 years, up from 51 years in 2017. Nurses aged 65 years or older account for 19.0% of the RN workforce, up from 14.6% in 2017 and 4.4% in 2013. They also comprise the largest age category. The median age of LPNs/LVNs was 53 years, up from 52 years in 2017. LPNs/LVNs who are aged 65 years or older account for 18.2% of the workforce. This cohort has grown by 5.0 percentage points since 2017 and by 8.3 percentage points since 2015. The aging of the nurse workforce is expected to continue: In 2020, more than one-fifth of all nurse respondents replied positively when asked if they plan to retire in the next 5 years.

      Gender, Race, and Ethnicity

      Males accounted for 9.4% of the RN workforce, an increase of 0.3 percentage points since 2017. Additionally, males accounted for 8.1% of all LPNs/LVNs, an increase of 0.4 percentage points since 2017. In 2020, a third gender response option of “other” was added to the survey and was selected by 0.1% of nurses. Nearly 81% of RNs reported being White/Caucasian. RNs who reported being Asian accounted for 7.2% of the workforce, representing the largest non-Caucasian racial group in the RN workforce. Black/African American RNs increased from 6.0 % in 2013 to 6.7 % in 2020 and the proportion of RNs reporting being Hispanic/Latinx also increased from 2017. LPNs/LVNs who reported being Black/African American represent the second largest racial group in the workforce (17.2%) after White/Caucasian (69.5%). LPNs/LVNs who reported being Hispanic/Latinx account for 10.0% of the workforce, an increase of 2.6 percentage points since 2017.

      Education

      Approximately 42% of nurses in 2020 reported the baccalaureate nursing degree as their first U.S. nursing license, an increase of 5.8 percentage points from 2013. The percentage of respondents who initially earned a diploma or associate degree decreased by 7.5 points. Diploma (almost 50%) and associate degree (17.2%) were associated with RNs who were aged 65 years or older. Increasingly, a baccalaureate degree is more common in younger age groups for initial licensure (13.5% for RNs younger than 30 years and aged 30-34 years), which suggests the RN workforce is becoming increasingly educated at initial licensure. The most common highest level of nursing education is a baccalaureate degree across all groups (65.2% of RNs), which increased by 7.8 percentage points between 2013 and 2020. RNs achieving a doctorate of nursing practice (DNP) as their highest level of nursing education increased by a full percentage point from 0.4% in 2013 to 1.4% in 2020.
      In 2020, 81.5% of LPN/LVN respondents reported a vocational/practical certificate for their first nursing license. Interestingly, the proportion of LPNs/LVNs with an associate or baccalaureate degree increased over the years, while the number of those qualifying with a vocational/practical certificate and diploma has decreased. The highest level of nursing education reported by LPNs/LVNs were vocational/practical certificate (72%), diploma (12.2%), associate degree (12.7%), and baccalaureate degree (3.1%).

      Licensure

      Less than 1% of RNs also held an LPN/LVN license, while 6.6% held an advanced practice registered nurse (APRN) credential, which represents the highest proportion of RNs not credentialed as an APRN since 2013, dropping 3.4 percentage points since 2017. RNs responding to the survey were licensed for a median of 20 years. Most RNs (93.9%) reported receiving their entry-level nursing education in the United States and 24% reported holding a multistate license. Of those nurses reporting possession of a multistate license, 33% use that license for physical crossborder practice.
      LPN/LVN respondents reported they were licensed for a median of 17 years. In 2020, 21.2% of LPNs/LVNs reported holding a multistate license. Of those LPNs/LVNs reporting possession of a multistate license, 21.9% use that license for physical crossborder practice.

      Employment and Salary

      The major portion of responding RNs (84.1%) were actively employed in nursing, with 64.9% employed in nursing full time. This represents a 0.5% decrease in the proportion of RNs working full time from 2017 (65.4%). Hospital was the primary nursing practice setting selected by RNs (54.8%), representing a decrease of 0.9 percentage points from 2017. Ambulatory care setting was the second most frequently selected setting by 9.7% of RNs, followed by home health at 4.5% and the nursing home/extended care setting at 4.4%.
      Staff nurse was the title that most closely corresponded to the primary nursing position by 60.1% of respondents, up from 58.0% of 2017 respondents. The APRN title decreased from 10.1% in 2017 to 6.3% in 2020. In 2020, 13.4% of RNs reported their primary practice specialty was acute care/critical care, compared to 14.0% in 2017. The second most frequently selected specialty was medical- surgical at 8.5%, down from 8.6% of RN respondents in 2017. When Survey respondents were asked, “In your primary nursing practice position, do you spend the majority of your time providing direct patient care?” More than two-thirds, (68.6%) of RNs and 77.8% of LPNs/LVNs responded “yes”.
      The median pretax annual earnings for responding RNs increased from $60,000 in 2015 to $70,000 in 2020, constituting 3.3% growth in earnings during the 5-year period. Categorically, the percentage of respondents earning less than $40,000 annually decreased by 0.4 percentage points, the percentage making between $40,000 and $60,000 decreased by 3.9 percentage points. Since 2015, median earnings have risen in all states.
      Among responding LPNs/LVNs, 65.7% reported being actively employed in nursing full time, which is consistent with the 2017 survey (65.0%). The most notable increase was among those who selected retired, which increased from 8.7% in 2017 to 11.3% in 2020.
      The median pretax annual earnings for responding LPNs/LVNs increased from $38,000 in 2015 to $40,000 in 2017 and $44,000 in 2020. This constitutes a 3.2% simple annual growth in earnings during the 5-year period (0.1% lower than the growth in reported RN incomes during the same period). The largest increase has been in the $60,000 to $80,000 category, which has increased by 8.4 percentage points since 2015.

      Telehealth Utilization

      Telehealth utilization by nurses has remained relatively unchanged since 2017, with approximately 50% of RNs and LPNs/LVNs responding that they use telehealth technologies when providing nursing services. Considering that this survey was collected when healthcare delivery systems were transitioning to more telehealth due to the pandemic, it is expected that there will be a future trend toward an increase in time spent by nurses utilizing telehealth.

      Conclusion

      The nursing workforce in 2020 was more demographically diverse and representative of the country's population than in any other year in which this study was conducted. Although these data indicate that persons of color are still not adequately represented in the RN workforce, as younger nurses have entered the workforce, they have introduced greater racial diversity.
      The proportion of nurses reporting a plan to retire from nursing over the next 5 years is on the rise, so the U.S. healthcare system needs to be prepared for large numbers of nurses leaving the profession in the near future. This may be even more critical as we face the COVID-19 pandemic, which may accelerate the retirement rate given that persons older than 60 years are at increased risk for severe symptoms from COVID-19.
      The proportion of RNs holding a baccalaureate degree increased for those reporting their highest level of nursing education but remained steady for those reporting the degree held when obtaining their first nursing license. The proportion of RNs holding an associate degree when first licensed increased slightly in 2020. The proportion of LPNs/LVNs earning an associate or baccalaureate degree also increased, while those with a practical/vocational certificate or nursing diploma declined. The proportion of nurses with 10 or fewer years practicing declined according to survey respondents, while the proportion of those with between 11 and 30 years of experience grew in 2020. Evidence here suggests both RNs and LPNs/LVNs are more educated and more experienced now than in previous years.
      Nursing incomes have remained essentially flat over time, with increases that just barely beat out inflation. Of concern are greater- than-average drops in reported median income in specialties related to women and maternal-child health.
      While telehealth has become a major focus of healthcare delivery during the pandemic, it does not seem that there have been major changes to how nurses use telehealth, which may be due to the timing of this survey. It is anticipated that the use of telehealth will change a great deal in the future as our care delivery systems learn how best to utilize nursing services in this new normal.
      Over the next few years, new challenges will continue as the nursing workforce undergoes significant changes and healthcare delivery systems adjust to the pandemic. Ongoing monitoring of nursing data will be more important than ever. Ultimately, nursing will continue pursuing the goals of achieving higher levels of education, promoting diversity, and improving data collection regarding the national healthcare workforce.

      Introduction

      For the fourth time, the National Council of State Boards of Nursing (NCSBN) and the National Forum of State Nursing Workforce Centers (Forum) have collaborated on the biennial national survey of registered nurses (RNs) and licensed practical nurses/licensed vocational nurses (LPNs/LVNs). The purpose of this study is to collect information on the supply of RNs and LPNs/LVNs in the United States. This study presents a national, randomized sample survey of 157,459 licensed RNs and 172,045 LPNs/LVNs. Data were collected between February 19, 2020, and June 30, 2020, from 42,021 RN respondents and 39,765 LPN/LVN respondents. Data collected included details about nurses' demographics, educational attainment, employment, practice characteristics, and trends of the U.S. nursing workforce as of 2020. To illustrate supply trends, study results were compared to national nursing workforce studies from previous years as well as national studies from other entities that utilize different collection methods than the one described below. This consideration should be kept in mind when interpreting the comparison of statistics from various nursing workforce studies.

      Methods

      Sample

      All RNs and LPNs/LVNs with an active license in the United States and its territories were eligible to be survey participants. A portion of the sample was drawn from Nursys, NCSBN's licensure database. This database contains basic demographic and licensure information for RN and LPN/LVN licensees. Licensee lists and addresses were also obtained directly from the following boards of nursing (BONs): California (LPN/LVN), Hawaii, Indiana, Louisiana (LPN), Nevada, New Hampshire, Utah, and Wisconsin. For New York and Michigan, licensee lists and addresses were purchased from Exact Data. American Samoa and Virgin Islands chose not to participate in this survey.
      As of December 31, 2019, the total number of active RN licenses in the United States was 4,948,914 and the total number of active LPN/LVN licenses was 996,154 (

      National Council of State Boards of Nursing. (2020b). Number of nurses in U.S. and by jurisdiction. https://www.ncsbn.org/14283.htm

      ). Note that the numbers for Michigan reflect data from July 2017. Separate RN and LPN/LVN samples stratified by state were randomly selected from the RN licensees and LPN/LVN licensees. Surveys were mailed to 157,459 RNs and 172,045 LPNs/LVNs. Table 1 and Table 2 present the sampling by jurisdiction/state. Each jurisdiction is listed with the actual number of active licenses at the time of sampling and the number of surveys that needed to be received from each jurisdiction in order to construct a 95% confidence of plus or minus 3% error. Regardless of jurisdiction size, this calculated to be approximately 1,000 nurses for most states and less for the jurisdictions of Guam and the Northern Mariana Islands, respectively. To calculate the number of surveys that needed to be mailed out to reach the targeted survey response, response rates for online and paper surveys from the previous 2017 survey administration were used as estimates. For example, for Alaska in 2017 there was a 36.7% response rate for the RN survey. Given this estimated response rate, 2,728 RNs in Alaska were selected to be survey recipients in order to receive the target of 1,000 surveys. Actual response from Alaska RNs to the current survey (i.e., the number of responses returned) was 773, a response rate of 29.1%.
      Table 1RN Sampling: Number of Active RN Licenses
      JurisdictionNumber of Active

      RN Licenses
      Target

      sample
      Estimated total

      response rate
      Number of

      surveys mailed
      UndeliverableNumber

      Delivered
      Number of

      Responses
      Total

      Response Rate
      AK15,4871,00036.7%2,728692,65977329.1%
      AL85,7461,00027.2%3,673303,64395226.1%
      AR42,4871,00028.5%3,5042983,20676123.7%
      AZ93,9281,00032.4%3,0874142,67356121.0%
      CA444,9641,00031.5%3,177483,12981125.9%
      CO77,7051,00036.6%2,7341682,56668226.6%
      CT67,9241,00032.9%3,041273,01482027.2%
      DC27,5751,00028.3%3,532923,44080923.5%
      DE18,6741,00031.8%3,145123,13394730.2%
      FL316,5571,00026.1%3,832873,74586523.1%
      GA132,9221,00029.8%3,356713,28580024.4%
      HI24,6521,00032.8%3,050343,01692530.7%
      IA55,3551,00038.4%2,606302,57680931.4%
      ID22,9121,00039.6%2,523262,49789435.8%
      IL207,0011,00032.3%3,099683,03179026.1%
      IN116,2641,00033.5%2,988302,95895132.2%
      KS58,7811,00034.1%2,930232,90791131.3%
      KY71,6031,00029.7%3,371133,35887326.0%
      LA69,6991,00030.1%3,3191243,19560118.8%
      MA138,4811,00032.2%3,107413,06681726.6%
      MD82,6861,00033.3%3,000602,94076225.9%
      ME25,8071,00038.6%2,592292,56383832.7%
      MI149,8641,00039.1%2,558402,51886534.4%
      MN115,0681,00040.0%2,500252,47580632.6%
      MO113,0321,00030.0%3,333503,2831,09433.3%
      MS50,1031,00026.5%3,773613,71280121.6%
      MT18,3911,00046.3%2,161502,11184339.9%
      NC139,4521,00032.2%3,109463,06378925.8%
      ND16,0461,00043.7%2,289342,25583637.1%
      NE31,0001,00036.7%2,725312,69490533.6%
      NH24,2171,00035.4%2,8231842,63941115.6%
      NJ133,0291,00031.9%3,134973,03756818.7%
      NM28,7151,00035.0%2,861892,77282529.8%
      NV45,2541,00031.9%3,1381003,03872723.9%
      NY358,9011,00026.1%3,832943,73873719.7%
      OH211,7691,00032.4%3,085153,07089029.0%
      OK51,1101,00027.8%3,595573,53897827.6%
      OR65,3331,00039.8%2,510322,47871628.9%
      PA225,8521,00035.6%2,807362,77183630.2%
      RI25,0141,00033.7%2,970732,89780327.7%
      SC71,3921,00029.7%3,368843,28481724.9%
      SD18,4731,00040.5%2,471282,44382533.8%
      TN104,7801,00027.5%3,633523,58188124.6%
      TX336,5201,00024.4%4,106664,04087921.8%
      UT35,9311,00025.2%3,976913,8851,12629.0%
      VA107,4951,00031.4%3,185443,14183526.6%
      VT16,9911,00037.5%2,668292,63978129.6%
      WA105,5261,00039.3%2,5481462,40277232.1%
      WI105,8981,00046.0%2,1741172,05772135.1%
      WV31,4731,00026.7%3,751263,72594425.3%
      WY9,2131,00042.3%2,365532,31279534.4%
      Guam1,52817523.1%7585070815822.3%
      Northern

      Mariana

      Islands
      4,33416419.0%8617278910513.3%
      TOTAL4,948,91451,33932.6%157,4593,764153,69542,02127.3%
      Note. RN = registered nurse.
      Table 2LPN/LVN Sampling: Number of Active LPN/LVN Licenses
      JurisdictionNumber of Active

      LPN/LVN

      Licenses
      Estimated

      sample: 95%

      confidence,

      3% error
      Estimated total

      response rate
      Number of

      surveys

      mailed
      UndeliverableNumber

      Delivered
      Number of

      Responses
      Total

      Response

      Rate
      AK84517424.8%7015065114322.0%
      AL18,6271,00027.3%3,660823,57886724.2%
      AR14,5951,00025.2%3,9613703,59180722.5%
      AZ10,5061,00026.5%3,7706513,11952716.9%
      CA102,8511,00023.5%4,2511424,10977919.0%
      CO8,4231,00030.7%3,2522762,97662821.1%
      CT12,7571,00021.6%4,638984,54094620.8%
      DC1,95728719.9%1,442711,37120915.2%
      DE3,04070323.3%3,0151662,84957620.2%
      FL61,6241,00019.9%5,0231464,8771,03921.3%
      GA29,8611,00022.6%4,424974,32794421.8%
      HI1,83658729.9%1,961391,92262932.7%
      IA9,8321,00031.7%3,158703,08890529.3%
      ID3,6261,00031.4%3,183833,10096931.3%
      IL26,2041,00027.2%3,670843,58677021.5%
      IN24,3561,00025.0%3,9961033,8931,04726.9%
      KS10,4031,00028.6%3,499773,42297528.5%
      KY13,2691,00024.4%4,104404,06492422.7%
      LA22,7111,00019.4%5,156495,1071,05120.6%
      MA19,7211,00023.6%4,237524,18591221.8%
      MD11,6991,00023.6%4,2421434,09982420.1%
      ME1,99468736.0%1,908591,84954129.3%
      MI24,2371,00030.8%3,251743,17787827.6%
      MN21,0171,00040.2%2,489332,45673229.8%
      MO24,7371,00023.3%4,2981374,1611,22229.4%
      MS14,3331,00023.0%4,3481144,2341,07125.3%
      MT2,63670943.5%1,629521,57759537.7%
      NC22,5431,00030.3%3,301763,22580825.1%
      ND3,58493841.2%2,276592,21777134.8%
      NE5,4791,00035.7%2,800152,78590032.3%
      NH3,15727726.6%1,0419195015115.9%
      NJ23,8861,00023.3%4,3001104,19079118.9%
      NM2,60973329.5%2,4871502,33752022.3%
      NV4,2561,00026.7%3,7422133,52977321.9%
      NY82,3021,00019.5%5,121935,0281,19023.7%
      OH54,1941,00029.3%3,411903,32176323.0%
      OK16,3821,00021.4%4,663964,5671,03022.6%
      OR5,8011,00029.7%3,3691123,25779824.5%
      PA53,8911,00030.6%3,273553,21887927.3%
      RI2,28660827.0%2,252852,16746021.2%
      SC12,1311,00024.8%4,0281113,91794224.0%
      SD2,63489635.9%2,498612,43774530.6%
      TN30,2971,00023.3%4,293724,22193622.2%
      TX107,3681,00021.2%4,7181244,59486218.8%
      UT2,80658121.1%2,758912,66765224.4%
      VA27,3831,00022.8%4,3791104,26984819.9%
      VT2,53362526.0%2,4001992,20149822.6%
      WA11,4341,00028.8%3,4762713,20586427.0%
      WI12,4351,00039.7%2,516512,46588836.0%
      WV7,8151,00021.9%4,575774,49889920.0%
      WY96431633.8%9354788825428.6%
      Guam2352318.1%12751222318.9%
      Islands52820.5%395341029.4%
      TOTAL996,15445,15228.0%172,0455,828166,21739,76523.9%
      Note. LPN/LVN= licensed practical nurse/licensed vocational nurse.

      Survey Instrument and Materials

      The survey instrument is based on the Forum's Nurse Supply Minimum Data Set (MDS), which was approved in 2009 after an intensive process of consensus-building and data compilation on the nursing workforce at the state level. The Nurse Supply MDS was last updated by the Forum in 2016 to account for the transformations that occurred in healthcare and nursing during the past decade (

      The National Forum of State Nursing Workforce Centers. (2016). Minimum nurse supply dataset. https://www.nursingworkforcecenters.org/ wp-content/uploads/2020/10/National-Forum-Supply-Minimum- Dataset_September-2016.pdf

      ). Additionally, the 2020 survey instrument includes three new questions regarding the Nurse Licensure Compact (NLC; Appendix A). The survey was a four-page Scantron document with 38 questions. Data elements from the latest revision of the Nurse Supply MDS were incorporated, resulting in the following changes to the survey between the 2017 and 2020 waves of data collection:
      • A “Middle Eastern/North African” category was added as a race response option and “other” was added as a gender response option
      • Respondents were asked specifically about where they received their entry-level nursing education and where they received their initial license
      • A question about plans to leave nursing was added
      • A question about whether the nurse provided direct patient care was added
      • Questions about the NLC were added.

      Procedure

      The Western Institutional Review Board granted approval for the current study. A unique identification number was generated and assigned to each sampled participant. The identification number was only to be used to record that the survey had been returned. This helped prevent unnecessary and expensive duplicate mailings to those selected to participate in the study. The unique access code identifier was also used for the online survey option. Once materials were developed and the sampling file was complete, surveys were distributed over a 20-week period starting the week of February 17, 2020, that included the following steps:
      • Weeks 1-2: A cover letter and paper survey were mailed via first-class U.S. mail to all nurses selected to participate. The letter included a URL and access code to take the survey online.
      • Week 6: For nurses who had not responded, a cover letter, paper survey, and pre-paid reply envelope were mailed via first class U.S. mail.
      • Week 10: For nurses who still had not responded, an additional cover letter, paper survey, and pre-paid reply envelope were mailed via first-class U.S. mail.
      • Week 20: Deadline for receipt of all surveys. Once the survey was closed, the final data file was compiled separately for RNs and LPNs/LVNs.
      Survey response data are kept on department-secured servers. NCSBN's research staff, three key members of the Forum, and key personnel at Scantron had initial access to the identifiable data. Scantron no longer has access to the identifiable data.
      The functioning of the survey was impacted by COVID-19. Details of the impact are presented in Appendix B.

      Analysis

      At the close of the survey, 42,021 of 153,695 successfully delivered RN surveys were returned, yielding a response rate of 27.3%. There were 39,765 of 166,217 successfully delivered LPN/LVN surveys returned, resulting in a 23.9% response rate. A formal nonresponse bias analysis was conducted immediately following the close of the survey. An analysis of basic demographic data (i.e., gender, age, and race/ethnicity) for all RN licensees sampled from the Nursys database was used to compare survey respondents to survey nonrespondents. Results revealed White/Caucasian nurses, female nurses, and nurses aged 50 years or older may have been slightly overrepresented in both the RN and LPN/LVN samples. Because of missing or incomplete data on race/ethnicity, only gender and age were used to make nonresponse weighting adjustments. Additionally, since sampling was stratified by state, to prevent smaller states from being overrepresented in the overall analysis, a weighting variable was constructed to adjust for differing nursing population sizes across states. A description of this process can be found in Appendix C.
      For an accurate and comprehensive view of the statistics drawn from the sample, the number of actual valid answers to each question is reported for every table. Missing data were not imputed; hence, the presented statistics represent the actual responses from participants who responded to each respective survey item. If a participant did not respond to a certain item, they were not part of the analysis for that item. Additionally, some tables display data for all responding nurse licensees while other tables display data for employed nurses. If a table is specific to nurses employed in nursing, it is explicitly stated. Many tables include bar graphs to help you easily visualize and comprehend the data presented.

      Population Estimate

      For each question on the survey, frequencies are shown that reflect the nonresponse weighting adjustments. For some of the questions, an additional set of frequencies are shown that display the data scaled up to reflect estimates of the nursing population in the subgroup identified. For example, the 391,141 males reported in the 2020 column of Table 3 reflect the number of male respondents adjusted to the population level of the number of RNs after the nonresponse weighting adjustments were made to the survey results, and after adjusting the population number to account for nurses having licenses in multiple states.
      Table 3Gender Distribution of Registered Nurses, 2013-2020
      Weighted Sample Values
      Gender2013 (n = 40,364.5)2015 (n = 43,330.9)2017 (n = 48,084.9)2020 (n= 41,698.8)
      n%n%n%n%
      Male2,678.9 6.63,459.6 8.04,369.3 9.13,915.29.4
      Female37,685.6 93.439,871.4 92.043,715.5 90.937,739.990.5
      Other43.60.1
      Estimated Population Values
      Gender2013201520172020
      n%n%n%n%
      Male221,4166.6277,5428.0354,4539.1391,1419.4
      Female3,114,76793.43,198,65092.03,546,32190.93,770,33690.5
      Other4,3560.1
      Note. “Other” was added as a response option with the 2020 survey.
      The adjustments for multiple licenses were derived from data in the Nursys database in December 2019. At that time, the database contained 4,948,914 RN licenses, which corresponded to 4,198,031 unique RNs. The number of RN survey responses was 42,021. This produced an RN population adjustment factor of 4,198,031/42,021 = 99.90, which was multiplied by sample counts to produce population estimates.
      For LPNs/LVNs, the December 2019 database contained 996,154 licenses, which corresponded to 944,813 unique LPNs/LVNs. The number of LPN/LVN survey responses was 39,765. This produced an LPN/LVN population adjustment factor of 944,813/39,765 = 23.76, which was multiplied by sample counts to produce population estimates.

      Registered Nurse Results

      Gender

      Males accounted for 9.4% of the RN workforce, which is an increase of 0.3 percentage points from 2017 and 2.8 percentage points from 2013. In 2020, respondents were able to select “other” in response to the gender question on the survey, and it was selected by 0.1% of nurses (Table 3).

      Age

      The median age of RNs was 52 years. Although the median age of the workforce has remained approximately the same since 2013, the age distribution of the workforce has changed substantially. Nurses who are aged 65 years or older account for 19% of the RN workforce and comprise the largest age category. The proportion of nurses aged 65 years or older increased by 5.1 percentage points from 2013 and by 4.4 percentage points from 2017 (Table 4 and Figure 1).
      Table 4Age Distribution of Registered Nurses, 2013-2020
      Weighted Sample Values
      Age in Years2013 (n =

      34,793.9)
      2015 (n

      = 41,258.6)
      2017 (n

      = 47,527.3)
      2020 (n =

      39.899.2)
      n%n%n%n%
      18-292,997.98.63,905.29.54,594.59.73,349.58.4
      30-342,615.47.54,098.09.94,762.810.03,792.09.5
      35-392,784.08.03,928.19.54,390.69.24,006.210.0
      40-443,088.68.94,200.710.24,356.79.23,645.99.1
      45-493,379.39.74,398.210.75,250.711.13,956.59.9
      50-544,652.613.44,724.811.54,914.910.34,191.610.5
      55-595,887.716.95,622.413.65,834.412.34,502.011.3
      60-644,570.113.15,254.912.76,489.813.74,884.212.2
      654,818.413.95,126.312.46,932.914.67,571.319.0
      Estimated Population Values
      Age in Years2013201520172020
      n%n%n%n%
      18-29247,7788.6313,2919.5372,7169.7334,6268.4
      30-34216,1647.5328,7599.9386,37410.0378,8339.5
      35-39230,0988.0315,1279.5356,1759.2400,23210.0
      40-44255,2818.9337,00010.2353,4309.2364,2379.1
      45-49279,3059.7352,84310.7425,95311.1395,2679.9
      50-54384,54313.4379,04111.5398,71210.3418,75410.5
      55-59486,62516.9451,05113.6473,30312.3449,76411.3
      60-64377,72413.1421,57412.7526,46813.7487,94712.2
      ≥ 65398,24713.9411,25612.4562,41414.6756,39719.0
      Figure 1
      Figure 1Age Distribution of Registered Nurses, 2013-2020

      Age by Gender

      The proportion of female RNs in the 65 years or older cohort is almost double of total male RNs, while almost half of male RNs are in 35 to 54 aged cohort (Table 5).
      Table 5Age Distribution of Registered Nurses by Gender, 2020
      Weighted Sample Values
      Age in YearsMale (n

      =3,690.6)
      Female (n =

      36,004.7)
      Other (n

      = 36.4)
      Total (n =

      39,731.7)
      n%n%n%n%
      19-29316.28.63,021.28.45.916.33,343.38.4
      30-34353.19.63,429.49.57.620.83,790.19.5
      35-39483.313.13,511.49.87.319.94,002.010.1
      40-44431.611.73,207.38.91.43.83,640.39.2
      45-49449.212.23,480.59.78.423.23,938.19.9
      50-54479.813.03,690.310.30.00.04,170.110.5
      55-59393.010.74,088.711.40.00.04,481.711.3
      60-64355.29.64,502.512.50.00.04,857.712.2
      ≥ 65429.111.67,073.419.75.818.97,508.418.9

      Race/Ethnicity

      The racial composition of the RN workforce in 2020 is nearly identical to that in 2017. Nearly 81% of nurses reported being White/ Caucasian.
      Nurses who reported being Asian accounted for 7.2% of the workforce. Although this is a slight decrease (0.3 percentage points) from 2017, nurses who reported being Asian represent the largest non-White/Caucasian racial group in the workforce. The proportion of RNs who reported being Black/African American accounted for 6.7% of the workforce, which is an increase of 0.5 percentage points from 2017 (Table 6).
      Table 6Race of Registered Nurses, 2017-2020
      Weighted Sample Values
      Race2017 (n= 47,966.3)2020 (n =41,702.0)
      n%n%
      American Indian or Alaska Native176.00.4194.10.5
      Asian3,605.67.52,996.37.2
      Black/African American2,995.96.22,800.76.7
      Native Hawaiian or other Pacific Islander226.30.5175.90.4
      Middle Eastern/North African89.40.2
      White/Caucasian38,766.180.833,595.180.6
      Other1,367.82.9967.72.3
      More than one race category selected828.51.7882.82.1
      Estimated Population Values
      Race20172020
      n%n%
      American Indian or Alaska Native14,2760.419,3910.5
      Asian292,4977.5299,3407.2
      Black/African American243,0326.2279,7996.7
      Native Hawaiian or other Pacific Islander18,3620.517,5730.4
      Middle Eastern/North African8,9310.2
      White/Caucasian3,144,81280.83,356,25780.6
      Other110,9602.996,6762.3
      More than one race category selected67,2141.788,1952.1
      Note. Respondents were asked to select all that apply. The responses were subsequently recoded to ensure that the race categories were mutually exclusive. Respondents selecting multiple race categories were reclassified into the “More than one race category selected” category. For the 2020 survey, “Middle Eastern/North African” was added as a response category.

      Hispanic/Latinx Ethnicity

      The proportion of RNs reporting being Hispanic/Latinx was 5.6%, which is an increase of 0.3 percentage points compared to 2017 (Table 7).
      Table 7Hispanic or Latinx Ethnicity of Registered Nurses, 2013-2020
      Weighted Sample Values
      Hispanic or

      Latinx
      2013 (n = 41,876.0)2015 (n = 45,989.3)2017 (n = 47,852.6)2020 (n = 41,483.3)
      n%n%n%n%
      Yes1,406.63.41,654.03.62,528.15.32,335.95.6
      No40,469.596.644,335.396.445,324.594.739,147.494.4
      Note. In the 2013 and 2015 surveys, the Hispanic/Latino origin and race categories were combined into one question. The categories were separated for the 2017 and 2020 surveys.

      Race/Ethnicity by Gender

      Although male nurses account for only 9.4% of the RN workforce, male nurses account for a disproportionately high proportion of all non-White/Caucasian racial groups: male nurses account for 13.6% of all multiracial nurses and 34.3% of nurses identifying as Native Hawaiian or other Pacific Islanders (Table 8).
      Table 8Race of Registered Nurses by Gender, 2020
      Weighted Sample Values
      RacenMaleFemaleOther
      n%n%n%
      American Indian or Alaska Native189.513.67.2175.992.80.00.0
      Asian2,985.5470.015.72,514.384.21.20.0
      Black/African American2,785.1306.011.02,477.188.91.90.1
      Native Hawaiian or other Pacific Islander175.960.434.3115.565.70.00.0
      Middle Eastern/North African88.316.919.171.480.90.00.0
      White/Caucasian33,478.92,779.08.330,672.691.627.40.1
      Other962.2125.513.0824.985.711.81.2
      More than one race category selected872.5118.813.6752.586.21.30.2
      Total41,538.03,890.29.437,604.190.543.60.1
      Note. Respondents were asked to select all that apply. The responses were subsequently recoded to ensure that the race categories were mutually exclusive. Respondents selecting multiple race categories were reclassified into the “More than one race category selected” category. For the 2020 survey, “Middle Eastern/North African” was added as a response category.

      Race by Age

      Although younger nurses are generally more racially diverse than older nurses, the youngest RNs (aged 19 to 29 years) are notably less diverse than RNs aged between 30 and 49 years. As compared to the next oldest cohort of nurses (aged 30 to 34 years), the youngest nurses are less likely to be Asian, Black/African American, Native Hawaiian or other Pacific Islander, or multiracial. The proportion of nurses ages 19-29 years who identify as White/Caucasian (84.1%) is higher than the proportion of White/Caucasian nurses in any other cohort younger than 60 years (mean = 75.1%, highest = 76.8%) and higher than the proportion of White/Caucasian nurses in the RN workforce as a whole (80.7%) (Table 9).
      Table 9Race Distribution of Registered Nurses by Age, 2020
      Weighted Sample Values
      Age in

      Years
      nn (%)
      American

      Indian or

      Alaska

      Native
      AsianBlack/

      African

      American
      Native Ha-

      waiian or

      Other Pacif

      ic Islander
      Middle

      Eastern/

      - North

      African
      White/

      Caucasian
      OtherMore Than

      One Race
      19-293,334.012.7 (0.4)204.8 (6.1)143.0 (4.3)7.9 (0.2)5.4 (0.2)2,804.5 (84.1)51.9 (1.6)103.6 (3.1)
      30-343,787.012.4 (0.3)397.6 (10.5)205.2 (5.4)21.6 (0.6)9.8 (0.3)2,908.6 (76.8)103.4 (2.7)128.4 (3.4)
      35-393,990.722.2 (0.6)315.5 (7.9)281.7 (7.1)44.2 (1.1)9.3 (0.2)3,054.7 (76.6)128.9 (3.2)134.1 (3.4)
      40-443,641.321.0 (0.6)328.5 (9.0)317.8 (8.7)10.4 (0.3)14.4 (0.4)2,781.3 (76.4)75.7 (2.1)92.2 (2.5)
      45-493,939.319.8 (0.5)547.9 (13.9)342.2 (8.7)24.5 (0.6)12.8 (0.3)2,782.4 (70.6)142.4 (3.6)67.4 (1.7)
      50-544,171.126.6 (0.6)347.7 (8.3)323.9 (7.8)23.2 (0.6)6.4 (0.2)3,245.2 (77.8)96.4 (2.3)101.6 (2.4)
      55-594,491.422.2 (0.5)195.3 (4.4)314.2 (7.0)10.9 (0.2)11.8 (0.3)3,772.3 (84.0)96.5 (2.2)68.1 (1.5)
      60-644,849.020.0 (0.4)255.6 (5.3)283.1 (5.8)24.5 (0.5)7.7 (0.2)4,113.4 (84.8)76.3 (1.6)68.4 (1.4)
      657,542.528.8 (0.4)275.7 (3.7)434.8 (5.8)6.2 (0.1)7.2 (0.1)6,606.3 (87.6)116.3 (1.5)67.3 (0.9)
      Total39,746.2185.8 (0.5)2,868.6 (7.2)2,646.0 (6.7)173.5 (0.4)84.9 (0.2)32,068.5 (80.7)887.8 (2.2)831.2 (2.1)
      Note. Respondents were asked to select all that apply. The responses were subsequently recoded to ensure that the race categories were mutually exclusive. Respondents selecting multiple race categories were reclassified into the “More than one race category selected” category. For the 2020 survey, “Middle Eastern/North African” was added as a response category.

      Education

      Type of Nursing Degree or Credential for First U.S. Nursing License

      The percentage of nurses reporting the baccalaureate as the nursing degree that qualified them for their first U.S. nursing license increased by 5.8 percentage points between 2013 and 2020, although this rate remained unchanged from 2017. The percent of respondents who initially earned a diploma or associate degree decreased by 7.5 points during the same period (Table 10 and Figure 2).
      Table 10Type of Nursing Degree or Credential of Registered Nurses for First U.S. Nursing License, 2013-2020
      Weighted Sample Values
      Nursing Degree or Credential2013 (n =

      41,747.9)
      2015 (n =

      45,758.5)
      2017 (n

      = 47,650.0)
      2020 (n =

      41,383.6)
      n%n%n%n%
      Vocational/practical certificate1,993.84.82,442.15.32,850.66.02,382.85.8
      Diploma7,364.617.66,539.314.35,708.112.04,581.211.1
      Associate degree16,152.038.717,625.938.517,332.536.415,611.537.7
      Baccalaureate degree15,019.536.017,853.439.019,922.741.817,313.641.8
      Master's degree1,218.02.91,297.92.81,836.03.91,494.53.6
      Estimated Population Values
      Nursing Degree or Credential2013201520172020
      n%n%n%n%
      Vocational/practical certificate164,7934.8195,9165.3231,2476.0238,0495.8
      Diploma608,69217.6524,60714.3463,06012.0457,67611.1
      Associate degree1,334,98738.71,414,02038.51,406,06236.41,559,63837.7
      Baccalaureate degree1,241,37936.01,432,27139.01,616,18641.81,729,68341.8
      Master's degree100,6732.9104,1212.8148,9423.9149,3053.6
      Figure 2
      Figure 2Type of Nursing Degree or Credential of Registered Nurses for First U.S. Nursing License

      Type of Nursing Degree or Credential for First U.S. Nursing License by Age

      Two degrees are associated with older RNs: diploma (almost 50% are aged 65 years or older) and associate degree (17.2% are aged 65 years or older). A baccalaureate degree is increasingly more common in younger age groups as the education qualifier for initial licensure (13.5% are younger than 30 years; and 13.5% are aged 30 to 34 years). This suggests the workforce is becoming increasingly educated at initial licensure (Table 11).
      Table 11Type of Nursing Degree or Credential of Registered Nurses for First U.S. Nursing License by Age, 2020
      Weighted Sample Values
      Nursing Degree or CredentialnAge in Years, n

      (%)
      19-2930-3435-3940-4445-4950-5455-5960-64> 65
      Vocational/practical certificate2,305.595.0140.7212.6239.0254.6227.4280.0328.5527.8
      (4.1)(6.1)(9.2)(10.4)(11.0)(9.9)(12.1)(14.3)(22.9)
      Diploma4,422.585.589.0151.1127.7198.8278.5544.8748.42,198.6
      (1.9)(2.0)(3.4)(2.9)(4.5)(6.3)(12.3)(16.9)(49.7)
      Associate degree14,947.0890.81,181.71,533.21,563.11,577.71,809.11,879.91,946.62,564.9
      (6.0)(7.9)(10.3)(10.5)(10.6)(12.1)(12.6)(13.0)(17.2)
      Baccalaureate degree16,417.42,208.82,218.21,889.91,491.31,694.21,667.71,596.71,642.12,008.6
      (13.5)(13.5)(11.5)(9.1)(10.3)(10.2)(9.7)(10.0)(12.2)
      Master's degree1,367.950.4143.9193.8180.2185.2162.7141.8156.4153.6
      (3.7)(10.5)(14.2)(13.2)(13.5)(11.9)(10.4)(11.4)(11.2)
      Total39,460.43,330.53,773.53,980.63,601.33,910.44,145.44,443.34,822.07,453.5
      (8.4)(9.6)(10.1)(9.1)(9.9)(10.5)(11.3)(12.2)(18.9)

      Highest Level of Nursing Education

      The percentage of RNs reporting a baccalaureate degree as their highest level of nursing education increased by 7.8 percentage points between 2013 and 2020. Additionally, the percentage of RNs reporting a graduate degree as their highest level of nursing education increased by 2.1 percentage points. The percentage of RNs reporting a diploma or associate degree declined by 9.9 percentage points. Overall, 65.2% of RNs report their highest level of nursing education as a baccalaureate degree or higher in 2020. RNs earning a doctorate of nursing practice (DNP) as their highest level of nursing education increased by a full percentage point from 0.4% in 2013 to 1.4% in 2020 (Table 12 and Figure 3).
      Table 12Highest Level of Nursing Education of Registered Nurses, 2013-2020
      Weighted Sample Values
      Nursing Education Level2013 (n =

      35,016.5)
      2015 (n =

      38,625.9)
      2017 (n =

      48,140.7)
      2020 (n =

      41,571.5)
      n%n%n%n%
      Diploma4,319.412.33,551.39.23,547.77.42,782.86.7
      Associate degree11,331.632.411,608.830.113,729.128.511,683.228.1
      Baccalaureate degree14,097.040.316,762.543.421,744.145.219,998.548.1
      Master's degree4,846.013.86,085.115.88,238.317.16,200.514.9
      Doctoral degree: PhD217.00.6340.20.9284.10.6281.20.7
      Doctoral degree: DNP142.50.4239.10.6551.21.1569.11.4
      Doctoral degree: nursing other62.90.239.00.146.10.156.10.1
      Note. In the 2013 and 2015 surveys a single question “What is your highest level of education?” was asked with the set of possible responses including both nursing and non-nursing degrees. The degree types were separated for the 2017 and 2020 surveys. PhD = doctor of philosophy; DNP = doctor of nursing practice.
      Figure 3
      Figure 3Highest Level of Nursing Education of Registered Nurses

      Highest Level of Nursing Education by Gender

      In terms of highest level of education, the education level with the largest proportion of males was those with a DNP at 13.9%. The education levels with the largest proportion of females were those with a Diploma at 95.9% and those with a PhD at 95.7% (Table 13.)
      Table 13Gender of Registered Nurses by Highest Level of Nursing Education, 2020
      Weighted Sample Values
      Nursing Education LevelnMaleFemaleOther
      n%n%n%
      Diploma2,758.1111.94.12,646.295.90.00.0
      Associate degree11,627.61,214.810.510,411.189.51.70.0
      Baccalaureate degree19,934.71,804.89.118,100.190.829.70.2
      Master's degree6,179.2651.210.55,515.889.312.20.2
      Doctoral degree—PhD279.712.14.3267.695.70.00.0
      Doctoral degree—DNP565.678.713.9486.986.10.00.0
      Doctoral degree—nursing other56.13.86.852.393.20.00.0
      Total41,401.03,877.39.437,480.090.543.60.1
      Note. In the 2013 and 2015 surveys, a single question “What is your highest level of education?” was asked with the set of possible responses including both nursing and non-nursing degrees. The degree types were separated for the 2017 survey. PhD = doctor of philosophy; DNP = doctor of nursing practice.

      Highest Level of Nursing Education by Race

      The most common highest level of nursing education is a baccalaureate degree across all groups. Asian RNs are more likely to have a baccalaureate degree (67.0%) as compared to the overall population of RNs (48.1%) (Table 14).
      Table 14Highest Level of Nursing Education of Registered Nurses by Race, 2020
      Weighted Sample Values
      RacenDiplomaAssociateBaccalaureateMaster'sDoctoral

      (PhD)
      Doctoral

      (DNP)
      Doctoral

      (Other)
      American Indian or Alaska191.915.3 (8.0)67.4 (35.1)79.9 (41.7)24.1 (12.6)0.0 (0.0)5.2 (2.7)0.0 (0.0)
      Native
      Asian2,974.791.5 (3.1)420.3 (14.1)1,991.9 (67.0)433.8 (14.6)12.4 (0.4)17.8 (0.6)6.9 (0.2)
      Black/African American2,757.676.5 (2.8)676.4 (24.5)1,335.7 (48.4)570.6 (20.7)30.0 (1.1)60.7 (2.2)7.7 (0.3)
      Native Hawaiian or other175.94.9 (2.8)30.9 (17.6)103.5 (58.8)25.2 (14.3)0.0 (0.0)11.4 (6.5)0.0 (0.0)
      Pacific Islander
      Middle Eastern/North88.61.2 (1.4)23.2 (26.2)46.8 (52.8)13.3 (15.0)0.0 (0.0)4.1 (4.6)0.0 (0.0)
      African
      White/Caucasian33,409.52,551.4 (7.6)9,899.3 (29.6)15,397.5 (46.1)4,847.4 (14.5)227.2 (0.7)445.2 (1.3)41.5 (0.1)
      Other933.414.9 (1.6)287.1 (30.8)500.8 (53.7)115.3 (12.4)2.3 (0.2)13.0 (1.4)0.0 (0.0)
      More than one race cate-869.515.8 (1.8)224.7 (25.8)460.5 (53.0)150.9 (17.4)8.5 (1.0)9.0 (1.0)0.0 (0.0)
      gory selected
      Total41,401.12,771.6 (6.7)11,629.3 (28.1)19,916.6 (48.1)6,180.6 (14.9)280.4 (0.7)566.5 (1.4)56.1 (0.1)
      Note. In the 2013 and 2015 surveys, a single question “What is your highest level of education?” was asked with the set of possible responses including both nursing and non-nursing degrees. The degree types were separated for the 2017 and 2020 surveys. For the race question, respondents were asked to select all that apply. The responses were subsequently recoded to ensure that the race categories were mutually exclusive. Respondents selecting multiple race categories were reclassified into the “More than one race category selected” category. For the 2020 survey, “Middle Eastern/North African” was added as a response category. PhD = doctor of philosophy; DNP = doctor of nursing practice.

      Highest Level of Nursing Education by Age

      More than half of respondents whose highest level of nursing education is a diploma are aged 65 years or older. Conversely, those reporting a baccalaureate degree as their highest level of education tend to be younger than 35 years (12.8% are younger than 30 years of age; 12.8% are between 30 and 34 years of age) (Table 15).
      Table 15Age of Registered Nurses by Highest Level of Nursing Education, 2020
      Weighted Sample Values
      Nursing Education LevelnAge in Years, n (%)
      19-2930-3435-3940-4445-4950-5455-5960-64> 65
      Diploma2,673.755.130.741.353.2107.7143.9318.0469.81,453.8
      (2.1)(1.2)(1.6)(2.0)(4.0)(5.4)(11.9)(17.6)(54.4)
      Associate degree11,154.3606.2711.21,041.41,017.11,076.41,352.01,478.11,618.02,254.0
      (5.4)(6.4)(9.3)(9.1)(9.7)(12.1)(13.3)(14.5)(20.2)
      Baccalaureate degree19,006.02,434.32,436.12,125.11,816.81,995.91,933.31,885.91,921.62,456.9
      (12.8)(12.8)(11.2)(9.6)(10.5)(10.2)(9.9)(10.1)(12.9)
      Master's degree5,907.8223.3523.4694.2648.8665.8644.1670.8726.21,111.1
      (3.8)(8.9)(11.8)(11.0)(11.3)(10.9)(11.4)(12.3)(18.8)
      Doctoral degree - PhD272.98.8 (3.2)9.7 (3.5)6.9 (2.5)11.923.235.837.439.799.5
      (4.4)(8.5)(13.1)(13.7)(14.6)(36.5)
      Doctoral degree - DNP544.814.964.080.871.666.557.656.466.466.7
      (2.7)(11.7)(14.8)(13.2)(12.2)(10.6)(10.4)(12.2)(12.3)
      Doctoral degree - nursing other51.90.0 (0.0)0.8 (1.6)1.7 (3.3)1.6 (3.1)3.6 (6.9)6.95.69.122.6
      (13.4)(10.7)(17.5)(43.5)
      Total39,611.33,342.63,775.93,991.53,621.03,939.14,173.74,452.14,850.87,464.5
      (8.4)(9.5)(10.1)(9.1)(9.9)(10.5)(11.2)(12.2)(18.8)
      Note. In the 2013 and 2015 surveys, a single question “What is your highest level of education?” was asked with the set of possible responses including both nursing and non-nursing degrees. The degree types were separated for the 2017 and 2020 surveys.

      Highest Level of Non-nursing Education

      The 2017 survey asked about the highest level of non-nursing education. The percentage of RNs reporting an associate degree as their highest level of non-nursing education increased 1.9 percentage points between 2017 and 2020. Those reporting a baccalaureate degree remained about the same, increasing by 0.2 percentage points. RNs reporting a master's or doctorate degree as their highest level of nursing education decreased slightly, 1.4 and 0.7 percentage points, respectively (Table 16 and Figure 4).
      Table 16Highest Level of Non-Nursing Education of Registered Nurses, 2020
      Weighted Sample Values
      Non-nursing Education Level2017 (n =

      19,904.5)
      2020 (n =

      17,698.1)
      n%n%
      Associate degree7,025.935.36,578.137.2
      Baccalaureate degree9,115.445.88,141.546.0
      Master's degree3,150.815.82,547.414.4
      Doctoral degree612.43.1431.12.4
      Note. In the 2013 and 2015 surveys a single question “What is your highest level of education?” was asked with the set of possible responses including both nursing and non-nursing degrees. The degree types were separated for the 2017 and 2020 surveys.
      Figure 4
      Figure 4Highest Level of Non-nursing Education of Registered Nurses

      Licensure

      Type of License Currently Held

      Respondents were asked to report all the nursing licenses they currently hold. Less than 1% of responding RNs also held an LPN/LVN license, while 6.6% held an advanced practice registered nurse (APRN) credential. The percentage of RNs also holding an APRN credential is the lowest reported since 2013, dropping 3.4 percentage points since 2017 (Table 17 and Figure 5).
      Table 17Type of License Currently Held by Registered Nurses, 2013-2020
      Weighted Sample Values
      License2013 (n =

      41,658.3)
      2015 (n =

      46,047.8)
      2017 (n

      = 48,128.0)
      2020 (n

      = 41,601.8)
      n%n%n%n%
      RN39,521.694.943,730.295.045,971.395.540,378.397.1
      LPN215.90.5330.80.7386.20.8323.60.8
      APRN3,046.47.33,974.78.64,788.610.02,763.26.6
      Estimated Population Values
      License2013201520172020
      n%n%n%n%
      RN3,266,51494.93,508,21995.03,729,31895.54,033,92097.1
      LPN17,8450.526,5340.731,3280.832,3290.8
      APRN251,7887.3318,8708.6388,46110.0276,0526.6
      Note. Respondents were asked to select all that apply. RN = registered nurse; LPN = licensed practical nurse; APRN = advanced practice registered nurse.
      Figure 5
      Figure 5Type of License Currently Held by Registered Nurses, 2013-2020

      Number of Years Licensed

      RNs responding to the survey were licensed for a median of 20 years. Nearly one third (30.5%) were licensed for 10 years or less. An additional 22.1% were licensed between 11 and 20 years. These figures are similar to those reported in 2017 (32.9% and 19.7%, respectively) (Table 18 and Figure 6).
      Table 18Number of Years the Registered Nurse Has Been Licensed, 2013-2020
      Weighted Sample Values
      Years Licensed2013 (n =

      37,655.3)
      2015 (n =

      39,771.5)
      2017 (n

      = 46,757.6)
      2020 (n =

      38,741.0)
      n%n%n%n%
      0-109,845.526.213,307.333.515,397.632.911,802.630.5
      11-207,156.219.07,753.419.59,217.719.78,577.422.1
      21-307,340.519.56,855.817.28,121.617.46,934.117.9
      31-408,213.021.87,311.418.48,226.117.65,951.615.4
      > 405,100.013.54,543.711.45,794.612.45,475.414.1
      Estimated Population Values
      Years Licensed2013201520172020
      n%n%n%n%
      0-10813,74726.21,067,56933.51,249,09632.91,179,11730.5
      11-20591,47219.0622,00919.5747,76719.7856,90922.1
      21-30606,70119.5549,99717.2658,84417.4692,73917.9
      31-40678,81821.8586,54718.4667,32617.6594,58415.4
      > 40421,52513.5364,51111.4470,07312.4547,01014.1
      Figure 6
      Figure 6Number of Years the Registered Nurse Has Been Licensed, 2013-2020

      Country Where Entry-Level Nursing Education Was Received

      The majority of RNs (93.9%) reported receiving their entry-level nursing education in the United States, while 3.3% reported obtaining their nursing education in the Philippines, 0.5% in Canada, and 0.5% in India (Table 19).
      Table 19Country of Entry-Level Nursing Education of Registered Nurses, 2020
      Weighted Sample Values
      Country2020 (n = 41,745.5)
      n%
      United States31,192.593.9
      Canada224.70.5
      Philippines1,360.33.3
      India212.80.5
      Other755.21.8
      Estimated Population Values
      Country2020
      n%
      United States3,116,23093.9
      Canada22,4480.5
      Philippines135,8983.3
      India21,2590.5
      Other75,4471.8

      Credentialed to Practice as an APRN

      Respondents were asked whether they were credentialed in their state as an APRN enabling them to practice in any of the four APRN roles, including nurse practitioner (NP), clinical nurse specialist (CNS), certified registered nurse anesthetist (CRNA), or certified nurse midwife (CNM). Most respondents (91.6%) indicated they were not credentialed to practice as an APRN. This represents the highest proportion of RNs not credentialed as an APRN since 2013. In 2020, 5.5% of respondents reported being credentialed as an NP, compared with 8.5% in 2017 (Table 20 and Figure 7).
      Table 20Registered Nurse Credentials to Practice as an APRN, 2013-2020
      Weighted Sample Values
      Credential2013 (n =

      40,053.2)
      2015 (n = 43,045.0)2017 (n =

      47,713.6)
      2020 (n

      = 41,129.2)
      n%n%n%n%
      Nurse practitioner2,266.45.73,129.47.24,067.18.52,257.15.5
      Clinical nurse specialist1,243.13.1576.81.3983.52.1769.21.9
      Certified registered nurse anesthetist509.11.3571.91.3728.71.5399.70.9
      Certified nurse midwife159.30.4167.70.4242.00.5192.00.5
      Not licensed/certified as any above35,875.390.838,599.389.742,004.288.037,677.691.6
      Estimated Population Values
      Credential2013201520172020
      n%n%n%n%
      Nurse practitioner187,3255.7251,0537.2329,9338.5225,4915.5
      Clinical nurse specialist102,7413.146,2751.379,7872.176,8461.9
      Certified registered nurse anesthetist42,0781.345,8791.359,1141.539,9310.9
      Certified nurse midwife13,1650.413,4520.419,6360.519,1810.5
      Not licensed/certified as any above2,965,14590.83,096,59589.73,407,49888.03,764,11291.6
      Note. Respondents were asked to select all that apply. APRN = advanced practice registered nurse.
      Figure 7
      Figure 7Registered Nurses Credentialed as APRNs

      Multistate License

      New to the 2020 survey, 24% of nurses reported holding a multistate license (Table 21. The NLC has important implications for how nursing workforce statistics on surplus and shortage of workforce supply are calculated by state. States record the number of nurses' licenses issued; however, care must be taken to account for those nurses licensed in each state who are delivering care elsewhere. The number of licensed nurses in a state does not equal the number of nurses providing services in the state. More work is needed to understand how the NLC contributes to meeting the workforce needs of each state in the nation.
      Table 21Registered Nurses Holding a Multistate License, 2020
      Weighted Sample Values
      Multistate License2020 (n = 34,825.9)
      n%
      Yes8,367.424.0
      No26,458.576.0
      Note. Respondents were asked to answer this question only if they were actively employed in nursing.
      Use of Multistate License. Of nurses reporting possession of a multistate license, 33% use it for physical crossborder practice and 20% of respondents indicated using it for “other” uses (Table 22).
      Table 22How a Multistate License is Used by Registered Nurses, 2020
      Weighted Sample Values
      Use of Multistate License2020 (n = 5,481.8)
      n%
      Physical crossborder practice1,816.733.1
      Telehealth868.015.8
      Distance education446.88.2
      Disaster support155.72.8
      Travel nursing190.13.5
      Have not used1,314.824.0
      Other1,095.620.0
      Note. Respondents were asked to answer this question only if they were actively employed in nursing. Respondents were asked to select all that apply.

      Employment

      Employment Status

      The Physical crossborder practice employed in nursing with 64.9% employed in nursing full time. This represents a slight decrease in the proportion of RNs working full time from 2017 (65.4%) but an increase from 2015 (62.9%) (Table 23 and Figure 8).
      Table 23Employment Status of Registered Nurses, 2013-2020
      Weighted Sample Values
      Employment Status2013 (n =

      42,145.6)
      2015 (n =

      46,210.2)
      2017 (n =

      48,146.9)
      2020 (n =

      41,783.4)
      n%n%n%n%
      Actively employed in nursing full-time25,447.360.429,088.562.931,476.665.427,101.064.9
      Actively employed in nursing part-time6,276.114.96,088.013.25,820.912.14,901.711.7
      Actively employed in nursing per diem3,069.57.33,675.28.03,424.97.13,133.67.5
      Actively employed in a field other than1,713.04.11,576.13.41,108.92.3882.42.1
      nursing full-time
      Actively employed in a field other than1,169.02.8850.81.8605.71.3438.51.1
      nursing part-time
      Actively employed in a field other than512.71.2377.70.8267.50.6188.50.5
      nursing per diem
      Working in nursing only as a volunteer810.61.9564.51.2645.61.3517.11.2
      Unemployed, seeking work as a nurse1,144.42.71,070.72.31,030.22.1809.11.9
      Unemployed, not seeking work as a nurse1,463.33.51,611.63.51,616.23.41,362.43.3
      Retired4,755.111.34,993.710.84,916.910.24,824.711.6
      Estimated Population Values
      Employment Status2013201520172020
      n%n%n%n%
      Actively employed in nursing full-time2,103,25460.42,333,60662.92,553,46765.42,707,47664.9
      Actively employed in nursing part-time518,72714.9488,40513.2472,20412.1489,69511.7
      Actively employed in nursing per diem253,6967.3294,8378.0277,8347.1313,0577.5
      Actively employed in a field other than141,5834.1126,4453.489,9562.388,1552.1
      nursing full-time
      Actively employed in a field other than96,6162.868,2551.849,1391.343,8081.1
      nursing part-time
      Actively employed in a field other than42,3791.230,2980.821,7020.618,8320.5
      nursing per diem
      Working in nursing only as a volunteer66,9961.945,2881.252,3741.351,6601.2
      Unemployed, seeking work as a nurse94,5872.785,8962.383,5732.180,8321.9
      Unemployed, not seeking work as a nurse120,9453.5129,2873.5131,1143.4136,1083.3
      Retired393,01411.3400,61310.8398,87110.2482,00311.6
      Note. Respondents were asked to select all that apply.
      Figure 8
      Figure 8Employment Status of Registered Nurses, 2013-2020

      Reasons for Being Unemployed

      Respondents were asked to select all the reasons for being unemployed. Taking care of home and family was the most frequently selected reason for being unemployed by 49.0% of respondents. The percentage of RNs who indicated they were unemployed because they experienced difficulty in finding a nursing position was 14.6%, which is down from 15.4% in 2017. The percentage of RNs who indicated they were disabled was 10.7%, and 8.1% listed being in school as the reason for unemployment (Table 24 and Figure 9).
      Table 24Reasons for Unemployment of Registered Nurses, 2013-2020
      Weighted Sample Values
      2013 (n =

      2,549.0)
      2015 (n =

      2,272.4)
      2017 (n =

      2,567.2)
      2020 (n =

      2,122.1)
      n%n%n%n%
      Taking care of home and family1258.749.41137.350.01226.847.81,039.549.0
      Disabled486.219.1298.513.1347.613.5226.410.7
      Inadequate salary58.42.348.22.173.72.953.72.5
      School195.47.7143.16.3186.07.2172.28.1
      Difficulty in finding a nursing position672.126.4352.015.5395.015.4310.314.6
      Other774.830.4557.424.5758.929.6680.232.1
      Note. Respondents were asked to answer this question only if they were unemployed. Respondents were asked to select all that apply.
      Figure 9
      Figure 9Reasons for Unemployment of Registered Nurses, 2013-2020

      Retirement Plans

      In the 2020 survey, a new question was added: “Do you plan to retire or leave nursing in the next 5 years?” More than one-fifth (22.1%) intend to retire or leave nursing in the next 5 years (Table 25).
      Table 25Registered Nurse Plans to Retire or Leave Nursing, 2020
      Weighted Sample Values
      Plan to Retire Within 5 years2020 (n = 34,360.2)
      n%
      Yes7,584.522.1
      No26,775.877.9
      Estimated Population Values
      Plan to Retire Within 5 years2020
      n%
      Yes757,71622.1
      No2,674,98777.9
      Note. Respondents were asked to answer this question only if they were actively employed in nursing.

      Number of Positions Currently Held

      Respondents were asked to identify the number of positions in which they were currently employed as a nurse. The majority of respondents (83.9%) reported holding just one position as a nurse, which represents a 0.6 percentage point increase from 2017. The percentage of nurses who reported working in two positions decreased from 13.9% in 2017 to 13.7% in 2020. The percentage of respondents who indicated that they held three or more positions in nursing also slightly decreased from 2.8% in 2017 to 2.4% in 2020 (Table 26).
      Table 26Number of Positions Currently Held by Registered Nurses, 2013-2020
      Weighted Sample Values
      Number of Positions Held2013 (n =

      33,264.5)
      2015 (n =

      37,114.2)
      2017 (n =

      39,414.3)
      2020 (n =

      33,992.6)
      n%n%n%n%
      128,069.184.431,499.384.932,827.283.328,516.383.9
      24,434.613.34,744.012.85,496.713.94,664.113.7
      3760.82.3870.82.41,090.52.8812.22.4
      Estimated Population Values
      Number of Positions Held2013201520172020
      n%n%n%n%
      12,319,94984.42,527,01084.92,663,03083.32,848,86983.9
      2366,52213.3380,58512.8445,90513.9465,95813.7
      3 or more62,8832.369,8612.488,4632.881,1412.4
      Note. Respondents were asked to answer this question only if they were actively employed in nursing.

      Number of Hours Worked During a Typical Week in All Nursing Positions

      More than half of responding RNs (58.7%) reported working 32 to 40 hours in a typical week in all positions. This is consistent with the results from the 2017 survey (58.6%) and the 2015 survey (58.4%). The second most frequently reported category was 41 to 50 hours (14.5%). This represents a decrease from 2017 (15.8%) and 2015 (16.4%) (Table 27 and Figure 10). (See Fig. 11.)
      Table 27Number of Hours Registered Nurses Worked During a Typical Week in All Nursing Positions, 2013-2020
      Weighted Sample Values
      Hours Worked per Week2013 (n =

      32,645.8)
      2015 (n =

      36,327.6)
      2017 (n =

      39,293.3)
      2020 (n =

      33,847.5)
      n%n%n%n%
      1-151,808.95.51,697.74.71,903.74.81,624.04.8
      16-231,695.45.21,655.74.61,728.14.41,402.34.1
      24-313,397.710.43,536.99.83,765.09.63,251.09.6
      32-4018,434.156.521,174.358.423,012.658.619,850.658.7
      41-505,289.316.25,957.316.46,198.015.84,915.114.5
      51-601,369.54.21,636.94.51,851.34.71,479.94.4
      ≥ 61651.02.0578.81.6834.72.11,324.53.9
      Estimated Population Values
      Hours Worked per2013201520172020
      Weekn%n%n%n%
      1-15149,5065.5136,2004.7154,4344.8162,2434.8
      16-23140,1245.2132,8264.6140,1904.4140,0944.1
      24-31280,82510.4283,7459.8305,4269.6324,7859.6
      32-401,523,60056.51,698,69258.41,866,84158.61,983,13858.7
      41-50437,17116.2477,91816.4502,79615.8491,03414.5
      51-60113,1924.2131,3184.5150,1804.7147,8474.4
      ≥ 6153,8032.046,4321.667,7122.1132,3223.9
      Note. Respondents were asked to answer this question only if they were actively employed in nursing.
      Figure 10
      Figure 10Number of Hours Registered Nurses Worked During a Typical Week in All Nursing Positions, 2013-2020

      Primary Nursing Practice Position Setting

      Figure 11
      Figure 11Primary Nursing Practice Position Setting of Registered Nurses, 2013-2020
      Table 28Primary Nursing Practice Position Setting of Registered Nurses, 2013-2020
      Weighted Sample Values
      Practice Setting2013 (n =

      34,238.0)
      2015 (n =

      37,372.1)
      2017 (n =

      38,870.1)
      2020 (n =

      33,640.6)
      n%n%n%n%
      Hospital19,343.556.520,311.954.421,646.555.718,441.854.8
      Nursing home/extended care2,210.86.51,807.24.81,859.74.81,486.74.4
      Assisted living facility233.30.6211.20.5177.50.5
      Home health2,057.76.02,288.06.11,685.94.31,501.74.5
      Hospice757.82.0674.32.0
      Correctional facility229.00.7259.60.7294.80.8277.70.8
      School of nursing1,011.93.01,357.03.61,028.92.7954.12.8
      Public health609.21.8595.41.6539.31.4407.51.2
      Dialysis center493.61.3386.81.2
      Community health739.92.2786.92.1780.82.0565.31.7
      School health service1,145.93.31,092.82.91,025.32.61,057.83.1
      Occupational health224.10.7250.30.7292.60.8230.70.7
      Ambulatory care setting2,994.48.74,201.111.23,649.29.43,271.69.7
      Insurance claims/benefits477.21.4673.71.8694.11.8841.12.5
      Policy/planning/regulatory/li censing agency152.30.4148.70.486.90.288.10.3
      Other3,042.18.93,366.39.03,823.69.83,278.09.7
      Estimated Population Values
      Primary Practice Setting2013201520172020
      n%n%n%n%
      Hospital1,598,76856.51,629,50654.41,756,02155.71,842,39454.8
      Nursing home/extended care182,7246.5144,9824.8150,8654.8148,5264.4
      Assisted living facility18,7180.617,1320.517,7330.5
      Home health170,0696.0183,5536.1136,7654.3150,0254.5
      Hospice61,4712.067,3652.0
      Correctional facility18,9300.720,8280.723,9180.827,7430.8
      School of nursing83,6373.0108,8633.683,4662.795,3182.8
      Public health50,3541.847,7631.643,7481.440,7111.2
      Dialysis center40,0401.338,6431.2
      Community health61,1502.263,1282.163,3372.056,4751.7
      School health service94,7083.387,6662.983,1782.6105,6783.1
      Occupational health18,5190.720,0800.723,7360.823,0480.7
      Ambulatory care setting247,4958.7337,02811.2296,0309.4326,8439.7
      Insurance claims/benefits39,4451.454,0461.856,3061.884,0292.5
      Policy/planning/regulatory/li censing agency12,5860.411,9300.47,0500.28,8010.3
      Other251,4388.9270,0579.0310,1789.8327,4839.7
      Note. Respondents were asked to answer this question only if they were actively employed in nursing.

      Primary Nursing Position Title

      Staff nurse was indicated as the title that most closely corresponds to respondents' primary nursing position and was selected by 60.1% of respondents, up from 58.0% in 2017. “Other—health related” was the next most frequently selected position by 9.7% of respondents. The APRN title decreased from 10.1% in 2017 to 6.3% in 2020. Between 2013 and 2020, there was a 3.1% decrease in respondents who indicated that their primary practice position was nurse manager. RNs selecting case manager as their primary position (7.4%) was an increase from what was reported in 2017 (6.4%). The percentage of respondents who selected nurse faculty/educator increased slightly from 4.0% in 2017 to 4.1% in 2020. Each of the remaining positions were selected by less than 2% of the responding nurses. Additionally, 0.5% selected “other—not health related” (Table 29 and Figure 12).
      Table 29Primary Nursing Position Title of Registered Nurses, 2013-2020
      Weighted Sample Values
      Primary Title2013 (n =

      34,356.6)
      2015 (n =

      37,711.1)
      2017 (n =

      39,063.1)
      2020 (n =

      33,713.7)
      n%n%n%n%
      Consultant772.52.2672.41.8577.41.5531.71.6
      Nurse researcher251.30.7247.20.7235.90.6155.60.5
      Nurse executive834.42.4881.42.3725.31.9647.71.9
      Nurse manager3,792.011.03,045.88.13,126.28.02,673.37.9
      Nurse faculty/educator1,105.43.21,422.23.81,558.24.01,392.54.1
      Advanced practice registered nurse2,531.47.43,069.18.13,946.110.12,130.26.3
      Staff nurse21,902.163.721,920.758.122,673.058.020,265.960.1
      Case manager2,524.86.72,519.26.42,485.37.4
      Other—health related3,068.98.93,685.19.83,561.99.13,277.49.7
      Other—not health related98.70.3242.50.6139.70.4154.20.5
      Estimated Population Values
      Title2013201520172020
      n%n%n%n%
      Consultant63,8462.253,9441.846,8441.553,1191.6
      Nurse researcher20,7700.719,8300.719,1390.615,5450.5
      Nurse executive68,9622.470,7062.358,8361.964,7071.9
      Nurse manager313,41811.0244,3438.1253,6098.0267,0717.9
      Nurse faculty/educator91,3603.2114,0993.8126,4084.0139,1154.1
      Advanced practice registered nurse209,2227.4246,2148.1320,12110.1212,8146.3
      Staff nurse1,810,23863.71,758,57358.11,839,29458.02,024,62860.1
      Case manager202,5466.7204,3686.4248,2897.4
      Other—health related253,6478.9295,6379.8288,9509.1327,4239.7
      Other—not health related8,1550.319,4530.611,3320.415,4050.5
      Note. Respondents were asked to answer this question only if they were actively employed in nursing.
      Figure 12
      Figure 12Primary Nursing Position Title of Registered Nurses, 2013-2020

      Primary Nursing Position Specialty

      In the 2017 survey, secondary practice specialties were modified. Categories now include adult and family health, cardiology, other—clinical, and other—nonclinical specialties.
      In 2020, 13.4% of RNs reported their primary practice specialty was acute care/critical care compared to 14.0% in 2017. The second most frequently selected specialty was medical-surgical at 8.5%, down from 8.6% of RN respondents who selected this specialty in 2017. Perioperative was the third most frequently selected specialty by 6.7% of respondents, up from 5.8% in 2017. RNs selecting other specialties (13.1%) represented an increase from 12.0% in 2017 (Table 30 and Figure 13).
      Table 30Primary Nursing Position Specialty of Registered Nurses, 2013-2020
      Weighted Sample Values
      Primary Specialty2013 (n =

      33,516.5)
      2015 (n = 36,424.1)2017 (n =

      37,484.3)
      2020 (n =

      32,364.8)
      n%n%n%n%
      Acute care/critical care5,789.017.34,159.111.45,239.214.04,338.513.4
      Adult health871.92.6756.12.11,447.13.91,172.93.6
      Family health1,243.43.3801.22.5
      Anesthesia654.32.0549.91.5705.51.9379.41.2
      Cardiology1,291.03.41,086.03.4
      Community335.01.0356.71.0386.61.0300.90.9
      Geriatric/gerontology1,988.85.91,754.74.81,918.55.11,614.25.0
      Home health1,515.34.51,604.04.41,360.13.61,226.13.8
      Maternal-child health/obstetrics1,662.25.01,633.94.51,778.14.71,422.34.4
      Medical surgical4,248.612.73,695.710.13,203.18.62,757.88.5
      Nephrology476.41.3555.71.5500.71.6
      Occupational health333.41.0280.70.8339.80.9314.41.0
      Oncology952.72.81,044.02.91,046.92.8955.93.0
      Palliative care/hospice498.91.5529.11.5643.31.7522.21.6
      Pediatrics1,995.86.01,570.34.31,774.14.71,345.94.2
      Neonatal808.42.2809.52.2725.42.2
      Perioperative2,195.76.02,187.75.82,173.26.7
      Public health510.61.5466.01.3472.31.3428.91.3
      Psychiatric/mental health/substance abuse1,340.54.01,418.43.91,534.14.11,206.83.7
      Rehabilitation691.42.1717.32.0725.41.9541.41.7
      School health1,097.23.31,025.12.8945.52.5980.03.0
      Emergency/trauma566.01.72,026.75.62,027.35.41,818.45.6
      Women's health651.31.9651.71.8567.11.5490.51.5
      Other—clinical specialties4,507.712.04,229.513.1
      Other—nonclinical specialties775.12.11,032.13.2
      Other6,568.419.66,200.817.0
      Primary care1,340.52.61,092.53.0
      Genetics40.60.1
      Informatics318.20.9
      Neurology/neurosurgical337.10.9
      Orthopedic436.11.2
      Radiology191.20.5
      Urology87.50.2
      Telehealth288.51.2
      Note. Respondents were asked to answer this question only if they were actively employed in nursing.
      Figure 13
      Figure 13Primary Nursing Position Specialty of Registered Nurses, 2013-2020

      Providing Direct Patient Care—Primary Nursing Position

      A new question was added to the 2020 survey regarding direct patient care. Survey respondents were asked, “In your primary nursing practice position, do you spend the majority of your time providing direct patient care?” More than two-thirds (68.6%) responded “yes” (Table 31).
      Table 31Registered Nurses Providing Direct Patient Care—Primary Nursing Position, 2020
      Weighted Sample Values
      Direct Patient Care2020 (n = 34,080.7)
      n%
      Yes23,391.868.6
      No10,688.931.4
      Estimated Population Values
      Direct Patient Care2020 (n = 34,080.7)
      n%
      Yes2,336,91568.6
      No1,067,85531.4
      Note. Respondents were asked to answer this question only if they were actively employed in nursing.

      Secondary Nursing Practice Position Setting of Registered Nurses

      More than one-third of RN respondents (36.7%) identified their secondary nursing practice position setting as being in a hospital, which has been consistent during the past three surveys. The second most frequently selected setting for secondary nursing positions was ambulatory care (9.6%) followed by school of nursing (8.7%), home health (8.4%), and nursing home/extended care (7.1%) (Table 32 and Figure 14).
      Table 32Secondary Nursing Practice Position Setting of Registered Nurses, 2013-2020
      Weighted Sample Values
      Secondary Practice Setting2013 (n =

      4,415.5)
      2015 (n =

      4,877.3)
      2017 (n =

      6,153.3)
      2020 (n =

      5,121.6)
      n%n%n%n%
      Hospital1,061.524.01,632.633.52,213.436.01,879.136.7
      Nursing home/extended care502.911.4277.25.7456.77.4363.87.1
      Assisted living facility58.91.258.41.058.31.1
      Home health560.512.7577.511.8555.79.0430.18.4
      Hospice185.93.0139.32.7
      Correctional facility52.11.272.21.568.31.146.20.9
      School of nursing439.710.0519.710.7493.68.0446.28.7
      Public health66.81.538.10.889.21.568.91.3
      Dialysis center87.71.454.71.1
      Community health188.04.3191.13.9209.63.4121.62.4
      School health service191.34.3171.73.5173.02.8113.22.2
      Occupational health90.22.039.00.857.10.936.30.7
      Ambulatory care setting506.711.5451.29.3556.79.1492.69.6
      Insurance claims/benefits38.80.939.40.851.70.844.10.9
      Policy/planning/regulatory/licensing agency19.00.46.10.17.10.122.50.4
      Other698.015.8802.516.5889.314.5806.915.8
      Figure 14
      Figure 14Secondary Nursing Practice Position Setting of Registered Nurses, 2013-2020

      Secondary Nursing Position Title

      The most frequently selected position title that corresponds to secondary nursing practice position was staff nurse at 57.6%, up from 55.8% in 2017, followed by nurse faculty/educator at 10.8%. APRN respondents were at 8.7%, down from 12.1% in the 2017 survey. Respondents who selected the “other—health related” category were at 9.7%, similar to the past two surveys (Table 33 and Figure 15).
      Table 33Secondary Nursing Practice Position Title of Registered Nurses, 2013-2020
      Weighted Sample Values
      Secondary Title2013 (n

      = 5,370.9)
      2015 (n

      = 4,857.8)
      2017 (n =

      6,145.9)
      2020 (n =

      5,080.8)
      n%n%n%n%
      Consultant244.24.6216.04.5201.23.3165.63.3
      Nurse researcher41.60.828.90.636.20.621.90.4
      Nurse executive77.01.446.61.034.60.640.30.8
      Nurse manager301.15.6143.23.0235.43.8196.23.9
      Nurse faculty/educator469.48.7482.09.9601.59.8547.010.8
      Advanced practice registered nurse520.69.7521.810.7743.012.1443.98.7
      Staff nurse3,050.756.82,767.957.03,430.855.82,924.957.6
      Case manager157.83.4256.34.2205.54.1
      Other—health related628.111.7475.09.8573.79.3490.29.7
      Other—not health related38.10.718.60.433.30.545.30.9
      Note. Respondents were asked to answer this question only if they were actively employed in nursing.
      Figure 15
      Figure 15Secondary Nursing Practice Position Title of Registered Nurses, 2013-2020

      Secondary Nursing Position Specialty

      Acute care/critical care was the highest reported specialty for the secondary nursing position (10.7%), followed by the medical surgical specialty (7.7%) and the geriatric/gerontology specialty (7.3%) (Table 34 and Figure 16).
      Table 34Secondary Nursing Practice Position Specialty of Registered Nurses, 2013-2020
      Weighted Sample Values
      Secondary Specialty2013 (n =

      5,285.6)
      2015 (n =

      4,791.1)
      2017 (n =

      5,895.2)
      2020 (n =

      4,887.2)
      n%n%n%n%
      Acute care/critical care673.112.7386.28.1602.610.2523.210.7
      Adult health187.53.6124.72.6309.05.2229.64.7
      Family health149.12.5116.72.4
      Anesthesia115.22.276.21.6161.22.795.12.0
      Cardiology119.82.097.02.0
      Community120.52.372.11.5116.22.069.41.4
      Geriatric/gerontology421.18.0295.76.2433.27.4355.07.3
      Home health414.27.8404.48.4378.96.4332.96.8
      Maternal-child health/obstetrics234.44.4182.83.8168.72.9133.42.7
      Medical surgical485.99.2324.56.8451.57.7360.67.4
      Nephrology37.90.8112.61.940.80.8
      Occupational health86.41.644.20.959.01.036.20.7
      Oncology83.41.637.50.866.61.155.11.1
      Palliative care/hospice83.61.655.91.2140.72.491.11.9
      Pediatrics243.04.6219.64.6242.74.1226.84.6
      Neonatal87.51.886.31.558.91.2
      Perioperative227.14.7269.84.6222.14.5
      Public health81.01.546.21.087.41.569.51.4
      Psychiatric/mental health/sub-237.84.5265.75.5317.45.4266.25.5
      stance abuse
      Rehabilitation121.52.3109.72.3150.32.6119.82.5
      School health200.03.8177.73.7146.02.5123.72.5
      Emergency/trauma98.11.9291.56.1375.16.4290.86.0
      Women's health68.01.353.11.179.81.460.31.2
      Other—clinical specialties714.412.1744.615.2
      Other—nonclinical specialties156.92.7168.43.5
      Other1155.421.91,033.721.6
      Primary care134.72.6144.73.0
      Genetics11.00.2
      Informatics20.00.4
      Neurology/neurosurgical21.00.4
      Orthopedic21.50.5
      Radiology13.90.3
      Urology5.20.1
      Telehealth40.90.8
      Note. Respondents were asked to answer this question only if they were actively employed in nursing.
      Figure 16
      Figure 16Secondary Nursing Practice Position Specialty of Registered Nurses, 2013-2020

      Providing Direct Patient Care—Secondary Nursing Practice Position

      A new question was added to the 2020 survey regarding direct patient care. Survey respondents were asked, “In your secondary nursing practice position, do you spend the majority of your time providing direct patient care?” Nearly three-fourths (72.0%) responded “yes” (Table 35).
      Table 35Providing Direct Patient Care—Secondary Nursing Position of Registered Nurses, 2020
      Weighted Sample Values
      2020 (n = 5,076.1)
      n%
      Yes3,653.372.0
      No1,422.728.0
      Note. Respondents were asked to answer this question only if they were actively employed in nursing.

      Salary/Earnings

      2020 Pretax Annual Earnings From Primary Nursing Position

      The median pretax annual earnings for responding RNs have slowly increased from $60,000 in 2015 to $70,000 in 2020. This constitutes a 3.3% simple annual growth in earnings during the 5-year period. Categorically, the percentage of respondents earning less than $40,000 annually decreased by 0.4 percentage points, the percentage making between $40,000 and $60,000 decreased by 3.9 percentage points in 2020 from 2017. The percentage of respondents in categories earning more than $60,000 per year all saw small increases in 2020 from 2017 (1.3% for those between $60,000 to $80,000, 1.2% for those earning more than $80,000 but less than $100,000, and 1.8% in those earning more than $100,000) (Table 36 and Figure 17).
      Table 36Annual Earnings of Registered Nurses, 2015-2020
      Weighted Sample Values
      Annual Earnings2015 (n =

      32,455.7)
      2017 (n =

      35,745.6)
      2020 (n =

      29,453.8)
      n%n%n%
      < $40,0004,711.314.54,217.811.83,355.611.4
      $40,000 to < $60,0008,436.826.08,243.423.15,639.519.2
      $60,000 to < $80,0009,202.028.410,213.328.68,808.029.9
      $80,000 to < $100,0005,279.816.36,386.317.95,617.019.1
      ≥ $100,000 or more4,825.714.96,684.818.76,033.820.5
      Estimated Population Values
      Annual Earnings201520172020
      n%n%n%
      < $40,000377,96414.5342,16011.8335,23511.4
      $40,000 to < $60,000676,83726.0668,72923.1563,40419.2
      $60,000 to < $80,000738,22428.4828,53028.6879,94729.9
      $80,000 to < $100,000423,56816.3518,07117.9561,15619.1
      ≥ $100,000387,13614.9542,29218.7602,79620.5
      Note. Respondents were asked to answer this question only if they were actively employed in nursing. Salary includes overtime and bonuses but does not include sign-on bonuses.
      Figure 17
      Figure 17Annual Earnings of Registered Nurses, 2015-2020

      Earnings by Gender and Specialty

      Looking across all the specialties, the specialty with the highest median salary remains anesthesia ($170,000 overall). Across nearly all specialties, men have a higher median salary than women. In 2017, the only specialty where women reported higher earnings was oncology. In 2020, women reported higher median earnings in the specialties of nephrology, palliative care/hospice, and rehabilitation. Of note, out of 23 specialties (not including the “other” categories), 16 reported a drop in median incomes at an average of -$3,200 since 2017. Greater-than-average drops in reported median income occurred in family health (-$9,250), maternal-child health/obstetrics (-$4,000), pediatrics (-$5,000), neonatal (-$5,250), and women's health (-$7,425) (Table 37).
      Table 37Median Annual Earnings by Gender and Specialty of Registered Nurses, 2020
      SpecialtyMaleFemaleOtherTotal
      nEarningsnEarningsnEarningsnTotal
      Acute care/critical care523$75,0003,109$70,0001$60,0003,633$71,000
      Adult health74$80,130909$74,000983$74,000
      Family health53$94,000863$75,000916$75,000
      Anesthesia128$184,500237$160,000365$170,000
      Cardiology96$83,836815$69,000911$70,000
      Community22$77,134260$67,040282$68,578
      Geriatric/gerontology92$70,8501,455$65,0002$68,2401,549$66,000
      Home health75$73,000978$65,0002$38,4131,055$65,000
      Maternal-child health/obstetrics4$64,5001,251$64,0002$74,0001,257$64,000
      Medical-surgical206$65,0002,219$62,0001$75,0002,426$62,000
      Nephrology63$70,000379$74,0001$71,721443$73,000
      Occupational health21$99,500259$76,0001$88,000281$78,000
      Oncology36$75,468784$70,000820$70,000
      Palliative care/hospice29$70,000435$70,0001$76,000465$70,000
      Pediatrics50$77,0001,115$62,0001$20,5871,166$62,000
      Neonatal7$80,000586$66,8001$690,000594$67,750
      Perioperative142$78,7001,693$68,6401,835$70,000
      Public health27$80,000384$60,951411$62,180
      Psychiatric/mental health/substance abuse175$75,000926$70,0002$109,0001,103$71,000
      Rehabilitation33$64,400388$65,000421$65,000
      School health14$67,000789$50,000803$50,000
      Emergency/trauma256$77,5001,220$69,0003$72,0001,479$70,000
      Women's health1$120,000441$62,150442$62,575
      Other—clinical specialties251$81,0003,605$70,0002$45,5003,858$71,000
      Other—nonclinical specialties63$88,000892$77,000955$78,000
      Total2,441$78,00025,992$68,29120$71,861
      Note. Respondents were asked to answer this question only if they were actively employed in nursing. Salary includes overtime and bonuses but does not include sign-on bonuses.

      Earnings by Highest Education

      As expected, higher-level degrees result in increases in median earnings, with those reporting DNP as their highest degree receiving the highest earnings. Overall, reported earnings by education category have dropped by an average of $3,700 since 2017. Respondents with a diploma report a decrease of $7,900 in median earnings since 2017. Other decreases include those with an associate degree ($2,000), baccalaureate degree ($1,000), master's degree ($5,000), doctoral degree - PhD ($6,400), and doctoral degree - DNP ($4,000). Respondents with a doctoral degree in other nursing reported no change in median earnings since 2017 (Table 38).
      Table 38Median Annual Earnings of Registered Nurses by Highest Education, 2017 and 2020
      Highest Education20172020
      nEarningsnEarnings
      Diploma1,358$72,9001,318$65,000
      Associate degree8,303$65,0008,308$63,000
      Baccalaureate degree12,714$68,00014,964$67,000
      Master's degree4,999$95,0004,617$90,000
      Doctoral degree—PhD200$100,000209$93,600
      Doctoral degree—DNP413$104,000519$100,000
      Doctoral degree—nursing other37$96,00040$96,000
      Note. Respondents were asked to answer this question only if they were actively employed in nursing. Salary includes overtime and bonuses but does not include sign-on bonuses. In the 2013 and 2015 surveys, a single question, “What is your highest level of education?” was asked with the set of possible responses including both nursing and non-nursing degrees. The degree types were separated for the 2017 and 2020 surveys. PhD = doctor of philosophy; DNP = doctor of nursing practice.

      Earnings by State

      Since 2015, median earnings have risen in all states. States with the highest median earnings for RNs continue to be California ($90,000), Hawaii ($90,000), New York ($80,000), Oregon ($80,000), and Washington ($80,000). The following states with the lowest median earnings have also remained unchanged over time: South Dakota ($62,000), Iowa ($63,000), Kansas, and North Dakota ($65,000). Despite no changes in the rankings by state, the states with the lowest reported median earnings reported much higher increases in earnings over time since 2015 than the states with the largest reported median earnings. The lowest ranked states reported an average increase in annual earnings of 4.2% since 2015. While the states with the highest reported annual earnings averaged an increase of just 1.4 percentage points in reported earnings during the same period. The states with the highest increase in median wages since 2015 are Indiana (6.0%), Utah (5.7%), Tennessee (5.5%), Nebraska (5.2%), and Virginia (5.0%). Also, of note, the Northern Mariana Islands saw the highest increase (14.3%) in reported median earnings since 2015 (Table 39).
      Table 39Median Annual Earnings in Primary Nursing Position by State(s) Where Registered Nurses Are Currently Practicing, 2015-2020
      State/Jurisdiction201520172020State/Jurisdiction201520172020
      Alabama$55,000$60,000$68,000Nebraska$54,000$60,000$68,000
      Alaska$70,000$76,000$79,000Nevada$72,000$77,000$78,000
      Arizona$69,000$70,500$75,000New Hampshire$64,000$66,500$75,000
      Arkansas$56,000$61,605$68,000New Jersey$76,000$75,915$80,000
      California$90,000$88,000$90,000New Mexico$62,000$69,500$73,000
      Colorado$63,000$65,000$74,030New York$77,000$80,000$80,000
      Connecticut$75,000$75,000$80,000North Carolina$58,890$61,000$69,000
      Delaware$71,000$71,900$75,000North Dakota$54,000$60,000$65,000
      District of Columbia$75,000$79,000$80,000Ohio$58,000$65,000$70,000
      Florida$60,000$65,500$72,000Oklahoma$58,326$64,000$70,000
      Georgia$64,000$68,000$75,000Oregon$75,000$80,000$80,000
      Hawaii$82,000$85,000$90,000Pennsylvania$62,000$70,000$75,000
      Idaho$60,000$62,000$70,000Rhode Island$70,000$70,000$77,400
      Illinois$65,000$67,000$73,169South Carolina$57,000$64,000$69,609
      Indiana$53,000$64,000$69,000South Dakota$51,000$54,000$62,000
      Iowa$51,662$58,000$63,000Tennessee$55,000$62,000$70,000
      Kansas$54,000$64,000$65,000Texas$68,700$72,000$75,000
      Kentucky$60,000$64,000$68,000Utah$53,000$65,000$68,000
      Louisiana$60,000$65,000$68,000Vermont$62,000$61,000$73,492
      Maine$60,000$63,000$68,800Virginia$60,000$69,000$75,000
      Maryland$70,000$74,466$78,000Washington$70,000$75,000$80,000
      Massachusetts$75,633$76,000$79,655West Virginia$55,000$62,000$68,000
      Michigan$60,000$67,000$73,000Wisconsin$60,000$63,000$70,500
      Minnesota$64,870$66,000$74,000Wyoming$64,000$65,000$70,000
      Mississippi$58,000$60,000$68,000Guam$52,000$60,000$61,604
      Missouri
      Missouri did not participate in the 2015 and 2017 surveys.
      Missouri did not participate in the 2015 and 2017 surveys.
      $68,640Northern Mariana$35,000$41,600$60,000
      Montana$58,000$60,000$66,000Islands
      Note. Respondents were asked to answer this question only if they were actively employed in nursing. Salary includes overtime and bonuses but does not include sign-on bonuses.
      low asterisk Missouri did not participate in the 2015 and 2017 surveys.

      Earnings by Years Licensed and Age

      Median annual wages increase with both experience and age; however, wage increases are more dependent on experience than age (Table 40).
      Table 40Median Annual Earnings of Registered Nurses by Years Licensed and Age, 2020
      Age in YearsNumber of Years Licensed
      0-12-56-10≥ 11Total
      nEarningsnEarningsnEarningsnEarningsnEarnings
      19-29555$49,0001,780$58,573455$60,0008$55,0002,798$56,000
      30-34166$50,000814$60,0001,754$65,000410$65,0003,144$62,000
      35-39102$50,000523$60,000913$68,0001,646$70,0003,184$66,000
      40-4474$51,708347$60,000576$67,0001,894$74,7672,891$70,000
      45-4947$54,000210$62,200402$70,5002,212$76,0002,871$74,000
      50-5421$57,300172$64,329363$70,0002,444$78,0003,000$75,000
      55-5911$48,00081$62,400208$65,5003,207$79,0003,507$77,000
      60-642$66,00024$62,500118$69,5003,448$76,0003,592$75,000
      ≥ 659$70,00025$65,00066$62,5002,996$65,0003,096$65,000
      Total987$50,0003,976$60,0004,855$65,00018,265$75,00020,083
      Note. Respondents were asked to answer this question only if they were actively employed in nursing. Salary includes overtime and bonuses but does not include sign on bonuses.

      Earnings by APRNs

      CRNAs continue to report the highest salaries among ARPNs (median $180,000 in 2020). Reported salaries from APRN professions have remained relatively stable since 2017 (Table 41).
      Table 41Median Annual Earnings by APRN Role, 2017 and 2020
      APRN Role20172020
      nEarningsnEarnings
      CNP2,982$100,0001,958$100,000
      CNS644$88,000448$80,000
      CRNA557$171,000341$180,000
      CNM186$97,750116$86,000
      Note. Respondents were asked to answer this question only if they were actively employed in nursing. Salary includes overtime and bonuses but does not include sign-on bonuses. APRN = advanced practice registered nurse; CNP = certified nurse practitioner; CRNA = certified registered nurse anesthetist; CNM = certified nurse midwife.

      Telehealth Utilization

      Percentage of Time Providing Telehealth

      Telehealth utilization by nurses seems to have remained relatively unchanged since 2017, However, since 2015, there has been a 4.7 percentage point decrease in nurses providing telehealth services up to 25% of their time and a 4.2 percentage point increase in nurses providing telehealth more than 75% of their time. Considering that this survey was collected right at the time that healthcare delivery systems were been transitioning to more telehealth due to the pandemic, it is expected that there will be an increase in time spent by nurses utilizing telehealth. However, considering that most nurses work in inpatient hospital settings, the increase in telehealth may only be seen in nurses with advanced practice degrees working in ambulatory and primary care settings (Table 42 and Figure 18).
      Table 42Percentage of Time Registered Nurses Report Providing Telehealth, 2015-2020
      Weighted Sample Values
      Provides Telehealth2015 (n =

      37,354.6)
      2017 (n =

      39,441.6)
      2020 (n =

      33,582.4)
      n%n%n%
      Never19,119.151.218,095.145.917,460.252.0
      1%-25%11,710.731.412,490.631.78,960.826.7
      26%-50%2,560.56.92,851.27.22,184.96.5
      51%-75%1,785.34.82,201.65.61,634.54.9
      76%-100%2,179.15.83,803.29.63,341.910.0
      Estimated Population Values
      Provides Telehealth201520172020
      n%n%n%
      Never1,533,81151.21,467,92045.91,744,32952.0
      1%-25%803,54931.41,013,26831.7895,21226.7
      26%-50%175,6916.9231,2947.2218,2786.5
      51%-75%122,5024.8178,6025.6163,2924.9
      76%-100%149,5195.8308,5299.6333,86610.0
      Figure 18
      Figure 18Percentage of Time Registered Nurses Report Providing Telehealth, 2015-2020

      Telehealth Across State Borders

      Compared with previous years, in 2020, more nurses report providing telehealth services across state borders. In 2015, 39% of nurses reported providing telehealth services across state borders compared to 47% in 2020. While more nurses report providing this service, there has been minimal change in the percent of the time nurses spend in this activity since 2017. The only change of note is that those reporting above 75% of their time spent providing telehealth services across state borders had the largest change since 2015 with a 3.5 percentage point increase (Table 43 and Figure 19).
      Table 43Percentage of Time Registered Nurses Spend Providing Telehealth Across State Borders, 2015-2020
      Weighted Sample Values
      Provides Telehealth2015 (n =

      18,456.1)
      2017 (n =

      17,573.3)
      2020 (n =

      13,965.3)
      n%n%n%
      Never11,186.760.69,535.054.37,395.653.0
      1%-25%5,843.231.76,294.535.84,663.633.4
      26%-50%626.83.4692.23.9678.04.9
      51%-75%298.51.6414.02.4366.92.6
      76%-100%500.92.7637.63.6861.26.2
      Figure 19
      Figure 19Percentage of Time Registered Nurses Spend Providing Telehealth Across State Borders, 2015-2020

      Telehealth Across International Borders

      A small percentage of nurses in the United States provide services across international borders. This percentage has changed little from 2015 to 2020 going from 7.7% in 2015 to 8.6% in 2020 (Table 44 and Figure 20).
      Table 44Percentage of Time Registered Nurses Spend Providing Telehealth Across International Borders, 2015-2020
      Weighted Sample Values
      Provides Telehealth2015 (n =

      18,096.1)
      2017 (n =

      16,369.8)
      2020 (n =

      13,208.2)
      n%n%n%
      Never16,707.292.314,548.688.912,087.291.5
      1%-25%1,194.76.61,488.29.1965.97.3
      26%-50%96.30.5129.40.874.00.6
      51%-75%33.70.2103.70.632.90.3
      76%-100%64.30.499.80.648.30.4
      Figure 20
      Figure 20Percentage of Time Registered Nurses Spend Providing Telehealth Across National Borders, 2015-2020

      Modes of Communication Used for Telehealth

      The use of telephones continues to be the most common method of communication for telehealth provision. However, telephone use has declined 3.5 percentage points since 2015 in favor of video calls, Voice over Internet Protocol (VoIP), and electronic messaging (increases of 8.1, 5.4, and 5.9 percentage points, respectively, since 2015) (Table 45 and Figure 21).
      Table 45Modes of Communication Used for Telehealth by Registered Nurses, 2015-2020
      Weighted Sample Values
      Mode of Telehealth2015 (n =

      15,864.1)
      2017 (n =

      17,066.0)
      2020 (n =

      13,775.4)
      n%n%n%
      Electronic messaging2,954.018.63,599.621.13,379.324.5
      VoIP528.73.3817.34.811,297.78.7
      Virtual ICU167.71.1276.91.6316.32.3
      Telephone15,406.797.116,143.994.612,893.393.6
      Email5,128.232.35,574.432.74,497.932.7
      Video call463.72.9619.83.61,517.111.0
      Other1,070.96.8926.45.4753.55.5
      Note. VOIP = Voice over Internet Protocol; ICU = intensive care unit.
      Figure 21
      Figure 21Modes of Communication Used for Telehealth by Registered Nurses, 2015-2020

      Licensed Practical Nurse/Licensed Vocational Nurse Results

      Gender

      Males accounted for 8.1% of all LPNs/LVNs, which is an increase of 0.4 percentage points since 2017. In 2020, a third category, “other” was added to the response options to the gender question on the survey and was selected by 0.1% of LPNs/LVNs (Table 46).
      Table 46Gender Distribution of Licensed Practical Nurses/Licensed Vocational Nurses, 2015-2020
      Weighted Sample Values
      Gender2015 (n =

      28,891.0)
      2017 (n =

      34,616.8)
      2020 (n =

      39,530.0)
      n%n%n%
      Male2,169.77.52,670.97.73,195.88.1
      Female26,721.392.531,945.992.336,303.191.8
      Other31.10.1
      Weighted Sample Values
      Gender201520172020
      n%n%n%
      Male65,2467.561,0647.775,9328.1
      Female803,55992.5730,38392.3862,55991.8
      Other7390.1
      Note. “Other” was added as an option with the 2020 survey.

      Age

      The median age of LPNs/LVNs was 53 years. LPNs/LVNs who are aged 65 years or older account for 18.2% of the workforce. This cohort has grown by 5.0 percentage points since 2017 and by 8.3 percentage points since 2015 (Table 47 and Figure 22).
      Table 47Age Distribution of Licensed Practical Nurses/Licensed Vocational Nurses, 2015-2020
      Weighted Sample Values
      Age in Years2015 (n =

      27,172.4)
      2017 (n =

      34,454.1)
      2020 (n =

      37,868.7)
      n%n%n%
      17-292,652.59.83,072.78.92,816.17.4
      30-342,579.59.52,930.18.53,163.88.4
      35-392,689.39.93,541.210.33,710.19.8
      40-443,331.812.33,539.410.33,885.010.3
      45-493,375.112.44,052.611.84,253.511.2
      50-543,076.411.33,875.011.24,056.510.7
      55-593,516.312.94,428.012.94,305.611.4
      60-643,264.912.04,476.913.04,770.812.6
      ≥ 652,686.69.94,538.313.26,907.318.2
      Estimated Population Values
      Age in Years201520172020
      n%n%n%
      17-2979,7649.870,2518.966,9107.4
      30-3477,5699.566,9918.575,1728.4
      35-3980,8739.980,96210.388,1529.8
      40-44100,19412.380,92110.392,30710.3
      45-49101,49512.492,65411.8101,06311.2
      50-5492,51311.388,59511.296,38210.7
      55-59105,74212.9101,23912.9102,30111.4
      Estimated Population Values
      Age in Years201520172020
      n%n%n%
      60-6498,18212.0102,35613.0113,35412.6
      ≥ 6580,7919.9103,75913.2164,11718.2
      Figure 22
      Figure 22Age Distribution of LPNs/LVNs, 2015-2020

      Age by Gender

      The age distribution of male LPNs/LVNs differs from the age distribution of female LPNs/LVNs. The proportion of female LPNs/LVNs aged 65 years or older is almost double that of male LPNs/LVNs in that age cohort, while a larger proportion of male LPNs/LVNs are in the 40-59 age range (Table 48).
      Table 48Age Distribution of Licensed Practical Nurses/Licensed Vocational Nurses by Gender, 2020
      Weighted Sample Values
      Age in YearsMale (n

      =3,046.1)
      Female (n =

      34,652.2)
      Other (n

      = 21.8)
      Total (n =

      37,720.1)
      n%n%n%n%
      17-29256.08.42,556.37.41.67.52,813.97.5
      30-34251.48.32,905.18.40.52.43,157.08.4
      35-39263.88.73,438.39.90.41.73,702.49.8
      40-44395.613.03,454.910.015.872.53,866.310.3
      45-49413.413.63,831.611.11.04.54,246.011.3
      50-54408.313.43,633.910.50.83.94,043.010.7
      55-59412.613.53,876.811.20.41.64,289.711.4
      60-64287.19.44,439.112.80.62.94,726.812.5
      ≥ 65357.911.86,516.218.80.73.26,874.818.2

      Race/Ethnicity

      LPNs/LVNs who reported being White/Caucasian account for 69.5% of the workforce. LPNs/LVNs who reported being Black/African American represent the second largest racial group in the workforce (17.2%). Between 2017 and 2020, the proportion of LPNs/LVNs identifying as Asian increased by 2.4 percentage points to account for 5.0% of the workforce (Table 49).
      Table 49Race/Ethnicity of Licensed Practical Nurses/Licensed Vocational Nurses, 2017 and 2020
      Race2017 (n =

      34,467.5)
      2020 (n =

      39,397.4)
      n%n%
      American Indian or Alaska Native219.80.6316.60.8
      Asian897.42.61,980.65.0
      Black/African American6,372.418.56,790.717.2
      Native Hawaiian or other Pacific Islander62.40.2225.20.6
      Middle Eastern/North African33.70.1
      White/Caucasian24,604.071.427,385.169.5
      Other1,568.54.61,743.94.4
      More than one race category selected743.12.2921.62.3
      Race20172020
      n%n%
      American Indian or Alaska Native5,0240.67,5220.8
      Asian20,5172.647,0595.0
      Black/African American145,69218.5161,34617.2
      Native Hawaiian or other Pacific Islander1,4270.25,3510.6
      Middle Eastern/North African8010.1
      White/Caucasian562,52471.4650,66869.5
      Other35,8604.641,4354.4
      More than one race category selected16,9902.221,8972.3
      Note. Respondents were asked to select all that apply. The responses were subsequently recoded to ensure that the race categories were mutually exclusive. Respondents selecting multiple race categories were reclassified into the “More than one race category selected” category. For the 2020 survey, “Middle Eastern/North African” was added as a response category.

      Hispanic/Latinx Ethnicity

      LPNs/LVNs who reported being of Hispanic/Latinx ancestry account for 10.0% of the workforce. The proportion of LPNs/LVNs identifying as Hispanic/Latinx increased by 2.6 percentage points since 2017 (Table 50 and Figure 23).
      Table 50Hispanic or Latinx Ethnicity of Licensed Practical Nurses/Licensed Vocational Nurses, 20152020
      Weighted Sample Values
      Ethnicity2015 (n = 30,620.8)2017 (n = 34,449.3)2020 (n = 39,335.6)
      n%n%n%
      Hispanic or Latinx ancestry1,964.66.42,558.67.43,912.810.0
      Not of Hispanic or Latinx ancestry28,656.393.631,890.692.635,422.990.0
      Estimated Population Values
      Ethnicity201520172020
      n%n%n%
      Hispanic or Latinx ancestry59,0796.458,4987.492,96810.0
      Not of Hispanic or Latinx ancestry861,74693.6729,11992.6841,64590.0
      Figure 23
      Figure 23Hispanic or Latinx Ethnicity of Licensed Practical Nurses/Licensed Vocational Nurses, 2015-2020

      Race/Ethnicity by Gender

      In comparison to their overall representation in the workforce, LPNs/LVNs who are male are disproportionately likely to identify as racial minorities. Males account for 8.1% of all LPNs/LVNs, but account for substantially larger proportions of LPNs/LVNS who identify as Native Hawaiian or other Pacific Islander (22.1%), Asian (17.2%), and Black/African American (11.0%) (Table 51).
      Table 51Race/Ethnicity of Licensed Practical Nurses/Licensed Vocational Nurses by Gender, 2020
      Weighted Sample Values
      GendernMaleFemaleOther
      n%n%n%
      American Indian or Alaska Native316.318.45.8%296.393.7%1.60.5%
      Asian1,970.7339.517.2%1,624.682.4%6.60.3%
      Black/African American6,758.3742.611.0%6,015.789.0%0.00.0%
      Native Hawaiian or other Pacific Islander225.249.822.1%175.377.9%0.00.0%
      Middle Eastern/North African33.33.510.5%29.889.5%0.00.0%
      White/Caucasian27,284.71,674.16.1%25,604.793.8%6.00.0%
      Other1,736.4244.214.1%1,475.985.0%16.30.9%
      More than one race category selected919.3101.911.1%817.388.9%0.10.0%
      Total39,244.23,174.08.1%36,039.691.8%30.60.1%
      Note. Respondents were asked to select all that apply. Responses were subsequently recoded to ensure that the race categories were mutually exclusive. Respondents selecting multiple race categories were reclassified into the “More than one race category selected” category.

      Race/Ethnicity by Age

      Although LPNs/LVNs younger than 50 years account for a larger proportion of minority nurses, the youngest cohort of LPNs/LVNs (age 19 to 29 years) is more racially similar to nurses between the ages of 50 and 59 years. Compared to the next oldest cohort (age 30 to 34), the youngest LPNs/LVNs are more likely to be White/Caucasian (73.6% vs. 66.3%) and less likely to identify as Asian, Black/African American, Native Hawaiian or other Pacific Islander, or multiracial. As compared to the entire LPN/LVN workforce, a smaller proportion of LPNs/LVNs younger than 30 years identify as belonging to a racial minority group (26.6% vs. 30.3%) (Table 52).
      Table 52Race/Ethnicity of Licensed Practical Nurses and Licensed Vocational Nurses by Age, 2020
      Weighted Sample Values
      Age in

      Years
      nn (%)
      American

      Indian or

      Alaska

      Native
      AsianBlack/

      African

      American
      Native

      Hawaiian or

      Other Pacific

      Islander
      Middle

      Eastern/

      North

      African
      White/

      Caucasian
      OtherMore Than

      One Race
      17-292,789.034.0 (1.2)174.9 (6.3)286.0 (10.3)5.5 (0.2)4.7 (0.2)2,051.2 (73.6)144.2 (5.2)88.4 (3.2)
      30-343,131.432.7 (1.1)214.2 (6.8)481.1 (15.4)27.5 (0.9)1.4 (0.1)2,075.6 (66.3)177.0 (5.7)121.9 (3.9)
      35-393,680.021.1 (0.6)239.1 (6.5)725.5 (19.7)56.7 (1.5)10.9 (0.3)2,335.8 (63.5)173.7 (4.7)117.2 (3.2)
      40-443,850.238.3 (1.0)189.3 (4.9)815.7 (21.2)32.9 (0.9)0.0 (0.0)2,468.5 (64.1)195.1 (5.1)110.5 (2.9)
      45-494,233.635.5 (0.8)247.3 (5.8)993.4 (23.5)29.7 (0.7)2.0 (0.1)2,625.3 (62.0)204.0 (4.8)96.5 (2.3)
      50-544,028.627.3 (0.7)199.6 (5.0)752.0 (18.7)31.8 (0.8)2.7 (0.1)2,714.0 (67.4)220.0 (5.5)81.3 (2.0)
      55-594,274.128.9 (0.7)190.4 (4.5)708.2 (16.6)23.7 (0.6)4.3 (0.1)3,076.0 (72.0)178.8 (4.2)63.9 (1.5)
      60-644,748.937.2 (0.8)206.5 (4.4)699.6 (14.7)7.0 (0.2)1.7 (0.0)3,570.8 (75.2)134.7 (2.8)91.4 (1.9)
      ≥ 656,855.944.7 (0.7)234.9 (3.4)950.2 (13.9)7.9 (0.1)1.9 (0.0)5,293.4 (77.2)201.1 (2.9)121.6 (1.8)
      Total37,591.7299.7 (0.8)1,896.1 (5.0)6,411.7 (17.1)222.9 (0.6)29.7 (0.1)26,210.6 (69.7)1,628.5 (4.3)892.6 (2.4)
      Note. Respondents were asked to select all that apply. Responses were subsequently recoded to ensure that the race categories were mutually exclusive. Respondents selecting multiple race categories were reclassified into the “More than one race category selected” category.

      Education

      Type of Nursing Degree or Credential for First U.S. Nursing License

      In 2020, 81.5% of respondents reported that a vocational/practical certificate in nursing qualified them for their first U.S. nursing license. An additional 10.1% reported that a diploma was their qualifying degree, while 7.2% and 1.3% reported it was an associate or baccalaureate degree, respectively. Interestingly, the proportion of LPNs/LVNs with an associate or baccalaureate degree increased over the years, while those qualifying with a vocational/practical certificate and diploma has decreased (Table 53).
      Table 53Type of Nursing Degree or Credential of Licensed Practical Nurses/Licensed Vocational Nurses for First U.S. Nursing License, 2015-2020
      Weighted Sample Values
      Degree or Credential2015 (n =

      30,223.3)
      2017 (n =

      34,108.8)
      2020 (n =

      38,868.2)
      n%n%n%
      Vocational/practical certificate25,257.483.628,395.083.231,665.681.5
      Diploma3,661.312.14,098.612.03,914.410.1
      Associate degree1,168.83.91,521.34.52,793.37.2
      Baccalaureate degree135.80.493.90.3495.01.3
      Estimated Population Values
      Degree or Credential201520172020
      n%n%n%
      Vocational/practical certificate759,53783.6649,19783.2752,37181.5
      Diploma110,10112.193,70712.093,00610.1
      Associate degree35,1463.934,7824.566,3687.2
      Baccalaureate degree4,0850.42,1460.311,7601.3

      Type of Nursing Degree or Credential for First U.S. Nursing License by Age.

      LPNs/LVNs whose initial education to receive their license was an associate degree were more likely to be younger than those whose initial education was a vocational/practical certificate. Additionally, those whose initial education was a baccalaureate degree tended to be slightly older than those with an associate degree, but younger than those with a vocational/practical certificate (Table 54 and Figure 24).
      Table 54Type of Nursing Degree or Credential of Licensed Practical Nurses/Licensed Vocational Nurses for First U.S. Nursing License by Age, 2020
      Weighted Sample Values
      Degree or CredentialnAge in Years, n (%)
      18-2930-3435-3940-4445-4950-5455-5960-64> 65
      Vocational/ practical30,275.12,280.92,489.12,844.33,002.73,251.03,190.23,494.93,956.45,765.4
      certificate(7.5)(8.2)(9.4)(9.9)(10.7)(10.5)(11.5)(13.1)(19.0)
      Diploma3,714.4248.8318.5439.2445.4505.4447.8404.7348.6556.1
      (6.7)(8.6)(11.8)(12.0)(13.6)(12.1)(10.9)(9.4)(15.0)
      Associate degree2,649.6212.3263.1337.0312.4355.2278.8272.5284.0334.3
      (8.0)(9.9)(12.7)(11.8)(13.4)(10.5)(10.3)(10.7)(12.6)
      Baccalaureate degree470.333.049.437.648.263.779.431.269.258.7
      (7.0)(10.5)(8.0)(10.2)(13.6)(16.9)(6.6)(14.7)(12.5)
      Total37,109.42,774.93,120.13,658.13,808.84,175.43,996.24,203.34,658.26,714.5
      (7.5)(8.4)(9.9)(10.3)(11.3)(10.8)(11.3)(12.6)(18.1)
      Figure 24
      Figure 24Type of Nursing Degree or Credential of LPNs/LVNs for First U.S. Nursing License by Age, 2020

      Highest Level of Nursing Education

      When asked about the highest level of nursing education earned, 72.0% reported a vocational/practical certificate, 12.2% reported a diploma, 12.7% reported an associate degree, and 3.1% indicated a baccalaureate degree. The percentage of LPNs/LVNs who reported an associate or baccalaureate degree increased markedly since 2015, while those earning a vocational/practical certificate or diploma declined (Table 55 and Figure 25).
      Table 55Highest Level of Nursing Education Among Licensed Practical Nurses/Licensed Vocational Nurses, 2015-2020
      Weighted Sample Values
      Education Level2015 (n =

      25,626.5)
      2017 (n

      = 34,208.6)
      2020 (n =

      38,746.1)
      n%n%n%
      Vocational/practical certificate19,481.376.026,615.377.827,899.972.0
      Diploma3,882.515.24,900.814.34,732.512.2
      Associate degree1,888.67.42,509.67.34,910.112.7
      Baccalaureate degree308.51.2182.80.51,203.53.1
      Note. In the 2013 and 2015 surveys a single question “What is your highest level of education?” was asked with the set of possible responses including both nursing and non-nursing degrees. The degree types were separated for the 2017 and 2020 surveys.
      Figure 25
      Figure 25Highest Level of Nursing Education Among LPNs/LVNs, 2015-2020

      Highest Level of Nursing Education by Race

      Across all race/ethnicity groups, the highest level of nursing education was reported as the vocational/practical certificate. Asian LPNs/ LVNs are more likely to hold a baccalaureate degree (23.6%) than all other groups (3.1% for all other groups combined) (Table 56).
      Table 56Highest Level of Nursing Education of Licensed Practical Nurses/Licensed Vocational Nurses by Race, 2020
      Weighted Sample Values
      Racen Vocational/ Practical CertificateDiplomaAssociate DegreeBaccalaureate Degree
      n%n%n%n%
      American Indian or Alaska Native306.6224.273.134.711.3%47.115.4%0.70.2%
      Asian1,922.91,074.655.9166.48.7%228.711.9%453.223.6%
      Black/African American6,629.04,345.065.61,164.017.6905.113.7214.93.2
      Native Hawaiian or other Pacific Islander222.2173.478.03.21.412.05.433.615.1
      Middle Eastern/North African33.221.364.23.610.74.814.43.610.7
      White/Caucasian26,768.020,026.074.83,027.511.33,320.312.4394.21.5
      Other1,695.71,177.869.5210.312.4231.613.776.14.5
      More than one race category selected890.3638.671.7101.211.4127.414.323.12.6
      Weighted Sample Values
      RacenVocational/ Practical CertificateDiplomaAssociate DegreeBaccalaureate Degree
      n%n%n %n%
      Total38,467927,680.9 72.04,710.8 12.24,8770 12.71,199.3 3.1
      Note. In the 2013 and 2015 surveys, a single question “What is your highest level of education?” was asked with the set of possible responses including both nursing and non-nursing degrees. The degree types were separated for the 2017 and 2020 surveys. For the race question, respondents were asked to select all that apply. The responses were subsequently recoded to ensure that the race categories were mutually exclusive. Respondents selecting multiple race categories were reclassified into the “More than one race category selected” category. For the 2020 survey, “Middle Eastern/North African” was added as a response category.

      Highest Level of Non-nursing Education

      About a third (32.3%) of LPNs/LVNs indicated they earned a non-nursing degree. Of those reporting a non-nursing degree, 69.8% reported an associate degree and 24.1% reported a baccalaureate degree. An additional 6.2% indicated they had earned a non-nursing graduate degree (Table 57).
      Table 57Highest Level of Non-Nursing Education of Licensed Practical Nurses/Licensed Vocational Nurses, 2017 and 2020
      Weighted Sample Values
      Non-Nursing Education2017 (n =

      9,832.6)
      2020 (n =

      12,497.8)
      n%n%
      Associate degree6,762.068.88,719.769.8
      Baccalaureate degree2,460.125.03,008.124.1
      Master's degree515.65.2674.05.4
      Doctoral degree95.01.095.90.8

      Licensure

      Number of Years Licensed

      LPN/LVN respondents reported they were licensed for a median of 17 years. A little more than a third of respondents (36.9%) were licensed for 0-10 years, as compared to 43.7% in 2015 and 40.7% in 2017. An additional 23.4% were licensed between 11 and 20 years, which represents an increase from previous years (Table 58 and Figure 26).
      Table 58Number of Years Licensed Practical Nurses/Licensed Vocational Nurses Have Been Licensed, 2015-2020
      Weighted Sample Values
      Years Licensed2015 (n =

      26,138.0)
      2017 (n =

      33,652.6)
      2020 (n =

      36,311.8)
      n%n%n%
      0-1011,417.843.713,694.140.713,401.436.9
      11-205,258.920.16,674.019.88,502.223.4
      21-304,018.015.45,483.916.36,028.316.6
      31-403,552.013.64,531.913.54,213.211.6
      ≥ 411,891.47.23,268.69.74,166.711.5
      Estimated Population Values
      Years Licensed201520172020
      n%n%n%
      0-10343,35343.7313,09040.7318,41636.9
      11-20158,14520.1152,58919.8202,01223.4
      21-30120,82815.4125,37916.3143,23216.6
      31-40106,81513.6103,61413.5100,10511.6
      ≥ 4156,8777.274,7309.799,00011.5
      Figure 26
      Figure 26Number of Years LPNs/LVNs Have Been Licensed, 2015-2020

      Initially Licensed in the United States

      Almost 99% of LPN/LVN respondents were initially licensed in the United States, while 0.6% were initially licensed in the Philippines, 0.1% in Canada, and 0.1% in India (Table 59).
      Table 59Country in Which Licensed Practical Nurses/Licensed Vocational Nurses Were Initially Licensed, 2020
      Weighted Sample Values
      Country2020 (n = 39,472.5)
      n%
      United States38,959.198.7
      Canada48.20.1
      Philippines237.90.6
      India28.90.1
      Other198.40.5
      Estimated Population Values
      Country2020
      n%
      United States925,66598.7
      Canada1,1450.1
      Philippines5,6520.6
      India6870.1
      Other4,7140.5

      Multistate License

      In 2020, 21.2% of LPNs/LVNs reported holding a multistate license (Table 60).
      Table 60Licensed Practical Nurses/Licensed Vocational Nurses Holding a Multistate License, 2020
      Weighted Sample Values
      Multistate License2020 (n = 32,235.9)
      n%
      Yes6,847.521.2
      No25,388.378.8
      Note. Respondents were asked to answer this question only if they were actively employed in nursing.

      Use of Multistate License

      Of those LPNs/LVNs reporting possession of a multistate license, 21.9% use it for physical crossborder practice. The largest majority of respondents indicated using it for “other” purposes (Table 61).
      Table 61How Multistate License is Used by Licensed Practical Nurses/Licensed Vocational Nurses, 2020
      Weighted Sample Values
      Use of Multistate License2020 (n = 4,378.1)
      n%
      Physical crossborder practice959.121.9
      Telehealth286.06.5
      Distance education202.64.6
      Disaster support147.23.4
      Travel nursing52.71.2
      Have not used1,573.535.9
      Other1,309.129.9
      Note. Respondents were asked to answer this question only if they were actively employed in nursing. Respondents were asked to select all that apply.

      Employment

      Employment Status

      Among responding LPNs/LVNs, 65.7% reported being actively employed in nursing full time, which is consistent with the 2017 survey (65.0%). The most notable increase was among those who selected retired, which increased from 8.7% in 2017 to 11.3% in 2020. Approximately 11% of LPNs/LVNs reported working in nursing part-time (Table 62 and Figure 27).
      Table 62Employment Status of Licensed Practical Nurses/Licensed Vocational Nurses, 2015-2020
      Weighted Sample Values
      Employment Status2015 (n =

      30,766.0)
      2017 (n =

      34,570.2)
      2020 (n =

      39,579.6)
      n%n%n%
      Actively employed in nursing full-time18,823.461.222,476.565.026,020.565.7
      Actively employed in nursing part-time3,714.012.14,151.912.04,275.910.8
      Actively employed in nursing per diem2,179.47.12,227.56.42,326.05.9
      Actively employed in a field other than nursing full-time1,504.34.91,306.63.81,257.83.2
      Actively employed in a field other than nursing part-time868.52.8756.72.2600.91.5
      Actively employed in a field other than nursing per diem386.71.3193.60.6230.50.6
      Working in nursing only as a volunteer366.11.2408.91.2383.61.0
      Unemployed, seeking work as a nurse1,558.75.11,162.03.41,260.93.2
      Unemployed, not seeking work as a nurse1,588.9 5.25.21,595.0 4.64.61,614.7 4.14.1
      Retired2,9271 9.59.52,991.2 8.78.74,4577 11.311.3
      Estimated Population Values
      Employment Status201520172020
      n%n%n%
      Actively employed in nursing full-time566,05361.2513,88465.0618,24565.7
      Actively employed in nursing part-time111,68612.194,92512.0101,59510.8
      Actively employed in nursing per diem65,5407.150,9286.455,2665.9
      Actively employed in a field other than nursing full-time45,2364.929,8743.829,8853.2
      Actively employed in a field other than nursing part-time26,1162.817,3012.214,2771.5
      Actively employed in a field other than nursing per diem11,6291.34,4270.65,4770.6
      Working in nursing only as a volunteer11,0081.29,3501.29,1141.0
      Unemployed, seeking work as a nurse46,8735.126,5663.429,9593.2
      Unemployed, not seeking work as a nurse47,7825.236,4674.638,3654.1
      Retired88,0249.568,3878.7105,91511.3
      Note. Respondents were asked to select all that apply.
      Figure 27
      Figure 27Employment Status of LPNs/LVNs, 2015-2020

      Reason for Being Unemployed

      Respondents were asked to select all the applicable reasons for being unemployed. Taking care of home and family was the most frequently selected reason for being unemployed (43.3%) in 2020, which is an increase from 2017 (41.4%) and from 2015 (39.1%). The second and third most frequently selected reasons were “other” by 29.2% of respondents and ‘disabled' at 16.9%. By comparison, in 2017, 21.1% of respondents reported disability, 15.6% responded difficulty in finding a nursing position, and 26.4% reported the other category (Table 63 and Figure 28).
      Table 63Reasons for Unemployment Among Licensed Practical Nurses/Licensed Vocational Nurses, 2015-2020
      Weighted Sample Values
      Unemployment Reaso2015 (n =

      2,644.5)
      2017 (n

      = 2,696.8)
      2020 (n =

      2,781.4)
      n%n%n%
      Taking care of home and family1,033.039.11,117.441.41,203.243.3
      Disabled463.317.5570.021.1470.516.9
      Inadequate salary77.93.0111.54.1133.74.8
      School393.914.9288.410.7336.512.1
      Difficulty in finding a nursing position610.423.1419.615.6384.513.8
      Other600.122.7713.026.4812.329.2
      Note. Respondents were asked to answer this question only if they were unemployed. Respondents were asked to select all that apply.
      Figure 28
      Figure 28Reasons for Unemployment Among LPNs/LVNs, 2015-2020

      Retirement Plans

      In the 2020 LPN/LVN survey, a new question was added: “Do you plan to retire or leave nursing in the next five years?” Only one-fifth of respondents (20.2%) answered “yes.” (Table 64).
      Table 64Retirement Plans of Licensed Practical Nurses/Licensed Vocational Nurses, 2020
      Weighted Sample Values
      Plan to Retire Within 5 Years2020 (n = 31,693.0)
      n%
      Yes6,406.820.2
      No25,286.279.8
      Estimated Population Values
      Plan to Retire Within 5 Years2020
      n%
      Yes152,22520.2
      No600,79879.8
      Note. Respondents were asked to answer this question only if they were actively employed in nursing.

      Number of Positions Currently Held

      Respondents were asked to identify the number of positions in which they were currently employed as a nurse. In 2020 and 2017, 82.4% of LPN/LVN respondents indicated holding just one position as a nurse. The percentage of LPNs/LVNs who reported working in two positions increased slightly from 14.9% in 2017 to 15.1% in 2020. The percentage of respondents who indicated that they held three or more positions in nursing slightly decreased from 2.7% in 2017 to 2.5% in 2020 (Table 65).
      Table 65Number of Positions Currently Held by Licensed Practical Nurses/Licensed Vocational Nurses, 2015-2020
      Weighted Sample Values
      Number of Positions2015 (n =

      23,317.3)
      2017 (n =

      27,576.8)
      2020 (n =

      31,231.7)
      n%n%n%
      119,706.584.522,725.082.425,738.982.4
      23,113.013.44,117514.94,705.715.1
      3 or more497.82.1734.32.7787.12.5
      Estimated Population Values
      Number of Positions201520172020
      n%n%n%
      1592,61184.5519,56382.4611,55482.4
      293,61313.494,13914.9111,80715.1
      3 or more14,9702.116,7882.718,7012.5
      Note. Respondents were asked to answer this question only if they were actively employed in nursing

      Number of Hours Worked During a Typical Week in all Nursing Positions

      In the 2020 survey, 58.6% of responding LPNs/LVNs reported working 32 to 40 hours in a typical week in all positions, which decreased from 59.4% in 2017 and 60.4% in 2015. The second most frequently reported category was 41 to 50 hours (14.9%). This represents a slight decrease from 16% in 2017 (Table 66 and Figure 29).
      Table 66Number of Hours Worked by Licensed Practical Nurses/Licensed Vocational Nurses During a Typical Week in All Nursing Positions, 2015-2020
      Weighted Sample Values
      Hours Worked per Week2015 (n =

      22,450.6)
      2017 (n =

      27,505.7)
      2020 (n =

      30,985.7)
      n%n%n%
      1-15913.14.11,132.64.11,214.43.9
      16-231,088.94.91,298.44.71,323.64.3
      24-311,866.48.32,031.17.42,238.67.2
      32-4013,562.860.416,328.259.418,164.758.6
      41-503,410.015.24,412.716.04,609.114.9
      51-60928.34.11,391.15.11,567.25.1
      ≥ 61681.13.0911.53.31,868.16.0
      Estimated Population Values
      Hours Worked per Week201520172020
      n%n%n%
      1-1527,4594.125,8964.128,8543.9
      16-2332,7444.929,6864.731,4494.3
      24-3156,1268.346,4377.453,1897.2
      32-40407,85960.4373,31459.4431,59258.6
      41-50102,54615.2100,88816.0109,51214.9
      51-6027,9164.131,8055.137,2375.1
      ≥ 6120,4823.020,8413.344,3866.0
      Figure 29
      Figure 29Number of Hours Worked by LPNs/LVNs During a Typical Week in All Nursing Positions, 2015-2020

      Primary Nursing Practice Position Setting

      Of the responding LPNs/LVNs, 27.5% indicated that their primary nursing practice position was in a nursing home/extended care setting, down from 31.7% in 2017. The hospital setting was the second most frequently selected setting by 12.8% of LPNs/LVNs, a 3.2 percentage point increase since 2017, followed by home health at 12.4% and 8.6% in the ambulatory care setting. Hospice (2.1%) and dialysis center (0.9%) were added as new categories in the 2017 survey (Table 67 and Figure 30).
      Table 67Primary Nursing Practice Position Setting of Licensed Practical Nurses/Licensed Vocational Nurses, 2015-2020
      Weighted Sample Values
      Primary Practice Setting2015 (n =

      n
      22,989.1)

      %
      2017 (n =

      n
      26,459.8)

      %
      2020 (n =

      n
      30,055.4)

      %
      Hospital2,478.910.82,540.39.63,831.412.8
      Nursing home/extended care6,911.930.18,385.331.78,250.327.5
      Assisted living facility1,369.56.01,484.25.61,679.55.6
      Home health3,451.015.03,710.514.03,733.312.4
      Hospice426.61.6639.82.1
      Correctional facility670.22.9738.62.8729.32.4
      School of nursing142.00.678.40.3173.70.6
      Public health399.81.7498.31.9623.12.1
      Dialysis center165.80.6266.10.9
      Community health922.64.0888.13.41,073.83.6
      School health service683.93.0697.42.6977.23.3
      Occupational health174.90.8166.60.6187.30.6
      Ambulatory care setting2,061.29.01,797.36.82,588.28.6
      Insurance claims/benefits259.71.1241.30.9331.81.1
      Policy/planning/regulatory/licensing agency32.30.124.40.136.70.1
      Other3,431.214.94,616.717.44,933.916.4
      Estimated Population Values
      Primary Practice Setting201520172020
      n%n%n%
      Hospital74,54410.858,0799.691,03412.8
      Nursing home/extended care207,85430.1191,71531.7196,02627.5
      Assisted living facility41,1836.033,9335.639,9055.6
      Home health103,77915.084,83414.088,70312.4
      Hospice9,7531.615,2022.1
      Correctional facility20,1542.916,8872.817,3282.4
      School of nursing4,2700.61,7920.34,1270.6
      Public health12,0221.711,3941.914,8052.1
      Dialysis center3,7900.66,3230.9
      Community health27,7454.020,3053.425,5133.6
      School health service20,5653.015,9452.623,2183.3
      Occupational health5,2600.83,8100.64,4500.6
      Ambulatory care setting61,9849.041,0916.861,4958.6
      Insurance claims/benefits7,8101.15,5170.97,8841.1
      Policy/planning/regulatory/licensing agency9730.15570.18720.1
      Other103,18214.9105,55317.4117,22916.4
      Figure 30
      Figure 30Primary Nursing Practice Position Setting of LPNs/LVNs, 2015-2020

      Primary Nursing Position Title

      Staff nurse was the title reported as most closely corresponding to the LPN/LVN respondents' primary nursing position by 72.8%. The second most frequently selected position title was “other—health related” at 15.6%, followed by 5.5% of respondents choosing nurse manager as their title, slightly lower than the 6.2% reported in 2017 (Table 68 and Figure 31).
      Table 68Primary Nursing Position Title of Licensed Practical Nurses/Licensed Vocational Nurses, 2015-2020
      Weighted Sample Values
      Title2015 (n =

      23,567.8)
      2017 (n =

      26,776.9)
      2020 (n = 30,512.5)
      n%n%n %
      Consultant140.60.6152.70.6148.4 0.50.5
      Nurse researcher65.00.351.20.266.3 0.20.2
      Nurse executive137.60.670.90.3120.6 0.40.4
      Nurse manager1,365.45.81,661.56.21,680.2 5.55.5
      Nurse faculty/educator967.94.1257.51.0310.51.0
      Advanced practice registered nurse401.71.79.00.0149.40.5
      Staff nurse16,214.168.819,564.673.122,209.972.8
      Case manager595.32.5561.42.1842.82.8
      Other—health related3,444.214.64,275.516.04,768.815.6
      Other—not health related236.01.0172.70.7215.50.7
      Estimated Population Values
      Title201520172020
      n%n%n%
      Consultant4,2270.63,4900.63,5260.5
      Nurse researcher1,9550.31,1700.21,5750.2
      Nurse executive4,1380.61,6210.32,8650.4
      Nurse manager41,0605.837,9866.239,9215.5
      Nurse faculty/educator29,1074.15,8871.07,3771.0
      Advanced practice registered nurse12,0791.72060.03,5500.5
      Staff nurse487,58968.8447,30873.1527,70572.8
      Case manager17,9022.512,8352.120,0252.8
      Other—health related103,57214.697,75116.0113,30615.6
      Other—not health related7,0971.03,9490.75,1200.7
      Note. Respondents were asked to answer this question only if they were actively employed in nursing.
      Figure 31
      Figure 31Primary Nursing Position Title of LPNs/LVNs, 2015-2020

      Primary Nursing Position Specialty

      Among LPN/LVN respondents, 26.6% selected geriatric/gerontology as the employment specialty that most closely corresponded to their primary nursing practice position, down from 30.5% in 2017. Home health was the second most frequently selected employment specialty (8.4%) followed by adult health (8.3%). A slightly greater proportion of LPNs/LVNs selected “other—clinical specialties” in 2020 (11.5%) compared to 2017 (10.8%). The acute care/critical care employment specialty responses increased from 2.7% in 2017 to 4.1% in 2020 (Table 69 and Figure 32).
      Table 69Primary Nursing Position Specialty of Licensed Practical Nurses/Licensed Vocational Nurses, 2015-2020
      Weighted Sample Values
      Primary Position Specialty2015 (n =

      21,932.4)
      2017 (n =

      25,214.9)
      2020 (n =

      28,417.9)
      n%n%n%
      Acute care/critical care458.52.1670.02.71,157.64.1
      Adult health960.64.41,968.07.82,354.28.3
      Family health1,712.46.81,840.36.5
      Anesthesia18.00.117.60.122.50.1
      Cardiology250.41.0312.51.1
      Community262.61.2216.80.9323.61.1
      Geriatric/gerontology6,064.127.77,685.830.57,545.926.6
      Home health2,109.39.62,228.28.82,372.58.4
      Maternal-child health/obstetrics120.50.6225.10.9266.50.9
      Medical surgical777.33.5728.62.91,008.23.6
      Nephrology133.70.6201.00.8258.20.9
      Occupational health154.50.7160.80.6183.40.7
      Oncology137.10.6152.90.6252.50.9
      Palliative care/hospice348.21.6354.71.4490.71.7
      Pediatrics1,326.06.11,880.27.51,819.56.4
      Neonatal28.20.128.80.140.80.1
      Perioperative93.10.476.40.3135.30.5
      Public health173.10.8257.61.0332.41.2
      Psychiatric/mental health/substance abuse1,084.85.01,205.04.81,405.04.9
      Rehabilitation847.73.91,081.54.3990.83.5
      School health612.92.8646.22.6870.13.1
      Emergency/trauma157.20.7127.50.5261.60.9
      Women's health342.81.6291.01.2426.21.5
      Other—clinical specialties2,724.110.83,264.911.5
      Other—nonclinical specialties324.11.3482.91.7
      Other3,400.715.5
      Primary care1,695.57.7
      Genetics182.20.8
      Informatics41.40.2
      Neurology/neurosurgical90.60.4
      Orthopedic185.50.9
      Radiology24.20.1
      Urology102.10.5
      Estimated Population Values
      Primary Position Specialty201520172020
      n%n%n%
      Acute care/critical care13,7872.115,3192.727,5044.1
      Adult health28,8884.444,9957.855,9368.3
      Family health39,1516.843,7256.5
      Anesthesia5420.14010.15350.1
      Cardiology5,7251.07,4251.1
      Community7,8961.24,9560.97,6891.1
      Geriatric/gerontology182,35927.7175,72230.5179,29026.6
      Home health63,4309.650,9448.856,3708.4
      Maternal-child health/obstetrics3,6230.65,1480.96,3320.9
      Medical surgical23,3753.516,6592.923,9553.6
      Nephrology4,0220.64,5950.86,1350.9
      Occupational health4,6470.73,6770.64,3580.7
      Oncology4,1240.63,4970.65,9990.9
      Palliative care/hospice10,4711.68,1091.411,6591.7
      Pediatrics39,8756.142,9887.543,2316.4
      Neonatal8480.16590.19690.1
      Perioperative2,7980.41,7470.33,2150.5
      Public health5,2070.85,8891.07,8981.2
      Psychiatric/mental health/substance abuse32,6225.027,5504.833,3834.9
      Rehabilitation25,4933.924,7274.323,5413.5
      School health18,4322.814,7742.620,6743.1
      Emergency/trauma4,7290.72,9150.56,2160.9
      Women's health10,3081.66,6531.210,1261.5
      Other—clinical specialties62,28210.877,57411.5
      Other—nonclinical specialties7,4111.311,4741.7
      Other102,26615.5
      Primary care50,9867.7
      Genetics5,4800.8
      Informatics1,2440.2
      Neurology/neurosurgical2,7230.4
      Orthopedic5,5770.9
      Radiology7270.1
      Urology3,0710.5
      Note. Respondents were asked to answer this question only if they were actively employed in nursing.
      Figure 32
      Figure 32Primary Nursing Position Specialty of LPNs/LVNs, 2015-2020

      Providing Direct Patient Care—Primary Nursing Position

      A new question was added to the 2020 survey regarding direct patient care. Survey respondents were asked, “In your primary nursing practice position, do you spend the majority of your time providing direct patient care?” A large majority (77.8%) of LPNs/LVNs responded “yes” (Table 70).
      Table 70Licensed Practical Nurses/Licensed Vocational Nurses Providing Direct Patient Care Through Primary Nursing Position, 2020
      Weighted Sample Values
      Provide Direct Patient Care2020 (n = 31,443.7)
      n%
      Yes24,460.377.8
      No6,983.522.2
      Estimated Population Values
      Provide Direct Patient Care2020
      n%
      Yes581,17577.8
      No165,92722.2
      Note. Respondents were asked to answer this question only if they were actively employed in nursing.

      Secondary Nursing Position Setting

      Nursing home/extended care settings was the most frequently chosen setting by 31.7% of LPN/LVN respondents as their secondary nursing position, down from 32.5% in 2017. Additionally, the percentage of LPNs/LVNs who indicated their secondary nursing position in a home health setting decreased from 26.8% in 2017 to 23.5% in 2020. At the same time, the hospital setting percentage increased by 3.1 percentage points in 2020 (9.1%) up from 6.0% in 2017, and the ambulatory care setting increased to 3.3% in 2020 from 2.8% in 2017. The respondents who reported the assisted living facility as their secondary nursing position setting was nearly the same between 2017 and 2020 (7.6% and 7.4%) (Table 71 and Figure 33).
      Table 71Secondary Nursing Position Setting Among Licensed Practical Nurses/Licensed Vocational Nurses, 2015-2020
      Weighted Sample Values
      Secondary Nursing Position2015 (n

      = 3,018.7)
      2017 (n =

      4,376.2)
      2020 (n =

      5,067.9)
      n%n%n%
      Hospital180.46.0261.26.0461.19.1
      Nursing home/extended care813.326.91,422.032.51,608.231.7
      Assisted living facility232.57.7332.37.6374.87.4
      Home health961.331.91,173.126.81,189.723.5
      Hospice115.72.6177.83.5
      Correctional facility108.73.6136.63.1125.12.5
      School of nursing32.71.110.40.254.81.1
      Public health30.31.055.81.354.11.1
      Dialysis center35.00.830.40.6
      Community health69.12.385.22.0108.02.1
      School health service42.11.4111.92.6109.92.2
      Occupational health16.90.631.10.744.30.9
      Ambulatory care setting78.42.6121.72.8165.73.3
      Insurance claims/benefits6.50.222.80.525.80.5
      Policy/planning/regulatory/licensing agency15.90.516.60.46.20.1
      Other430.514.3444.810.2532.010.5
      Note. Respondents were asked to answer this question only if they were actively employed in nursing.
      Figure 33
      Figure 33Secondary Nursing Position Setting Among LPNs/LVNs, 2015-2020

      Secondary Nursing Position Title

      It remains that more than three-quarters (77.7%) of LPN/LVN respondents reported their secondary nursing position title as staff nurse, which is similar to 2017 (78.5%). The percentage of LPNs/LVNs who reported a secondary nursing position title of nurse manager was 3.1%, down from 3.4% in 2017. The next highest category reported was case manager at 2.3% of respondents, followed by nurse faculty/ educators at 2.2%. Unspecified titles are in the category of “other—health related” positions at 11.9% (Table 72 and Figure 34).
      Table 72Secondary Nursing Position Title of Licensed Practical Nurses/Licensed Vocational Nurses, 2015-2020
      Weighted Sample Values
      Secondary Title2015 (n =

      2,980.3)
      2017 (n

      = 4,217.2)
      2020 (n

      = 4,942.1)
      n%n%n%
      Consultant37.51.345.21.147.01.0
      Nurse researcher7.00.21.30.07.30.2
      Nurse executive10.40.410.00.28.60.2
      Nurse manager59.92.0141.43.4153.23.1
      Nurse faculty/educator132.04.458.41.4107.92.2
      Advanced practice registered nurse34.11.12.60.136.10.7
      Staff nurse2,167.272.73,309.278.53,842.277.7
      Case manager53.81.866.61.6111.62.3
      Other—health related440.314.8528.912.5586.211.9
      Other—not health related38.31.353.51.342.10.9
      Figure 34
      Figure 34Secondary Nursing Position Title of LPNs/LVNs, 2015-2020

      Secondary Nursing Position Specialty

      Nearly one-third of LPNs/LVNs (30.6%) reported their secondary nursing position specialty was geriatric/gerontology, a decrease of nearly 4 percentage points from 2017 (34.5%). Home health was the second most frequently selected specialty at 18.2%, followed by adult health at 8.0%, and “other—clinical specialties” at 7.9% of respondents (Table 73 and Figure 35).
      Table 73Secondary Nursing Position Specialty of Licensed Practical Nurses/Licensed Vocational Nurses, 2015-2020
      Weighted Sample Values
      Secondary Position Specialty2015 (n =

      2,809.3)
      2017 (n =

      4,024.3)
      2020 (n

      = 4,686.1)
      n%n%n%
      Acute care/critical care70.92.5120.53.0188.04.0
      Adult health63.82.3236.65.9373.08.0
      Family health88.62.2101.92.2
      Anesthesia0.00.01.90.10.00.0
      Cardiology13.10.312.30.3
      Community37.31.372.31.864.91.4
      Geriatric/gerontology834.029.71,388.234.51,432.130.6
      Home health568.120.2679.516.9853.618.2
      Maternal-child health/obstetrics10.50.421.40.525.10.5
      Medical surgical48.21.773.91.8117.42.5
      Nephrology9.30.327.80.719.30.4
      Occupational health17.20.627.30.738.20.8
      Oncology1.60.19.00.216.50.4
      Palliative care/hospice77.82.858.01.4105.82.3
      Pediatrics181.76.5378.69.4271.75.8
      Neonatal8.40.31.70.00.30.0
      Perioperative0.50.02.90.117.50.4
      Public health21.60.857.61.465.81.4
      Psychiatric/mental health/substance abuse111.84.0159.54.0224.14.8
      Rehabilitation108.33.9184.24.6174.13.7
      School health39.81.482.82.172.91.6
      Emergency/trauma43.61.648.41.245.21.0
      Women's health10.50.417.10.421.80.5
      Other—clinical specialties227.05.6368.07.9
      Other—nonclinical specialties48.31.276.41.6
      Other420.115.0
      Primary care76.92.7
      Genetics29.91.1
      Informatics3.60.1
      Neurology/neurosurgical3.40.1
      Orthopedic6.70.2
      Radiology1.80.1
      Urology1.80.1
      Note. Respondents were asked to answer this question only if they were actively employed in nursing
      Figure 35
      Figure 35Secondary Nursing Position Specialty of LPNs/LVNs, 2015-2020

      Providing Direct Patient Care—Secondary Nursing Practice Position

      A new question was added to the 2020 survey regarding direct patient care. Survey respondents were asked, “In your secondary nursing practice position, do you spend the majority of your time providing direct patient care?” The vast majority (85.5%) responded “yes” (Table 74).
      Table 74Providing Direct Patient Care—Secondary Nursing Practice Position of Licensed Practical Nurses/Licensed Vocational Nurses, 2020
      Provide Direct Patient Care2020 (n = 5,140.8)
      n%
      Yes4,393.885.5
      No747.014.5
      Note. Respondents were asked to answer this question only if they were actively employed in nursing.

      Salary/Earnings

      2020 Pretax Annual Earnings From Primary Nursing Position

      The median pretax annual earnings for responding LPNs/LVNs increased from $38,000 in 2015 to $40,000 in 2017 and $44,000 in 2020. This constitutes a 3.2% simple annual growth in earnings during the 5-year period (0.1% lower than the growth in reported RN incomes during the same period). Categorically, there has been a trend since 2015 of the percentage of respondents earning less than $40,000 annually decreasing while percentages in all other wage categories have increased. The percent of LPNs reporting wages under $40,000 has decreased by 17.7 percentage points from 2015 to 2020 while all other earnings categories have increased. The largest increase has been in the $60,000 to $80,000 category, which has increased by 8.4 percentage points since 2015 (Table 75 and Figure 36).
      Table 75Annual Earnings of Licensed Practical Nurses/Licensed Vocational Nurses, 2015-2020
      Weighted Sample Values
      Earnings2015 (n =

      19,436.4)
      2017 (n =

      24,473.1)
      2020 (n =

      26,035.6)
      n%n%n%
      < $40,00010,138.352.211,190.345.78,988.034.5
      $40,000 to < $60,0007,088.336.59,819.440.110,653.640.9
      $60,000 to < $80,0001,418.57.32,243.99.24,073.615.7
      $80,000 to < $100,000174.60.9361.11.51,118.14.3
      ≥ $100,000616.83.2858.43.51,202.34.6
      Estimated Population Values
      Earnings201520172020
      n%n%n%
      < $40,000304,87752.2255,84545.7213,55434.5
      $40,000 to < $60,000213,15736.5224,50140.1253,12940.9
      $60,000 to < $80,00042,6577.351,3039.296,78815.7
      $80,000 to < $100,0005,2500.98,2561.526,5664.3
      ≥ $100,00018,5483.219,6263.528,5674.6
      Note. Respondents were asked to answer this question only if they were actively employed in nursing. Salary includes overtime and bonuses but does not include sign-on bonuses.
      Figure 36
      Figure 36Annual Earnings of LPNs/LVNs, 2015-2020

      Earnings by Gender and Specialty

      For all specialties, the median salary for males is higher than the median salary for females. LPNs/LVNs working in occupational health and rehabilitation tied for the specialty with the highest median salary. LPNs/LVNs working in school health have the lowest median salary overall. These rankings remain unchanged from the previous survey (Table 76).
      Table 76Median Annual Earnings of Licensed Practical Nurses/Licensed Vocational Nurses by Gender and Specialty, 2020
      SpecialtyMaleFemaleOtherTotal
      nEarningsnEarningsnEarningsnEarnings
      Acute care/critical care95$54,000776$45,000871$45,000
      Adult health176$50,0001,607$45,0002$40,5001,785$45,000
      Family health41$45,7601,933$38,0001974$38,000
      Anesthesia2$59,50012$37,50014$42,500
      Cardiology17$45,000252$40,000269$40,000
      Community22$53,000281$41,000303$42,000
      Geriatric/gerontology430$53,0006,278$46,0003$65,0006,711$47,000
      Home Health135$50,0001,605$42,0001,740$42,000
      Maternal-child health/obstetrics187$42,000187$42,000
      Medical-surgical66$47,000756$41,0001$45,000823$41,041
      Nephrology16$57,500144$45,0001$50,000161$46,600
      Occupational health13$49,000148$50,0001$74,000162$50,000
      Oncology9$38,000173432961$19,000183$43,000
      Palliative care/hospice16$54,000333$47,000349$47,500
      Pediatrics56$42,0751,321$40,0001$50,0001,378$40,000
      Neonatal23$45,00023$45,000
      Perioperative11$52,00098$45,000109$45,760
      Public health18$43,000249$40,000267$40,000
      Psychiatric/mental health/substance abuse142$51,4001,009$45,0001$64,0001,152$45,000
      Rehabilitation90$55,000756$50,0002$44,640848$50,000
      School health16$39,000631$29,000647$29,000
      Emergency/trauma26$47,584173$40,000199$41,674
      Women's health316$40,780316$40,780
      Other—clinical specialties170$52,0002,624$44,0001$46,7842,795$44,800
      Other—nonclinical specialties25$59,599314$50,000339$50,000
      Total1,593$50,00021,999$43,00014$48,392
      Note. Respondents were asked to answer this question only if they were actively employed in nursing. Salary includes overtime and bonuses but does not include sign-on bonuses.

      Earnings by Highest Education

      Holding true from previous years, LPNs/LVNs with baccalaureate degrees have the highest median salaries (Table 77).
      Table 77Median Annual Earnings of Licensed Practical Nurses/Licensed Vocational Nurses by Highest Education, 2017 and 2020
      Highest Education Level20172020
      nEarningsnEarnings
      Vocational/practical certificate-nursing16,750$42,00017,947$43,000
      Diploma3,709$41,6003,589$43,000
      Associate degree2,199$40,0003,565$45,000
      Baccalaureate degree227$51,619566$60,000

      Earnings by State

      Reported median earnings rose in most states. The highest median earnings were for LPNs/LVNs practicing in New York ($60,000) and Alaska ($56,559). California, Nevada, and Washington, D.C., tied at around $55,000. The lowest median earnings were for LPNs/ LVNs practicing in Alabama ($39,000), South Dakota ($38,000), Mississippi ($37,000), and West Virginia ($36,000). Unlike with RNs where the highest gains in earnings were also the states with the lowest earnings, the states with the highest gains in earnings since 2015 for LPNs/LVNs are New York (10%), Idaho (5.8%), Michigan (5.7%), South Dakota (5.3%), and Oregon (5.0%). Notably, LPNs/LVNs working in the Northern Mariana Islands had both lower reported median earnings than LPNs/LVNs in all U.S. states and also saw an 8% decline in those earnings since 2015 (Table 78).
      Table 78Median Annual Earnings of Licensed Practical Nurses/Licensed Vocational Nurses in Primary Nursing Position by State(s) Where Currently Practicing
      State201520172020State201520172020
      Alabama$33,000$35,000$39,000Montana$36,260$37,440$43,000
      Alaska$50,000$52,000$56,559Nebraska$33,000$38,000$40,000
      Arizona$48,000$48,000$52,000Nevada$48,000$49,000$55,000
      Arkansas$33,500$37,000$40,000New Hampshire$42,000$45,500$50,000
      California$45,000$48,000$55,836New Jersey$45,000$48,000$54,000
      Colorado$42,000$45,000$50,000New Mexico$45,000$45,000$50,000
      Connecticut$49,000$50,000$52,360New York$40,000$45,000$60,000
      Delaware$45,000$47,000$50,000North Carolina$38,000$41,000$44,000
      District of Columbia$53,000$50,000$55,000North Dakota$35,000$37,000$40,000
      Florida$37,000$40,000$43,210Ohio$34,000$36,000$40,000
      Georgia$36,000$39,800$42,000Oklahoma$35,000$37,000$40,000
      Hawaii$45,000$46,000$50,000Oregon$42,240$47,000$53,000
      Idaho$32,560$38,000$42,000Pennsylvania$39,000$40,320$44,000
      Illinois$40,000$40,000$45,000Rhode Island$45,000$50,000$50,000
      Indiana$36,000$40,000$45,000South Carolina$37,124$40,000$42,000
      Iowa$34,640$36,000$41,000South Dakota$30,000$34,865$38,000
      Kansas$35,000$39,000$41,500Tennessee$34,000$36,000$40,000
      Kentucky$35,000$40,000$42,000Texas$40,082$43,000$49,383
      Louisiana$35,000$38,000$40,000Utah$36,000$41,000$41,000
      Maine$36,000$40,000$43,500Vermont$37,128$42,000$45,000
      Maryland$45,000$50,000$53,012Virginia$36,000$40,000$44,000
      Massachusetts$48,000$50,000$54,000Washington$44,000$48,000$54,000
      Michigan$35,000$40,000$45,000West Virginia$32,000$35,000$36,000
      Minnesota$33,000$36,750$40,000Wisconsin$35,000$38,000$40,000
      Mississippi$35,000$35,000$37,000Wyoming$40,000$40,500$44,000
      Missouri
      Missouri did not participate in the 2015 and 2017 surveys.
      Missouri did not participate in the 2015 and 2017 surveys.
      $40,000Guam$34,000$32,000$40,000
      Northern Mariana Islands$55,000$28,500$32,959
      Note. Respondents were asked to answer this question only if they were actively employed in nursing. Salary includes overtime and bonuses but does not include sign-on bonuses.
      low asterisk Missouri did not participate in the 2015 and 2017 surveys.

      Earnings by Years Licensed and Age

      Similar to RNs, there are steady increases in reported median salary as the number of years licensed increases, and less increase when looking at increase in age within the same number of years of experience (Table 79).
      Table 79Median Annual Earnings of Licensed Practical Nurses/Licensed Vocational Nurses by Years Licensed and Age, 2020
      Number of Years Licensed
      Age in Years0-12-56-10> 11Total
      nEarningsnEarningsnEarningsnEarningsnEarnings
      18-29655$29,9831,159$38,000286$40,0009$60,0002,109$35,300
      30-34318$33,519804$40,000847$42,000256$42,0002,225$40,000
      35-39234$35,000583$42,000789$44,422859$45,0002,465$42,806
      40-44176$37,872413$42,000651$45,0001,330$43,0002,570$43,000
      45-49119$35,675339$45,000511$47,0001,772$48,0002,741$46,360
      50-5488$37,720268$45,000415$47,1212,107$48,0002,878$47,000
      55-5945$40,000123$44,000329$45,0172,671$48,0003,168$47,084
      60-6417$49,92058$42,075200$45,0002,909$46,6003,184$46,000
      ≥ 6516$11,82051$45,000103$43,0002,645$42,0002,815$42,000
      Total1,668$32,3163,798$40,0004,131$45,00014,558$45,167
      Note. Respondents were asked to answer this question only if they were actively employed in nursing. Salary includes overtime and bonuses but does not include sign -on bonuses.

      Telehealth Utilization

      Percentage of Time Providing Telehealth

      There has been little change over time in the percentage of LPNs/LVNs who report providing telehealth services (Table 80 and Figure 37).
      Table 80Percentage of Time Licensed Practical Nurses/Licensed Vocational Nurses Spend Providing Telehealth, 2015-2020
      Weighted Sample Values
      Provides Telehealth2015 (n =

      23,619.9)
      2017 (n =

      27,760.6)
      2020 (n =

      31,095.7)
      n%n%n%
      Never12,723.153.912,715.845.815,504.349.9
      1%-25%5,496.623.36,436.423.26,799.821.9
      26%-50%2,207.19.32,821.310.22,993.39.6
      51%-75%1,490.66.32,253.88.12,240.47.2
      76%-100%1,702.47.23,533.312.73,557.911.4
      Estimated Population Values
      Provides Telehealth201520172020
      n%n%n%
      Never382,60653.9290,72245.8368,38149.9
      1%-25%165,29423.3147,15723.2161,56321.9
      26%-50%66,3739.364,50310.271,1219.6
      51%-75%44,8266.351,5298.153,2327.2
      76%-100%51,1957.280,78112.784,53511.4
      Note. Respondents were asked to answer this question only if they were actively employed in nursing.
      Figure 37
      Figure 37Percentage of Time LPNs/LVNs Spend Providing Telehealth, 2015-2020

      Telehealth Across State Borders

      Of those providing nursing services remotely, there has been a 9.2 percentage point increase in those who reported providing telehealth across state borders compared to 2015 (Table 81 and Figure 38).
      Table 81Percentage of Time Licensed Practical Nurses/Licensed Vocational Nurses Spend Providing Telehealth Across State Borders, 2015-2020
      Weighted Sample Values
      Provide Telehealth2015 (n =

      11,421.5)
      2017 (n =

      12,214.3)
      2020 (n =

      12,981.4)
      n%n%n%
      Never7,566.566.26,849.956.17,413.457.1
      1%-25%3,140.427.54,040.133.14,062.831.3
      26%-50%371.13.2622.95.1692.75.3
      51%-75%180.41.6372.23.1390.83.0
      76%-100%163.11.4329.32.7421.73.3
      Note. Respondents were asked to answer this question only if they were actively employed in nursing
      Figure 38
      Figure 38Percentage of Time LPNs/LVNs Spend Providing Telehealth Across State Borders, 2015-2020

      Telehealth Across International Borders

      Figure 39
      Figure 39Percentage of Time Licensed Practical Nurses/Licensed Vocational Nurses Spend Providing Telehealth Across International Borders, 2015-2020
      Table 82Percentage of Time Licensed Practical Nurses/Licensed Vocational Nurses Spend Providing Telehealth Across National Borders, 2015-2020
      Weighted Sample Values
      Provide Telehealth2015 (n =

      11,089.2)
      2017 (n =

      11,117.1)
      2020 (n =

      12,295.4)
      n%n%n%
      Never10,201.892.09,800.388.211,068.090.0
      1%—25%633.35.7807.07.3814.26.6
      26%-50%129.01.2208.11.9193.31.6
      51%-75%82.00.7189.01.7115.80.9
      76%-100%43.10.4112.71.0104.20.9

      Modes of Communication Used for Telehealth

      LPNs/LVNs providing services via phone or electronically to patients or clients were also asked to identify the modes of communication used. In 2020, 92.8% of LPNs/LVNs reported using a telephone to communicate with patients or clients, a 2.9 percentage point decrease from 2015; 30.5% reported using email to communicate with patients or clients, which is a slight decrease from the 29.5% in 2015; and 27.0% reported using electronic messaging for patient/client communication in 2020 compared to 21.9% in 2015 (Table 83 and Figure 40).
      Table 83Modes of Communication Used by Licensed Practical Nurses/Licensed Vocational Nurses for Telehealth, 2015-2020
      Weighted Sample Values
      Mode of Telehealth2015 (n =

      8,881.7)
      2017 (n =

      11,164.0)
      2020 (n =

      12,154.9)
      n%n%n%
      Electronic messaging1,947.721.92,510.822.53,280.427.0
      VoIP187.72.1349.63.1947.97.8
      Virtual ICU84.91.0125.21.1287.52.4
      Telephone8,498.595.710,405.093.211,274.792.8
      Email2,622.229.53,226.228.93,706.730.5
      Video call207.42.3260.72.31,371.811.3
      Other883.09.91,027.29.2998.18.2
      Note. Respondents were asked to answer this question only if they were actively employed in nursing. Respondents were asked to select all that apply. VoIP = Voice over Internet Protocol; ICU = intensive care unit.
      Figure 40
      Figure 40Modes of Communication Used by Licensed Practical Nurses/Licensed Vocational Nurses for Telehealth, 2015-2020
      As with their RN colleagues, the use of telephones continues to be the most common method of communication for telehealth provision. However, telephone use has declined 2.9% since 2015 in favor of video calls, VoIP, and electronic messaging (increases of 9, 5.7, and 5.1 percentage points since 2015, respectively) (Table 83 and Figure 40).

      Discussion and Implications

      Demographics

      The workforce in 2020 is more demographically diverse and representative of the country's population than in any other year in which this study was previously conducted. Overall, the RN workforce is 81% White/Caucasian. In contrast, 72% of the U.S. population identifies as Caucasian (

      U.S. Census Bureau. (2020). ACS demographic and housing 1-year estimates: 2019. https://www.census.gov/newsroom/press-kits/2020/ acs-1year.html

      ). Although these data indicate that persons of color are not adequately represented in the RN workforce, as younger nurses have entered the workforce, they have introduced greater racial diversity by identifying as an underrepresented minority. Nurses between the ages of 19 and 49 comprise 47% of all RNs but account for 49% of RNs who are Black/African American and more than 60% of RNs who are multiracial, Asian, or Native Hawaiian or other Pacific Islander.
      In a pattern similar to that of RNs, younger LPNs/LVNs have introduced more racial diversity to the workforce. It is notable, however, that the racial distribution of the LPN/LVN workforce much more closely matches the racial distribution of the U.S. population than does the RN workforce. As the workforce ages and the less racially diverse generation of nurses begins to retire out of practice, it will be important to monitor whether persons of color become overrepresented among LPNs/LVNs. LPN/LVN licensure requires the lowest level of nursing education and yields a median annual salary that is more than 35% lower than the median income of RNs.
      An additional area that warrants monitoring is the proportion of nurses in the workforce who are working past typical retirement age. Nurses aged 65 years or older account for nearly 20% of each of the RN and LPN/LVN workforces. In 2017, this same age cohort accounted for 15% of RNs and 13% of LPNs/LVNs. During the COVID-19 pandemic, which has resulted in a high rate of complications and mortality for patients older than 65 years, many nurses may reconsider how long they plan to remain in the workforce. Employers should develop and implement succession plans to ensure that the rapid loss of the workforce's oldest nurses does not result in an unrecoverable loss of expertise.
      Although women continue to account for the largest majority of nurses, the proportion of men licensed as RNs or LPNs/LVNs in the country is increasing. Currently, men account for just under 10% of the RN workforce, which is up from 7% in 2013. The same pattern, though less pronounced, holds true for the proportion of men in the LPN/LVN workforce. The increase in the number of men in the overall nursing workforce reflects the improved representation of men among nurses younger than 50 years. Men account for a higher proportion of nurses within every age cohort between 19 and 49 years of age than they account for in the workforce as a whole.

      Employment

      Data suggest an average of 83% of all nurses who maintain licensure are employed in nursing; of those, roughly two-thirds work full-time, 10% work part-time, and about 7% work per diem shifts. During the past four reporting periods, there has been a consistent number of RNs and LPNs/LVNs who maintain a nursing license and report working in fields other than nursing. Using weighted sample values, this translates to approximately 200,000 licensees. Additionally, there are approximately 175,000 projected licensees who report being unemployed but are not seeking work as nurses. Still another nearly 15% of unemployed nurses who are seeking nursing employment reported difficulty in finding a nursing position.
      For nurses who report being unemployed, about half of RNs and roughly 43.3% of LPNs/LVNs cite taking care of home and family as their reason for not working. Being disabled is another significant reason reported for unemployment among RNs (10.7%) and LPNs/ LVNs (16.9%). This is consistent with the research, which suggests that nurses suffer workplace injuries at a higher incidence than other professionals (
      • Dressner M.A.
      • Kissinger S.P.
      Occupational injuries and illnesses among registered nurses.
      ).
      The proportion of nurses reporting a retired nursing employment status is on the rise. In a new survey question for 2020, respondents were asked if they plan to retire in the next 5 years. More than one-fifth of all nurses replied positively to the question. This response correlates to the longstanding belief that we will see a tsunami of nurses retire and leave the profession in the near future (

      McMenamin, P. (2014, April 9). Tsunami warning: Massive RN retirements coming. Medscape Nurses. https://www.medscape.com/ viewarticle/823183

      ). The authors note this may be more critical as we face COVID-19 pandemic responses, which may more quickly accelerate the retirement rate due to the increased health risks that COVID-19 places on persons older than 60 years.
      Nearly 84% of RNs work only one position in nursing; however, 13.7% reported that they work two positions and 2.4% reported working three positions or more. Nearly 60% of nurses work 32 to 40 hours a week and more than one-fifth of nurses work more than 40 hours per week. Similar to RNs, 82.4% of LPNs/LVNs reported being currently employed in only one position, and those who reported working two positions increased from 2017 to 2020. One-fifth of LPNs/LVNs report working 41 to 50 hours in their typical week and roughly 60% report working 32 to 40 hours.
      Hospitals continue to be the primary practice setting for RNs, followed by the ambulatory care setting, home health, and nursing homes. The number of LPNs/LVNs who are working in hospitals have increased since 2017, which corresponds with the decrease of those who reported working in nursing homes or extended care settings.
      Of those nurses who provide direct patient care, more than 90% of the respondents hold the title of staff nurse. Not surprisingly, the title with the least amount of direct patient care is a nurse executive. In the specialty area of anesthesia, 94.7% of respondents provide direct patient care; for nurses who report neonatal as their specialty, 91.2% provide direct patient care. Of those nurses reporting geriatric/ gerontology as their specialty area, less than half (45.1%) provide direct patient care. Those nurses who report public health (31.0%) and community (26.7%) as specialty areas are providing direct patient care at a proportion lower than all other specialties.

      Education

      In the 2020 survey, the proportion of RNs holding a baccalaureate degree increased for those reporting their highest level of nursing education but remained steady for those reporting the degree held when obtaining their first nursing license. The proportion of RNs holding an associate degree when first licensed increased slightly in 2020. This trend had been declining in recent years. When only considering the highest nursing degree earned, the proportion of RNs earning a baccalaureate degree or higher continues to increase, although the proportion will fall short of the National Academy of Medicine's goal of 80% of RNs hold a baccalaureate degree or higher (). The proportion of LPNs/LVNs earning an associate or baccalaureate degree also increased slightly this year, while the proportion of those with a practical/vocational certificate or nursing diploma declined.
      There is also evidence RNs and LPNs/LVNs are continuing their nursing education after obtaining their initial nursing license. Comparing the highest level of nursing education to the educational attainment when first licensed show that proportionally more RNs hold a baccalaureate or graduate degree than did at initial licensure. Additionally, proportionally more LPNs/LVNs hold an associate or baccalaureate degree as their highest level of nursing education than at initial licensure.

      Licensure

      Evidence suggests both RNs and LPNs/LVNs are more experienced now than in previous years. The proportion of nurses with 10 or fewer years practicing declined according to survey respondents, while the proportion of those with between 11 and 30 years of experience grew in 2020. As in previous years, most RNs (95%) and LPNs/LVNs (99%) obtained their initial nursing license in the United States.

      Salary

      Nursing incomes overall have at best remained essentially flat over time, with increases that just barely beat out inflation. Regional income increases in specific states as described in the report may be a good indicator for where employment demand for nurses is high in the country. Of concern are greater-than-average drops in reported median income in specialties related to women and maternal-child health. However, this finding may simply be an indicator that there is less demand in these areas as our population ages.
      While telehealth has become a major focus of pandemic healthcare delivery, at the time of this survey, it does not seem that there have been major changes to how nurses use telehealth. It is anticipated that this will change a great deal in the future as our care delivery systems learn how best to utilize nursing services in this new normal.

      Limitations

      One of the difficulties of a national survey is making a single national observation when nursing, as a profession, is highly dependent on regional and local factors. This must be kept in mind when interpreting the results of the survey.
      The survey was conducted during the COVID-19 pandemic. The responses received pre-pandemic did not differ from the responses received after the initial months of the pandemic for most of the survey questions; however, there were some exceptions. Respondents in the Pre-COVID groups were more likely to be younger, fully employed, and working in hospitals. Respondents in the Post- COVID groups were more likely to be older, retired, and working in home health.
      Response rates in social science and public surveys have been declining for quite some time. The Nursing Workforce Survey has reflected this decline. The RN response rates were 38.5% in 2013, 34.3% in 2015, 32.8% in 2017, and 27.3% in 2020. The LPN/LVN rates were 28.0% in 2015, 26.5% in 2017, and 23.9% in 2020. A response rate decline of RNs dropping to 30% and the LPN/LVNs dropping to 25% may have been expected from 2017 to 2020 even without the pandemic. But the decline in response rates was larger for RNs and LPN/LVNs and may also have been a result of the COVID pandemic.
      The following groups of nurses may have been slightly overrepresented in both the RN and LPN/LVN samples: White/Caucasian, female, and age of 50 years or older. Because of missing or incomplete data on race/ethnicity, only gender and age could be used to make nonresponse weighting adjustments (Appendix C).
      While the response trends of APRNs remained consistent with prior surveys, the overall proportion of APRN responses in the 2020 cycle declined after years of incremental growth. Future survey administrations are necessary to determine whether this reflects a permanent shift in respondent profile or is an outlier due to the pandemic.

      Conclusion

      The nursing workforce has slowly changed during the past 2 years as evidenced by the information described in this report in terms of employment setting, age, diversity, and education. Efforts to increase baccalaureate-prepared nurses in the workforce according to the goal outlined in the Future of Nursing report (National Academy of Medicine, 2011) have resulted in an increase in the number of baccalaureate- prepared nurses. However, the goal of 80% baccalaureate-prepared nurses by 2020 has not been met. The workforce is also shifting as older nurses retire and Generation Z enters the workforce. Challenges will continue in the nursing workforce, such as matching workforce diversity to population, compensation, and opportunity; exploring the role of nurses in new practice settings; and adjusting to changes in healthcare delivery modalities such as telehealth. Ultimately, nursing will continue pursuing the goals of achieving higher levels of education, promoting diversity, and improving data collection regarding the nation00al healthcare workforce.

      Appendices

      Appendix A 2020 National Workforce Study Questionnaire

      Appendix B Impact of COVID-19 on Survey Responses

      During data collection for the survey, the United States became engulfed in the COVID-19 pandemic. The response to the pandemic caused major shifts in the country's workforce activities, which included a rapidly increasing workload for nurses on the “frontlines,” shifts in priorities for nurses not on the frontlines, and a temporary closure of the physical sites for many businesses. Among those temporary business closures was the data processing center of the Workforce Survey's vendor, Scantron. During the closure, a large volume of workforce survey responses was not processed. Scantron re-opened their offices in mid-April and spent the rest of the month catching up on the processing of the backlog of responses.
      In an attempt to determine whether the COVID-19 pandemic impacted the responses to the survey, a study was conducted that compared the answers to questions from surveys collected before the pandemic to those received after the state of the workforce had changed. A “Pre-COVID” group of RNs and LPNs/LVNs was collected, whose data process date was identified as being March 11, 2020, or earlier (March 11 was the date a global pandemic was declared by the World Health Organization). A “Post-COVID” group of RNs and LPNs/LVNs was also collected, whose data process date was identified as being May 1, 2020, or later. May 1 was chosen because Scantron had caught up with the processing backlog by that date. Records from the interim period, when it could not be determined whether the response was sent to Scantron® before or after the pandemic took effect, were excluded from the analysis.
      The Pre-COVID group of RNs consisted of 3,293 respondents whereas the Post-COVID group of RNs consisted of 9,871 respondents. For the LPNs/LVNs, the Pre-COVID group consisted of 1,622 respondents while the Post-COVID group consisted of 11,246 respondents. The distributions of the responses to all the survey questions were calculated for the Pre-COVID and Post-COVID groups. For most of the survey questions, the differences between the response distributions for the Pre-COVID and Post-COVID groups were negligible for both the RN and LPN/LVN surveys. The exceptions for both license types were found in the responses to the gender, age, years licensed, employment status, and employment setting questions:
      • In the Pre-COVID RN group, 15.1% of the respondents were male, whereas 8.5% of the respondents in the Post-COVID RN group were male. For LPNs/LVNs, 12.9% of the respondents in the Pre-COVID group were male, whereas 7.3% of the respondents in the Post-COVID group were male.
      • In the Pre-COVID RN group, the median age of the respondents was 42 years, whereas in the Post-COVID RN group the median age of the respondents was 52 years. For LPNs/LVNs, the median age of the respondents in the Pre-COVID group was 42 years, wheras the median age of the respondents in the Post-COVID group was 54 years.
      • In the Pre-COVID RN group, the median number of years that respondents were licensed was 12, whereas in the Post-COVID RN group, the median number of years the repondents were licensed was 20. For LPNs/LVNs, the median number of years licensed in the Pre-COVID group was 9, whereas the median number of years licensed in the Post-COVID group was 18.
      • In the Pre-COVID RN group, 75.3% of the respondents worked full-time, whereas 65.3% of the respondents in the Post-COVID RN group worked full-time. For LPNs/LVNs, 74.4% of the respondents in the Pre-COVID group worked full-time, whereas 66.2% of the respondents in the Post-COVID group worked full-time.
      • In the Pre-COVID RN group, 4.6% of the respondents were retired, whereas 12.1% of the respondents in the Post-COVID RN group were retired. For LPNs/LVNs, 2.4% of the respondents in the Pre-COVID group were retired, whereas 12.5% of the respondents in the Post-COVID group were retired.
      • In the Pre-COVID RN group, 62.2% of the respondents worked in hospitals, whereas 54.9% of the respondents in the Post-COVID RN group worked in hospitals. For LPNs/LVNs, 16.6% of the respondents in the Pre-COVID group worked in hospitals, whereas 12.9% of the respondents in the Post-COVID group worked in hospitals.
      • In the Pre-COVID RN group, 2.9% of the respondents worked in home health, wheras 5.1% of the respondents in the PostCOVID RN group worked in home health. For LPNs/LVNs, 8.9% of the respondents in the Pre-COVID group worked in home health, whereas 13.0% of the respondents in the PostCOVID group worked in home health.
      In general, respondents prior to the pandemic were more likely to be younger, fully employed, and working in hospitals. Respondents after the pandemic were more likely to be older, retired, and working in home health (Appendix B).
      A caveat: Without data from comparable comparisons in previous surveys, it cannot be determined whether the differences in responses are strictly due to the pandemic. It is quite possible that the different response patterns for the demographic variables (gender, age, years licensed) would also be found in earlier surveys. However, working full-time, retirement status, and working in hospitals could quite reasonably be a result of the pandemic.

      Appendix C Registered Nurse Nonresponse Analyses and Sample Weighting

      A formal nonresponse bias analysis was conducted following the close of the survey. Although response rates are a valuable indicator of survey quality, they are not a good measure of response bias. An analysis of basic demographic data (i.e., gender, age, race/ethnic- ity, number of years since graduation, number of years since first licensed) for all registered nurse (RN) licensees sampled from the Nursys database was used to compare the survey respondents and nonrespondents to determine the representativeness of the survey participants.
      Variables in the data file came from both the Nursys database (i.e., the frame data) and responses to the survey (i.e., survey data). The variables used in the nonresponse analysis were from the frame and include state, date of birth, gender, and ethnicity. The dependent variable in the analysis was whether or not the sampled RN population completed the questionnaire.

      Preliminary Analysis

      Of the 153,695 RNs in the sample frame, 42,021 responded for a response rate of 27.3%
      This response rate corresponds to the American Association of Public Opinion's Response Rate 1 (the minimum response rate), in which the numerator is the number of completed questionnaires and the denominator is the total sample size. Retrieved from https://www.aapor.org/AAPOR_Main/media/publications/ Standard-Definitions20169theditionfinal.pdf
      (Table C1). Table C2, Table C3 show the frequencies for the categorical variables. Table 4 shows the descriptive statistics for age. The only demographic information used for the following analyses comes from Nursys, not the survey.
      Table C1Response Bias of Registered Nurses: Response Rate (N = 153,695)
      Response Statusn%
      Nonresponse111,67472.7
      Response42,02127.3
      Table C2Response Bias of Registered Nurses: Gender (N = 153,695)
      Gender Response Variablesn%Valid %
      ValidFemale86,02556.089.5
      Male10,0656.510.5
      Total96,09062.5100.0
      MissingRestricted/unknown3,3822.2
      Missing54,22335.3
      Total57,60537.5
      Table C3Response Bias of Registered Nurses: Race/ Ethnicity (N = 153,695)
      Race/Ethnicity Response Variablesn%Valid %
      ValidWhite43,32228.277.5
      Black/African American3,9222.67.0
      Asian2,0751.43.7
      Hispanic2,2901.54.1
      Native Americans7720.01.4
      Pacific Islander710.00.1
      Other3,4182.26.1
      Total55,87036.4100.0
      MissingRestricted/unknown41,09226.7
      Missing56,73336.9
      Total97,82563.6
      Table C4Response Bias of Registered Nurses: Descriptive Statistics for Age (N = 91,540)
      MSDMinMax
      Age in Years46.813.72092

      Bivariate Analysis

      Table C5, Table C6 show the bivariate relationships between the demographic variables from the sample frame and whether or not the respondent completed the survey. There were far fewer men in the database (10,065 compared to 86,025 women) and they were less likely to complete the survey (20.3% compared to 28.5% among women).
      Table C5Response Bias of Registered Nurses: Survey Completion Rate by Gender
      GendernComplete Survey?
      NoYes
      Female86,02571.5%28.5%
      Male10,06579.7%20.3%
      Total96,09072.3%27.7%
      Note. χ2 (1, N = 96,090) = 309.6, p < .001.
      As presented in Table 6, nurses who identified as Pacific Islander were most likely to respond, with a response rate of 29.6%. African American nurses were least likely to respond, with a response rate of 19.0%.
      Table C6Response Bias of Registered Nurses: Survey Completion Rate by Race/Ethnicity
      Race/EthnicitynComplete Survey?
      NoYes
      White43,32272.0%28.0%
      African American3,92281.0%19.0%
      Hispanic2,29077.7%22.3%
      Asian2,07574.4%25.6%
      Native American77278.9%21.1%
      Pacific Islander7170.4%29.6%
      Other3,41871.4%28.6%
      Total55,87073.0%27.0%
      Note. χ2 (6, N = 55,870) = 198.0; p < .001.
      Table C7 displays the mean age of RNs. On average, those who completed the survey were 4.9 years older than the nonrespondents. This relationship is statistically significant (p < .001).
      Table C7Response Bias of Registered Nurses: Differences in Mean Age by Survey Completion
      Complete Survey?nAge in Years
      MSD
      No65,63245.413.2
      Yes25,90850.314.3
      Total91,54046.813.7
      Note. A t test shows that the relationship is significant at the <.001 level.

      Weights

      In the 2015 and 2017 National Nursing Workforce Survey reports, nonresponse adjustments were made for gender and age. In 2020, nonresponse adjustments were again made for gender and age. There was a high degree of missing race/ethnicity data in the sample frame (63.6% missing/unknown). It was deemed impractical to use race/ ethnicity for nonresponse adjustment even though there were differences in response rates by the category.
      For the 2020 Survey, nonresponse adjustments were applied for gender and age in the jurisdictions for which data were obtained through the Nursys database. To create the combined age and gender (AgeGender) nonresponse weights (i.e., AgeGenderWgtC), the survey response rates for the age variable were compared at the5-year age group level and neighboring cells with similar response rates were collapsed. Upon completion of this process, six age groups were created (16 (AuthorWas this the youngest age? Elsewher in the article, 17, 18, and 19 are used.) to 49, 50 to 54, 55 to 59, 60 to 64, 65 or older, missing). These six age groups were combined with the gender variable response categories (male, female, missing (AU: What about the “other” response option? (This question also pertains to the relevant LPN/LVN section)) to produce 18 AgeGender categories. The survey response rate for each AgeGender category (# responding/# in sample frame) was calculated and used to create each category's weight as follows:
      AgeGender Category Weight=Overall Survey Response RateAgeGender Category Survey Response Rate
      As an example of how this was calculated, there were 1,479 RNs in the sample frame whose gender was identified as male and whose age was missing. Out of these 1,479 RNs, 251 responded. The AgeGender response rate for this category was determined to be 251/1479 = .1697. The overall survey response rate was 42021/153695 = .2734. Hence, the AgeGender weight for the age missing-gender male category was .2734/.1697 = 1.611.
      When the AgeGender weights for each respondent are totaled up, the sum comes to 42,021—the same as the total number of respondents. Table C8 displays the weights for the 18 AgeGender categories in jurisdictions for which data were obtained through the Nursys database.)
      Table C8Response Rate Bias of Registered Nurses: AgeGender Weights
      Age in YearsMissingGender
      FemaleMale
      16-491.3101.1521.602
      50-541.0761.0081.308
      55-590.8400.8111.199
      60-640.7490.7100.907
      > 650.6230.6070.698
      Age missing1.0301.1181.611
      In a similar manner, poststratification weights (i.e., JurisdictionWgtC) were constructed at the state level to adjust for differing sampling rates across states. These adjustments were made by comparing the number of responses to the number of licensees in that state. Analysis of the raw data, without accounting for the sample design, would lead to the overall results being too heavily influenced by states with fewer licensees.
      For example, there were 444,964 licensed RNs in California, out of which 811 responded. The California response per license rate was 811/444964 = .0018. The overall response per license rate was 42021/4948914 = .0085. Hence, the poststratification weight for California was .0085/.0018 = 4.659.
      Overall weights (pct_wgtC), which combined the AgeGender and poststratification weights were created by multiplying the AgeGender and poststratification weights for each individual to create an initial set of weights, adding the initial weights together, and slightly adjusting the weights so that they summed 42,021.
      The overall weights adjust the distribution across states, age, and gender but the sum is the actual number of RNs in the subset of completed responses. They can be applied when analyzing relationships between variables without the effect of artificially altering the degrees of freedom and thereby affecting significance tests. The AgeGender weights, poststratification weights, and overall weights are summarized in Table C9.
      Table C9Response Bias of Registered Nurses: Descriptive Statistics of Weights, Complete Responses Only
      nMinMaxSumMean
      AgeGender

      (AgeGenderWgtC)
      42,0210.6071.61142,0211.000
      Poststratification

      (JurisdictionWgtC)
      42,0210.0824.65942,0211.000
      Combined (pct_wgtC)42,0210.0497.41542,0211.000
      Note. Combined (pct_wgtC) was used in reporting results.

      Licensed Practical Nurse/Licensed Vocational Nurse Nonresponse Analyses and Sample Weighting

      As with the RNs, a formal nonresponse bias analysis was conducted on the licensed practical nurse/licensed vocational nurse (LPN/LVN) data following the close of the survey. Variables in the data file came from both the Nursys database (i.e., the frame data) and responses to the survey (i.e., survey data). The variables used in the nonresponse analysis were from the frame and include state, date of birth, gender, and race/ethnicity. The dependent variable in the analysis was whether or not the sampled LPN/LVN population completed the questionnaire.

      Preliminary Analysis

      Of the 166,217 LPNs/LVNs in the sample frame, 39,765 responded for a response rate of 23.9% (Table C10). Tables C11 and C12 show the frequencies for the categorical variables. Table C13 shows the descriptive statistics for age.
      Table C10Response Bias of Licensed Practical Nurses/Licensed Vocational Nurses: Response Rate
      Response Status(n = 166,217)%
      No126,45276.1
      Yes39,76523.9
      Table C11Response Bias of Licensed Practical Nurses/Licensed Vocational Nurses: Gender
      Gender Response Variables(n = 166,217)%Valid %
      Valid Female93,31756.191.8%
      Male8,3445.08.2%
      Total101,66161.2100.0%
      Missing Restricted/unknown1,0330.6
      Missing63,52338.2
      Total64,55638.8
      Table C12Response Bias of Licensed Practical Nurses/Licensed Vocational Nurses: Race/ Ethnicity
      Race/Ethnicity Response Variables(n = 166,217)%Valid %
      ValidWhite39,16523.6%73.4%
      Black/African6,9754.2%13.1%
      American
      Asian7090.4%1.3%
      Hispanic3,3732.0%6.3%
      Native American8110.5%1.5%
      Pacific Islander630.0%0.1%
      Other2,2331.3%4.2%
      Total53,32932.1%100.0%
      MissingRestricted/unknown48,74029.3%
      Missing64,14838.6%
      Total112,88867.9%
      Table C13Response Bias of Licensed Practical Nurses/Licensed Vocational Nurses: Descriptive Statistics for Age (n = 97,238)
      MSDMinMax
      Age in Years47.013.61993

      Bivariate analysis

      Table C14, Table C15 show the bivariate relationships between the demographic variables from the sample frame and whether or not the respondent completed the survey. There were far fewer men in the database (8,344 compared to 93,317 women), and they were less likely to complete the survey (17.2% compared to 24.6% among women).
      Table C14Response Bias of Licensed Practical Nurses/Licensed Vocational Nurses: Survey Completion Rate by Gender
      GendernComplete Survey?
      NoYes
      Female93,31775.4%24.6%
      Male8,34482.8%17.2%
      Total101,66176.0%24.0%
      Note.Note. χ2 (1, N = 101,661) = 229.8, p > .001.
      Table C15Response Bias of Licensed Practical Nurses/Licensed Vocational Nurses: Survey Completion Rate by Race/Ethnicity
      Race/EthnicitynComplete Survey?
      NoYes
      White39,16574.3%25.7%
      African American6,97582.2%17.8%
      Asian70976.2%23.8%
      Hispanic3,37380.3%19.7%
      Native American81179.8%20.2%
      Pacific Islander6381.0%19.0%
      Other2,23378.9%21.1%
      Total53,32976.0%24.0%
      Note.Note. χ2 (6, N = 53,329) = 258.5, p > .001.
      From Table C15, LPNs/LVNs who identified as White were most likely to respond, with a response rate of 25.7%. African American nurses were least likely to respond, with a response rate of 17.8%.
      Table C16 displays the mean age of LPNs/LVNs. On average, those who completed the survey were 5.3 years older than the nonrespondents. This relationship is statistically significant.
      Table C16Response Bias of Licensed Practical Nurses/Licensed Vocational Nurses: Differences in Mean Age by Survey
      Complete Survey?nAge in Years
      MSD
      No73,80645.713.2
      Yes23,43251.014.0
      Total97,23847.013.6
      Note. A t test shows that this relationship is significant at the <.001 level.

      Weights

      In the 2015 and 2017 National Nursing Workforce Survey reports, nonresponse adjustments were made for gender and age. Due to the high degree of missing race/ethnicity data in the sample frame (67.9% missing/unknown), it was still deemed impractical to use that category for nonresponse adjustment.
      To create the combined age and gender (AgeGender) nonresponse weights (i.e., AgeGenderWgtC), the survey response rates for the age variable were compared at the 5-year age group level, and neighboring cells with similar response rates were collapsed. Upon completion of this process, six age groups were created (16 to 49, 50 to 54, 55 to 59, 60 to 64, 65 or older, missing). These six age groups were combined with the gender variable response categories (male, female, missing) to produce 18 AgeGender categories. The survey response rate for each age-gender category (# responding/# in sample frame) was calculated and used to create each category's weight, as follows:
      AgeGender Category Weight=Overall Survey Response RateAgeGender Category Survey Response Rate
      An example of how this was calculated can be found in the RN nonresponse sample weighting section.
      When the AgeGender weights for each respondent are totaled, the sum comes to 39,765—the same as the total number of respondents. Table C17 displays the weights for the 18 AgeGender categories in jurisdictions for which data were obtained through the Nursys database.
      Table C17Response Bias of Licensed Practical Nurses/Licensed Vocational Nurses: AgeGender Weights Min Max Sum Mean
      Age in YearsGender
      MissingFemaleMale
      18 to 491.4961.2531.715
      50 to 541.1770.9771.355
      55 to 590.9440.7991.187
      60 to 640.7650.6971.049
      65 or older0.6650.5920.745
      Age missing0.9931.0781.435
      In a similar manner poststratification weights (i.e., JurisdictionWgtC) were constructed at the state level to adjust for differing sampling rates across states. However, these adjustments were made not by comparing the number of responses in a state to its sample frame count, but rather by comparing the number of responses to the number of licensees in that state. An example of how these weights were calculated can be found in the RN nonresponse sample weighting section.
      Overall weights (pct_wgtC), which combined the AgeGender and poststratification weights, were created by multiplying the AgeGender and poststratification weights for each individual to create an initial set of weights, adding the initial weights together, and slightly adjusting the weights so that they sum up to 39,765.
      The overall weights simply adjust the distribution across states, age, and gender but sum to the actual number of LPNs/ LVNs in the subset of completed responses. They can be applied when analyzing relationships between variables without the effect of artificially altering the degrees of freedom and thereby affecting significance tests. The AgeGender weights, poststratification weights, and overall weights for LPNs/LVNs are summarized in Table C18.
      Table C18Response Bias of Licensed Practical Nurses/Licensed Vocational Nurses: Descriptive Statistics of Weights, Complete Responses Only
      nMinMaxSumMean
      AgeGender39,7650.5921.71539,7651.000
      (AgeGenderWgtC)
      Poststratification39,7650.1175.27039,7651.000
      Combined

      (pct wgtC)
      39,7650.0837.05939,7651.000
      Note. pct_wgtC was used in reporting results.

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