In May, the Health Resources and Services Administration (HRSA) released highlights of the 2012 National Sample Survey of Nurse Practitioners (NSSNP).1 The survey is similar to the one traditionally conducted for the registered nurse (RN) workforce every 4 years since 1977. The NSSNP provides information about the nurse practitioner (NP) workforce-specifically their education, certification, and practice patterns. NP workforce is defined as positions that require an NP credential. A representative sample of approximately 13,000 NPs from all over the United States responded to questions on the survey; an explanation of the surveying methods is available online at: http://datawarehouse.hrsa.gov/data/dataDownload/AboutNSSNP2012.aspx#2. There were a total of 154,000 NPs who were licensed in the United States in 2012. Of the total licensed NPs, 86% (132,000) could be included in the NP workforce. Faculty comprised almost 3% of the NP workforce, while nurse administrators represented only 1%. Fourteen percent of licensed NPs (22,000) were not employed in an NP position, and 11,000 (7%) were working as RNs.
The results
Some of the highlighted results were not surprising. Eighty-six percent of the NP workforce was White and non-Hispanic, and 7% was male. The average age was 48 years with 16% at 60 years and older, balanced by 14% under the age of 35. The highest percentage (18%) was in the 55 to 59 age group. Approximately 94% held master's degrees, and of the remaining 6%, 67% were trained before 1992 and had been "grandfathered in." Only 5% held doctoral degrees in 2012 with no distinction made between research and practice doctorates.
Ninety-six percent of the NP workforce provided direct patient care with 48% stating that they were working in primary care. Family NPs represented nearly half of the 76% who indicated that they held national certification in a primary care population focus (family, adult, pediatric, or gerontology) at some point in their career, meaning that certification might not have been current at the time of the survey. As the year of graduation advanced from 1992 through 2007, fewer NPs had selected primary care for practice (59% to 42%). Since 2008, however, a small reversal has been seen with more NPs choosing primary care (48%). Approximately 16% of the NP workforce in 2012 was employed in internal medicine or pediatric subspecialties, 6% in psychiatric/mental health practices, and one third in hospital inpatient and outpatient settings. Only 11% worked where there was no physician on-site. While 95% had an individual National Provider Identifier (NPI) number, only 63% reported ever having used their personal NPI for billing.
Rallying young nurses
I observed several things about the NP workforce from these data. NPs are part of the aging U.S. population, perhaps working longer than their counterparts in the past. We need to attract greater numbers of younger nurses into the profession. We have done well through education by requiring a master's degree to be eligible for national certification, but more NPs must select primary care for practice in the future. The consensus model will force NPs to seek employment in the area in which they were educated and trained. NPs must also persist in seeking recognition for the work they do as providers and to not continue as part of physician or facility billing. Another goal would be to have 0% of nurses educated and trained as NPs working in RN positions. And of course, increasing diversity in the NP workforce is a desired outcome.
The NSSNP was the first survey conducted by HRSA focusing on the NP workforce. Although the highlights presented in the report are preliminary, they provide some insight into who we are as providers. Much rich data remains. Researchers and others interested in analyzing data further are encouraged to access a public use file, which will be housed on HRSA's Warehouse Data (currently in development). Check the HRSA website periodically for more information, and take advantage of an opportunity to disseminate results.
Jamesetta Newland, PhD, RN, FNP-BC, FAANP, DPNAP
EDITOR-IN-CHIEF [email protected]
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