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Diving Into Occupation-Level Data: A Focus on Nursing

ByBlake Decker

In our newest blog post, we turn our attention to an area that has long been seen as a critical element to the quality of society: the field of nursing. In our previous posts in this series, we have looked at broad trends in terms of projected growth occupations, as well as reviewing supply-and-demand gaps in the projected highest growth occupations (numeric and percentage). Our previous post focused on selected engineering occupations. In this post, we are reviewing more granular data in terms of current supply and demand in nursing occupations, as we seek to understand current and projected gaps for licensed vocational nurses, registered nurses, and nurse practitioners across Texas.

Examining the supply and demand gap across nursing Occupations

Throughout this series, we have been using the “CIP-to-SOC” crosswalk that connects academic programs (CIP codes) with occupations (SOC codes) to determine where gaps exist between estimated job openings and degrees awarded. However, the high-need nature of the field of nursing provides greater levels of data collection and utilization when compared to other occupational areas. One such data source is the Texas Department of State Health Services (TDSHS), as we will be using TDSHS data to show supply and demand projections for nursing fields through 2036.

Based on technical documentation, the TDSHS models supply of nurses using data simulations that include several data elements: new entrants to the nursing workforce, nurses (RN/LPN) who leave the workforce, adjusting hours worked based on the age of nurses, and interstate movement of nurses during the year. This definition is important, because the analysis below differs from our previous blog posts that couched supply strictly in terms of the number of graduates produced during a given year by Texas institutions. In the visualization below, all counts are stated in terms of “Full-Time Equivalents” as calculated by the TDSHS, and each occupational group (LVN, RN, Nurse Practitioners) can be selected using the group selector above the visualization. Definitions for each occupational group are included at the end of the blog post.

  • Registered Nurses (RNs): The gap between the demand needed for RNs in Texas and the supply of RNs in Texas is projected to remain fairly consistent from 2022 to 2036. In 2022, the gap was 15.7 percent (supply of 239,447 versus demand of 284,125), as it is projected to be 15.6 percent (supply of 304,116 versus demand of 360,487) in 2036. In order to close the supply-demand gap in RNs in Texas by 2036, the state would collectively need to produce/import/retain an average of 50,000 registered nurses each year over the course of the 2022-2036 timeframe.
  • Nurse Practitioners (NPs): The TDSHS data for NPs shows the most dramatic shift in terms of an increasing gap in the amount of supply versus demand in Texas from 2022 to 2036. What starts out as an 8,110-person surplus in 2022 balloons to an estimated 31,459-person surplus in 2036. While the estimated demand increases by 26 percent over the length of the data window, the estimated supply has a 100-percent increase from 2022 to 2036 in the TDSHS data. On the TDSHS website, the NP data are broken down into five separate categories. The medical specialties (NP) category is the only one estimated to have unmet need (demand > supply) across all years in the TDSHS data, while four categories (primary care, psychiatry, women’s health, and other NP specialties) show higher supply than demand by 2036.
  • Licensed Vocational Nurses (LVNs): In the base year of 2022, the TDSHS estimated an excess supply of LVNs in Texas of more than 16,000 nurses (supply of 67,409 versus demand of 51,351) for a surplus of 31.2 percent. What is interesting is the projected switch in this trend as the state approaches 2034. While the supply-side only dips slightly over the course of the 15-year window in the data, the demand for LVNs in Texas is projected to increase by 39 percent through 2036, resulting in an estimated gap between supply and demand of approximately 5 percent.

So What?

As shown above, the greatest category of overall need in the field of nursing in Texas is registered nurses. One of the central tenets to understanding supply-and-demand for RNs is the total population of licensed nurses in the state. According to TDSHS’s “2023 Nursing Supply Report,” 396,852 RNs held an active license in Texas in 2023. A quick glance at the demand numbers for RNs in the visualization above shows the demand for RNs in 2023 was around 290,000 in Texas. So, why does Texas, on average, have a 50,000-person gap between supply and demand shown in the TDSHS data above? Based on the Nursing Supply Report, only 58.5-percent of RNs with active licenses met the following criteria to be counted as part of the available “supply”, which is defined as someone with an active license, employed in nursing, having a primary address in Texas, and without an Advanced Practice Registered Nurses (APRN) license. This resulted in fewer than 240,000 RNs with active licenses working in nursing in Texas in 2023.

The 41.5-percent drop from the overall total of licensed RNs in Texas to those counted in this 240K supply number highlights the multifaceted nature of the challenges facing Texas in terms of meeting the demand for RNs in the near and far term. From the perspective of nursing preparation programs, TDSHS reported there were more than 32,000 students enrolled in pre-licensure (RN) preparation programs across Texas in 2023, and almost 15,000 of those students graduated from their RN program of study in 2023. For RNs working in the field, data from Lightcast, a labor market analytics company, showed there were almost 77,000 registered nurses who separated from their employer in Texas in 2023, which represents a 30-percent turnover for RNs in Texas in 2023. When taking into account separations, which includes movement within and exits out of the field of nursing, as well as new jobs created (almost 7,000) in 2023, Lightcast estimated there were almost 21,000 new RN openings needing to be filled in Texas in 2023. When accounting for the number of RN graduates in 2023 from the TDSHS, there was a 6,000-person gap between the demand (annual openings) and supply (new graduates) in the Lightcast data.

The mobile nature of nursing professional, as shown by a 30-percent turnover rate above, highlights the complexities surrounding the field of nursing. These data collectively support the view that solutions to the issue of meeting the demand for RNs in the state of Texas must include both increasing the pipeline into the profession as well as retaining a greater percentage of nurses once they are in the field, factors addressed in a recently-published report of the Texas Healthcare Workforce Task Force. While certainly prevalent across the field of nursing, the issues discussed above are not distinctive to nursing. Similar challenges exist in the field of teaching as well, which will be the focus of our final blog post of this series.

Definitions

The following definitions have been summarized from several sources to provide a sense of the differences between the three nursing categories presented above:

  • Licensed Vocational Nurses (LVN) complete at least one year of post-secondary training. LVNs practice under the direct supervision of Registered Nurses and/or physicians. Most LVN programs in Texas are offered by community and technical colleges, hospitals, and for-profit entities. 
  • Registered Nurses (RN) complete either a two-year Associate or four-year Bachelor’s degree. RNs are licensed healthcare providers who provide direct patient care in a variety of settings. They can supervise LVNs. RNs may also have specialized training in areas such as critical care and maternal and infant care.
  • Nurse Practitioners (NP) complete a master’s degree in addition to their bachelor’s degree and are recognized as advanced practice registered nurses. NPs may specialize in a variety of healthcare areas including family practice, psychiatric mental health, and may also hold leadership positions as nurse educators and administrators. NPs may supervise RNs and provide direct patient care. They collaborate with and practice under the supervision of a physician.