Chapter 2:  The LPN workforce

Relatively little is known about the LPN workforce in the United States.  As far as we have been able to determine, there has only been one national survey of LPNs, conducted in 1983 (U.S. Department of Health and Human Services, 1985). We have not been able to locate a single database providing information about the number of licensed practical nurses in the Nation.  Information about the size, demographics, and employment characteristics of this workforce must be obtained from a variety of disparate sources.  Since none of these sources of data can provide comprehensive information, some of the data are conflicting when compared across sources.

Workforce Size and Distribution

According to estimates from the Census 2000 Special Equal Employment Opportunity Tabulation (U.S. Bureau of the Census, 2000), there were 596,355 licensed practical nurses in 2000.  This figure, however, is lower than the total number of active LPN licenses and number of jobs held by LPNs.  The following table compares figures from various sources.

Table 2.1:  Licensed Practical Nurses in the United States

In Table 2.2 we compare two different measures of LPN supply by State.  In every State except Maryland, the number of active licenses is much larger than the LPN population estimate.  In Maryland the estimated population exceeded the total number of active licenses by 909.  The population estimates as a percent of the total number of active licenses range from 35 percent to 111 percent.  Since a person can have an LPN license in more than one State, using the number of active licenses as a measure of supply most likely overstates the number of LPNs in each State. 

Table 2.2:  Total Active LPN Licenses and Estimated LPN population

*Estimates may not add to total due to rounding

Sources: (1) (Crawford, 2001) (2) (U.S. Bureau of the Census, 2000)

Table 2.3 shows the estimated number of LPNs and RNs per 100,000 population, and ranks States based on these ratios.  There are about four times as many RNs as there are LPNs per 100,000 people in the U.S. population.  Massachusetts and New Hampshire stand out as having the greatest difference between the numbers of RNs and LPNs, having over 1000 RNs and under 200 LPNs per 100,000 population.  Overall, there is more variation in the numbers of RNs per capita than of LPNs.  Though the distribution of LPNs throughout the U.S. does not closely match the distribution of RNs, there are some similarities. 

In 2000, the estimated number of LPNs per 100,000 population ranged from a low of 88 in Oregon to a high of 365 in Arkansas.  Other States with low numbers of LPNs per 100,000 people include Alaska, Nevada, Colorado, Utah, and Hawaii.  In fact, the Western part of the U.S. appears to have the lowest concentration of LPNs, while the South and Midwest (e.g., Arkansas, Oklahoma, Louisiana, Minnesota, and North Dakota) have the highest.  This pattern is similar to that reflected in the data for RNs.  States with the lowest numbers of RNs per 100,000 individuals in the population include Nevada, California, Utah, Idaho, and Texas – mostly western States.  The highest numbers are in the Northeast and Midwest (e.g., Massachusetts, New Hampshire, Iowa, South Dakota, and Rhode Island).

Table 2.3:  LPNs and RNs Per 100,000 Population

Sources: (1) (U.S. Bureau of the Census, 2000) (2) (U.S. Bureau of the Census, 2003)

Demographics of LPNs

Information about the demographic characteristics of LPNs can be obtained from the Current Population Survey (CPS).  The CPS is a monthly survey of households conducted by the Bureau of the Census for the Bureau of Labor Statistics.   It is the primary source of information on the labor force characteristics of the U.S. civilian non-institutional population (see http://www.bls.census.gov/cps/overmain.htm) (U.S. Bureau of the Census, 2004).  The CPS contains individual and family demographic information.  LPNs are self-identified in these data by reporting that their occupation is licensed practical nursing.  We computed all data presented here using weights provided by the Bureau of the Census to ensure that the data represent the U.S. population. With relatively few LPNs in some years of this survey, the data may not represent the LPN workforce accurately.  Furthermore, the CPS was revised in 1994, resulting in the discontinuation of several variables in dataset.  Several questionnaire items were changed, making comparisons across all years difficult or impossible depending on the variable.  Thus, some of the demographic information we report is for recent survey years only. 

Table 2.4 shows the number of LPNs in the CPS from 1984 to 2001. The number of LPNs identified in the CPS has declined from 1,002 in 1984 to 584 in 2001.  This drop follows the decline in the total number of records in the CPS between 1984 and 2001.  Thus, it does not reflect a trend in the supply of LPNs; rather, it reflects the drop in the number of households surveyed by the Census. 

Table 2.4:  Number of LPNs Identified in the Current Population Survey Outgoing Rotation Group Files, 1984-2001 (Unicon Research Corporation, 2002)

The regional distribution of nurses in the 1984-2001 CPS data is shown in Figures 2.1 through 2.3.  All three types of nursing personnel—LPNs, RNs, and nurse aides—have a similar regional distribution.  The major difference is that more LPNs live in the South and fewer in the Northeast, as compared to RNs in the data.  This is in agreement with the population estimates.

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Table 2.5 presents the gender and racial/ethnic characteristics of LPNs in the United States from 1984 through 2001.  Men are a slowly growing share of the LPN workforce, comprising only 3 percent of LPNs in 1984 and 5 percent in 2001.  The share of LPNs that is male is similar to that of the RN workforce (See Spratley et al. (2000) for information on RN gender distribution).

The LPN workforce is predominantly white, although the ethnic diversity of LPNs has grown over time.  In 1984, 77 percent of the LPN workforce was white, but this share dropped to 67 percent by 2001.  The largest minority group of LPNs is blacks, comprising 26 percent of the workforce in 2001.  Blacks are overrepresented in the LPN workforce relative to the total U.S. population.  Hispanics account for 3 percent and Asians account for 2 percent of the LPN workforce; these ethnic groups are significantly underrepresented in this workforce, and these shares have not changed substantially since the 1980s.  About 1 percent of the LPN workforce is Native American; this is consistent with the general population (see Census 2000 population estimates at http://quickfacts.census.gov/qfd/States/00000.htm).

Table 2.5:  Distribution of Licensed Practical Nurses by Gender and Race/Ethnicity

Source: Current Population Survey Outgoing Rotation Group Files, 1984-2001

Most LPNs are married (Table 2.6).  From 1984 to 2001, the share of LPNs that reported being married varies between 56 percent and 66 percent, with no clear pattern of change over time.  During this same time period, between 23 percent and 32 percent were widowed, divorced, or separated, and 10 percent to 14 percent were never married.

Table 2.6:  Marital Status of Licensed Practical Nurses

Source: Current Population Survey Outgoing Rotation Group Files, 1984-2001

As with registered nurses, the mean age of LPNs has been increasing since the 1980s.  In 1984, the mean age was 39.  By 2001, the mean age was 43.  As shown in Table 2.7, LPNs are slightly older than RNs on average.  The age distribution of LPNs in the 1984-2001 CPS data is shown in Figure 2.4.  The histogram shows the distribution of the ages of LPNs.  The numbers on the left indicate the age range, while those on the right are the number of LPN observations.  The box plot to the right of the histogram illustrates the 75^th (age 49) and 25^th (age 32) percentiles, denoted by the top and bottom of the box, respectively.  The plus sign in the upper half of the box signifies the mean (age 41).  Both plots indicate that the LPN workforce leans toward older ages, rather than being evenly spread out across all ages.  Based on these data, we can expect large numbers of LPNs to retire within the next 25 years.

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Table 2.7:  Mean Age of Licensed Nurses

Source: Current Population Survey Outgoing Rotation Group Files, 1984-2001

More LPNs are U.S.-born than RNs.   In 2001, 94 percent of LPNs had been born in the U.S.  This percent was the same in 1994, the earliest date for which the CPS has data on citizenship status.  However, the data shows that an increasing percent of RNs are foreign-born: 11 percent in 2001 compared to 8 percent in 1994.  The CPS also collects data on when survey respondents immigrated to the U.S.  The data shows that foreign-born LPNs mostly immigrated to the U.S. in the 1970s, 1980s, and late 1990s.

Table 2.8 shows the educational attainment of LPNs in the CPS data.  The CPS education data prior to 1992 indicate only the highest grade attended and completed.  College is defined as ranging from 13 years of education to 18 or more years of education.  Between 1984 and 1991, 47 percent to 59 percent of LPNs completed at least 1 year of college. Beginning in 1992, information on degrees attained is available.

Almost 66 percent of LPNs in 1992 completed some college or an AA degree.  This percent increased to almost 80 percent by 2001.  Between 1992 and 2001, there was a small increase in the percentage of LPNs with a bachelor’s degree.  The bachelor’s degrees may have been in non-nursing fields of study.  Since 1996, this figure has hovered near 5 percent.  Less than 1 percent holds a master’s or doctorate degree in any field of study.  Those who have only a high school education (including those who did not graduate) represent a decreasing proportion of LPNs.  In 1992, this figure was 30 percent; by 2001 it had decreased to 15 percent.

Table 2.8:  Educational Attainment of LPNs

Source: Current Population Survey Outgoing Rotation Group Files, 1992-2001

The Current Population Survey contains family income information by income categories.  In any year, however, 4 percent to 13 percent of LPNs in the CPS data have no family income information.  From 1984 to 2001, the majority of LPNs responded that their family income was less than $50,000 per year.  Between 1984 and 1985, more than half reported family incomes less then $25,000. Since the 1980s, the proportion of LPNs with family incomes over $50,000 increased so that by 2001 one-third of LPNs were in this family income category. 

Employment status of LPNs

The Current Population Survey asks respondents whether they are employed.  However, we should note that since 1994, the CPS variable for employment status has been derived from all labor force items in the survey; this was not the case previously. Thus, it is possible that estimates from the CPS understated the percent of working survey respondents prior to 1994.  Also, it is important to keep in mind that LPNs are self-identified in the CPS data (by reporting that their occupation is licensed practical nursing).  Thus, some people might have licenses as LPNs, but do not identify themselves as such because they are working in other fields (or not working at all).

In 1984, 80 percent of LPNs said they were employed; this share rose to 94 percent by 2001 (Figure 2.5). This is very similar to RN employment trends in the data.  Relatively small shares of LPNs are unemployed at any time, with the rate always below 5 percent between 1984 and 2001. LPNs reporting that they were not part of the labor force decreased from 16 percent in 1984 to 5 percent in 2001.  It is unclear whether this is due to changes in the CPS survey in 1994, or whether there is a higher share of LPNs in the labor force in recent years.

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The CPS asks survey respondents why they are not in the labor force, but the precise questions have changed over time.  Between 1984 and 1988, 52 percent to 69 percent of LPNs not in the labor force reported housekeeping responsibilities as the main reason for not working.  Another 5 percent to 11 percent reported being in school, while 17 percent to 32 percent reported other reasons for not working, including retirement.  Comparable data for RNs not in the labor force indicate the following: 66 percent to 72 percent reported housekeeping responsibilities, 4 percent to 6 percent indicated school, and 20 percent to 26 percent claimed other/retired as the main reason for not looking for work.

In 1989, a new variable was added to the CPS that provided more detail as to why survey respondents were not looking for work.  (However, this variable was discontinued after 1993).  Between 1989 and 1992, 4 percent to 10 percent of LPNs (and 4 percent to 7 percent of RNs) not looking for work reported they were in school; this is a similar share as between 1984 and 1988.  Illness and disability were reported by 21 percent to 35 percent of LPNs, compared to 11 percent to 19 percent of RNs, not in the labor force.  In 1989, 47  percent indicated that they were “keeping house,” with this share declining to 30 percent by 1992. Likewise, compared to previous survey years, a smaller and declining share of RNs reported housekeeping responsibilities as the main reason for not seeking employment. Retirement was reported as the reason for 8 percent to 14 percent of LPNs and 15 percent to 23 percent of RNs not looking for work.

Between 1994 and 2000, 22 percent to 50 percent of LPNs who were not in the labor force said they were retired.  Not surprisingly, this share is higher than the estimated retired shares of the 1980s, since LPNs are now older on average.  The retirement figures for RNs in the 1994-2000 CPS data range from 29 percent to 41 percent, with no clear trend.  The proportion of LPNs who reported not being in the labor force due to disability varies from 9 percent to 39 percent between 1994 and 2000. This figure ranges from 5 percent to 19 percent for RNs. Again, there is no clear trend in the data for LPNs or RNs.  In almost every survey year since 1994, most LPNs and RNs who reported not being in the labor force did not provide a detailed reason for their labor force status.  By 2001 over 80 percent of LPNs not working and not seeking work provided an answer that fell into the “other” category.

Since 1994, the CPS has asked respondents if they hold more than one job.  LPNs reported having more than one job at a rate of 6 percent to 9 percent between 1994 and 2001. A somewhat larger share of RNs reports having more than one job during this same time period.  It is unclear from the data whether there is an upward trend in LPNs holding multiple jobs. 

Work settings of LPNs

LPNs work primarily in hospitals and nursing and personal care facilities (Table 2.9).  From 1984 to 2001, the proportion of LPNs working in hospitals declined from 54 percent to 32 percent.  During this same time period, the percent of LPNs working in nursing and personal care facilities grew from 26 percent to 32 percent.  The proportion of RNs working in hospitals also declined between 1984 and 2001, but by only by 10 percentage points.  However, even at its lowest, 60 percent in 2001, the share of RNs working in hospitals is greater than that of LPNs in every year.  Also, the data do not show an increase in the percent of RNs working in nursing and personal care facilities; this share stays near 7 percent in all years. 

In 1984, 6 percent of LPNs worked in offices and clinics of physicians; by 2001, this had increased to 12 percent.  The share of RNs in this work setting likewise doubled, from 5 percent to 10 percent.  There is no obvious trend in the percent of LPNs working for personnel supply services (e.g. temporary agencies), although the percents are lower overall in the 1990s compared to the 1980s.  The same is true for RNs in the data.  Between 1984 and 2001, 2 percent to 9 percent of LPNs (compared to 1 percent to 5 percent of RNs) worked in this industry.  Private households were the work setting of 4 percent of LPNs in 1984.  By 1994, less than 1 percent worked in private households. Less than 1 percent of RNs worked in private households in any year. 

The CPS industry classification system includes a category called “health services not elsewhere classified (n.e.c.).”  In 1984, 3 percent of LPNs were employed in work settings within this broad industry class.  The proportion of LPNs in these work settings increased to 11 percent by 2001.  Similarly, RN employment in this industry category increased – from 5 percent in 1984 to 12 percent in 2001.  Unfortunately, we do not know what precise industries are included in the “health services (n.e.c.)” category.  LPNs also are increasingly working in industries other than those discussed above, such as elementary and secondary schools, colleges and universities, child day care services, public administration, and other industries not traditionally associated with the type of work done by LPNs (e.g., real eState). 

Table 2.9:  Distribution of LPNs by Work Setting

n.e.c. = not elsewhere classified

Source: Current Population Survey Outgoing Rotation Group Files, 1984-2001

The majority of LPNs work in private sector jobs, and the percent has increased from almost 80 percent to 89 percent between 1984 and 2001.  In 1984, 19 percent Stated that they were employed by government agencies; this share declined to 10 percent by 2001 (Figures 2.6 and 2.7).  Only 0.4 to 2 percent of LPNs reported being self-employed in any year.  The data do not show much change in the employment sectors of RNs.  Between 1984 and 2001, around 80 percent of RNs worked in the private sector, and 20 percent for government.

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Hours of Work

There are several questions in the Current Population Survey that correspond to hours of work.  We report means for the variables denoting total hours worked in the previous week and usual hours worked per week.  There are two variables that denote usual weekly work hours.  The main differences between these two variables follow: (1) one of the variables was introduced in 1994 and the corresponding survey question is asked of all respondents who report having a job the week prior to being surveyed, and (2) the other variable, though available throughout our sample period, has missing values for salaried workers after 1993. 

Figure 2.8 compares the means of the three variables that correspond to hours of work per week.  Between 1984 and 2001, LPNs on average worked more than 34 hours per week, which is the same as RNs.  LPNs worked slightly more on average in 2001 than they did in 1984.  Between 1986 and 1990, mean weekly work hours increased by over 1 hour if measured by usual hours worked per week, and by more than 2 hours if measured by total hours worked last week.  After 1993, LPNs’ mean usual weekly hours of work fall farther below mean total hours worked in the previous week.  This likely is due to the missing values in the data for salaried LPNs from 1994 onward.  However, the variable “total usual weekly hours,” which was added to the survey in 1994, has values for both salaried and hourly workers, and the mean of this variable indicates that LPNs worked 37 to 38 hours per week between 1994 and 2001.  Overall, the CPS data show some evidence of a small increase in the average weekly work hours of LPNs, but there is a high degree of fluctuation in the data, especially during the 1990s.  RNs’ mean weekly work hours hold steady at 36 to 37 between 1984 and 2001.

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The majority of LPNs work full-time, and the share working full-time increased between 1984 and 2001.  The CPS asks respondents that work less than 35 hours per week what their main reason is for working part-time.  The reasons reported by the CPS have changed over time. Between 1984 and 1993, the reasons identified in the CPS include slack work or business conditions; could only find part-time work; own illness, health, or medical limitations; too busy, didn’t want full-time work; reported less than 35 hours, but usually works full-time; and all other reasons.  Since 1994, additional reasons are seasonal work, childcare problems, other family/personal obligations, school or training, and retired or social security limit earnings.  Also, “too busy, didn’t want full-time” was dropped from the survey. 

Between 1984 and 1993, most LPNs who reported working less then 35 hours per week responded that they were too busy and/or didn’t want full-time work.  After the survey change in 1994, most responded that they usually do work full-time.   Those reporting slack business or could not find full-time work ranged from less than 1 percent to almost 12 percent between 1984 and 2001.  The highest percentages were during the 1990s. There is no obvious trend in the percent that work less then 35 hours per week because of childcare problems or own illness, health, or medical limitations.  Furthermore, these percentages are small (almost always under 4 percent). From 1994 to 2001, 4 percent to 11 percent of LPNs reported school or training as their reason for working part-time. An increasing percent since 1994 have responded that they are retired or that social security limits earnings: 2 percent in 1994 and 4 percent by 2001.  

Earnings

The Current Population Survey asks respondents who report they are paid by the hour for their hourly pay rate.  As shown in Figure 2.9, the hourly earnings of LPNs increased 19 percent between 1984 and 2001, from $12.21 to $14.56 (all figures are adjusted for inflation).  By 1994, LPNs earned over $14 per hour on average. However, LPNs experienced a slight decline in their hourly earnings between 1994 and 1998, which corresponds to the decline in real RN wages reported by others (Spetz, 1998).  By 1999 LPNs’ mean hourly pay rate had bounced back to $14.  The data for RNs shows a similar pattern—an overall increase of nearly 19 percent ($17.78 in 1984 and $21.15 in 2001) with a slight drop between 1993 and 1997. 

The CPS also collects information on usual weekly earnings before deductions from both hourly and salaried workers.  As shown in Figure 2.10, the weekly earnings of LPNs increased 23 percent between 1984 and 2001.  In 1984, LPNs earned nearly $450 per week on average.  By 1994, this figure had increased to $531.  The data shows a decline in average weekly earnings after 1994.  It wasn’t until 2001 that LPNs’ mean weekly earnings rose above the 1994 value to $555.

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Summary

In this chapter, we used data from the Current Population Survey, U.S. Census Bureau, Bureau of Labor Statistics, and the National Council of State Boards of Nursing to describe the licensed practical nurse workforce.  Most of the reported figures are weighted estimates. 

We provided corresponding data on registered nurses for comparison, and found the following similarities:

• Both workforces are aging, with LPNs being slightly older on average;
• Males represent a small percent of both workforces, but this percent is increasing;
• The western region of the U.S. has the lowest numbers of LPNs and RNs relative to the population;
• RNs and LPNs share similar employment trends—greater percents were employed in 2001 than in 1984;
• On average, RNs and LPNs work about the same number of hours per week—between 36 and 38 hours;
• The share of RNs and LPNs working in physician offices/clinics doubled between 1984 and 2001, and the share working in health services “not elsewhere classified” increased; and
• The hourly pay rate of RNs and LPNs increased 19 percent between 1984 and 2001.

Differences we found between the two workforces include the following:

• The RN workforce is larger than the LPN workforce, but the actual size of the LPN workforce is unclear since the available data is conflicting;
• Compared to RNs, more LPNs live in the South and fewer in the Northeast;
• Fewer LPNs are foreign-born, whereas an increasing percent of RNs are immigrants;
• RNs work in hospitals in greater proportions than LPNs, and the share of LPNs working in hospitals declined more than that of RNs between 1984 and 2001;
• The percent of LPNs working in nursing and personal care facilities increased between 1984 and 2001, but not the percent of RNs; and
• By 2001, the percent of LPNs working in the private sector was greater than the percent of RNs.

References

Crawford, L. H., Marks, C., Gawel, S. H., White, E., & Obichere, L. (2001). 2000 Licensure and Examination Statistics. Chicago: National Council of State Boards of Nursing.

National Council of State Boards of Nursing. (2004). Home page, from http://www.ncsbn.org/about/index.asp

Spetz, J. (1998). Hospital employment of nursing personnel. Has there really been a decline? Journal of Nursing Administration, 28(3), 20-27.

Spratley, E., Johnson, A., Sochalski, J., Fritz, M., & Spencer, W. (2000). Findings from the National Sample Survey Of Registered Nurses. Retrieved March, from http://bhpr.hrsa.gov/healthworkforce/rnsurvey/rnss1.htm

Unicon Research Corporation. (2002). CPS Utilities, Earner Study, Outgoing Rotation 2001 Software & Documents (Version 5.1). College Station, TX: Unicon Research Corporation.

U.S. Bureau of the Census. (2000). Census 2000 Special Equal Employment Opportunity (EEO) Tabulation. Retrieved January 2004, from http://www.census.gov/hhes/www/eeoindex.html

U.S. Bureau of Labor Statistics. Occupational Outlook Handbook:  Licensed Practical and Licensed Vocational Nurses, 2004, from http://www.bls.gov/oco/ocos102.htm

U.S. Bureau of the Census. (2003). Annual Estimates of the Population for the United States and States, and for Puerto Rico: April 1, 2000 to July 1, 2003, 2004, from http://eire.census.gov/popest/data/States/tables/NST-EST2003-01.php

U.S. Bureau of the Census. Current Population Survey, 2004, from http://www.bls.census.gov/cps/cpsmain.htm

U.S. Department of Health and Human Services, D. o. N. (1985). First National Sample Survey of Licensed Practical/Vocational Nurses, 1983. Springfield, VA: National Technical Information Service, Accession No. HRP 0906278.