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RNs Who Are
Not Working in Nursing: A Profile
Julie Sochalski, Ph.D., R.N., F.A.A.N.
Senior Scholar DN/HRSA and Assistant
Professor
University of Pennsylvania School of Nursing
Participation in the nursing workforce
has been rising steadily over the past
two decades. Data from the National Sample
Survey of Registered Nurses (NSSRN) shows
that the percent of RNs who were working
in nursing rose from 76.6 percent in 1980
to 82.7 percent in 1996, and holding at
81.7 percent in 2000 (see Figure 1). In
2000 there were nearly 500,000 RNs who
were not working in nursing. Among them,
70.8 percent were not working at the time
of the survey, and 27.2 percent were employed
in occupations other than nursing (see
Figure 2). The proportion of RNs who are
employed in other occupations among those
not working in nursing has increased slightly
during the 1990s: 25.8 percent and 26.6
percent of RNs not working in nursing
were found to be working in other occupations
in 1992 and 1996, respectively. The proportion
working in a health care occupation was
relatively consistent across this period,
though, at nearly 45 percent of RNs working
in other occupations in each survey.
 [D]
Figure 2: Distribution of RNs Not
Working in Nursing by Employment Status
[D]
The purpose of this paper is to describe
the characteristics of the population
of RNs who are not working in nursing,
to compare them with RNs currently working
in nursing, and to examine the factors
that are associated with choosing to work
in fields outside of nursing. Finally,
this paper will discuss the implications
of these findings for the future nursing
workforce.
RNs working
in other occupations
In 2000, there were around 135,600 RNs
who reported working in an occupation
other than nursing. This group profiles
somewhat differently than RNs working
in nursing (Table 1). First, RNs working
in other fields were older than RNs working
in nursing: their mean age was 48.4 years
compared to 43.3 years, respectively,
and half as many were under the age of
40. Furthermore, RNs in other occupations
were half as likely to have young children
(less than six years of age) in the home,
and they had received their highest nursing
degree six years earlier on average than
RNs working in nursing, both of which
would correspond with their higher mean
age. Second, RNs employed in other occupations
were somewhat less likely to work full-time.
Finally, income levels may be higher
for those working outside of nursing.
The NSSRN collects annual individual earnings
and annual household earnings information
for RNs working in nursing; however, only
annual household earnings information
is collected from RNs working in other
occupations. Consequently, only indirect
comparisons, via annual household earnings,
are possible. As shown in Table 2, a somewhat
greater proportion of RNs working in other
occupations have an annual household income
of $75,000 or higher than RNs working
in nursing. Household incomes are influenced
by at least two factors: work effort,
i.e., working full-time or part-time,
and the presence of other wage earners
in the household or other sources of income.
To control for these factors, annual household
incomes were compared for single RNs who
were working full-time in both groups.
Here the comparison is somewhat more dramatic.
There was a three-fold difference in the
proportion of single full-time RNs whose
annual household incomes were at least
$75,000: 24 percent of those working in
other occupations compared with eight
percent of those working in nursing.
Eighteen percent of these otherwise employed
RNs had left nursing in the last year,
and 79 percent left more than one year
ago. Among those who left nursing more
than a year ago, the mean time period
since nursing employment was nine years.
Table 3 compares RNs who left nursing
in the last year with those who left more
than a year ago. RNs who left recently
were four years younger on average and
were twice as likely to be less than 40
years of age. Also noteworthy, just over
half of those departing nursing recently
were working full-time, compared to nearly
two-thirds of those who left nursing more
than a year ago and the nearly three-quarters
of RNs who were working in nursing.
The NSSRN assesses the reasons that RNs
left employment for other occupations
(Table 4). The principal reason for leaving
nursing was better hours, listed by half
of each group. More rewarding work and
better salaries were the next two most
frequent reasons given for seeking employment
outside of nursing. Regardless of the
length of time since leaving nursing,
the reasons motivating that move appear
to be quite similar. What is striking
is the high ranking of non-financial reasons
that were associated with the move to
other fields of work. While these positions
may also be come with higher salaries,
better salaries ranked third after workplace
flexibility regarding hours and how fulfilling
the work itself is as reasons for leaving
nursing.
RNs not currently
working
There were around 350,000 RNs who were
not currently working. Two-thirds of these
nurses left nursing employment more than
one year ago, on average six years earlier,
and 31 percent left within the last year.
This group is comprised of nurses who
have exited the workforce temporarily,
for child-rearing for example, and those
who have exited permanently.
Roughly one-third of this group, around
123,000, were 50 years of age of younger.
Table 5 compares these nurses with RNs
aged 50 years and under who were working
in nursing. A higher proportion of those
who are not working were prepared at the
BSN level or higher, were more likely
to be married, and were nearly twice as
likely to have young children in the home
than RNs of the same age who were working
in nursing. Among those who were married,
the proportion reporting annual household
earning of at least $75,000 was the same
for each group. These findings suggest
that annual household income was sufficient
for RNs who were not working to remain
out of the workforce, and that factors
other than salary may be needed to encourage
them to re-enter the workforce.
Around 132,000 RNs who were not working
could be classified as "pre-retirement,"
at 51-65 years of age. Seventy percent
of them left nursing employment over a
year ago, leaving eight years ago on average.
Compared to non-working RNs who were 50
years of age of less, only half as many
in the pre-retirement group (29%) were
educated at the BSN level or higher. However,
there were nearly 11,000 RNs in this group
with a masters or doctorate degree. And
finally, there were 92,000 RNs who were
over 65 years of age, with 89% having
left nursing employment on average 10
years earlier.
Implications
The population of RNs not currently working
in nursing represents a diverse group of
nurses whose profile is different from RNs
currently working in nursing. One reason
to examine this population is to determine
whether some potential exists for recruiting
RNs back to the workforce from this group:
would changes in the workplace create both
an incentive to return to the nursing workforce
and, perhaps more importantly, to retain
those who may be considering leaving for
the same reasons.
These data suggest that for RNs employed
in other occupations, flexibility in the
workplace with regards to working hours,
and in particular more opportunities for
part-time employment, may motivate some
of these RNs to return, or encourage those
who are contemplating a move to stay.
In addition, the structure of the work
itself and working conditions would also
have to be addressed. Nearly half of this
group reported that more rewarding work
was one of the reasons that they left
the profession. Career ladders and other
opportunities to develop clinical expertise,
to practice in that professional role,
and to be rewarded for those skills, may
be one strategy that could address this
concern. Finally, better salaries would
need to be explored as well. While this
was the third most frequent reason that
nurses reported influencing their decision
to leave, it may be that these RNs are
earning higher salaries in these jobs,
regardless as to whether it motivated
their departure. Better salaries could
also go a long way towards assisting in
retaining the current workforce in nursing.
The slow rise in the proportion of nurses
working in other fields among RNs not
working in nursing during the 1990s suggests
that all of these factors should be considered
in developing a broad-based strategy to
retain these nurses. These nurses represent
a group that are interested in staying
in the workforce, though under the right
conditions.
Some of the same factors may be operant
for the group of RNs who are not currently
working. However, the survey does not
assess the reasons these RNs have left
the workforce. Furthermore, the survey
does not ask whether they view their exit
as temporary, and whether they intend
to return to the nursing workforce and
when. It is likely that within this group
are RNs who have left temporarily for
child-rearing obligations and who intend
to return. Indeed, 42% of non-working
RNs who are 50 years of age and under
report having young children in the home,
and some share of this group are likely
a part of the cycle of RNs who are moving
out of and into the workforce at any point
in time. Child care options may be a necessary
factor to motivate the return of this
group, or at least an earlier return that
the one planned. Of note is the rather
sizeable group of RNs between ages 51-65
who have a masters or doctorate —
nearly 11,000 nurses. Depending on the
length of time since they have worked
in nursing, with some retraining this
group of nurses may represent a resource
to partially fill the gap in nursing faculty
shortages while the educational system
redoubles its efforts to produce the next
generation of nursing faculty.
However, current interest in returning
to nursing is rather low among this population,
and decreases with age and the length
of time since their last nursing job (Table
6). Only 5.7% of RNs employed in other
occupations and 8.0% of RNs who were not
working reported that they were looking
for work in nursing. These rates of interest
in nursing employment are higher among
those who are younger and those who left
nursing within the last year. Many factors
enter into the decision to participate
in the workforce, and these figures underscore
the challenge to be faced in both encouraging
RNs to return to the nursing workforce
as well as creating the conditions that
will retain those who may be considering
departure.
The examination of this population of
nurses could provide a valuable window
into the characteristics of RNs that are
leaving the nursing workforce, the reasons
behind that departure, and what it may
take to retain them. A few modifications
to the data collected in the NSSRN would
go a long way towards that effort. First,
a clear definition of who is and who is
not working in nursing is needed. Currently,
respondents to the survey self-identify
whether they are working in nursing. Adding
a clarifying question to follow the self-identification
of nursing employment could provide a
more complete and consistent picture of
who is not working in nursing. Further
detail on the types of positions these
RNs hold would add very useful information
to the survey. Second, assessment of the
reasons for not working in nursing should
be extended to nurses who are not working.
Third, individual annual income should
be obtained from RNs who are employed
in other occupations, and not just of
RNs working in nursing. Salary enhancements
have been identified as an important strategy
to attract and retain nurses in the workforce,
and information on the salary potential
of these non-nursing occupations filled
by RNs could inform the development of
competitive salary strategies. Finally,
complete data on work history is needed,
of both RNs working in nursing and those
who are not. Years of work experience
since receiving their basic nursing education,
both in and outside of nursing, and breaks
in that work history would provide a much
better picture of the work profile and
workforce participation patterns of RNs,
and could guide future workforce planning
efforts.
Work Cited
Sochalski, J. (2002). Nursing shortage
redux: Turning the corner on an enduring
problem. Health Affairs, 21 (5),
157-164.
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