Nurses play a central role in our health care system. Key factors determining the future supply of nurses are the number who are being educated by US nursing programs and the number entering the US after graduating from foreign nursing programs. The number of first-time takers of the National Council Licensure Examination (NCLEX), a prerequisite to become licensed as a Registered Nurse (RN), provides a good metric for the number of new nurses.
The National Council of State Boards of Nursing (NCSBN), the sponsor of the NCLEX, publishes data quarterly on the number of exam takers and pass rates. While the NCSBN publishes data for first-time and repeat exam takers, the vast majority of first-time takers end up passing the exam. The data presented below—which updates my post from last year—is for first-time exam takers only, as that data represents a simpler, easy-to-understand metric of the pipeline of new nurses. First-time takers are also a direct reflection of the output of the nation's nursing programs.
Parsing The Numbers: Varying Trends Underneath An Overall Leveling Off Of Growth Well Above Historical Levels
After 14 years of steady growth, the number of newly educated registered nurses in America appears to be leveling off. According to the NCSBN, the number of first-time takers in 2015 (157,843) decreased very slightly compared to the number in 2014 (157,879) (Figure 1). Even with this leveling off, the 2015 number is 130 percent higher than the first-time takers in 2001 (68,700).
The trends are very different for baccalaureate (BSN) and associate degree (AD) exam takers. BSN programs require four years of education while Associate Degrees (AD) require two years. "Diploma" graduates from hospital-based programs generally require about two years of education and training.
BSN first-time exam takers continued their steady, long-term growth, increasing by 2,142 in 2015 to 70,857, a growth of 3.1 percent compared to 2014. This was the 14th year of steady growth for this group, with 2015 numbers up 186 percent over 2001 (Figure 2).
By contrast, for the second year in a row, the number of first-time associate degree exam takers decreased, down nearly 2,000, or 2.3 percent, in 2015 compared to 2014 (Figure 2). This could reflect a tightening job market for AD nurses, which would be consistent with anecdotes of new ADs having a more difficult time finding a job than BSNs. It is too early to know whether this is the beginning of a long-term trend.
The number of new diploma-prepared nurses entering the pipeline continues to decrease. After rising between 2001 and 2006, at the height of the nursing shortage, the number has generally been declining and is down by nearly a third since 2010.
The number of new foreign-educated RNs taking the NCLEX rose to its highest level in hour years. However, it is too soon to know if this is the beginning of a new trend, and the total is still only about a quarter of the peak reached in 2007 (Figure 3).
Progress And Remaining Challenges
Progress On Tackling Predicted Nursing Shortage; Projections Vary By Community
In response to concerns with nursing shortages in the early 2000s, there was a concerted effort to increase the number of new nurses. The nation's nursing programs have clearly responded. A recent projection of the future supply and demand for registered nurses by the federal Health Resources and Services Administration finds that some communities are likely to face a surplus, although others will likely face a shortage. One implication is that efforts to spur future growth of the pipeline should be targeted to specific communities, rather than across all communities.
Progress On Increasing Percentage Of Baccalaureate Nurses But Work Remains To Meet Goal
The 2010 Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, recommended that 80 percent of the nursing workforce have a BSN by 2020. Clearly, a growing number of registered nurses in the US have a BSN: BSNs now represent 46 percent of new exam takers, compared to 36 percent in 2001. The steady growth in BSN first-time takers and the decrease in AD first time-exam takers have narrowed the gap that previously existed in terms of the source of new nurses (Figure 4). If the number of first-time US-educated BSN exam takers in 2015 (70,857) is combined with the more than 56,000 registered nurses who completed RN to BSN programs, the annual BSN pipeline (126,857) far exceeds the 84,379 AD first-time takers.
If current trends continue, in the near future half of new nurses may be entering the field with a BSN. Moreover, according to the Association of American Colleges of Nursing (AACN), the number of existing registered nurses with associate degrees and diplomas completing their BSN degree has been growing rapidly. However, it will take many more years before 80 percent of RNs have BSNs.
Progress On Lessening Nursing 'Brain Drain' Despite 2016 Backslide
The continued low number of foreign-educated nurses taking the NCLEX compared to the mid-2000s—even with the 2016 increase in foreign-educated nurses—is consistent with the World Health Organization's Global Code of Practice on the International Recruitment of Health Personnel signed by the US and 191 other countries in 2010. The Code of Practice called for all countries to do a better job of educating and training the health workers they need rather than taking health professionals from less developed countries.
In 2015, international nursing graduates represented only about 5 percent of first time NCLEX takers. This is very modest in comparison to the 23 percent of the physicians entering graduate medical education in 2014-15 who were graduates of foreign medical education.
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