Little pieces, the whole elephant: A portrait of the nurse and nurse aide workforce in Colorado

Here at CHI we’ve conducted a lot of workforce surveys, but each survey on its own feels like just a piece of what’s actually going on in the wide world. It’s like a group of blind men describing an elephant: the man who feels a leg says the elephant is like a pillar; the one who feels the tail says the elephant is like a rope, and so on. To better understand the entire elephant is why CHI seeks to put information together into a broader context.

In our work we have amassed information from a broad segment of the health care workforce that provides nursing and nursing-related care in Colorado, namely registered nurses (RNs), licensed practical nurses (LPNs) and, at the paraprofessional level, certified nurse aides (CNAs). We’ve composed findings into a newly released report, Colorado’s Nurse and Nurse Aide Workforce: A Portrait. Some key findings of the report:

• Up to one-quarter of Colorado nurses and CNAs said they planned to leave their current position or their profession in the next one to five years. LPNs and RNs most frequently pointed to insufficient wages, too much stress and lack of respect.
• Some licensed CNAs, LPNs and RNs reported they were not working in their field at the time of the surveys. Retention was low among LPNs and RNs, especially older RNs. Both groups of nurses cited insufficient wages and inconvenient hours as key reasons for not working as a nurse. Other top factors varied by occupation: family reasons among CNAs, job stress and lack of respect for LPNs, and job stress and retirement among RNs.
• One-third to one-half of CNAs, LPNs and RNs expressed interest in seeking further education. The most common reasons for not pursuing additional education were cost, lack of time or interest, or satisfaction with current work and education.

Projections of strong growth in employment demand for CNAs, LPNs and RNs in Colorado are causing concern about whether the supply of nurses and nurse aides will be sufficient to meet future demand. LPN and RN programs sometimes share educational resources and, compared to CNAs, have some distinct and some shared experiences relating to workplace recruitment and retention. Also, while the occupations are distinguished by training and scope of duties, policies to bolster the population of RNs can build on some of the natural movement through the workforce in the fashion of a “career ladder.”

I’ll leave you with some questions to emphasize the value of understanding more of this particular workforce elephant:

• How different or similar are these workers in terms of their composition and how can this inform strategies for growing the workforce?
• Are there some common or unique educational needs that can be bolstered?
• What are the barriers to seeking further education?
• Are there some common or unique institutional changes that can encourage retention of this broad swath of workers?