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Vacancy and Turnover Rates
In 2000, the United States had approximately 2.7 million registered nurses, of whom 2.2 million were employed in nursing.39 Of these, approximately 1.3 million were employed in hospitals.40 There are two primary estimates of the overall RN vacancy rate for the nation's hospitals. The American Organization of Nurse Executives has calculated the national vacancy rate as 10.2 percent (see table).41 Alternatively, the American Hospital Association has estimated an average vacancy rate of 13.0 percent.42 The number of RN positions in hospitals that now stand vacant is estimated at between 126,000 and 153,000.43 Moreover, the problem keeps getting worse. Fully 60 percent of hospitals reported that their vacancy rate increased from 1999 to 2001, while overall demand for RNs continues to rise. Based on current trends, the First Consulting Group concludes, "a projected 15 percent vacancy rate in 2003 is a very conservative estimate."44
Similarly, the share of all RN jobs that turn over in a given year has been increasing. One survey found that 42 percent of hospitals experienced increased turnover rates over the 1999–2001 period.45 The median turnover rate for hospital RNs rose from 12 percent in 1995 to 15 percent in 1998, it is projected to rise to 16 percent in 2000 and it may be as high as 25 percent by 2005.46
These national averages mask considerable variation from state to state — some jurisdictions have relatively adequate staff, while others are already suffering crisis levels of RN turnover and unfilled jobs in hospital nursing staffs. Across the country, more than one in seven hospitals reports a severe nurse shortage, with vacancy rates above 20 percent.47 The average vacancy rate for Maryland hospitals was 14.7 percent in 2000, up from 3.3 percent just three years before. Vacancy rates in Florida and California averaged 16 percent and 20 percent respectively.48 In the New York metropolitan area, the percentage of hospitals that experienced more than 10 percent turnover in direct care RNs increased from 28 percent in 1998 to 39 percent in 2000 and 60 percent in 2001. "We are edging closer to a precarious situation," warns Greater New York Hospital Association President Kenneth Raske.49
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