However, NSSRN data show that a number of these nurses are leaving the field of nursing altogether. In 2000, 18.3 percent of licensed nurses were not working in the field of nursing. Evidence indicates that these are not just retired older nurses. Almost 3 percent of women and 2 percent of men graduating from nursing schools between 1988 and 1991 were not working in nursing within the first 4 years following graduation. By 9 to 12 years after graduation, 11 percent of women and 6 percent of men had departed from the profession. More recent graduating classes have higher departure rates. Among 1996–1999 graduates, 4.1 percent of women and 7.5 percent of men left the profession within 4 years of graduating (Sochalski, 2002). This loss of experienced nurses can represent a threat to patient safety.
Most data on the nursing workforce are collected on RNs; less is known about LPNs/LVNs and NAs, who together make up 42.6 percent of nursing staff. It is known, however, that nursing staff overall are predominantly female and ethnically different from the workforce at large and those they serve. RNs are older than the total U.S. workforce and aging more rapidly. NAs are often poor and without health insurance—unable to receive the services they provide to others. A small portion of nursing staff are not employees of the health care organizations (HCOs) in which they work, but provide care to patients as “contingent” workers.
The RN workforce is predominantly female (94.6 percent), although the small proportion of male RNs rose from 2.7 percent in 1980 to 5.4 percent in 2000 (Spratley et al., 2000). The NA workforce is similarly largely female. Women are estimated to make up 79.6 percent, 90.9 percent, and 89.2 percent of hospital, nursing home, and home care aides, respectively (GAO, 2001b). Although data are unavailable on the gender of LPNs/LVNs, they are likely predominantly female as well.
The high proportion of women in the nursing workforce has a number of implications. Conflicts in nurse–physician relationships have been attributed in part to gender conflicts and inequalities in society at large (McMahan and Hoffman, 1994). In addition, responsibilities at home, such as caring for children or older family members and performing household chores, may contribute to the commission of errors in two ways. First, family obligations may add to the long hours worked by many nurses in their professional workplace and contribute to the sleep deficits and fatigue that are associated with the commission of errors. Of nurses employed in the field in 2000, 55 percent had children living at home (Spratley et al., 2000).