profound, both in terms of numbers and in terms of adequate distribution of the skills and educational preparation of the workforce. Determination of the adequacy of the nursing workforce (registered nurses, licensed practical nurses, and nurse assistants) in the institutional health service settings that are within the scope of this inquiry calls for an assessment of the overall supply of nursing personnel in the context of the shifting demand for their services and the factors affecting such demand.

This chapter provides a brief overview of the supply of nursing personnel and their employment trends. It examines the adequacy of the quantity and comments on the educational preparation of the supply, given the changing demands for nursing services. The chapter concludes by briefly commenting on the implications for nursing personnel as the nation approaches the next century, and offers a commentary on the kinds of knowledge and skills needed in the nursing workforce to provide effective nursing care in the future.

Supply Of Nursing Personnel

Nursing personnel for purposes of this study include registered nurses (RN), licensed practical nurses, (LPN), and nurse assistants (NA).1 Approximately 3 million health care personnel in the United States work in nursing (HRSA, 1992).

RNs and LPNs are subject to state licensing requirements. Although all RNs take the same licensing examination to qualify for practice, they are prepared through 1 of 3 educational pathways that can take 2, 3, or 4 years of training. This diversity in training requirements is a matter of considerable controversy within the nursing profession. All RNs are not alike in terms of basic and advanced clinical education and skills; their responsibilities may range from the provision of direct patient care at the staff level, to management and direction of complex nursing care systems in the institutional and community settings, as well as to teaching and other academic functions.

LPNs primarily provide direct patient care in institutional settings under the direction of a physician or an RN. Nurse assistants and other ancillary nursing


Ancillary nursing personnel, nursing support personnel, assistive personnel, nurse extenders, unlicensed nursing personnel, multi-competent workers, nurse assistants, or aides are all generic terms used to refer to the various clinical and nonclinical jobs that augment nursing care. This group of employees includes an array of support nursing personnel including certified nurse assistants, orderlies, operating room technicians, home health aides, and others. They assist the licensed nurse by performing routine duties in caring for patients under the supervision of an RN or an LPN. Although Congress defined ''nurse" for the purposes of this study to include RN, LPN, and NA, it has not been possible at all times to disaggregate information on NAs from the remaining support personnel since national statistics are often collected and/or tabulated for the group as a whole. For example, the American Hospital Association does not separate information on nurse assistants from that on other "ancillary nursing personnel." Throughout this report, the term ancillary nursing personnel will be used for this group of staff when nurse assistants cannot be disaggregated.

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