personnel assist licensed nurses in the provision of basic care to patients, and they work under the supervision of licensed nursing personnel (ICONS, 1993).

At this time, no uniform standards exist for training, competency evaluation, and certification for nurse assistants to qualify for work in all health care settings. Since the implementation of the 1987 Nursing Home Reform Act, nurse assistants employed in nursing facilities, who provide most of the direct care to residents, have to be certified and are required to take a minimum of 75 hours of training within 4 months of employment and be tested for competency in order to be certified to work in nursing facilities. No comparable standard exists for work in hospitals. There appears to be wide variations among hospitals in the level of training provided to this group of nursing staff. For example, in a study of California hospitals, Barter and colleagues (1994) found that the average ancillary personnel in a hospital may receive less than a month of combined classroom and on-the-job training, ranging from less than 1 week to 3 weeks. (See Chapters 5 and 6 for further discussion of NA training.)

Hospitals are the major employers of nursing personnel (RNs, LPNs, and NAs). Many LPNs and nurse assistants also work in nursing homes and other long-term care (LTC) settings, as well as in ambulatory care settings and home health care service. With the exception of hospitals, detailed national data are not readily available on the employment patterns of nursing personnel. Most of the national databases focus on RNs.2 The last comprehensive national sample survey of LPNs, comparable to the periodic National Sample Survey of Registered Nurses, was conducted by the U.S. Public Health Service in 1983. Some information on LPNs, however, can be gleaned from data available from the Bureau of the Census of the U.S. Department of Commerce, the Bureau of Labor Statistics (BLS) of the Department of Labor, the National League for Nursing (NLN), and individual LPN programs. Data on nurse assistants are limited to basic employment-related statistics specific to the employment setting and some aggregate data from the employment statistics published by the BLS. Hence, the discussion in this chapter unavoidably is heavily weighted toward supply and demand issues affecting RNs.

Registered Nurses

RNs are the largest group of health care providers in the United States. For several decades, their numbers have been continually increasing in absolute num-


National databases available for nursing workforce supply and demand include the National Sample Survey of Registered Nurses, data from the National Center for Health Statistics, the American Hospital Association (AHA) Annual Surveys of Hospitals, AHA Nursing Personnel Surveys, monthly employment statistics compiled by the Bureau of Labor Statistics, and national data on nursing school enrollment and graduations collected by the National League for Nursing.

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