Taking a Closer Look at Indiana's Nursing Workforce

Numerous factors are dramatically impacting the supply and demand of Indiana’s nursing workforce, including Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Advanced Practice Nurses (APNs).  As a result of changing demographics, such as an aging population that will require more care;  evolving healthcare delivery models; increased coverage rates; and changes in healthcare reimbursement under the Affordable Care Act (ACA), the future supply and demand balance of the nursing workforce is unclear at this point in time.

In fact, there are conflicting reported projections on what Indiana’s nursing workforce will look like by 2025. Health Resources and Services Administration’s (HRSA’s) Health Workforce Simulation Model projects the supply of RNs and LPNs will outpace the demand at the national level and in 34 states, including Indiana.  HRSA’s model projects the state to have a surplus of 20,200 RNs and a surplus of approximately 1,970 LPNs by 2025. In contrast, Indiana University’s Data Report: 2013 Indiana Nursing Workforce projects there will be a shortage of RNs around 2018 and increasing to about 260,000 by 2025.

When analyzing the supply and demand of Indiana’s workforce, it is important to take a closer look at model inputs and assumptions. HRSA’s Health Workforce Simulation Model assumes that nurses will practice in states where they received their education and training. HRSA’s model also relies on publically available data sources that represent population samples and are extrapolated to simulate demand for healthcare services in different settings. Despite national models showing a projected surplus of RNs and LPNs, current and future nursing shortages in Indiana are cause for concern with the workforce distribution of the nursing profession. Other factors, such as the shift in nursing scope of practice and roles in new care delivery models, and efficiency gains also impact these projections—and some of these factors cannot be easily quantified.

In Indiana, RNs and LPNs are more heavily concentrated in urban counties. Workforce policy and planning discussions should not only be centered on increasing training of the nursing workforce and number of positions, but should simultaneously focus on creating an equitable distribution of the nursing workforce throughout Indiana. Furthermore, as the nation’s population ages, it will be important to increase expertise in geriatric issues in the near future. Indiana University’s Data Report: 2013 Indiana Nursing Workforce indicates that only 7% of Indiana’s nursing workforce currently specializes in geriatrics/gerontology. 

Educational system capacity to train the future nursing workforce is also a cause for concern. Nationwide, and in Indiana, there are more faculty positions that can be filled; consequently, schools of nursing sometimes turn away qualified students. Doctorally-prepared nurses tend to show more interest in advanced clinical practice than teaching or research. Incentivizing nurses at this level to enter education and research will be a key policy strategy to build capacity to train new nurses and replace those who are retiring.

The state of Indiana is positioned to collect timely data on nursing professionals as a result of Indiana’s Professional Licensing Agency’s (IPLA’s) renewal process and state-level survey data. Ongoing research and evaluation efforts aimed at understanding trends of the nursing profession will enable policy makers and stakeholders to understand how Indiana’s healthcare workforce will need to respond to evolving healthcare policies and healthcare needs of Hoosiers.

TPMA looks forward to closely tracking policy discussions and ongoing evaluation efforts, and plans to collaborate with stakeholders to translate these ongoing research efforts into defined strategies to respond to the shifting dynamics and evolving trends of the healthcare industry.