Business and Leadership
Patricia B. Strasser, PhD, RN, COHN-S, CCM, FAAOHN
Review of Occupational Health Nurse Data From
Recent National Sample Surveys of Registered
Nurses—Part I
by Margaret C. Thompson, PhD, RN, COHN-S, FAAOHN
The U.S. Department of Health and Human Services obtains information
about U.S. registered nurses through the periodic National Sample Survey
of Registered Nurses (NSSRN). Occupational health nurses comprise less
than 1% of the U.S. nursing population and published NSSRN reports usually
include only estimates of the total occupational health nurse population and
minimal information about occupational health nurses’ characteristics. The
objectives of this study were to develop a knowledge base of occupational
health nurses’ characteristics; examine characteristics that may influence entry
and retention in occupational health nursing practice; and explore indications
of demand for occupational health nurses. Descriptive and inferential statistics
were used in a secondary analysis of data from recent (1992 to 2004) NSSRN.
The findings are reported in two parts. This article, Part I, provides descriptive
data about occupational health nurses based on responses to the 1992 through
2004 NSSRN questionnaires. Part II will provide findings from analysis of
2004 responses indicative of occupational health nurses’ entry, retention, and
demand characteristics.
O
ccupational health nurses are
“the largest group of health
care providers serving the
worksite” (American Association
of Occupational Health Nurses, Inc.
About the Author
Dr. Thompson is Principal/Occupational Health
Consultant, Croft-Taylor Consulting, LLC, Ridgefield, CT.
The author discloses that she has no significant financial interests in any product or class
of products discussed directly or indirectly in
this activity.
Dr. Strasser is President, Partners in Business
Health Solutions, Inc., Toledo, OH; and Adjunct
Assistant Professor, University of Michigan,
School of Nursing, Occupational Health Nursing
Program, Ann Arbor, MI.
doi:10.3928/08910162-20091223-01
january 2010, vol. 58, no. 1
[AAOHN], 2008), yet published information about the occupational
health nurse population is scarce.
Published occupational health nurse
data are most often based on surveys
of AAOHN members, occupational
health nurses certified by the American Board for Occupational Health
Nurses (ABOHN), or occupational
health nurse students and alumni of
the National Institute for Occupational Safety and Health (NIOSH)
Education and Research Centers
(ERC) and other academic programs.
These studies have provided valuable information about occupational
health nurses and occupational health
nurse practice. AAOHN, ABOHN,
and academic program data provide
information about demographics,
educational preparation, academic
degrees, and specialty certification
of their occupational health nurse
communities. However, membership
populations may vary and member or
cohort characteristics may not represent the occupational health nurse
population.
Information about the U.S. occupational health nurse population is
obtained by the U.S. Department of
Health and Human Services, Health
Resources and Services Administration (HRSA), Bureau of Health
Professions, through the National
Sample Survey of Registered Nurses
(NSSRN). The NSSRN is a periodic
survey of registered nurses that provides information about the U.S.
registered nurse population. According to HRSA, “(t)he NSSRN is the
Nation’s most extensive and comprehensive source of statistics on
all individuals with active registered
nurse licenses to practice nursing
in the United States whether or not
they are employed in nursing. It provides information on the number of
registered nurses, their educational
background and practice specialty
areas, their employment settings,
position levels, job satisfaction and
salaries. It also provides information on their geographic distribution
and personal characteristics includ-
27
business and leadership
ing gender, racial/ethnic background,
age, and family status” (HRSA, Bureau of Health Professions, 2006b, p.
i). Occupational health nurses are a
relatively small portion of the overall
nursing population (generally < 1%),
and published NSSRN reports usually include only estimates of the total
occupational health nurse population
and minimal information about their
specific characteristics.
The researcher identified a need
to study characteristics of the entire
occupational health nurse population.
The effect, if any, of the current nursing shortage on occupational health
nursing is not known. The supply estimates for occupational health nurses used by the Institute of Medicine’s
Committee to Assess Training Needs
for Occupational Safety and Health
Personnel in the United States (2000)
were based primarily on membership
data provided by AAOHN. Palmer
(2003) has suggested that a severe
shortage of occupational health nurses could affect both worker health
and the economy. Consistent with
strategies recommended to combat the overall nursing shortage, the
profession must develop and implement strategies for the education and
training of future occupational health
nurses and recruitment and retention of nurses in the specialty practice. Beyond the need to know who
occupational health nurses are, current information about occupational
health nurses could be used to support occupational health nurse work
force analysis and inform strategies
for both the education and training
of current and future occupational
health nurses. Knowledge of occupational health nurses’ demographics
can also be used to develop sampling
strategies for future research.
Study Purpose and
Method
This study employed descriptive and inferential statistics in a
secondary analysis of data from recent NSSRN questionnaires (1992
through 2004). The purposes of the
study were to develop a knowledge
base of characteristics of the U.S. occupational health nurse population;
28
examine characteristics that may influence entry into and retention in the
specialty practice through comparisons with other community-based
clinical nursing groups; and explore
indications of demand for occupational health nurses. The underlying
research questions asked were:
l
What are the demographic and
employment characteristics of U.S.
occupational health nurses?
l
Were there significant changes
in those characteristics during the
period from 1992 to 2004?
l
Do characteristics related to entry
and retention differ between occupational health nurses and nurses
in other community-based clinical
employment settings?
l
Are indications of demand for
occupational health nurses evident in
changes in occupational health nurse
positions or employment locations?
The NSSRN targeted population
is the current U.S. registered nurse
population as of March of each study
year. Registered nurses in the study
sample “answer questions on their
education and training in nursing,
professional nursing certifications,
education and workforce participation prior to becoming a registered
nurse, current and recent workforce
participation, income, demographic
characteristics, and States in which
they hold current licenses” (HRSA,
Office of Information Technology,
2005, p. 1).
The sample design used for each
of the surveys since 1977 has consisted of “a complex, nested sample
frame, with equal probabilities of
selection of nurses sampled in each
State” (HRSA, Office of Information Technology, 2005, p. 1). Lists
of current registered nurse licenses
in each state were used to develop
the sampling frame. Although it is
possible that individual nurses may
be sampled sequentially, the survey
does not attempt to track nurses over
time (HRSA, Office of Information
Technology, 2005).
The sample survey instrument
used in the NSSRN “was designed
to ensure that the data collected from
study to study provides sufficient
continuity so that an evaluation can
be made of trends in nursing,” although new areas may be covered in
specific surveys (HRSA, Bureau of
Health Professions 2006b, p. 3). The
questionnaires used for the 1992,
1996, 2000, and 2004 NSSRN can
be found in published survey reports
(HRSA, Bureau of Health Professions, 2006b; Moses, 1993, 1997;
Spratley, Johnson, Sochalski, Fritz, &
Spencer, 2001) and in NSSRN documentation files on the HRSA data
warehouse website (HRSA, Office of
Information Technology, 2005).
For each survey year, the questionnaire was mailed to each nurse
selected for the sample at the address
provided on the state license list. The
cover letter requested voluntary participation and detailed the purposes
of the study, the agency conducting the study, how confidentiality is
maintained, value and use of study
results, and instructions on completing the questionnaire. Until 2004,
questionnaires were returned solely
by postal mail; a web version of the
questionnaire was made available to
respondents in 2004. Return of the
completed survey was evidence of the
participant’s consent to participate.
Various strategies, including multiple
mailings and follow-up telephone interviews of nonrespondents, to clarify ambiguous responses or obtain
missing information were employed
to ensure adequate response. Survey
response rates of 70% or higher were
reported for 1992 through 2004, providing data from 30,000 to 35,000
respondents in each survey year. Additional details regarding the survey
methodology, survey instruments,
sample sizes, and response rates can
be found in published survey reports
and in NSSRN documentation files
cited above.
Public use files for each survey
year are made available to researchers by HRSA. Public use files contain
collected response data, including
assigned sampling weights (calculated to reflect the complex survey
design and the individual’s selection
probability, adjusted for multiple licenses, and to lessen nonresponse
bias), and provide documentation
such as survey background, technical
AAOHN Journal
business and leadership
or programmer information, variable
naming conventions and definitions,
sample variance estimation, design
notes, and the Codebook (HRSA,
Office of Information Technology,
2005). These data files were downloaded into SAS statistical software
for analysis.
The target population for this
study was nurses who reported employment in an occupational health
setting at the time of each survey,
resulting in sample sizes of 306 for
1992, 280 for 1996, 459 for 2000,
and 277 for 2004.
The primary comparison groups,
nurses employed in community-public health and ambulatory care settings, were selected because both
populations, similar to occupational
health nurses, provide adult clinical care in diverse non-hospital settings. Similar to occupational health
nursing, community-public health
nursing has been described as both a
practice setting and a specialty nursing practice (Kovner & Harrington,
2001). The nursing groups used in
the comparative analyses were similarly identified by the responding
nurses’ indicated employment setting
in the 2004 NSSRN: communitypublic health (3,292) and ambulatory
care (3,569).
Variables used for analysis in
this study were based on responses to
the NSSRN questionnaires. For certain measures (e.g., nursing group,
advanced practice, position and position level, highest education level,
or age), the study included variables
constructed by NSSRN researchers
from response variables. The characteristics examined relevant to entry and retention included autonomy,
salary, job satisfaction, and position
change. As there is no direct indicator of autonomy in the NSSRN response data, the study used position
title, master’s or doctoral education,
advanced practice education and
preparation, and professional certificates as indicators of autonomy. The
NSSRN data files do not provide separate response data for master’s and
doctoral education. “All responses to
either master’s or doctorate education are regrouped in the public use
january 2010, vol. 58, no. 1
files into one combined level that
covers both degrees” (HRSA, Bureau of Health Professions, 2006a,
p. C-9). The characteristics examined relevant to occupational health
nurse demand were position change,
geographic location (state and U.S.
Census Bureau region; U.S. Census
Bureau, 2001), and type of employment setting (industry, government,
or other). The subgroup, nurses new
to occupational health, included all
nurses who reported employment in
an occupational health setting at the
time of the survey (2004), who also
reported not being employed in nursing in the year prior to the survey
(2003) or who reported employment
in a setting other than occupational
health in the year prior to the survey.
Nurses with continuing employment
in occupational health included all
nurses who reported employment
in occupational health in the year
prior to the survey (2003) who also
reported employment in an occupational health setting in the survey
year (2004). A detailed description of
measures used in the study and information about the sociological theory
and concepts on which the indicators
of autonomy are based are available
from the author.
Data Analysis
A preliminary review of the unweighted response data provided in
the NSSRN public use data files was
completed prior to data analysis. SAS
survey analysis procedures assume
missing values are missing at random
and are excluded or deleted prior to
analysis. As generally only a small
proportion (< 10%) of cases were
missing, no additional adjustments
were made. Distributions of variables
were generally adequate for analysis.
Where the number of responses for
a particular response category was
less than 10, population estimates
were not calculated and comparisons
were not made. Where necessary and
feasible, categories were collapsed to
provide adequate cell sizes.
The complex nature of the survey design was taken into account by
the use of SAS survey analysis procedures for descriptive and inferen-
tial analysis. Descriptive statistics for
characteristics of nurses employed
in occupational health settings and
in the comparison settings were estimated. Relationships between variables of interest, changes over time,
and group comparisons were analyzed using chi-square and ordinary
least squares and logistic regression
analysis. Data analyses and population estimates used the final sampling
weights provided for each respondent in the NSSRN public use data
files. Analysis of changes in salaries
over time included an adjustment for
inflation based on the Bureau of Labor Statistics’ Consumer Price Index
to determine real increases in occupational health nurse salaries. Analyses considered and controlled for the
influence of other relevant characteristics, such as education, age, familywork life elements, and geographic
location, on the characteristics related to entry, retention, and demand.
Data Limitations
Although use of the NSSRN
database allows access to a large
amount of information that would
not otherwise be available to occupational health nurse researchers, it
is not without limitations. Estimates
of occupational health nurses and
estimates of other nursing groups
used for comparisons were based on
responses to the NSSRN question regarding employment setting. In each
survey year, this question allows the
respondent to choose only one employment setting from the listed responses. For example, occupational
health nurses working in a hospital or
university employee health services
must choose either the hospital, the
academic, or the occupational health
employment setting. Also, only three
choices exist within that occupational health setting category: private
industry, government, or other. This
grouping does not reflect the diversity of occupational health nurses’
employment settings.
The wording of the questions
asked may change from one survey
year to the next and questions may
be eliminated or new questions added, limiting analysis of changes over
29
business and leadership
Figure 1. Occupational health nurse population estimates, 1980 to 2004. (Sources:
Health Resources and Services Administration, Bureau of Health Professions,
2002a, 2002b, 2002c, 2006b; Moses, 1993, 1997; Spratley, Johnson, Sochalski,
Fritz, & Spencer, 2001.)
time. Variables used as indicators of
specific concepts (e.g., autonomy,
entry, or retention) reflect both theoretical constructs and the limitations
imposed by the survey questions and
may not accurately represent the
characteristic of interest.
The comparatively small number of occupational health nurses
in each survey sample also imposes
limitations, potentially compromising the unbiased nature of population
estimates and making it difficult to
reliably analyze responses of particular subsets (i.e., occupational health
nurses with specific characteristics
or groups of characteristics), reliably
analyze group comparisons, or derive
useful or reliable conclusions.
Study Findings
Study findings are reported in
two parts. This part, Part I, provides
descriptive data about U.S. nurses
employed in occupational health settings. This section describes a representative image of occupational
health nurses: their work settings, positions, roles, education, certification,
training, salaries, and general demographics both currently and in how
these may have changed from 1992
to 2004. In Part II, findings from the
analysis of entry, retention, and demand characteristics among occupational health nurses will be reviewed
and discussed. Where applicable,
findings are discussed in the context
of information about the overall registered nurse population reported by
NSSRN researchers and of information about nurses employed in community-public health and ambulatory
30
care settings previously reported or
comparatively analyzed in this study.
U.S. Occupational Health Nurses’
Descriptive Data
Data from the 2004 NSSRN indicated an estimated 22,447 nurses
were employed in occupational health
settings (HRSA, Bureau of Health
Professions, 2006b). Viewing the occupational health nurse population
estimates over time (Fig. 1), it can
be seen that the occupational health
nurse population increased approximately 17% during the period from
1992 to 2004. However, extending the
time period back to 1980, when the
occupational health nurse population
was estimated at 29,362 (HRSA, Bureau of Health Professions, 2002a), a
decline of almost 24% in the number
of nurses employed in occupational
health settings becomes evident. The
extremely large occupational health
nurse population estimated in 2000
appears to be an outlier for which a
specific explanation has not been determined. As discussed with NSSRN
survey researchers, it may be related
to specifics of the 2000 sampling
strategy. The 2004 occupational
health nurse population estimate, although considerably smaller than the
estimate reported for 2000, appears
more consistent with the pattern of
earlier survey estimates. After a 34%
decline from 1980 through the lowest
estimate in 1992, occupational health
nurse population estimates increased
12% from 1992 to 1996 and increased
4% from 1996 to 2004 (excluding the
2000 estimate).
How do these changes compare
with changes in the overall registered
nurse population estimates? Despite
cyclical nursing shortages (related,
in part, to increased and diversified
demand), the estimated number of
registered nurses employed in nursing in the United States rose almost
31% from 1992 (1,853,024) to 2004
(2,421,351) (HRSA, Bureau of
Health Professions, 2006b; Moses,
1993) and increased more than 90%
when the time period was extended
back to 1980 (1,277,041) (HRSA,
Bureau of Health Professions,
2002a). The reasons for changes in
occupational health nurse population
estimates and differences in those
changes from the overall registered
nurse population have not been specifically studied, but possible explanations will be presented for discussion and further study in the second
part of this report.
What are the characteristics of
these occupational health nurses, and
how have they changed from 1992
to 2004? Summaries of the employment, education, and demographic
characteristics reported by nurses
employed in occupational health settings in 2004 and changes over time
are provided in Tables 1 through 3
and Figures 2 and 3.
Occupational Health Nurses’
Employment Characteristics
In 2004 (Table 1), approximately two thirds of occupational health
nurses (66%) reported working in
private industry and 23% reported
working in government settings; settings were not specified for the remaining 11%. A subsequent survey
question asked if the employed nurse
provided direct care to patients in a
hospital setting; approximately 11%
of occupational health nurses reported that they did. More than two thirds
of occupational health nurses reported working full-time (68%) and as
employees of the facility in which
they worked (76%). Occupational
health nurses’ work-time status was
similar to that reported in 2004 for
all employed registered nurses (71%
worked full-time), for nurses employed in community-public health
settings (70%), and for ambulatory
AAOHN Journal
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na
Table 1
2004 Occupational Health Nurses’
Employment Characteristics
na
Position title (grouped)
%b
Employment setting type
Private industry
Government
Other
175
66.5
70
22.8
32
10.7
Employment status
Employee of facility
209
76.3
Through employment agency
33
13.5
Self-employed or per diem
29
10.2
Full-time
188
67.7
Part-time
89
32.3
Work-time status
Employment region (U.S. Census
Bureau region)
Northeast
63
Administrator or assistant administrator
19
5.3
Consultant
12
4.4
Supervisor
10
4.4
Instructor
Head or assistant head of nursing
Staff or general duty nurse
Nurse practitioner
c
5
c
Certified nurse anesthetist
2
c
Researcher
3
c
Private duty nurse
1
c
Informatics nurse
0
24.0
Other
91
32.4
Surveyor, auditor, or regulator
17.5
Patient coordinator
18
7.2
1
c
2
c
46
14.5
29
10.0
7
c
Dominant function (> 50% of time)
Staff-level position
Yes
109
41.9
Administration
No
166
58.1
Consult with agency
Yes
31
11.0
No
243
89.0
Direct patient care
Direct patient care in hospital
Represented by labor union
29
243
78
28.9
Research
2
c
Supervision
7
c
Teach nursing or health care
3
c
11.5
Other
13
4.6
88.5
None
133
50.1
Registered nurse license required for position
Yes
264
95.4
No
11
4.6
Extremely satisfied
113
40.4
Satisfied
117
42.3
Neither satisfied nor dissatisfied
25
10.8
Dissatisfied
14
3.9
6
c
Job satisfaction
M
SE/
Median
All
4.1
0.7/4
Full-time only
4.1
0.1/4
Part-time only
4.2
0.1/4
Job satisfaction
january 2010, vol. 58, no. 1
5.1
3
South
Extremely dissatisfied
41.9
13
Nurse clinician
26.1
No
109
Clinical nurse specialist
68
Yes
c
9.5
0
Midwest
55
4
27
Nurse midwife
Home health
West
%b
M
SE/
Median
Percentage of time spent in
Administration
22.6
1.6/18
Consultation
13.9
1.2/10
Direct patient care
38.3
2.3/30
Research
3.3
3.3/0
Supervision or management
8.9
1.2/0
Teaching nursing or other
4.1
4.1/0
Health profession other
9.1
1.5/0
Note. Study sample = 277. Population estimate ~ 22,447.
Data adapted from Thompson (2008). aSample. bEstimated
population. Total percentage may not equal 100 due to rounding, not applicable, missing responses, or more than one
possible response. cPopulation estimates were not calculated
where sample sizes were less than 10.
31
business and leadership
Table 2
2004 Occupational Health Nurses’ Average Annual
Earnings
Earnings (Thousands)
M (SE)
Median
$48.3 (1.8)
$50.0
Full-time
$58.3 (1.5)
$56.0
Part-time
$26.7 (2.9)
$20.0
Private industry
$48.6 (2.2)
$56.0
Government
$47.9 (3.3)
$48.0
Other
$47.2 (5.0)
$50.0
Overall
Work-time status
Work setting type
Employment status
Employee of facility
$51.9 (1.8)
$52.0
Through employment agency
$34.9 (5.4)
$28.0
Self-employed or per diem
$38.5 (7.0)
$21.9
Northeast
$50.2 (3.8)
$49.0
Midwest
$48.9 (3.1)
$47.0
South
$49.4 (2.7)
$54.0
West
$43.2 (5.2)
$40.0
Yes
$44.5 (2.5)
$44.1
No
$50.9 (2.4)
$54.0
No
$46.7 (1.8)
$50.0
Yes
$64.4 (6.5)
$65.0
None
$47.0 (1.6)
$48.0
1 or more
$53.3 (4.9)
$55.0
Diploma
$43.7 (2.5)
$46.0
Associate
$42.0 (2.8)
$43.0
Baccalaureate
$50.1 (3.3)
$54.0
Master’s or doctorate
$64.3 (5.1)
$68.0
Employment region (U.S. Census Bureau region)
Staff-level position
Advanced practice nursing certification
Professional certificates
Highest nursing education
Note. Study sample = 277. Population estimate ~ 22,447. Data adapted from
Thompson (2008).
care nurses (65%) (HRSA, Bureau of
Health Professions, 2006b). However, the proportion of nurses who were
employees of the facility in which
they worked was larger for these other groups (90% or more) than for occupational health nurses (HRSA, Bureau of Health Professions, 2006b).
32
A larger proportion of occupational
health nurses worked through temporary employment agencies (14%)
or were self-employed or per diem
(10%) than nurses in the other groups
(< 2% agency; 6% to 7% self-employed or per diem) (HRSA, Bureau
of Health Professions, 2006b).
Occupational health nurses’
employment settings were distributed with some regularity across the
country’s regions: approximately half
were located in the Northeast (24%)
and Midwest (26%). Almost one third
of the employment settings were located in the South (32%). The fewest settings were located in the West
(18%). This distribution is similar to
that of the employed registered nurse
population (22%, 26%, 34%, and
18%, respectively) (HRSA, Bureau
of Health Professions, 2006a). Generally, the sparse distribution of occupational health nurse respondents
across the states did not allow for
calculation of population estimates
for individual states. Occupational
health nurses’ employment settings
located in seven states (California,
Maryland, Massachusetts, Michigan,
New York, Ohio, and Texas) and in
the District of Columbia were estimated to account for just more than
two fifths (41%) of the occupational
health nurse population.
The NSSRN questionnaire asks
respondents employed in nursing to
select, from a list of possible titles,
the position title that best corresponds
to the title of their principal nursing
position. The position titles reported
by occupational health nurses had
considerable variability: occupational health nurse respondents reported
having 27 of the 36 possible titles
and several other nonspecified titles.
The most frequently reported position title was staff nurse (39%). Case
manager (14%) was the next most
frequently reported. Other frequently
reported position titles included consultant (4%), nurse coordinator (5%),
nurse practitioner (5%), and supervisor or assistant supervisor (4%).
The reported position titles were also
collapsed by the NSSRN researchers
into 18 grouped position categories;
the grouped position titles for the position titles reported by occupational
health nurses are shown in Table 1.
Within the grouped position titles,
the NSSRN researchers constructed
a staff-level category that included
the charge nurse, float nurse, public
health nurse, travel nurse, and team
leader position titles, reporting that
AAOHN Journal
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Table 3
Years since graduation from initial nursing program
2004 Occupational Health Nurses’
Education and Certification
na
%b
Initial nursing education
Diploma
Associate
Baccalaureate
Master’s or doctorate
94
35.2
111
40.8
69
23.5
2
c
Received health field degree prior to initial nursing education
No
242
87.2
Yes
35
12.8
Employed in health care prior to initial nursing education
No
128
49.4
Yes
149
50.6
Nursing aid
90
60.4
Licensed practical-vocational nurse
39
26.2
If yes, type of employment
Other
Allied health
Manager in health care
9
c
32
21.5
6
c
0-5
11
3.4
6-10
37
12.0
11-15
32
10.1
16-25
73
28.3
123
46.2
58
21.4
26+
Highest nursing education
Diploma
Associate
73
27.0
109
38.1
37
13.5
No
24
8.6
Yes
253
91.4
223
78.8
54
21.2
No
256
92.3
Yes
21
7.7
M
(SE)
Median
Baccalaureate
Master’s or doctorate
Advanced practice nursing certification
Professional certificates
None
1 or more
Current degree program
Initial nursing education received outside the United States
No
265
97.1
Yes
8
c
Emergency response training (since January 2000)
No
162
59.3
Yes
115
40.7
more than 59% of employed nurses
held staff-level positions in 2004
(HRSA, Bureau of Health Professions, 2006b). Less than half of the
occupational health nurses (42%)
reported having position titles in the
staff-level category.
Analysis of two related measures, percentage of time spent in
an activity and dominant function,
provided a high-level view of the activities of occupational health nurses.
The 2004 NSSRN questionnaire
asked employed nurses to estimate
the percentage of their time spent in
each of six listed activities (administration, consultation with agencies or
professionals, direct patient care, research, supervision or management,
plus an other category) during a usual
work week (HRSA, Bureau of Health
january 2010, vol. 58, no. 1
Number of emergency response training
hours
33
(7.9)
10
Note. Study sample = 277. Population estimate ~ 22,447.
Data adapted from Thompson (2008). aSample. bEstimated
population. Total percentage may not equal 100 due to
rounding, not applicable, missing responses, or more than
one possible response. cPopulation estimates were not calculated where sample sizes were less than 10.
Professions, 2006b). Reflecting the
diversity of roles and responsibilities
inherent in the occupational health
nurse position, the estimated averages for occupational health nurses
as a group indicated that their time
was divided among several activities
(Table 1): direct patient care (38%),
administration (23%), consultation with agencies or professionals
(14%), supervision or management
(9%), teaching (4%), research (3%),
and other unspecified activities (9%).
Dominant function, a variable constructed by the NSSRN researchers,
identifies the activity that occupies
more than 50% of the nurse’s time; if
no function occupies more than 50%
of the nurse’s time, then the nurse
is reported as having no dominant
function (HRSA, Bureau of Health
Professions, 2006b). Also reflecting
the diversity of occupational health
nurses’ roles, more than 50% of occupational health nurses were estimated to have no dominant function.
Less than 30% of occupational health
nurses were estimated to have direct
patient care as their dominant function; for 10% of occupational health
nurses, administration was the estimated dominant function.
The extent and nature of changes
over time differed across these characteristics. Proportionately fewer
occupational health nurses reported
working full-time in 2004 (68%)
than in 1992 (76%). Occupational
health nurses responding to the 1992
NSSRN reported working in only
two of the three possible settings
(government and private industry);
33
business and leadership
Figure 2. Changes in occupational health nurses’ reported earnings, 1992 to
2004. OHNs = occupational health nurses; RNs = registered nurses.
no occupational health nurses reported working in the other response
category. In 2004, 11% of occupational health nurses reported working in a setting in the other response
category, which may explain the
decrease in reported employment in
private industry from 1992 (81%) to
2004 (67%). A smaller proportion of
occupational health nurses reported
working as an employee of the facility (77%) in 2004 than did in 1992
(85%), and a larger proportion reported working through a temporary
employment agency in 2004 (14%)
than did in 1992 (6%). The proportion reporting self-employment or
working per diem remained about the
same (10%). Reflecting the increased
diversity of functions within the occupational health nurse role, in 2004
a larger proportion of occupational
health nurses were estimated to have
no dominant function (50%) than
were estimated in 1992 (37%), and
proportionately fewer occupational
health nurses were estimated to have
either administration (10%) or direct
patient care (29%) as their dominant
function than in 1992 (39% and 20%,
respectively).
In 2004, occupational health
nurses reported annual earnings
ranging from $3,000 to $130,000;
average annual earnings were estimated at $48,303 for all occupational
health nurses (Table 2). Annual earnings reported by occupational health
nurses working full-time ranged
34
from $18,000 to $130,000; average
annual earnings for full-time occupational health nurses were $58,343,
an average similar to that of the
full-time registered nurse population ($57,785) but slightly more than
that of the average annual earnings
reported for full-time communitypublic health nurses ($52,347) and
for full-time ambulatory care nurses
($56,265) (HRSA, Bureau of Health
Professions, 2006b). For part-time
occupational health nurses, reported
annual earnings ranged from $3,000
to $93,600; average annual earnings
were $26,736. Average annual earnings for occupational health nurses
who reported being employed by
the facility in which they worked
were considerably higher ($51,930)
than the earnings reported by occupational health nurses who were employed through a temporary agency
($34,857) and by occupational health
nurses who reported self-employment
or working per diem ($38,485). The
major portion of these differences
can be explained by the larger proportions of part-time occupational health
nurses in each of the latter two categories (26% and 25%) than of fulltime occupational health nurses (8%
and 2%). For all occupational health
nurses, average annual earnings were
similar across work setting type:
$48,615 in private industry, $47,862
in government, and $47,222 in the
other nonspecified settings. Except
for the West, where average annual
earnings were reported as $43,158,
average earnings were similar across
the regions: $50,221 in the Northeast,
$48,888 in the Midwest, and $49,393
in the South. As would be expected,
average annual earnings were higher
for occupational health nurses in
non-staff positions ($50,876) than
for occupational health nurses in
staff-level positions ($44,445); higher for occupational health nurses who
reported advanced practice certification ($64,411) than for those who did
not ($46,709); higher for occupational health nurses who reported having
professional certificates ($53,281)
than for occupational health nurses
who did not ($47,701); and generally
higher as education level rose. Average annual earnings for occupational
health nurses who reported master’s
or doctoral degrees were $64,300;
for occupational health nurses with
baccalaureate degrees, they were
$50,093; and for occupational health
nurses with associate degrees, they
were $42,010. The average annual
earnings for occupational health
nurses with a diploma as their highest nursing-related education were
$43,652, slightly higher than those
reporting an associate degree. As noted by the NSSRN researchers, occupational health nurses have complex
patterns of earnings and education;
these may be influenced, in part, by
a larger proportion of diploma-prepared nurses with more years of experience (HRSA, Bureau of Health
Professions, 2006b).
Figure 2 illustrates changes in
occupational health nurses’ average
earnings over time, based on survey
reported earnings (“actual” earnings). Actual average annual earnings for full-time occupational health
nurses increased 58.3% from 1992,
when full-time occupational health
nurses’ average annual earnings were
estimated at $36,847, to 2004, when
they were estimated at $58,343. This
increase is slightly higher than the
53.1% increase in actual average
earnings reported for all full-time
registered nurses ($37,738 in 1992;
$57,785 in 2004) (HRSA, Bureau of
Health Professions, 2006b; Moses,
1993). Earnings for occupational
AAOHN Journal
business and leadership
health nurses who worked part-time
increased 51.2%, from $17,577 in
1992 to $26,581 in 2004. However,
during this same time period, the
purchasing power of earnings declined as the cost of living increased,
lessening the real value of the additional earnings. From 1992 to 2004,
the Consumer Price Index rose an
average of 2.5% annually, increasing
overall by 30.1% (Bureau of Labor
Statistics, 2009). When adjusted for
these changes, the real increase in
full-time occupational health nurse
earnings between 1992 and 2004 is
28.2% (58.3% minus the 30.1% Consumer Price Index increase).
In 2004, most occupational
health nurses (83%) described themselves as feeling moderately (4) or
extremely satisfied (5) about their
positions (Table 1). This rate was
among the highest in job satisfaction
reported by nurses in various settings:
76% for all employed nurses; 84%
for ambulatory care nurses; and 81%
for public-community health nurses
(HRSA, Bureau of Health Professions, 2006b). Comparisons of job
satisfaction rates over time are not
feasible because the 1992 and 1996
surveys did not include a question on
job satisfaction and the 2000 survey
asked a somewhat different question. In 2000, the question asked was
“Compared to a year ago, how would
you best describe your feelings about
your nursing job?” (Spratley et al.,
2001). In 2004, the question was
“How would you best describe your
feelings about your principal nursing
position?” (HRSA, Bureau of Health
Professions, 2006b).
Occupational health nurses’ responses to two questions new to the
NSSRN questionnaire in 2004 provide additional information not previously available. Slightly less than 5%
of occupational health nurse respondents indicated that a registered nurse
license was not required for their position, and approximately 12% indicated that they were represented by
a labor union (Table 1). Responses
for all employed registered nurses
indicated an estimated 1% held positions that did not require a registered
nurse license, and an estimated 17%
january 2010, vol. 58, no. 1
Figure 3. Occupational health nurses’ initial nursing education, 1992 to 2004.
Figure 4. Occupational health nurses’ highest educational preparation, 1992 to
2004.
were represented by a labor union.
For community-public health nurses,
estimates were just under 2% for license not required and 14% for union
representation; for ambulatory care
nurses, the estimates were 2% and
7%, respectively (HRSA, Bureau of
Health Professions, 2006b).
Education and Certification
In 2004, more than half of the
occupational health nurses responding (51%) reported employment in a
health care setting prior to the start
of their initial nursing education
program, and a smaller proportion
(13%) reported receiving a degree in
health care prior to their initial nursing program (Table 3). Associate degree programs were the initial nursing education program for the largest
proportion (41%) of occupational
health nurses responding to the 2004
NSSRN. Initial nursing education
through diploma programs was reported by 35% of occupational health
nurses, and baccalaureate or higher
degree programs were the initial programs for 24% of occupational health
nurses. These proportions represent a
considerable change from 1992 (Fig.
3), when diploma programs were the
initial nursing education for 60% of
occupational health nurses, associate
degree programs for 22%, and baccalaureate and higher degree programs
for 17%. Although similar to trends
seen in the registered nurse population, the movement away from diploma programs as initial nursing
education is not as pronounced for
occupational health nurses as for the
registered nurse population. The proportion of occupational health nurses
who attended diploma programs as
their initial nursing education (35%)
remained larger in 2004 than for the
registered nurse population (25%)
(HRSA, Bureau of Health Professions, 2006a). The primary factor influencing this appears to be the larger
proportion of occupational health
35
business and leadership
nurses (75%) for whom graduation
from initial nursing education was
16 or more years ago, when diploma
programs were more frequently attended, than the proportion of registered nurses (60%) who graduated 16
or more years ago (HRSA, Bureau
of Health Professions, 2006a). Only
a few occupational health nurses
(< 10) who graduated less than 16
years prior to the survey reported
completing a diploma program as
their initial nursing education program. Approximately two thirds of
occupational health nurses (65%)
with between 11 and 15 years since
graduation completed associate degree programs as their initial nursing
program and 26% completed baccalaureate programs. For occupational
health nurses with between 6 and 10
years since graduation, 54% completed associate degree programs and
32% completed baccalaureate degree
programs. Sample numbers were too
small to allow estimations of other
combinations of years since graduation and type of initial nursing education reported by occupational health
nurses. Almost all occupational
health nurses (97%) reported receiving their initial nursing education in
the United States.
Following the trend for nurses to
complete additional education, more
than 27% of occupational health nurses were estimated to have associate
degrees as their highest educational
preparation; 38% to have baccalaureate degrees; and 14% to have master’s or doctoral degrees (Table 3).
Less than one fourth of occupational
health nurses (21%) were estimated
to have a diploma as their highest educational preparation. These findings
represent considerable change from
1992 (Fig. 4), when the diploma was
the highest educational preparation,
estimated for half of occupational
health nurses; less than one tenth had
master’s or doctoral degrees (8%) and
less than one fourth had either associate (20%) or baccalaureate (22%)
degrees. An estimated 8% of occupational health nurses in 2004 reported
current enrollment in a formal education program leading to an academic
degree or certificate degree program;
36
almost half of those occupational
health nurses (48%) were enrolled in
master’s degree programs. In 1992,
an estimated 10% of occupational
health nurses reported current enrollment in degree programs; more than
half (56%) of those occupational
health nurses were enrolled in baccalaureate degree programs.
Following a general nursing
trend, occupational health nurses have
increasingly reported advanced practice education and certification. In
2004, 9% of occupational health nurses were estimated to have advanced
practice status, a number comparable
to the number of advanced practice
nurses estimated in the overall registered nurse population (8%) (HRSA,
Bureau of Health Professions, 2006b)
but considerably larger than the proportion of occupational health nurses
(5%) estimated in 1992.
Two questions regarding education and certification were asked
for the first time in 2004; one concerned professional certificates and
the other emergency response training. Respondents were asked to identify up to three national professional
nursing certificates received in their
career, excluding those reported in
earlier responses to advance practice
questions. Because of the volume,
diversity, and variation in professional practice certificates reported
by respondents, NSSRN researchers
developed an aggregated list “which
summarized the focus of the enumerated certifications into 26 new categories of national professional nursing certifications” (HRSA, Bureau of
Health Professions, 2006a, p. C-25).
A derived variable that summarized
the count “of the number of national
professional certifications in nursing
which the nurse reported . . .” (HRSA,
Bureau of Health Professions, 2006a,
p. C-25) was constructed. Twenty-one
percent of occupational health nurses
were estimated to have one or more
national professional certifications
in nursing, a larger proportion than
that estimated for all employed registered nurses (14%), for communitypublic health nurses (12%), or for
ambulatory care nurses (11%). The
focus of certificates listed by occupa-
tional health nurses varied: the largest group (27%) were summarized
in the family practice or ambulatory
category; 13% were summarized in
the case management category; 8%
in acute and critical care; and 15%
in the other functional category. The
remaining certificates listed were
scattered in small numbers through
many of the other categories, perhaps
reflecting the diverse experience of
occupational health nurses. It is not
possible to determine from the available data the number of occupational
health nurses who reported specific
certification in occupational health
nursing.
Less than half of the occupational health nurses (41%) reported
having received training in recognizing or responding to specific
emergencies. This was roughly the
same proportion estimated for all
employed registered nurses (42%)
and for community-public health
nurses (43%). However, this proportion was higher than the proportion
of ambulatory care nurses (31%)
who reported receiving emergency
response training. Of the occupational health nurses who reported
receiving training, 74% received
training in recognizing or responding to a biological attack, 64% for a
chemical attack, 40% for a nuclear
or radiological attack, 77% for infectious disease epidemics, and 69%
for natural disasters or other public
health emergencies.
Additional Demographics of
Occupational Health Nurses
As in the overall nursing population, males and those of non-White
and Hispanic racial or ethnic background continued to make up only
a small portion of the estimated occupational health nurse population
in 2004 (Table 4). The proportion
of males was slightly higher for occupational health nurses (8%) than
for all employed registered nurses
(6%), for community-public health
nurses (5%), and for ambulatory
care nurses (5%). The number of
occupational health nurses identified as male in the 1992 survey (7
of 306 occupational health nurse re-
AAOHN Journal
business and leadership
na
%b
197
71.6
Widowed, divorced, or separated
61
20.2
Never married
19
8.3
None
121
48.1
1 or more
155
51.9
< $15,000
3
c
$15,001 to $25,000
1
c
$25,001 to $35,000
7
c
$35,001 to $50,000
24
1.9
$50,001 to $75,000
72
26.0
$75,001 to $100,000
67
21.0
$100,001 to $150,000
61
21.4
30
13.8
No
259
94.1
Yes
18
5.9
Table 4
2004 Occupational Health Nurses’
Demographics
Marital status
Now married
na
%b
260
92.4
17
7.6
236
89.7
27
10.3
Gender
Female
Male
Race or ethnicity
White and non-Hispanic
Other
Age in years (grouped)
< 25
0
25-29
5
c
30-34
15
5.2
35-39
21
6.7
40-44
39
10.9
45-49
51
19.7
50-54
47
17.2
55-59
45
16.2
60-64
33
12.1
> 65
20
9.0
M (SE)
Median
Age
All
50.8 (0.7)
51
Full-time only
49.6 (0.8)
51
Part-time only
53.3 (1.5)
52
spondents) was too small to permit
analysis of changes over time. The
single survey question regarding racial and ethnic background of earlier
surveys was expanded in the 2000
and 2004 surveys, providing more
specific information on racial or ethnic background for the overall nursing population in recent years but
limiting detailed occupational health
nurse comparisons over time. Generally, however, the proportion of occupational health nurses reporting
their racial or ethnic background as
White and non-Hispanic decreased
from 94% in 1992 to 90% in 2004,
representing a small increase in the
diversity of the occupational health
nurse population. The proportion of
White, non-Hispanic occupational
health nurses estimated in 2004
was somewhat higher than the estimated proportion for all employed
january 2010, vol. 58, no. 1
Children or dependents living at
home or providing significant care
Household income
> $150,001
Speak other languages fluently
Note. Study sample = 277. Population estimate ~ 22,447. Data
adapted from Thompson (2008). aSample. bEstimated population. Total percentage may not equal 100 due to rounding,
not applicable, missing responses, or more than one possible
response. cPopulation estimates were not calculated where
sample sizes were less than 10.
registered nurses (81%), slightly
lower than that of community-public health nurses (92%), and slightly
higher than that of ambulatory care
nurses (89%).
With an average age of 50.8
years, nurses employed in occupational health settings had the highest
average age among nursing groups
from various employment settings.
The average age for all employed
registered nurses was reported as
45.4, and as 48.4 for communitypublic health nurses (HRSA, Bureau of Health Professions 2006b).
The average age was higher for occupational health nurses working
part-time (53.3) than for full-time
occupational health nurses (49.6).
As in the overall nursing population,
the overall occupational health nurse
average age was higher in 2004 than
in 1992, when it was 47.9. In 2004,
more than half (55%) of occupational
health nurses were 50 years or older
and approximately two fifths (43%)
were between the ages of 30 and 49.
Few occupational health nurse respondents were 29 or younger.
Almost three fourths of occupational health nurses (72%) indicated
that they were currently married;
about 20% indicated being separated,
divorced, or widowed; and less than
10% indicated they had never married. More than half (52%) of occupational health nurses reported they
either had children younger than 18
at home or had others for whom they
provided significant care. Responses
regarding marital status, with the
exception of the never married category, have changed little over time.
In 1992, 75% of occupational health
nurses reported being currently married; 20% were widowed, divorced,
37
business and leadership
IN SUMMARY
Review of Occupational Health Nurse
Data From Recent National Sample
Surveys of Registered Nurses
Part I
Thompson, M. C.
AAOHN Journal 2010; 58(1), 27-39.
1
Study data provide a knowledge base of occupational health nurses
that can be used to support the analysis of the occupational health
nurse work force, to inform strategies for the education and training of
current and future occupational health nurses, and to inform strategies for the recruitment and retention of occupational health nurses.
The occupational health nurse demographic data can be used to
develop sampling strategies for future research about occupational
health nurses.
2
Study data provide practicing occupational health nurses with
information about the characteristics of their occupational health
nurse colleagues throughout the United States. Occupational health
nurses can use elements of this information (e.g., educational status,
certification, or participation in emergency response training) as they
create and evaluate their individual professional development plans.
or separated; and 5% had never married. Almost half of occupational
health nurses (49%) in 1992 reported
they had children living at home;
the earlier survey did not ask about
non-child dependent care. In 2004,
more than four fifths of occupational
health nurses (83%) reported household income of $50,000 or more,
slightly higher than the proportion
of employed registered nurses (79%)
who reported that level of household
income.
The proportion of occupational
health nurses (6%) who reported
speaking another language fluently
was slightly less than for employed
nurses generally (9%) and for community-public health nurses (8%),
but similar to ambulatory care nurses
(6%). One fourth of occupational
health nurses reported residence in
one of the 17 states participating in
the Nursing Licensure Compact at
the time of the survey. This proportion of compact state residence was
similar to the proportion for all employed registered nurses (24%), for
all community-public health nurses
38
(23%), and for all ambulatory care
nurses (24%). A slightly higher proportion of occupational health nurses
(14%) used the Internet to respond to
the survey than employed nurses did
generally (12%).
Discussion
The findings presented provide
a basic description of occupational
health nurses employed in the United
States in 2004 and of changes occurring in that population during the
period from 1992 to 2004. The data
indicated that occupational health
nurses mirror, in many respects, the
characteristics and trends seen in
the overall nursing population. Despite cyclical nursing shortages, the
occupational health nurse population, similar to registered nurses in
general, increased in estimated size
during the years 1992 to 2004. Gender and racial or ethnic backgrounds
remained non-diverse; occupational
health nurses, as in the general nursing population, are predominately
female and White, non-Hispanic.
Concerns regarding the aging of the
nursing work force are particularly
applicable for occupational health
nurses, who have the highest average
age among the groups of nurses employed in various settings.
Employment settings of occupational health nurses are distributed throughout the United States,
although a sizable portion of settings are concentrated in just eight
states. Knowledge of this concentration may be useful in developing
sampling strategies for future studies of the occupational health nurse
population. The diversity of roles and
responsibilities described in publications for occupational health nurses
is reflected in the data: in the variety
of position titles, functions, and time
expenditures for particular activities
reported by occupational health nurses. The data also verified the claims
of increased diversity in occupational health nurses’ roles and functions
over time.
Reflecting trends in the registered nurse population, occupational
health nurses have become increasingly educated and specialized. Far
fewer occupational health nurses received their initial nursing education
through diploma programs in recent
years, and most occupational health
nurses, regardless of type of initial
nursing education, reported receiving associate or higher degrees during their career. In addition, a larger
proportion of occupational health
nurses reported having advanced
practice education and certification.
It is encouraging that a sizable proportion of occupational health nurses
reported receiving training in recognizing and responding to various
emergencies and natural disasters.
However, given the importance of
occupational health nurses’ role in
all hazard planning and response and
the seriousness of potential consequences if such emergencies occur,
it is critical that the need for such
training be more strongly supported
so that all occupational health nurses
are encouraged to receive training.
This descriptive part of the study
provided an initial knowledge base
of occupational health nurses. The
second part of this study will pro-
AAOHN Journal
business and leadership
vide additional information about
occupational health nurses and their
employment decisions when findings
from the analysis of entry, retention,
and demand characteristics of occupational health nurses are reviewed
and discussed. The NSSRN data are
a valuable resource for researchers
who are interested in studying occupational health nurses and the nursing profession and can provide the
starting place for a variety of much
needed in-depth studies.
Supported in part by grants from
the AAOHN Foundation.
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39
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