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The Business of Nursing

Jan 4, 2024 | Guest Author, Healthcare

Tridsanu | Envanto

According to the International Council of Nurses, the field of nursing “encompasses [the] autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well and in all settings.” You can find nursing professionals staffing the front lines of all levels of care providing illness prevention and health promotion. They also take part in research, advocacy, policy making, education, and management within the healthcare industry.

The title “nurse” refers to someone who holds particular qualifications and has demonstrated necessary competency, but it actually describes a whole alphabet soup of different levels of care and training, including CNA, LPN, AAS, ADN, BSN, RN, MSN, APRN, NP, DNP, and PhD. One way to think about nurses is by three general categories: non-degree, degree, and advanced degree. Non-degreed nurses include certified nursing assistants (CNA) and licensed practical nurses (LPN), which complete nursing education programs that may conclude with a diploma or certificate but generally not a university degree. Degreed nurses include those with an undergraduate degree in the field, such as an Associate of Applied Science in Nursing (AAS), an Associate Degree in Nursing (ADN), or a Bachelor of Science in Nursing (BSN).

Many people associate the word “nurse” with the role of a registered nurse (RN); these professionals have earned associate or bachelor’s degrees from a nationally accredited nursing program and passed the National Council Licensure Examination (NCLEX) exam. RNs have broad responsibilities that include performing physical exams and health histories, providing health counseling and education, administering medications and other personalized interventions, and coordinating care with a wide array of healthcare professionals. In some workplaces, RNs oversee CNAs and LPNs.

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Advanced degreed nurses are those with a graduate degree in the field, such as a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP). Graduate study can lead to more autonomy, management, or administrative positions, with some clinicians pursuing advanced practice registered nurse (APRN) or nurse practitioner (NP) licensure as a generalist, a specific patient population like pediatrics, or other specialization like certified registered nurse anesthetist or nurse midwife.

Where Are Alaska’s Nurses?

Healthcare is a big industry in Alaska. According to the Alaska Hospital and Healthcare Association, in 2021 the state saw $3 billion in wages generated through nearly 43,000 healthcare jobs, which is 11 percent of Alaska’s entire workforce. One in three Alaska healthcare jobs is a nurse, with 43 percent of all healthcare wages being paid to nurses. Average Alaska RN annual earnings were $82,205 in 2018, with 9 percent earning less than $40,000 and 12 percent earning more than $120,000. Alaska NPs earned on average $108,889 in 2018.

The number of practicing nurses varies greatly in different communities. Anchorage is the central hub of nursing resources in Alaska, employing 64.5 percent of all the state’s nurses: 68 percent of the state’s RNs, 63 percent of all LPNs and vocational nurses, 57 percent of all nurse assistants, and 49 percent of all NPs. Fairbanks employs 10.5 percent of all nurses, and the remaining 25 percent are distributed throughout the rest of the state.

Travel nurses or temporary duty nurses are RNs who work for independent staffing agencies and take temporary positions to fill in short-term employment gaps in high-need areas. Travel nursing is a specialty that took root in the ‘70’s during persistent nursing shortages, but the demand for travel nurses accelerated during the COVID-19 pandemic, with a national peak of 45,000 open positions during late 2021, according to staffing agency Aya Healthcare.

To attract nurses to the open positions, employers offer higher salaries, housing, and often relocating costs. Travel nurses can bridge the short-term supply and demand gaps, meet healthcare facilities’ mandatory nurse-patient ratios, and provide nurses with the adventure that comes from exploring new hospitals and care systems—but the pay and job security can vary, housing can be complicated, and institutions may cancel contracts if their needs shift.

Nurses are assuming new roles in a broad range of settings, from ambulatory care to community-based care.

The Statistically Typical Nurse

Who Alaska’s nurses are is a little difficult to nail down because the industry is growing so rapidly, with a 50 percent increase of positions during the last fifteen years. Also, since nursing positions have relatively high turnover or churn—as much as 25 percent of workers can be replaced annually—specific demographics can change often.

  • Most nurses are residents. In 2020 the Alaska Department of Labor and Workforce Development (DOLWD) reported 81 percent of NPs, 84.3 percent of RNs, and 93.5 percent of CNAs were Alaska residents.
  • The average age of licensed and employed Alaska RNs was 47.5 years old with 17.1 years in the nursing profession according to the 2018 National Sample Survey of Registered Nurses (NSSRN). This number is a little higher than the national average of 46 years old.
  • Women outnumber men nine-to-one as registered nurses. Notably, male RNs earn about 14 percent more salary than female RNs in Alaska.
  • 78 percent of licensed and employed Alaska RNs identified as white non-Hispanic according to the 2018 NSSRN, which tracks close to 80 percent of RNs nationally identifying as white non-Hispanic, according to the 2022 National Nursing Workforce Survey conducted by National Council of State Boards of Nursing and the National Forum of State Nursing Workforce Centers.
  • 62 percent of RNs nationally report an increase in their workload during COVID-19, and 50 percent of RNs reported feeling emotionally drained from work “every day” or “a few times a week” according to an analysis of the 2022 National Nursing Workforce Survey in the Journal of Nursing Regulation, April 2023.

According to DOLWD, growth and churn required Alaska to recruit more than 1,500 new RNs annually to meet demand, based on three-year averages from 2019 to 2021. Nurse demographics of today could be very different in five years.

Demand for Nurses

The state’s need for new nurses is not likely to decrease in the short term. DOLWD’s October 2022 Alaska Economic Trends article “Ten-year Occupational Projections” stated, “Healthcare represents fourteen of the top twenty-five [individual occupations] for percent growth,” with RNs, CNAs, and NPs all on the high-growth occupation list with a projected 12 percent growth before 2030. Nationally, 29 percent of emergency nurses surveyed by the American Nurses Foundation in 2022 said that they planned to leave their job, with one of the main reasons being insufficient staffing.

Alaska is one of nine states that is not part of a universal licensure program, the Nurse Licensure Compact (NLC), that allows nurses to practice throughout most of the US without obtaining additional state licenses. The Alaska Division of Corporations, Business, and Professional Licensing in the article “The Facts: Why Alaska Needs to Join the Nurse Licensure Compact” states:

“Do we know if joining the NLC will be the “silver bullet” that fixes our nursing vacancy issues? No. However, we know that if we continue to be one of the only US jurisdictions that is not part of the NLC, it will become even harder for Alaska to bring in the traveling nurses we rely on so heavily, retain our nursing graduates, and encourage nurses from other states to make Alaska their home.”

NLC membership might be on Alaska’s nursing horizon.

Many major changes in the Alaska nursing profession are likely to be in response to this increasing demand and shrinking supply. The profession may see a shortened work week without a decrease in compensation, investing in virtual care tools that allow hybrid work options, the creation of in-house per diem pools to offer more staffing flexibility, and having more nurses in decision-making roles to ensure their voices are heard as authentic leaders.

A commitment to workplace safety and overall well-being may reduce the number of nurses who leave the field. According to the 2019 National Health Care Retention and RN Staffing Report, it is estimated that workplace violence causes 17.2 percent of nurses nationally to leave their job every year. The Alaska Nurses Association reports from their 2019 Workplace Violence survey that 91 percent of Alaska nurses have witnessed or experienced workplace violence.

Virtual nursing began in Electronic Intensive Care Units (eICU), a model of telemedicine where state-of-the-art technology is used to provide an additional layer of critical care service to patients, where patients do not have to be in the same hospital as their healthcare providers. This virtual nursing supported by an increased use of technology and artificial intelligence may move to other units as well as patient education, discharge planning, and other tasks that do not require hands-on care.

Nurses are expanding their reach and impact in the redesigned health care system. They are assuming new roles in a broad range of settings, from ambulatory care to community-based care. New job titles are emerging, such as population health manager, patient coach, informatics designer, geriatric care manager, and care transition specialist. Nurses are also increasingly employed as “boundary spanners,” connecting patients with services in health and community settings.

Alaska’s Evolving Healthcare System

Alaskans experience lower life expectancy and higher rates of chronic diseases, injuries, and mental illness. Overall Alaskans have lower access to healthcare than the rest of the country due to remoteness, the high cost of healthcare, and cultural barriers.

Today’s nursing workforce provides many more services, including care coordination and transitional care, use of data and evidence, interprofessional collaboration, and process performance improvement. Alaska’s next generation of nurses are being prepared for the workforce beyond traditional skills with an understanding of addressing socioeconomic factors, protecting the environment, and respecting cultural differences—including culturally appropriate healthcare services and working with traditional healers.

For instance, the Alaska Pacific University nursing program has been designed to address the strong cultural identity that Alaskans have, using a foundation of cultural safety in their curriculum. Cultural safety is an important concept in nursing education. It refers to the need for nurses to be aware of and respect the cultural beliefs and practices of their patients. This is essential for providing safe and effective care, as it helps to ensure that patients feel comfortable and respected during their treatment. Achieving cultural safety is a complex and challenging process, but it is essential to address the health disparities in Alaska and provide equitable and high-quality patient care. By educating nurses about cultural safety, and by creating a culture of cultural safety in healthcare organizations, progress can be made towards achieving this goal.

The COVID-19 pandemic challenged the Alaska nursing industry in unimaginable ways, and the next decade will require a larger, stronger, and more diversified nursing workforce that is technologically savvy and prepared to provide integrated care. It will require nurses who value health and well-being and are ready to address systemic inequities that have fueled wide and persistent health disparities across the state.

Lincoln Garrick is an assistant professor of business, MBA director, and alumnus at Alaska Pacific University. He has more than twenty years of experience in the business, marketing, and communications fields, providing public affairs and strategy services for national and Alaska organizations.
Dr. Marianne Murray, DNP, RN, CHSE is a professor of nursing and the director of nursing programs at APU. Since coming to APU, Murray has been involved in the creation of the curriculum in the practical nursing program and the associate degree program. Murray has served as the executive director of the Alaska Board of Nursing and assisted with many regulation changes during the COVID-19 pandemic.
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Welcome to the June 2024 issue, which features our annual Transportation Special Section. We've paired it this year with a focus on the Pacific Northwest and Hawai'i, as Alaska has close ties to both that reach far beyond lines of transportation. Even further out past our Pacific Ocean compatriots and our Canadian neighbors to the east, Alaska's reach extends to India and Singapore. Enjoy this issue that explores many of Alaska's far-flung business dealings.
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