Discussion of the categorization of principal nursing position must be related to discussion of the setting of that position. The two concepts of position and setting are related and may sometimes be difficult to distinguish. The NSSRN classifies settings by “major categories” first and then describes individual settings. The Indiana survey does not have “major categories”, but we created groupings for our first draft of the survey analysis (January 7, 2007). The individual Indiana categories are shown in Table 4 as they relate to the NSSRN categories, but their membership in our groupings is also shown.
TABLE A3.2: Comparison of Work Setting Categories; 2004 National Sample Survey of RNs vs. Indiana RN Survey 2005 NSSRN Work Settings & Codes Indiana Work Settings & Codes
type of 2005 Group Membership New in
Classifications (Grouped by Major Categories) CODE match * Classifications (Not Grouped) CODE Count (for this study) 2005
Hospital (Exclude nursing home units and all off-
site units of hospitals, but include all on-site clinics and other services of the hospitals)
Non-Federal, short-term hospital, except 110 ?? Hospital (in- & out-patient) 7 8,575 hosp patient care
psychiatric (for example, acute care hospital) 110 ?? Hospital (in-patient) 8 12,201 hosp patient care
Non-Federal, long-term hospital, except 120 ?? Hospital (out-patient) 9 1,010 hosp patient care
psychiatric 120 ?? Hospital ER/ED 10 2,078 hosp patient care
Non-Federal psychiatric hospital 130 ?? Hospital operating room 11 1,030 hosp patient care yes
Federal Government hospital 140
Other type of hospital 150
Nursing Home/Extended Care Facility
Nursing home unit in hospital 210 ? Long-term acute care facility/unit 29 644 non-hosp patient care yes
NSSRN Work Settings & Codes Indiana Work Settings & Codes
type of 2005 Group Membership New in
Classifications (Grouped by Major Categories) CODE match * Classifications (Not Grouped) CODE Count (for this study) 2005
Nursing Education Program ?? Nursing education program 15 375 education
LPN/LVN program 310
Diploma program (RN) 320
Associate degree program 330
Bachelor’s and/or higher degree
nursing program 340
Other program 350
Public or Community Health Setting
Official State Health Department 402 410 Public health department (city, county or state) 19 255 government agency yes
Official State Mental Health Agency 405 920, 940 State agency (other than state public health department) 36 97 government agency yes
Official City or County Health Department 410 402 Public health department (city, county or state) 19 255 government agency yes
Combination (official/voluntary) nursing service 415
Visiting nurse service (VNS/NA) 420
Home health service unit (hospital-based) 422 425 Home health care agency 5 1,603 non-hosp patient care
Home health agency (non-hospital based) 425 422 Home health care agency 5 1,603 non-hosp patient care
Community mental-health organization or facility (including freestanding psychiatric outpatient clinics)
430 Community mental health center 25 191 non-hosp patient care yes
430 outpatient? Mental health/addictions facility/unit 14 218 non-hosp patient care
Substance abuse center/clinic 431 Community substance abuse agency 26 18 non-hosp patient care yes
Community/neighborhood health center 435 Community health center/clinic 2 628 non-hosp patient care
Planned Parenthood/family planning center 440
Day care center 445 Adult day care 23 32 non-hosp patient care yes
Rural health care center 450
Retirement community center 455
Hospice 460 Hospice 6 592 non-hosp patient care
Other 465
NSSRN Work Settings & Codes Indiana Work Settings & Codes
type of 2005 Group New in
Classifications (Grouped by Major Categories) CODE match * Classifications (Not Grouped) CODE Count (for this study) 2005
School Health Service ?? School/college setting 20 1,300 education
Public school system 510
Private or parochial elementary or secondary school 520
College or university 530
Other 540 540
Occupational Health (Employee Health Service) ?? Occupational health setting 31 347 non-hosp patient care yes
Private industry 610
Government620 620
Other 630 630
Ambulatory Care Setting ?? Ambulatory care setting (surgical/other) 1 2,385 non-hosp patient care
Solo practice (physician) 710 ?? Physician/dentist private office 16 1,994 non-hosp patient care
Solo practice (nurse) 715 ?? Primary care center/clinic 17 688 non-hosp patient care
Partnerships (physicians) 720 720 ?? Urgent care center/clinic 21 129 non-hosp patient care
Partnerships (nurses) 725 ?? Non-residential care facility/unit 30 28 non-hosp patient care yes
Group practice (physicians) 730 outpatient? Mental health/addictions facility/unit 14 218 non-hosp patient care Group practice (nurses) 735
Partnership or group practice (mixed group of professionals) 740
Freestanding clinic (physicians) 750 750
Freestanding clinic (nurses) 755
Ambulatory surgical center 760
NSSRN Work Settings & Codes Indiana Work Settings & Codes
type of 2005 Group Membership New
in
Classifications (Grouped by Major Categories) CODE match * Classifications (Not Grouped) CODE Count (for this study) 2005
Insurance Claims/Benefits
Government 810
State or local agencies 820
Insurance company 830 Insurance company 12 336 private business yes
Private industry/organization 840 ? Drug company 4 88 private business yes
840 ? Law firm 28 49 private business yes
Policy, Planning, Regulatory, or Licensing Agency
Central or regional Federal agency 910 Federal agency 35 147 government agency yes
State Board of Nursing 920 405, 940 State agency (other than state public health department) 36 97 government agency yes
Nursing or health professional membership association 930
Health planning agency, non-Federal 940 405, 920 State agency (other than state public health department) 36 97 government agency yes
Other 945
Other
Correctional facility 950 Prison 18 141 non-hosp patient care yes
Private duty in a home setting 955 Private duty nursing 32 69 non-hosp patient care yes
Home-based self-employment 960
Other 965
* type of match definitions: none Research setting 34 112 research yes
blank = good match none Other 22 900 other
? = questionable match none Supplemental staffing agency 27 33 private business yes
?? = match to summary category only none Continuing education/staff development 3 101 education yes
number(s) = other NSSRN category(ies) included in this Indiana category
text? = question about which NSSRN category is relevant
In general, the NSSRN and the Indiana survey correspond better on work setting categories than on primary position categories. The greatest difference between the two surveys on work settings is in the “hospital” major category. The NSSRN distinguishes among types of hospitals while the Indiana survey distinguishes among different hospital settings. Distinction among types of hospitals is lost by the Indiana survey while distinction among types of hospital settings is lost by the NSSRN. It seems that the distinctions among hospital settings may be more important.
Making both kinds of distinctions may not be necessary and would be cumbersome. However, the particular hospital settings referring to outpatients and inpatients in the Indiana survey may need clarification.
In several other major categories the NSSRN has much greater detail than the Indiana survey. These include the areas of ambulatory care, school health, occupational health, and nursing education. More detail and more clarity may be needed in the Indiana survey, particularly in the areas of ambulatory care and school health.
Some Indiana categories are difficult to categorize in the NSSRN system. Mental health settings and state government settings are particularly difficult to reconcile with NSSRN.
Conclusion
The most pressing problem with the design of the Indiana Registered Nurse Survey concerns the “principal position” categories. It would seem that closely following the NSSRN categorization would be the best solution. In addition, very clear labeling of APN-related categories is needed. Many nurses could reasonably identify themselves as a “clinical nurse specialist” because they specialize to some extent in particular clinical areas. Clearer identification seems necessary so that “clinical nurse specialist” is recognized as a specific designation within the broader
“Advanced Practical Nurse” designation. Some Indiana “principal position” categories that clearly refer to “settings” should be dropped. The distinction between “position” and “setting” is not always clear and is sometimes confusing even in the NSSRN. But the Indiana survey need not be more confusing than the NSSRN and following the national design provides advantages in comparability. The current Indiana principal positions are also very difficult to summarize into broad major categories.
The work “settings” in the Indiana survey correspond more closely to NSSRN than the principal positions. But even with the “settings”, closer correspondence to NSSRN is desirable. Much of the difference between the two surveys with regard to settings is due to differing detail in different areas. The Indiana survey may need more detail in hospital settings than the NSSRN provides. But the detail and clarity of ambulatory care settings in the NSSRN should be more closely followed in the Indiana survey. The Indiana survey should explicitly group their settings into major categories as the NSSRN does. The same major categories should be probably be used in the Indiana survey.