Clinical Nonlicensed Personnel in U.S. Hospitals: Job Trends from 2010 to 2015

Clinical Nonlicensed Personnel in U.S. Hospitals: Job Trends from 2010 to 2015

Published: Jan 01, 2018
Publisher: Nursing Outlook, vol. 66, issue 1

Patricia Pittman

Suhui Evelyn Li

Xinxin Han

Time Lowe


Despite the large numbers in health care industry, little is known about the clinical nonlicensed personnel (CNLP) in U.S. hospitals and how their staffing has changed over time.


The purpose of this analysis is to better understand the conformation and recent trends in CNLP staffing in U.S. hospitals from 2010 to 2015.


Using Premier's OperationsAdvisor database, we examined trends in staffing of 25 CNLP jobs and graduate nurses (GNs) in U.S. hospitals and by hospital units, including medical–surgical units, outpatient units, and emergency departments, from 2010 to 2015, based on their skill levels. We measured CNLP and graduate nurse staffing using the average number of full-time equivalents (FTEs) in each hospital. We performed statistical analysis to compare the changes in the number of FTEs between 2010 and 2015.


Over the 6-year period from 2010 to 2015, we observed declining trends in the average number of high-skill and middle-skill CNLP FTEs by 22% and 7%, respectively, and increases in the average number of low-skill and graduate nurse FTEs by 38% and 117%, respectively. This skill mix shift appears to be most pronounced in emergency departments.


Changes in staffing levels and the skill mix of the hospital workforce warrant further study to understand both the reasons behind the observed changes and their effects on health outcomes. Although labor efficiency is an important goal, it is also critically important to assess whether reductions and/or the skill mix shifts among support staff impact nurse workload and, by extension, patient safety.

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