Missouri Nurses Nearing Retirement

According to data from the 2020 Missouri Nursing Workforce Report

Well before  COVID-19  strained our health care system,  Missouri was facing a nursing shortage , especially in rural parts of the state. This shortage may be exacerbated in the coming years by an increasing number of nurses reaching retirement age. The series of maps below aims to demonstrate which Missouri counties may face significant nurse retirements in the coming years.  

All maps presented in this application are fully interactive. Readers can zoom in and out, left-click on counties and hospitals to open pop-ups with additional information, and pan around. By zooming in to the county-scale, readers will notice that two additional layers become available - rural health clinics and long-term care facilities. As with hospitals and counties, readers can left-click on any feature from these two additional layers to view more details about those facilities.


About Missouri’s nursing license types

The Missouri State Board of Nursing offers two license types: Licensed Practical Nurse (LPN) and Registered Nurse (RN). RNs who complete additional education or training and obtain national certification and recognition from the Missouri State Board of Nursing may practice as Advanced Practice Registered Nurses (APRNs) in Missouri.

Each nursing license type is defined by Missouri statute section  335.016, RSMo .

  • Licensed Practical Nurses (LPNs) provide care under the direction of a Registered Nurse (RN) or someone licensed to prescribe such as a physician or physician’s assistant. LPNs comprise the majority of the nursing workforce in Missouri’s long-term care facilities such as nursing homes.
  • Registered Nurses (RNs), sometimes called registered professional nurses, provide patient education, assessment, administration of medications and treatments, care coordination, and teaching and supervision of LPNs. RNs most often practice in a hospital setting.
  • Advanced Practice Registered Nurses (APRNs) have completed advanced nursing education and are certified by a nationally recognized professional organization as a Certified Nurse Midwife (CNM), Certified Nurse Practitioner (CNP), Clinical Nurse Specialist (CNS), or Certified Registered Nurse Anesthetist (CRNA). APRNs may hold more than one certification. Like RNs, APRNs most often practice in hospitals. However, CNPs are an important source of primary care as well, and often practice in outpatient clinics.

Percent of Licensed Practical Nurses Ages 55 and Up, 2020

Licensed Practical Nurses

Since their educational path is shorter than colleagues with other nursing credentials, LPNs tend to be younger than RNs and APRNs. In most Missouri counties, less than half the LPN workforce is aged 55 or older. Only one county (Worth) has a majority of LPNs aged 55 or older. There are four additional counties (Howard, Knox, Lewis and Monroe) where exactly 50% of available LPNs are in the older age cohort. While these counties are relatively close to one another, only two—Knox and Lewis—are contiguous. There does not appear to be a major geographic concentration of impending retirements. 


Percent of Registered Nurses Ages 55 and Up, 2020

Registered Nurses

Registered nurses tend to be older than LPNs but younger than APRNs. They have higher levels of education than LPNs, and their scope of practice includes LPN supervision. However, they have not yet completed the advanced training required to achieve APRN status. Seven counties (DeKalb, Osage, Holt, Reynolds, Chariton, Maries, and Macon) report that more 50% of RNs have reached age 55 or older. In one county (Ozark) exactly 50% of RNs were age 55 or greater.

RNs comprise the large majority of nurses in Missouri. Therefore, retirements among this group have the greatest potential to impact Missourian’s access to nursing care. Additionally, the majority of RNs work in hospital settings, and the hospital workforce in particular is under duress due to the Covid-19 pandemic.


Percent of Advance Practice Registered Nurses Ages 55 and Up, 2020

Advanced Practice Registered Nurses

Because APRNs require more training than LPNs or RNs, it is not surprising that APRNs are generally the oldest of these three professional cohorts. 

Ten Missouri counties (Knox, Dallas, Holt, DeKalb, Texas, Morgan, Ripley, St. Clair, Cedar, and Bates) have more than half of APRNs age 55 or greater, and another eleven counties have half of APRNs nearing retirement age. All APRNs in four counties (Knox, Dallas, Holt, and DeKalb) are age 55 or above. 

While some of the counties with an older APRN workforce are relatively close to one another, there is no significant clustering. In other words, Missouri is unlikely to suffer a complete loss of APRN care at the regional level.


Observations

No county in Missouri currently faces a complete loss of their nursing staff due to retirements. Data ranges vary between the three maps, but no one Missouri county reported that the majority of all three categories of nurses are aged 55 and older.

Additionally, there aren't any major spatial patterns to the data once they are mapped out. Counties with an older average nursing workforce aren't clustered together. It is, therefore, less likely that huge chunks of the state would suddenly find themselves completely devoid of anyone to fill nursing staff shortages.

However, some Missouri counties may be on the verge of losing many nurses in a short period of time to retirement. In some counties, retirements may occur in areas lacking basic health care services. For example, the four previously mentioned counties in which every APRN is close to retirement age also lack a hospital. 

Another example is DeKalb and Holt counties, where a majority of both RNs and APRNs are approaching retirement age and there is no hospital currently operating. 

Healthcare Resources of DeKalb and Holt Counties, 2020


For more information on Missouri’s nursing workforce please see the  2020 Missouri Nursing Workforce Report 

Map Data

Missouri counties shapefile courtesy of the Missouri Department of Agriculture, Division of Weights, Measures and Consumer Protection, Land Survey Program

Missouri hospitals, rural health clinics, and long term care facilities shapefiles courtesy of the Missouri Department of Health and Senior Services