Registered Nurse Educational
Level And The Decision To
Work As A Hospital Staff Nurse
Lynn Unruh, PhD, RN, LHRM Jackie Zhang, PhD
University of Central Florida [email protected]
Academy Health Annual Meeting Orlando, FL, June 2-5, 2007
Presentation Topics
|Research rationale & questions
|Prior studies
|
Data sources and measures
|Statistical analysis
|
Results
|Discussion
Research Rationale and
Questions
o
Nursing leaders are calling for
making a BSN the entry-level
educational requirement for RNs
oDo BSN-prepared RNs work in the
hospital bedside setting in the
same proportion as diploma and
ADN-prepared RNs?
o
Would making the entry-level
requirement a BSN accentuate the
nursing shortage?
Prior Studies
|
Brewer and Nauenberg (2003)
|Around ½ of the studies of RN
participation in nursing work find a
negative effect from education:
o Ault and colleagues (1994) o Ezrati (1987)
|
Two studies find a positive effect
from education :
o Buerhaus, et al., (1991) o Chiha & Link (2003)
o
Others find no effect
Study Design
|The influence of educational preparation
on the likelihood of RN’s working as staff nurses in the hospitals is analyzed using:
zStandard labor supply model zStratified samples based on
•Gender •Marital status
zOther demographic and employment
variables
zStatistical tests for the endogeneity of
wages
Data Source and Sample
|National Sample Survey of RNs
(NSSRN) from the U.S. DHHS,
BHP
z
Year 2000 data
|
The sample taken from NSSRN
z included diploma, AD &
BD-prepared RN’s
z excluded PhD and Master’s
Measures
| Response variable
z RN working in a hospital in a staff nurse role or not
| Explanatory variables: ● Educational level ●Demographic
characteristics ●Employment
o Instrumental variables to test for endogeniety of wage variable: o Inpatient days in the county o Median income in the county
Statistical Analysis
|Imputed wages for non-working RNs zModel was run using OLS
|Main model was rested for
endogeneity of wages
zFound to not be a problem |Logistic regression of the binary
hospital staff nurse employment variable on the explanatory variables
zLogistic models were run unstratified, and stratified for gender and marital status
Analysis cont.
|Probabilities of hospital staff nurse
employment given life stage profiles
|Estimation of impact on hospital
nursing shortage using probabilities from logistic regression:
z[(Prob BD – Prob Dip) X (% Dip
graduates)] + [(Prob BD – Prob AD) X (% AD graduates)]
Results: Logistic of Working as a
Hospital Staff Nurse
0.828 -0.188*** Region- Northeast 0.904 -0.101* * Region- South 0.523*** -0.196*** -0.105*** -0.158*** -0.110*** -0.059*** Estimate 1.686 Asian 0.821 Female 0.900 All the children in home > 6
0.853 At least 1 child in home <6
0.895 Married 0.942 Age Demographic variables Odds Ratio *p<.05; **p<.01; ***p<.001; ****p<.0001
Results: Logistic of Working as a
Hospital Staff Nurse
0.376 -0.977*** Additional non-nrs degree
1.205 0.187*** Previous degree 0.325*** 0.238*** 0.075*** 0.367*** Estimate 1.383 Highest ed in nrs= AD 1.269 Highest ed in nrs= Dip Education variables 1.017 Wages 1.443 Fulltime Employment variables Odds Ratio *p<.05; **p<.01; ***p<.001; ****p<.0001
Results: Probability of Working as a
Hospital Staff Nurse by RN Profiles
Percent Probability 22.83 32.52 71.61 82.47 41.77 AD 21.35 30.66 69.82 81.19 39.69 Diploma 17.62 Age 60, married, no child
25.83 Age 50, married, child>6
64.57 Age 30, married, child<6
77.28 Age 24, unmarried, no child
Female, white
34.14
Full sample
Results: Probability of Working as a
Hospital Staff Nurse by RN Profiles
26.51 33.29 31.40 Age 60, married, no child
Percent Probability 44.84 71.61 82.47 AD 42.71 69.82 81.19 Diploma 37.00 Age 50, married, child>6
64.57 Age 30, married, child<6
77.28 Age 24, unmarried, no child
Female, Asian
BD
Results: Probability of Working as a
Hospital Staff Nurse by RN Profiles
20.65 26.48 24.83 Age 60, married, no child
Percent Probability 36.97 64.54 77.25 AD 34.98 62.54 75.70 Diploma 29.77 Age 50, married, child>6
56.81 Age 30, married, child<6
71.05 Age 24, unmarried, no child
Male, White
BD
Results Summary:
|
Compared to an RN with a BD, the
odds of working as a hospital staff
nurse are
z27% higher if the RN has a diploma z38% higher if RN has an AD
|
Compared to an RN with a BD, the
probability of being more likely to work
as a hospital staff nurse is:
z5.5% higher if the RN has a diploma z8% higher if the RN has an AD
Results Summary:
|There is a statistically strong relationship
between working as a hospital staff nurse and
zage (-)
zpresence of children (-) zgender (female = -) zrace (Asian = +)
zworking in the northeast and south (-) zadditional degrees (-)
zprevious degrees (+) zworking fulltime (+) zwages (+)
Results: Impact on Hospital
Staff Nurse Shortage
|
Our estimate shows that the supply of
hospital staff nurses could fall by:
z(.3414 - .3969)(3.77%) + (.3414 - .4177)(61%) = z(-5.5%)(3.77%) + (-7.63%)(61%) = z-0.20% + -4.65% = z -4.85%
Discussion
|
5% decline in hospital staff nurses
should not be ignored
|
Hospital staff nurse supply can be
improved by
zLabor market adjustments
•Wage adjustment
zPolicy or administrative directions
•RN workforce with children
•Older RN workforce
z
Narrow the job attractiveness gap
•Improvement in working conditions z
Increase number of new entrants
References
| Aiken, LH, Clarke, SP, Cheung, RB, Sloane, DM & Silber, JH. (2003). Educational levels of hospital nurses and surgical patient mortality. The Journal of the American Medical Association,290(12), 1617-1623.
| AHA (2007). Trendwatch Chartbook 2007: Trends Affecting Hospitals and Health Systems. Available at:
http://www.aha.org/aha/research-and-trends/trendwatch/2007chartbook.html
| American Organization of Nurse Executives. (2005). Practice and Education Partnership for the Future. Washington, DC: American Organization of Nurse Executives. Available at:
http://www.aone.org/aone/resource/practiceandeducati on.html
References
| AMN Healthcare. (April 12, 2007). Survey: Work Conditions, Not Pay, of Most Importance to Nursing Students, Available at:
|
http://media.corporate-ir.net/media_files/irol/13/130589/release041107.pdf
| ANA (2001). Analysis of American Nurses Association staffing survey. Warwick, RI:
| Cornerstone Communications Group. Retrieved from:
http://nursingworld.org/staffing/ana_pdf.pdf
| Antonazzo, E., Scott, A., Skatun, D., & Elliott, R. F. (2003). The labor market for nursing: a review of the labor supply literature. Health Economics, 12, 465-478.
References
| Ault, D.E., & Rutman, G.L. (1994). On selecting a measure of labor activity: evidence from registered nurses, 1981 and 1989. Applied Economics, 26, 851-863.
| Bishop, C.E. (1973). Manpower policy and the supply of nurses. Industrial Relations, 12(1), 86-94. | Brewer. C.S., & Nauenberg, E. (2003). Future
intentions of registered nurses employed in the Western New York labor market: relationships among demographic, economic, and attitudinal factors. Applied Nursing Research, 16(3), 144-155. | Buerhaus, P.I. (1991). Economic determinants of
annual hours worked by registered nurses. Medical Care, 29(12), 1181-1194.
References
|Chiha, Y.A., & Link, C.R. (2003). The shortage of registered nurses and some new estimates of the effects of wages on registered nurses labor supply: a look at the past and a preview of the 21st century. Health Policy, 64, 349-375. |Duffield, C., Aitken, L., O-Brien-Pallas, L., Wise,
W.J. (2004). Nursing: a stepping stone to future careers. Journal of Nursing Administration, 34(5), 238-245.
|Dunn, S., Wilson, B., Esterman, A.(2005). Perceptions of working as a nurse in an acute care setting. Journal of Nursing management, 13, 22-31.
References
| Estabrooks, C.A., Midodzi, W.K., Cummings, G.C., Ricker, K.L. & Giovanetti, P. (2005, March/April). The impact of hospital nursing characteristics on 30-day mortality. Nursing Research, 54(2), 72-84.
| Ezrati, J.B. (1987). Labor force participation of registered nurses. Nursing Economics, 5(2), 82-89.
| FNHP, AFT. (2001). The nurse shortage: Perspectives from current direct care nurses and former direct care nurses. Washington, D.C. Peter D. Hart Associates. Retrieved from:
http://65.110.81.56/pubs-reports/healthcare/Hart_Report.pdf
References
|Hatcher, B.J. (2006). Wisdom at work: the importance of the older and experienced nurse in the workplace. Princeton, NJ: The Robert Wood Johnson Foundation. Available at: http://www.rwjf.org/files/publications/other/wisdo matwork.pdf?gsa=1
|Hirsh, B., & Schumacher, E. (2005). Classic or new monopsony? Searching for evidence in nursing labor markets. Journal of Health Economics, 24, 969-989.
|Joint Commission on Accreditation of Healthcare Organizations. (2002). Health care at the crossroads: Strategies for addressing the evolving nursingcrisis. Retrieved
from:www.jcaho.org/about+us/public+policy+init iatives/health+care+at+the+crossroads.pdf
References
| Khowaja, K., Merchant, R. J., Hirani, D. (2005). Registered nurses perception of work satisfaction at a tertiary care university hospital. Journal of Nursing management, 13, 32-39. | Laing, G.P., & Rademaker, A.W. (1990).
Married registered nurses’ labor force participation. The Canadian Journal of Nursing Research, 22(1), 21-38.
| Link, C.R., & Landon, J.H. (1975). Monopsony and union power in the market for nurses. Southern Economic Journal, 41(4), 649-659.
References
| Link, C.R., & Settle. R.F. (1979). Labor supply responses of married professional nurses: new evidence. The Journal of Human Resources, 14, 256-267.
| Link, C.R., & Settle. R.F. (1980). Financial incentive and labor supply of married professional nurses: an economic analysis. Nursing Research, 29(4), 238-243. | Link, C.R., & Settle. R.F. (1981). Wage
incentives and married professional nurses: a case of backward-bending supply? Economic Inquiry, 19, 144-156.
References
| Link, C.R., & Settle, R.F. (1985). Labor supply responses of licensed practical nurses: a partial solution to a nurse shortage. Journal of Economics and Business, 37, 49-57. | Link, C.R. (1992). Labor supply behavior of
registered nurses: female labor supply in the future? Research in Labor Economics, 13, 287-320.
| National Council of State Boards of Nursing (2005). 2004 NCLEX Examination Statistics. Available at:
https://www.ncsbn.org/LES_2004.pdf
References
| Philips, V.L. (1995). Nurses’ labor supply: participation, hours of work, and discontinuities in the supply function. Journal of Health Economics, 14, 567-582.
| Staiger, D., Spetz, J., & Phibbs, C. (1999). Is there monopsony in the labor market? Evidence from a natural experiment. National Bureau of Economic Research Working Paper Series,Paper 7258. Available:
http://www.nber.org/papers/w7258.
References
| Tourangeau, A.E, Doran, D.M., McGillis Hall, L., O'Brien Pallas, L., Pringle, D., Tu, J.V. & Cranley, L.A. (2007, January). Impact of hospital nursing care on 30-day mortality for acute medical patients. Journal of Advanced Nursing, 57(1), 32-41. | U.S. DHHS, HRSA (2000). The Registered Nurse
Population: Findings from the National Sample Survey of Registered Nurses,March 2000, U.S. DHHS, HRSA, BHP, Division of Nursing. Retrieved from:
http://bhpr.hrsa.gov/healthworkforce/reports/rnsurve y/rnss1.htm
| U.S. DHHS, HRSA (2006). What is Behind HRSA’s Projected Supply, Demand, and Shortage of Registered Nurses?Available at:
http://bhpr.hrsa.gov/healthworkforce/reports/behindr nprojections/index.htm
