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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 lunruh@mail.ucf.edu Academy Health Annual Meeting Orlando, FL, June 2-5, 2007. Presentation Topics.

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registered nurse educational level and the decision to work as a hospital staff nurse

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

lunruh@mail.ucf.edu

Academy Health Annual Meeting

Orlando, FL, June 2-5, 2007

presentation topics
Presentation Topics
  • Research rationale & questions
  • Prior studies
  • Data sources and measures
  • Statistical analysis
  • Results
  • Discussion
research rationale and questions
Research Rationale and Questions
  • Nursing leaders are calling for making a BSN the entry-level educational requirement for RNs
  • Do BSN-prepared RNs work in the hospital bedside setting in the same proportion as diploma and ADN-prepared RNs?
  • Would making the entry-level requirement a BSN accentuate the nursing shortage?
prior studies
Prior Studies
  • Brewer and Nauenberg (2003)
  • Around ½ of the studies of RN participation in nursing work find a negative effect from education:
    • Ault and colleagues (1994)
    • Ezrati (1987)
  • Two studies find a positive effect from education :
    • Buerhaus, et al., (1991)
    • Chiha & Link (2003)
  • Others find no effect
study design
Study Design
  • The influence of educational preparation on the likelihood of RN’s working as staff nurses in the hospitals is analyzed using:
    • Standard labor supply model
    • Stratified samples based on
      • Gender
      • Marital status
    • Other demographic and employment variables
    • Statistical tests for the endogeneity of wages
data source and sample
Data Source and Sample
  • National Sample Survey of RNs (NSSRN) from the U.S. DHHS, BHP
    • Year 2000 data
  • The sample taken from NSSRN
    • included diploma, AD & BD-prepared RN’s
    • excluded PhD and Master’s prepared RN’s
measures
Measures
  • Response variable
    • RN working in a hospital in a staff nurse role or not
  • Explanatory variables:

● Educational level ● Demographic characteristics ● Employment

  • Instrumental variables to test for endogeniety of wage variable:
    • Inpatient days in the county
    • Median income in the county
statistical analysis
Statistical Analysis
  • Imputed wages for non-working RNs
    • Model was run using OLS
  • Main model was rested for endogeneity of wages
    • Found to not be a problem
  • Logistic regression of the binary hospital staff nurse employment variable on the explanatory variables
    • Logistic models were run unstratified, and stratified for gender and marital status
analysis cont
Analysis cont.
  • Probabilities of hospital staff nurse employment given life stage profiles
  • Estimation of impact on hospital nursing shortage using probabilities from logistic regression:
    • [(Prob BD – Prob Dip) X (% Dip graduates)] + [(Prob BD – Prob AD) X (% AD graduates)]
results logistic of working as a hospital staff nurse
Results: Logistic of Working as a Hospital Staff Nurse

*p<.05; **p<.01; ***p<.001; ****p<.0001

results logistic of working as a hospital staff nurse1
Results: Logistic of Working as a Hospital Staff Nurse

*p<.05; **p<.01; ***p<.001; ****p<.0001

results summary
Results Summary:
  • Compared to an RN with a BD, the odds of working as a hospital staff nurse are
    • 27% higher if the RN has a diploma
    • 38% 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:
    • 5.5% higher if the RN has a diploma
    • 8% higher if the RN has an AD
results summary1
Results Summary:
  • There is a statistically strong relationship between working as a hospital staff nurse and
    • age (-)
    • presence of children (-)
    • gender (female = -)
    • race (Asian = +)
    • working in the northeast and south (-)
    • additional degrees (-)
    • previous degrees (+)
    • working fulltime (+)
    • wages (+)
results impact on hospital staff nurse shortage
Results: Impact on Hospital Staff Nurse Shortage
  • Our estimate shows that the supply of hospital staff nurses could fall by:
    • (.3414 - .3969)(3.77%) +

(.3414 - .4177)(61%) =

    • (-5.5%)(3.77%) + (-7.63%)(61%) =
    • -0.20% + -4.65% =
    • -4.85%
discussion
Discussion
  • 5% decline in hospital staff nurses should not be ignored
  • Hospital staff nurse supply can be improved by
    • Labor market adjustments
      • Wage adjustment
    • Policy or administrative directions
      • RN workforce with children
      • Older RN workforce
    • Narrow the job attractiveness gap
      • Improvement in working conditions
    • Increase number of new entrants
references
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/practiceandeducation.html
references1
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.
references2
References
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  • 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.
references3
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.
references4
References
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  • 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
references5
References
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references6
References
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references7
References
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  • Link, C.R., & Settle. R.F. (1981). Wage incentives and married professional nurses: a case of backward-bending supply? Economic Inquiry, 19, 144-156.
references8
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.
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references9
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references10
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