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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.

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Registered Nurse Educational Level And The Decision To Work As A Hospital Staff Nurse

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  1. 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

  2. Presentation Topics • Research rationale & questions • Prior studies • Data sources and measures • Statistical analysis • Results • Discussion

  3. 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?

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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)]

  10. Results: Logistic of Working as a Hospital Staff Nurse *p<.05; **p<.01; ***p<.001; ****p<.0001

  11. Results: Logistic of Working as a Hospital Staff Nurse *p<.05; **p<.01; ***p<.001; ****p<.0001

  12. Results: Probability of Working as a Hospital Staff Nurse by RN Profiles

  13. Results: Probability of Working as a Hospital Staff Nurse by RN Profiles

  14. Results: Probability of Working as a Hospital Staff Nurse by RN Profiles

  15. 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

  16. 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 (+)

  17. 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%

  18. 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

  19. 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

  20. 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.

  21. 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.

  22. 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.

  23. 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

  24. 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/wisdomatwork.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 nursing crisis. Retrieved from:www.jcaho.org/about+us/public+policy+initiatives/health+care+at+the+crossroads.pdf

  25. 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.

  26. 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.

  27. 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

  28. 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.

  29. 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/rnsurvey/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/behindrnprojections/index.htm

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