Registered Nurses: The Curious Case of a Persistent Shortage (original) (raw)
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Labor Market Trends Among Registered Nurses: 2008-2011
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Explanations for Persistent Nursing Shortages
Forum for Health Economics & Policy, 2000
This paper contributes to the economics literature on nursing market shortages by putting forward two new models that suggest three new explanations for perceived nursing shortages. The first model focuses on hospitals hiring both permanent staff nurses and temporary contract nurses. It shows that hiring both classes of nurses can represent optimizing behavior, and that an interesting kind of perceived nursing shortage results from this dual hiring. The second model posits two classes of hospitals, "premier" and "funds-constrained," and generates two distinct kinds of nursing shortages: economic shortages, involving unfilled, budgeted positions, and "noneconomic" professional standards shortages. We believe that the perceived existence of professional standards shortages may be a significant explanation for the widespread impression of persistent shortages.
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Registered nurses (RNs) play a critical role in health care delivery. With an aging US population, health care demand is growing at an unprecedented pace. Using projected changes in population size and age, the authors developed demand and supply models to forecast the RN job shortage in each of the 50 states. Letter grades were assigned based on projected RN job shortage ratios. The number of states receiving a grade of "D" or "F" for their RN shortage ratio will increase from 5 in 2009 to 30 by 2030, for a total national deficit of 918 232 (725 619 -1 112 112) RN jobs. There will be significant RN workforce shortages throughout the country in 2030; the western region will have the largest shortage ratio of 389 RN jobs per 100 000. Increased efforts to understand shortage dynamics are warranted.
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Health care administrators and public policy makers are currently much concerned with the labor supply of nurses and nursing assistants. Hospitals and nursing homes, complaining of labor shortages, request public assistance to enable them to pay higher wages. Before committing public funds, policy makers want up-to-date estimates of the wage elasticities of labor supply for nurses and nursing assistants. Constructing a framework within which these elasticities can be estimated requires consideration of the nature and possible origins of the reported shortages. Based on annual time-series data for the US, 1988-2002, the study has derived posterior distributions for short- and long-run own wage elasticities of labor supply by Registered Nurses (RN) and nursing aides, orderlies, and attendants (NAOA). This analysis suggests that increased public assistance to health care providers, designed to raise wages, probably would not reduce reported shortages arising from monopsony power but wo...
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Even as concerns about nursing shortages continue nationwide and for individual states in the United States, there is little information on the impact of nursing shortages at substate levels, such as counties or groups of small counties. National and state level assessments can mask wide geographic variation in the distribution of registered nurses (RNs). The Center for Health Workforce Studies at the School of Public Health, University at Albany, developed a practical approach to projecting RN supply and demand at substate levels. The experimental model used in this research was adapted from a methodology utilized for the RN National Supply Model and National Demand Model developed by the Health Resources and Services Administration in the department of Health and Human Services to make RN supply and demand projections at the broader national and state levels. The Center's research highlighted the value of substate analyses in the identification of RN supply and demand gaps and...
Human Resources for Health, 2012
Economic downturns and recession lead to budget cuts and service reductions in the healthcare sector which often precipitate layoffs and hiring freezes. Nurses, being the largest professional group in healthcare, are strongly affected by cost reductions. Economic downturns destabilize the nursing labour market with potential negative outcomes, including serious shortages, extending beyond the recessionary period. The objectives of this manuscript are to provide an overview of the potential short-and long-run impact of economic downturns on the supply and demand of nurses, and present healthcare decision makers with a framework to enhance their ability to strategically manage their human resources through economic cycles. A narrative review of the literature on the effects of economic downturns on the nursing labour market in developed countries was carried out with a special focus on studies offering a longitudinal examination of labour force trends. Analysis indicates that economic downturns limit the ability of public payers and institutions to finance their existing health workforce. As salaried healthcare workers, nurses are especially susceptible to institutional budget cuts. In the short run, economic downturns may temporarily reduce the demand for and increase the supply of nurses, thereby influencing nursing wages and turnover rates. These effects may destabilise the nursing labour market in the long run. After economic downturns, the market would quickly display the prerecessionary trends and there may be serious demand-supply imbalances resulting in severe shortages. Potential long-term effects of recession on the nursing labour market may include a downsized active workforce, difficulty in retaining younger nurses, a decreased supply of nurses and workforce casualisation. Lack of understanding of labour market dynamics and trends might mislead policy makers into making misinformed workforce downsizing decisions that are often difficult and expensive to reverse. In the aftermath of an economic downturn, the costs of attracting nurses back often outweigh the short term cost savings. Effective management should support the nursing workforce by creating attractive and stable work environments to retain nurses at a manageable cost.
Serving the Medicaid and Medicare Populations: Nursing Labor Market Dynamics
Members-only Library, 2018
In this paper we examine the effects of changes in Medicaid and Medicare coverage on the employment of registered nurses, licensed practical nurses, and certified nursing assistants. With estimates using time series data, we find that Medicaid coverage has a significant positive effect on the employment of registered nurses in the short run. A 10 percent increase in Medicaid coverage is associated with a 2.74 percent increase in registered nurse employment. Results also show that a model of monopsony power, previously applied to hospitals, is relevant to nursing homes.
Hospital Speedups and the Fiction of a Nursing Shortage
Labor Studies Journal, 2005
In recent years, hospital managers and public policy makers alike have focused considerable energy on the prospect of an imminent national shortage of hospital nurses. In response, officials have urged both increased funding for nursing schools and increased importation of foreign nurses from the Philippines and other developing countries. The study below documents that this policy direction is fundamentally misguided. There is no shortage of nurses in the United States. The number of licensed registered nurses in the country who are choosing not to work in the hospital industry due to stagnant wages and deteriorating working conditions is larger than the entire size of the imagined "shortage." Thus, there is no shortage of qualified personnelthere is simply a shortage of nurses willing to work under the current conditions created by hospital managers. Extensive survey data among both currently working nurses and those who have left the profession indicate a very strong consensus regarding the causes and potential solutions to this problem. Nurses will return to hospital work if the wages are improved and, above all, if nurse-to-patient ratios are restored to a level at which RNs believe they can provide professional care. If conditions are improved, enough nurses will be drawn back into the hospital industry to solve the alleged shortage. If, on the other hand, conditions remain stagnant or deteriorate further, new graduates of nursing schools will continue to abandon the profession in large numbers, and no increase in new graduates will suffice to keep hospitals adequately staffed. In a final section of the paper, a survey of magnet hospitals indicates that the industry can afford to implement improved staffing levels while remaining economically competitive.
Nurse Staffing Levels: Impact of Organizational Characteristics and Registered Nurse Supply
Health Services Research, 2007
Objective. To assess the impact of nurse supply in the geographic areas surrounding hospitals on staffing levels in hospital units, while taking into account other factors that influence nurse staffing. Data Sources. Data regarding 279 patient care units, in 47 randomly selected community hospitals located in 11 clusters in the United States, were obtained directly from the hospitals from the U.S. Census report, National Council of State Boards of Nursing, and The Centers for Medicare and Medicaid Services. Study Design. Cross-sectional analyses with linear mixed modeling to control for nesting of units in hospitals were conducted. For each patient care unit, the hours of care per patient day from registered nurses (RNs), LPNs, nursing assistants, and the skill-mix levels were calculated. These measures of staffing were then regressed on type of unit (intensive care, medical/surgical, telemetry/stepdown), unit size, hospital complexity, and RN supply. Principal Findings. RN hours per patient day and RN skill mix were positively related to intensity of patient care, hospital complexity, and the supply of RNs in the geographic area surrounding the hospital. LPN hours, and licensed skill mix were predicted less reliably but appear to be used as substitutes for RNs. Overtime hours increased in areas with a lower RN supply. Vacancy and turnover rates and the use of contract nurses were not affected by nurse supply.