The Future of the Nursing Workforce in the United States: Data, Trends, and Implications

by Buerhaus, Peter I.

• ISBN13: 9780763756840
• ISBN10: 0763756849
• Edition: 1st
• Format: Paperback
• Copyright: 2008-03-01
• Publisher: JONES & BARTLETT PUBLISHERS

Summary

The Future of the Nursing Workforce in the United States: Data, Trends and Implications provides a timely, comprehensive, and integrated body of data supported by rich discussion of the forces shaping the nursing workforce in the US. Using plain, jargon free language, the book identifies and describes the key changes in the current nursing workforce and provide insights about what is likely to develop in the future.The Future of the Nursing Workforce offers an in-depth discussion of specific policy options to help employers, educators, and policymakers design and implement actions aimed at strengthening the current and future RN workforce. The only book of its kind, this renowned author team presents extensive data, exhibits and tables on the nurse labor market, how the composition of the workforce is evolving, changes occurring in the work environment where nurses practice their profession, and on the publics opinion of the nursing profession.

Author Biography

Peter I. Buerhaus, PhD, RN, FAAN, Valere Potter Distinguished Professor of Nursing, Director, Center for Interdisciplinary Health Workforce Studies, Institute for Medicine and Public Health, Vanderbilt University Medical Center Douglas O. Staiger, PhD, John French Professor in Economics Dartmouth College Research Associate National Bureau of Economic Research David I. Auerbach, PhD, Principal Analyst Health and Human Resources Division Congressional Budget Office

Table of Contents

Preface	p. xi
Acknowledgments	p. xiii
About the Authors	p. xv
Introduction and Overview
Introduction and Overview	p. 1
Focus on Registered Nurses	p. 2
Economic Perspective	p. 3
Ominous Outlook	p. 3
Overview of Book	p. 4
Introduction and Overview	p. 4
Factors That Influence the Demand for RNs	p. 5
Factors That Influence the Supply of RNs	p. 6
Shortages of Hospital RNs, Impact on Quality, and RN Working Conditions	p. 8
Implications and Recommendations	p. 10
Data on the Nursing Workforce	p. 11
Current Population Survey (CPS)	p. 11
National Sample Survey of Registered Nurses (NSSRN)	p. 12
Privately Funded National Surveys	p. 14
A Final Comment	p. 15
Detailed Information About Data Sources	p. 16
Current Population Survey	p. 16
National Sample Survey of Registered Nurses (NSSRN)	p. 18
National Surveys Conducted for the Johnson & Johnson Campaign for Nursing's Future	p. 20
Resources	p. 23
References	p. 24
Key Trends in the Healthcare Industry and the Nursing Workforce	p. 25
Overview of the Healthcare System and RN Employment	p. 25
RN Employment	p. 26
Labor Force Characteristics of RNs	p. 32
Participation in the Workforce, Hours Worked, and Key Demographic Characteristics	p. 33
Earnings of Registered Nurses	p. 37
Educational Preparation	p. 39
Comparing Key Trends Between RNs and Other Professions	p. 41
Chapter Summary	p. 43
References	p. 44
A Brief Primer on Demand and Supply	p. 45
The Demand for Labor	p. 46
The Supply of Labor	p. 48
Equilibrium in a Competitive Labor Market	p. 50
Equilibrium When Multiple Markets Compete for the Same Type of Labor	p. 54
Labor Market Shortage as Disequilibrium	p. 55
Chapter Summary	p. 56
Factors That Influence the Demand for RNs
The Demand for Health Care and the Derived Demand for Registered Nurses	p. 57
Society's Demand for Health Care Changes in the Health, Size, and Age Composition of the Population	p. 59
Sociocultural Characteristics	p. 62
Economic Factors	p. 63
Changes in the Organization of the Healthcare System	p. 66
Technology	p. 69
Healthcare Organizations' Demand for Registered Nurses	p. 70
Factors That Determine Organizations' Demand for RNs	p. 71
Projections of the Future Demand for Nurses	p. 75
BLS Projections to 2014	p. 76
HRSA's Projections Through 2020	p. 78
Chapter Summary	p. 79
References	p. 81
Managed Care and the Nurse Labor Market	p. 83
Overview of Managed Care	p. 84
The Impact of Managed Care on the Demand for Registered Nurses	p. 86
Identifying States That are Early Adopters of Managed Care	p. 87
Trends in the Employment and Earnings of Nurses in Early Adopter and Laggard States	p. 89
Trends in the Employment of RNs by Sector in Early Adopter and Laggard States	p. 92
Chapter Summary	p. 94
References	p. 95
Factors That Influence the Supply of RNs
The Short-Run Supply of Registered Nurses	p. 97
Economic and Noneconomic Factors That Determine the Short-Run Supply of RNs	p. 98
Economic Factors Impacting RNs' Decisions to Participate in the Nurse Labor Market and Number of Hours Worked	p. 98
Impact of Noneconomic Factors on the Short-Run Labor Supply of RNs	p. 106
Changes in Hospital RN Employment Associated with RN Wages and Nonwage Income	p. 112
RN Employment Changes in "Bust" versus "Boom" Years	p. 112
Recent Changes in RN Employment	p. 115
Changing Composition of the RN Workforce in the United States	p. 117
Increasing Proportion of Foreign-Born RNs	p. 118
An Aging RN Workforce	p. 118
Chapter Summary	p. 120
References	p. 121
The Long-Run Supply of Registered Nurses	p. 123
Overview of Trends in Nursing Education	p. 124
Factors That Determine the Long-Run Supply of RNs	p. 126
Changes in the Population	p. 128
Changes in Societal Preferences for a Career in Nursing (the Cohort Effect)	p. 129
Influence of RN's Age (Age Effects)	p. 130
Alternative Sources of RNs	p. 131
Economic Factors and the Decision to Become an RN	p. 132
Number and Capacity of Nursing Education Programs	p. 136
Previous Projections of the Long-Run Supply of RNs: 2000 to 2020	p. 140
Overview of Authors' 2000 Projection Model and Estimates of the Long-Run Supply of RNs Through 2020	p. 142
Overview of HRSA's 2002 Projection Model and Estimates of the Long-Run Supply of RNs Through 2020	p. 142
Chapter Summary	p. 143
The Influence of Economic Factors in Determining the Choice of Nursing Education Programs and Expanding the RN Workforce	p. 145
References	p. 147
Changing Preferences for a Career in Nursing	p. 151
Data on Career Choices of Young People	p. 152
Declining Interest in Nursing	p. 154
Explanations for the Decline in Interest in Nursing	p. 155
What Is Behind the Recent Rise in Interest in Nursing?	p. 160
Chapter Summary	p. 160
References	p. 161
Associate Degree Graduates and the Rapidly Aging Registered Nurse Workforce	p. 163
Rise in Associate Degree Graduates	p. 163
Explaining the Increase in the Percentage of Associate Degree RN Graduates	p. 165
Changing Patterns of Ages of Graduates	p. 167
Cohort Effects as an Explanation for Patterns and Trends Observed for Associate Degree Graduates	p. 168
Older Age of New Graduates	p. 170
Chapter Summary	p. 171
References	p. 172
Forecast of the Supply and Age of Registered Nurses Through 2025	p. 173
Overview of Forecasting Model and Key Results	p. 173
Components of Our Forecast Model	p. 174
Cohort, Population, and Age Effects	p. 175
Prior Workforce Supply Model and Forecasts	p. 179
Updating Our Forecast	p. 180
Age and Supply Forecasts Through 2025	p. 183
Implications of the Resourgence of the 1970s Cohorts	p. 186
Chapter Summary	p. 188
How the Projection Model Was Estimated	p. 188
Estimating the Model	p. 189
Forecasting Using the Model	p. 190
Incorporating Recent Changes in Age Effects	p. 191
References	p. 191
Shortages of Hospital RNs, Impact on Quality, and RN Working Conditions
Shortages of Registered Nurses: Then and Now	p. 193
Defining, Explaining, and Measuring Hospital Shortages of RNs	p. 194
Economic Definition of a Hospital RN Shortage (and Surplus)	p. 194
Measuring Hospital RN Shortages	p. 198
The Development of Hospital RN Shortages in the United States	p. 199
Inflexible RN Wages and Hospital RN Shortages in the 1960s and 1970s	p. 200
Demand-Driven RN Shortages in the 1980s	p. 201
The RN Labor Market in the 1990s: Another Shock in Demand	p. 203
Deterioration in Hospital RN Working Conditions	p. 204
Influence of a Changing Age Composition of the RN Workforce in the Development of the Current Shortage of RNs	p. 205
Aging RN Workforce	p. 206
RN Shortages in Intensive Care Units and Operating Rooms	p. 207
Changes in RN Wages and Reported Hospital Vacancy Rates: 2002 to 2006	p. 210
Chapter Summary	p. 212
Why Hospitals Are Often Slow to Increase RN Wages When Experiencing a Shortage of RNs	p. 214
Hospitals Might Not Realize a Shortage Exists Hospitals Do Not Know How Much to Raise Wages	p. 214
Fear That Raising Wages Might Actually Decrease Employment	p. 215
Less Costly Alternatives	p. 216
Collusion Among Hospitals	p. 216
References	p. 217
Impact of the Current Shortage of Hospital Registered Nurses	p. 219
Overview of the Quality and Safety Improvement Environment	p. 220
Development of a National Movement to Improve Quality and Safety	p. 220
Patient Outcomes Associated with Hospital Nurse Staffing	p. 224
Complexity of Studies of Hospital Nurse Staffing and Patient Outcomes	p. 225
Summary of Results of Hospital Nurse Staffing Studies and Patient Outcomes	p. 226
Impact of the Current Shortage of Hospital RNs: Perceptions of Physicians, RNs, and Hospital Executives	p. 229
Surveys of RNs, Physicians, Hospital CEOs, and Hospital CNOs	p. 230
Survey Findings	p. 231
Chapter Summary	p. 239
References	p. 241
Registered Nurses' Perceptions of the Hospital Workplace Environment, 2002 to 2006	p. 245
Overview of National RN Surveys	p. 246
Survey Themes and Data	p. 246
Characteristics of RN Samples	p. 247
Survey Results	p. 248
Prevalence, Severity, and Impact of the Current Hospital RN Shortage	p. 248
Causes of the Nursing Shortage and RNs' Views of How to Solve the Shortage	p. 251
Characteristics of the Hospital Work Environment Job and Career Satisfaction	p. 253
Likelihood of Advising a Career in Nursing	p. 263
Chapter Summary	p. 264
References	p. 265
Implications and Recommendations
Long-Term Implications of an Aging RN Workforce	p. 267
The Aging RN Workforce and Its Impact on the Future Supply of RNs	p. 268
The Growing Demand for Health Care and Its Impact on the Future Demand for RNs	p. 269
The Unprecedented Shortage of RNs That Is on the Horizon	p. 271
Implications for Hospitals and Other Employers of RNs	p. 272
Implications for Quality, Safety, and Access to Care	p. 274
Implications for RNs Themselves	p. 276
Implications for Nursing Education Programs	p. 277
Chapter Summary	p. 279
References	p. 281
Strategies to Ensure a Better Future for the RN Workforce	p. 283
Transition Policy Strategies	p. 284
Transition Demand Side Strategies	p. 284
Transition Supply Side Strategies	p. 289
Transition Policies Involving RN Wages	p. 294
Long-Run Policies	p. 295
Reducing Barriers to Enter the Nursing Profession in the United States	p. 296
Nursing as an Undervalued Social Benefit	p. 299
Chapter Summary	p. 302
References	p. 303
Index	p. 305
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