Nursing labor markets - an Introduction


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An Overview of the field of Nursing and outlook for the future. By Joanne Spetz, Ph.D.
Professor at the Philip R. Lee Institute of Health Policy Studies at the University of California San Francisco.

Published in: Education, Health & Medicine
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Nursing labor markets - an Introduction

  1. 1. Nursing labor marketsAn introductionJoanne Spetz, Ph.D.University of California, San FranciscoApril 20, 2012 1
  2. 2. Nursing in a nutshell• Focus on helping people and communities attain, maintain, and recover optimal health• Science and art• Care, not cure• Modern nursing developed as a profession in the 1800s – Military and religious roots – Florence Nightingale and the Crimean War• 3 million US nurses today 2
  3. 3. What do nurses do?• Nursing process – Assess and diagnose needs of patients – Plan and implement interventions – Evaluate the outcomes of care 3
  4. 4. Types of nurses• Registered nurses (RNs) (associate degree or higher)• Licensed practical / vocational nurses (1-2 years of education)• Unlicensed assistants, certified nursing assistants• Advanced practice RNs (master’s degrees) – Nurse practitioners (NPs) – Certified Nurse Midwives (CNMs) – Clinical Nurse Specialists (CNSs) – Certified Registered Nurse Anesthetists (CRNAs) 4
  5. 5. Basic RN education, 2008 Source: 2008 National Sample Survey of RNs 5
  6. 6. Highest education of U.S. RNs, 2008 After receiving an RN license, many nurses continue their education.Source: 2008 National Sample Survey of Registered Nurses 6
  7. 7. Age distribution of RNs, 1980-2008 7Source: 2008 National Sample Survey of RNs
  8. 8. Gender distribution of RNs 6.6% Male Female 93.4% Source: 2008 National Sample Survey of RNs 8
  9. 9. Racial/ethnic distribution of RNs 0% 20% 40% 60% 80% 100% 83.2% White, non-Hispanic 65.6% 3.6% Hispanic/Latino 15.4% 5.4% RN population Black/African-American 12.2% US population 5.8% Asian or Pacific Islander 4.5% 0.3% American Indian/Alaska Native 0.8% 1.7% Two or more races 1.5% Source: 2008 National Sample Survey of RNs 9
  10. 10. Geographic variation in RN supply Employed RNs per 100,000 Pacific MountainWest North CentralEast North CentralWest South CentralEast South Central South Atlantic Middle Atlantic New England 0 200 400 600 800 1,000 1,200 Source: 2008 National Sample Survey of RNs 10
  11. 11. Where do nurses work in the US? Hospital 62.3% Other 3.9%Home health 6.4%Ambulatory care 10.5% Community/ public health Education Nursing home 7.8% 3.8% 5.3%Source: 2008 National Sample Survey of Registered Nurses 11
  12. 12. What determines nurse supply?• Number of licensed nurses able to work• Flow of nurses into labor force (graduations & immigration)• Flow of nurses out of labor force (retirements & emigration)• Decisions of licensed nurses to work – Wages that can be earned – Family economic situation – Marital status, children, other dependents – Burnout, stress, schedules, interests 12
  13. 13. Percent of RNs Working in Nursing, by some of 2008 We might collapse Age, these groups by decade to Nurses under 60 years simplify the chart. old work at high100% rates, but at older 90% ages, their employment 80% rates drop substantially. 70% 60% 50% 40% 30% 20% 10% 0% 25 5 30 9 35 4 40 9 45 4 50 9 55 4 60 9 65 4 70 9 4 + 2 -2 -3 -3 -4 -4 -5 -5 -6 -6 -7 75 erndU 13 Source: 2008 National Sample Survey of RNs
  14. 14. What determines RN demand?• Demand for health care services – Mix of services• Licensure regulations – RN scope of practice limits what non-RNs can do – Technology can substitute• Policy – Minimum staffing regulations – Reimbursement levels from insurance – Pay for performance 14
  15. 15. Nursing Labor Markets: Cycles ofShortage and Surplus• Since WW2, there have been near-constant nursing shortages• Cycles of surplus and shortage have been studied by policymakers and economists• Most recent “surplus” was mid-1990s• We have had a “shortage” since the late 1990s, although this might be changing
  16. 16. Why do we see shortages orsurpluses?• Delays in wage increases• Delays in increasing or decreasing the number of new nurses• Licensing regulations• Minimum staffing requirements• Limited number of employers – Some workplaces are more desirable than others
  17. 17. Predictors of Shortage of HospitalNursing Workforce in US• Higher probability of shortage for in Hospitals that are : – Public – In Southern states – That serve a high share of Medicare and Medicaid patients – That serve patients that are sicker or have more complex health needs – Use of “team” nursing staffing structure (Seago, Ash, et al., 2001) 17
  18. 18. Leading Reasons for not working innursing (% important or very important) Stress on the job Other dissatisfaction (job) ChildcareDissatisfaction w/ nursing profession Other family Salary Inconvenient schedules Try another occupation Benefits Job-related illness/injury 0% 20% 40% 60% 18 Source: Board of Registered Nursing 2006 Survey
  19. 19. There are few ways to increasenurse supply• Short-term supply – Increase work hours of those now working – Recruit nurses who are licensed but not working• Long-term supply – Attract more people to the profession • Improve working conditions, salaries • Marketing – men, underrepresented minorities – Expand nursing education pipeline – Increase efficiency of nursing programs 19
  20. 20. Was the shortage of the 2000sdifferent from prior shortages?• Severity of shortage was greater than in the past• Demand did not adjust even when wages rose – Focus on staffing due to recent research – Minimum nurse-to-patient ratios• Delays in generating new graduates – Projected retirements of aging nurses are large – Difficult to generate enough new graduates to keep up 20
  21. 21. Has the shortage ended?• Newly graduated RNs are having trouble finding jobs in some markets• Demand has dropped due to less health care demand – More people are uninsured• Supply of current RNs has risen – Working RNs taking extra shifts and overtime – Experienced nonworking RNs seeking jobs• Is this a temporary situation? 21
  22. 22. The Affordable Care Act andNursing: Changes in Care• Health insurance expansions  higher demand for all health services – RN demand will rise• Programs to emphasize preventive care  higher demand for primary care providers – Higher demand for Nurse Practitioners – RN demand could rise because they can provide many of these services• Incentives for more home and community care – Greater need for RNs who work in home health and public settings 22
  23. 23. The Affordable Care Act andNursing: Changes in Payment andTraining• Performance-based payment  more emphasis on quality – RNs contribute to better quality  demand will rise• Bundled payments  efforts to increase continuity of care – RN case managers will become more important – RNs in home and transitional settings needed• Health workforce investments – Funding increases for advanced nursing education – Grants to increase diversity – Loan repayment and scholarships to work in underserved areas 23
  24. 24. Some final thoughts…• Nursing is one small piece of health care in the US…• But it reflects all the problems of health policy – Quality of care – Cost of care – Access to care 24
  25. 25. To learn more• Robert Wood Johnson Foundation Future of Nursing• U.S. Health Resources and Services Administration reports html• American Nurses Association• Johnson and Johnson’s Discover Nursing 25
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