The Future of the Nursing Workforce in the United States: Data, Trends, and Implications
, by Buerhaus, Peter I.
- ISBN: 9780763756840 | 0763756849
- Cover: Paperback
- Copyright: 3/1/2008
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.
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
| 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 |
| Table of Contents provided by Ingram. All Rights Reserved. |
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