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

Lynn Unruh, PhD, RN, LHRMJackie Zhang, PhDUniversity of Central Floridalunruh@mail.ucf.edu

Academy Health Annual Meeting Orlando, FL, June 2-5, 2007

Presentation Topics

Research rationale & questions Prior studies Data sources and measures Statistical analysis Results Discussion

Research Rationale and Questionso Nursing leaders are calling for

making a BSN the entry-level educational requirement for RNs

o Do BSN-prepared RNs work in the hospital bedside setting in the same proportion as diploma and ADN-prepared RNs?

o Would making the entry-level requirement a BSN accentuate the nursing shortage?

Prior Studies Brewer and Nauenberg (2003) Around ½ of the studies of RN

participation in nursing work find a negative effect from education:o Ault and colleagues (1994)o Ezrati (1987)

Two studies find a positive effect from education :o Buerhaus, et al., (1991)o Chiha & Link (2003)

o Others find no effect

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

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

Measures

Response variable RN working in a hospital in a staff

nurse role or not Explanatory variables:

● Educational level ● Demographic characteristics ● Employment

o Instrumental variables to test for endogeniety of wage variable:o Inpatient days in the countyo Median income in the county

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

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)]

Results: Logistic of Working as a Hospital Staff Nurse

Estimate

Odds Ratio

Demographic variables

Age -0.059*** 0.942

Married -0.110*** 0.895

At least 1 child in home <6 -0.158*** 0.853

All the children in home > 6 -0.105*** 0.900

Female -0.196*** 0.821

Asian 0.523*** 1.686

Region- Northeast -0.188***

0.828

Region- South -0.101* * 0.904*p<.05; **p<.01; ***p<.001; ****p<.0001

Results: Logistic of Working as a Hospital Staff Nurse

Estimate

Odds Ratio

Employment variables

Fulltime 0.367*** 1.443

Wages 0.075*** 1.017

Education variables

Highest ed in nrs= Dip 0.238*** 1.269

Highest ed in nrs= AD 0.325*** 1.383

Additional non-nrs degree -0.977*** 0.376

Previous degree 0.187*** 1.205

*p<.05; **p<.01; ***p<.001; ****p<.0001

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

Percent Probability Diploma AD BD

Full sample 39.69 41.77 34.14

Female, white

Age 24, unmarried, no child 81.19 82.47 77.28

Age 30, married, child<6 69.82 71.61 64.57

Age 50, married, child>6 30.66 32.52 25.83

Age 60, married, no child 21.35 22.83 17.62

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

Percent Probability Diploma AD BD

Female, Asian

Age 24, unmarried, no child

81.19 82.47 77.28

Age 30, married, child<6 69.82 71.61 64.57

Age 50, married, child>6 42.71 44.84 37.00

Age 60, married, no child 31.40 33.29 26.51

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

Percent Probability Diploma AD BD

Male, White

Age 24, unmarried, no child 75.70 77.25 71.05

Age 30, married, child<6 62.54 64.54 56.81

Age 50, married, child>6 34.98 36.97 29.77

Age 60, married, no child 24.83 26.48 20.65

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 diploma38% 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 diploma8% higher if the RN has an AD

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 (+)

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%

Discussion 5% decline in hospital staff nurses

should not be ignored Hospital staff nurse supply can be

improved byLabor market adjustments

• Wage adjustmentPolicy or administrative directions

• RN workforce with children• Older RN workforce

Narrow the job attractiveness gap• Improvement in working conditions

Increase number of new entrants

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