Presentation Topics. Research Rationale and Questions. Prior Studies. Data Source and Sample. Study Design

Transcription

1 Registered Nurse Educational Level And The Decision To Work As A Hospital Staff Nurse Lynn Unruh, PhD, RN, LHRM Jackie Zhang, PhD University of Central Florida lunruh@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 Questions o 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 N-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, & prepared RN s excluded PhD and Master s prepared RN s 1

2 Measures o Response variable RN working in a hospital in a staff nurse role or not Explanatory variables: Educational level Demographic characteristics Employment Instrumental variables to test for endogeniety of wage variable: o Inpatient days in the county o 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 Prob Dip) X (% Dip graduates)] + [(Prob Prob ) X (% graduates)] Results: Logistic of Working as a Hospital Staff Nurse Demographic variables Age Married At least 1 child in home <6 All the children in home > 6 Female Asian Region- Northeast Region- South Estimate *** *** *** *** *** 0.523*** *** * * Odds Ratio *p<.05; **p<.01; ***p<.001; ****p<.0001 Results: Logistic of Working as a Hospital Staff Nurse Results: Probability of Working as a Employment variables Fulltime Wages Education variables Highest ed in nrs= Dip Highest ed in nrs= Additional non-nrs degree Previous degree Estimate 0.367*** 0.075*** Odds Ratio *** *** *** *** Full sample Female, white *p<.05; **p<.01; ***p<.001; ****p<

3 Results: Probability of Working as a Results: Probability of Working as a Female, Asian Male, White Results Summary: Compared to an RN with a, the odds of working as a hospital staff nurse are 27% higher if the RN has a diploma 38% higher if RN has an Compared to an RN with a, the probability of being more likely to work as a hospital staff nurse is: 5.5% higher if the RN has a diploma 8% higher if the RN has an 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: ( )(3.77%) + ( )(61%) = (-5.5%)(3.77%) + (-7.63%)(61%) = -0.20% % = -4.85% Discussion 5% decline in hospital staff nurses should not be ignored Hospital staff nurse supply can be improved by Labor market adjustments Wage adjustment Policy or administrative directions RN workforce with children Older RN workforce Narrow the job attractiveness gap Improvement in working conditions Increase number of new entrants 3

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