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

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_at_mail.ucf.edu
• Academy Health Annual Meeting
• Orlando, FL, June 2-5, 2007

2
Presentation Topics

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

3
Research Rationale and Questions

• Nursing leaders are calling for making a BSN the
  entry-level educational requirement for RNs
• Do BSN-prepared RNs work in the hospital bedside
  setting in the same proportion as diploma and
  ADN-prepared RNs?
• Would making the entry-level requirement a BSN
  accentuate the nursing shortage?

4
Prior Studies

• Brewer and Nauenberg (2003)
• Around ½ of the studies of RN participation in
  nursing work find a negative effect from
  education
• Ault and colleagues (1994)
• Ezrati (1987)
• Two studies find a positive effect from education
  
• Buerhaus, et al., (1991)
• Chiha Link (2003)
• Others find no effect

5
Study Design

• The influence of educational preparation on the
  likelihood of RNs 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

6
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 RNs
• excluded PhD and Masters prepared RNs

7
Measures

• 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
• Inpatient days in the county
• Median income in the county

8
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

9
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)

10
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 lt6 -0.158 0.853
All the children in home gt 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
plt.05 plt.01 plt.001 plt.0001
11
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
plt.05 plt.01 plt.001 plt.0001
12
Results Probability of Working as a Hospital
Staff Nurse by RN Profiles
Percent Probability
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, childlt6 69.82 71.61 64.57
Age 50, married, childgt6 30.66 32.52 25.83
Age 60, married, no child 21.35 22.83 17.62
13
Results Probability of Working as a Hospital
Staff Nurse by RN Profiles
Percent Probability
Percent Probability Diploma AD BD
Female, Asian
Age 24, unmarried, no child 81.19 82.47 77.28
Age 30, married, childlt6 69.82 71.61 64.57
Age 50, married, childgt6 42.71 44.84 37.00
Age 60, married, no child 31.40 33.29 26.51
14
Results Probability of Working as a Hospital
Staff Nurse by RN Profiles
Percent Probability
Percent Probability Diploma AD BD
Male, White
Age 24, unmarried, no child 75.70 77.25 71.05
Age 30, married, childlt6 62.54 64.54 56.81
Age 50, married, childgt6 34.98 36.97 29.77
Age 60, married, no child 24.83 26.48 20.65
15
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 diploma
• 38 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 diploma
• 8 higher if the RN has an AD

16
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 ()

17
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

18
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

19
References

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20
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21
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