registered nurse educational level and the decision to work as a hospital staff nurse lynn unruh,...
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Registered Nurse Educational Level And The Decision To Work As A Hospital Staff Nurse
Lynn Unruh, PhD, RN, LHRMJackie Zhang, PhDUniversity of Central [email protected]
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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