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

2. Presentation Topics Research rationale & questions Prior studies Data sources and measures Statistical analysis Results Discussion

3. 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 ADN-prepared RNs? o 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: 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

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 o Instrumental variables to test for endogeniety of wage variable: o Inpatient days in the county o 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 <6-0.158***0.853 All the children in home > 6-0.105***0.900 Female-0.196***0.821 Asian0.523***1.686 Region- Northeast-0.188***0.828 Region- South -0.101* *0.904 *p<.05; **p<.01; ***p<.001; ****p<.0001

11. Results: Logistic of Working as a Hospital Staff Nurse Estimate Odds Ratio Employment variables Fulltime0.367***1.443 Wages 0.075***1.017 Education variables Highest ed in nrs= Dip0.238***1.269 Highest ed in nrs= AD0.325***1.383 Additional non-nrs degree-0.977***0.376 Previous degree0.187***1.205 *p<.05; **p<.01; ***p<.001; ****p<.0001

12. Results: Probability of Working as a Hospital Staff Nurse by RN Profiles Percent Probability DiplomaADBD Full sample39.6941.7734.14 Female, white Age 24, unmarried, no child 81.1982.4777.28 Age 30, married, child<669.8271.6164.57 Age 50, married, child>630.6632.5225.83 Age 60, married, no child21.3522.8317.62

13. Results: Probability of Working as a Hospital Staff Nurse by RN Profiles Percent Probability DiplomaADBD Female, Asian Age 24, unmarried, no child 81.1982.4777.28 Age 30, married, child<6 69.8271.6164.57 Age 50, married, child>642.7144.8437.00 Age 60, married, no child31.4033.2926.51

14. Results: Probability of Working as a Hospital Staff Nurse by RN Profiles Percent Probability DiplomaADBD Male, White Age 24, unmarried, no child 75.7077.2571.05 Age 30, married, child<6 62.5464.5456.81 Age 50, married, child>634.9836.9729.77 Age 60, married, no child24.8326.4820.65

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

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