California regonal regstered nurse workforce report card

Various reports and opinion papers have offered suggestions to alleviate the national and California RN shortages. The methodology of using the report card concept for comparing the number of RN jobs per 100,000 populations regionally with the national database further highlights the severe shortage of RN's in various regions in California. This report card method may potentially be used as a planning or forecasting tool, as well as a monitoring tool to initiate workforce development strategies and projects, and to evaluate their effectiveness over time.     

The potential imposition of wage controls on nurses: a threat to nurses, patients, and hospitals

When there are shortages of RNs, hospitals and health care organizations in competitive nurse labor markets respond by increasing wages: some hospitals will respond faster and some will offer higher wages than others. The wage increase brings about two important short and long-run outcomes that, together, will increase the supply of RNs in the labor market. Because wage controls prevent the flexibility of wages to adjust, they can cause a shortage to develop when the demand for RNs is increasing (as in the 1970s), and wage controls will lengthen the duration of a shortage once it has begun. The impacts of prolonged RN shortages are multifaceted and destructive to nurses, patients, and hospitals. Looking ahead over the next 15 years when the demand for RNs is expected to grow by roughly 3% per year and the supply of RNs by much less than that, a new nursing shortage is projected to develop and reach a deficit of 285,000 RNs by 2020. The worst thing that could happen to the nursing profession would be to impose wage controls on nurses as this would prevent the needed short and long-run labor supply responses from developing and thereby eliminate the shortage.     

Why are shortages of hospital RNs concentrated in specialty care units?

This article is the first in a series examining the interplay between the aging of the nurse workforce and other factors driving the growing nursing shortage that are already affecting some specialty areas. Nearly 60% of the current RN workforce is over 40 years of age; and the percentage of RNs under age 30 has fallen by nearly 40% since 1980. The total number of FTE RNs is projected to shrink after 2010, likely resulting in shortages of RNs "when the large baby-boom generation of RNs starts to retire." Because ICUs have historically attracted younger RNs, the rapid decline in the number of RNs in the workforce under age 30 plays a large role in explaining the development of shortages in the ICU. The growing difficulties staffing operating rooms and other peri-operative services is seen as related to the aging work force as more diploma prepared nurses have been attracted to this specialty because they had educational exposure to this area.     

Registered nurses: the impact of wages on labour force participation and hours worked – are wages an effective mechanism for addressing RN shortages with evidence from 1960 to 2008?

Registered nurses (RNs) are critical producers and coordinators of patient care in acute and non-acute settings (Needleman et al. 2011). The Affordable Care Act coupled with an ageing population, are increasing demand for health care and, in turn, RNs. Numbering 3 million, RNs comprise the largest professional occupation in health care. Therefore, the labour force participation and hours worked are of keen interest to stakeholders and policymakers. Rising demand may exacerbate nursing shortages and have important effects on costs. We estimate the impact of wages on participation and hours worked as a possible policy tool to increase nursing supply. In 2008, the RN wage had a positive and significant effect on participation and a small positive but only marginally significant effect on hours worked given participation. The latter elasticity for married females (single females) was 0.11 (0.33). Therefore, the elasticity of hours worked with respect to the nurse wage is and unlikely to have an important effect on the participation rates or hours worked of currently trained female RNs. Consequently, wage increases are unlikely to be an effective policy to increase the labour supply among the currently licensed RNs and will not relieve any short-term nursing shortage.     

FACTORS AFFECTING THE LABOR SUPPLY DECISIONS OF REGISTERED NURSES

We estimate the labor force participation and the full‐time and part‐time work decisions of female registered nurses (RNs) and find higher wages are not a significant factor to (a) increase the likelihood of working nor (b) to encourage full‐time work. Another key factor is age which, given the aging of the RN population, foreshadows dwindling labor supply. This, while demand for RNs is predicted to continue to rise, will exacerbate labor shortages in the market for RNs. The results also offer insight to explain the reduction in labor supply wage elasticities for female workers in general in the United States. (JEL I11, J22, J44)     

The recession's effect on hospital registered nurse employment growth

Recessions are not uncommon in the United States, but the most recent recession is arguably the most severe economic downturn since the Great Depression of the 1930s. Although recessions result in increases in national unemployment in most sectors of the economy, they have resulted in increases in registered nurse (RN) employment as many non-working married RNs re-enter the workforce when their spouses lose their jobs. Over the past decade, hospital RN employment increased by more than 400,000 with virtually all of this growth associated with the two recessions that occurred during this period. The most recent recession led to an increase in hospital RN employment that was not only unprecedented in size, estimated at nearly 250,000, but was marked by the employment of large numbers of RNs over 50 years of age. While national unemployment rates remain high, hospitals should prepare for an eventual jobs recovery when many RNs are likely to leave the workforce.     

Associate degree graduates and the rapidly aging RN workforce

This second segment of a four-part series examines the inter-relationship between the growth in associate degree nursing programs and the aging of the RN workforce. A growing proportion of new RNs have entered the workforce via associate degree programs, increasing from 40% in 1977 to 60% in 1996. New graduates, as well as working RNs, are approximately 5 years older in 1996 than 20 years earlier. Findings suggest that the rapid aging of the RN workforce can not be directly attributed to the rise in the number of older-aged graduates of associate degree programs. Rather, the declining propensity of those born after 1960 to enter nursing has resulted in fewer young RNs, and therefore: (1) an aging workforce, and (2) fewer new grads from baccalaureate programs (which have always attracted younger RNs) relative to grads from associate degree programs (which have always attracted older RNs).     

Validating HRSA's nurse supply and demand models: a state-level perspective

In addition to federal initiatives, solutions to the nursing shortage must also be devised at the state level. Understanding the timing and severity of the nursing shortage in a particular state is paramount to devising appropriate solutions In 2005, the Health Resources and Services Administration released new versions of the Nurse Supply Model and Nurse Demand Model designed to project the supply of RNs and demand for RNs, LPNs, and nurse aides in the United States through the year 2020. The process used by two state-level analysts to project nurse supply and demand in North Carolina using the HRSA models is described. The authors conclude that the models work well for state-level forecasting but that users should carefully assess the default data provided with the model against independent data sources specific to their states.     

The older nurse in the workplace: does age matter?

Between 2010 and 2020, over 40% of the RN workforce will be over 50 years of age, and many RNs are expected to retire and withdraw from the workforce. Given that older nurses are the fastest growing cohort of the workforce, the important findings presented in this article deserve careful consideration by policymakers, health care leaders, and managers.     

Six-part series on the state of the RN workforce in the United States

This series on the state of the nursing workforce focuses on describing the results of the national surveys of RNs. The series begins with an analysis of RNs' perceptions of the current nursing shortage and whether they perceive the shortage has gotten better or worse over the past few years. Future topics will include RNs' perceptions of being a nurse and how they perceive certain aspects of their jobs; RNs' awareness of the J&J Campaign and whether they think it has been effective; RNs' perceptions of the impact of the shortage on the quality of patient care in hospitals; and various issues related to the age and diversity of the nursing profession.     

Registered nurses' perceptions of nursing

In Part II of this six part series on the state of the registered nurse (RN) workforce in the United States, the focus is on RNs' perceptions of nursing including RNs' satisfaction with their jobs in general and on specific elements of their work experiences, such as the quality of professional relationships. Satisfaction with a nursing career and whether RNs would recommend nursing to others are also examined. The improvements in nursing found in this analysis of two national surveys in 2002 and 2004 should be broadly communicated not only to energize individuals and organizations to continue their efforts to improve the workplace environment, but to challenge the many individuals in the nursing profession who hold onto a sense that nothing will ever improve in their organizations.     

城镇职工医疗保险政策研究:个人账户与医疗支出

自医疗保险的个人账户政策推行以来,国内外学者对它的功能和作用一直存在争议.本文利用南京市医疗保险数据,采用非平衡面板固定效应回归模型及Robust和Cluster校正的方法,对2002-2006年门诊患者个人账户与医疗支出进行了实证分析.结果显示:个人账户在一定程度上有朝着约束医疗费用的方向发展,特别是对于退休人群而言,医疗个人账户资金在医疗需求更大的人群中得到了释放,而在医疗需求较小的人群中得以储存.该研究的基本结论是,个人账户对城镇医疗保险制度的影响与预期的政策目标基本一致.     

人口老龄化与劳动力发展规划

随着人口老龄化程度的提高和劳动力短缺问题的加重,越来越多的发达国家开始研究劳动力发展与规划问题。中国目前虽然从总体来看还没有出现劳动力短缺的问题,但是随着人口老龄化高峰的到来,劳动力规模缩小和一些劳动技能出现短缺却是必然的趋势。为了应对未来人口老龄化所带来的劳动力问题,做到未雨绸缪,有必要从现在开始启动适合中国国情的劳动力发展与规划的研究,分析在人口老龄化较高程度下劳动力在宏观和微观层面上的供求格局和变化趋势,寻求未来合理有效利用劳动力的最佳途径。     

How should we collect data on the nursing workforce?

R esearchers who study the nursing workforce use data about nurses and data about nursing jobs. Diifferent approaches - sample surveys and relicensure surveys - used to collect data on RNs, and the benefits and weaknesses of these approaches, are reviewed. Predicting the future supply of nurses is more complex than estimating the current supply, as factors that affect future supply must be considered. Simple forecasts can be created with relatively few variables, which could be collected through relicensure surveys. However, more detailed assessments of potential retirement patterns, changing family norms regarding childcare and household work, and movements into higher education require the rich data more often found in sample surveys.     

缺水型城市水资源供需匹配的模拟和预测——以甘肃省兰州市为例

兰州属于严重缺水的西北城市,年均降雨量偏少,地表水资源贫乏,水资源供需矛盾不断加剧。文章采用线性和非线性方程形式对兰州市农业、工业、生态和城乡生活用水需求进行模拟和预测,并在不同的水资源供给方案下得到未来时期内兰州市及各区县的时空匹配缺水量。结果显示:未来兰州市水资源短缺问题较为严重,可预测的缺水量最小值为4.605亿m^3/a,缺水量最大值为15.448亿m^3/a。在未来需水量预测中,农业和生态用水需求呈现为不断上升趋势,工业用水需求呈现为“U”型趋势,城乡生活用水需求呈现为倒“U”型趋势。并且,各区县的水资源空间匹配失衡状况较为严重。     

Factors influencing work productivity and intent to stay in nursing

The researchers document the individual and workplace characteristics associated with decreased work productivity and intent to stay in nursing for nurses employed in direct patient care in the hospital setting. Factors associated with decreased work productivity were age, total years worked as a RN, quality of care provided, job stress score, having had a job injury, and having a health problem. Nurse leaders must place additional efforts on changes needed to improve the hospital workplace environment to decrease job stress, improve RNs' ability to provide quality care, and to assure the health and safety of nurses. Reducing job stress and providing adequate staffing so quality of care can be provided will enhance job satisfaction which will also encourage RNs to stay at the bedside. Improved work environments may delay older RNs' retirement from the workforce.     

Hospital staff shortage: the role of the competitiveness of pay of different groups of nursing staff on staff shortage

Shortages of nursing staff in OECD countries have been a preoccupation for policy makers. Shortages of staff may be the consequence of uncompetitive pay. In the private sector, employers in different regions can offer different pay rates to reflect local amenities and cost of living. Hospitals in the UK however cannot set the pay for their employees, and as a result they might therefore incur staff shortages. Moreover, occupational groups do not operate in isolation. Shortages of staff may also be the consequence of the competitiveness of pay of an alternative group of staff. This is investigated using two distinct groups of nursing staff: assistant nurses (ANs) and registered nurses (RNs) working in English hospitals in 2003–2005 using national-level data sets. We find that an increase by 10% of the pay competitiveness of RNs decreases the shortage of both the RNs and of ANs by 0.6% and 0.4%, respectively.     

The effect of workforce issues on patient safety

The workforce of any health care organization is vital to its continued survival, but a highly competent and committed workforce is vital to its success. The evidence is clear: employees influence not only the financial performance of the organization, but also the safety and quality of the clinical care provided to patients. Health care organizations must understand these important linkages and have in place corporate strategies to manage workforce issues with a systems focus that ensures excellent leadership and operational processes, a healthy culture, and optimum patient outcomes. New levels of knowledge, resources, and implementation are needed to move health care in the United States to the next level of quality performance. Staff satisfaction and retention should be at the heart of the clinical improvement strategies. Such an approach will allow organizations to cope and thrive in an environment of workforce shortages and increasing consumer demand for quality. To quote Robert Waller, MD, of the Mayo Clinic, "The goal is the best care for every patient, every day. Our patients deserve nothing less.     

Awareness and perceptions of the Johnson & Johnson Campaign for Nursing's Future: views from nursing students, RNs, and CNOs

Johnson & Johnson launched the Campaign in February 2002. Data from surveys of nursing students, RNs, and CNOs reflect a high level of awareness of several key elements of the Campaign--advertisements, recruitment materials, the discovernursing.com Web site, and regional "Promise of Nursing" fundraising events. The J & J Campaign for Nursing's Future represents the largest involvement of the private corporate sector, and through this initiative we are learning new and innovative ways to examine the challenges confronting the nursing workforce and develop actions to help resolve them.     

Trends in the experiences of hospital-employed registered nurses: results from three national surveys

The comparative results of three national surveys provide the only known source of data describing the evolving state of the nursing workforce over time in this country. These national random sample surveys expose the harmful effects of a lingering shortage of nurses and make plain that much work remains to be done to improve the experiences of hospital-employed RNs. At the same time, nurses and others involved in hospital patient care should be encouraged by the improvements that have been made in recent years, despite the presence of a nursing shortage.