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Effect of Prior Health-related Employment on the Registered Nurse Workforce Supply
Methods: We analyzed the 2008 National Sample Survey of Registered Nurses (NSSRN), a nationally representative survey of the RN population holding active nursing licenses, linked with county-level variables from the Area Resource File. We conducted separate analyses for married females (un-weighted/weighted N=21,513/2,006,419) and single females (un-weighted/weighted N=7,708/709,707), based on likelihood ratio tests. We estimated a cross-sectional bivariate probit (BVP) model where the two dichotomous dependent variables were (a) working or not working as RN and (b) working full-time (FT) or part-time (PT) as RN. The BVP equations were estimated with each of two sets of covariates. The common covariates were six dichotomous variables of prior health-related employment before initial RN education: manager, LPN/LVN, allied health, clerk, nursing aide, and all other health-related positions. Other variables in the common set included age, race, highest level of nursing education, full/part-time student status, ages of children, other household income, predicted market RN hourly wage and county-level variables (unemployment rate; percent of uninsured population; and primary care practitioners/ the medical, surgical and other specialists per 1,000-population). The second set of covariates, used only in the regression equation in which FT/PT employment was the dependent variable, were indicators for employment in hospital, nursing home or other work setting.
Results: Among married female RNs, the BVP analysis showed that prior health-related employment in relatively lower wage occupations, such as allied health, clerk, or nursing aide (mean hourly wage in 2008: $12~$16), was positively associated with working as an RN (marginal effect = 0.009~0.027, p<0.05~0.10; the reference group is RNs without prior health-related employment). The magnitude of these associations appears reasonable when compared to other covariates, e.g., age. Namely, compared to RNs <30 years old, RNs aged 30-39 years had lower probabilities of working as RNs by 2.3 percentage points. The BVP analysis results also showed that prior health-related employment in relatively higher wage categories, such as a health care manager or LPN/LVN (mean hourly wage in 2008: $31~$43), was positively associated with working full-time as an RN (marginal effect = 0.039~0.096. p<0.01). Among single female RNs, there was no statistical association between prior health care employment and their work supply decisions, both (a) working or not working as RN and (b) working full-time or part-time.
Conclusions: Our analyses indicate that RNs with prior health-related employment were more likely to work as RNs and/or work longer hours than those without such prior experience. Policy implications for stabilizing the long-run RN workforce supply are to promote an expanded career-ladder program and a nursing school admission policy that targets non-RN healthcare workers with an interest in becoming RNs.