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Sociodemographic, market, and political factors that influence nurses who do not work in nursing

Dissertation
Author: Lisa M. Black
Abstract:
Purpose. The purpose of this research was to describe registered nurses not working at all and those working in non-nursing compared to those working in nursing. Factors associated with registered nurses not working or working in non-nursing employment were examined in terms of sociodemographic characteristics, market factors, and political factors. Background & significance. Empiric and anecdotal literature have demonstrated an exodus of registered nurses from the nursing profession. This study has policy implications for addressing these workplace losses. Conceptual framework. This research is guided by economic labor market theory. Research design & methods. Secondary data from the 2004 National Sample Survey of Registered Nurses with a sample of 35,635 nurses was used for the analysis. A two-stage least squares model was estimated using a predicted market wage for all nurses in the sample and univariate probit equations were used. Key fFindings. Nurses who worked in non-nursing and those who did not work at all were different from nurses who work in non-nursing. The main reason nurses gave for working in non-nursing was dissatisfaction with the nursing workplace. Salary was not a significant predictor controlling for other factors. Male nurses and nurses over the age of 45 were more likely to work in non-nursing than female nurses and younger nurses. Nurses with young children in the home, those with at least a baccalaureate degree in nursing, and those who lived in politically liberal counties were more likely to be employed in nursing than nurses without children, those in politically conservative states, and those with lesser education. Working in non-nursing was contingent upon not participating in the nursing market. Implications for health policy. New policy remedies are needed to recruit new nurses to nursing and to retain those who are leaving the profession. Continued salary enhancements in the absence of real changes in the nursing workplace will not contribute significant long-term solutions to the current nursing shortage.

Table of Contents Abstract ……………………………………………………………………….. vi List of Tables ………………………………………………………………… ix

Chapter 1: Introduction …………………………………………………….. 1 Background and Significance …………………………………………….. 2 Contribution of this Dissertation Research ……………………………….. 7 Specific Aims …………………………………………………………….. 9 Plan for the Dissertation ………………………………………………….. 10

Chapter 2: Review of the Nursing Labor Market Literature ……………... 11 The Registered Nurse Labor Market and Workforce Participation of Registered Nurses ………………………………………………………… 16 Economic determinants of nursing labor supply and participation ………. 23 Future work intentions of nurses in and out of nursing …………………... 29 Signs of possible strengthening of the nursing workforce ..……………… 34 Monopsony Power in the Nursing Labor Market ………………………… 35 State of the Nursing Workforce Shortage ………………………………… 42 Aging of the Nursing Workforce …………………………………………. 50 Recruitment of Foreign Nurses …………………………………………… 56 Summary & Conclusions of Review of the Literature …………………… 60

Chapter 3: Theoretical Framework ………………………………………… 68 Economic Labor Market Theory ………………………………………… 70 The Demand for Nursing Labor ………………………………………… 72 The Supply of Labor to the Nursing Workforce ………………………… 79 The Economic Theory of the Decision to Work ………………………… 84 The Economic Theory of Household Production ………………………… 92 Work Satisfaction and Registered Nurse Preferences………………………………………………………………… 97 Summary and Conclusions of Chapter Three …………………………….. 99

Chapter 4: Research Design and Methods …………………………………. 101 Sources of Data & Sample ……………………………………………….. 101 Description of Variables …………………………………………………. 108 Analytical Model …………………………………………………………. 124 Specific Hypothesized Relationships ……………………… ……………. 125 Data Analysis …………………………………………………………….. 126 Descriptive Analysis ……………………………………………………... 128 Regression Models ……………………………………………………….. 129 Prediction of the market wage …………………………………………… 130 Estimation of the Univariate Probit Models ……………………………... 134 Variables Used in the Univariate and Bivariate Probit Equations ………. 132 Protection of Human Subjects ……………………………………………. 138 Summary and Conclusion of Chapter four ………………………………. 138

viii

Chapter 5: Results …………………………………………………………… 140 Descriptive Findings: Specific Aim #1 …………………………………... 140 Descriptive Findings: Specific Aim #2 …………………………………... 158 Analytic Findings: Specific Aim #3 ……………………………………… 181 Analytic Findings: Specific Aim #4 ……………………………………… 196 Analytic Findings: Specific Aim #5 ……………………………………… 205 Analytic Findings: Specific Aim #6 ……………………………………… 212 Summary of Findings …………………………………………………….. 216

Chapter 6: Discussion ………………………………………………………... 218 Discussion of Specific Aim #1 …………………………………………… 218 Discussion of Specific Aim #2 …………………………………………… 224 Discussion of Specific Aim #3 …………………………………………… 231 Discussion of Specific Aim #4 …………………………………………… 240 Discussion of Specific Aim #5 …………………………………………… 247 Discussion of Specific Aim #6 …………………………………………… 252 Limitations of the Study ………………………………………………….. 253 Implications for Health Policy ……………………………………………. 255 Implications for Future Research ………………………………………… 259 Summary and Conclusions ………………………………………………. 263

References …………………………………………………………………….. 266

Appendices

Appendix A: Theoretical Model of Registered Nurses Who Do Not Work in Nursing .. 284 Appendix B: Bivariate Probit Regression ……………………………………………… 285 Appendix C: US Census Regions and Divisions ………………………………………. 291 Appendix D: Average Composite Liberal Scores for State Delegations ………………. 292 Appendix E: Political Affiliation of State Governors ………………………………….. 293 Appendix F: National Sample Survey of Registered Nurses (2004) Questionnaire …... 294

ix

List of Tables 1. Table 4.1: Specific Hypothesized Relationships ……………………… ……….. 125 2. Table 4.2: Categories of Nurses Not Working in Nursing ………………………. 128 3. Table 4.3: Variables to Predict Registered Nurse Market Wage ………………… 130 4. Table 4.4: Variables Used in the Univariate and Bivariate Probit Equations …….135 5. Table 5.1: Registered Nurse Employment Status by Age in 2004……………... 141 6. Table 5.2: Employment Status by Gender ……………………………………….. 143 7. Table 5.3: Employment Status by Highest Educational Achievement …………... 144 8. Table 5.4: Employment Status by Age of Children at Home ……………………. 145 9. Table 5.5: Employment Status by Race/Ethnicity ……………………………….. 147 10. Table 5.6: Employment Status by US vs Foreign Education ……………………. 147 11. Table 5.7: Employment Status by Other Family Income ………………………... 149 12. Table 5.8: Employment by Student Status ………………………………………..150 13. Table 5.9: Employment Status by Years Since Graduation ……………………… 151 14. Table 5.10: Employment Status by Health Care Experience Prior to RN Licensure ……………………………………………………………. 152 15. Table 5.12: Employment Status by Congressional Liberalism ………………….. 155 16. Table 5.13: Employment Status by Gubernatorial Political Affiliation …………. 156 17. Table 5.14: Employment Status by U.S. Census Region ………………………… 157 18. Table 5.15: Type of Employment outside of Nursing …………………………… 158 19. Table 5:16: Categories of Nurses Not Working in Nursing ……………………... 159 20. Table 5.17: Reasons Not Working in Nursing by Age …………………………...

161 21. Table 5.18: Reason Not Working in Nursing by Gender ………………………... 163 22. Table 5.19: Reasons Not Working in Nursing by Marital Status ……………….. 164 23. Table 5.20: Reasons Not Working in Nursing by Highest Educational Preparation …………………………………………………………... 166 24. Table 5.21: Reasons Not Working in Nursing by Age of Children at Home …… 167 25. Table 5.22: Reasons Not Working in Nursing by Ethnicity and Foreign Nursing Education ……………………………………………………………. 169 26. Table 5.23: Reasons Not Working in Nursing by Other Family Income ……….. 171 27. Table 5.24: Reasons Not Working in Nursing by Student Status ……………….. 173 28. Table 5.25: Reasons Not Working in Nursing by Years Since Graduation ……... 174 29. Table 5.26: Reasons Not Working in Nursing by Urban Influence ……………… 176 30. Table 5.27: Reasons Not Working in Nursing by Congressional Liberalism and Gubernatorial Political Affiliation …………………………………... 178 31. Table 5.28: Reasons Not Working in Nursing by Census Region ………………. 180 32. Table 5-29: Descriptive Statistics; Nurses Employed in Nursing, Employed in Non-Nursing, and Not Employed 183 33. Table 5.30: OLS Regression Equation to Predict Hourly Wage for All RNs …… 185 34. Table 5.31: Univariate Probit Regression – Married and Unmarried Nurses Not Working in Nursing Compared to Working in Nursing …………….. 188 35. Table 5.32: Univariate Probit Regression – Married and Unmarried Nurses Working in Non-Nursing Compared to Working in Nursing ………. 198 36. Table 5.33: Univariate Probit Regression – Married and Unmarried Nurses Working in Non-Nursing Compared to Not Working At All ……….. 206

x

List of Figures

1. Figure 3.1: Graphical Depiction of Labor Market Supply and Demand ………… 72 2. Figure 3.2: Graphical Depiction of Labor Market Demand …………………….. 73 3. Figure 3.3: Shift in Registered Nurse Employment Due to Increased Demand … 74 4. Figure 3.4: Graphical Depiction of the Marginal Utility of Wage ……………… 75 5. Figure 3.5: Marginal Product of Labor ………………………………………….. 78 6. Figure 3.6 Relative Demand Elasticities ………………………………………… 81 7. Figure 4.1: Predicted Hourly Market Wage Distribution ………….…………….. 132

Chapter I: Introduction 1

Sociodemographic, Market, and Political Factors that Influence Nurses Who Do Not Work in Nursing

CHAPTER 1: INTRODUCTION This study aims to examine the population of registered nurses in the United States who are either not working or are engaged in non-nursing employment. The presence of adequate numbers of registered nurses in direct care roles is essential to the well-being of the United States health care system. Empirical and anecdotal literature have demonstrated a significant exodus of registered nurses, particularly from hospital nursing. Hospital employment losses have been shown to occur in a bimodal pattern. Large numbers of nurses have been found to leave hospital nursing within five years of graduation from their basic program of nursing education, and then this pattern has been shown to level out until nurses reach forty-five to fifty-five years of age (Bowles & Candela, 2005; Buerhaus, Staiger, & Auerbach, 2000a). At these later ages, the exodus from nursing once again becomes acute. Whether this reflects a shift of nurses out of the nursing market due to a specific set of sociodemographic variables of the nursing population or the market in which these nurses work, or whether this shift is merely representative of the societal trend to deliver nursing care in non-acute settings is unsettled in the available literature. Research (Buerhaus et al., 2000a; Buerhaus, Staiger, & Auerbach, 2000d, 2003) has demonstrated a trend toward fewer young people entering nursing in recent decades, leading to severe shortages of nurses at the bedside. Other research has suggested that this nursing

Chapter I: Introduction 2

shortage trend may have an adverse effect on patient safety (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002; Long & Bernier, 2004). It is important to identify factors that may contribute significantly to losses of nursing personnel. Identification of such factors may aid in the generation of future predictive models to estimate worsening nursing workforce trends, or may identify potential strategies toward future remediation of the ever-increasing nation-wide shortage of acute care registered nurses. Such predictive modeling may provide valuable policy insights and allow for the creation of policy remedies that might augment the supply of acute care registered nurses in a way that keeps pace with the changing health care needs of the United States population. Background & Significance Registered nurses comprise the largest number of health care professionals in the United States. The end of the old and the birth of the new millennium has been a time of turbulence for many of these nurses. Hospital re-engineering, cost containment, managed care, increased patient acuity, aging of the workforce, technological advances, increasing system complexity, and shifting of care from hospital to community and long-term settings all have had an impact on the environment in which nurses work (Buerhaus, Staiger, & Auerbach, 2000a). Nurses have been intimately affected by rapid and unpredictable changes. News reports discuss threats of nursing strikes over mandatory overtime, inadequate staffing, heavy workloads, over-reliance on lesser educated ancillary personnel, and other workplace issues. Other reports suggest that these concerns are generating a revolving door through which nurses enter and leave the bedside and the profession at increasingly alarming rates. Hours of research and large

Chapter I: Introduction 3

sums of money have been expended trying to depict, interpret, understand, and resolve the phenomenon of nurses leaving nursing with little long-term success. Previous attempts retain nurses in the workforce have included hiring bonuses, wage increases, foreign nurse immigration, and educational assistance packages. A recurring theme in the body of nursing workforce literature suggests that if this trend of nursing exits continues unchecked, nursing workforce shortages are projected to continue and worsen into the next decade when 78 million baby boomers begin to reach retirement age and will likely begin to consume increasing amounts of health care resources (Buerhaus, 1999). Employment patterns of registered nurses vary across time and are linked to many factors. Household income, marital status, number and age of children in the household, current working conditions, wages, and availability of career mobility all have been indicated as factors that influence employment patterns (Aiken, 1983; Buerhaus et al., 2000a; Buerhaus, 1991c; Prescott, 1989). Worker behavior, including the decision to work at all and for how long, is related to these social and economic factors. Labor force participation is ultimately a decision about how to spend time, whether in leisure or at work for pay. Labor supply theory suggests that in addition to workplace preferences, nurses’ workplace behaviors concerning desired work hours depend on the nurse’s wealth and the wage rate the nurse can command. The phenomenon of career inactivity in professional nursing has been widely portrayed in the literature as a major cause of disequilibrium in the registered nurse labor supply (Aiken, Blendon, & Rogers, 1991; Fottler & Widra, 1995; Laird, 1993; Link & Settle, 1981; Schoen & Schoen, 1985). Yet, there has been a general lack of

Chapter I: Introduction 4

understanding of the diverse forces and counterforces that shape the inactive nurse pool and the likelihood of this population to return to nursing. The proportion of registered nurses who were not working in nursing was relatively stable throughout the 1990s. The 1992 and 1996 National Sample Surveys of Registered Nurses showed that approximately 71 – 73% of these nurses were employed outside of nursing, or had retired (Moses, 1992; Moses, 1996). However, in 2000 approximately 81,000 of those not working were age forty-three or younger, which is younger than the mean age of registered nurses currently working in nursing. Raising particular concern is the increasing proportion of new registered nurses who were not working in nursing. The proportion of new male entrants into the profession who were not working in nursing more than doubled between 1992 and 1996, from two percent to 4.6%, and then rose again by more than half to 7.5% in 2000. By comparison, the proportion of new female nurses who were not working in nursing also increased, although at a slower rate, from 2.7% to 4.1% and remained close to that level in 2000 and 2004 (Sochalski, 2002a). The growth in those not employed in nursing between 1992 and 1996 is not wholly surprising given the lower demand for registered nurses during a period of major health care restructuring, especially in hospitals, where the majority of new graduates have historically been employed. However, the drop off in employment patterns for men between 1996 and 2000 occurred during a time of higher demand for nurses, raising questions as to why a larger group was exiting the profession during a time of plentiful employment opportunities in nursing (Sochalski, 2002a).

Chapter I: Introduction 5

Sochalski (2002a) found that the reasons for nurses not working in nursing varied by gender. Among all nurses who were not employed in nursing in 2000, 56% of men were employed in other positions, roughly twice the rate of women (26%). This same pattern held among new entrants to the profession with 78% of men and 39% of women employed in fields other than nursing. Of new nurses surveyed in 2000, 25% of new nurses employed in other fields indicated that they had never worked in nursing. This pattern might be expected during times of economic hardship in the health care industry, such as during the emergence of prospective payment in the 1990’s when 57% of new nurses working outside of nursing had no nursing experience. During this time, however, 56% of these nurses indicated they were actively seeking nursing employment, compared with only 13% of the nurses working outside of nursing in 2000. The most common reasons for working in other fields were better hours, more rewarding work, and better pay in other fields. This accelerating rate of loss of nurses during a time of increasing demand underscores the need to determine the reasons for the professional exodus (Sochalski, 2002a). Brewer and Nauenberg (2003) found several important differences between registered nurses in hospital and non-hospital settings in relation to economic incentive to work, job perceptions, job satisfaction, and organizational commitment, though these differences did not predict markedly different intentions to leave their place of employment. Primarily, older, more experienced hospital nurses were found to be more likely to express an intention to leave their current place of employment and the nursing profession in general. This finding is supported in the work of Fottler and Wilda (1995) in which nurses working in hospitals were more likely to leave nursing employment than

Chapter I: Introduction 6

were their non-hospital counterparts. Moreover, those leaving for employment-related reasons were more likely not to return if they were previously employed in a hospital. Additionally, those who left hospital employment for personal (non-employment related) reasons were more likely to return to nursing if they were currently out of the workforce than if they had accepted employment outside of nursing (Fottler & Widra, 1995). This latter group appeared to be largely lost to the nursing profession. Dissatisfaction stemming from limited opportunities for promotion and further training have been found to have a greater impact on intentions to leave a workplace or the profession than did dissatisfaction stemming from excessive workload or inadequate wages (Shields & Ward, 2001). Additionally, registered nurse perceptions of hospital reorganization have been found to adversely affect intention to leave nursing employment (Shindul-Rothschild, Berry, & Long-Middleton, 1996; Sochalski, 2002a). Conversely, however, those nurses who possessed a high degree of attachment to the profession, perceived a high cost of having left nursing, and had a more positive view of the profession were likely to return to the workforce after they had left (Fottler & Widra, 1995). Inactive nurses also were more likely to return to the profession if they had more dependent children and a shorter period of inactivity. These findings were contrary to the relationship hypothesized by Fottler and Wildra (1995). Crosstabulation of workplace activity with income found that those registered nurses with more dependents supported their families with similar total family incomes to those with fewer dependents suggesting a lower per captia family income for registered nurses with more dependents, and thus, a greater incentive for the nurse to reenter the nursing labor market (Fottler & Widra, 1995).

Chapter I: Introduction 7

Brewer et al. (2006) report the first study in the labor market literature that included market variables in the prediction of registered nurse workforce participation. This research used a bivariate probit model to determine if working full or part time was conditional on a choice to work in nursing and found that “working in nursing is not independent of working full time or part time” (p. 860). Other key findings of Brewer et al. (2006) were that age, other family income, and prior work experience were negatively related to the decision to work as a registered nurse, and that wage (as a predicted variable) was not related to the decision to work as a registered nurse, but negatively influenced whether or not a nurse worked full-time. Brewer et al. (2006) further found that age, children, minority status, student status, employment status, other income and job setting had a negative impact on whether a nurse worked full time. In Brewer’s (2006) work, health care experience prior to initial RN licensure had a positive effect on whether married registered nurses worked, and married nurses who were more dissatisfied with nursing employment were less likely to work full-time. With respect to the market-level factors, Brewer et al. (1996) found that market-level variables such as the percentage of the population over the age of 65, the number of uninsured, and unemployment rate were more likely to influence whether a nurse worked part-time or full-time than whether the nurse worked at all. Contribution of this Dissertation Research The factors that influence nurses to leave nursing employment or the profession are complex and interwoven. Little empirical work, and even less analytic research, has been undertaken that specifically examines the factors associated with registered nurses who either do not work at all, and those who choose to work in non-nursing employment.

Chapter I: Introduction 8

Moreover, no analytical studies in the retrievable literature have specifically modeled nurses who work in non-nursing employment. Nurses who work in non-nursing employment are important to study because this group represents a population that does work, but does not contribute to the labor market for registered nursing. This dissertation research aims to close this knowledge gap and to identify sociodemographic, market, and political differences between nurses who are actively employed in nursing and those who work in non-nursing or do not work at all. Further, this research empirically examines the reasons that these nurses do not work in nursing. Additional study of the factors involved in the decisions of registered nurses not to work in nursing is needed to enhance understanding of the dynamics of nurses who choose not to nurse. Ultimately, this understanding may allow for the development of sound health care policy which will stem the flow of nurses away from the bedside. Building on the work of Brewer et al. (2006), this study extends the body of knowledge in relation to registered nurse labor market behavior in four important ways. First, this research uses the most recent 2004 NSSRN data to determine if the new data produce findings consistent with the work of Brewer et al. (2006) that used 2000 data. Second, market analysis is conducted at the county level rather than at the MSA level to include rural and male nurses; populations that were excluded by Brewer. Third, this research includes measurement of the political environment in which nurses work that has not previously been examined in relation to registered nurse labor market behavior. Finally, this dissertation research specifically examines factors and covariates that predict nurses not working in nursing and those who work in non-nursing employment which have not previously been analytically examined in the available literature.

Chapter I: Introduction 9

Specific Aims Analysis of nursing workforce data offers the opportunity to address questions regarding the sociodemographics of the population of nurses who do not work in nursing. Examination of those nurses who participate in the labor market, but work in non nursing employment is equally important to understanding of the unique qualities of this population of nurses. Toward this end, this dissertation has six specific aims. This dissertation research aims to: 1. Describe registered nurses who are working in non-nursing employment and those who are not working at all compared with nurses who are working in nursing. 2. Examine the reasons that registered nurses gave for not working in nursing in terms of sociodemographic, market, and political factors. 3. Determine if registered nurses who work in non-nursing employment or do not work at all are different from those who work in nursing in terms of sociodemographic characteristics, political factors, and market factors. 4. Determine if registered nurses who work in non-nursing jobs (excluding those who do not work) are different from those who work in nursing in terms of sociodemographic characteristics, political factors, and market factors. 5. Determine if registered nurses who work in non-nursing employment are different from those who do not work at all in terms of sociodemographic characteristics, political factors, and market factors. 6. Measure the relative importance of factors that affect the joint decision not to work in nursing and to work in non-nursing.

Chapter I: Introduction 10

Plan for the Dissertation This chapter has provided an introduction to the problem to be investigated in this dissertation. The second chapter presents a thorough review of the nursing labor market literature. Chapter three provides a discussion of economic labor market theory and presents how traditional labor market theory is blended with the theoretical perspectives of the decision to work and household production to provide the guiding framework for this study. The data sources and the methods are presented and discussed in chapter four. Finally, the results of this study are presented in chapter five and are discussed in relation to previous research and theory in chapter six. Finally, implications for health policy and directions for future research are presented and further discussed.

Chapter II: Review of the Literature 11

CHAPTER II: REVIEW OF THE EMPIRICAL LITERATURE Registered nurses comprise the largest number of health care professionals in the United States. The end of the old and the birth of the new millennium has been a time of turbulence for many of these nurses. Hospital re-engineering, cost containment, managed care, increased patient acuity, aging of the workforce, technological advances, increasing system complexity, and shifting of care from hospital to community and long-term settings have all had an impact on the environment in which nurses work (Buerhaus, Staiger, & Auerbach, 2000a). Nurses have been intimately affected by rapid and unpredictable changes. Headlines report that patients are being injured or are dying due to mistakes made by nurses, most often resulting from inherent failures in the health care delivery systems in which they work (Institute of Medicine, 2004). Other news reports discuss threats of nursing strikes over mandatory overtime, inadequate staffing, heavy workloads, over-reliance on lesser educated ancillary personnel, and other workplace issues. Warnings of nurse surpluses are quickly replaced with concerns about shortages. If these trends continue unchecked, nursing workforce shortages are projected to continue into the next decade when 78 million baby boomers begin to reach retirement age and will likely begin to consume increasing amounts of health care resources (Buerhaus, 1999). Employment patterns of registered nurses vary across time and are linked to many factors. Household income, marital status, number and age of children in the household, current working conditions, wages, and availability of career mobility all have been indicated as factors that influence employment patterns (Aiken, 1983; Buerhaus et al., 2000a; Buerhaus, 1991c; Prescott, 1989). Worker behavior, including the decision to

Chapter II: Review of the Literature 12

work at all and for how long, is related to these social and economic factors. Labor force participation is ultimately a decision about how to spend time, whether in leisure or at work for pay. Labor supply theory suggests that in addition to workplace preferences, nurses’ workplace behaviors concerning desired work hours depend on the nurse’s wealth and the wage rate the nurse can command. Some individuals may prefer to spend more time in household tasks, caring for children, cooking, and cleaning while others are willing to pay other individuals for household maintenance. If the general economy is doing well and households have adequate wealth to buy more leisure time, some household members may choose to work less (Ehrenberg & Smith, 2005). History indicates that there are cycles of increased need and utilization of nurses in the United States. Repeated cycles of nurse workforce shortages have existed since World War II (Huber, 2000). Schoeman (1988) indicates a shortage exists when the “number of hours of labor that nurses are willing to provide under current labor market conditions is less than the number of hours that employers would like to purchase under these conditions” (p.1). Possible causes, ramifications, and solutions for shortages are frequently explored because the ability to respond appropriately is a driving force in the health care industry. The cost involved in employing registered nurses is the largest single expenditure to health care facilities in the United States, comprising approximately 20% of the total hospital budget (Foley, 2002). Therefore, the ability to control cost while maintaining quality care through the employment of RNs is paramount to the health of the patient care industry. Workforce shortages emerge as a result of an imbalance in supply and demand conditions (Aiken, 1995; Buerhaus, 1991c; Prescott, 1989; Ventura, 2004). Because

Full document contains 321 pages
Abstract: Purpose. The purpose of this research was to describe registered nurses not working at all and those working in non-nursing compared to those working in nursing. Factors associated with registered nurses not working or working in non-nursing employment were examined in terms of sociodemographic characteristics, market factors, and political factors. Background & significance. Empiric and anecdotal literature have demonstrated an exodus of registered nurses from the nursing profession. This study has policy implications for addressing these workplace losses. Conceptual framework. This research is guided by economic labor market theory. Research design & methods. Secondary data from the 2004 National Sample Survey of Registered Nurses with a sample of 35,635 nurses was used for the analysis. A two-stage least squares model was estimated using a predicted market wage for all nurses in the sample and univariate probit equations were used. Key fFindings. Nurses who worked in non-nursing and those who did not work at all were different from nurses who work in non-nursing. The main reason nurses gave for working in non-nursing was dissatisfaction with the nursing workplace. Salary was not a significant predictor controlling for other factors. Male nurses and nurses over the age of 45 were more likely to work in non-nursing than female nurses and younger nurses. Nurses with young children in the home, those with at least a baccalaureate degree in nursing, and those who lived in politically liberal counties were more likely to be employed in nursing than nurses without children, those in politically conservative states, and those with lesser education. Working in non-nursing was contingent upon not participating in the nursing market. Implications for health policy. New policy remedies are needed to recruit new nurses to nursing and to retain those who are leaving the profession. Continued salary enhancements in the absence of real changes in the nursing workplace will not contribute significant long-term solutions to the current nursing shortage.