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Primary Care Nurse Practitioner Wage Differences by Employment Setting
Abstract
Background:
Previous studies reported that primary care nurse practitioners working in primary care settings may earn less than those working in specialty care settings. However, few studies have examined why such wage difference exists.
Purpose:
This study used human capital theory to determine the degree to which the wage differences between dingsPCNPs working in primary care versus specialty care settings is driven by the differences in PCNPs' characteristics.
Methods:
A cross-sectional, secondary data analysis was conducted using the restricted file of 2012 National Sample Survey of Nurse Practitioners.
Findings:
Feasible generalized least squares regression was used to examine the wage differences for PCNPs working in primary care and specialty care settings. Oaxaca-Blinder decomposition technique was used to explore the factors contributing to wage differences.
Discussion:
The results suggested that hourly wages of PCNPs working in primary care settings were, on average, 7.1% lower than PCNPs working in specialty care settings, holding PCNPs' socio-demographic, human capital, and employment characteristics constant. Approximately 4% of this wage difference was explained by PCNPs' characteristics; but 96% of these differences were due to unexplained factors.
Conclusion:
A large, unexplained wage difference exists between PCNPs working in primary care and specialty care settings.
... Previous studies have suggested a few factors that might be associated with nurse practitioner job satisfaction and intention to leave in primary care settings. Some have reported that states with a more restrictive scope of practice legislation have fewer nurse practitioners practicing in primary care (Graves et al., 2015;Spetz et al., 2017;Xue et al., 2018); and that nurse practitioners were more likely to leave if their organization had a more restricted and less supportive environment or a lower salary (Li et al., 2018;Poghosyan et al., 2017a). ...
... This is consistent with our previous work, which suggested that in both primary care and acute care settings, a supportive, cohesive, and independent practice environment was associated with lower levels of burnout, turnover and a higher level of job satisfaction (Cimiotti et al., 2019). The reason that the practice setting was not highly valued by nurse practitioners could be due to the unobserved factors that were not available in this current study, such as the practice patterns of primary care and acute care settings (Li et al., 2018). Efforts are needed to further examine, at a more granular level, the different practice patterns of nurse practitioners in primary care and acute care settings and how those might affect nurse practitioner job choice. ...
Background
Nurse practitioners play a critical role in improving the access to care and in meeting the needs for health care. However, prior to the COVID-19 pandemic, the average turnover rate of nurse practitioners was 10% with associated total direct cost that ranged from $85,832 to $114,919 for each episode of turnover in the United States. Little is known about the job preference of nurse practitioners and the cost savings to an organization that provides jobs with characteristics attractive to nurse practitioners.
Objective
The aim of this study was to identify the preferred job characteristics that are associated with nurse practitioners' job choices; and to determine the extent to which nurse practitioners would need to be compensated for practicing without these characteristics.
Design
A two-stage design using a mixed method approach.
Setting(s).
The state of Georgia in the United States.
Participants
2757 nurse practitioners who were actively licensed were invited to participate. Of the 412 participants, 372 actively employed in Georgia were included in the analysis.
Methods
A 2-stage discrete choice experiment was designed. Stage-1 was a qualitative design using a focus group to identify nurse practitioners' preferred job characteristics. Stage-2 was a quantitative design using survey distribution and analysis. A mixed logit model were used for ranking nurse practitioners' preferred job characteristics and the extent to which they would need to be compensated.
Results
On average nurse practitioners were 47.4 years of age; the majority were female (90%), white (75.3%), and educated at the master's level (88.7%). Participants did not value teams that were not very cohesive (β = − 1.50); administration that was not very responsive and supportive (β = − 1.04); being supervised by a physician (β = − 0.58); not having their own panel of patients (β = − 0.42); and not billing under their own National Provider Identifier (β = − 0.18). Participants would need an increase in annual income of USD$21,780 for practicing in a not very cohesive team; USD$15,280 for practicing with a not very responsive administration; and USD$21,450 for being supervised by a physician.
Conclusions
A cohesive, responsive, and supportive working environment and being able to practice independently are important characteristics for nurse practitioners when choosing a job. Healthcare managers should provide a workplace culture that reflects these preferred job characteristics to attract and retain nurse practitioners. Policymakers should consider reforming the scope of practice legislation to promote the independent practice of nurse practitioners.
... The impact of wage increases can harm the development of the business climate where one of the adverse effects caused after the determination of the minimum wage increase is the staff retrenchment (PHK) which can macro-impact on high unemployment and sluggish macroeconomic growth, including the growth of the economic sector, which will in turn have an impact on the consumption by the community itself (Böhm, 1978;Sasaki et al., 2013;Du & Wang, 2019;Greiner et al., 2004;Lankisch et al., 2019;Okudaira et al., 2019). Several studies have made the variable wage a hot issue discussed among researchers who link wages and employment (e.g., Ariga & Kambayashi, 2010;Baek & Park, 2016;Dickson & Fongoni, 2019;Holtemöller & Pohle, 2019;Li et al., 2018;Perugini & Pompei, 2016). From the economic theory and wage theory, there is causality between wages and labor absorption. ...
... Ioan stated in his study that investment is a counterweight to the short-term economic growth strategy and technological capacity advancement as a new strategy in terms of optimal employment. Several researchers have found the influence and relationship between wages and labor absorption (e.g., Ariga & Kambayashi, 2010;Baek & Park, 2016;Dickson & Fongoni, 2019;Holtemöller & Pohle, 2019;Li et al., 2018;Perugini & Pompei, 2016). The influence between wages and employment can be realized as long as regulation, job security, and aggregate demand for labor can take place positively. ...
The purpose of this study is to provide benefits and ethically-rooted managerial implications based on theoretical underpinnings through an empirical study using correlation between wages, bank credit, government expenditure on economic growth, and employment via a case study in Indonesia. Besides that, managerial implications strive to provide benefits to the government regarding the importance of establishing effective and pro-development regulations to realize economic growth and employment through the efficient role of wages, bank credit, and government spending. This study uses secondary macroeconomic data from the period 2010-2019 with analysis using the correlation test with the Pearson correlation method. Out of eight hypotheses tested, two hypotheses do not have a significant correlation. The details of the statistical results obtained the following correlations: the correlation between bank credit and wages has a significant, but indirect (negative) correlation. However, the correlation between bank credit and economic growth has a direct and significant (positive) correlation. Government expenditure correlates positively with wages, but correlates negatively with bank credit. Wages are positively correlated with economic growth, but have no significant effect on employment. Finally, economic growth has a positive correlation with government expenditure, but does not have a significant correlation with employment.
In the U.S. primary care practice of the future, the physician's role will increasingly be played by nurse practitioners, and the 150 million adults with one or more chronic conditions will receive some of their care from registered nurses functioning as care managers.
This study compares different approaches to measuring the number of nurse practitioners (NPs) providing primary care services using data from the 2012 U.S. National Sample Survey of Nurse Practitioners, North Carolina licensing data from 2011, and a 2010 California survey of nurse practitioners and nurse midwives. Estimates of the number and share of NPs providing primary care depend on how one defines primary care. If the definition is based on the field of NP education, the estimated shares in primary care specialties are 83.5% in North Carolina and 90.7% in California; if the definition is based on current or past fields of certification, the estimated shares are 79.9% in North Carolina and 74.5% nationally. The estimated number is even smaller if one considers employment setting (58.4% in North Carolina, 66.8% in California, and 67.8% nationally), and shrinks to about half of NPs if focusing on current field of clinical specialization.
© The Author(s) 2015.
Primary care is a growing area, and nurse practitioners (NPs) hold promise for meeting the need for additional providers. This article reports on the future plans of more than 300 primary care NP students in family, adult, and adult gerontology programs. The sample was obtained through NP faculty, and data were collected via an online survey. Results indicated that although these students chose primary care, only 48% anticipated working in primary care; 26% planned to practice in rural areas, and 16% planned to work in an inner city. Reasons cited as important for pursuing a primary care position included the long-term patient relationship, faculty and preceptor mentors from the NP program, and clinical experiences as a student. Implications include providing more intensive faculty mentoring to increase the number of individuals seeking primary care positions after graduation and help with future career planning to meet personal career and nursing profession needs. [J Nurs Educ. 2015;54(x):xxx-xxx.].
Copyright 2015, SLACK Incorporated.
This paper analyzes whether a black–white racial wage differential exists in the nursing labor market in the US. Despite claims of a nursing shortage, little examination of whether racial inequalities in the labor market might contribute to this purported shortage has occurred. Possible explanations for black–white differences in RN compensation include racial differences in: occupation; returns to skills; metropolitan residency; union membership. Regression analysis on wages for registered nurses (RNs) was conducted. Findings suggest a wage penalty for non-union black nurses compared to non-union white nurses as well as the absence of a racial wage differential for union nurses.
This study examines whether, compared to their private sector counterparts, public sector health care employers are at a disadvantage using part-time (PT) nurses to lower labour costs. Findings reveal a lack of a PT wage differential. Public and Private sector PT nurses are less likely to receive health care and pension coverage compared with full-time (FT) nurses. Yet, these PT/FT nonwage compensation coverage differentials do not vary across sectors. The nonwage findings are interpreted as suggesting that public sector health care employers are just as likely as private sector health care employers to benefit from cost savings associated with lower nonwage coverage for PT nurses.
Registered nurses (RNs) employed in hospitals realize a large wage advantage relative to RNs employed elsewhere. Cross-sectional estimates indicate a hospital RN wage advantage of roughly 20%. This paper examines possible sources of the hospital premium, a topic of some interest given the current shifting of medical care out of hospitals. Longitudinal analysis of Current Population Survey data for 1979-94 suggests that a third to a half of the advantage is due to unmeasured worker ability, and the authors conclude that the remainder of the advantage probably reflects compensating differentials for hospital disamenities. Supporting these conclusions is evidence that hospital RNs have higher cognitive ability and higher-quality job experience than non-hospital RNs, and indications that shift work accounts for roughly 10% of the hospital premium. (Abstract courtesy JSTOR.)
This summary article discusses the status of the nursing shortage in the United States, with emphasis on successful strategies to address it. Liaisons between the American Association of Critical-Care Nurses (AACN) and the Society for Critical Care Medicine, as well as with the American College of Cardiology, are highlighted, with primary emphasis on the strategy of nurse-physician collaboration.
Modern Labor Economics: Theory and Public Policy, now in its thirteenth edition, continues to be the leading text for one-semester courses in labor economics at the undergraduate and graduate levels. It offers a thorough overview of the modern theory of labor market behavior, and reveals how this theory is used to analyze public policy. Designed for students who may not have extensive backgrounds in economics, the text balances theoretical coverage with examples of practical applications that allow students to see concepts in action. Experienced educators for nearly four decades, co-authors Ehrenberg and Smith believe that showing students the social implications of the concepts discussed in the course will enhance their motivation to learn. As such, this text presents numerous examples of policy decisions that have been affected by the ever-shifting labor market. This new edition continues to offer: A balance of relevant, contemporary examples; Coverage of the current economic climate; Introduction to basic methodological techniques and problems; Tools for review and further study. In addition to providing updated data and examples throughout, the thirteenth edition offers greater coverage of inequality, healthcare policy, and labor-replacing technologies. The text is also supported by a full range of companion online materials.
Background and purpose:
While male nurses have been shown to earn considerably more than female nurses, there is less evidence on gender disparities in salary among nurse practitioners (NPs). This study examines whether the gender gap in NP salaries persists after controlling for differences in work setting and demographic factors.
Methods:
We analyzed the relationship between gender and salary (2011 pretax earnings) among 6591 NPs working as NPs at least 35 h per week, using the 2012 National Sample Survey of Nurse Practitioners. We first conducted bivariate regression analyses examining the relationship between gender and earnings, and then developed a multivariate model that controlled for individual differences in demographic and work characteristics.
Conclusions:
Male NPs earned $12,859 more than female NPs, after adjusting for individual differences in demographics and work characteristics. The gender gap was $7405 for recent NP graduates, and grew over time. Male NPs earned significantly more than female NPs across all clinical specialty areas.
Implications for practice:
The gender disparities in NP salaries documented here regardless of professional seniority or clinical area should spark healthcare organizations to conduct pay equity assessments of their employees' salaries to identify and ameliorate pay inequality.
An adequate physician supply is important for the effective and efficient delivery of health care services and, therefore, for population health and the cost and quality of health care. Assessments of the adequacy of physician supply often focus on three dimensions of the physician population: its size; its composition (e.g., the mix between primary care and specialty physicians); and its geographic distribution. Policies that aim to alter physician supply generally focus on both current and future supply along these three dimensions because physician training is a lengthy process; therefore, changes implemented to alter supply do not have immediate effects. Each of the three dimensions of physician supply is important for health care spending and for population health because physician clinical decisions affect approximately 90% of each health care dollar spent. In addition, as physicians provide health care services that, with some exceptions, cannot be provided by non-physicians, the size, composition, and geographic distribution of the physician population affects the amount and type of health care services available. A number of studies have found physician shortages overall, in certain specialties, and in certain geographic areas. The federal government pays for physician services, primarily through the Medicare and Medicaid programs, and supports physician training through a number of programs in various departments and agencies. Given current investments in physician services and the physician workforce, the adequacy of the current and future physician supply may be of interest to Congress. The Patient Protection and Affordable Care Act (PPACA, P.L. 111- 148) may affect physician supply because it expands insurance coverage to those previously uninsured. PPACA also includes provisions that may affect the size, composition, and geographic distribution of the physician population by supporting changes to physician training, compensation, and practice. Specifically, provisions targeting the number of physicians trained and their productivity may affect the size of the physician population. The composition of the physician population may be altered by provisions targeting the supply of primary care providers or specialties in shortage. Provisions addressing the diversity of the physician workforce and those incentivizing practice in rural or other underserved areas may affect the geographic distribution of the physician population. Finally, PPACA includes provisions that provide for data collection and evaluation of the adequacy of the workforce in general, and federal workforce programs specifically. Whether and how these provisions will affect physician supply is not yet known because some of these provisions have not been implemented yet, are temporary, will not have immediate effects, or rely on discretionary funding. This report examines each dimension of physician supply, separately discussing current (and, where appropriate, future) concerns and relevant changes included in PPACA that may affect each dimension. The report then discusses workforce planning activities included in PPACA that may affect all three dimensions of supply.
Background:
Health care professionals, organizations, and policy makers are calling for expansion of the nurse practitioner (NP) workforce in primary care to assure timely access and high-quality care. However, most efforts promoting NP practice have been focused on state level scope of practice regulations, with limited attention to the organizational structures.
Purpose:
We examined NP practice environments in primary care organizations and the extent to which they were associated with NP retention measures.
Methodology:
Data were collected through mail survey of NPs practicing in 163 primary care organizations in Massachusetts in 2012. NP practice environment was measured by the Nurse Practitioner Primary Care Organizational Climate Questionnaire, which has four subscales: Professional Visibility, NP-Administration Relations, NP-Physician Relations, and Independent Practice and Support. Two global items measured job satisfaction and NPs' intent to leave their job. We aggregated NP level data to organization level to attain measures of practice environments. Multilevel logistic regression models were used.
Findings:
NPs rated the relationship between NPs and physicians favorably, contrary to the relationship between NPs and administrators. All subscales measuring NP practice environment had similar influence on the outcome variables. With every unit increase in each standardized subscale score, the odds of job satisfaction factors increased about 20% whereas the odds of intention of turnover decreased about 20%. NPs from organizations with higher mean scores on the NP-Administration subscale had higher satisfaction with their jobs (OR = 1.24, 95% CI [1.12, 1.39]) and had lower intent to leave (OR = 0.79, 95% CI [0.70, 0.90]).
Practice implications:
NPs were more likely to be satisfied with their jobs and less likely to report intent to leave if their organizations support NP practice, favorable relations with physicians and administration, and clear role visibility. Creating productive practice environments that can retain NPs is a potential strategy for increasing the primary care workforce capacity.
Data are from the National Sample Survey of Registered Nurses (NSSRN). Ordinary least-squares regression was used for the model, which included gender (male, female), age, race (white, nonwhite), marital status (married, divorced or widowed, never married), children at home (yes, no), foreign education (yes, no), education (diploma, associate’s degree, bachelor’s degree, master’s or doctorate degree), hours worked per week, years since graduation, polynomial of second degree and years since graduation, Metropolitan Statistical Area (MSA) (in MSA, not in MSA), state (51 categories), survey year (1988, 1992, 1996, 2000, 2004, 2008), work setting (hospital, ambulatory, other), clinical specialty (orthopedics, medical or surgical, neurology, newborn or pediatrics, chronic care, psychiatry, cardiology, other), job position (staff nurse, advanced clinical nurse, nurse anesthetist, education/research, senior academic, middle management, senior administration, other), and interaction terms of gender with work setting, clinical specialty, job position, and survey year. All continuous variables were mean centered. This model accounted for about half of the variance in salaries (R² = 0.46). The estimated average salary gap was $5148. Orthopedics was the only nonsignificant clinical specialty. Senior academic was the only nonsignificant job position. Survey weights were applied to make results nationally representative. Salary amounts reflect 2013 dollars and were normalized using the consumer price index. Error bars indicate 95% confidence intervals.
Corresponding Author: Ulrike Muench, PhD, RN, Department of Social and Behavioral Sciences, University of California, 3333 California St, San Francisco, CA 94118 (ulrike.muench@ucsf.edu).
Author Contributions: Dr Muench had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: All authors.
Acquisition, analysis, or interpretation of data: Muench, Sindelar, Buerhaus.
Drafting of the manuscript: All authors.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Muench, Busch.
Obtained funding: Muench.
Administrative, technical, or material support: Muench, Busch, Buerhaus.
Study supervision: Sindelar, Busch.
Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Buerhaus reported receiving payment for lectures from a variety of organizations, associations, universities, and groups; and being appointed chair of the National Health Care Workforce, which was established under the Affordable Care Act, but has not begun any work yet. No other disclosures were reported.
Funding/Support: This study was in part supported by a grant from Sigma Theta Tau, Delta Mu Chapter.
Role of the Funder/Sponsor: Sigma Theta Tau had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Information: We dedicate this study to Donna Diers, PhD (Yale School of Nursing), who died during the early stages of this research.
A National Sample Survey of Nurse Practitioners was conducted in 2012 to provide a national estimate of the nurse practitioner (NP) workforce and new information on services provided by NPs, their specialty areas, and job satisfaction. Data from almost 13,000 respondents show that 76% of NPs in the workforce are trained in primary care and 48% of NPs in patient care provide primary care. There is also evidence of increased proclivity to specialize in primary care among the most recent graduates, indicating that NPs will continue to play a critical role in improving access to primary care.
The average observed wage of Black registered nurses (RNs) is higher than that of White RNs in the National Sample Survey of Registered Nurses over 2 decades from 1984 to 2004. In this study, wages of Black and White RNs were analyzed controlling for factors likely to affect wages in addition to race. Results indicate racial inequality in wages of RNs: Black RN wages exceeded White RNs wages over 2 decades from 1984-2004. This significant difference remained after controlling for factors likely to affect wages in addition to race such as experience, education, employer type, and specialty among other factors.
Aims and objectivesTo examine overall job satisfaction and its association with extrinsic and intrinsic characteristics of job satisfaction among nurse practitioners at the chosen practice site. The objectives were to identify relevant retention and recruitment strategies, from the nurse practitioners perspective, by examining (1) what role aspects are most satisfying, and (2) approaches for successful, professional development and integration in the role. Background
Supportive professional practice environments are particularly important to nurses' satisfaction with their work and the quality of patient care provided. Hence, research that examines nurse practitioners practice implications and barriers in today's healthcare system is essential. Design/MethodsA descriptive-correlational design using survey methodology. A nonprobability sample of convenience was used. The outcome measures were: The Misener Nurse Practitioner Job Satisfaction Scale and two investigator-developed surveys. ResultsParticipants expressed dissatisfaction with professional and monetary recognition, assertive influence, administrative support and collegial relationships. Conclusions
Interaction of subscale factors on overall job satisfaction and demographic survey findings has important implications for health administrators and nurse practitioners in similar organisations. Relevance to clinical practiceStakeholders in healthcare milieus need to be fully engaged in the redesign of the American healthcare system heeding the recommendations of the Institute of Medicine to provide safer health systems to the public. By doing this, issues related to frustration by nurse practitioners related to job satisfaction will be addressed. The need for cooperation, participation, collaboration and instrumental communication are essential in the delivery of safe, quality patient care. A better understanding of intrinsic professional rewards needs to be learned by nurse practitioners who want to seek professional satisfaction and engage in the survival and growth of the profession. Nurse practitioners armed with this translational information have viable agenda items that can be negotiated into extrinsic rewards.
Background:
Internationally educated registered nurses comprise 5.4% of the U.S. nursing workforce. These nurses perceive unequal treatment in the workplace. However, studies comparing their wages to U.S.-educated registered nurses are limited and inconclusive. It is unclear whether there is a wage differential in the U.S. labor market.
Objectives:
The aims of this study were to determine if there is a difference in the wages of internationally and U.S.-educated nurses and to determine the extent to which the wage gap relates to differences in the human capital, employment, and demographic characteristics of the two groups.
Methods:
The 2008 National Sample Survey of Registered Nurses data were used for this secondary data analysis study. The sample included 988 internationally educated nurses and 21,715 U.S.-educated nurses. Multiple regression and Oaxaca decomposition were used to find predictors of log hourly wages.
Results:
Internationally educated nurses earned 5% higher log hourly wages, controlling for human capital, employment, and demographic characteristics. Male gender, working in a metropolitan area, hospital job, union representation, higher nursing experience, and higher education exerted significant positive effects on hourly wages. Oaxaca decomposition showed that 67% of the wage differential was because of the differences in the characteristics of two groups.
Discussion:
If there is any form of discrimination against internationally educated nurses in the United States, it does not translate into wage inequality. Predictors of economic success should be explored in future research.
Purpose:
The purposes of this cross-sectional descriptive study were three-fold: to describe job satisfaction among a national nurse practitioner (NP) sample; to examine differences in NP job satisfaction based on their intent to leave current positions, the nursing profession, and the NP role as a direct care provider; and to describe the relationship between job satisfaction and anticipated turnover.
Data sources:
Data were collected from 254 NPs who attended the 2008 American Academy of NPs (AANPs) 23rd National Conference. The Misener NP Job Satisfaction Scale (MNPJSS) was used to measure NP job satisfaction. The Anticipated Turnover Scale (ATS) was used to assess NP perception or opinion of the possibility of voluntarily terminating their present job. Intent to leave variables were measured with single-item questions.
Conclusions:
The NPs sampled were satisfied with benefits, challenge, and autonomy. They were minimally satisfied with professional growth, intrapractice partnership, and collegiality. Twenty-seven percent of NPs indicated intent to leave current positions; a small percentage (5.5%) indicated intent to leave the nursing profession and the NP role as a direct care provider (5.5%). There were significant differences in job satisfaction based on intent to leave current positions, and higher job satisfaction scores were significantly related to intent not to leave current positions. There was a significant negative relationship between job satisfaction and anticipated turnover. This study contributes to the current literature that has minimally addressed NP job satisfaction and has not addressed NPs' intent to leave current positions, the nursing profession, or the NP role as a direct care provider. This is the first national NP study of job satisfaction, intent to leave, and anticipated turnover.
Implications for practice:
This study will help bridge the gap in literature relating to NP job satisfaction, their intent to leave, and anticipated turnover. The results of this study could potentially assist employers in developing strategies for recruitment and long-term retention. These results may also give insight into how NPs can make their work environments more fulfilling. Additionally, these results may contribute to continued role adaption necessary for the constantly changing work environments in which NPs currently practice.
This paper assesses the relative value to employers and Registered Nurses (RNs) of different types of basic education in nursing: the associate degree; the baccalaureate degree; and the nursing diploma. Using the National Sample Surveys of Registered Nurses the determinants of nursing wages are evaluated with a Tobit model. After finding that RNs do not expect to gain (financially) from obtaining the baccalaureate degree in nursing (BSN) the reasons why a prospective nurse would pursue a BSN are explored. Non-wage career objectives and personal circumstances when education begins appear to be more important determinants of the choice of RN training than financial returns.
Despite numerous studies examining nursing wages, very little attention has focused on nursing wage differentials. We build on previous research by modeling nursing wages and examining male–female wage differences within the context of the current nursing shortage. Our results show that male nurses do earn a wage premium, largely explained by employment as a nurse anesthetist, job satisfaction, and experience. Whether or not this differential indicates discrimination toward females in the US nursing labor market is unclear. Since males represent a small proportion of the nursing workforce, the time required for males to become prevalent in the nursing labor market and help ease the nursing shortage is unknown. Consequently, one must ask whether the male wage premium is sufficient to attract substantial numbers of men into nursing, and whether wages, in general, are sufficient to attract the requisite numbers of males and females into nursing to address the shortage ‘crisis’.
This chapter provides an overview of the literature linking health, health insurance and labor market outcomes such as wages, earnings, employment, hours, occupational choice, job turnover, retirement, and the structure of employment. The first part of the paper focuses on the relationship between health and labor market outcomes. The empirical literature surveyed suggests that poor health reduces the capacity to work and has substantive effects on wages, labor force participation and job choice. The exact magnitudes, however, are sensitive to both the choice of health measures and to identification assumptions. The second part of the paper considers the link between health insurance and labor market outcomes. The empirical literature here suggests that access to health insurance has important effects on both labor force participation and job choice; the link between health insurance and wages is less clear.
Nurse Practitioners (NPs) are certified within a population-focused specialty area, practice in a variety of settings, and treat a wide range of patients. Little is known about what agreement exists between certification obtained and actual site of practice. The purpose of this study was to examine NP practice sites as compared with their certification and examine additional education they received after employment.
Adult (ANP), family (FNP), and acute care nurse practitioners (ACNPs) certified by the American Nurses Credentialing Center were surveyed regarding certification, demographic information, practice setting, routine responsibilities, and additional training they may have obtained.
An expert panel defined categories of traditional practice settings consistent with NP credentialing examinations and scopes of practice. Equal numbers of randomly chosen ANPs, ACNPs, and FNPs (N = 2,000) were mailed surveys. Responses were coded and analyzed.
The overall survey response was 69.8% (n= 1216). Of the FNP, ANP, and ACNP respondents, 5%, 7%, and 42%, respectively, reported practicing in a nontraditional practice setting. Of nurses practicing in a nontraditional setting, 74% (135 of 182) were ACNPs, with 90% practicing in a nontraditional, ambulatory care setting. Sixty-five percent (13 of 20) of the FNPs practicing in a nontraditional setting were practicing in a high-acuity emergency department, and 56% (15 of 27) of the ANPs practicing in a nontraditional setting were practicing in a high-acuity intensive care unit. The top responses of additional education received were pharmacology, laboratory interpretation, and ordering diagnostic tests.
While greater than 90% of ANPs and FNPs practice in settings consistent with their certification, a proportion of NPs practice in nontraditional settings and may benefit from additional education (formal, on-the-job, and continuing education) and mentoring.
This study explores why registered nurses employed in nonprofit nursing homes earn higher wages than those employed in proprietary facilities. Previous studies have explained this finding in a property rights context, where higher wages were posited to result from the weaker incentives for cost minimization accompanying nonprofit status. This paper tests an alternative explanation of sectoral wage differences which is predicated on the reason for the coexistence of for-profit and nonprofit firms in a given industry. Informational constraints concerning the quality of care are posited to cause the long-term health care market to fail to provide care at the upper levels of a quality of care continuum. Nonprofits are viewed as a response to this form of market failure, acting to fulfill customers demand for higher quality (and higher cost) long-term care, with attendant demand for higher quality nurses than in for-profit homes. Both the observed sectoral pattern in selectivity, and wage decompositions based on selectivity corrected wage regressions, call into question the property right explanation yet are consistent with an asymmetric information explanation.
Currently, a gap of more than $135,000 separates the median annual subspecialist income from that of a primary care physician, yielding a $3.5 million difference in expected income over a lifetime. These income disparities dissuade medical students from selecting primary care and should be addressed to ensure sufficient patient access to primary care.
The shortage of primary care providers (PCPs) in the United States may be worsened with health reform if more individuals receive health insurance coverage. Previous research suggests that Advanced Practice Registered Nurses (APRNs) can provide as high quality care and achieve the same health outcomes as physicians. However, APRNs are usually reimbursed at lower rates than physicians by both Medicare and Medicaid. Private health insurance regulations and Any Willing Provider laws vary from state to state but in general do little to facilitate the ability of APRNs to be reimbursed for their services or to be credentialed as PCPs. To maximize the utilization of APRNs as PCPs, the payment system should be remodeled. A clear regulatory framework and payment rationale are needed along with data on the type and complexity of care provided by various practitioners to increase efficiencies and improve access to health care.
Efforts to retain nurses within the profession are critical for resolving the global nursing shortage, but very little research explores the phenomenon of nursing workforce attrition in the U.S. This study is the first to simultaneously investigate the timing of attrition through survival analysis, the exit path taken (career change vs. labor force separation), and the major socioeconomic, family structure, and demographic variables predicting attrition in this country. Using nationally representative U.S. data from the 2004 National Sample Survey of Registered Nurses (N=29,472), we find that the rate of labor force separation is highest after the age of 60, a typical pattern for retirement. However, a non-trivial proportion of career change also occurs at older ages (50+ years old), and the rate of labor force separation begins to climb at relatively young ages (30-40 years old). Particularly strong predictors of early labor force separation include being married and providing care to dependents in the home (young children or elderly parents). Career change is predicted strongly by higher levels of education, male gender, and current enrollment in a non-nursing degree program. Having an Advanced Practice credential reduced the hazards of attrition for both exit paths. The results suggest a fruitful path for future research and a number of policy approaches to curbing nurse workforce attrition.
As a consequence of the rapid growth of temporary agency employment in Germany, the debate on the remuneration of temporary agency workers has intensified recently. The study finds that the earnings gap of temporary help workers in Germany is indeed large and increased during the past decade. Decomposition reveals that the widening gap mainly is driven by changes in relative skill prices and less by differences in the workforce composition. Temps already have to accept a marked earnings decline before entering the temporary help sector. Nevertheless, after leaving the sector temporary help workers no longer have to accept a pay penalty. A recent reform set a high incentive for temporary help agencies to pay their workers according to a collective agreement. Surprisingly, the unionization of the sector could not bring thewidening earnings gap to a halt.
The often-used method for decomposing wage differentials into human capital and discrimination components is reformulated so that both t he disadvantage, or "cost," discrimination it imposes on a black or minority wage earner and the advantage, or "benefit," it bestows on a white or majority wage earner can be estimated. Copyright 1988 by MIT Press.
The current severe nursing shortage in the United States has many causes and its solution requires new strategies. Collaboration among the American Association of Critical-Care Nurses (AACN), the Society of Critical Care Medicine (SCCM) and the American College of Cardiology (ACC) has provided a model for the multidisciplinary approach needed. Nurse-physician collaboration is an important strategy to address the ongoing shortage.
Any solution to the imbalance between nurse supply and demand must incorporate at least three related strategies: recruitment of students, redesign of the staff nurse's role, and implementation of known retention promoters. The authors discuss a retention study and examine the characteristics of and disincentives for nurses who have chosen to leave nursing in pursuit of another career. This examination demonstrates how retention is intricately tied to redesign of the staff nurse role and how retention initiatives and staff nurse role redesign may serve to enhance recruitment into the profession.
Career ladders or adjusted and expanded pay scales when implemented well provide staff motivation and rewards. There are those who will say that this is the wrong time to do anything that will be seen as costing money, and that implementing a career ladder will cost money. Of course, it will cost money. But, who is counting the money being lost due to staff turnover and extensive recruitment strategies and gimmicks? It cannot be avoided any longer. Something must be done about nursing salary compression. Some employers have justified keeping nursing salaries down based on the fact that nurses comprise the largest personnel costs of their institutions. Nurses must counter this opposition with another fact - nurses are the only personnel required to serve around the clock, 7 days a week. Of course, their numbers will account for the largest personnel costs. Why should nursing continue to accept low, compressed wages in such a complex, stressful, and litigious patient care environment when the costs for pharmaceuticals, durable products, procedures, and other personnel are increasing and being paid? Federal and state governments have proposed legislation such as loan forgiveness programs and scholarships. Perhaps now is the time to investigate legislation at the federal and state levels that would allocate money to agencies that develop and implement salary scales or career ladders that compensate registered nurses based on education and experience. If this were to happen, there would also need to be the creation of a monitoring system for ongoing evaluation of agency consistency and compliance over time. States could then set a rewards program for agencies that are in compliance by giving them additional monetary allocations for their salary programs. Surely, this would be a better approach than just loan forgiveness programs, sign-on bonuses, and scholarships that reward only a few. Yes, this solution would be complex, but it is visionary and it would be a major move toward stabilizing the nursing workforce by improving working conditions for nurses that would ultimately result in recruitment of more bright and talented young people and the retention of capable, experienced nurses.
Nurses in acute care hospitals report that situations in their work setting and profession are in dire need of repair. Although they waiver on their intention to remain in their institution and nursing, they do not waiver on their selected resolution to nursing's shortage. A total of 787 staff nurses in eight geographically and demographically diverse states responded and were asked to select the "Top 5" actions they thought would improve nursing and decrease the shortage. Creating career ladders was endorsed by most respondents (85%) with increasing pay endorsed by the fewest (33%). When selecting the single most important action, they reversed the order--increased pay was the most endorsed (26%), and creating career ladders and increased educational opportunities were endorsed by less than 1%. Nurses appeared to be concerned about the profession in general; however, when asked the "most important" thing to do, an age-old action was selected--increase pay.
Physician income is generally high, but quite variable; hence, physicians have divergent perspectives regarding health policy initiatives and market reforms that could affect their incomes. We investigated factors underlying the distribution of income within the physician population.
Full-time physicians (N=10,777) from the restricted version of the 1996-1997 Community Tracking Study Physician Survey (CTS-PS), 1996 Area Resource File, and 1996 health maintenance organization penetration data.
We conducted separate analyses for primary care physicians (PCPs) and specialists. We employed least square and quantile regression models to examine factors associated with physician incomes at the mean and at various points of the income distribution, respectively. We accounted for the complex survey design for the CTS-PS data using appropriate weighted procedures and explored endogeneity using an instrumental variables method.
We detected widespread and subtle effects of many variables on physician incomes at different points (10th, 25th, 75th, and 90th percentiles) in the distribution that were undetected when employing regression estimations focusing on only the means or medians. Our findings show that the effects of managed care penetration are demonstrable at the mean of specialist incomes, but are more pronounced at higher levels. Conversely, a gender gap in earnings occurs at all levels of income of both PCPs and specialists, but is more pronounced at lower income levels.
The quantile regression technique offers an analytical tool to evaluate policy effects beyond the means. A longitudinal application of this approach may enable health policy makers to identify winners and losers among segments of the physician workforce and assess how market dynamics and health policy initiatives affect the overall physician income distribution over various time intervals.
The chapter presents a survey and exposition of the development of the earnings function as an empirical tool for the analysis of the determinants of wage rates. Generically, the term “earnings function” has come to mean any regression of individual wage rates or earnings on a vector of personal, market, and environmental variables thought to influence the wage. The premier application is to the study of the effects of investment in schooling and on-the-job training on the level, pattern, and interpersonal distribution of life cycle earnings associated with the pioneering work on human capital by several mentioned scholars. The chapter is devoted to the theoretical and empirical development of the human capital earnings function during the past 25 years. The chapter surveys the empirical estimates of the rate of return to education and the pattern of life cycle earnings. The chapter discusses the derivation of human capital earnings functions under the assumption of homogenous human capital and introduces the model of heterogeneous human capital described. The chapter considers theoretical and econometric issues, which arise when there is inequality of opportunity and ability and closes with a discussion of empirical findings concerning ability bias. The chapter also describes some recent literature on several topics such as signalling, implicit contracts, and specific human capital, which extend or modify certain aspects of the human capital model.
Nurse practitioners' job satisfaction and intent to leave current positions, the nursing profession, and the nurse practitioner role as a direct care provider
- De Milt