David I. Auerbach talks with
ScienceWatch.com and answers a few questions about
this month's New Hot Paper in the field of Social Sciences,
general.
Article Title: Better late than never: Workforce
supply implications of later entry into
nursing
Authors:
Auerbach,
DI;Buerhaus, PI;Stalger, DO
Journal: HEALTH AFFAIR
Volume: 26
Issue: 1
Page: 178-185
Year: JAN-FEB 2007
* Congress Budget Off, Hlth & Human Resources Div,
Washington, DC USA.
* Congress Budget Off, Hlth & Human Resources Div,
Washington, DC USA.
(addresses have been truncated)
Why do you think your paper is highly
cited?
The fate of health care provision in the US (especially hospital care)
rests heavily on the shoulders of the more than 2.5 million registered
nurses. When we don't have enough nurses, quality of care suffers—and
since health care is far from a typical "market" in the economic sense, we
don't expect imbalances of supply and demand to quickly work themselves out
via the invisible hand.
Impending shortages such as those predicted by our forecast models are
cause for concern among patients, policymakers, and nurses themselves.
Because nursing is such a large profession, primarily employing women,
there is also a great deal of general interest in nursing issues from a
labor market and general economy point of view—almost everyone either
knows a nurse, is a nurse, or has had contact with one recently.
Does it describe a new discovery, methodology, or
synthesis of knowledge?
Our paper discusses emerging trends not yet described—we use the most
recent data in a novel way, combined with a novel forecast model. The most
interesting trend discussed is the emergence of a new group of people
entering the nursing profession—women in their mid to late 20s who
may have started out in other careers and who have switched to nursing as a
stable career with secure employment prospects. This trend may also be
linked to a decline in manufacturing jobs or to the economic prospects of
many of their current or potential spouses.
Would you summarize the significance of your paper
in layman's terms?
"The fate of
health care provision in the US
(especially hospital care) rests
heavily on the shoulders of the
more than 2.5 million registered
nurses."
This paper is significant because it captures the trend discussed above in
a forecast model. We document this trend for the first time—that
people are much less likely to enter the nursing profession directly from
high school than in the past, but many are turning to nursing as a second
career. While this trend does not appear strong enough yet to reverse large
pending shortages as baby-boomer nurses retire in the next decade (reported
in our earlier work), it is something to watch carefully.
How did you become involved in this research, and
were there any problems along the way?
I became involved in this work in 1997 as a Ph.D. student as a result of a
single idea combined with a single data innovation (both from the mind of
Professor Douglas Staiger of the Dartmouth College Department of Economics
and one of my two co-authors; the other is Peter Buerhaus, Director of the
Center for Interdisciplinary Health Workforce Studies at Vanderbilt
University). The idea was to use the annual Current Population Survey (CPS)
to track labor market trends of nurses. This had not been tried before, as
only specialized, infrequent nurse surveys had been used for this purpose.
We found the CPS to have a large enough sample of nurses (some 3,000 per
year since the 1970s) to allow for the application of a common labor
economics model describing a workforce in terms of cohort, age, and period
effects to the nurse labor market. The model forecast the future workforce
much more accurately than other leading models.
Where do you see your research leading in the
future?
We have recently published a book The Future of the Nursing Workforce
in the United States: Data, trends, and implications, with Jones and
Bartlett publishers. We hope to reach a large audience with this book which
describes the current workforce and trends that have led to what we observe
today and where we think things are going in the future. Importantly, the
book ends with two chapters discussing strategies and recommendations for
how to best accommodate and even to reverse future projected shortages.
With no action, these shortages could significantly hamper the quality of
health care in the US.
Do you foresee any social or political implications
for your research?
As noted above, we hope to reach a wide audience, including policymakers
and decision-makers with our research which projects a dire future if we do
not begin to make adjustments today. One of these adjustments, for example,
that would help lessen future shortages would be to try to remove barriers
for entry into the nursing profession that apparently exist for both men in
general and also particularly for members of the Hispanic population, who
are underrepresented across nursing programs at all levels and whose ranks
remain disproportionately small compared to the growth in the Hispanic
population.
David Auerbach
Principal Analyst
Health & Human Resources Division
Congressional Budget Office
Washington, DC, USA
NOTE: The views expressed
in this article are those of the author and should not be interpreted as
those of the Congressional Budget Office.
Keywords: nursing, health care provision, nursing profession,
baby-boomer nurses, retire, labor market trends, current population
survey, cps, health care in the us.