Trends in the Experiences of Hospital-Employed Registered Nurses: Results From Three National Surveys

Peter I. Buerhaus, PhD, RN, FAAN; Karen Donelan, ScD; Beth T. Ulrich, EdD, RN, FACHE, FAAN; Catherine Desroches, Dr.P.H.; Robert Dittus, MD, MPH

Disclosures

Nurs Econ. 2007;25(2):69-79. 

In This Article

Perceptions of the Nursing Shortage

Prevalence and Severity

Across the 6 years covered by the three surveys, large majorities of hospital-employed RNs perceived the supply of RNs was less than demand in both the United States and in their local communities. In 2006 more than nine in ten RNs (93%) perceived the supply of nurses nationally to be less than demand (52% "much less" and 41% "somewhat less" than demand). This is a noticeable in crease compared to 2004 when only 73% of RNs surveyed said they perceived the supply of RNs across the country was less than demand (29% "much less" and 44% "somewhat less" than demand).

Figure 1 shows that majorities of RNs also perceive the supply of nurses in their local communities was less than demand. In 2006, 77% of RNs thought that the supply of RNs was less than demand (33% "much less" and 44% "somewhat less"). Although a large majority, the total percent of RNs who perceived supply to be less than demand in 2006 was not as great as the percent in either 2004 (84%) or in 2002 (87%). A close examination of Figure 1 shows that in 2006 significantly fewer (44%) RNs felt that the supply of RNs was "somewhat less than the demand" than in 2004 (55%). Similarly, in 2006, significantly fewer RNs (33%) perceived that the supply was "much less than demand" than in 2002 (43%). Additionally, the percent of RNs who perceived that supply was "about equal to demand" in creased gradually over the three surveys, and only a fraction of RNs perceive that supply is "somewhat greater" or "much greater" than demand in their communities.

Figure 1.

Supply of Nurses in Local Community: Perceptions of Hospital-Employed Registered Nurses Providing Direct Patient Care in 2002, 2004, and 2006

In each of the three surveys, RNs were asked about the severity of the nursing shortage in the past year in the hospital where they had worked the most. From 2002 to 2004, RNs' perceptions of a "very serious" or "somewhat serious" shortage of nurses in hospitals decreased significantly, falling from 95% to 82%. This rate of decline did not continue in 2006, however, as 79% of RNs perceived a shortage of nurses (19% a "very serious shortage" and 60% a "somewhat serious shortage") in the hospital where they worked most during the past year.

Causes of the Nursing Shortage and Hospitals' Recruitment Efforts

In both the 2002 and 2004 surveys, RNs identified the top five reasons for the nursing shortage as "inadequate salary and benefits," "more career options for women," "undesirable hours," a "negative healthcare work environment," and "nursing not seen as a rewarding career" (see Table 2 ). In the 2006 survey, RNs continued to rank these same reasons in the top five causes of the shortage, although "faculty shortages in nursing schools" increased significantly as the third highest rated cause (the proportion who perceived "fewer applicants admitted to nursing schools" increased significantly as well). While still a leading factor, the role of salary decreased significantly over the 6 years covered by the three surveys: In 2002, 58% of RNs agreed that "salary and benefits" was a main cause of the shortage, far more than the 41% of RNs in 2004 and nearly twice as many as the 32% of RNs who agreed with this view in 2006. The proportion of RNs who agreed that "negative perception of the health care work environment" was a main cause of the nursing shortage also dropped significantly, from 29% in 2002 to 15% in 2006. Similarly, the percent of RNs who ranked more career options for women and undesirable hours as main causes of the shortage decreased significantly from 2002 to 2006.

In the 2004 and 2006 surveys, RNs were asked whether they had observed hospitals using recruitment strategies and if they thought any of the strategies they had observed were effective. Between 40% and 60% of RNs had observed six of the seven recruitment strategies shown in Table 3 , with economic strategies the most frequently observed strategy across the two surveys. Hospital recruitment strategies were observed more frequently by RNs surveyed in 2006 than in 2004, particularly "in creasing advertising" (57% vs. 44%) and "sponsored career fairs or community outreach programs" (54% vs. 43%). The least frequently observed recruitment strategy was "outreach to foreign nurse graduates" which was perceived by roughly 1/4 of RNs in both surveys.

In general, the recruitment strategies used by hospitals shown in Table 3 are perceived to be effective. However, fewer RNs in 2006 than in 2004 (roughly 10-20 percentage points lower) perceived that hospital recruitment strategies were effective, particularly those that "provided tuition benefit," "offered signing bonuses," "pro vided flexible work schedules," and "increased salaries."

RNs' Views of How to Solve the Shortage

When RNs were asked about the strategies they thought would solve the nursing shortage, Table 4 shows that the vast majority (over 3/4) in all three surveys perceived that "improving the work environment" and "improving wages and benefits" would help a great deal. Compared to 2002, however, significantly fewer RNs in 2006 (though still a clear majority) agreed that these two strategies were the leading ways to resolve the shortage. Other strategies in which more than half of RNs thought would help solve the shortage included "higher status of nurses in the hospital environment" and "better hours." Across the 6 years covered by the three national surveys, just under 60% felt that "better hours" would help a great deal, whereas significantly more RNs thought that "financial aid," "increased capacity to educate and train nurses," "non-financial programs to encourage people to enter nursing," and "recruitment of men and minorities" also would help solve the shortage a great deal. Fewer RNs across the surveys (roughly one-third) thought that "use of support staff" would help solve the shortage a great deal.

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