|
Report
in Adobe/.pdf
I.
Background
II.
Nursing Supply Model
III.
Nursing Demand Model
IV.
Assessing the Adequacy of Future Supply
V.
Limitations of the Models and Areas for Future Research
VI.
References
Exhibits
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 |
|
VI. References
Aiken,
L.H., Clarke, S.P., Sloane, D.M., Sochalski, J., and Silber,
J.H. (October 2002). Nurse staffing and patient mortality,
nurse burnout, and job dissatisfaction. Journal of the
American Medical Association, 288(16): 1987–1993.
American
Hospital Association. Hospital Statistics. Various
years.
American
Nurses Association. (2001). Analysis of American Nurses
Association Staffing Survey. Presentation by Cornerstone
Communications Group on February 6, 2001.
Askildsen,
J.E., Baltagi, B.H., and Holmas, T.H. (2002). Will Increased
Wages Reduce Shortage of Nurses? A Panel Data Analysis of
Nurses’ Labor Supply. Unpublished manuscript. Available
at <http://www.eco.rug.nl/~espe2002/Askildsen.pdf>.
Accessed September 2004.
Buerhaus,
P.I., Staiger, D.O., and Auerbach, D.I. (2000). Implications
of an aging registered nurse workforce. Journal of the
American Medical Association, 283(22): 2948–2954.
Bureau
of Health Professions. (2001). The Registered Nurse Population,
March 2000: Findings from the National Sample Survey of
Registered Nurses.
Bureau
of Health Professions. (2002). Projected Supply, Demand,
and Shortages of Registered Nurses: 2000–2020.
Bureau
of Health Professions. (2004). Nursing Supply Model:
Technical Report and User Guide. Report prepared by
The Lewin Group for the National Center for Health Workforce
Analysis.
Bureau
of Health Professions. (2004). Nursing Demand Model:
Development and Baseline Projections. Report prepared
by The Lewin Group for the National Center for Health Workforce
Analysis.
Bureau
of Health Professions. (2004). Nursing Demand Model User
Guide. Report prepared by The Lewin Group for the National
Center for Health Workforce Analysis.
Dumpe,
M.L., Herman, J., and Young, S.W. (1998). Forecasting the
nursing workforce in a dynamic healthcare market. Nursing
Economics, 16(4): 170–179.
Fritz,
M.S. (1999). The Nursing Demand-Based Requirements Forecasting
Model. 10th Federal Forecasters Conference,
1999: Papers and Proceedings.
Hogan,
P.F., Dall, T.D., Smith, S.G., Mackin, P.C., Mackie, C.D.,
Darling, K.L., Harris, D.A., McCloy, R.A., and Statman,
M.A. (1995). Conceptual Framework for Analyzing and Developing
a Compensation System. Report prepared for the Eighth
Quadrennial Review of Military Compensation Taskforce.
InterStudy,
InterStudy Competitive Edge. Various years.
Lane,
J., and Gohmann, S. (1995). Shortage or surplus: Economic
and non-economic approaches to the analysis of nursing labor
markets. Southern Economic Journal, 61: 644–654.
Minino,
A.M., Arias, E., Kochanek, K.D., Murphy, S.L., and Smith,
B.L. (September 2002). Deaths: Final data for 2000. National
Vital Statistics Reports, 50(15), National Center for
Health Statistics, Hyattsville, MD.
National
Council of State Boards of Nursing, Inc. 2000 Licensure
and Examination Statistics.
Prescott,
P.A. (2000). The enigmatic nursing workforce. Journal
of Nursing Administration, 30(2): 59–65.
Robinson,
E.S., and Mee, C.L. (2003). Nursing 2003 Salary Survey.
Nursing 2003, 33(10):50–53. <http://www.nursingcenter.com/home/index.asp>.
Accessed September 2004.
Seago,
J.A., Ash, M., Spetz, J., Coffman, J., and Grumbach, K.
(2001). Hospital registered nurse shortages: Environmental,
patient, and institutional predictors. Health Services
Research, 36(5): 831–852.
Sloan,
F.A., and Richupan, S. (1975). Short-run supply responses
of professional nurses: A microanalysis. The Journal
of Human Resources, 10(2):241-257.
Spetz,
J. (1999). The effects of managed care and prospective payment
on the demand for hospital nurses: Evidence from California.
Health Services Research, 34(5): 993–1010.
Spetz,
J., and Given, R. (2003). The future of the nurse shortage:
will wage increases close the gap? Health Affairs,
22(6):199–206.
Appendix:
State-Level Supply, Demand, and Shortage Projections
Exhibit
A-1. Baseline FTE RN Supply, by State and Year, 2000 to
2020
| STATE |
SSRN
Estimate |
Projection |
Change
from
2000–2020 |
| 2000 |
2005 |
2010 |
2015 |
2020 |
| AK |
4,200 |
3,800 |
3,200 |
2,500 |
2,000 |
-52% |
| AL |
29,900 |
33,700 |
36,600 |
38,200 |
39,100 |
31% |
| AR |
16,400 |
18,100 |
19,300 |
19,800 |
19,900 |
21% |
| AZ |
29,000 |
30,100 |
30,700 |
30,500 |
30,100 |
4% |
| CA |
155,500 |
156,200 |
153,300 |
148,200 |
144,300 |
-7% |
| CO |
28,100 |
28,300 |
27,200 |
25,100 |
23,000 |
-18% |
| CT |
28,000 |
25,400 |
22,900 |
19,900 |
17,200 |
-39% |
| DC |
7,300 |
6,900 |
6,500 |
5,900 |
5,400 |
-26% |
| DE |
6,100 |
6,300 |
6,300 |
6,100 |
5,800 |
-5% |
| FL |
108,100 |
111,100 |
112,000 |
110,200 |
106,600 |
-1% |
| GA |
49,400 |
49,500 |
48,200 |
45,300 |
41,800 |
-15% |
| HI |
7,200 |
7,700 |
7,900 |
8,100 |
8,200 |
14% |
| IA |
25,200 |
26,300 |
26,600 |
26,000 |
25,000 |
-1% |
| ID |
7,000 |
7,300 |
7,400 |
7,300 |
7,100 |
1% |
| IL |
88,100 |
88,000 |
85,600 |
81,900 |
77,100 |
-12% |
| IN |
41,400 |
41,800 |
41,600 |
40,400 |
38,500 |
-7% |
| KS |
20,600 |
21,600 |
22,100 |
21,800 |
21,100 |
2% |
| KY |
28,800 |
32,300 |
34,700 |
35,500 |
35,300 |
23% |
| LA |
30,200 |
34,100 |
37,200 |
39,100 |
39,800 |
32% |
| MA |
63,600 |
62,700 |
60,100 |
56,000 |
51,400 |
-19% |
| MD |
36,400 |
36,500 |
35,600 |
33,800 |
31,800 |
-13% |
| ME |
11,200 |
11,600 |
11,600 |
11,100 |
10,500 |
-6% |
| MI |
70,000 |
72,400 |
72,000 |
68,900 |
66,000 |
-6% |
| MN |
39,200 |
41,000 |
41,800 |
41,200 |
39,700 |
1% |
| MO |
44,400 |
45,600 |
45,700 |
44,200 |
42,800 |
-4% |
| MS |
18,400 |
20,900 |
22,600 |
23,600 |
23,800 |
29% |
| MT |
6,400 |
6,500 |
6,500 |
6,300 |
5,900 |
-8% |
| NC |
59,900 |
64,500 |
67,400 |
68,600 |
68,000 |
14% |
| ND |
5,400 |
5,700 |
5,800 |
5,800 |
5,600 |
4% |
| NE |
13,300 |
14,100 |
14,700 |
14,900 |
14,900 |
12% |
| NH |
9,300 |
9,500 |
9,300 |
8,800 |
8,100 |
-13% |
| NJ |
60,400 |
58,200 |
55,000 |
50,500 |
44,900 |
-26% |
| NM |
9,600 |
10,500 |
11,000 |
11,300 |
11,500 |
20% |
| NV |
9,000 |
9,300 |
9,200 |
8,700 |
8,100 |
-10% |
| NY |
138,100 |
142,600 |
142,300 |
137,400 |
131,500 |
-5% |
| OH |
86,900 |
89,300 |
88,900 |
85,500 |
79,700 |
-8% |
| OK |
18,900 |
20,600 |
21,500 |
22,100 |
22,500 |
19% |
| OR |
21,800 |
22,600 |
22,400 |
21,100 |
19,800 |
-9% |
| PA |
111,800 |
105,900 |
99,200 |
90,600 |
80,400 |
-28% |
| RI |
9,300 |
9,300 |
9,000 |
8,400 |
7,900 |
-15% |
| SC |
23,400 |
25,100 |
25,900 |
26,200 |
26,000 |
11% |
| SD |
7,000 |
7,600 |
7,900 |
7,900 |
7,800 |
11% |
| TN |
40,900 |
42,700 |
42,800 |
41,800 |
40,100 |
-2% |
| TX |
107,600 |
115,300 |
118,700 |
119,000 |
118,500 |
10% |
| UT |
11,400 |
12,900 |
14,100 |
14,900 |
15,400 |
35% |
| VA |
46,300 |
47,600 |
47,600 |
46,300 |
44,000 |
-5% |
| VT |
4,900 |
5,000 |
4,800 |
4,400 |
4,000 |
-18% |
| WA |
37,900 |
38,100 |
37,300 |
35,100 |
33,000 |
-13% |
| WI |
41,300 |
42,900 |
43,300 |
42,200 |
40,100 |
-3% |
| WV |
13,200 |
14,200 |
14,600 |
14,600 |
14,000 |
6% |
| WY |
3,200 |
3,300 |
3,300 |
3,300 |
3,300 |
3% |
| U.S.
a |
1,890,700 |
1,942,500 |
1,941,200 |
1,886,100 |
1,808,000 |
-4% |
a
Due to rounding, national totals might fail to equal the
sum across states.
Exhibit
A-2. Baseline FTE RN Demand, by State and Year, 2000 to
2020
| State |
SSRN
Estimate |
Projection |
Change
from 2000–2020 |
| 1996 |
2000 |
2005 |
2010 |
2015 |
2020 |
| AK |
4,400 |
4,300 |
4,900 |
5,500 |
6,100 |
6,700 |
56% |
| AL |
30,900 |
31,400 |
33,900 |
36,800 |
40,300 |
44,400 |
41% |
| AR |
16,100 |
18,500 |
20,200 |
22,000 |
24,300 |
26,900 |
45% |
| AZ |
28,900 |
34,000 |
38,700 |
43,200 |
48,500 |
54,700 |
61% |
| CA |
159,500 |
165,500 |
178,700 |
200,900 |
228,900 |
260,900 |
58% |
| CO |
27,500 |
30,000 |
34,000 |
38,100 |
42,500 |
47,500 |
58% |
| CT |
28,200 |
30,200 |
31,800 |
34,000 |
36,600 |
39,600 |
31% |
| DC |
8,500 |
8,800 |
8,900 |
9,500 |
10,200 |
11,000 |
25% |
| DE |
5,800 |
6,400 |
7,000 |
7,600 |
8,100 |
8,800 |
38% |
| FL |
107,300 |
115,500 |
129,300 |
144,700 |
164,300 |
187,800 |
63% |
| GA |
48,700 |
52,800 |
58,400 |
64,600 |
71,600 |
79,500 |
51% |
| HI |
8,200 |
10,000 |
11,100 |
12,400 |
13,900 |
15,700 |
57% |
| IA |
24,400 |
27,100 |
28,600 |
30,000 |
31,800 |
34,100 |
26% |
| ID |
6,000 |
6,200 |
7,300 |
8,200 |
9,200 |
10,500 |
69% |
| IL |
88,400 |
85,200 |
89,600 |
94,900 |
101,300 |
109,000 |
28% |
| IN |
40,800 |
43,000 |
46,600 |
49,800 |
53,500 |
57,400 |
33% |
| KS |
19,000 |
20,200 |
21,500 |
23,100 |
24,900 |
27,000 |
34% |
| KY |
26,900 |
29,200 |
31,200 |
33,500 |
36,300 |
39,400 |
35% |
| LA |
30,700 |
31,800 |
34,200 |
37,100 |
40,600 |
44,600 |
40% |
| MA |
59,900 |
68,300 |
71,700 |
76,200 |
81,700 |
87,800 |
29% |
| MD |
38,300 |
36,800 |
39,400 |
42,600 |
46,100 |
50,000 |
36% |
| ME |
11,400 |
12,400 |
13,100 |
14,100 |
15,300 |
16,800 |
35% |
| MI |
69,100 |
67,700 |
71,300 |
75,100 |
79,600 |
84,300 |
25% |
| MN |
35,400 |
39,200 |
42,600 |
46,200 |
50,400 |
55,300 |
41% |
| MO |
45,000 |
51,600 |
54,900 |
58,600 |
63,100 |
68,200 |
32% |
| MS |
18,700 |
19,900 |
21,400 |
23,100 |
25,400 |
28,000 |
41% |
| MT |
5,800 |
5,500 |
6,300 |
7,000 |
7,800 |
8,800 |
60% |
| NC |
54,400 |
61,500 |
68,400 |
75,500 |
83,700 |
92,900 |
51% |
| ND |
5,900 |
5,800 |
6,200 |
6,700 |
7,300 |
8,000 |
38% |
| NE |
13,400 |
14,800 |
15,900 |
17,100 |
18,500 |
20,200 |
36% |
| NH |
9,800 |
10,500 |
11,500 |
12,600 |
13,800 |
15,100 |
44% |
| NJ |
59,700 |
65,600 |
69,700 |
74,600 |
80,400 |
87,300 |
33% |
| NM |
10,200 |
11,000 |
12,500 |
14,100 |
15,900 |
18,000 |
64% |
| NV |
8,800 |
10,200 |
12,100 |
13,300 |
14,700 |
16,200 |
59% |
| NY |
148,100 |
151,000 |
156,000 |
163,800 |
174,000 |
185,700 |
23% |
| OH |
86,400 |
90,500 |
95,700 |
101,000 |
107,300 |
113,700 |
26% |
| OK |
18,400 |
18,400 |
20,000 |
22,000 |
24,300 |
27,000 |
47% |
| OR |
21,100 |
22,000 |
24,800 |
27,700 |
31,100 |
35,100 |
60% |
| PA |
107,100 |
110,200 |
115,000 |
120,300 |
127,200 |
135,200 |
23% |
| RI |
9,300 |
10,900 |
11,400 |
12,000 |
12,800 |
13,800 |
27% |
| SC |
24,200 |
25,700 |
28,300 |
31,100 |
34,400 |
38,100 |
48% |
| SD |
7,000 |
6,900 |
7,500 |
8,100 |
8,700 |
9,500 |
38% |
| TN |
43,100 |
50,600 |
55,800 |
61,300 |
67,800 |
75,400 |
49% |
| TX |
117,000 |
129,100 |
143,800 |
160,600 |
179,900 |
202,100 |
57% |
| UT |
11,000 |
12,000 |
13,800 |
15,600 |
17,500 |
19,600 |
63% |
| VA |
47,800 |
49,200 |
53,600 |
58,600 |
64,300 |
70,300 |
43% |
| VT |
4,300 |
4,600 |
5,000 |
5,400 |
5,800 |
6,300 |
37% |
| WA |
34,400 |
36,300 |
40,800 |
46,100 |
52,100 |
59,100 |
63% |
| WI |
37,200 |
37,000 |
39,800 |
42,800 |
46,300 |
50,300 |
36% |
| WV |
13,500 |
12,600 |
13,200 |
13,900 |
14,700 |
15,700 |
25% |
| WY |
3,500 |
3,500 |
4,000 |
4,500 |
5,100 |
5,800 |
66% |
| U.S.a |
1,889,300 |
2,001,500 |
2,161,300 |
2,347,000 |
2,569,800 |
2,824,900 |
41% |
a
Due to rounding, national totals might fail to equal the
sum across states.
Exhibit
A-3. Baseline FTE RN Supply and Demand, 2000 and 2005
| State |
2000 |
2005 |
| Supply |
Demand |
Supply
- Demand |
Supply
÷ Demand |
Supply |
Demand |
Supply
- Demand |
Supply
÷ Demand |
| AK |
4,200 |
4,300 |
-100 |
98% |
3,800 |
4,900 |
-1,100 |
78% |
| AL |
29,900 |
31,400 |
-1,500 |
95% |
33,700 |
33,900 |
-200 |
99% |
| AR |
16,400 |
18,500 |
-2,100 |
89% |
18,100 |
20,200 |
-2,100 |
90% |
| AZ |
29,000 |
34,000 |
-5,000 |
85% |
30,100 |
38,700 |
-8,600 |
78% |
| CA |
155,500 |
165,500 |
-10,000 |
94% |
156,200 |
178,700 |
-22,500 |
87% |
| CO |
28,100 |
30,000 |
-1,900 |
94% |
28,300 |
34,000 |
-5,700 |
83% |
| CT |
28,000 |
30,200 |
-2,200 |
93% |
25,400 |
31,800 |
-6,400 |
80% |
| DC |
7,300 |
8,800 |
-1,500 |
83% |
6,900 |
8,900 |
-2,000 |
78% |
| DE |
6,100 |
6,400 |
-300 |
95% |
6,300 |
7,000 |
-700 |
90% |
| FL |
108,100 |
115,500 |
-7,400 |
94% |
111,100 |
129,300 |
-18,200 |
86% |
| GA |
49,400 |
52,800 |
-3,400 |
94% |
49,500 |
58,400 |
-8,900 |
85% |
| HI |
7,200 |
10,000 |
-2,800 |
72% |
7,700 |
11,100 |
-3,400 |
69% |
| IA |
25,200 |
27,100 |
-1,900 |
93% |
26,300 |
28,600 |
-2,300 |
92% |
| ID |
7,000 |
6,200 |
800 |
113% |
7,300 |
7,300 |
0 |
100% |
| IL |
88,100 |
85,200 |
2,900 |
103% |
88,000 |
89,600 |
-1,600 |
98% |
| IN |
41,400 |
43,000 |
-1,600 |
96% |
41,800 |
46,600 |
-4,800 |
90% |
| KS |
20,600 |
20,200 |
400 |
102% |
21,600 |
21,500 |
100 |
100% |
| KY |
28,800 |
29,200 |
-400 |
99% |
32,300 |
31,200 |
1,100 |
104% |
| LA |
30,200 |
31,800 |
-1,600 |
95% |
34,100 |
34,200 |
-100 |
100% |
| MA |
63,600 |
68,300 |
-4,700 |
93% |
62,700 |
71,700 |
-9,000 |
87% |
| MD |
36,400 |
36,800 |
-400 |
99% |
36,500 |
39,400 |
-2,900 |
93% |
| ME |
11,200 |
12,400 |
-1,200 |
90% |
11,600 |
13,100 |
-1,500 |
89% |
| MI |
70,000 |
67,700 |
2,300 |
103% |
72,400 |
71,300 |
1,100 |
102% |
| MN |
39,200 |
39,200 |
0 |
100% |
41,000 |
42,600 |
-1,600 |
96% |
| MO |
44,400 |
51,600 |
-7,200 |
86% |
45,600 |
54,900 |
-9,300 |
83% |
| MS |
18,400 |
19,900 |
-1,500 |
92% |
20,900 |
21,400 |
-500 |
98% |
| MT |
6,400 |
5,500 |
900 |
116% |
6,500 |
6,300 |
200 |
103% |
| NC |
59,900 |
61,500 |
-1,600 |
97% |
64,500 |
68,400 |
-3,900 |
94% |
| ND |
5,400 |
5,800 |
-400 |
93% |
5,700 |
6,200 |
-500 |
92% |
| NE |
13,300 |
14,800 |
-1,500 |
90% |
14,100 |
15,900 |
-1,800 |
89% |
| NH |
9,300 |
10,500 |
-1,200 |
89% |
9,500 |
11,500 |
-2,000 |
83% |
| NJ |
60,400 |
65,600 |
-5,200 |
92% |
58,200 |
69,700 |
-11,500 |
84% |
| NM |
9,600 |
11,000 |
-1,400 |
87% |
10,500 |
12,500 |
-2,000 |
84% |
| NV |
9,000 |
10,200 |
-1,200 |
88% |
9,300 |
12,100 |
-2,800 |
77% |
| NY |
138,100 |
151,000 |
-12,900 |
91% |
142,600 |
156,000 |
-13,400 |
91% |
| OH |
86,900 |
90,500 |
-3,600 |
96% |
89,300 |
95,700 |
-6,400 |
93% |
| OK |
18,900 |
18,400 |
500 |
103% |
20,600 |
20,000 |
600 |
103% |
| OR |
21,800 |
22,000 |
-200 |
99% |
22,600 |
24,800 |
-2,200 |
91% |
| PA |
111,800 |
110,200 |
1,600 |
101% |
105,900 |
115,000 |
-9,100 |
92% |
| RI |
9,300 |
10,900 |
-1,600 |
85% |
9,300 |
11,400 |
-2,100 |
82% |
| SC |
23,400 |
25,700 |
-2,300 |
91% |
25,100 |
28,300 |
-3,200 |
89% |
| SD |
7,000 |
6,900 |
100 |
101% |
7,600 |
7,500 |
100 |
101% |
| TN |
40,900 |
50,600 |
-9,700 |
81% |
42,700 |
55,800 |
-13,100 |
77% |
| TX |
107,600 |
129,100 |
-21,500 |
83% |
115,300 |
143,800 |
-28,500 |
80% |
| UT |
11,400 |
12,000 |
-600 |
95% |
12,900 |
13,800 |
-900 |
93% |
| VA |
46,300 |
49,200 |
-2,900 |
94% |
47,600 |
53,600 |
-6,000 |
89% |
| VT |
4,900 |
4,600 |
300 |
107% |
5,000 |
5,000 |
0 |
100% |
| WA |
37,900 |
36,300 |
1,600 |
104% |
38,100 |
40,800 |
-2,700 |
93% |
| WI |
41,300 |
37,000 |
4,300 |
112% |
42,900 |
39,800 |
3,100 |
108% |
| WV |
13,200 |
12,600 |
600 |
105% |
14,200 |
13,200 |
1,000 |
108% |
| WY |
3,200 |
3,500 |
-300 |
91% |
3,300 |
4,000 |
-700 |
83% |
| U.S.a |
1,890,700 |
2,001,500 |
-110,800 |
94% |
1,942,500 |
2,161,300 |
-218,800 |
90% |
a
Due to rounding, national totals might fail to equal the
sum across states.
Exhibit
A-4. Baseline FTE RN Supply and Demand, 2010 and 2015
| State |
2010 |
2015 |
| Supply |
Demand |
Supply
- Demand |
Supply
÷ Demand |
Supply |
Demand |
Supply
- Demand |
Supply
÷
Demand |
| AK |
3,200 |
5,500 |
-2,300 |
58% |
2,500 |
6,100 |
-3,600 |
41% |
| AL |
36,600 |
36,800 |
-200 |
99% |
38,200 |
40,300 |
-2,100 |
95% |
| AR |
19,300 |
22,000 |
-2,700 |
88% |
19,800 |
24,300 |
-4,500 |
81% |
| AZ |
30,700 |
43,200 |
-12,500 |
71% |
30,500 |
48,500 |
-18,000 |
63% |
| CA |
153,300 |
200,900 |
-47,600 |
76% |
148,200 |
228,900 |
-80,700 |
65% |
| CO |
27,200 |
38,100 |
-10,900 |
71% |
25,100 |
42,500 |
-17,400 |
59% |
| CT |
22,900 |
34,000 |
-11,100 |
67% |
19,900 |
36,600 |
-16,700 |
54% |
| DC |
6,500 |
9,500 |
-3,000 |
68% |
5,900 |
10,200 |
-4,300 |
58% |
| DE |
6,300 |
7,600 |
-1,300 |
83% |
6,100 |
8,100 |
-2,000 |
75% |
| FL |
112,000 |
144,700 |
-32,700 |
77% |
110,200 |
164,300 |
-54,100 |
67% |
| GA |
48,200 |
64,600 |
-16,400 |
75% |
45,300 |
71,600 |
-26,300 |
63% |
| HI |
7,900 |
12,400 |
-4,500 |
64% |
8,100 |
13,900 |
-5,800 |
58% |
| IA |
26,600 |
30,000 |
-3,400 |
89% |
26,000 |
31,800 |
-5,800 |
82% |
| ID |
7,400 |
8,200 |
-800 |
90% |
7,300 |
9,200 |
-1,900 |
79% |
| IL |
85,600 |
94,900 |
-9,300 |
90% |
81,900 |
101,300 |
-19,400 |
81% |
| IN |
41,600 |
49,800 |
-8,200 |
84% |
40,400 |
53,500 |
-13,100 |
76% |
| KS |
22,100 |
23,100 |
-1,000 |
96% |
21,800 |
24,900 |
-3,100 |
88% |
| KY |
34,700 |
33,500 |
1,200 |
104% |
35,500 |
36,300 |
-800 |
98% |
| LA |
37,200 |
37,100 |
100 |
100% |
39,100 |
40,600 |
-1,500 |
96% |
| MA |
60,100 |
76,200 |
-16,100 |
79% |
56,000 |
81,700 |
-25,700 |
69% |
| MD |
35,600 |
42,600 |
-7,000 |
84% |
33,800 |
46,100 |
-12,300 |
73% |
| ME |
11,600 |
14,100 |
-2,500 |
82% |
11,100 |
15,300 |
-4,200 |
73% |
| MI |
72,000 |
75,100 |
-3,100 |
96% |
68,900 |
79,600 |
-10,700 |
87% |
| MN |
41,800 |
46,200 |
-4,400 |
90% |
41,200 |
50,400 |
-9,200 |
82% |
| MO |
45,700 |
58,600 |
-12,900 |
78% |
44,200 |
63,100 |
-18,900 |
70% |
| MS |
22,600 |
23,100 |
-500 |
98% |
23,600 |
25,400 |
-1,800 |
93% |
| MT |
6,500 |
7,000 |
-500 |
93% |
6,300 |
7,800 |
-1,500 |
81% |
| NC |
67,400 |
75,500 |
-8,100 |
89% |
68,600 |
83,700 |
-15,100 |
82% |
| ND |
5,800 |
6,700 |
-900 |
87% |
5,800 |
7,300 |
-1,500 |
79% |
| NE |
14,700 |
17,100 |
-2,400 |
86% |
14,900 |
18,500 |
-3,600 |
81% |
| NH |
9,300 |
12,600 |
-3,300 |
74% |
8,800 |
13,800 |
-5,000 |
64% |
| NJ |
55,000 |
74,600 |
-19,600 |
74% |
50,500 |
80,400 |
-29,900 |
63% |
| NM |
11,000 |
14,100 |
-3,100 |
78% |
11,300 |
15,900 |
-4,600 |
71% |
| NV |
9,200 |
13,300 |
-4,100 |
69% |
8,700 |
14,700 |
-6,000 |
59% |
| NY |
142,300 |
163,800 |
-21,500 |
87% |
137,400 |
174,000 |
-36,600 |
79% |
| OH |
88,900 |
101,000 |
-12,100 |
88% |
85,500 |
107,300 |
-21,800 |
80% |
| OK |
21,500 |
22,000 |
-500 |
98% |
22,100 |
24,300 |
-2,200 |
91% |
| OR |
22,400 |
27,700 |
-5,300 |
81% |
21,100 |
31,100 |
-10,000 |
68% |
| PA |
99,200 |
120,300 |
-21,100 |
82% |
90,600 |
127,200 |
-36,600 |
71% |
| RI |
9,000 |
12,000 |
-3,000 |
75% |
8,400 |
12,800 |
-4,400 |
66% |
| SC |
25,900 |
31,100 |
-5,200 |
83% |
26,200 |
34,400 |
-8,200 |
76% |
| SD |
7,900 |
8,100 |
-200 |
98% |
7,900 |
8,700 |
-800 |
91% |
| TN |
42,800 |
61,300 |
-18,500 |
70% |
41,800 |
67,800 |
-26,000 |
62% |
| TX |
118,700 |
160,600 |
-41,900 |
74% |
119,000 |
179,900 |
-60,900 |
66% |
| UT |
14,100 |
15,600 |
-1,500 |
90% |
14,900 |
17,500 |
-2,600 |
85% |
| VA |
47,600 |
58,600 |
-11,000 |
81% |
46,300 |
64,300 |
-18,000 |
72% |
| VT |
4,800 |
5,400 |
-600 |
89% |
4,400 |
5,800 |
-1,400 |
76% |
| WA |
37,300 |
46,100 |
-8,800 |
81% |
35,100 |
52,100 |
-17,000 |
67% |
| WI |
43,300 |
42,800 |
500 |
101% |
42,200 |
46,300 |
-4,100 |
91% |
| WV |
14,600 |
13,900 |
700 |
105% |
14,600 |
14,700 |
-100 |
99% |
| WY |
3,300 |
4,500 |
-1,200 |
73% |
3,300 |
5,100 |
-1,800 |
65% |
| U.S.a |
1,941,200 |
2,347,000 |
-405,800 |
83% |
1,886,100 |
2,569,800 |
-683,700 |
73% |
a
Due to rounding, national totals might fail to equal the
sum across states.
Exhibit
A-5. Baseline FTE RN Supply and Demand, 2020
| State |
2020 |
| Supply |
Demand |
Supply
- Demand |
Supply
÷ Demand |
| AK |
2,000 |
6,700 |
-4,700 |
30% |
| AL |
39,100 |
44,400 |
-5,300 |
88% |
| AR |
19,900 |
26,900 |
-7,000 |
74% |
| AZ |
30,100 |
54,700 |
-24,600 |
55% |
| CA |
144,300 |
260,900 |
-116,600 |
55% |
| CO |
23,000 |
47,500 |
-24,500 |
48% |
| CT |
17,200 |
39,600 |
-22,400 |
43% |
| DC |
5,400 |
11,000 |
-5,600 |
49% |
| DE |
5,800 |
8,800 |
-3,000 |
66% |
| FL |
106,600 |
187,800 |
-81,200 |
57% |
| GA |
41,800 |
79,500 |
-37,700 |
53% |
| HI |
8,200 |
15,700 |
-7,500 |
52% |
| IA |
25,000 |
34,100 |
-9,100 |
73% |
| ID |
7,100 |
10,500 |
-3,400 |
68% |
| IL |
77,100 |
109,000 |
-31,900 |
71% |
| IN |
38,500 |
57,400 |
-18,900 |
67% |
| KS |
21,100 |
27,000 |
-5,900 |
78% |
| KY |
35,300 |
39,400 |
-4,100 |
90% |
| LA |
39,800 |
44,600 |
-4,800 |
89% |
| MA |
51,400 |
87,800 |
-36,400 |
59% |
| MD |
31,800 |
50,000 |
-18,200 |
64% |
| ME |
10,500 |
16,800 |
-6,300 |
63% |
| MI |
66,000 |
84,300 |
-18,300 |
78% |
| MN |
39,700 |
55,300 |
-15,600 |
72% |
| MO |
42,800 |
68,200 |
-25,400 |
63% |
| MS |
23,800 |
28,000 |
-4,200 |
85% |
| MT |
5,900 |
8,800 |
-2,900 |
67% |
| NC |
68,000 |
92,900 |
-24,900 |
73% |
| ND |
5,600 |
8,000 |
-2,400 |
70% |
| NE |
14,900 |
20,200 |
-5,300 |
74% |
| NH |
8,100 |
15,100 |
-7,000 |
54% |
| NJ |
44,900 |
87,300 |
-42,400 |
51% |
| NM |
11,500 |
18,000 |
-6,500 |
64% |
| NV |
8,100 |
16,200 |
-8,100 |
50% |
| NY |
131,500 |
185,700 |
-54,200 |
71% |
| OH |
79,700 |
113,700 |
-34,000 |
70% |
| OK |
22,500 |
27,000 |
-4,500 |
83% |
| OR |
19,800 |
35,100 |
-15,300 |
56% |
| PA |
80,400 |
135,200 |
-54,800 |
59% |
| RI |
7,900 |
13,800 |
-5,900 |
57% |
| SC |
26,000 |
38,100 |
-12,100 |
68% |
| SD |
7,800 |
9,500 |
-1,700 |
82% |
| TN |
40,100 |
75,400 |
-35,300 |
53% |
| TX |
118,500 |
202,100 |
-83,600 |
59% |
| UT |
15,400 |
19,600 |
-4,200 |
79% |
| VA |
44,000 |
70,300 |
-26,300 |
63% |
| VT |
4,000 |
6,300 |
-2,300 |
63% |
| WA |
33,000 |
59,100 |
-26,100 |
56% |
| WI |
40,100 |
50,300 |
-10,200 |
80% |
| WV |
14,000 |
15,700 |
-1,700 |
89% |
| WY |
3,300 |
5,800 |
-2,500 |
57% |
| U.S.a |
1,808,000 |
2,824,900 |
-1,016,900 |
64% |
a
Due to rounding, national totals might fail to equal the
sum across states.
[1]
The
modeling and resulting projections used in this paper were
developed under contract DHHS-250-01-0001 with the Lewin
Group. Tim Dall, Lewin Group, was the principal investigator
for the contract. This paper was prepared in a joint effort
by Marilyn B. Biviano, Steve Tise, Marshall Fritz and William
Spencer. Additional information on these models,
projections from these models, and the data and assumptions
are available in other reports: Projected Supply, Demand,
and Shortages of Registered Nurses:2000–2020 (BHPr,
2002),
NSM: Technical Report and User Guide (BHPr, 2004), NDM:
Development and Baseline Projections (BHPr, 2004), and NDM
User Guide (BHPr, 2004).
[2]
The U.S. Census Bureau’s projections were developed before
the 2000 Census and underestimated the U.S. population in
2000. Consequently, we adjusted the projections to reflect
this undercount. Men continue to constitute a small percentage
of the RN workforce, doubling from approximately 2.7% in
1980 to 5.4% in 2000 (BHPr, 2001). As the proportion of
RNs who are male grows, the NSM might have to add a gender
component to track difference in workforce participation
patterns and retirement rates between male and female RNs.
[3]
The data, methods, and assumptions used to calculate baseline
demand projections are described in Section III .
[4]
An annual survey of RN salaries finds that RN hourly earnings
increased by nearly 7%, on average, between 2002 and 2003
(Robinson and Mee, 2003).
[5]
NDM Development and Baseline Projections (NCHWA,
forthcoming), NDM User’s Guide (NCHWA, forthcoming),
and The Nursing Demand–Based Requirements Forecasting
Model (Fritz, 1999).
[6]
To estimate per capita use of healthcare services, we use
the 1996 Health Cost Utilization Project (HCUP) database
for hospital inpatient services, 1996 National Hospital
Ambulatory Care Survey (NHAMCS) for hospital outpatient
and emergency services, 1997 National Nursing Home Survey
(NNHS) for nursing facilities, and 1995 National Home and
Hospice Care Survey (NHHCS) for home health. See Section
0 for a discussion of the choice of 1996 as the base year.
[7]
Estimates of actual use of healthcare services come from
multiple sources. The American Hospital Association (AHA)
provides state-level estimates of inpatient days, outpatient
visits, and emergency visits. The American Health Care Association
(AHCA) provides state-level estimates of residents in nursing
facilities. State-level estimates of home health visits
were constructed using data from the Centers for Medicaid
and Medicare Services (CMS) and other sources.
[8]
Preliminary analyses to control for heteroskedasticity included
the estimation of “difference-in-differences” models, using
regression analysis, to control for state fixed effects.
In these regressions, both the dependent and exogenous variables
are transformed so the estimate for each state in a particular
year is that year’s deviation from the state’s multiyear
average. One important limitation of the difference-in-differences
approach is that it eliminates cross-state variation in
the dependent and exogenous variables, which is an important
source of information for estimating the relationship between
healthcare use and its determinants. For example, HMO enrollment
rates vary substantially across states, but in a given state
might change little over the few years included in the regression
analysis. Many of the exogenous variables that were statistically
significant in the difference-in-differences models are
the same variables used in the NDM’s final projection equations.
[9]
The HMO variable (and assessment trend) is included as a
proxy for factors that make clinicians and consumers more
cost-conscious, whether that be through the application
of managed care principles or out-of-pocket costs such as
co-pay and deductibles.
[10]
The ability of healthcare providers to substitute lower-cost
nurses for higher-cost nurses is more than simply an economic
phenomenon; rather, it also reflects legal and quality considerations.
RNs receive special training that enables them to provide
certain services that LPNs cannot provide. Thus, in only
a limited range could substitution be made without jeopardizing
healthcare delivery quality.
[11]
Lane and Gohmann estimate nurse supply and demand simultaneously
using two approaches: (1) a two-stage least squares model
and (2) a “switching” model that relaxes the assumption
that the market for hospital nurses is in equilibrium. The
authors report an own-wage elasticity of demand of -1.14
when using the two-stage least squares model, but they believe
the estimate of -0.92 from the switching model to be more
accurate.
|
