California minimum staffing law,
nurse satisfaction, wages, and
hours worked: Analyses of 1997,
2004, 2006, and 2008 survey
data.
Michelle Tellez, RN. MS. PhD.
California State University, East Bay
michelle.tellez@csueastbay.edu
What shortage?
• Nurse shortage since 1998
• Estimated to reach 340,000 by 2020
• California is 49th in RN per capita
Objectives of the study
1. To describe changes in the California nurse
population from 1997 to 2008.
1.
2.
3.
4.
1997 before ratios
2004 immediately after implementation
2006 mid-term effects
2008 long-term effects
2. To examine the relationship between wages,
satisfaction, staffing, and year of survey on
hours worked per week.
Research questions
▫
What are the marginal effects of :




Year of survey
Staffing: RNs+LVNs+AIDEs hours per patient days
Overall satisfaction with job
Hourly wages
▫ on the number of hours nurses work ?
Sample
• California RNs who were able to respond at the
margin (incrementally) to the regulatory changes
taking place in the state.
• Inclusion criteria were:
▫
▫
▫
▫
▫
(a) that nurses be female,
(b) be between the ages of 20 and 65,
(c) reside in the state,
(d) be working in nursing at the time of the survey,
(e) have completed the California BRN questionnaire
in full.
Figure 1. Gender of currently working RNs residing in California, by survey year.
Why just females?
100%
7.4%
7.4%
10.5%
14.4%
92.6%
92.6%
89.5%
85.7%
1997
2004
2006
2008
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Male
Female
Table 2. Employment status of RNs with active California licenses residing in California, by survey year
Note: 2006 and 2008 data are weighted to represent all RNs with active licenses
Why just working nurses?
1997
Employed in
nursing
Not employed in
nursing
Number of
respondents
2004
2006
2008
84.2% 87.5% 86.7%
86.9%
15.8% 12.5% 13.3%
13.1%
2,955
4,890
4,280
4,346
Study design
• Secondary data analysis of cross-sectional
survey data
▫ California Board of Registered Nursing Surveys
from 1997, 2004, 2006 and 2008
▫ California Area Resource Files of 2007
▫ Office of Statewide Health Planning and
Development (OSHPD) hospital data for 1996,
2003, 2005, 2007
Year of the survey: 1997 (proxy for before the ratio implementation), 2004 (immediately after implementation), 2006 (mid-term) and 2008 (long-te
Table 1. Frequency of participants that met the inclusion criteria by survey year.
Final Sample included in the study
1997 2004
Frequency
(%)
2006 2008 Total
1482 2122 2332 2532 8472
(17.5) (25.0) (27.5) (29.9) (100)
Model to estimate: Hours worked
Demographic s
Human Capital
Work
Characteristics
Age & Age sq
Level of education Setting
Ethnicity
Type of position
Marital status
Satisfaction
Children
Staffing
Other dependents
Wages
Foreign or US
educated
Other income
Region
Region of the state
the nurse resides
Analysis
1.
2.
3.
4.
Computed frequencies and means.
Computed OLS regression using the model .
Computed OLS with the model + interactions.
Computed a 2SLS regression + instrumental
variables to account for endogeneity.
5. Tested for non-linear relationships.
Objective 1.
1. To describe changes in the California nurse
population from 1997 to 2008.
Age
25%
1990
20%
1993
1997
2004
15%
2006
2008
10%
5%
0%
Under
30
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65 or
older
Race and Ethnicity
Racial/Ethnic
backgrounds
White, not Hispanic
1997
2004
2006
2008
64.5%
61.5%
62.0%
55.5%
Hispanic
4.9%
6.5%
5.7%
8.3%
Black/African American
4.8%
3.5%
4.6%
4.1%
Asians
22.8%
25.3%
24.5%
28.8%
Other
2.9%
3.2%
3.2%
3.4%
Number of Cases
2,458
2,948
3,712
4,756
Marital status
1997
2004
2006
2008
Never married
13.5%
12.3%
12.6%
13.9%
Married
66.5%
68.2%
66.9%
67.6%
Separated or
divorced
17.6%
17.0%
16.7%
15.5%
Widowed
2.4%
2.6%
3.8%
2.9%
Number of
Cases
2,463
2,946
3,719
4,046
Children living at home
None
One or more
Number of Cases
1997
38.2%
61.8%
2,297
2004
45.7%
54.3%
2,933
2006
53.1%
46.9%
3,406
2008
49.2%
50.8%
4,153
Other dependents
100%
90%
6.2%
5.3%
6.9%
15.8%
16.2%
14.9%
23.9%
80%
70%
4 or more people
60%
3 people
2 people
50%
1 person
40%
81.2%
76.1%
74.3%
73.8%
73.7%
30%
Any
None
20%
10%
0%
1997
2004
2006
2008
Level of education
100%
6.8%
8.5%
90%
13.2%
12.2%
80%
38.0%
70%
38.1%
40.9%
41.6%
60%
Master's or Doctorate
Degree
Baccalaureate degree
50%
Associate degree
40%
36.7%
30%
39.7%
36.3%
36.7%
9.6%
9.5%
2006
2008
20%
26.6%
10%
18.4%
13.7%
0%
1997
2004
Diploma program
Location of education
1997
2004
2006
2008
California
55.1%
58.3%
56.7%
55.1%
Other States
24.0%
22.2%
25.6%
21.4%
International
20.9%
19.4%
17.8%
23.5%
Number of
respondents
2,366
2,894
3,732
4,076
Location of employment
1997
2004
2006
2008
57.4%
57.7%
8.0%
7.5%
7.4%
9.0% 10.8%
12.6%
16.0%
6.0%
9.9%
10.5%
7.7%
Other
10.9% 10.8%
12.9%
11.9%
Number of Cases
2,444
3,661
Acute hospital
60.2% 60.9%
Nursing homes/Home care/Skilled
nursing
Ambulatory care
13.9%
Department of Public Health
2,971
4,080
Type of position
1997
2004
2006
2008
Direct patient care provider/staff nurse
62.1% 57.3% 65.1% 63.5%
Management
16.3% 19.2% 14.6% 18.3%
Advance Practice Nursing
6.7%
6.5%
6.9%
5.9%
Other
15.1% 16.9% 13.7% 13.7%
Number of cases
2,375
2,925
3,675
4,108
Satisfaction
1997
2004
2006 2008
Physical work
environment
3.60
3.45
3.57
3.59
Your job overall
3.95
3.94
4.05
4.14
*
3.83
3.96
The nursing profession
overall
Annual income from nursing
1997
2004
2006
2008
$20,000 or less
9.5%
4.9%
4.6%
2.4%
$20,001 to $40,000
20.9%
12.1%
7.6%
5.3%
$40,001 to $60,000
34.5%
34.4%
20.3%
16.0%
$60,001 to $80,000
27.1%
28.6%
33.4%
30.8%
$80,001 to $100,000
0%
13.0%
20.8%
25.7%
$100,001 to $125,000
0%
3.6%
9.1%
13.2%
More than $125,000
0%
1.1%
4.1%
6.6%
$45,073
$59,937
$73,542
$81,428
2,420
2,885
3,447
3,728
Mean Annual Income
Number of Cases
Average hourly wages RNs in the survey
1997
2004
2006
2008
Mean in hourly
$34.67
wages
$38.60
$44.80
$46.97
Number of
cases
2,122
2,332
2,536
1,482
Average hours worked per week
1997
2004
2006
2008
Mean in hours
36.3
35.6
35.2
36.5
Standard deviation
11.0
11.9
*
*
Number of cases
2,470
3,064
3,510
3,984
Objective 2.
• To examine the relationship between wages,
satisfaction, staffing , year of survey and the
number of hours worked.
Overall Satisfaction with job
Dv: Ave hours
worked per
week
OLS
β
(Robust Std Er)
OLS with
Interactions
β
(Robust Std Er)
2SLS with
Interactions
and Ivs
β
(Robust Std Er)
All RNs
Not sig
Not sig
Not sig
Acute care RNs
Not sig
Not sig
Not sig
0.371* (0.160)
Not sig
Not sig
Acute care in
direct pt care
positions
Note: age, age squared, ethnicity, marital status, children, other dependents,
level of education, location of education, location of employment, position held,
region of residence, staffing, other income, and wages were included in the first
2 equations. The 3rd equation was conducted in 2 steps. First step omitted.
Overall satisfaction
DV: Hours worked
All RNs
Satisfaction
Satisfaction squared
Satisfaction Categories
(2008)
Neither vs Dissatisfied
Satisfied vs Dissatisfied
Very Satisfied vs Disssatis.
OLS
OLS
Not sig
-2.528** (0.933)
-.246 (0.441)
0.162 (0.162)
Note: age, age squared, ethnicity, marital status, children, other dependents,
level of education, location of education, location of employment, position held,
region of residence, staffing, other income, and wages were included in the
equations.
Staffing: RNs+LVNs+ Aides hours per pt day
group
OLS
β
(Robust Std Er)
OLS with
Interactions
β
(Robust Std Er)
2SLS with
Interactions
and IVs
β
(Robust Std Er)
All RNs
Not sig
Not sig
Not sig
Acute care RNs
Staffing*2004
Staffing*2006
Staffing*2008
Not sig
Not sig
-4.405 (2.329)
4.010 (2.216)
4.515 (2.661)
5.099*(2.459
Acute care in
direct pt care
positions
Staffing*2004
Staffing*2006
Staffing*2008
Not sig
Not sig
-4.088* (2.020)
4.380* (2.021)
5.067* (2.332)
4.570* (2.115)
Staffing
Ave. Hours
worked
All RNs
Staffing
Staffing Squared
Staffing
Categories
OLS
OLS
β
β
(Robust Std Er) (Robust Std Er)
Not sig
Not enough
people in the
lower categories
Note: age, age squared, ethnicity, marital status, children, other dependents, level of
education, location of education, location of employment, position held, region of
residence, staffing, other income, and wages were included in the equations.
DV: Ave. Hours
worked per
week
OLS
β
(Robust Std Er)
OLS with
Interactions
β
(Robust Std Er)
All RNs
Wage*2004
Wage*2006
Wage *2008
-0.194** (0.012)
-0.139** (0.022)
-0.104** (0.029)
-0.039 (0.027)
-0.054* (0.023)
Acute care RNs
Wage*2004
Wage*2006
Wage *2008
-0.206** (0.018)
-0.144** (0.034)
-0.100* (0.040)
-0.054 (0.046)
-0.064 (0.034))
-0.741* (0.361)
0.070 (0.230)
0.428 (0.257)
0.496 (0.285)
-0.192** (0.019)
-0.136** (0.031)
-0.099* (0.044)
-0.066 (0.045)
-0.046 (0.524)
-0.575* (0.260)
0.075 (0.188)
0.219 (0.206)
0.408 (0.210)
Acute care +
direct pt care
Wage*2004
Wage*2006
Wage *2008
2SLS with
Interactions
and Ivs
β
(Robust Std Er)
Not sig
Tested for non-linear relationship
DV: Hours worked
All RNs 1997-2008
Wage
Wage squared
Wage Categories
$25-$29.99 vs <$25
$30-$34.99 vs <$25
$35-$39.99 vs <$25
$40-$44.99 vs <$25
$45-$49.99 vs <$25
$50-$54.99 vs <$25
$55-$120. vs <$25
OLS
Wage & Wage
squared
OLS
Wage Categories
-0108** (0.028)
-0.0008** (0.0003)
-0.683 (0.459)
-1.975** (0.403)
-1.933** (0.419)
-3.106** (0.408)
-3.898** (0.445)
-5.424** (0.477)
-8.190** (0.442)
Note: age, age squared, ethnicity, marital status, children, other dependents, level of
education, location of education, location of employment, position held, region of
residence, staffing, other income, and wages were included in the equations.
Wage effects by year of survey
2
0
$25-29.99 $30-34.99 $35-39.99 $40-44.99 $45-49.99 $50-54.99
Wage effects
-2
-4
-$55
120.00
1997
2004
-6
2006
2008
-8
-10
-12
-14
Wage categoreis
Year of survey
DV: Ave. hours
worked per week
OLS
All RNs
2004
2006
2008
-0.422 (0.424)
0.886 (0.468)
1.863** (0.505)
Acute care
2004
2006
2008
-1.102 (0.551)
0.519 (0.626)
1.450* (0.650)
Acute + direct pt care
2004
0.450 (0.559)
2006
1.55* (0.702)
2008
1.850* (0.685)
Note: age, age squared,
ethnicity, marital status,
children, other
dependents, level of
education, location of
education, location of
employment, position
held, region of residence,
staffing, other income,
and wages were included
in the equations.
Conclusion
•
•
•
•
Satisfaction – already max out.
Staffing – positive effect to staff nurses
Wages – afford nurses to work fewer hours
Ratios law – improve the workload and helped
maintain the hours worked stable.
Thank you!