Lisa Black, PhD, RN University of Nevada, Reno

Lisa Black, PhD, RN
University of Nevada, Reno
Joanne Spetz, PhD & Charlene Harrington, PhD, RN, FAAN
University of California San Francisco
The purpose of this study was to
describe sociodemographic, market, and
political factors that predict nurses who
choose non-nursing work.
122,178 Registered Nurses (RNs) in the
United States work in non-nursing jobs1
Family concerns (3.8%), career-related
reasons (18.2%), concerns with the nursing
work environment (59.9%), and retirement
(11.7%) are cited as reasons for choosing nonnursing work2
The effect of salary on nursing labor market
behavior remains unsettled in the recent labor
market research
New Contributions…
This study examined the 4% of RNs in the United
States who remain licensed to practice, yet work
outside of nursing
Male RNs were included in the analysis – a population
that is frequently excluded in labor market research
As was done by Brewer et al.3, market factors were
examined to determine the effect of local market
factors on labor market behavior. This study used
county-level factors derived from the Bureau of Health
Professions (BrHP) Area Resource File
Political variables were measured to determine if
congressional political ideology affects nursing labor
market behavior
Data Sets
 2004 National Sample Survey of Registered
Nurses (NSSRN)1
 County-level Area Resource File (2006)4
 National Journal (2004) Congressional
Liberalism Rankings5
• 2004 NSSRN (N = 35,635) data population
weighted using HRSA sampling weights to
represent 2,909,357 RNs licensed to practice in
the US
Analytical Model
RNs working outside of nursing defined as those who
maintained an active license to practice, but worked in
a job that did not require a professional nursing license
NSSRN, ARF, and NJ data merged on county of
Descriptive differences tested with t-tests and
Pearson’s Chi2
Regression model estimated using two-stage residual
inclusion5 to control for wage endogeneity
Logistic regression model reporting odds ratios
estimated to determine factors on which RNs working
outside of nursing differ from those who work in nursing
Nurses working outside of nursing were,
on average, 5.5 years older, had been
out of school six years longer, were
more likely to have a graduate degree,
be white and educated in the US, be
male, have no children in the home, and
have greater sources of family income
Types of Non-Nursing Work
Selected Logistic Results
Positive predictors of non-nursing work
Hourly wage was a positive predictor of non-nursing work
for unmarried nurses only (OR 1.13*)
Male Gender
 Married OR 2.3*
 Unmarried OR 2.5*
Children under age 6
 Married OR 1.6*
 Unmarried OR NS
*p < .01
Higher Nursing Education
○ Married OR 1.4*
○ Unmarried OR NS
 Graduate
○ Married OR 1.5*
○ Unmarried OR NS
Selected Logistic Results
Positive Predictors of non-nursing work
The longer an RN had been out of school, the more
likely s/he was to be working outside of nursing
N = 1,850,249
N = 704,053
6 – 10 years
11 – 15 years
16 – 25 years
< 25 years
*p > .01
Selected Logistic Results
Negative predictors of non-nursing work
Educated outside the US
 Married OR 0.9*
 Unmarried OR 0.8*
 Married OR 0.16*
 Unmarried OR 0.41*
Pre-licensure Work
*p < .01
US Census Region
 South
○ Unmarried OR 0.4*; Married OR NS
 West
○ Unmarried OR 0.3*; Married OR NS
○ Married OR 0.8*
○ Unmarried OR NS
○ Married OR 0.6*
○ Unmarried OR NS
Physicians per 1,000 population
Political Ideology
 Liberal Congressional
Representation (OR .7* for married
and unmarried)
Salary was not a primary explanatory factor. Solutions beyond
salary enhancements are important to long-run market stabilization
Married nurses’ labor market behavior was much more elastic than
that of unmarried nurses in response to different sociodemographic
situations. This is consistent with the findings of numerous previous
authors. It was assumed this would be highly interactive with the
presence of young children in the home. However, this correlation
was quite modest (r = 0.38).
Nurses with longest professional tenure most likely to leave, taking
institutional knowledge with them. Changes to the design of the
nursing work environment are needed to retain “mature” nurses
Male nurses were more than twice as likely to leave nursing than
were female nurses. It is essential that the profession address sex
role stereotypes that make men less likely to choose nursing, and
then more likely to leave once they do
Additional workplace support is needed for nurses with
young children at home. Flexible scheduling may allow
these nurses to work while raising young families
Foreign-born nurses behave differently in the nursing
labor market, and are more likely to continue working in
nursing – and to also work in roles that are typically
viewed as “less desirable” by US educated RNs
Regional variations in RN to population concentration
appear to contribute to nursing labor market behavior. It
is unclear whether this reflects workplace incentives in
areas of acute shortage or more opportunities for mobility
in areas with less severe shortages
Future Directions
Buerhaus et al7 recently published data showing a surge of
nursing employment since the beginning of the recession.
Examination of the forthcoming 2008 NSSRN data will
provide information re: whether this surge has also affected
the number of nurses choosing non-nursing work
Further research is needed to specifically examine the
NLMB of male RNs
The effect of the political environment has not previously
been described as a determinant of NLMB. Additional
research is needed to further explore this phenomenon
Regional variations in RN labor supply appear to contribute
to mobility out of the profession. Further investigation of this
effect can further describe the factors that contribute to
these regional variations
HRSA (2006).Findings from the March 2004 National Sample Survey of Registered Nurses.
Washington D.C.: U.S. Department of Health and Human Services Administration
Black, L.M., Spetz, J. Harrington, C. (2008). Nurses working outside of nursing. Societal trend or
workplace crisis. Policy, Politics, and Nursing Practice, 9(3): 143-157
Brewer, C.S., Kovner, C.T., Yow-Wu, W., Greene, W., Liu, Y., Reimers, C. (2006). Factors influencing
female registered nurses’ work behavior. Health Services Research, 41, 860-886.
Bureau of Health Professions (2006). Area Resource File. Available at
National Journal (2006). 2006 Vote Ratings: Senate Liberal Scores. Available at
Terza, J.V., Basu, A., & Rathouz, P.J. (2008). Two stage residual inclusion estimation. Addressing
endogeneity in health econometric modeling. Journal of Health Economics, 27, 531 – 543.
Buerhaus, P.I., Auerbach, D.I., Staiger, D.O. (2009). The recent surge in nurse employment: Causes
and Implications. Health Affairs [epub ahead of print]