Abstract
The nurse workforce—the nurses available to provide care to a group of patients or a population and the characteristics of these nurses—provides a critical context for the Quality Health Outcomes Model (QHOM). This chapter begins with a brief consideration of workforce issues within the QHOM. Two forces at the heart of workforce analysis (supply and demand) and how these forces play out in various arenas for nursing practice are discussed. This chapter does not focus on managers’ decisions regarding coverage of patient care responsibilities by nursing staff and nursing personnel qualifications, which fall within the realm of staffing (see Chaps. 4 and 13). Instead, it will focus on the size and composition of the body of nurses providing care, the forces that influence this body of nurses, and how workforce parameters act as an element of context for staffing, practice environments, and nursing care delivery. The chapter concludes with discussions of ongoing and emerging trends likely to influence the nurse workforce, especially in relation to healthcare quality and safety considerations.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
American Association of Colleges of Nursing (2019) Nursing fact sheet. https://www.aacnnursing.org/news-Information/fact-sheets/nursing-fact-sheet
American Hospital Association (AHA) Strategic Policy Planning Committee (2001) Workforce supply for hospitals and health systems. Trustee 54(6):suppl 4 p. following 6
Anthony MK, Standing TS, Glick J, Duffy M, Paschall F, Sauer MR, Kosty Sweeney D, Modic MB, Dumpe ML (2005) Leadership and nurse retention: the pivotal role of nurse managers. J Nurs Adm 35(3):146–155
Auerbach DI, Buerhaus PI, Staiger DO (2017) How fast will the registered nurse workforce grow through 2030? Projections in nine regions of the country. Nurs Outlook 65(1):116–122
Blau FD, Kahn LM (2017) The gender wage gap: extent, trends, and explanations. J Econ Lit 55(3):789–865
Brody J (2020) A pandemic benefit: the expansion of telemedicine. The New York Times. https://www.nytimes.com/2020/05/11/well/live/coronavirus-telemedicine-telehealth.html
Buerhaus PI (2009) Avoiding mandatory hospital nurse staffing ratios: an economic commentary. Nurs Outlook 57(2):107–112
Buerhaus PI (2010) It’s time to stop the regulation of hospital nurse staffing dead in its tracks. Nurs Econ 28(2):110
Canadian Institute for Health Information (CIHI) (2020) Nursing in Canada, 2019: a lens on supply and workforce. CIHI, Ottawa. https://www.cihi.ca/sites/default/files/document/nursing-report-2019-en-web.pdf
Chapman SA, Spetz J, Seago JA, Kaiser J, Dower C, Herrera C (2009) How have mandated nurse staffing ratios affected hospitals? Perspectives from California hospital leaders. J Healthc Manag 54(5):321–335
Chi NC, Sparks O, Lin SY, Lazar A, Thompson HJ, Demiris G (2017) Pilot testing a digital pet avatar for older adults. Geriatr Nurs 38(6):542–547
Christensen SS, Wilson BL, Edelman LS (2018) Can I relate? A review and guide for nurse managers in leading generations. J Nurs Manag 26(6):689–695
Clarke SP (2016) The BSN entry to practice debate. Nurs Manag 47(11):17–19
Clarke S, Patrician P (2001) Entry to practice in Ontario. Am J Nurs 101(2):73–75
De Groot K, Maurits EEM, Francke AL (2018) Attractiveness of working in home care: an online focus group study among nurses. Health Soc Care Commun 26(1):e94–e101
Dombrowski W, Yoos JL, Neufeld R, Tarshish CY (2012) Factors predicting rehospitalization of elderly patients in a postacute skilled nursing facility rehabilitation program. Arch Phys Med Rehabil 93(10):1808–1813
Douglas K (2010) Ratios—if it were only that easy. Nurs Econ 28(2):119–125
Dreachslin JL, Gilbert MJ, Malone B (2013) Diversity and cultural competence in health care: a systems approach. Jossey-Bass, San Francisco
Dubois CA, D’Amour D, Tchouaket E, Clarke S, Rivard M, Blais R (2013) Associations of patient safety outcomes with models of nursing care organization at unit level in hospitals. Int J Qual Health Care 25(2):110–117
Foronda C, Baptiste DL, Reinholdt MM, Ousman K (2016) Cultural humility: a concept analysis. J Transcult Nurs 27(3):210–217
Friedberg MW, Reid RO, Timbie JW, Setodji C, Kofner A, Weidmer B, Kahn K (2017) Federally qualified health center clinicians and staff increasingly dissatisfied with workplace conditions. Health Aff 36(8):1469–1475
Girvin J, Jackson D, Hutchinson M (2016) Contemporary public perceptions of nursing: a systematic review and narrative synthesis of the international research evidence. J Nurs Manag 24(8):994–1006
Gooch K (2016) How 5 health systems are recruiting, retaining nurses during an RN shortage. https://www.beckershospitalreview.com/hr/how-5-health-systems-are-recruiting-retaining-nurses-during-an-rn-shortage.html
Goode CJ, Pinkerton S, McCausland MP, Southard P, Graham R, Krsek C (2001) Documenting chief nursing officers’ preference for BSN-prepared nurses. J Nurs Adm 31(2):55–59
Gordon S, Buchanan J, Bretherton T (2008) Safety in numbers: nurse-to-patient ratios and the future of health care. Cornell University Press, Ithaca, NY
Greenlaw SA, Shapiro D (2018) Demand and supply at work in labor markets. In: Principles of microeconomics, 2nd edn. OpenStax, Houston, pp 84–92. https://openstax.org/details/books/principles-microeconomics-2e
Greipp ME (2003) Salary compression: its effect on nurse recruitment and retention. J Nurs Adm 33(6):321–323
Griffiths P, Ball J, Drennan J, Dall’Ora C, Jones J, Maruotti A, Pope C, Recio Saucedo A, Simon M (2016) Nurse staffing and patient outcomes: strengths and limitations of the evidence to inform policy and practice. Int J Nurs Stud 63:213–225
Health Facilities: Nurse staffing. California AB-394 (1999). http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=199920000AB394
Hooper C, Craig J, Janvrin DR, Wetsel MA, Reimels E (2010) Compassion satisfaction, burnout, and compassion fatigue among emergency nurses compared with nurses in other selected inpatient specialties. J Emerg Nurs 36(5):420–427
Institute of Medicine (2011) The future of nursing: leading change, advancing health. National Academies Press, Washington, DC. https://www.nap.edu/catalog/12956/the-future-of-nursing-leading-change-advancing-health
Jesuthasan R, Boudreau JW (2018) Reinventing jobs. Harvard Business School Press, Boston
Jones TL, Yoder LH, Baernholdt M (2019) Variation in academic preparation and progression of nurses across the continuum of care. Nurs Outlook 67:381–392
Kingma M (2006) Nurses on the move: migration and the global health care economy. Cornell University Press, Ithaca, NY
Koerner J (1992) Differentiated practice: the evolution of professional nursing. J Prof Nurs 8:335–341
Lake ET, Sanders J, Duan R, Riman KA, Schoenauer KM, Chen Y (2019) A meta-analysis of the associations between the nurse work environment in hospitals and 4 sets of outcomes. Med Care 57:353–361
Mallidou AA, Cummings GG, Estabrooks CA, Giovannetti PB (2011) Nurse specialty subcultures and patient outcomes in acute care hospitals: a multiple-group structural equation modeling. Int J Nurs Stud 48(1):81–93
Markkanen P, Galligan C, Quinn M (2017) Safety risks among home infusion nurses and other home health care providers. J Infus Nurs 40(4):215–223
Marshall J, Edmonson C, England V (2017) Nurse manager’s guide to recruitment and retention. HCPro, Middleton, MA
Menzik J (2017) New York governor signs BSN in 10 into law for nurses. https://www.nurse.com/blog/2017/12/20/new-york-governor-signs-bsn-in-10-into-law-for-nurses/
Mitchell PH, Ferketich S, Jennings BM (1998) Quality health outcomes model. Image J Nurs Sch 30(1):43–46
Montag ML (1963) Technical education in nursing? Am J Nurs 63(5):100–103
Neatherlin JS, Prater L (2003) Nursing time and work in an acute rehabilitation setting. Rehabilit Nurs 28:186–190
Needleman J, Pearson ML, Upenieks VV, Yee T, Wolstein J, Parkerton M (2016) Engaging frontline staff in performance improvement: the American Organization of Nurse Executives implementation of Transforming Care at the Bedside Collaborative. Jt Comm J Qual Patient Saf 42(2):61–69
Petit Dit Dariel O, Regnaux JP (2015) Do Magnet®-accredited hospitals show improvements in nurse and patient outcomes compared to non-Magnet hospitals: a systematic review. JBI Database System Rev Implement Rep 13(6):168–219
Reinhard SC, Young HM (2009) The nursing workforce in long-term care. Nurs Clin N Am 44(2):161–168
Roche M, Duffield C, Dimitrelis S, Frew B (2015) Leadership skills for nursing unit managers to decrease intention to leave. Nurs Res Rev 5:57–64
Royal College of Nursing (RCN) (2020) The UK nursing labour market review 2019. Author, London. https://www.rcn.org.uk/-/media/royal-college-of-nursing/documents/publications/2020/april/009-135.pdf?la=en
Sandelowski M (2000) Devices and desires: gender, technology, and American nursing. University of North Carolina Press, Chapel Hill, NC
Serratt T (2013) California’s nurse-to-patient ratios, part 3: eight years later, what do we know about patient level outcomes? J Nurs Adm 43(11):581–585
Shaffer FA, Bakhshi MA, Farrell N, Álvarez TD (2020) Original research: the recruitment experience of foreign-educated health professionals to the United States. Am J Nurs 120(1):28–38
Skillman SM, Palazzo L, Keepnews D, Hart LG (2006) Characteristics of registered nurses in rural versus urban areas: implications for strategies to alleviate nursing shortages in the United States. J Rural Health 22:151–157
Susskind R, Susskind D (2015) The future of the professions. Oxford University Press, New York
U.S. Department of Health and Human Services, Health Resources and Services Administration (2010) The registered nurse population: findings from the 2008 National Sample Survey of Registered Nurses. U.S. Department of Health and Human Services, Health Resources and Services Administration, Rockville, MD. https://data.hrsa.gov/DataDownload/NSSRN/GeneralPUF08/rnsurveyfinal.pdf
U.S. Department of Health and Human Services, Health Resources and Services Administration (2017) National and regional supply and demand projections of the nursing workforce: 2014–2030. U.S. Department of Health and Human Services, Health Resources and Services Administration, Rockville, MD. https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/NCHWA_HRSA_Nursing_Report.pdf
U.S. Department of Health and Human Services, Health Resources and Services Administration (2019) Brief summary results from the 2018 national sample survey of registered nurses. U.S. Department of Health and Human Services, Health Resources and Services Administration, Rockville, MD. https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/nssrn-summary-report.pdf
Vanhook P, Bosse J, Flinter M, Poghosyan L, Dunphy L, Barksdale D (2018) The American Academy of Nursing on policy: emerging role of baccalaureate registered nurses in primary care (August 20, 2018). Nurs Outlook 66(5):512–517
Wei H, Sewell KA, Woody G, Rose MA (2018) The state of the science of nurse work environments in the United States: a systematic review. Int J Nurs Sci 5:287–300
Wojnar DM, Whelan EM (2017) Preparing nursing students for enhanced roles in primary care: the current state of prelicensure and RN-to-BSN education. Nurs Outlook 65(2):222–232
Wolff AC, Ratner PA, Robinson SL, Oliffe JL, McGillis-Hall L (2010) Beyond generational differences: a literature review of the impact of relational diversity on nurses’ attitudes and work. J Nurs Manag 18(8):948–969
World Health Organization (WHO) (2007) Task shifting to tackle health worker shortages. https://www.who.int/healthsystems/task_shifting_booklet.pdf
World Health Organization (WHO) (2020) State of the world’s nursing 2020: investing in education, jobs and leadership. https://www.who.int/publications/i/item/9789240003279
World Health Professions Alliance (2008) Joint health professions statement on task shifting. https://www.whpa.org/news-resources/statements/joint-health-professions-statement-task-shifting
Zangaro GA, Streeter R, Li T (2018) Trends in racial and ethnic demographics of the nursing workforce: 2000 to 2015. Nurs Outlook 66(4):365–371
Zittel B, Moss E, O’Sullivan A, Siek T (2016) Registered Nurses as professionals: accountability for education and practice. Online J Issues Nurs 21(3). http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Registered-Nurses-as-Professionals.html
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Clarke, S.P. (2021). The Nurse Workforce. In: Baernholdt, M., Boyle, D.K. (eds) Nurses Contributions to Quality Health Outcomes. Springer, Cham. https://doi.org/10.1007/978-3-030-69063-2_3
Download citation
DOI: https://doi.org/10.1007/978-3-030-69063-2_3
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-69062-5
Online ISBN: 978-3-030-69063-2
eBook Packages: MedicineMedicine (R0)