The Impact of the COVID-19 Pandemic on Registered Nurse Employment Across Settings

It is unknown whether the stress of the COVID-19 pandemic, which had a particular impact on inpatient and long-term care (LTC) nurses, had an effect on nurses' choice of employment settings.

Determine whether the COVID-19 pandemic contributed to changes in nurses' choice of employment setting.

This study used data from the 2018 and 2022 National Sample Survey of Registered Nurses to conduct a difference-in-difference analysis. We constructed a state-level measure of COVID-19 caseload, defined as COVID-19 cases per hospital bed; High versus Low COVID-19 states were defined as those above versus below the median, respectively. Logistic regression models were used to estimate the effect of exposure to High COVID-19 caseload (vs. Low) and time (2022 vs. 2018) on nurse employment choices across inpatient, LTC, outpatient, and nonclinical settings.

From 2018 to 2022, the size of the US nursing workforce grew from 3.27 to 3.57 million nurses; however, RN FTEs increased in outpatient settings and decreased in all other settings. In adjusted analyses, nurses were less likely to work in LTC settings in 2022 than in 2018; yet, those exposed to High COVID-19 caseloads were 0.9% (95% CI: 0.3-1.5) more likely to work in LTC than those exposed to Low COVID-19 caseloads. Differences between High versus Low COVID-19 caseload exposure were not statistically significant for the likelihood of working in inpatient, outpatient, and nonclinical settings.

Our findings suggest that exposure to High COVID-19 caseload was not associated with changes in nurses' employment settings.