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Managed care and the nurse workforce

P I Buerhaus1, D O Staiger

  • 1Harvard Nursing Research Institute, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA.

JAMA
|November 13, 1996
PubMed
Summary

Managed care influenced nursing employment trends, leading to slower growth in hospitals and a shift to nonhospital jobs. However, its impact on nurse earnings was less significant than other economic factors.

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Area of Science:

  • Health Services Research
  • Nursing Economics
  • Healthcare Workforce Studies

Background:

  • The healthcare landscape has seen significant shifts due to managed care.
  • Understanding the impact on the nursing workforce is crucial for policy and practice.
  • Previous research has explored workforce trends, but recent data on managed care's specific influence is needed.

Purpose of the Study:

  • To analyze national employment and earnings trends for nursing personnel from 1983 to 1994.
  • To investigate the association between managed care penetration and changes in nursing employment and wage growth.

Main Methods:

  • Retrospective analysis of US Bureau of the Census Current Population Surveys (1983-1994).
  • Comparison of employment and earnings trends in states with high versus low Health Maintenance Organization (HMO) enrollment.
  • Focus on registered nurses (RNs), licensed practical nurses (LPNs), and nurse aides.

Main Results:

  • Overall growth in RN employment (37%) and wages (22%) from 1983-1994.
  • Early 1990s saw stagnant RN wages and a shift to nonhospital settings like home health care.
  • High HMO enrollment correlated with slower RN and LPN employment growth and a stronger shift from hospital jobs.

Conclusions:

  • Managed care is linked to reduced hospital employment growth for RNs and a move to nonhospital roles.
  • The overall effect of managed care on nursing personnel earnings was modest and overshadowed by broader economic forces.

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