Managed care has hurt the growth of registered-nurse employment and earnings, according to a study published in the January-February edition of Health Affairs.
The study used the Census Bureau's Current Population Survey to compare nursing with other occupations.
Employment of registered nurses and nurses aides boomed from 1983 to 1994, growing twice as fast as other occupations. Wages improved markedly. But since 1994, employment growth for registered nurses has been half as strong. The authors attribute the slowdown to a lack of employment growth in hospitals. From 1994 to 1997, real wages for registered nurses declined 1.5% per year.
However, employment growth for licensed practical nurses and aides improved in that period, suggesting that hospitals substituted less-skilled personnel for registered nurses. Even so, registered-nurse staffing per hospital bed has risen since 1994.
In states with high managed-care penetration, growth in nurse employment tapered off starting in 1990. That trend spread to low-penetration states around 1994. But between 1996 and 1997, nursing employment surged 8.2% in high managed-care states, led by hospital employment. The report suggests that hospitals realized they might have reduced nurse staffing too much, given the increase in patient acuity.
"I don't think we can necessarily let this study stand alone, to say managed care is the ultimate culprit (for) the decrease in nurses' salaries and employment," said Sara Foer, spokeswoman for the American Nurses Association.
The study concludes that the slowdown in registered-nurse employment was a transitional stage while hospitals downsized to increase efficiency. As high-HMO regions pass through this period, they resume hiring more nurses.