Publications

OBJECTIVE: The author reviews the causes of nursing shortages and surpluses and
examines data from California hospitals to demonstrate how these cycles are
expressed in the demand for and wages of nurses.

BACKGROUND: Nursing shortages have been reported cyclically for more than 50
years in the United States. There has been little data analysis demonstrating the
relationship between the current shortage and changes in wages and nurse
staffing.

METHODS: Analysis of longitudinal hospital and patient data from the California
Office of Statewide Health Planning and Development. Summary statistics of
patient utilization, nurse staffing, and nurse wages were computed.

RESULTS: The data demonstrate that cyclical shortages are accompanied by higher
wages and employment. This has been true in recent years. However, in
medical-surgical units, hours per patient day declined between 2001 and 2002,
perhaps reflecting the inability of hospitals to find more nurses to meet
staffing goals.

CONCLUSIONS: Nurse staffing per patient day and per discharge have remained
stable, despite concerns about low staffing levels. Improved measures of patient 
care needs and studies of the precise staffing requirements for different types
of patients and configurations of staff are required to make recommendations
about staffing and policy.