Search tips
Search criteria 


Logo of hsresearchLink to Publisher's site
Health Serv Res. 2001 October; 36(5): 831–852.
PMCID: PMC1089263

Hospital registered nurse shortages: environmental, patient, and institutional predictors.


OBJECTIVE: To examine the characteristics of acute-care hospitals that report registered nurse shortages when a widespread shortage exists and when a widespread shortage is no longer evident. DATA SOURCE: Secondary data from the American Hospital Association's Nursing Personnel Survey from 1990 and 1992 were used. The study population was all acute-care hospitals in the United States. STUDY DESIGN: Outcome variables included whether a hospital experienced a shortage in 1990, when many hospitals reported a nursing shortage, or whether a hospital reported a shortage in both 1990 and 1992. Predictor variables included environmental, patient, and institutional characteristics. Associations between predictor and outcome variables were investigated using probit analyses. PRINCIPAL FINDINGS: Location in the South, a high percentage of nonwhite county residents, a high percentage of patients with Medicaid or Medicare as payer, a higher patient acuity, and use of team or functional nursing care delivery consistently predicted hospitals reporting shortages both when there was a widespread shortage and when there was no widespread shortage. CONCLUSIONS: Although some characteristics under the direct control of hospitals, such as nursing care delivery model, are associated with their reporting a shortage of nurses, shortage is also strongly associated with broader population characteristics such as minority communities and a public insurance payer mix. Awareness of these broader factors may help inform policies to improve the distribution of nurse supply.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.8M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Aiken LH. The hospital nursing shortage. A paradox of increasing supply and increasing vacancy rates. West J Med. 1989 Jul;151(1):87–92. [PMC free article] [PubMed]
  • Aiken LH, Mullinix CF. The nurse shortage. Myth or reality? N Engl J Med. 1987 Sep 3;317(10):641–646. [PubMed]
  • Aiken LH, Smith HL, Lake ET. Lower Medicare mortality among a set of hospitals known for good nursing care. Med Care. 1994 Aug;32(8):771–787. [PubMed]
  • Bernreuter ME, Goddard LR. Specialty maldistribution. The next nursing crisis? J Nurs Adm. 1994 Jan;24(1):11–15. [PubMed]
  • Buerhaus PI. Effects of RN wages and non-wage income on the performance of the hospital RN labor market. Nurs Econ. 1993 May-Jun;11(3):129–135. [PubMed]
  • Buerhaus PI. Capitalizing on the recession's effect on hospital RN shortages. Hosp Health Serv Adm. 1994 Spring;39(1):47–62. [PubMed]
  • Casey N. A significant shortage of qualified nurses in the NHS. Nurs Stand. 1996 Jan 17;10(17):3–3. [PubMed]
  • Davis B. Effective utilization of a scarce resource: RNs. Nurs Manage. 1994 Feb;25(2):78–80. [PubMed]
  • Dracup K, Bryan-Brown CW. One more critical care nursing shortage. Am J Crit Care. 1998 Mar;7(2):81–83. [PubMed]
  • Felton G. Increasing the quality of nursing care by introducing the concept of primary nursing: a model project. Nurs Res. 1975 Jan-Feb;24(1):27–32. [PubMed]
  • Friss L. Nursing studies laid end to end form a circle. J Health Polit Policy Law. 1994 Fall;19(3):597–631. [PubMed]
  • Ginzberg E. Improving health care for the poor. Lessons from the 1980s. JAMA. 1994 Feb 9;271(6):464–467. [PubMed]
  • Greene J, Nordhaus-Bike AM. Nurse shortage. Where have all the RNs gone? Hosp Health Netw. 1998 Aug 5;72(15-16):78–80. [PubMed]
  • Havens DS, Aiken LH. Shaping systems to promote desired outcomes. The magnet hospital model. J Nurs Adm. 1999 Feb;29(2):14–20. [PubMed]
  • Hoffart N, Woods CQ. Elements of a nursing professional practice model. J Prof Nurs. 1996 Nov-Dec;12(6):354–364. [PubMed]
  • Johnston CL. Changing care patterns and registered nurse job satisfaction. Holist Nurs Pract. 1997 Apr;11(3):69–77. [PubMed]
  • Friedman CP, Twarog RG, File DD, Youngblood PL, de Bliek R. Computer databases as an educational tool in the basic sciences. Acad Med. 1990 Jan;65(1):15–16. [PubMed]
  • Komaromy M, Grumbach K, Drake M, Vranizan K, Lurie N, Keane D, Bindman AB. The role of black and Hispanic physicians in providing health care for underserved populations. N Engl J Med. 1996 May 16;334(20):1305–1310. [PubMed]
  • Kovner C, Gergen PJ. Nurse staffing levels and adverse events following surgery in U.S. hospitals. Image J Nurs Sch. 1998;30(4):315–321. [PubMed]
  • Kramer M. The magnet hospitals. Excellence revisited. J Nurs Adm. 1990 Sep;20(9):35–44. [PubMed]
  • Minnick A, Roberts MJ, Curran CR, Ginzberg E. What do nurses want? Priorities for action. Nurs Outlook. 1989 Sep-Oct;37(5):214–218. [PubMed]
  • Montague J. Teamwork. Primary nursing pioneers. Hosp Health Netw. 1995 Dec 5;69(23):56–56. [PubMed]
  • Pathman DE, Konrad TR, Ricketts TC., 3rd The National Health Service Corps experience for rural physicians in the late 1980s. JAMA. 1994 Nov 2;272(17):1341–1348. [PubMed]
  • Prescott PA. Shortage of professional nursing practice: a reframing of the shortage problem. Heart Lung. 1989 Sep;18(5):436–443. [PubMed]
  • Relf M. Increasing job satisfaction and motivation while reducing nursing turnover through the implementation of shared governance. Crit Care Nurs Q. 1995 Nov;18(3):7–13. [PubMed]
  • Robertson JF, Herth KA, Cummings CC. Long-term care: retention of nurses. J Gerontol Nurs. 1994 Nov;20(11):4–10. [PubMed]
  • Rohrlach G. The shortage of theatre personnel--a crisis! Br J Theatre Nurs. 1997 Nov;7(8):39–41. [PubMed]
  • Scott JG, Sochalski J, Aiken L. Review of magnet hospital research: findings and implications for professional nursing practice. J Nurs Adm. 1999 Jan;29(1):9–19. [PubMed]
  • Shoemake A. Solutions to the home healthcare nursing shortage. Home Healthc Nurse. 1994 Jul-Aug;12(4):35–39. [PubMed]
  • Shogren E, Calkins A, Wilburn S. Restructuring may be hazardous to your health. Am J Nurs. 1996 Nov;96(11):64–66. [PubMed]
  • Shortell SM, Zimmerman JE, Rousseau DM, Gillies RR, Wagner DP, Draper EA, Knaus WA, Duffy J. The performance of intensive care units: does good management make a difference? Med Care. 1994 May;32(5):508–525. [PubMed]
  • Zander K. Second generation primary nursing. A new agenda. J Nurs Adm. 1985 Mar;15(3):18–24. [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust