Ulrike Muench

The Nursing Workforce in an Era of Health Care Reform

The importance of registered nurses is expected to increase under health care reform. Thanks to a surge in RN graduates, predicted workforce shortages have not materialized. But some uncertainties still threaten the sufficiency of the workforce in the future.

Implementation of a lifestyle program in primary care by nurse practitioners

Purpose: The purpose of this study is to describe the implementation process and participant satisfaction with a lifestyle program provided by nurse practitioners (NPs) in primary care to adults at risk for type 2 diabetes (T2D) compared to enhanced standard care. Data sources: A mixed‐method clinical trial design was used (n= 58). NPs were interviewed prior to beginning the program, at 3 months, and at completion of the program. NPs also completed a questionnaire on lifestyle counseling at baseline. Process data were collected on attendance, attrition, and intervention fidelity. Participants completed a satisfaction survey at completion of the program and a sub‐sample were interviewed at the end of the program. Conclusions: NPs reported that they felt well‐prepared and moderately effective in providing lifestyle change counseling. Participant attendance was high and in‐person sessions were implemented with good success. Participants in the lifestyle program were more satisfied with the program, reporting that the program was a good experience. Implications for practice: Implementation of a lifestyle program to prevent T2D in primary care is feasible and acceptable to NPs and participants. Developing a structured program may improve health outcomes.

Salary differences between male and female registered nurses in the United States.

Salary Differences Between Male and Female Registered Nurses in the United States Fifty years after the Equal Pay Act, the male-female salary gap has narrowed in many occupations.1 Yet pay inequality persists for certain occupations, including medicine and nursing. Studies have documented salary differences across clinical settings for diverse cohorts of physicians2,3 and higher salaries for male registered nurses (RNs).4-6 In nursing, analyses have not considered employment factors that could explain salary differences,6 have been cross-sectional,4,5 and have not been based on recent data. The objective of this study was to examine salaries of males and females in nursing over time and to include a more recent sample.

Nursing Testimony Before Congress, 1993-2011

This article describes nurses’ testimony before congressional committees between1993 and 2011. We address three questions: (a) How have trends in nurses’ testimony changed over time? (b) What do data reveal about nursing’s engagement with health policy issues on the congressional agenda? (c) How might the findings be useful in implementation of health care reform and the Institute of Medicine report on the Future of Nursing. Using LexisNexis® Congressional online database, we identified 434 nursing testimonies presented at congressional hearings. Descriptive statistics were used to examine characteristics of the nurse expert witnesses and the testimonies topics on which they testified. Nurses most frequently testified on workforce issues (36%), followed by access and coverage (14%). The majority of the nurse witnesses had graduate degrees 65% and lived and worked in fewer than 10 states. Nurses appeared before House or Senate appropriations committees 38% more often than before any other congressional committees. Our findings point to the need for additional research, especially given the crescendo of calls for nursing to step up to the political table. The article concludes with implications for future research and policy action.

California Nurse Practitioners Are Positioned To Fill The Primary Care Gap, But They Face Barriers To Practice

Nurse practitioners are well prepared to help fill care gaps arising from shortages of primary care physicians in California. This article reports findings from a survey of California nurse practitioners that examined their employment and practice barriers. The number of nurse practitioners per capita varies across California counties and is positively correlated with the number of physicians per capita. Hispanic and Filipino nurse practitioners are more likely to live in underserved areas. Nurse practitioners and their education programs are concentrated in the same counties that have high physician-to-population ratios. In these counties, recently graduated nurse practitioners are more likely to report that they plan to relocate to another state in the next five years. Expanding education programs in underserved areas, increasing the diversity of the nurse practitioner workforce, and ensuring that nurse practitioners feel empowered to fully use their skills are necessary to meet both current and future primary care needs.

The male-female earnings gap for nurses in Germany: A pooled cross-sectional study of the years 2006 and 2012

BACKGROUND Nursing is one of the largest occupations for women in every country. Evidence suggests a substantial male-female pay gap for registered nurses in the U.S., possibly contributing to disparities between genders more broadly. Differences in motivation and skills between men and women have long been considered important factors in the gender earnings gap, but these factors are difficult to measure. Because of country specific educational pathways and limited upward job mobility in Germany, nurses tend to be more homogenous in their motivation to work and their work skills compared to the U.S. OBJECTIVE To study male-female earnings in the nursing labor market in Germany. DESIGN This is a pooled cross-sectional study of survey data collected for the years 2006 and 2012. METHODS We used a representative survey of nurses (n = 828) who are active labor force participants. In a multivariate ordinary least squares regression, the analysis estimated the log of monthly earnings for male and female nurses. The full model accounted for demographic, human capital, and geographic characteristics, in addition to employment characteristics, such as hours worked, additional education obtained, years of nursing experience, years of labor market experience, career inactivity, years with the employer, and responsibilities at work, among other factors. We conducted follow-up analyses to test alternative explanations for the pay gap, examining earnings for nurses who no longer worked in nursing and testing potential differences in motivation with the likelihood of working nightshifts and length of time with current employer. RESULTS Unadjusted monthly earnings for full-time male nurses were 30% higher, or 700 Euros more, than monthly earnings for full-time female nurses. In the fully adjusted analysis, male nurses out-earned female nurses by approximately 9.3%, or 260 Euros per month. Follow-up analyses suggested that better outside options exist for male than female nurses in the German labor market, while we found no support for gender differences in motivation.

Projections of the Long-Term Growth of the Registered Nurse Workforce: A Regional Analysis.

Providing regional projections of the RN workforce will allow underlying differences in the age structure of the RN workforce to become more visible. By providing regional-level projections, it will also be possible to identify those regions whose RN workforce is expected to grow at a slower rate relative to other regions. States in the South and Midwest have a greater supply of younger-aged RNs available to replace fewer numbers of older-age RNs compared to other regions. In contrast, the Northeast and West have fewer younger RNs currently in their workforce yet a relatively larger number of older age RNs to replace. These differences in age structure may be partly due to differences in nursing school enrollment and expansion in nursing education capacity across regions. This information can help guide national and state health workforce planners, employers, educators, and others in developing policies and initiatives that may impact nursing supply in their states.