Journal List > J Korean Acad Nurs > v.43(1) > 1002922

TOOLS
Park, Seo, and Lee: Structure of Nurse Labor Market and Determinants of Hospital Nurse Staffing Levels
Original Article
Journal of Korean Academy of Nursing

Journal of Korean Academy of Nursing 2013; 43(1): 39-49.

Published online: 28 February 2013

DOI: https://doi.org/10.4040/jkan.2013.43.1.39

Structure of Nurse Labor Market and Determinants of Hospital Nurse Staffing Levels

Bohyun Park1, Sukyung Seo2, Taejin Lee3

1Department of Nursing, Kimcheon Science College, Gimcheon, Korea.

2BK21 Center for Elderly Health Policy Research, Seoul National University, Seoul, Korea.

3Graduate School of Public Health, Seoul National University, Seoul, Korea.

Address reprint requests to: Lee, Taejin. Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742, Korea. Tel: +82-2-880-2726, Fax: +82-2-762-9105, tjlee@snu.ac.kr

Received 30 May 2012       Accepted 26 September 2012

© 2013 Korean Society of Nursing Science

Abstract

Purpose

To analyze the structure of Korean nurse labor market and examine its effect on hospital nurse staffing.

Methods

Secondary data were obtained from Statistics Korea, Education Statistics, and Health Insurance Review & Assessment Service and Patient Survey. Intensity of monopsony in the nurse labor market was measured by Herfindahl Hirshman Index (HHI). Hospital nurse staffing level was divided into high and low. While controlling for confounding factors such as inpatient days and severity mix of patients, effects of characteristics of nurse labor markets on nurse staffing levels were examined using multi-level logistic regressions.

Results

For characteristics of nurse labor markets, metropolitan areas had high intensity of monopsony, while the capital area had competitive labor market and the unemployed nurse rate was higher than other areas. Among hospital characteristics, bed occupancy rate was significantly associated with nurse staffing levels. Among characteristics of nurse labor markets, the effect of HHI was indeterminable.

Conclusion

The Korean nurse labor market has different structure between the capital and other metropolitan areas. But the effect of the structure of nurse labor market on nurse staffing levels is indeterminable. Characteristics such as occupancy rate and number of beds are significantly associated with nurse staffing levels. Further study in support of the effect of nurse labor market is needed.

Keywords: Nursing staff, Economics, Nursing, Health care sector, Hospitals

Figures and Tables

Table 1
Definition of Variables and Data Sources
jkan-43-39-i001

Note: Capitalize all of the above names.

HIRA=Healthcare insurance review & assessment service; HHI=Herfindahl Hirshman index; KRINP=The Korean research institute for nursing policy; KOSIS=Korean statistical information service; CMI=Case mix index.

Table 2
Demand and Supply for Nurses by Region
jkan-43-39-i002

HHI=Herfindahl Hirshman index; RN=Registered nurse.

Table 3
Wage of Nurses by Hospital Characteristics
jkan-43-39-i003

*10,000 won/year; **Duncan grouping: a>b, c>d; †General hospital: 1st-2nd grade, Tertiary hospital: 3rd grade or higher; ‡General hospital: 3rd-5th grade, Tertiary hospital: 4-6th grade.

Table 4
Hospital and Environmental Characteristics by Nurse Staffing Level
jkan-43-39-i004

*Fisher's exact test; CMI=Case mix index; HHI=Herfindahl Hirshman index; RN=Registered nurse.

Table 5
Determinants of Hospital Nurse Staffing Levels (Dependent variable: High nurse grade)
jkan-43-39-i005

OR=Odds ratio; CMI=Case mix index; HHI=Herfindahl Hirshman index; ICC=Intraclass correlation.

*HHI was calculated on the basis of hospital's nurse share in their labor market(HHI_RN).

Notes

This manuscript is based on a part of the first author's doctoral dissertation from Seoul National University.

This study was supported by the research fund of the Korea Health & Medical Worker's Union in 2011.

References

1. Adamache KW, Sloan FA. Unions and hospitals: Some unresolved issues. J Health Econ. 1982. 1(1):81–108.
2. Bhaskar V, Manning A, To T. Oligopsony and monopsonistic competition in labor markets. J Econo Perspect. 2002. 16(2):155–174. http://dx.doi.org/10.1257/0895330027300.
3. Blegen MA, Goode CJ, Reed L. Nurse staffing and patient outcomes. Nurs Res. 1998. 47(1):43–50. http://dx.doi.org/10.1097/00006199-199801000-00008.
4. Blegen MA, Vaughn T, Vojir CP. Nurse staffing levels: Impact of organizational characteristics and registered nurse supply. Health Serv Res. 2008. 43(1):154–173. http://dx.doi.org/10.1111/j.1475-6773.2007.00749.x.
5. Bloom JR, Alexander JA, Nuchols BA. Nurse staffing patterns and hospital efficiency in the United States. Soc Sci Med. 1997. 44(2):147–155. http://dx.doi.org/10.1016/S0277-9536(96)00063-9.
6. Brewer CS, Frazier P. The influence of structure, staff type, and managed-care indicators on registered nurse staffing. J Nurs Adm. 1998. 28(9):28–36. http://dx.doi.org/10.1097/00005110-199809000-00007.
7. Cho SH, June KJ, Kim YM, Park BH. Changes in hospital nurse staffing after implementing differentiated inpatient nursing fees by staffing grades. J Korean Acad Nurs Adm. 2008. 14(2):167–175.
8. Cho WH. Labor economics: Theory and reform policy. 1999. Paju: Bobmunsa.
9. Dickens WT, Lang K. Neoclassical and sociological perspectives on segmented labor markets. 1987. Cambridge: National Bureau of Economic Research.
10. Feldman R, Scheffler R. The union impact on hospital wages and fringe benefits. Ind Labor Relat Rev. 1982. 35(2):196–206. http://dx.doi.org/10.2307/2522318.
11. Greene J, Nordhaus-Bike AM. Nurse shortage. Where have all the RNs gone? Hosp Health Netw. 1998. 72(15-16):78. 80.
12. Grumbach K, Ash M, Seago JA, Spetz J, Coffman J. Measuring shortages of hospital nurses: How do you know a hospital with a nursing shortage when you see one? Med Care Res Rev. 2001. 58(4):387–403. http://dx.doi.org/10.1177/107755870105800401.
13. Hirsch BT, Schumacher EJ. Classic or new monopsony? Searching for evidence in nursing labor markets. J Health Econ. 2005. 24(5):969–989. http://dx.doi.org/10.1016/j.jhealeco.2005.03.006.
14. Hodge MB, Romano PS, Harvey D, Samuels SJ, Olson VA, Sauvé MJ, et al. Licensed caregiver characteristics and staffing in California acute care hospital units. J Nurs Adm. 2004. 34(3):125–133. http://dx.doi.org/10.1097/00005110-200403000-00005.
15. Jeong HJ, Yang BM. Monopsony power of general hospitals in nurse labor market. Korean J Hosp Manage. 2000. 5(2):40–58.
16. Kim YM, Cho SH, Jun KJ, Go SH. The effects of institutional and market factors on nurse staffing in acute care hospitals. Korean J Health Policy Adm. 2007. 17(2):68–90.
17. Kim YM, June KJ, Cho SH. Factors related to nurse staffing levels in tertiary and general hospitals. J Korean Acad Nurs. 2005. 35(8):1493–1499.
18. Mark BA, Jones CB, Lindley L, Ozcan YA. An examination of technical efficiency, quality, and patient safety in acute care nursing units. Policy Polit Nurs Pract. 2009. 10(3):180–186. http://dx.doi.org/10.1177/1527154409346322.
19. Miller RA. The herfindahl-hirschman index as a market structure variable: An exposition for antitrust practitioners. Antitrust Bull. 1982. 27(3):593–618.
20. Ministry of Health & Welfare. OECD health data. 2008. Retrieved May 2, 2008. from http://stat.mw.go.kr/front/statData/publicationView.jsp?menuId=43&bbsSeq=9&nttSeq=13157&searchKey=&searchWord=&nPage=2.
21. Mullner R, Beyers M, Levy P, Byre C, Mallin K. Community hospital characteristics associated with RN and LPN vacancy rates. Soc Sci Med. 1983. 17(15):1055–1059. http://dx.doi.org/10.1016/027 7-9536(83)90411-2.
22. Oh YH. Distributional change in major health manpower in Korea, 2000-2006. Health Welf Policy Forum. 2008. 139:98–110.
23. Peterson CA. Nursing shortage: Not a simple problem-no easy answers. Online J Issues Nurs. 2001. 6(1):1.
24. Robinson JC. Market structure, employment, and skill mix in the hospital industry. South Econ J. 1988. 55(2):315–325. http://dx.doi.org/10.2307/1059105.
25. Seago JA, Ash M, Spetz J, Coffman J, Grumbach K. Hospital registered nurse shortages: Environmental, patient, and institutional predictors. Health Serv Res. 2001. 36(5):831–852.
26. Staiger DO, Spetz J, Phibbs CS. Is there monopsony in the labor market? Evidence form a natural experiment. J Labor Econ. 2010. 28(2):211–236.
27. Sullivan D. Monopsony power in the market for nurses. J Law Econ. 1989. 32(2):S135–S179. http://dx.doi.org/10.1086/467192.
28. Yett DE. An analysis of the causes and consequences of salary differentials in nursing. Econ Inq. 1966. 5(1):103. http://dx.doi.org/10.1111/j.1465-7295.1966.tb01990.x.
TOOLS
Similar articles