HRSA -

U.S. Department of Health and Human Services

What is Behind HRSA's Projected Supply, Demand, and Shortage of Registered Nurses?

VI. References

Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J., and Silber, J.H. (October 2002). Nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288(16): 1987–1993.

American Hospital Association. Hospital Statistics. Various years.

American Nurses Association. (2001). Analysis of American Nurses Association Staffing Survey. Presentation by Cornerstone Communications Group on February 6, 2001.

Askildsen, J.E., Baltagi, B.H., and Holmas, T.H. (2002). Will Increased Wages Reduce Shortage of Nurses? A Panel Data Analysis of Nurses’ Labor Supply. Unpublished manuscript. Available at <http://www.eco.rug.nl/~espe2002/Askildsen.pdf>. Accessed September 2004.

Buerhaus, P.I., Staiger, D.O., and Auerbach, D.I. (2000). Implications of an aging registered nurse workforce. Journal of the American Medical Association, 283(22): 2948–2954.

Bureau of Health Professions. (2001). The Registered Nurse Population, March 2000: Findings from the National Sample Survey of Registered Nurses.

Bureau of Health Professions. (2002). Projected Supply, Demand, and Shortages of Registered Nurses: 2000–2020.

Bureau of Health Professions. (2004). Nursing Supply Model: Technical Report and User Guide. Report prepared by The Lewin Group for the National Center for Health Workforce Analysis.

Bureau of Health Professions. (2004). Nursing Demand Model: Development and Baseline Projections. Report prepared by The Lewin Group for the National Center for Health Workforce Analysis.

Bureau of Health Professions. (2004). Nursing Demand Model User Guide. Report prepared by The Lewin Group for the National Center for Health Workforce Analysis.

Dumpe, M.L., Herman, J., and Young, S.W. (1998). Forecasting the nursing workforce in a dynamic healthcare market. Nursing Economics, 16(4): 170–179.

Fritz, M.S. (1999). The Nursing Demand-Based Requirements Forecasting Model. 10^th Federal Forecasters Conference, 1999: Papers and Proceedings.

Hogan, P.F., Dall, T.D., Smith, S.G., Mackin, P.C., Mackie, C.D., Darling, K.L., Harris, D.A., McCloy, R.A., and Statman, M.A. (1995). Conceptual Framework for Analyzing and Developing a Compensation System. Report prepared for the Eighth Quadrennial Review of Military Compensation Taskforce.

InterStudy, InterStudy Competitive Edge. Various years.

Lane, J., and Gohmann, S. (1995). Shortage or surplus: Economic and non-economic approaches to the analysis of nursing labor markets. Southern Economic Journal, 61: 644–654.

Minino, A.M., Arias, E., Kochanek, K.D., Murphy, S.L., and Smith, B.L. (September 2002). Deaths: Final data for 2000. National Vital Statistics Reports, 50(15), National Center for Health Statistics, Hyattsville, MD.

National Council of State Boards of Nursing, Inc. 2000 Licensure and Examination Statistics.

Prescott, P.A. (2000). The enigmatic nursing workforce. Journal of Nursing Administration, 30(2): 59–65.

Robinson, E.S., and Mee, C.L. (2003). Nursing 2003 Salary Survey. Nursing 2003, 33(10):50–53. <http://www.nursingcenter.com/home/index.asp>. Accessed September 2004.

Seago, J.A., Ash, M., Spetz, J., Coffman, J., and Grumbach, K. (2001). Hospital registered nurse shortages: Environmental, patient, and institutional predictors. Health Services Research, 36(5): 831–852.

Sloan, F.A., and Richupan, S. (1975). Short-run supply responses of professional nurses: A microanalysis. The Journal of Human Resources, 10(2):241-257.

Spetz, J. (1999). The effects of managed care and prospective payment on the demand for hospital nurses: Evidence from California. Health Services Research, 34(5): 993–1010.

Spetz, J., and Given, R. (2003). The future of the nurse shortage: will wage increases close the gap? Health Affairs, 22(6):199–206.

Appendix: State-Level Supply, Demand, and Shortage Projections

Exhibit A-1. Baseline FTE RN Supply, by State and Year, 2000 to 2020

STATE	SSRN Estimate	Projection				Change from 2000–2020
STATE	2000	2005	2010	2015	2020	Change from 2000–2020
AK	4,200	3,800	3,200	2,500	2,000	-52%
AL	29,900	33,700	36,600	38,200	39,100	31%
AR	16,400	18,100	19,300	19,800	19,900	21%
AZ	29,000	30,100	30,700	30,500	30,100	4%
CA	155,500	156,200	153,300	148,200	144,300	-7%
CO	28,100	28,300	27,200	25,100	23,000	-18%
CT	28,000	25,400	22,900	19,900	17,200	-39%
DC	7,300	6,900	6,500	5,900	5,400	-26%
DE	6,100	6,300	6,300	6,100	5,800	-5%
FL	108,100	111,100	112,000	110,200	106,600	-1%
GA	49,400	49,500	48,200	45,300	41,800	-15%
HI	7,200	7,700	7,900	8,100	8,200	14%
IA	25,200	26,300	26,600	26,000	25,000	-1%
ID	7,000	7,300	7,400	7,300	7,100	1%
IL	88,100	88,000	85,600	81,900	77,100	-12%
IN	41,400	41,800	41,600	40,400	38,500	-7%
KS	20,600	21,600	22,100	21,800	21,100	2%
KY	28,800	32,300	34,700	35,500	35,300	23%
LA	30,200	34,100	37,200	39,100	39,800	32%
MA	63,600	62,700	60,100	56,000	51,400	-19%
MD	36,400	36,500	35,600	33,800	31,800	-13%
ME	11,200	11,600	11,600	11,100	10,500	-6%
MI	70,000	72,400	72,000	68,900	66,000	-6%
MN	39,200	41,000	41,800	41,200	39,700	1%
MO	44,400	45,600	45,700	44,200	42,800	-4%
MS	18,400	20,900	22,600	23,600	23,800	29%
MT	6,400	6,500	6,500	6,300	5,900	-8%
NC	59,900	64,500	67,400	68,600	68,000	14%
ND	5,400	5,700	5,800	5,800	5,600	4%
NE	13,300	14,100	14,700	14,900	14,900	12%
NH	9,300	9,500	9,300	8,800	8,100	-13%
NJ	60,400	58,200	55,000	50,500	44,900	-26%
NM	9,600	10,500	11,000	11,300	11,500	20%
NV	9,000	9,300	9,200	8,700	8,100	-10%
NY	138,100	142,600	142,300	137,400	131,500	-5%
OH	86,900	89,300	88,900	85,500	79,700	-8%
OK	18,900	20,600	21,500	22,100	22,500	19%
OR	21,800	22,600	22,400	21,100	19,800	-9%
PA	111,800	105,900	99,200	90,600	80,400	-28%
RI	9,300	9,300	9,000	8,400	7,900	-15%
SC	23,400	25,100	25,900	26,200	26,000	11%
SD	7,000	7,600	7,900	7,900	7,800	11%
TN	40,900	42,700	42,800	41,800	40,100	-2%
TX	107,600	115,300	118,700	119,000	118,500	10%
UT	11,400	12,900	14,100	14,900	15,400	35%
VA	46,300	47,600	47,600	46,300	44,000	-5%
VT	4,900	5,000	4,800	4,400	4,000	-18%
WA	37,900	38,100	37,300	35,100	33,000	-13%
WI	41,300	42,900	43,300	42,200	40,100	-3%
WV	13,200	14,200	14,600	14,600	14,000	6%
WY	3,200	3,300	3,300	3,300	3,300	3%
U.S.^a	1,890,700	1,942,500	1,941,200	1,886,100	1,808,000	-4%

^a Due to rounding, national totals might fail to equal the sum across states.

Exhibit A-2. Baseline FTE RN Demand, by State and Year, 2000 to 2020

State	SSRN Estimate	Projection					Change from 2000–2020
State	1996	2000	2005	2010	2015	2020	Change from 2000–2020
AK	4,400	4,300	4,900	5,500	6,100	6,700	56%
AL	30,900	31,400	33,900	36,800	40,300	44,400	41%
AR	16,100	18,500	20,200	22,000	24,300	26,900	45%
AZ	28,900	34,000	38,700	43,200	48,500	54,700	61%
CA	159,500	165,500	178,700	200,900	228,900	260,900	58%
CO	27,500	30,000	34,000	38,100	42,500	47,500	58%
CT	28,200	30,200	31,800	34,000	36,600	39,600	31%
DC	8,500	8,800	8,900	9,500	10,200	11,000	25%
DE	5,800	6,400	7,000	7,600	8,100	8,800	38%
FL	107,300	115,500	129,300	144,700	164,300	187,800	63%
GA	48,700	52,800	58,400	64,600	71,600	79,500	51%
HI	8,200	10,000	11,100	12,400	13,900	15,700	57%
IA	24,400	27,100	28,600	30,000	31,800	34,100	26%
ID	6,000	6,200	7,300	8,200	9,200	10,500	69%
IL	88,400	85,200	89,600	94,900	101,300	109,000	28%
IN	40,800	43,000	46,600	49,800	53,500	57,400	33%
KS	19,000	20,200	21,500	23,100	24,900	27,000	34%
KY	26,900	29,200	31,200	33,500	36,300	39,400	35%
LA	30,700	31,800	34,200	37,100	40,600	44,600	40%
MA	59,900	68,300	71,700	76,200	81,700	87,800	29%
MD	38,300	36,800	39,400	42,600	46,100	50,000	36%
ME	11,400	12,400	13,100	14,100	15,300	16,800	35%
MI	69,100	67,700	71,300	75,100	79,600	84,300	25%
MN	35,400	39,200	42,600	46,200	50,400	55,300	41%
MO	45,000	51,600	54,900	58,600	63,100	68,200	32%
MS	18,700	19,900	21,400	23,100	25,400	28,000	41%
MT	5,800	5,500	6,300	7,000	7,800	8,800	60%
NC	54,400	61,500	68,400	75,500	83,700	92,900	51%
ND	5,900	5,800	6,200	6,700	7,300	8,000	38%
NE	13,400	14,800	15,900	17,100	18,500	20,200	36%
NH	9,800	10,500	11,500	12,600	13,800	15,100	44%
NJ	59,700	65,600	69,700	74,600	80,400	87,300	33%
NM	10,200	11,000	12,500	14,100	15,900	18,000	64%
NV	8,800	10,200	12,100	13,300	14,700	16,200	59%
NY	148,100	151,000	156,000	163,800	174,000	185,700	23%
OH	86,400	90,500	95,700	101,000	107,300	113,700	26%
OK	18,400	18,400	20,000	22,000	24,300	27,000	47%
OR	21,100	22,000	24,800	27,700	31,100	35,100	60%
PA	107,100	110,200	115,000	120,300	127,200	135,200	23%
RI	9,300	10,900	11,400	12,000	12,800	13,800	27%
SC	24,200	25,700	28,300	31,100	34,400	38,100	48%
SD	7,000	6,900	7,500	8,100	8,700	9,500	38%
TN	43,100	50,600	55,800	61,300	67,800	75,400	49%
TX	117,000	129,100	143,800	160,600	179,900	202,100	57%
UT	11,000	12,000	13,800	15,600	17,500	19,600	63%
VA	47,800	49,200	53,600	58,600	64,300	70,300	43%
VT	4,300	4,600	5,000	5,400	5,800	6,300	37%
WA	34,400	36,300	40,800	46,100	52,100	59,100	63%
WI	37,200	37,000	39,800	42,800	46,300	50,300	36%
WV	13,500	12,600	13,200	13,900	14,700	15,700	25%
WY	3,500	3,500	4,000	4,500	5,100	5,800	66%
U.S.^a	1,889,300	2,001,500	2,161,300	2,347,000	2,569,800	2,824,900	41%

^a Due to rounding, national totals might fail to equal the sum across states.

Exhibit A-3. Baseline FTE RN Supply and Demand, 2000 and 2005

State	2000				2005
State	Supply	Demand	Supply - Demand	Supply ÷ Demand	Supply	Demand	Supply - Demand	Supply ÷ Demand
AK	4,200	4,300	-100	98%	3,800	4,900	-1,100	78%
AL	29,900	31,400	-1,500	95%	33,700	33,900	-200	99%
AR	16,400	18,500	-2,100	89%	18,100	20,200	-2,100	90%
AZ	29,000	34,000	-5,000	85%	30,100	38,700	-8,600	78%
CA	155,500	165,500	-10,000	94%	156,200	178,700	-22,500	87%
CO	28,100	30,000	-1,900	94%	28,300	34,000	-5,700	83%
CT	28,000	30,200	-2,200	93%	25,400	31,800	-6,400	80%
DC	7,300	8,800	-1,500	83%	6,900	8,900	-2,000	78%
DE	6,100	6,400	-300	95%	6,300	7,000	-700	90%
FL	108,100	115,500	-7,400	94%	111,100	129,300	-18,200	86%
GA	49,400	52,800	-3,400	94%	49,500	58,400	-8,900	85%
HI	7,200	10,000	-2,800	72%	7,700	11,100	-3,400	69%
IA	25,200	27,100	-1,900	93%	26,300	28,600	-2,300	92%
ID	7,000	6,200	800	113%	7,300	7,300	0	100%
IL	88,100	85,200	2,900	103%	88,000	89,600	-1,600	98%
IN	41,400	43,000	-1,600	96%	41,800	46,600	-4,800	90%
KS	20,600	20,200	400	102%	21,600	21,500	100	100%
KY	28,800	29,200	-400	99%	32,300	31,200	1,100	104%
LA	30,200	31,800	-1,600	95%	34,100	34,200	-100	100%
MA	63,600	68,300	-4,700	93%	62,700	71,700	-9,000	87%
MD	36,400	36,800	-400	99%	36,500	39,400	-2,900	93%
ME	11,200	12,400	-1,200	90%	11,600	13,100	-1,500	89%
MI	70,000	67,700	2,300	103%	72,400	71,300	1,100	102%
MN	39,200	39,200	0	100%	41,000	42,600	-1,600	96%
MO	44,400	51,600	-7,200	86%	45,600	54,900	-9,300	83%
MS	18,400	19,900	-1,500	92%	20,900	21,400	-500	98%
MT	6,400	5,500	900	116%	6,500	6,300	200	103%
NC	59,900	61,500	-1,600	97%	64,500	68,400	-3,900	94%
ND	5,400	5,800	-400	93%	5,700	6,200	-500	92%
NE	13,300	14,800	-1,500	90%	14,100	15,900	-1,800	89%
NH	9,300	10,500	-1,200	89%	9,500	11,500	-2,000	83%
NJ	60,400	65,600	-5,200	92%	58,200	69,700	-11,500	84%
NM	9,600	11,000	-1,400	87%	10,500	12,500	-2,000	84%
NV	9,000	10,200	-1,200	88%	9,300	12,100	-2,800	77%
NY	138,100	151,000	-12,900	91%	142,600	156,000	-13,400	91%
OH	86,900	90,500	-3,600	96%	89,300	95,700	-6,400	93%
OK	18,900	18,400	500	103%	20,600	20,000	600	103%
OR	21,800	22,000	-200	99%	22,600	24,800	-2,200	91%
PA	111,800	110,200	1,600	101%	105,900	115,000	-9,100	92%
RI	9,300	10,900	-1,600	85%	9,300	11,400	-2,100	82%
SC	23,400	25,700	-2,300	91%	25,100	28,300	-3,200	89%
SD	7,000	6,900	100	101%	7,600	7,500	100	101%
TN	40,900	50,600	-9,700	81%	42,700	55,800	-13,100	77%
TX	107,600	129,100	-21,500	83%	115,300	143,800	-28,500	80%
UT	11,400	12,000	-600	95%	12,900	13,800	-900	93%
VA	46,300	49,200	-2,900	94%	47,600	53,600	-6,000	89%
VT	4,900	4,600	300	107%	5,000	5,000	0	100%
WA	37,900	36,300	1,600	104%	38,100	40,800	-2,700	93%
WI	41,300	37,000	4,300	112%	42,900	39,800	3,100	108%
WV	13,200	12,600	600	105%	14,200	13,200	1,000	108%
WY	3,200	3,500	-300	91%	3,300	4,000	-700	83%
U.S.^a	1,890,700	2,001,500	-110,800	94%	1,942,500	2,161,300	-218,800	90%

^a Due to rounding, national totals might fail to equal the sum across states.

Exhibit A-4. Baseline FTE RN Supply and Demand, 2010 and 2015

State	2010				2015
State	Supply	Demand	Supply - Demand	Supply ÷ Demand	Supply	Demand	Supply - Demand	Supply ÷ Demand
AK	3,200	5,500	-2,300	58%	2,500	6,100	-3,600	41%
AL	36,600	36,800	-200	99%	38,200	40,300	-2,100	95%
AR	19,300	22,000	-2,700	88%	19,800	24,300	-4,500	81%
AZ	30,700	43,200	-12,500	71%	30,500	48,500	-18,000	63%
CA	153,300	200,900	-47,600	76%	148,200	228,900	-80,700	65%
CO	27,200	38,100	-10,900	71%	25,100	42,500	-17,400	59%
CT	22,900	34,000	-11,100	67%	19,900	36,600	-16,700	54%
DC	6,500	9,500	-3,000	68%	5,900	10,200	-4,300	58%
DE	6,300	7,600	-1,300	83%	6,100	8,100	-2,000	75%
FL	112,000	144,700	-32,700	77%	110,200	164,300	-54,100	67%
GA	48,200	64,600	-16,400	75%	45,300	71,600	-26,300	63%
HI	7,900	12,400	-4,500	64%	8,100	13,900	-5,800	58%
IA	26,600	30,000	-3,400	89%	26,000	31,800	-5,800	82%
ID	7,400	8,200	-800	90%	7,300	9,200	-1,900	79%
IL	85,600	94,900	-9,300	90%	81,900	101,300	-19,400	81%
IN	41,600	49,800	-8,200	84%	40,400	53,500	-13,100	76%
KS	22,100	23,100	-1,000	96%	21,800	24,900	-3,100	88%
KY	34,700	33,500	1,200	104%	35,500	36,300	-800	98%
LA	37,200	37,100	100	100%	39,100	40,600	-1,500	96%
MA	60,100	76,200	-16,100	79%	56,000	81,700	-25,700	69%
MD	35,600	42,600	-7,000	84%	33,800	46,100	-12,300	73%
ME	11,600	14,100	-2,500	82%	11,100	15,300	-4,200	73%
MI	72,000	75,100	-3,100	96%	68,900	79,600	-10,700	87%
MN	41,800	46,200	-4,400	90%	41,200	50,400	-9,200	82%
MO	45,700	58,600	-12,900	78%	44,200	63,100	-18,900	70%
MS	22,600	23,100	-500	98%	23,600	25,400	-1,800	93%
MT	6,500	7,000	-500	93%	6,300	7,800	-1,500	81%
NC	67,400	75,500	-8,100	89%	68,600	83,700	-15,100	82%
ND	5,800	6,700	-900	87%	5,800	7,300	-1,500	79%
NE	14,700	17,100	-2,400	86%	14,900	18,500	-3,600	81%
NH	9,300	12,600	-3,300	74%	8,800	13,800	-5,000	64%
NJ	55,000	74,600	-19,600	74%	50,500	80,400	-29,900	63%
NM	11,000	14,100	-3,100	78%	11,300	15,900	-4,600	71%
NV	9,200	13,300	-4,100	69%	8,700	14,700	-6,000	59%
NY	142,300	163,800	-21,500	87%	137,400	174,000	-36,600	79%
OH	88,900	101,000	-12,100	88%	85,500	107,300	-21,800	80%
OK	21,500	22,000	-500	98%	22,100	24,300	-2,200	91%
OR	22,400	27,700	-5,300	81%	21,100	31,100	-10,000	68%
PA	99,200	120,300	-21,100	82%	90,600	127,200	-36,600	71%
RI	9,000	12,000	-3,000	75%	8,400	12,800	-4,400	66%
SC	25,900	31,100	-5,200	83%	26,200	34,400	-8,200	76%
SD	7,900	8,100	-200	98%	7,900	8,700	-800	91%
TN	42,800	61,300	-18,500	70%	41,800	67,800	-26,000	62%
TX	118,700	160,600	-41,900	74%	119,000	179,900	-60,900	66%
UT	14,100	15,600	-1,500	90%	14,900	17,500	-2,600	85%
VA	47,600	58,600	-11,000	81%	46,300	64,300	-18,000	72%
VT	4,800	5,400	-600	89%	4,400	5,800	-1,400	76%
WA	37,300	46,100	-8,800	81%	35,100	52,100	-17,000	67%
WI	43,300	42,800	500	101%	42,200	46,300	-4,100	91%
WV	14,600	13,900	700	105%	14,600	14,700	-100	99%
WY	3,300	4,500	-1,200	73%	3,300	5,100	-1,800	65%
U.S.^a	1,941,200	2,347,000	-405,800	83%	1,886,100	2,569,800	-683,700	73%

^a Due to rounding, national totals might fail to equal the sum across states.

Exhibit A-5. Baseline FTE RN Supply and Demand, 2020

State	2020
State	Supply	Demand	Supply - Demand	Supply ÷ Demand
AK	2,000	6,700	-4,700	30%
AL	39,100	44,400	-5,300	88%
AR	19,900	26,900	-7,000	74%
AZ	30,100	54,700	-24,600	55%
CA	144,300	260,900	-116,600	55%
CO	23,000	47,500	-24,500	48%
CT	17,200	39,600	-22,400	43%
DC	5,400	11,000	-5,600	49%
DE	5,800	8,800	-3,000	66%
FL	106,600	187,800	-81,200	57%
GA	41,800	79,500	-37,700	53%
HI	8,200	15,700	-7,500	52%
IA	25,000	34,100	-9,100	73%
ID	7,100	10,500	-3,400	68%
IL	77,100	109,000	-31,900	71%
IN	38,500	57,400	-18,900	67%
KS	21,100	27,000	-5,900	78%
KY	35,300	39,400	-4,100	90%
LA	39,800	44,600	-4,800	89%
MA	51,400	87,800	-36,400	59%
MD	31,800	50,000	-18,200	64%
ME	10,500	16,800	-6,300	63%
MI	66,000	84,300	-18,300	78%
MN	39,700	55,300	-15,600	72%
MO	42,800	68,200	-25,400	63%
MS	23,800	28,000	-4,200	85%
MT	5,900	8,800	-2,900	67%
NC	68,000	92,900	-24,900	73%
ND	5,600	8,000	-2,400	70%
NE	14,900	20,200	-5,300	74%
NH	8,100	15,100	-7,000	54%
NJ	44,900	87,300	-42,400	51%
NM	11,500	18,000	-6,500	64%
NV	8,100	16,200	-8,100	50%
NY	131,500	185,700	-54,200	71%
OH	79,700	113,700	-34,000	70%
OK	22,500	27,000	-4,500	83%
OR	19,800	35,100	-15,300	56%
PA	80,400	135,200	-54,800	59%
RI	7,900	13,800	-5,900	57%
SC	26,000	38,100	-12,100	68%
SD	7,800	9,500	-1,700	82%
TN	40,100	75,400	-35,300	53%
TX	118,500	202,100	-83,600	59%
UT	15,400	19,600	-4,200	79%
VA	44,000	70,300	-26,300	63%
VT	4,000	6,300	-2,300	63%
WA	33,000	59,100	-26,100	56%
WI	40,100	50,300	-10,200	80%
WV	14,000	15,700	-1,700	89%
WY	3,300	5,800	-2,500	57%
U.S.^a	1,808,000	2,824,900	-1,016,900	64%

^a Due to rounding, national totals might fail to equal the sum across states.

[1] The modeling and resulting projections used in this paper were developed under contract DHHS-250-01-0001 with the Lewin Group. Tim Dall, Lewin Group, was the principal investigator for the contract. This paper was prepared in a joint effort by Marilyn B. Biviano, Steve Tise, Marshall Fritz and William Spencer. Additional information on these models,
projections from these models, and the data and assumptions are available in other reports: Projected Supply, Demand, and Shortages of Registered Nurses:2000–2020 (BHPr, 2002),
NSM: Technical Report and User Guide (BHPr, 2004), NDM: Development and Baseline Projections (BHPr, 2004), and NDM User Guide (BHPr, 2004).

[2] The U.S. Census Bureau’s projections were developed before the 2000 Census and underestimated the U.S. population in 2000. Consequently, we adjusted the projections to reflect this undercount. Men continue to constitute a small percentage of the RN workforce, doubling from approximately 2.7% in 1980 to 5.4% in 2000 (BHPr, 2001). As the proportion of RNs who are male grows, the NSM might have to add a gender component to track difference in workforce participation patterns and retirement rates between male and female RNs.

[3] The data, methods, and assumptions used to calculate baseline demand projections are described in Section III .

[4] An annual survey of RN salaries finds that RN hourly earnings increased by nearly 7%, on average, between 2002 and 2003 (Robinson and Mee, 2003).

[5] NDM Development and Baseline Projections (NCHWA, forthcoming), NDM User’s Guide (NCHWA, forthcoming), and The Nursing Demand–Based Requirements Forecasting Model (Fritz, 1999).

[6] To estimate per capita use of healthcare services, we use the 1996 Health Cost Utilization Project (HCUP) database for hospital inpatient services, 1996 National Hospital Ambulatory Care Survey (NHAMCS) for hospital outpatient and emergency services, 1997 National Nursing Home Survey (NNHS) for nursing facilities, and 1995 National Home and Hospice Care Survey (NHHCS) for home health. See Section 0 for a discussion of the choice of 1996 as the base year.

[7] Estimates of actual use of healthcare services come from multiple sources. The American Hospital Association (AHA) provides state-level estimates of inpatient days, outpatient visits, and emergency visits. The American Health Care Association (AHCA) provides state-level estimates of residents in nursing facilities. State-level estimates of home health visits were constructed using data from the Centers for Medicaid and Medicare Services (CMS) and other sources.

[8] Preliminary analyses to control for heteroskedasticity included the estimation of “difference-in-differences” models, using regression analysis, to control for state fixed effects. In these regressions, both the dependent and exogenous variables are transformed so the estimate for each state in a particular year is that year’s deviation from the state’s multiyear average. One important limitation of the difference-in-differences approach is that it eliminates cross-state variation in the dependent and exogenous variables, which is an important source of information for estimating the relationship between healthcare use and its determinants. For example, HMO enrollment rates vary substantially across states, but in a given state might change little over the few years included in the regression analysis. Many of the exogenous variables that were statistically significant in the difference-in-differences models are the same variables used in the NDM’s final projection equations.

[9] The HMO variable (and assessment trend) is included as a proxy for factors that make clinicians and consumers more cost-conscious, whether that be through the application of managed care principles or out-of-pocket costs such as co-pay and deductibles.

[10] The ability of healthcare providers to substitute lower-cost nurses for higher-cost nurses is more than simply an economic phenomenon; rather, it also reflects legal and quality considerations. RNs receive special training that enables them to provide certain services that LPNs cannot provide. Thus, in only a limited range could substitution be made without jeopardizing healthcare delivery quality.

[11] Lane and Gohmann estimate nurse supply and demand simultaneously using two approaches: (1) a two-stage least squares model and (2) a “switching” model that relaxes the assumption that the market for hospital nurses is in equilibrium. The authors report an own-wage elasticity of demand of -1.14 when using the two-stage least squares model, but they believe the estimate of -0.92 from the switching model to be more accurate.