This paper examines the relationship between registered nurse compensation and the persistent nursing shortage in the United States, with a particular focus on Florida. Drawing on government reports, salary databases, and peer-reviewed research, the paper argues that wage levels are a critical yet underexamined driver of nurse recruitment and retention. It proposes a quantitative survey-based study design targeting nursing schools, professional associations, and hospitals, with data to be analyzed using Bayesian network modeling. The paper concludes that substantial, sustained wage increases are necessary to close the nursing gap and calls for dissemination of findings through professional journals and nursing conferences.
In the decade between 2004 and 2014, the estimated number of open positions for registered nurses was anticipated to reach 2.1 million. This number reflects both attrition and the growth of the healthcare and medical fields responding to an aging national population. Best practices in staff recruiting in the medical arena call for an "adequate supply of nurses and high-quality patient care through competitive, transparent wage-setting, collective bargaining, and nurse/patient ratio standards" (Lovell, 2006).
An interesting phenomenon has emerged in research on the state of nursing in the United States: just over 20 percent of the nearly 50 studies conducted to analyze the nursing workforce recommended wage increases in order to attract more nurses into professional preparation programs and into the workforce. The U.S. Government Accountability Office conducted a study to look critically at the key factors influencing the emerging nurse shortage, which is particularly evident in hospitals across the country. The study concluded that "inadequate staffing, heavy workloads, the increased use of overtime, a lack of sufficient support staff, and the adequacy of wages" all played a substantive part in local efforts to recruit and employ nurses. Clearly, as these studies have been articulated, what has been overlooked to an astonishing degree is the link between the number of workers seeking a job and the wages offered for those jobs. Economists generally argue that the linkage between wages and the number of job seekers is a key driver of labor markets.
A number of studies conducted by commercial websites such as Salary.com and PayScale have demonstrated that considerable variation exists in the salaries and working conditions for registered nurses across study locations. The salary information is clear enough when it comes to describing the differential pay received by nursing staff under disparate working conditions, but it does not clarify the very real differences seen in job performance and work requirements — differences that translate into the salary variations observed. As a case in point, PayScale reports that the average national annual salary for registered nurses ranges from $40,847 to $78,905. National hourly rates for registered nurses vary widely by work type and location of service provision, with an average hourly rate of $19.78 to $36.25. National average overtime rates for registered nurses range from $16.31 to $55.46.
The state of Florida shows a fairly consistent midrange compensation for registered nurses, with an average annual salary of $61,942 in Orlando and $64,829 in Miami. Although these figures are useful for career guidance and similar purposes, they do not provide enough detail to guide labor action in individual states. A more comprehensive study with greater detail about job demands and cost-of-living rates is needed. For the purpose of this study, the unit of analysis is compensation for registered nurses in the state of Florida.
"Survey methodology and Bayesian modeling approach"
Spitz and Given (2003) argue that inflation-adjusted wages will need to increase 3.2 to 3.8 percent each year between 2002 and 2016 — a cumulative wage increase of 69 percent — in order for the nursing shortage to be curtailed. These figures point to a near-doubling of compensation costs paid for registered nurses by 2016. Regardless, higher wages coupled with increased staff training are crucial to any effort to end the shortage of registered nurses in the United States.
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