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Hospital Nursing Workforce Costs, Wages, Occupational Mix, and Resource Utilization

Welton, John M. PhD, RN

Journal of Nursing Administration: July-August 2011 - Volume 41 - Issue 7/8 - p 309-314
doi: 10.1097/NNA.0b013e3182250a2b

Background: The objective of the study was to better understand how hospitals use different types of RNs, LPNs, and nurse aides in proprietary (for-profit), nonprofit, and government-owned hospitals and to estimate the wages, cost, and intensity of nursing care using a national data set.

Method: This is a cross-sectional observational study of 3,129 acute care hospitals in all 50 states and District of Columbia using data from the 2008 Occupational Mix Survey administered by the Centers for Medicare & Medicaid Services (CMS). Nursing skill mix, hours, and labor costs were combined with other CMS hospital descriptive data, including type of hospital ownership, urban or rural location, hospital beds, and case-mix index.

Results: RN labor costs make up 25.5% of all hospital expenditures annually, and all nursing labor costs represent 30.1%, which is nearly a quarter trillion dollars ($216.7 billion) per year for inpatient nursing care. On average, proprietary hospitals employ 1.3 RNs per bed and 1.9 nursing personnel per bed in urban hospitals compared with 1.7 RNs per bed and 2.3 nursing personnel per bed for nonprofit and government-owned hospitals (P < .05). States with higher ratios of RN compared with LPN licenses used fewer LPNs in the inpatient setting.

Conclusion: The findings from this study can be helpful in comparing nursing care across different types of hospitals, ownership, and geographic locations and used as a benchmark for future nursing workforce needs and costs.

Author Affiliation: Dean, School of Nursing & Health Sciences, Florida Southern College, Lakeland.

The author declares no conflict of interest.

Correspondence: Dr Welton, School of Nursing & Health Sciences, Florida Southern College, 111 Lake Hollingsworth Dr, Lakeland, FL 33801 (

© 2011 Lippincott Williams & Wilkins, Inc.