Economist Charts New Ground in Studies of Nursing Labor Market

    • October 3, 2014

When Joanne Spetz enrolled in a doctoral program in economics in the 1990s, few economists were specializing in health care and fewer still in the nursing labor market.

But Spetz, PhD, FAAN, the daughter of a nurse, was drawn to the inchoate field. “The language of the field was very familiar to me because of my mom’s work,” she says. “I had an affinity for it because that was what we talked about at home.”

She also got encouragement at Stanford and the Palo Alto Veterans Health System, where she was earning her doctorate under pioneering health economists including Victor Fuchs, MA, PhD, Douglas Staiger, PhD, and Ciaran Phibbs, PhD. Spetz had written her “second-year paper” on the difference in earnings for baccalaureate-educated registered nurses (RNs) versus associate-degree RNs, with guidance from Fuchs, Stagier and John Pencavel, PhD, a labor economist. At the same time, Staiger and Phibbs had received a grant to study the impact of a recent decision by the U.S. Department of Veterans Affairs to change the way it paid RNs. Staiger invited Spetz to be the research assistant for the study, which confirmed Spetz’s plan to focus her doctoral energies on the nurse labor market.

When Spetz finished her dissertation in 1995, she wondered whether she had made an error in judgment—at least when it came to her own marketability. This was, after all, a time of nurse surpluses, and few saw the need to devote resources to preparing for future shortages. Hospitals were cutting nursing staff to compensate for falling admissions rates and shorter lengths of stay, and some workforce experts were calling for the closure of some nursing schools, she says. “There was a broad sense that nursing was on the decline,” she says. “I went into the job market at that time with a dissertation on different aspects of the nursing labor market, and I got a lot of strange questions, especially from economics departments.”

But Spetz was able to convince prospective employers of the value of nursing-focused research. “I was able to show that the nursing labor market experiences cycles of surpluses and shortages over time. This had been shown before, but a new generation of researchers apparently had forgotten it. I argued that the tremendous nursing surplus we were experiencing at the time would turn into a shortage and, sure enough, it did.”

Spetz landed her first job at the Public Policy Institute of California, where she researched the nursing labor market and hospital employment trends. In 1997, she began to collaborate with faculty at the Center for California Health Workforce Studies (CCHWS) at the University of California, San Francisco (UCSF) —just as nursing was becoming a hot topic because the nurse workforce shortages she and a few others had predicted were beginning to materialize.

In 2001, she moved to UCSF to become the associate director of CCHWS, and she is now director of the UCSF Health Workforce Research Center. She is also the associate director for research strategy at the UCSF Center for the Health Professions; a professor of economics at the Philip R. Lee Institute for Health Policy Studies; and a consultant to the Future of Nursing: Campaign for Action, a joint initiative of the Robert Wood Johnson Foundation (RWJF) and AARP to transform health care through nursing. In 2011, Spetz was inducted into the American Academy of Nursing—one of the few non-nurses to receive the prestigious honor.

A Wide Range of Topics

Throughout her career, she has researched a wide range of topics in nursing and health care. She has studied programs that aimed to expand the supply of nurses, researched the effects of health information technologies in hospitals, examined the relationship between nursing and patient outcomes, analyzed hospital services and organization, and assessed the effects of minimum nurse staffing regulations on patients and hospitals.

In her position at UCSF, Spetz conducts regular surveys of California’s nursing workforce for the state Board of Registered Nursing. She has studied the demographics of the nursing workforce in central California and looked at the impact of a new minimum nurse staffing law in the state. She also conducted research for the National Sample Survey of RNs in 2008 and the National Sample Survey of Nurse Practitioners in 2012, both of which were overseen by the Health Resources and Services Administration. And she frequently provides testimony and technical assistance to state and federal agencies and policymakers.

In 2011, Spetz began to work with the Interdisciplinary Nursing Quality Research Initiative (INQRI), a program supported by RWJF that supports interdisciplinary research into the link between nursing care and patient outcomes. Her work has provided valuable evidence to the Campaign for Action, which is grounded in a 2010 Institute of Medicine (IOM) report on the future of nursing to which she contributed. Now a research manager for the Campaign, Spetz provides data on everything from the impact of health information technology on nursing work to the number of schools that require coursework on interprofessional collaboration.

“Joanne is one of the Campaign’s greatest assets,” said Campaign director Susan B. Hassmiller, PhD, RN, FAAN, RWJF’s senior adviser for nursing. “Her rock-solid research and her ability to translate her research into lay terms enable us to make a compelling, evidence-based case for the need to transform the nursing profession to improve health and health care in our country.”

For the Campaign, Spetz also returned to a subject she examined two decades ago in her doctoral dissertation: the return on investment of a bachelor’s degree in nursing (BSN). In her doctoral research, she found that earning a BSN did not make financial sense for most nurses at that time. “Unless you were planning to go into management, it really was not worth the time to get a baccalaureate, especially if you were over 30,” she says. “In general, it made sense to get a two-year degree and get to work.”

She recently returned to the question for the Campaign, which is working to implement the IOM recommendation that 80 percent of nurses hold BSNs or higher by 2020. The return on investment of a BSN has improved in the years since she first looked at the question, she says, and the return on an accelerated RN-to-BSN is especially high now.

In the years since Spetz has been in the field, health economics has grown into a major specialty, but there is still a lot more research to be done—especially with regard to the nursing and health care workforce, Spetz says. “There are so many things to learn. We need to answer questions about how the workforce is changing, if and how quality improvement efforts are meeting health care needs, and more. There’s so much we don’t know about how nurses can fully contribute to health care.”

Spetz intends to do her part to answer those questions—and the nursing profession, the health care industry, and patients themselves stand to benefit when she does.