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The Drivers of the Nursing Workforce Gap: A Theoretical Framework

2021, Social Science Research Network

This paper presents a new model of nursing labour supply that reconciles key features of the current state of nursing in the NHS: a large, persistent and potentially growing workforce gap; staff surveys that show that nurses gain great satisfaction from the job they do, but feel they don't have enough colleagues to enable them to do it well; a large fraction of nurses working paid and unpaid overtime; nurses leaving citing as significant factors both workload and an inability to deliver the quality of care that they would like to give. The paper examines both the intensive and extensive margins of nurse labour supply by extending the standard model of labour supply to include the intrinsic value nurses attach to providing care, which depends on the time a nurse can spend with each patient. This leads nurses to overworking in a well-defined sense. Choosing to work as a nurse involves balancing off: relative pay; the disutility from overworking as a nurse; the intrinsic benefit derived from nursing. For given levels of demand and a given relative wage for nursing, there may be multiple "equilibrium" levels of the workforce gap, some of which are unstable. However calibrating the model to recent data for the UK shows that the current workforce gap seems to be characterised as a unique stable equilibrium, and that increasing the pay of nurses is an effective means of reducing the gap.

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