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Answer & Explanation:Using the article
attached, address the following questions:What is the intended
purpose of the study?How does the research
questions/hypotheses address the problem as detailed by the researcher? How does the content in
the purpose statement and research questions define the methodology used in the
study?How was the data
collected and analyzed?What was the benefit of
using the selected statistical test?What was the outcome of
the study? Requirements
Using one (1) of
the methods below, develop a final project addressing the Assignment questions:3–5 page executive
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(15–20 slides)Infographic Educational/training
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use APA format
article_for_unit_8.pdf
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Business and Leadership
Patricia B. Strasser, PhD, RN, COHN-S, CCM, FAAOHN
Review of Occupational Health Nurse Data From
Recent National Sample Surveys of Registered
Nurses—Part I
by Margaret C. Thompson, PhD, RN, COHN-S, FAAOHN
The U.S. Department of Health and Human Services obtains information
about U.S. registered nurses through the periodic National Sample Survey
of Registered Nurses (NSSRN). Occupational health nurses comprise less
than 1% of the U.S. nursing population and published NSSRN reports usually
include only estimates of the total occupational health nurse population and
minimal information about occupational health nurses’ characteristics. The
objectives of this study were to develop a knowledge base of occupational
health nurses’ characteristics; examine characteristics that may influence entry
and retention in occupational health nursing practice; and explore indications
of demand for occupational health nurses. Descriptive and inferential statistics
were used in a secondary analysis of data from recent (1992 to 2004) NSSRN.
The findings are reported in two parts. This article, Part I, provides descriptive
data about occupational health nurses based on responses to the 1992 through
2004 NSSRN questionnaires. Part II will provide findings from analysis of
2004 responses indicative of occupational health nurses’ entry, retention, and
demand characteristics.
O
ccupational health nurses are
“the largest group of health
care providers serving the
worksite” (American Association
of Occupational Health Nurses, Inc.
About the Author
Dr. Thompson is Principal/Occupational Health
Consultant, Croft-Taylor Consulting, LLC, Ridgefield, CT.
The author discloses that she has no significant financial interests in any product or class
of products discussed directly or indirectly in
this activity.
Dr. Strasser is President, Partners in Business
Health Solutions, Inc., Toledo, OH; and Adjunct
Assistant Professor, University of Michigan,
School of Nursing, Occupational Health Nursing
Program, Ann Arbor, MI.
doi:10.3928/08910162-20091223-01
january 2010, vol. 58, no. 1
[AAOHN], 2008), yet published information about the occupational
health nurse population is scarce.
Published occupational health nurse
data are most often based on surveys
of AAOHN members, occupational
health nurses certified by the American Board for Occupational Health
Nurses (ABOHN), or occupational
health nurse students and alumni of
the National Institute for Occupational Safety and Health (NIOSH)
Education and Research Centers
(ERC) and other academic programs.
These studies have provided valuable information about occupational
health nurses and occupational health
nurse practice. AAOHN, ABOHN,
and academic program data provide
information about demographics,
educational preparation, academic
degrees, and specialty certification
of their occupational health nurse
communities. However, membership
populations may vary and member or
cohort characteristics may not represent the occupational health nurse
population.
Information about the U.S. occupational health nurse population is
obtained by the U.S. Department of
Health and Human Services, Health
Resources and Services Administration (HRSA), Bureau of Health
Professions, through the National
Sample Survey of Registered Nurses
(NSSRN). The NSSRN is a periodic
survey of registered nurses that provides information about the U.S.
registered nurse population. According to HRSA, “(t)he NSSRN is the
Nation’s most extensive and comprehensive source of statistics on
all individuals with active registered
nurse licenses to practice nursing
in the United States whether or not
they are employed in nursing. It provides information on the number of
registered nurses, their educational
background and practice specialty
areas, their employment settings,
position levels, job satisfaction and
salaries. It also provides information on their geographic distribution
and personal characteristics includ-
27
business and leadership
ing gender, racial/ethnic background,
age, and family status” (HRSA, Bureau of Health Professions, 2006b, p.
i). Occupational health nurses are a
relatively small portion of the overall
nursing population (generally < 1%),
and published NSSRN reports usually include only estimates of the total
occupational health nurse population
and minimal information about their
specific characteristics.
The researcher identified a need
to study characteristics of the entire
occupational health nurse population.
The effect, if any, of the current nursing shortage on occupational health
nursing is not known. The supply estimates for occupational health nurses used by the Institute of Medicine’s
Committee to Assess Training Needs
for Occupational Safety and Health
Personnel in the United States (2000)
were based primarily on membership
data provided by AAOHN. Palmer
(2003) has suggested that a severe
shortage of occupational health nurses could affect both worker health
and the economy. Consistent with
strategies recommended to combat the overall nursing shortage, the
profession must develop and implement strategies for the education and
training of future occupational health
nurses and recruitment and retention of nurses in the specialty practice. Beyond the need to know who
occupational health nurses are, current information about occupational
health nurses could be used to support occupational health nurse work
force analysis and inform strategies
for both the education and training
of current and future occupational
health nurses. Knowledge of occupational health nurses’ demographics
can also be used to develop sampling
strategies for future research.
Study Purpose and
Method
This study employed descriptive and inferential statistics in a
secondary analysis of data from recent NSSRN questionnaires (1992
through 2004). The purposes of the
study were to develop a knowledge
base of characteristics of the U.S. occupational health nurse population;
28
examine characteristics that may influence entry into and retention in the
specialty practice through comparisons with other community-based
clinical nursing groups; and explore
indications of demand for occupational health nurses. The underlying
research questions asked were:
l
What are the demographic and
employment characteristics of U.S.
occupational health nurses?
l
Were there significant changes
in those characteristics during the
period from 1992 to 2004?
l
Do characteristics related to entry
and retention differ between occupational health nurses and nurses
in other community-based clinical
employment settings?
l
Are indications of demand for
occupational health nurses evident in
changes in occupational health nurse
positions or employment locations?
The NSSRN targeted population
is the current U.S. registered nurse
population as of March of each study
year. Registered nurses in the study
sample “answer questions on their
education and training in nursing,
professional nursing certifications,
education and workforce participation prior to becoming a registered
nurse, current and recent workforce
participation, income, demographic
characteristics, and States in which
they hold current licenses” (HRSA,
Office of Information Technology,
2005, p. 1).
The sample design used for each
of the surveys since 1977 has consisted of “a complex, nested sample
frame, with equal probabilities of
selection of nurses sampled in each
State” (HRSA, Office of Information Technology, 2005, p. 1). Lists
of current registered nurse licenses
in each state were used to develop
the sampling frame. Although it is
possible that individual nurses may
be sampled sequentially, the survey
does not attempt to track nurses over
time (HRSA, Office of Information
Technology, 2005).
The sample survey instrument
used in the NSSRN “was designed
to ensure that the data collected from
study to study provides sufficient
continuity so that an evaluation can
be made of trends in nursing,” although new areas may be covered in
specific surveys (HRSA, Bureau of
Health Professions 2006b, p. 3). The
questionnaires used for the 1992,
1996, 2000, and 2004 NSSRN can
be found in published survey reports
(HRSA, Bureau of Health Professions, 2006b; Moses, 1993, 1997;
Spratley, Johnson, Sochalski, Fritz, &
Spencer, 2001) and in NSSRN documentation files on the HRSA data
warehouse website (HRSA, Office of
Information Technology, 2005).
For each survey year, the questionnaire was mailed to each nurse
selected for the sample at the address
provided on the state license list. The
cover letter requested voluntary participation and detailed the purposes
of the study, the agency conducting the study, how confidentiality is
maintained, value and use of study
results, and instructions on completing the questionnaire. Until 2004,
questionnaires were returned solely
by postal mail; a web version of the
questionnaire was made available to
respondents in 2004. Return of the
completed survey was evidence of the
participant’s consent to participate.
Various strategies, including multiple
mailings and follow-up telephone interviews of nonrespondents, to clarify ambiguous responses or obtain
missing information were employed
to ensure adequate response. Survey
response rates of 70% or higher were
reported for 1992 through 2004, providing data from 30,000 to 35,000
respondents in each survey year. Additional details regarding the survey
methodology, survey instruments,
sample sizes, and response rates can
be found in published survey reports
and in NSSRN documentation files
cited above.
Public use files for each survey
year are made available to researchers by HRSA. Public use files contain
collected response data, including
assigned sampling weights (calculated to reflect the complex survey
design and the individual’s selection
probability, adjusted for multiple licenses, and to lessen nonresponse
bias), and provide documentation
such as survey background, technical
AAOHN Journal
business and leadership
or programmer information, variable
naming conventions and definitions,
sample variance estimation, design
notes, and the Codebook (HRSA,
Office of Information Technology,
2005). These data files were downloaded into SAS statistical software
for analysis.
The target population for this
study was nurses who reported employment in an occupational health
setting at the time of each survey,
resulting in sample sizes of 306 for
1992, 280 for 1996, 459 for 2000,
and 277 for 2004.
The primary comparison groups,
nurses employed in community-public health and ambulatory care settings, were selected because both
populations, similar to occupational
health nurses, provide adult clinical care in diverse non-hospital settings. Similar to occupational health
nursing, community-public health
nursing has been described as both a
practice setting and a specialty nursing practice (Kovner & Harrington,
2001). The nursing groups used in
the comparative analyses were similarly identified by the responding
nurses’ indicated employment setting
in the 2004 NSSRN: communitypublic health (3,292) and ambulatory
care (3,569).
Variables used for analysis in
this study were based on responses to
the NSSRN questionnaires. For certain measures (e.g., nursing group,
advanced practice, position and position level, highest education level,
or age), the study included variables
constructed by NSSRN researchers
from response variables. The characteristics examined relevant to entry and retention included autonomy,
salary, job satisfaction, and position
change. As there is no direct indicator of autonomy in the NSSRN response data, the study used position
title, master’s or doctoral education,
advanced practice education and
preparation, and professional certificates as indicators of autonomy. The
NSSRN data files do not provide separate response data for master’s and
doctoral education. “All responses to
either master’s or doctorate education are regrouped in the public use
january 2010, vol. 58, no. 1
files into one combined level that
covers both degrees” (HRSA, Bureau of Health Professions, 2006a,
p. C-9). The characteristics examined relevant to occupational health
nurse demand were position change,
geographic location (state and U.S.
Census Bureau region; U.S. Census
Bureau, 2001), and type of employment setting (industry, government,
or other). The subgroup, nurses new
to occupational health, included all
nurses who reported employment in
an occupational health setting at the
time of the survey (2004), who also
reported not being employed in nursing in the year prior to the survey
(2003) or who reported employment
in a setting other than occupational
health in the year prior to the survey.
Nurses with continuing employment
in occupational health included all
nurses who reported employment
in occupational health in the year
prior to the survey (2003) who also
reported employment in an occupational health setting in the survey
year (2004). A detailed description of
measures used in the study and information about the sociological theory
and concepts on which the indicators
of autonomy are based are available
from the author.
Data Analysis
A preliminary review of the unweighted response data provided in
the NSSRN public use data files was
completed prior to data analysis. SAS
survey analysis procedures assume
missing values are missing at random
and are excluded or deleted prior to
analysis. As generally only a small
proportion (< 10%) of cases were
missing, no additional adjustments
were made. Distributions of variables
were generally adequate for analysis.
Where the number of responses for
a particular response category was
less than 10, population estimates
were not calculated and comparisons
were not made. Where necessary and
feasible, categories were collapsed to
provide adequate cell sizes.
The complex nature of the survey design was taken into account by
the use of SAS survey analysis procedures for descriptive and inferen-
tial analysis. Descriptive statistics for
characteristics of nurses employed
in occupational health settings and
in the comparison settings were estimated. Relationships between variables of interest, changes over time,
and group comparisons were analyzed using chi-square and ordinary
least squares and logistic regression
analysis. Data analyses and population estimates used the final sampling
weights provided for each respondent in the NSSRN public use data
files. Analysis of changes in salaries
over time included an adjustment for
inflation based on the Bureau of Labor Statistics’ Consumer Price Index
to determine real increases in occupational health nurse salaries. Analyses considered and controlled for the
influence of other relevant characteristics, such as education, age, familywork life elements, and geographic
location, on the characteristics related to entry, retention, and demand.
Data Limitations
Although use of the NSSRN
database allows access to a large
amount of information that would
not otherwise be available to occupational health nurse researchers, it
is not without limitations. Estimates
of occupational health nurses and
estimates of other nursing groups
used for comparisons were based on
responses to the NSSRN question regarding employment setting. In each
survey year, this question allows the
respondent to choose only one employment setting from the listed responses. For example, occupational
health nurses working in a hospital or
university employee health services
must choose either the hospital, the
academic, or the occupational health
employment setting. Also, only three
choices exist within that occupational health setting category: private
industry, government, or other. This
grouping does not reflect the diversity of occupational health nurses’
employment settings.
The wording of the questions
asked may change from one survey
year to the next and questions may
be eliminated or new questions added, limiting analysis of changes over
29
business and leadership
Figure 1. Occupational health nurse population estimates, 1980 to 2004. (Sources:
Health Resources and Services Administration, Bureau of Health Professions,
2002a, 2002b, 2002c, 2006b; Moses, 1993, 1997; Spratley, Johnson, Sochalski,
Fritz, & Spencer, 2001.)
time. Variables used as indicators of
specific concepts (e.g., autonomy,
entry, or retention) reflect both theoretical constructs and the limitations
imposed by the survey questions and
may not accurately represent the
characteristic of interest.
The comparatively small number of occupational health nurses
in each survey sample also imposes
limitations, potentially compromising the unbiased nature of population
estimates and making it difficult to
reliably analyze responses of particular subsets (i.e., occupational health
nurses with specific characteristics
or groups of characteristics), reliably
analyze group comparisons, or derive
useful or reliable conclusions.
Study Findings
Study findings are reported in
two parts. This part, Part I, provides
descriptive data about U.S. nurses
employed in occupational health settings. This section describes a representative image of occupational
health nurses: their work settings, positions, roles, education, certification,
training, salaries, and general demographics both currently and in how
these may have changed from 1992
to 2004. In Part II, findings from the
analysis of entry, retention, and demand characteristics among occupational health nurses will be reviewed
and discussed. Where applicable,
findings are discussed in the context
of information about the overall registered nurse population reported by
NSSRN researchers and of information about nurses employed in community-public health and ambulatory
30
care settings previously reported or
comparatively analyzed in this study.
U.S. Occupational Health Nurses’
Descriptive Data
Data from the 2004 NSSRN indicated an estimated 22,447 nurses
were employed in occupational health
settings (HRSA, Bureau of Health
Professions, 2006b). Viewing the occupational health nurse population
estimates over time (Fig. 1), it can
be seen that the occupational health
nurse population increased approximately 17% during the period from
1992 to 2004. However, extending the
time period back to 1980, when the
occupational health nurse population
was estimated at 29,362 (HRSA, Bureau of Health Professions, 2002a), a
decline of almost 24% in the number
of nurses employed in occupational
health settings becomes evident. The
extremely large occupational health
nurse population estimated in 2000
appears to be an outlier for which a
specific explanation has not been determined. As discussed with NSSRN
survey researchers, it may be related
to specifics of the 2000 sampling
strategy. The 2004 occupational
health nurse population estimate, although considerably smaller than the
estimate reported for 2000, appears
more consistent with the pattern of
earlier survey estimates. After a 34%
decline from 1980 through the lowest
estimate in 1992, occupational health
nurse population estimates increased
12% from 1992 to 1996 and increased
4% from 1996 to 2004 (excluding the
2000 estimate).
How do these changes compare
with changes in the overall registered
nurse population estimates? Despite
cyclical nursing shortages (related,
in part, to increased and diversified
demand), the estimated number of
registered nurses employed in nursing in the United States rose almost
31% from 1992 (1,853,024) to 2004
(2,421,351) (HRSA, Bureau of
Health Professions, 2006b; Moses,
1993) and increased more than 90%
when the time period was extended
back to 1980 (1,277,041) (HRSA,
Bureau of Health Professions,
2002a). The reasons for changes in
occupational health nurse population
estimates and differences in those
changes from the overall registered
nurse population have not been specifically studied, but possible explanations will be presented for discussion and further s …
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