Purpose: To understand how the work environment of nurses is changing in states with high enrollment in health maintenance organizations (HMOs), the underlying forces driving change, and how these forces are expected to affect employment and earnings of nurses in the future. Financing and delivery systems that have developed in some states with high enrollment in HMOs are generally regarded as indicative of the future for all the United States.
Design: Survey in 1995 of a convenience sample of 62 health executives in 11 states with high enrollment in HMOs. Executives included officials in state governments, state and metropolitan hospital associations, professional and nonprofessional nursing associations, state boards of nursing, community and public health, home health care, nursing homes, other non-acute care associations, and leading HMOs.
Methods: Through structured telephone interviews, executives were asked about changes in nurse employment, earnings, collective bargaining, fringe benefits, nurses' roles, substitution of licensed practical nurses (LPNs) and aides for RNs, patient severity, quality of patient care, and expectations for nurse employment during the remainder of the decade.
Findings: Executives perceive a mostly positive and fast-changing nurse labor market but they are concerned about the aging RN work force, possible development of an RN shortage, and linking quality of patient care to the provision of nursing services. They doubt the ability of nurse educators to respond quickly to the need to prepare nurses for rapidly changing employer requirements.
Conclusions: Public and private forces are causing rapid, profound changes in health care delivery and throughout the nurse labor market. These changes are most evident in the shift in employment of nurses from hospitals to home health. Despite anxiety associated with these changes, no evidence of an "employment disaster" exists in the views of health executives.