Internal Migration of Nurses in the United States: Migratory Prompts and Difference in Job Satisfaction between Migrants and Non-Migrants
Siow, Elaine, Ng, Jeffrey, Nursing Economics
Nurses in the United States are among the most mobile professionals because of the shortage of nurses in many states and the transferability of their skills across different work- places (Buchan, Parkin, & Sochalski, 2003; Bureau of Health Professions, 2002, 2004a, 2004b; Flanagan, Baldwin, & Clarke, 2000). The move- ment of nurses within the United States plays an important role in the distribution of the nursing labor supply within the country (Bureau of Health Professions, 2004b). In this study, internal migration is defined as the inter-state movement of a person for employment as a reg- istered nurse. The definition is con- sistent with the definition of a migrant as "one who moves from one region to another by chance, instinct, or plan" (The Free Dictionary Online, 2012). There is a body of literature that has exam- ined the international migration of nurses (Aiken, Buchan, Sochalski, Nichols, & Powell, 2004; Bieski, 2007; Brush, Sochalski, & Berger, 2004; McGillis Hall et al., 2009; Polsky, Ross, Brush, & Sochalski, 2007; Ross, Polsky, & Sochalski, 2005). With the exception of a 2004 report of the National Sample Sur- vey of Registered Nurses (NSSRN), which found that more educated and younger nurses are more likely to migrate internally within the United States (Bureau of Health Professions, 2004b), there is little research on internal migration. One possible explanation is that migra- tion, be it of nurses or other labor types, has been typically viewed and studied as an international phenomenon (Freeman, Baumann, Blythe, Fisher, & Akhtar-Danesh, 2012; Greenwood, 1997).
Migration theories typically formulate the issue of migration from a utility/satisfaction maxi- mization perspective. These theo- ries assume people migrate from one place to another in pursuit of increased satisfaction from better employment opportunities, higher wages, a preferred bundle of ameni- ties, better living conditions, and many other factors. Prior studies of nurses' job satisfaction have fo- cused on personal, organizational, and economic factors (Djukic, Kovner, Budin, & Norman, 2010; Kovner, Brewer, Wu, Cheng, & Suzuki, 2006; Larrabee et al., 2003; Lu, While, & Barriball, 2005). Not much is known about whether internal or international migration status is related to job satisfaction. This is an important issue because health care systems with more sat- isfied nurses are expected to pro- vide higher-quality care and experi- ence lower employee turnover (Baernholdt & Mark, 2009; Djukic et al., 2010; Larrabee et al., 2003; Shields & Ward, 2001; Vahey, Aiken, Sloane, Clarke, & Vargas, 2004; Wilson, Squires, Widger, Cranley, & Tourangeau, 2008).
Internal migration of nurses is of particular importance in the United States. It is a contributing metric in the Nursing Supply Model (NSM) used by the Bureau of Health Professions to analyze and report the distribution of the nurse workforce (Bureau of Health Pro- fessions, 2004a, 2004b). According to the Bureau, there is substantial variation in the NSM-projected nursing supply for the period 2000 to 2020 due to net inter-state migra- tion, among other factors. Policies that provide nurses opportunities to practice in different states make it important to monitor the amount of activity and the reasons behind nurses' geographic mobility. In 2000, the National Council of State Boards of Nursing developed a new initiative known as the Nursing Licensure Compact (NLC) to facili- tate the ability of nurses to practice in any participating state through a streamlined licensure reciprocity process without the need for addi- tional cost and applications. This compact is a mutual recognition model of nurse licensure that allows a nurse to be licensed in the state of residency and to practice in other compact states, subject to each state's practice law and regula- tions. As of June 2010, 24 states were participating in the NLC. More research is needed from the labor economics perspective to develop a better understanding of the movement of the nursing labor force within a country, especially in developed countries where such movement is common but still understudied (Lucas, 1997). …