Examining Factors Predicting the Percentage of Registered Nurse Vacancies in Hospitals in the United States

The nursing shortage is getting worse in the United States, with an average national registered nursing vacancy percentage of 9.9% among hospitals as of April 2024. Limited prior research has used nursing vacancies as a measure of nursing shortages, even though nursing vacancies have been identified to be strongly correlated with self-reported nursing shortage status of hospitals. Long-term solutions to nursing shortages could be developed by identifying factors associated with nursing vacancies to provide insight that could lead to improvements in nursing staff retainment. This dissertation aimed to examine the percentage of registered nurse vacancies as a measure of nursing shortages to identify factors associated with nursing shortages. We utilized hospital and county level data from the American Hospital Association annual surveys (years 2012-2019) and the Social Determinants of Health 2019 dataset, which is a project funded by the Patient Centered Outcomes Research Trust Fund. We compared hospitals and counties with nursing vacancy percentages less than 10% to hospitals and counties with nursing vacancy percentages greater than or equal to 10% based on various hospital and county level factors respectively. We created multiple linear regression models to predict nursing vacancies using hospital and county level variables. Furthermore, we created logistic regression models to predict the odds of having 10% or more vacant RN positions using hospital and county level variables. We also created a repeated measures analysis of variance model to predict nursing vacancies using independent hospital-level variables as predictors between 2012 and 2019. Our results identified registered nursing workloads as a strong influencer of registered nursing vacancy percentage. We also determined that urban hospitals and counties, mental health hospitals, and hospitals in the northeast have greater percentages of registered nursing vacancies. For-profit hospitals previously had higher registered nursing vacancy percentages, but as time has passed, the registered nursing vacancy percentages have decreased for for-profit hospitals as the percentages have increased for non-profit hospitals. Findings from this study can be used to justify the use of nursing vacancies as a measurement of nursing shortages and to identify potential barriers and solutions to nursing shortages.