Manpower Planning for Nurse Personnel TIMOTHY J. KEAVENY, PHD, AND ROGER L. HAYDEN, DBA, CDP

Abstract: A technique is described which can be applied to manpower planning for nurse personnel at a state or regional level. An iterative process explores the implications of alternative planning policy decision strategies intended to balance manpower supply and requirements. Impacts of the following policy alterna-

tives are estimated: scale of operations of education institutions; interstate migration patterns; labor force participation rates; and job design of licensed practical nurse (LPN) and registered nurse (RN) positions. (Am. J. Public Health 68:656-662, 1978.)

Introduction

tion generated by planning specialists with policy decisions promulgated by decision making bodies. What are interpretations of "'supply" and "'requirements"? "'Requirements" is defined as the personnel necessary to provide the health services demanded by a state or region's population. "Demand" refers to the manpower which consumers will use or employ given wages, prices, and income. Requirements are not based on estimates of the number of personnel necessary to attain some desired health status.6 "Supply" of health manpower is defined as the number of full-time equivalent (FTE) employed personnel, coinciding with Altman's "active supply" of manpower in contrast to a ""potential supply".7 Potential supply is defined as currently licensed or certified health manpower, and includes both those employed and those not employed. Numerous factors are synthesized in assessing supply and requirements in state or regional planning such as licensing agencies, education institutions, and employer and employee organizations. Educational institutions are the primary source of a supply of trained personnel, while licensing requirements define the proportion of ""trained" personnel qualified to be employed. Health care delivery organizations (employers) affect demand through job design and staffing patterns. Employee organizations, representing the interests of the membership, have an impact on the employment conditions under which members make available their labor services. Figure 1 depicts those parametric variables related to supply of health manpower resources and points at which human decisions can influence labor supply, the exception being death. Actions can be taken by state level policy decision makers which affect either the supply of health manpower or requirements for their services. For example, addi-

Principal components of a health manpower planning process are: identification of current supply; projection of future supply; identification of current requirements; projection of future requirements; and affecting a balance between supply and requirements. Baker points out that it is not the health manpower planner who, in reality, makes decisions intended to bring about a coordinated synchronization between supply and requirements, but policy decision makers at higher levels of government. ' Policy decision makers must be included as integral components in a planning process, rather than merely being recipients of planning information. Effective manpower planning involves an active interchange of planning information among planning specialists and decision makers; otherwise, planning reports developing independently of decision makers are doomed to collect dust on a storage shelf.2-5 Planning information is a vehicle for quantitatively expressing impacts of policy decisions on the supply and requirement of health manpower. The "bottom line" in evaluation of a planning alternative can be viewed as the match between supply and requirements for a particular policy decision. Therefore, an effective health manpower planning process is compelled to closely link planning informa-

Address reprint requests to Dr. Timothy J. Keaveny, Department of Business Administration, University of Wyoming, Laramie, WY 82071. Formerly at the University of Wyoming, Dr. Hayen is now with the University of Nebraska at Omaha. This paper, submitted to the Journal, May 28, 1976, was revised and accepted for publication January 24, 1978.

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AJPH July, 1978, Vol. 68, No. 7

KEAVENY AND HAYDEN Entry

Exit

Health profession training and education

v

Migration from other states and countfies

Active

Supply of

Health

I Migration from state

_ Withdraw from the 'occupation or the labor force

Manpower

Re-entry into the labor force

Resources

Death

Efficient utilization

FIGURE 1-Selected variables effecting the supply of health

man-

power resources

tional educational facilities increase supply, while modifications of legal constraints for staffing hospitals, extended care facilities, and so on impact requirements.

Planning Process A sequence of events for a closely linked process involved in ascertaining the basic components of an integrated health manpower plan are depicted in Figure 2. A task force of policy decision makers establish goals and objectives for health care planning in general, and health manpower planning specifically. Then, planning specialists identify current supply and requirements and their associated relationships by collecting and analyzing historical data. What is the composition of the policy decision task force? Various groups and organizations having an interest in health manpower planning would be informed of the planning activity. If the number of such groups and organizations is relatively small, one could permit anyone to participate who is willing to do so. Otherwise, it would be necessary to restrict participation in some way, e.g., one or two participants for each concerned association, agency, or organization. With only limited experience in this process it is difficult to establish guidelines but it appears that a task force consisting of more than 25 individuals would be so large that group discussion and evaluation would be extremely slow. After forming the group, preparing the initial projections, and giving task force members an opportunity to study these projections, the group would meet for the purposes of suggesting refinements and modification in the projections, and to arrive at a recommended course of action to match projected active supply and requirements. Data may be obtained from ongoing data collection systems or, depending on policy alternatives, may be acquired on a one time only basis, outside usual data collection chanAJPH July, 1978, Vol. 68, No. 7

FIGURE 2-Planning

process

nels. Since it is virtually impossible to anticipate all the data requirements for every conceivable policy alternative, one time, ad hoc data collection is likely to be imperative. Relationships based on historical conditions are utilized to develop a manpower planning model for projecting future supply and requirements. These historical projections can be viewed as assessments of what might transpire if current conditions precipitate into the future. However, since it is usually desirable to assess the effect of policy resource allocation decisions which will facilitate improvement of existing conditions, manpower planning relationships are revised and projections developed that reflect alternative decisions and policies. This can be viewed as the "'what if?" phase of planning. Deficiencies in historical data or a need for collecting and analyzing additional data may arise upon inspection of the projections for a particular policy alternative. Should this occur, the planning process returns to the earlier stages to rectify discovered deficiencies. The focus in this process is on output in the form of "what if" assessments of alternative decisions and policies, which a planning task force would receive from planning specialists. Information describing alternatives would be reviewed by the task force of decision makers. Their review may point out inadequacies of the alternatives considered and require further planning iterations. 657

MANPOWER PLANNING

If implications of the alternatives presented are deemed appropriate, the decision makers could select a preferred strategic course of action, i.e., make a decision, or establish a policy. This approach is in concert with basic decision making principles; it facilitates the interjection of judgment and intuition in the manpower planning process by the policy setting, decision making body. The health manpower planning model may have its parameters adjusted to reflect future anticipated conditions by the task force. Since data are not available from the future, it is only possible to anticipate it, not measure it; historical data by themselves are seldom adequate. Parametric adjustment is best implemented from the intuition and judgment of the decision making task force. Such group or participative decision making is positively associated with the quality of decisions and with commitment to having decisions successfully implemented.8 The proposed approach may be described as an offshoot of the delphi technique, a procedure in which, after critical review, a consensus is obtained for revisions to a plan. Milkovich, Annoni and Mahoney found manpower forecasts derived via the delphi technique to be more accurate than those based solely on statistical techniques.9 Implementation of the planning process is achieved through application of computer-based decision support systems. Without aid of the computer, the assessment of planning alternatives quickly becomes bogged down in the drudgery of calculating alternative projections. Computer-based techniques remove this barrier providing the vehicle for implementation of the modified delphi planning process.

Current Application The proposed systematic integrated health manpower planning technique is demonstrated by its application to nursing personnel at a state level in Wyoming. The occupational categories considered are registered nurses (RNs) and licensed practical nurses (LPNs). Impact of the following policy related decision variables is estimated: scale of operations of educational institutions; interstate migration patterns; labor force participation rates; and job design of LPN and RN positions. Although anticipated population growth in Wyoming has changed since the projections discussed were completed, they suffice to describe an approach to planning which is the focus of this effort, rather than presentation of current forecasts of supply and requirements for nursing personnel.

Supply of Nurses Projecting a future potential supply of nurses involves identifying current supply, estimating future flow into the state's supply of nurses, and estimating future flow-out of the state's supply of nurses. Components considered in estimating the flow into Wyoming's potential supply were: annu658

al number of new nurses educated in Wyoming;* annual number of individuals re-activating their licenses; and annual number of new licenses issued to nurses not educated in the state. Estimating the number of new licenses issued to nurses not educated in Wyoming is the operationalization of the variable, migration from other states and countries, presented in Figure 1. In estimating the flow-out of Wyoming's supply of nurses, the variable was annual number failing to renew their licenses, which summarizes all three variables specified in Figure 1 as flowing from a state's supply of nurses. Regression equations (see Appendix, Table 1) were utilized in establishing relationships to make projections. In projecting the supply of labor services for an occupation predominated by women, it is necessary to estimate labor force participation; being licensed does not insure employment. Nurses indicate on their license renewal form if they are employed full-time or part-time and, if employed part-time, how many hours per week and weeks per year. From this, labor force participation was estimated by age for both full-time and part-time personnel. The full-time labor force participation rate for a given age cohort is defined as the number reporting full-time employment (FTE) divided by the number of active licenses in the particular age group. An age distribution of the projected number of licensed nurses was estimated, the projected number of licensed nurses being the potential supply of nurses. Labor force participation rates by age were applied to the estimated age distributions to project the active supply of RNs and LPNs. Part-time nursing personnel were adjusted to estimate the supply of full-time equivalent nurses.**

*The regression equation projecting number of newly licensed RNs educated in-state was found to be more predictive when the variable "number of degree granting institutions" was included (see Appendix, Table 1). Conceptually, size of class or number of graduates would appear to be a more robust measure. However, the number of schools is a surrogate measure for number of nursing graduates. In the present case, historically, a series of schools with a maximum capacity of about 25 students were built, the constraint being the ability of hospitals in close proximity to the schools to absorb student nurses. Consequently, the supply of new nurses educated in-state approximates a step function varying with number of schools and, in this case, is a useful predictor. The utility of this variable may be unique to this situation, and the more general variable, number of students, may be more predictive in other situations. **Among nurses projected to be employed part-time, it was estimated the average number of hours per week was 20.65 for RNs and 22.59 for LPNs. The average number of weeks per year was estimated to be 44.71 for RNs and 46.61 for LPNs. A full-time nurse was assumed to work 2,000 hours per year. The number of part-time nurses was converted to full-time as follows:

The projected Projected number of full- _ number of time employees full-time + RNs/LPNs RNs/LPNs LProjected number of part-time \RNs/LPNs

1 Average Average / 2,000 hours x weeks per year 1 per week RNs/LPNs RNs/LPNs / AJPH July, 1978, Vol. 68, No. 7

KEAVENY AND HAYDEN

A possible means by which the active supply of Wyoming nurses can be depleted, which may not be reflected by licensure nonrenewal, is migration to another state while maintaining one's Wyoming license. Available historical documents did not identify the number of such cases. If such information were available, the potential supply of nurses could be adjusted accordingly. The adjustment for this factor was to modify labor force participation rates. If a nurse with an active Wyoming license was not employed in Wyoming, that nurse was classified as not employed.

Requirements for Nurses Ratios of the 1974 RN FTE and LPN FTE to 1974 state population served as the basis for estimating future requirements for nurses. The ratio of FTE RNs to total population was 3.39/1,000 and for LPNs it was 1.12/1,000 in 1974. As a point of comparison, the national ratio of FTE RNs to population in 1970 was 3.06/1,000.10 The use of a nurse-population ratio as the basis for projecting personnel requirements is subject to many criticisms. Bognanno et al., present a detailed discussion of the difficulties inherent in this approach.1' Two central criticisms are the considerations in the selection of an optimal ratio, and the fact that the ratio approach assumes a percentage change in the utilization of nurses by the population in question equivalent to the percentage change in labor productivity among nurses over the forecast period. Concerning the selection of an optimal ratio, assuming historical data are available, the stability of the ratio over time can be investigated. From the view of planning technicians, it would be advantageous to review 10 or 15 years of historical nurse-population ratios to determine if the ratios are relatively constant over time, or if a stable trend can be observed. Such data were not available in the current application. Kreisberg, et al., point out that experts are frequently asked to select the ratio to be used for making projections.6 Reliance on experts allows one to circumvent the problems associated with an absence of historical data. The task force (see Figure 2) constitutes Wyoming's experts in the field of nursing, and the 1974 nurse-population ratio constitutes a starting point for preparing projections. The task force evaluates the nurse-population ratio; if judged invalid, the ratio is subjectively changed, and the projections revised. Further, the sensitivity of the ratio may be investigated as alternative "what if" plans with additional evaluation undertaken commensurate to the sensitivity for a particular planning situation for a given planning task force. The second criticism points out that in using the ratio method one is making an unrealistic assumption. Granted, but the crucial question is, can the ratio method permit one to make reasonably accurate projections of requirements? Wendell Burton, director of employment for Minnesota Mining and Manufacturing Co., stated that in 14 years of experience with the ratio method, one-year projections were never in error by more than one per cent.12 This suggests that the answer to the question posed above, in regard to short-term AJPH July, 1978, Vol. 68, No. 7

forecasts, is: yes, ratio projections can be sufficiently accurate. The current application treats all RNs as equivalent and all LPNs as equivalent. A refinement of this homogeniety would undoubtedly be advantageous. For example, RNs and LPNs could be grouped by location of employment, e.g., hospital, clinic, nursing home, etc., and ratios of each grouping could then be employed to prepare projections of requirements for each category of RN and LPN. Alternatively, the categorization could focus on the type of position held, e.g., geratric, pediatric, surgical, obstetric, etc. The implications of these refinements can be significant. For example, historical data indicate differential rates of change in the employment of nurses among types of hospitals and nursing homes.13 Energy development with its expansion of coal mining in Wyoming will almost certainly cause a shift in relative requirements with respect to type of nurse position. Expansion of employment opportunities in Wyoming will tend to draw individuals who are early in their work careers and have young families. Further, mining involves high risks of injury. Given these factors, refinements of the nature suggested are clearly warranted and would increase the precision of the projections. The planning task force would be expected to provide input to subjectively refine the projections. The ratio method has a number of advantages. It is easy to understand and apply, and has relatively simple data requirements. Given these advantages, along with relatively accurate short-term projections, why not use it? Particularly, if the only alternative is not to plan because of insufficient data-an easy trap to fall into if one does not want to do any planning, but only complain about the lack of data.

Supply vs Requirements Figures 3 and 4 compare the projected requirements and supply of FTE RNs and LPNs, respectively. On both figures, curve A represents the projections of requirements and curve C represents the projections of supply under the situation of extending historical conditions into the future. With regard to Figure 3, curve C nearly matches curve A for the entire planning period. The projections suggest that little action is necessary in planning for RN personnel, except to continue doing what has been done in the past. The conclusion is quite different when one inspects Figure 4, which concerns the supply and requirements for LPNs. Curve C represents supply and is an extension of past trends. Projected supply is nearly double the projected requirements for FTE LPNs by 1985. Clearly, this identifies a planning situation in which a policy decision should be evaluated by a task force, policy decision making body.

Planning Alternatives Development of the historically based projections completed the first iteration of the planning process portrayed in Figure 2. Equipped with a conceptually satisfactory, his659

MANPOWER PLANNING 1650' 1600-

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YEAR FIGURE 3-Projected requirements and supply of FTE RNs KEY A: Projected requirements for FTE RNs B: Projected requirements for FTE RNs assuming annual increment of 1 per cent in number of RN positions filled by LPNs C: Projected supply of FTE RNs

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YEAR FIGURE 4-Projected requirements and supply of FTE LPNs KEY A: Projected requirements for FTE LPNs B: Projected requirements for FTE LPNs assuming an annual increment of I per cent in number of RN positions filled by LPNs C: Projected supply of FTE LPNs D: Projected supply of FTE LPNs assuming no expansion of current schools and continuation of current labor force participation rates

torically-based projection model, strategic policy planning alternatives can be investigated and evaluated. Policy alternatives have been selected and analyzed to illustrate the manner in which a planning model may be used by a policy decision task force. The planning model is operated in a 660

chauffer driven mode with planning specialists operating it for the task force to generate planning information. To demonstrate this process, policy alternatives which result in an impact on the following decision variables are investigated: scale of operations of educational institutions; interstate migration patterns; labor force participation rates; and job design of LPN and RN positions. Investigation of policy alternatives was facilitated by the utilization of a computer-based, decision support planning tool, a planning language. Without this approach, it would not have been practical to explore the effects on supply and requirements of the variety of alternatives presented. Figure 4 suggests an excess supply of LPNs is likely to occur if historical trends continue. Assuming the task force is satisfied with the validity of the projections of supply and requirements, the consideration of alternative approaches to matching these projections can proceed. One solution would be to assume no further expansion of LPN educational institutions. In Figure 4, curve A represents requirements, curve C represents supply assuming a continuation of past trends, and curve D represents the projected supply of LPNs should no expansion of LPN training facilities occur. This strategy reduces the estimated excess supply somewhat, but not completely. Other policy actions involve facilitating or encourageing the out-migration of graduates of in-state LPN educational institutions, and permitting labor force participation rates to decline. With these projections of requirements and supply, the reduction in retention of in-state educated LPNs necessary to equate supply and requirements for LPNs can be estimated. Or, similarly, a reduction in labor force participation rates which would equate projected supply and projected requirements can be determined. Assuming a continuation of the current labor force participation rate, the retention rate of in-state educated LPNs would have to drop to a level of 8-15 per cent during the entire ten-year planning horizon. Assuming a continuation of the current 80 per cent retention of in-state educated LPNs, FTE labor force participation rates are projected to gradually decline from the 1975 level of 66 per cent to 39 per cent in 1985. Task force members would most likely reject such alternatives as unacceptable. Another course of action remains. This would involve encouraging task delegation or rather a redistribution of duties from RNs to LPNs. Research reported by Goldstein and Horowitz suggests a great many duties performed by RNs and LPNs are common.' The substitution of LPNs for RNs is a policy planning alternative which assumes the manipulation of requirements by state health planners. At first glance it would seem that job design and staffing patterns in hospitals, clinics, and nursing homes are the actions implied by this alternative. While this is technically correct, discussions concerning the redistribution of duties from RNs to LPNs with Wyoming hospital administrators suggest that state law concerning staffing requirements acts as a constraint prohibiting such action. Ignoring the legal restriction on the assumption that it might be changed, projected requirements for RNs and AJPH July, 1978, Vol. 68, No. 7

KEAVENY AND HAYDEN

LPNs were revised assuming that annually an additional 1 per cent of the FTE RN positions projected initially are staffed by LPNs, beginning in 1976. Figures 3 and 4 compare the projections of revised requirements with projected supply of RNs and LPNs, respectively. Curves B and C of Figure 3 represent the revised projection of requirements and projected supply for RNs. The near balance of supply and requirements for RNs, curves A and C, would be disturbed. In Figure 4, curve B, the revised estimate of requirements, lies about midway between curves A and D, suggesting that redistribution of nursing duties of the magnitude suggested would reduce the projected excess supply of LPNs by approximately one-half.

Summary and Conclusions The consideration of alternative policy planning strategies by a task force can be expanded very easily with the proposed system. The task force could, given the revised estimate of requirements, return to consider the levels of labor force participation and retention of newly trained nurses which match supply with requirements. Alternatively, they could investigate the implications of further substituting LPNs for RNs. Because the system is computer-based, revisions of planning strategies involve little time and personnel effort. In fact, without a computer-based planning language system, it is doubtful that this planning process, which links planning information from planning technicians with a policy decision making body, could be successfully implemented because other alternatives are too costly, time consuming or both. Regarding the general approach to manpower planning, participation of key personnel from the state is viewed as essential for effective planning. The above alternatives make it clear representatives of nursing associations, employer associations, licensing agencies and educational institutions should be included in the decision making process. The successful implementation of any alternative solution would hinge to a large extent on the cooperation of the above actors, and that cooperation would depend to a significant degree on their opportunity to influence the selection of an alternative.

AJPH July, 1978, Vol. 68, No. 7

REFERENCES 1. Baker TD: Dynamics of Health Manpower Planning, Medical Care 4, No. 4 (1966) pp. 205-211. 2. Brekke, D and Liebman, M: Health Manpower Planning Process, Mimeographed August, 1974. 3. McClendon B J: Health Manpower Linkage Systems, Paper presented at the National Association for Regional Medical Programs Annual Meetings, September, 1975. 4. Snoke W, and Glasgow JM: Regional Planning: Pious Platitude or Practical Implementation, Inquiry 7, No. 3 (September, 1970) pp. 17-25. 5. Abt Associates. A Methodology for Studying Linkages for Health Manpower Education Planning and Decision Making, DHEW, Health Resources Administration, Rockville, MD, March, 1975. 6. Kriesberg HM, Wu J, Hollander ED, and Bow J: Critical Review of Methodological Approaches Used to Determine Health Manpower Supply and Requirements, DHEW, Health Resources Administration, Washington, DC, April, 1975. 7. Altman H: Present and Future Supply of Registered Nurses, DHEW Publication No. (NIH) 72-134, November, 1971. 8. Sisk, HL: Management and Organization, 2nd ed., South-Western Publishing Co., Cincinnati, 1973. 9. Milkovich GT, Annoni, AJ, and Mahoney TA: Use of the Del-

10. 11.

12.

13. 14.

phi Technique in Manpower Forecasting, Industrial Relations Center, University of Minnesota, Minneapolis, August, 1971. DHEW, Health Resources Administration. The Supply of Health Manpower: 1970 Profiles and Projections to 1990, DHEW Publication No. (HRA) 75-38, December, 1974. Bognanno MF, Jeffers JR, and Oliver C: Evidence on the Physician Shortage, in Labor and Manpower, R. Pegnetter, Ed. Center for Labor and Management, College of Business Administration, The University of Iowa, Ames, (1974), pp. 131-153. Burton, W. Case Study-Minnesota Mining and Manufacturing Co., in Proceedings: Workshop for Manpower Planning and Forecasting Systems, Industrial Relations Center, University of Minnesota, Minneapolis, 1967. DHEW, Health Resources Administration. Source Book: Nursing Personnel, DHEW Publication No. (HRA) 75-43, December, 1974. Goldstein HM, and Horowitz MA: Research and Development in the Utilization of Medical Manpower, Center for Medical Manpower Studies, Northeastern University, Boston, MA, October, 1974.

ACKNOWLEDGMENTS This research effort was supported in part under HEW Region VIII Contract 298-74-C-0008.

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MANPOWER PLANNING APPENDIX TABLE 1 -Regression Equations Predicting Flows In and Out of the State's Supply of Nurse Personnel 1. 2. 3. 4. 5. 6.

New in-state educated RNs: Y = -9.94 + 1.05 (year) + 15.29 (number of schools)' New in-state educated LPNs: Y = -32.72 + 3.75 (year)2 New non-in-state educated RNs: Y = -191.25 + 18.75 (year)3 New non-in-state educated LPNs: Y = -106.71 + 7.82 (year)4 Nonrenewal RNs: Y = -233.87 + 21.51 (year)5 Nonrenewal LPNs: Y = -87.08 + 6.83 (year)6 Variable

B

St. Err. B

1.04964 .24731 Year 15.28764 3.81364 Number of schools -9.9421 Constant R2 = .86 **F01(1 ,18) = 8.28 Year = Given calendar year - 1950, e.g., 1975 = 25 for analysis purposes. Number of schools = Number of institutions granting degrees to registered nurses.

2Variable Year Constant **F 01(1,16) = 8.53 Year as defined in 1. 3Variable Year Constant **F 01(1,16) = 13.74 Year as defined in 1. 4Variable

Year Constant

B 3.74923 -32.7241

5Variable

B 18.75 -191.25

F

171.384**

St. Err. B 2.12995

F

77.493**

R2 = .93 B 7.82 -106.71

B

21.51 -233.869

*F05(1 ,6) = 5.99 Year as defined in 1. 6Variable Year Constant *F05(1 ,6) = 5.99 Year as defined in 1.

18.014** 16.070**

R2 = .92

*F.01(1,6) = 13.74 Year as defined in 1. Year Constant

St. Err. B .28639

F

B 6.83 -87.03

St. Err. B 1.526

F 26.283**

R2 = .81 St. Err. B 6.97

F

10.04*

R2 = .63 St. Err. B 2.03

F

11.31

R2 = .65

NOTE: The number of observations used to calculate the above regression equations varied. The data summarized in equations 1 and 2 are based on 1953-1974 licensures for RNs and 1956-1974 licensures for LPNs. For the remaining equations, only 1967-1974 data were used. During the 1960s, migration into Wyoming was limited, consequently using pre-1967 data reduces the ability to predict immigration by nurses. An additional consideration is that in 1966 it became possible for nurses to enter an "inactive" status. The data available for this project do not distinguish those choosing to enter this status from those who die or who migrate to another state. Consequently, with respect to the regression equations predicting failure to renew licenses, only the data since 1966 are applicable. One remaining estimate affecting supply is needed. As indicated above, nurses in Wyoming can elect to enter an "inactive" status. At a later time they can request reactivation and again be licensed nurses. Analyzing these reactivation data via regression resulted in betas which were not significant. Consequently, the average number of reinstatements between 1967 and 1974 has been used to estimate this source of supply during the forecast period. Data were available only for RNs. The mean number of reinstatements was 39.11. Given the above equations which are able to predict the number of nurses entering or leaving the state's supply of nurses, projections were made of the number of nurses that would be licensed in each forecast year.

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AJPH July, 1978, Vol. 68, No. 7

Manpower planning for nurse personnel.

Manpower Planning for Nurse Personnel TIMOTHY J. KEAVENY, PHD, AND ROGER L. HAYDEN, DBA, CDP Abstract: A technique is described which can be applied...
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