title: The effect of prior healthcare employment on the wages of registered nurses.
abstract: The proportion of registered nurses (RNs) with employment in health-related positions before their initial RN education has increased in the past two decades. Previous research found that prior health-related employment is positively associated with RN workforce supply, potentially due to the wage differences based on different career paths. This study's objective is to test the hypotheses that prior health-related employment is associated with differences in starting wages and with different rates of wage growth for experience as an RN.
  
  
  
  We conducted a cross-sectional analysis using the 2008 National Sample Survey of Registered Nurses (NSSRN) linked with county-level variables from the Area Health Resource File. We estimated a Heckman model where the second-stage equation's outcome variable was the logarithm of the RN hourly wage, accounting for the self-selection of working or not working as an RN (i.e., the first-stage equation's outcome variable). Key covariates included interaction terms between years of experience, experience squared, and six categories of prior health-related employment (manager, LPN/LVN, allied health, nursing aide, clerk, and all other healthcare positions). Additional covariates included demographics, weekly working hours, marital status, highest nursing degree, and county-level variables (e.g., unemployment rate). We estimated the marginal effect of experience on wage for each type of prior health-related employment, conducting separate analyses for RNs whose initial education was a Bachelor of Science in Nursing (BSN) (unweighted N = 10,345/weighted N = 945,429), RNs whose initial education was an Associate degree (unweighted N = 13,791/weighted N = 1,296,809), and total population combining the former groups (unweighted N = 24,136/weighted N = 2,242,238).
  
  
  
  Prior health-related employment was associated with higher wages, with the strongest wage differences among BSN-educated RNs. Among BSN-educated RNs, previous employment as a health care manager, LPN/LVN, or nursing aide produced statistically higher starting wages ($1.72-$3.86 per hour; $3400-$7700 per year; p = 0.006-0.08). However, experience-based wage growth was lower for BSN-educated RNs previously employed as allied health workers, LPN/LVNs, or nursing aides. Among Associate degree-educated RNs, wage difference was not observed except for higher initial wage for RNs with previous employment as LPN/LVNs.
  
  
  
  Prior employment in health-related positions was associated with both starting salary and experience-based wage growth among BSN-educated RNs. The higher wage return for those with a BSN may motivate non-RN healthcare workers to seek a BSN in their transition to RN jobs, which could help advancement toward the 80 % BSN workforce recommended by the U.S. Institute of Medicine.
authors.affiliation: Department of Public Health Sciences, University of California, Davis, School of Medicine, One Shields Ave., Medical Sciences 1C, Davis, CA, 95616, USA. byoo@ucdavis.edu.
authors.forename: Byung-Kwang
authors.initials: BK
authors.lastname: Yoo
authors.affiliation: Center for Outcomes Research, Department of Internal Medicine, University of Illinois College of Medicine at Peoria, One Illini Drive, Peoria, IL, 61656, USA.
authors.forename: Minchul
authors.initials: M
authors.lastname: Kim
authors.affiliation: Department of Statistics, Graduate Group in Biostatistics, University of California, Davis, Mathematical Sciences Building 4118, One Shields Avenue, Davis, CA, 95616, USA.
authors.forename: Tzu-Chun
authors.initials: TC
authors.lastname: Lin
authors.affiliation: Independent Consultant, 1766 Crittenden Rd, Rochester, NY, 14623, USA.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Sasaki
authors.affiliation: Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street, #4202, Sacramento, CA, 95817, USA.
authors.forename: Debbie
authors.initials: D
authors.lastname: Ward
authors.affiliation: Philip R. Lee Institute for Health Policy Studies & Healthforce Center, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA, 94118, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Spetz
mesh_terms: D003430:Cross-Sectional Studies; D004651:Employment; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009726:Nurses / Q000191:economics*; D012456:Salaries and Fringe Benefits; D012959:Socioeconomic Factors; D014481:United States
keywords: Education of Registered Nurse; Prior Employment; Registered Nurse; Salary; Wage