Nurses With Activity Limitations: Implications for an Aging Nurse Workforce

Thursday, 27 July 2017: 4:50 PM

Barbara Wilson, PhD, RN
College of Nursing, University of Utah, Salt LakeCity, UT, USA


Though previous studies have examined the causes of work-related illness and injuries among nurses, little is known about labor market disparities between nurses with and without long-term activity difficulties, e.g., some sort of physical or psychological impairment. Because nursing is a profession where physical or psychological difficulties increase sharply over the course of one’s career as s/he ages (Matt, Fleming, & Maheady, 2015; Wray, Asplin, Gibson, Stimpson, & Watson, 2009), the issue of potential labor market disparities for nurses with activity limitations is an important one.

 Dissimilar outcomes for nurses with activity limitations does not necessarily indicate any market discrimination against such nurses, where ‘discrimination’ means disparate treatment where productivity is equivalent. A nurse with an activity limitation may simply choose to work fewer hours so his/her total annual wage and salary may be less. But whether nurses with activity limitations are truly discriminated against is not clear. Hence, the purpose of this study was to understand the extent to which annual total wage and salary disparities were due to discriminatory treatment, and the extent to which wage and salary disparities were due to voluntary choice, by decomposing annual wages into work participation, hours, and hourly wage components.


The American Community Survey (ACS, 2014) is an ongoing, extensive governmental survey of the population which includes basic demographic information, wages, hours of work, and employment status, with consistently defined variables key to our analysis. A representative sample of about 30,000 registered nurses (RNs) is contained in each year’s sample of the ACS. Moreover, these data also contain “difficulties with daily activities” measures, which we employ as our variable of principal interest, used to measure the impact of dressing difficulties, uncorrectable vision or hearing problems, difficulties with physical activities, difficulties with memory, and difficulties with independent living. Our sample, from 2006 to 2014, is limited to those whose occupation is self-identified as a registered nurse (RN) in their current or most recent job, and whose ages are between 25 and 70 years old.

To sort out the effect ‘difficulties with daily activities’ measures of annual wages, wage rate, and employment probability, we take advantage of the following relationships: since log(annual wages)=log(hourly wage rate * number of annual hours) = log(hourly wage rate) + log(annual hours), if we know the regression of log(annual wages) and log(hourly wage rate) on our independent variables, then we automatically know the coefficients of the regression of log(annual hours) on the independent variables (since regressions are linear mathematical operators). For example, if the coefficient of males in the log(annual wages) regression is .2 (males make 20 percent more than females with similar sociodemographic status), and the coefficient of males in the log(hourly wage rate) were .05 (the male nurse wage rate is percent higher than the female nurse wage rate), then the male coefficient in the hours regression is .15 (.05 + .15 =.2). Hence, using multiple regressions we examined evidence on annual wages, hourly wages (so we can infer the regression on annual hours), and the likelihood of employment.


As seen in virtually all other studies of the North American labor markets, some groups made more than others: male nurses had higher wages (17 percent more than female nurses), blacks had lower wage rates (black nurses made 5% less than white nurses per hour, but they worked more hours so that total annual wages were not significantly different from white annual earnings), and Hispanic nurses made 7.5 percent less than non-Hispanic whites per hour.

Wage income increased with age (up to about age 55 in the 2013 sample), while employment was highest in the mid-forties. This is consistent with data from the US Census Bureau (2010) who reported that nurses aged 45-54 years replaced those aged 35 to 44 years as the largest age group of RNs in the U.S., reflected by the median RN age in 2000 of 42.4 and 45.4 in 2009 (Juraschek, Zhang, Ranganathan, & Lin, 2012). The effect of educational attainment, given that one is a RN, and of a certain age, shows no particular trend.

As suggested by the regression results, there was relatively little disparity in the hourly wages between the abled and disabled nurses. But there was enormous disparity in the disabled’s employment and hours of work opportunities, and hence a moderate amount of disparity in annual wages. For example, a nurse who reported some sort of physical or mental impairment or disability in 2009 made, on average, 33.6 percent less and had nearly 64 percentage lower likelihood of being employed relative to nurses without physical impairments or activity limitations.


Nearly 40% of the RNs currently working in the U.S. are over the age of 50 (Auerbach, Buerhaus, & Staiger, 2015). Baby boomer RNs are continuing to work into their late 50s and 60s, and there are currently more workers in the US over age 55 years of age than ever before (Phillips & Miltner, 2015). This significantly increases the probability that nurses with activity limitations will be a substantial portion of the nursing workforce moving forward. In addition, employment among healthcare practitioner occupations is expected to increase by 21.4% and will result in almost 1.6 million new jobs, driven by an increasing demand for healthcare services. Registered Nurses will account for more than one-third of the growth in this occupational group (Bureau of Labor Statistics, 2010).

Labor market discrimination is an important problem for persons with activity limitations across many occupations. Labor market discrimination for disabled persons, coupled with gender inequality in the U. S. labor market, may pose additional challenges for nurses, who are predominantly female. Whatever the cause, jobs dominated by females pay less on average than jobs dominated by males, and women’s occupations pay less than male dominated occupations in many countries (Olson, 2013).

Nurses with a broad range of activity limitations are currently employed in the hospital setting (Wood & Marshall, 2010), although persons with activity limitations have historically been under-represented in the nursing workforce. Approximately 154,000 of the 2.2 million nurses surveyed in 2000 indicated they were employed in positions other than nursing because of disability or illness (Matt, 2008). For those nurses that do work with a disability, significant barriers can exist in getting and keeping jobs (Guillett, Neal-Boyland, & Lathrop, 2007), including acceptance by co-workers, supportive environment, organizational policies related to accommodations, and an understanding of how these physical limitations affect the nurse and the nurses’ job performance (Job Accommodation Network, 2011; Guillett et al., 2007; Matt, 2008 & 2011). Given the current data presented here, there is evidence that the issue of practicing nurses with physical or mental impairments or activity limitations will continue to grow in importance to the nursing workforce.

Global implications:

As noted by Sherman, Chiang-Hanisko & Koszalinski (2013), the aging nursing workforce is a global challenge. On a recent RN4CAST project funded by the European commission, a nursing shortage of over 600,000 nurses was projected across Europe by 2020 (Sherman et al., 2013). Falling fertility rates and the aging population with increased life expectancies have created a declining ratio of young and working adults to the number of retirees. In fact, the Organization for Economic Co-operation and Development estimated that by 2015, the number of retirees would outnumber those entering the workforce (Warmuth, 2008). Indeed, the aging of the nursing workforce is anticipated to lead to projected nursing shortages in many countries (Buchan, Twigg, Dussault, Duffield, & Stone, 2015).

Because a substantial number of nurses who, as they continue to age, will experience increasing activity difficulties, it is imperative that employers provide job accommodations and resources for nurses developing activity limitations. As examples, employers can promote flexible schedules and alternative work assignments; create environments that foster acceptance and support of disabled nurses (e.g., use of flexible access computer stations with different types of chairs at the nurses’ station); and conduct a careful review of job descriptions to ensure essential job functions are accurately reflected and describe the professional nursing role (Guillett et al., 2007; Matt, 2011; Matt et al., 2015). Employers must also ensure all possible resources are being used to provide work accommodations including consultation with the disabled nurse (JAN, 2011), and education of co-workers regarding how to interact with their peers with physical limitations (Matt, 2008). In so doing, the “caring” profession will best care for their own.