Structure of Nurse Labor Market and Determinants of Hospital Nurse Staffing Levels

간호사 노동시장의 구조분석 및 병원 간호사 확보수준의 결정요인

  • Park, Bohyun (Department of Nursing, Kimcheon Science College) ;
  • Seo, Sukyung (BK21 Center for Elderly Health Policy Research, Seoul National University) ;
  • Lee, Taejin (Graduate School of Public Health, Seoul National University)
  • 박보현 (김천과학대학교 간호학과) ;
  • 서수경 (서울대학교 BK21노인보건정책연구사업팀) ;
  • 이태진 (서울대학교 보건대학원)
  • Received : 2012.05.30
  • Accepted : 2012.09.26
  • Published : 2013.02.28


Purpose: To analyze the structure of Korean nurse labor market and examine its effect on hospital nurse staffing. Methods: Secondary data were obtained from Statistics Korea, Education Statistics, and Health Insurance Review & Assessment Service and Patient Survey. Intensity of monopsony in the nurse labor market was measured by Herfindahl Hirshman Index (HHI). Hospital nurse staffing level was divided into high and low. While controlling for confounding factors such as inpatient days and severity mix of patients, effects of characteristics of nurse labor markets on nurse staffing levels were examined using multi-level logistic regressions. Results: For characteristics of nurse labor markets, metropolitan areas had high intensity of monopsony, while the capital area had competitive labor market and the unemployed nurse rate was higher than other areas. Among hospital characteristics, bed occupancy rate was significantly associated with nurse staffing levels. Among characteristics of nurse labor markets, the effect of HHI was indeterminable. Conclusion: The Korean nurse labor market has different structure between the capital and other metropolitan areas. But the effect of the structure of nurse labor market on nurse staffing levels is indeterminable. Characteristics such as occupancy rate and number of beds are significantly associated with nurse staffing levels. Further study in support of the effect of nurse labor market is needed.


Supported by : 보건의료산업노동조합


  1. Adamache, K. W., & Sloan, F. A. (1982). Unions and hospitals: Some unresolved issues. Journal of Health Economics, 1(1), 81-108.
  2. Bhaskar, V., Manning, A., & To, T. (2002). Oligopsony and monopsonistic competition in labor markets. Journal of Economic Perspectives, 16(2), 155-174.
  3. Blegen, M. A., Goode, C. J., & Reed, L. (1998). Nurse staffing and patient outcomes. Nursing Research, 47(1), 43-50. 6199-199801000-00008
  4. Blegen, M. A., Vaughn, T., & Vojir, C. P. (2008). Nurse staffing levels: Impact of organizational characteristics and registered nurse supply. Health Services Research, 43(1), 154-173. 3.2007.00749.x
  5. Bloom, J. R., Alexander, J. A., & Nuchols, B. A. (1997). Nurse staffing patterns and hospital efficiency in the United States. Social Science and Medicine, 44(2), 147-155.
  6. Brewer, C. S., & Frazier, P. (1998). The influence of structure, staff type, and managed-care indicators on registered nurse staffing. Journal of Nursing Administration, 28(9), 28-36.
  7. Cho, S. H., June, K. J., Kim, Y. M., & Park, B. H. (2008). Changes in hospital nurse staffing after implementing differentiated inpatient nursing fees by staffing grades. The Journal of Korean Nursing Administration Academic Society, 14(2), 167-175.
  8. Cho, W. H. (1999). Labor economics: Theory and reform policy. Paju: Bobmunsa.
  9. Dickens, W. T., & Lang, K. (1987). Neoclassical and sociological perspectives on segmented labor markets. Cambridge: National Bureau of Economic Research.
  10. Feldman, R., & Scheffler, R. (1982). The union impact on hospital wages and fringe benefits. Industrial and Labor Relations Review, 35(2), 196-206.
  11. Greene, J., & Nordhaus-Bike, A. M. (1998). Nurse shortage. Where have all the RNs gone? Hospitals and Health Networks, 72(15-16), 78-80.
  12. Grumbach, K., Ash, M., Seago, J. A., Spetz, J.,& Coffman, J. (2001). Measuring shortages of hospital nurses: How do you know a hospital with a nursing shortage when you see one? Medical Care Research and Review, 58(4), 387-403.
  13. Hirsch, B. T., & Schumacher, E. J. (2005). Classic or new monopsony? Searching for evidence in nursing labor markets. Journal of Health Economics, 24(5), 969-989. 03.006
  14. Hodge, M. B., Romano, P. S., Harvey, D., Samuels, S. J., Olson, V. A., Sauvé, M. J., et al. (2004). Licensed caregiver characteristics and staffing in California acute care hospital units. Journal of Nursing Administration, 34(3), 125-133.
  15. Jeong, H. J., & Yang, B. M. (2000). Monopsony power of general hospitals in nurse labor market. Korean Journal of Hospital Management, 5(2), 40-58.
  16. Kim, Y. M., Cho, S. H., Jun, K. J., & Go, S. H. (2007). The effects of institutional and market factors on nurse staffing in acute care hospitals. Korean Journal of Health Policy and Administration, 17(2), 68-90.
  17. Kim, Y. M., June, K. J., & Cho, S. H. (2005). Factors related to nurse staffing levels in tertiary and general hospitals. Journal of Korean Academy of Nursing, 35(8), 1493-1499.
  18. Mark, B. A., Jones, C. B., Lindley, L., & Ozcan, Y. A. (2009). An examination of technical efficiency, quality, and patient safety in acute care nursing units. Policy, Politics & Nursing Practice, 10(3), 180-186. http://dx.doi. org/10.1177/1527154409346322
  19. Miller, R. A. (1982). The herfindahl-hirschman index as a market structure variable: An exposition for antitrust practitioners. The Antitrust Bulletin, 27(3), 593-618.
  20. Ministry of Health & Welfare. (2008). OECD health data.Retrieved May 2, 2008, from
  21. Mullner, R., Beyers, M., Levy, P., Byre, C., & Mallin, K. (1983). Community hospital characteristics associated with RN and LPN vacancy rates. Social Science and Medicine, 17(15), 1055-1059. 7-9536(83)90411-2
  22. Oh, Y. H. (2008). Distributional change in major health manpower in Korea, 2000-2006. Health and Welfare Policy Forum, 139, 98-110.
  23. Peterson, C. A. (2001). Nursing shortage: Not a simple problem-no easy answers. Online Journal of Issues in Nursing, 6(1), 1.
  24. Robinson, J. C. (1988). Market structure, employment, and skill mix in the hospital industry. Southern Economic Journal, 55(2), 315-325.
  25. Seago, J. A., Ash, M., Spetz, J., Coffman, J., & Grumbach, K. (2001). Hospital registered nurse shortages: Environmental, patient, and institutional predictors. Health Services Research, 36(5), 831-852.
  26. Staiger, D. O., Spetz, J., & Phibbs, C. S. (2010). Is there monopsony in the labor market? Evidence form a natural experiment. Journal of Labor Economics, 28(2), 211-236.
  27. Sullivan, D. (1989). Monopsony power in the market for nurses. Journal of Law and Economics, 32(2), S135-S179.
  28. Yett, D. E. (1966). An analysis of the causes and consequences of salary differentials in nursing. Economic Inquiry, 5(1), 103. 10.11 11/j.1465-7295.1966.tb01990.x