ABSTRACT
The COVID-19 pandemic intensified pre-existing nursing shortages and contributed to uneven recovery in registered nurse (RN) employment across U.S. states. This study examines whether state COVID-19 policy environments in 2021 were associated with RN employment growth from 2021 to 2022. Using a cross-sectional sample of the 50 U.S. states and the District of Columbia (N = 51), this study models the percentage change in total RN employment from 2021 to 2022 as the dependent variable. To capture policy environments as bundles, individual policies are aggregated into three additive indices: Access and Affordability, Public Health Mandates, and Labor Mobility and Care Disruption. The third index is interpreted as a mixed labor-supply context because its components include both supports for labor-force attachment and family-care constraints. The models control for state-level economic and demographic conditions, along with a compensation-structure proxy. The primary GLM specifications, estimated with a Gaussian family, identity link, and Huber–White robust standard errors, produce directional patterns similar to those from OLS robustness checks, although the estimates are generally imprecise. The Access and Affordability index is positive across specifications, the Public Health Mandates index is negative and only marginally significant in the simpler specification, and the Labor Mobility and Care Disruption index is close to zero. Overall, the results provide limited evidence that broad state policy bundles alone explain cross-state variation in short-horizon RN employment recovery. From a managerial perspective, the findings support continuity-of-care and workforce-monitoring strategies during major disruptions, but they do not justify treating any policy bundle as a causal lever for RN employment.
Keywords
COVID-19 policy; telehealth; nursing workforce; employment recovery; state policy variation; mandates; labor mobility; health economics.