SPEAKER：Dr. Yixin Iris Wang, University of Illinois at Urbana-Champaign

TIME/DATE：2026.7.6   10:00

CLASSROOM：A403

ABSTRACT

In response to staffing shortages in U.S. nursing homes, exacerbated during the pandemic, the federal government issued a nationwide certification waiver in 2020 for nurse aides in training (NATs), allowing them to work beyond the four-month certification limit. The waiver expired in June 2022 but was partially extended in a subset of states (i.e., treatment states) for an additional year. We exploit this state-level variation and use a difference-indifferences framework to examine the impact of extending the uncertified duration of NATs on staffing conditions and care quality. We find that the waiver extension increased nurse aides’ staffing levels by retaining NATs in treatment states and was associated with improvements in the overall care quality. However, these gains are accompanied by risks stemming from changes in staffing composition. The waiver extension increased both the share of NATs and their average uncertified duration in treatment states. Because NATs are required to participate in periodic training, these changes may disrupt the continuity of labor-intensive care routines. Consistent with this mechanism, we document increases in urinary tract infections and greater reliance on catheterization, with the latter effect associated with a higher share of NATs remaining uncertified beyond eight months. As policymakers revisit extending NATs’ uncertified duration as a potential long-term solution to persistent staffing shortages, our findings highlight a trade-off between staffing levels and staffing composition and provide actionable insights on how to calibrate the certification limits to alleviate shortages without compromising care quality.

GUEST BIO

Yixin Iris Wang (王亦昕) is an Associate Professor of Business Administration at the Gies College of Business, University of Illinois at Urbana-Champaign. She conducts research in empirical operations management, focusing on supply chain risk management, pharmaceutical and nursing shortages, and people-centric operations. She has extensive experience working with large-scale data to examine how supply networks, public policy, and human interactions influence organizational performance. Her research includes collaborations with U.S. academic medical centers and experimental studies with pharmacy retail chains in China, through which she analyzes data and develops practical solutions.