At the same time, there has been ongoing concern about controlling hospital costs, which have experienced real growth of approximately 2 percent per year despite decades of efforts at hospital payment reform and utilization control.2 Efforts by hospitals to control labor costs have had major effects on nurses—the largest component of hospital labor. Lower rates of entry into the nurse workforce in the 1990s, and the impact on long-term shortages of nurses, have been attributed in part to the perceptions by potential nurses that the quality of work life as a nurse was low.3