HOSPITAL NURSE STAFFING SURVEY

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1 2012 Ceter for Nursig Workforce St udies HOSPITAL NURSE STAFFING SURVEY Vacacy ad Turover Itroductio The Hospital Nurse Staffig Survey (HNSS) assesses the size ad effects of the ursig shortage i hospitals, largest employer of urses. Durig the sprig of 2012, the Ceter for Nursig Workforce Studies (TCNWS) admiistered the HNSS to 603 hospitals. These icluded for-profit, o-profit, public, ad Departmet of State Health Services-operated hospitals, as well as hospitals liked to academic istitutios; military hospitals were ot surveyed. The facilities surveyed were geeral acute care, psychiatric, special, ad rehabilitatio hospitals. 373 (61.9%) hospitals respoded to the survey. The hospitals that completed the 2012 HNSS were represetative of all hospitals by regio ad bed size. This report presets the fidigs of the 2012 HNSS related to positio vacacies ad staff turover at hospitals. It icludes rates of each across geographic regios ad ursig types. Accordig to a 2011 TCNWS report, our state faces a cotiuig ursig shortage. 1 Nurse vacacy ad turover rates are amog the key measures for assessig a ursig workforce shortage, the severity of the shortage, ad chages i the ursig labor market over time. The 2012 HNSS vacacy rates reported herei measure the percetage of positios that were vacat over a oe week period durig oe of the year s peak occupacy times (1/22/2012-1/28/2012). The 2012 HNSS turover rates measure the frequecy of staff separatios, both volutary ad ivolutary, over a oe year period (1/1/ /31/2011). High vacacy ad turover rates ca lead to egative outcomes that ca affect quality of care such as losig experieced staff ad icreasig the workload ad stress levels of existig staff. 2 High vacacy ad turover is also costly to hospitals due to the high cost associated with overtime or the use of agecy urses to fill vacat positios as well as the cost associated with recruitig qualified urses. Methods of Calculatio This vacacy ad turover report provides the positio vacacy rate ad the media facility vacacy rate for each of the urse types. TCNWS has chose to report both methods i order to compare our data to work beig doe by other etities across the state ad coutry. The two methods for calculatig vacacy rates describe two differet cosideratios: the positio vacacy rate describes the proportio of all full-time equivalet (FTE) positios that are vacat across all respodig hospitals, whereas the media facility vacacy rate provides the midpoit of vacacy rates amog all hospitals, regardless of hospital or staff size. I this report, the regioal positio vacacy rate was calculated by takig the sum of all vacat direct patiet care RN FTE positios i each regio, dividig it by the total of all FTE positios, occupied or vacat, i each regio ad multiplyig by 100. This was also doe for the statewide positio vacacy rate. FTE positios are defied as the total umber of occupied ad vacat FTE positios i the hospital. Vacat FTE positios are defied as the total umber of FTE positios that were vacat i the hospital regardless of whether they were beig actively recruited or were o hold or froze. Regioal positio vacacy rate = ( Vacat FTE positios beig recruited, o hold or froze i a regio) / ( Occupied ad vacat FTE positios i a regio) x 100 Statewide positio vacacy rate = ( Vacat FTE positios beig recruited, o hold or froze across the state) / ( Occupied ad vacat FTE positios across the state) x 100 The facility vacacy rate was calculated by dividig the umber of vacat FTE positios i a hospital by the total umber of FTE positios (occupied ad vacat) i that hospital ad multiplyig by 100. Some researchers prefer media value over mea values because medias are less sesitive to outliers. This is because 50% of hospitals have a turover rate that is less tha the media value ad the other 50% of hospitals have a turover rate higher tha the media value. Facility vacacy rate = ( Vacat FTEs beig recruited, o hold or froze i a facility) / ( Occupied ad vacat FTE positios i a facility) x 100 Whe vacacy rate is calculated for each idividual hospital, the media facility vacacy rate represets the media value for all hospitals. Source: 1 Ceter for Nursig Workforce Studies, Nursig Workforce i 2011 Demographics ad Treds, cws/2011_ursig_workforce.pdf 2 America Associatio of Colleges of Nursig, Nursig Shortage Fact Sheet, 2012, Publicatio #: of 6 February 2013

2 2012 Hospital Nurse Staffig Survey: Vacacy ad Turover Report Methods of Calculatio (cotiued) The facility turover rate was calculated by dividig the total umber of separatios by the average umber of employees (both full-time ad part-time) the hospital had durig the reportig period. That umber was the multiplied by 100. The survey istrumet asked hospitals to provide the umber of full ad part-time positios at two poits (1/1/2011 ad 12/31/11) ad the umbers provided were the averaged to calculate the average umber of employees. Facility turover rate = Total Number of Separatios x 100 (Average # Full-time) + (Average # Part-time) Whe turover rate is calculated for each idividual hospital, the media facility turover rate represets the media value for all hospitals. Registered Nurses (RNs), Licesed Vocatioal Nurses (LVNs), ad Nurse Aides (NAs) -- Table 1. Number of Occupied ad Vacat FTE Positios i by Nurse Type Total Vacat Occupied FTE FTE Positios Positios Statewide Positio Vacacy Rate Number of Hospitals that Reported Zero Vacacies Registered Nurses (RNs) ,032 4, % 90 Licesed Vocatioal Nurses (LVNs) 316 5, % 219 Nurse Aides (NAs) ,032 1, % 152 Note: =umber of hospitals i that reported FTE positios for each urse type. Table 1 presets the total umber of occupied ad vacat FTE positios i by urse type ad the resultig positio vacacy rate for each. RNs were the most umerous urse type i hospitals ad had the highest positio vacacy rate. Just 25.6% of hospitals reported zero RN vacacies, while 69.3% reported zero LVN vacacies ad 46.2% reported zero NA vacacies. Table 2. Positio Vacacy Rates i by Regio ad Nurse Type Regio 1 Pahadle Regio 2 Regio 3 East Regio 4 Gulf Coast Regio 5 Cetral Regio 6 Grade Regio 8 West RNs % 5.2% 7.6% 7.1% 11.0% 12.6% 22.2% 9.0% LVNs % 2.7% 4.5% 4.4% 10.5% 11.0% 1.5% 3.2% NAs % 4.5% 5.9% 8.6% 11.0% 13.3% 7.8% 7.2% Note: =umber of hospitals i that reported FTE positios for each urse type. The positio vacacy rates i Table 2 represet the total percetage of vacacies for a positio across a regio. Overall, the positio vacacy rate for RNs i was 8.1% i 2012, though the positio vacacy rates for RNs raged from 4.1% i Regio 1 to 22.2% i. For LVNs i, the positio vacacy rate was 5.2% i Regioally, the positio vacacy rate for LVNs raged from 1.5% i to 11.0% i Regio 6. For NAs i, the positio vacacy rate was 7.5% i 2012 with a rage from 4.5% i Regio 2 to 13.3% i Regio 6. The positio vacacy rates i Regios 5 ad 6 (Cetral ad, respectively) exceeded the state rates for all three urse types. I Regios 1 (Pahadle) ad 2 ( ), positio vacacy rates were below the state rates for all three urse types. Publicatio #: of 6 February 2013

3 2012 Hospital Nurse Staffig Survey: Vacacy ad Turover Report Registered Nurses (RNs), Licesed Vocatioal Nurses (LVNs), ad Nurse Aides (NAs) (cotiued) -- Figure 1. Statewide Positio Vacacy Rates by Nurse Type, Figure 1 represets the positio vacacy rates for from for RNs, LVNs, ad NAs. From 2010 to 2012, there was a 20.9% icrease i the overall positio vacacy rate for RNs. However, the 2012 RN positio vacacy rate remaied lower tha it was prior to Amog LVNs, there was a cosiderable decrease (40.2%) i the positio vacacy rate from 2010 to The 2012 LVN rate was roughly half of the 2006 rate. The 2012 positio vacacy rate for NAs decreased slightly to 7.5% from 7.9% i Table 3. Media Facility Vacacy Rates i by Regio ad Nurse Type Regio 1 Pahadle Regio 2 Regio 3 East Regio 4 Gulf Coast Regio 5 Cetral Regio 6 Grade Regio 8 West RNs % 4.7% 5.3% 4.5% 7.1% 7.5% 7.2% 7.1% 5.6% LVNs 316 0% 0% 0% 0% 0% 0% 0% 0% 0% NAs 329 0% 0% 4.7% 4.1% 10.2% 5.8% 4.2% 3.9% 3.1% Note: =umber of hospitals i that reported occupied ad vacat FTE positios for each urse type. Table 3 represets the media facility vacacy rate by regio ad urse type. These umbers represet the media value whe vacacy rates are calculated for each idividual hospital. The media value is reported because it is less sesitive to outliers tha the mea. Vacacy rates of 0% reflect that at least half of the hospitals i each regio had zero vacacies for their urse positios. Table 1 (page 2) shows the umber of hospitals that reported zero vacacies for the differet urse types. Overall, the media facility vacacy rate for RNs i was 5.6% i 2012, dow from 6.2% i The media facility vacacy rate for RNs raged from 4.5% i Regio 4 to 7.5% i Regio 6. Overall, the media facility vacacy rate for LVNs i was 0% i 2012, the same rate see i Overall, the media facility vacacy rate for NAs i was 3.1% i 2012, dow from 3.9% i Media facility vacacy rates i Regios 5, 6, 7, ad 8 exceeded the state rates amog both RNs ad NAs. Table 4. Media Facility Turover Rates i by Regio ad Nurse Type Regio 1 Pahadle Regio 2 Regio 3 East Regio 4 Gulf Coast Regio 5 Cetral Regio 6 Grade Regio 8 West RNs % 21.2% 25.8% 17.6% 20.2% 21.2% 24.9% 22.3% 21.4% LVNs % 19.4% 40.0% 21.3% 10.0% 18.5% 22.2% 22.9% 20.0% NAs % 36.0% 30.2% 21.0% 28.7% 28.6% 31.3% 31.3% 30.7% Note: =umber of hospitals i that reported average umber of employees ad total separatios for each urse type. The umbers i Table 4 represet the media facility turover rate i by regio ad urse type amog hospitals that reported a average umber of employees ad the total umber of separatios for the reportig period. These umbers represet the middle value whe turover is calculated for each idividual hospital facility. The media value is reported because it is less sesitive to outliers tha the mea. Overall, there was a 21.4% media facility turover rate for RN positios amog the 351 hospitals that respoded to this questio. This umber meas that roughly half of all hospitals had a turover rate for RNs greater tha 21.4% ad roughly half had a turover rate lower tha 21.4%. Cotiued o page 4 Publicatio #: of 6 February 2013

4 2012 Hospital Nurse Staffig Survey: Vacacy ad Turover Report Registered Nurses (RNs), Licesed Vocatioal Nurses (LVNs), ad Nurse Aides (NAs) (cotiued) -- As see i Table 4, there was also a 20.0% media facility turover rate amog LVN positios. However, the turover rate betwee regios raged from 10.0% i Regio 5 to 40.0% i Regio 3. The highest overall turover rate was amog Nurse Aides (30.7%). This urse type also had the highest turover rate i 6 of the 8 regios. Note that the Cetral ad regios both had turover rates below the state rates, while the Pahadle, West, ad the Grade exceeded the state rates for all three urse types. Figure 2. RN Vacacy ad Turover Rates by State ad Year Figure 2 compares vacacy ad turover rates to those of Florida 3 ad Califoria 4, two states that have updated vacacy ad turover rates sice As i 2010, cotiued to have higher vacacy rates tha other states. The turover rate i was also higher tha i both Florida ad Califoria. Advaced Practice Registered Nurses (APRNs) I 2011, there were 10,995 Advaced Practice Registered Nurses (APRNs) i. 6,676 were Nurse Practitioers (NPs), 1,602 were Cliical Nurse Specialists (CNSs), 2,449 were Certified Registered Nurse Aesthetists (CRNAs), ad 268 were Certified Nurse Midwives (CNMs). 5 As with RNs, recet data have show that the umber of NPs i o a per capita basis was lower tha the umber i the US as a whole. Moreover, border couties i showed eve lower umbers tha the rest of the state, especially amog NPs, CRNAs, ad CNSs. Table 5. Number of Occupied ad Vacat FTE Positios by APRN Type Occupied FTE Positios Total Vacat FTE Positios Statewide Positio Vacacy Rate Number of Hospitals that Reported Zero Vacacies Nurse Practitioers (NPs) % 66 Cliical Nurse Specialist (CNSs) % 21 Certified Registered Nurse Aesthetists (CRNAs) % 55 Certified Nurse Midwives (CNMs) % 4 Note: =umber of hospitals i that reported FTE positios for each APRN type. 3 Sources: Florida Ceter for Nursig, Nurse Employer Idustry Reports, February Allied for Health Quarterly Turover ad Vacacy Report, 2d Quarter, Hospital Coucil of er Califoria 5 Ceter for Nursig Workforce Studies, Nursig Workforce i 2011 Demographics ad Treds, cws/2011_ursig_workforce.pdf Publicatio #: of 6 February 2013

5 2012 Hospital Nurse Staffig Survey: Vacacy ad Turover Report Advaced Practice Registered Nurses (APRNs) (cotiued) Table 5 presets the umber of occupied ad vacat FTE positios i by APRN type ad the resultig positio vacacy rate for each. NPs were the most commo advaced practice urse type i ad were employed i the most umber of hospitals. Over two-thirds of hospitals with NP positios had zero vacacies. CNS positios had the highest vacacy rate i amog APRN types, with 15 reported vacacies out of 84 CNS FTE positios. This represeted a 17.9% vacacy rate for CNSs amog reportig hospitals. Sixty-two hospitals reported 13 vacacies out of CRNA FTE positios, a 3.5% vacacy rate. This was the lowest vacacy rate amog the APRN types ad 88.7% of hospitals had zero CRNA vacacies. The umber of hospitals reportig CNM FTE positios was relatively low, but still there was a vacacy rate of 15.8%. Table 6. Positio Vacacy Rates i by Regio ad APRN Type Regio 1 Regio 2 Regio 3 Regio 4 Regio 5 Regio 6 Grade Regio 8 Pahadle East Gulf Coast Cetral West NPs % 12.6% 10.3% 7.7% 18.2% 23.5% 42.9% 10.3% CNSs % 16.7% 0% 0% 0% 0% 60.0% CRNAs 62 0% 5.8% 0.9% 1.3% 0% 25% 0% 0% CNMs % 0% 9.1% Note: =umber of hospitals i that reported FTE positios for each APRN type. A dash ( - ) idicates that there were o FTE positios reported i the regio. Table 6 displays the positio vacacy rate by regio for each of the APRN types. Positio vacacy rates ca be greatly affected by a small umber of hospitals that reported a large umber of vacacies i a give regio. For example, i Regio 8 where 36 hospitals respoded to the survey, just two hospitals had CNS positios. Table 6 reports a 60.0% positio vacacy rate while Table 7 reports that the media facility vacacy rate for CNSs was 33.3%. This disparity i the two methods of reportig vacacy rates ca be explaied by the fact that oe hospital reported all 6 of the vacacies for this positio i Regio 8, while the other hospital reportig CNS positios idicated 0 vacacies. The positio vacacy rate for NPs raged from 5% i Regio 1 to 42.9% i. The positio vacacy rate for CNS raged from 0% i multiple regios to 60.0% i Regio 8. The positio vacacy rate for CRNAs raged from 0% i multiple regios to 25.0% i Regio 6. Oly Regios 2, 3, ad 4 reported CNM positios. All vacacies for CNMs were i Regios 2 ad 4. Table 7. Media Facility Vacacy Rates i by Regio ad APRN Type Regio 1 Pahadle Regio 2 Regio 3 East Regio 4 Gulf Coast Regio 5 Cetral Regio 6 Grade Regio 8 West NPs 98 0% 0% 0% 0% 0% 0% 50% 0% 0% CNSs 28-0% 0% 0% 0% 0% 0% 33.3% 0% CRNAs 62 0% 0% 0% 0% 0% 0% 0% 0% 0% CNMs 6-0% 0% 8.3% % Note: =umber of hospitals i that reported FTE positios for each APRN type. A dash ( - ) idicates that there were o FTE positios reported i the regio. Table 7 shows the media facility vacacy rate by regio ad APRN type. These umbers represet the media value whe vacacy rates are calculated for each idividual hospital. The media value is reported because it is less sesitive to outliers tha the mea. The zeros i this table reflect the umber of hospitals i each regio that reported 0 vacacies for their APRN positios. Table 5 (page 4) shows the umber of hospitals that reported 0 vacacies for the differet APRN types. Cotiued o page 6 Publicatio #: of 6 February 2013

6 2012 Hospital Nurse Staffig Survey: Vacacy ad Turover Report Advaced Practice Registered Nurses (APRNs) (cotiued) There were media facility vacacy rates higher tha zero i some regios, but a overall media facility vacacy rate of zero for the state may be attributed to a umber of thigs. Oe is that o a regioal level, the umber of hospitals reportig FTE positios for ay of the APRN types is much lower tha the total umber of hospitals reportig across the state. Aother reaso is that the umber of FTE APRN positios i each hospital is small, i relatio to RN or LVN positios, for example. Thus, the small umber of FTE APRN positios could have a impact o the icreased vacacy rate calculated for a give regio. Table 8. Media Facility Turover Rates i by Regio ad APRN Type Regio 1 Pahadle Regio 2 Regio 3 East Regio 4 Gulf Coast Regio 5 Cetral Regio 6 Grade Regio 8 West NPs % 0% 0% 6.35% 0% 0% 0% 0% 0% CNSs % 0% 0% 0% 0% 100% 0% 0% CRNAs % 0% 0% 0.5% 33% 0% 0% 0% 0% CNMs 6-50% 0% 20% % Note: =umber of hospitals i that reported both average umber of employees ad total umber of separatios for each APRN type. A dash ( - ) idicates that there were o FTE positios reported i the regio. The umbers i Table 8 represet the media facility turover rate i by regio ad APRN type amog hospitals with APRN FTE positios of each type. The media facility turover rate i was 0% for all APRN types but CNMs. This is idicative of the high umber of hospitals that reported zero separatios durig the reportig period. Publicatio #: of 6 February 2013

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