NEW YORK S GROWING DEMAND

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1 Nurses and Allied Health Professionals NEW YORK S GROWING DEMAND Results from the 2011 Health Care Professionals Workforce Survey JUNE 2011 Published by

2 The 2011 Health Care Professionals Workforce Survey was conducted by in collaboration with WNYHA Western New York Healthcare Association

3 The demand for nurses and allied health professionals in New York is on the rise as the state begins to emerge from the recession and new health care reform initiatives take hold. During 2010 (the period covered by this report), 40% of the hospitals that responded said they anticipated overall growth in demand for staff and in particular for registered nurses (RNs), physician assistants (PAs), and nurse practitioners (NPs). They also reported higher vacancy rates for these and other allied professionals. Survey respondents indicated that many of these types of professionals were very difficult to recruit, either because of shortages or competition. This contrasts with last year s survey, when respondents saw lower vacancy and turnover rates due presumably to the economic recession, and 40% reported reducing staff, 32% were implementing hiring freezes, and 25% were planning layoffs. Nurses and Allied Health Professionals: New York s Growing Demand includes responses received from a 2011 survey of New York State hospitals to assess the staffing levels of nurses and allied health professionals in The survey covered 2010 vacancy and turnover rates; recruitment and retention challenges; nursing degree distribution; and hospital subsidies of nursing education. The findings reported represent 105 hospitals/health systems, a 58% response rate. The Healthcare Association of New York State (HANYS) and Greater New York Hospital Association (GNYHA) conducted the 2011 Health Care Professionals Workforce Survey in collaboration with the State University of New York (SUNY) Center for Health Workforce Studies (CHWS) with support from Western New York Healthcare Association (WNYHA), Rochester Regional Healthcare Association (RRHA), Iroquois Healthcare Alliance (IHA), Northern Metropolitan Healthcare Association (NorMet), and Nassau-Suffolk Hospital Council (NSHC). The report provides statewide and regional data. The Western New York and Rochester regions were combined due to their smaller response rates. The relatively higher turnover rates in this year s survey results suggest that an improvement in the overall health care workforce job market is prompting nurses and allied health professionals to change jobs. According to the U.S. Bureau of Labor Statistics, the recession resulted in a loss of 8.4 million jobs, but health care gained 732,000 jobs over the same period. As the nation recovers from the recession, the health care and social assistance sector seems to be proving more resilient than other industries, with more than 19,000 jobs added over the past year in New York, according to the New York State Department of Labor (DOL). Nursing and allied health professionals are among the fastest growing segment for jobs, with a reported addition of 5,000 private sector jobs in March 2011 alone. DOL considers employment prospects for nursing and other health care jobs as highly favorable and indicates a growing demand for these positions. NURSES AND ALLIED HEALTH PROFESSIONALS: NEW YORK S GROWING DEMAND JUNE

4 In a CHWS April 2010 report, The Health Care Workforce in New York 2008, the number of professional licensees registered with the state grew as follows between 2003 and 2008: GROWTH IN NUMBER OF LICENSEES BY PROFESSION, % 21% 14% 13% 10% 7% Physician Assistants Nurse Practitioners Physical Therapists Social Workers Occupational Therapists Licensed Practical Nurses In that same report, all regions of the state showed health sector job growth between 2003 and Similarly, this Survey found that 40% of responding hospitals anticipated an overall job growth in coming months. The percentage of respondents anticipating growth by type of health care staff was as follows: ANTICIPATED GROWTH, % 34.3% 31.4% 25.7% 23.8% 14.3% RNs Physician Assistants Nurse Practitioners Certified Nurse s Aides Coders Pharmacists 2 NURSES AND ALLIED HEALTH PROFESSIONALS: NEW YORK S GROWING DEMAND JUNE 2011

5 NURSES Hospitals reported much higher nurse vacancy and turnover rates for 2010 than in Nearly 50% of respondents expected their nursing staff to grow over the next few months and 47% reported that experienced nurses are very difficult to recruit. Demand for nurses is likely to grow for several reasons. As has been the case for more than a decade, the average age of a nurse is on the rise, with more than 50% of RNs in the state being 50 years or older. Simultaneously, there is a growing population of elderly people with multiple chronic conditions, along with an increased overall complexity of disease, creating an increased demand on health care resources. Further, implementation of the federal Affordable Care Act (ACA) and related activities is expected to expand the scope of practice for nursing and allied health professionals and increase demand for them. According to another recent CHWS report, 12% of currently active nurses in New York expect to leave their current position in the coming year. Of those, 24% said they will retire (about 4% of all active nurses). This represents a loss of about 8,100 RNs in the coming year. The retirement rate reported in the 2011 Health Care Professionals Workforce Survey was 4.2% for the same period. RETIREMENT RATES FOR RNS BY NEW YORK STATE REGION, 2011 NURSES AND ALLIED HEALTH PROFESSIONALS: NEW YORK S GROWING DEMAND JUNE

6 Responses from the 2010 nursing and allied workforce survey report suggest that the economy played a major role in keeping vacancy and turnover rates unusually low over the last year and declining over the last two years. Older nurses were reluctant to retire and nurses who had left the nursing profession were returning. As reported in last year s workforce survey report, what resulted was a large number of newly graduating nurses who were unable to find jobs, giving a temporary indication that the nursing shortage had receded. RN VACANCY AND TURNOVER IN NEW YORK HOSPITALS, The above chart shows that the New York State RN vacancy rate increased to 6.1% in 2010 from 3.6% in 2009, mirrored by significant growth in turnover. Consistent with responses on vacancy rates, hospitals described recruitment of experienced RNs as very difficult. While nearly 47% of responding facilities statewide reported recruitment difficulties, some regions reported even greater challenges, with 62% of the Northern Metropolitan (Hudson Valley) region indicating recruitment difficulties, followed by New York City (58%) and the Northeastern regions (53%). However, once recruited, only 11% of respondents indicated that nurses were difficult to retain. 4 NURSES AND ALLIED HEALTH PROFESSIONALS: NEW YORK S GROWING DEMAND JUNE 2011

7 The chart on the right shows the specific reasons respondents cited for their recruitment difficulties. HOSPITAL-REPORTED REASONS FOR DIFFICULTIES RECRUITING EXPERIENCED RNS, 2010 Percent Reporting Recruitment Difficulty 47% Of this 47%, the following reasons were noted: Shortage of Workers Competition for Experienced RNs Salary Levels 41% 73% 29% HOSPITALS REPORTING RECRUITMENT DIFFICULTY FOR EXPERIENCED RNS BY REGION, 2010 While 71% of respondents in the Central New York region attributed the recruitment difficulties to the nursing shortage, other regions responded in greater numbers to competition for experienced nurses. NURSES AND ALLIED HEALTH PROFESSIONALS: NEW YORK S GROWING DEMAND JUNE

8 Regional differences in competition for experienced RNs were reported as listed on the right. PERCENT REPORTING COMPETITION FOR EXPERIENCED RNS, 2010 Western NY/Rochester Central NY Northeastern NY Northern Metropolitan 79% 71% 59% 85% Long Island 87% New York City 63% Anticipated Growth in Demand for RNs in the Coming Year As the chart below indicates, nearly half of responding hospitals anticipate growth in the demand for nurses in the coming year. This number is much higher on Long Island, where nearly 80% of respondents anticipate a growth in demand. PERCENT OF RESPONDING HOSPITALS THAT ANTICIPATE GROWTH IN DEMAND FOR RNS, NURSES AND ALLIED HEALTH PROFESSIONALS: NEW YORK S GROWING DEMAND JUNE 2011

9 Nursing Education Levels The Institute of Medicine s (IOM) 2010 report, The Future of Nursing: Leading Change, Advancing Health, made several health care reform recommendations, including improving nursing education and collecting data for workforce planning and policy making. IOM recommended increasing the proportion of nurses with a Bachelor of Science in Nursing (BSN) degree to 80% of the workforce by According to CHWS, across the state, only 33% of RNs have a BSN. Of these, only 19.2% are in upstate New York and 18% are in northeastern New York, compared to 48.3% in the downstate region. These disparities could likely be attributed to a lack of access to BSN programs, as more of these nursing education programs are located downstate. Further, while approximately 9,800 new nurses graduated in the past year in New York State, only 13% (about 1,200 nurses) of these graduates completed their BSN. STATEWIDE DISTRIBUTION OF NURSING DEGREES, 2010 MSN, 5.2% PhD, 0.2% BSN, 33.0% Associate, 43.7% Diploma, 6.3% NURSING DEGREES UPSTATE, 2010 NURSING DEGREES DOWNSTATE, 2010 Notes: Figures may not sum to 100% due to survey responses. MSN: Master of Science in Nursing PhD: Doctorate NURSES AND ALLIED HEALTH PROFESSIONALS: NEW YORK S GROWING DEMAND JUNE

10 REGIONAL DISTRIBUTION OF NURSING DEGREES, 2010 Statewide Western NY/Rochester Central NY Northeastern NY Associate Degree 43.7% 47.9% 69.0% 52.8% Northern Metropolitan 39.6% Long Island 35.4% Diploma BSN MSN PhD 6.3% 7.3% 4.6% 13.9% 5.0% 5.8% 33.0% 21.3% 23.2% 18.8% 20.1% 41.7% 5.2% 1.9% 2.9% 4.5% 1.9% 8.5% 0.2% 0.3% 0.3% 0.3% 0.0% 0.1% New York City 30.0% 2.7% 54.5% 7.6% 0.2% Notes: Figures may not sum to 100% due to survey responses. MSN: Master of Science in Nursing PhD: Doctorate The 2011 survey also asked how many hospital nurses were pursuing a higher level of education in 2010, and while the numbers are encouraging, they again reveal regional disparities. Of those pursuing a BSN, 34% are on Long Island and 26% are in New York City. Of those pursuing an MSN, 30% are located on Long Island and 47% are in New York City; and, of those pursuing a doctoral degree, 50% are located in New York City and 24% are on Long Island. The percentages of those pursuing degrees upstate are much smaller. NUMBER OF NURSES PURSUING HIGHER EDUCATION, 2010 Certified Nurse s Aide to Licensed Practical Nurse (LPN) LPN to RN Associate to BSN BSN to MSN ,889 1,631 MSN to PhD 62 8 NURSES AND ALLIED HEALTH PROFESSIONALS: NEW YORK S GROWING DEMAND JUNE 2011

11 When asked about strategies that hospitals employ to encourage further nursing education, 43% of responding hospitals indicated that they provide on- or off-site RN to BSN programs, and 27% provide on- or off-site BSN to MSN programs. Consistent with other findings related to higher education, these percentages are higher in the Long Island and New York City regions. This is reflected in the chart below, where, unlike in other regions, most hospitals in the Long Island and New York City regions did not indicate that proximity to a nursing program is a barrier to nurses pursuing higher degrees. BARRIERS TO PURSUING HIGHER NURSING DEGREES BY REGION, 2010 Statewide Western NY/ Rochester Central NY Northeastern NY Northern Metropolitan Long Island New York City Family Responsibilities 89% 93% 86% 88% 77% 87% 96% Courses Conflict with Work Schedule 76% 64% 64% 65% 92% 87% 79% Need for Financial Assistance 62% 71% 79% 88% 54% 17% 75% Lack of Reasonable Proximity to RN Program 25% 21% 21% 29% 77% 13% 8% Prerequisite Requirements 20% 21% 14% 12% 39% 9% 29% NURSES AND ALLIED HEALTH PROFESSIONALS: NEW YORK S GROWING DEMAND JUNE

12 Hospitals are well aware of the barriers to nurse education and are responding accordingly. For example, nearly all hospitals provide tuition reimbursement to nurses and a substantial majority work with nurses schedules to accommodate their continuing education efforts. The various strategies that hospitals have employed are listed by their rate of use and region below. STRATEGIES TO ASSIST NURSES IN FURTHERING THEIR EDUCATION BY REGION, 2010 Statewide Western NY/ Rochester Central NY Northeastern NY Northern Metropolitan Long Island New York City Tuition Reimbursement 96% 93% 100% 94% 100% 100% 92% Scheduling Changes 85% 86% 50% 88% 92% 87% 96% Providing On- or Off-site RN to BSN 43% 43% 29% 47% 23% 57% 46% Scholarships 37% 64% 29% 59% 31% 17% 33% 10 NURSES AND ALLIED HEALTH PROFESSIONALS: NEW YORK S GROWING DEMAND JUNE 2011

13 ALLIED HEALTH PROFESSIONALS Responses to the survey indicate the strong need for allied health professionals will likely grow as more New Yorkers become insured through ACA and aging baby boomers continue to place a growing demand on the health care system. The 2011 survey collected information from hospitals on vacancy, turnover, recruitment, and retention for a large subset of health care professionals. What follows is a summary of these responses by the various professions. Nurse Practitioners and Physician Assistants With a growing shortage of primary care physicians and increasing demand for primary and preventive health services across the nation, the role that nurse practitioners (NPs) and physician assistants (PAs) perform in health care delivery will continue to expand and evolve. A recent Robert Wood Johnson Foundation report on the health care workforce found that team-based care and an expanded role for advance practice nurses could mitigate the shortage of primary care providers. Additionally, IOM s report, The Future of Nursing: Leading Change, Advancing Health recommended that nurses be allowed to practice to the full extent of their education and training. Legislation was introduced in New York to increase the scope of practice of NPs. Seventeen states across the country have already passed legislation to increase NP scope of practice, specifically by allowing NPs to practice without a collaborative agreement so that they can provide muchneeded services in areas with severe physician shortages. Responses to the 2011 Health Care Professionals Workforce Survey reflect the recommendations in these reports and legislation and reflect an increased demand for NPs and PAs in New York State. Thirty-one percent of survey respondents indicated a growth in demand for NPs and 34% indicated growth in demand for PAs in Vacancy rates have increased significantly since last year s survey based on 2009 data for both of these professions. Last year s report showed a 7.8% vacancy rate for NPs and a 4.5% vacancy rate for PAs. This year, those rates are 11.8% and 9.7%, respectively. While turnover rates for PAs remained stable compared to last year, NP turnover more than doubled, suggesting that NPs are indeed in increased demand. NURSES AND ALLIED HEALTH PROFESSIONALS: NEW YORK S GROWING DEMAND JUNE

14 VACANCY AND TURNOVER FOR NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS, Consistent with this year s hospital survey results, a recent study by CHWS on the supply and demand of health care workers found that the number of licensed NPs grew by 21% over a five-year period ( ), and the number of licensed PAs grew 30% over the same period. According to DOL, the employment prospects for PAs in New York are favorable. DOL does not include NPs as a specific category for its analysis. Nearly one-third of survey respondents indicate that NPs are very difficult to recruit, and 22% indicate that PAs are very difficult to recruit. In the CHWS 2010 report, The Healthcare Workforce in New York, 2008, recruitment difficulty for NPs and PAs in the hospital setting scored 3 on a scale of 1 to 5 (where 5 was most difficult). When these same data are broken down by region, Central New York emerges as the region where recruiting these professionals is most difficult, with 71% of Central New York hospitals reporting that NPs were very difficult to recruit and 64% indicating that PAs were very difficult to recruit. Central New York also is an area with a growing physician shortage. 12 NURSES AND ALLIED HEALTH PROFESSIONALS: NEW YORK S GROWING DEMAND JUNE 2011

15 For every allied health care profession, except radiologic technicians, vacancy rates rose relative to last year s survey. This year s survey added new categories, including clinical laboratory technologists and several health information technology (HIT) categories. While we cannot compare these new categories to past years, the vacancy rates reported for those categories in 2010 are listed at right. Notably, hospitals anticipated growth in several categories of professionals in which they also indicated challenges with recruitment. This was the case for medical coders, pharmacists, physical therapists, and clinical laboratory technologists. The highest vacancy rates across the state VACANCY RATES BY PROFESSION, 2010 Clinical Lab Technologist HIT Analyst HIT Technical Support HIT Program Manager 7.5% 6.5% 6.4% 4.8% were also seen in some of these same professions. These higher turnover rates could probably be attributed to the increased demand for these health care professionals and greater choice of available jobs. VACANCY RATES FOR ALLIED HEALTH PROFESSIONALS, NURSES AND ALLIED HEALTH PROFESSIONALS: NEW YORK S GROWING DEMAND JUNE

16 TURNOVER RATES FOR ALLIED HEALTH PROFESSIONALS, Anticipated Growth in Allied Health Professions The percentage of respondents indicating anticipated growth for the allied health professions (excluding RNs, PAs, and NPs discussed earlier in this report) is shown in the chart to the right. Hospital responses to questions about anticipated growth in clinical lab technologists varied by New York State region, with 35% in the Northeastern region and 70% in the Long Island region anticipating growth over the next year. Sixty-five percent of respondents on Long Island also predicted growth for medical coders and HIT program managers. PERCENT OF RESPONDENTS INDICATING GROWTH, 2010 Clinical Lab Technologists Certified Nurse s Aides Physical Therapists Medical Coders 29% 26% 27% 24% Pharmacists 14% 14 NURSES AND ALLIED HEALTH PROFESSIONALS: NEW YORK S GROWING DEMAND JUNE 2011

17 Staff Recruitment and Retention This year, the most difficult professions to recruit are noted to the right: Additionally, respondents were asked to cite reasons for recruitment difficulty and were given the following choices: shortage of workers, competition for workers, and salary levels. They were asked to check all that apply. Fifty-eight percent of respondents believe that there is a shortage of medical coders, and 49% believe there is a shortage of clinical laboratory technologists. Twenty-nine percent of hospitals cited competition as the reason for difficulty in recruiting PAs, and 45% stated that competition was the reason for difficulty in recruiting pharmacists. Thirty-nine percent of respondents cited competitive salary levels as the barrier to pharmacist recruitment. Retention of allied health care professionals does not appear to be a problem for respondents, with the exception of certified nurse s aides. PERCENT REPORTING DIFFICULTY RECRUITING, 2010 Medical Coders Clinical Lab Technologists Physical Therapists Pharmacists Respiratory Therapists HIT Analysts 55% 47% 44% 39% 33% 33% RECRUITMENT DIFFICULTIES OF SPECIFIED PROFESSIONALS BY REGION, 2010 Western NY/ Rochester Central NY Northeastern NY Northern Metropolitan Long Island New York City Medical Coders 69% 87% Pharmacists 57% 50% 41% 69% Clinical Lab Technologists 50% 59% 63% Physical Therapists 57% 47% 77% HIT Program Managers and Analysts 61% 42% *Please note: Blank gray boxes indicate insignificant findings. NURSES AND ALLIED HEALTH PROFESSIONALS: NEW YORK S GROWING DEMAND JUNE

18 Conclusion Implementation of ACA, along with the numerous reports related to the state of health care and the health care workforce including IOM s Future of Nursing report, all denote increasing demands on the health care workforce and an expansion of nursing and allied workforce scopes of practice. Nurses and allied health professionals are in demand nationally and, as indicated in this year s survey responses, in New York State. There is a corresponding shortage in many of the nursing and allied health care professions, as many experienced workers retire and the demands on the health care system increase. Additionally, for certain allied health professionals, including medical coders, clinical laboratory technologists, and pharmacists, there is not only a projected growth in demand, but recruitment challenges as well. It is difficult to know if these are issues specific to hospitals or are being experienced by other parts of the health care sector. More data are needed to better understand the nature of the workforce shortages New York State and the national health care industry are facing, as well as to develop appropriate strategies in addressing these supply and demand gaps. To this end, ACA established a National Health Care Workforce Commission, but the appointed members have not yet met, due in large part to a lack of funding. New York State was one of the first five national pilot states in which the Robert Wood Johnson Foundation is sponsoring the development of a Regional Action Coalition (RAC) to advance the recommendations put forth in the IOM Future of Nursing report. One of the goals of the New York State RAC is a focus to improve the data collection and information gathering infrastructure. HANYS, GNYHA, and the other allied associations will continue to advocate for and support both state and federal legislation that addresses workforce shortages for nurses and allied health professionals. Further, the associations will continue to work with the Governor s office, the State Legislature, and all relevant stakeholders in expanding the health workforce capacity to meet the growing demands of New York State s patients. We will work to ensure that any workforce expansion and redesign activities do not place unfunded burdens on facilities. Lastly, we will continue to advocate against any harmful workforce legislation. 16 NURSES AND ALLIED HEALTH PROFESSIONALS: NEW YORK S GROWING DEMAND JUNE 2011

19 HEALTHCARE ASSOCIATION OF NEW YORK STATE One Empire Drive, Rensselaer, NY (518)

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