Southern Oregon Nursing

Transcription

1 Southern Oregon Nursing Summit World Café Information Overview January 9 & 15, 2008 Red Lion Inn Medford Sponsored by: Gordon Elwood Foundation Jefferson Regional Health Alliance Rogue Valley Workforce Development Council

2 Sponsors 2 Gordon Elwood Foundation Health Care Coalition of Southern Oregon Jefferson Regional Health Alliance Ashland Community Hospital Asante Health System Jackson County Health & Human Services Josephine County Public Health OHSU School of Nursing - Ashland Campus Providence Medford Medical Center Rogue Community College Southern Oregon University Veterans Administration - SORCC Rogue Valley Workforce Development Council Pacific Retirement Services The Job Council Southern Oregon Cadre of Nurse Executives

3 Why We re Here Today To promote connection and collaboration between individuals and institutions, employers, educators, and the public at large around the nursing workforce issue. To identify fresh regional strategies for supporting a strong, excellent nursing workforce in southern Oregon. To inspire institutional and community action that is aligned with these strategies 3

4 Nursing Summit Focus Areas Nurse Recruitment & Demand Nursing Education Nurse Retention - Profession & Practice 4

6 Nurse Recruitment & Demand National By 2010, the demand for full-time registered nurses will exceed supply, and grow wider in ensuing years Nationwide, there are 796 registered nurses per 100,000 persons in the population [1:126] The national average age of a registered nurse is 44 years 6 Source: Bureau of Health Professions

7 Nurse Recruitment & Demand Oregon Currently 844 registered nurses employed in healthcare per 100,000 Oregonians [1:118], nearly the highest level in a decade This rate is significantly improved from 1996 when there were 777 registered nurses per 100,000 Oregonians [1:128] However, the nurse-to-patient ratio increase is due mostly to nurses migrating into Oregon & nurses returning to the workforce, not increased capacity at Oregon s schools of nursing 7 Source: Oregon s Nursing Shortage - Northwest Health Foundation

8 Nurse Recruitment & Demand Oregon The average age of a registered nurse in Oregon is 47 years 38% of Oregon s nursing workforce is aged 50 years and older The demand for registered nurses will grow steadily; an additional 15,700 registered nurse job openings are expected between 2007 and Source: Oregon Center for Nursing

9 Nurse Recruitment & Demand Oregon The age distribution of Oregon s population will change dramatically over the next 20 years Oregonians aged 65 or older just eclipsed one million, accounting for 25% of all residents [OCN, 2007] By 2012, Oregon will be the fourth oldest state in the nation with respect to age distribution [US Census Bureau, 2007] Given that there is a nationwide nursing shortage, it may not be possible to attract out-ofstate nurses to Oregon 9

10 Nurse Recruitment & Demand Oregon 10 Hospitals: 55% of Oregon s registered nurses practice in hospitals Percentage of Oregon s hospitals reporting shortages: 60 % report shortages in ICU nurses 55 % report shortages in surgical nurses 30% report shortages in obstetrical nurses Recruiting for float, relief, or night shift positions is problematic for 40% of Oregon s hospitals Average time to fill vacant positions: four months Turnover rates average 18% per year, with the highest levels in newly graduated nurses Source: Northwest Health Foundation

11 Nurse Recruitment & Demand Oregon Ambulatory Care 15 % of Oregon s registered nurses practice in physicians offices and clinics Vacancy rates: 10-15% Average time to fill vacant positions: days Turnover rates average 18 22% Length of time required to fill positions reflects: Severity of the shortage; these positions were once easy to fill because of daytime hours and regular work schedules Ambulatory care salaries considerably lower than in hospitals 11 Source: Northwest Health Foundation

12 Nurse Recruitment & Demand 12 Oregon Long Term Care: 10% of Oregon s registered nurses practice in long-term care settings 35% of all long-term care facilities report a severe shortage of registered nurses 48% report a severe shortage of certified nursing assistants 20% report a severe shortage of licensed practical nurses Average time to fill vacancies: 60 days for nurses Turnover rates are very high and average 48% Long-term care shortages escalated steeply between 1998 and 2007, and are expected to worsen Source: Northwest Health Foundation & National Commission on Nursing Workforce for Long Term Care

13 Nurse Recruitment & Demand Oregon Public Health 7% of Oregon s registered nurses work in public and community health Two-year turnover rates have increased from 18% in 2000 to 39% in Source: Northwest Health Foundation

14 Nurse Recruitment & Demand 14 Local Hospitals Anecdotally, Two-year turnover rates for newly graduated nurses range from 27% to 100% Public Health and Safety Net Clinics There are 77 nurses and nurse practitioners for 78,995 low-income the medically uninsured persons, a nurse-topopulation ratio of 1:1,025 compared to the 1:118 state ratio Nurse practitioner positions have been open as long as two and one-half years The shortage of baccalaureate prepared nurses will be most immediately felt in public and community health settings.

15 Nurse Recruitment & Demand 15 Local The need for nurses in the Rogue Valley is expected to almost double by 2015 (188% increase) and almost triple by 2020 (289% increase) We are headed for a dangerous nursing workforce shortage Community Jackson County Supply Demand Shortage Josephine County Supply Demand Shortage 1,187 1, ,118 1, ,490 1, Both Counties Shortage ,147 (projections based on Nursing Demand Model - HRSA- Bureau of Health Professionals)

17 Nursing Education National With the tightening of the financial circumstances in hospitals, there is a nationwide shortage of clinical training sites for student nurses There is evidence that nursing is not attracting young people. Nationally, the average age at graduation is 31.7 years The average age of new doctoral recipients in nursing is 45 years (compared to 39 years in all other health sciences), and 46% of all nursing professors are age 50 to Source: American Association of Colleges of Nursing

18 Nursing Education 18 Oregon Oregon s nurse executives prefer employing nurses with baccalaureate preparation, but also say they would hire a non-degreed, experienced nurse before hiring a new graduate [NWHF] Enrollment of ethnic minorities in nursing programs has increased from 10% in 1995 to 15% in 2006; however, substantially higher attrition rates are reported [Oregon State Board of Nursing] Oregon s average age at graduation from nursing school is 32.1 years, resulting in a shorter work-life [OSBN] As an alternative to schools of nursing in Oregon s public education sector, contract nursing education programs are emerging in Oregon (i.e., the Providence system)

19 Nursing Education Oregon Oregon has a large pool of qualified nursing school applicants - six qualified applicants for every position Nursing education programs in Oregon expanded their capacity between and increased the number of graduates by 75% By 2010, an estimated 65 FTE nursing faculty positions in Oregon will be vacated due to retirement 19 Source: Oregon Center for Nursing

20 Nursing Education Local In spring 2007, Rogue Community College had 180 qualified applicants for 36 slots in its school of nursing for first year students [RCC] A smaller number of Josephine County s registered nurses elect to pursue BSN programs than do their cohorts in other Oregon communities [OSBN] Local secondary schools lack an adequate ratio of academic advisement counselors, leaving many graduates unprepared for entry to nursing school 20

22 Nurse Retention Profession & Practice National The volume of work placed on nurses has increased, adding to nurses perception of inadequate staffing and work overload Patients are sicker and discharged sooner There are significant reductions in nursing support staff State and federal regulatory requirements are greatly increased Starting salaries for registered nurses are competitive and attractive, but salary compression practices result in most nurses reaching their maximum earning potential within seven years of graduation 22 Source: HRSA 2004 National Sample Survey of Registered Nurses

23 Nurse Retention Profession & Practice National Only 83% of currently-licensed registered nurses are actively employed The average age of employed registered nurses is 43.3 years, with registered nurses less than 30 years old representing only 10% of the total working nurse population Workplace issues (dissatisfaction with the supervisor, workload, and staffing patterns, limited career prospects) constitute the leading factor contributing to nurse turnover Newly created positions in clinical informatics, radiographic imaging, quality management, utilization review, case management, and pharmaceutical sales are siphoning nurses from direct patient care. 23 Source: American Association of Colleges of Nursing

24 Nurse Retention Profession & Practice Oregon Nurses in focus groups express concern about providing safe patient care. They report inability to perform basic care, patient assessment & monitoring in a timely manner, or provide emotional support to patients or families. Focus groups report a lack of mentoring available to new nurses, as the number of experienced nurses has substantially decreased. 24 Source: Northwest Health Foundation

25 Nurse Retention Profession & Practice Oregon 25 Nurses in focus groups clearly describe the lack of a supportive working environment. Issues such as effective communication, a feeling of esprit de corps, and a sense of respect and dignity were reported as diminished in current hospital work environments Nurses in skilled care facilities reported that nurse managers were less visible and unavailable Nurses in acute care settings conveyed a sense of powerlessness and frustration, and indicated that they were rarely involved in problem-solving on issues that affected their practice Source: Northwest Health Foundation

26 Nurse Retention Profession & Practice Oregon Nurses are frustrated by the lack of attempts to retain qualified nurses in their practice settings: They point to sign-on bonuses and the payment of premium wages to temporary staff while their own wages stagnate They want salary schedules in which competence, advanced training, and experience are rewarded 26 Source: Northwest Health Foundation

27 Nurse Retention Profession & Practice Oregon Nearly one-half of Oregon s registered nurses are 50 years of age or older; the proportion of older nurses has doubled in the past 20 years An exodus of retiring nurses is now underway; by 2025, 41% of currently licensed registered nurses will retire Oregon s nurses are not leaving the workforce early 80% of nurses are currently employed in nursing Only 58.5% of Oregon s nurses work full-time Oregon has the fourth highest proportion in the nation of nurses employed part-time at 41.5% 27 Source: Oregon Center for Nursing

28 Nurse Retention Profession & Practice Local Anecdotally, high turnover in nurse executive positions (hospitals and education) lead to inconsistent progress in improving policy change, practice, organizational culture, work environment and empowerment issues 28

29 Nursing Summit Focus Areas Nurse Recruitment & Demand Nursing Education Nurse Retention - Profession & Practice Nursing Workforce Summary Analysis & Conclusions 29

30 Nursing Workforce Summary Analysis and Conclusions The Rogue Valley is indeed headed for a dangerous nursing workforce shortage The causes for this shortage are multi-dimensional and complex The nursing shortage is adversely affecting patient care, safety and morale of the workforce, and driving up the cost of care The impending decline in the supply of registered nurses will come at a time when the first of the 78 million Baby Boomers begin to retire and enroll in the Medicare program 30

31 Nursing Workforce Summary Analysis and Conclusions 31 This shortage will be unlike nursing shortages of the past: left unchallenged, it will not simply cycle back into an adequate supply; it will worsen over the next decade. The lack of educated and experienced nurses will have profound impacts on every area of health care most critically in (descending order) Intensive care units Elder care Surgical units Community-based safety net clinics Public health

32 Nursing Workforce Summary Analysis and Conclusions The future depends on our community s ability to draw together collective insight that will inform common action It is imperative to understand the causes of the shortage and to collaborate with all sectors of the healthcare industry consumers, government agencies, educational institutions, and health-providing organizations to forge a path toward a solution The health of all Oregonians and our Rogue Valley communities, is directly dependent on our combined capacities to craft innovative, enlightened, responsive, strategic, and effective solutions 32

33 33 World Café

34 Problem: Nursing Shortage Strategy an approach to an issue Action Steps ways to make that strategy happen Example: Strategy: increase number of nursing faculty at OHSU (Southern Region) and RCC Action Steps: increase salary by: Lobbying legislature for additional funding Write a grant 34

35 Southern Oregon Nursing Summit World Café Information Overview January 9 & 15, 2008 Red Lion Inn Medford Sponsored by: Gordon Elwood Foundation Jefferson Regional Health Alliance Rogue Valley Workforce Development Council

36 Southern Oregon Nursing Summit World Café Thank you for attending, for your valuable input and your partnership and commitment in moving forward January 9 & 15, 2008 Red Lion Inn Medford Sponsored by: Gordon Elwood Foundation Jefferson Regional Health Alliance Rogue Valley Workforce Development Council