Florida Hospitals Workforce Challenges: 2012 Workforce Survey Highlights

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1 2012 Update DATA Brief Florida Hospitals Workforce Challenges: 2012 Workforce Survey Highlights November 2012

2 DATABrief 2012 FHA Workforce Survey: Nurse and Allied Health Recruitment and Retention A lthough hospitals in Florida continue to face challenges associated with the recruitment and retention of nurses and allied health professionals, the 2012 FHA Workforce Survey indicates that some hospitals continue to experience a temporary reprieve. At the same time, predictions for long-term shortages loom as experts anticipate an increase in demand in the coming years, in part due to an aging baby boomer population, and in part due to new coverage under the Affordable Care Act to come in This report highlights the findings of the Florida Hospital Association s (FHA) 2012 workforce survey, as well as efforts currently underway by FHA to address hospitals workforce challenges in the state of Florida. It is an incremental update to the FHA 2011 DATABrief on Florida Hospitals Workforce Challenges, which included a comprehensive analysis of the workforce environment in Florida and across the nation. FHA Helps Members Meet their Workforce Needs on Multiple Fronts FHA is addressing workforce challenges across the state through a variety of initiatives that gather data for informed decision-making, deepen understanding of workforce challenges, and help Florida s hospitals and other key stakeholders to develop long-term solutions to meeting the state s health care needs. For more information, go to Annual Workforce Conference. FHA s annual workforce conference facilitates sharing of best practices, encourages networking opportunities, and provides valuable tools and information as hospitals strive to ensure a robust workforce that can deliver high-quality, safe and cost-effective patient care. The 2012 workforce conference focused on Creating a Culture of Accountability in the Midst of Accelerated Change, and provided members with tools to master the challenges of workforce recruitment, engagement, retention and education. The 2013 workforce conference date and topic is to be determined. Workforce Survey. The FHA has conducted workforce staffing surveys since 1987 in order to provide the statewide and regional benchmarks for nursing and allied health vacancy and turnover metrics. Salary Surveys. The FHA Salary Surveys are the only statewide compensation survey about Florida hospital employee compensation. Conducted for over 25 years, the FHA Salary Surveys continue to be the most comprehensive, statewide compensation information about hospital positions in Florida. The FHA Management/Department Head Salary Survey provides annual salary analysis by region of the state, bed size, and net patient revenue for 95 common management and department head positions. It also includes tenure data. FHA S Non-Management Salary Survey provides wage analysis for 258 key hospital, physician office, skilled nursing, psychiatric, and rehabilitation positions by region of the state and bed size. Minimum rate, maximum hire rate, maximum hourly rate, average effective rate, and shift differentials are reported for each position. FLACAREERS. The FLACAREERS website has been developed to feature FHA member hospitals and assist them in recruiting qualified health care professionals to their organizations. Physicians, nurses and other licensed health care professionals who use the internet to find job openings in Florida connect directly with hospitals about career opportunities and open positions. For more information, go to Bi-monthly Labor Calls. FHA hosts a series of bi-monthly teleconferences on hospital labor issues and activities in 2

3 FLORIDA HOSPITALS WORKFORCE CHALLENGES: 2012 WORKFORCE SURVEY UPDATE Florida. Each one-hour program begins with a brief presentation about a current labor topic, followed by an opportunity to ask questions and learn about labor activity in all areas of Florida. The regular teleconferences are intended to keep FHA members up-to-date about current issues and trends, as well as provide an opportunity for networking with colleagues across the state. Speakers include experts in various workforce issues from across the nation, and attendees generally include FHA institutional members, including CEOs, COOs, CNOs, human resources, and health care recruiters. Workforce Spotlight. FHA s Workforce Spotlight initiative identifies and promotes the implementation of innovative and effective workforce strategies in Florida s hospitals. Identifying and sharing best practices enables hospitals to capitalize on the good work already being done, resulting in long-term recruitment and retention strategies that maximize limited resources and lead to greater staff and patient satisfaction without reinventing the wheel. Workforce Violence Task Force. FHA has established a Workplace Violence Task Force to make Florida s hospitals and health systems safer for our patients, employees and communities. Recognition, reporting and prevention of workplace violence is the priority focus of efforts. Overview of the 2012 Workforce Survey FHA has conducted nurse staff surveys since 1988, and allied health surveys periodically during the same time. The survey captures information on nurse vacancy rates, turnover rates, timeframes for filling vacant positions, and additional aspects of nurse staffing as well as vacancy rates, turnover rates, and timeframes for filling select allied health positions. Detailed graphs displaying the results from the FHA Workforce Staffing Survey appear on the following pages, divided into three sections: Nursing Results, Allied Health Results, and General Hospital Information. The Nursing Results include graphs displaying the following: For the 2012 Workforce Survey FHA surveyed all Florida hospitals to gather their vacancy and turnover information RN vacancy rates in Florida hospitals; Length of time to fill vacant direct care RN positions; for the week of May 20-26, 2012, and for RN turnover rates in Florida hospitals; the 12 months ending May 31, Turnover rates in Florida hospitals by Forty eight surveys representing 87 nursing specialty; facilities were received, a 33.2 percent response rate. Vacancy rates in Florida hospitals by nursing specialty; Overall, hospitals are divided about Length of time to fill nursing whether there is a nursing shortage in positions by specialty; Florida. When asked if their hospital is experiencing difficulties in filling nursing positions, one-half answered yes and onehalf answered no (See Illustration 1). Only one hospital reported any Number of contracted RNs used by hospitals; Percent of RNs with a BSN degree; difficulty recruiting newly licensed RNs, but the majority of hospitals do report challenges when recruiting Half of Hospitals Believe There Is a Nursing Shortage Illustration 1: Is There a Nursing Shortage? experienced RNs. Nearly one quarter of responding hospitals reported that recruiting experienced RNs is very difficult (See Illustration 2). When asked about whether there is a shortage of allied health professionals, responses were equally divided. Half of the responding hospitals said that they experience difficulties in filling allied health professions, while half said they do not (See Illustration 13). No 50% Yes 50% N=46 November

4 DATABrief Type of RNs hired last year; and Percent of graduate RNs leaving the hospital within a year of employment. The Allied Health Results includes graphs displaying the following: Whether hospitals are having difficulties filling allied health positions; Vacancy rates in Florida hospitals by allied position; Turnover rates in Florida hospitals by allied position; and Length of time to fill allied positions. General Hospital Information includes graphs displaying the following: Hospitals conducting random employee drug screenings; and Whether influenza vaccinations are mandated for employees. Survey Highlights Florida s hospitals continue to experience some workforce challenges and still anticipate the looming threat of greater workforce shortages in the future. At the same time, in 2012 responding hospitals report facing reduced challenges in recruiting and retaining both nurses and allied health professionals when compared to Key findings in each area are outlined below. Nursing Highlights. Nursing highlights from the survey include: The average RN vacancy rate for participating hospitals was 5.1 percent for the last week of May 2012, which is 1.4 percentage points less than the RN vacancy rate was in After three years of vacancy rates increasing, 2012 vacancy rates fell. Despite the decline, experts continue to predict that the vacancy rate will grow again in the future. Some believe this recent drop may be attributed to the poor economy and is not reflective of projected long-term shortages. Vacancy rates differed by nursing specialty, with the highest vacancy rates reported for stepdown and telemetry (8 percent) and ARNP (7.7 percent), followed by emergency, CCU, pediatric CCU, operating room, and medical/surgical nurses. Hospitals Have Little Difficulty Recruiting Newly Licensed RNS; Some Difficulty Recruiting Experienced RNs Illustration 2: Difficulty Recruiting RNs by Experience Newly Licensed RNs Experienced RNs Percent Number Percent Number Not Difficult 97.7% % 10 Somewhat Difficult 2.3% % 24 Very Difficult 0.0% % 11 Not Applicable 0.0% 0 0.0% 0 Neonatal CCU and rehabilitation nurses have the lowest vacancy rates. RN turnover rates in Florida hospitals have declined for the fourth consecutive year. In 2012, the overall RN turnover rate was reported at 12 percent, which is the second-lowest nursing turnover rate in the past 18 years. Although the overall RN turnover rate was 12 percent, the turnover rate for LPNs was reported at 18.5 percent. Other nurse specialties with higher turnover rates include stepdown and telemetry (15.9 percent), CCU nurses (14.6 percent) and psychiatric nurses (14.3 percent). No hospitals reported difficulty filling open LPN positions. The positions that take the longest time to fill include ARNP and operating room nurses, followed by CCU, emergency and stepdown and telemetry nurses. When asked about the use of contracted RNs, seventy percent of hospitals report that they currently have ten or fewer. Ten hospitals report having between 6-10 contracted RNs, and another nine hospitals report having five or fewer 4

5 FLORIDA HOSPITALS WORKFORCE CHALLENGES: 2012 WORKFORCE SURVEY UPDATE contracted RNs. Seven hospitals report having have eleven or more. Hospitals report wide variance in the percent of their RNs that have a BSN degree; most hospitals report that the percent of RNs with a BSN degree range between percent of their total nursing staff. The majority of nurses hired by Florida hospitals in the past year are experienced (68 percent). Although the vast majority of new hires continue to be experienced nurses, the percentage of newly graduated nurses hired in 2012 was slightly higher than it was in Florida hospitals report different experiences when asked about the percent of newly graduated RNs that leave the hospital within a year of employment, ranging from less than three percent to more than 10 percent. The disparity in the answers indicates that turnover for new nurses varies significantly among Florida hospitals. Allied Health Highlights. Highlights When asked about allied health vacancy rates, the 2011 and 2012 results were similar. Like 2011, in 2012 occupational therapists (OTs) had the highest vacancy rate, although the rate dropped from 10.4 percent in 2011 to 7.5 percent in The next-highest reported vacancy rates include speech pathologists, physical therapists (PTs), certified surgical technicians, and medical records coders. In addition to having the highest vacancy rates, PTs, speech pathologists, and OTs have the longest time to fill open positions, with about one-third of hospitals reporting that each position takes more than ninety days to fill. Certified surgical technicians have the highest turnover rates among allied professions in Florida s hospitals (15.6 percent), followed by pharmacy technicians, computer tomography technicians, and ultrasound technicians. At the same time, none of those positions have a reportedly long length of time to fill. A small percentage of hospitals reported that ultrasound technicians take more than 90 days to fill, but no hospitals reported that any of the other positions with the highest turnover take more than 90 days to fill. Overall Hospital Highlights. In addition to questions specific to nurses and allied health professionals, survey respondents provided information about random drug screenings and mandated employee influenza vaccinations. Findings include: Three quarters of hospitals do not conduct random drug screenings, while one quarter of hospitals do. One in five of the responding organizations reported that influenza vaccinations are mandated for their employees, and another one in five are considering making the vaccination mandatory. The remaining respondents (nearly sixty percent) do not mandate vaccinations, nor are they currently considering a mandate. related to allied health professions from the survey include: Like the nursing shortage, hospitals are equally divided about whether there is a shortage of allied health professionals; half report difficulties in recruiting allied health professionals and the other half report no difficulties. The percentage of hospitals reporting difficulties in filling allied health positions is significantly less in 2012 when compared to 2011 (half reported difficulty in 2012, compared to nearly three quarters in 2011). November

6 DATABrief Nursing Results RN Vacancy Rates Dropped in 2012 Illustration 3: RN Vacancy Rates in Florida Hospitals: % 16% 14% 12% 10% 8% 6% 4% 2% 5.6% 7.7% 11.2% 8.5% 11.3% 15.6% 12.5% 9.9% 8.2% 8.5% 7.9% 4.0% 4.5% Notes: Survey reflects vacancy information for the last week of May Nurse staffing survey not conducted in 1996, 2006 or See FHA Workforce Staffing Survey for 2006 data. 6.5% 5.1% 0% Florida hospitals RN vacancy rates dropped over one percentage point in 2012 to 5.1 percent, down from 6.5 percent in RN vacancy rates are not as low as they were in 2009, but are substantially lower than they have been over the past fifteen years. Many experts attribute this recent drop to the economy, and continue to predict severe nursing shortages in the future as demand increases due to aging baby boomers as well as the anticipated growth in health care coverage resulting from the Patient Protection and Affordable Care Act. Over Three-Quarters of RN Openings Are Filled in 60 Days or Less Illustration 4: Length of Time to Fill Vacant Direct Care RN Positions < 30 Days 28.6% Days 47.6% > 90 Days 4.8% Days 19.0% N=21 Over three-quarters of Florida hospitals report that RN openings take less than 60 days to fill. In contrast to 2011, nearly three in ten hospitals report that they fill RN openings in less than 30 days. In 2011, no hospitals reported filling RN openings in less than 30 days. Similarly, in 2011 nearly two in ten hospitals reported that open RN positions took more than 90 days to fill, while in 2012 less than five percent reported that filling vacant RN positions took more than 90 days. This temporary reprieve coincides with the reduced 2012 RN vacancy rate. 6

7 FLORIDA HOSPITALS WORKFORCE CHALLENGES: 2012 WORKFORCE SURVEY UPDATE Stepdown & Telemetry Nurses, ARNPs Have the Highest Vacancy Rates Illustration 5: Vacancy Rates in Florida Hospitals by Nursing Specialty Stepdown & Telemetry ARNP Emergency CCU Pediatric CCU Operating Room 8.0% 7.7% 6.4% 6.0% 5.6% 5.5% Response Stepdown and telemetry nurses and ARNPs have the highest vacancy rates of all nurse specialties, and are several percentage points higher than the average vacancy for all nursing positions. Emergency and CCU nurses have the nexthighest vacancy rates. Neonatal CCU and rehabilitation nurses have the lowest vacancy rates. Medical/Surgical 5.5% 38 Other Direct Care 4.4% 35 LPNs 4.2% 40 Psychiatric 4.0% 22 Neonatal CCU 3.0% 21 Rehabilitation 2.9% 20 Total Direct Care 5.1% 43 Total 5.1% 37 0% 2% 4% 6% 8% 10% November

8 DATABrief ARNP and Operating Room Nurse Positions Take the Longest Time to Fill Illustration 6: Length of Time to Fill Positions ARNP Operating Room CCU Emergency Stepdown & Telemetry Other Direct Care Neonatal CCU 16% 15% 15% 17% 17% 18% 17% 26% 24% 15% 11% 10% 7% 6% Response ARNP and operating room nurse positions take the longest time to fill. These results are similar to 2011, where operating room nurses reportedly took the longest time to fill, followed by ARNPs. However, in 2011 the percentages for both were higher than in 2012, indicating some relief for hospitals. No hospitals report LPN positions taking more than 60 days to fill. Psychiatric Pediatric CCU Rehabilitation Medical/Surgical LPNs 15% 13% 7% 3% 3% 0% 5% 6% Overall, total time to fill positions has lessened from 2011, with more hospitals in 2012 reporting that the time to fill positions is days, compared to most hospitals reporting time to fill was more than 90 days in Total Direct Care 19% 5% 21 Total 15% 4% 26 0% 20% 40% 60% Days > 90 Days 8

9 FLORIDA HOSPITALS WORKFORCE CHALLENGES: 2012 WORKFORCE SURVEY UPDATE RN Turnover Rates Have Declined for Four Consecutive Years Illustration 7: Turnover Rates in Florida Hospitals: % 20% 15% 10% 5% 13.6% 19.1% 17.2% 15.4% 20.5% 18.6% 18.2% 12.9% 10.8% 15.0% 14.7% 12.6% 12.2% Notes: Survey reflects vacancy information for the last week of May Nurse staffing survey not conducted in 1996, 2006 or See FHA Workforce Staffing Survey for 2006 data. 12.3% 12.0% 0% RN turnover rates in Florida hospitals have declined for the past four consecutive years. Despite the decline, the average RN turnover rate for Florida hospitals remains at 12 percent. Turnover is disruptive to the workplace and ultimately to patient care. Recruiting and onboarding new nurses, and the potential need to rely on temporary staff during the recruitment process is costly, and can negatively impact patients and remaining employees. LPNs, Stepdown & Telemetry Nurses Have the Highest Turnover Illustration 8: Turnover Rates in Florida Hospitals by Nursing Specialty LPNs Stepdown/Telemetry CCU Psychiatric Emergency Medical/Surgical Rehabilitation Pediatric CCU Other Direct Care ARNP Operating Room Neonatal CCU Total Direct Care Total 10.0% 9.1% 11.6% 11.3% 10.6% 12.0% 12.6% 12.0% 14.6% 14.3% 13.9% 13.9% 15.9% 18.5% Response LPNs and stepdown and telemetry nurses have the highest turnover rates, followed by CCU and psychiatric nurses. Operating room and neonatal CCU nurses have the lowest turnover. 0.0% 5.0% 10.0% 15.0% 20.0% November

10 DATABrief Number of Contracted RNs Most Hospitals Currently Have Ten or Fewer Contracted RNs Illustration 9: Number of Contracted (Agency or Travel) RNs Used by Hospitals 5 or Less A contracted RN is defined as either an agency or a travel nurse. Most hospitals report having 10 or fewer contracted RNs, with 10 hospitals reporting they have 6-10 contracted RNs, and another nine hospitals reporting that they have five or fewer. Only three hospitals report having contracted RNs, and five report having more than 25. More than Number of Hospitals Percent of RNs with BSN Degree The Majority of Hospitals Report percent of their RNs have a BSN Degree Illustration 10: Percent of RNs with a BSN Degree > 60% 40% - 59% 20% - 39% < 20% The majority of Florida hospitals report that the percent of RNs with a BSN degree ranges between percent; eight hospitals reported that BSNs represent percent of their RNs, and six hospitals reported that BSNs represented percent of their RNs. Only three hospitals reported that less than twenty percent of their RNs have a BSN, or that more than sixty percent (2 hospitals) of their RNs have a BSN degree Note: Twenty seven hospitals do not track. Number of Hospitals 10

11 FLORIDA HOSPITALS WORKFORCE CHALLENGES: 2012 WORKFORCE SURVEY UPDATE The Majority of Nurses Hired in Florida in the Past Year are Experienced Illustration 11: Type of RNs Hired: June 1, 2011 May 31, 2012 Total RNs Hired: 5,787 Experienced RNs 68.2% Graduate Nurses 31.8% In 2012, reporting Florida hospitals hired over 5,700 nurses (compared to over 6,500 in 2011). Of the nurses hired, slightly more were newly graduated nurses in 2012 than they were last year (nearly 32 percent were new graduates in 2012, compared to nearly 28 percent in 2011). Although the percentage of new graduates hired is increasing, the majority of nurses hired continue to be experienced RNs. N=32 Percent of Graduate RNs Graduate RN Turnover within the First Year Varies Among Florida Hospitals Illustration 12: Percent of Graduate RNs Leaving the Hospital Within a Year of Employment Less than 3% 3% - 5% 6% - 10% More than 10% Number of Hospitals Similar to 2011, in 2012 graduate RN turnover within the first year varied among Florida hospitals. When asked about new RNs leaving the hospital within a year of employment, the largest number of hospitals (8) reported that 6-10 percent of new graduates leave within the first year. The second-largest number of hospitals (7) reported that 3-5 percent leave in the first year, while six hospitals reported that less than three percent leave in the first year. At the same time, five hospitals reported that more than 10 percent leave in the first year. The disparity in the answers indicates that turnover varies significantly among Florida hospitals. November

12 DATABrief Allied Health Results Half of Hospitals Have Difficulty Filling Allied Health Positions Illustration 13: Are Hospitals Having Difficulties Filling Allied Health Positions? No 50% Yes 50% Similar to hospital responses about whether there is a nursing shortage in Florida, half of the responding hospitals reported difficulty filling allied health positions, while the other half do not perceive a challenge in filling allied health positions. N=46 OTs, Speech Pathologists and PTs Have the Highest Vacancy Rates Illustration 14: Vacancy Rates in Florida Hospitals by Allied Position Occupational Therapist 7.5% Speech Pathologist 6.5% Physical Therapist 6.3% Certified Surgical Technician 5.2% Medical Records Coder 5.0% Medical Technologist 4.6% Pharmacy Technician 4.2% Cardiovascular Technician 4.1% Pharmacist 3.6% Medical Transcriptionist 3.3% MRI Technician 3.3% Ultrasound Technician 3.1% Mammography Technician 3.0% Computer Tomography Technician 3.0% Respiratory Therapist 2.9% Radiologic Technologist 2.6% Radiology Therapist 2.2% Medical Laboratory Technician 1.6% Nuclear Medicine Technologist 0.9% Response Occupational therapists have the highest vacancy rate of all allied professions (7.5 percent), followed by speech pathologists (6.5 percent) and physical therapists (6.3 percent). The lowest vacancy rates are for medical laboratory technicians (1.6 percent) and nuclear medicine technologists (0.9 percent). 0% 3% 6% 9% 12% 12

13 FLORIDA HOSPITALS WORKFORCE CHALLENGES: 2012 WORKFORCE SURVEY UPDATE Certified Surgical Technicians Have the Highest Turnover Rate, Followed by Pharmacy and Computer Tomography Technicians Illustration 15: Turnover Rates in Florida Hospitals by Allied Position Response Certified Surgical Technician 15.6% 26 Pharmacy Technician 13.5% 28 Computer Tomography Technician 13.3% 23 Ultrasound Technician 13.0% 26 Speech Pathologist 11.8% 23 Radiology Therapist 11.2% 12 Occupational Therapist 11.0% 28 Cardiovascular Technician 10.0% 22 Physical Therapist 9.9% Medical Transcriptionist 9.8% 15 Medical Technologist 9.7% 25 Medical Laboratory Technician 9.7% 18 Respiratory Therapist 9.1% 28 Medical Records Coder 9.1% 24 Nuclear Medicine Technologist 8.4% 25 Pharmacist 7.6% 26 Radiologic Technologist 7.4% 27 MRI Technician 5.1% 20 Mammography Technician 2.7% 23 Certified surgical technicians have the highest turnover rate of all allied professions (15.6 percent), followed by pharmacy technicians (13.5 percent) and computer tomography technicians (13.3 percent). The lowest turnover rates are for MRI technicians (5.1 percent) and mammography technicians (2.7 percent). 0% 5% 10% 15% 20% November

14 DATABrief Vacancies in PT, Speech Pathology and OT Take the Longest Time to Fill Illustration 16: Length of Time to Fill Positions Physical Therapist 27% 33% Speech Pathologist 21% 32% Occupational Therapist 23% % Medical Records Coder 19% 28% Medical Technologist 23% 17% Pharmacist 26% 9% Cardiovascular Technician 14% 7% Certified Surgical Technician 18% Mammography Technician 14% 3% Medical Transcriptionist 13% 4% Ultrasound Technician 11% 3% MRI Technician 14% Nuclear Medicine Technologist 9% 3% Radiology Therapist 6% 6% Respiratory Therapist 11% Computer Tomography Technician 10% Medical Laboratory Technician 4% 4% Pharmacy Technician 5% Radiologic Technologist 5% Response Physical therapists, speech pathologists, and occupational therapists take the longest time to fill. Those three professions also have the highest reported vacancy rates, although in a slightly different order (see Illustration 14). And although certified surgical technician is the position with the highest turnover rate, the length of time to fill that position is typically 90 days or less, with no hospitals reporting certified surgical technician positions taking more than 90 days to fill. The positions that hospitals report the least trouble filling quickly include medical laboratory technician, pharmacy technician, and radiologic technologist. 0% 20% 40% 60% 80% Days > 90 Days 14

15 FLORIDA HOSPITALS WORKFORCE CHALLENGES: 2012 WORKFORCE SURVEY UPDATE General Hospital Information One Quarter of Hospitals Conduct Random Drug Screenings Illustration 17: Are employees randomly drug screened? Yes 25.5% One quarter of hospitals report conducting random employee drug screenings. The remaining 75 percent of hospitals do not conduct random employee drug screens. No 74.5% N=47 One in Five Hospitals Mandate Employee Influenza Vaccinations, While Another One in Five are Considering It Illustration 18: Are influenza vaccinations mandated for employees? No 57.4% Yes 21.3% Under Consideration 21.3% One in five Florida hospitals currently mandate influenza vaccinations for employees, and another one in five are considering making the vaccination mandatory. Just over half of Florida s hospitals do not mandate influenza vaccinations, and don t report considering a mandate. N=47 November

16 DATABrief, published by the Florida Hospital Association, highlights information and data about important health care issues and trends affecting Florida s hospitals and the patients and communities they serve. Copyright 2012 by the Florida Hospital Association. All rights reserved. 306 East College Avenue Tallahassee, FL Tel: (850) Fax: (850)