A Government Stimulus Package for Full-time Nurse Employment. The Employer Response

Transcription

1 Mary Crea-Arsenio, MSc Andrea Baumann, RN PhD Mabel Hunsberger, RN PhD Nursing Health Services Research Unit A Government Stimulus Package for Full-time Nurse Employment. The Employer Response Canadian Association for Health Services and Policy Research (CAHSPR) Halifax, Nova Scotia May 11, 2011 McMaster University 1

2 Context Overview Scope of the issue Government strategies The Nursing Graduate Guarantee (NGG) NGG Evaluation Study, Methods Sample Results Conclusions Nursing Health Services Research Unit 2

3 Scope of the Issue: Change in Nature of Work 1980s: full-time (FT) and permanent employment began to decline Employment trend continued toward flexible, non-standardized work 3

4 Scope of the Issue: Nursing Healthcare restructuring in 1990s led to: increase in casual and agency nurses loss of nurses from the Ontario workforce : 7,563 RN * and 3,559 RPN s ** By 1999 the Ontario government became concerned *Registered Nurse **Registered Practical Nurse 4

5 Ontario Government Strategies 1999 Nursing Enhancement Fund Ontario Nursing Strategy % FT Commitment Government policies targeted to increase FT nursing employment with a goal of 70% FT New Graduate Employment Policy created supernumerary FT positions across sectors 5

6 Background: The Policy Creation Trend study of new graduate nurses* Employment rates and preferences Initially RNs; RPNs included from 2004 *Baumann et al

7 Background: The Policy Creation Initial analysis revealed: low rates of FT employment for new nursing graduates six months post graduation majority of new graduates preferred FT Recommendations focused on the need to improve FT employment opportunities for new graduates* *Baumann et al

8 Nursing Graduate Guarantee (NGG)- A Government Stimulus Package February 2007, Ontario Ministry of Health and Long-Term Care (MOHLTC) announced the NGG policy initiative: incentive funding for employers to hire new graduate nurses into temporary FT supernumerary (above staff complement) positions for up to six months 8

9 Components of the Policy HealthForceOntario (HFO): Employment Portal Supernumerary Full-time Positions Extended Orientation and Mentorship Programs MOHLTC Nursing Graduate Guarantee Legend Red-Strategies Green-Initiative Blue-Goal 6 mos New Graduate Full-Time Employment 9

10 The Employment Process New Graduate Register on portal to search and apply for positions Employer (Acute, LTC, Community, Public Health) Register on portal to post available positions Employer re-invests remaining funds; NGG complete NURSING GRADUATE GUARANTEE PORTAL New Grad applies to positions of interest Bridge to FT No re-investment funds; NGG complete Employer invites New Grads of interest for interview Employer sends offer of employment through the portal. If New Grad accepts, there is a Match MOHLTC provides six months funding for each matched position. Temporary Supernumerary position including orientation/ mentorship Did NOT Bridge to FT Employer must provide & fund additional 6 weeks of FT employment. 1) New grad offered position (FT, PT, Casual) 2) Employment ended 10

11 NGG Evaluation The purpose is to examine employer response over time to a government stimulus (NGG) created to increase FT employment of new graduate nurses in Ontario. 11

12 Research Questions 1) What are the determinants of employer participation in the NGG initiative? 2) How did the incentive funding impact new graduate nurse employment? 12

13 Mixed Methods* Employer Survey: Methods Employer NGG participant and non-participant Focus Groups: Only employers who participated in the NGG *Tashakkori & Teddlie

14 Inclusion Criteria Based on program eligibility requirements established by the government. Employers must: be a health care organization that employs nurses be funded by the government of Ontario for the provision of nursing services have the infrastructure to support implementation of the initiative (e.g., mentors). 14

15 Profile of Ontario Healthcare Employers There are 1198 nurse employers in Ontario: 159 (13.3%) hospitals 606 (50.6%) long-term care facilities 433 (36.1%) community and other organizations Source: MOHLTC,

16 Analysis Survey data entered into PASW(version 18.0; SPSS Inc., Chicago, IL, USA) Frequency distributions performed on employer demographics, program ratings and employment practices Thematic analysis of focus group data major themes were highlighted and key findings categorized under each thematic heading *Boyatzis

17 Number of employers Nursing Health Services Research Unit Employer Participation in the NGG Figure 1. Provincial Employers by Sector and Participation in NGG, * 0 Hospital LTC Community and Other Total Employers Sector NGG Participants Provincial Totals Source: MOHLTC, 2010 * In 2009/10, 219 (18%) of employers matched to a new graduate nurse 17

18 Survey Response Rates 18

19 Survey Nursing Health Services Research Unit Table 1. Employer survey respondents by sector of employment, Frequency (%) Sector of Employment Employer NGG Participants Employer NGG Non-Participants Acute Care Hospital 67(43) 25(10) Long-Term Care Facility 48(31) 117(47) Public Health 11(7) 11(5) Community 10(7) 54(20) Other Hospitals (CCC/Rehabilitation, Addiction 9(6) 13(5) and Mental Health) Other (FHT, College/University) 10(6) 32(13) Total 155(100)* 252(100) Source: Baumann et al., 2010 *Missing data for matched employers (n=7) 19

20 Survey Results: Employer NGG Non-Participants Two main reasons for lack of participation: 1. lack of FT jobs 2. not aware of the initiative 20

21 Table 2. Employer NGG Non-Participant Survey Respondents: Reasons for Not Participating in NGG, 2008 and 2009 Reason Frequency (%) Not aware of the initiative 79(44%) 28(15%) No FT jobs available 77(43%) 110(58%) Did not have adequate human resources to support initiative 25(14%) 35(18%) Did not have adequate electronic resources 1(1%) 3(2%) Other (please specify) 30(17%) 40 (21%) Source: Baumann et al., 2010 Note: Percentage does not add to 100% as employers were able to check more than one reason 21

22 Sector Differences in Reasons for Not Participating in NGG In 2009, survey results showed that: 59% of employers who indicated a lack of FT jobs were from long-term care sector 39% of employers who indicated they were unaware of the initiative were from community organizations 22

23 Barriers to Offering Full-Time Jobs: Employer NGG Non-Participant Survey respondents identified the following barriers to offering FT: Budget constraints (38% in 2008; 36% in 2009) Hiring restrictions imposed by collective agreements (13% in 2008; 18% in 2009) Need for experienced nurses (10% in 2008; 3% in 2009) 23

24 Employer NGG Participants Challenges Survey respondents indicated that they were not always able to transition new graduate into a FT permanent position the main reason was a lack of FT vacancies 24

25 Other Barriers to Full-time Employment Table 3. Employer NGG participant survey respondents, barriers to offering FT, 2008 and 2009 Frequency(%) Barriers to offering FT No vacancies/ft positions 44 (36) 33(32) Collective agreements 35 (28) 25(24) Budget constraints 23 (19) 29(28) Small, rural facility 9 (7) -- Need experienced nurses 1 (1) 0(0) Low turnover -- 4(4) Other (salary disparities, lack of nurses, no 16 (13) 11(11) barriers) Total 123(100) 104(100) Source: Baumann et al., 2010 Note: Percentage does not add to 100% as employers were able to check more than one reason 25

26 Percentage Full-time Nursing Health Services Research Unit How did the NGG affect FT employment for new graduate nurses? Figure 2. Full-time Employment of CNO New Member RNs and RPNs, % 80% 76% 79% 71% 60% 40% 20% 47% 59% 21% 24% 34% 41% 36% RN RPN 0% * Year Source: CNO, 2010 *First cohort of graduates who participated in the NGG Note: Date of employment data reflects new graduates from the previous year (e.g., new graduates who became licensed and registered with the College of Nurses of Ontario in 2006 are not included in the new member employment data until 2007). 26

27 Focus Groups NGG participants (N=42 organizations) 1. Large acute care (n=6) 2. Medium acute care (n=5) 3. Small acute care (n=7) 4. Rural acute care (n=5) 5. Long-term care (n=8) 6. Community healthcare organization (n=7) 7. Public health unit (n=4) 27

28 What were some of the challenges? Employer focus group participants identified a decrease in the number of NGG positions they were able to post for new graduates from 2008 to 2009 Reasons for this change included: Lack of staff to mentor new graduates Cost to carry new graduate for additional six weeks Increase in internal PT staff applying for FT positions 28

29 Focus Group Results: What were the advantages to participating in NGG? NGG was great recruitment strategy that helped them meet health human resource needs. Many indicated they could not hire as many new graduates if the NGG did not exist "This [NGG] is definitely giving us an opportunity to get new grads in so that they re ready when postings become available six months down the road." 29

30 Another Benefit: Extended Orientation/Mentorship Mentorship component resulted in more confident nurses and better integration Having the structured program where there is accountability... on the organization to mentor... as well as the expectation that the new grad will complete a minimum amount of orientation, I think really makes the program beneficial and [allows] a lot of them to succeed more so than if they were just simply hired in with our old practices. 30

31 Conclusions Since 2005, there is an upward trend in FT employment of new graduate nurses Acute care hospitals benefited most from the policy initiative Community organizations and LTC facilities were the least likely to benefit Greatest barrier to participation was the lack of FT jobs Budgetary constraints 31

32 Evidence for Health Human Resource Planning The NGG stimulus package provides incentive to employers to recruit new graduates full-time Policy-makers need to address the issues in LTC and community sectors The policy initiative has been successful in increasing full time jobs over time 32

33 References Nursing Health Services Research Unit Baumann, Blythe, J., Cleverley, K., & Grinspun, G. (2006, May). Health Human Resource Series Number 2. Educated and underemployed: The paradox for nursing graduands. Hamilton, Ontario: Nursing Health Services Research Unit, McMaster University. Baumann, A., Hunsberger, M., & Crea-Arsenio, M. (2010, August). Health Human Resource Series Number 27. Employment integration of nursing graduates: Evaluation of a provincial policy strategy. Hamilton, Ontario: Nursing Health Services Research Unit, McMaster University. Baumann, A., Hunsberger, M., Idriss, D., Alameddine, M., & Grinspun, D. (2008, June). Health Human Resource Series Number 10. Employment of nursing graduates: Evaluation of a provincial policy strategy. Hamilton, Ontario: Nursing Health Services Research Unit, McMaster University. Baumann, A., Hunsberger, M., Idriss-Wheeler, D., & Crea-Arsenio, M. (2009, November). Health Human Resource Series Number 19. Employment integration of nursing graduates: Evaluation of a provincial policy strategy. Hamilton, Ontario: Nursing Health Services Research Unit, McMaster University. College of Nurses of Ontario. (2010). Membership statistics report Toronto, Ontario: Author Ministry of Health and Long-Term Care, Nursing Secretariat. (2010, June). Nursing graduate guarantee participation. Unpublished data. Toronto, Ontario: Author. 33

34 Contact Information Andrea Baumann, RN PhD Nursing Health Services Research Unit McMaster University Michael DeGroote Centre for Learning MDCL 3500 (905) ext