2013 Annual Report New Mexico Health Workforce Committee. October 1, 2013

Transcription

1 2013 Annual Report New Mexico Health Workforce Committee October 1, 2013

2 New Mexico Health Workforce Committee (2013 Members) Name Richard Larson, Chair Charlie Alfero Jane Batson Carolyn Bonham Britt Catron Shauna Casaus Betty Chang Mark Chisholm Mark Chiu Danny Cross Leslie Danielson Nancy Darbro Stephanie Dominguez Jeff Dye Doris Fields Veronica Garcia Joie Glenn Jerry Harrison Lynn Hart Annie Jung Art Kaufman Beth Landon Larry Loring Steve Lucero G.R. Randy Marshall Tamra Mason Diana McWilliams Michael Moxey Amanda Quintana Nancy Ridenour Carolyn Roberts Valerie Romero-Leggott Tres Schnell Eric Spencer Leonard Thomas Dale Tinker Beth Vasquez Alfredo Vigil Organization UNM Health Sciences Center Center for Health Innovation at Hidalgo Medical Center ENMU-Roswell UNM Health Sciences Center NM Dept of Health NM Board of Nursing UNM Health Sciences Center HED NM Medical Society NM Board of Pharmacy UNM Health Sciences Center NM Board of Nursing NM Dental Hygienists Association NM Hospital Association NM NAACP NM Voices for Children NM Association for Home and Hospice Care NM Health Resources New Mexico Medical Board New Mexico Medical Society UNM Health Sciences Center NM Hospital Association New Mexico Board of Pharmacy NM Hispanic Medical Society New Mexico Medical Society Central NM Community College NM Behavioral Health Collaborative NM Dental Association New Mexico Medical Board UNM Health Sciences Center NM Nursing Association UNM Health Sciences Center NM Department of Health New Mexico Public Education Department Indian Health Services New Mexico Pharmacists Association AARP New Mexico Health Care Provider Staff Molly Bleecker Vanessa Hawker Sam Howarth Karen Meador Mark Moffett Joseph Sanchez Roseanne Shaw UNM Health Sciences Center UNM Health Sciences Center University of New Mexico NM Behavioral Health Collaborative UNM Health Sciences Center UNM Health Sciences Center UNM Health Sciences Center

3 Contents Executive Summary... 1 The Challenges of Data Collection... 1 Findings... 2 Recommendations... 2 Nursing Workforce Report... 5 Primary Care Physician Workforce Report Psychiatry Workforce Report Dentistry Workforce Report... 60

4 Executive Summary Many factors limit access to health care in New Mexico, including a low standard of living, lack of insurance and a large geographical area (121,000 square miles), over which 2.1 million people are spread unevenly. The number and distribution of health care professionals is a critical and often-overlooked piece of this equation. Although there is widespread agreement that New Mexico needs more providers in nearly every health-related profession, there has not been detailed analysis of how many additional health providers are needed and where, our capacities to increase the supply, and how best to recruit and retain health professionals to the areas that they are needed. Further pressing the need for this analysis is the Patient Protection and Affordable Care Act, which will increase demand for health care services and health professionals. In order to begin addressing these challenges, the New Mexico Legislature in its 2012 session amended sections of the Health Care Work Force Data Collection, Analysis and Policy Act to transfer the duty of collecting and analyzing health care work force data from the Department of Health to the University of New Mexico. The statute (Section 24-14C-1 NMSA 1978) also directed the Chancellor of Health Sciences to convene the New Mexico Health Workforce Committee, which includes broad representation from New Mexico s health care professionals, health care consumers, professional groups, health care work force educators, the Department of Health, the Public Education Department, the Higher Education Department and the professional licensing boards. Under the legislation, the work group is required to: 1) submit its annual report to the Legislature on Oct. 1 and include detailed data on health care professional practices through the state, and 2) make short- and long-term recommendations on potential areas of improvement. The Health Workforce Committee also is charged with analyzing and making recommendations regarding incentives to attract qualified individuals, including those from minority groups under-represented among health care professions, to pursue health care education and practice in New Mexico. The committee convened in January 2013 and began working in earnest last spring as data was received from the professional licensing boards. A key element of the data in this report (and what distinguishes it from previous analysis) is that health professional boards have begun to require additional information with re-licensure. As a result, we are able to distinguish health professionals in New Mexico who are not only licensed in the state but validate that they practice in the state, where their practice is located and several characteristics of their practice that were not evident before. Because this reporting process was first implemented by the nursing board and then followed by the medical board, our report this year focuses on nursing, primary care physicians and psychiatrists. We also include an initial report on dentistry, due to the magnitude of the health care disparity in oral health. In future years, we will expand our reporting to additional professions as their boards implement new reporting processes for re-licensure. The Challenges of Data Collection Professional board licensure records alone do not accurately reflect the number of professionals who actually practice in New Mexico. For example, the rolls of licensed physicians do not indicate which ones are practicing out of state, or are retirees who have chosen to keep their licenses current. Nor do they reflect physicians employed by the Indian Health Service who are licensed in another state. The ability to collect more accurate data on practices throughout the state through licensure surveys gives a considerably more accurate picture of the health care profession shortages. 1

5 House Bill 19 (2012) directed the licensing boards to begin recording answers on six areas related to practice patterns to provide a more accurate understanding of New Mexico s current and future workforce needs. While not all professional boards have yet begun conducting these surveys, the nursing and medical boards have done so. Given the limited amount of information available, the committee has elected to focus its analysis and recommendations in this report on the health professions where there is clear evidence of significant need: nursing, primary care medicine, psychiatry and dentistry. The committee expects to expand the scope of its analysis to additional professions as the mandated data-gathering processes are phased in by other licensing boards and state funding is provided to sustain the effort. Findings Each profession covered in this study reports a deficit in the number of active practitioners and this has consequences for patient care. As the nursing contributors point out, Shortages create barriers to health care access. They also cause the current workforce to be more prone to stress, fatigue, errors and burnout. As a result of this shortage, the majority of practices in some professions (primary care and psychiatry) are rated as full or nearly full in terms of the patients that can be seen, which creates a clear barrier to accessing quality health care. Although there is unmet demand for health care services, there will also be major challenges in providing adequate workforce in the future. First, a significant number of practitioners plan to retire, scale back their practices or take other steps that would limit the supply of health care in New Mexico. Second, there are barriers to training or recruiting more practitioners. Third, the recruitment and retention of health care professionals in the areas where they are needed most remains a challenge. These latter two issues will be covered in future reports in more detail. Recommendations I. Addressing Nursing Workforce Needs There needs to be a significant increase in the number of BSN and APRN graduates (especially in primary care and mental health). In order to accomplish this, the committee recommends: 1. A significant increase in BSN and APRN educators. 2. That educational nursing programs seek accreditation by the National League for Nursing Accrediting Commission or Commission on Collegiate Nursing Education. 3. That collaboration with nursing schools and nursing partners (e.g., New Mexico Nursing Education Consortium, New Mexico Board of Nursing and New Mexico Center for Nursing Excellence) should be maintained and expanded. 4. That incentives for hospitals and clinics be developed to increase the number of clinical preceptors. One such incentive could be a state-funded nurse residency program. In addition, our committee will have to work with boards, employers and others to understand and make recommendations related to the: 1. Challenges of collecting more accurate data on APRNs that reflects their factual practice area and education. 2

6 2. Challenges to nursing recruitment and retention. 3. Challenges to enhancing underrepresented minority participation in the nursing workforce. II. Addressing Primary Care Physician Needs 1. A multifaceted approach to addressing the significant physician shortage should be undertaken that includes enhancing the educational pipeline, expanding recruitment and retention and bolstering physician extender programs. 2. Loan repayment and other financial assistance programs should be strongly considered as incentives to encourage practitioners to work in underserved areas and in primary care. 3. Increasing state-funded PCP resident slots could increase the number of PCPs 4. Funding physician extender programs such as Project ECHO would assist in filling the PCP deficit. 5. In the future, this committee should study ways to improve recruitment and retention of PCPs to rural areas in New Mexico. III. Addressing Psychiatry Needs 1. There should be an increase in the training of psychiatrists and greater recruitment to rural communities. 2. Similar to PCPs, there is a need to increase the number of resident positions, perhaps through state funding. 3. Similar to PCPs, technology such as Project ECHO should be explored as ways to extend and multiply psychiatrists effectiveness. 4. The assessment of workforce needs in future years should not only include psychiatrists but also other mental health care providers, including counselors, social workers, psychiatric nurse clinicians and psychologists. 5. The workforce committee should assess mechanisms to enhance recruitment and retention of psychiatrists in rural communities as well as mechanisms to increase the number of Native American and Hispanic psychiatrists. Data show that psychiatric patients prefer a caregiver of their own race or ethnicity, and these groups represent a significant portion of New Mexico s population. IV. Addressing Dentistry Needs 1. Begin laying the groundwork to improve access to dental care and grow the pipeline of dentists. This infrastructure could support construction of a dental school in New Mexico. 2. Increase the number of WICHE slots to support all New Mexico students who wish to become dentists. 3. Establish a BA/DDS program to recruit and support New Mexico s pre-dental and dental 3

7 4. Initiate or expand existing loan repayment or scholarship programs for up to the entire cost of dental school in exchange for practice in highly underserved areas. 5. Establish Community Dental Health Coordinator training programs in conjunction with at least one accredited dental assisting and one dental hygiene program. 4

8 Nursing Workforce Report Summary The New Mexico nursing workforce is composed of licensed practical nurses (LPNs), registered nurses (RNs), certified nurse practitioners (CNPs), certified nurse specialists (CNSs) and certified registered nurse anesthetists (CRNAs). The CNPs, CNSs and CRNAs make up the advanced practice registered nurse (APRN) workforce. Our best estimate indicates that we have a shortage of approximately 2,306 RNs and 284 APRNs in the state. This shortage is in the context of 3,298 LPNs who are actively licensed in New Mexico, of whom 2,372 (72%) have a place of employment linked to a New Mexico county. There are 25,317 actively licensed RNs in New Mexico, of whom 15,713 (62%) have a place of employment linked to a New Mexico county. There are 1,286 actively licensed APRNs in New Mexico, of whom 1,201 (93%) have a place of employment linked to a New Mexico county. It s important to note that nurses can be licensed simultaneously in multiple states. Approximately 1,840 of the 2,306 RN deficit would need to be BSN-prepared in order to meet the existing shortfall and the Institute of Medicine-recommended goal of having an 80% BSN-prepared nursing workforce by To meet this goal, state BSN programs would have to graduate approximately 263 additional BSNs per year over the next seven years. The New Mexico Nursing Education Consortium (NMNEC) is the pathway to increasing the BSN-prepared workforce. A collaborative of all New Mexico nursing programs, NMNEC has created a common core nursing education curriculum, transforming the current structure into a resource-efficient and easilyaccessible baccalaureate program for students. NMNEC goals are to: Increase number of nurses with BSN and graduate degrees in New Mexico. Improve efficiency, quality and educational outcomes of nursing education through cooperation among community colleges and universities. Increase workforce diversity by improving nursing education for minorities, particularly in rural areas. High-quality patient care hinges on having a well-educated nursing workforce. In New Mexico during calendar year 2011, a total of 1,003 nurse candidates (both Associate Degree in Nursing- and Bachelor of Science in Nursing-prepared candidates) took the National Council Licensure Examination (NCLEX). Eight hundred four of the 1,003 candidates passed (80.2% pass rate). In order to fill the shortage of required nurses, we will need to significantly enhance our RN to BSN programs, increase our training of APRNs and improve our retention and recruitment of nurses to rural communities. We will also need to enhance our recruitment of underrepresented minorities into the profession. The latter two issues will be examined by this committee in coming years. Nursing Workforce Current Need The Institute of Medicine s 2011 Future of Nursing report suggests that a more educated nursing workforce would be better equipped to meet the demands of an evolving health care system, and this need could be met by increasing the percentage of nurses with a Bachelor of Science in Nursing (BSN) degree. An increase in the proportion of nurses with a BSN also would assist in New Mexico s nursing pipeline development. BSN-prepared nurses are poised to achieve higher levels of education at the 5

9 master s and doctoral levels, required for nurses to serve as primary care providers, nurse researchers and nurse faculty positions currently in great demand across the profession and within the health care system. The American Association of Colleges of Nursing (AACN, 2013) proposes that quality patient care hinges on having a well-educated nursing workforce. According to AACN, research has shown that lower mortality rates, fewer medication errors and more positive outcomes are all linked to baccalaureate- and graduate-prepared nurses. According to the New Mexico Legislative Finance Committee report (Department of Health and Allied Agencies, 2013), New Mexico, like other states, has a nursing shortage. While no definitive benchmarks exist for how many nurses a population should have, one approach is to use the national average, which is 874 nurses per 100,000 population. Kaiser Family Foundation (2011) reports that New Mexico has around 740 registered nurses (RNs) per 100,000 population. Using these data, approximately 3,000 additional RNs are needed in New Mexico. Recently, the need for additional nurses has been somewhat suppressed by the poor economy. This is attributed to older nurses continuing to work past a traditional retirement age. Additionally, the poor economy tends to make hospitals more conservative in hiring. RNs may hold either an associate degree in nursing (ADN) or a bachelor of science in nursing (BSN) degree. Nationally, 66% of all nursing graduates earn ADNs, as opposed to BSNs. However, in New Mexico current NCLEX data indicate that 85% of the recent nursing graduates were ADN-prepared (New Mexico Board of Nursing, 2012). Increasing the number of prepared nurses is more than a matter of adding cohorts to training programs. Based on the success of locally and federally funded nurse residency and nurse preceptor programs, in order to close the training gap between graduation and readiness for the work environment, an investment in state-funded nurse residencies would reduce attrition of theses precious resources. The Future of Nursing report (Institute of Medicine, 2011) called for a more highly educated nursing force. The report recommended that 80% of the nursing workforce hold bachelor s degrees by 2020 to meet the nation s demand for health care. In addition, IOM recommends implementing nurse residency programs. In 2011 the New Mexico Center for Nursing Excellence (Center) reported the New Mexico had 19,402 licensed nurses with a New Mexico residency. The Center also reports a current employment rate of New Mexico nurses of 80.5%, or approximately 15,600 nurses in the workforce. Estimates of nursing demand generally take into consideration retirement rates, new demand driven by the Affordable Care Act (ACA), and population growth. In 2009, the House Joint Memorial 40 task force estimated that New Mexico will face a shortage of 5,000 nurses by the year Estimates of the national nursing shortage range from a deficit of 300,000 to 1 million RNs by In a 2012 study published in Public Health Resources, researchers used projected changes in population and age to develop demand and supply models to forecast the nursing shortage in all 50 states. The model projected a severe shortage throughout the country by 2030, with the western region (including New Mexico) having the greatest shortfall. Nationally, both nurses and nurse faculty are rapidly approaching retirement age. According to the AACN, the average age of employed RNs is 43.3 years. In New Mexico, 42% of all licensed nurses are 50 or older. The national average age of nursing school associate professors is 52. The AACN points to average faculty age as a factor that will severely limit nurse production to meet future demand (Department of Health and Allied Agencies, 2013). 6

10 Determining nurse retirement rates in New Mexico is difficult and best estimated through re-licensure rates. The New Mexico Center for Nursing Excellence (2011) reports that the total number of new nurses (1,936) did not fully replace newly inactive licenses (2,685), suggesting that the state s supply is dwindling (Department of Health and Allied Agencies, 2013). According to the New Mexico Board of Nursing Report (2012), the active-license status of nurses by age illustrates that the age category of 50 to 60 has the largest number of active-licensed nurses, at 6,411, followed by the age category of 30 to 40, with 5,671 active-licensed nurses. New Mexico Nursing Workforce by County Nearly one-half of New Mexico RNs practice in Bernalillo County. Five counties (Doña Ana, Santa Fe, San Juan, Chaves and McKinley) comprise the next 25% of the overall RN workforce. Nearly half of the certified nurse practitioners (CNPs) in New Mexico practice in Bernalillo County (47.6%), and the percentage is higher for certified nurse specialists (CNSs; 57.8%). The Kaiser Family Foundation (2011) reports that the average ratio of CNPs to population is 0.58 per 1,000. Applying this ratio to all APRNs, only four counties (Bernalillo, Eddy, Mora and Quay) are above the national average ratio. Figure 1. New Mexico LPN Workforce by County 7

11 Figure 2. New Mexico RN Workforce by County Table 1. New Mexico Nursing Workforce by County of Employment, 2012 County Population Registered Nurse* Count Percent Count Percent RNs per 1,000 Bernalillo 673, % 7, % Catron 3, % % 2.46 Chaves 65, % % 6.41 Cibola 27, % % 4.57 Colfax 13, % % 5.22 Curry 49, % % 6.25 De Baca 1, % % 3.11 Doña Ana 214, % 1, % 6.54 Eddy 54, % % 7.17 Grant 29, % % Guadalupe 4, % % 3.69 Harding % % 1.41 Hidalgo 4, % % 1.46 Lea 66, % % 5.19 Lincoln 20, % % 5.91 Los Alamos 18, % % 8.37 Luna 25, % % 3.23 McKinley 73, % % 5.86 Mora 4, % % 1.7 8

12 Otero 66, % % 5.88 Quay 8, % % 3.88 Rio Arriba 40, % % 4.37 Roosevelt 20, % % 3.43 San Juan 128, % % 6.57 San Miguel 28, % % 8.96 Sandoval 135, % % 2.8 Santa Fe 146, % 1, % 7.43 Sierra 11, % % 5.55 Socorro 17, % % 4.66 Taos 32, % % 5.86 Torrance 16, % % 1.37 Union 4, % % 8.35 Valencia 76, % % 2 Total 2,085, % 15, % 7.53 *Registered nurse counts and percentages do not include individuals with an advanced practice license. Figure 3. New Mexico APRN Workforce by County 9

13 Table 2. New Mexico Nursing Workforce by County of Employment, 2012 County Population Certified Nurse Practitioners Certified Nurse Specialist Certified Nurse Anesthetist Count Percent Count Percent Count Percent Count Percent APRNs per 1,000 Bernalillo 673, % % % % 0.85 Catron 3, % % % % 0 Chaves 65, % % % % 0.46 Cibola 27, % % % % 0.44 Colfax 13, % % % % 0.83 Curry 49, % % % % 0.48 De Baca 1, % % % % 0.52 Doña Ana 214, % % % % 0.54 Eddy 54, % % % % 0.79 Grant 29, % % % % 0.51 Guadalupe 4, % % % % 0.22 Harding % % % % 0 Hidalgo 4, % % % % 0.42 Lea 66, % % % % 0.41 Lincoln 20, % % % % 0.49 Los Alamos 18, % % % % 0.61 Luna 25, % % % % 0.52 McKinley 73, % % % % 0.23 Mora 4, % % % % 0.85 Otero 66, % % % % 0.29 Quay 8, % % % % 0.91 Rio Arriba 40, % % % % 0.62 Roosevelt 20, % % % % 0.44 San Juan 128, % % % % 0.31 San Miguel 28, % % % % 0.55 Sandoval 135, % % % % 0.21 Santa Fe 146, % % % % 0.59 Sierra 11, % % % % 0.25 Socorro 17, % % % % 0.4 Taos 32, % % % % 0.67 Torrance 16, % % % % 0.31 Union 4, % % % % 0.9 Valencia 76, % % % % 0.26 Total 2,085, % % % %

14 Demographics In surveys at re-licensure, LPNs, RNs and APRNs report their race/ethnicity, with each survey permitting one response. The U.S. Census Bureau separates the reporting of ethnicity and race: ethnicity is reported as Hispanic or non-hispanic, and the respondent then self-selects a race. The reporting for nurses here under-reports racial categories, such as White, Hispanic or Black, Hispanic. It also may drive the Other category for individuals self-reporting one of the above categories or multiple racial categories. Nurses who identify as Hispanic and American Indian or Alaska Native comprise a large portion of the LPN workforce, but represent a smaller proportion of the RN and APRN workforce. At the advanced practice level, approximately 70% of the workforce is Caucasian, non-hispanic. The U.S. Census Bureau (2012) reveals that 47% New Mexico s population reports a race/ethnicity of Hispanic or Latino, trailed by White alone, not Hispanic or Latino, at 39.8%. The Census Bureau figures do not parallel with the New Mexico nursing workforce. For example, 19.7% of RNs identify as Hispanic, while White, Non-Hispanic represent 35.9%. Similarly, 14% of APRNs identify as Hispanic, while White, Non-Hispanic represent 69.9%. Moreover, New Mexico is one of the 10 states with the largest American Indian and Alaska Native alone-or-in-combination populations (Census Bureau, 2010). The Census Bureau figures for American Indian and Alaska Native represent 10.2% of the New Mexico population. While, the New Mexico Nursing Workforce figures illustrate that 3.3% of American Indian or Alaska Native are RNs and 0.9% are APRNs. The relationship between the New Mexico nursing workforce by race and ethnicity Table 3 and the Census Bureau figures reveals that the New Mexico nursing workforce is not well balanced, given the state s demographics. Table 3. New Mexico Nursing Workforce by Race and Ethnicity, 2012 Licensed Practical Advanced Practice Registered Nurse* Race/Ethnicity Nurse Nurse Count Percent Count Percent Count Percent American Indian or Alaska Native % % % Asian or Pacific Islander % % % Black or African American % % 9 0.7% Caucasian, Non-Hispanic % 6, % % Hispanic % 3, % % Other % % % Unknown or Unreported 1, % 6, % % Total 2, % 18, % 1, % *Registered nurse counts and percentages do not include individuals with an advanced practice license. Practice status More than 50% of the New Mexico nursing workforce work in a full-time position using their nursing license, with LPNs at 51.9%, RNs at 56.4%, and APRNs at 68.9%. More than 10% of the LPN workforce maintain an active license but either are not employed or work in a non-nursing job. The extent to which 11

15 Unreported or Unknown is an informative non-response compared with the proportion of respondents who did not have the opportunity to answer the question at re-licensing is unclear. Table 4. New Mexico Nursing Workforce by Practice Status, 2012 Licensed Practical Advanced Practice Registered Nurse* Practice Status Nurse Nurse Count Percent Count Percent Count Percent Full-Time 1, % 10, % % Part-Time % 2, % % Not Nursing % 1, % % Unreported or Unknown % 3, % % Total 2, % 18, % 1, % *Registered nurse counts and percentages do not include individuals with an advanced practice license. The primary work setting for LPNs is long-term care/nursing homes (25.1%). Nearly half (47.9%) the RN workforce works in a hospital environment. The primary location for APRNs is split evenly between clinics (32.0%) and hospitals (31.8%). Table 5. New Mexico Nursing Workforce by Location of Employment, 2012 Licensed Practical Advanced Practice Registered Nurse* Location Nurse Nurse Count Percent Count Percent Count Percent Clinic % 1, % % Community / Public Health % % % Home Health % % % Hospital % 9, % % Industrial Nurse 3 0.1% % 2 0.2% Nursing Home % % % Office Nurse % % % Other % 2, % % School Nurse % % % School of Nursing 3 0.1% % % Self-Employed % % % Unknown or Unreported % 2, % % Total 2, % 18, % 1, % *Registered nurse counts and percentages do not include individuals with an advanced practice license. More than half the LPN and RN workforce works in staff positions, with the next largest position classified as Other. For APRNs, half (50.5%) the workforce works in an Other Position, with the 12

16 second most common position being staff (28.2%). Administrative and supervisory positions tend to be RN positions. Table 6. New Mexico Nursing Workforce by Position of Employment, 2012 Licensed Practical Advanced Practice Registered Nurse* Position Nurse Nurse Count Percent Count Percent Count Percent Administrator % % % Administrator/Assistant % % 1 0.1% CNP (Nurse Practitioner) 0 0.0% 1 0.0% % CNS (Clinical Specialist) 0 0.0% 4 0.0% 1 0.1% Consultant % % % CRNA (Certified Registered Nurse Anesthetists) 0 0.0% 2 0.0% 7 0.5% Head Nurse % % % Head Nurse/Assistant % % 0 0.0% Instructor 1 0.0% % % Nursing School Instructor 3 0.1% % 3 0.2% Staff 1, % 10, % % Supervisor % % % Supervisor/Assistant % % 1 0.1% Other % % % Other Position % 1, % % Unknown or Unreported % 3, % % Total 2, % 18, % 1, % *Registered nurse counts and percentages do not include individuals with an advanced practice license. Consistent with the LPN employment location of practice in long-term/nursing home care, approximately one-third (30.2%) of LPNs work in geriatric care. RNs are split between other positions (6.0%), special care units (18.1%) and medical/surgical care (14.2%). APRNs work primarily in other practice areas (40.9%) and special care units (14.5%). 13

17 Table 7. New Mexico Nursing Workforce by Practice Area, 2012 Licensed Practical Advanced Practice Registered Nurse* Practice Area Nurse Nurse Count Percent Count Percent Count Percent Administrator 0 0.0% 1 0.0% 0 0.0% CNS 0 0.0% 2 0.0% 0 0.0% Community / Public Health % 1, % % Consultant 0 0.0% 1 0.0% 0 0.0% General Practice 3 0.1% 3 0.0% 0 0.0% Geriatric % 1, % % Medical / Surgical % 2, % % Obstetrics/Gynecology % 1, % % Pediatric / Child Maternal % 1, % % Psychiatric / Mental Health % % % Special Care Unit % 3, % % Staff 0 0.0% 4 0.0% 0 0.0% Other-Position % 4, % % Not Applicable % % 1 0.1% Unknown or Unreported % 2, % % Total 2, % 18, % 1, % *Registered nurse counts and percentages do not include individuals with an advanced practice license. Education, training and primary & secondary specialties The majority of LPNs have either a degree in practical nursing or an LPN certificate as their primary practice degree. Half (50.4%) of New Mexico RNs have an ADN as their primary degree, 27.1% have a baccalaureate degree in nursing as their primary degree and 13.6% have a baccalaureate degree in nursing as their secondary degree. For the APRNs, approximately one-third of the workforce has a baccalaureate degree in nursing as their primary degree, and another one-third have a master s degree in nursing as their primary degree. The following list is of survey questions that were not collected until Because there is insufficient data in the following categories they are not included in this year s report: Average hours worked per week. Average weeks worked per year. Percentage of practice engaged in direct patient care and other activities. Practice plans for the next five years. Professional liability insurance costs and availability. 14

18 Table 8. New Mexico Nursing Workforce by Education, 2012 Licensed Practical Registered Advanced Practice Education / Degrees Nurse Nurse* Nurse Count Percent Count Percent Count Percent Primary Degree: High School or GED % 1, % % Primary Degree: Diploma % 1, % % Primary Degree: Vocational/Practical 1, % % 7 0.5% Primary Degree: LPN Certificate 1, % % % Primary Degree: Associate (Nursing) % 9, % % Primary Degree: Associate (Other) 0 0.0% 0 0.0% 0 0.0% Primary Degree: Baccalaureate (Nursing) % 5, % % Primary Degree: Baccalaureate (Other) % % % Primary Degree: Masters (Nursing) 2 0.1% % % Primary Degree: Masters (Other) 5 0.2% % % Primary Degree: Doctoral (Nursing) 4 0.1% % 7 0.5% Primary Degree: Doctoral (Other) 2 0.1% % % Secondary Degree: High School or GED 7 0.2% 3 0.0% 0 0.0% Secondary Degree: Diploma % % % Secondary Degree: Vocational/Practical % 4 0.0% 1 0.1% Secondary Degree: LPN Certificate % 0 0.0% 0 0.0% Secondary Degree: Associate (Nursing) % 4, % % Secondary Degree: Associate (Other) % % 1 0.1% Secondary Degree: Baccalaureate (Nursing) 3 0.1% 2, % % Secondary Degree: Baccalaureate (Other) % % % Secondary Degree: Masters (Nursing) 2 0.1% % % Secondary Degree: Masters (Other) % % % Secondary Degree: Doctoral (Nursing) 0 0.0% % % Secondary Degree: Doctoral (Other) 2 0.1% % % Total 2, % 18, % 1, % *Registered nurse counts and percentages do not include individuals with an advanced practice license. Current Production (Pipeline) According to the New Mexico Board of Nursing (2012) report, New Mexico has five BSN programs, 21 ADN programs (including 10 LPN programs) and two standalone Practical Nurse (PN) programs. The five BSN programs include two public schools (University of New Mexico and New Mexico State University) 15

19 and three private schools (Brookline accelerated program, Brookline traditional program and Grand Canyon University, which are not accredited). The ADN programs include the following: Anamarc Educational Institute* Breckinridge School of Nursing and Health at ITT Technical Institute* Brown Mackie College* Carrington College* Central New Mexico Community College Clovis Community College Doña Ana Community College* Eastern New Mexico University-Roswell Luna Community College Navajo Technical College* New Mexico Junior College New Mexico State University-Alamogordo New Mexico State University-Carlsbad Northern New Mexico College Pima Medical Institute* San Juan College Santa Fe Community College University of New Mexico-Gallup* University of New Mexico Taos University of New Mexico Valencia Western New Mexico University *Non-accredited institution. ADN and PN ADN ADN ADN and PN ADN and PN ADN and PN ADN and PN ADN ADN and PN ADN ADN and PN ADN ADN and PN ADN and PN ADN and PN ADN ADN ADN ADN ADN ADN The two stand-alone PN programs are Albuquerque Public Schools and Computer Career Center/Division of Vista College. Additionally, New Mexico has seven RN-to-BSN programs. Five state institutions University of New Mexico, New Mexico State University, Western New Mexico University, New Mexico Highlands University and Northern New Mexico Community College all offer an accredited online RN-to-BSN program. Two private institutions offer the RN-to-BSN Grand Canyon University and University of Phoenix (neither accredited). Nearly 300 New Mexico RNs were enrolled in RN-to-BSN completion programs in the school year, according to the Center for New Mexico Nursing Excellence (2011). During calendar year 2011, the number of candidates in the combined (ADN and BSN) programs produced 1,003 potential nurses who participated in the NCLEX. Eight hundred four of 1,003 candidates who took the NCLEX exam passed (80.2% pass rate). The following table indicates the number of candidates in the ADN and BSN programs, the number who passed the NCLEX, the number who failed and the total percentage. Overall, Table 9 illustrates that New Mexico nursing programs have an average pass rate of 80.15%. 16

20 Table 9. NCLEX: Number of Candidates, Number Passed, Number Failed, and Total Percentage in the ADN and BSN Programs Registered Nursing Program Number of Candidates Number Passed Number Failed Total Percentage Anamarc Educational Institute*, ** Breckinridge at TT Technical* Brookline Accelerated College* NA NA NA NA Brookline Traditional College* NA NA NA NA Brown Mackie College* NA NA NA NA Carrington College* Central New Mexico Community College Clovis Community College Doña Ana Community College* Grand Canyon University* NA NA NA NA Eastern New Mexico University Roswell Luna Community College Navajo Technical College* NA NA NA NA New Mexico Junior College New Mexico State University Alamogordo New Mexico State University Carlsbad New Mexico State University Las Cruces Northern New Mexico College Pima Medical Institute* San Juan College Santa Fe Community College University of New Mexico Albuquerque University of New Mexico Gallup* University of New Mexico- Taos University of New Mexico- Valencia NA NA NA NA Western New Mexico University STATE TOTAL NOTE: Accredited schools hold accreditation from either the Commission on Collegiate Nursing Education (CCNE) or National League for Nursing Accreditation Commission (NLNAC). *Non-accredited institution. **Students tested out of state. 17

21 During calendar year 2011, the combined (PN) programs produced 172 potential PNs who participated in the NCLEX. One hundred sixty-three of 172 candidates who took the NCLEX exam passed (94.8% pass rate). The following table indicates the number of candidates, number passed, number failed and total percentage. Table 10. NCLEX: The Number of Candidates, Number Passed, Failed, and Total Percentage in Combined PN Programs Practical Nursing Program Number of Number Number Total Candidates Passed Failed Percentage Albuquerque Public Schools** % Anamarc Educational Institute*,** % Carrington College** % Central New Mexico Community College % Clovis Community College % Computer Career Center/Vista** % Doña Ana Community College % Luna Community College % New Mexico Junior College % New Mexico State University - Carlsbad % Northern New Mexico College % Pima Medical Institute** % STATE TOTAL % *Students tested out of state. **Non-accredited institution Gap Analysis Nationally, the average number of RNs per 1,000 population is between 8.54 (HRSA, 2013) and 8.74 (Kaiser, 2011). Using an average of 8.64 RNs per 1,000 population, only Bernalillo, Grant and San Miguel Counties have RN-to-population ratios greater than the national average. New Mexico would need 2,306 additional RNs across the state to reach the national average of RNs per 1,000 population (Table 11). The Kaiser Family Foundation (2011) reports that the average ratio of nurse practitioners to population is 0.58 NPs per 1,000. To reach this ratio at the state level, New Mexico would need 284 additional APRNs. 18

22 Figure 4. RN Shortages by County 19

23 Table 11. Gap Analysis of Active RN Workforce in New Mexico, 2012 Population Registered Nurse* County Count Percent Count Percent Bernalillo 673, % 7, % -1,906 Catron 3, % % 23 Chaves 65, % % 146 Cibola 27, % % 111 Colfax 13, % % 45 Curry 49, % % 119 De Baca 1, % % 11 Doña Ana 214, % 1, % 450 Eddy 54, % % 80 Grant 29, % % -50 Guadalupe 4, % % 23 Harding % % 5 Hidalgo 4, % % 34 Lea 66, % % 229 Lincoln 20, % % 55 Los Alamos 18, % % 5 Luna 25, % % 135 McKinley 73, % % 203 Mora 4, % % 33 Otero 66, % % 183 Quay 8, % % 42 Rio Arriba 40, % % 172 Roosevelt 20, % % 106 San Juan 128, % % 265 San Miguel 28, % % -9 Sandoval 135, % % 792 Santa Fe 146, % 1, % 178 Sierra 11, % % 37 Socorro 17, % % 70 Taos 32, % % 91 Torrance 16, % % 116 Union 4, % % 1 Valencia 76, % % 509 Total 2,085, % 15, % 2,306 *Registered nurse counts and percentages do not include individuals with an advanced practice license. Advanced Practice Registered Nurses (APRNs), nurses who are educated at the master s or doctoral level, are essential to the health care workforce. APRNs are important providers of primary care. Nurse Gap 20

24 Practitioners (NPs) practice in primary care and acute settings. NPs provide initial, ongoing and comprehensive care for patients, including assessment, diagnosis, treatment and management of patients with acute and chronic illnesses (HRSA, 2013). While the degree of independence or supervision required by a licensed (physician) provider for the NP to practice varies from state-to-state, NPs in New Mexico have full practice authority under the New Mexico Nurse Practice Act (NMSA section ). Fifteen percent (5 of 33) of the counties in New Mexico are characterized as having satisfactory numbers of APRNs for their populations while 85% (28 of 33) of counties lack sufficient APRNs for their population. Maintaining a larger APRN workforce in relationship to the population may help improve access, streamline care, make care delivery more efficient, decrease costs and protect patient choice. Figure 5. New Mexico APRN Shortages by County 21

25 Table 12. GAP Analysis of Active CNPs in New Mexico, 2012 County Population Certified Nurse Practitioners Count Percent Count Percent APRNs per 1,000 CNP Gap Bernalillo 673, % % Catron 3, % % 0 2 Chaves 65, % % Cibola 27, % % Colfax 13, % % Curry 49, % % De Baca 1, % % Doña Ana 214, % % Eddy 54, % % Grant 29, % % Guadalupe 4, % % Harding % % 0 0 Hidalgo 4, % % Lea 66, % % Lincoln 20, % % Los Alamos 18, % % Luna 25, % % McKinley 73, % % Mora 4, % % Otero 66, % % Quay 8, % % Rio Arriba 40, % % Roosevelt 20, % % San Juan 128, % % San Miguel 28, % % Sandoval 135, % % Santa Fe 146, % % Sierra 11, % % Socorro 17, % % Taos 32, % % Torrance 16, % % Union 4, % % Valencia 76, % % Total 2,085, % % Comparison Between License and Survey Data There is a substantial difference (17.4%) between the total number of LPNs in the state by license address compared with the address of practice. An evaluation of nursing practice status was conducted for the active 2012 LPNs in an attempt to disaggregate the difference. At the state level, two factors explain the difference. The first is that 12.4% of the active LPNs reported that they are not employed in nursing practice. This may be because they either work full or part time in a non-nursing position or are 22

26 inactive in nursing but maintain an active license. A second reason is that 16.7% of the active LPNs did not provide an answer for nursing status. Better information should emerge through future rounds of license renewals. Of the remaining active LPNs in New Mexico, 55.3% report that they are employed full time in nursing, and 15.7% report that they are employed part time in nursing. Table 13. Comparison of Survey and Licensure Data for Active Licensed Practical Nurses, 2012 County LPNs by Address of Primary LPNs by Address of Licensure Difference in Practice Physician per per Population Count Percent Count Percent Count 1,000 1,000 Bernalillo 673, % % Catron 3, % % Chaves 65, % % Cibola 27, % % Colfax 13, % % Curry 49, % % De Baca 1, % % Doña Ana 214, % % Eddy 54, % % Grant 29, % % Guadalupe 4, % % Harding % % Hidalgo 4, % % Lea 66, % % Lincoln 20, % % Los Alamos 18, % % Luna 25, % % McKinley 73, % % Mora 4, % % Otero 66, % % Quay 8, % % Rio Arriba 40, % % Roosevelt 20, % % San Juan 135, % % San Miguel 128, % % Sandoval 28, % % Santa Fe 146, % % Sierra 11, % % Socorro 17, % % Taos 32, % % Torrance 16, % % Union 4, % % Valencia 76, % % Total 2,085,538 2, % , %

27 Table 5 illustrates a sharp contrast between the workforce location of employments between LPNs, RNs and APRNs. Some 25.1% of LPNs work in nursing homes, whereas 47.9% of RNs work in hospitals and 32.0% of APRNs work in clinics. Figure 6. New Mexico LPNs by Address of License 24

28 Table 14. Comparison of Survey and Licensure Data for Active Registered Nurses, 2012 RNs by Address of Licensure RNs by Address of Primary Practice Difference in County per Population Count Percent Count Percent per 1,000 Physician 1,000 Count Bernalillo 673,460 7, % , % Catron 3, % % Chaves 65, % % Cibola 27, % % Colfax 13, % % Curry 49, % % De Baca 1, % % Doña Ana 214,445 1, % , % Eddy 54, % % Grant 29, % % Guadalupe 4, % % Harding % % Hidalgo 4, % % Lea 66, % % Lincoln 20, % % Los Alamos 18, % % Luna 25, % % McKinley 73, % % Mora 4, % % Otero 66, % % Quay 8, % % Rio Arriba 40, % % Roosevelt 20, % % San Juan 135, % % San Miguel 128, % % Sandoval 28,891 1, % % ,171 Santa Fe 146,375 1, % , % Sierra 11, % % Socorro 17, % % Taos 32, % % Torrance 16, % % Union 4, % % Valencia 76, % % Total 2,085,538 19, % , % ,690 There is a substantial difference (19.0%) between the number of RNs in the state by license address compared with the address of practice. An evaluation of the nursing practice status was conducted for the active 2012 RNs in attempts to disaggregate the difference. At the state level, two factors explain the difference. The first is that 8.9% of the active RNs reported that they are not employed in nursing practice. This may be because they either work full or part time in a non-nursing position or are inactive in nursing but maintain an active license. A second reason is that 14.4% of the active RNs did not provide an answer for nursing status. Better information should develop through future rounds of license 25

29 renewals. Of the remaining active RNs in New Mexico, 60.7% report that they are employed full time in nursing, and 16.0% report that they are employed part time in nursing. Figure 7. New Mexico RNs by Address of License 26

30 Table 15. Comparison of Survey and Licensure Data for Nurses, 2012 CNPs by Address of CNPs by Address of Practice Licensure County per per Population Count Percent Count Percent 1,000 1,000 Difference in APRN Count Bernalillo 673, % % Catron 3, % % Chaves 65, % % Cibola 27, % % Colfax 13, % % Curry 49, % % De Baca 1, % % Doña Ana 214, % % Eddy 54, % % Grant 29, % % Guadalupe 4, % % Harding % % Hidalgo 4, % % Lea 66, % % Lincoln 20, % % Los Alamos 18, % % Luna 25, % % McKinley 73, % % Mora 4, % % Otero 66, % % Quay 8, % % Rio Arriba 40, % % Roosevelt 20, % % San Juan 135, % % San Miguel 128, % % Sandoval 28, % % Santa Fe 146, % % Sierra 11, % % Socorro 17, % % Taos 32, % % Torrance 16, % % Union 4, % % Valencia 76, % % Total 2,085,538 1, % , % The difference (6.6%) between the total numbers of APRNs in the state by license address versus practice address is small compared to other nursing license groups. However, this difference translates to a lack of access to primary care for thousands of New Mexicans. Murray, Davies and Boushon (2007) suggest that a primary care physician can treat anywhere from 25 to 45 patients per day (the norm is 20 to 25). They also found that the average number of visits per 27