Nursing Supply and Demand Study Acute Care

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1 212 Nursing Supply and Demand Study Acute Care Sponsors: 21 Sherman Avenue, Suite 1 Cincinnati, OH Phone: (513) 531-2

2 Table of Contents 2 I. Introduction and Executive Summary... 3 II. Hospital Survey (Demand)... 5 A. Registered Nurse (RN) Staff Turnover (24-211) Reasons for Leaving Position Registered Nurses Hired by Level of Experience Registered Nurses Hired by Specialty Area... 7 B. Registered Nurse Staff ( comparison) RN Positions: Total RN Positions: Full / Part-time and Vacancy Rates RN Positions: Specialty Areas RN Positions: Role... 1 C. Registered Nurse Staff Demographics ( comparison) Age Distribution Race and Ethnicity Gender Hospital RN Educational Level III. Schools of Nursing Survey (Supply) A. Students Program Admissions Student Demographics (Age / Race/Ethnicity/Gender) Student Retention Pass Rates for the NCLEX Examination Placement of Graduates B. Concerns Limiting Program Capacity C. Faculty Positions Demographics (Age / Race/Ethnicity/ Gender) Faculty Compensation Faculty Changes and Expected Retirements... 19

3 I. Introduction and Executive Summary 3 The purpose of the Health Council s is to assist Greater Cincinnati health care organizations in projecting the future nursing work force requirements and ultimately create a stronger health care community. Nurses will continue to impact the lives of the Greater Cincinnati population through the promotion of health, the prevention of disease and the care of the ill, disabled and dying. Study objectives: 1. Gather regional data on current nursing faculty, student admission and retention, nursing work force and work force needs. 2. Compare 212 results to the 26, 28 and 21 Supply/Demand studies. Hospital and school survey data were collected between September and December 212. To improve estimates of supply and demand, data were also supplemented from other Health Council sources, including the Annual Vacancy/Turnover/Age Survey. This survey considered only hospital demand for nurses and did not include other community needs for registered nurses. The nursing work force (Demand) findings will be presented first, followed by the schools of nursing (Supply) findings. Among some of the study s highlights: Experienced nurses gained the hiring edge over new nurse graduates. The percentages of unfilled nursing positions increased from 21 to 212, and over 7 percent of all new nurses hired to fill these positions were experienced nurses. Education levels for RNs have sharply increased over the last several years. The number of nurses with bachelor s degrees increased to 43 percent in 212, up from 33 percent in 28. The number of nurses with master s degrees also climbed considerably, up to 8 percent in 212 from 3 percent in 28. The education of nurses continues to rise in importance due to the increasing complexity in health care and the responsibility of nurses. The Tristate is fortunate to have a variety of BSN and graduate programs for nurses to choose from, states Darla Vale, Dean of Adult and Graduate Studies, College of Mount St. Joseph. Vacancy rates continue to creep higher. The 212 RN vacancy rate of 6.6 percent represents the highest vacancy rate since 28, and it is also the second consecutive annual increase in the vacancy rate since bottoming out at 3 percent in 21. Medical/surgical and critical care nurses continue to be the specialty areas with the highest demand, and these positions remain the most difficult to fill. Retirements have also increased in just the last year. The 211 RN retirement rate jumped to.77 percent, up from.51 percent in 21. Retirements are expected to increase in future years over 16 percent of the region s RNs are age 55 and older. As the economy improves and our veteran nurses continue to retire, the number of RN positions available to both new graduates and experienced nurses are expected to increase, said Mary Duffey, executive director of the Health Council s Health Care Work Force Center. In addition, the roles of nurses are transitioning which presents new and exciting opportunities in acute and ambulatory care.

4 4 Nursing faculty continues to age. Faculty age distributions for 212 indicate an aging of the population; faculty members age 6 and over increased to 2 percent in 212 from 18 percent in 21, and faculty members age 5-59 increased to 49 percent in 212 from 35 percent in 21. These figures suggest that nearly 7 percent of the nursing faculty in regional nursing schools is over the age of 5. This trend highlights the need for additional nursing faculty to replace soon-to-be retiring faculty. The rapidly changing health care delivery system, with its changing work force and patient demographics, drives how and where care is delivered. These changes will require the presence of more highly educated nurses at all levels. The need for Nurse Practitioners continue to rise as health care is delivered outside the walls of the traditional hospital setting and across the continuum. Hospitals and Colleges of Nursing will need to collaborate even more closely to ensure the future needs of health care delivery systems are met, as it relates to both hospital staff and college faculty. Joint appointments and other creative and innovative ideas will need to be generated and implemented to achieve this, notes Jane Swaim, RN, Chief Nursing Officer, St. Elizabeth Healthcare. Hospitals that participated in the study include: Atrium Medical Center The Christ Hospital Cincinnati Children s Hospital Medical Center Clinton Memorial Hospital Highland District Hospital Lindner Center of HOPE Margaret Mary Community Hospital NorthKey Community Care St. Elizabeth Healthcare TriHealth UC Health Nursing schools that participated in the study include: The Christ College of Nursing and Health Sciences Cincinnati State Bethesda School of Nursing College of Mount St. Joseph Gateway Community and Technical College Northern Kentucky University Southern State Community College University of Cincinnati College of Nursing University of Cincinnati Blue Ash College Xavier University A special thank you to our Sponsors:

5 II. Hospital Survey (Demand) 5 A. Registered Nurse (RN) Staff Turnover (24-211) 1. Changing Full-time / Part-time Employment Status within the Organization There has been a recent reversal in the trend of changing employment status over the last several years. In 26 and 27, significantly more RNs changed to full-time status and decreased their part-time status. However, starting in 28 the trend leveled off as less RNs opted to change to full-time status. Most economic indicators, including the Federal Reserve and overall U.S. job figures, suggested that the economy improved in 211. The RN trend tends to follow the economy, and less nurses moving to full-time indicates anticipated economic improvement. The percentages and trends are shown below in Figure PT to FT FT to PT Linear (PT to FT) Figure 1. age of registered nurses who changed from part-time to full-time or full-time to part-time and the linear trend for part-time to full-time employment status 2. Reasons for Leaving Position The largest percentage of nurses in 21 and 211 left for Other reasons such as relocation and personal reasons. (See Figure 2.) While this trend declined in 29, there was an upward drift through 211 in this category, likely due to nurses choosing positions outside the hospital setting. Within the hospital setting, nurses were mostly stable in their positions and did not opt to move to a different position at the hospital. Staff reductions did increase slightly to 2 percent, up from 1 percent in previous years. Over 9 percent of nurses who left and specified a reason indicated that they were retiring. According to the Health Resources and Services Administration (HRSA), the highest rates of retirement occurred between ages 62 and 65. A Health Council 21 survey concurred with these figures and indicated that the average age of retirement for RNs in Cincinnati was 63. However, delays in retirement age might occur as a result of inadequate retirement savings. According to a TD Ameritrade survey released in January 213, 74 percent of baby boomers indicated they will have to rely heavily on Social Security funds.

6 6 Reason for leaving hospital position Staff Red. Fired/Term. Retired Different Nursing Position Left Nursing Took Position Outside Hospital Other Figure 2. Reasons for leaving the hospital position are compared for years % Registered Nurse Retirement Rate 2.% 1.%.59%.51%.77%.% 29 Retirement Rate 21 Retirement Rate 211 Retirement Rate Figure 3. Hospital RN Retirement Rate Registered Nurses Hired by Level of Experience While there were record numbers of new graduate nurses hired in 28, new graduate hires have leveled off in recent years. Only 2 percent of new graduate nurses were hired in 21. In 211, however, new grads accounted for 3 percent of all nurse hires, which is close to the 31 percent average from To help ensure patient safety and ensure high quality patient care, nursing experts maintain that it is important to have a good balance of experience nurses available to mentor new nurses.

7 7 In 29 the Greater Cincinnati RN vacancy rate was at its lowest point (3 percent) since the collection of data began in 199. Vacancies have again begun trending upward over the last three years which should open up additional new graduate opportunities. The U.S. Bureau of Labor Statistics (BLS) reported that between 26 and 216, RNs are projected to add the largest number of new jobs among all occupations 587,. Registered Nurse Experience Level New Grad Exper. RN Figure 4. of new RN hires by type of new hire: New Graduate, Experienced RN for the years Registered Nurses Hired by Specialty Area The percentages of RNs hired for a specialty area were similar for 21 and 211. As expected, medical/surgical and critical care nurses continue to be the specialty areas with the highest demand and remain the most difficult positions to fill. The Registered Nurses hired by specialty area are shown in Figure 5. Registered Nurses Hired by Specialty Area M/S CC OR OB/GYN Psych Other 211 Figure 5. age of Registered Nurses hired by specialty area. M/S (Medical/Surgical); CC (Critical Care); OR (Operating Room); Ob/Gyn (Obstetrics/Gynecology); Psych (Psychiatric)

8 B. Registered Nurse Staff ( comparison) 8 1. RN Staff Positions: Total Due to the differences in study participants, it is difficult to capture specific job growth statistics for RNs over this two year period. However, according to the Health Council s 212 Annual Vacancy Survey, hospitals had 13,51 RN positions (total nurses plus openings) in 211 compared to 12,84 RN positions in 21. This represents a 1.6 percent job growth for RNs in acute-care hospitals during 211. The increased number of staffed beds has played a key role in sustaining this job growth. In 212, the community had 4,816 staffed beds, up from 3,855 beds in 2, according to the 213 American Hospital Association Guide. The Staff RN retention rate increased slightly in 211; the 21 retention rate was 91 percent as compared to the 211 retention rate of 92 percent. These figures reflect that RNs are remaining in their positions longer, thus stabilizing the nursing work force with lower turnover. 2. RN Staff Positions: Full / Part-time and Vacancy Rates In 21 the vacancy rate dipped to 3 percent, but in 212 the vacancy rate was back up to 6.6 percent. Many factors will likely increase vacancy rates, notably older nurses heading for retirement, an aging population and health care reform driving up the demand for patient care due to increasing numbers of insured individuals, particularly in community settings. See Figure 6 and Figure Full Time and Part Time RN Positions Full Time Part Time Figure 6. age of full-time versus part-time positions for years 26, 28, 21 and 212

9 9 Figure 7. Vacancy rates based on the Health Council s annual vacancy survey 3. RN Staff Positions: Specialty Areas As shown previously in the 21 survey, medical/surgical and critical care positions continue to show the highest demand among RN specialty areas. These two specialty areas will likely continue to be the primary focus for staffing acute care beds. Changes are shown in Figure Registered Nurses by Specialty Area M/S CC OR OB/GYN Psych Other Figure 8. of specialty RN staff for years 26, 28, 21 and 212.

10 4. RN Staff Positions: Role 1 The proportions of RN staff by role are consistent from 26 to 212 (see Figure 9). Approximately 9 percent of hospital RNs are in direct care roles for all surveys. The ideal ratio of administration, staff education and direct care providers depends on organizational structure and staff characteristics. However, the high ratio of direct care providers for the last six years indicates a strong value for the importance of nursing care and a high level of acuity demands well-educated and clinically competent nurses. The region is also expecting a continual rise in the number of Advanced Nurse Practitioner positions as the industry encourages and supports practice to the full extent of nurses education and training. The other category s upward trend may indicate transformation in acute health care institutions as increasing numbers of RNs are being utilized in many new roles including information technology and electronic health records, research and continuous improvement programs to optimize patient safety and quality Registered Nurses by Role Direct Care Administration Education Other Figure 9. of RN positions by role C. Registered Nurse Staff Demographics ( comparison) 1. Age Distribution for Registered Nurses Hospitals have seen a slight increase in nurses in the and 65+ age groups, and they have also seen a big jump in nurses years of age (see Figure 1). Meanwhile, much of the percentage drop is with middle-aged nurses in the and age groups. These numbers still show the influx of nurse graduates who have entered the field in the last several years as well as a larger number of older nurses delaying retirement, likely due to the economy. According to the Health Council s vacancy survey, the average age of RNs who retired was 63 in contrast to the previous national figure of 55 years. The expectation is that this upward trend may continue as baby boomers desire to work into their later years, however, retirements are inching closer for nurses in the older age brackets. The Council s semi-annual age survey showed that 27 percent of the region s nurses are age 5 or older, which is in line with the American Association of Colleges of Nursing figures which show that nurses in their 5s represent onefourth of the total nursing work force nationally.

11 Registered Nurses by Age Distribution Figure 1. of RN age distribution for years 26, 28, 21 and Race and Ethnicity for Registered Nurses There was little change in race/ethnicity distribution from 26 through 212, with non-hispanic white RNs representing over 9 percent of the distribution. (See Figure 11.) Non-Hispanic blacks represent 5 percent, and all other minorities represent 3 percent of the RN population. Nationally, according to Minority Nurse.com, approximately 4.2 percent of the RN population are African American (non-hispanic); 3.1 percent are Asian, Native Hawaiian or Pacific Islander (non-hispanic); 1.7 percent are Hispanic or Latino;.3 percent are American Indian or Alaska Native; and 1.4 percent categorize themselves as two or more races and non-hispanic Registered Nurses by Race/Ethnicity/Gender White Black Hispanic Asian Other Male Figure 11. age of Registered Nurses by Race/Ethnicity/Gender for 26, 28, 21 and 212

12 3. Gender 12 The percentage of males employed in local hospitals was 7 percent in 212, which represents a slight increase over the 6 percent rate in 21. Regional initiatives attempting to attract males to RN fields include hospital sponsored explorer programs for males and a local chapter of the American Assembly of Men in Nursing. The demographics of nursing are beginning to change. In 198, there were 45,6 male nurses, according to the Institute of Medicine report; by 24, that number jumped to 168,181. Today, men comprise just over 7 percent of all RNs, and that number is projected to grow; more than 11 percent of students in nursing baccalaureate programs in the school year were men, reports the American Association of Colleges of Nursing. 4. Hospital RN Educational Level Education levels for RNs have sharply increased over the last several years. (See Figure 12.) Using data from the same set of hospitals in 21 and 212, the number of nurses with bachelor s degrees remained steady at 43 percent, however, the number of nurses with master s degrees increased to 9 percent in 212, up from 3 percent in 21. With five Magnet hospitals in our region, the expectation is that nurses in these organizations will endeavor to advance their educational level. Magnet certification requires hospitals to continually increase their numbers of RNs who possess a bachelor s or higher degree of education. Additionally, in 21 the Institute of Medicine (IOM) Committee released a report with eight recommendations for the future of nursing. Three have a direct impact on nursing education: Increase the nurses with a baccalaureate degree to 8 percent in 22 Double the number of nurses with a doctorate by 22 Ensure that nurses engage in lifelong learning The IOM committee charged with preparing the evidence-based recommendations stated that nurses need to attain higher education to meet the demands of the future health care system and the needs of patients in the future. Locally, some hospitals now prefer to hire RNs with a bachelor s degree. Nationally, the American Association of Colleges of Nursing (AACN) released preliminary data showing that enrollment into entry-level baccalaureate nursing programs increased by 5.6 percent in 211 compared to 21. This marked the 11 th consecutive year of enrollment growth in professional RN programs, and the growth of professional RN students suggests that numbers of those with bachelor s degrees or higher are likely to continue climbing over the next several years. Hospital support of advanced education plus flexible online education will allow nurses additional opportunities to pursue advanced degrees in the coming years. Several regional schools also bring the RN to BSN programs to their hospital campus.

13 Nurse Educational Level Figure 12. age for educational levels of hospital RNs in 28, 21 and 212

14 III Schools of Nursing Survey (Supply) 14 A. Students 1. Program Admissions The number of student admissions remained fairly steady in 211 compared to 21 with 1,322 admissions in 211. The distribution of student admissions for is shown in Figure 13. A small number of programs show a waiting list, although the waiting list numbers have declined in recent years Qualified Admitted Figure 13. The number of qualified applicants and the number of admitted students to schools of nursing for the years Student Demographics (Age / Race/ Ethnicity / Gender) In 21 and 211, the age distribution of nursing students showed a significant rebound in the number of young students in the age range (See Figure 14). National figures show that registered nurses who graduated with a bachelor s or higher degree tend to be five years younger at graduation than those nurses who graduate with an ADN or diploma. If this national trend continues, it is likely that the age distribution of nurses in local nursing schools may continue to lean toward younger nursing students, a trend that was previously forecast in earlier supply and demand studies. The race/ethnicity of admitted students shows that white and black students increased whereas the number of Hispanic and Asian students saw slight decreases. See Figure 15. Nursing s leaders recognize a strong connection between a culturally diverse nursing work force and the ability to provide quality, culturally competent patient care. Though nursing has made great strides in recruiting and graduating nurses that mirror the patient population, more must be done before adequate representation becomes a reality. The need to attract students from under-represented groups in nursing specifically men and individuals from African American, Hispanic, Asian, American Indian and Alaskan native

15 backgrounds is gaining importance given the Bureau of Labor Statistics projected need for more than a million new and replacement registered nurses by According to data from the 28 National Sample Survey of Registered Nurses (NSSRN), nurses from minority backgrounds represented 16.8 percent of the registered nurse (RN) work force. Considering racial/ethnic backgrounds, the RN population is comprised of 5.4 percent African American; 3.6 percent Hispanic; 5.8 percent Asian/Native Hawaiian;.3 percent American Indian/Alaskan Native; and 1.7 percent multi-racial nurses. The need to attract diverse nursing students is paralleled by the need to recruit more faculty from minority populations. Few nurses from racial/ethnic minority groups with advanced nursing degrees pursue faculty careers. According to 21 data from AACN member schools, only 12.6 percent of full-time nursing school faculty comes from minority backgrounds and only 6.2 percent are male Age Distribution Figure 14. of age groups for nursing students admitted for academic years Race/Ethnicity White Black Hispanic Asian Other Figure 15. of nursing student admission by race/ethnicity for academic years

16 3. Student Retention 16 Retention rates for the academic school years of 26, 28, 21 and 212 are shown in Figure Retention 1st Year 2nd Year 3rd Year 4th Year Figure 16. retention for nursing students in Academic Years 26, 28, 21 and 212 Student retention for all academic years increased in 212 compared to 21. The primary reason identified by nursing schools for attrition was students inability to meet academic expectations. 4. Pass Rates for the NCLEX Examination In 26, 89 percent of local graduates passed the NCLEX Examination on the first attempt, and 28 and 21 saw those numbers decline. By 212, this number rebounded somewhat as 86 percent of graduates passed the NCLEX on the first attempt. Nationally, the pass rate has hovered just under 9 percent. 1% 98% 96% 94% 92% 9% 88% 86% 84% 82% 8% NCLEX Pass Rates Local Pass Rate National Pass Rate Figure 17. Pass rate of nursing graduates passing NCLEX examination on the first try for the years 26, 28, 21 and 212

17 5. Placement of Graduates 17 In 21, the percentage of new graduates who were hired into hospital settings dipped to 8 percent as more new graduate nurses were hired into other health care settings outside the hospital. The expectation is that this trend will continue as health care reform drives more health care services into the community setting with an emphasis on preventive care. Additionally, greater opportunities will be available in long-term care due to the increased numbers of elderly patients needing home or residential care. Two years ago the National Student Nurses Association published an advisory that warns that the market is flooded with experienced nurses who have come back to work out of retirement or delayed retirement. However, as the economy continues to improve, the number of RN positions available to new graduates is expected to significantly increase. B. Concerns Limiting Program Capacity Factors limiting program capacity were rated as: 4 (critical), 3 (major), 2 (moderate), 1 (minor) and (none). The comparison of concerns for 26, 28, 21 and 212 are shown in Figure 19. Clinical placement concerns have evolved as the greatest concern in 212 with classroom space also becoming a significant concern. Regionally, a centralized clinical placement system within the Tristate Nursing Resource Center (TNRC) assists with real-time availability tracking and notable efficiencies in cost and time commitments to scheduling students in clinical rotations. There were 14,472 placements utilizing the Health Council s TNRC system during the academic school year. Nationally, there is a trend to utilize high-fidelity simulated clinical experiences due to the decrease of available hospital settings. Locally, two-year programs averaged 1.5 high-fidelity simulation hours in the first year and 11 high-fidelity simulation hours in the second year. However, four-year programs offered much less high-fidelity simulation hours during their first years 1.25 hours but then had increased offerings of 12 hours in the second year. Four-year programs elected to have the bulk of their high-fidelity simulation hours occur during the third and year with an average of hours in the third year. The fourth year of the program included 5.75 hours. Average Rating Limiting Factor Financial Faculty Clinical Placement Classroom Figure 19. Average rating ( 4) for concerns limiting program capacity for Academic Years 26, 28, 21 and 212

18 C. Faculty Positions In 212, there were 44 faculty positions (filled and unfilled positions) with a vacancy rate of 9 percent. The vacancy rate has dropped slightly since 26 when it was 12 percent, though it has spiked up since its low of only 3 percent in 21. A Special Survey on Vacant Faculty Positions released by AACN in 212 indicated that the national vacancy rate was 7.6 percent with most of those vacant faculty positions preferring a doctoral degree. Meanwhile, the percentage of full-time faculty increased slightly in 212 compared to 21 while the 212 faculty turnover rate was 12 percent. Faculty Status Full Time Part Time Figure 18. full-time and part-time faculty status for 26, 28, 21 and Demographics (Age / Race/ Ethnicity / Gender) The faculty age distributions for 21 indicate an aging of the population (see Figure 19). Faculty members age 6 and over increased to 2 percent in 212 from 18 percent in 21, and faculty members age 5-59 increased to 49 percent in 212 from 35 percent in 21. These figures suggest that nearly 7 percent of the nursing faculty in regional nursing schools is over the age of 5, and this trend highlights the need nurses with advanced education to replace soon-to-be retiring faculty. Nationally, the average age for a master s degree-prepared nurse professor was 58 years according to AACN. The AACN also reported that associate professors and assistant professors across the United States had an average age of 56 and 51, respectively.

19 19 Age Category (Years) Figure 19. of faculty in age categories for years 26, 28, 21 and Faculty Compensation The average starting salary for full-time faculty in 212 was $6,837 compared to $55,986 in 21. The average hourly rate for part-time faculty in 212 was $36.18 compared to $33. in 21. Nationally according to AAPN, master s prepared faculty earned a salary of $72,28 in 211. AAPN also reported that the average salary of a nurse practitioner is $91,31 which is significantly higher than nursing faculty salaries. Low salaries are historically considered as one of the primary reasons nurses with masters and doctorates have not been attracted into nursing education. 4. Faculty Changes & Expected Retirements The percentage of faculty who left their position due to retirement declined slightly in 212 compared to 21, however, retirements are expected to increase in future years (See Figure 2). Faculty retention continues to be a growing issue, especially since a large portion of the current faculty is nearing retirement age. The Tristate region recognizes the continual need for competent and properly prepared nursing faculty to educate the nurses of tomorrow.

20 Left Position Reason for Leaving Retired Figure 2. of educators who left the position or retired for academic years 26, 28, 21 and 212

21 21

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